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Breaking down barriers to health care

Mass. General’s Dr. Karen Winkfield says that to improve access to health care and clinical trials, the solution has to be sustainable.

Wendy Maeda/Globe Staff

Mass. General’s Dr. Karen Winkfield says that to improve access to health care and clinical trials, the solution has to be sustainable.

When Dr. Karen Winkfield leaves Massachusetts General Hospital to discuss health issues at Boston-area churches and clinics, she refers to her message as the “triple A:” awareness, advocacy, and ambassadorship.

It’s a message that the 44-year-old radiation oncologist says she developed during her outreach work with racial and ethnic minorities, who report having more difficulty accessing health care than their white counterparts, according to a federal study.

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Winkfield said she wants to break down the barriers these communities face in accessing health care, including obstacles to enrolling in clinical trials.

“I was really struck by the fact that I didn’t see very many minority patients in many of the Harvard affiliates when I was training,” Winkfield says in an interview at her office at MGH. “I was really curious about that.”

Winkfield, who grew up on Long Island, N.Y., says she first became interested in barriers to health care as a medical student at Duke University, where she volunteered at a health clinic in a public housing development in Durham, N.C.

Most of the patients were elderly and didn’t see a physician regularly, Winkfield says. Some, for example, knew they had diabetes, but didn’t correctly use meters for measuring their blood glucose levels, she recalls.

Later, when Winkfield was doing her residency in radiation oncology in Boston, she says, she met an African-American woman in her 60s who had diabetes and hypertension. The woman had stopped taking her medications because they became unaffordable, and, as a result, developed an ulcer on her foot.

‘If you look at some of the big prostate-cancer clinical trials, the enrollment of black men was only 5 percent.’

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“She wasn’t necessarily savvy enough to say, ‘Hey, I cannot afford these medications. Are there other options?’ ” Winkfield says.

A national report released in May by the federal government’s Agency for Healthcare Research and Quality says 26 percent of Americans — especially racial and ethnic minorities and poor people — report having difficulty getting health care.

“Access to care is pretty sad,” says Dr. Ernest Moy, who directs the National Healthcare Quality and Disparities Reports. “Blacks and Hispanics usually have the worst access to care.”

When Winkfield came to Boston in 2006 to complete her medical training, she says, the Dana-Farber/Harvard Cancer Center approached her about participating in outreach events sponsored by faith-based organizations. She started out with talks about breast cancer and traveled to churches in Dorchester, Randolph, Cambridge, and Brockton.

The Rev. Barbara Dulin of Greater Love Tabernacle Church in Dorchester says Winkfield has been instrumental in educating parishioners about breast cancer, which is more likely to kill black women than all other women, according to the Office on Women’s Health at the Department of Health and Human Services.

“The women are very comfortable with her,” Dulin says. “People ask her a lot of questions.”

Pastor Lawrence Ward of Abundant Life Church in Cambridge says Winkfield gave a talk at the congregation’s block party in 2012, and then counseled his family when his sister and sister-in-law were diagnosed with breast cancer.

“She’s very genuine, very caring, and very professional at what she does,” Ward says. “She’s willing to go above and beyond to help you.”

Winkfield has also appeared as a guest on Touch 106.1 FM, a popular unlicensed radio station that was shut down by federal agents in April.

“I wish there was a way for me to have a larger platform,” says Winkfield, who also has a website, drkarenwinkfield.com. “I’m only one individual.”

Five months ago, Winkfield was named to be one of the leaders of the Lazarex-MGH Cancer Care Equity Program, a three-year, $3 million effort aimed at increasing clinical trial enrollment in medically disadvantaged communities.

Winkfield says she’s helping to enroll racial and ethnic minorities in an open clinical trial looking at two different types of radiation techniques to treat prostate cancer: photons and X-rays.

She says that getting them to participate in the trial is important because black men have the highest rates of prostate cancer and get the disease earlier in life.

“Is there a biological difference? It’s not clear,” she says. “Unless men and women of color are enrolling in clinical trials, it’s hard to actually make blanket statements about what some of the causes are.”

Winkfield says about 10 percent of the people who have enrolled in the prostate cancer trial are minorities.

“If you look at some of the big prostate-cancer clinical trials, the enrollment of black men was only 5 percent in some of those even though they have the biggest incidents rates,” Winkfield says. “The goal would be to do much better.”

Winkfield says there are multiple obstacles to enrolling black men in such a trial, including reluctance to participate, distrust of the medical establishment, and logistical obstacles such as transportation and finances. Winkfield says that to make headway, the solution has to be long lasting.

“I would be loath to think that you as an institution would go in, do a study, provide resources . . . and then leave what was already a vulnerable population potentially even more vulnerable,” Winkfield says. “My goal . . . is to find ways that we can build sustainability.”

Laura Crimaldi is a Globe reporter. She can be reached at laura.crimaldi@globe
.com
. Follow her on Twitter @lauracrimaldi.
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