clinical challenges, needs and opportunities in the
TRANSCRIPT
![Page 1: CLINICAL CHALLENGES, NEEDS AND OPPORTUNITIES IN THE](https://reader030.vdocuments.site/reader030/viewer/2022012018/615c38dca4a58b37992d3fe6/html5/thumbnails/1.jpg)
CLINICAL CHALLENGES, NEEDS AND OPPORTUNITIES IN THE PERUVIANAMAZON REGION
Magaly Blas, MD, MPH, PhD
Miguel Egoavil, MD
School of Public Health and Administration
Universidad Peruana Cayetano Heredia
![Page 2: CLINICAL CHALLENGES, NEEDS AND OPPORTUNITIES IN THE](https://reader030.vdocuments.site/reader030/viewer/2022012018/615c38dca4a58b37992d3fe6/html5/thumbnails/2.jpg)
2
PERU
![Page 3: CLINICAL CHALLENGES, NEEDS AND OPPORTUNITIES IN THE](https://reader030.vdocuments.site/reader030/viewer/2022012018/615c38dca4a58b37992d3fe6/html5/thumbnails/3.jpg)
![Page 4: CLINICAL CHALLENGES, NEEDS AND OPPORTUNITIES IN THE](https://reader030.vdocuments.site/reader030/viewer/2022012018/615c38dca4a58b37992d3fe6/html5/thumbnails/4.jpg)
WHY WORK IN THE AMAZON?
4
94% extreme poverty at riverine communities81% women deliver without the care of a trained health care provider3 times higher infant mortality2 times higher maternal mortality than national average
Loreto
![Page 5: CLINICAL CHALLENGES, NEEDS AND OPPORTUNITIES IN THE](https://reader030.vdocuments.site/reader030/viewer/2022012018/615c38dca4a58b37992d3fe6/html5/thumbnails/5.jpg)
![Page 6: CLINICAL CHALLENGES, NEEDS AND OPPORTUNITIES IN THE](https://reader030.vdocuments.site/reader030/viewer/2022012018/615c38dca4a58b37992d3fe6/html5/thumbnails/6.jpg)
![Page 7: CLINICAL CHALLENGES, NEEDS AND OPPORTUNITIES IN THE](https://reader030.vdocuments.site/reader030/viewer/2022012018/615c38dca4a58b37992d3fe6/html5/thumbnails/7.jpg)
7
HEALTH POST DURING AND AFTER RAINY SEASON
![Page 8: CLINICAL CHALLENGES, NEEDS AND OPPORTUNITIES IN THE](https://reader030.vdocuments.site/reader030/viewer/2022012018/615c38dca4a58b37992d3fe6/html5/thumbnails/8.jpg)
HOW FAMILIES ARRIVE TO THE HEALTH POST
8
![Page 9: CLINICAL CHALLENGES, NEEDS AND OPPORTUNITIES IN THE](https://reader030.vdocuments.site/reader030/viewer/2022012018/615c38dca4a58b37992d3fe6/html5/thumbnails/9.jpg)
HEALTH POST DURING RAINY SEASON
9
![Page 10: CLINICAL CHALLENGES, NEEDS AND OPPORTUNITIES IN THE](https://reader030.vdocuments.site/reader030/viewer/2022012018/615c38dca4a58b37992d3fe6/html5/thumbnails/10.jpg)
![Page 11: CLINICAL CHALLENGES, NEEDS AND OPPORTUNITIES IN THE](https://reader030.vdocuments.site/reader030/viewer/2022012018/615c38dca4a58b37992d3fe6/html5/thumbnails/11.jpg)
FRACTURED SERVICE DELIVERY
Community Community health agent
Health post
Medical ship
![Page 12: CLINICAL CHALLENGES, NEEDS AND OPPORTUNITIES IN THE](https://reader030.vdocuments.site/reader030/viewer/2022012018/615c38dca4a58b37992d3fe6/html5/thumbnails/12.jpg)
![Page 13: CLINICAL CHALLENGES, NEEDS AND OPPORTUNITIES IN THE](https://reader030.vdocuments.site/reader030/viewer/2022012018/615c38dca4a58b37992d3fe6/html5/thumbnails/13.jpg)
