Members of Sunnybrook’s Odette Cancer Centre Oncology Nursing department participated in an International Society of Nurses in Cancer Care twinning program in Kenya to share expertise with oncology nurses at a symposium and workshop and to gain insight into local funding and cultural issues affecting cancer incidence and care delivery.The Odette Cancer Centre Oncology Nursing group of Kathy Beattie, Angela Boudreau, Marg Fitch and Sherrol Palmer-Wickham met with health-care professionals at rural and urban facilities including Kenyatta National Hospital, Kijabe Hospital and Aga Khan University Hospital. One of the most common female cancers in Africa is cervical cancer – a highly preventable disease in North America due to ready access to the annual Pap screening test. In Kenya, there is no funding available to facilitate free, public access of the Pap test and tragically, cervical cancer remains prevalent. For cancer screening and prevention, Kenya’s oncology nurses improvise. Instead of using more costly Pap tests which require laboratory support, they conduct acetic acid tests and visualization examinations – a low-resource and moderately effective screening method for cervical cancer. Related to breast cancer, another common cancer in Africa, nurses go to where women frequent. In the grocery stores on market day, or in the furniture stores, nurses set up low-cost, temporary breast health assessment clinics that are well attended. Half of Kenya’s population lives below the poverty line. The group learned that poor socio-economic status highly predisposes a cancer patient to late screening and treatment intervention at more advanced stages of disease. Also, lack of funding in cancer care, for example, means lack of specialty chemotherapy equipment such as intravenous tubing and chemotherapy gowns and gloves to better protect patients and health-care professionals. Patients are often given direct injections instead of injections in a running intravenous. This puts them at risk for drugs leaking out of the vein, and damaging healthy tissue. Nurses, pharmacists and physicians are at risk of long term toxic exposure as they continually prepare and administer drugs with improper ventilation and no protective gear. “We also learned about ‘the curse of cancer’ which often discourages individuals from seeking immediate treatment,” says Sherrol Palmer-Wickham, manager, Ambulatory clinics and Chemotherapy unit, Sunnybrook’s Odette Cancer Centre. “For a woman diagnosed with cancer, her personal ‘value’ is affected and so is the value of her family and the marriageability of her daughter(s). The woman and her family are viewed as cursed, therefore she will not tell anyone about her diagnosis and may not seek treatment.” Having gained some insight into cancer care challenges, the group worked with staff from Aga Khan University Hospital to develop for over 70 oncology nurses, a chemotherapy workshop of most relevant topics presented in a culturally sensitive way to facilitate more intra-professional and patient care discussions and greater linkages among local hospitals. “We helped clarify some care delivery questions, for example, in the frequent association of cancer treatment (chemotherapy or radiotherapy) with the consequent death of a patient,” says Angela Boudreau, clinical practice leader, Chemotherapy unit, Sunnybrook’s Odette Cancer Centre. “We hoped to add expertise and facilitate discussions so that the association would lead instead to a better understanding. As the week progressed, nurses began to recognize the complexities of the disease, and of treatments, as factors that can impact outcome. Some of these included treatment at advanced stages of disease, treatment complications or treatment side effects. This thinking helped establish that a patient’s death can be caused by factors other than treatment itself.” “We went to Kenya to help be a catalyst for moving things forward from within the system. We gained profound respect for these nurses who deliver care despite significant challenges,” says Kathy Beattie, supervisor, Chemotherapy unit, Sunnybrook’s Odette Cancer Centre. “Our goal was to make the symposium about learning and empowerment, and to acknowledge local expertise. We hope these nurses will share their experiences with peers, to help affect change,” says Marg Fitch, head, Oncology Nursing, Sunnybrook’s Odette Cancer Centre. The International Society of Nurses in Cancer Care twinning project was generously supported by a grant awarded from the International Union Against Cancer (UICC/ Union Internationale Contre le Cancer).