Volunteering in Honduras: Results and Reflections

Abstract

According to the GLOBOCAN 2012 data released by the International Agency for Research on Cancer, an estimated 14.1 million new cancer cases and 8.2 million cancer deaths occurred worldwide in 2012. This is an immense increase compared with 2008 statistics, which reported 12.7 and 7.6 million new cases and deaths, respectively. 1 Low-and low-middle-income countries accounted for more than half of the new cancer cases and nearly two thirds of all cancerrelated deaths. The social and economic disparities in cancer prevention and treatment present a disproportionate burden in these low-resource settings. Honduras is a low-middle-income country with a total population of 8.3 million. Cancer accounts for 13% of deaths each year. The most common cancers reported are prostate, gastric, cervix, liver, and breast. The mortality rates from cervix and gastric cancers are among the highest globally, at 18.5 and 8.8%, respectively. 2,3 There are 24 surgical, eight gynecologic, 13 medical, and four radiation oncologists in Honduras. Hospital General San Felipe (HGSF) is the only public cancer hospital in Honduras that treats underserved patients. Currently, there is only one surgical oncology training program in Honduras. During the 4-year curriculum, residents are taught to provide surgical care for men and women with a wide spectrum of malignancies.Efforts to improve the education and training of residents in surgery and oncology in countries with limited specialists have been growing in the last decade. Medical volunteerism in such countries has become an area of interest for medical students, residents, fellows, and attending physicians from outside of the affected countries, and there are a number of models for providing this assistance. Barriers to successful exchanges between volunteers and in-country physicians include time constraints of the volunteers and infrastructure deficits in low-resource settings that prohibit optimal learning environments. Increasingly, a combination of short-term, hands-on teaching sessions coupled with ongoing Internet-based instruction by volunteers at a distance has emerged as a successful model for supporting incountry physicians to provide increasingly sophisticated medical and surgical care within the limits of available resources. For example, a successful program of surgical training to perform radical hysterectomies in patients with cervical cancer has been implemented in Kenya through collaboration with the Society of Gynaecologic Oncology of Canada. 4 The 2-week intensive program, which is staffed by one expert Canadian surgeon, included seven video didactics, a pre-and post-test, and seven live surgical sessions with oral and written feedback after each patient case. Short-term follow-up revealed four successful radical hysterectomies by the Kenyan surgeons after the Canadian trainer had left. Similarly, the Central America Gynecologic Oncology Education Program, an initiative that is focused on the education and training of obstetrics and gynecology residents in the prevention an...

Clinical trials in low and middle-income countries — Successes and challenges

“…Through collaborations between MD Anderson Cancer Center Global Academic Programs in the United States and Instituto de Cancerologia in Medellin, Colombia, the surgical and oncological outcomes of management of patients with early cervical cancers were found to not be different between the two institutions. Involvement of multiple organizations is needed to help improve patient care, research, and training of pathologists, oncology nurses, and oncologists specializing in gynecologic cancers in LMICs (Adefuye et al, 2013, Schmeler et al, 2013, Chuang et al, 2014, Chuang et al, 2015, Sagae et al, 2016). These organizations include CCRN, International Gynecologic Cancer Society, Society of Gynecologic Oncology, ASCO, and World Health Organization.…”

Improving Oncology-Pathology Collaboration in Resource-Limited Settings: An American Society of Clinical Oncology/College of American Pathologists Initiative

“…These efforts will build on past work in Honduras by ASCO and its collaborator Health Volunteers Overseas to provide training in multidisciplinary cancer treatment and palliative care through volunteer visits to Honduran medical facilities, in-person training workshops, and professional development awards for young oncologists. 34 The established collaboration has endured through political unrest, natural disasters, and global pandemics. Focus on needs identified by endemic Honduran clinicians allowed investment and agility by local clinicians and Honduran authorities, lending sustainability and evergreen collaboration to the project.…”

Volunteering in medical oncology

“…The scenario described by Miklos Simon, Bhutan Program director where "two oncologists along with six oncology nurses handling the country's oncologic care" is highly commended, yet not uncommon even in this 21st century, in many developing nations [3]. The Honduras volunteering experience described by Chuang et al [4] further echoes the plea of many developing countries requiring quality oncology services required to be put in place. With rising disparities in cancer care, volunteering in oncology may potentially bridge the gap and improve cancer services in less developed nations.…”

“…Tertiary oncology specialist centres potentially could lend their expertise to assist and collaborate with cancer specialists or physicians with special interest in managing cancers in less developed nations. Utilizing telemedicine helps to also provide accessible, multi-disciplinary support and recommendations to developing nations [25].…”