'I spotted a lump when preparing for my ritual bath'

In the Orthodox Jewish community, there is a sacred space for women: the mikveh. Now it has also become a place where they can spot signs of breast cancer and domestic violence, and guide one another towards help.

It is a religious requirement for all married Orthodox women to go to the mikveh, or ritual bath, at night seven days after their period has finished. It is a way to spiritually purify themselves. While some women in the Jewish community might take issue with the need to "purify" themselves for their husbands, it has great emotional significance for many others.

A woman will traditionally go to the mikveh for the first time just before her wedding and will continue to go every month until she stops menstruating.

Before stepping into the mikveh, a woman will first spend time cleaning her body thoroughly and making sure that there are no external objects on her which would form any kind of barrier between her and the mikveh water - an example of this might be a bit of leftover nail varnish, or fluff from a towel. She will step into a private room where she can bathe, shampoo, comb her hair, clean under her nails and examine her body carefully.

Once she is ready, she will go to the mikveh, where she needs to fully immerse her body, including each hair on her head. She will usually immerse herself completely three times and say a blessing.

A mikveh typically resembles a private miniature swimming pool which is filled with "living" natural water, usually rainwater. There will often be one attendant present to guide the woman, but women in Israel have recently won the right to immerse themselves alone, which some prefer. There will, however, be attendants in the building if a woman wishes to speak with them or seek their guidance.

In Israel, where around 750,000 women go to the mikveh each month, charities are taking the initiative to train the attendants who work there to look out for signs of cancer or domestic violence so they can sensitively direct women to find help.

They are also encouraging mikvehs to put up posters for breast cancer awareness, as well as domestic violence, so that they can take steps to help themselves.

Dr Naomi Marmon Grumet is the founder of the Eden Center in Jerusalem, a charity which has so far trained about 800 mikveh attendants, working in about 150 mikvehs, who go to talks on breast cancer with medical professionals. The mikveh attendants take part in role-playing exercises to plan how they could delicately suggest that women seek help, and they are also given numbers they can pass on for doctors.

She explains that mikveh attendants will avert their eyes when a woman steps in to immerse herself, but they might still see something such as a bruise or an unusual lump.

They might also notice that one of the women is reluctant to leave the mikveh building after the bath, as this means returning to her husband, which might be a sign that she is being abused. In the Orthodox community, marital relations will only resume once a woman has been to the mikveh, seven days after the end of her period.

Dr Marmon Grumet did her doctorate about how Jewish women observe laws about ritual purity, which is when she started speaking to women about their experiences at the mikveh.

One of them was a woman with 10 children whose husband was abusive.

"She told me that the only woman who really knew about it was the mikveh attendant, because, she told me, 'She sees my body, she sees my bruises.'

"A light went on in my head and I realised that there are people in our community who see a lot of things, and if they only knew how to reach out and help women, then they could really be an amazing resource. They could be first responders and not just see women, but also offer some kind of help or support."

For Marmon Grumet, the support could simply involve showing women that they care.

"I don't expect mikveh attendants to be therapists, but to be able to say to women 'There's a hotline that you can call and they'll support you' - or just to say 'I care, and I'm here for you - you don't deserve this'."

In other scenarios, women might actually ask the attendant for their advice.

Marmon Grumet gives the example of a woman who told the attendant that her breast was bleeding sometimes, although she thought it might have been because of her new bra. The attendant told her that she needed to get it checked and gave her the name of a doctor.

The woman came back to thank her. "I would have just written it off, but it was stage one cancer," she said.

"We certainly don't want attendants offering unwanted comments about women's bodies. However, sometimes a woman will say, 'Does this look okay?'

No-one understands the importance of checking your breasts at the mikveh more than Shani Taragin, 45, a Jewish law teacher in Jerusalem.

Taragin noticed that she had a lump in her breast five years ago, as she was preparing to immerse herself. She was teaching at a summer camp and so she was using the natural waters of a nearby lake for her mikveh.

