BullETin October 2013 1

Issue October 2013

In this Issue

Vice President’s Message 1

ASCN UK Meeting 1

APETNA Meeting 2

Paediatric Stoma Clinic 3

Malaysia Site Visit 5

NNGF Day Celebrations 6

Upcoming Meetings 13

Vice-President’s MessageSusan Stelton, Vice-President, WCET

Hello Everyone!This issue includes information about the ASCN UK Meeting, the APETNA Meeting, a new Paediatric Stoma Clinic and the Malaysia ETNEP. It also features ways in which our members celebrated Norma N. Gill Day on June 26. Thank you to everyone who sent information and photos about how you celebrated the day. Please send me your news items for the next BullETin by 15 November.

The Association of Stoma Care Nurses Congress – United Kingdom

The ASCN UK Board Standing Left to right: Rebecca Davonport, Treasurer, Jules Plumb, Secretary, Wendy Osborne  , Education Office, Gilly Tomsett, Vice Chair, and Judy Hanley, Chair.

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APETNA 2013 Congress:The Korean Association of Wound Ostomy Continence Nurses (KAWOCN) held the 5th APETNA Congress during 6-7 September 2013 in Seoul, Korea. The main theme of this event was communication, coordination and collaboration of ET nurses. More than 400 ET nurses and doctors from 17 Asia-Pacific countries attended: 146 from Korea and 255 persons from other countries.

The congress was comprised of scientific programs including special lectures and symposiums on ostomy care, pressure ulcer management, and various wound management protocols and free paper sessions. In total 132 abstracts were presented: 20 were oral presentations and 112 were poster presentations.

The Korean Society of Coloproctology and 12 sponsor companies actively helped support this congress. APETNA will donate EUR 2000 to the NNGF.

Gala Event

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First “Paediatric Stoma and Gastrostomy Clinic” in Gauteng, South AfricaBy Jolanda Janse Van Noordwyk

And so the story begins……..a Paediatric Stoma and Gastrostomy Clinic was set up at Chris Hani Baragwaneth Academic Hospital in Johannesburg, South Africa, as a result of a (UFS) University of Free State Stomaltherapy student and a group of paediatric surgeons accommodating an identified need in the community.

Chris Hani Baragwaneth Academic Hospital, a public hospital, is the biggest and probably one of the busiest hospitals in South Africa. Situated in Soweto, Johannesburg, South Africa, the Chris Hani Baragwaneth hospital is the third largest hospital in the world, occupying 173 acres (0.70 km2), with 3 200 beds and 6760 staff members. This hospital furthermore receives patients from beyond the immediate community of Soweto and is a referral hospital for other areas of South Africa and beyond. The paediatric surgery department is also the busiest unit of its kind in South Africa, and the Paediatric Surgeons thus treat a vast array of interesting pathology. Not least of which includes Ano-rectal Malformations (ARM).

South Africa has a population of about 52 million people. ARM affects both genders, and occurs in about 1 out of 5,000 infants. During normal bowel movement, stool travels through the large intestine, to the rectum, and then to the anus. The nerves in the anal area help us sense the need for a bowel movement and stimulate muscle activity, thus the muscles in the anus helps control when a bowel movement occurs. ARM is a birth defect which relates to the anus and rectum, but often includes the urinary and genital tracts, taking place in the lower end of the digestive tract, which develops abnormally. Several abnormalities can occur, with an ARM, such as the anal passage may be narrow, the rectum may not connect to the anus, a membrane may be present over the anal opening, or the rectum may attach to a part of the urinary tract or the reproductive system within an irregular path.

ARM’s are a complicated congenital abnormality that requires long term care in a specialist centre. Follow-up of these patients is essential to achieve good outcomes. Up until recently all ARM patients at Chris Hani Baragwaneth Hospital were followed up in a general outpatient clinic and seen by junior surgeons who had limited experience with this condition.

After returning from an outreach mission in Ghana, treating patients with ARM, Dr C. Westgarth-Taylor was inspired to make some changes to the current system at Chris Hani Baragwaneth. After long discussions with Dr J. Loveland (Head of the Paediatric Surgical Department) they came up with a plan to create a specialist clinic for ARM patients.

