"It’s a typical mammogram room—if you went to a hospital it would look exactly the same," says mammographer Valerie Rice. "It’s nothing really different, except that it’s in a moving vehicle!"
Rice's exam room is on wheels—a large coach bus, pink of course.
Snow is falling in the parking lot outside, and horses are tied up to poles in the frozen ground. Today the mobile mammography unit is parked at the Mennonite Christian Assembly Church in Fredericksburg, Ohio, within a buggy ride’s distance from some of the largest Amish settlements in the state.
"We like to bridge the gap between the culture of Amish and Mennonite communities and the culture of health care," says Melissa Thomas.
Thomas is the director of the Center for Appalachia Research and Cancer Education, which focuses on cancer disparities in those communities. She organizes mobile clinics like this one about 25 times a year.
"We try to find screening locations that are in the most remote sections of the state, that are serving more than likely a more conservative group of Amish that may not have access or availability into the local hospital systems," she says.
Ohio is home to one of the largest Amish populations in the country. And the majority of Ohio’s Amish settlements are in Appalachian counties, where cancers that can be detected by preventative testing occur at higher rates.
There is little data available on the Amish community, though Thomas says what she found in her own research is startling.
"What really surprised us was the higher death rate of breast cancer among Amish women in these two regions," she says. "What was disturbing to us is that the leading cause of death of Amish women under 60 was breast cancer."
Beyond distance, there are other reasons Amish women underutilize methods like mammograms. There’s a language barrier: Some in the community are more comfortable speaking Dutch or German than English.
Cost can also be an impediment. The Amish don’t participate in the health insurance market, instead pulling money for procedures from a group fund.
Many Amish women simply say they don’t know what resources are available
"That was the way with me, when I had my diagnosis," says 80-year-old Ella Miller. "What do I do? Where do I go? I felt like being out in the boonies about it."
Miller is Amish, and a 30-year survivor of breast cancer. Now she's a community health worker with the mobile clinic.
"People think a mammogram will cause cancer," Miller says. "It’s very hard to get that out of their mind."
Research shows the majority of Amish women underestimate breast cancer risk and are more likely to believe that sort of myth. Miller says that makes it difficult to get the women in the door.
In nearby Holmes County, a community health assessment found that about 60% of non-Amish residents had gotten mammograms, compared to only 20% of Amish women.
If they receive a positive test results, it can be even more difficult to encourage Amish women to seek medical intervention.
"There are some people that think that is meant to be, and that is God’s plan for their life," Miller says. "And there are those that refuse treatment, whatever, and they don’t seek treatments, that this is what God meant for them in their life. And whenever their life ends, so be it."
Miller says a mastectomy years ago gave her a chance to fulfill her greater purpose: to help other women in her community.
"You should still do what needs to be done so God can heal you," Miller says. "Because you need to help yourself, somewhat. Yes, God will help you, but you also have to do your part."
After a diagnosis, the project helps connect women with nearby hospital systems for further care. Then the mobile clinic rolls on to another settlement in the state.
