A Busy First Year for the Ghana-Edinburgh Childhood Cancer Care Partnership

Last year, AfrOx helped to set up a twinning partnership between the childhood cancer unit at the Korle Bu Teaching Hospital (KBTH) in Accra and the Royal Hospital for Sick Children (RHSC) in Edinburgh, to help improve care for children with cancer in Ghana. Dr Vanita Sharma, Head of Programmes, AfrOx describes how one year into the programme a lot has been achieved, thanks to the hard work of everyone involved…

To read more about the background and aims of the partnership, click here. 

After a busy twelve months, the twinning project between the Accra and Edinburgh paediatric cancer units has got off to a very encouraging start. Over 100 Ghanaian doctors and nurses have taken part in two workshops held at KBTH in November 2010 and April this year.  The first workshop was led by the Edinburgh team, including two doctors, a nurse and a play therapist, and focused on training staff from KBTH as well as some staff from Ghana’s only other paediatric oncology unit in Kumasi. The KBTH staff decided on the content of the workshop training, to ensure that teaching was directed towards their needs. (To read how the first workshop went, click here). The second workshop, in April, was led by Dr Lorna Renner, who heads the busy KBTH team, and brought together doctors and nurses from other hospitals in Ghana to raise awareness of children’s cancer and the importance of early detection and referral. 

One challenge that arose during the year was how best to maintain contact between the two teams in between workshops. We’ve therefore set up an internet link between the two units, using the website MedicineAfrica.com.  Georgina Newman, a medical student volunteer, ran sessions for the Edinburgh and Ghana teams on how to use the website and the first online tutorial took place in July.  There are now monthly online tutorials taking place, with nurses from RHSC Edinburgh providing training for the team of nurses from KBTH in Ghana.  To read about the MedicineAfrica project and the training in Edinburgh, click here, and to find out more about the training and first tutorial in Ghana, click here.

A childhood cancer database has also been set up at KBTH to enable accurate monitoring so that key areas for improvement of care can be identified and acted upon. AfrOx donated two computers to be used for inputting the data for the registry.  We also supported Dr Meaghann Weaver, a paediatrician from the US to travel to Ghana for three weeks to train the local data clerks on how to use the new registry. All new patient data is now being added which will allow a more accurate assessment of the problems faced in paediatric cancer care in Ghana.

One of the project’s main objectives was to raise awareness of childhood cancer across Ghana. Working with the Ghana Parents Association of Children with Cancer (GHAPACC), AfrOx designed two posters to raise awareness of the signs and symptoms of childhood cancer in Africa, which can be viewed here. We’ve donated over 2000 copies of each poster to GHAPACC which they have used in their local communities’ schools, churches and work places.  The posters were also used at events on international child cancer day in February and for training health-workers in early detection in the April workshop.  

Finally, the KBTH child cancer unit must be sustainable in the long term. To this end, AfrOx and World Child Cancer have all been working closely to help support efforts to secure local funding.  One key success has been that a local foundation, CanCare Foundation has agreed to raise funding in Ghana to support the project and has been providing funding towards subsidising the costs of treatment for families that cannot afford it.  World Child Cancer has also provided fundraising skills training to GHAPACC who run regular events to raise money to support the unit.

We’d like to thank all those who have been working hard over the last year to get the project off to such a successful start. In the second year, we hope to build on the solid foundations already established to achieve sustainable improvements in childhood cancer treatment at KBTH and across Ghana. Please check this blog regularly for progress updates.

If you would like to donate to support AfrOx’s work, please click here.

MedicineAfrica Training in Ghana

In her previous blog entry, Georgina Newman described the project she’s been working on setting up a link between two paediatric oncology units using the innovative website MedicineAfrica. Here she tells us how the training in Ghana went…

After training the team at the Edinburgh Royal Hospital for Sick Children, I then travelled to Accra, Ghana, to introduce members of the paediatric department at Korle-Bu Teaching Hospital to the concept of MedicineAfrica. After an initial presentation, seventeen selected members of the department, including doctors, nurses and a pharmacist were given practical training in small groups on how to use the website.

During the training sessions we created medical cases, practised tutorials and even learnt how to upload X-rays to the cases. There were, of course, some glitches, which mostly centred around a sometimes rather slow internet connection. However, overall, the team were enthusiastic and felt the new technology would provide a useful teaching tool and be particularly helpful for discussing complicated cases. In fact, two of the doctors wanted to persuade their colleagues to join so that the website could also be used as an intra-departmental teaching tool.

