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Report NNCTR/INCTR Nepal:
Introduction Although the percentage of infectious diseases is decreasing in Nepal, there has been an increase in non-communicable diseases, including heart disease, cancer, diabetes and asthma, which account for an increasing proportion of deaths. The number of new cancer patients per year in Nepal is estimated to be 45,000, and this number is likely to increase. With this in mind, NNCTR/INCTR Nepal, with the support extended by INCTR, and in concert with local government and non-governmental organizations (NGOs), hospitals and communities, has developed several programs related to prevention, treatment and research in the field of cancer in several districts in Nepal. More than 121,722 people have benefited from the public awareness program conducted by NNCTR/INCTR Nepal in the last six years. During the same period more than 10,250 healthy married women (between 30 and 60 years of age) have been screened for cervical cancer and provided treatment when necessary – including for infectious conditions identified during screening. More than 1,640 health workers have participated in the Palliative Care Sensitization Program. 355 people, including social workers, technicians and other trainers have been given training appropriate to their role in ongoing programs. The progress report of NNCTR and planned activities for the period of January 2008 to October 2008 are presented here. The activities are discussed under the following headings: 1. Cancer education. 2. Cervical and breast cancer screening and prevention. 3. Cervical cancer vaccine program. 4. Palliative care program. 5. Anticipated outcomes. 1. Cancer Education 1a. Workshop on nursing oncology – an update (6th Jan - 11th Jan 2008) Venue: Nursing in-Service Education Room, Tribhuvan University Teaching Hospital (TUTH) - Participants: 26 Nurses from five Hospitals. A one-week continuing education program in all aspects of the nursing care of patients with cancer was jointly organized by NNCTR/INCTR Nepal and TUTH with the support of INCTR and the Rural Women’s Development and Unity Centre, Nepal. Dr. Yogendra Prasad Singh of TUTH was the principal coordinator of the workshop. Topics discussed included patient evaluation, general nursing oncology, cancer surgery, radiotherapy and cancer chemotherapy. In the course of the workshop, nurses were acquainted with breast self-examination, cervical cancer screening by Pap smear and VIA/VILI, lung cancer and smoking, gastrointestinal cancer, psychosocial aspects of care, pain management and palliative care. Field visits were arranged to some centers where relevant activities are ongoing, and nurses' knowledge was tested prior to and after the workshop. 1b. Training the trainers (TTT) programs (20th to 24th April 2008) Venue: Chetana Kendra Training Centre Budol, Banepa - Participants: 20 persons participated in the training from 13 non-governmental organizations which coordinate their programs with the NNCTR/INCTR Nepal's Cancer Education program. A five-day TTT program was conducted for persons from seven districts in Nepal (Kaski, Makawanpur, Mahottari, Sarlahi, Kabhre, Kathmandu and Lalitpur). 1c. Cancer education TTT refresher training (25th April 2008) Venue: Chetana Kendra Training Center Budol, Banepa - Participants: 25 cancer educators who are Cancer Education program Local Trainers. A one-day refresher course was held for cancer educators from five districts. The achievements of the program to date and planned changes were discussed and the important role of the educators emphasized. NNCTR resource persons Dr. Aarati Shah, Dr. Y.P. Singh and Dr. Sudip Shrestha provided the training, organized by NNCTR/INCTR Nepal.
1d. District level coordination meeting and networking ( 25th April 2008) Venue: Chetana Kendra Training Center Budol, Banepa - Participants: 35 representatives of relevant district organizations, local cancer educators/trainees and doctors. NNCTR/INCTR Nepal held a meeting designed to improve networking among local governments, NGOs and hospitals working on cancer prevention and early detection at the community level in several districts of Nepal. A network comprising 13 NGO's has already been formed and cancer education programs are in operation in seven districts. The main objective of the meeting was to discuss the mobilization of local resources and facilities at minimum cost. A review was presented of progress of NNCTR since its establishment to the present, and future plans relating to its collaborative activities with the participating NGOs were discussed. 1e. School and community level cancer education program During the years of NNCTR/INCTR’s operations, more than 16,000 individuals from 95 schools and communities have benefited from its school- and community-based cancer education programs. Concrete achievements can be demonstrated and activities have significantly expanded during this period. There were four handicapped trainees among them and they in turn educated 82 handicapped (deaf) people for cancer education in two districts. The Federation of Handicapped Association (deaf) of Nepal also collaborated in the cancer education programs.
