Breast Course for nurses CBMH

We have just finished another Breast Course for Nurses at CBMH.  It was a similar model but as always, there was something new.  The health care workers attending the course were a mixture of state and private nurses.  Not only did they come from different sectors but also from different disciplines.  Midwives, oncology sisters, ward staff, academic nurses, radiographers and clinic staff.  It is always more rewarding to teach a mixed group of health care workers as each discipline contribute a different viewpoint to a discussion.
Kate and Astrid giving lecture on lymphedema

The course was run over 2 days. Day 1 covered familiar territory.  Clinical assessment of the breast, benign breast changes, special investigations of the breast, wound care, lymphedema and advocacy and community working.  The lectures were given by a variety of people including Sr Karen Hill, Britta Dedekind, Sr Lieske, Linda Greeff, Kate and Astrid.  A huge thanks to all of them.

Day 2 concentrated on breast cancer.  The morning lectures were given by Dr Boeddinghaus, Dr Maurel, Dr Raats and Dr Dedekind.  Different aspects of breast cancer management were covered. After the tea break, we had a new session.  Dr Magda Heunis ran the session on follow up of breast cancer patients.  In Tygerberg breast clinic, we are in the process of developing a policy for breast cancer follow up.  We had a discussion about what a follow up programme should involve:surveillance for a new breast cancer, assessment of side effects from breast cancer treatment, psycho social support and a network for referral if there is another problem.  Who should see breast cancer survivors?  How often should women be seen?  How often should they be offered a mammogram? Thanks to Magda for giving a comprehensive overview.

Dr Riette Burger was involved in our program for the first time.  She is passionate about palliative care and has introduced a course for students at US.  She ran the palliative care session with help from Sr Margot van der Wielen from St Lukes Hospice.

Cornelli (Lancet) demonstrating a core biopsy
For me, this course was a lovely mixture of my colleagues from CBMH and my new colleagues from Tygerberg Hospital. I look forward to being involved in more public/private breast cancer initiatives. Thanks as always to Mr Tilney for his continued support for the Breast Course for Nurses. Congratulations to Wendy Bokwe who won the spot prize for suggesting yellow as a colour for breast cancer campaigns.

Thank you to Pathcare for sponsoring the Breast Care books that each participating student receives as their study material.  To all of our sponsors for this course: Pathcare, Netcare CBMH, Lancet Laboratories, Morton and Partners and all of those that gave time to lecture and prepare the course, a massive thank you!

Last but not least, it was wonderful to be with the familiar trio: Sr Karen, Sr Lieske and Michelle. Without them, none of this would ever happen.


Flamingo list. Tygerberg Hospital: over 100 procedures

Earlier this year, I started working at Tygerberg Academic Hospital (TBAH), Cape Town. I last worked there 18 years ago and returning has been quite remarkable.  I am working in the Breast and Endocrine unit with Dr Karin Baatjes and Dr Ilna Conradie.

In 2016, they started participating in the Flamingo project. The project was set up by a group of cancer survivors and volunteers, spearheaded by Dr Liaana Roodt. They fund "catch up theatre lists" which are done on Saturdays by volunteers. Initially, they were only at Groote Schuur Hospital. The result was that the waiting time for surgery for people with breast cancer dropped from 3 months to 6 weeks. Since Tygerberg has become part of the project, there has been a similar reduction in waiting time for surgery for breast cancer patients.

I have been involved with the last 3 lists.  In total, there have been 11 lists done over 9 Saturdays. 101 operations have been done benefitting 90 women with breast cancer.  The lists require enormous commitment from surgeons, anaesthetists, medical students, nursing staff, support admin staff and, of course, the Flamingo Project.  Last Saturday, we had 2 lists.

Prior to theatre, all the patients have to be admitted by the surgical team, (Dr Firdaus, Dr Changfoot
and Dr Botes). The patients are in the 2 main surgical wards, D3 and D5, (thank you to the nursing staff on duty).  Mr Visagie, (the theatre boss) coordinates their transport from the wards to theatre where they are looked after by the nursing staff. Sr Theron co ordinates the theatre nursing teams.  On Saturday,  we had 10 theatre nurses involved.

Once in theatre, they are anaesthetised by volunteer anaesthetists from both the department of Anaesthetics in Tygerberg Hospital and private anaesthetists. Thanks to Prof Levine and his team.
The operations were all done by Ilna Conradie, Karin Baatjes and myself.  Our assistants were medical students from the US surgical society.

In total, over 30 staff gave their time freely last Saturday.  Quite remarkable.  All of this is made possible by the management at TBAH (Dr Chiaparilli, Dr Maart and Dr Muller) and of course, Dr Liana Roodt and Project Flamingo.

The benefit to the women having their surgery at the weekend is immediate and obvious.  However, there is a benefit all our patients with breast cancer  operated on at TBAH as their waiting time is decreased.  From all of us, on behalf of the hundreds of patients who have benefitted either directly or indirectly, THANK YOU to the donors and supporters of Project Flamingo.


Kenya's 1st Annual International Breast Cancer Symposium

Sr Lieske recently attended the 1st Annual International Breast Cancer Symposium in Nairobi, Kenya. The following is a summary that she wrote of the 2 days that she spent there:

Lieske, Samuel and Julie
"I arrived on Wednesday evening to a green, lush and beautiful Nairobi. I travelled with Julie Belloni of Sysmex who was one of the sponsors for the symposium. Her colleague, Samuel, fetched us from the airport. He took us to have a taste of the local cuisine: pork and mukimo (a dish made from potato, maize, peas and onion).

