LAWRENCE, Kan. - The large, white RV looks something like a bookmobile, nothing really intimidating.
The engine is humming and a sign on the door cheerfully advises patients they can come in and wait. Two women sit on a retaining wall nearby, saying little and deeply inhaling the smoke from their cigarettes as they look toward the vehicle.
Stepping through the door is difficult. Results of anticipated tests strike at the vitals of women, for inside the RV, mammograms are being done.
Inside peach-colored couches welcome patients waiting for a test. A television built into the wall noisily competes with the low rumbling of the RV engine. Two women sit silently waiting for their turn. They aren't speaking or watching the television, they both appear deep in thought.
Breast cancer - the very thought frightens many women away from procedures that could save their lives. Fear of mastectomies or surgical procedures prevents women from taking the first step in breast care health, a mammography. The loss of a breast is more traumatic to some women than facing death. Their breasts they believe are what identify them sexually.
"I don't know if it is that they are afraid we are going to find something or what it is," Susan Poulson, a registered mammography technician, said. Whatever it is, Poulson wants women to know they have nothing to fear, but fear itself. Poulson travels to Indian Health Service hospitals and clinics in the Kansas and Oklahoma area, performing mammograms, making her rounds in the white RV.
"It's funny, but once they have come in, they keep coming back." Poulson said. "It's just getting them here that first time."
How often should women have mammographies? "A baseline at 35 to 40 years of age and then every two years after that," Poulson said. "After 50, we recommend it yearly after that."
Most women know a mammography can save their lives by detecting breast cancer early, when it is most curable, but many shy away, saying they are too busy or afraid it will hurt.
What actually goes on during a mammogram?
Poulson enters the room and picks up a chart. "Follow me," she says.
She motions to a small door. "Go in there and take off your shirt and bra, then put on one of the gowns with the opening in the front."
That done, Poulson comes back and begins to explain the procedure. "Hold your arm up and rest your breast on the machine." A cold-looking metal shelf about the size of a book is where she points.
A clear piece of plastic hovers above the exposed breast, "OK, there is going to be pressure on your breast. We have to do a side view and a view from the top," Poulson says as she adjusts the machine.
She manipulates the breast without embarrassment as though she is arranging fruit in a bowl, cheerfully keeping up a conversation as she busies herself. She has everything the way she wants it now.
There is pressure, but nothing really uncomfortable. "Take a deep breath and hold it," Poulson says. "Don't move." She steps behind a shield and comes back. The process is repeated three more times.
"Now get dressed and wait until I develop these. If I don't have a clear shot, I may have to do it again." Poulson disappears.
Within 10 minutes of entering the RV, the mammogram is done and the film is developed. "Looks good. A doctor will read it with a magnifying glass and then we will send you a letter with the results," Poulson says, with a smile.
Anything obvious? "Not that I could see. You will get a letter in two to three weeks giving you the complete report. Nothing to worry about."
Poulson turns and smiles again, picking up her chart she addresses the next woman. "Go in there and remove your blouse and bra."