Red Door Program Aids Sexually Active Teens

Gordon Delaney, Valley Bureau, Red Door

A health and support centre for teenagers has a new program intended for sexually active young women.

The Red Door, based in Kentville, now provides women under 20 with Pap tests and screening for sexually transmitted diseases.

The tests are administrated by nurses in the facility, at 20 Webster Ct., behind the Cornwallis Inn.

The health and support centre opened nine years ago to provide services for young people. “Through a series of surveys, it became clear that women are under-screened, and adolescent women have an added risk,” said Dr. Chris Toplack, one of two doctors on the Red Door medical advisory committee.

Sexually active women under 20 have been identified as a high-risk group for cervical abnormalities and sexually transmitted diseases. The reasons included the early age they begin sexual intercourse, multiple sexual partners, contact with high-risk men and smoking.

In Nova Scotia, 56 percent of Grade 11 students have had sexual intercourse, with three of every five having two or more partners, according to the latest Canada Youth and AIDS Study.

Research also shows women under 20 have low rates of screening for disease. When asked in a survey why they don’t have a yearly Pap test, 39 per cent of women respond that they were embarrassed, and 30 per cent said they feared pain. A recent survey of more than 100 girls and women between 13 and 20 in Kings County schools showed two-thirds didn’t know what a Pap test was. One-third said they would rather go to a centre like the Red Door for screening than a doctor’s office.

That’s why we’re addressing this need in a youth-friendly atmosphere here at the Red Door,” Dr. Toplack said, adding that three nurses have been trained to provide the services.

Having local nurses do the screening instead of doctors is new in the Annapolis Valley, dr. Toplack said. But nurses in urban areas, including Halifax, are conducting these tests.

Phyllis Sweet, a retired community health nurse and coordinator of the Red Door said she thinks the facility is “overcoming some of the barriers young women have by doing the screening here with female providers.”

Ms. Sweet is one of the nurses involved in the program. The others are registered nurses Jo Waterbury and Hope Graham, volunteers at the centre.

The Red Door also provides information on reproductive and other health issues, along with counselling, Ms. Sweet said.

The program is still being evaluated but most responses have been positive, she said.

Groundbreaking Service Puts Red Door on Health Care’s Cutting Edge

In order for the Pap smear procedure to be effective woman must come for the procedure. If any barriers or discouraging experiences prevent women from coming, then the health care team has been ineffective.

Kentville’s Red Door, for nine years a model centre for wellness and accessible services for youth, now offers one more important service to a high-risk group of women.

Following a successful pilot project, the Red Door is providing Pap smears and screening for sexuality transmissible infections (STIs) to young women. The target group of sexually active women under the age of 20 has been attracted by a non-threatening atmosphere and female providers.

In Nova Scotia, the early age of intercourse, multiple sexual partners, contact with high risk male sexual partners and smoking all contribute to an increased risk for cervical abnormalities and STIs. The lack of screening for this population has been attributed to embarrassment, fear of pain and the relatively few female physicians available to carry out the procedures.

The pilot program at the Red Door, through provincial guidelines for shared competency training has prepared three volunteer nurses to perform the screening. Medical committee member Dr. Chris Toplack said Monday that the three nurses have been so successful: a) because they are women; and, b) because the Red Door is youth friendly.

“That makes it self-empowering. It’s a qualitatively different experience,” she said for the teens coming go the Red Door. The program has just published a manual that can help nurses in other centres train to perform the screening.

Not that nurses have never carried out the procedures in Nova Scotia before, but outside Metro Halifax it was almost always doctor doing the screening. Rural women, in general have been documented in studies as under-screened. Toplack says adolescent women are at particular risk.

The medical committee’s delight at the Red Door’s new service is because the centre attracts “a riskier, more vulnerable population,” Toplack noted. Many physicians, she said, book Pap smears and face “no shows”.

Being able to channel adolescent through a non-traditional setting like the Red Door for this clinical component is a new advantage that Toplack says teenaged girls will find vastly nore attractive than the traditional male doctor’s office.

“I think they listen to their peers talk about the good experience they had at the Red Door,” says Toplack, and word of mouth will bring more young women into the Kentville centre.

She pays tribute to the three “exceptional nurses” who began training in May of 1997 to do the screening. Clinic coordinator Phyllis Sweet, who is one of the trio, says that the pilot project, which ended last September, proved to be very rewarding.

The project arose out of the 1996 survey of 103 young women aged 13 to 20 in Kings county schools, which demonstrated a need for improved education on reproductive care. Two-thirds of that group could not accurately report what a Pap smear was for.

Sweet and her colleagues, Joy Waterbury and Hope Graham, have thus far screened 83 young women. Given the early rate of sexual activity and the high rate of teen pregnancy in Nova Scotia, this chance to inform a high risk group about reproductive health care has been an important educational opportunity, says Sweet. “We want to get them young, get them early and teach them about a healthy lifestyle. We want them to have a positive first experience (with a Pap smear) and prevent those 50-year-old women who’ve never been screened,” Sweet stated.

The highly experienced nurse says she thinks the centre has overcome many of the barriers that have been cited previously. “We put our focus on young women’s bodies,” she says. Sweet notes that their manual can help groups in places like Cape Breton.

For Toplack, the newly minted manual provides “a well documented policy and process.” It also ensures that the results of screening are communicated to family physicians like her.

The Red Door attracts seldom or first-time health care presenters, as Toplack calls them, between age 13 and 30. Women come from as far away as Windsor and Yarmouth because of the non-traditional setting and anonymity.

She says teen health centres like the Red Door are “a sorely underfunded area” within the health care system. Toplack and Dr. Elizabeth king also visit satellite centres at Central Kings, Horton and West Kings in order to reach this vulnerable population. Young women who have left school only have the Red Door to go if they seek these kind of services. Another member of the medical committee, Kentville gynaecologist Jas Singh says, “we need this type of service in rural communities all over Nova Scotia.”

He adds that there aren’t very many physicians who will worry about female practitioners taking work away from them. “The test is the most important thing,” he says, “not the politics of the situation. I won’t be concerned that they will cut into my turf.”

In fact, notes Toplack, the gynaecological cancer screening program has gone on record as saying any and all options have to be explored to improve access to screening.

All women who are sexually active or 18 years of age should have an annual Pap test. Since Nova Scotia has one of the highest rates of cervical cancer in Canada, Pap tests can save lives.