INTERCONNECTING THE SYSTEMS
Community health agent
![Page 14: CLINICAL CHALLENGES, NEEDS AND OPPORTUNITIES IN THE](https://reader030.vdocuments.site/reader030/viewer/2022012018/615c38dca4a58b37992d3fe6/html5/thumbnails/14.jpg)
COMMUNITY HEALTH AGENTS SENDINGHEALTH INFORMATION
![Page 15: CLINICAL CHALLENGES, NEEDS AND OPPORTUNITIES IN THE](https://reader030.vdocuments.site/reader030/viewer/2022012018/615c38dca4a58b37992d3fe6/html5/thumbnails/15.jpg)
MEDICAL SHIP RECEIVING HEALTH INFORMATION
![Page 16: CLINICAL CHALLENGES, NEEDS AND OPPORTUNITIES IN THE](https://reader030.vdocuments.site/reader030/viewer/2022012018/615c38dca4a58b37992d3fe6/html5/thumbnails/16.jpg)
LORETO: PARINARI DISTRICT
Loreto
![Page 17: CLINICAL CHALLENGES, NEEDS AND OPPORTUNITIES IN THE](https://reader030.vdocuments.site/reader030/viewer/2022012018/615c38dca4a58b37992d3fe6/html5/thumbnails/17.jpg)
13 COMMUNITIES WERE TARGETED
Distrito de Parinari -Loreto
Río Marañon
![Page 18: CLINICAL CHALLENGES, NEEDS AND OPPORTUNITIES IN THE](https://reader030.vdocuments.site/reader030/viewer/2022012018/615c38dca4a58b37992d3fe6/html5/thumbnails/18.jpg)
SEARCH FOR PHONE SIGNAL
18
![Page 20: CLINICAL CHALLENGES, NEEDS AND OPPORTUNITIES IN THE](https://reader030.vdocuments.site/reader030/viewer/2022012018/615c38dca4a58b37992d3fe6/html5/thumbnails/20.jpg)
PROJECT RESULTS
Community Women 10 to 45 years old Pregnant women
N =799 % N=132 %
San Martin de Tipishca 110 13.8 11 9.9
San Roque 103 12.9 22 21.4
Leoncio Prado 103 12.9 20 19.4
San Jose de Samiria 95 11.9 21 22.1
Parinari 88 11.0 11 12.2
Santa Rosa de Lagarto 57 7.1 10 17.5
Nueva Arica 50 6.3 8 15.7
Nuevo San Juan 49 6.1 9 18.4
San José de Parinari 42 5.3 5 11.9
San Miguel 37 4.6 6 16.2
Shapajilla 24 3.0 4 16.7
Bolivar 21 2.6 4 19.1
Santa Clara 20 2.5 1 5
20
![Page 21: CLINICAL CHALLENGES, NEEDS AND OPPORTUNITIES IN THE](https://reader030.vdocuments.site/reader030/viewer/2022012018/615c38dca4a58b37992d3fe6/html5/thumbnails/21.jpg)
DEMOGRAPHIC CHARACTERISTICS
• Mean age: 23 years (10-45)
• 21% Cocama-cocamilla
• Years of education: 6 (0-16)
• 54% had some years of primary school
• 87.4% had insurance (SIS)
• 55.6% were cohabitating/married
21
![Page 22: CLINICAL CHALLENGES, NEEDS AND OPPORTUNITIES IN THE](https://reader030.vdocuments.site/reader030/viewer/2022012018/615c38dca4a58b37992d3fe6/html5/thumbnails/22.jpg)
REPRODUCTIVE HEALTH
• Mean number of pregnancies: 4 (1-12)
• Among those who had a partner 57% were using some type of contraception
• 54.7% referred that they did not want more children (last pregnancy)
22
![Page 23: CLINICAL CHALLENGES, NEEDS AND OPPORTUNITIES IN THE](https://reader030.vdocuments.site/reader030/viewer/2022012018/615c38dca4a58b37992d3fe6/html5/thumbnails/23.jpg)
PROGRAM RESULTS
Before Mama River
After Mama River p*
ANC 1st trimester
33.3% 96.1% 0.04
≥ 6 PNC
70.6% 96.3% 0.50
Birth at health center/medical ship
