2012-08-23

Co.Exist

Extremely Effective Breast Exams, From Blind German Women

The Discovering Hands program employs sightless women to give careful breast exams when doctors’ schedules don’t give them time. Does their heightened sense of touch make them the ideal candidates?

One day in 2006, Dr. Frank Hoffmann was taking a shower and fuming to himself about the German medical system’s new reimbursement rules on mammograms and how it meant doctors had less time—just 1 to 3 minutes for non-mammography breast exams of patients. Then an idea hit him: What if you could train blind women, with their heightened sense of touch, to perform in-depth breast exams on patients for 30 minutes?

Six years later, he’s got an organization called Discovering Hands that’s developed government-approved training techniques and has patented special equipment such as a braille-enhanced, tactile tape measure for the blind women to use as a guide for their hands to traverse the patient’s breast in search of atypical, cancerous nodules.

He’s trained 20 blind women in the intensive course as Clinical Breast Examiners (CBE) and has found paying jobs with livable wages for 14 of them so far, who work at 17 different locations around Germany and have scanned 8,000 breasts for cancer. A large-scale study at a renowned gynecological hospital in Bavaria is currently in the process of being launched, financed by a German charitable foundation. For now, he says an initial study they did of 451 patients showed blind women can detect lumps 6 to 8 millimeters in diameter. Doctors often only find those over one centimeter in diameter.

The organization is an example of several within the social entrepreneurship space that aims to create employment for people traditionally considered "disabled." "We transform their perceived disability into a capability," says Stefan Wilhelm, Hoffmann’s project manager. For example, Pia Hemmerling in Hamburg was wondering what to do after she was diagnosed with glaucoma at age 21 and began to lose her sight. The travel agency where she worked said she could keep working there but she didn’t feel comfortable doing so. "I knew that to work in an office was not in my future," she said, realizing that she couldn’t peruse catalogs and book flights quickly anymore without getting headaches and eye aches. "I couldn’t do it."

So she started working part time as a waitress at a Hamburg restaurant where blind servers deliver food to seeing customers who dine in the dark. She heard about Discovering Hands and enrolled in the training in 2008 and landed a job at a women’s clinic in Hamburg shortly afterward.

"I like to work with people," she says. "I do something very important and I like it. I can help someone." She’s found tumors in several patients already. She appreciates that patients remember her and are glad to talk to her when they are in the clinic. "I feel like a psychologist sometimes," she said.

Hoffmann and Wilhelm believe the women’s presence in a doctor’s office actually calms patients and offers a rare human touch not often found in medicine anymore. "Nowadays, in medicine, the doctor doesn’t touch you as often as they used to. Many patients really want a physical contact between the person who treats you and you, says Willhelm. "The German word for treatment is Behandlung. The word hand is involved. Centuries before, it was normal to go to a healer, you would be touched in the real sense of the word. It’s not that common anymore."

Hoffman’s goal is to train 60 CBEs who can scan 53,000 breasts per year in Germany, a number that would make their business model financially sustainable. That would also be enough volume to feed a large-scale clinical study to confirm their view that this method leads to better detection of smaller cancer cells. After that, Hoffmann thinks the prospects of blind breast scanners get really exciting.

"Maybe in underdeveloped countries it would be even more interesting than in Germany and the U.S.," he muses. "Pakistan and Africa are full of blind people. They also don’t have as many medical devices and equipment to offer mammography to all the people."

They want to contract with more insurance companies to pay for the treatment instead of patients paying out of pocket for the exams. In Germany, because of new rules in 2005, insurance companies don’t pay for regular mammography scans until women are older than 50, unless doctors suspect a lump. Radiation fears in the U.S. have also ratcheted back mammograms.

But what do the big makers of mammography equipment—GE, Phillips, Siemens—think of this venture which might cut into their business more than insurance and government rules already have? "As a matter of fact, we didn’t ask them," says Hoffmann.

Siemens, Philips, and GE declined to comment on Dr. Hoffmann’s project. But Siemens’ health insurance (and other German health insurance companies) actually pay for female patients to undergo the scans by the blind women, according to Hoffman. The American Cancer Society also didn’t offer a comment on the project.

Hoffmann doesn’t care what the medical scanning and cancer research organizations think about his project. "We want to improve the medical situation," he says, in a deliberate, Werner Herzog-like voice. "We want to make early detection better. We want to create a totally new working field for vision impaired people."

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