The Ministry of Health (MSP Y BS) reported that in recent weeks, the SARS-Cov2 virus has positioned itself as the leading cause of death among women in the period of pregnancy, childbirth and puerperium, while generating a considerable increase in the total number of deaths in this sector of the population. “There has been an exponential increase in the number of maternal deaths caused by Covid 19, most of which occurred in the months of April and May 2021, surpassing other causes such as eclampsia, haemorrhage and sepsis, which have historically occupied the first place of death in this population group,” says a report shared on the official MSPy BS website.
By the end of May, 76 maternal deaths had been recorded, 45 of them confirmed with Covid-19, representing 60% of the total. The age group ranges from 18 to 46 years of age, according to the MSP communication.
On Saturday, 5 June, Paraguay received 99,600 doses of the Modern vaccine against the coronavirus, out of a total of 400,000 donated by the Government of Qatar. The vaccines will be given to pregnant women from 18 years of age and 20 weeks of pregnancy onwards.
“E-Day” vaccination for pregnant women only
The Ministry of Health has established Saturday 19 June as “E Day” for vaccinating pregnant women, from 07:00 to 17:00 hours. This Saturday, the Ministry of Health will focus its vaccination campaign exclusively on pregnant women, over 18 years of age and 20 weeks of gestation or more, on a day that the Ministry of Health has called “E Day”, as announced at a press conference on Wednesday.
Some 12,000 pregnant women have already registered in the Ministry’s database, although so far some 4,000 pregnant women have been vaccinated with the Moderna doses intended for this group, according to official sources. The Director of Health Programmes of the Ministry of Public Health, Patricia Veiluva, talks about the most important recommendations for pregnant and lactating women in these times of pandemic, taking into account the local context.
The institution carried out solidarity initiatives in the context of the Covid-19 pandemic, at a time of significant increases in the number of infections and deaths as a result of the disease.
Paraguay is going through a third wave of COVID-19 with a significant upturn, while at the national level the same high plateau continues, with around 14,000 cases per week, according to official sources from the Ministry of Public Health.
Public and private hospitals are overcrowded with patients and the number of beds in the Intensive Care Unit (ICU) is at an all-time high. In view of this sad reality and in response to the various recurring needs incurred by the families of patients for the treatment of the families hospitalised in the different health care centres, the FJRE team made a modest contribution which was applied to solidarity and healthy breakfasts for the families of patients who are waiting for news of their hospitalised patients. In addition, fixed or conventional stretchers were donated to the Hospital de Clínicas and the Hospital de Barrio Obrero.
On 30 March we offered the first healthy breakfast for about 100 people. On the same day stretchers were delivered to the Hospital de Clínicas (San Lorenzo) and the Hospital de Barrio Obrero (Asunción). On the 20th of April again a team of the foundation was present in front of the contingency ward in the Hospital de Villa Elisa and also in the Hospital San Pablo de Asunción, providing the second batch of breakfasts for more than 150 people.
The Rassmuss Foundation is grateful for the valuable support of generous benefactors who contributed to this initiative in such difficult times.
In 2020, at the beginning of the pandemic, the FJRE led an important support campaign, gathering the support of 10 banks and an equal number of generous benefactor families, donating US$ 140,000 worth of supplies to the Ministry of Health.
Despite being preventable, preeclampsia (hypertension in pregnancy) is one of the main causes of maternal death in Paraguay. Pregnant women infected with COVID-19 are more likely to develop preeclampsia or suffer a complication called eclampsia. The Juan Rassmuss Foundation (FJRE) carried out awareness-raising activities in public hospitals, and also inaugurated improvements in the first visit clinic for pregnant women at the Hospital de Fernando de la Mora.
So far in 2021, there have been 63 maternal deaths. Half of these deaths were associated with COVID-19 and many of them were caused by hypertensive conditions (preeclampsia/ eclampsia).
New scientific studies show an increased likelihood of pre-eclampsia or eclampsia when a pregnant woman is diagnosed with Covid19.
“The clinical pictures of COVID-19 and preeclampsia can overlap or be very similar,” refers Dr. Patricia Veiluva, Director of Health Programs (MSPBS).
Unlike in 2020, when there were still no cases of maternal deaths associated with Covid-19, since the beginning of 2021 these cases have been increasing. Veiluva points out that “a patient with Preeclampsia and Covid-19 is a very high-risk patient, requiring great care and should be hospitalized for further treatment”.
Preeclampsia is one of the most common serious complications in pregnancy. It is associated with elevated blood pressure and abnormal urine protein. It manifests after 20 weeks of pregnancy and the first weeks after delivery. In its early stages it is asymptomatic, detectable only by tests performed during prenatal consultations. It is therefore essential that pregnant women attend their prenatal consultations, taking all the necessary precautions.
