St. Jude Children’s Research Hospital



Most people know of St. Jude Children’s Research Hospital as one of the premier institutions in the United States for treating children with cancer. The nation’s third-largest health charity, St. Jude supports cutting-edge clinical research in pediatric oncology, while accepting and treating patients without regard to the family’s ability to pay. Fewer know that since 1992, under the direction of Dr. Raul Ribeiro, St. Jude has extended its compassionate reach into the international arena.

International Outreach now has or is in the process of developing partner sites in 16 countries: Brazil, Chile, China, Costa Rica, El Salvador, Ecuador, Guatemala, Honduras, Ireland, Jordan, Lebanon, Morocco, Mexico, Russia, Syria and Venezuela. Dr. Ribeiro, a native Brazilian, went to St. Jude on a fellowship program in the mid-1980s and then returned to practice pediatric medicine in his hometown of Curitiba. In 1990, he was invited back to St. Jude, where he helped to launch a “twinning” program that matches St. Jude doctors in the U.S. with their counterparts abroad.

“This program began with a request from a mother of a child with acute myeloid leukemia,” recalls Dr. Ribeiro. “She and her husband had brought the child to St. Jude from El Salvador. She came to us and told us that her son was lucky, but that other kids in El Salvador were dying of cancer. She asked if there was anything we could do for children who could not come to the U.S.”

Bone marrow transplant at Calvo McKenna, Santiago, Chile.

The Board of St. Jude agreed to support a pilot program in El Salvador. Within the first three years, doctors had improved the cure rate for acute lymphoblastic leukemia (ALL) from 5% to 50%. Between January 1994 and December 1996, complete remission was achieved in 82.4% of ALL patients. “With the resources we would spend to treat one child in the U.S., we could treat 100 children in El Salvador,” Dr. Ribeiro recalls. “In 1999, based on the success of this model, the Board approved the principles of the international twinning program and agreed to expand into other countries.”

The main objectives, he says, are to increase the cure rate and to help the twin institution achieve sustainability. “As the program develops, we help them develop fundraising strategies, we train physicians and nurses, and we develop protocol-based therapies. We work with the community to assure that patients and their families have a place to stay, and we work with the hospital to improve infrastructure. We don’t invest in buildings or buy medication. But once we have demonstrated that it is possible to cure cancer, we make alliances with the government to extend our model to other medical centers.”

St. Jude’s approach varies, of course, according to the geopolitical and economic situation of each country. In Nicaragua, for instance, funding may come from European sources but, in Brazil, funding is locally generated.

Dr. Pui and Dr. Ribeiro with physicians, patients and parents at Shanghai Children Medical Center.

“One reason our international programs are successful is that we require the pediatric oncologist to be fully dedicated to cancer patients. St. Jude supplements his salary, so we avoid having very well-trained oncologists treating ear infections,” Dr. Ribeiro says.

For each country, St. Jude appoints one U.S.-based physician as medical director of the international program; he is the “twin” of a physician abroad. Eight or nine other St. Jude physicians devote up to 50% of their time to the twinning program.

Three nurses are assigned to training, an administrative director helps keep order, and a volunteer coordinator helps place field workers. “About thirty percent of all college students have said they want to participate in international humanitarian volunteer work,” says Ribeiro. “This is a great resource for our twinning programs.”

Some twinning units have developed into training centers. Guatemala’s center has matured enough to sponsor a fellowship program. Thanks to a partnership between St. Jude and Hospital Calvo McKenna, the Chilean public health system now has a bone marrow transplant unit—the cost of the transplant procedures has been paid by the government.

In Lebanon, St. Jude has partnered with the American University of Beirut to build a pediatric cancer clinic. “We’re doing very well there,” he says. “Fundraising from the Gulf region has been very successful, and about 100 new patients a year are being served.”

In accordance with its mission, St. Jude Children’s Research Hospital still accepts newly diagnosed patients from abroad to its U.S. facilities, but the twinning programs promote a local solution. “Whether a child from another country wants to come, or whether he or she is too sick to come, we try to offer an opportunity for that child. In practice, we can better fulfill our mission if we can refer them to a facility closer to their own home.”

Marcia Landskroener for INCTR