2. Cervical and Breast Cancer Screening and Prevention 2a. Australian embassy, Nepal – the direct aid program (dap)/small grant program In 2007, NNCTR/INCTR Nepal submitted a proposal to the Australian Embassy for a small grant to provide access to 1,500 women for cervical cancer prevention, screening, treatment and follow-up. The Embassy accepted the proposal and signed an agreement with NNCTR/INCTR Nepal on October 29, 2007. Up to the present, under this program, cervical cancer awareness programs have been organized in 26 centers. More than 2060 women have been screened for cervical cancer; 45% were found to have a genital infections and 20% had uterine prolepse of varying degrees, probably resulting from multiple pregnancies. Patients with cancer were referred for follow-up investigations. 2b. Treatment for women with uterine prolapse Surgery for prolapse is rather expensive for many women. Accordingly, NNCTR/INCTR Nepal developed an understanding with Scheer Memorial Hospital (SM), Banepa, to provide less expensive treatment, which the majority of women take advantage of. In addition the Rural Women’s Development and Unity Center, Nepal has agreed to provide funds for the treatment of 52 cases of prolapse. Although not cancer, many women benefit from the inexpensive care provided for this problem and NNCTR/INCTR Nepal continues to seek additional funding for such services.
2c. Cervical and breast cancer technical skill transfer workshop (25th Feb to 2nd March 2008) Venue: Tribhuvan University Teaching Hospital, Kathmandu (TUTH) - Participants: 25 senior nurses from various institutions. A seven-day refresher course on Cervical and Breast Cancer Screening technical skills was jointly organized under NNCTR/INCTR Nepal and TUTH with the support of INCTR and the Rural Women’s Development and Unity Centre, Nepal. The course, again, was coordinated by Dr. Yogendra Prasad Singh of TUTH. 2d. Technical skill transfer workshop on cervical cancer screening, prevention and treatment for medical doctors and nurses Venue: Eye Centre, Tribhuvan University Teaching Hospital, Kathmandu - Participants: 71 health workers, 14 doctors and seven nurses. NNCTR/INCTR Nepal, TUTH and Phase Worldwide, UK, jointly organized a four-day technical skills transfer program from 24th to 29th June 2008 at four different centres – TU Teaching Hospital, Chhatrapati Free Clinic, the Maternity Hospital, Kathmandu and Scheer Memorial Hospital, Banepa. Support was provided by INCTR and the Nepal Health Tax Fund, Ministry of Health, Nepal.
On the first day, more than 71 health workers took part in the theory class. On the following three days of practical workshops, 14 doctors and seven nurses were trained. During the practical workshops 39 patients with positive cases selected from different primary screening camps were referred for further investigation and treatment by colposcopy and cryotherapy. The principal international consultants from Phase Worldwide UK, (an INGO) were obstetricians and gynaecologists Dr. David Nunns, Dr. Rafiat Adekunle, Dr. Sotirios Vimplis and Dr. Gerda Pohl, all from UK. The national faculty was comprised of Dr. Aarati Shah, Dr. Sheela Verma, Dr. Raj Shree Jha and Dr. Meeta Singh. Dr. Meeta of TUTH was the principal coordinator. The workshop was very successful; all of the participating Nepalese doctors and nurses had a very good opportunity to share skills and knowledge with the International consultants, and doctors from other hospitals have shown a keen interest in joining such workshops in the future. Phase Worldwide UK has agreed to provide support for a six-week training facility for two doctors every year for three years, beginning in 2007. Four Nepalese doctors have already completed the six-week training program in the UK. The last group is expected to leave for UK early next year.
