The International Cancer Corps program is a partnership between ASCO and Health Volunteers Overseas (HVO)—an international medical education organization with 25 years of experience working with professional medical societies to develop education and training programs. With the help of program directors based in North America, HVO pairs volunteers with a medical center where the training needs of the facility match the expertise of the volunteer. The aim of the ICC program is to exchange medical expertise, develop training programs, and build long-term, supportive relationships between ASCO and the clinicians who provide cancer care in countries that have an HVO/ICC presence.

ASCO interviewed HVO/ICC oncology nurses Loyda Braithwaite and Roberta Beisoabout their experiences at the Tegucigalpa, Honduras site. 

	Oncology Nurses Roberta Beiso (left) and Loyda Brathwaite (right) speak to a local nurse (center) about chemotherapy administration at San Felipe Hospital in Tegucigalpa, Honduras. (June 2013)

What made you interested in volunteering; why did you choose to go to Honduras?

Ms. Braithwaite: My interest in cancer care began early in my professional career. During undergraduate nursing studies in Panama, I performed clinical practices at the Panamanian National Oncology Institute. Since then, I knew oncology was my calling. While practicing as an RN in the U.S., I have had many opportunities to acquire the latest knowledge and evidence-based practices in cancer care nursing. However, I was aware that there are several limitations that impede nurses in developing countries to access these resources.

Even though I had a strong desire to share these opportunities with my colleagues in developing countries, I had not been able to reach this goal. When I read about HVO and ICC in conjunction with ASCO, I was thrilled with the idea of volunteering in oncology nursing education. I became very interested in the program because HVO focuses on teaching and providing academic training to health care professionals in several areas, including cancer care.

Ms. Beiso: Participating in an overseas health care volunteer program was something I have wanted to do even before entering nursing school. I looked into many organizations offering volunteer opportunities, but had difficulty finding a particular program that aligned with my goals of teaching abroad. The day I read the mission and values statement of HVO, I knew I found what I had been looking for. "Quality, improve, empower," and, most importantly, "educate" were the words that made me feel that I could finally give back in the way I had dreamed about. The idea of not only providing care for patients, but being able to teach and collaborate with the nurses who would be working long after my week was up, inspired me to choose HVO.

What were your first impressions of the San Felipe Hospital?

Ms. Braithwaite: I was amazed to see the condition patients had to be in to get treatment for their illnesses. The lack of staff, clinical resources, and basic elements, such as water, were very difficult to assimilate to. I could not believe that this hospital was one of only two public institutions in the entire country that would provide surgery, chemotherapy, and radiotherapy administration for patients with cancer.

Ms. Beiso: My first impression of San Felipe Hospital was eye-opening. The patients are strong and have very basic expectations. I witnessed much more family involvement than in the U.S. in every aspect of care. For instance, many families provide their loved ones with home-cooked meals because there are no dietary services. Even more surprising to me was the fact that family members also provide the chemotherapy, and other medications from local pharmacies, to be used for the patients while in the hospital. The lack of staff, supplies, and general polices stood out to me as a challenge. Since San Felipe Hospital is one of only two oncology providers in the entire country of Honduras, patients have to travel far distances and wait for many months between diagnosis and treatment. These circumstances delay treatment and allow diseases to progress leading to poor patient outcomes. The fact that there are only three medical oncologists and one surgical oncology physician program limits the opportunity for advancement and progression in the field, as well as access to care.

What surprised you about your visit to the hospital in Tegucigalpa?

Ms. Braithwaite: The "dying room" or area for terminal patients was the most surprising area of all. The concept of palliative care has not been developed or incorporated into the care of patients with terminal diseases. However, I was also impacted by the nurses’ passion and dedication to their patients, even with all the limitations and constraints to do their job.

Ms. Beiso: Many things surprised me about my time in San Felipe Hospital. I was touched by the warmth, passion, dedication, eagerness to learn, and adaptability of the nurses. It was clear to me that we shared the emotional involvement and strain that this field can bring, which plays a huge part in our sense of duty to heal. We found camaraderie in each other, knowing that this is the very reason we chose this profession and bonded over the challenges we face universally as nurses. I was in awe by the amount of patients that spend their last days in the hospital due to the advanced stages of disease. Even though most patients present to the hospital with advanced disease, there is a huge lack of palliative care resources and training. There is no formal training for chemo certification, and many of the nurses learn to give chemo while on the job. This leads to inconsistency in care.

Oncology Nurses Roberta Beiso (blue shirt) and Loyda Brathwaite (seated, foreground) perform a training exercise with oncology nursing staff at San Felipe Hospital in Tegucigalpa, Honduras. (June 2013)

What lasting impressions/effects do you think your visit might have?

Ms. Braithwaite: I felt that my major contribution was to empower nurses--strengthening their professional confidence--and to provide them with basic knowledge that will open new opportunities and solidify their careers as nursing professionals. I also enjoyed translating the slides and being able to offer these educational sessions in the nurses’ primary language, Spanish. However, this was just a small step in the development of well-prepared oncology nurses who are able to utilize their knowledge and professional skills to improve the care of patients and families affected by cancer.

Ms. Beiso: I hope that our time at San Felipe Hospital had an impact on the nurses and other staff we worked with. I would like to think of our time as a small start, planting a seed for change. Our lectures gave the nurses a sense of empowerment. Putting emphasis on communication and the importance of the nurses' role, I feel, made a lasting impact. Hopefully, this will be remembered by the nurses and will trickle down into all areas of their work, leading to the ambition to want to continue learning and, in turn, teach what they have learned to others. Having nurses as part of the medical volunteer team clearly has a direct positive impact on the patients, families, nurses, physicians, and overall level of oncology care in Honduras. Through each lecture we presented, we emphasized a theme of empowerment and pride in our role as nurses. I think this aspect is crucial in creating a stepping stone for change and advancement. I sincerely hope our time helped create a positive spark of awareness.