- hace 9 horas
Después de once años al frente del Instituto Nacional de Cancerología, Carolina Wiesner habla sobre los avances que han transformado el tratamiento del cáncer, los desafíos que todavía enfrenta Colombia para prevenirlo y atender a los pacientes, y el futuro de la investigación oncológica en el país. Una conversación sobre su legado y las tareas que siguen pendientes.
Categoría
🗞
NoticiasTranscripción
00:10Greetings to all the audiences of El Espectador who connect with us through all
00:16Our platforms, it's great to be back with you all. My name is Diego Quiseno Mesa.
00:22I am a journalist in the health and science section of this newspaper and I want to welcome you.
00:28Welcome to this space, and I want to extend a very warm greeting to Carolina Biesner, she is a medical surgeon with a master's degree.
00:37in public health and a specialist in philosophy of science, until a few days ago she was the director of
00:43national cancer institute for more than 11 years and was a researcher at the
00:51institute for nearly 20 years, that's right, Dr. Carolina, welcome, thank you Diego for this cordial
00:58Invitation and a very special greeting to the entire audience of the spectator, Doctor, after a
01:04After a decade of work at this institution, how does it feel to finish this stage of your life? Well, I
01:15I feel fulfilled, I feel very happy and satisfied. It was an honor for me to represent the institute.
01:22At the national cancer center, we have a very special human talent team, specialized technical and professional.
01:31I learned so much from the institute; it's an academic space where you learn something new every day.
01:37Something new where there are challenges to face, where there are ethical, human, and administrative situations.
01:45Scientific financial benefits and, of course, being able to help patients is an activity that generates a
01:54a deep feeling of helping those who need it most, and whenever I listen to the professionals
02:03Many of those who graduate with their second specialization say in their speeches, "I don't know what it is about the..."
02:09institute, but one ends up falling in love with that institution even though it is located in a place
02:15complex in a difficult place in a place that is not supposed to be so beautiful but is very enriching
02:23The institute, perhaps for those who suddenly don't have it there in their memory, is the entity
02:32public of
02:33The most important research and treatment in terms of cancer in Colombia was born in 1934 within the
02:43national university and little by little it was transformed until it became the entity and institution
02:51pioneer in scientific research, development and care that I am not so indeed at the beginning
02:59In 20th-century Colombia, Colombian medicine was heavily influenced by French medicine.
03:05And during that time, Madame Curie discovered all of radiotherapy, and with Claude Regov, they founded an institute.
03:13Radium was being used in France at that time, and cancer was already a major problem in France; in Colombia it wasn't.
03:19was
03:20and through the national university where the professors were already studying radiotherapy
03:26It was considered that, given the cost of the treatment, state support was important; then they were the
03:32national university that promoted when the collected resources were not used
03:38To face the war with Peru, it was used in the construction of this building, and one reads the
03:45History shows that in Congress, doctors were saying no, or politicians were saying we weren't going to invest in something.
03:51so
03:51It's expensive, it's not a priority, and in the sector, those who work in the private sector, this is going to...
03:56to be a
03:57Unfair competition, in short, but let's say the institute was established in 1934 and prepared the country
04:04in all the possibilities of human talent development and technological incorporation for what today
04:11It was already the second leading cause of death, so in 1953 it ceased to be part of the national university and passed to
04:19The newly appointed Ministry of Hygiene, which was founded in 1954 as an attached entity, because since
04:25Then it began to receive resources from the nation for its operation, which fortunately today
04:32It remains clear that in 2015 you arrive at the general management and during the 92 93 years of existence of the
04:42The institute has been the only woman to reach that general management position that she found when she arrived in
04:50in terms of how the country was in cancer and how the country has transformed in these more than 20
04:57years
04:58Well, yes, the position of director of the national cancer institute is a government position, that is to say, it is
05:05Appointed by the minister and the president at the time, at that time it was Dr. Alejandro
05:12Gaviria, who was the Minister of Health, appointed me at first; I was later in charge.
05:19The director leaves three months after the new president takes office. So, after that, we have...
