Career nurse Penelope Layne has been quietly leading an army of three at the Guyana Cancer Registry for the last twelve years. It is still in its embryonic stage but it is through the work done by the trio in their small Oronoque Street, Queenstown office that Guyana can determine the prevalence of cancer.
“The most important reason for a country having a cancer registry is to know the country’s burden of cancer… That is the only way you can know how to get a cancer programme going and where to focus much needed [attention] towards a particular cancer,” Layne told the Sunday Stabroek in a recent interview.
The registry is in the process of compiling its second five-year report assisted by the Pan American Health Organisation (PAHO) but already Layne, who is the registrar, is concerned about the continued prevalence of cervical cancer especially among women of child-bearing age. It is hoped that by the end of the year with the input of the Ministry of Health, the report will be completed and made public.
She said it is very heartening that women are taking more interest in their reproductive health, but the high prevalence of cervical cancer is of “immense” concern to her.
“We can’t continue losing our young mothers like that [to cervical cancer] and what is more worrying is cervical cancer is a very slow cancer, and so long as it is caught early it is 100% treatable, and that is why you need to do a pap smear,” she noted.
Five years ago the registry was invited to be a part of a consortium called the African & Caribbean Cancer Consortium which has proved very successful. Layne was encouraged to look at an aspect of the disease and she chose to look at cancer among women in the Guyanese population, placing special emphasis on women in their child-bearing years.
She said she was surprised to find that that a significant number of women in that age group had cancer and she said it was something which warrants some more research which she intends to do. She has since submitted her paper to the consortium board, and it has been accepted, and she is expected to make a presentation on it shortly. The paper was also accepted by the Annual Conference of International Association of Cancer Registries.
Training
A nurse for 36 years Layne said when she got the job as registrar she knew nothing about what was expected of her, but she quickly got on track with training in France and Trinidad with an attachment in England at a well-known registry.
The Guyana registry became a reality in May 2001, and one of the driving forces behind it was the late Dr Walter Chin, who headed the then Cancer Board. PAHO and its country representative Dr Bernadette Theodore-Ghandi were instrumental in making the registry a reality. The registry is a member of the International Association of Cancer Registries and Layne is a member of the International Association of Cancer Registrars.
It was knowing that her job as head of the UNDP dispensary would soon be no more that prompted her to apply for the post of registrar in response to an advertisement, and she was accepted.
“I have not regretted it; my disposition is I like challenges and I took it on and I am quite pleased with the registry where it is right now,” she said.
To be the registrar one has to have a medical background, and Layne recalled during her training in France she was the only nurse on the course, as all the other registrars were doctors.
The registry is a part of the Chronic Disease Department of the Ministry of Health and when that department submits annual reports information from the cancer registry will be included.
Layne and her staff visit all the major hospitals and health facilities around the country and while they do not go to the riverain areas and some of the interior locations, she said they are certain of capturing nearly everyone as treatment is not administered in those areas and persons must travel to hospitals for this. She explained that they have also hooked up with the rural area medical team which is doing work through the St Joseph Mercy Hospital, and a lot of information was received from them.
“We are not bothered by the riverain areas and those little health posts, because treatment and diagnosis are not done in those places; people come out into town. But what we might have a difficulty with is after they would have been treated… and they go back to their areas and they die. We might miss that because their deaths might not be registered, so it could be that we might have a few of those persons in the system who are dead,” Nurse Layne said.
Barring one private medical institution, the registry was successful in getting all medical institutions to see the importance of having data readily available to them following some sensitization programmes. Layne said some of the private hospitals have cancer data recorded separately, which makes it easier, and while initially the data at the Georgetown Public Hospital Corporation (GPHC) was in disarray, it has come together and its records department has been computerized.
Data is also collected from the laboratory and the health ministry’s statistical department, where all death information is collected. After the information is collected from all institutions Layne said her staff return to the office and cross-check to eliminate any duplication, and she does the final cross-checking during the data coding. During this process Layne says she receives invaluable assistance from the pathologist on the West Coast, Dr Walcott and Dr Nehaul Singh at the GPHC.
“So I stand by the data that is coming out of the registry,” Layne said, adding that it is not practical to generate a report annually, hence the five-yearly report.
She now aims to get her data included in an international report called Cancers Inside Continents, and while it would be a difficult task since the data is vetted with a fine tooth comb, Layne is confident that with a “little more brushing up” she would achieve that goal.
Moulding
And while she manages the registry Layne also discharges the important function of lecturer at the nursing school, a role that she sees as very important in moulding the future nurses of the country.
She was trained as a nurse at the GPHC and while nursing was her second choice as a young woman since she wanted to be trained as a teacher in domestic science, she is still awaiting a reply to an application she had sent many moons ago to the Carnegie School of Home Economics.
“But I have always said I would do it again in a heartbeat; I have enjoyed every year of nursing,” Layne said.
As a lecturer she has fulfilled her calling of teaching, and she noted that she is passionate about the medical profession and about nursing education and is peeved when she hears what is happening at the hospitals involving nurses. She said that nurses need to understand that when persons are sick they are very emotional and so are their relatives, and they may be rude and they have to deal with this in an appropriate manner.
“It is my opinion that a lot of people coming into the profession are coming for all the wrong reasons; they come in because it is a springboard to go further afield. But my point is while you are here you need to focus on your studies and be the best,” Layne observed.
She said it is known that nurses are being trained for the overseas market and what they will be required to do overseas is what they are not prepared to do locally.
“In my humble opinion nobody can pay a nurse; there are things we have to do as nurses that we can’t be paid for, you have to want to it from the bottom of your heart,” she said, and she warned that if an individual is not prepared for that they should not enter the profession.
Layne said she always wanted the opportunity to interact with students who are in their first days of training, and she now has that chance. She is expecting great things from the two groups she is now dealing with, since she is in contact with them five days a week.
Layne sees these trainees as change agents, as she feels there is a need to build the image of the nursing profession. While it is an uphill staff for the tutors of the school she said they would continue the work.
She feels that there are many older nurses who still remain in Guyana and who could be used as role models for those who are now entering the profession.
“Nursing now has gone a far way from bedside nursing; the sky is the limit now for nurses as you can specialize in so many areas. You can do management you can do your masters and provide teaching skills, and not only in the classroom but also in the area of clinical instructor,” she noted.
During her extensive career of active nursing Layne worked in almost all the departments at the GPHC, the Best (tuberculosis) Hospital now known as the West Demerara Regional Hospital, in the Essequibo region and at the Campbellville Health Centre. At one time she headed the Guyana Pharmaceutical Corporation Medical Centre before moving to UNDP, and then to her present position as registrar at the cancer registry where she
Layne is also a founder member of the Periwinkle Support Group which started as a breast cancer support group, but has now evolved into a cancer support group. Notwithstanding the work of the six-year-old group, Layne feels that there is a great need for a cancer society. Such a society existed in the past – another of Dr Chin’s initiatives – but it became defunct some years ago.
Layne is a proud of mother of two sons, her first, a pharmacy technician is working, and her second just completed law school in Trinidad and will be graduating with honours.
