Opened with care

Eduardo Zambrano’s office at Stanford Hospital is overflowing with small, colorful boxes, each of which once contained a tumor sample mounted on a glass slide or embedded in wax. The boxes, covered in suns, stars, flowers and other images of life and hope, were hand-painted in Latin America as a gesture of gratitude from families of sick children living there. 

“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,” says Zambrano, MD, chief of pathology at Lucile Packard Children’s Hospital Stanford.

In the past 12 years, Zambrano has received nearly 1,000 of these samples from pediatric oncologists in Latin America who treat desperately poor patients. An expert in pediatric solid tumors, he volunteers his time to examine the samples under the microscope and then issue a diagnosis.

The children’s cancers are often advanced — typically because they lack an accurate diagnosis or appropriate treatment. Poverty adds other burdens: A patient who had been treated for advanced neuroblastoma returned to the medical center because rats had bitten his feet at home while he slept, Zambrano says.

“Very often the diagnosis from the home country is either incomplete because they don’t have the resources to perform the confirmatory tests, or it’s wrong because they don’t have the expertise in pediatric tumors,” says Zambrano, a professor of pathology and of pediatrics at the School of Medicine. “It’s frequent that I have to give them a significantly different diagnosis.”

Though he has reviewed cases from Mexico, Bolivia, Guatemala, Brazil, Argentina and his native Ecuador, many of the samples come from Venezuela, where he has a long-standing collaboration with a pediatric oncologist whom he texts or emails every day. She sends him 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 has met some of his young patients and their families in Venezuela, though it’s become too dangerous to travel there because of political and economic chaos, he says.

“It’s a tragedy in Venezuela. 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” as a member of the “privileged minority,” he says. While growing up, he says he witnessed deep inequalities — critically ill poor who were denied access to the hospital — that he hopes now to help address.

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.

“These cases have served me tremendously in teaching my residents and fellows,” he says. In recent months, he has been working with colleagues both inside and outside of Stanford to obtain financial support for the service.

“I consider it very valuable, and it’s something that really moves me,” he says. “A lot of meaning would be lost if I couldn’t do this work. And it’s important to have meaning.”