Lawrence Ikahu tells Eakin about his goal to develop stoma care in Kenya and the challenges he faces.
Lawrence is the first WCET International Delegate in Kenya, who works at the Aga Khan University Hospital in Nairobi. We were first introduced to Lawrence in 2009 by Prilli Stevens, who had been carrying out some voluntary work in Kenya. At this time, Lawrence had asked us for some basic stoma care supplies for his patients. We were of course happy to oblige.
Since then Lawrence has been working to establish a national colonic cancer patient support group and further develop stoma care. When Lawrence approached us this summer, to help him further his education, we were delighted to support such a worthwhile cause. Eakin agreed to fund Lawrence’s 3 year BSc in Cancer Care, which he has just started via distance learning, in conjunction with the University of South Wales.
We recently interviewed Lawrence to find out how is he progressing with his studies.
1. Describe a typical day in your hospital?
I am based in the oncology department (outpatient cancer care). Normally I am in the office by 7.15 am. I quickly go through my emails as most doctors, nurses and often relatives will have questions for me on stoma care or colorectal cancer screening. Typically I will get five or so emails regarding these topics, I will note the concerns on my diary and will normally work on solutions to answer them by the end of the day. Next I will do a quick blind visit to the major wards just to check if there are any patients needing my help. By 8 am I am ready to wear my regular hat (oncology nurse) and administer chemo and screen patients. All the surgeons and majority of nurses are aware of my roles, so during the day I will get called upon to see a new ostomate. The workload can be heavy but I get to see most patients. Often I will get walk in patients from public hospitals having been referred to see me. Unless this is an emergency I will usually schedule to see them some other day but usually within the week. By 5pm I usually still have so much to do, but I put all clinical work aside and take 30 minutes to answer the emails I had noted in the morning. Between 5.30 and 6.45pm, I wear my latest hat (student) and do some studying for my course at the University of South Wales. By 7pm I will head home. The exception of this routine is on Fridays, when I leave 5 pm on the dot to catch up with friends and have a bit of fun to unwind.
2. What are the main challenges in your everyday work?
The challenges are there but I try to turn them into opportunities to improve and bring the change I want to see, I don’t let them stand in my way. First and foremost I am not yet fully credentialed but I am in the process of doing so. This is a challenge because I can’t be fully released to serve as an ET, so I juggle between my regular work. The administration has promised that once am fully credentialed I will be fully released to run the services freely.
The other challenge is lack of awareness, products and stigma. This field of nursing has not yet fully evolved in Africa and a lot of times you want to help, you know what needs to be done but lack of products or social stigma stands in your way. Patients are suffering too much out there in their cocoons and knowing that you can help them but don’t know how to can be very discouraging at times.
The other challenge is workload. I love what I do but a lot of times it’s a case of too much to do so little time to do it. I am the WCET ID and this has facilitated me to see patients in the major hospitals, especially public, without conflict of interest as it’s voluntary. I often have to go after work or Saturday mornings otherwise they won’t get help.
There is a lot of hope as Enterostomal Therapy Nurses Education Program is currently going on Kenya twinning with Australia, 22 of us will be Stoma Wound Continence Nurses by February 2014. It is hoped that this will greatly improve the current scenario.
3. How are you progressing with your studies and how do you hope this will help you overcome the challenges you face?
This has been a big dream come true. My interest in oncology nursing goes way back six years ago, just after graduating from my medical Training College as RN. Cancer has been on the rise in sub-Saharan Africa and I feel the strongest urge ever to be part of the solution. There are no universities offering such programs in Kenya, it has been five years of searching, logistical challenges have not been kind either. In this part of the world breast and cervical cancers have been given a lot of attention. It occurred to me that colorectal cancer unlike others is more demanding because rehabilitation is lifelong. I made the decision to be a colorectal nurse and I know by doing cancer studies I will have a better chance in bringing solution to the society. With this degree and as a credentialed SWCN I will be sure to impact on the whole trajectory of the disease dynamics right from creating awareness, screening, rehabilitation and research. Overall ultimately improving the quality of life and for this am very excited.
4. How did your interest in stoma care develop? Who has inspired you throughout your career to date?
Would you believe it? Two different patients from different social economical classes and a colorectal surgeon were the catalysts that helped awaken my passion.
Scenario one – As a junior nurse fresh from college I was allocated a ‘difficult’ patient, a new ileostomate. I had no clue where to start but the agony he was going through made me determined to solve his problem, at least for my own sake as I was going to be with him the rest of the week! So there I was scratching my head looking at a stoma for the first time, raw skin all around and a distraught patient. I was so lost in the case I didn’t hear the surgeon come in, he said to me, “Lawrence you will make a great Stoma care nurse.” His name is Dr R. Chauhan and I have never looked back. This particular patient had all the financial ability to afford quality products but he was suffering. The thirst to gain new skills and improve care was ever growing.
Scenario two – This was heart breaking, seeing a man on the streets with a stoma exposed, begging for help.
I was then convinced this is what I needed to do the rest of my life…………..be there for Ostomates through all faculties.
I later moved to the oncology department, my manager Mr Makumi was and still is very supportive in my milestones. It is through his efforts that I knew WCET and now seven years down the line I am about to be credentialed. I feel convinced I am in the right direction.
5. What advice would you give to other colleagues starting stoma care projects in developing countries?
I would like to address them through a short story.
The story of the courageous weaver bird. It so happened in this beautiful forest .The dry season soon came and the jungle became very dry. Soon the forest caught fire. Typically all animals including the king of the jungle (lion) took to their heels. Their homes were going to be no more. However the weaver bird rushed to the nearby stream and drew water with its beak. It would come and pour the water on the fire, it did this countless times in attempt to put out the fire. When the other animals saw this, they laughed so much asking the weaver bird what it was doing, the weaver bird said it was putting out the fire….they laughed all the more and wondered how its small beakful of water can put out a vast bush fire.
The weaver bird had this to say, “I am doing what I can, with what I can, however I can, and the best way I can to stop the fire.”
The other animals saw the sense and soon joined in to supplement the efforts and they succeeded.
To those colleagues in Africa, there are a million reasons to give up but my message to you is, “Do what you can, the best way you can with what you can”. The policy makers and industry players will join your efforts in due course but just don’t sit there.
Do not give up. Remember it’s the quality of life of that patient whom you have impacted that matters most.
Where there is a will there is a way as the century – old adage says.
Vision, passion and persistence
6. What are your hopes for the future after completing your studies?
I see a future full of great achievements in the war against cancer in general. I envision having a very active Colon Cancer Foundation in Kenya which will engage in awareness, research, mitigating stigma, finding easier treatment options, up-to date rehabilitation techniques and empowered patients. This is my ultimate goal.
DE 
