Cervical Cancer Training at Mary Leakey Girls’ School

On June 20th Africa Cancer Foundation, in partnership with the Medical Society for Action Network launched  a three-week cervical cancer awareness curriculum at Mary Leakey Girls’ Secondary School.  Click here to see photos from the day.  Margaret Muthura of Africa Cancer Foundation reported that the girls were very eager to learn!

KENCO’s High Turnout, Productive Meeting

DSCN1511

More than twenty-five cancer advocates from fourteen cancer organizations and the Ministry of Health came together today for the third meeting of the Kenya Network of Cancer Organizations.  Each organization shared about the focus of their cancer advocacy work, and the group received a very informative report from Dr. Karagu of the Non-Communicable Disease Division of the Ministry of Public Health and Sanitation.  Dr. Karagu highlighted the current Cancer statistics in Kenya, the challenges of fighting Cancer in Kenya (health systems, infrastructure, workforce), and Ministry initiatives in Cancer control.  Some of the current initiatives include:

  • Development of Cancer Treatment Guidelines
  • Pilot study on rolling out HPV Vaccine for Cervical Cancer
  • Grant application to Gates Foundation for increased cervical cancer awareness
  • Ministerial team to develop plan for opening 4 regional Cancer centers (Eldoret, Mombasa, Nyeri, Kisumu)
  • Incorporation of questions on Cancer in upcoming household demographic survey
  • Step survey to determine risk factors and distribution of non-communicable diseases in the country

The Network partner organizations also discussed the KENCO organizational structure and made great strides toward formalizing this informal networking/advocacy body, so that it will have a firm structure for moving forward and pushing for cancer control as a united front.

Many thanks to Faraja Cancer Support Trust for hosting today’s meeting!

A time of mourning becomes a time for awareness

DSC04992

STOMA World Kenya recently traveled to Kisumu for the funeral of one of their members.  Reporting on the event, Sally Agallo, STOMA World Kenya’s Secretary, shares

“We recently travelled to Kisumu for a member’s burial and we were given a platform to create awareness on colon cancer. We had people ask many questions and what was a burial turned into an awareness campaign forum.”

DSC05006

STOMA World Kenya reports that colon and rectal cancers have been on the rise in Kenya in the last 5 years, actually becoming in the top ten of the most burdensome cancers in society. Unfortunately, most of these cancers are diagnosed in the late stage. Surgeries that are performed to cure the disease (when diagnosed early) often result in diversion of the natural way to pass stools.  A special hole is created in the abdomen (called a stoma) which becomes the new way to pass stool and special bags are used to collect the waste (usually called colostomy, depending on where the surgery is done).  An ileostomy bag is for an ilestomy, which is the stoma created involving the small intestine, colostomy is the stoma created involving the colon or rectum.

A person who has a stoma and uses such special bags as a way of elimination is called an Ostomate.  The rehabilitation of such patients is very taxing and they need a lot of support, ranging from accessing these appliances (which are hardly available in Kenya), addressing stigma, sexuality and other quality of life issues (having to walk around with a bag is not the easiest thing to do.)  STOMA World Kenya supplies ostomy and ileostomy bags to members at their monthly meetings.  Contact STOMA World Kenya, sallykwenda@yahoo.com, 0725 234 935.

More awareness needs to be raised in communities about this and all cancers.  It’s work like that of STOMA World Kenya and other KENCO Network organisations that is shifting public perception of cancer, one talk at a time!

Devolving palliative care in Kenya

Author: Aquinas Nyakundi

29 April 2013
  • Professor Emile Rwamasibiro, Chair of the Rwanda Medical and Dental Council (RMDC) addressing delegates
Professor Emile Rwamasibiro, Chair of the Rwanda Medical and Dental Council (RMDC) addressing delegates

As Kenya moves to a devolved system of governance, community health care workers would play an integral part in health care delivery, including palliative care.

Community health care workers should have health literacy for better health care delivery in the devolved system of governance in Kenya.

This was the message from the Chair of Rwanda Medical and Dental Council (RMDC) Professor Emile Rwamasibiro while addressing delegates at the Kenya Medical Association (KMA) 41stAnnual Scientific Conference & Annual General meeting.

