C. Muhayimana

D.G. Umuhizi

L. Buswell

L. Svoboda

S. Kennell-Heiling

V. Hategekimana

Annals of Global Health

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Oncology nursing workforce capacity building in rural Rwanda:
                        Strengthening specialized cancer care through nursing education and skill
                        development

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Human Resources and Workforce A n n a l s o f G l o b a l H e a l t h , V O L . 8 2 , N O . 3 , 2 0 1 6M a yeJ u n e 2 0 1 6 : 4 7 3 – 5 1 0484Data and disease in Dhaka: Patterns and perceptions ofillness in an unplanned community in SankarA. Morse1, I. Zahid2, T. Sultana2, J. Reba2, M. Sabuz2, S. Akter2,F. Akter2, S. Biwash2, P. Palash2, S. Tuni2, R. Sultana2, I. Painter1;1University of Washington School of Public Health, Seattle, Wash-ington, USA, 2Spreeha Bangladesh Foundation, Dhaka, BangladeshBackground: We conducted a survey of residents in an unplannedcommunity in Sankar, Dhaka, Bangladesh to determine perceptionsof the origin and manifestation of disease with the aim to createimproved interventions to increase clinical care utilization. Currently,approximately 11% of local families use the Spreeha clinic.Methods: We surveyed 77 individuals in their homes using randomcluster sampling and a version of the Illness Perceptions Question-naire adapted for the purpose and translated into Bangla. We askedrespondents to evaluate their perceptions of illness outcomes andphysician capabilities on a 5-point Likert Scale and to evaluate diseaseorigins andmanifestations on a binary scale.We recruited participantsby going door-to-door, alternating sides of the road and speaking tothe first willing individual in each housing block. We analyzed resultswith descriptive statistics and two-sample t-tests in Stata andcompared them with clinical diagnoses.Findings: Three-quarters of respondents were women. Mostrespondents were aware of biological pathogens (89.61%) and thedangers of environmental pollution (90.92%), but 71.43% believedthat supernatural forces also cause illness and 10% madeunprompted statements that all illness comes from Allah. Half ofrespondents felt they were at risk of illness. Respondents weresignificantly more likely to report believing that a physician couldaid them in the event of an illness if they also indicated that theyfelt they had control over whether they became ill (p ¼ 0.0020)or if they felt that they were at risk of becoming ill (p ¼ 0.0357).There was not a statistically significant difference in the proportionsof individuals indicating belief in a doctor’s capabilities and accep-tance of either superstition (p ¼ 0.1095) or their acceptance of bio-logic pathogens (p ¼ 0.6054).Interpretation: Knowledge of biological pathogens is common,but there is still a lag in clinical utilization among Sankar residents.Spreeha might find more success in shifting focus in health promo-tion interventions from pathogen education to highlighting indi-vidual control over health outcomes and individual risk.Funding: None.Abstract #: 2.028_HRWOncology nursing workforce capacity building in ruralRwanda: Strengthening specialized cancer care throughnursing education and skill developmentC. Muhayimana1, S. Kennell-Heiling2, L. Svoboda3, D.G. Umuhizi1,V. Hategekimana1, L. Buswell3; 1Butaro Hospital, Butaro, Rwanda,2Partners in Health, Butaro, Rwanda, 3Dana-Farber Cancer Institute,Boston, MA, USAProgram: Providing specialized oncology education and trainingtonurses in a rural hospital in a low-income country requires humanandfinancial resources and governmental and institutional support. Since2012, the Dana-Farber Cancer Institute (DFCI) has collaboratedwithPartners inHealth and theRwandanMinistry ofHealth toprovideoncology nursing education and skill development. DFCI developeda global oncology nurse fellowship to place aUS-trained oncology nursein-country for three to 12 months to mentor, teach, and build in-country nursing expertise and leadership.Structure: The following describes two nurse training programstaught by DFCI nurse fellows: a three week orientation for nursesfrom the oncology department at Butaro Hospital and a 12 weekcourse for nurses from referral hospitals in Rwanda to build nationalnursing capacity. Both tracks include an overview of cancer, treat-ments, chemotherapy, side effects, oncologic emergencies, palliativecare, patient and family education, and survivorship. Teachingmethods were contextually related to cancer care in Rwanda, andinclude lectures, readings with discussion questions, oral presenta-tions, role-plays, and clinical practice. Evaluations consist of preand post tests, demonstration of skills, and competency checkliststo track mastery of skills and knowledge.Outcome & Evaluation: The three week program has been offeredsix times with 46 nurses completing training. Knowledge assessmentscores from this program show an average increase of 14% betweenpre and post tests. The experience has yielded an educated and skilledoncology workforce at Butaro Hospital and has developed the firstRwandan oncology nurse leaders a ward manager, a care coordinatorand an educator who now co-teaches both training programs toensure sustainability. The 12 week program was piloted with twostudents. Knowledge assessment scores from the pilot show anaverage increase of 18% between pre and post tests.Going Forward: In order to develop a robust model of sustain-ability, DFCI is collaborating with the University of Rwanda todevelop a Masters curriculum in oncology nursing using contentfrom the above courses. Oncology nursing workforce capacitybuilding is paramount to address the burgeoning global cancerburden. Similar low resource settings should strive to prioritizeoncology education for nurses.Funding: DFCI.Abstract #: 2.029_HRWGlobal task shifting to nurse anesthetists: A systematicliterature reviewS. Mukhopadhyay1,2, P. Milsom3, F. Federspiel3; 1Program in GlobalSurgery and Social Change, Harvard Medical School, Boston, MA,USA, 2University of Connecticut Integrated Residency Programs,Farmington, CT, USA, 3Dept. of Global Health and Social Medicine,Harvard Medical School, Boston, MA, USABackground: Estimates of the surgical workforce defined assurgeons, anesthesiologists, and obstetricians indicate 2.2 millionmore providers are necessary to address the current global surgicalburden of disease. This shortage is concentrated in low- andmiddle-income settings. Although major increases are required inall three cadres, trained anesthesiologists have historically beenparticularly lacking. Task shifting, the movement of tasks from

Oncology nursing workforce capacity building in rural Rwanda: Strengthening specialized cancer care through nursing education and skill development

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