It was by chance that Eva Ramírez Ríos noticed a small lump in her right breast while taking off her blouse one day in July 2015. She couldn’t sleep that night, knowing what the lump likely meant.
Two months later, Ramírez Ríos was preparing for surgery to remove both her breasts and both her ovaries after doctors diagnosed her with invasive breast cancer. After surgery it was four months of chemotherapy, then another six weeks of radiation.
There were times when she thought she couldn’t do it anymore, when her hair and eyebrows were falling out and when her skin turned black from the radiation, Ramírez Ríos said.
But sitting next to her husband last week, more than two years after she was first diagnosed, Ramírez Ríos said she wouldn’t be here today without those treatments and the program that allowed her to access them.
Ramírez Ríos is undocumented and doesn’t have insurance. She and her husband say they never would have been able to afford her breast cancer treatment on their own.
That’s where North Country HealthCare’s Well Woman Healthcheck and Treatment Link programs come in. Together, they provide free breast and cervical cancer screening and diagnostic services as well as low-cost or free treatment for women diagnosed with breast cancer who are low income, don’t have insurance and don’t qualify for other sources of assistance.
They are known as a payer of last resort.
But after this March, the Treatment Link program will face deep financial cuts that could force it to reduce its services or put them on hold until it finds another source of money.
Almost 100 percent of the program’s funding for breast cancer treatments comes from the Susan G. Komen organization, which closed its doors in Arizona in July. The organization said the closure was due to declining donations and event participation. But that means an end to the $150,000 that Komen Arizona has donated to the Treatment Link program annually for at least the past 15 years, said Elizabeth Markona, North Country’s Treatment Link program coordinator.
The organization already reduced its donation to $50,000 this year, but an anonymous $100,000 donation will help the program get by until its fiscal year ends in March, Markona said.
The money pays for breast cancer treatment, from chemotherapy drugs to surgeries to radiation, for about 25 women each year, she said. The program can treat that many women thanks to several financial breaks. Care providers in the community donate their time or have agreed to provide surgeries and radiation treatments at Medicare rates, which knocks about 70 percent off the billed amount, Markona said. At those rates, a typical surgery costs about $4,000 and radiation treatment costs about $20,000, she said.
Sometimes those Medicare prices are less than the cost to administer the treatment, but providers agree to them because they support the cause, Markona said. The providers involved in just Ramírez Ríos's case, for example, included Northern Arizona Radiology, Flagstaff Surgical Associates, Arizona Oncology, the Cancer Center of Northern Arizona, Flagstaff Ob/Gyn and Plastic Surgeons of Northern Arizona.
Individuals served by Treatment Link also can qualify for programs through pharmaceutical companies that provide their drugs for free if no generic version is available. Without that, chemotherapy drugs can run into the hundreds of thousands of dollars, Markona said. Instead Treatment Link pays just the administration costs of the drugs that run between $15,000 and $25,000.
Now healthy and cancer-free, Ramírez Ríos said she has no idea what she would have done without North Country’s services. The programs covered all of the costs involved in her nine months of treatment besides the medication she bought for pain and nausea. Ramírez Ríos’ husband, Marco Carillo Solis, said even if he got on some kind of payment plan, he wouldn’t have been able to pay back the full treatment cost in his lifetime.
“To be honest, we were just really lucky to get that help," Carillo Solis said. “If we didn’t get help from the program, she would have died.”
Ramírez Ríos now tells all of her friends to get screened regularly in hopes they will never have to experience what she went through.
But the Well Woman Healthcheck program, which provides free breast and cervical cancer screenings for all who qualify, will also see deep reductions due to the loss in Treatment Link funding. While the Healthcheck program is funded by state and federal dollars, that money comes with the condition that North Country only screen people if it can guarantee that if they are diagnosed with cancer, it can link them to and assist them with treatment costs.
That is the role of the Treatment Link program.
If Treatment Link’s services go away, then North Country staff estimate they would have to reduce the number of women they screen for breast and cervical cancer by about half, Markona said. The health center currently screens more than 1,000 women each year, she said.
“That's a very significant chunk of women we screen who we wouldn’t be able to screen,” she said.
