FJRE SPONSORS INTERNSHIP IN THE UK

In July, the FJRE sponsored an internship in the UK for Dr. Daniel Ramalho, National Coordinator of the Red Code Program of training in obstetric emergencies, to bring new work experiences in the field of maternal and child health.

The specialist had the opportunity to participate in the Operative Birth Simulation Training courses and the Practical Obstetric Multi-Professional Training, both imparted by the Royal College of Obstetricians and Gynecologists.

During his stay in the UK, Dr. Ramalho made visits to hospitals, accompanying day and night shifts at the John Radcliffe Teaching Hospital in Oxford, and the Horton Hospital in Banbury. He also took part of the meeting of the British Gynecology Cancer Society in London.

University of Oxford

THE FJRE IS EXPANDING!

We are very happy to announce that soon the Juan Rassmuss Echecopar Foundation Preeclampsia project will be implemented in the Loma Pyta Hospital, which belongs to the Ministry of Health network. We hope to start our work in the last quarter of 2018.

As a Foundation, we want to continue contributing to maternal and child health in Paraguay, which is why we are working to reach more sectors of the population through our programs and in partnership with public and private institutions.

Loma Pyta Hospital

PROMOTING INTEGRATION AROUND MATERNAL HEALTH

Directors of the foundation convened a meeting of the group of professionals who participated in the group that the Foundation sponsored to attend the X congress of SOGIA, (Chilean Society of Child and Adolescent Gynecology) during the month of June in the city of Santiago de Chile. The purpose was to promote spaces of exchange around the issues of maternal and child health.

During the meeting, the professionals shared their experience regarding the learning obtained in the training and how they have applied it in their work. We hope to continue promoting this type of exchanges, adding more specialists, to continue contributing to maternal and child health in Paraguay.

Meeting

MEETING BETWEEN THE MINISTER OF HEALTH AND FJRE

Directors and executives of the FJRE visited the Minister of Health Dr. Julio Mazzoleni, in order to introduce the Foundation and share with him the projects and expansion plans that the organization has for the coming months. It was a very productive meeting, as it confirmed the interest of both parties to sign an Inter-institutional Framework Agreement that allows for greater actions that promote the improvement of maternal and child health in the country.

FOR YOUR INTEREST:

The IDB has just launched the book “From the patient experiences of primary health care in Latin America and the Caribbean”, we hope you can read the material (Spanish):

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CONTINUOUS TRAINING IN THE FOUNDATION´S PRIORITY TOPICS

Dr. Nils Wytzes visited us during the last week of May and spent days of intense training in the Service of Obstetrics and Gynecology of the Hospital de Clínicas.

The sessions included: “Update on basic concepts on detection, prevention and treatment of preeclampsia”, as well as “Vital Support for newborns”. Both sessions were addressed to resident doctors. For this last workshop we had the generous loan of the models used by Dr. Daniel Ramalho within the Red Code program.

Dr. Gustavo Brítez conducted the training in “Update on basic concepts on detection, prevention and treatment of preeclampsia” aimed at Obstetricians who are part of the group of professionals who will be incorporated very soon to the Obstetrics and Gynecology Service. This training will be continued until the entire group of around 40 professionals is reached.

“For the colleagues it was an excellent experience in the didactic approach of training for the prevention and treatment of pre-eclampsia of the pregnant patients who come to our services” said Lic. Cleide Ribas, Head of the Department of Obstetrics Hospital de Clinicas.

During the same week we received the visit of Julia Duvall and Elizabeth Wood, American students of medicine, who very actively supported the training efforts carried out.

EXPANSION OF THE COLLABORATION OF THE FOUNDATION JUAN RASSMUSS ECHECOPAR (FJRE)

Since May, the FJRE has begun an approach with the Loma Pyta Hospital, of the Ministry of Public Health network. We have visited the Hospital, gathering data that will guide us in the direction that our collaboration will take, to maximize the impact, taking advantage of the existing strengths.

As a first step, we have donated supplies that will help improve the care of patients who attend the area of ​​Gynecology and Obstetrics, consisting of a fetal monitor, pulse oximeters, tensiometers, thermometers, scales and ultrasonic dopplers. We accompanied the donation with a training session in the use of these supplies.

We expect to expand the collaboration with Loma Pyta, starting with the implementation of the project of detection, prevention and treatment of preeclampsia.

“I am grateful to the Juan Rassmuss Foundation for giving us the opportunity to strengthen and improve the health of our patients”, said Dr. Gloria Ortiz, Head of the Department of Gynecology at the Loma Pyta Hospital.

HEALTH PROJECTS MANAGEMENT COURSE

On June 1 and 2, the FJRE organized a Workshop on “Project Management in the Health Area”, which had 30 invited participants, from different departments: Ministry of Public Health, Dean’s Office of the Medicine Career UNA, Obstetric-Gynecology Service Hospital Clinicas, Loma Pyta Hospital, and Military Hospital.

