GRAACC: excellence in fighting children´s cancer
In 2014, the GRAACC Hospital attended more than 3 thousand children and teenagers, accomplished more than 26 thousand medical appointments, 1.5 thousand surgical procedures, 40 bone marrow transplants and 16 thousand chemotherapy sessions.
As a reference in the treatment and research of children and youth cancer in Latin America, being one of the most respected and successful NGOs in the country, GRAACC – Grupo de Apoio ao Adolescente e à Criança com Cancer (Support Group to Children and Youth with Cancer) is a non-profit organization which was born with the mission of guaranteeing to children and teenagers with cancer, under the most advanced scientific standard, the right to attain all chances of healing with quality of life. Currently the institution reaches levels of healing of around 70%.
GRAACC was created in 1991, attending in a house under the concept of day-care hospital, in which patients received assistance and returned to their homes. In 1998, the Institution founded the IOP – Instituto de Oncologia Pediátrica ( Institute of Pediatric Oncology), unit managed by GRAACC with technical and scientific partnership with Unifesp – Universidade Federal de São Paulo (Federal University of São Paulo), located at Rua Botucatu, 743 – São Paulo, with 11 floors comprising an area of 4.200 m2, which is a Reference Center for the treatment of children and youth cancer, attending children and teenagers from all over Brasil – 40% of them coming from outside of São Paulo.
By IOP (Institute of Pediatric Oncology), GRAACC guaranties a high level assistance. Through the equipment and medical staff, the patient that is assisted by the GRAACC Hospital has at his disposition the highest technology and an excellent infrastructure. The hospital performs, in average per year, more than 26 thousand medical appointments, 1.5 thousand surgical procedures, 40 marrow transplants and 16 thousand chemotherapy sessions. With an estimated budget of 91 million Reais for 2015, it attends around 300 new cancer cases per year. More than five thousand children and teenagers have already been assisted by the institution – specialized in cases of high complexity, like tumors of the central nervous system, bone tumors, leukemia and other neoplasia that require transplant.
By the fact that it was reaching its occupational technical limit and with the purpose of being a reference in education and research in Latin America, GRAACC is enlarging the installations of its hospital. The first step was accomplished through the donation of a real estate property of 4.191 m2 by the Municipality of São Paulo. The construction work for the enlargement of the GRAACC Hospital started in October 2011. The investments are estimated to be 100 million Reais to raise a building complex with an area of around 16 thousand square meters.
The construction will be developed in different phases, so that the first unit, with six regular floors and two underground ones, has been inaugurated by year end 2013. Among the different ways to financially help the GRAACC expansion project there is a resource collection through FUMCAD – Fundo Municipal dos Direitos da Criança e do Adolecente (Municipal Fund of Children and Teenagers Rights) (http://fumcad.prefeitura.sp.gov.br). The fund allows for the destination of part of the income tax of persons and businesses to projects that guarantee the fundamental rights of the children and youth population like GRAACC. Persons may destine up to 6% of their due income tax and businesses up to 1%.
Part of the resources for the construction of the first expansion phase of GRAACC, have been donated by the following businesses: Revista Sorria, Editora Mol, Droga Raia, União Química, Bio Lab, Gearbulk, RedeCard, Bradesco, Santander, Colgate-Palmolive, Prefeitura Municipal de Barueri, Prefeitura Municipal de São Paulo, Grupo Orsa, Eurofarama, Mckinsey & Company, Credit Suisse Hedging-Griffo, Credit Suisse Hedging-Griffo Corretora, Banco Itaú, ABBOTT Laboratórios do Brasil, CSN, Atlas Schindler S/A, BPN Brasil, Central Nacional UNIMED, Suzano Papel e Celulose, Dormas Sistemas de Controles para Portas, Vogler Ingredientes, Lâmpadas Golden e Local Frios.
The success of GRAACC is due, mainly, to the consistent partnerships it has stablished along the years: with UNIFESP – Escola Paulista de Medicina (São Paulo Medical School), which provides the technical and scientific support and guarantees the knowledge, education and research; with businessmen who take part in the management and financing; with the civil society ( thousands of people make monthly donations to GRAACC) and with volunteers that permanently act in 22 sectors and more than three thousand additional ones that work in special events for the mobilization of the GRAACC cause and the raising and collection of financial resources. The efficient management of its volunteering processes granted GRAACC with the ISO 9001 quality certification, that was recently awarded by ABS Quality Evaluation – QE, one of the world leaders in certification. GRAACC is annually audited by Ernst & Young – EY.
The institution has become a reference in education and in the development of research in the fields of clinic, surgery and biology of children´s cancer, always with the objective of increasing the level of healing attained and relying on the technical and scientific support of UNIFESP – Escola Paulista de Medicina (São Paulo Medical School). Looking ahead into the future, when an individualized medicine is expected, the GRAACC directors have maintained a close and permanent relationship with the St Jude International Hospital (www.stjude.org), in Memphis – Tennessee – US, recognized by its discoveries in the area. St Jude shares with the scientific and medical community of GRAACC its advances in new drugs and laboratorial methods.
The institution performs clinic, biological and genetic studies with national and international partners. Its staff is comprised by doctors, monitors, coordinators and trainees. The objective is that the research may allow an early access to innovative therapies and provide an even better improvement in the Hospital methods, in this way becoming an important benefit for the children´s cancer treatment.