Funding for a similar program in Prescott is going away as well, which means there will be no funding for breast cancer treatment in northern Arizona, Markona said.
“There just aren't other grants that pay for treatment,” she said.
Those helped by the Treatment Link program include undocumented immigrants like Ramírez Ríos, people with high deductible health insurance plans, men diagnosed with breast cancer and new immigrants because even documented immigrants will not qualify for assistance until they have been here with documentation for five years, Markona said.
In terms of other resources, Northern Arizona Healthcare, the parent organization over Flagstaff Medical Center, offers $89 mammograms in Cottonwood and Sedona during the month of October and has a financial assistance program for people who don't have insurance and don't qualify for Medicaid, spokeswoman Sophia Papa wrote in an email.
The American Cancer Society also helps cancer patients and their families in the Flagstaff area. But the nonprofit has no plans to take over the services formerly offered by Komen, spokeswoman Brittany Conklin wrote in an email.
“We recognize there are some gaps in funding and resources available in Arizona since Komen has left,” Conklin wrote in the email. The American Cancer Society is working with the state’s Well Woman program and other hospitals and Federally Qualified Health Centers like North Country to develop a state approach for addressing these gaps, she wrote.
The American Cancer Society made its own changes to cut back on costs in July when it closed its Flagstaff office and switched its two local representatives to working out of their homes.
WASHINGTON — Silent for more than a week, President Donald Trump all but endorsed embattled Alabama Republican Senate nominee Roy Moore on Tuesday, discounting the sexual assault allegations against him and insisting repeatedly that voters must not support Moore's "liberal" rival.
The president said he would announce next week whether he will campaign for Moore, who faces Democrat Doug Jones in a Dec. 12 special election to fill the seat once held by Attorney General Jeff Sessions.
Trump, who won election despite facing more than a dozen accusations of sexual misconduct himself, dismissed questions from reporters about backing a Republican accused of sexual assault over a man who is a Democrat. Trump pointed to Moore's assertions that he did nothing wrong.
"Roy Moore denies it, that's all I can say," Trump said. In fact, he repeated 10 times in a 5-minute session outside the White House that the GOP candidate has denied any wrongdoing.
Two Alabama women have accused Moore of assault or molestation — including one who says she was 14 at the time — and six others have said he pursued romantic relationships when they were teenagers and he was a deputy district attorney in his 30s.
Trump didn't explicitly say he was endorsing Moore, but he said with emphasis, "We don't need a liberal person in there. ... We don't need somebody who's soft on crime like Jones."
He also noted that the allegations came from behavior alleged to have happened decades ago.
"Forty years is a long time," Trump said, questioning why it took so long for Moore's accusers to come forward.
Former Sen. Sessions has said he has no reason to doubt the allegations against Moore, Republican leaders in Washington have called for Moore to leave the race, and the White House has repeatedly said Trump himself felt Moore would "do the right thing and step aside" if the allegations proved true.
But Trump had been publicly silent until Tuesday when he exchanged questions and answers with reporters, shouting to be heard over the noise of his Marine helicopter, waiting to take him to Air Force One, which then flew him to his Mar-a-Lago estate in Palm Beach, Florida, for Thanksgiving.
Senate Majority Leader Mitch McConnell and House Speaker Paul Ryan, both Republicans, have called on Moore to leave the race in light of the accusations. The Republican National Committee and the National Republican Senatorial Committee have pulled their support for his campaign.
Trump backed incumbent Sen. Luther Strange in a September Republican primary, but moved quickly to embrace Moore after he won. A White House official said Tuesday that Trump's attack on Jones did not amount to a formal endorsement of Moore, only that Trump was communicating that sending the Democrat to Washington would hamper his agenda.
Republican leaders briefly explored the possibility of seeking a write-in candidate but have determined those efforts would only increase Jones' chances by splitting the GOP vote in the Republican state. Sessions has resisted pleas to mount a last-minute campaign for his old seat.
The allegations against Moore come amid a national reckoning over misdeeds by powerful men in media, business and politics.
