ICCN2020 is proceeding as planned, and a great program is in place. ISNCC is aware of the global news regarding the Coronavirus (COVID) and the evolving travel advisories. At the moment, health authorities in the United Kingdom stated that risks to individuals in the UK remain low (https://www.gov.uk/guidance/wuhan-novel-coronavirus-information-for-the-public). We’re following the guidance of the World Health Organization (WHO) and the UK Department of Health and Social Care. We will monitor the UK Foreign Office (https://www.gov.uk/foreign-travel-advice/china and communicate any changes for arrivals in the UK. Please note that many airports have added additional screening for visitors arriving from China and for those who have visited China recently.
As nurses we know, and the WHO reminds us, frequent hand washing with soap and water is the best way to prevent infections.
The 15th of February is International Childhood Cancer Day, and this year it is particularly significant for nurses looking after children and adolescents with cancer across the globe. 2020 is the year when the World Health Organisation (WHO) Global Initiative for Childhood Cancer (GICC) converges with the WHO and International Council of Nurses’ Year of the Nurse and Midwife. We have an unprecedented opportunity to bring childhood cancer, and children’s cancer nurses, to the attention of policymakers, service providers, physicians, and our nursing community.
Cancer is almost universally thought of as a disease of adulthood, but it is also a leading cause of global childhood mortality from non-communicable diseases, affecting approximately 300,000 children and adolescents annually. In high-income countries like the UK, it is the number one cause of death in children 1 to 15 years of age. However, the burden of childhood cancer falls most heavily on low and middle-income countries (LMIC), with higher populations of children and adolescents and where many are never even diagnosed of their disease; many never reach treatment, and those who do have significantly lower survival rates than those treated in high-income countries, where over 80% now survive.
Over 80% of children and adolescents with cancer live in LMIC, where cure rates may be as low as 20%, and it is the shocking inequity in access to treatment, and the outcomes of care which led to the launch of the WHO Global Initiative for Childhood Cancer (GICC) in 2018, funded by St Jude Children’s Research Hospital in the US. The aim of this initiative is to improve the global survival rate of the commonest childhood cancers to 60% by 2030. To achieve that target, capacity building is required in all aspects of childhood cancer care in all LMIC. The workforce is a critical element of capacity building; nurses together with midwives, constitute the largest group of health workers across the globe.
Expert pediatric oncology nurses are fundamental to providing high quality, safe and effective care to children and adolescents with cancer and their families, and yet nurses in LMIC frequently lack specialized training, and hospitals often have inadequate staffing and resources to provide quality care. This is a major impediment to treatment programs and contributes to low survival rates in these settings. The Nurse Specialists of the GICC is a coalition of nurse leaders from across WHO Regions. The group seeks to advocate for nurses caring for children and adolescents with cancer, with an emphasis on nurses in LMIC. We have published an open-access paper on the ethical imperative to provide a safe work environment and specialist training for nurses working in this field.
On International Childhood Cancer Day in the Year of the Nurse and Midwife, we call upon all engaged in childhood cancer services to acknowledge and support the critical role of nurses and to provide those in LMIC with the training, resources and leadership opportunities they so richly deserve to contribute to the goal of improving both care and cure.
Ariesta Milanti, BSN, RN, MHC, Public communication committee, Indonesian Oncology Nurses Association
In the global map of the tobacco issue, Indonesia holds some prominent figures. According to the World Health Organisation data, Indonesia ranked first in the prevalence of tobacco smoking (76.2% among males aged 15 years) (WHO, 2015). This number is estimated to keep increasing by up to 82.5% by 2020 (WHO, 2015). More than 97 million Indonesian people are exposed to the tobacco smoke (Ministry of Health Republic of Indonesia, 2013). On the other hand, Indonesia is the 6th leading tobacco-producing country in the world (FAO, 2017), and in the top five countries with the highest level of tobacco industry interference (Assunta, 2019). Additionally, Indonesia is the only country in Southeast Asia that has not ratified the Framework Convention on Tobacco Control/FCTC (WHO FCTC, 2018).