MAY 22 WORLD DAY FOR THE PREVENTION OF PREECLAMPSIA
Worldwide, preeclampsia and other hypertensive disorders of pregnancy are one of the leading causes of maternal and neonatal illness and death according to the Pan American Health Organization (PAHO/WHO).
Every May 22nd, World Preeclampsia Day is commemorated in order to raise awareness about the complications of preeclampsia and alert to warning signs or symptoms, for which early and prompt consultation with a specialist is recommended, as soon as a woman learns that she is pregnant.
WARNING SIGNS OF PREECLAMPSIA
Swelling of the hands, feet or face
Blurred vision or sensitivity to light
Pain in the pit of the stomach
MAIN ACTIVITY OF THE FJRE FOR RECALL
Fernando De La Mora Hospital
On Thursday, May 20 from 9:00 am to 11:00 am, a talk on Preeclampsia awareness was given to patients and hospital staff, accompanied by a healthy breakfast. The talk was given by Dr. Susan Contreras, medical advisor of the FJRE. This was followed by the inauguration of the improvements to the maternity clinic.
THE CHALLENGE OF PREVENTION
The Juan Rassmuss Echecopar Foundation seeks to improve maternal and perinatal outcomes with a focus on Preeclampsia and to this end has implemented a risk assessment system to optimise the prevention and early detection of the disease. The main focus of the FJRE’s Preeclampsia Challenge is to strengthen health professionals so that they can correctly evaluate all pregnant women at their first visit about the risk factors of Preeclampsia, and thus provide them with early diagnosis, indications and counseling, encouraging pregnant women to strictly attend their routine check-ups.
Another important aspect of the support work of the Rassmuss Foundation is the provision of medical equipment, supplies and medicines for the early detection of the disease, such as blood pressure measuring devices and test strips for the detection of protein in urine. Currently, the FJRE is collaborating with 5 partner hospitals and 21 Family Health Units in the Capital and Central areas. The hospitals with which the FJRE is currently working are Hospital Loma Pyta, Hospital de Clínicas, Hospital Barrio Obrero, Hospital Fernando de la Mora, Hospital de Lambaré and soon Hospital San Pablo.
The Global Pandemic has affected the working life of the whole of humanity, causing the need for adaptation in every one of the face to face activities in which we would normally engage.
As a Foundation which collaborates within the Health spectrum, focusing primarily on strengthening the capabilities of our office staff, we reacted rapidly in order to fulfill our 2020 training plans, adapting them to online education. Regular and routine training, together with workshops and congresses were all designed for adaptation to a digital mode.
The coordinators of both the Preeclampsia Challenge and the Adolescence Programme have organized Webinar events with the clear objective of imparting the most up -to-date knowledge available. We have always worked within the framework of the previously established planning, in this most unusual year. The impact produced by these webinars was of great significance at both a national and international level.
In order to meet high standards, information was provided to professionals, from home and abroad, with a long and established trajectory.
The first webinar, aimed at professionals from the Gynecology and Obstetrics field, was led by the renowned Prof. Dr. Paulino Vigil-De Gracia, from Panama. Recognized as a high-level speaker and lecturer by his professional colleagues, he is a reference point in Latin America as a specialist in Fetal Maternal medicine. His presentation discussed “Preeclampsia Diagnosis in Covid-19 Times and the Management of Hypertensive Disorders during Pregnancy”.
Another of the webinars focused on Adolescent Sexual Health and Reproduction in times of Covid 19. Here the current national situation was revealed and professionals working with adolescents from throughout the country were invited. The event was supported by the Ministry of Public Health and Social Welfare (MSPyBS). There was a clear necessity to discuss the threat posed by the current pandemic to these adolescents and the vulnerability of their situation, together with how to bring about more effective responses by ensuring access to Health Care services.
The following webinar about Preeclampsia was led by the also renowned Prof. Dra. Liliana Voto, from Argentina. She spoke about “Prediction and Prevention of Preeclampsia”. Dr. Voto has received recognition, through awards and distinctions for her contribution to education, research and science, at both national and international level. She is the author of the book “Hypertension and Pregnancy”, published in June 2020, and other contributions to various scientific publications.
In October we received the participation of the well-known Chilean Infant and Juvenile Gynecologist, Dra. Andrea Huneeus. Together with two colleagues, she presented the topic, “An Update of Sexual Health and Adolescent Reproduction in 2020”.
Also, in October the “Preeclampsia Challenge” presented the webinar, “The Importance and Utility of Biochemical Markers in Preeclampsia”. On this occasion, Prof. Dr. Jesid Miranda, from Colombia, was our guest Speaker.