GRAACC has a data base with information about patients and research/discoveries about osteosarcoma (a type of bone tumor), which is present in 7% of children´s cancer cases. Recognized by its work in the evolution of the osteosarcoma treatment, GRAACC received the Health Award 2006 and 2010, category Children´s Health and Institution of the Year, from Revista Saude (Health Magazine). By its research work over craniopharyngioma, a brain tumor, GRAACC received the award A.J. Raimondi ISPN, from the International Society of Pediatric Neurosurgery, England, in 2007. In 2008 and 2010, it was recognized with the best award in pediatric oncology in Brasil, the Rhomes Aur.
GRAACC has a multidisciplinary team that unite their efforts to continuously improve the services rendered to patients and their families, humanizing the hospital assistance and offering a comprehensive treatment, as a way to maintain the adherence to the treatment and to minimize the late effects of the disease. Psychological, social assistance and social service support are additional services offered in this regard.
Once the disease is diagnosed, the first assistance the patient´s family receives is from the social service of GRAACC, which clarifies all the patient rights (free public transportation, withdrawal from the guaranty fund, among others). This support service develops , through a multidisciplinary team, projects to bring benefits to the patients: Pain Clinic, with a permanent follow up of the pain suffered by the patient during treatment; Friendly Leg Project, sponsored by partner businesses, which make prostheses donations; and Professional Support Project, which provide support for the professional development of ex-patients, among others.
Since 40% of patients come from the inland of the state of São Paulo and from other states, GRAACC offers accommodation in a Support House – The São Paulo Ronald McDonald House, which has a building area of 2.200 m2 and 30 apartments, being each one exclusive for each patient and his companion, as well as living rooms, an equipped kitchen, laundry and gardens, guaranteeing in this way comfort and quality of life.
GRAACC had further innovated with the project Mobile School that, since 2000, has brought to its patients a quality education, by means of qualified teachers, following the same curricular grid of the child´s original school, to guarantee that he or she may not lag behind in relationship to the colleagues of the same group and age who attend classes outside of the hospital. In this period, more than 25 thousand children and teenagers have been supported by the project covering basic and children´s education, with ages ranging from 4 to 23 years. The support group has a total of twelve teachers and two coordinators, in the areas of Portuguese, Mathematics, History, Pedagogy, among others.
Another GRAACC project is the Formation and Upgrading Intervention in Hospital Pedagogy, which has the purpose of preparing professors with a specialization in hospital pedagogy to work in hospital classes within the public school network or in hospital projects. This training and professional enablement aims at knowledge multiplying and to promote a positive impact in the health system of the Country.
Also under the philosophy of Comprehensive Treatment, GRAACC created a Multi Professional Clinic to Assist Patients Outside of Treatment – CforT (in Portuguese), which provides support to patients already outside of treatment for at least 2 years. CForT has a multidisciplinary nature and includes the areas of nursing, medical, nutrition, speech, physiotherapy, psychology, social assistance and education.
After the treatment, when the patient returns to the hospital for routine exams he goes through these areas receiving complete assistance, with the aim of preventing late effects, being them either physical or emotional. The project relies on three pillars: reintegration of the patient into the society; emotional work with the families and treatment remembrances (traumas). One of the main objectives of CForT is to change the patient´s victimization frame, in the attempt to show that he has the conditions to live a normal life.
The initiative to organize GRAAC was from Dr. Sergio Petrilli, then head of the Oncology sector of the Pediatric Department of the Escola Paulista de Medicina ( São Paulo Medical School); Jacinto Antonio Guidolin, a volunteer engineer, and Lea Della Casa Mingione. Everything started with the transfer of the Oncology Pediatric Sector of Hospital São Paulo to a house, with the assistance under the concept of day care hospital, in which the patients received medical care and assistance and returned to their homes.
The persevering work to fight against children´s cancer and the positive results attained convinced supporters and creators that much more could be done. The mobilization of the private sector and other organizations has led, in 1998, to the inauguration of the GRAACC Hospital. The hospital is totally equipped and has an hospitalization area (infirmary, Intensive Care Unit and Surgery Center), laboratories (hematology and immunophenotyping, cytogenetics, molecular biology and cryopreservation) and a support area (rehabilitation and prosthesis, pain control, therapeutic playroom, and social assistance) besides areas of nutrition, psychology, nursing, odontology, and social assistance.
The GRAACC Hospital has a playroom, one of the first in hospitals in Brasil, the Senninha Therapeutic Playroom, in which children and teenagers take their time to play while they wait for a medical appointment, an exam or some other medical procedure. The Playroom received more than 26 thousand children in 2011.
In 2004 GRAAC inaugurated, in partnership with the ORSA Foundation, the first chemo room in Brasil, a playful space created to guarantee to the child and teenager welfare during one of the most traumatic phases of the cancer treatment: the chemotherapy treatment. With 300m2, divided in accordance with the patient’s age group, the space offers 31 positions, guaranteeing an individualized care, two room for blood collection and a special room for transplanted patients.
The hospital has a modern Diagnostic by Image Center, with high technology equipment like magnetic resonance, computed tomography, bone densitometry, ultrasound with Doppler and X ray. With this infrastructure GRAACC is capable of offering the best quality in diagnostic for patients already in the institution or coming from the outside.