Developing Pediatric Oncology in Mexico

Roberto Rivera-Luna is director of hematology-oncology at the National Institute of Pediatrics in Mexico City.

When Dr. Roberto Rivera-Luna first started practicing pediatric oncology, he was one of only two such specialists in his country. Twenty-eight years ago, he used to see as many as 80 patients a day. Thanks to his efforts to establish formal training at the National University of Mexico and elsewhere, today there are 72 pediatric oncologists working throughout Mexico. During the course of his career, Rivera-Luna helped to train 51 of them at his own institution, the National Institute of Pediatrics. Four hospitals—all in Mexico City—are now training physicians in this specialty.

Still, it's not enough.
"My institution is unique among those in under-developed countries because our standards of care and therapeutic results are comparable to those anywhere in the world," says Rivera-Luna. "The problem is that this is one of a few institutions in Mexico that take care of children with cancer. I wish there could be many more. There is a need to really admit a country such as ours has a problem with childhood cancer. Among children ages 4 to 15, it is the second-highest cause of mortality."

Not only is the incidence of childhood cancer in Mexico on the rise, as it is in many developed nations, more children are dying because of lack of care. Thirty-eight percent of children who die of cancer are never diagnosed. Those doctors trained in pediatric oncology are concentrated in urban areas, Rivera-Luna says, making it difficult for families to seek treatment. Even more heartbreaking is the prevailing attitude of many general practitioners and even some adult oncologists who refuse to treat children with cancer.

Rivera-Luna is leading a national effort to institute outreach programs in the 12 states without any pediatric oncologists. The intent is to encourage adult oncologists and hematologists to diagnose young patients with cancer and refer them for treatment.

"We hope to sensitize physicians to accept their responsibility as physicians, as specialists, and as Mexicans, so they accept pediatric patients and become part of multidisciplinary approach to children," Rivera-Luna says.

Another initiative involves developing regional institutions that can make treatment more accessible. "Some families now come from as far away as 1,000 miles," he says. "There is no need for someone to come from a Tijuana-border town to Mexico City. There is a big pediatric hospital that has an excellent pediatric oncology department in Sonora-150 miles from Tijuana."

As a way to produce more doctors, Rivera-Luna would like to see university hospitals in large cities around the country develop pediatric oncology departments and, eventually, pediatric oncology training programs. When Rivera-Luna was a young physician he worked for a year as a family doctor with Dr. Herbert Nassour at a private hospital in Austin, Texas. With time this man became his mentor.

Dr. Nassour, a Texan of Lebanese extraction, guided Rivera-Luna to return to Mexico and work in rural areas. He did so for a year before going back to the USA to pursue formal training, first as a resident in pediatrics at Baylor College of Medicine and then as a fellow in pediatric hematolgy/oncology, both in Houston, Texas. Once again, as a friend, Dr. Nassour insisted Rivera-Luna go back to Mexico and work for children with cancer from low socioeconomic backgrounds.

"He made a big impression on my professional life," Rivera-Luna recalls. "I remember very vividly, at night after six surgeries, Dr. Nassour would invite me to his home to discuss the philosophy of patient care and the need to develop different approaches to medicine in under-developed countries."

--Marcia C. Landskroener