Meet Our Team
Q&A with Camara van Breemen
Camara van Breemen has volunteered with Two Worlds Cancer Collaboration since 2018. She has served as a Director for four years. Camara is a nurse practitioner and works at Canucks Place Children’s Hospice in Vancouver, Canada
Photo: Chuck Russell/Two Worlds Cancer
How did you become involved with Two Worlds Cancer Collaboration?
I met Fraser Black [Dr. Black is a long time TWCC volunteer] and then I was interviewing Rachel Neufeld who I hired as a nurse practitioner at Canuck Place Children’s Hopsice and she said, “I volunteered with TWCC.” Then I met Gillian Fyles [ Dr. Fyles is a TWCC director since 2010] through our work with serious conversation education.
There was just so many people that I respected that I thought, ‘This must be good.’
It seems like it's been part of my world forever now.
How long have you been at Canuck Place Children’s Hospice and what's your role?
I was one of the first clinical nurses hired and in my 28 years I've done many different roles including bedside nurse. I did my masters in psychology and became a play therapist. So I coordinated the bereavement program and the sibling grief group for quite a while.
And then I became a nurse practitioner. Currently my role is leading the community team which sees children across the province [British Columbia, Canada] and supports them in their home community, particularly at end-of-life.
The other big piece of my role is in education. I lead the serious illness conversation program, which is really an important piece of work in which we train clinicians to communicate with families better and to have these conversation within an advanced care planning model.
You also collaborate with BC Children's Hospital, what is your role there?
Because so many children go in and out of BC Children's Hospital or other hospitals, my role along with our small community team is to really support transitions. So transitions into hospital and when they return to their home community.
Really, we support their health condition. That is pain and symptom management, communication – so advanced care planning, and serious illness conversations – care coordination, and family support. We are with family as their child's illness and trajectory changes.
How did you end up in health care and specifically palliative care?
My parents said I had to go to university. So I wanted to go to university and come out with a job and nursing seemed a fit for me, because I do like to help, and I do like the technical and the scientific knowledge that nursing brings. But I also love the art of nursing.
My true calling, I would say, is working with children. And I started that in pediatric oncology. I loved caring for those kids many of whom get better.
But I also was very drawn to the room no one wanted to go into. I wanted to have the skills to be able to go into that room comfortably without the fear of going in to see a family.
What's your role with the Sunflower Children's Network?
I think I’m a doer in that I do what I’m asked. I show up to ECHO sessions [online palliative care education]. I support the fellows and provide mentorship, education, and debriefings.
The reason this organization works for me is because I've had leaders that allow me to vision. I like to vision. I get things going and then let someone else sustain it.
This whole global piece has been a big learning for me. I see possibilities and opportunities in other people. So I have brought a lot of people to TWCC and I've formed relationships.
I think the grant that we got from The Centre for International Child Health* was really seizing an opportunity. Knowing I didn't have all the skills to do this, so really it was working with the right people – the nurse researchers and the Sunflower Children’s Network leadership.
* The one-year grant provided the opportunity for an interdisciplinary team from Two Worlds Cancer Collaboration, BC Children's Hospital, Canuck Place Children’s Hospice, BC Children's Health Research Institute, and the University of British Columbia to travel to Kanti Children’s Hospital and Bhaktapur Cancer Hospital in Nepal sharing their expertise in palliative care and pediatric pain management. The team is collaborating with Nepali healthcare practitioners to develop and deliver a sustainable training program in pediatric palliative care for Nepali nurses.
What are your impressions from your visits to the programs in India over the years, and also more recently Nepal and the Philippines?
I think wherever we are in the world, there's both people and systems that need to come together to grow our work in pediatric palliative care.
And so when you look at Hyderabad and you look at the expanse of the knowledge of the people that are doing the work right now, it’s been decades in the making. And they've had to navigate the system to grow. Hyderabad is growing in that expert realm.
That local knowledge and intention is just so important whichever area you're in. Our influence to that area can be small, medium or large.
The Philippines, I think is in this novice phase. They are novice in their clinical work and they’re novice in influencing the system. I would say Nepal is in the middle because of all the adult [palliative care] work that's happened in Nepal and the country is smaller. That's been a potentiator of the pediatric program.
Is there a young patient that you saw during your recent travels that stays with you?
In the Philippines there was a little girl, a two-year-old, who had a terrible abdominal cancer that we visited at home. They were able to treat it, but she required a colostomy. So her family needed supplies at home and to manage that. They sent Mom home with some morphine and some medications to help the girl’s pain.
