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.