Breast cancer activism in Saudi Arabia has helped spark a cultural revolution bringing thousands of women together to help raise awareness. Earlier this month, 11 Saudi women climbed Mount Everest as part of a public campaign to draw attention to the disease. Two years ago, nearly 4,000 Saudi women gathered in Jeddah to form the largest human breast cancer ribbon. The event broke a Guinness World Record and was the first time Avon sponsored its Walk for Life event in Saudi Arabia. The idea for the gathering came about after some brainstorming by HRH Princess Reema Bint Bandar Al Saud. A successful entrepreneur she serves as president and CEO of ALFA International and AL HAMA LLC, two leading luxury retail corporations and co-founder of Yibreen, a women's day spa in Riyadh. Al Saud points out the aim wasn't about breaking records, but about generating conversations and awareness on breast cancer.
Al Saud's involvement in breast cancer awareness began six years ago, shortly after learning a very close friend had become diagnosed with the disease. She joined the volunteer efforts of a dozen Saudi women working in the medical field who took it upon themselves during their lunch breaks and after hours to educate women. Together their efforts evolved into the creation of the Zahra Breast Cancer Association. The organization has been able to generate income and benefit from the push for CSR programs in the Kingdom. Businesses such as mobile phone companies and banks have been eager to build partnerships with the organization as they see women as important target markets.
As a disease that knows no borders or religion, Al Saud says the issue is not that women in the Kingdom have been deliberately avoiding the topic. She explains it's a cultural issue, as it affects a region of the body people aren't used to talking about in public or can distribute information easily about because of its imagery. She credits Zahra for coming up with creative ways to raise public awareness. For example, the teams developed "the house of Zahra," which is a four-wall kiosk that travels from mall to mall. Upon entering the Zahra house, women can meet with a nutritionist and learn about early detection techniques. The women have proven that it's possible to reach a phenomenal amount of women and create private spaces in very public areas regardless of the cultural context. A sad story Al Saud recalls occurred at one of the Zahra houses set in a mall after four friends who visited all felt lumps. Both Al Saud and Dr. Modi Batterjee, founder of the Albidayah Breastfeeding Resource and Women's Awareness Center, offer their insight into the success and challenges of raising awareness in the Kingdom.
How has breast cancer awareness evolved in Saudi Arabia over the years?
Batterjee: A decade ago, breast cancer was not an issue that was discussed at all. Even five years ago is was not addressed as it is today. Previously the word "breast cancer" was never uttered in public. Families would not disclose if a relative had it. This mindset still exists today, but not at the same intensity as it had before. This cultural rejection made it very difficult to do any kind of awareness work.
Eight years ago my mother and I opened AlBidayah Center, the first and only breastfeeding resource and women's awareness center in Saudi Arabia. When a woman becomes familiar with her breasts through breastfeeding, she becomes sensitive to any minor changes that may occur in that area of her body and is more likely to identify any sign of cancer at an early stage. We are trying to empower women to become their own advocates. Our services include first aid and CPR, prenatal breastfeeding education, postnatal breastfeeding counseling, breast cancer education and breast self-examination training. We also provide new mothers with support products such as breast pumps and phototherapy unit and participate in ongoing activities such as breast cancer campaigns.
We are able to hold classes for schoolgirls at our center and teach them how to do breast self-examinations. Previously this service was occasional and mainly for the expat community. Today with the presence of associations such as Zahra, we are more able to actively address the social needs for breast cancer awareness. I am very happy to volunteer my work for any active society.
Does the health care system in Saudi Arabia effectively address breast cancer needs?
Al Saud: While health care is free in Saudi Arabia, one issue is that a certain segment of society, mainly the middle- and upper-class, get treated for breast cancer in the States or Europe. This lowers the number of reported cases and doesn't allow for correct statistics to be given to the health ministry. Therefore funding for breast cancer versus perhaps liver cancer and other forms of cancers becomes skewed. It would make sense that money goes to funding that reflects types of cancer with higher reported cases.
