Those of us who Train Health Professionals must also Endeavor to Ensure Quality Training - Prof. Aziato

Prof. Lydia Aziato

Prof. Lydia Aziato, former Dean, School of Nursing and Midwifery has noted that Ghanaian women identify breast lesions accidentally or purposively through regular breast self-examination. She made this remark as she delivered her inaugural lecture on the topic, “The Intersection of Subjectivism and Patient Centered Nursing for Breast Cancer Care and Pain Management.”

Prof. Aziato revealed that there are over 2.3 million women diagnosed with breast cancer and 685,000 deaths which indicates that there are breast cancer survivors who require care, support, and treatment. She added that in Africa, breast cancer ranked first in both incidence and mortality in 2020 with 16.8% new cases and 12.1% deaths. She also noted that in Ghana, breast cancer ranked first in incidence and second in mortality with 18.7% and 13.0% respectively.

Citing predisposing factors such as family history, early menstruation, late menopause, and no full-term pregnancies, Prof. Aziato noted that the disease emanates from uncontrolled growth of abnormal cells. She identified the signs of breast cancer as lumps, changes in the size or shape of the breast, nipple and skin, and pain which is a late sign. Prof. Aziato disclosed that the treatment choices included surgery, chemotherapy, radiation therapy and immunotherapy or could be hormonal depending on the stage and type of breast cancer.

Sharing key findings related to breast cancer diagnosis, reaction to diagnosis and factors influencing care-seeking decisions, Prof. Aziato mentioned that early diagnosis can save a life; but diagnosis was sometimes delayed because of emotional reactions such as shock and sadness due to the fear of death associated with breast cancer. She asserted that women who were reliant on their spouses financially were more prone to delayed treatment and encouraged them to be self-reliant. “It is important for women to endeavor to work and manage their finances to be economically independent, to take control and contribute to their healthcare needs”, She stated.

Prof. Aziato disclosed that faith had been a major finding in research, and this was congruent with the evidence that most Ghanaians were religious. She said “The women with breast cancer entrusted their treatment to God. These women prayed and offered sacrifices to invoke the power of God for healing and financial support for treatment due to financial challenges”. She added that unfortunately, the many months of prayer did not cure the breast cancer but rather contributed to the spread of the cancer cells.

Prof. Aziato cited concerns with privacy and confidentiality due to public stigma, and challenges with breast prosthesis, pain management and wound care as challenges associated with breast cancer surgery. She further noted that the high cost of silicon prosthesis lead to some women using other materials such as cloth, and customised Plaster of Paris (POP) for artificial breast which prove uncomfortable. Furthermore, the lecturer defined mastectomy as the removal of the breast and disclosed that the process affect the body image, grooming and intimacy of women. She said “Pain after breast surgery also impede rest and sleep as well as exercising the arm which result in swollen arm also known as lymphoedema. The discomfort associated with the lymphoedema lead to poor quality of life”. Prof. Aziato added that women who are single with mastectomy are more inclined to hide their mastectomy status because they are not sure any man would accept them without a breast. She also cited hair loss, change of skin color, diarrhoea, vomiting, weakness and sore mouth as severe side effects women experienced due to chemotherapy.

Prof. Aziato revealed that a dominant finding was secrecy because disclosure results in stigmatisation and there are several misconceptions about breast cancer and its treatment, especially death associated with breast surgery. She noted that the negative misconceptions heightened the stigma; as a result, women avoided this by keeping their breast cancer diagnosis and loss of breast to themselves and only informed those they trusted.

Regarding social support, Prof. Aziato said, “It was consistently evident that women with breast cancer receive support from family, friends, health professionals and other bodies such as the church and NGOs. The support received were physical, emotional, financial, spiritual and social”. She noted that although the National Health Insurance Scheme (NHIS) covered surgery and chemotherapy, it was not always reliable since some women pay out of pocket due to the unavailability of drugs and the cost of laboratory investigations which is not covered by the NHIS.

