MACHIAS, Maine — It doesn’t sound like much of a party, but for 10 Washington County women the promise of a free colonoscopy is definitely cause for celebration.
The opportunity comes on Saturday, March 26, courtesy of two ambitious nurses who appealed to local medical providers and other groups to donate their time, expertise and other resources to help raise public and professional awareness during Maine Colorectal Cancer Awareness Month.
National guidelines recommend a screening colonoscopy at age 50 and every five years after that. That’s considered optimal for identifying colon cancer at an early stage, when it is among the most treatable of all cancers.
“My doctor said I should have a colonoscopy back in January,” said 56-year-old Catherine Smith of Columbia. The doctor’s office even set her up with an appointment for the procedure.
“I had to call up and cancel the appointment; I just couldn’t afford it,” she said. “I’m still paying off the last one I got when I was 51.”
Without health coverage, a colonoscopy is an out-of-pocket experience that is also out of reach for many people. The basic procedure — subject to various add-ons and complications — can cost anywhere from $1,130 at Mercy Hospital in Portland to $4,895 at tiny Charles A. Dean Memorial Hospital in Greenville, according to recent information compiled by the Maine Health Data Organization.
Smith’s small workplace doesn’t offer comprehensive health insurance — it’s too expensive for the employer and the workers alike. Like many Mainers, Smith has only “catastrophic” coverage which kicks in in the event she is diagnosed with a life-threatening condition. Other than that, she’s on her own.
Never mind that Smith’s mother died of colon cancer at the age of 54, and that cancer runs in her extended family. Never mind that Maine has among the highest rates of cancer diagnosis in the nation, according to the U.S. Centers for Disease Control and Prevention, or that Washington County has the highest rate of colon cancer deaths and — not coincidentally, perhaps — the lowest rate of colon cancer screening in the state. Or that the colon cancer rate for women in Maine has declined over the past decade — except in Washington County, where the rate has actually risen. Catherine Smith couldn’t afford a colonoscopy, and she wasn’t going to have one.
Tackling the problem at the local level
The statistics raised red flags for registered nurses Erin Flannery and Karen Labonte.
Flannery is the school nurse at Washington Academy, and Labonte is the chief nursing officer at Down East Community Hospital in Machias. Both women have been pursuing their bachelor’s degrees in nursing online through the University of Maine at Fort Kent and discovered the disturbing information while researching a paper for one of their courses. They decided to tackle the problem head-on, tapping local resources to raise local awareness and drive up local screening rates.
“I went online and found a group in Colorado that had a ‘colonoscopy party,’” said Flannery, describing a free colorectal screening event for low-income women. “They picked the women up at their homes in limousines and took them to a spa for pedicures afterwards.”
Spas and limousines being in limited supply in Washington County, Flannery and Labonte opted for a less froufrou approach.
They approached Down East Community Hospital, which promptly agreed to donate its endoscopy facilities, equipment and nursing staff for a one-day colonoscopy event for 10 patients. They secured the services of local colorectal specialist Dr. Aziz Massaad, along with a staff anesthesiologist and a nurse anesthetist. Dahl-Chase Diagnostic Services in Bangor agreed to biopsy any suspicious specimens found during the colonoscopies, for free. And a pharmaceutical distributor promised to round up the prep kits needed for the infamous overnight bowel purge that enables a clear look at the colon, which is typically 5 to 6 feet long in adults and must be squeaky-clean for the examination to be accurate.
All that was needed was to find some patients. The nurses contacted 10 primary care physicians in the area and asked each one to identify one uninsured or underinsured female patient who was overdue for a colonoscopy.
“Out of the clear blue sky, I got a call from one of the office nurses asking if I wanted to be involved,” Catherine Smith said.
She jumped at the chance.
“My daughter really wants me to have this [colonoscopy] done,” Smith said. “She was only 10 years old when her grandmother passed away. My mother only lived a year and a half after she was diagnosed. She had symptoms for a long time, but she waited way too long to get treated.”
Spotty progress in improving access to screening
About a year ago, Maine was awarded a five-year federal grant of about $4 million to provide free colonoscopy screenings for uninsured and underinsured adults throughout the state. The programs are up and running at Maine Medical Center in Portland, Central Maine Medical Center in Lewiston, MaineGeneral Health in Augusta and Eastern Maine Medical Center in Bangor, and so far have provided free exams to about 185 Maine residents.
Eleody Libby, executive director of the Washington County: One Community agency in Machias said it will be a fine day when the federal program sets up in rural facilities like Down East Community Hospital so Washington County residents don’t have to factor in a 90-minute drive to Bangor on top of an uncomfortable overnight prep and the anxiety of the scoping procedure itself.
Libby said public health programs funded by the 1998 tobacco settlement have been working to spread the word about colorectal cancer and the importance of routine colonoscopy. In Washington County, materials have been distributed to medical offices and other public locations, she said , and local public seminars and professional workshops have aimed to raise awareness as well. The upcoming one-day colonscopy event will help educate the public, she said, even though there are many, many more women and men in the area who should undergo the screening.
Flannery and Labonte said they will personally deliver the colonoscopy prep kits to each participating woman’s home a few days before the screening. Picture the Publishers Clearinghouse Sweepstakes van — without the van, Ed McMahon, confetti, balloons and swooning housewives. Just the cheerful good wishes of some local providers and the sincere appreciation of 10 women who would otherwise probably not get screened for the potentially deadly disease of colon cancer.
For more information on the state’s Colorectal Cancer Control Program call 877-320-6800 or visit the website of the Maine Center for Disease Control and Prevention and click on “National Colorectal Cancer Awareness Month.”