17.7% 35.3% 0.03
Birth at home
82.4% 64.7% 0.03
Days to get ID card
120 (7-2520) 30 (5-240) <0.001
23
![Page 24: CLINICAL CHALLENGES, NEEDS AND OPPORTUNITIES IN THE](https://reader030.vdocuments.site/reader030/viewer/2022012018/615c38dca4a58b37992d3fe6/html5/thumbnails/24.jpg)
TEAMPRINCIPAL INVESTIGATOR
MIDWIFE
ICT COORDINATOR
DIRECTOR AMAZONHOPE MEDICAL SHIP
DIRECTOR HEALTH DIRECTION LORETO
MAJOR OF PARINARI
ODK PROGRAMMER
MEDICAL STUDENT
24
![Page 25: CLINICAL CHALLENGES, NEEDS AND OPPORTUNITIES IN THE](https://reader030.vdocuments.site/reader030/viewer/2022012018/615c38dca4a58b37992d3fe6/html5/thumbnails/25.jpg)
COMMUNITY AGENTS
25
![Page 28: CLINICAL CHALLENGES, NEEDS AND OPPORTUNITIES IN THE](https://reader030.vdocuments.site/reader030/viewer/2022012018/615c38dca4a58b37992d3fe6/html5/thumbnails/28.jpg)
OPPORTUNITIES
![Page 29: CLINICAL CHALLENGES, NEEDS AND OPPORTUNITIES IN THE](https://reader030.vdocuments.site/reader030/viewer/2022012018/615c38dca4a58b37992d3fe6/html5/thumbnails/29.jpg)
![Page 30: CLINICAL CHALLENGES, NEEDS AND OPPORTUNITIES IN THE](https://reader030.vdocuments.site/reader030/viewer/2022012018/615c38dca4a58b37992d3fe6/html5/thumbnails/30.jpg)
WE ARE APPLYING FOR A SCALING-UP OF THE MAMA RIVER PROJECT
• With Grand Challenges Canada and the National Council of Science and Technology
![Page 31: CLINICAL CHALLENGES, NEEDS AND OPPORTUNITIES IN THE](https://reader030.vdocuments.site/reader030/viewer/2022012018/615c38dca4a58b37992d3fe6/html5/thumbnails/31.jpg)
NEEDS ON ICT IN THE PERUVIAN AMAZON
• The connectivity is still a problem in this region• We need more infrastructure
• Use alternatives technologies like satellite communication
• Better connection among the different health systems
• Use of low cost mobile applications
• Implementation of an Electronical Health Record
• Use of standards• Classification (ICD 10)
• Reference Language (like SNOMED-CT)
• Interoperability (HL7)
![Page 32: CLINICAL CHALLENGES, NEEDS AND OPPORTUNITIES IN THE](https://reader030.vdocuments.site/reader030/viewer/2022012018/615c38dca4a58b37992d3fe6/html5/thumbnails/32.jpg)
Telecommunications coverage in the Peruvian Amazon Region
![Page 34: CLINICAL CHALLENGES, NEEDS AND OPPORTUNITIES IN THE](https://reader030.vdocuments.site/reader030/viewer/2022012018/615c38dca4a58b37992d3fe6/html5/thumbnails/34.jpg)
Prototype Mama River application (based in Open Data Kit)
34
![Page 35: CLINICAL CHALLENGES, NEEDS AND OPPORTUNITIES IN THE](https://reader030.vdocuments.site/reader030/viewer/2022012018/615c38dca4a58b37992d3fe6/html5/thumbnails/35.jpg)
WHATSAPP IN COMMUNITY AGENTS CELL-PHONE
![Page 36: CLINICAL CHALLENGES, NEEDS AND OPPORTUNITIES IN THE](https://reader030.vdocuments.site/reader030/viewer/2022012018/615c38dca4a58b37992d3fe6/html5/thumbnails/36.jpg)
THERE ARE DIFFERENT HEALTH SYSTEMSIN PERU
Arzobispo Loayza National
Hospital (MOH)
Edgardo Rebagliatti Hospital
(ESSALUD)
Militar
Hospital