In an earlier post, I described preparations for two “Understanding Cancer” workshops at St. Albert’s Mission Hospital in Zimbabwe Nov. 10 and 11. The workshops were presented to hospital staff and a few teachers from the mission’s school. Both workshops went well, and we learned a great deal from the experience. The workshops were sponsored by the OSUCCC – James. The idea was to bring the expertise of OSUCCC – James oncologists and cancer researchers, in the form of video lectures, to provide cancer education to audiences that have limited Internet access. The “Understanding Cancer” workshops included 14 video lectures from the free, noncredit, online video course Introduction to the Science of Cancer offered by the OSUCCC – James and Ohio State’s Office of Distance Education and eLearning. The online course includes more than 35 videos. Each video lecture explains a particular cancer-related topic. St. Albert’s is a 140-bed hospital located 120 miles north of the capital city Harare. It is an area of subsistence farmers, with the hospital on the edge of the Zambezi escarpment, with the Zambezi Valley 4,900 feet below. On a clear day, one can see the Cahora Bassa reservoir on the horizon in the neighboring nation of Mozambique. People living in the valley are poorer than those on the escarpment. The valley is a more difficult place to live. It is hotter, has poor soil, and malaria is a greater problem. St. Albert’s oversees 11 “rural health centers,” small clinics run by nurses who dispense antiretroviral and certain other drugs and provide basic care. The most distant rural health center is more than 100 miles from St. Albert’s in the valley and only a few feet from the Mozambique border. The workshops were held in the hospital’s new chapel and began at 9 a.m. The Tuesday workshop included 30 hospital staff and two teachers; unfortunately, the school administration decided at the last minute that they could not release teachers for the workshops. The second had 51 hospital staff, including a primary-care nurse from each of the 11 rural health centers. Each of the 3- to 15-minute videos was downloaded from the online cancer course onto a flash drive. The videos were projected onto a screen using a laptop computer and digital projector provided by the hospital. We planned to follow each video with a question-and-answer period. A doctor from St. Albert’s, Dr. Stanely Tapesana, led the Tuesday workshop and discussion periods. Wednesday morning, Dr. Tapesana was in surgery most of the day, and I led the discussions. Upon arrival, each attendee received: A copy of the workshop agenda A 50-page booklet that contained the cancer information presented in each video lecture (I brought 150 copies of the booklets to Zimbabwe as checked luggage). A workshop pretest to gauge the person’s starting knowledge of cancer. To provide anonymity, each person identified his or her pretest, and subsequent post-test, using a number written on a back corner of the booklet. They also identified their job. We asked them to skip questions they were unsure of and complete the quiz as quickly as possible. A writing pad and pen provided by the hospital. Dr. Stanley Tapesana and Mr. Joseph Makaza preparing for the 'Understanding Cancer' workshop. Mr. Joseph Makaza, the hospital’s information officer, set up the laptop and hospital projector, then hung a white cloth for a projection screen. Dr. Tapesana brought speakers from his home stereo, which provided better audio than the projector alone. The hospital was without electricity both days, so the emergency backup generator was used to provide power for the workshop. (Typically, electrical power was available starting around 8:30 p.m. until 3:00-8:30 a.m. during my two-week visit). Dr. Tapesana was a masterly teacher. He related well to the audience, incorporated humor into the discussion and moved between English and Shona (the endemic language) as he expanded on the videos.  Dr. Tapesana leading a discussion between videos. The second workshop on Wednesday was attended by 51 people, and it included a primary-care nurse from each remote rural health center. Dr. Tapesana was in surgery most of the day, so I filled in between videos. My approach was to discuss something mentioned in a video and expand on it. For example, the treatment video mentions standard therapy, which was a chance to address clinical trials. They were not familiar with clinical trials. When I talked about hereditary cancer after the prevention video, I learned that they did not know about BRCA1 and BRCA2 gene mutations. Both workshops ended at 4 p.m. Lessons learned during the two workshops: The video lectures are a useful and practical means of cancer education, with electrical power. American English was understandable to the audience; delivering the lectures at a moderate pace is important for “English-as-a-second-language” audiences. Providing a booklet with the information presented in each video lecture was extremely useful. The booklet enabled Dr. Tapesana to review the content and technical level of the videos prior to the workshop. He also used the booklet to write the pretest questions. The pretest had 62 true/false questions that focused on the most important points for nurses, midwives and nurse-aids in the St. Albert’s setting. Two example questions: The following are cancers Carcinomas (T) Lymphomas (T) Sarcomas (T) Leukemias (T) The following are screening procedures for cancer Visual inspection with acetic acid (VIA) (T) Mammography (T) Fecal occult blood test (T) Magnetic resonance imaging (MRI) (F) CT scans (F) Dr. Tapesana used the pretest as a teaching tool. During the discussions, he read the appropriate questions out loud, e.g., “The following are cancers: carcinomas, true or false.” The audience answered in chorus. During the workshops, attendees had the booklet open in front of them and followed the information as it was presented during a video, then took the booklets with them for later review. Last, the booklet would allow cancer education to continue even in a worst-case scenario—if electricity becomes unavailable or the projector breaks down—by traditional lecture using the booklet as the textbook. The pretest and post-tests and an evaluation form for the second workshop will be analyzed in coming weeks. Based on comments heard after the two workshops, those who attended believed they knew much more about cancer than they did before the workshop. As one nurse mentioned to hospital director Dr. Julia Musariri, “I know better how to talk to patients about cancer.” The hospital used its emergency generator to power the workshops. Normally, the hospital reserves the generator for surgeries – cesarean sections, mainly – and runs it for 2-3 hours midday for X-rays, lab tests, to run the autoclave and to power the kitchen and laundry. (Parts of the hospital are solar powered, and solar power is gradually being installed in other areas.) Although they needed to use the emergency generator, Dr. Musariri said, “We thought the workshops were a priority for our nurses and staff because they would share what they learned with patients in our hospital and also at home and in the villages. It will improve the quality of life for people, and that is why we are here.” Thanks and keep well…Darrell