Dr. Felix Brizuela is Head of Outpatient Clinic and Statistics at the San Pablo Maternity Hospital and now coordinator of the new Espacio Ñangareko, inaugurated on 11 March. He points out that almost 100% of teenage pregnancies are unplanned, and with the opening of this new space, the aim is prevention and health promotion through continuous training and the provision of available planning methods. “The idea is to offer prevention to our adolescent women who generally come to us with an unplanned pregnancy”.
Brizuela reports that the adolescent area of the San Pablo Hospital had a relatively inconsistent functioning, firstly because of the pandemic and secondly because of the lack of a physical space. In terms of care at the San Pablo Maternity and Children’s Hospital, more than 20% of births correspond to adolescent pregnancies and 17% of maternal mortality in Paraguay, which means that adolescent pregnancy constitutes a risk, which is why it is essential to make more serious efforts in the area of adolescent sexual and reproductive health care, with a focus on women.
We share an audiovisual with the narration of Dr. Brizuela about the expectations of Nangareko’s opening at the San Pablo Hospital.
In addition to the work carried out in Paraguay, the Rassmuss family carries out philanthropic initiatives in other countries. One of the most important initiatives is in Chile, with the sister foundation Sara Raier de Rassmuss http://www.fsrr.cl, which works to strengthen early education in that country. There are also initiatives in Peru and Argentina. In order to consolidate and increase these efforts, two experienced professionals have been brought on board: Chris Wade as Board member and Katherine Hutter as Executive Director of the Rassmuss Foundation Network. Both visited Asunción to learn more about the work of FJRE. Their visit took place at the same time as the inauguration of the Ñangareko Hospital San Pablo, which was a pleasant event. The Director of the FJRE, Patricia Abed and all the staff of the Foundation warmly welcome and thank them for their contribution to the strengthening of our work.
With the presence of directors of the Juan Rassmuss Echecopar Foundation (FJRE) and other special guests, the opening of the fifth Ñangareko adolescent space was celebrated at the nationally renowned hospital for maternal health.
On Friday 11 March, the Foundation, together with the Ministry of Health and the San Pablo General Maternal and Child Hospital in Asunción, inaugurated the new Ñangareko Adolescent Space. For the FJRE it represents the fifth space to be set up in strategic health care centres for the public health system. The Ñangareko Adolescent Centres have a seal of excellence and quality. The initiative has been promoted by the Rassmuss Foundation since 2017, in close collaboration with the Ministry of Public Health.
In line with national efforts, we have contributed to the reduction of teenage pregnancies in Paraguay, from 20,000 in 2017 to 13,500 in 2021.
Dr. Vicente Acuña Appleyard, director general of San Pablo, stated that thanks to this collaboration, a long-cherished project of the hospital is being fulfilled. “Of the 4,000 births attended at San Pablo, 25 per cent were women under the age of 19. There has been a gradual decrease thanks to educational campaigns, but there is still a long way to go. It is precisely this space that will allow easy access for adolescents – girls and boys – to consultations and sexual education to reduce the risk of unplanned pregnancies and prevent sexually transmitted diseases. Acuña also highlighted the accessibility of the space, which is located at the hospital’s front entrance, providing differentiated care for the adolescent population attending Ñangareko. A multidisciplinary team has been set up to provide comprehensive care, with specialists in gynaecology, obstetrics, nutrition, psychology and social services, among others. Attention is provided from Monday to Friday during continuous hours.
Juan Enrique Rassmuss, Founder and Vice President of the Foundation, thanked the Ministry of Health for constantly opening its doors to work in a symbiotic and collaborative manner. He reflected, “We fundamentally believe that these achievements are possible thanks to public-private collaboration. Individuals, civil society and companies working together with the government to achieve these important challenges. He also recalled that the Foundation has just celebrated its fifth anniversary, “We are inaugurating the fifth Ñangareko, and we are also very proud of the work being done on pre-eclampsia, of which San Pablo Hospital is also a part. The Pre-eclampsia Challenge, whose aim is to eliminate maternal deaths from this disease” he said.
