By Diane Mapes
IMAGINE DRIVING TO THE EMERGENCY ROOM only to find there's no entrance. You can see the doctors and nurses through the windows, but you can't find a way in to access their care.
Dr. Angelique Richard, a staunch champion of improving patients' access to cancer care, doesn't need to imagine such a scenario. The longtime oncology nurse, now chief nurse executive and vice president of Clinical Operations at Fred Hutch's treatment arm, Seattle Cancer Care Alliance, has seen it play out for decades with patients who don't have the money, the insurance, the trust or the language skills necessary to navigate a complex, and often confusing, health care system.
"I've seen people present very, very late. Many times that's the situation with people who are minorities or underrepresented or are uninsured or underinsured. They present later in their disease so their options aren't as great," she said. "I've also seen patients literally have to hire an attorney and go to court with their insurance companies [to get access to treatment]. Cancer patients and families should be able to focus on getting better, not on getting access or figuring out how to pay for their care."
Richard has advocated on behalf of these patients throughout her 30-year career as a nurse, researcher and health care administrator. She's written countless grants, spent years doing community outreach and, whenever possible, brought up patient access to lawmakers and movers and shakers, including Vice President Joe Biden during his Cancer Moonshot visit to Fred Hutch in March.
Never, however, did Richard imagine her advocacy on behalf of underrepresented patients would end up helping her own baby sister.
Photo courtesy of Fred Fox Studios
"I'm closest in age to Angelique. I'm her cheerleader and a big fan and I'll do whatever she tells me to do," said Apryl Richard Paige, a 46-year-old administrative assistant from Chicago who was diagnosed with breast cancer in August 2012.
Paige remembers accompanying her big sister to the early cancer detection talks she gave at women's clubs and faith-based organizations. "I listened to her when she told the ladies, 'Get to know your breasts.'"
When she found a lump in her own breast during a self-exam, Paige immediately went to her sister, who felt the mass, then shepherded Paige through her biopsy. When it turned out to be cancer, both sisters were doubly devastated: Paige was between jobs at the time and had no insurance.
"The first thing I thought about was my family and the financial burden," she said. "I didn't know how I would pay for any of it."
Richard not only helped her younger sister deal with the anguish of a cancer diagnosis, she pointed her to crucial resources, such as a social worker, a patient navigator and a hospital fund designed to help uninsured and underinsured women. Months before, Richard herself had facilitated the Susan G. Komen grant that paid for her sister's diagnostic mammogram.
"If I hadn't had her help navigating all of that I would have spent a lot of time stressing out, and that's not exactly what patients should have to go through," Paige said. "I don't have a health care background, so I didn't know what questions to ask. And there were so many things I'd never heard of. She even asked the oncologist about clinical trials and I'm now participating in one. It was very helpful."
Richard also connected her sister with breast cancer survivors who helped answer questions about treatment, buying wigs and foods to avoid — or focus on — during chemo. Since then, Paige has gone on to advocate for and support others diagnosed with breast cancer.
"I knew when I was diagnosed that I was lucky. My sister was an oncology nurse and she was passionate about it," Paige said. "I knew she'd look out for me. And she has. I've become more educated and more comfortable learning about all the different things related to cancer. I'm grateful to have her expertise."
Richard wants to see a health care system where every patient has access to specialized cancer care, innovative new treatments and clinical trials, regardless of socioeconomic or insurance status. Her three decades in health care — and the profound insights she gained during her sister's cancer journey — have also pushed her to seek better support for patients and families who are often overwhelmed and/or worn down by baffling medical-speak and a Byzantine insurance system.
Since joining SCCA in 2014, Richard has made key inroads, connecting with community groups like the African-American cancer advocacy group Cierra Sisters; expanding the SCCA mobile mammogram program; setting up a new public health partnership with the national social service nonprofit Mercy Housing; and creating a training and mentorship program for cancer care providers in Guam, where both oncologists and oncology nurses are scarce.
Photo by Robert Hood / Fred Hutch
But there is much more to do when it comes to eliminating barriers to care, she said.
"We know there are individuals out there [in need of care] and we have an obligation to educate and heighten awareness," she said. "We have many efforts that are underway, but we know that the community-at-large — particularly minorities — may have issues with trusting traditional medicine. There have been studies in the past that have shaken that trust. We have an opportunity and an obligation to right that wrong, if you will."
A compassionate big sister to all, Richard is well-placed to do just that.
"Nursing is the No. 1 trusted profession in the country," she said. "I think we're in a wonderful position to help restore trust."
Write to Diane Mapes at firstname.lastname@example.org