The webinars were transmitted through the official accounts of FJRE, on Youtube and Facebook, generating new followers and subscribers. On every one of these webinars, as well as national professionals, we had participation from interested medical staff from many different countries, who interacted with questions and furthermore gave their thanks and congratulations on the organization of the events.
Despite the difficulties imposed by the pandemic, the FJRE has managed to increase collaboration with 2 hospitals in the MSPyBS network, from the second week in November 2020. We have already been working in a very positive way with both hospitals since 2019.
The Hospital de Barrio Obrero has added the Preeclampsia Challenge to its existing cooperation with the Adolescent Programme; and in Fernando de la Mora Hospital, the adolescence programme has started in addition to the Preeclampsia Challenge.
We interviewed the CEOs, Dr. Derlis León, of Barrio Obrero Hospital and Dr. Luis Battaglia of the Fernando de la Mora Hospital. Here are their opinions of the increase in collaboration that has taken place before the end of the year.
We shall begin with Doctor Derlis León, who received us in his office where we were witness to the hectic activity which is involved in the management of a hospital like “Barrio Obrero”.
The doctor began the interview by saying, “This hospital requires long, intensive hours of work in order to achieve everything that we do”.
¿What is your view of the increased collaboration between Hospital Barrio Obrero and the Rassmuss Foundation, with the implementation of thePreeclampsia Challenge? ¿ What expectations do you have of it?
A: The Rassmuss Foundation is one of our most important collaborators, if not the most important (without wishing to offend anyone he added, smiling). We already have experience of working together; it will be a year in December, since the opening of the Adolescent Space, the second to be opened in the country.
This has enabled us to increase the spectrum of coverage for adolescent care, with a multidisciplinary team, not only with the gynecological approach, but also with an overall view of this sector of the population. We feel that we are heading in a most satisfactory direction.
The pandemic has caused us to delay our plans. The idea was to grow and expand to include schools within the area. We are gradually returning to normality for our adolescent population in Ñangareko.
Based on this experience and in the confidence of knowing that this cooperation will be consolidated further, the Preeclampsia Challenge will be an addition of great importance. The early detection in a pregnancy of signs of high blood pressure, which is in fact what this is, means that the early intervention, through measures established by protocols, lives are saved. Not just one life, but two in fact. We believe that the impact that this will have on our population will be totally positive.
If we want to do good within Public Health, within our designated area, this is the best place. Barrio Obrero and all the surrounding area, have a high risk population, with the existing poverty band and extremely unfavorable economy. This means that very often we cannot reach those in this very disadvantageous economic situation. Therefore, we believe that with the alliance with the Rassmuss Foundation we will have the chance to identify the likely complications early on, and save lives. After all, that is our main aim.
¿Could you give us an idea of a basic patient profile for Barrio Obrero Hospital?
A: The surrounding population – our designated population – is more than 200,000 people, as well as people we receive from other districts: only 55% of patients are local, the rest come from areas beyond, Chaco, lower Chaco, towns in Central and other parts of the interior, due to the services we offer. We have a disadvantaged population, with a level of extreme poverty. This implies a low level of education, which means that often patients arrive late for an appointment or intervention, and as we all know, arriving late for prenatal care, or receiving no prenatal care, can result in complications and risk lives. This is the real situation in Barrio Obrero in terms of patient profile and their situation of vulnerability. Added to this we have addictions, and a high crime rate, ingredients typical of a vulnerable community.
¿What is the number of pregnant women which you hope will benefit from the Preeclampsia Challenge?
A: We are talking about more than 1,300 births per year in the Barrio Obrero Hospital, we can multiply that number by three for consultations by pregnant women – as not all the patients give birth here – we are looking at 3000 pregnancies who receive attention in the first stage, which is a significant number. The idea is that from the moment they walk through the Barrio Obrero door they receive what is known as a first appointment. By strengthening that first contact we are able to encompass the main part of the attention and information that the patient receives from us; in order to provide the most thorough consultation possible.
¿How do you view Maternal Health within the country, in terms of hypertensive disorders during pregnancy and early detection of these? In your opinion what aspects should we be pushing for in the Health Authority?
A: We continue to witness the deaths of both mothers and children due to poor or insufficient prenatal control. So, as well as encouraging all pregnant women to attend prenatal appointments, there needs to be a commitment from us or a commitment from the health system to improve coverage in order to make access to these controls effective throughout the country. We are also working on this through our health units. We have 19 Family Health Units – USF (Unidades de Salud Familiar) – around the hospital, plus 3 specialised centres. The Preeclampsia Challenge is also working with the Family Units. So, the idea is to create and reinforce the link between them and ourselves as a Hospital Model, so that pregnant mothers can have appointments in a timely manner and, at the same time, identify the possibility of any complication such as high blood pressure, which, if not detected and controlled, could lead to fatality.