It is worth mentioning that companies and individuals also contributed funds, materials, supplies and equipment to set up this new Ñangareko adolescent space. The infrastructure was improved, setting up consultation rooms and a waiting area, which were specially designed and equipped to receive adolescent population. The total investment was around U$D 13,000. The executive director, Patricia Abed, emphasised that “generosity is a value that many people think is being lost, but the truth is that it is not. There are always people who give without expecting anything in return and the inauguration of this fifth Ñangareko space is proof of this”, she said during her speech. The event was attended by representatives of the Ministry of Health, medical advisors, officials of the San Pablo hospital and other special guests.
WHAT DOES THE FOUNDATION’S COLLABORATION IN THE ÑANGAREKO SPACES STRATEGY CONSIST OF?
Ñangareko (care, protect, welcome, in Guaraní), reflects the spirit of the space: an environment where adolescents feel protected, allowing them to access a new concept of differentiated, friendly, comprehensive health care, available without the need to request an appointment, and providing access to all services in just one place and in a quick and efficient manner.
Once the cooperation agreement between the foundation and the hospital has been signed, commitments are made to provide care with high quality standards. To this end, the foundation provides ongoing training and education for healthcare professionals through the foundation’s medical advisors. These trainings cover the full spectrum of medical competencies needed to provide excellent service, as well as soft skills for a warm, respectful and empathetic care. The foundation’s support includes infrastructure improvements and the provision of certain equipment and supplies. Emphasis is placed on making the full spectrum of planning methods available at all times.
The FJRE is a philanthropic foundation that has been working in the country for 5 years under a collaboration agreement with the Ministry of Public Health, and focuses on two strategic axes: prevention and early detection of pre-eclampsia as the leading cause of maternal death in the country, and adolescent health with an emphasis on sexual and reproductive health, through the strategy Espacios Adolescentes Ñangareko (Ñangareko Adolescent Spaces).
For Paraguay’s public health system, 2021 continued to be a very complicated year marked by the Covid-19 pandemic, despite the gradual improvement of the situation in relation to the previous year. The need to focus on care and mass immunization of the population demanded a lot of effort and resources from the Ministry of Health.
The overall situation has been challenging in terms of the expected growth in the number of patients served, and the expansion of the Foundation’s collaboration with the Ministry. However, despite the limitations imposed by the pandemic, this interview highlights some of the milestones achieved.
We would especially like to highlight the unconditional effort made by health professionals closely linked to the support provided year after year. Patricia Abed, Executive Manager, recounts some of the achievements.
The Foundation presented the milestones for the year 2021 on the evening of Tuesday 14 December. The framework of the event was to celebrate mainly the health professionals, due to them substantial progress was achieved in relation to the two strategic axes that our institution has been carrying out for more than 4 years.
The Rassmuss Foundation has been supporting Paraguay’s public health system since 2017 in two priority areas:
Reducing maternal and perinatal morbidity and mortality rates due to pre-eclampsia and its complications, the leading cause of maternal death in the country, and promoting comprehensive adolescent health, through the establishment of Espacios Ñangareko in public hospitals, under a concept of high quality, differentiated, friendly care, in a physical environment where adolescents feel cared for.
MILESTONES ACHIEVED DURING 2021 DESAFÍO PRE-ECLAMPSIA
Fulfilling one of the objectives of the challenge, that of providing comprehensive care of excellence to each patient admitted to partner hospitals, training was carried out during the months of July, September, October and November to strengthen knowledge on prevention and early detection of pre-eclampsia in all partner hospitals, reaching a total of 173 professionals, including obstetrician-gynecologists, obstetricians and nurses.
At the invitation of the Ministry of Public Health (MSPyBS), a training module on “Management of severe pre-eclampsia” has been incorporated into the NATIONAL CODE RED response system. For this purpose, training dynamics were previously recorded with each medical advisor of the foundation, followed by live questions and answers with them via the zoom platform. The impact so far is of 343 trained professionals at the national level.
