Written by Hiram Gay, MD, professor of Radiation Oncology at Washington University in St. Louis
I have known Dr. Edgar Ruiz since 2015. He is the current Radiation Oncology Department Chair at LIGA Nacional contra el Cáncer/ Instituto de Cancerología (LIGA/INCAN) in Guatemala. He is a remarkable physician who along with a team of radiation oncologists, physicists, dosimetrists, radiation therapists, nurses, secretaries, and many others, along with the leadership of Dra. Vicky de Falla and LIGA, has been instrumental in the epic transformation of their department from 1970’s technology to current technology. His holistic approach to patient care includes improving the hospital environment with updated furniture, wall paintings and equipment generously donated by BJC Healthcare. Most importantly this has been a transformation that has greatly benefited cancer patients in Guatemala.
Tell us about your journey to becoming a radiation oncologist and what drew
you to it?
I obtained my medical degree in 1998 from the San Carlos de Guatemala University. Initially I did a few years of general surgery with the intention of becoming an oncologic surgeon. I came to LIGA/INCAN in 2003 not knowing what radiation oncology was. Due to a shortage of doctors, as a resident I was sent to cover the radiation oncology department. I enjoyed radiation oncology because of the unique combination of patient care and technology, although at the time the available technology was outdated compared to more developed countries. I then switched my medical specialty, changing the scalpel for therapeutic X-rays. After 2 years of residency at LIGA/INCAN, I contacted the International Atomic Energy Agency (IAEA) to evaluate the possibility of a scholarship to further advance my training. I was accepted at several centers in Latin America and Spain. Ultimately the IAEA gave me a scholarship to train in Zaragoza, Spain at the Lozano Blesa University Hospital, where I completed my training in radiation oncology. I returned to work at LIGA/INCAN and a private practice from 2008 to 2017. From 2017 to 2020 I worked only at private practices which gave me a unique perspective on their operation and advanced technology. Finally, in June 2020, I returned to LIGA/INCAN exclusively, where shortly after my arrival, I was named department chair.
What do you enjoy the most of being a physician?
What I enjoy the most is when a patient asks about their treatment. When the patient is involved in their healthcare and is invested in their recovery, I find it satisfying to educate them, explain the treatment, risks and benefits of radiotherapy. I feel great when they finish treatment without significant side-effects, and subsequently make a full recovery.
What are the challenges you face as chief of the Department of Radiation Therapy of a
cancer hospital in Guatemala that serves 25% of the cancer patients in the
country?
The biggest challenge I have faced since becoming department chief has been to have staff under my charge. As we have significantly modernized the department, having the staff accept and adapt to newer and better ways of doing things has been very challenging. With great difficulty, eventually the staff realized the incredible benefits of these changes for patients. Changing the department’s culture to a more patient-centric one took time.
Another great challenge has been to reduce the patient waiting list to get treatment, which is a constant challenge with our very limited budget. In collaboration with Washington University in St. Louis and Varian Medical Systems, through a United States Agency for International Development (USAID)/The American Schools and Hospitals Abroad (ASHA) program grant, we were able to install a state-of-the-art linear accelerator to treat patients. We were able to reduce the waiting list significantly in the first quarter of 2021 and using the linear accelerator, peaked at treating more than 100 patients per day. Ironically, the project was so successful that by mid-2021, we had depleted the government budget to treat patients. This put me in a very difficult ethical dilemma. I knew I had the personnel and technology to save cancer patients-many of them poor women with cervical and breast cancer-but could not due to lack of government funding. The existing government contract limits the number of patients we can treat. This is incomprehensible. Cancer patients just don’t have the luxury of waiting months for government budgetary issues to be resolved. Ultimately, on October 15, 2021, LIGA decided to provide radiotherapy treatments for free until the government resolves the budgetary constraints. LIGA has also started some fundraising initiatives to mitigate the problem. Currently, we have at least 200 patients on the waiting list.
How do you balance your work with family life?
Balancing work with family life is not too hard. We are a working family. My
wife is a pediatric endocrinologist and she also spends all day at the clinic and hospital.
My two daughters, who are wonderful, perform their tasks and activities with a lot of dedication. We spend the weekends together, enjoying walks and family life.
What would you tell people who are interested in global health and want to
get involved?
There are many ways to help. At the LIGA/INCAN we have more and more cancer patients each year, exceeding the budgeted numbers in the established government funding agreements. Most patients lack the economic resources to travel from their homes, which often are far away, to Guatemala City, and receive radiotherapy treatments. This often requires finding a place to live during treatments, and also paying for food and treatment while being unable to work. This is an enormous burden for most Guatemalan families and without an adequate social network, is near impossible.