Held at Lukenya in Machakos, the main theme of this year’s conference was; ‘Healthcare Delivery in a Devolved Government System’

In Rwanda, Prof. Rwamasibiro said that one man and two women are elected in every village and trained in management of focused health issues.

“These men and women are the ones who facilitate outreach and sensitization activities and are rewarded on performance since their role is not a full time payable job. They are enthusiastic as they are elected by locals and given high status in the village.” He said.

Through such an approach, the RMDC chair said most health issues have been tackled making people in the village know more than their city counterparts.

“Do not fear to embrace innovation strategies and choose developmental models that work for you.” Prof. Rwamasibiro advised.

The Permanent Secretary in the Ministry of Medical Services M/s. Mary Ngari said that the constitution stipulates that every person has a right to the highest attainable standard of health, which includes the right to health care services and reproductive health care.

M/s. Ngari said that the ministry has repositioned itself to fulfill this right. She challenged health care workers to be in the forefront in leadership to ensure patients receive high quality services despite devolution adding that it (devolution) is being done with a lot of care.

Palliative care providers and representatives were among the delegates attending the conference where non-communicable diseases and palliative care were given a spot light.

Kenya Hospices and Palliative Care Association (KEHPCA)’s Special Coordinator for Access to Pain Relief and Palliative Care, Dr Esther Muinga addressed delegates on the Integration of Palliative Care into the Kenyan Health Systems.

Dr Muinga said that through the Waterloo project, a time-limited initiative to significantly improve access to palliative care in Malawi and Kenya, 115 health care providers have been trained in end-of-life care in the country.

She said that the aim of the project is to improve the quality of life of patients affected by HIV/AIDS and other life limiting illnesses.

This, she said, is after a research carried out indicated that the need for education was paramount in pain management, sexuality, communication, care for carers, breaking bad news, nutrition and death & bereavement among others.

“As a result of this project, palliative care has been integrated in 11Level 5 Hospitals and additional 30 Level 4 Hospitals are targeted for similar integration this year.” She added.

In addition, Dr Muinga said that there has been significant recognition of palliative care in both ministries of health that have been operational in the previous government as a result of continued advocacy activities.

She sighted challenges in the integration as shortage of staff, lack of space within hospitals for palliative care units, lack of interest in palliative care from those chosen for training and deployment of trained staff to other areas.

This year, Dr Muinga said that there are steps being undertaken to further palliative care in Kenya which include;

  • Inclusion of pharmacists in palliative care
  • Involvement of 30 Level 4 Hospitals in palliative care training
  • Provision of oral morphine as an important analgesic in government hospitals through Kenya Medical Supplies Agency
  • Inclusion of palliative care in underadecuate training.

Mr. Elijah Musau, head of palliative care department at Machakos Level 5 Hospital gave a hospital story on integrating palliative care.

Mr. Musau said he has encountered a case where medical staff were talking about a patient’s illness without knowledge that the patient was overhearing them having not been informed, adding that this is illegal.

He said that introducing the new concept at the facility was hardly embraced by the medical staff who before understanding what palliative care entailed could for example shout at a patient to make their bed and stop pretending.

“Put yourself in the shoes of your patient. If that was your parent, child or relative, could you wish them to be treated the way you are treating the patient?” He asked.

Though given a building earmarked for demolition, Mr. Musau said that through funds from KEHPCA, they managed to refurbish it to a modern unit.

“Before renovation, patients used to wonder if they had been referred there to die.” He said.

He said that there exists effective and inexpensive methods of pain and symptom management, terming the Continuous Medical Education (CME) that has helped in training health care workers in palliative care as an effective tool.

He told delegates that palliative care is provided by an interdisciplinary team of health care providers and that it can be started anywhere.

Addressing a concern raised by a section of the delegates that having stand alone units would lead to stigma associated to separation from usual health care, Mr. Musau said that palliative care providers most times offer services within wards and the separate units create a conducive environment for counseling and sharing with family members, a service that cannot be offered in the wards.

“It also helps us to attend to patients referred from other centers, who are not admitted in the hospital.” He added.

On challenges of establishing a palliative care unit in a Level 5 Hospital, Senior Nursing Officer M/s. Lydia Warui from Nyeri Provincial General Hospital (PGH) said that cultural barriers limit their service provision.

She said that home based care is not well accepted among some communities who insist that a patient should stay in hospital.