05:27President Duque arrives, I eat, they ask me to continue, and then President Petro comes with the
05:35Minister Carolina Corcho, I have found, and that is what I have liked about the institute, that the positions of
05:42Directors are not political appointees of the government; rather, for these 92 years, a [unclear - possibly " ... if not "unclear - if not "unclear - if "unclear - if "unclear - if "unclear - if "unclear - if "unclear - if "
05:48technical tradition, so since I came from the area of research in the
05:54The deputy director of investigations was learning from all the dynamics because the public sector is
06:00complex and we need to have institutional memory of how this complex sector works, which is very
06:06Since it's bureaucratic, it has extremely strict processes and procedures, so I
06:11I found an institute whose previous director was Dr. Raúl Burillo, a research technician.
06:18leaving some conditions, then, of a great accumulation of technical reasoning, modernity, structure because of it
06:27What is most important for an institution is that the people who arrive find conditions
06:32which are favorable for fulfilling its functions, so it was a mature, solid institution
06:37We recently celebrated the magazine's 85th anniversary and had the opportunity to reflect with the
06:44previous directors and how each one contributed to making the magazine increasingly better
06:49So, as a scientist, I've liked seeing in the public sphere the possibility of the state being innovative.
06:55provide services and break with the social representation that the public is corrupt and bureaucratic
07:02The inefficient institute testifies, as Mariana Matsucato mentions in her work, that the state has to
07:09to generate well-being and must invest, and the institute is a transparent, emblematic entity that proves it is.
07:17It's possible to build something like that, of course. Cancer, Dr. Carolina, has been gradually transforming with the
07:27years in a growing problem for health systems and for countries you in some
07:34Just as I was saying, it has ceased to be a lethal disease and has become a chronic illness and
07:39How has this transformation from cancer to a chronic disease been experienced in Colombia, and what are the...
07:46The epidemiological panorama of this disease in the country, well, the institute since its inception
07:53He was always concerned about how to create a national cancer registry in the country and has worked and has
07:59received, let's say, technical guidance from the International Agency for Research on Cancer where
08:05You can track the incidence of new cases and see how it was in Colombia
08:09increasing the incidence of cancer, particularly infection-associated cancers, because cancers
08:16Associated with infection occur in countries or societies that have less human development, so from
08:23My perspective throughout this journey is that cancer was a relatively rare disease; people felt sorry for it.
08:28Saying I had cancer was taboo; it was hidden when I entered high school in the late 90s.
08:35The most prevalent cancers are those associated with infection, and as time has passed, it has become clear that these
08:40They have decreased relatively and other cancers such as breast cancer and prostate cancer are positioned without
08:46However, we occupy an intermediate place on the world stage, but what we have been able to see is that the
08:52In countries of the European or northern region, the reduction in mortality is impressive, that is to say...
09:00a very high incidence of very high mortality have reduced have achieved reductions of 40% and 30%
09:06one hundred and we barely have it, although the incidence is lower because the reduction in mortality is
09:11So Colombia and the institute have been able to learn how to reduce the incidence and
09:19Precisely with the incorporation of all the new medical technologies, cancer is no longer associated
09:27with a synonym for death, but rather the person assumes, faces, and takes on the treatment, and we see great
09:36That's a very interesting difference, doctor, that's what you were saying about cancers, that's a very interesting cure possibility.
09:42infection, and because, well, there we have, for example, I understand, the one about BPH, that there is a vaccine and that there is already
09:50countries that have almost achieved eradication thanks to that vaccine, and in Colombia we have
09:56It's not a sad story, considering that vaccine we've been trying to recover little by little, I don't know.
10:04All the technologies to eliminate coyote cancer already exist in the world, considering the
10:09elimination that the incidence is relatively low, four per one hundred thousand women who have the
10:14When I arrived at the institute, infection was one of the leading causes of death from cancer.
10:21from coyoterino and we see how ten years after the health system reform thanks to which
10:27Universal coverage was achieved and mortality is starting to decline; this is obviously a reflection of what
10:32This also happened in previous decades because women have a higher level of education
10:39And so they have greater access to treatment and prevention technologies like vaccines; however, if one
10:46Look at the trend, we would expect it to continue going down, but it stagnated, it stayed there, so that has to be
10:52It has to do with access to technology, and we would hope that in the future girls and young women will be vaccinated.
