St. Jude Global: Where We Are

Fostering relationships and sharing resources across multiple regions to facilitate worldwide collaboration

 

For more than a quarter century, St. Jude has forged powerful relationships with 24 partner sites spread throughout Brazil, Chile, China, Costa Rica, the Dominican Republic, Ecuador, El Salvador, Guatemala, Haiti, Honduras, Jordan, Lebanon, Mexico, Morocco, Nicaragua, the Philippines and Venezuela.

Building on those relationships, St. Jude Global will develop regional networks to promote self-sufficiency and the sharing of knowledge and skills among international sites. Through this model, we aim to accelerate global improvements in the clinical care of children with cancer and other life-threatening diseases.

The regional structures are integrated into St. Jude Global to form the St. Jude Global Alliance, which facilitates collaboration, research and transfer of knowledge across regions and programs. This alliance can integrate all stakeholders in advocacy, global health, and research and innovation.

By sharing expertise and experience among countries, regions and institutions, the St. Jude Global Alliance will achieve our vision in which all children have access to quality care no matter where they live.

Regional Programs

  1. A diverse part of the world spanning a large geographical area, the Asia Pacific region encompasses nearly half of the known global burden of childhood cancer. St. Jude Global’s work regionally is detailed below for two countries, along with an overview of the extended engagement across more than 15 countries in the region.

    Philippines

    • A partnership with Southern Philippines Medical Center in Davao in 2006 supported the expansion of care for children with cancer from four beds shared with other services to a 25-bed Children’s Cancer and Blood Diseases unit in 2011. This partnership demonstrated the value of dedicated pediatric oncology providers, including trained nurses. Collaborative efforts supported locally have since led to a new Children’s Cancer Institute inaugurated in 2016 with a full complement of multidisciplinary staff dedicated to the care of children with cancer. An active regional network has been created on the island of Mindanao to facilitate timely diagnosis and referrals.
    • More recently, St. Jude Global partnered with the University of Philippines-Philippine General Hospital in Manila. Initiatives to date include the formalization of embedded roles for pediatric oncology nursing education and palliative care; establishment of quality improvement processes in blood bank safety, pathology, infection prevention and care; development of a regional referral model for retinoblastoma care; and analyses to address preventable treatment failure.
    • Building on these and other relationships, St. Jude co-hosted the country’s first National Childhood Cancer Control Workshop in August 2017 with the national Pediatric Oncology Society and the Philippines Department of Health. Diverse stakeholders throughout the country met for two days to define the situation and opportunities for childhood cancer care and to establish a national collaborative action plan considering needs across the health system.

    Myanmar

    • With approximately 2,000 new cases of childhood cancer anticipated per year, only two primary hospitals have dedicated units for children with cancer: Yangon Children’s Hospital and the 300-bed Mandalay Children’s Hospital. St. Jude Global, along with other regional and international organizations, have supported the local leaders and the Myanmar Ministry of Health and Sports to establish a national program to strengthen childhood cancer capacity. At the invitation of the World Health Organization (WHO) and local leaders, since 2016, St. Jude has helped to coordinate a global collaboration of stakeholders including government, civil society, academic and hospital leaders together with international partners, including co-organization of the first and second national workshops on the childhood cancer control program in Myanmar in May 2016 and May 2019.
    • The number of children diagnosed in Myanmar each year has increased by more than 50% since 2013. St. Jude Global has supported the creation, mapping and structured collaborative assessments of the first organized national referral network for children with cancer. Formally approved by the Ministry of Health and Sports to involve the two dedicated units alongside 17 divisional and state hospitals as community network sites and three as shared care network sites, the new national network has engaged more than 35 clinicians and nurses since 2018, and facilitated the referral of more than 100 patients to the dedicated units. To guide progress, St. Jude Global meets regularly with local and international stakeholders, including hospital leaders, the Ministry of Health and Sports, and WHO partners.

