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


Breast Course for Nurses day 2, Marondera

Day 2 at Marondera Hospital proved to be as interesting as the first day but was different as we had more doctors and oncology sisters attending. In the morning, there were general lectures and discussion about the management of breast cancer and the challenges of being in a limited resource setting. Dr Nyamhunga likened the problems encountered with managing breast cancer to being similar to the problems in a relationship (that was the first time I had heard that metaphor!). Dr Innocent Kundiona, (one of the surgeons from Harare who travels to Marondera to do the weekly surgery) stayed with us to discuss the surgical management of women.
Dr Nyamhunga
Doctors going through biopsy techniques

We felt privileged to have so many doctors as there was a nationwide strike going on while we were there.  The junior doctors are paid relatively little ($500/month) and get some remuneration for overtime but it amounts to very little given that many of them are on call every other week. Their hours are a long way from reaching the regulated hours worked by doctors in most other countries.

Dr Anna Nyakabau, Dr Jenny Edge, Dr Maita Mvere
In the afternoon, Dr Mvere joined us for a discussion on appropriate breast screening for low to middle income countries. Although she is a radiologist, she was not advocating for routine mammography but for routine clinical breast examination and focussed ultrasound. Sonar is difficult to use as a screening tool. Breasts are naturally not homogeneous and one can often get the impression of masses within the substance. She is advocating for "focussed US". What that means is that a general doctor should be able to use an US to distinguish a solid from a cystic mass and be able to biopsy a women with a mass. We spent the afternoon together in the maternity section with the doctors demonstrating the technique.

Lieske, Faniso, Junior

Lieske ran a parallel session focussing on lymphoedema management. She was joined by Junior Mavu and Faniso Mdenda. They are 2 trained lymphoedema therapists in Harare. There are currently very few trained lymphoedema therapists in Zimbabwe, this makes the management of lymphoedema very difficult. Many nurses have not heard of lymphoedema and if they have, they often do not know that there is management for the patient.

Junior bandaging Enia's arm

Lieske discussed the anatomy and physiology of the lymphatic system and went through some exercises that the nurses can teach their patients. Junior went through basic lymphoedema management including a bandaging example. Faniso went through risk reduction steps. They ended off with a discussion re wound care.

We had 131 health care professionals from various hospitals and clinics participate over the 2 days. On returning to Cape Town, Lieske received an email from one of the nurses, Enia Mutenga, who said that they ran an HIV campaign shortly after the course and that they did breast examinations on many of the women due to the training they received. Thank you Enia, a lovely message to receive! 


Breast course for nurses: Marondera day 1

Last week, Anna Nyakabau, Sr Lieske and I ventured to Marondera in Zimbabwe and held a two day Breast Course for Nurses.  The first day was over-subscribed and we ended with attendance by 80 health care workers.  The majority were midwives and registered nurses.
Dr Nyakabau talking about the principles of cancer
 Marondera is 70 km east of Harare.  We were taken there by Chenjerai, from Island Hospice, who are based in Harare.  As they don't have in-patient facilities he has to work from his vehicle and all their care is given on an outpatient basis.

The hospital is a district level hospital with an emergency unit, theatre and a busy maternity and baby unit.  Over 1500 cataract operations are performed each year.  General surgeons from Harare also do out reach theatre lists on a weekly basis.
Matron Julliet Hungwa

I was given a guided tour by Matron Julliet Hungwa who, with Dr Dhege, was instrumental in organising the course and ensuring that the facilities were ready and available for us. (The hospital is spotlessly clean!) We also need to thank Joseph, Enia and Esther who made a formidable team

Marondera has a well established school of nursing and about 50% of the students were midwives.  We asked them how they coped with the challenge of communicating with patients in Shona/Ndebele as many of the words used for the management of patients with breast cancer do not exist in vernacular languages. Their feedback will be a valuable source of local knowledge and I am looking forward to analysing their responses.

The most interesting sessions for me are those where I learn more about the community: the palliative care session, run by Dr Agnes Terrerai and Chenjerai Bhodeni, and the afternoon session on outreach programmes.  Having discussed various interventions that may make a difference to women's understanding of breast cancer, there was consensus that the best access to the older generation was through the younger generation.

I found it fascinating that in a community with a culture of respect towards the older population, all the participants felt that eduction at school level would result in the children teaching the older generation about the signs and symptoms of breast cancer.

Many thanks to all our sponsors: Lancet Laboratories, Mary Ann Oncology, Medical Imaging centre, B Braun and BARD, we are deeply grateful for your continued support.