10:58against the BPH vaccine or coyote cancer vaccine and in a short time because we are almost at six
11:04We can see that the public health problem has reduced that dynamic that you mentioned in relation to the
11:11mortality that we have not achieved in the country and I understood well to reduce it to the levels at which
11:18There are other countries in the region, what do you think is the reason? Well, there are many factors in this case.
11:25The vaccine lost credibility; fears began to spread that this vaccine was supposedly manufactured.
11:30It is associated with adverse events that were not actually associated with this vaccine.
11:37So the country stopped vaccinating, girls stopped getting vaccinated, and parents no longer wanted to be vaccinated.
11:44lost the vaccination that was previously required at school to be vaccinated at health services that
11:50makes it more difficult to achieve 80 or 90 percent coverage, so these are phenomena that
11:56We could call them social determinants, but precisely when we launched the ten-year plan for
12:02In cancer control, we see how there are risk factors when one looks at the long term and how they are treated
12:08with the political level, all the actions at the community level, and of course some greater ones
12:14Treatment technologies since the introduction of a new treatment in recent years
12:20Systemic therapies such as immunotherapy have completely transformed the reality of cancer treatment.
12:27The new therapeutic weapon began to be introduced precisely when I became director
12:33Before that, we saw, for example, melanoma patients who had metastatic lesions.
12:39how the use of these drugs, which were also initially used in research, made the
12:45transformation and today a patient can have a survival rate of 10 or 20 years with the use of these
12:51treatments when previously survival was very low, then they are so complex.
12:58This disease requires thinking about long-term goals that are seen 20 years later when it is done
13:02Prevention encompasses everything related to early diagnosis and the entire therapeutic framework involved.
13:08that a multidisciplinary approach is needed, meaning that all the major treatment centers...
13:13Cancer patients should not be scattered throughout the country, but rather sent to a few centers where they can be treated.
13:19Leverage technology and human talent, because if we all do everything, which is what sometimes happens
13:25In Colombia, then, fragmentation, lack of comprehensiveness, and reprocessing mean that we don't have
13:32The efficiency seen in other countries means Colombia has made many advances, but when
13:39We compare the survival rates of certain high-incidence pathologies such as breast cancer and other cancers.
13:44Prostate compared to similar countries in the region, our survival rate could be better
13:49So there's still a lot to do; we still need to work on this, on what the evidence shows.
13:56Scientific evidence has already proven that it works. Of course, you mention there are several very, very, very things.
14:02Important to this topic of technological development, I would like to return to it a little later
14:06Doctor, but this issue of the fragmentation of health services seems very interesting to me.
14:13At some point, he had an argument with one of his colleagues during an interview earlier and
14:18I was asking about this desire that sometimes appears in newspapers and news reports to have an institute
14:27national cancer center by city or region and he was telling me that's not ideal.
14:32ideal is
14:32to have large specialized centers and generate a route around them, and that was somewhat the role that
14:37The institute had, and faced with those challenges of comprehensiveness, with that desire for comprehensiveness, what challenges?
14:44The country still has a good thing going on, because the constitution allows people to start their own businesses.
14:51so all doctors can start their own commercial or service initiatives
15:00service, but it has been shown worldwide, for example, that the European organization of institutes of
15:07Cancer considers the number of new patients treated by an institution that does not
15:13It must be below 2,500; between 2,000 and 7,000 is considered an indicator because that's where it is.
15:18all the
15:18human talent, all the technology is more efficient, all the diagnostic possibilities for the
15:24Hematolymphoid neoplasms are very expensive because they are concentrated in one place because they are
15:29120 pathologies, and then each one goes to the place where there is the greatest efficiency, so for example
15:37I would say Bogotá, Bogotá, Bogotá has roughly 8 million inhabitants with an incidence rate of 180 per
15:46Out of 100,000, we could say there are between 8,000 and 15,000 new cases, and we have roughly
15:54150
15:55institutions that register oncology services, if one divides, well knowing that it is an average, it would be
16:02So, each entity in Bogotá is fine, but 250 new patients isn't a quality criterion?
16:09One says, for example, that the institute receives 6,000 new patients and the large hospital clinics
16:14In Bogotá there are between 2,000 and 3,500, so all the other new patients are scattered and fragmented.
16:21Then it would be a matter of organizing ourselves; for example, the Netherlands made the decision, the specialists
16:28In oncology, we are going to concentrate patients with the same pathologies so that they go to different [specialties/departments].