    Other programs

    • In addition, St. Jude Global works closely with leaders in Cambodia, with collaborative efforts to date including co-hosting a national childhood cancer stakeholder meeting in March 2018, enabling additional specialty training for the first pediatric radiation oncologist in the country, and continuing technical support for the National Cancer Center to develop a pediatric oncology nurse educator program. St. Jude Global also has led stakeholder mapping and strategic planning activities to improve childhood cancer care with partners in Sri Lanka and Indonesia. 
    • In addition to institutional and national programs, St. Jude Global coordinates regional opportunities that extend our reach to more than 40 institutions across more than 15 countries. Sample initiatives include online educational and case-based multidisciplinary meetings with resource sharing via Cure4Kids, as well as supported onsite specialty training regionally and internationally for young investigators, clinicians and program leaders. Recurring online meetings coordinated by St. Jude Global include the St. Jude-VIVA Asia Pacific Tumor Board, and the St. Jude Leukemia Lymphoma Hour with more than 240 regional cases discussed and associated resources identified and shared. More than 30 multidisciplinary providers in the region have been supported to attend short- and long-term international training in the past three years.
    • St. Jude Global is also partnering with key institutions in Singapore including the VIVA Foundation, National University Health System and KK Women’s and Children’s Hospital to continually improve the treatment and research of childhood cancers, and the training of pediatric oncologists in Asia and beyond. Collaborative initiatives include an annual meeting in Singapore, the St. Jude–VIVA Forum. This scientific forum helps global experts and local providers exchange information and resources on best practices, alongside an annual pre-forum dedicated to low- and middle-income country needs and working group meetings to advance regional research and multidisciplinary practice. In recent years, St. Jude Global also has co-sponsored and co-organized specialty training symposia on retinoblastoma (2017) and pediatric cancer pathology (2018) and pediatric cancer surgery (2019). These meetings connected providers across institutions and countries to facilitate practice improvements and continuing collaborations. St. Jude Global helps facilitate access to this educational and networking opportunity for participants from institutions and countries throughout the Asia Pacific region, involving a core of more than 35 institutions and 11 countries.
  2. El Salvador

    A large region with a strong network, the Central and South America region incorporates multiple sites and projects.

    The first international outreach program ever initiated by St. Jude occurred in 1993, at Benjamin Bloom Hospital in El Salvador. Later, programs were developed in Guatemala, Honduras, Costa Rica, Nicaragua, the Dominican Republic and Haiti. These programs have national reach and aim to provide access to care to most children with cancer in the region.

    Through the years, the collaborative nature of the Central American programs led to the creation of the Asociación de Hemato-Oncología Pediátrica de Centro América (AHOPCA). This regional network has adopted the structure and functions of a consortium. Participants include programs in Guatemala, El Salvador, Nicaragua, Honduras, Costa Rica, Panama, the Dominican Republic and Haiti. AHOPCA has standardized treatments, with thousands of children treated through its guidelines and research protocols.

    AHOPCA also provides education and training. The Unidad Nacional de Oncología Pediátrica in Guatemala City offers a pediatric oncology fellowship program. Twenty-one pediatric oncologists have graduated from this program. They provide specialized care to children with cancer in the region.

    During the past two years, St. Jude Global has developed a series of strategy workshops. These workshops strengthen regional health systems. They also advance the development of high-quality national pediatric oncology programs. Participants include representatives of the Ministries of Health of all the countries in the region and the Pan-American Health Organization.

    In South America, St. Jude Global has long-standing capacity-building, education and research activities in Ecuador, Chile and Brazil. In Chile, St. Jude supported a National Hematopoietic Stem Cell Transplant program for nearly 20 years. This program is one of only two ASH-designated training centers for pediatric bone marrow transplantation in Latin America.

    St. Jude Global plans to develop national initiatives in Bolivia, Paraguay and Peru. Strategic planning meetings and focused workshops have been conducted, and plans will be consolidated during the next year.

