Eduardo Zambrano’s spare office in Stanford Hospital displays some of the essentials of his pathology practice: a large microscope which dominates his desktop and a cabinet overflowing with colorful, hand-painted wooden boxes, each one representing a Latin American child with cancer.
Over the last 12 years, Zambrano, MD, has received as many as 1,000 tumor samples from pediatric oncologists in Venezuela and other Latin American countries who treat desperately poor young patients with various forms of cancer. Each sample is carried on a glass slide or embedded in wax, then carefully wrapped in tissue paper and lovingly packaged in a wooden box painted by a patient’s mother or local artisan as a gesture of gratitude. The boxes are covered in suns, stars, flowers and other images of life and hope.
“To me, behind each one of these boxes is a child with cancer, and to know we’ve been able to help them is very special to me,” said Zambrano, chief of pathology at Lucile Packard Children’s Hospital Stanford. An expert in pediatric solid tumors, he volunteers his service on behalf of these youngsters.
A professor of pediatrics and of pathology who came to Stanford a year ago, he said he receives one or two of these boxes a week. He examines the samples under the microscope and then issues a diagnosis, some involving rare cancers. Clinicians ship the samples to him because in these low-resourced countries, they don’t have the means to accurately diagnose the problem.
“Very frequently the diagnosis (from the home country) is either incomplete because they don’t have the resources to perform confirmatory tests or it’s wrong because they don’t have expertise in pediatric tumors,” he said. “It’s frequent that I have to give them a significantly different diagnosis than what they sent.”
Among the most common tumors he sees are pediatric sarcomas, which can originate in various parts of the body; neuroblastomas; lymphomas; and brain tumors.
Though he has reviewed cases from Mexico, Bolivia, Brazil and his native country of Ecuador, many of the samples come from Venezuela, where he has a longstanding collaboration with a pediatric oncologist whom he texts or emails every day. She also sends him many photos of children in recovery, as well as notes of thanks: “You are a little angel who helps all of us,” reads one in Spanish.
Zambrano also has visited Venezuela and met some of his patients and their families, but in recent years, the country, worn down by years of oppressive governance, has become too dangerous for travel, he said.
“It’s a tragedy in Venezuela,” which is now one of the southern continent’s poorest countries, he said. “For me, it’s really an obligation to provide this service to them and a way to pay back for what I received in my childhood in South America.”
Because some of the cases he diagnoses are rare or advanced forms of cancer not often seen here, they also serve as valuable teaching tools, he said.
“These cases have served me tremendously in teaching my residents,” he said.
Zambrano said the work is a particularly rewarding part of his day. “I consider it very valuable, and it’s something that really moves me,” he said. “A lot of meaning would be lost if I couldn’t do this work. And it’s important to have meaning.”
He said he is now looking for an outside funding source to help support the service.
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Photo by Ruthann Richter