16:35sites and we could be more efficient, that's quite difficult here in Colombia, so we always
16:42We're going to have those difficulties of fragmentation and the patient going from one place to another, for example in
16:48The institute has all the services to properly care for patients, but because of the
16:53So, when hiring, the insurers consider that they prefer chemotherapy, I don't know what might happen
17:01It's cheaper elsewhere and they don't offer the full package, so I do think there should be one.
17:07a review of the role of insurance in ensuring comprehensive care
17:13Of course, and that ensures the patient can have access to everything they need in one place.
17:20quality
17:20And that he doesn't have to move around so much because when you see him in Bogotá, there are difficulties.
17:25Of course, but if one expands it even further to the regional level, it's much worse when they have to
17:30Moving from one region to another is therefore very important in terms of cancer control.
17:36The organization of cancer treatment cannot be based on free demand and the dynamics of
17:41That market isn't efficient; sometimes I feel like we're in a war situation.
17:47sitting down, and then we should have a much more collaborative approach to cancer control.
17:53For example, we made a collaboration agreement with the Santa Fe Foundation so that
17:58When there is damage to any equipment, patients can go, and have gone, to the institute of
18:04In cancer treatment, we have the same equipment and the same technology, and the patients are amazed.
18:10They are well cared for and their treatment is not interrupted, and that also allows, I suppose, doctor.
18:16It also improves the time between diagnosis and the start of treatment, which is key in what
18:21It has to do with cancer; well, the diagnosis is an issue that goes beyond the major centers.
18:26In oncology, the idea is that the diagnosis can be made anywhere; that is, if a patient
18:32He has a symptom that is suspicious for cancer, which a general practitioner might suspect; for that, he needs a...
18:38training that can request the corresponding exams and that can be sent
18:44directly to the corresponding diagnostic procedures are sometimes the same specialists
18:50that do not allow the general practitioner, for example, if a general practitioner has a patient who was made
18:55A screening test for occult blood and wants to refer him for a colonoscopy, but it doesn't allow it; he must first go
19:02to the specialist so that the specialist orders the colonoscopy are tiny details, but if we look at it in
19:07On a large scale we could be more efficient; diagnosis and suspicion must be in every corner, and from there with
19:15The support of major cancer centers to make the definitive diagnosis, or the patient arrives with
19:21Once the diagnosis is confirmed, only the staging is done; this bottleneck in the diagnosis is what causes the bottleneck.
19:27because sometimes the patient has to go to the cancer center to confirm their diagnosis
19:32that we are not efficient, that's why we have worked and recently a new law came out that
19:40He tells universities that they have to modify their curriculum so that general practitioners have
19:45the skills to make an early cancer diagnosis because at this moment in teaching it is
19:51somewhat fragmented, semiology is learned here, pathology there, and we have understood that the
19:58Teaching for general practitioners should be from a very behavioral, semiological point of view.
20:04These tests, and when you have this, that's when you refer him to the specialist because there aren't enough.
20:10Specialists have already demonstrated that the demand for new cancer patients is far above
20:17The supply of specialists and in the country we have not done enough to ensure that the universities and the universities for
20:24that there be more training of human talent in institutions that could expand the offer such as
20:30It's the institute, and well, we haven't achieved it perfectly. You were just talking, doctor, about
20:36also the development of these new treatments, drugs, and technologies in general in the face of
20:41cancer and these last 20 years have been a period of rapid development in terms of technologies
20:48It's impressive how Colombia is doing in implementing these technologies, and I understand
20:55The institute also had made significant progress in the development of, for example, biosimilars and other technologies.
21:01Well, yes, as I was telling you, when I entered high school, it had already started.
21:09a new era of treatment which is immunotherapy, which is the use of innovative biotechnologies for the
21:16Cancer treatment has brought about a great revolution, and we are starting to worry.
21:23When we saw not only the increase in prescriptions but also in costs, I must say
21:28that in the institute between 2019 and 2024 an increase of 600 percent
21:36in spending
21:38The medications are monoclonal antibodies, and when we talked to the doctors, it turned out that they are the ones that have them.
21:46INVIMA approval is what the evidence has shown, and we therefore authorize the prescription and the expenditure
21:55We had great tension with the insurers because they were saying, "But how is it that you're... it costs us..."
