What's happening in TBH breast unit: Save the date

Fund raising events going on for Tygerberg Hospital breast clinic

Transport fund raiser.  Please feel free to come and join us and make a difference to patients' ability to complete their breast cancer treatment

Justin Marais: a final year medical student is running a marathon.  Please sponsor him:
You can track his progress on line. https://www.backabuddy.co.za/champion/project/justin-marais

Breast Course 4 Nurses

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Breast course for Nurses fundraiser.  13/12/19.  The location is still to be arranged.  Please contact Michelle Norris 0829204610.  Michelle.Norris@netcare.co.za


Medical students involvement in the breast unit at Tygerberg Hospital

At Tygerberg Breast unit, we have 4th and 5th year Stellenbosch University medical students rotating through.  Although the groups are quite big (15-20 students) we try to involve them in all the activities of the firm and ensure that their time with us is beneficial to both the patients and to them.

Image result for national wellness 6 componentsLast year, Dr Baatjes introduced a wellness programme.  Each group of students rotating through our firm have been asked to do a wellness project. Wellness, as a concept, is more complex than health.  Health can be defined as being free from disease.  Wellness is a more dynamic concept and, according to the National Wellness Institute, has 6 key components: environmental, spiritual, physical, intellectual, social and emotional.

We have had many different themes over the year including chair yoga, colouring in, meditation, origami, singing performances and ways to make you feel better.  Every second week, on Thursday, the students are asked to present their topic in the waiting room whilst patients are waiting to be seen in either the thyroid clinic or the breast clinic.  The presentations have been well received by patients and staff.  For us, it is a necessary break and time of reflection in what is otherwise a very long day.

Last weekend, Cape Town hosted the Cape Town marathon.  Over 26000 runners were involved in the event.  Justin Marais, a remarkable young medical student, used it as a warm up event for the Prison to Prison marathon. He will be running the event in December 2019, just as he qualifies, to raise funds for the Tygerberg breast unit.

You can track his progress on line https://www.backabuddy.co.za/champion/project/justin-marais

Thank you Justin


Breast Care Course

- by Lieske Wegelin

May 2019 marked the beginning of the Breast Care Course through Stellenbosch University. 10 students from various organisations including Eerste River Hospital, Rondebosch Cancercare, Worcester Hospital, Wits Health Consortium, Addington Hospital, a Netcare patient navigator and 2 nurses in private practice joined for the course.

The Breast Care Course was borne as a result of needing a higher level education course similar to the Breast Course for Nurses but specifically for Registered Nurses (RN) working in a breast clinic. The purpose of the course is to enable the RN to confidently assess patients with breast problems in a breast clinic / unit.

The course is run over 6 months with 1 theoretical week at the beginning and the remainder of the time being used for practical hours and online / self study. By the end of the course, the learners will be able to:
- Perform a comprehensive clinical assessment, including a clinical breast examination.
- Have the basic understanding of fine needle aspiration biopsy and core biopsy technique to assist a trained professional.
- Categorise a patient as having a malignant, benign or indeterminate breast lesion.
- Appropriately refer a patient for further investigation.
- Be able to categorise a patient as needing referral for genetic testing.
- Interpret basic investigation results related to breast pathology.
- Have a basic understanding of breast cancer treatment and the management of side effects of treatment.
- Be able to advise patients on follow up procedure.

The 1 week theoretical part of the course was packed with lectures and practical sessions.

Day 1 focused on the normal breast, clinical breast examination and history taking. The afternoon was spent discussing staging and metastatic screening. Dr Edge, Dr de Villiers and I presented on this day.

Day 2 started off with a presentation on cytology and histology and was followed by a practical session about biopsy techniques. The students each got a chance to see how difficult obtaining a good specimen can be. Thank you to Lancet Laboratories (Carol van der Velde and Dr Dittrich) and BARD (Paula Nieuwoudt) for sponsoring this session. The next sessions were about interpreting these investigations and this was done by making use of case studies presented by Dr Van Staden, a medical officer in the Tygerberg Breast Clinic. Dr Riaan Duvenhage came all the way from Worcester Hospital to present his excellent work on electronic notes and data collection. They have a very comprehensive and up to date data set due to the electronic nature of their notes. The day ended with a brilliant interactive session on genetics presented by Mardelle Schoeman.

Day 3 started with radiological investigations of the breast. Dr Retha Hattingh presented this important session. Dr Karin Baatjes then used case studies to assist the students with differentiating between normal and abnormal imaging. We were then joined by Dr Francios Malherbe and Sr Galiema Fish from the Groote Schuur Breast Clinic. They presented the process that patients follow in the breast clinic at Groote Schuur. After lunch, I went through benign changes of the breast and then the group got to do peer evaluations on the topic of clinical breast examination.

