This is the third installment of the Global News series entitled Unheard of. Unserviced. nautical Women's health In crisis.
In our first two stories, we introduced you to a woman who I struggled for years to get diagnosed with PCOS.and future mother feeling resentful after expensive infertility treatment.
When doctors noticed invasive breast carcinoma on Kim White's spot mammogram at Cumberland Regional Health Center in Amherst, North Carolina, they told her the doctor would contact her if there was cause for concern because she didn't have her own family doctor.
The 58-year-old mother and grandmother of five went home and waited, anxiously awaiting results that could change her life.
Before her diagnosis, White says her family lived a simple life in Nova Scotia.
Submitted by: Kim White
She says five days passed, then six, then seven, and there was no call.
“I think we're celebrating,” White says, nodding across the living room to her husband and daughter. 'Cause apparently I don't have cancer because they didn't call me.»
But on June 7 the phone rang.
It was the local hospital administrator who called her to set up an appointment for a biopsy with the staff surgeon.
“That’s how I found out I had breast cancer because they don’t call you into an office and tell you everything is negative,” White recalls through tears. “Just the callousness of actually getting information from an administrator… just made me really angry.”
This was not the first cancer diagnosis White had received.
Twenty-five years ago, while White and her husband were living in Ontario, she learned she had acute leukemia. She says Ontario was far ahead of Nova Scotia when it came to cancer treatment, even decades ago.
White was diagnosed with leukemia 25 years ago while living with her husband in Ontario.
Ella McDonald / Global News
“My diagnosis was immediate, my treatment was immediate.,– says White, – But this experience of waiting is simply painful.“
White says that when she went to see a local surgeon in Amherst, she was informed that she would not be able to have surgery on site due to the hospital's safety policy, which prohibits operating on patients with a higher body mass index (BMI).
“Being a big woman, you are stigmatized every day,” White explains. “Yes, it's my choice to be overweight, but I'm discriminated against in every aspect of life? Even the mammogram machines – I had to do this breast twice,” she says, pointing to her breasts.
“I’ve never thought of my weight as a discriminatory mechanism in health care, but clearly it is.”
White was referred to IWK Medical Center in Halifax for surgery, about a two-hour drive from her home in Amherst.
But she was turned away again, this time, she said, because her BMI wasn't high enough for Women's and Children's Hospital to intervene.
She was sent back to Cumberland County for preoperative evaluations, all of which cleared her for surgery, but she claims she faced further weight discrimination during a consultation with an anesthesiologist.
Before consulting with an anesthesiologist, White says preoperative tests initially cleared her for surgery at Cumberland Regional Health Center.
Ella McDonald / Global News
According to Nova Scotia Health, “anesthesiologists typically evaluate each referral based on multiple health factors (such as heart or lung disease) to provide the safest possible care,” but White doesn't believe her tests were adequately factored into determining candidacy for surgery.
“He didn't look at any information in my file because he was asking me all the same questions. Do you have difficulty climbing stairs? Do you have difficulty walking? Do you have difficulty breathing? These are all questions about weight,” she says. “And then, at the very end of all these questions that make me feel worse, the answer is no. Because we have politics.”
Without seeing a date for the operation, White began calling the Prime Minister's office.
She says she left 14 messages demanding an appointment before it was too late.
She also sent a letter to the standing committee on health requesting that the Ministry of Health and Wellness provide a plan for what steps it will take to close gaps in breast cancer treatment in the province. To her dismay, the committee decided not to proceed.
“The IWK recently hired a nurse navigator to provide a central point for unassigned patients to ensure they receive timely results, referrals, diagnoses and care. The IWK is also working to establish a breast health research unit,” said Susan Corkum-Greek, PC MLA for Lunenburg, at Committee 9. September.
“And for that reason, we will not support this proposal.”
Expanding access and research is vital, according to experts like Tammy O'Rourke, a nurse practitioner in Cape Breton.
However, O'Rourke said the province needs to take a hard look at its existing BMI policies.
“Knowing what we know about the accuracy of BMI, and knowing what we've seen in systematic reviews about the use of BMI for surgery, we need to rethink this,” O'Rourke says. “A woman should not be considered based solely on her BMI for life-saving surgery. This should not happen in Canada – morally, ethically, socially – we should not allow this to happen.”
In her opinion, whether to perform an operation in a hospital or not should be decided on a case-by-case basis.
“We need to think beyond BMI in relation to surgical risk,” says O'Rourke. “(Thinks) “Okay, what happens if I don’t operate on this patient? What will the outcome be compared to what might happen if I operate?” … It comes down to a benefit-risk analysis.”
Nova Scotia Health said in a statement that while it cannot comment on individual cases such as White's, it recognizes how important timely access to quality surgical care can be.
“Nova Scotia Health does not have a provincial policy regarding BMI and surgical eligibility,” it added, and “patient safety is the top priority and on occasion a case may be referred to a tertiary center if it is deemed to be in the best interests of the patient.”
But O'Rourke believes Nova Scotia's medical system is hypocritical in its BMI policies.
“A rural hospital should not be able to set its own BMI policy that is not scientific or evidence-based,” O'Rourke says. “There's something else behind this policy other than patient safety. Because when you have two hospitals in the same province that have disagreements about patient safety and BMI, it's an access issue that they're not admitting to.”
Access issues, White said, need to be addressed by Premier Tim Houston.
“Maybe he should start implementing policies and tools in rural hospitals to care for women in this province,” she suggests.
“It was mentally draining, not only dealing with a cancer diagnosis, but dealing with a medical system that was biased against you from the very beginning.”
White eventually underwent a lumpectomy at the IWK Breast Clinic on August 26th.
Ella McDonald / Global News
White hopes updated medical equipment, revised policies and adequate staffing will allow women of all BMIs to receive timely surgery, whether they live in Halifax Regional Municipality or elsewhere in the province.
“You have to rely on your health care system,” White says. “But when this health care system fails, it costs people their lives. It costs women… their lives.”