22:02too much and we say this is an academic hospital this is a university hospital the
22:07We prescribe the medication as evidence, and of course, particularly for example with
22:13The increase in the risk band was being exceeded by the health insurance company Capital Salud, and it was a matter of
22:20The use of medications then creates tension between insurers and providers, but
22:25which also allowed us to analyze what we can do because not everything that INVIMA approves is sometimes
22:32INVIMA does not question the price of the medication, but rather its efficacy and safety.
22:37It enters the market and the treatment increases five or ten times; we compare one gram of
22:45A monoclonal antibody purchased in Colombia costs five million, and that same gram of that same
22:51An innovative drug in a high-income country like the Netherlands costs 900,000, so there are some distortions.
22:57in very large markets and I think it's necessary to have a drug policy because...
23:04This is a very significant percentage; it is what has financially impacted the health system.
23:10So we have a significant fiscal deficit, making international references
23:18particularly with the Netherlands and with the track record and capabilities that the institute has
23:23Developed in the production of compounded medications, the institute has been producing formulas since 2004.
23:29masterclasses in radiopharmaceuticals and this service is well positioned, and now we even sell to the sector
23:37Private radiopharmaceuticals at a reasonable price when the patient is there; production is not done.
23:43not on a large scale, but on an industrial scale, but for patients who have their own names; that's called a magistral formula.
23:48Then it was the same pharmaceutical chemists from the institute who told me, what if we started
23:53to think about it and, with other advice, to find out if it was possible to produce a masterful production of
24:01biotechnological, that is, on a small scale as was done since the second half of the 20th century
24:08Those who developed Nobel Prize-winning technologies used these technologies, and we conducted a 10-year study.
24:15pre-feasibility, feasibility, international benchmarks with Germany at the time of the
24:20pandemic all these cell cultures that are genetically engineered for the
24:27Colombian monoclonal antibody production; those who worked there told us that's a project
24:33We love disruptive, we're passionate about it, and with all the international advice we're starting the project
24:39So that's an absolutely spectacular strategic project that, when I retired, the minister had already...
24:48Ana María Vesga was aware of the project, and this project will have support from the ministry's future budget allocations.
24:55Because it's a project we're going to invest in, and the idea is to be able to, at some point, through a
25:03research, development and national process to have biosimilar monoclonal antibodies in the
25:08institute that is being considered on a small scale with a 50-liter bioreactor initially for the
25:14patients of the institute and later the capacity could be expanded is an absolutely project
25:22fascinating strategic state that has received national and international recognition and I have learned
25:29that when projects, people believe in the projects regardless of the changes
25:33The administration continues and grows because it's not possible to think of ambitious projects if not
25:39We break the barriers of time, then changes in administration, changes in director, the leaders
25:44They are convinced there, but if everyone supports it, the project will last over time because
25:50We are sure that personalized medicine is what greats like Professor Habslelenkens say in
25:59In the Netherlands, personalized medicine needs to be scaled down, and in that context, as you mentioned before, this
26:06This project is precisely the right path; we believe it is the right path, and there is gratitude for the
26:12Ministry of Health for the support we have received. Perfect, Doctor. In your administration there were also two
26:20There were many milestones, but among the most recent I remember two in particular: one is the transformation of the institute
26:28I understand one is a law from 2023, and the other is much more recent, which is the ten-year plan that
26:34Colombia has up to two thousand and thirty-five [units/resources] for everything related to cancer. Let's review both.
26:42Both topics are good. When I arrived as director of the cancer institute, I came from the sector of
26:50The research was extremely complex to carry out in a state-owned social enterprise.
26:55because all the administrative bureaucracy is focused on the functioning of the hospital and the
27:00The institute had eighty-two years of history in research with some very important topics.
27:05complexities regarding opportunity and resource management, so I wanted to create an institution
27:13much more modern so that researchers could have the recognition of those who have done the
27:19PhD, greater agility in the purchase of reagents, that is, the whole issue of opportunity
27:24And of course, the private sector in cancer services, because oncology is a business that
27:30It is profitable that it was skyrocketing, that it was skyrocketing in all regions of Colombia and when the
27:36The incidence of cancer was the highest in Colombia; the cancer institute was becoming a
27:41That little bit there was absurd, right? Because the remuneration of doctors there is the remuneration of a
27:50Public officials and those in the private sector can earn five times more, so they are the same.
