Transplant, new model of care give hope to Salvadoran mom after cancer diagnosis

By Cynthia Weiss

When Veronica Ciudad-Real was diagnosed with multiple myeloma — a blood cancer she had never heard of — in early 2021, the single mother had more questions than answers. At 40, she was younger than most patients diagnosed with the disease. Then she learned that the treatment she needed most was unavailable in her home country of El Salvador. Amid a pandemic, Veronica would have to leave her home and her 14-year-old daughter to receive a life-saving bone marrow transplant.

As her family searched online for options, Mayo Clinic kept coming up as a leader in multiple myeloma care, but the idea of connecting with the health care organization from thousands of miles away, without speaking English, was overwhelming to Veronica, who began chemotherapy locally.

It was only after her sister, Jeannette, who was visiting from the U.S., made a passing comment to another health care provider that the sisters learned Mayo Clinic had a patient liaison in El Salvador.

Soon they connected with Claudia Maria Fernandez, whose primary role is to coordinate care for international patients with specialists at Mayo's three main locations in the U.S. She arranged for Veronica to have a virtual visit with Dr. Sikander Ailawadhi, a hematologist and oncologist at Mayo Clinic Comprehensive Cancer Center in Jacksonville, Florida, and an expert in multiple myeloma. Via video visit — and in collaboration with her local team in El Salvador — they developed a plan that would culminate in Veronica receiving a bone marrow transplant.

"At first, I had a natural fear of the process that was described by the doctor. There was fear of being in the hospital and of the language barrier," recalls Veronica.

Jeannette, who lives about two hours southwest of the clinic, would be her constant companion — and her voice.

On July 4, 2021, Veronica traveled to the U.S. to begin the process for transplant. Though eager to start treatment, her anxiety was compounded when she learned she would have to spend about two weeks in the hospital after her transplant.  

Watch: Veronica shares more about her experience as an international patient at Mayo Clinic

A new model of care

Recognizing the challenges of her situation, which were compounded by COVID-19, her health care team proposed an alternative. Veronica was a candidate for Mayo Clinic's Advanced Care at Home program, which meant she would be able to recover in the company of her family.

The new initiative, which launched in June 2020, gives patients with conditions previously managed in a hospital the option to receive compassionate, high-quality virtual and in-person care and recovery services at home. 

Veronica would be the first recipient of bone marrow transplant to recover in the comfort of home.

"When Mayo presented the Advanced Home Care Program to us, my fears and anxiety were greatly reduced because my family was going to be with me the whole time," says Veronica.

The family secured a rental home within a few miles of the clinic, and within three days of her transplant, Veronica joined them. The transition to at-home care was easy. The experience, she says, was profound.

"My daughter, even though she was in El Salvador, was able to call and talk with me anytime. My family was always right there for constant support. This helped me physically and emotionally so that my recovery was my focus. I believe this contributed to my recovering sooner," she says.

As a care provider, Jeannette also found the experience rewarding. She noted that she was able to continue working while caring for Veronica and had support from extended family that would have been difficult otherwise amid COVID-19 restrictions.

A bright future

Though she will need ongoing follow-up care, thanks to her bone marrow transplant, Veronica can expect to live a normal life for the next several years, says Dr. Ailawadhi.

At her 100-day posttransplant appointment, Dr. Ailawadhi gave Veronica the news she was waiting for: she will soon be able to safely travel back to El Salvador and reunite with her daughter, Daniela, after eight long months.

"It was, and continues to be, a painful process for my mom and I to be apart," says Daniela. "But I'm thankful to God and the whole Mayo Clinic team for her transplant. Because of this treatment, my mom will live a longer life and stay by my side."

As excited as she is to return home, Veronica also reflects on her challenges with gratitude and the unexpected silver lining after her diagnosis.

"I am extremely grateful to Mayo Clinic," says Veronica. "It's been a beautiful experience — to feel at home even without understanding the language. I have felt loved by everyone, by all the staff. They have a spectacular team."

For the safety of its patients, staff and visitors, Mayo Clinic has strict masking policies in place. Anyone shown without a mask was recorded prior to COVID-19 or recorded in an area not designated for patient care, where social distancing and other safety protocols were followed.

Related articles

• "What is multiple myeloma?"
• "Multiple myeloma: New, better treatments are improving outcomes."

A version of this article was originally published on the Mayo Clinic News Network.