“Chronic illnesses are associated with curses and discussion of end-of-life issues is not appreciated by some people.” She said.

M/s. Warui said that prescription issues remain a challenge as nurses who are mostly in charge of palliative care units are not allowed to prescribe morphine, adding that there is hope as KEHPCA works to put in place protocols and palliative care guidelines.

She surprised many when she projected a picture of unused toilets on the screen, saying that it was the place allocated for Nyeri Palliative Care Unit which they later managed to renovate to habitable standards.

Stella Kubania presented a case of Meru Level 5 Hospital with regard to palliative care in a Government Health Institution.

M/s. Kubania said that the palliative care unit has a capacity of 311 beds with a total of about a thousand admissions and 2900 outpatients.

She said that the hospital has purchased 100grams of morphine this year which would help the unit in management of patient pain.

“We occupy a two-roomed premise that has a kitchen and a restroom where we converted the kitchen chimney to be a strong room for morphine storage.” M/s. Kubania said.

According to the senior nursing officer, the opening of the unit has enabled most patients to be enrolled for the services offered at the unit and their quality of life has greatly improved.

“Patients who would have otherwise gone home without care have been enrolled and followed up in the unit and morphine consumption in the hospital has gone up.” She said.

Her wish is for the government to offer cancer treatment and provide palliative care drugs to promote palliative care in all corners of the country.

Mediamax Network Limited corporate affairs officer M/s. Nyatichi Nyasani said that the media has been known to give priority to sensational stories and little airtime for health features.

“The media tends to focus on negative stories since they consider such stories to be newsworthy yet medical stories can sway opinion.” M/s. Nyasani said.

She said that in the devolved government, the media needs to review the success of governors in the provision of health services and bring such successes to the limelight.

Suicidal Cancer Patients Worry Health Experts, by Elizabeth Ombati

A high number of terminally ill cancer patients are emotionally disturbed and lack good psychological care, a new study has shown. Conducted at the Kenyatta National Hospital, the study found that psychological distress could have a serious negative impact on patients with advanced cancer or those who are terminally ill, including reducing their quality of life. 

The study, which sampled 389 patients at the hospital’s oncology clinic, established that depression makes many patients desire to commit suicide. Researchers found a high prevalence of depression and anxiety disorders at 44 and 69.2 % respectively, among respondents.

In the study, the Psychological and social profiles of cancer patients seen at KNH, shows prevalence rate of depression is much higher than in the general population.  It found that 93% of cancer respondents who had stage three and four cancers had several depression disorders.  It also found that 42.4% of the respondents were feeling hopeless about their situation.  The research established that most patients lack psychological care, especially counseling before being informed they had cancer.  “Slightly more than a half of the respondents 56.7% of 251 people, were counseled after the news of having cancer had been broken to them, while 43.3% (138) did not having received any counselling” according to the report.

The researchers note that news of the diagnoses is always broken without proper preparation; hence the patient receives the news as though it is a death sentence. The risk of suicide among the respondents was high at 93% (362) people. Half of respondents said they thought of committing suicide in the past 12 months. However, many had not attempted to end their lives.

ABOUT THE STUDY
The study was led by Prof David Ndetei who was the principal investigator and his two co-principal investigators, Dr. Alice Muthnoi Musibi, a medical specialist in oncology at the hospital.  Others who took part are Dr. Joyce Nato, national professional officer in charge, non-communicable disease including mental health, and WHO Kenya country office.  The highest number of respondents 33.3% (130) had breast cancer, followed by 24.5% (95) having gynecological cancers, then 14.8% (56) having gastrointestinal cancer, 8.2% (32) with ear, nose and throat cancer. The rest had various cancers including skin cancer, bone cancer, lung cancer, and kidney cancer.

In Kenya, the most common cancers in men are esophagus, prostate and Kaposi’s sarcoma. And in women breast cancer is the leading cause of death followed by cervical and throat cancer. KNH cancer department attends to 150 patients daily. Out of 28,000 cancer cases diagnosed across the country in 2011, at least 22, 000 people died. This is mainly attributed to late diagnoses. Worldwide, it is estimated that seven million people die from cancer annually.