For the second consecutive year, the free online course on “Preeclampsia: prevention, diagnosis and management” has been made available through the platform of the National Institute of Health (INS), aimed at obstetrician-gynecologists, family doctors, obstetrics graduates and final year students of these careers. A total of 1,050 professionals participated in this second edition.
EXPANSION TO NEW HEALTH CARE CENTRES
Centro Ciudad Mujer at the Villa Elisa Hospital
In September, the agreement was signed with the General Hospital of Villa Elisa to begin training in the health module of the Ciudad Mujer Centre. The capacities of health personnel have been strengthened and the implementation of the Pre-eclampsia Challenge strategy has begun.
Hospital Materno Infantil San Pablo
On 22 September, a meeting was held to present the Preeclampsia Challenge at the San Pablo Hospital involving all the doctors in service, followed by the signing of the collaboration agreement; and on 3 December, the San Pablo Hospital officially joined the Challenge, together with the remodelling and improvements to the prenatal clinic.
With these two additions, the Preeclampsia Challenge is now present in 7 hospitals, the other 5 being: Hospital de Clínicas, Hospital de Loma Pyta, Hospital de Barrio Obrero, Hospital de Fernando de la Mora and Hospital de Lambaré.
CONTRIBUTION FROM COMPANIES INTERESTED IN JOINING THIS CAUSE
Thanks to the contribution of Banco Sudameris, we were able to purchase and provide all the necessary supplies to carry out 24,000 risk assessments for the prevention of pre-eclampsia in the 7 partner hospitals. In 2021, 14,977 consultations were registered in our partner hospitals.
ADOLESCENCE PROJECT, ÑANGAREKO SPACES CONCEPT
This year, in response to the pandemic situation, we have placed emphasis on ensuring that all Ñangareko spaces offer the best possible range of planning methods, at all times and throughout the year.
We have purchased and distributed 300 units of subdermal implants, as well as intrauterine devices for adolescents, known as mini diu, to the sites. The corresponding training on insertion and removal of both methods has been carried out in the partner hospitals beforehand.
A very important fact to highlight is that despite experiencing difficulties and challenges during the pandemic, the number of pregnancies in the adolescent centres we support has not been higher than in previous years. This is thanks to the commitment and effort made by the professionals who provide services there.
As part of the expansion of the ÑANGAREKO concept, the alliance between the Foundation and the Adolescent Home of the San Lorenzo de Calle’i Hospital was made official: The Adolescent Home will now have the seal of excellence of the Ñangareko Spaces.
For this new collaboration, we optimised the premises and also provided the necessary supplies, equipment and tools for optimal care. As usual in the work system, the staff of the service will be constantly strengthened with support and training in order to provide high quality care.
At the moment, we are initiating the necessary improvements to inaugurate the Ñangareko area of the San Pablo Hospital, a national reference in maternal and infant care, in approximately 30 days.
REASONS FOR CONSULTATIONS IN THE ÑANGAREKO SPACES
We are very pleased that in despite the short period of supporting the Ministry of Health’s efforts to prevent unintended adolescent pregnancy, figures show that progress is being made in the right direction.
In 2018, the main reasons for consultations were adolescent pregnancies. In 2021, more than 70% of patients have been admitted for gynaecology or planning and only 30% for pre-natal care.
The 2021 closing event was attended by health professionals from the partner hospitals, representatives of the Ministry of Public Health, special guests, representatives of the companies that support the Foundation and benefactor partners.
One of the challenges for the new year is to reach vulnerable communities in the Capital and Central departments.
With much enthusiasm and great commitment from the Foundation, we plan to directly reach the most vulnerable communities of Asunción and the Central Department with our work. The goal is to expand the message of the axes we have been working on, reaching groups of families that we do not have access to through conventional media. We want to provide adolescents and women of reproductive age with sufficient and timely information that will allow them to develop knowledge and attitudes to be able to make decisions and prevent risks that compromise their health and integral development. In the month of November 2021, this new work axis has been incorporated and is currently in the methodological design stage, in order to adequately reach the communities, an action planned for February 2022.