Swiveling on a stool behind the wood counter at the hair salon where she works, Leandra Stewart pats her flat belly. For the last few years she has had cramping near her naval during her menstrual cycle, and it has only gotten worse in recent months.
If only she had had regular checkups when she arrived from Trinidad seven years ago, she said, she might be diagnosed by now. But then, at 29 with no health insurance, she had more pressing issues to deal with. Steward visited a gynecologist in the United States for the first time last month and is now awaiting the results of blood tests.
"I didn't have the option to go to the doctor as soon as I came." she said. "My pain had gotten worse, but you have to pay that fee and I didn't have money at the time."
A new study shows that recent immigrant women are 24 percent less likely to get a gynecological checkup than women born in the United States. And according to the Cancer Awareness Network for Immigration Minority Populations, English-speaking Caribbean women in Brooklyn are more likely to be diagnosed with advanced stages of cervical cancer than black women born in the United States. Because a large portion of the foreign born population in Prospect Heights is from the Caribbean, health is a major concern for these women. By their own admission and physician observation, a lack of funds and serious cultural barriers prevent them from getting checkups.
Prospect Heights sits in community district eight where, according to the 2000 U.S. census, 71 percent of the foreign born population is from the Caribbean, mostly from Trinidad, Tobago and Jamaica.
Dr. Desmond Browne, who emigrated from St. Vincent 20 years ago, has one of the only family medical practices in the neighborhood. Dr. Browne said that many of the recently immigrated Caribbean women who have come to his office say they have never had a pap smear, most likely because they have limited access to insurance and they are uneasy in the new and unfamiliar setting.
Last year, a woman came into his office with her husband, who, Dr. Browne said, acted like a dictator, telling the doctor where his wife was hurting. Dr. Browne was unable to make a diagnosis because it was unclear whether the wife was telling her husband the whole story.
"You really need to get it from the right source," he said.
"Obviously these are very smart women, but they have a slightly reduced exposure to these things in their communities."
A recent study, conducted in 2006 by UICC World Cancer Congress, in Washington DC, said that the disparity in gynecological checkups is possibly due to lack of acculturation. Dr. Browne agrees. He said women immigrants are usually the last in the family to adjust to their new lives. While they are at home, children are learning about American culture at school and husbands are assimilating at work. However, the Cancer Awareness Network suggested that a reason these women are slow to get checkups is not that they are sheltered at home. It is that they lack the time for checkups because they are busy managing their work and family.
Many of the women interviewed said that when they arrived they simply had a lot on their minds. Stewart said she found it impossible to obtain working papers. And as an illegal immigrant without those papers, she could not get health insurance.
Dr. Browne said he works with medical labs that are willing to lower their prices when patients do not have insurance. Usually he can get labs to do tests for about $150 and he will only charge $40 to $50 per visit, which comes to about half of the usual price of $80.
There are no free clinics in the neighborhood, but in neighboring Crown Heights, the Community Healthcare Network runs a center geared toward the Caribbean population. It is called the Caribbean House Health Center. However, many women are unaware that these services exist, or do not know how to locate them.
"We do not turn anyone away," said center director, Joy Drummond.
"We accept everyone, but most of the patients we see are West Indian immigrants."
Some women in the neighborhood said that they have made emergency visits to hospitals. However, many fail to get a complete exam. Ena Jackson, 57, cook at The Jamaican Bakery in Prospect Heights, who arrived from Jamaica seven years ago, said that she sees a private doctor for skin problems. Her doctor wants her to undergo tests, but she cannot afford to get a "head to toe" exam.
Stewart, on the other hand, finally has a work permit that allowed her to get health insurance.
Her blood tests came back negative, but the pain persists. Perhaps her appointment with Dr. Browne will reveal the source of the problem.
"Well, I'm kind of getting used to the pain now," she said.