Interview Quotes

My experience researching the case about the JBCP was a transformative experience. I have learned so much about so many things -- everything from public health to business operations to capacity-building. It was a wonderful compliment to my Zuckerman Fellowship experience.

The process of transcribing my interview recordings has been slow-going and tedious, but I am really enjoying the opportunity to take a second look at what I learded and reflect to a deeper degree.

Here are some quotes that I transcribed today:

"I looked at the subject and I thought, okay, we have an obligation to the community. We have to do something, and then the thing came as breast cancer. If you look at cancer control programs, they look at the burden, and the resources, and what the country can offer. So the burden was #1 cancer in Jordan is breast, even if you combine male and female, breast cancer will stand out as the most common cancer in Jordan. If you took the females, 37-38% of all cancers in women in Jordan are breast cancer. (We don't have many cervix cancer cases.) We decided to take up breast cancer, and breast cancer has been tested, the way to handle breast cancer has been tested over the past 40-50 years, so there are models to choose from."

"One of the challenges we face at the Ministry of Health is finding resistence from doctors. Some doctors, they don't even believe in screening mammography. Others are just too lazy -- they say, 'you're coming in and you're bringing more work for me? I don't like that.' You're dealing with different personalities. A lot of people challenge what we're trying to do, but somehow we have to find ways around that. So I want to meet with those doctors. Usually in such centers we try to get the doctors who meet with women of our target group, who are usually in family medicine, or the internists, mainly the specialists, but not the gynecologists, (because the gynocologists here generally see young women in their 20s who are still having babies.)"

"At the ground level, you do find a lot of resistence because, believe it or not, these doctors are overloaded."

"And their argument is valid. At one of the health centers where we installed a mammogram machine, an average doctor sees, per day, over six working hours, sees 60 patients to 70 patients. So that doctos is basically overloaded ... you're taking about 5 to 4 minutes per patient, probably even less. So the doctor comes to me and says, 'how do you expect me to perform a clinical breast examination on a female and then refer her for a mammogram?' (I need to take her information, then perform an exam, which takes minimum 15 minutes.) They make a strong argument, but nonetheless, we need to have to get this rolling."

"We have no national guidelines, so every doctor will do what he thinks is right. If you are young, and you are afraid, and you are scared, and so on, my duty is to reassure you, and everything is okay. But I will reassure you after I have done all the necessary things. What they do is say, "Come on you're young, this is nothing, this is a milk gland, you don't need anything. And they don't do neither an ultrasound or a mammogram. And this poor woman, she was looking for that reassurance, and she flees, and she doesn't come back, and after six, seven months, she has a full-blown something."

"I had a general idea about cancer. No one in my family had ever been through that ... the idea was in my mind. For example, if someone has breast cancer, it should be something very obvious and they can see it easily. Whenever I look at my breasts, they are very good-looking! I thought it was just in the shape! But in the lecture we attended, the doctor said, no, the diagnosis should be in the early stages. If you can see something, it means it is in the late stages and it's dangerous. That was the thing that shocked me -- you might have the tumor and never know it. If it's going to happen, it will happen despite all this (health, family, environment)."

"We are all looking for success -- if I see that this program is successful, why should I keep money away from them?"

"[Arab Women Speak Out is] quite a flexible program, but it helps to build women's empowerment, and get women to have an opportunity to recognize, to some degree, their own worth. We find that it's very much a prerequisite to women's ability to take action regarding their own health. Letting women see how important their own health is to the success of their family, and therefore, empowering them to seek medical care or family planning."

"For any behavior change and process, it is like like, there are dimensions. It's not awareness only. So you start with awareness. Then you need to have policies, you need to have services, so it's a chain ... so awareness won't do much without having the services available."''

"What is the point of awareness if there are no services for diagnosis and treatment?"

"What is needed in Jordan, more than the [mammography] machines themselves, is to have a standard for the quality for mammography. Most equipment is not checked, and most equipment is not ready for mammography. Even the CRs -- not all of them. I think this is a problem, because a lot of them, they have CRs, they have X-rays, but they don't have a standard, because if your machine is not 100% correct, it will give false negative or false positive results ... This is what is needed, more than anything else. Plus, the equipment doesn't work."