A Global Picture

Moana Papa speaks with the soft lilt of her home country, New Zealand, but her roots are Polynesian. Her father comes from Samoa and her mother is Maori, the indigenous people of New Zealand.

She is proud of her heritage, but since her diagnosis of stage 3 breast cancer in 2005 at age 32, her passion is the education of other minority women in her country. She will leave the 2010 San Antonio Breast Cancer Symposium with information for the women of her country.

It wasn’t until after she was diagnosed with cancer that Papa learned from her mother that her maternal grandmother died of breast cancer at age 34 and that two of her grandmother’s sisters had also had breast cancer.

“I wasn’t happy with my mother for not sharing that information with me,” Papa says, “but in my culture, that kind of information is seen as very personal and does not come up in conversation—even in the family.”

Like many minorities around the world, her people have struggled with discrimination and, Papa says, part of that is not receiving adequate medical care despite the fact that it’s free.

When Papa found the lump in her breast, she immediately went to a breast surgeon, who told her it was nothing to worry about—without doing a biopsy. “I was brought up not to question authority,” Papa says. “Looking back, I knew in myself that it wasn’t right and that it was abnormal. Less than a year later I went back, and they did a biopsy.” It was malignant.

A mastectomy revealed a large tumor and seven positive lymph nodes. Papa had a mastectomy, chemotherapy and hormonal therapy for the estrogen-positive tumor. She also turned to her native healing tradition as a complementary therapy, using an herbal poultice on her breast.

Papa says the diagnosis helped her make the decision to follow her passion, so she quit her job as a college education coordinator and went back to school for a communications degree. It was a decision supported by her husband and two children, a daughter and son who are now 10 and 15, respectively. She has already talked with her daughter about breast cancer and the family history.

Once she received her degree, Papa knew she wanted to use her skills to help the other native women diagnosed with breast cancer, so they would not have the same experience she had. While Auckland, her home city and home to more than 1.2 million people, had established education programs for the majority-white population, it had none specific to the indigenous cultures. For two years, she built relationships with medical professionals and eventually became known as someone they could recommend as support for native women.

“These women need hand-holding,” she says. “It is culturally difficult for them to engage, and some will go to healers instead of seeking medical care.”

Papa’s support group meets at a community house, and the 14 women who gather challenge all her skills as a counselor, communicator and native woman, she says, because a gathering demands a certain level of hospitality, including good food.

“The meeting is social, with activities for the women because the information cannot be given directly,” she explains.

Papa says the older women drive the meeting. One look from an older woman says “go to the kitchen and help,” Papa says. For this reason, she has to be very careful how information is presented, keeping it indirect and as part of the social event.

“The information has to come in the social context as part of conversation and storytelling,” she says, adding that she has assumed the role of granddaughter. Still, she will talk with the older women before beginning to be sure they approve of the group topic.

Papa says she is eager to take back to her support group in New Zealand what she is learning at the San Antonio Breast Cancer Symposium, and then she laughs when she says she has to figure out how to present it.