Volunteering in Honduras: Results and Reflections

According to the GLOBOCAN 2012 data released by the International Agency for Research on Cancer, an estimated 14.1 million new cancer cases and 8.2 million cancer deaths occurred worldwide in 2012. This is an immense increase compared with 2008 statistics, which reported 12.7 and 7.6 million new cases and deaths, respectively. Lowand low-middle–income countries accounted for more than half of the new cancer cases and nearly two thirds of all cancerrelated deaths. The social and economic disparities in cancer prevention and treatment present a disproportionate burden in these low-resource settings. Honduras is a low-middle–income country with a total population of 8.3 million. Cancer accounts for 13% of deaths each year. The most common cancers reported are prostate, gastric, cervix, liver, and breast. The mortality rates from cervix and gastric cancers are among the highest globally, at 18.5 and 8.8%, respectively. There are 24 surgical, eight gynecologic, 13 medical, and four radiation oncologists in Honduras. Hospital General San Felipe (HGSF) is the only public cancer hospital in Honduras that treats underserved patients. Currently, there is only one surgical oncology training program in Honduras. During the 4-year curriculum, residents are taught to provide surgical care for men and women with a wide spectrum of malignancies. Efforts to improve the education and training of residents in surgery and oncology in countries with limited specialists have been growing in the last decade. Medical volunteerism in such countries has become an area of interest for medical students, residents, fellows, and attending physicians from outside of the affected countries, and there are a number of models for providing this assistance. Barriers to successful exchanges between volunteers and in-country physicians include time constraints of the volunteers and infrastructure deficits in low-resource settings that prohibit optimal learning environments. Increasingly, a combination of short-term, hands-on teaching sessions coupled with ongoing Internet-based instruction by volunteers at a distance has emerged as a successful model for supporting incountry physicians to provide increasingly sophisticated medical and surgical care within the limits of available resources. For example, a successful program of surgical training to perform radical hysterectomies in patients with cervical cancer has been implemented in Kenya through collaboration with the Society of Gynaecologic Oncology of Canada. The 2-week intensive program, which is staffed by one expert Canadian surgeon, included seven video didactics, a preand post-test, and seven live surgical sessions with oral and written feedback after each patient case. Short-term follow-up revealed four successful radical hysterectomies by the Kenyan surgeons after the Canadian trainer had left. Similarly, the Central America Gynecologic Oncology Education Program, an initiative that is focused on the education and training of obstetrics and gynecology residents in the prevention and treatment of gynecologic cancers, is a collaboration between the American College of Obstetrics and Gynecology and six Central American countries and includes in-country training trips with US gynecologic oncologists with ongoing distance learning and support. Another option for training physicians from low-resource settings is for these individuals to travel to high-resource settings for training. However, this approach has drawbacks. A recent report suggests that the numbers of physicians emigrating from Sub-Saharan Africa to the US is increasing and will negatively affect low-resource countries, where there is a great need for health care providers. Training of physicians in their respective countries offers the advantage of hands-on training, given that direct patient contact is not allowed during an observership in the United States. In addition, the context of care and the resources available for treatment are different in settings such as Honduras compared with the United States. Despite increasing numbers of medical missions to assist underserved countries, there is still a lack of formalized educational curricula and supervised training in these countries. In this article, we describe the Health Volunteers Overseas (HVO) Oncology Training Program in Honduras, which focuses on providing education, surgical training, and research mentorship to surgical oncology residents, nurses, and other health care providers in Tegucigalpa, Honduras.