27:56patients, it's the, the public resources, it's the same procedures, it's the same doctors, and in
28:02The institute could only receive a remuneration that I must say may be five times lower than what
28:07It is paid in the private sector then, with all the experience of the previous directors, I
28:15I said I also received that it was necessary to change and propose a new labor system, so we started working
28:22a labor system that functions like a private labor system that is much more flexible without losing the
28:27On the condition that the institute is public, there are many public institutions in other agricultural sectors that
28:33They have a private system and greater flexibility, so we started to see this situation arise.
28:43visible in the pandemic is the way in which people in the public sector are not permanent staff but
28:48They prefer not to be on the factory floor but rather provide services because in economic terms it is more economical
28:54Better, but in terms of quality, not being on-site is absurd, so we started working and this
29:02The need became visible in the Congress of the Republic, initially in the reform with Minister Ruiz.
29:10Fernando Ruiz, that was shelved, but at that moment the congressmen brought to light a problem that was not previously visible.
29:17so clear and they supported a bill, a new bill specifically for the institute where it
29:24would change
29:24The legal nature and the labor regime; the legal nature because it is a research and innovation institute
29:31With a hospital, it's a hybrid entity that didn't exist in the country; it's either a hospital or an institute.
29:37Research here is the two things that are positioned in the world because, well, the hospitals that
29:43They conduct research of better quality and of course it will finally be a legal system, the project was
29:50unanimously approved by the Senate in 2022, the period in which my term was ending
29:57of the
29:58President Duque, however, was sued by the National Civil Service Commission for saying that
30:08That private regime was unconstitutional, and the constitutional court ruled in favor of the plaintiffs.
30:17Our private system has ended, which I must say is the private system that is approved for the San Hospital.
30:24Juan de Dios, who had been put forward as a proposal for the reform of the health sector, that is, the sector
30:29The health system needs a special regime, I'm sure of that, and I believe that special regime is the regime
30:35private, which now has the San Juan de Dios hospital, but which turned out to be unconstitutional for the
30:39The paradoxes of a cancer institute are that it cannot be recognized in the titles of an institute of
30:45Research and innovation that does not recognize doctoral degrees and an entity that must follow
30:54providing their services and that now they must be opened to a merit-based competition, which is fine with the risks
31:02which has a merit-based competition since the questions are not in accordance with the functions they perform
31:09not the people but the functions of the state official we are talking about so that now the
31:15questions that are in accordance with the specific functions in oncology then that was a situation and
31:22We are therefore left with a legal nature, expansion of the formal employment structure of nurses
31:29that were previously provided by a company that offered services in terms of quality, it is important that the
31:37Nurses, assistants, chemists, and physicists are on the plant for quality purposes; that's how it was.
31:44The story of the institutional transformation, which remained somewhat incomplete, has perhaps two aspects.
31:49Points, Doctor, because if I understand correctly, the merit-based competition is not designed to assess...
31:57topics as specific as the civil servant or doctor who needs such a specific entity as the
32:04National Cancer Institute, and it's important that people understand that it's not a no.
32:11No, it's not a path that makes me understand that a doctorate or years of research are worthwhile.
32:22and
32:23They need to be valued differently when entering an entity like the institute, and perhaps the second
32:28The point for both of them to answer together is that the fact that the institute has perhaps lost that regime also implies a
32:39bit
32:39Which implies that this also presents an obstacle to research and science that can be done, or prevents it.
32:47the
32:48professionals who can do scientific research at the institute, well, if there really is a very low supply
32:56specialists in oncology, meaning that a monthly competition is held, now what we were telling the commission
33:01national civil service, if we open a merit-based competition for oncology specialists, because there are very few of them, almost
33:09that those who are working at the institute are in other institutions and those who are at the institute
33:15They want to continue working there, that is to say
33:21Well, the number of applicants isn't so large that thousands would apply and only the best would pass; I'd say that
33:28the
33:28The supply is small, and those who apply are likely to be taking the risk that...
33:35the
33:37The second specialty is not recognized within the degrees; a medical specialist is recognized then.