Training completed it was time for our first tutorial! Fiona Bruce from Edinburgh tutored six nurses and one pharmacist from Korle Bu on the ‘Role of the Nurse in Oncology’. Participants were divided into two groups; each group had at least one computer literate member and shared a laptop. Initially participants were a little apprehensive but the tutorial soon generated a large amount of lively discussion and interest. Tutor and participants discussed the differences between the oncology wards in Accra and Edinburgh. The Ghana team members appeared to enjoy the tutorial and the opportunity to link up with the Edinburgh team. 

So what next? For the next few months, until the November workshop, the Edinburgh team at the Royal Hospital for Sick Children will be giving monthly tutorials to the Ghanaian nurses, who will access the website using the two laptops provided to the unit by AfrOx and World Child Cancer. It is hoped that the tutorials will help build the relationship between the two paediatric oncology teams and that they will promote knowledge exchange and skill retention, as they have done in Somaliland. The effectiveness of the tutorials will then be discussed at the November workshop. If found to be useful, the tutorials will be extended to all members of the Ghanaian oncology team. Please check back for an update on the project later in the year..

AfrOx’s Cancer Nurse Training Programme in Ghana

Through the AfrOx Cancer Nurse Training Programme, AfrOx aims to provide training for nurses in Malawi, Ghana and Uganda.  Stewart Kerr, Project Manager, AfrOx, tells us more about the first nurse training workshop in Ghana ….

Nurses have an essential role in the provision of cancer care in Africa and they work tirelessly to look after their patients.  Cancer nurses in Africa are front line care givers: they administer drugs, communicate with the patients and their families, change dressings and help maintain the dignity of the patient throughout their treatment or until they pass away.  However, these cancer nurses are often overworked, poorly paid and have low social status; and they have few career development opportunities.  

A critical problem is that in countries like Ghana, Uganda and Malawi, there is no specialist training available for cancer nurses.  This year, working in collaboration with the University of Warwick, medical training schools, and ministries of health, AfrOx’s aim is to provide training for 100 nurses involved in cancer care in Ghana, Uganda and Malawi and to provide a free online training programme that will be of benefit to cancer nurses across Africa.

The first training workshop took place in Malawi in May (click here to learn more), and this month, we held the first workshop in Ghana at the Komfo Anokye Teaching Hospital (KATH) in Kumasi.  We took out a team of three volunteers Sally Campalani, Caitlin McCoy, and Fiona Young, who are full time oncology nurses based in the UK with a vast wealth of experience in oncology nursing and training of nurses new to oncology. 

The local faculty leaders included Dr Awauh (Medical Director of KATH), Dr Osei Obonsu (Medical Oncologist at KATH), Mrs Patience Ampong (Director of Nursing Services KATH), Mrs Sekyere and Mrs Antwi (both oncology nurses, KATH). 

Thirty, handpicked Ghanaian nurses who work with cancer patients in their day to day duties attended the workshop, dressed rather splendidly in there smart uniforms with fabulous nursing caps which reminded me of pictures I have seen of nurses from the UK in 1950s, which put me to shame dressed in my shorts and flip-flops.

Sally, Caitlin and Fiona worked together with the talented local faculty to run the training workshop.  The team covered a range of subjects, including how to communicate with oncology patients, the basic biology of cancer, an explanation of the treatments available in Ghana (Radiotherapy, Chemotherapy and Surgery), administration and side effects of the treatments, signs and symptoms of cancer and advocacy.  One question that arose during the workshop was that some nurses feared that after patients had gone through radiotherapy, they were radioactive and they were thus reluctant to touch them for 24 hours after their treatment.  The faculty explained how radiotherapy worked and helped to dispel this myth and encouraged these nurses that it would be safe to continue to care and tend to their patients after radiotherapy.

In the session on advocacy, when we were talking about how to raise awareness of cancer in the community, we found that a majority of the nurses at some point or another had talked with women in their community or at their church about the signs and symptoms of cancer - especially breast and cervical.  They also run a small palliative care outreach programme, where they go to the homes of terminally ill cancer patients and teach their families how to care for them and administer pain relief. I was impressed to learn that they carry out this service voluntarily, out of a feeling of duty towards their patients, usually without their transport costs or overtime being paid for.  Thus, for this reason it is confined to Central Kumasi.