The symposium was hosted by the Aga Khan University Hospital of Nairobi and the venue was the beautiful Trademark Hotel. The theme was "Updates in Breast Cancer Management" Both local and international speakers presented a wide variety of topics.

Day 1, session 1 started with a overview of the historical evolution of breast cancer management by Dr Miriam Mutebi, a local breast surgeon. Dr Mutebi has been involved with previous Breast Course for Nurses courses in Cape Town. Following this were lectures about the surgical and medical management of breast cancer.

Session 2 was mostly about imaging for breast cancer. The Aga Khan offers mammography, tomosynthesis, ultrasound, CT scanning and breast MRI. Stereotactic biopsy is available but there is no MRI biopsy currently available. With very few trained and qualified breast radiologists within Kenya, many of the peripheral hospitals and clinics offer ultrasound imaging but the images are sent to Aga Khan for interpretation. Session 2 ended with a presentation by Tayreez Mushani. Ms Mushani is the co-ordinator of the Oncology Diploma Program in Nairobi and she developed the curriculum for this programme, a first such programme in the East African Region. Since commencement in Aug 2016, 23 nurses have trained in oncology.

Session 3 included case presentations. Early breast cancer, Her2 heterogeneity and metastatic breast cancer cases were presented and discussed.

Lieske, Tayreez and Margaret
The day ended with 3 workshops. The members of the symposium signed up for the workshop of their interest. Track 1 was a surgical pathological workshop. Track 3 was a palliative care workshop. Track 2, which I was involved with, was an oncology nursing workshop. It started off with breast clinical examination (CBE) training by Tayreez Mushani and Dr Margaret Barton-Burke, a professor of oncology - department of nursing at the Memorial Sloan Kettering Cancer Centre. The nurses then got to practice CBE on models. We then went on to a session about lymphoedema. There are currently no trained lymphoedema therapists within Kenya. The Breast Course for Nurses material was used. I started with the anatomy and physiology of the lymphatic system. Following this, we went through the Lymphatic Education Africa risk factors. We then went on to go through exercises that the nurses can share with their patients. There was a lot of enthusiasm and I hope that there will soon be a few trained lymphoedema therapists in the country.

Nursing oncology track
Day 2, session 1 was mostly to do with patient support including the role of counselling and psychosocial support. I gave a talk on the use of alternative information sources used by breast cancer patients and how these sources often influence the way that patients manage their breast cancer.

Advocacy presentation

Session 2 was about advocacy and policy for patients with breast cancer. David Makumi, chairman of the Kenya Network for Cancer Organisations and passionate cancer control advocate, gave a presentation about local perspectives on patient advocacy. He asked important questions such as "are patients receiving the best possible care?" and "is care being delivered by a multidisciplinary team as it should be?"

Nursing oncology programme
Session 3 had breakaway sessions with various topics.

The symposium ended with reflections and goals going forward. Dr Mutebi presented 5 aims including:
1. promoting regional technical collaborations
2. promoting greater participation in the global oncology community
3. reducing duplication of efforts
4. creating guidelines that are easily updated and disseminated
5. widespread participation within the African oncology community

Dr Mutebi, Dr Mwanzi, Lieske

Well done to all the organisers and sponsors on a brilliant first symposium filled with relevant information and workshops! A special thank you to Dr Miriam Mutebi for inviting me to attend and speak.

Thank you to the Breast Course for Nurses and Dr Jenny Edge for getting me there and back again.

And of course, when in Nairobi...always make the time to visit the giraffe sanctuary. You may even be fortunate enough to kiss one!"

Lieske at the Giraffe centre

- by Lieske Wegelin


MySchool Application - Breast Course for Nurses

The Breast Course for Nurses is our registered NPO aimed at equipping health care workers with the skills to manage patients with breast problems. To date, 750 health care workers have completed the Breast Course for Nurses. Courses have been held in the following places:

*South Africa - Cape Town, Johannesburg, Durban, Port Elizabeth
*Zimbabwe - Harare, Bulawayo, Marondera
*Namibia - Windhoek, Ongwediva
*Malawi - Lilongwe

The MySchool MyVillage MyPlanet was established in September 1997 by a parent who wanted to help raise funds for his child's school. Read more here: http://www.myschool.co.za/about-myschool/our-history

The MySchool MyVillage MyPlanet card can be used at any of the following places:
- Woolworths
- Engen Convenience Centres
- Loot.co.za
- Bidvest Waltons and many other places (http://www.myschool.co.za/partners/partner-profiles)

The Breast Course for Nurses (BCN) has applied to become a beneficiary of the programme. As the course is provided to the nurses for free, we rely on sponsorship in order to run a course. Funds raised will help us to continue providing the course to health care workers throughout South Africa and the rest of Africa. In order for the BCN to have a successful application, we need 50 people to either sign up for a card or add the BCN as a beneficiary (each individual can have up to 3 beneficiaries). In order to either sign up or add the BCN as beneficiary, a form needs to be completed. Once we have 50 applicants, you will receive your card or your beneficiary will be updated.

If you would like to sign up (its free) or add the BCN as a beneficiary, please complete the following form (http://www.myschool.co.za/schools/downloads/category/31-schools-sign-up-your-new-parents?download=101:application-form-english) and send it to Lieske: lieskewegelin@gmail.com or email Lieske with any questions related to the application.

Every swipe counts in raising funds for the selected beneficiary!

- blog post by Lieske Wegelin