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UNC Lineberger’s Thomas Alexander, MD, MPH.

The majority of pediatric cancers cases worldwide occur in low- to middle-income countries. This can present significant medical challenges because these countries may have a scarcity or outright lack of trained pediatric cancer care providers.

UNC Lineberger’s Thomas Alexander, MD, MPH, and colleagues report in the journal the Pediatric Blood & Cancer on their work to help establish a pediatric hematology-oncology training curriculum in Ethiopia, which has 6,000-12,000 new pediatric cancer cases annually but, as recently as 2013, had no dedicated pediatric hematology‐oncology programs.

In collaboration with the Asian Project, they developed a formal two-year pediatric hematology-oncology fellowship program. Alexander, an assistant professor in the UNC School of Medicine Department of Pediatrics, said the goal was to create a sustainable local capacity in Ethiopia to treat pediatric blood disorders and cancers.

Four physicians have completed comprehensive subspecialty training, and all have remained local. There are now two pediatric cancer centers in Ethiopia, led by former fellows, that have a combined capacity of 64 inpatient beds and more than 800 new diagnoses per year. Another program graduate is developing a pediatric cancer program in Nairobi, Kenya. The fellowship program is currently training two additional fellows, and leadership and oversight is being transitioned to program graduates. Moreover, it is supporting the development and growth of dedicated pediatric cancer care services where none existed seven years ago.

The authors write that developing a dedicated pediatric cancer service presents a range of challenges, including fellow recruitment, access to chemotherapy, and retention of pediatric nurses and oncology pharmacists. In addition, they noted gaining government and institutional support is critical to a program’s success.