Debts with life

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Deudas con la vida

When 45 exceeds its status as a number to represent the deaths of newborns, the frustration of women who wanted to be or repeat the experience as mothers, and family pain; alarms go off and it is urgent to determine causes, conditions and responsibilities.

The red light bulb is activated because in a province like Ciego de Ávila some indicators compromise the results of the Maternal and Child Care Program (PAMI), among the most sensitive and worthy of all the efforts of the Cuban health system, characterized by being equal to the first world.

In his recent rendering of account, the governor of the province, Tomás Alexis Martín Venegas, stressed that the PAMI does not show satisfactory results, with 32 deaths, a mortality rate of 12.5 per thousand live births and a reduction in deliveries with respect to the preceding year.

He also drew attention to the non-compliance of the underweight index by reaching 6.5, representative of an increase in 21 cases in relation to the 2020 period, which was influenced, in an essential way, by municipalities such as Morón, Florencia, Primero de Enero, Venezuela and Ciego de Ávila.

Days later, the growing trend is maintained: almost 14 deaths per thousand live births and the report of low weight close to 7%. Meanwhile, the decrease in births is around 200 if compared to the previous period.

The dialogue with Dr. Luis Carmenate Martínez, head of the Gynecology and Obstetrics Group and an official of the PAMI in the territory, allowed us to scrutinize the various aspects of the problem, based on deficiencies in prenatal care, due to non-compliance with the protocols to attend to pregnant women and children with risk factors.

This was reflected in the adequate and timely assistance to pregnant women with hypertension and diabetes mellitus; and to premature and growth-restricted neonates, without ruling out that in some babies the combination of both factors leads to a state of severity, he argued.

The physician also referred to the incorrect identification of pregnant women who require admission to maternal homes and deficiencies in the functioning of the Genetics Center, resolved with the improvement of the local infrastructure.

The COVID-19 pandemic, although it was not the essential cause of the problem, had a negative impact on the PAMI, as the majority of health personnel and hospitals were assigned to control this disease, which inevitably decreased the quality of health care assistance to pregnant women and newborns.

To date, the SARS-CoV-2 virus has not caused the death of any Ciego de Ávila neonate, but four, of the 10 deceased pregnant women, were due to complications derived from that virus, the Head of the Gynecology and Obstetrics Group in the province said.

Deudas con la vida

To improve the indicators, it is expected to improve health care, complete the basic work groups and meet the needs of specialists in Pediatrics and Internal Medicine, to which training processes and preparation of new professionals are taxed, he emphasized.

He specified that hospitals and basic work groups do not present difficulties with specialists in Obstetrics Gynecology, however, training in this specialty and in others such as Perinatology and Imaging is prioritized, which will represent a strength in the near future.

Other actions related to management activity (cadre movements, tightening of controls to primary health care services and redesign of medical care protocols) should also reverse the negative trends of the last four years.

Guarantees are the improvement of conditions in the areas linked to the PAMI, including the restoration of wards for pregnant women and neonatology, delivery rooms and curettage, and the creation of a milk bank that will provide the fluid of its kind to premature infants for avoiding nutritional and digestive disorders.It is also necessary to improve intersectoral work, because this is not an exclusive problem of Public Health.

For more than 15 days, a MINSAP team has been monitoring and advising the specialists linked to PAMI. Carmenate Martínez, declared that they intervene, jointly, in the reevaluation of all pregnant women in the province with 26 or more weeks of gestation, which will facilitate decision-making.

Apart from institutional debts, the manager insisted on the responsibilities of the population to contribute to the health of pregnant women and newborns. He focused on preconception risk, related to planning and prior control of diseases before pregnancy, such as diabetes mellitus, hypertension and obesity, to name just a few of the most common.

Planning a pregnancy includes the prior ingestion of folic acid and iron supplements, medications available in the pharmacy network, Dr. Carmenate Martínez alleged. Consumption is the responsibility of the patients; however, guidance from the primary care system and health promotion and education teams is essential.

Non-compliance with medical diets, irregularities in attending consultations and refusals to enter maternity homes when the conditions of the pregnant woman or the future baby require it, also affect the results of the province.

In the current circumstances, if there is no spontaneous formation of consciousness, the family doctor and nurse should contribute to create it during interaction with the community, that space where it is shown that a considerable part of the problems have been solved.

It is not enough to have a dozen maternal homes if the occupational index is low, when the more than 150 capacities should be insufficient in the face of frequent disorders. It is necessary to investigate the true causes of the resistance to remain there, it is not possible that so many women assume motherhood recklessly, nor it is fair to hide the deficiencies through the generalization of indiscipline.

In his most recent visit to the province, Deputy Prime Minister Jorge Luis Perdomo Di-Lella expressed concern about the situation of PAMI, with a tendency to worsen in the last four years and, sadly, with the most unfavorable indicators in the country. His call was to improve the work systems in primary and secondary health care, where COVID-19 revealed the main problems, even demonstrated how to solve them.

It only remains to do and do it well, to pay off debts with life and disconnect the alarm that remains active in the face of the crying off for death.