Progress on Global Health according to Gates
[youtube=http://www.youtube.com/watch?v=qtC_7v4XQ3k]
Posted by ldries in Global Health Topics
Making Seconday Care a Primary Concern: the Rural Hospital in Ecuador
Below is an exert from the Pan American Health Organization’s article by Andean Health and Development’s founder, David Gaus, M.D.
In 2001, Andean Health & Development (AHD, Milwaukee, Wisconsin), also known as Salud y Desarrollo Andino (Saludesa, Quito, Pichincha, Ecuador), a non-governmental organization (NGO), opened a 17-bed rural hospital, built jointly with the local municipality and the Ministry of Health (MOH) of Ecuador. The hospital serves a rural community of 50 000 that had no prior secondary care services. AHD/Saludesa’s efforts to develop a quality, primary/secondary care, selfsustaining public/private health network have led to important experiences in the administration of a rural hospital. In this article, AHD shares some of
these experiences through a discussion of rural hospitals in Ecuador.
Rural communities in Ecuador continue to experience unprecedented urban and international migration (1), resulting in shrinking rural infrastructures as political forces increasingly respond to the demands of growing urban populations. Ecuador’s public spending on health is 2.1% of its national budget, among the lowest in the Western Hemisphere (2). Furthermore, the high turnover rate among top-level MOH personnel—31 ministers in 37 years (3)—has made it exceedingly difficult for Ecuador to implement a long-term strategic health plan or define the role of the MOH in the health care landscape.
The MOH, Social Security Institute (Instituto Ecuatoriano de Seguridad Social, IESS), private sector physicians, and NGOs form a network of more than 4,000 primary care centers throughout the country (4). However, the secondary and tertiary care facilities, available in the larger urban areas, have extremely limited access for rural populations. Poor, rural patients requiring transfer for secondary or tertiary care encounter almost insurmountable obstacles.
A three-hour transfer to the capital city for a high-risk patient in labor can turn into nine hours when there is no receiving facility. In a situation such as this, the birth may occur en route, in the back of a pickup truck. Common obstacles to transporting patients to urban hospitals are:
• Patient unfamiliarity with large cities and their transportation systems
• Costly transportation for transfer
• Lack of in-town family support and lodging for family members of ill patients
• Bed unavailability due to severely congested tertiary care hospitals
• Insensitive medical personnel at receiving urban hospitals
Despite the obstacles however, technically, administratively, and financially well-maintained RSCHs, situated in appropriately-sized communities, offer many advantages over their urban tertiary counterparts. Specifically, the well-run RSCH:
• Keeps patients close to families
• Prevents traumatic long distance journeys
• Provides continuing medical education to an oftentimes relatively abandoned group of primary care providers in the community
• Decongests overburdened tertiary care city hospitals
• Delivers important curative services more economically due to lower fixed overhead costs
• Provides important leadership in developing local
capacity in the public and private health sector
For the complete PAHO Article, please click here:
http://www.andeanhealth.com/html/PAHO%20Making%20Secondary%20Care%20a%20Primary%20Concern.pdf
REFERENCES
Rev Panam Salud Publica/Pan Am J Public Health 23(3), 2008 217
Gaus et al. • Making secondary care a primary concern
By David Gaus, Diego Herrera, Michael Heisler, Barnett L. Cline, and Julius Richmond, University of Wisconsin, School of Medicine and Public Health,
Madison, Wisconsin, United States of America and Andean Health & Development, Emory University School of Medicine, Atlanta, GA, Department of Tropical Medicine, Tulane University, New Orleans, LO, Harvard Medical School, Boston, MA, Former U.S. Surgeon General, Former U.S. Assistant Secretary of Health.
Please click HERE to continue reading.
Posted by ldries in Global Health Topics
Biography of an Ecuadorian Resident
Amanda is one of the Ecuadorian residents at Hospital Pedro Vicente Maldonado. She has a focused curriculum specific to the Rural Hospital Model. This is one of the best programs in the country for medical training. She has written her bio in both Spanish and English!
“My name is Amanda Elizabeth Tene Rueda. I am 26 years old. I was born in Quito, but my family is originally from Loja. I studied in Universidad Central del Ecuador. I was interested in family medicine when I was working as a rural physician in San Gabriel. I liked my first rotation in Hospital PVM. It was very hard and I learn very much about rational medicine, even though I never had enough time to study!!
I think family medicine is very important in order to improve the health conditions in my country, especially in rural areas. Fortunately, I can dedicate more time to my career because I don’t have children or any other huge responsibility. I am single, my family is big – 8 members, I am the second, but I am the only physician.
Mi nombre es Amanda Elizabeth Tene Rueda. Tengo 26 años. Naci en Quito, pero mi familia es de Loja. Estudié en La Universidad Central del Ecuador. Hice el año de medicatura rural en San Gabriel provincia del Carchi. Ahí me nació la el interés por la medicina familiar. Me interesó mucho desde el principio la idea de hacer un postgrado en hospital rural. La primera rotación ha cumplido con las espectativas, aunque siempre hace falta mas tiempo para estudiar. Estoy contenta de haber escogido la carrera.
Pienso que la medicina familiar será un pilar importante para el mejoramiento de la salud sobre todo en las comunidades rurales. Afortunadamente, puedo entregar mucho más tiempo al postgrado porque no tengo hijos, ni otra responsabilidad mayor. Mi familia es un poco grande somos 8 personas, soy la segunda, la única médico de la familia.”
Learn more about Andean Health & Development at www.andeanhealth.org.
Posted by ldries in Stories
Debunking myths about the 'Third World'
Interesting TED Talk on health and income among and within regions of the world.
[ted id=92]
Posted by ldries in Global Health Topics
Reflections from a Visiting Hospital PVM Resident
I found the elective in PVM a fantastic cultural and educational experience. From the moment I arrived in PVM, I felt welcomed by the community and the hospital and right at ease in the working and living arrangements. The faculty, residents and staff were all warm and inviting; everyone was helpful and with answering my many questions. The patients were friendly and easy going and the medical cases were varied and intellectually challenging.
Initially, it is always disorienting to be in a new environment and unfamiliar medical system, but the small hospital, helpful staff and open atmosphere made it easy to adapt. Educationally, it was a good contrast to what I normally see in the US. The pathology was often more acute and severe, but the cases tended to be less complicated with polypharmacy and multiple medical comorbidities. It was a different sort of challenge than I am used to, and it taught me to think through the cases differently.
Instead of relying on a battery of easily accessible tests and an entire pharmacy of different medications, we were forced to think carefully through what we needed, what we actually had and how we could make do to best serve the patient. It was in many ways a more refined and intellectual approach to medicine in that the cases required critical thinking and decision making instead of following a cookbook algorithm approach to medicine. I came back feeling more confident with my own ability to work in new environments and approach problems from different angles.
Living with the Ecuadorian residents was probably the highlight of my trip. It was an excellent way to make fast friends and learn the inner workings of the Ecuadorian medical education system. The residents were wonderfully kind people and included me in everything. We had a great time making meals together, staying up late to study over cups of coffee, sharing gossip and venting about the usual frustrations of work and life. It was hard to part ways when my time came to leave but we still keep in touch by email.
-Rienera Sivesind
Please visit www.andeanhealth.org to learn more information about Andean Health and Development.
Posted by ldries in Stories