It was very dark, and so at the time she examined herself much more carefully to see if there were any foreign objects on her body, such as a smudge of sun cream. Taragin had always quickly checked her breasts when preparing for a mikveh, but this time she was more thorough.

"I felt a lump in the upper left-hand corner of my breast and I kept on pressing it. It really felt like an external object. I kept on pushing and pushing it down and then I realised that it was internal, so I could go ahead and immerse myself in the mikveh.

Even as I immersed, all I could think about was, 'What is this lump?'"

Taragin knew that something wasn't right, and she booked an appointment with a specialist as quickly as she could, who found that it was breast cancer.

At this point, Taragin had already been working with the Eden Center, teaching Jewish law to mikveh attendants, but she decided that she would incorporate breast cancer awareness into her courses.

"My story shows that you can really use the mikveh as a basis for teaching breast cancer awareness," she says.

It's a very important project - Ashkenazi Jewish women, Jews of central or Eastern European descent, have a high risk of developing breast or ovarian cancer. This is because one in 40 Ashkenazi Jews will carry a BRCA gene mutation, more than 10 times the rate of the general population. Recent studies show that Sephardi Jews, of Portuguese or Spanish descent, may also be genetically predisposed to hereditary breast and ovarian cancer.

"It's almost like the halacha (Jewish law) is telling you to be sensitive to your body," Taragin says.

It is also a woman's time to be in touch with her physical state. "You are examining yourself anyway, so it's an amazing opportunity to check yourself."

In terms of mikveh attendants spotting signs of cancer, Taragin recommends that they are as delicate as possible.

"There are ways of saying things so you are not invading a woman's privacy," she says.

She has this philosophy for domestic violence as well. The Eden Center is also advocating for mikvehs to put up posters with hotline numbers. There is a growing problem with domestic violence in Israel, with 20 women killed in 2018, according to data collected by the women's charity WIZO.

The Eden Center is also offering training for its mikveh attendants to be much more sensitive in terms of making sure that women who have cancer, or who have had cancer, have a positive experience when they are at the mikveh. This training would include, for example, that a mikveh attendant does not stare at a woman who might have had a mastectomy or treat her in any way which might make her feel uncomfortable.

There is also now a scheme in England to give information and advice for mikveh attendants, to help them be sensitive to the needs of women who have received a diagnosis and also inform them so that they can act as a resource within the community. Chai Cancer Care, the Jewish community's cancer support charity, have developed booklets for mikveh attendants.

The scheme has been launched in London and Manchester by Michal Mocton, 41, who had breast cancer six years ago.

Mocton was inspired to set up the training after her own experiences of going to the mikveh when she was diagnosed.

She says that mikveh attendants are only checking to see if women have immersed themselves, but some women will feel especially self-conscious.

"It's important for attendants to remember that she might not have shown anyone her scars, and then she is under bright light, having to scrutinise her body and then feeling like someone else might be looking at her when she steps into the mikveh."

She recommends that mikveh attendants should take their cues from the woman herself - they should not stare, and act with heightened sensitivity.

The booklet makes attendants aware that increasing numbers of women are having elective mastectomies if they have the BRCA gene, and recommends that these women should feel welcome and cared for.

"Going to the mikveh is the height of spirituality, but it can be very hard for women who have received a diagnosis," says Louise Hager, the chair of Chai Cancer Care.

"It's a privilege to be a mikveh attendant and to help women fulfil this mitzvah (religious obligation). The more we can do to prepare them, the better.

"We are entering an age where women are more open to talking about cancer. We need to empower the mikveh attendants to have that information and feel they can pass it on".

Mocton went to the mikveh for the last time at 37 when she had her ovaries removed, as this meant that she would no longer be menstruating. She wants attendants to be aware that some of the women might be going to the mikveh for the last time, and it's important that they help make her experience meaningful.

She asks attendants to remember that the "mitzvah of mikveh has connected women for generations", which is why it's so important that every single woman who goes there feels welcome and connected to her heritage.

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