From Scotland to Ghana: sharing knowledge to improve cancer care

Fiona Bruce makes life a little more tolerable for young cancer patients in her role as a paediatric haematology/oncology advanced nurse practitioner at NHS Lothian’s Royal Hospital for Children and Young People. But her work isn’t confined to Edinburgh.

In fact, it’s taken her all the way to Ghana, where she volunteered with the UK-based organisation World Child Cancer to provide vital care to young cancer patients. Since 2011, Fiona has visited Ghana 4 times with the charity, and has also continued this work from closer to home in Scotland through the delivery of remote training.  
 
This work earned her the People’s Choice Award at the RCN Scotland Nurse of the Year Awards in 2023. The award gives the Scottish public the chance to recognise the work of nursing staff who’ve made a difference and gone that extra mile to ensure the highest standards of care.  

Team efforts from the off

Despite her newness to nursing, Fiona felt determined to get involved as soon as she came across the project in Edinburgh in 2011.

When she first went out to Ghana, the fundamentals of paediatric oncology care were starkly absent. As well as handling the workforce gaps, families had to fund medications themselves, and couldn’t even add their children to a registry to record the number of patients – because there wasn’t one.  

Limited resources meant patient safety was put on the backburner, with medications lying around in easy reach – worlds away from the protected pharmacy departments we take for granted in the NHS.

Since then, Fiona has offered her skilled support in a variety of ways, both in-person and remotely.

The teams in Ghana can now complete a specific training programme in cancer. They’ve been introduced to more structured supportive care pathways, and can access ongoing monthly online tutorials when distance gets in the way. Fiona and her team also helped paediatric oncologists set up a unit at Accra’s Khole Bhu Hospital.

The Royal Hospital for Children and Young People had just twinned with Ghana via World Child Cancer when Fiona got started, having now worked on the formation of 7 hospitals across the country that are delivering top-tier care.

This is a notable contrast to when Fiona started out, when there was just 1 nurse, in her 80s, delivering treatment to as many of the approximately 1,300 children who develop cancer in Ghana per year as she could. Given her self-assigned patch covered 100 miles, patients often had long distance to travel for appointments – and many would have not been able to access care at all. 

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Part of progress

A lot has changed within global cancer care, but also on more localised levels as each nurse charts their growth. “My responsibilities are very different to when I started, but it's difficult to step back because it's still such a rewarding scheme to be involved in,” says Fiona.  
 

“Being new doesn't mean you don’t have something valuable to share”

“The partnership has actually changed the nursing practice over there. They would do their training, then just get a job as a nurse – without specific branches, like paediatrics or mental health. That's how it had always been for them. I was put forward to develop a virtual accreditation course, to differentiate structure for paediatric oncology and boost morale more widely.”

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Joining the cause

Fiona encourages other nurses to help break barriers within their own specialism, even if the physical mileage concerns them. She stresses that they can still drive change from closer to home, and it can be a long-term project that can be picked up again as situations change.  
 
“You don’t have to be in the middle of horror zones – there are always ways you can help. Being new doesn't mean you don’t have something valuable to share. Be confident in yourself and just do it – don't think too much about any negatives,” Fiona says.  
 
And haematology is one area of nursing and medicine that’s developed a lot lately. Like Fiona’s own fusion of haematology/oncology, much of this crosses over to the cancer wards, with CAR-T treatment one recent example. Sharing lessons learnt from this arena with more socioeconomically deprived nations is a privilege not taken lightly by Fiona.  

This year, the “lovely surprise” of her award has reinforced that nurses aren’t in the role for public plaudits, but receiving recognition was meaningful. “Nursing is ever-evolving and this felt like a real team effort,” she says.