Friday, May 13, 2016

Educating chareidi women about breast cancer

Tablet Magazine   Black-and-white posters called pashkevilim are one of the main ways that Israel’s ultra-Orthodox—who shun TV, radio, and Internet—get their information. So, when Ruth Colian, a 34-year-old Haredi mother and law student, wanted to advise ultra-Orthodox women in conservative Jewish neighborhoods of Jerusalem, Bnei Brak, and Beit Shemesh to undergo routine breast cancer screenings, she made a poster. But she faced one big problem: She couldn’t use the words breast or cancer, or her posters would surely be ripped down.

Instead, the posters that Colian hung this winter—joining dozens of others encouraging modest dress, advertising Torah classes, and bearing the names of recently deceased community members—instructed the “dear woman” to “preserve your life,” and said that “there is a 90 percent rate of survival for early detection.” They also contained a phone number to call for more information.

Even without explicit language on them, the posters worked. Colian got hundreds of calls, many from women who said they had never gone for cancer screening because they had simply never heard of it in their sheltered communities. “I especially remember one sad phone call from a 42-year-old woman, who asked me, ‘What is a mammogram?’ ” Colian said. “To ask what is a mammogram at 42 years old is a very sad thing. It is a disaster. This is what I am trying to change, just the world around me.”[...]

“We see a meaningful change in attitudes toward screening,” said Anat Freund, a professor at Haifa University who has conducted research on ultra-Orthodox attitudes toward breast cancer and other medical conditions. “There is a lot more legitimization of breast cancer screening in the community.” The change comes as the ultra-Orthodox community has demonstrated more openness in other areas as well, including to higher education and the work force, Freund said, “but there are still lots of challenges and barriers.”[...]

Despite the rabbinical approval of mammography, doctors, ultra-Orthodox Jews, and others who have studied the issue say that the community’s tradition of modesty prevents discussion of the issue, so many women remain unaware of cancer screening.

“Breast is an immodest word, and cancer is ‘that disease,’ or ‘women’s disease,’ ” said Michoel Sorotzkin, an ultra-Orthodox rabbi and founder and chairman of the Hala clinic, which, although it serves all women, aims to make religious women more comfortable by taking steps like providing female doctors when requested and understanding that many patients may want to consult with rabbis before treatments.[...]

But rabbis are increasingly realizing that they must change this way of thinking.

“It seems that women today are in danger,” Moshe Sternbuch, vice president of the rabbinical court of Eidah HaHaredis, the leading ultra-Orthodox religious legal authority, wrote recently in a widely distributed rabbinical decree. “You should not rely on the biblical verse that God will protect, but rather be vigilant about check-ups.” In April, the ultra-Orthodox weekly Yated Neeman, a publication so concerned with modesty that it doesn’t print women’s names but instead uses only their first initials, printed Sternbuch’s statement. It was accompanied by statements from other rabbis emphasizing the previous psak on the issue, 15 years ago, stating that it is a religious obligation for women over 50 to get mammograms and other tests as needed.

“But this time the wording was much stronger,” said Sara Siemiatycki, the ultra-Orthodox founder and director of Bishvilaych, a women’s nonprofit health clinic founded to serve religious women in Jerusalem. Sorotzkin, at Hala, also said such a statement signals a change in attitude. “They see what’s happening,” he said. “Sometimes you need a collection of tragedies before taking action.”[...]

In another recent development, the Israel Cancer Association has been holdings meeting with ultra-Orthodox leaders on the topic of testing for mutations in the BRCA gene, which indicate a higher susceptibility for breast and ovarian cancers. It is estimated that one in every 40 people of Ashkenazi descent carry such a mutation. While the medical community in general is still formulating policies on whom should be tested and when, the issue is even more complex in the ultra-Orthodox sector. In addition to concerns about the impact of genetic testing on marriage prospects, there are also halakhic issues with how to treat women at higher risk of developing cancer, including the practice of preventative mastectomy and hysterectomy, Sorotzkin said.

“There is an increasing awareness that this is an important subject,” said Ephrat Levy-Lahad, director of the medical genetics institute at Shaare Zedek Medical Center in Jerusalem, which is working with the cancer association to reach out to the ultra-Orthodox sector on the issue of genetic testing in connection to breast cancer. “You just have to do it in a way that’s open to their social and cultural environment.” [...]

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