Project: Community Health Action Initiative (CHAI)
Organization: South Asian Network
Artesia, CA
Story written by Suvas Patel and Zul Surani with input from Nina Sharmin and Vandana Ranjan

Making a World of Difference
A normal day at the office for a CHAI Community Health Advisor at South Asian Network (SAN) is nothing short of being eventful and filled with new encounters. On a typical day at the office, just as Vandana Ranjan, the multilingual Community Health Advisor has settled in with a hot cup of “chai,” the phone rings.  On the other end was a concerned female voice speaking in Punjabi, asking about “how breast cancer is spread.” The woman identified herself as Pooja and tells Vandana that someone in her Gurudwara (Sikh place of worship) had breast cancer and her breast has been removed. She says, “what Karma this woman must have brought from her past life to have such a horrible thing happen to her.” In her frantic voice she showed concern not only for herself but also for women in her family and at the Gurudwara. She said women hear things on television about cancer but they don’t really understand until it is too late.

Vandana realized that this was an opportunity not only to educate Pooja but if successful, also women in her Gurudwara.  She talks to Pooja about early detection of breast cancer and encourages Pooja to make an appointment to get a mammogram. Vandana knows that Pooja is very nervous and may never act upon this information so she also asks to visit her at home. Her first goal is to get Pooja more involved in her own health and make sure she and her family have access to a regular health care provider. In the long run, she also hopes to get Pooja involved in community education.

Vandana visited Pooja in east Hollywood where six people live in her two-bedroom apartment. During their conversation, Vandana uses a CHAI survey to conduct an assessment. In answer to Vandana’s questions, Pooja explains how she has never received a physical exam and is unaware of what tests are needed to see if she has breast cancer. Vandana is saddenedthat in her eight years of living in the U.S, Pooja remains uninsured and has never gotten tests for herself. From her extensive experience with working with the community, Vandana knows this is likely a result of lack of information in Punjabi and of South Asian women designating very low priority to their personal health. 

Being a competent and trained community health advisor, Vandana counsels Pooja in regards to breast cancer and the various actions she can take to prevent and detect cancer early. In addition, Pooja receives the results of her comprehensive health assessment and a “Khatta” (health passport) which explains very simply and in her language what tests she needs to get and when.  Pooja expresses her appreciation for Vandana’s visit but also explains how she feels uncomfortable calling a clinic and setting up an appointment. Vandana offers to serve as her interpreter. Then she helps Pooja by making an initial appointment for her health checkup at a “South Asian friendly” clinic in her neighborhood, one of 14 clinics in CHAI’s community clinic network.

Over the span of a couple of months, Vandana and Pooja established and built upon a case worker-client relationship. Vandana has already gotten a glimpse of Pooja and her family’s lifestyle and has identified things that put Pooja at risk for top diseases that affect South Asians such as diabetes, heart disease and cancer. Pooja is overweight and does not exercise and her husband uses Gutka (chewing tobacco from India). However, as a result of her encounter with Vandana, Pooja is now more comfortable in going to the clinic and has more knowledge about her health, the tests she needs to get and how often. Vandana carefully explains to her that this is a start and she has a long way to go to complete all the tests necessary and make changes in her life to prevent disease.

Last month, Pooja helped Vandana organize a CHAI workshop for women at her Gurudwara where Pooja also got the opportunity to talk about getting her first mammogram. Women at the Gurudwara were very emotional because they finally felt a sense of control, after collectively going through the experience of a congregation member having breast cancer and not knowing what to do. Vandana gave each woman a “khatta” and showed them as a group how to use it. She also encouraged women to “team up” and help each other in completing all the tests recommended in the “khatta.” Vandana is now working with Pooja to organize a South Asian women’s breast cancer screening day at a clinic near the Gurudwara on Vermont Avenue.

Vandana and the CHAI program are examples of how the involvement of the right person at the right time can make a world of difference in the health of individual immigrants and spark collective action. 

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