In Indonesia, more than 230,000 tobacco-related deaths occur every year; in which lung cancer contributes as the highest cause of cancer death (Ministry of Health Republic of Indonesia, 2015). With the increasing trend of smoking in a younger population less than 15 years old, this figure is very likely to increase (National Development Bureau Indonesia, 2017). Most smokers in Indonesia are those with lower levels of education and socio-economics and live in the villages.
The above overview may give a hint on how severe the tobacco problem is and how arduous it can be for tobacco control advocacy in Indonesia. Despite the myriad challenges, Indonesian nurses through the Indonesian Oncology Nurses Association (IONA) are keen to contribute to it. That is why we take the ISNCC position statement on tobacco control very seriously. In our national meeting, we learned it and decided to translate its key points into our national agenda. We are compelled by the statement that nurses should take the lead in tobacco control activities.
Therefore, we organised a tobacco-control campaign in seven provinces throughout Indonesia (link to the article here). It was a major event to mark IONA’s anniversary. The cancer nurses conducted public education talks about tobacco control at the hospitals and community and called the attendees to write down their anti-tobacco commitment statements. It was both exciting and rewarding for us to be able to do more for the community, apart from our daily practices at the oncology wards or units.
But as the event was concluded, so was our tobacco control advocacy book. We had no idea on how to sustain the agenda or how to implement a more comprehensive intervention encompassing the educational and cessation programs – let alone advocating policy. We may be powerless – or even clueless – in public health advocacy.
Reflecting on our attempt to create an advocacy program for tobacco control which embarked on the ISNCC position statement, we come up with several questions. Which area of tobacco control advocacy should we start with and how? How can we build our capacity on this matter? How to mobilize resources? How can we build a base of support locally and internationally? We have a strong hope for ISNCC to lead an orchestrated effort for the cancer nurses in Indonesia, as in other low- and middle-income countries, to carry out tobacco control advocacy. Despite having the main focus to strengthen our cancer nursing competency, in our national cancer nurse organization, we are aware of the importance to spare our energy for urgent public health issues such as tobacco problems in our country. We cannot wait until we are fully ‘enhanced’ as the cancer nurses, but around us, more Indonesians start smoking at a very young age and keep smoking until they are old, and more patients are suffering and dying from tobacco-related cancer. We need to do better.
Assunta, M. (2019). Global Tobacco Industry Interference Index. In Global Center for Good Governance in Tobacco Control (GGTC). Retrieved from https://exposetobacco.org/wp-content/uploads/2019/10/GlobalTIIIndex_Report_2019.pdf
FAO. (2017). Tobacco.
Ministry of Health Republic of Indonesia. (2013). Riset Kesehatan Dasar (RISKESDAS) 2013. Laporan Nasional 2013, 1–384. Retrieved from http://www.depkes.go.id/resources/download/general/Hasil Riskesdas 2013.pdf
Ministry of Health Republic of Indonesia. (2015). Data and information on cancer situation (Data dan Informasi Kesehatan Situasi Penyakit Kanker). Buletin Kanker, 1(1), 1–5. https://doi.org/10.1007/s13398-014-0173-7.2
National Development Bureau Indonesia. (2017). Modul sinkronisasi RPJMD-RPJMN bidang kesehatan dan gizi masyarakat (Module of development plan synchronisation in public health and nutrition).
WHO. (2015). Tobacco use data by country. Retrieved from http://apps.who.int/gho/data/node.main.65
WHO FCTC. (2018). Progress report on regulatory and market developments on electronic nicotine delivery systems (ENDS) and electronic non-nicotine delivery systems (ENNDS): Report by the Convention Secretariat. Retrieved from http://www.who.int/fctc/cop/sessions/cop8/FCTC_COP_8_10-EN.pdf
Ariesta Milanti, BSN, RN, MHC, Public communication committee, Indonesian Oncology Nurses Association
Indonesian Oncology Nurses Association (IONA) organized a simultaneous anti-tobacco campaign on the 18th of October 2018 in seven provinces throughout Indonesia. The campaign marked the IONA’s anniversary and responded to the call of the International Society of Nurses in Cancer Care (ISNCC) tobacco position statement that nurses should take the lead in tobacco control activities.
