Building the clinical workforce of pediatric infectious diseases in Bolivia for better care of children with cancer
Authors: Rodriguez-Auad Juan Pablo , Velasco-Alvarez Victor Hugo , Caniza Miguela A 
Published: October 2024

Abstract

Background
Infections in children with cancer can be fatal if not appropriately managed. Access to trained and competent professionals in infection care and prevention (IC&P) improve care outcomes. Bolivia expects about 1700 new pediatric cancer cases annually. In 2023, 2371 hematological neoplasms were reported in children, cared mainly at 4 public hospitals where, until 2016, 5 pediatric infectious disease (PID) specialists were working in 2 of these 4 hospitals. For better PID clinical workforce for critically ill children, we built a PID medical residency training. In 2017, the training accepted its first trainees at Hospital del Niño “Dr. Ovidio Aliaga Uría” (Hospital del Niño), a public hospital in La Paz. Here, we describe the program, how we built it, and its outcomes.

Methods
The PID training goal is to train leaders in PID for clinical observations, PID literature interpretation, and to transform them into concepts that can be applied to ID pathogenesis or treatment. At the end of the 2-year PID training program, we expect trainees will gain expertise in PID clinical practice and clinical or translational science research. Our PID program was based on other PID specialty training programs from Mexico, Spain, and the USA of which, we adapted standard topics and formats of training. The content has routine and prevalent PIDs of Bolivia and the region, including on immunocompromised patients. We expected that the trainee dedicate full time to the PID training program plus caring for assigned patients and those requested consultations in the wards and clinics of Hospital del Niño; review articles; participate in clinical discussions; attend the Infection Control Course of St. Jude Children’s Research Hospital; attend and / or present in the PID case-based learning international sessions; visit the virology, bacteriology, parasitology and immunology laboratories of the national reference laboratory; and attend international rotations at participating hospitals.

Results
Since 2017, 5 new PID pediatricians graduated from our program, 3 work in public hospitals that care for children with cancer and 2 work in government insurance hospitals. They are working in hospitals in La Paz (n=2), Cochabamba (n=1), Santa Cruz (n=1), and Tarija (n=1). These graduates are leaders in ICP, antimicrobial stewardships, and education of hospital staffs. As per December 2023, they produced 5 articles for local journals, 2 for international journals, 7 abstracts for scientific meetings. Currently, 2 pediatricians participate in the PID training program, and post-graduation, they plan to work in departments of Potosí and Sucre where there are no PID specialists. Challenges to establish PID specialists in Bolivia are lack of value attributed to PID and its role in care quality.

Conclusion
Creating local expertise in PID are essential to improve and sustain the optimum care for children with cancer in Bolivia especially in places where these personnel did not exist before. However, for best investment return of PID trained professionals, having PID job descriptions and paid positions in hospitals will absorb PID specialists to benefit the largest population of children with cancer in Bolivia.