Our story this month is not one of the happy ones but it is one that needs to be told especially as our country’s leaders debate the future of the Affordable Care Act. While we still do not know what the final outcome of this story will be, it clearly illustrates the devastating results that are borne by individuals and society when people do not have access to basic health care and go without screening and medical care for many years.

Mary (not her real name) is 59 years old. She cleans house for a living and makes about $28K per year. She did not have insurance and had not seen a doctor in many years. She never had a mammogram even though her grandmother, mother and sister have all had breast CA. Before coming to us she had noticed blood in her urine or hematuria, for about 6 months but what made her come to us was a breast lump she had noticed for 3 weeks. She called us after she was sent home from the ER told she needed to see a specialist, no insurance, and no way to pay for them. She was in pain, still trying to work. The ER gave her our name on a list of places she might be able to get help. When she shared her fears with a friend, the friend told her to come to our Count Me In program. We were the only one that responded to her inquiry.

Once she made contact with us there were still challenges in getting her in around her work schedule because she was afraid to take time off of work as she was afraid of losing her job since she had missed a lot of work previously.
Upon arriving she seemed defeated. She had been having hematuria for months. She was in pain, afraid, had been to the ER and they told her they suspected cancer but she had no way to pay for it and no insurance. She made too much for Medicaid and felt like the plans available in the health insurance exchange were too expensive for her. She just felt trapped, hopeless. She was just going to ignore the whole bladder issue, but then she found the breast lump too. That was the straw that got her to reach out to us.

One of our first steps was to let her know we would work to find her help and then get her set up with multiple appointments to get the issues worked up.
We used BCCCNP for the breast lump while simultaneously getting her connected with our contact for patient financial assistance at the Spectrum Heath Medical group to work up the bladder issue.
We have helped with coordinating and scheduling appointments. One of our providers is now her primary care doctor. She is also seeing the Care Manager and Social worker at CHC as well as now under the care of the team at Lemmon Holton Comprehensive Cancer Center.
Her breast lump was cancer. Simultaneously, we worked to get her patient assistance funds to work up the hematuria. Because of that breast cancer diagnosis she now qualifies for Medicaid under the Medicaid treatment Act. Her hematuria was caused by bladder cancer. While doing the pre op for her surgery it was noticed the she had some suspicious areas in her lungs as well. She has had initial surgeries for the breast and bladder cancer and is working with the multidisciplinary care team at the Lemmon-Holton cancer center to plan the next steps. This is what can happen when people do not have access to basic health care. They do not have regular preventive visits and screenings and when problems arise they delay seeking care because they fear the cost. This woman, one of the working poor, has 3 kinds of cancer, likely significantly advanced. While she now has access to health care, it may have come too late.