Holding hands, Nisha and Neha are waiting at the reception of a Delhi hospital. For Nisha, 22, it is her first day at work. Neha, her senior with six years of experience, has come to support her younger friend. Both are vision-impaired medical tactile examiners (MTE) and can detect what those with vision may often miss – tumours in the breast.
After an eight-month training period, Nisha was hired by CK Birla Hospital in Punjabi Bagh in its oncology department where she works from 9 am to 5 pm, detecting breast cancer in women visiting for a checkup.
Her expertise, Tactile Breast Examination, is a unique technique that uses the highly developed sensory skills of visually impaired women for manual breast health screening. Using a standard system based on Braille strips, MTEs are trained to conduct safe, repeatable, and accurate clinical breast examinations without any radiation or side effects.
Nisha has been living in Delhi for the last year. “Before this, I was in Ludhiana, Punjab, where I did my graduation. I was also giving training to visually impaired children but the money was not great and I wanted a full-time job,” she said.
For Nisha, who hails from Amritsar, challenges began early on in life: She was four when she lost her vision. Her parents died, leaving her with the responsibility of a younger sister who is presently at a children’s home in Ludhiana. “I want to earn money so I can educate my sister and we both can live together,” said Nisha, who made her way to the Capital after coming across a vacancy at NAB India Centre for Blind Women & Disability Studies.
An NGO, NAB works to train blind women as MTEs in collaboration with Discovering Hands, an initiative of Dr Frank Hoffman, a German gynaecologist, who devised a course in this regard.
Like Nisha, 18 women have been trained as MTEs by the NGO; eight of them have been placed in hospitals across the country, including Medanta in Gurgaon, Sight Care Cancer Hospital in Bengaluru, and Tata Memorial Hospital in Varanasi.
On joining the programme, Nisha learned how to detect breast cancer by dividing the chest into four zones with a docostrip (document orientation system) – a specially designed tape, which has Braille dots with red, black and white markers. She says the procedure of detecting lumps involves carefully checking the breast, by palpating every centimetre with varying pressure. The findings are then documented and shared with senior doctors.
Neha is from the first batch of Discovering Hands which began in 2017. A certified MTE and a computer trainer for the visually impaired, she said she started her work at Fortis as an MTE after completing an internship in Medanta. Now, she visits community centre camps for screening of women.
Neha, who hails from UP’s Hapur, said that while it might make a few patients nervous at first, her impairment is a reason why many are more comfortable being screened by her.
“Often patients wonder how a visually impaired person will be able to do the inspection but when we speak with them, they start trusting us. It takes 30-40 minutes to examine each patient. Also, when they get to know that we can’t see them, they become more comfortable and do not hesitate in undressing in front of us,” said the single mother of a teenage boy.
Neha lost her husband to cancer a few years ago. A college graduate, she developed retinitis pigmentosa, a rare disease that leads to gradual vision loss, eight years ago. She only has light perception now, she shared.
On what makes MTEs crucial to cancer detection, Sonal, master trainer and programme manager for NAB India, said Dr Hoffmann, in his study, found that MTEs can catch lumps as small as 6-8mm.
Sonal said while blind women are not trained to conclude whether a patient has breast cancer or not, they can explain characteristics of the abnormalities in one’s breasts, including shape, size, consistency, depth, movability with exact precision.
On the requirements needed to be an MTE, Sonal added, “They should have cleared Class X, should have basic knowledge of English and computers. We then assess their tactile skills, motor skills, memory retention, and Braille skills over five days. In the following six months, they are trained in theory and practicals, which include knowledge about cells, organs, organ systems, breasts, breast cancer, treatment, therapies, medications etc.”
After training, the women undergo an exam and an internship following which they are designated as MTEs.
Sonal said that with the rising number of breast cancer cases among Indian women, MTEs can play a key role in early diagnosis.
‘Even better than conventional techniques’
So, how does medical tactile examination hold significance in early detection? Dr Mandeep Singh Malhotra, Director-Surgical Oncology, CK Birla Hospital, said the solution to catching breast cancer is its early diagnosis in which the tactile strength of blind women is a great help.
“If we have a patient at stage 1 or 2, the survival rate is as high as 80- 90%… For early detection, we carry out mammography but it is effective only after the age of 45. Now, the only option left for women below that age is ultrasound, which is costly. We advocate self-breast examination but women are not very confident. This is when a blind MTE comes into the picture. Since their vision is not there or is very less, tactile perception becomes better,” he said.
Highlighting exactly how useful an MTE is, Dr Malhotra added: “The German study said if a woman conducts a self-breast examination, she will be able to catch a lump of 2 cm, which can be a stage 1 or 2 situation. On regular testing, a doctor can detect a 1 cm lump. If the same examination is performed by a visually impaired person, a lump of even .5 cm can be detected.”
In a validation study carried out on the German study, it was found that MTEs were able to find a lump in three out of 10 women. “In seven women where they would say no, the chances of them not being able to catch the lump is just 1% which is even better than the conventional techniques,” added Dr Malhotra.
Nisha (left) and Neha (right) are vision-impaired medical tactile examiners. (Express Photo) 
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