3. Cervical cancer vaccine program 3a. Cooperation with australian cervical cancer foundation (ACCF) In 2007, the australian cervical cancer foundation (ACCF) was formally established in Brisbane, Australia. The main goal of ACCF is to raise funds in cash or in kind for supplying Human Papilloma Virus (HPV) vaccines for protecting women from uterine cervical cancer. Michael T. Wille is the Executive Chairman of ACCF and Dr. Surendra Bade Shrestha, President of NNCTR/INCTR Nepal has been appointed Director of the Nepalese program. NNCTR/INCTR Nepal and ACCF signed a Memorandum of Understanding in 2007, according to which NNCTR/INCTR Nepal would be the sole administering agency for the vaccine in Nepal and would mobilize necessary funds for all local expenses for the management of the program. ACCF has set a goal of supplying up to 10,000 courses of HPV vaccine every year, gradually increasing from 100 courses in March 2008. NNCTR/INCTR Nepal has received clearance from the Drug Administration Department to use the vaccine in Nepal. The program was formally launched in March 2008 in Nepal at an event hosted by the Australian Embassy. To date, 100 female students of the 12-14 age group from five schools have been vaccinated. 3b. Visit by a team from the australian cervical cancer foundation (ACCF) A six-member ACCF team, including its Chairman, Michael T. Wille, Deputy Chairman, Lenore Wille, Prof. Ian Frazer, the inventor of the HPV vaccine, Gardasil, and the ACCF Director, Mrs. Linda Lavarch, former Member of the Queensland Parliament, Australia, visited Nepal for a five-day period. The main purpose of the visit was to share the team’s knowledge and experience with Nepalese medical professionals and other stakeholders of the HPV vaccine in Nepal. Many Nepalese doctors took a keen interest in the interactive program. The highlights of the program were: i. On October 2nd, 2008, Prof. Ian Frazer gave a presentation on HPV vaccines at TUTH. 105 medical professionals attended. ii. On October 3rd, at the premises of Australian Embassy, Prof. Ian Frazer held a “meet the press” program. He briefed the press about HPV vaccine. The same day he gave another presentation at an event held at Hotel Radisson. Many medical professionals from different hospitals and medical institutions attended. A lively question and answer session followed. iii. On October 4th, a one-day field trip was organized with the entire ACCF team and officials of NNCTR/INCTR Nepal to the Village Development Committee (VDC) in Shankhu village. The purpose of the trip was to administer Gardasil to 80 schoolgirls in grades 7, 8 and 9 in the Shankheswore Malaxmi Vidhyalaya, Shankhu, and Kabhre districts. Prof. Frazer also briefed the press and the community about the importance of the vaccine. Although it was a school holiday, an impressive number of local people and students came to receive the vaccine. This was the second visit of the ACCF President and the first for the other board directors. On their first visit, the ACCF team had brought with them 300 doses of Gardasil, sufficient for 100 girls, and on the second, 3000 doses, sufficient for 1000 girls. Many Nepalese people and medical professionals had an opportunity to learn about the HPV vaccine from Prof. Frazer, and knowledge of this advance was also widely disseminated by the media. ACCF President Michael Wille and Prof. Ian Frazer have given assurances that they will be bringing in more and more vaccine to Nepal in order to vaccinate more schoolgirls with the intent of saving the lives of hundreds of women from cervical cancer. This will be no small task – there are estimated to be approximately 140,000 girls aged 11-14 in Nepal. The ACCF team Nepal program was organized and managed by NNCTR/INCTR Nepal with support from the Australian Embassy, the Nepal Oncology Society, TU Teaching Hospital and the ACCF from Brisbane, Australia. A total of 184 girls have been given the HPV vaccine to date. 4. Palliative Care Program 4a. A two-day international palliative care workshop in nepal supported by INCTR and UICC (1st - 2nd Feb. 2008) Venue: Staff Collage, Jawalakhel, Lalitpur - Participants 1st Feb: 30 (25 doctors & five government officials). Participants 2nd Feb: 38 (nurses and social workers from 12 hospitals, four government offices and 11 social organizations). NNCTR/INCTR Nepal organized a two-day workshop on “The Challenges of Palliative Care Development in Nepal,” which was aimed at developing and strengthening palliative care in Nepal. The first day was devoted to the education of doctors, the second to nurses. The workshop was inaugurated by Dr. Bishnu Prasad Pandit, Secretary of Health and Population Ministry of the Nepali Government. Dr. Surendra Bahadur Bade Shrestha, President of NNCTR/INCTR Nepal, welcomed the international and national participants and made a brief presentation in which he described the work of NNCTR/INCTR Nepal in cancer prevention, treatment and research, and its involvement in the development of palliative care in Nepal. The objectives of the workshop were: 1) To discuss the challenges of developing palliative care in Nepal. 2) To acquire an understanding of the challenges in developing accessible and affordable palliative care in Nepal. The focus of this workshop was to provide information about the goals and methods used in the delivery of palliative care as well as teaching methods for various health care providers. Special attention was given to the need for a multidisciplinary approach. 5. Anticipated outcomes The organizers anticipate two major outcomes of this workshop, as follows: In the course of the workshop, efforts were made to explore the present status and the urgent need for palliative care in Nepal. It sensitized the policymakers and various stakeholders to the need for the formulation of a national policy as an urgent priority, and the need to base the policy on a thorough understanding of the present situation and the challenges faced in moving forward. |
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Copyright © 2010 The International Network For Cancer Treatment and Research