Just Tuesday, longtime Michigan Rep. John Conyers acknowledged that his office settled a sexual harassment complaint involving a former staffer, though he "vehemently" denied allegations in the complaint.
BuzzFeed reported that Conyers' office paid a woman more than $27,000 under a confidentiality agreement to settle a complaint in 2015 that she was fired from his Washington staff because she rejected the Democrat's sexual advances.
Trump said he was "very happy" that women are speaking out about their experiences.
"I think it's a very special time because a lot of things are coming out, and I think that's good for our society and I think it's very, very good for women," he said.
More than a dozen women came forward in the waning days of the 2016 presidential election to say that Trump had sexually assaulted or harassed them over the years. He denied it. A tape was also released catching him boasting in 2005 that he could grab women's private parts with impunity. "When you're a star, they let you do it," Trump said on the "Access Hollywood" tape.
Trump, who has said all of his accusers lied, declined to answer Tuesday when asked why he does not believe Moore's accusers.
Jones, Moore's senatorial opponent, served as a federal prosecutor in Alabama, where he brought charges against two Ku Klux Klan members over their roles in killing four girls in the 1963 16th Street Baptist Church bombing in Birmingham.
Jones began airing a new ad Monday that features statements made by Sessions, Alabama Sen. Richard Shelby and first daughter Ivanka Trump responding to the allegations against Moore.
Shelby, a fellow Republican, said he will "absolutely not" vote for Moore. Ivanka Trump said there's "a special place in hell" for people who prey on children.
"I've yet to see a valid explanation, and I have no reason to doubt the victims' accounts," Ivanka Trump told the AP last week.
The ad was the first direct assault by the Jones camp against Moore on the allegations.
Moore's camp has begun firing back at the media and one of the accusers. His campaign held an afternoon news conference to vigorously question the account of Beverly Nelson, who said Moore assaulted her when she was a 16-year-old waitress.
The campaign quoted two former restaurant employees and a former customer who said they did not remember Nelson working there or Moore eating there.
The last time Northern Arizona University student Shannon McKinley saw the professor who taught her interior design class was on Monday, Oct. 30.
“She told all of us that she was going to post some of the notes online because we had a test that Wednesday,” McKinley said. “That Wednesday she didn’t show up and we had another teacher give us the test.”
McKinley and many other students never got the notes they were promised by test day because the now former professor of that class, Melissa Santana was arrested earlier that Monday on five counts of felony stalking - one involving a student - and three counts of giving false information to law enforcement.
By Nov. 1, two days after her arrest, Santana no longer worked for NAU (officials decline to comment whether she was fired or resigned). Her salary was $54,000 a year, according to the NAU Budget report.
Several students who had Santana as a teacher were shocked to hear that a professor they described as respected, dedicated and accessible was accused of committing years of online harassment against Forest Service hotshot firefighters and their families, as well as a student.
“I just couldn’t believe it,” said Stephen Petrie, who had two classes with Santana. “When I heard about what happened, it just didn’t make sense because she was good and friendly teacher.”
Petrie said he would regularly attend office hours with Santana and described the professor’s classes as difficult.
“She was a tough grader but it was so she could push you,” Petrie said. “I would go to office hours a lot because her class was so difficult. She always made time for me and was always quick to respond to my emails.”
NAU student Breanna Keith said she was concerned when Santana did not show up to her last class.
“She just didn’t show up and I thought that was really strange since she never missed a class,” Keith said.
McKinley said there wasn’t a lot of communication between the college and its students regarding Santana’s status.
“It was just suspicious because no one in the department would tell us what was going on,” McKinley said. They would just tell everyone that she was on leave and would probably not be coming back.”
She learned about her professor’s arrest two weeks later, when she googled Santana’s name.
However, McKinley still said that the interior design department did a good job picking up the pieces after Santana was arrested.
“I think they were in a tough position and they did a really good job keeping our class going after everything that happened,” McKinley said. “It was a really shocking situation and it probably was just as surprising to them as it was to the students.”
Santana’s husband and multiple friends of his did not wish to comment when contacted by the Daily Sun.
Santana is scheduled to appear in federal court on Nov. 29.