“Very good experience, instructors with thorough knowledge, who kept the audience excited. We learnt a lot of apparently simple things, and how to really take advantage of our daily activities” said Dr. Liz Navarro, Head of Residents Gynecology Service, Hospital de Clínicas.

The instructors were invited from Chile: Prof. Álvaro Albornoz Bueno from Universidad del Desarrollo, Prof. Felipe García from Universidad Andrés Bello and Prof. Rodolfo Torres from Universidad Alberto Hurtado.

ADVANCED LIFE SUPPORT UPDATE

The second week of February, Drs. Benjamin Harris and Jason Walsh gave a series of advanced life support update workshops, specifically focused on obstetric emergencies. We consider this of great importance, since it complements the efforts made by the Red Code Program team developed by the Ministry of Public Health throughout the national territory, under the coordination of Dr. Daniel Ramalho, who generously shared his training models with us. This program was implemented by the Ministry with the intention that the health personnel will be able to identify an obstetric emergency and perform urgent assessment of the patient. Thus, in case a pregnant woman presents hemorrhage, eclampsia or convulsions, the team will be able to respond quickly.

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MATERNAL MORTALITY IN LATIN AMERICA

Maternal death is internationally recognized as an indicator of development and currently as one of increasing importance in health. This is so, because maternal mortality is avoidable, and its prevention depends directly on the coverage and quality of health services.

The choice of this topic seemed to us of fundamental importance, since Paraguay reports one of the highest rates of maternal death in Latin America. Thus, in the ranking of the Latin American countries in which more women died due to complications related to pregnancy or childbirth, for every 100,000 live births; Paraguay ranks 4th behind Haiti, Bolivia and Nicaragua; with approximately 130 deaths per 100,000. Meanwhile, Argentina has approximately 50, Peru 70, Brazil 40, and Chile 20.

As the image shows, Paraguay is one of the 3 countries in South America with the highest rates of maternal death.

Source: WHO World Health Organization 2015 en Universidad New South Wales Australia.

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VISIT OF VOLUNTEER PROFESSIONALS UNIVERSITY OF OXFORD

At the beginning of February, medical students who have just finished their studies at the University of Oxford arrived to participate as a support to the projects with which we are working within theGynecology and Obstetrics Service of the Hospital de Clínicas. Specifically, the Pre-eclampsia prevention and treatment project that has been implemented for several months now. The young doctors are Dr. Joseph O ‘Sullivan, who will remain until the end of March, and Dr. Lia Orlando, who stayed for two weeks. We are very grateful to them, as well as to the families who received them in their homes.

 “ÑANGAREKO SPACE” IS STRENGTHENED

The adolescent clinic “Espacio Ñangareko” created with the support of our Foundation in the Hospital de Clinicas continues to strengthen its operation at a steady pace. A key element for this is the obstetrician Juanita González, who is part of the team since the beginning of the activities in December 2017. She is efficient and responsible, she has a warm and kind attitude with the patients, and today she shares with us some impressions about her daily work:

“In these first 3 months we’ve had a very rewarding experience in the attention of our young adolescents who come to the clinic.
This is an integral space where we receive everyone with quality and human warmth, cordial treatment so they want to return to visit us without setbacks.

I hope this space continues to grow to help girls and their families, giving them the best of us”.

Juanita González

Bachelor in Obstetricia

INAUGURATION OF CLINIC “ESPACIO ÑANGAREKO”

On December 11, 2017, in partnership with the National University of Asunción, we opened the first “Ñangareko Place” Clinic. A clinic designed for the exclusive use of young women and adolescents under 20 years of age for their sexual and obstetric health.

We started working on the building in September 2017, with the help of Karina Bittar from DOXA, who transformed the space into a light, spacious and comfortable place, with a roomy reception area and 3 private clinic boxes. Each consulting room is equipped with modern and practical equipment that provides doctors everything they need to offer a good level of care, while maintaining a comfortable and non-threatening environment for our patients. Our goal is to offer a comprehensive service, with on-site diagnostic tests, ready supply of medicines and vitamins, in addition to orientation in various contraceptive options.

We are delighted with our opening event. The resident doctors were excellent ambassadors of the University and the Clinic, giving presentations of what they learned last year and we received a very positive reception from all our guests.

Juan Enrique Rassmuss Raier, President of the FJRE, sharing a few words at the inauguration.

Joanne Avery, Vice President of FJRE, Prof. Dr. Carol Lole-Harris Senior Medical Advisor and Prof. Dr. David Harris with the proud organizing and clinical team

COMFORT FOR OUR BENEFICIARIES

But much more important is how the clinic has been received by the more than 300 young women already received until the end of February, who have given us positive comments about the new facilities and the professional support received at Espacio Ñangareko, which is open from 7:00 and until 5:00 p.m. Monday through Friday (except Tuesday morning).

Some comments, shared from our Guestbook, which is available at the clinic to receive observations and suggestions.

