World Cancer Leaders’ Summit 2015
Twinning US cancer centres with partners in the developing world
Dr Carlos Rodriguez-Galindo - Harvard Medical School, Boston, USA
Now children get cancer and a lot can be done for them but globally, and I’m thinking of low and middle income countries, many children don’t get adequate treatment. Can you tell me what are the issues that you’ve been addressing right here in Istanbul?
As you said, kids get cancer and actually cancer has become a problem of the countries with limited resources because 80% of the children that develop cancer every year actually live in countries with limited resources. More than that, actually 90% of all the deaths that happen every day and every year of childhood cancer actually occur in those countries, so countries with limited resources have 80% of the cases and 90% of the deaths.
And yet in well-resourced settings children get their cancers cured.
Get cured, yes, 80-85% of the children get cured.
Can you tell me something about the outreach programme that you’ve been working on with St Jude?
St Jude has developed for many years now, close to 15-20 years, partnerships with many countries and programmes in limited resource settings, that’s what we call a twinning model. This is a model that St Jude has done but other institutions around the globe have also done. So this is a very common model that has been explored in paediatrics. So the way that these models work, and particularly the St Jude model with more than twenty centres around the globe with which St Jude has partnered, is what we call a twinning. Twinning is a very close partnership so twins are twins for life, so you just basically walk along the way with your partner, his or her problems are your problems.
So you’ve got centres in the US who are twinned with centres in a low or middle income country?
That’s right. So St Jude has partnerships with centres in Mexico and Central America, South America, Africa, the Middle East, Asia and other centres in the US or Europe do the same.
That’s very hands on and potentially very helpful.
Yes, very hands on.
What sorts of things have you been able to do? Can you give me an example of the kind of way this co-operation has paid off?
Yes. So there are many good examples, let me give you one, for example Guatemala. In Guatemala I know the programme in Guatemala because the leader of the programme in Guatemala trained with me. He’s from Guatemala, we were fellows at the same time, his name is Federico Antillon. So he went back to Guatemala because he felt that that basically was what he was supposed to do and St Jude twinned with him. There was nothing at that time, basically just very loose programmes and doctors that were not properly trained. He consolidated all the oncology services for the country in one unit which is where he was working with help from St Jude, with training, with funding, with resource allocation and technology transfer. He was able to build that programme to the point that the programme grew faster than the hospital. So that led to the rupture, not a rupture but a break-off. So they said, ‘OK, we are growing so fast, we don’t want to put more pressure on the hospital, we are now our own.’ Still attached to the hospital but they grew to become a national paediatric cancer centre with that attachment to St Jude but now they have grown above the resources that St Jude was giving at the beginning.
I can see that it’s not just the availability of resources but organisation is one of the keys. What is the secret of success in getting that organisation and co-ordination right? Obviously the twinning helps, doesn’t it?
Yes, but you said it very clearly, it’s not about resources only. So this process is much more granular than that, resources are key. But at the end of the day you need a local leader, someone that is the champion that really wants to do it. Then you need to work in synchrony and in harmony with the other needs of the hospital or the country but without putting too much pressure, at the same time without relinquishing some of the needs that you need to address. So these programmes have to grow in a step-wise increment. We need to think about both the healthcare system’s flow, the administration, education, psychosocial support, so you need to really provide good care to the families and to the children. There are four or five components that you need to put together.
So if we were to summarise what is your recipe for doing well, you’re in a low resource setting, what is your quick summary of how to fix it?
You need three components: one is a good local leader that knows how to do it that is partnered, if possible, with a centre in a high income country that can provide the resources, if not the resources the advice. You need a hospital that is willing and a government that is willing to take that risk and host and have the capacity to grow. And then, very important in that recipe, is a grass roots movement, like an advocacy group, a local advocacy group, that can provide that third component which is the pressure, in a sense.
It sounds marvellous but how do you persuade the centres of excellence in well-resourced countries to participate in this?
I think that the only, what I say is a moral imperative, so I would always say, ‘You don’t have any other choice.’ The point is that we are paediatric oncologists, our goal is to cure childhood cancer, period, and that means curing my kids and all the other kids. I don’t think that I’m doing a good job if everything I do as an academician, as a researcher, as a programme leader is focussing on 20% of those children. So the point that I tried to make is that the breakthrough in childhood cancer will come the moment that we resolve the global problem, that will be the true breakthrough, not through the use of, say, molecular therapies. The true breakthrough will be when we are able to provide access to care and cure with a standard of care for the majority of these kids.
And from your experience at St Jude there’s a lot of will within doctors and clinicians generally to help with this.
Yes, it is. Actually what I think that it’s refraining most of these centres and doctors from doing is that they don’t know how to do it - it’s just too big of a problem for me to take care of. But you don’t need to think about curing all the kids in the world, just get one centre, one region, one country, focus on that, do a good needs assessment and then say, ‘OK, I’m here for the long run so let’s see how we can do, we’ll do it together. It may take ten years, it may take twenty years but I’m staying with you.’