The training workshop was very successful, with 100% of the nurses stating in their post evaluation questionnaire that they would change their day-to-day clinical practice in the treatment of cancer patients.  We were impressed by the hard-working cancer nurses and the inspiring leadership team at KATH who are both committed to providing good cancer care for their patients.  As a long-term objective of this programme, we are hoping to set up a formal partnership to provide longer-term mentoring and training; and to support efforts in Ghana to set up a post-graduate specialist cancer nurse training course.

Please check this blog regularly for progress updates.

If you would like to donate to support AfrOx’s work, please click here.

Supporting Childhood Cancer Care through MedicineAfrica

Georgina Newman, intern at Afrox, tells us about the new project she’s been working on to set up an innovative link between two paediatric oncology units, one based in Edinburgh, the other in Ghana…

As part of its strategy to improve cancer care in Ghana, AfrOx together with World Child Cancer, are supporting a twinning project between the paediatric oncology unit of The Royal Hospital for Sick Children in Edinburgh and the paediatric oncology unit of Korle Bu Teaching Hospital, Accra. Currently, professionals from Edinburgh travel to Ghana twice a year to deliver workshops that cover a range of issues chosen by the Ghanaian professionals. Unfortunately, there is little opportunity for contact between the teams between the workshops, which is where the innovative website, MedicineAfrica, and my internship come in.

MedicineAfrica is a new website that allows healthcare professionals to give online tutorials to professionals or students in a totally different area. It was originally pioneered in Somaliland and the UK where British psychiatrists gave newly qualified doctors in Somaliland tutorials in mental health and psychiatric care. Because Somaliland has very few experienced doctors and no psychiatrists at all, MedicineAfrica is helping fill a gap in the continual professional development of Somaliland’s new generation of junior doctors. By doing this, MedicineAfrica hopes to increase their motivation and to slow the brain drain.

During my internship, I have been facilitating a link between the Edinburgh and Ghana teams using MedicineAfrica. This involved travelling to Edinburgh in June to teach the Edinburgh team how to use the website. It was the first time I had met the doctors and nurses from Edinburgh; they were lovely and really enthusiastic about the whole project, asking intelligent and perceptive questions about the twinning project. The morning was spent discussing the project and how to take it further and in the afternoon, I taught them how to use MedicineAfrica. During the two hours we spent together, we created medical case studies, tutorials, PowerPoint presentations and gave sample tutorials. Despite the Edinburgh team’s initial wariness of the website, internet breakages, and moments of utter confusion, the team left the session feeling much more confident using the website than they had done previously. 

In July, I then travelled to Ghana to meet the team at the Korle Bu Teaching Hospital to teach them how to use the website and attempt the first online tutorial between the Edinburgh and Ghana teams. Please read my next post to see how the training in Ghana went..

Full More Than Fufu

In April, an AfrOx team led an oncology training workshop in Ghana along with a team from World Child Cancer. Meaghann Shaw Weaver shares a special moment with us....

April started out with a full agenda at the oncology training workshop in Ghana. These two days of focused sessions offered training in oncology interventions and supportive care. 

Much more than projects and pursuits, the real "fullness" of joy in Ghana comes from the strength of partnerships in working together for patient care. When removing the bandage from a biopsy site yesterday, a young patient's mum quietly told me "we must be brave together" and held my hand while I removed the tape. This is a mum who sits in a plastic chair next to her son's bed night after night, vigilant and hopeful in her bravery. This same mum insisted on sharing jollof rice with me today when she noticed I'd been at the hospital through lunch.

No matter that the day's serving of jollof rice was heaping and the fufu (pounded yam) expanded in my stomach, my heart still felt fuller than my stretched stomach at the day's close in Ghana. My heart feels full with admiration for the courage of patients, the perseverance of families, and the care offered by colleagues and mentors in Ghana. Ghana reveals the full potential of the human spirit when perseverance and partnership combine.

World Cancer Day

To mark World Cancer Day, the Ghana Health Service and Cancer Society of Ghana held a series of events in Accra to raise awareness of cancer. 

The program of the day included a march by 500 school children to the National Hockey Stadium which was followed by speeches to raise awareness of the signs and symptoms of cancer amongst the general public. 