The consultants working in the paediatric surgical department at Chris Hani Baragwaneth Academic Hospital all have an interest in managing patients with ARM. It was thus easy to formulate a strategy to develop the clinic. By chance Dr J. Loveland bumped into Sr Jolanda Janse van Noordwyk, in May 2012. They got chatting about the prospects of an ARM clinic and Sr J. Janse van Noordwyk, a stomaltherapy student at the University of the Free State’s School of Nursing, was keen to get involved.

Sr. J. Janse van Noordwyk, Dr J. Loveland, Dr R. Fartacek and Dr C. Westgarth-Taylor held several meetings to discuss the way forward. Sr J. Janse van Noordwyk pledged to supply the Paediatric Stoma and Gastrostomy Clinic with staff for a year, which was to be her, Sr P. Robinson, Sr M. Le Roux, and Sr M. Radebe, if the Peadiatric Surgery Department would supply the infrastructure. She compiled a list of identified needs to set up such a clinic, including obtaining samples and quotes (inclosing local tenders) from stoma product and anal dilator suppliers. She promised to train up the hospital’s staff, who could then take over the running of the clinic.

In the meantime Dr J. Loveland discussed the plans with the CEO of Chris Hani Baragwaneth Academic Hospital. She agreed that the clinic would be hugely beneficial to the children of the hospital, and so gave her blessing. A clinic space was identified and procurement of all necessary equipment and consumables was arranged.

Since the clinic began 11 months ago, a dedicated Consultant Paediatric Surgeon and a now qualified stomaltherapy nurse see all patients every Wednesday morning between 08H00 and 13H00. The multidisciplinary team comprises of the Paediatric - , Gastroenterology - , Urology - , and Radiology Departments, with a dedicated Dietician, and

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Speech Therapist. Sr J. Janse van Noordwyk and Sr P. Robinson managed to complete all their paediatric practical training requirements at this clinic for the Stomaltherapy Post Basic Program.

At the Chris Hani Baragwaneth’s “Paediatric Stoma and Gastrostomy Clinic”, output and input stomas are cared for, another first in South Africa. Procedures and training at the clinic includes amongst others teaching bowel washouts (rectum), MACE procedures (Malone Antegrade Continence Enemas), Mitrofanof principals, intermittent catheterizations of urinary diversions, Anal dilation programs, Fistulas such as Perineal / Perianal fistula’s, Recto-vestibular / urethral bulbar fistula’s, Persistent cloaca, and abnormal connections or openings between 2 epithelial surfaces, hollow organs or a hollow organ and the skin.

Gastrostomy patients/ parents are pre-counselled at the clinic and consent for Percutaneous Endoscopic Placement of feeding tubes is obtained. Education is given on the post-operative care and management of the stomas and any peri-stomal skin complications are treated, as well as replacement of enteral feeding devices takes place when needed. These patients are seen weekly by the Speech therapist and Dietician. We treat on average about 40 patients per month.

At the end of the clinic, ward rounds are done to attend to patients who are not able to visit the clinic. Newborn babies and mothers are seen in the Neonatal ICU, and the mothers often visit the clinic during their baby’s hospitalization, even if just for support and to talk to the other parents gathered in the waiting area. The end of 2012 was a joyous time at the clinic as donations of toys and clothes were received from caring companies, and handed out to show the community’s children our love and care for them.

Sr J. Janse van Noordwyk and Sr P. Robinson both believe that counselling, education and training of the parent or care giver is as imperative as good stoma care, as this optimizes patient outcomes, compliance, and empowers the parents or care givers to confidently continue with treatment at home as they return to a normal life. Many of the children are well adopted and attending school.

“I am extremely proud of the end product and grateful for the excellent stoma care at the clinic. We have a well-run clinic that has improved the management, outcome and follow-up of these patients”, Dr C. Westgarth-Taylor said. “We are in the process of identifying a nurse to take over from Jolanda’s team. This nurse will be sent on a stoma-therapy course to complete his/her training at UFS in 2013.”

