A HISTORY OF THE PROCESS AND
AN EXPLANATION OF WHAT IT MEANS TO HAVE ACHIEVED IT
Interview with Dr. Altamirano, pediatric oncologist, regarding the achievement of receiving accreditation for the Pediatric Oncology Unit in Baja California Sur.
LCCF – You and LCCF have been working together for several years in Culiacan where LCCF assisted children with cancer from BCS to travel and be treated there under your care. LCCF also assisted with the operational costs of the Culiacan Casa Valentina (hospitality house). How and when did this process move to BCS?
Dr. Altamirano – It all began when I arrived here in La Paz to work at the State Oncology Center where I looked after the children that were being treated in Sinaloa but were native to BCS. We began with treatment for 5 children that were very stable and did not require to be hospitalized. Eleven months later we started treating them here in the Salvatierra Hospital as they needed to be hospitalized. In July, 2012, we had the first leukemia patient who stayed in La Paz to be treated instead of going away to Sinaloa. Since that time we have continued to treat children cancer locally from BCS, however, we did not have a proper space as we were using beds in the pediatric ward. It wasn’t until April of 2013 that the current area was set up with 11 beds, 3 of them for special care, and an area for outpatient chemotherapy. From this point on, we were working towards achieving accreditation with the ongoing support from the Los Cabos Children’s Foundation.
What is the accreditation process like?
The accreditation system for catastrophic expenses such as cancer means that through the Seguro Popular insurance plan the federal government reimburses a portion of the treatment for each child diagnosed with cancer. The accreditation process is done based on a long list issued by the government with over two hundred items to comply with. The list contains items such as human resources, infrastructure, support services and supplies.
How did the collaboration with the foundation begin to achieve this project?
I arrived in Sinaloa in 1988 to establish the pediatric oncology unit and work towards accreditation. Children were being sent from BCS to Sinaloa that were in critical conditions, many of them losing blood and some of them passed away. The first contact for support by the LCCF was to form the Santa Josefina Blood Bank to solve this problem. The blood bank was financed 100% by the foundation and I was in charge of it. LCCF supported children from Los Cabos that were being sent to Sinaloa for treatment with the collaboration of Amigos de Los Niños. Through these relationships and in meetings we agreed that LCCF would assist with the requirements list needed for accreditation. They helped us specifically with equipment such as the cancer crash cart, the nurse’s supply inventory such as diagnostic syringes, hand sanitizer dispensers, needles, bandages, caths, special expensive equipment like perfusion pumps for chemotherapy and also with staff training.
What does it mean for the children of Baja to have an accredited pediatric oncology unit?
This accreditation is a formal certification and for the families it brings them the security of having a place that treats their children with cancer at an optimal level of care. The pediatric oncology unit went through a very thorough and strict exam that demands the highest international levels of attention for children with cancer. It demands those standards from the staff, the infrastructure, the materials used and our procedures. Being accredited means protocoled treatments, i.e., treatments given properly and with the highest quality medications. These protocols mean to treat patients with proven international criteria. Of course, there are still many things that we do not have, such as a radiotherapy area. However, Seguro Popular allows this case because we have agreements with accredited external units that can provide those services. We had to achieve 90% of the list of items required for accreditation and we were at 95%. We will be checked every two years and need to pass the exam to maintain accreditation.
It also guarantees the patient that is affiliated with the Seguro Popular insurance plan their treatment will be covered 100%. This is a three party commitment as the federal government does not provide all the resources. Actually, the federal government through the catastrophic expenses insurance provides a portion that represents about 30% of the expenses of the treatment that goes mostly to chemotherapy. The rest is supplied by the State government and by non-governmental organizations. It’s important to know that Seguro Popular is given automatically to children with cancer. Therefore, they do not require to have been affiliated beforehand to receive the critical treatment they need. This is important because most of the patients are from families with low income.
How were services provided without this help from the federal government?
Thanks to the non-profit organizations that together have covered the needs in all the different municipalities of the State of Baja. Some like LCCF focusing in Los Cabos, others in La Paz or the North of the State, all combined they were able to cover all the expenses for chemotherapies.
What would it be like for a patient if these non-profits would not be in place?
Basically they could not be treated. They would have to go to another State in Mexico to be treated requiring a severe strain to the family and their finances.
Now that pediatrics, intensive care and the pediatric oncology unit is accredited what are the goals moving forward for your unit?
Well now that we have the support of the federal government it does not mean that we will not need help to get the daily supplies that non-profits have provided. When the current stock is finished we will need to replenish it as the hospital is not capable to buy them.
Unfortunately, childhood cancer is on the rise and there is no way to prevent it. There is where we need the help of non-profits, to develop early detection programs, assist with lab tests, provide constant training, stock supplies and assist with the transportation expenses for families out of La Paz. The hospital can only provide the space and the staff.
When we receive this federal assistance, the help from non-profits could go towards improving diagnostic procedures. For example, there is one very important and expensive test called PET that is needed to decide whether we should continue or stop treatment but it is only available in Guadalajara and Mexico, it costs about $1,500.00 USD
Dr. Altamirano finished, full of excitement at the possibilities, by telling us that this accreditation opens doors to being considered as a research field for very renowned research centers in the United States. It also makes the pediatric oncology unit’s relationship with St. Jude’s Children’s Research Hospital stronger as they have been a great support and they are more eager than ever to help. In addition, the BCS unit will be considered and discussed in the annual international pediatric oncology congress and oncology meetings which, of course, will develop and grow the unit even more and make it better and better.