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.
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.