Here are some snaps of the team, and the unveiling of AfrOx's Cancer Prevention posters...

To see the posters in all their glory, click here.

Palliative Care Conference

Palliative care is an essential component of cancer care. Pain and symptom control, coupled with counselling and spiritual care, enables patients to die with dignity, preventing a painful and distressing death.

Research has shown, however, that 79% of the global morphine supply is used by only 6 countries (USA, Canada, France, Germany, Australia and Britain). In Africa, there are also restrictions on the prescription of morphine because of fears about addiction. Without access to palliative care, most cancer patients in Africa die in considerable pain. 

At the end of January, AfrOx - in partnership with the American Society of Clinical Oncology and the Ghana Health Service - ran a palliative care workshop at the Korle Bu teaching hospital in Accra. There were 111 participants, ranging from medical students to social workers, representing nine of Ghana's ten regions.

The workshop gave an overview of what work is currently being done in Ghana on palliative care, and introduced models of palliative care being used in other African countries, including Uganda, Egypt and Tanzania. Discussions ranged from practical issues - such as pain medication - to ethics; while role-plays helped participants to explore how best to communicate with patients.

Before the conference, participants wanted to find out more information about what their role (as doctor, nurse, pharmacist, social worker), was in delivering palliative care to terminally ill patients.  They wanted a greater understanding of treatment methods and drugs involved in palliative care, and to know how to identify pain in patients, especially when dealing with a child. We hope that the conference has armed them with the tools they need to start developing effective methods of palliative care in Ghana.

To find out more about our palliative care programme, click here.

Childhood Cancer - November Workshop

One of AfrOx's ongoing aims is to enable twinning programmes between hospitals in the UK and Africa. In November, a team from the Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh had their first formal visit to the Childrens’ Cancer Unit at the Korle Bu Teaching Hospital, Accra, Ghana...

The twinning programme
Dr Lorna Renner, a senior paediatric oncologist in Accra, used to work with the team in Edinburgh and has since set up a busy unit to treat childhood cancer in Accra. The idea behind the twinning programme is that the team from Edinburgh provides teaching and training support using all means possible (visits for workshops, email, and if possible videoconferences); while AfrOx provides financial support and coordinates workshops and poster campaigns to raise awareness of childhood cancer throughout the country. It is vital that the content of the teaching and training is decided by the resource-poor country themselves, and not by the resource-rich nation.

The November workshop
The first formal workshop took place between 12-13 November 2010. The programme included talks on brain tumours, Wilms tumour and bone tumours; as well as supportive care, administration of chemotherapy, play specialist techniques and palliative care. The workshop was attended by  around 50 doctors, nurses and pharmacists from Korle Bu teaching hospital as well as from the hospital in Kumasi.

On the first day, topics included multidisciplinary team working, introduction to twinning programmes, bone tumours, brain tumours and play therapy techniques including guided imagery. Angela Edgar presented very important information on the setting up of a registry - without this it is impossible to assess improvements in diagnosis and survival rates and reduction in abandonment.

On the second day there were sessions on administration of chemotherapy and supportive care, an interactive play therapy session using patients and some siblings, and talks on Wilms tumour and palliative care. The latter was very much appreciated by all who attended.

Although hard work, the overall feeling of the RHSC team was that the workshop had been a success. The team from Edinburgh are all extremely keen to return to Ghana later in 2011 and to consolidate on what was achieved this time.


The visiting team was made up of Dr Emma Johnson, (Associate Specialist), Dr Angela Edgar, (consultant), Staff Nurse Fiona Bruce, Play Specialist Helen Veitch, and Vanita Sharma from AfrOx.

To find out more about our work, click here.

