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How a link from afar saves children in Latin America

Frances Stock, MD, is the lone pediatric oncologist in her city of Merida, Venezuela, where she cares for about 1,000 patients, some of whom travel by burro on dirt roads for treatment. She earns the equivalent of $18 a month for her work at a government-run hospital, sometimes paying for medications herself for her young patients, most of whom are very poor.

Stock has no local pathologist to rely on for expert diagnosis, so for the past 12 years, she has been seeking help from Stanford pathologist Eduardo Zambrano, MD. Every week, she sends him a batch of tumor samples, carefully wrapped in tissue and placed in wooden boxes beautifully painted by patients’ families, local artisans and in one case, by a patient himself.

“This is way for them to pay back in gratitude for the work he is doing,” she told me in Spanish during a recent visit to Stanford. “He’s an extraordinarily generous person, like the guardian angel for our patients.”

In the latest issue of Stanford Medicine magazine, I write about Zambrano’s volunteer work, but I only recently met the physician behind many of the patients whom he diagnoses long-distance. Stock says she met Zambrano in 2004 through a colleague and began sending him tumor samples out of desperation. At first, the samples arrived in plain brown boxes, but Stock’s mother, who is very supportive of her work, suggested the idea of sending them in decorative packaging. Her mother even paints some of the boxes herself and occasionally chips in to help pay for patient expenses.

Resources are extraordinarily limited in Venezuela, where the economy has virtually collapsed amid political turmoil. Stock runs a private pediatric practice to help support herself, but it’s the cancer work that is dear to her heart, she told me. She told the story of one patient, a 3-year-old girl with Wilms’ tumor, a rare kidney cancer that primarily affects children. Zambrano, chief of pathology at Lucile Packard Children’s Hospital Stanford, not only provided the diagnosis but also the histology – the microscopic anatomy — of the little girl’s cancer, which helped determine the course of treatment, Stock said. The child lived with her family in a hut in the mountains, without electricity or running water, but was faithful in coming to her appointments, traveling by burro for as much as four hours to get to the city for her weekly chemotherapy treatments, she said.

I asked how the little girl was doing now. “Bien – good,” Stock replied with a wide smile.

Zambrano showed photos of another patient he’d diagnosed for Stock. The photos showed a teary-eyed newborn, his face bloated by a massive tumor that had been mistaken for infection. Zambrano sent his diagnostic results to pediatric oncology specialists at Stanford, who recommended a course of treatment. By six weeks, the tumor had shrunk, and the photos showed a smiling child, “all because of appropriate intervention – the right diagnosis and treatment right away,” he said.

Zambrano is now obtaining help from a group of Stanford undergraduates in cataloguing all of the cases he’s diagnosed from afar, about 75 percent of which come from Stock. He used to receive more samples from practitioners elsewhere in Latin America, including Mexico, Bolivia, Brazil, Argentina and his native Ecuador, but they have begun limiting the cases they send because they cannot afford Stanford’s fees, he said.

So he is actively looking for a funding source to support the service. He said the work is not only “the right thing to do,” but serves as a valuable educational tool, as many of the samples come from rare tumors that students here, as well as clinicians, might otherwise not see.

Previously: Strive, thrive and take five: Stanford Medicine magazine on the science of well-beingThe “little angel” who helps young Latin American children with cancer, Guatemala project inspires and motivates Stanford medical student and Legal changes could make new cancer drugs more accessible to kids, says Nature editorial
Photo of hand-painted boxes by Gregg Segal