THOUGH the long-awaited hospitaldevoted to the care of cancer patients hasbeen postponed without a date for completion,health-care workers in Costa Rica aremoving toward a quicker and more comprehensiveresponse to cancer.Cancer is the second-highest cause ofdeath in the country, responsible for 20%of all deaths, according to the Costa RicanInstitute against Cancer.Each year, cancer kills 3,500 people inCosta Rica and a new case is diagnosedevery two hours. It is estimated that in thenext 10 years it will claim the lives of42,000 more people in the country.A series of workshops on cancer heldearlier this month concluded with a speechfrom the Health Minister, Dr. María delRocío Sáenz, that was mindful of the currentnational health-care system’s shortcomingsin dealing with cancer.THE workshops are part of a nationalplan that will culminate, for now, in a newcancer-diagnosis center for which officialsexpect to break ground this year and finishbuilding by December 2005.A plot of land for the center and thefuture hospital has been set aside next tothe Immigration offices in La Uruca, anorthwest sector of San José.The cost of the center is still unknown,pending the results of a study of the country’scancer-treatment system and changesproposed by a private consultant, accordingto cancer institute representatives.Previous estimates supplied by theHealth Ministry in May put the diagnosiscenter at $6.5 million and the strengtheningof cancer care – such as health-worker andpublic education – at $1.84 million. The costof the future hospital also remains unknown.THE center and a program of health workertraining and public education are ajoint effort between the Ministry of Health,the Institute against Cancer and the SocialSecurity System (Caja), the country’snational public health-care system.Heads of those institutions bill the centeras the first phase in the eventual completionof a larger, technologically up to datecancer hospital, but critics called it thehospital’s death knell.First conceived in 1998, the cancerhospital has remained on paper and took ashape in an architect’s model, but no budgetfor the facility has been assigned.Sáenz said the cancer center and eventualhospital are necessary because it is notpractical to supply every existing hospitalwith the equipment needed to treat the disease.WAITING lists for cancer treatmentshave surpassed 100 people in the country’slargest hospitals, a problem that leaves peoplewho may suffer from the disease waitingup to five weeks for a diagnosis and at leastthree months for an operation, according toa report in the daily La República about thestate of cancer in the country.A subsequent Tico Times inquiry intothe length of those waiting lists yieldedinconclusive results. As of the end of May,Dr. Eduardo López, general manager of themedical division of the Caja, reported thatone of the nation’s major hospitals, the SanJuan de Dios, in San José, had a list of 51patients awaiting surgery, and none awaitingradiation or chemotherapy treatments.The Calderón Guardia Hospital did notreveal the numbers on its lists by presstime. Other San José hospitals did not havewaiting lists, including México, which saidit has not had patients on a waiting list forthe past two years, the Irazú MedicalCenter of Radiotherapy, and the NationalChildren’s Hospital.SOME cancer patients must wait up toa year for care, according to the report inLa República, which said a lack of infrastructureand specialized personnel are toblame for the problem that has made an“agony” of cancer care in Costa Rica.Arturo Chacón, a 59-year-old cancerpatient of the Calderón Guardia Hospital inSan José, travels from his home in Turrialba,on the Caribbean slope, once a month toreceive his dose of radiation therapy.Though his pain has grown more persistentand he finds it harder to wait the entiremonth before each visit, because of the waitinglists of patients needing the same treatment,he has had no success with hisrequests to decrease the wait between doses.THE Ministry of Health proposed thenew cancer-diagnosis center to help withthe overload of patients, but critics, includinga number of congressional deputies,decried the clinic as a paltry substitute forthe postponed cancer hospital.Through preventive and educationalprograms and more efficient diagnosis andtreatment, the planned hospital could havesaved the country more than $45 millionannually, according to some estimates.The Caja shells out $60 million peryear in the care of cancer patients but,based on an investigation by La República,the planned hospital could have loweredthose costs to $14 million annually, includingmedicine, and would have spent $4million on preventive programs.Now, the Caja spends only $50,000 onprevention programs and spends the vastmajority of its cancer budget on patient care..MINISTER Sáenz said in her addressit is possible “to prevent up to 30% ofdeaths by cancer with changes in diet,reduction of tobacco consumption and anincrease in physical activity.”In Costa Rica, she said, many peopledo not seek medical treatment until theircancers are in advanced stages, and oftenmedical personnel are not attentive towarning signals.The workshops addressed those issues,instructing health workers in the promotionof self-diagnosis among patients, forexample, and to go for a check-up if thereare any warning signs.“It is not only about big purchases ofequipment nor architectural projects. It isabout building the best organization andfluidity of the process with appropriateadjustments to the network of services,”Sáenz said.Former Minister of Health RogelioPardo frowns on the idea to not go aheadwith the hospital construction plans.“IT’S a shame they have thrown outthree years of work in which they had settledon an architectural model and workedout the training of personnel in foreignhospitals and universities, for a project thatis probably just an improvisation,” Pardotold La República.The stalling of the planned hospitalalso elicited criticism from the LegislativeAssembly.Marta Zamora, of the Citizens’ ActionParty, said that, against wind and tide, thelegislative Commission of Social Affairswould persist with the idea that the countryhave a specialized cancer hospital.“The project must be conceived assomething more than a diagnostic center.What do I do with detection if I don’t havethe possibility of treatment?” she asked.The ruling Social Christian Unity Partydefended the new center, saying it is the firststep in the later construction of the hospital.