Partnership with St. Jude Children's Research Hospital International Outreach Program in Morocco
Update September 2002

Background and Rationale

The two major pediatric oncology centers in Morocco are Service d'Hémato-oncologie Pédiatrique de l'Hôpital 20 Aôut 1953 in Casablanca and Unité d'Hémato-oncologie Pédiatrique, Hôpital d'Enfants de Rabat in Rabat, located about 60 miles apart. There is a considerable degree of cooperation between the two centers and both have well developed, committed fund raising organizations, L'Avenir in Rabat with the Princesse Lalla Meryem as the honorary president and AGIR in Casablanca. Professor Fouzia Alaoui, the chief of service of the pediatric hematology/oncology service in Rabat, is the president of L'Avenir. Dr. Alaoui visited St. Jude as a visiting fellow and is intensely committed to the program. Professor Mhamed Harif is the second in command of the oncology service in Casablanca. Dr. Harif visited St. Jude on two occasions as a visiting fellow and works tirelessly for his program. Resources in both cities include the fund raising organizations, Ronald McDonald equivalent houses for parents and patients, established oncology programs with some trained physicians and existing, although somewhat primitive by our standards, hospitals with infrastructures of pediatric care.

Through their partnership with International Outreach, the programs in Morocco plan to further improve staff training for their pediatric hematology/oncology units with a special emphasis on raising the quality of treatment in the region of children with solid tumors and the development of a cancer registry.

Accomplisments to date

Drs. Raul Ribeiro, director of the St. Jude International Outreach Program, and Judy Wilimas, medical director for the Morocco program, visited the partner sites in Rabat and Casablanca on September 23 and 24, 2002. The programs have made significant improvements in nursing, infection control, pathology and patient care, achieving the priorities and goals set for the first 3 years of the partnership. The infection control program in Casablanca and the psychosocial program with social workers, teachers and a domiciliary care facility in Rabat are particularly strong and worthy of mention. Facilities are being improved. Casablanca is renovating the inpatient and outpatient areas and developing a domiciliary care facility; Rabat is planning to build a new oncology unit. Drs. Harif and Alaoui both believe that the nurses have gained skills, confidence and a more caring attitude toward their patients through their training. French speaking nurses from Canada assisted St. Jude International Outreach in this training.

Needs Assessment

Needs are those commonly seen in developing countries: limited money for drugs and patient care, lack of trained nurses, limited numbers of trained physicians and other support personnel. Although there is a language barrier, most physicians speak English and physician training in hematology/ oncology, infectious diseases, pathology, surgery, and other areas is accomplished either at St. Jude or in Morocco by setting up training seminars that could reach more physicians. In addition to supporting the current programs (infection control, nursing education, pathology) our priority for the next year is on helping to institute modern locally appropriate patient care protocols, beginning with leukemia. Since the infrastructure and facilities have been improved, this is the logical next step in developing a first class pediatric oncology program. Specific goals include reinstituting immunophenotyping, improving data management, developing continuing education programs, and providing expertise to develop protocols. Our first step is to establish internet connections for nursing, pathology, infection control and hematology/oncology. St. Jude will work with Drs. Alaoui and Harif to establish monthly discussions using HorizonLive, a software that enables real time conferencing via the Internet. This format could also be used to facilitate protocol development, develop lectures with institutions in France, and provide continuing education for the nurses. We will also continue to host staff from both centers at St. Jude. We suggest that a protocol be instituted to study the use of catecholamines in patients with abdominal masses in a developing country.

To maximize resources we will continue to facilitate interactions and joint development of programs between Rabat and Casablanca. We are pleased with the collaborative spirit displayed by both Centers. The pathologists in Rabat and Casablanca are setting an excellent example as they are working very closely together to strengthen diagnosis for all the children of Morocco.

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