Barra Stoma Staff Jolanda Janse Van Noordwyk and baby with g-tube

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Site Visit to review the Malaysian Enterostomal Therapy Nursing Education Program Submitted by Carol Stott, Education Committee Member, Australia

One of the roles of the WCET Education Committee, under the leadership of the chairperson Vera Santos from Brazil, is to review Enterostomal Therapy Nursing Education Programs (ETNEPS) to make sure that they fit certain criteria which is known as WCET recognition. As part of the review process a member of the WCET education committee travels to the site to attend part of the course. This is usually for between one and two weeks. The country requesting the review pays the expenses of the reviewer. I was fortunate enough to be asked to go to Malaysia to review their course which was being held in Kuala Lumpur the capital of Malaysia. The hospital, University of Malaysia Medical Centre (UMMC), where most of the lectures were given, was actually located in Petaling Jaya which is the next city or town to Kuala Lumpur.

The course was 12 weeks, with 6 weeks theory and 6 weeks practical. Tan Teng Peng (past president and now advisor to the Malaysian Enterostomal Therapy Nurses Association (METNA) and Mariam Nasir (ETNEP program director) who is also the current president of METNA and the other committee members organised and ran a very good course. Rozita Mohamad the program co-director and the other preceptors and committee members gave their time and expertise to ensure that the course was a huge success and 31 new ET nurses graduated mainly from Malaysia but some from other countries in SE Asia.

The course covered theoretical aspects of stoma therapy nursing, wound management and promotion of continence with clinical placement at several hospitals with trained ET nurses as preceptors. The work that is being carried out in the wards and stoma and wound clinics is very impressive, mirroring the dedication of the Malaysian ETN’s, Doctors and other health care workers.

The hospitals are massive, with Kuala Lumpur General Hospital having 3,800 beds and UMMC 1,500 beds. The logistics of running something this big are just incredible. Most people attend the hospitals for much of their primary health care as it is made very convenient for them. Such things as community nurses and community outreach programs are in their infancy in Malaysia, but will be coming. I was asked to talk to senior nurses and medical staff at UMMC about discharge planning when I was there. We had a very lively interactive discussion about bed managers, patient discharge lounge and other initiatives which are ‘tried and tested’ in Australia but just being introduced in Malaysia.

During the course I gave about 8 hours of lectures on a wide range of topics from paediatrics ‘Congenital gastrointestinal tract –conditions requiring a stoma’, Stoma and Wound management in Gynaecological Oncology patients and Hyperbaric Oxygen Therapy and Wound care

During the course the students organised an Ostomate gathering where there was entertainment and ‘interactive fun’. All the participants including Ostomates, Student ET nurses and ET nurses all enjoyed themselves. The students also helped to organise the inaugural Malaysian Enterostomal Therapy Nursing Conference which ran over two days with several national and international speakers. The students all had to present their case studies at this conference and were marked on such things as content, presentation skills and PowerPoint presentation preparation. I was very impressed by all of the presentations.

Widasari Sri Gitari from Indonesia attended the conference with 11 of her own students. Wida who is the director of the Indonesian ETNEP gave a very interesting presentation about ET nursing in Indonesia and their achievements over the past few years.

Dr Harikrishna, a renowned international speaker, gave a very good presentation on Diabetic wound management in Asia. His views on such things as Collagen dressings were very entertaining and kept the conference amused.

Another notable presentation was by Dr Christina Ong, who is the President/ founder of EMPOWERED, which is an awareness program for early detection of bowel cancer. One of their initiatives is to advertise that ‘Empowered’ is going to be coming to a poor socio-economic area by leaflet drops and posters advertising an information evening.

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Time and effort is spent fund-raising for this so that there are such things as food raffles to ‘entice’ people to attend. The Faecal Occult Blood testing kits are given out at the meetings and currently there is an 85% return rate, which is extremely good. If a person has a positive test, a medical student volunteer with training from ‘Empowerment’ plus a nurse volunteer with ‘Empowerment’ training break the news to the person. The medical student supports the patient through any treatment that they require which is all free of charge.

