Recognizing the need for professional nurses, training began in earnest, led by a nurse fluent in Spanish, Nora Donahue, a native of Peru. Ms. Donahue convinced the Salvadoran nurses that developing their professional skills was critical to the survival of the children and future generations of nurses who would come after them even though they themselves would not experience monetary gains. Nurse training has contributed significantly to the dramatic improvement of the quality of care and survival of the pediatric cancer patients in El Salvador. Over the past decade, survival for acute lymphocytic leukemia, the commonest form of childhood cancer, has improved from about 10% to almost 60% in El Salvador.

Prior to 2000, St. Jude International Outreach met the needs for nurse training but it was decided that a different method was needed that would maximize available resources. In 2000, because of the progress made in El Salvador, International Outreach began a collaborative program with the professional nursing society in El Salvador, Sociedad de Profesionales de Enfermeria Sodeproe S.A. de C.V., to establish an International Training Center for HEM/ONC Nurses in Central America. Nurses from all of the Spanish speaking countries affiliated with St. Jude International Outreach are trained with an initial 12-weeks basic program in El Salvador. This program was initiated using the: Train the Trainer concept. A core team of 6 skilled multicultural nursing educators were trained to teach both the didactic and clinical portions of the St. Jude Children's Research Hospital Hematology-Oncology nursing curriculum.


The first class started in May 2000, with 16 nurses from Honduras, El Salvador, Guatemala, Costa Rica, Dominican Republic, Panama, and Mexico. To date, a total of 111 nurses from 16 Latin American countries have been educated in the training center and currently practice/teach pediatric hematology-oncology nursing in their respective countries.

There have been significant advances in the care of cancer patients and how care is delivered. Though the nursing educators in the El Salvador school can access information, language barriers do exist because most of the information is in English. The train the trainer model, using a multimedia, multilingual approach helped International Outreach overcome the barriers and support the instructors in updating their knowledge.

Measures of the success of the program include: (1) willingness of the Pan American Health Organization to provide scholarships, (2) willingness of the hospitals throughout Latin America to repeatedly release their staff to participate in a 12-week training course away from their institutions and their follow-up evaluations of the nurses performance, (3) evaluations completed by participants, and (4) willingness of the participants to train for 12-weeks, away from their homes in another country. Many trainees are called upon to suspend their income during the training period.