KIEV, Ukraine – Nina Klotsman needs $500 a month to stay alive. She doesn’t have it.
The soft-spoken engineer from Cherkassy has worked since 1995 for Project Kesher, a Jewish women’s organization that does community building and social activism in more than 150 cities throughout the former Soviet Union. Klotsman is also in charge of the group’s Women’s Health project, which is ironic as she herself has breast cancer.
“Women’s health was a very small part of what we did when I started with the group,” she says. “Then an American woman brought us brochures about women’s health – menstruation, menopause, the importance of exercise, how to do breast self-exams.”
It was while she was checking her breasts in 2003 that Klotsman discovered a lump.
“I was so scared,” she says. “Here I was teaching other women, and I got it myself.”
She had chemotherapy, radiation and surgery in 2005, followed by regular visits every three months to her local oncology clinic. No one suggested any further treatment.
By early this year the symptoms returned. She was weak and nauseous, and had terrible back pain. A blood test showed no cancer cells, so she was sent to a city hospital for an “upset stomach.”
Meanwhile, another Project Kesher activist took Klotsman’s X-rays to a doctor in New York. He said the cancer had metastisized to her bones, and she needed immediate medical treatment that included hormone supplements and bone-strengthening drugs.
“I went back to my doctor and he said, ‘That’s true, it’s what you need,’ ” Klotsman relates. “So I asked him why he didn’t suggest it to me earlier, and he said, ‘I knew you couldn’t afford it.’ ”
When the Soviet Union collapsed in 1991, so did its free medical system. People in the region now suffer and die from diseases and conditions that could be treated easily in the West but are beyond their financial reach.
Project Kesher focuses on women’s health-care issues, particularly breast cancer, because it affects so many people and takes so little to detect.
Olga Krasko, Project Kesher’s coordinator in Belarus, says half the women in her country have breast cancer.
“We’re close to Chernobyl,” she notes. “In the radioactive areas they’ve built special health centers with good equipment for exams. But in the smaller cities there’s almost nothing, and no experts.”
Kesher’s director of infrastructure, Elena Kalnitskaya of Makeevka, says most cities don’t have mammogram machines. Even her own city, with a half-million residents, lacks the vital tool.
Unless they can pay for private doctors, most women have to travel to free clinics in large cities. The clinics don’t take appointments, so the women wait in line all day. If they are not seen, they must try again the next day – if they can take the time from work. Many give up.
Project Kesher activists have come up with some piecemeal solutions.
In the Belarusan capital of Minsk, they met with the city’s chief mammologist, who agreed to examine needy women for free once a week. He followed through for a few months.
In Ukraine they bought speculums, mirrors and gowns and distributed them to doctors in outlying cities, “so they could treat women who hadn’t been to a gynecologist in years,” Kalnitskaya says.
The Makeevka group convinced a local doctor to perform free breast palpations for three days – a one-time arrangement.
“It’s not enough to get a mammogram machine for one town, we need to go to the government” for national solutions, says Project Kesher’s executive director, Karyn Gershon.
Health education and home-based preventive care is among the organization’s priorities, particularly given the financial limitations of the region. Project Kesher groups teach women and girls how to do breast self-exams, and where to go if they find a lump.
“Many women run straight to the gynecologist, who isn’t an expert in breast cancer,” Krasko points out. “Unfortunately our women avoid oncologists – they think it means they’re doomed. We explain that there are treatments for cancer today.”
But the best drugs cost money, even in Belarus where basic health care is still free. In Russia and Ukraine, countries with greater political freedom – including the freedom to pay for medicines – the situation is particularly acute.
Klotsman’s doctor has suggested she volunteer for an experimental drug being tested by an oncology clinic in Kiev.
“They’ll give it to me for free, but who knows if it’s effective?” she says. “It might even be harmful.”
Meanwhile, Klotsman has redoubled her efforts to bring better health care to other women. She has received a grant to conduct health education programs for women over 40, and says 60 women’s groups have signed on. She is in charge of the project in Ukraine.
Klotsman is determined to stay alive for as long as she can.
“I have a 15-year-old daughter,” she says quietly. “I have to live.”