Developing Stoma Care and Cancer Care in Kenya

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Lawrence Ikahu tells Eakin how he is progressing with his studies and how his stoma care project in Kenya is developing.

We introduced Lawrence Ikahu last year after we had agreed to help him further his education by funding his 3 year BSc in Cancer Care, which he studies via distance learning, in conjunction with the University of South Wales. We interviewed him recently to see how he is progressing with his studies and how his stoma care project in Kenya is developing.

1. How is your stoma care project in Kenya developing since we last spoke?

We now have18 fully qualified Stoma Wound and Continence Nurses (SWCNs) in Kenya and 2 from Neighboring Tanzania. This was one of two dream come true projects for me, coupled of course with the existing vibrant ostomates support groups network system in the country. It has been very important for me that the SWCNs evolve and grow their own capacity, so I am taking more time now seeing patients. As late as last month, during the national palliative care conference, one of the SWCNs gave an excellent paper on stoma and fistula care. So we are moving in the right direction, but still a lot needs to be done to see this specialty fully evolve.

2. You are now into your 2nd year of studies, how are your progressing? Have you been able to bring these new skills to help overcome the challenges you face in everyday work?

My studies have been among one of the most exciting milestones in my life. I am now in year 2 and I must say this online model favors me a lot, consequently several Kenyan nurses now are looking forward to pursue the same course! The first module really helped me understand the science behind cancer and was a great area to start from as I have a firm foundation. We are now covering the impact of cancer, I am passionate about improving the quality of life for cancer patients. This is the module that is going to educate me to be able to handle the challenges.

3. Last month you were awarded Nurse of the Year Award for Nairobi County. What does this mean to you?

When I was awarded nurse of the year in Nairobi County and second nationally, this was a most humbling moment. I am not and do not pretend to be the best. We have very good experienced nurses in Kenya who I have a lot of respect. The fact that the national nursing leadership noticed my dedication to stoma, wound and continence care in itself is a big win, not for me but for patients and the nurses who have taken interest in this field. We are now seeing a lot of change of attitude for the better and more nurses are recognizing this area.

4. You recently helped set up distribution of Eakin products in Kenya. Can you tell us some more about this?

You know how they say that there is the climax of every journey? For me this is it. I have used Eakin wound pouches and skin care products for 5 years, through donations or importing from South Africa. The results, of which I publish regularly through case studies, made me dream and wish for one thing only, that one day there will be a dedicated Eakin distribution in Kenya.

So when a dedicated ostomate and a committed sales executive well known to me kept saying how they would wish to start a company in my field of specialty, I saw this as the opportunity I was waiting for. This was 2 ago and through my input, advice and very thoroughly looking at all logistics, finally Incostom limited was born. Incostom is made from the words incontinence and stoma. Their ethos is life without limits.

We have seen an influx of stoma bag manufacturers set up distributorship in Kenya recently. This is good. However, one area has been left out. Skin care, high output stomas and fistulae.

It is important I clarify that every distributor in Kenya sought my advice in the past and I encouraged them. The difference is that Incostom were looking to cover an area that is not covered. The ownership of Incostom is very dedicated and I have no doubt it shall flourish.

Technologically Kenya has greatly advanced and East Africa is being seen as the next IT hub in Africa. A lot of services have gone online, clothing, properties, food, etc. Seeing how healthcare is not taking advantage of this and seeing how stoma care and continence care products are intimate, Incostom is the first company to embrace online shopping. As is usual with all flagship and pioneer projects, a lot of challenges are to be expected but we believe this is the way of the future.

Finally a lot of clients visiting the East African region, may it be as expatriates, tourists or simply coming back home after treatment abroad, often feel lost as to where to get help. Similarly some avoid coming to take holidays here as they are not sure if they will get help or products. Incostom will aggressively market itself as the home company away from home, so that all may feel comfortable to come to the region, with assurance that all the care and products will be available for them. We are in the process of producing a very interactive user friendly website which will be launched very soon.

Eakin funds Kenyan nurse to further his education

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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………… 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.