1. RRP in Developing Countries Arturo Avila Chávez MD Director Voice Center México

2. Incidence ??????? ??????? NOT KNOWN NOT KNOWN Between 1500 – 2500 cases around the country Between 1500 – 2500 cases around the country

3. Main Problem CULTURAL MEDICAL ECONOMICAL

4. Voice as an Issue Voice is NOT a Health Issue Voice is NOT a Health Issue People IGNORE the problem exists People IGNORE the problem exists Dysphonia = Alarm Dysphonia = Alarm People receive medical care only when they are completely dysphonic or with respiratory distress People receive medical care only when they are completely dysphonic or with respiratory distress

5. Health Services Public Hospitals (subsidized by government) Public Hospitals (subsidized by government) ISSSTEISSSTE IMSSIMSS SSASSA Most of the general population Most of the general population Not all are free Not all are free Different levels of medical attention Different levels of medical attention 1st – 3d level1st – 3d level Very few centers for high specialized medical attention in all the country Very few centers for high specialized medical attention in all the country

6. Health Services 80 to 120 consultations per day 80 to 120 consultations per day 10 surgeries a day 10 surgeries a day 6 -8 moth waiting for surgery 6 -8 moth waiting for surgery Some patients even have to wait to be operated until they have respiratory distress Some patients even have to wait to be operated until they have respiratory distress

7. Health Services Public Hospitals Public Hospitals Big gap between first consultation and day of surgery Big gap between first consultation and day of surgery Bureaucratic paper work Bureaucratic paper work Time consuming Time consuming Centralized country Centralized country Private Practice Private Practice The least amount of patients with RRPThe least amount of patients with RRP Need an InsuranceNeed an Insurance Otherwise…..Very expensive! Otherwise…..Very expensive!

8. Medical Issues RRP is a third level attention problem! (Highly Specialized) RRP is a third level attention problem! (Highly Specialized) Some residency programs don't have a good laryngological training, which reflects a wrong Dx and Tx. Some residency programs don't have a good laryngological training, which reflects a wrong Dx and Tx. WHY?WHY?

9. Medical Issues Larynx is ENT´s the most hidden structure Larynx is ENT´s the most hidden structure

10. Medical Issues Equipment Equipment DiagnosisDiagnosis

11. Medical Issues

14. Surgery Surgery EquipmentEquipment

15. Medical Issues

16. Surgical techniques Surgical techniques MICROSURGERYMICROSURGERY

17. Medical Issues Antivirals Antivirals Interferon Interferon Vaccines Vaccines Phytosorb DIM Phytosorb DIM I3C I3C PDT PDT Retinoids Retinoids Mytomicin Mytomicin

18. Drugs Availability Meds Meds Very expensive $$$Very expensive $$$ Interferon Interferon Cidovofir Cidovofir Non AvailableNon Available No International Sale Representatives No International Sale Representatives

19. RRP Information Pt is not informed about RRP Pt is not informed about RRP CauseCause SymptomsSymptoms Treatment OptionsTreatment Options No societies or foundations to support RRPNo societies or foundations to support RRP Patients are all by themselvesPatients are all by themselves

20. Main Problems Cultural Cultural The RRP manifestations are almost certainly under- described and non existent for general population The RRP manifestations are almost certainly under- described and non existent for general population Lack of Information (educational programs) Lack of Information (educational programs) Health care system Health care system CentralizedCentralized Better training residency programsBetter training residency programs Subspecilized Doctors Subspecilized Doctors DX tools and TX equipmentDX tools and TX equipment Drug AvailabilityDrug Availability

21. Solutions Take advantage of RRP IRS´s infrastructure as a plataform Take advantage of RRP IRS´s infrastructure as a plataform Inform PeopleInform People Most of the affected people only know Spanish and don't have access to internet Most of the affected people only know Spanish and don't have access to internet Language barrier Language barrier

22. Solutions Expand activities Expand activities Create a supportive community network in Developing Countries. Create a supportive community network in Developing Countries. Creat groups of people, committed people, specially patients and Doctors to approach RRP IRS as a backup for multipurpose Creat groups of people, committed people, specially patients and Doctors to approach RRP IRS as a backup for multipurpose Interaction with Meds suppliers for easier access and cheaper prices Interaction with Meds suppliers for easier access and cheaper prices

23. Thank You!