Day 4 was all to do with the management of breast cancer. Dr Ilna Conradie (surgeon at TBH) spoke about surgery for breast cancer. Dr Pieter Barnardt (oncologist at TBH) discussed chemotherapy and it's side effects. Dr Magda Heunis (radiation oncologist at TBH) spoke about radiotherapy. The day ended with Dr Irene Boeddinghaus (oncologist from Vincent Pallotti Oncology) speaking about endocrine therapy. During the middle of the day, Dr Carien Otto, a medical officer from the Tygerberg Breast Clinic came to be part of a discussion about running a breast clinic and the administration thereof.

The last day, Day 5, started with a brief session on lymphoedema. This was followed by Ann Steyn and Carla Lind from Reach for Recovery speaking about volunteers and their role in the patients management and journey. Linda Greeff (a social worker with many years of experience), then discussed the psychosocial aspects of a breast cancer diagnosis, a topic that is often not discussed or mentioned when a patient is newly diagnosed.

The last part of the theory week allowed for practical assessment of the students. We all went over to the Tygerberg breast clinic where the students were fortunate enough to examine and take a history from a few patients that were in the ward waiting to be operated on the following day. It is always a very different experience when one is faced with a real patient as opposed to practicing on colleagues or mannequins. We were very fortunate to have such lovely patients willing to assist.

The next Breast Care Course will commence in May 2020. If you are interested in attending, please send me an email (lieskewegelin@gmail.com) so that I can keep you on the mailing list and keep an eye on the Stellenbosch University short course website (https://shortcourses.sun.ac.za/)

Talitha, Lettie, Elna, Jenny, Hayley, Lieske, Jenna, Nontokozo, Danine, Claudia, Patricia, Margaret, Liesel and Ebenecia

Thank you to the University of Stellenbosch Department of Nursing and Midwifery, all the lecturers,  sponsors of the students and the patients.


Khayelitsha Breast Course for Nurses

Our recent Breast Course for Nurses was held at Khayelitsha District Hospital (KDH). The participants were mostly nurses working in the primary clinics that refer to KDH. Although all the
courses we have run are different, there were a number of administrative changes to this course.

We have partnered with the African Cancer Institute, based at Stellenbosch University. The partnership will allow us to be more effective nationally and also quantify the impact our course is having. Prof Sewram opened the course and spoke about the importance of local research into breast cancer. Without data and effective research, we are unable to advocate for the change needed to see more access to care.

The lectures on the first day were given by a variety of speakers: myself, Dr Austin Goliath (surgeon working at KDH) and Dr Britta Dedekind. The afternoons lymphoedema session was run by Jen Dunn from the Lymphatic Therapy Centre in Durbanville and Linda Greeff who once again brought all her energy and knowledge to the course.

We started the second day with an "assessment".  Instead of assessing individual nurses, we looked at the clinic knowledge. One of the aims of the BCN (and the PEP foundation) is to promote understanding about breast changes and management of breast problems to all who work in a clinic and not focus on an individual health care worker.  We plan to run annual BCN in KDH and so assess the clinics each year to see what impact our course has had. Dr Anne Gudgeon (a breast cancer expert and breast cancer survivor) was our "patient". In the evening, we were discussing the day and she made comment to me that she felt "cared for" by all the nurses who examined her. An ongoing challenge of the course is to make it more realistic. For the first time, we had inpatients who were bought from the ward by Dr Goliath.

Many thanks to them for being so accomodating. All of us found it sobering to be reminded about why we were there.

Sr Correia (a wound care expert and the first sister to teach on the BCN) facilitated a discussion about wound care and practical ways of dealing with locally advanced breast cancer. The excellent palliative care session was run by Dr Margie Venter and 4 members of her palliative care team. (A big thank you). The afternoon session was run by Carol and Corneli from Lancet Laboratories. It was a practical session and the participants had a chance to understand the challenges of FNABs and core biopsies.

On the last day, we had 2 new sessions: an excellent talk on down staging breast cancer given by Dr Karin Baatjes and a session on communication given by Elna Sutherland. What I learnt from her session is that LISTENING is not WAITING TO SPEAK!
For most of us working in the public sector, one of our major battles is making the patient journey more efficient and shorter.  We took this opportunity to use all the expertise in the room and finished the day with a discussion about referral pathways.  I hope we will soon have some new initiatives to help make the process faster and more seamless.

Once again, many thanks to all the people involved in making it such a successful course. The course was sponsored by The African Cancer Institute (ACI), Lancet Laboratories and Bard. In particular, our thanks to Dr Austin Goliath, Sr Milanie Bennett and Alecia Louw from KDH, Dr Phillips and Cheryl Steyn (KESS), Prof Sewram, Shane and Claudia (ACI), Carol (Lancet Laboratories) and Dr Germarie Fouche (Family Practitioner at Michael Mapongwana Community Health Centre).

Last but not least: the biggest thanks go to Sr Lieske, who, as usual, had everything and everyone organised!

BCN Khayelitsha Group