Zlotnick Reflection - Calvin Lau

June 7, 2023

A joint meeting between the pediatric oncologists and pediatric surgeons representing the Pan American Health Organization and the Peruvian Ministry of Health. This meeting focused on establishing a specific training program for pediatric surgical oncology.

The Pediatric Emergency Department team at INEN, including Dr. Victoria Calloretti (3rd from the left) the attending pediatric oncologist in the ED. "Emergencias” is roughly about 25 beds and often at capacity.  Everything from new presentations of cancer, to febrile neutropenia and chemotherapy-induced vomiting, are treated here by this amazing team. 

Photos courtesy of Calvin Lau

What I will remember most fondly from being at Instituto Nacional de Enfermedades Neoplásicas (INEN) in Lima, Peru, is the bravery, persistence, and compassion of the doctors and nurses there. In many ways, their hospital functions similarly to Stanford’s. There are wards, with patients, there are orders that are passed down from doctor to nurse, and clinical information relayed from nurse to doctor. The pediatric oncology team at INEN uses many Children’s Oncology Group leukemia/lymphoma protocols much like institutions across the United States, and otherwise, they utilize European protocols for brain tumors.

While the mechanics of the INEN seemed familiar, the nuts and bolts with which we implemented care illuminated new challenges in patient care. INEN is the cardinal, nearly singular, referral site for non-insured people all across Peru. Thus, the sheer volume of diagnoses and patients is tremendous. Doctors work tirelessly to round, chart, and advance care, which are managed with paper charts and orders.  

As in many low- and middle-income country settings, doctors faced challenges due to high patient volume and public funding limitations. For example, a lack of single isolation rooms for neutropenic patients can result in communicable illnesses, and supply shortages can result in delays in care and testing. Through all these challenges, the INEN doctors and nurses never once complained, and always worked together to find creative solutions, and collaborated to load-level the volume of work required from day to day. 

My fellow physician Jimena Ponce Farfan. She and the other pediatric oncology fellows at INEN are amazing! They work 7 days a week, coming in early in the morning and sometimes in the evenings to sign chemotherapy orders, examine all the children, and speak with the parents. 

Having spoken to multiple doctors about their hopes for the future of pediatric cancer care in Peru, the resounding theme was one of providing them agency to advance care in ways they have already identified. As an example, doctors have observed a disproportionately high rate of some cancers likely due to environmental exposures in populations near industrial farms. However, much like in the US, research funding and protected time can be very hard to come by, thereby limiting their ability to investigate this linkage further.

Through these conversations, I began to appreciate the role that research and science have in effecting policy change that impacts the lives of people. Just in the past five years, a National Childhood Cancer Law has expanded funding for expedited referral and diagnostic testing for pediatric cancers in Peru. We are beginning to see the effects of this policy in the hospital and clinics. 

I know that there is something very special and universal about how we view children, specifically sick children, and the community that rallies around them.

While I did see many differences in how doctors are able to deliver care, I was so touched by that same feeling that I get from being part of the pediatric cancer community here in the States. I know now that there is something very special and universal about how we view children, specifically sick children, and the community that rallies around them. I experienced that same culture of love, sadness, inspiration, and hope.

My time in Peru has made me dually sad and inspired. The sadness outlined by the context in which Peruvian pediatric cancer patients and pediatric cancer doctors face in their everyday lives, their struggles of access, equity of care, in addition to, the same terrible illnesses that befall people like themselves all over the world. And through this sadness, I start to feel hope and inspiration from this global community of those affected by pediatric cancer, the common threads that we all share in our singular goal to protect and improve the lives of these children.


Dr. Calvin Lau is a second-year pediatric resident and received a David A. Zlotnick Memorial scholarship to support his rotation in Peru.