Building bridges, not walls Dr Alexandra Diaz Alba Guadalajara, México
I´M a neuro-oncolgist in México, a country with a population of more than 127 million people. We are south of the United States and north of Guatemala. The official language in Mexico is Spanish but there are more than 68 native languages (such as Mayan, Uto-Aztecan, etc). I studied in Guadalajara, the second biggest city in Mexico and then moved to Mexico City to study neurology at the National Institute of Neurology and Neurosurgery where I had the opportunity to study brain tumours under the tutelage of Dr. Alberto González. My final work while studying brain tumours was on the topic of the response of central nervous system lymphomas to corticosteroids. Motivated by the lack of neurooncologists in Mexico I applied for, and was given, a scholarship for a fellowship at Hôpital Pitié-Salpêtrière in Paris with Professor Jean-Yves Delattre and Professor Khê Hoang-Xuan. The Pitié-Salpêtrière is the biggest reference hospital for brain tumours in France, with all the technology and medical help to learn how to diagnose and treat brain tumours.
Above: Dr Alexandra Diaz Alba from Mexico who is a neuro-oncologist
Things changed when I came back to Mexico to put in practice what I had learned. Mexico is the second most populated country in Latin America and the eleventh in the world. Twenty-four European countries would fit in Mexico. In 1892, successful results of brain tumour surgery were
published, and in 1949 the first neurological institute (and still most important nowadays) was founded. In Mexico there are three ways of getting medical assistance: (1) to buy private health insurance each year; (2) go to a public hospital with social insurance or (3) pay directly to the hospital/doctors. The minimum salary per day in Mexico is 80 pesos - about US $4.00. A well known chemotherapy for brain tumour treatment - temozolomide costs around $9,401 pesos for five capsules at 100 mg each. This means that somebody without social or private insurance would have to work 117 days to buy half of the treatment he needs for one month. Most of the health centres in Mexico are in big cities. Public hospitals are overcrowded and the waiting lists are long. There are 41 official oncology centres (infocancer.org. mx) but not all of them are used for treating patients with brain tumours. Since we are only a few neurologists with experience in neuro-oncology (less than ten for all of Mexico) it is difficult to create guidelines to treat Mexican patients, and the guidelines that are used in other countries aren´t really feasible here most of the time. Even when there is an economical way to buy treatment, chemotherapies largely used in most countries (like lomustine, which is the second line treatment for a very common malignant brain tumour called glioblastoma) are not available in Mexico and most of Latin America. So we have to figure out other ways to treat brain tumours. Here in my country, there is a lack of protocols and investigations in neuroscience, particularly in brain tumours. However, day-by-day more people are becoming interested in learning and getting involved in the neuroscience field. Left: Students from the ITESM (Instituto Mexicano de Estudios Superiores de Monterrey, campus Guadalajara)
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Brain Tumour