The Instituto Oncológico del Oriente Boliviano

The Instituto Oncológico del Oriente Boliviano, in Santa Cruz, is Bolivia’s sole cancer treatment center.

As one of the five major hospitals in Santa Cruz de la Sierra, the Instituto Oncológico del Oriente Boliviano (IOOB) is one of Bolivia’s most important public health organizations. It is the country’s only hospital for the exclusive treatment of patients with cancer, both adults and children.

Bolivia lies in the heart of South America, stretching from the heights of the Andes Mountains to the tropical Amazon River Basin, with a population comprised mainly of Native Indian ethnic groups and Mestizos. More than 58% of the Bolivian population, representing 4.6 million people, is considered poor.

Santa Cruz de la Sierra, the capital city of Santa Cruz, is the second largest city in Bolivia and the first in economic importance. Of the state’s population of two million, 76% live in the city itself. About 38% of the city’s population is poor; these people lack basic health services, live in substandard housing, have very poor education and enjoy very little access to health care.

As seen in Figure 1, infant deaths are very high. Some years ago, Bolivia had the dubious distinction of having, after Haiti, the highest infant mortality rate in South America and the Caribbean countries. The primary causes of mortality are diarrhea and respiratory tract infections. The National Health Programs focus primarily on infant and maternal deaths, and only since 1997 has a National Program covered all costs for these major diseases.

The government does not consider cancer to be a major health issue, and because of this, it does not cover any of the costs for diagnostic procedures, treatment or follow-up for patients with cancer. The government finances only the infrastructure, meaning the health facilities and some of the salaries paid to physicians and paramedical workers.

The IOOB was founded in 1978 by three visionary physicians who had completed their training in oncology outside the country. Since its inception under the leadership of seven professionals, the IOOB has had three major oncology divisions: radiotherapy, clinical oncology and surgery. It has grown to include 163 workers, of which 37 are physicians. The hospital has 60 beds in different wards that include surgery, clinical oncology, gynecology and pediatrics. It has several other services, including pathology, clinical laboratory, x-ray, ultrasound and mammography.

The newest addition to the hospital services is pediatric oncology. In l998 Dr. Yolanda Ernst became the first pediatric oncologist on staff. Before that time, an adult hematologist treated children, and there were only four beds for them. The Pediatric Department presently has two new wards with a total of 12 beds and an isolation room with one bed. The medical staff in the department include two pediatric hemato-oncologists, one pediatric surgeon, one pediatric anesthesiologist and two general pediatricians who cover at night, including emergencies.

As the population grows, so the need for cancer treatment and research increases. Dr. Martha Alicia Arrien, Executive Director of the hospital, has achieved several goals to meet growing demand, always striving to improve the quality of services offered by the hospital. One of the major goals has been the purchase of new radiotherapy treatment equipment, since the old equipment dates from the construction of the hospital.

The IOOB is a pioneer in cancer prevention programs in the country. The three largest programs are:

• Prevention of Cervical/Uterine Cancer, which has national importance since IOOB is the reference center for the cervical cytology performed throughout Bolivia. It provides quality control for other public institutions.
• Breast Cancer Prevention, in which there is a special program for screening women of low income.
• Skin Cancer Prevention, in which the Nevus Program helps with the removal and pathological diagnosis of suspected nevus.

The plans are many, but with little or no support from the Bolivian government, much of the work must be accomplished with international help from organizations such as the INCTR, CNI of the United States of America, and other international groups. Bolivian people also help by working as volunteers in different associations such as the Legión Cruceña de Combate al Cancer, Fundación de Amigos y Familiares de Niños con Cancer, SALVAME, and others that have the heart and will to help these patients who did not ask to be sick, but who have one of the most calamitous diseases, and very little economic resources or education to cope with it.

Volunteers with IOOB pediatric patients.

The hospital staff fervently hopes to convince the Health Office of the Government that cancer is a growing health problem in Bolivia, and that prevention, early diagnosis and adequate treatment can offer a better survival outcome to all Bolivian oncological patients.