Cancer Care in Nicaragua

Published Date: 28 March 2006

With the right mix of vision and dedication, the Radiotherapy Center in Nicaragua brings cancer care within the reach of thousands. The country is one of some 100 developing countries where the IAEA is helping national authorities to set up or improve cancer care facilities. Dr. Fabio Morales, Director of Nicaragua's Centro Nacional de Radioterapia (CNR), is a man of vision. With continued national and international support, he sees the center expanding and extending its services to bring affordable and high quality cancer treatment within the reach of every person in Nicaragua, rich and poor alike. Nicaragua's Center for Radiotherapy started operation more than 10 years ago, to address the country's growing incidence of cancer cases. A plaque in the waiting hall acknowledges the major donors, including the IAEA. A prevailing atmosphere of hope and expectation is evident in the waiting halls of Nicaragua's radiotherapy center - a tribute to the high quality of service and medical care patients receive from the CNR staff. As in most cancer centers in the developing world, the waiting room is filled to capacity with patients. A CNR oncologist explains the diagnosis to a distraught patient. The incidence of cervical cancer in women in developing countries, including Nicaragua, is on the rise, accounting for 70-80% of current global incidence. Since its establishment in 1995, over 7,300 patients have received treatment from Nicaragua's radiotherapy center. There are an estimated 5,000 new cancer cases in Nicaragua per year, half of which will need radiotherapy. The number of patients receiving treatment at CNR has increased by roughly 10% a year. A nurse monitors a patient receiving radiation treatment in one of the strategically located monitoring stations. CNR doctors believe that with care and the right combination of radiation-based treatment, about 77% of the gynecology-related cancer cases are curable. The IAEA supported Nicaragua's acquisition of its first cobalt-60 machine and the modern treatment planning system, as well as the medium-dose-rate brachytherapy machines being used in the center. These machines are used to treat up to 150 patients per day. Soon scheduled for commissioning, this high-dose-rate machine was acquired with IAEA help and will allow the center to provide continued high-quality treatment to a greater number of patients. The CNR is emphasizing IAEA standards in quality assurance and radiation protection and safety. Dr. Reynaldo Castillo is the first certified radiotherapist in Nicaragua and has worked at the CNR for the past ten years. Like most of the medical staff there, he has attended several international courses, with IAEA financial support. Dr. Castillo calls himself a "romantic", placing more value on the "good" he can do for cancer patients in Nicaragua than on higher pay or better career prospects elsewhere. The entrance and walls of the treatment rooms are decorated with flowers and scenic wallpaper to help brighten up the atmosphere. This is a very important aspect of the cancer therapy, says CNR Director Fabio Morales. Attention to details like these has earned the center a reputation for its level of patient care among donor institutions, including the IAEA. Eliazar, a 6-year old Nicaraguan boy, was diagnosed with cerebral cancer in August 2005. Since receiving treatment, Eliazar has suffered less pain and feels much better, brightening the chance to go back to school. All children referred to the center receive free treatment, including the medicine and laboratory tests they need. On average, five to six young patients undergo treatment each month. Maria Antonia Mora-Gutiérrez was diagnosed with stage 2 cancer of the uterus about three years ago. Deeply religious, she attributes her recovery to her faith and the excellent treatment and care she has received from the radiotherapy center. Now well on the road to recovery, she is thankful that CNR receives support from international bodies like the IAEA. This support, she says, enables the center to help people like her. When Josefa Espinosa-Jiménez was diagnosed with cervical cancer six years ago, she felt as if her world had collapsed around her. Poor, jobless, and with children to care for, she was desperate until someone advised her to turn to the center for help. She says that the care and free treatment she received turned her life literally around. She hopes that more women, especially in the same financial situation, are made aware that help is available. 47-year old Aleida Paz-Rivera is a nurse diagnosed with first stage cervical cancer about a year ago. She received radiotherapy, brachytherapy and teletherapy treatments from the center. Now cancer-free, she is leading an initiative at the Polytechnic University to train more nurses in oncology and radiation therapy to fill the lack of skilled personnel in these areas. Miguel-Angel Sánchez-Godoy was diagnosed with Hodgkins disease when he was just 6 years old. Characterized by swollen lymph glands, Hodgkins disease is a type of lymphoma or cancer of the lymph systems. It is the third most common type of cancer in children 10-14 years of age. Mother and son are joyous over the progress of Miguel-Angel's treatment at the center which has led to his steady recovery. Miguel-Angel is looking forward to resuming his schooling and his favourite activity, which is working on computer applications. Dr. María Delma Mejía is a recognized expert in gynecologic-oncology and the history of the cancer treatment programme in Nicaragua. She is an active contributor to the programme through her profession and as private benefactor, donating personal funds to help build a chemotherapy room at CNR. Local supporters like her help keep the center working at its best. Mercedes Meléndez has been with the center since it started operation. She has worked in cancer care for over 25 years. As head nurse at CNR, Mercedes typifies the care and dedication common among CNR medical staff. "Patients who don't know me by name just asks for the tall, thin nurse." she says with a smile. As the only psychologist in Nicaragua specializing in the care of cancer patients, Lic. Marjorie Gutiérrez is fully convinced that "treating the mind is key to treating the body". As in-house psychologist at CNR for 5 years, she's put great effort in helping patients conquer their initial fear and depression, and understand their disease through psychological counselling. "I've seen excellent response from my patients", she reports. "Most of them are in a stage where they are actively fighting the disease and trying to lead normal lives." Martha has worked as a radiation technician for 16 years and is one of the center's pioneeering staff. She says that, through all these years, her work satisfaction comes from seeing patients get cured of cancer. "Sometimes I meet former patients while walking home", she beams, "and seeing them leading normal lives again is the best reward one can get." The medical physicists at CNR are highly trained professionals. Most have undergone training or attended specialized courses with IAEA's support. Highly trained staff, the existing infrastucture, and a good track record have put Nicaragua in the list of priority countries in Latin America targetted for support under the IAEA's Programme of Action for Cancer Therapy (PACT). The programme seeks to upgrade radiotherapy capabilities in countries where cancer cases are high. A patient is helped to her car after receiving treatment from CNR. Cancer is rapidly reaching epidemic proportions in most middle and low-income countries, including Nicaragua. The World Health Organization estimates the number of new cancer cases in the developing world to reach 15 million by 2020, underlining the importance of centers like CNR in the fight against cancer. But their need is great and growing, and the IAEA is committed to continue helping these countries fight the disease.