Even as oncologists try to tackle the changing landscape of health care in the United States, many realize that both physicians and patients in this country are still in a better position than those fighting cancer abroad in low- and middle-income countries.
In 2009, ASCO joined with Health Volunteers Overseas to create its International Cancer Corps (ICC), designed to provide oncologists with opportunities to volunteer their time and expertise in some of the countries that need it most.
The World Health Organization currently estimates that low- and middle-income countries bear the burden of more than half of the estimated 12.7 million new cancer cases and 7.6 million cancers deaths occurring each year.
“There is an urgent need to address this growing crisis,” said ASCO Immediate Past President Sandra M. Swain, MD, FACP. “Through programs like the ICC, ASCO is able to connect more of its members with areas of need, and in so doing help lessen the suffering for people with cancer worldwide.”
The ICC originally launched three education and training sites in Tegucigalpa, Honduras; Addis Ababa, Ethiopia; and Hue, Vietnam. Due to the success of the ICC program at these locations, ASCO recently decided to expand its efforts to three new sites in San José, Costa Rica; Asunción, Paraguay; and Thimphu, Bhutan.
With assignments at each site ranging from as short as 1 week to as long as 1 month, volunteering with the ICC provides an opportunity that can fit the needs of both first-time volunteers and experienced volunteers looking to share their time and expertise.
Providing Interaction and Education in Costa Rica
Volunteers looking to take a shorter trip, or stay closer to home, might find an ideal location at the ICC site in Costa Rica’s Hospital del Mexico, San Juan de Dios Hospital or the Women’s Hospital in San José.
“Because the travel is not too arduous and there is not too great of a language barrier, traveling to Costa Rica is a great way to have a U.S. medical oncologist introduced to volunteerism with Health Volunteers Overseas,” said Costa Rica Program Director John Pippen, MD, of US Oncology.
Oncologists in Costa Rica are well trained and enthusiastic, but are hungry for interaction with U.S. oncologists, according to Dr. Pippen. Despite their very long and busy days spent in clinics, many local oncologists are still undercompensated for their time and are forced to maintain a second job working at private clinics in the evening.
“They do not always have the time and resources to do a lot of continuing medical education,” Dr. Pippen said. “The ICC volunteers are hoping to supply that piece that is missing.”
In addition, improvement in the education of other medical professionals who are part of a multidisciplinary treatment team is also a priority, according to local site Director Luis Corrales-Rodriguez, MD, a medical oncologist at Hospital San Juan de Dios.
In September, the Costa Rican site will have its first volunteer, a nurse, visiting to contribute to nurses’ education and spend time at two of the hospitals in the program. Dr. Pippen anticipates a second group of volunteers to visit in January.
“I expect us to discuss individual cases with the oncologists there, make rounds and visit with some of the hospital administrators,” Dr. Pippen said. “We also hope to have volunteers take the physicians’ books and journals, audiovisual aids, or cases on their computers to discuss in an effort to supply that interaction needed by local oncologists.”
At the Costa Rican sites, Dr. Pippen said that volunteers typically work about an 8-to-5 schedule each day, and then are free to explore the lively city of San Jose.
Making an Immediate Difference in Paraguay
For those volunteers interested in participating in ICC but looking to expand their horizons to another continent, the site at the Instituto Nacional del Cancer near Asuncion, Paraguay, may be a good fit.
Paraguay is a small country located in the middle of South America with a population of about 7 million. Cancer is the second leading cause of death there, and the Instituto Nacional del Cancer is the only public hospital with the necessary equipment to treat patients with cancer, according to local site director, José Duarte, MD.
“The cancer institute determined that it should initially concentrate the ICC efforts on the treatment of two common cancers that occur in women: breast and cervical cancer,” said Program Director Thomas Openshaw, MD, of Eastern Maine Healthcare Systems. “Patients with these diseases present with advanced disease and there are many obstacles to delivering quality care.”
Since the first volunteer visit to Paraguay, Dr. Duarte said that practice change is already apparent.
“We adopted a center in the institution managed by a multidisciplinary team—including a surgeon, medical oncologist, radiation oncologist, and nurse—to see all new patients with cervical cancer to assure a centralized processing, to delineate plans of treatments and to assure proper follow-up,” Dr. Duarte said.
Since then, the center has reduced current wait time for commencing treatment from 6 to 8 weeks to only 2 weeks. They have also created a database used for tracking patients and have established specific treatment protocols for cervical cancer.
Up next, Drs. Duarte and Openshaw hope to use future volunteers to begin to translate what they have set up for cervical cancer into a comprehensive central breast cancer program.
Building From the Ground Up in Bhutan
Finally, for those volunteers really looking to stretch their experience beyond the Western Hemisphere, a visit to the National Referral Hospital in Thimpu, Bhutan, may be just the ticket, providing an opportunity to have a big effect on a country with great need.
Bhutan is a small country located in the southern Himalayas with a population of about 700,000 people. Despite the government funded health-care system, the country is lacking in health-care professionals due to its relatively recent adoption of Western medicine.
“Currently, there are two oncologist specialists there, a surgical oncologist and a gynecologic oncologist,” said Bhutan Program Director Miklos Simon, MD, of Compass Oncology. “They try to handle all of the oncology care for the whole country together with six oncology nurses.”
With the current system, many patients each year are sent to India at the government’s expense to receive cancer care. With the help of the ICC, it is expected that some of this treatment can be transferred back to physicians within Bhutan.
Because so many patients in Bhutan will present with advanced cancers, developing a palliative care program is a priority. One of the first volunteers scheduled to visit Bhutan is a psycho-oncologist who will begin to provide communication and education training about some of the psychosocial issues of cancer.
“She will dig deeper and work closely with a local psychologist who is interested in developing a palliative care program,” Dr. Simon said.
In addition, many of the nurses in Bhutan received their training about a decade ago and are in need of an updated curriculum and refresher courses. Dr. Simon has recruited two volunteer nurses who will go to Bhutan in November and March to help to train nurses and teach oncology courses at the local nursing school.
“We see huge potential in the Bhutan site and are grateful to ASCO for helping us to meet some of its needs,” Dr. Simon said. ■
© 2013. American Society of Clinical Oncology. All rights reserved.
