This groundbreaking project is transforming breast cancer diagnosis by leveraging the heightened sense of touch of the blind women to make what is perceived as a disability into a life saving talent.
In India, where the most prevalent cause of cancer death in women is breast cancer, early detection is still a major problem. The most widely used screening instrument, the mammogram, is not generally accessible in rural areas, and cultural taboos also prevent breast exams. Meet the Medical Tactile Examiners (MTEs) blind women who are trained to detect abnormalities in breast tissue with very high accuracy. Their work is revolutionary in the face of widespread health facilities.
MTE practitioner Meenakshi Gupta, of Gurgaon, India, is a perfect example of the program’s reach. Born blind, Gupta spends as much as an hour thoroughly probing each centimeter of the breast with her fingertips, under the direction of Braille stamped orientation strips. Her results are recorded and reported to physicians for further diagnosis. Gupta’s heightened sense of touch allows her to feel out lumps as small as 6-8mm sizes that often pass by eye physicians in routine tests. As Dr. Hoffmann explains, “While doctors typically find tumours the size of 1-2 cm, MTEs have been known to detect those as small as 6mm and 8mm.”
The program’s roots trace back to Germany, where Hoffmann initially envisioned training blind women to help prevent breast cancer. Since its 2010 inception, Discovering Hands has expanded to several countries, including India, Austria, Colombia, and Nepal. In India, the program has trained 18 MTEs since 2017, and six are currently practicing while eight more are in training. With issues of training cost and social stigma, the program is slowly picking up pace, with the potential for increased early detection and dignified employment for blind women.
The intensive nine-month course equips MTEs with sophisticated skills in breast anatomy, psychology, and communication techniques. The students are taught to divide the breast into sections by applying skin friendly tapes and employ varying levels of pressure to detect irregularities. The process is thorough and empowering, since MTEs also instruct patients in self examining techniques. She now feels confident about examining five to eight patients a day, marking abnormalities for follow up.
Evidence exists on the effectiveness of tactile breast examination. A study comparing MTEs’ results to radiology results showed that the sensitivity level was high at 78% and the percentage of false negatives was low at just 1%. By employing an MTE, we are not losing anything, comments Dr. Mandeep Malhotra, a surgical oncologist. “When an MTE finds no abnormalities, we can be assured that the woman has a healthy breast at the moment and needs no further examination.” Such results are particularly heartening in India, where less than 1% of women undergo routine breast cancer screening.
In addition to their clinical effects, MTEs are breaking stereotypes and challenging disability perceptions. Neha Suri, a pioneer among India’s MTEs, shares her story of how the program has transformed her life. She was a homemaker dependent on her family, but now she earns a steady income and is able to support her son. “I used to feel like I was the only blind person in the world and that all I could do was sit at home and be a burden on the family,” says Suri. “Now I see it as a positive thing.”
The scheme also raises cultural sensitivities that normally prevent women from taking medical check-ups. Most women are not used to exposing their breasts in India’s conservative society to visit doctors. The deployment of blind examiners has lessened this taboo, and increasingly more women are seeking screening. As breast surgeon Dr. Kanchan Kaur explains, “The fact that breast examinations are being done by blind women has helped ease some of the stigma around going for a check up.”
Even though the program has a real impact, scaling up the program is extremely challenging. The training cost is too high, and most hospitals lack space or capacity to integrate MTEs. Scaling up the program is attempted, though, particularly in rural areas where healthcare is in short supply.
Discovering Hands’ potential lies beyond the detection of breast cancer. Hoffmann sees the possibility of training MTEs for other diagnostic areas, including lymphoma and glaucoma. The success of the program tells us that overcoming obstacles can bring enormous power, that disability is actually a special asset.
Gupta looks back on her experience and would like to see the program encourage others to recognize blind women as professionals, not patients. “Maybe then someday people will stop asking us how you commute, how you use your laptop, and understand that we don’t always go to the hospital for treatment. We can go there to work,” she says. Her words sum up the essence of Discovering Hands a game changing project that is saving lives, empowering women, and rewriting possibilities.