We’re driving out in the van for three hours and the whole team is there partly because I’m visiting – two nurses, a social worker, a fellow and two staff. As we stopped I asked, “Why are we stopping here?” And they said, “Oh, Mom has to come and get us.”
And I realized, of course, there's no address in the slums. This Mom has to leave her child, give her to a neighbor so she can come and get the healthcare people. It’s so hard because there's just so much poverty. There’s no sanitation. I'm thinking, ‘What are we doing here? There's no way we can help. This is insurmountable.’
We keep walking, stepping over puddles, and ducking our heads and we get into this tiny little place. Mom is telling the story of the last few days, and the little girl is warming up to us, and she's quite comfortable, the brothers are there, and all the neighbors are peeking in looking at us. And Mom is crying with joy because her little girl had a good sleep and has had a great week.
I thought this is why we do it. We help one child when we can. The one who's in front of us.
What do you see as TWCC’s biggest successes?
I guess my answer is spreading knowledge – our fellowships, our ECHO sessions. In all those things we're learning together. Learning and teaching together is super important and yet it's also not enough.
In palliative care communication with children who have illness, we do this very generalized framework of ask, tell, ask. If I'm working with a family I first ask them what they understand of their child's illness. And then I tell them from my perspective what's happening. And after I tell them I ask again. And they feed back to me their perspective.
I think TWCC does the same thing. We actually ask, suggest, ask. So we first ask, “What is it that you need – in Hyderabad, in Kathmandu, in Manila – to care for children? Then we come back as an organization and make suggestions. Then we go back to asking. Does that make sense? Is that a fit for you?
And sometimes they'll say, “That will never work here. That's not how our government works; how the system works. Our nurses will never get that opportunity.”
I think what suggests means is that it implies that we're using our own lens of health care and our own knowledge, but we actually have humility in suggesting something. In global work, we absolutely come from our own context of health care – our values and our morals and all of our baggage, and our truth.
What do you see as the biggest challenges?
I think our biggest challenge is fundraising. I don't think that's new. The challenge is gaining more influence. On the good side, through fundraising we’re doing that. On the downside by gaining more influence, we have to really be conscious of what we're doing.
Ideally collaborations are a two way flow – What do you learn from our partners and your experiences that you bring to your own practice?
Lots of things. I see some of the staff really just focus on the person in front of them and I really like that. They might only have 10 minutes but that person in front of them is who matters.
You walk through those busy hallways in Hyderabad and there's rows and rows of people. Vineela Rapelli [TWCC’s part-time, program coordinator in Hyderabad] taught me this focus. For whatever reason she would see that one person in need and she'd squat down and talk to them.
It’s the compassion. It's just so beautiful. It’s that person in front of them in that moment.
Also, I think being adaptable, making do with what you have as opposed to complaining about what you don't have. When I come back to Canada after a trip I'm renewed, because I’ve realized the power of the human spirit. It’s not confined to having a nice house, having a good job.
So really, those big lessons of relationship, being flexible, and being resilient in the face of really big hardships.
Mentorship is key to Two Worlds Cancer Collaboration’s approach. Did you have anybody to look to as a mentor when you started?
I've had mentors all the way along. It's kind of funny, I would say one of my mentors right now is Stuart Brown [Dr. Brown is a TWCC director since 2010]. We don't even talk that much, but I gravitate towards relationships that challenge me a little bit. Where the person is able to say, “ Why did you do that?” I watch how he navigates relationships in a very kind direct way that doesn't look direct somehow.
I've had many people that along the way that have supported my learning and growth. My colleague at Canuck Place, Natasha Datoo [ Dr. Datoo is also a TWCC volunteer] says how much I’ve taught her, but she's also taught me because she questions why I do things.
How do you personally counter the emotional heaviness of your work?
I truly believe in our common humanity. I believe that bad things happen to good people, and that is actually the human condition. I don't spend a lot of time confronting the unfairness.
My Mom taught me a lot about when suffering happens you help. In doing that work to help, compassion is actually not fatiguing. Compassion is actually life giving. In giving compassion to others I have to be compassionate to myself. Self-compassion means that I'm okay with my feelings that come out.
What do you do when you turn your palliative care brain off?
Recreation and boating with my husband. Hiking with my kids. They’re young adults now. I love to travel that also brings me joy.