Pink Lady Crafts for Cancer

The 9th annual Pink Lady Crafts for Cancer was held at the Lord Charles Hotel in Somerset West last weekend.  It was the first time that I had the pleasure of attending the day which is organised by Pink Lady® apples  The craft day is an annual fund raising event and the money raised goes towards a transport fund which supports women with breast cancer attending Tygerberg Hospital.

This year's craft was cake decorating. The masterclass was attended by 100 women. It was coordinated by Beate Strydom from the Birdcage Restaurant in Stellenbosch.  There were many beautiful cakes and whilst they were varied in their patterns and themes, the overall colour was pink. ( The Birdcage is a lovely coffee shop in Stellenbosch and as it is one of my son's favourites, I have had the pleasure of having tea there.)

After a musical interlude from Elandre and Josh (many thanks, particularly for the Cole Porter), we went on to an excellent buffet lunch in the large dining room.

Liza, Justus Apffelstaedt, Mike Burton and I all gave brief speeches outlining the transport fund and thanking the sponsors.  Having any cancer results in many trips to the breast centre.  In a large country such as South Africa, the distances travelled are often long and therefore expensive.  For many women, the cost can mean they cannot come for all their cancer treatment sessions.  This results in the treatment being less effective.

Ms van Eck with her cake

Over the last 12 months, the transport fund has paid for 2332 trips to the hospital for treatment.  As the cost of fuel is set to increase next year, the need for the fund will increase rather than decrease.  On behalf of the the women who have benefitted from the transport fund, I would like to thank the following sponsors: The Lord Charles Hotel, Rees Dynamic, Top promotions, Tart Supreme Coffee, Blue Jay-Pink Lady apples, TopFruit and Four Paws wine.

We were all given goody bags and our thanks to all the contributors. A huge thank you to Liza Matthews and Tania Fourie who coordinated the whole event.  I am really looking forward to further projects.
Pink Lady® apples team
On behalf of all the women who have benefitted from your generosity: I thank you.


Clinical Breast Examination Project

Written by Sr Lieske Wegelin

Last week Tuesday, I joined the advanced midwifery students of Stellenbosch University (SU) at the women's month breast education and examination project. It was held at the View Church in Tableview. The project was in collaboration with SU, View Church and SALT.

For the past few months, the midwives have attended lectures regarding breast health presented by Dr Edge. They have also been trained in clinical breast examination (CBE) and what to look out for when performing a CBE.

Dr Nomafrench Mbombo

The morning started with a brief introductory talk by Dr Leanne Greeff and a song performance followed. The group then welcomed Dr Nomafrench Mbombo, the Western Cape Minister of Health, to the stage. She spoke about women's health in general and the importance of events like these to educate our communities. Dr Doreen KM M’Rithaa, the head of the Advanced Midwifery students, spoke next and she was followed by a breast cancer survivor giving a talk about her experience of the process of being diagnosed and treated for breast cancer.

I represented the Breast Course for Nurses and spoke during the next session about the signs and symptoms of breast cancer and also how to perform a breast self-examination and the importance of doing this every month. The talks were aimed at educating the community members about early detection of breast problems.
T-shirts printed for the day

The midwives then each went to their assigned stations that they had set up to ensure privacy of the person being examined. The community members were offered a CBE by the midwives. Prior to having the CBE, the person's history was taken by members of the SALT group. I was there to assist with any queries or concerns the midwives had about the people they were examining.

Just over 150 members of the community received a CBE with +/- 12 people needing referral to the clinic. The doors stayed open until 16h30 when the last few people were seen and examined.

The feedback received was that the programme was very well done and very much needed. The midwives did a fantastic job!

Well done to each and every person that helped with the preparations of this day, hopefully the first of many to come.

Log in to Facebook, like our Breast Course 4 Nurses page and enjoy the recording of the event shown on the Expresso television show!

Sr Lieske, Dr Doreen and Sr Melanie


Ian Patterson

Last month, I had the privilege writing an article for Buddies magazine.  I chose to write about the  the ABS (Association Breast Surgeons) conference in Birmingham, UK. It was an excellent conference.  Unusually for a surgical conference, there was a session devoted to bullying in the workplace.

Ian Patterson was a surgeon working in the Midlands, UK.  He has recently been convicted for over-operating on women without breast cancer and doing unconventional operations on women with breast cancer. He has been sentenced to 20 years in prison.  

What went wrong?  

The NHS (National Health Service) is very regulated: much more regulated than the health service in South Africa.  Although Mr Patterson was guilty of several misdemeanours, his offences fell into 4 categories:
1. He over-managed and over-operated on women: he exaggerated their risk of breast cancer and sent them for too many investigations.
2. He did an operation that he made up called a “cleavage sparing mastectomy” It is a mastectomy that results in a lot of breast tissue left after surgery which clearly results in a more “natural looking” breast as a lot of the “natural breast tissue” was left after the operation.  
Doing Oncoplastic surgery is complex.  As the cancer surgeon, we have to sometimes accept that removing skin over the area of the cancer will leave a scar in a less acceptable place.  THE MOST IMPORTANT THING ABOUT BREAST CANCER SURGERY IS THE ADEQUATE MANAGEMENT OF THE CANCER. That should never be compromised for a more acceptable cosmetic outcome.
3. He did not follow protocols for diagnostic procedures. (Ideally all patients with breast cancer should be diagnosed without having surgery.  An operative biopsy should only be done if the diagnosis cannot be made preoperatively.)

Anyone who has breast cancer is discussed at a multi-disciplinary meeting attended by oncologists, surgeons, radiotherapists, pathologists, radiologists, psychologists, nurse practitioners etc.  These meeting are highly structured.  So how did Ian Patterson manage to treat so many women in an unconventional manner for so many years.

He was a charismatic, charming bully.
He was not a trained breast surgeon
He was not a member of any specialist breast surgery organisations

For many years, sexist or racist behaviour has been addressed in the workplace.  Bullying has been harder to define.  Harder to regulate.  A comment made by a colleague may be interpreted as bullying by one member of staff but not thought of as being offensive by another.  There has been a culture of telling people to toughen up. An impression that the “victim” of bullying is to blame rather than the person doing the bullying.

Ian Patterson was reported in 2003 to hospital management.  A report was commissioned.  He was investigated by a head and neck surgeon.  (Not a breast surgeon).  In 2007, he was reported again.  He was allowed to choose the panel who investigated him!  The whistle blower was noted to have “personal difficulties”.  Mr Patterson was asked to refrain from doing unconventional treatment but was allowed to continue practising. At the end of the day, it was his patients who brought charges against him.  He was found guilty and his work colleagues were criticised for not being more forceful in their objections to his management.  

He has cost the NHS £17.4m so far. It is projected that it will cost £34m in total when all the claims have been settled. 1200 patients’ management have to be reviewed

How can we learn from this sorry story and prevent it happening to an individual?  Wherever possible, choose a surgeon who specialises in breast cancer management and regularly attends breast conferences and ensure the surgeon works in an MDT.


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.