At Butaro Hospital, Rwanda, the first doses of chemotherapy are delivered

Anne Elperin and Vedaste Hategekimana prepare one of the first doses of chemotherapy at Butaro Hospital, Rwanda.

This May, clinical staff in Rwanda took a momentous step toward offering comprehensive cancer care at Butaro Hospital in the northern, rural Burera District. During the week of May 13, the hospital – run by Inshuti Mu Buzima, PIH’s sister organization in Rwanda – began administering chemotherapy to nine patients undergoing treatment for cervical, breast, or rectal cancer.

Soon, patients with cancer will receive the full spectrum of oncology care when the hospital unveils the new Butaro Cancer Center of Excellence on July 18.

The new national oncology referral center will offer services never-before available in this region of Rwanda, including cancer diagnosis, chemotherapy, surgery, psychosocial support, and palliative care.

The Center is the product of a unique partnership with Rwanda’s Ministry of Health, Jeff Gordon Children’s Foundation, Dana Farber Cancer Institute and Partners In Health.

Anne Elperin, the first Oncology Nurse Fellow at IMB has worked closely alongside hospital staff to begin building oncology capacity as the program ramps up. Through PIH’s partnership with the Dana Farber, oncology nurses like Anne will spend three-month shifts training and accompanying Inshuti Mu Buzima staff. 

In the above picture, Elperin and Butaro’s new Oncology Nurse Coordinator, Vedaste Hategekimana, collaborating to administer inpatient chemotherapy.

Until now, IV chemotherapy has been offered intermittently on a case-by-case basis. Through Anne’s careful training and mentorship, nurses at Butaro will begin providing chemotherapy on a regular basis.
 
One of IMB’s District Clinical Advisors, Dr. Lydia Pace, has been working closely with Anne Elperin and the newly designated oncology team at Butaro on these efforts. 

On May 18, Dr. Pace sent us the following email update. We want to share her thoughts with all of our supporters.

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From: Lydia Pace
Sent: Friday, May 18, 2012 4:33 PM
Subject: Chemo at Butaro

Dear all,

I wanted to share with you a brief report on our first week of administering chemotherapy at Butaro Hospital in anticipation of opening the Cancer Center of Excellence this summer. Even though we’ve been treating cancer with chemotherapy at the PIH-supported Rwinkwavu Hospital since 2007, this week was our first formal introduction of chemo to patients at Butaro Hospital, and it felt like the real thing!

Vedaste, our new Oncology Nurse Coordinator at Butaro, worked closely all week with Anne Elperin, our Oncology Nurse Fellow from Dana Farber Cancer Institute. The two mixed chemotherapy and administered the medication to patients while also teaching oncology-trained and non-oncology-trained nurses.

Vedaste did a fantastic job, was extremely meticulous, and is now "signed off" with chemotherapy administration. Anne and Di Longson, our General Nurse Educator, carefully guided Vedaste and other oncology-trained nurses as they learned dose calculations, the mixing and administration process, and how to address some unexpected – but inevitable – challenges, such as suboptimal IV systems and leaky dextrose bottles, and staff shortages.

Our biggest challenge was that everything we did took a long time, but the processes will speed up as we get more practice. And, it feels great to be able to offer a full spectrum of cancer care here at Butaro.

We gave chemotherapy to five patients: one with rectal cancer, one with cervical cancer, and three with breast cancer. I think they all received excellent care, and they were very appreciative. Daily hugs from Anne also helped.

We learned a LOT! For example, in the future, we’ll plan on giving chemotherapy on pre-specified days to cut down on pulling staff away from other parts of the hospital. We will also work on scheduling issues to ensure that enough oncology-trained nurses are available on specified days, and that the Internal Medicine ward remains well staffed.

Since this is the first time that non-oncology nurses have worked with chemotherapy, some of them felt alarmed seeing the chemo team in their bright blue protective gear.  People were concerned about whether the chemo is dangerous.

To address their concerns, Dr. Egide, who runs Non-Communicable Disease (NCD) program, has joined us for follow-up meetings with nurses to discuss their concerns about chemotherapy safety. It is a challenge to present this information in a way that is clear and honest, yet not anxiety-provoking. But I think that these discussions have gone well so far.

This kind of dialogue will be essential to making sure that the NCD/Oncology program is successful for both patients and providers, and that we all feel pride in and ownership of this exciting initiative. 

Several of our maternity nurses are interested in learning how to administer chemotherapy safely to our two young women with cancer on the maternity ward, one of whom has nearly completed her therapy and is doing well. That patient has been a source of inspiration to us all, demonstrating the potential of cancer care in saving lives.

I wanted to extend a huge thank you to Anne for her expertise, flexibility, patience, dedication and good humor, and thank you to the Dana Farber Cancer Institute for sharing her and others who will rotate into service in the future.

We feel enormously grateful!

All the best,
Lydia

Learn more about PIH's work in Rwanda.