How do gender laws and dynamics in Saudi Arabia impact your outreach efforts?
Al Saud: A lot of the young ladies that work with us in Riyadh have transportation allowances. The majority working with us can afford to be driven or are given an allowance for a driver. One of the new laws for employment in Saudi Arabia is to provide health insurance and social welfare. This has allowed us to have a higher caliber of individuals work for us and draw people who are well educated and looking for an environment that will secure them as they get older and grow in their careers. There are a lot of male doctors on the board with us and as members. We do set up university talks and have male volunteers that carry our messages such as sons and brothers of volunteers. We encourage community service reaching out to not just universities but also high school level kids and those working in offices. A broad range of people of different ages attend our events and volunteers in full sense of the word and are not just paper pushes.
How does awareness and treatment of breast cancer vary in urban areas versus more rural?
Al Saud: I am very confident that in major cities the message is well saturated and spread out so people have at least a basic awareness. One the big goals we have are to reach the rural areas. When the Zahra team makes trips to small villages, we don't just talk about breast cancer. We feel that in that type of environment, it's more appropriate to discuss the full health of women and bring breast cancer in as part of the conversation. The problem we find with the smaller clinics in more rural regions is by the time a patient is transferred when they realize they are at stage one all the way through the time they reach a doctor in larger city for treatment, the cancer may have already spread to stage 2 or stage 3. The processes they go through for treatment is often too long from the time of their first diagnose. What we would like to do is acquire information so we can pass it on to the hospitals and perhaps encourage more activity at an earlier stage in the more rural regions. Also more outreach can create a streamlining effect so if someone has been diagnosed, they could be prioritized for treatment rather than having to go through the full cycle of the medical system. We hope to be able to speed up this process.
Another thing we realized is the fear the women in rural areas has if she feels like there is something wrong with her health. Many fear becoming a burden on their families. As a result, a lot of women won't talk about what their feeling or if they notice something wrong. They don't want to be pegged as defective and left on the side. So there is a lot of education that has to go into rural areas. This has included educating men that women with breast cancer are not defective and it is easily curable if caught early.
The Ministry of Health has been amazing supporters and view themselves as co-collaborates. They support us in our activities through allowing us into hospitals and in our support groups we are developing throughout the country. In the Al Qassim province we also work with the King Abdul Aziz Women's Charity Committee run by the governor's wife Princess Noora. She is one of the most phenomenal women you'll ever meet and we view them as partners to Zahra and as a role model to our organization.
What makes Zahra stand out to you?
Al Saud: The Zahra Foundation has been phenomenal and I love the work because every single woman involved is beyond inspiring. The majority come from the medical field and are psychiatrists, counselors, oncologists, physical therapist, and psychologists. However, we also have those from business backgrounds and women from all walks of life. For example, many breast cancer survivors now work as volunteers. I love how Zahra represents a broad spectrum of who the Saudi women are. As women we are able to directly speak to other women and make our message more effective. Our team has a specific focus, dedication and game plan. There is nothing aggressive, sensational or offensive about what we do. We are not carrying a feminist banner but instead are carrying the banner of hope. We would like to reduce breast cancer to being as simple as treating a cavity in your mouth. If you feel something, get it checked and if there is something there, you deal with it and it shouldn't be a problem. I enjoy how professional everyone is and that the focus is very specific and targeted. If you are involved in multiple activities for example, it is easy to get lost in what you stand for and what you need to do in organizations where the spectrum is too broad. We are very targeted and I enjoy working in a place where there can be measured effects.
What advice do you have for people that want to get involved in nonprofit work?
Al Saud: The Ministry of Social Affairs has a great list of different organizations. Be honest and upfront on what you can give and follow through. The effort is worthwhile whether you pick breast cancer, Down syndrome or orphanages and if you offer five cents or five minutes. Identify whatever skill set is your strength. For example, business skills are definitely needed in a charity. Providing skills is as equally valuable as giving money. At Zahra, for instance, we have a pro bono lawyer and the value of his time is money we do not have to spend.
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