I gave 2 talks at the conference on nursing Informatics and nursing research. There were many other interesting presentations which were all very well received. The students also helped to organise the graduation dinner which was attended by ET nurses, both new and experienced, colorectal surgeons and company representatives

Malaysia is a fascinating safe country with very friendly people who were always helpful to me when I got lost and needed directions or, even more importantly, needed a western toilet!! Although I did spend a lot of time working, I did get some time for sightseeing and shopping

Kuala Lumpur is the capital of Malaysia. Even though it was only established as a mining town in the 1850’s, it is now a metropolis achieving city status in 1972. It is a thriving tourist centre with world class hotels and many shopping malls. One of my favourite shopping malls is Suria KLCC which is situated below the Petronas Twin Towers which are set in landscaped gardens with an artificial lake and beautiful fountains.

Tan Teng Peng took me to Malacca sight-seeing one day. Malacca is a historical town which has many interesting sites to see which illustrate very well Malacca’s turbulent past with Portuguese, Dutch, Chinese Vietnamese and British invasions over the previous 5 centuries. A very strong rickshaw driver managed to manoeuvre Tan Teng Peng and me into his rickshaw and give us a conducted tour of the wonderful sites of Malacca. He was very proud of his Portuguese ancestors and told us all about their community and their traditions in Malacca.

It is always good to spend time with hard working enthusiastic ETN’s who have a passion for stoma therapy nursing, and the Malaysian ETN’s certainly have that in abundance. Hopefully they will run many more courses in the years to come.

Norma N. Gill Day Celebrations June 26Here are many of the ways our members celebrated Norma Gill’s birthday across the globe from ‘A’ to ‘Z’:

Australia – sent by Lisa Wilson, The Royal Melbourne HospitalIn Australia I am hoping to have some reflections from around the country in our next Journal. I have taken on the role of Editor of the Journal of Stoma Therapy Australia. I look forward to working with our WCET colleagues. Both WCET and AASTN have a great deal to be proud of from our past practitioners.

Brazil – sent by Sonia Dias

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Canada – sent by Emily WissanjiMy name is Emily Wissanji and I am running a Facebook and twitter campaign for the Canadian Association for Enterostomal Therapy (CAET). In honour of the day - we have made a poster and will refer, share and tweet about it for the rest of the day and tomorrow as well!

We thought you may want to see it. Here is the poster:

Chile – sent by Heidi CamposThanks for reminding me about the day to celebrate Norma Gill Day. I will do a study day on Friday 28, June, sponsored this time by Convatec. I will tell about our leader Norma and how she developed stoma care nursing in the world.

Guangdong Province, China – sent by Xiao FangThank you for your helpful reminder for celebrating the WCET Norma N Gill Day. We’re going to run a ‘Celebrating Norma N Gill Day Afternoon Tea Activity’ very soon.

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Guangzhou, China - sent by Zheng Meichun Professor De Sen Wan organised a symposium to celebrate Norma N. Gill Day in the afternoon on 26th June, and all the ETs in Guangzhou were invited.

Beijing, China – sent by Song Yanli 宋艳丽

We celebrated the Norma N. Gill Day in our office with our new ETs of Beijing ET School. We held a seminar and did a workshop of ostomy care and wound care. Please kindly find the picture. NNG day is 26th so we show the finger 2 in the first line and show 6 in the second line. That mean is today is 26th

China - Anhui ET School

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China – sent by Chung Heong Wong

Jiangsu Province, China – sent by Linyan Wong

ET JuyunLi cares for a wound patient in a community clinic at the Jiangsu Province Hospital of Traditional Chinese Medicine to cherish the memory of Norma N Gill.

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Shanghai, China - sent by Chen Jie I was so happy to hear about Norma Gill Day. I read the attachment and decided to make a poster for my work place about ET nursing. I am proud to introduce Norma Gill’s history to my collegues and doctors. All of them have admiration for her spirit. 

Reading the poster and looking at the Norma N. Gill festschrift book.

The poster:你知道吗?

