Bringing health checkups to hard-to-reach areas is changing lives

Dora prefers not to use the word "obstacle” but instead chooses to talk about "knots” This choice reflects a way of life: an obstacle is a barrier to be overcome, while a knot is something that can be untangled.

With 20 years of experience in healthcare — half spent in direct care and the other half in service management — Dora has successfully unravelled many challenges. She claims the key to her success is simple: teamwork.

This approach has contributed to the success of Rutas Saludables, Mujeres en Territorios, which translates to Healthy Routes, Women in Territories.  The programme is led by Roche and brings together public and private stakeholders, with Dora participating as  Deputy Secretary of Public Health of Antioquia. The project is transforming cancer screenings for women in the most remote regions of this northwestern Colombian region.

Dora was born and raised in Bajo Cauca, Colombia, one of the most remote areas in northern Antioquia. It’s also one of the most economically and socially disadvantaged areas in the country. She vividly recalls how her entire village eagerly waited together for the highly anticipated  arrival of health caravans when she was a child.

"My mother and the other neighbours would be on the lookout, saying, ‘Be ready, they're coming to vaccinate the children. Be ready, they're coming to teach us how to brush our teeth.’ We experienced it with hope. When they arrived, it was finally a celebration — a very positive experience on an individual and community level," she recalls fondly.

Growing up in the region has been a fundamental motivation for her work in closing  health access gaps for the population in general and for women in particular. In Colombia's many rural areas, women are not only responsible for children, the elderly, and people with disabilities, they also work alongside their partners in the fields.

"I can't take care of anyone else if I don't take care of myself first. That's the invitation we're extending to women  — we are reaching out to each and every one of you," she affirms. At the Government of Antioquia, these actions are part of the Departmental Care Strategy.

The Rutas Saludables, Mujeres en Territorios project aims to provide health screenings to women by travelling to neighbouring territories and offering the opportunity for a checkup that would otherwise require them to travel between five and eight hours.

While there are medical centres in the area, they often lack the comprehensive and specific screenings offered by this project. In just six months, the programme conducted two breast detection campaigns, reaching 800 women. Between 8% and 10% of participating women have accessed breast ultrasound services, and one received a positive breast cancer diagnosis. The programme demonstrates the impact of early breast cancer detection, which can enable better patient outcomes.

The campaigns are organised on Saturdays making them more accessible. Dora admits they are exhausting: long distances must be covered, sometimes in oppressive heat, with long hours of work. Despite the fatigue, she always ends up happy and "teary-eyed" with emotion. That happiness comes from the words she hears most during those hours: "Thank you."

She describes the women's gratitude as "beautiful." "You were able to do something for someone, bringing a service to places where we know they wouldn't otherwise have had access," she says.

Dora admits that implementing the programme involved overcoming significant challenges, including  integrating the different sectors.

"When I proposed the plan at the department, they told me it wasn't possible because insurers would say no. But why would they refuse when this benefits not only the patients but also the insurers? If I find a patient in time, their treatment will be more economical," she says.

She investigated past actions and found that they had only sent a document about the programme. Dora  met personally with each insurer and explained the plan. "That face-to-face conversation changed everything, looking the other in the eye and saying, 'We want to do this, but you play a fundamental role. I need you to help us.' "

She was surprised by the response, which was the same she received from women she met at the screening campaigns: "Thank you," for taking the time and successfully conveying the importance of the project. She brought the insurers on board and convinced the municipalities to facilitate the locations for the checkups.

Community leaders and health promoters who identify patients and organise campaigns, are essential to the programme’s success, as patient demand for screening is required.  

Associations of breast cancer survivors also play a significant role. "We were surprised to find women who didn't want to get screened. They would say, 'I might have something, but since I don't know, I'm fine, I'm calm, nothing happens to me, and I can continue with my normal life’” Dora recalls. Here, the personal experiences of members of the Modo Rosa support group enable empathetic engagement through information, confidence building and an understanding of the importance of early diagnosis.

For Dora , at a time when many countries are debating public versus private healthcare, the Rutas Saludables, Mujeres en Territorios experience demonstrates that this divide can be bridged for the patient's benefit.

Every link in the chain is essential to the strategy's success. If one of them fails, the knot remains tied. "What I've learned, value most, and want to tell others is that it is indeed possible, as long as we work together," she says. "It's not about being one or the other. The invitation is for everyone because we all need each other."

To understand the importance of teamwork and alignment, Dora shares a memory from the latest campaign in the hometown of famous Colombian cyclist Rigoberto Urán.  After completing the campaign, she toured the town of Urrao until she found its popular ice cream factory.

The team ended their day by enjoying popsicles as a way to thank everyone involved in the campaign  for their commitment. It was much like the village celebrations Dora experienced as a child, but now from another perspective: having been the one to help bring access to health rights to hundreds of women.