International Outreach and Thoughts of Home

International Outreach and Thoughts of Home

Don S. Dizon, MD, FACP, FASCO

Oct 23, 2013
When I told my parents I wanted to be a doctor, they were worried—would I really want a life of being on call, could I handle the stress and the sleepless nights, wouldn’t I want a family some day? Yet even while they asked me questions, they were also very supportive and quite proud of me. I think they had dreamed that I would go on to be a doctor, return home, and practice medicine. They even purchased a plot of land, where my dad envisioned that I would open my very own clinic. On Guam.

For those who do not know, Guam is a U.S. Territory in the South Pacific. It measures 209 square miles (“one-sixth the size of Rhode Island,” I would say during interviews) and had a population of less than 200,000 people. It is so small that chances are good that when someone asked, “Hey—do you know so-and-so? He was from Guam too!” chances are I would either know that person or someone in their immediate family. I grew up there, and left at the age of 17 for college in the “mainland.” My mom still calls Guam home, and the last time I traveled there was on the first anniversary of my father’s death. Getting home is both very expensive (especially when the cost includes my spouse and three kids) and very long—about 24 hours in total travel time.

Although my parents dreamed I would come home once I completed training, I had other ideas. I am not exactly sure when I decided, but I envisioned a career in academic medicine. I saw myself as a teacher, and after training at Memorial Sloan-Kettering Cancer Center, I wanted to do what I could to improve on the standards of care and dedicated my career to clinical trials. It was as much a vocation as was the decision to go into medicine.

As my career took shape, my parents never stood in my way. Their only advice to me was simple—“Do whatever will make you happy.” It is a lesson I hope to impart to my own children. No matter how much time has passed, however, I’ve never forgotten my roots and my island home. Sometimes it takes a devastating loss to remind one of home—as it was when my father became ill and ultimately died of congestive heart failure.

Still, I often wonder how I can continue to make a difference, even from so far away. To do so, I’ve made it widely known through my friends on Guam, that I am available as a resource to anyone from the island who needs advice about a newly diagnosed malignancy and that I am willing to help navigate the medical system there. Indeed, I was recently in this position when a dear friend was diagnosed with lung cancer.

Most times, treatment for cancer if you are from Guam means  going off island for treatment, to places like Japan, the Philippines, or California. In places like my island (and some parts of rural America too), this isn’t uncommon.

The complexities of specialty care that must be rendered far from home was a theme that instilled my interest in international outreach. Beyond the resources on Guam, I became interested in health care systems throughout Asia. I became interested in understanding how care is delivered beyond the continental US, and what options are available for diagnosis and treatment in other parts of the world. More importantly, I wondered how I could make a difference in these places. This is so important especially given the rise in new cancer cases and the higher morbidity and mortality of those who live in resource-poor areas.

It turns out that these interests in international health are shared by many of us in academic oncology. From Ben Anderson and Julie Gralow’s work with the Breast Health Global Initiative to Bruce Chabner and Tim Russell’s work with the Botswana-Harvard partnership (now the Botswana Oncology Global Outreach), there are numerous examples of U.S.-trained oncologists aiding, educating, and assisting our colleagues across the world.

With this in mind, I thought it would be a great time to make sure ASCO members know how we could also get involved and “give back.” These opportunities are available as a member of ASCO’s International Cancer Corps, which helps support Health Volunteer Overseas, a medical education organization that provides local education and training opportunities aimed at strengthening the delivery of cancer care. Current education and training sites include Asuncion, Paraguay; Thimphu, Bhutan; San Jose, Costa Rica; Tegucigalpa, Honduras; and Hue, Vietnam. Other opportunities include participation in Multidisciplinary Cancer Management Courses which ASCO co-sponsors with other oncology societies, and mentoring young oncologists as part of the International Development Education Award (IDEA) program.

These types of programs are great opportunities for those of us who want to make a difference in cancer care both locally and globally. The challenges facing oncology on a global scale are more numerous, especially in the era of precision medicine where the cost of developing targeted treatments may be beyond the reach of most countries. Still, involvement internationally gives us an opportunity to learn and teach, beyond the borders of our own practice.

I don’t think you have to be from Guam to realize that.

For more information, visit ASCO International or email Doug Pyle at ASCO.


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Peter Paul Yu, MD, FASCO, FACP

Oct, 26 2013 7:11 PM

Hi Don,

Thank you for another insightful and inspiring commentary on patient centered cancer care and thank you for highlighting some of ASCO's innvovative programs being launched by the International Affairs Commitee and the ASCO International Affairs Department.  Other programs include the IDEA program, which provides a scholarship to oncology fellows from low resource countries to attend the Annual Meeting and stay on in the US for an additional week visiting a US cancer center.  ASCO is piloting a virtual mentorship program where a 2 year relationship is set up between a fellow with an established area of interest and a domestic mentor, which we hope will be more scalable and available to a greater number of international fellows.  The LIFE award provides a one year visiting scholarship to international oncologists.

Presently, these programs are offered to oncologists from low to medium resource countries.  However the prgrams are not linked to an individual country where they might have a greater impact on that countries healthcare system.  Do we put all of our eggs in one basket in hopes of a more lasting system wide impact?  It's something to consider.


Don S. Dizon, MD, FACP

Oct, 27 2013 10:10 AM

Dear Peter: Thanks for your comments! I think ASCO's leadership is critical, especially as we move towards precision medicine in oncology, where the risk for even greater inequality to access globally is a real possibility. I like the idea that we are considering systems globally, rather than locally, and the work ASCO is doing also shows one mission can complement the other. It shows that it is possible to advance cancer care while doing what we can to ensure that one can access screening, education, and even technology  no matter where one is based or practicing. Best for the rest of this weekend, DSD

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