    In addition to AHOPCA, St. Jude Global helped develop two other clinical research consortia in the region:

    • The Consorcio Latinoamericano de Enfermedades Hemato-oncológicas Pediátricas (CLEHOP) began because of the success of AHOPCA’s program for the treatment of children with Hodgkin lymphoma. Those excellent results triggered interest to extend this work to other parts of Latin America. CLEHOP integrates groups from Argentina, Peru, Ecuador, Mexico, Venezuela and Brazil to expand beyond the treatment of Hodgkin lymphoma and become a true Latin American cooperative group. In addition to a protocol for Hodgkin lymphoma, the group is developing a new clinical trial for acute promyelocytic leukemia.
    • Grupo de America Latina de Oncología Pediátrica (GALOP) originally started when a few institutions in South America teamed up with the Children’s Oncology Group to run common protocols. GALOP will now be part of the St Jude Global Alliance. This will allow more centers to take part in the group and reach more children with cancer in the region.
  3. Ching-Hon Pui, MD

    St. Jude Global’s work in China is a testament to partnerships formed by St. Jude through the decades.

    Each year, about 50,000 children are diagnosed with cancer in China, about 12,000 of whom have acute lymphoblastic leukemia (ALL). Prior to 2010, fewer than 10% of children with cancer received treatment because individual families were required to shoulder the financial burden of therapy. But thanks to St. Jude, the number of children receiving cancer treatment in China has skyrocketed.

    A few of the achievements in this region include:

    • In 1991, St Jude partnered with Shanghai Children’s Medical Center and Beijing Children’s Hospital to train physicians and nurses to treat children with ALL.
    • In 2005, St. Jude worked with Partner in Hope Foundation to raise funding to treat underprivileged children with ALL. To treat these patients, St. Jude designed a cost-effective clinical trial jointly with Shanghai Children’s Medical Center and Beijing Children’s Hospital.
    • This effort was a success, with 86% of more than 140 of the patients remaining in continuous remission. This excellent result with affordable cost was published in an international journal. As a result, China’s Minister of Health selected childhood ALL as one of the first diseases covered by the New Rural Cooperative Medical Care System in 2010.
    • To provide optimal treatment to a large number of patients, St. Jude worked with Shanghai Children’s Medical Center to establish the China National Childhood ALL Study Group. Since 2015, more than 4,000 patients with ALL have enrolled in a national clinical trial across 20 sites.
    • In 2017, the Chinese government approved the creation of the first National Children’s Medical Center, which had been proposed by St. Jude. Shanghai Children’s Medical Center and St. Jude are developing a framework for cancer treatment, training and research for the center.
    • To further strengthen research on childhood cancer and blood diseases in China, St. Jude Global staff are forming partnerships with two other outstanding institutions in China: Guangzhou Women’s and Children’s Medical Center, and Tianjin Institute of Hematology and Blood Diseases Hospital.
  4. Global director and staff in Jordan

    Unrest in the Middle East has resulted in an escalating refugee crisis. St. Jude Global is dedicated to helping bring quality medical care to children with cancer even in times of strife. This goal has been possible in collaboration with a strong St. Jude Global regional network.

    Lebanon

    • St. Jude has strong ties to the Children Cancer Center of Lebanon (CCCL) at the American University of Beirut Medical Center (AUBMC). This collaboration has fostered the development of national programs, unified standard-of-care protocols, and the formation of a Lebanese pediatric cancer network. These additions benefit all children in Lebanon.
    • During the past five years, St. Jude Global faculty have worked with the AUBMC and CCCL to establish a sustainable program to treat displaced children with cancer. This shows that such collaborations can save young lives even in times of crisis in a country with the highest number of refugees per capita in the world.
    • Several educational programs to enhance the region’s workforce are based at the AUBMC. These include fellowships in pediatric hematology-oncology and other subspecialty training.

    Jordan

    • Another longtime partner of St. Jude is the King Hussein Cancer Center (KHCC) in Jordan. St. Jude has recently begun a program for displaced children with cancer in Jordan. This country has the second highest number of refugees per capita in the world.
    • The KHCC is also a regional St. Jude Global training center.

    Humanitarian Efforts for the Care of Displaced Children

    • Our successes in Lebanon and Jordan demonstrate that in the presence of a strong network, curative cancer care can be delivered to children even in times of crisis. St. Jude is engaging other regional partners to help rebuild patient capacity in Syria and Iraq. St. Jude is also coordinating the care of displaced children with cancer, facilitating their return home when the crisis subsides. 

