32
The need to build on recent progress(linear accelerators and Cobalt-60) in the
public and private sector, and considering
cancer incidence and the proportion of
patients likely to need radiotherapy. Argentina,
Costa Rica and Panama meet this need to
a higher degree, while countries like Chile,
Bolivia, Mexico and Ecuador have major
deficits.While European guidelines recommend one
linear accelerator per 183,000 to 500,000
people,^67 “there is one single linear accelerator
in the entire public network in Paraguay [with
its population of almost 7m people],” says Dr
Mitsui. The other ones are in the private sector.
Similar situations are evident in Costa Rica,
according to Dr Vargas, and even in high-
income Chile, according to Dr Nervi. In Brazil,
according to Sergio Daniel Simon, president
of the Brazilian Society of Clinical Oncology,
“waiting times for radiotherapy are five months
overall.”Uruguay has by far the highest number of
radiation oncologists, with a density that
is somewhat average among high-incomecountries (for example, similar to Germany’s).^68
Paraguay and Bolivia, countries with lower
cancer incidence, are at the bottom of the
ranking (Bolivia did not report these data
in the first place). But even in countries that
perform relatively strongly for this indicator
in the region, such as Chile (4th), there can be
significant resourcing deficiencies. “In spite
of having a high income [in Chile], we have a
historical lag. We have about a fourth of the
number of oncologists we should have,” says
Dr Nervi. In many cases these differences
reflect different cancer needs, but examples of
the scarcity of the labour force, particularly in
remote regions, are common.According to Dr Sarria: “In the Amazonia
there is not a single oncologist. The conditions
have to be created for the labour force to be
better distributed in the country,” says Dr
Sarria. Addressing the gaps in such high-skilled
professions will require a sustained policy
commitment. As Dr Nervi suggests, “it will
take us 50 years to form all the specialists we
need. We should find a way to form specialists
faster.”(^67) BJ Slotman et al., “Overview of national guidelines for infrastructure and staffing of radiotherapy. ESTRO-QUARTS: work package 1, Radiotherapy and
Oncology, 2005.
(^68) The Economist Intelligence Unit, “Cancer preparedness around the world: National readiness for a global epidemic”, 2019.