Health Awareness Event at Our Lady of Visitation Church

On March 3rd 2013 the Cancer Awareness Centre of Kenya and Health Basics and Nutrition Services collaborated to create health and cancer awareness through nutrition and screening. Held at Our Lady of Visitation Catholic Church in Makadara, the event activities included nutrition and health talks, consultations, breast screenings, blood pressure and BMI checks and deworming for adults and children.  300 registered participants took part.

Nutritional talk 2

Assisted by a medical doctor, 2 nurses and 3 nutritionists, the group referred participants for further medical care as needed.  In the future, the group hopes to hold this event free of charge to reach out to more participants.

Checking BP

International Childhood Cancer Day Events

February 15th marked International Childhood Cancer Day.  In Nairobi, there were two big events to commemorate the day.

Hope 4 Cancer Kids (H4CK)
Event Tent
H4CK hosted a Fun Day for pediatric cancer patients on the field near the U of Nairobi Medical School at Kenyatta National Hospital.  There were several Network organizations present – KEHPCA, Women4Cancer, Africa Cancer Foundation, as well as a group of students from St. Christophers School that is starting their own foundation to help children with cancer.  There were also
several individual volunteers with Hope 4 Cancer Kids and independent volunteers.
KEHPCA staff help sell wristbands and t-shirts.
KEHPCA staff help sell wristbands and t-shirts.

There were speeches by H4CK, a patient’s mother, a pediatric patient, and even a prayer by one of the young patients.

A pediatric patient's mother gives a touching speech.
A pediatric patient’s mother gives a touching speech.
A (long-term) pediatric patient talks about the challenges of living with cancer.
A (long-term) pediatric patient talks about the challenges of living with cancer.

After the cake cutting, there was dancing and game playing … and many (much-need) smiles!

Time to cut the cake.
Time to cut the cake.

Read more about the H4CK event:

http://www.ehospice.com/kenya/ArticlesList/KidsFundaymarksInternationalChildrenCancerDay021813061905/tabid/5010/ArticleId/3226/language/en-GB/Kids-Fun-Day-marks-International-Childhood-Cancer-Day.aspx#.USIbII7jbIo 

Kenya Cancer Association (KCA)
On the same evening, KCA hosted a cocktail reception to launch their Art for Cancer Auction to raise funds for treatment of children with cancer at Kenyatta National Hospital.
Examples of artwork at Art for Cancer auction.
Examples of artwork at Art for Cancer auction.

The event was well attended by KCA volunteers, KEHPCA, Hope4Cancer Kids, representatives from schools that entered the art contest, other area artists and cancer advocates.

Audience at Art for Cancer launch event.
Audience at Art for Cancer launch event.

The KCA leadership team, including the night’s MC, David Makumi, made the event a good mix of humor, advocacy and a call for action.

Guest speaker, Donatella Lorch, addresses the crowd.
Guest speaker, Donatella Lorch, addresses the crowd.

The guest speaker was Donatalla Lorch, international journalist and wife of the World Bank Country Director, and additional talks were given by Dr. Jessie (pediatric oncologist at KNH), Anne Korir (KCA Chair), a pediatric cancer patient’s mother (and brief hello from the young ‘graduate’), and a 26-year old pediatric cancer survivor (and CEO of his own company!).

Cancer survivor gives supporting words.
Cancer survivor gives supporting words.

Prizes were given to the top art pieces, and the auction will continue to Wed Feb 20th — so get over to VIllage Market (2nd floor) to buy some art and support the kids at KNH.

The art teacher from one of the schools receives an award on her student's behalf.
The art teacher from one of the schools receives an award on her student’s behalf.
Another example of art from the auction to support children with cancer.
Another example of art from the auction to support children with cancer.

First Meeting of the Kenya Network of Cancer Organizations

On February 8th, 2013, sixteen representatives from ten cancer organizations in Kenya convened near the Yaya Centre in Nairobi.  The group varied from focusing on particular cancers (breast, prostate, etc) to particular specializations (prevention, palliative care, complementary therapies, etc).  However, all agreed that by working together, the reach of each organization can go farther, and the unified force can impact policy, media coverage, patient advocacy, international recognition, and much more.  And thus, the foundation of the Kenya Network of Cancer Organizations was laid.  In the coming months, the group will develop a constitution, register as an NGO, develop a plan of action, etc.  Stay tuned for great things to come!

Several attendees of the Feb 8 meeting of the Network.
Several attendees of the Feb 8 meeting of the Network.