Another hospital where the Juan Rassmuss Echecopar Foundation has had positive experience of working is at the Materno Infantil de Fernando de la Mora, an exemplar centre within the metropolitan area.
Luis Battaglia is a young gynecological obstetrician who has, through strong leadership, made his mark as Chief Director over the last two years. Here he tells us about the programmed opening of an Adolescent Space in Ñangereko.
¿During your management period the Foundation has been able to implement the Preeclampsia Challenge successfully, and only a few months on, you have been working towards opening the Ñangareko Adolescent Space. Could you tell us about the plans?
A: We have found the ideal space for 2 exclusive and well-equipped consulting rooms, a comfortable and pleasant
Waiting Area, totally suited to making our adolescents feel safe during the consultancies and with a multidisciplinary team ready to work in this area.
¿What numbers are we looking at in the Teenage Mothers unit?
The total number of adolescentes attended to between the ages of 10 and 14 is 765. Between the ages of 15 and 19, 1,752 We can also break down the consultancies into prenatal, gynecological and planning. We had 10 consultancies per year of ages 10 and 14 and 814 between the ages of 15 and 19.
¿In your view, what are the main challenges which you face with the Adolescent area, in terms of the consultations they receive within the hospital?
A: Apart from the specialised professionals who deal with them, regular and consistent training is of great importance. Attending appropriately with adolescents requires knowledge and familiarity with their problems and the skills to develop a comprehensive approach. Adolescence is a stage in life with special characteristics, needing a health system (both among professionals and in the service sector) which can give an appropriate response to their needs. For this reason we need to provide a space which is friendly and where our adolescents can feel at ease with the attention they receive, thereby avoiding more teenage pregnancies.
¿In your opinion, which aspects of public policy should be encouraged in order to reduce the number of pregnancies in adolescents?
We need to intensify the existing policies to prevent and reduce pregnancy in adolescents; providing educational spaces in waiting rooms through the Comprehensive Service for Adolescents. In order to promote the prevention of pregnancy in adolescents we should focus our efforts on public policies to ensure that the reproductive health services and access to information, together with comprehensive reproduction and sex education are available to everyone. We must provide comfortable, friendly spaces where our adolescents feel at ease and leave the consultancies with answers to their needs.
¿As a young professional, with great responsibility in the management of a hospital, how do you rate yourself?
A: I consider myself as a well-trained, responsible professional, with a commitment to the institution; I have a desire to innovate care services which offer comprehensive health to adolescents.
We are the first hospital with such services, which is of great importance to our users.
A brief Professional Summary:
Derlis León Sanabria43years old
Graduate in Medical Surgery fromUniversidad Nacional de Asunción with a specialisation in Pediatrics.
Also specialised in Health service Management – 2013.
General Director of Loma Pyta Hospital 2014 – August 2018.
Techincal Director of SENEPA September 2018.
General Director of Barrio Obrero Hospital, December 2018.
Luis Maria Battaglia Tescari, 36 years old
Graduate fromUniversidad del Pacífico 2010.
Medical surgeon, specialising in Gynecology and Obstetrics.
Post graduate in Hospital Administration – Universidad Nacional de Asunción.
Acting Head of Medical Management at the General Hospital of Santa Rosa del Aguaray.
General Manager – Hospital Materno Infantil de Fernando de la Mora, 2018 up to the present date.
As part of the more than satisfactory collaboration that is already in place in these hospitals, both hospitals now form part of the two Fundación Juan Rassmuss Echecopar focal programmes.
The initiation of the collaboration with Hospital Materno Infantil de Fernando de la Mora began mid – 2019, with the implementation of the Preeclampsia Challenge. In December of the same year, the Ñangereko Adolescents’ Space was opened in the Hospital General de Barrio Obrero.
The global context, with respect to the pandemic, postponed the expansion of our projects, focusing us on keeping in place the current ones and ensuring the highest standards of quality and anti – Covid measures. However, we do not wish to end this difficult year without fulfilling the expansion of our collaboration, in this case, by adding our Programmes within hospitals to those we have already been working in; with such excellent management by their directors and staff.
Since the creation of the Foundation, our Programmes have placed the focus on reaching more users, with the aim of decreasing complications and perinatal deaths derived from Preeclampsia; as well as giving teenage girls, a comfortable, friendly, private space in which to easily access consultations about their sexual health and changes relevant to their age.
The collaboration between the Foundation and their associated hospitals, is based on and prioritizes strengthening the abilities of both white – collar and administrative staff who provide services in the Gynecology Obstetrics and Adolescent areas. Additionally, support in the provision of input and medicines is provided according to specific needs and the budgetary possibilities of the Foundation.