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.


Pink Cricket 2018

Last weekend, Tony and I were invited to go to the Pink Cricket at the Wanderers.  Every year, one of the T50 games raises funds for a breast cancer project. Over the last few years, the money has gone to  Pink Drive.  This year, the money went to Charlotte Maxeke Hospital in Johannesburg with a third being apportioned to research and out reach programmes.  The Breast Course for Nurses is one of the outreach programmes run from Charlotte Maxeke Hospital.

The team inside the Wanderers
The team outside the Wanderers
 South Africa have done badly against the Indian team in the ODI series.  I don't know enough about cricket to know whether the Indians have been brilliant or RSA poor.  Virat Kholi has repeatedly shown why he is known as one of the best batters in the world. (He is the only batsman to currently hold an average of >50 in all 3 forms of the game).  It was a privilege to watch him bat.  South Africa, however, found a renewed energy.  The new members of the team had a chance to shine.  Ngiti with the ball, Klaasen and Phehlukwayo with the bat.  It was the only ODI that South Africa won.

The real winner are the patients who will be treated at the improved breast unit at the Charlotte Maxeke Hospital.  Breast cancer requires a multidisciplinary approach and many members of the diagnostic and treatment teams were there.  Sarah Nietz (surgeon) has been the public face of the team at the hospital and gave an excellent speech at the event.  In total, over R1.6m was raised and will go to both structural and logistical problems in the unit.

Thank you to cricket SA and all of you who gave so generously.


Regaining confidence after the diagnosis and treatment for breast cancer

I recently had the privilege of listening to a short story on BBC radio 4 called "chemo brain" written by Susmita Bhattacharya.  Susmita is a writer and a teacher and she developed breast cancer and like many people found life difficult afterwards. (Interestingly, in her "about me section" on her blog page, her diagnosis of breast cancer isn't mentioned).

The short story is well worth listening to and describes how she, like many other people, found the non physical side effects of chemotherapy difficult to cope with:

"the physical side effects of chemo had been spelt out...but what about the mind?..What would happen to my mind as the drugs entered my body....I became a writer who could not write"

Chemo brain caused her to loose her confidence.  She ended up writing notes to herself.  In the classroom, she had to rely on her years of experience to get her through her lessons.

She talks about the loneliness after the diagnosis of breast cancer.  She wanted to get on with her life as usual but life had changed for her and her family.  They have had to accept a new normal.

Susmita recalls how she regained her confidence.  She edited her novel and spent time with her local cancer support group.  She set up a writing workshop.  This gave her the confidence to write again.

It is now 2 years since she finished her treatment.  Writing about her experience has helped her come to terms with what has happened.  As a result of being a cancer survivor she has attended dance workshops, has had tea in the mayors house and has even visited Buckingham Palace.

She has learned to accept days as they come.

There are many reasons why breast cancer and its management can cause problems with confidence.  This year, at our annual CBMH October activity we have invited breast cancer survivors to discuss ways they have regained their confidence after the diagnosis and treatment of breast cancer.

If you are in Cape Town on 18/10/17, please come and join us.  For further details, contact Michelle Norris: Michelle.Norris@netcare.co.za.

Hope to see you there.