Authors:
Marie Goretti Uwayezu RN MScN1
Bellancille Nikuze RN MScN1
Emile Munyembaraga RN MScN1
Margaret I Fitch RN PhD1,2,3
1Scholl of Nursing and Midwifery, University of Rwanda, Kigali, Rwanda
2Bloomberg Faculty of Nursing, University of Toronto, Toronto Canada
3School of Nursing, New York University, New York, USA
The burden of cancer is increasing around the world with almost three-quarters of this burden expected to occur in middle- and low-income countries. The incidence is expected to double by 2050 in some Sub-Sahara African countries (Fidler et al., 2018). Rwanda lies at the heart of East Africa and has about 12.8 million inhabitants. Eighty-three percent live rurally in nuclear family compounds. The country can be held up as a model for how a resource-limited country can build a strong health care system.
The Rwandan health care system is a decentralized and multilayered system with specialized centres for some diseases. Cancer is one such specialty which is growing in terms of infrastructure and human resources. As of 2021 an estimated 10,704 new cancer cases were diagnosed annually and 7662 deaths occurred. The most frequent female cancer was cervical (12.2%) and for males was prostate (15.6%). Cancer surgery is available in district hospitals while chemotherapy and radiation treatment are available in selected specialty programs. Like other African countries, people face challenges in accessing diagnosis and treatment for cancer including lack of specialty centres close to home; transportation to screening, diagnosis and treatment facilities; financial concerns; and pain and symptom management. As a result many face a late diagnosis (Stage 3 or 4).
Rwanda has shown leadership for cancer control. A national five-year plan for cancer control exists as well as a comprehensive prevention program for HPV vaccination and clearly articulated palliative care policy, guidelines, and standards. The country launched its own morphine production and distribution program to meet the needs for pain management in palliative patients.
Advanced nursing and midwifery education was established in 1996 at the Kigali Health Institute with opportunities for advanced diploma, bachelor and master’s preparation. In 2007, five Schools of Nursing were established which, in 2013, were joined through a Ministry of Health initiative under the University of Rwanda. In 2015, a two-year Masters of Science Program was started with eight specialty tracks including Oncology Nursing. The other tracks were Critical Care and Trauma; Nephrology; Pediatrics; Neonatal; Perioperative; Medical-Surgical; and Education, Leadership and Management.
The Oncology Nursing Stream is a four-semester program and offers education for nurses across cancer screening, diagnosis, treatment and follow-up care of both adults and children. End-of-life care, psychosocial care and cancer rehabilitation topics are incorporated. A thesis is required, and clinical practice components occurs in several hospital, clinic, and home settings.
To date, three cohorts have graduated, and the 4th and 5th are enrolled. Graduates are assuming clinical and leadership roles in their respective health care facilities as well as faculty positions in Schools of Nursing. Additionally, they are beginning to publish their research and offer presentations at international conferences. The program is building capacity for oncology nursing in the country.
References
- Fidler MM, Bray F, Soerjomataram I. The global cancer burden and human development: A review. Scandinavian Journal of Public Health, 2018; 46: 27–36.
- Uwayezu, M.G., Nizure, B., & Fitch, M.I. (2020). Oncology Nursing Education: Looking Back, Looking Forwards and Rwanda’s Perspective. eCancer Journal, 14,1079. https://doi.org/10.3332/ecancer.2020.1079
- Uwayezu, M.G., Nikuze, B., Fitch, M.I (2020). A Focus on Cancer Care and the Nursing Role in Rwanda. Canadian Oncology Nursing Journal, 30(3), 223-226.
This study was presented at ICCN2022 virtual conference.
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