Abstract B54: Addressing cancer disparities in the border region: A novel model of twinning in pediatric oncology.
Authors: Aristizabal Paula , Ribeiro Raul C. , Roberts William D. 
Published: August 2014

Abstract
Background: Health institutions located along the borders of countries with profound economic disparities often face difficulties in providing care for children with complex diseases such as cancer. Until recently, many children with cancer from Baja California went untreated. We postulated that the St. Jude Children's Research Hospital (SJCRH) twinning model used to improve pediatric cancer care in low income countries could successfully be applied in this particular setting to reduce disparities in care. The impact of twinning programs has already been proven. Twinning is defined as a form of cooperation between centers in developed countries and low-income countries, whereby knowledge and organizational skills are shared and pediatric oncology units are established in a culturally sensitive manner and adapted to local health care systems. SJCRH has established several successful twinning programs worldwide.
Objectives: In 2008, Rady Children's Hospital San Diego (RCHSD) partnered with SJCRH and Hospital General-Tijuana (HGT), the largest hospital in northwestern Mexico, to initiate a twinning project aiming to establish a fully functional pediatric oncology unit and to improve care for children with cancer in the border region.
Methods: A modified SJCRH assessment tool was developed and revealed that, although the basic hospital infrastructure and services, were available (e.g.: anatomic pathology, laboratory and blood bank) the essential elements of a pediatric cancer unit, such as dedicated space, trained pediatric oncologists and nurses and uniform treatment were lacking. In addition, chemotherapy medications were available but not prepared according to proper procedure; medical records were incomplete; patients had no access to intensive therapy; and supportive care programs were lacking. A 5-year strategic plan was designed to provide salary supplementation for health care professionals, intensive education and training, and infrastructure improvement. A bicultural, Spanish-speaking pediatric oncologist from RCHSD was appointed to supervise the project and visited the partner site weekly to monitor progress closely.
Results: After four years, accomplishments include: the opening of a new isolated inpatient unit with updated technology, the training of nurses and staff, and the establishment of a dedicated inter-disciplinary team led by two local pediatric oncologists. Over 160 patients have benefited from accurate diagnosis and treatment, access to supportive care, infection control, specialized nurses, dedicated pediatricians, and psychosocial and nutritional programs. In December 2008, the pediatric oncology service at HGT received the Mexican Accreditation ensuring full coverage by a Federal insurance program for the underprivileged and contributing to local sustainability.
Conclusion: Border towns have a particularly high need for the development of programs to address health disparities. Initiatives in the border region constitute a unique model of twinning, since the proximity permits close follow-up and leads to establishment of reducing disparities programs in record time, benefiting hundreds of children.
Ongoing initiatives include, continued education and training for the staff and the community, a shelter for patients and expansion of education and subsidies for families.
Citation Format: Paula Aristizabal, Raul C. Ribeiro, William D. Roberts. Addressing cancer disparities in the border region: A novel model of twinning in pediatric oncology. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B54.