STAFF COMMITMENT

One of the most important elements in the success of the clinic is the support and commitment of our staff. We are very lucky having Dr. Celia Vázquez coordinating the unit. She has managed to maintain a positive attitude, even when things get difficult. She is highly appreciated by the patients and has been a great contribution for the starting of the clinic.
Her comments on how the first weeks of the clinic have been:

“The Espacio Ñangareko is a friendly place for adolescent care, which opened its doors on December 14, 2017, and since then, the number of patients has increased, due to the flexibility in the hours of service, which extends Monday through Friday from 07:00 to 17:00, except on Tuesday mornings. As a professional dedicated to the care of teenagers, I feel very proud to be able to work in this space, which has all the comfort to develop our task in the best way. It is important to point out that with the increase in the number of consultations, it is necessary to increase the number of professionals trained in the care of adolescents.

Thank you Juan Rassmuss Echecopar Foundation for investing in the integral health of Paraguayan adolescents, and thanks to the Head of the Department for enabling this to take place. ”

Dr. Celia Vázquez

Child and Adolescent Gynecology Specialist

SPECIAL THANKS

Many people have helped in various ways to start up this clinic, and we will use this space to thank some people specifically. This month we want to highlight:

About the Foundation

The aim of our foundations is to help young people build the skills to succeed in the complicated world in which they find themselves. In Chile and Peru our principal projects are Education based, but here in Paraguay we have focused on health care for adolescents and young mothers.

Key attributes of any project we work in is that it is sustainable, replicable and of a high impact and we believe that the best way to achieve this is by building human capital. So much of our focus is on training and skills development with local professionals.

In Paraguay we have concentrated on 2 projects: adolescent sexual health and pre-eclampsia. This newsletter will focus on Pre-eclampsia.

WHAT IS PRE-ECLAMPSIA?

Pre-eclampsia is the most common of the serious complications of pregnancy and is caused by a defect in the placenta. We do not fully understand the cause of the disease, but our knowledge is advancing all the time. There are, however, well -established treatments for the condition. Pre-eclampsia is a multi-system disorder, which can affect many parts of the body including the liver, kidneys, brain and blood clotting system. Sometimes it is life threatening to both mother and baby.

At least 25% of maternal deaths in Paraguay are due to this disease. Pre-eclampsia normally occurs in the second half of pregnancy, typically after 28 weeks. In its early stages it is symptomless and is detectable only by regular antenatal checks on the mother’s blood pressure and urine. Our pilot project at UNA aims to identify patients at high risk of pre-eclampsia and give them prophylactic medication in an attempt to prevent its onset. This will also allow early identification of patients with pre-eclampsia and allow doctors to initiate timely treatment and monitoring.

DR. BATAGLIA AT THE PRE-ECLAMPSIA ASSOCIATION IN THE UK

Our work with pre-eclampsia started in June 2017. Professor Dr. Ramón Bataglia, Jefe de Cátedra y Servicio de Clinica Gineco-obstetrica FCM- UNA, was invited by the Foundation to attend various courses and seminars in the UK. In the opportunity, he gave a speech at the Royal Society of Pre-Eclampsia in London, which was warmly received, and the Society offered their support for our project in Asunción.

PRE- ECLAMPSIA TRAINING ATUNIVERSIDAD NACIONAL DE ASUNCIÓN

The Foundation’s health advisor Professor Dr. Carol Lole Harris organized for two doctors to visit from the UK, to teach on the latest and research and WHO guidelines and best practices in use in the UK and Europe and practical sessions on diagnosing and treating pre-eclampsia.

RESOURCES NECESSARY TO COMBAT THE DISEASE

Fundamental to rapid detection of the illness are urine test strips, that can give an immediate indication of protein in the urine and good accurate blood pressure monitoring.

Our special thanks to Williams Medical Supplies for providing urine strips at cost and Action on Pre-Eclampsia UK for the innovative, easy to use blood pressure monitors.

Treatment in the early stages involves taking a calcium supplement and low level of Aspirin, both of which are available in the outpatients clinic free of charge.

STORIES FROM THE PROJECT

“Without a doubt, the project is having a positive impact on everyone involved. First of all, for all the clinical staff it is very valuable to have access to the latest scientific research and be involved in an evidence based project, targeting pre-eclampsia.

Secondly, the benefits extend to all users of the service. For the patients it is much easier.  Their lab results are instantly available, and medicine to help combat the illness is given free of charge and they take the blood pressure machine home with them, so there is no need to continually visit the pharmacy or clinic for blood pressure monitoring.
 
All this translates into saved lives for mothers and children who otherwise would have been at risk of suffering the consequences of this serious illness.  The patients have been incredibly grateful.  They feel more supported and secure during this important phase of their lives“.

(image above: A kind note of thanks from someone who has been supported by the project).

Dr Gustavo Britez
Jefe de Residentes del Servicio de Clinica Gineco-obstétrica del Hospital de Clinicas.