Not too many years ago, nearly half of the kids diagnosed with cancer in Guatemala wouldn't come in for treatment. There wasn't much chemotherapy to be had, and parents didn't think treatments worked. Most children with curable cancers died.
The situation is similar in many poor countries. There's little money for cancer care throughout the developing world. So whether or not you survive cancer depends on the country you live in, one recent study showed.
Two doctors — on opposite sides of the world — are working to change that. Dr. Chite Asirwa of Kenya and Dr. Federico Antillon of Guatemala are part of a growing number of health workers who believe it's time to stop accepting cancer as a death sentence in poor countries. At the end of January, Asirwa and Antillon were in Seattle to share what they've learned with the U.S. National Cancer Institute.
Goats and Soda
Your Odds Of Surviving Cancer Depend Very Much On Where You Live
Asirwa has picked an unlikely weapon against childhood cancers: a yellow tent hanging between a hospital and a cinderblock wall.
His route to that tent was a winding path that started during the early days of the HIV epidemic. He was training at Moi Teaching and Referral Hospital in Kenya. He remembers wheeling nearly a dozen patients to the morgue when he was on weekend duty. "I said what kind of profession was I getting into if I was just presiding over the dead?"
But then HIV became treatable. And people with HIV-associated cancers such as Kaposi's sarcoma and cervical cancer started getting treatment in the AIDS unit.
"It dawned on me that cancer can also be conquered," Asirwa says.
So over the past three years, Asirwa figured how to treat cancers at Moi Hospital. He joined AMPATH-Kenya, a partnership between Indiana University and Moi Hospital originally set up to treat HIV but has expanded to treat cancer. AMPATH is training health professionals in Kenya. Several pharmaceutical companies are donating drugs to treat cancer.
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"The moment [people] knew there was some form of cancer care at Moi Teaching and Referral Hospital, they started coming in truckloads," Asirwa says.
But the hospital didn't have a place for chairs for patients to sit in while getting treated, or for the IV poles used to dispense chemotherapy. So Asirwa took the unit outdoors: "We built a small tent just outside our clinical space," he says.
The tent may not be needed much longer. The project has been so successful that the Ruth Lilly Philanthropic Foundation and Indiana University have given $5 million for a new cancer treatment center at Moi Hospital, which will include 60 beds and two radiation units. It's scheduled to open in April.
But the chemotherapy tent won't go to waste. Asirwa says it might be a good place for blood transfusions.
Across the Atlantic Ocean in Guatemala, the key to cancer care was fried chicken, and the first stop was Memphis, Tennessee.
Federico Antilln spent three years there studying hematology and oncology at St. Jude Children's Research Hospital. When he returned to Guatemala, he had little access to cancer therapies. And other doctors at his hospital weren't interested in treating children with cancer.
"When a patient with cancer got sick and had to go to the ICU, they wouldn't accept the patient," he remembers. "They said, 'He has cancer, he's not going to live, why should we spend resources on someone who is not going to make it?' "
A few years earlier, Antillon and others had found that about 40 percent of the children diagnosed with cancer at two public hospitals in Guatemala abandoned treatment. Their families couldn't afford it, or they didn't think treatment worked. And many parents didn't even bring their children in for diagnosis until it was too late.
When he was at St. Jude's, Antillon had seen the good that chemo could do. And St. Jude's was interested in seeing what could be done about cancer in developing countries.
So St. Jude's gave Antillon seed money to train doctors, buy equipment and pay for nurses and others at the National Pediatric Oncology Unit in Guatemala City. The unit is part of the Universidad Francisco Marroquin.
Then Antillon went looking for more money. He began with the head of Pollo Campero, a fried chicken franchise with outlets in 12 countries, including the U.S. Then money came in from Pepsi, a Guatemalan bank and several other places. Finally, Antillon had enough to start a foundation called "Ayudame a Vivir" ("Help Me To Live").
The National Pediatric Oncology Unit now has a specialized cancer unit, with 60 beds and its own ICU, educated nurses, a pain care program, psychological support and more. It also pays transportation for patients and parents and for lodging in the city, and provides — for the poorest families — a food basket so parents don't have to worry if they have to miss work to help their children.
Antillon's big challenge now is getting children into the hospital early in their cancers. Late diagnoses make curable childhood cancers incurable.
He wants more, of course. "The hospital is already saturated," he says. "The beds are filled." On his dream list is a top of the line 21st-century facility.
"It should happen in every country," Antillon says — only not necessarily with a tent or fried chicken funding.
childhood cancer
Global Health
Cancer