International Webinars for Health Professionals

International Webinars for Health Professionals

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.

Hospital Directors satisfied with the expansion of the collaboration with the Foundation’s Programmes

Hospital Directors satisfied with the expansion of the collaboration with the Foundation’s Programmes

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 the Preeclampsia 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 Sanabria 43 years 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.

THE FJRE COLABORATION EXPANDS TO ASSOCIATED HOSPITALS

THE FJRE COLABORATION EXPANDS TO ASSOCIATED HOSPITALS

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.


Training session by Dr.Celia Vázquez for staff in the Adolescents’ Space in Ñangareko Fernando de la Mora
Patricia Veiluva: We must promote prenatal care and family planning more than ever

Patricia Veiluva: We must promote prenatal care and family planning more than ever

In light of difficult situations like the one we are presently living in, the Ministry of Public Health issues some recommendations for care during pregnancy. We also encourage the use of condoms to avoid ZIKA and other sexually transmitted diseases. 

An important factor to transmit to women who feel concerned is that, “there has been no description of the virus transmission from mother to child (vertical transmission), and neither through maternal milk. Social distancing is the rule”, expressed by Patricia Veiluva, Director of Ministry Health Programs. Also emphasizing that all pregnant women and their partners should take the same precaution measures as everybody else to avoid the infection by COVID-19.

Patricia Veiluva, Director of Ministry Health Programs

Has the present sanitary emergency affected prenatal care in hospitals?

They should not be affected, since they are essential services which cannot go a miss, there may have been some deficiencies initially, however there should be no lack of services.

In Paraguay have there been no registered cases of pregnant women with COVID-19?

To date, there are no cases of coronavirus among pregnant women, there where two suspected cases which were negative. 

What are the recommendations for pregnant women at this moment?

We urge prenatal control to be spaced out as much as possible, and that each consultancy be good quality in order to reduce unnecessary visits, except in cases of patients with risk factors such as hypertension, diabetes or any other maternal condition in which the doctor considers it necessary for more frequent visits. The ideal is to limit to four prenatal visits.

If risk factors are identified, they should attend the consultancy proposed by the health professional. When attending the health service, all precautions must be taken, communicating to the health professionals if the patient had or has any symptoms such as a fever, cough, difficulty breathing or feeling flu-like symptoms, in order to be channelled to the respiratory diseases service. We urge the patient to go to the health centre alone, not accompanied so as to minimize accumulation of people in the corridors and also to take advantage of the visit in the most efficient manner and take all the necessary studies. 

As with the general population, the message is to comply with the social isolation, measures of social distancing are indispensable. If it is necessary to go out keep a distance with other people, wash your hands, use alcohol gel and avoid agglomerations. 

The preeclampsia challenge and adolescence program expand

The preeclampsia challenge and adolescence program expand

The partnership between the Foundation and the District Hospital of Lambaré began with great enthusiasm, being the third Ministry of Health Public Hospital to join the Challenge. Approximately 8.000 pregnant women attend the hospital per annum, of which 2.000 are estimated to be at high risk of developing preeclampsia. 

On the 20th of February, the first prenatal consultations took place in the Preeclampsia Challenge Program, with the previous theoretical and practical training sessions of doctors, midwives and nurses regarding prevention and early detection of preeclampsia. The arrival and initial implementation of the Preeclampsia Challenge involved a change in paradigms for the health professionals on many levels. Health professionals took advantage, in a positive manner, of the new partnership to manage together with the hospital authorities, the renovation of the consultancy and waiting room for pregnant patients. The Hospital achieved a modern and remodelled prenatal care area with excellent facilities. In spite of the lack of resources public health centres usually have, the team of health professionals proved to be good articulators and the project initiated successfully. The city of Lambaré has a large population of approximately 180.000 inhabitants. The hospital also receives patients from other cities and nearby districts. 

Regarding the adolescence project, visits to Family Units in the Capital and Central region have proved to be of vital importance for capacity building of health professionals working in these regions; since achieving close communication between family units and their reference hospitals still remains a challenge. On the other hand, during the visits the high demand for information regarding sub dermic implants emerged, highlighting the need for opportune and appropriate counselling to adolescents who attend these community services. 

Tecnical team begins work in the East of the country

Tecnical team begins work in the East of the country

The objective is to reach the health centres soon with the collaboration which the Foundation offers in the areas of preeclampsia and adolescence. 

The Coordinators of the Preeclampsia Challenge and Adolescence, along with their medical advisors travelled to the region of Alto Paraná during the month of February to conduct technical visits to the hospitals and family health care units where the Foundation expects to extend its collaboration. Meetings were established with reference staff from the health centres and regional authorities. The presentation of the Preeclampsia Challenge and the adolescence program took place. Regarding the Preeclampsia Challenge, relevant epidemiological data of the region was collected. According to 2019 data, there were 8.000 births in the Ministry Public Health Care in the Alto Paraná region, of which 200 pregnancies suffered from preeclampsia and 60 suffered eclampsia. The prevalence of preeclampsia in the region is, approximately 2,5%, which reflects a high degree of underreporting according to regional authorities. 

Despite the fact that Alto Paraná is fast-growing and the X Region counts on the cooperation of Itaipú and the Inter-American Development Bank to improve health centres in the region, there are still many lives lost for preventative causes, as are the cases of preeclampsia. For this reason, the foundations collaboration on health professional’s capacity building will make a great impact in the joint effort of substantially reducing maternal and perinatal complications and deaths due to preeclampsia. 

According to the agreement reached between the foundations technical team and the regional health authorities, it is expected to reach 250 doctors and 600 midwives and nurses through prevention and early detection of PE training.  

Regarding the adolescence program, likewise visits to hospitals took place: to the Regional Hospital of Ciudad del Este, the Regional Hospital of Presidente Franco, the Regional Hospital of Minga Guazú, and also Family Units Km 7 Monday, Ciudad Nueva, and the X Sanitary Region.

Currently there are only two adolescent units and the demand is high. The foundations collaboration will focus firstly on training health professionals on appropriate care for adolescents. Secondly, it will focus on long term family planning methods and counselling for adolescents at risk of unintended pregnancies. During this year, the projection is to reach 400 professionals from different hospitals and health care units in the region. According to the Ministry of Health guidelines, once the sanitary emergency we are in is overcome and the quarantine is lifted, all Foundations activities will be resumed in order to fulfil its 2020 objectives.