33:43We need to generate all the mechanisms so that if a gynecologic oncologist is going to be present, but
33:50The position is that of a specialist physician; the duties should be in accordance with the specialty title and not with
33:56The title of a non-specialist means that many risks are run in administrative terms.
34:02Yes, it can be done; an open competition will be held, and all administrative staff who meet the requirements will be eligible.
34:08to present, but it seems to me that for such a specialized entity as a cancer institute, which is the
34:14The only public institution in the country that holds a merit-based competition of this type should be modified, no, no, I don't
34:21It seems appropriate to ensure that suitable personnel enter such a high-level institution.
34:26specialty because a nurse who has been working providing her services for 15 years presents herself
34:32to the competition and it doesn't pass because all these years of expertise are lost, and the idea was that they would enter
34:38by
34:38a merit-based competition related to the functions, but well, that's like the term, and the other question
34:45What did you do to me? Was she a doctor? Yes, exactly, because you were talking to us about the gender pay gap.
34:53that exists today without that regime, and whether that could also affect research and science.
35:00Yes, the institute has suffered from a brain drain; many people who
35:06The formations at the institute are spectacular; I had to hug them and say goodbye because of the differences
35:13The options offered in the private sector are very broad; I must say, for example, that a dermatologist
35:20An oncologist at the institute earns in a private entity like CETIC what he earns working two days there.
35:28is
35:29The difference between what one earns in the institute each month and the salary is too great.
35:36The idea is that
35:37people do not work in several entities the European organization of cancer institutes in its
35:42Accreditation standards state that medical specialists must be concentrated in a single
35:47an institution to improve research in order to teach in academia, but if
35:53They're working in different places, right? In the same city, well, no, that's not logical.
36:00The difference is always in the public sector; worldwide, salaries are slightly lower, but for example in
36:04In Europe, public spaces are for all citizens, offering the highest quality services where everyone goes.
36:10Private sector is an exception with not very high differences in remuneration, so the
36:16People are working happily, each in their own place, unlike in Colombia where they are compensating.
36:24the shortcomings of the public sector in other private entities or private entities that want to seek volume
36:30And the goodwill of having a large volume of patients, that seems to me inefficient and shouldn't be.
36:36to be the
36:36However, the institute receives state funding from the minister through the organization.
36:44We have research resources and profits from the Ministry of Health transfer
36:48We invested them in research, then the institute made
36:54research with the support of the Ministry of Science, the physical fund of the Ministry of Health and
37:00We are at the forefront and what is done there is so fascinating that people receive an incentive
37:07It's not always monetary, but it's a great incentive; logically, everyone should receive some form of compensation.
37:15In accordance with his training and abilities, all of those are perfect, and they are also challenges that then and
37:21obstacles that will have to be overcome in the future, hopefully, because an institute of
37:28Research and innovation that does not recognize the doctoral degree, we have said at the institute that is the
37:33Pleistocene, of course, Dr. Carolina Biesner. Thank you again for these few minutes.
37:51which are like the important priorities of Colombia that were included in the ten-year plan
37:58and a little bit about the decisions that Colombia has to make in the coming days
38:05Years battling cancer again, thank you so much for this space. Well, thank you very much, Diego. Well, it
38:10What I must say is that I have great gratitude; I feel thankful because of my graduation from the institute.
38:19We were able to do this at the national cancer center with the launch of the ten-year plan for cancer control.
38:24Cancer 2023-2026: work that was done in the previous administration with the participation of all
38:31I believe that in the face of cancer, these divisions cannot exist among the actors, and I thank the
38:37Minister Anamaría Vesga for the opportunity she gave me to launch this plan that
38:42It precisely shows the great challenges, the great paths; we shouldn't focus on all of them.
38:48not only the vicissitudes involved in controlling the pathology but also the great challenges that remained
38:53There, they are enshrined, and they will be the roadmap for the country, and I have nothing but gratitude for all of them.
38:59the
38:59To the people of the cancer institute, all my affection, all my love, all my gratitude.
39:06that this public entity continues to be an example of transparency, zero corruption, and efficiency and
39:13Responding to the citizens of Colombia, thank you very much Diego for this space. Thank you, Doctor.
39:19Carolina, and thank you all for watching this interview.
39:25and
39:25and
39:36Thanks for watching the video.