The campaign was held successfully at Dharmais Cancer Hospital, Jakarta; Bantul 2 Public High School, Yogyakarta; Dr. Karyadi Hospital and Tugurejo Hospitals, Semarang, Central Java; Sanglah Hospital, Denpasar, Bali; Dr. Wahidin General Hospital Sudirohusodo, Makassar, South Sulawesi; Dr. Soetomo Hospital, East Java; and Adam Malik General Hospital, Medan, North Sumatra. In all sites, we conducted public education on the dangerous effects of tobacco smoke and called the public to protect themselves from tobacco use and exposure. We also played a short video illustrating the ‘epidemic’ of tobacco smoke in Indonesia. In the video, a former heavy smoker described his process to quitting tobacco smoking. We invited people to build their personal commitment to fight tobacco smoke and to sign in our anti-tobacco declaration.
Our message was to take action against tobacco smoke.
In addition to those programs, each IONA chapters created their unique approaches as well. IONA chapter Yogyakarta successfully gathered 100 high school students in Bantul 2 High School and held a photo contest with the theme of an anti-tobacco movement. The photos were uploaded to the @himponidiy Instagram account to be more visible by the young people, the most vulnerable population targeted by the tobacco industry. IONA Yogyakarta will also conduct a continuous community service activities in this high school to sustain the program’s impacts.
The high school students recorded their anti-tobacco declaration and sent it to the local police office as proof of their commitment to avoid tobacco smoke.
IONA chapter Makassar-South Sulawesi held a series of anti-tobacco campaign programs at RSUP DR Wahidin Sudirohusodo. A total of 50 patients and their families enthusiastically participated in the education on the effects of tobacco smoke and signed their anti-tobacco declaration. Our anti-tobacco video was played continuously at the general polyclinic televisions.
Meanwhile in Bali, the anti-tobacco campaign day was also a huge success. The education and signing of the anti-tobacco declaration were attended by dozens of people. The local committee also released the balloons into the air as a symbol to stay away from the dangers of cigarettes.
The simultaneous anti-tobacco campaign was also carried out successfully by the IONA chapter North Sumatra. The activity began with the signing of the declaration “Supporting the Anti-Tobacco Movement” by the patients, family and hospital staff of the Adam Malik Hospital, the public education, and the coloring competition for the children with cancer. The participants said that the anti-tobacco campaign greatly motivated patients, families and all employees to stop smoking and support the anti-tobacco movement.
On the day of the campaign there were several participants who were committed to quitting smoking.
IONA Chapter Central Java organized the anti-tobacco campaign in two places at once, namely Dr. Karyadi hospital and Tugurejo hospital, Semarang, Central Java. The public education and the signing of the anti-tobacco declaration were attended by dozens of patients and families in the polyclinics of the two hospitals.
Meanwhile, IONA chapter East Java installed the large banners displaying the anti-tobacco movement at Dr. Soetomo General Hospital and FKP Airlangga University, Surabaya, East Java. They held a community education on tobacco smoke dangers and its prevention in November 2018.
In Jakarta, the anti-tobacco campaign day was hugely celebrated at the Dharmais National Cancer Center. The entire board of directors of RS Dharmais initiated the signing of the anti-tobacco declaration. Patients, families, nurses, doctors, and staff enthusiastically joined the education program, flash mobs, and various entertaining activities.
Among the feedback from the participants was the intention to spread the dangers of tobacco smoke information to their families and the plan to bring the heavy smokers in the family to get smoking cessation interventions.
This campaign demonstrates the strong intention of IONA to be at the forefront of tobacco control in Indonesia as one of the cancer prevention activities Tobacco smoke and exposure have proven to cause various types of cancer and other serious diseases. We hope to sustain and scale up the campaign across Indonesia.
As part of the World Cancer Day 2019 program, the International Society of Nurses in Cancer Care (ISNCC) and our partner the Union for International Cancer Control (UICC) are celebrating the contributions of nursing internationally. ISNCC represents over 60,000 cancer nurses worldwide, all of whom are vital to cancer care and control.
One of the biggest obstacles we face today in delivering quality cancer care is the shortage of trained healthcare professionals. Addressing the gap is the clearest way to achieving progress in reducing cancer. Find out more at Reducing the Skills Gap.