The Ghana-Edinburgh Childhood Cancer Care Partnership

AfrOx has been working on an exciting new project to set up a health partnership between the Korle Bu Teaching Hospital in Accra, Ghana and the Royal Hospital for Sick Children in Edinburgh, which aims to help improve the treatment of childhood cancer in Ghana.  Dr Vanita Sharma, Head of Programmes at AfrOx, tells us more…

Cancer is often perceived as a disease of affluent, Western societies, but this is not true. Whilst close to 80% of children survive cancer in richer countries, outcomes in Ghana are currently very poor with survival rates around 20%, despite the fact that effective and inexpensive drugs exist. There are many reasons for this: 

1) low diagnosis rates - probably only 20% of total childhood cancer cases are diagnosed, partly because there are currently only two hospitals in Ghana which diagnose and treat child cancer – the Korle Bu Teaching Hospital (KBTH) in Accra and the Komfo Anokye Teaching Hospital in Kumasi; 
2) late diagnosis – a lack of awareness means that many children present with cancer that is too advanced to start potentially curative treatment; 
3) lack of specialist child cancer care  - there are only two qualified paediatric oncologists in Ghana; 
4)  lack of accurate child cancer statistics, which makes it impossible to identify key areas for improvement;  
5) abandonment of treatment in up to 50% of children – many parents are unable to fund drug therapy and find it impossible to cope with the practical, social and economic pressures of a child undergoing cancer treatment;  
6) lack of palliative care which means that children dying from cancer often fail to receive adequate pain relief.  

One solution to the problem of child cancer in lower income countries is likely to lie in the development of twinning partnerships between hospitals, medics and parent support groups in resource poor settings and those in developed countries. Such twinning projects have already achieved great successes in other parts of the world, for example, links between US and South American hospitals. Through training, mentoring and regular contact, these partnerships provide a two-way transfer of skills and knowledge to develop locally appropriate solutions which are realistic and achievable. Financial support is also provided towards the costs of training programmes, drugs, equipment and awareness raising campaigns. Importantly, the long-term sustainability of child cancer units is secured by facilitating the development of strong relationships with local NGOs and parent support groups.  

AfrOx, working in collaboration with World Child Cancer, is jointly funding a 5 year twinning partnership between the Korle Bu Teaching Hospital (KBTH), Accra, Ghana and the Royal Hospital for Sick Children (RHSC), Edinburgh, UK.  The aim of the programme is to help improve the diagnosis, treatment and care of childhood cancer in Ghana. 

The programme was set up as a result of a request from Dr Lorna Renner, who qualified at the Royal Hospital for Sick Children (RHSC) in Edinburgh, and now heads up a dedicated paediatric oncology team at KBTH. Her team is committed to increasing survival rates for children with cancer across Ghana by developing expertise at the countries’ two specialist teaching hospitals, KBTH in Accra and Komfo Anokye in Kumasi, and creating satellite centres around Ghana where children can receive much of their treatment without having to travel long distances to Accra or Kumasi. This should enable more children to complete the full course of treatment. 

During an initial needs assessment visit to Ghana, we held discussions with staff at the KBTH unit, the Ghana Health Service and the Ministry of Health to decide on the goals of the partnership. Our initial objectives include:

1) improving pain management and the treatment of  infections in children with compromised immunity due to chemotherapy

2) provide training for health professionals from hospitals across Ghana through a series of workshops held twice a year at KBTH. Doctors and nurses from RHSC will travel to Accra to attend the training sessions and lead workshops

3) ensure that adequate chemotherapy and palliative care drugs are supplied so that all children receive the appropriate medication.
  

4) create a child cancer database to provide vital data to improve treatment.
  

5) improve the retention of skilled nursing staff at the KBTH unit by providing a monthly salary supplementation.  

6) improve adherence to treatment by recruiting a community outreach nurse who will be responsible for following up patients who have failed to return for treatment.   

7) implement awareness raising campaigns to promote recognition of the early signs and symptoms of childhood cancer and to remove the stigma associated with the disease.    

We’re very enthusiastic about the potential of this twinning partnership. Please do check back for updates on how the project is progressing…

If you would like to donate to support AfrOx’s work, please click here.

Welcome to the AfrOx blog

By 2020 there are expected to be 16 million new cases of cancer every year, 70 per cent of which will be in developing countries.

African countries are the least able of all developing countries to cope, and in most cases a diagnosis of cancer leads to a painful and distressing death.  AfrOx believes that the time to take action is NOW.

Our mission is to partner with African countries and help them to implement comprehensive cancer care and prevention programmes.

On this blog you can follow our progress, meeting the faces behind the programmes. You can read posts from the doctors and nurses providing vital training in Ghana, find out the latest developments in the Oxford office, and keep up to date with each of our programmes.

 We believe that cancer in Africa IS a disease that can be tackled. But it won’t happen on its own. We hope that you will join us as we try to achieve this goal.

To find out more about who we are and what we do, visit our website.