Paraguay is rolling out a new primary healthcare strategy called Atencion Primaria a Salud (A.P.S.). I mentioned it last year when I attended a workshop on health promotion and leprosy. Basically, the Ministry of Health is trying to provide a Unidad de Salud Familiar (U.S.F.), that is a “Family Health Unit”, consisting of a doctor, a couple of nurses, and health promoters, for every 5000 people.
A couple of weeks ago I went to the regional meeting for the U.S.F.s in the Central Chaco. I spend a lot of time hanging out with the U.S.F. where I’m doing my study, and I try to coordinate my activities with theirs and help out where I can, so they invited me to attend the meeting with them and see what the other U.S.F.s were up to.
The photo above shows the core team of my local U.S.F.. On the left is Nurse A., in the middle is Dr. C., and on the right is Sister C., who is also a nurse. Each of the 6 communities where they work has at least one health promoter and some of them also have a local health post. The U.S.F. makes a round of the communities once a month and during the rest of the month they are based out of a central health post. They also travel to other communities when there is a medical emergency.
At the meeting, each of the U.S.F. teams presented some background information about the communities where they worked (number of communities, where they are located on a map, ethnic composition, census data), some metrics for their major activities in the communities (total number of consultations, vaccination rates, number of births attended, number of tuberculosis cases, etc.), and talked about some of the major obstacles they faced in their work.
One of the groups, U.S.F. #2 based out of Tte. Irala Fernandez, made an awesome video that shows what it’s like to be on the front lines of global health. Nurse Luis kindly gave me a copy to post to the blog (I added some rough closed captioning in English):
The U.S.F.s in the Chaco are trying to provide primary healthcare in very difficult conditions. The communities are located over large distances, which become impassable in bad weather. The U.S.F. I work with is actually the first to receive a dedicated vehicle to transport them to their communities and fetch emergency patients. Previously they would have to get rides to communities with the local police or an occasional government truck that passed through. They have limited resources to provide care and create makeshift consultation offices under trees, in the back of a truck, or in a schoolroom. The Chaco is very ethnically diverse and there can be problems with cross-cultural communication and local politics. When they are not on duty (although I often see U.S.F. members attending patients outside of ‘office hours’) they live in isolated places with few creature comforts.
No wonder that the U.S.F.s have been slow to fill positions in the Chaco. Especially positions for doctors. Many of the doctors who decide to work for a U.S.F. in the Chaco, including Dr. C, did their medical training in Cuba, where there is a strong emphasis on health and social justice and medical professionals are strongly encouraged to work with underprivileged groups.
Despite the challenges they face, the U.S.F. team members are dedicated to their work and really fight to provide the best care they can under adverse conditions. Did you catch the positive tone of the video? They are amazing people.