Sarah Mitchell, right, a medical social worker who runs the breast health… (Francine Orr, Los Angeles…)
Stepping through the doors of the Downtown Women's Center is entering a world apart from the grind of skid row. In the comfortable, tasteful rooms of this converted shoe factory at San Pedro and 5th streets, homeless women can find a meal, a shower or — thanks to a new program — a mammogram. Starting in May, the center has offered monthly breast screenings to improve the preventive healthcare of its aging residents and visitors.
Nearly 1 in 3 homeless people in Los Angeles is a woman. And almost half of the 4,000 women who visit the Downtown Women's Center each year are older than 50. For a population struggling with chronic homelessness and the daily demands of survival, preventive cancer screening is a low priority, and often comes saddled with fear.
Most of the women who come to the center know cancer only in the context of poverty and have no access to healthcare, said Lisa Watson, the center's chief executive. They may have seen mothers or aunts develop a breast lump and, lacking treatment, soon die. Because they assume cancer is fatal, some women might avoid mammograms because they would rather not know about the disease. "This isn't what has to happen now," Watson said. "This is what early detection is all about."
The center, which opened in 1978, provides permanent housing for 71 women. About 200 more drop by each day but sleep at emergency shelters or elsewhere during the night. "Almost every woman who comes to skid row will walk through our doors at some point," Watson said. Offering mammograms on-site enables women to access the screening in a familiar setting that they already visit for meals and other services. "It's meeting the women where they're at," said Sarah Mitchell, a medical social worker who runs the breast health program.
The center partners with Inner Images, a mobile mammography service, whose technicians wheel a mammogram machine into the center at the end of each month. The center houses a specially designed room for the machine with thick concrete walls to absorb the radiation. Each screening costs the center $75, and they hope to ultimately provide mammograms for 30 women each month.
Of the 48 screenings offered in the first three months of the program, none have turned up cancer. But when one does, the center is ready to support a woman through treatment, as it has done for residents in the past. Depending on a woman's needs, the staff might offer bus tokens to reach appointments, bring visitors to the hospital, or provide money for a wig.
Mitchell hopes to remove some of the fear surrounding cancer by empowering women to take charge of their breast health. "This is in your control," she tells them. She includes breast health in the center's monthly workshops, and talks about the importance of self-exams. Integrating mammograms into the center's community also helps motivate women reluctant to get screened, Mitchell said. "If they've noticed that their friend's getting them here, they're kind of like, 'OK … I will because they are.'"
June Miranda, 60, recently moved to Los Angeles from Sacramento, but found herself without a home after a dispute with her landlord. Since the end of June, she's been sleeping at the Union Rescue Mission down the street and visiting the Downtown Women's Center during the day. It had been at least five years since her last mammogram, so when Mitchell came around with sign ups last month, Miranda decided it was time for another. "And I got a comfy pair of slippers," she said with a laugh — an incentive that the center offers women to get the screening.
Miranda appreciates that she doesn't have to endure long waits at the center's health clinic, compared to other places. "I'm able to relax," she said. At the center, "there's no stress. And this place is stressful enough when you get on the streets."
The center partners with a JWCH Institute community clinic to provide a centralized home for the women's medical services and records. Many of their clients have drifted to doctors all over the county as they've moved around. They also sponsor other health programs focused on fitness and nutrition to help the women decrease their risk for obesity and diabetes.
Any uninsured woman can use the center's health services, even if they're not homeless, Watson said. "Our health crosses all barriers and all boundaries of our society," she said. "It doesn't matter if you're homeless or have mental illness ... you still need that preventative care."