Paula Aristizabal, MD, MAS, on Surviving Childhood Leukemia Near the Border of the United States and Mexico

Paula Aristizabal, MD: Acute lymphoblastic leukemia is the most common childhood cancer and survival has improved dramatically in high income countries to rates over 80%. Unfortunately, in low and middle income countries, survival has not increased at the same pace. For example, in Mexico, a low income country that is just across the border from the US, survival range is between 10% and 60%. Since in San Diego we share a border with Tijuana, we saw the disparities and we thought that it was our social responsibility to do something about it so we implemented a twinning program and twinning involves when a center of excellence in a high income country partners and collaborates with a center in a low, middle income country. We started this twinning program in 2008 in collaboration with St. Jude Children's Research Hospital, and we were able to implement a new team in Tijuana that was able to provide the best care possible for all the pediatric cancers. Then in 2013, we realized that the burden of leukemia was getting higher and higher and we decided to implement a new model of health system strengthening called the WHO Framework for Action. The WHO Framework for Action has six building blocks that provide all the elements to improve care in a health system. We incorporated the WHO Framework for Action into the already existing twinning model to improve leukemia survival. We provided training to the team in Tijuana. We provided protocols that they could adapt. We provided mentorship and we provided support for a new infrastructure to develop the best possible leukemia care for children with with leukemia in Baja, California, Mexico. After the implementation of the program, survival for leukemia improved from 59% to 65% and, importantly, the survival for standard risk leukemia improved from 73% before implementing the program to 100%, which is totally amazing because that is the same survival that we have in San Diego, just 20 miles from Tijuana. Survival for high risk leukemia improved from 48% to 55%. It wasn't so significant but we know that that is an area of improvement that we hope that we can tackle in our next steps of the program. Our model in Tijuana, combining a twinning program with the WHO Framework for Action, was effective in improving survival in a low and middle income country. This model can be applicable to a partnership between a high income country and a low, middle income country, especially in regions that share a border but also in other low and middle income countries remotely. Something that we learned from COVID is that you can apply many of these models working remotely and we are extremely pleased with these results. Our next steps include the improvement of the survival for patients with high risk leukemia.