Touching on pain management, Prof. Aziato noted that this is regarded as the 5th vital sign in addition to temperature, pulse, respiration and blood pressure; thus, health professionals assess pain regularly especially in units where pain is common. She added, however, that pain is highly subjective since it could be expressed verbally or non-verbally and could be influenced by socialisation. She stressed that inadequate pain management is common and leads to prolonged hospitalisation and complications.

Prof. Aziato opined that although there is inadequate training across the levels of the healthcare system, some nurses and midwives make personal efforts to update their knowledge and skills. “With this high level of trust patients have in healthcare professionals, we owe it to them to keep our knowledge and skills at the highest level so we can meet this requirement of ‘knowing best’.

Those of us who train health professionals must also endeavor to ensure quality training,” she said.

Prof. Aziato disclosed that patients do not often ask questions about their medications or treatment options since they assume that the health professionals know the medications to give them. She encouraged patients and their families to make efforts to understand their health challenges and ask questions as much as possible so they can contribute to their care decisions.

On the four main principles to improve pain management, Prof. Aziato mentioned that patient and family require adequate information and education on pain management, effective teamwork is required between nurses, doctors, and other health team members regarding pain management, input and monitoring from hospital management and departmental leadership is required to achieve effective pain management, and contemporary evidence-based recommendations for pain management should be utilised.

In her concluding remarks, Prof. Lydia Aziato recommended that patients with breast cancer should be supported holistically. She called on the Government, NGOs and philanthropists to contribute to making treatment available to women, while public education on breast cancer is intensified to address the stigma associated with the disease. She also suggested that effective management of pain must be upheld as a core mandate of nursing and midwifery practice and advocated a sustainable collaboration between religious bodies, prayer camps, spiritualists, traditionalists & health care professionals in relation to breast cancer patient care.

In her closing remarks, Prof. Nana Aba Appiah Amfo, Vice-Chancellor and Chair for the occasion congratulated Prof. Lydia Aziato on the insightful lecture and encouraged members present to take cues from the lecture and inquire about medications and drugs prescribed for them. She appealed to healthcare professionals to ensure patients enjoy a comfortable atmosphere by making them feel at ease.

Prof. Nana Aba Appiah Amfo

Prior to the lecture, the Registrar, Mrs. Emelia Agyei-Mensah, welcomed all present and announced that “Inaugural lectures form an essential component of the University’s programme for an academic year and every academic who rises to the rank of a professor in his or her career in the University of Ghana is expected to deliver an inaugural lecture”. Mrs. Agyei-Mensah added that inaugural lectures offer the University an opportunity to recognise and showcase the achievements of faculty as they share their research with colleagues within and outside the University.

The Ghana Dance Ensemble graced the occasion with cultural performances as well as Seperewa appellation to herald the lecturer.

Ghana Dance Ensemble

Several presentations were made to Prof. Lydia Aziato to congratulate her on her achievement.

As a prelude to Prof. Lydia Aziato’s inaugural lecture, a week-long exhibition of her scholarly works on breast cancer, pain, surgical nursing care, women’s health, herbal medicine, and spirituality was held at the Balme Library.

In attendance were Prof. Clifford Nii-Boi Tagoe, Former Vice-Chancellor; Prof. Ayerttey, former Dean of Graduate Studies; Prof. Yaa Ntiamoah Baidu, former Acting Pro-Vice-Chancellor of Research, Innovation and Development (RID); Prof. Fred N. Binka, former Vice-Chancellor of University of Health and Allied Sciences (UHAS) and former Dean of the School of Public Health (UG); His Lordship Justice Jones Dotse and Justices of the Supreme Court of Ghana as well as Members of Council from UHAS.

A section of the audience at the event

Other dignitaries present included officials from the health sector, nursing and midwifery associations, members of the University community, the media fraternity, Prof. Aziato’s family and the general public.