I recently returned from a three-month rotation as a nurse fellow at a comprehensive cancer center at Butaro Hospital in Rwanda, a tiny African country known as the “land of a thousand hills.” The hospital, built and operated by the Ministry of Health and Partners In Health, is located in a rural, mountainous area where most residents are farmers. Because most homes do not have running water, people fill up 5-gallon jugs at the local water spigot.
The new cancer center, which opened in July 2012, includes up to 34 beds and an outpatient clinic. An outpatient infusion center will open this summer.
Patients travel from across Rwanda and neighboring countries for their cancer care here, often taking public transportation (very crowded mini-buses) or walking, which may take several hours. It is not uncommon for patients to travel a full day to get to the hospital and another to get back home. They bring along a caregiver who shares a hospital bed and provides personal care such as bathing and feeding.
Last year, Dana-Farber introduced a fellowship that allows one nurse at a time to spend a three-month rotation here, teaching local nursing staff how to care for cancer patients. The three nurses who came before me trained their Rwandan colleagues in many aspects of oncology nursing, such as mixing chemotherapy drugs, administering chemotherapy accurately and safely, and building knowledge about cancer and the side effects of chemotherapy.
When I arrived last spring, I helped introduce better systems for managing a growing volume of patients. Paper charts are now better organized. There is a calendar for recording appointments and admissions, a dose calculation sheet so a second nurse can double-check chemotherapy doses, and there are worksheets to organize the day’s activities.
While I was there, the Partners In Health team was implementing an electronic medical record (EMR) in the cancer unit. The EMR contains pre-built chemotherapy order templates that do all the calculations needed, reducing the chance for human error. We are also building a report that summarizes, for the pharmacy, all the chemotherapy needed for the day, thereby eliminating the need for the nurse to hand-write every drug needed. The EMR will also replace our handwritten appointment book by generating patient lists.
As the last DFCI nurse fellow during the first year of the program, I will give a written assessment to the Rwandan nurses to evaluate their knowledge base at this point in time. Using the assessments and each our own experiences, the three other nurse fellows and I will develop a road map for year two of the fellowship.