    Pediatric Oncology East and Mediterranean Group

    • The Pediatric Oncology East and Mediterranean Group was established in 2013. This network of physicians, scientists and health care professionals is spread across more than 80 childhood cancer centers in the Middle East, northern Africa and southern Asia. The network includes sites in Algeria, Armenia, Bahrain, Egypt, India, Iraq, Iran, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Palestine, Qatar, Saudi Arabia, Sudan, Syria, Tunis, Turkey, the United Arab Emirates and Yemen.
    • This St. Jude Global-supported group has several collaborations in patient care, epidemiology, education and research.
  5. Group from Moscow meeting on Eurasia Region in 2018

    The Eurasian Region, referring to the Commonwealth of Independent States, encompasses 13 countries with more than 80,000 children with an expected 10,000 to 11,000 new cancer diagnoses per year.

    St. Jude Global’s work in this region has stemmed from longtime connections and partnerships with the Dmitry Rogachev Medical Center in Moscow, Russia. The Eurasian Regional Program was formed in 2018 from this relationship.

    The first workshop on pediatric cancer care in the Eurasian region was held in Moscow in April 2018, in partnership with the World Health Organization (WHO) Non-Communicable Disease European Office, the Dmitry Rogachev Center, the Russian National Society of Pediatric Hematologists and Oncologists, and the Ministry of Health of the Russian Federation. The meeting was attended by 21 delegates from Eurasian countries, including Russia, Belarus, Azerbaijan, Armenia, Moldova, Kazakhstan, Turkmenistan, Uzbekistan, Kyrgyzstan, Tajikistan and Mongolia; and 41 invitees from the WHO, St. Jude and the Dmitry Rogachev Center. Themes discussed at the workshop included education, research, patient-centered care, health systems development projects and the formation of multi-center collaborative networks.

    The following priorities were identified. Action plans to address these are underway:

    1. Collaboration: Form a collaborative network for pediatric hematology-oncology specialists that will be integrated in the St. Jude Global Alliance.
    2. Health Systems: Create integrated standards for childhood cancer care.
    3. Patient Care: Launch an initiative to improve pediatric palliative care and enhance growth and development in other patient-care related fields.
    4. Education: Increase opportunities for pediatric hematology-oncology education, especially nursing education and specialization.
    5. Research: Establish pediatric cancer registries, to enable further research and organization in the region.

    A second strategic planning workshop is planned for fall 2018 in Kazakhstan.

  6. Group at St. Jude Mexico Regional Program

    In Mexico, 5,000 to 6,000 children through age 18 are diagnosed with cancer each year. About 60 pediatric hematology-oncology units are accredited by the government-sponsored health insurance program. These units are spread throughout the 32 established, federated states. The first capacity-building partnership in Mexico was established in 1999 with the Hospital Pediátrico de Sinaloa in Culiacán, followed by Hospital Civil de Guadalajara in 2001 and Hospital Pediátrico de Tijuana in 2007.

    During the last two years, the Mexico program has increased significantly. With the development of a broader and more comprehensive regional initiative, the three-institution program has expanded into a network of 11 institutions.

    Through strategic planning meetings and workshops, the group set the following priorities and areas of work:

    • Collaboration: Integrate more than 10 pediatric disciplines in this multidisciplinary group. The group includes more than 100 health care professionals from 11 pediatric oncology units.
    • Modernization: Standardize and modernize the diagnosis of acute lymphoblastic leukemia through a clinical trial that features risk-adaptation with minimal residual disease evaluation.
    • Quality improvement: Implement quality improvement initiatives for a broad range of topics, from cancer treatment delivery to supportive care.
    • Evidence-based interventions: Develop a clinical and epidemiological research platform in pediatric oncology to help generate evidence-based interventions.

    The goal of the Mexico region is to increase the survival of children in that country from a baseline of less than 50% to greater than 75% in the near future.

  7. Nearly of a quarter of the world’s children ages 0–14 live in Sub-Saharan Africa, one of the world’s most resource-limited settings. Through a new regional program within St. Jude Global, local physicians and leaders of existing partnerships in high-income counties have been engaged to develop mutually beneficial collaborations and build a regional alliance. Initial efforts involve countries such as Zimbabwe. In that country, work has started to improve the quality of care for both childhood cancer and life-threatening blood diseases such as sickle cell disease.

 

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