今天是Norma Gill日！Norma Gill Thompson (1920 – 1998)

美国人，是世界第一个造口治疗师。1954年，Norma Gill当时是一位三个孩子的年轻母亲，曾患溃疡性结肠炎5年之久，是克利夫兰医院的Turnbull医生采用全结肠切除、回肠造口术治愈了她的疾病。由于她的祖母也是一位结肠造口者，Norma Gill非常了解造口病人所面临的各种问题。她每天跟随Turnbull医生巡视病房，逐渐成为向病人提供相关咨询、指导病人使用造口器具的专门人员。Turnbull与Norma Gill女士这样的合作关系为造口治疗开辟了新的方向和希望，在全世界范围内得到同行们的赞同。1958年Turnbull邀请Norma到克里夫兰医学中心协助工作。1961年成立了第一所造口治疗师学校。

1978年在意大利米兰成立了世界造口治疗师协会（the World Council of Enterostomal Therapists，WCET），Norma Gill成为第一任协会主席。WCET是一个国际性护理协会，现总部设在美国，它为合格的肠造口治疗护理培训提供专业机构和教育。

WCET的目标是：

造口治疗全球化发展

让所有的造口患者无论他们生活在哪里，都能接受到由专业造口治疗护理人员带来 的造口护理 希望通过纪念Norma Gill日，让更多的人加入到为造口患者提供支持、帮助、教育的队伍中来.儿童国际造口治疗师ET 陈劼

2013-6-26

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Historic Photo of ET Program in Hong Kong – sent by Widasari Sri Gitari (of Indonesia)I love the way that Norma and all the ETs around the world are doing their job and committment. I am so proud to be there between you and all the members. This was the picture when I have done my ETs in HongKong. And as 1st ETNEP in HK, we have taken a picture with Norma and Our best teacher Marylin Spencer. It was a great time to be there with all the wonderful ETs from HK

Kanpur, Up India – sent by Laxmi Shanker KushwahaTo celebrate Norma. N. Gill Day we conducted  a stoma care program at GSVM MEDICAL COLLEGE, KANPUR, UP INDIA among the junior Drs by sharing  information about the rights of the ostomate.

I have conducted stoma care presentation at LLR hospital at Kanpur,Up India on 26/06/13, I have served meal and at last we have given spiral (notebook) along with pen. All General Surgeons took an active part in the program.

Dr. Subandhu Tripathi opened the program.

Indonesia – sent by Irma ArisantyI will publish information about Norma Gill Day in facebook.

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Nepal

South Africa – sent by Mrs Pam Zungu and Joyce Mavanini

Mrs Pam Zungu sitting on the left side and Joyce Mavanini standing on the attached picture had in-service education with the hospital management staff to honour Norma N. Gill Day on 26 June.

The main focus was to highlight the importance of an informed consent for a patient who undergoes surgery for colostomy. It was surprising to note the interest shown by the management team regarding Stomatherapy. They had full insight of what is taking place in this field and asked a lot of questions which we addressed. We had a wonderful day and also got the opportunity to empower other colleagues on the Stomatherapy field. The day was fulfilling for us as we achieved our goal: “That more people become aware of all the extraordinary accomplishments in the world of enterostomal therapy nursing.”

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South Africa – sent by Judy Chamberlain, WCET Life Member

Thank you for the lovely message on Norma Gill’s birthday. I am sure you all celebrated a wonderful career, thanks to her and Robert Turnbull Jr.!

To celebrate it this end, I am running a large Health Awareness Day in our big hall here in Doone Village, where at least 20 Exhibitors will give exposure to the public on various nursing, medical, surgical, and other needs particularly the elderly, including WCET banners and information.  So there you are ... my contribution !! I have had to delay it to 14th September but know it will be a success and very well supported.

United States of America - sent by Dr. Diane Krasner

Norma was a great lady and I am honoured to have known her . . . sort of like knowing Florence Nightingale. I’ve got a copy of the NNGF ready to give to a nursing colleague at our meeting tomorrow! Thanks for the great idea.

Upcoming Meetings:Just 8 months to go until the WCET Congress!

20th WCET Biennial Congress, 15-19 June, 2014, Gothenburg, Sweden