Interview with Dr Magaly Blas, researcher and epidemiologist

Technological Advances in Maternal Health in the Amazon: The Case of Mamás del Río

In the heart of the Amazon rainforest, where roads become rivers and distances are measured in days of navigation, Mamás del Río emerges as a beacon of hope for communities facing limited medical care. Led by Dr Magaly Blas, with extensive experience in epidemiology and public health, this program has proven to be an innovative model for improving maternal and neonatal health through technology adapted to challenging environments. This article explores how the program has integrated technology to enhance care in rural and indigenous areas, highlighting the importance of public-private partnerships in this process.

CHECK THE FULL VIDEO INTERVIEW HERE

In this video, Dr Magaly Blas, an epidemiologist, introduces Mamás del Río, a program improving maternal and neonatal health in the Peruvian and Colombian Amazon. The program empowers community health workers with tablets for educational content and monitoring tools, transforming healthcare in remote areas.

CC are in English and many other languages.

Dr. Magaly Blas and Mamás del Río

Dr Magaly Blas is a physician from the Universidad Peruana Cayetano Heredia, with a master's and a doctorate in epidemiology from the University of Washington. She currently leads the Mamás del Río program, which aims to improve maternal and neonatal health in remote and indigenous communities in the Peruvian and Colombian Amazon. Besides directing the program, Dr Blas also plays a crucial role as head of the Political Advocacy Secretariat in Medicine and Public Health at the Medical College of Peru.

Using Technology to Improve Maternal and Newborn Health

Mamás del Río has implemented technology directly into the hands of community health workers, who play a vital role in their isolated communities. Each community worker receives a tablet that serves as an educational and monitoring tool. This tablet contains "digital stories," interactive narratives created in collaboration with the communities themselves, addressing specific maternal and neonatal health topics. During home visits, the tablet guides the workers on danger signs during childbirth and promotes safe childbirth practices, using multimedia content that deeply resonates with the local communities.

“We equip our community health workers with tablets that contain interactive educational content and monitoring tools. This not only facilitates education on maternal and neonatal care but also allows continuous health monitoring in communities where access to health centres is limited. We have demonstrated that it is possible to adapt technological tools to function without an internet connection, ensuring that critical information reaches even the most remote communities.”

Examples of Public-Private Collaborations

Strategic collaborations with public and private entities have been fundamental to the success of Mamás del Río. Under Dr. Blas’s leadership, the program has established strong partnerships with the Ministry of Health and regional governments, as well as support from the Ministries of Foreign Affairs of Peru and Colombia. This partnership has facilitated the expansion of the program along the border, significantly improving access to healthcare in previously inaccessible areas. Additionally, the program has received funding from the Inter-American Development Bank and Grand Challenges Canada, which have supported key scaling and impact assessment initiatives.

“We work in close partnership with the Ministry of Health and regional governments, as well as international organisations, to scale the program and ensure its long-term sustainability.”

Research Methods and Impact Evaluation

Mamás del Río has used rigorous research methods to evaluate the impact of its interventions on maternal and neonatal health. Studies have been conducted before and after the program in selected communities, using repeated censuses to measure changes in health indicators. The results of these studies have been published in specialised journals, such as The Lancet Regional Health Americas, highlighting significant improvements in newborn care, the promotion of breastfeeding, and increased institutional deliveries.

“These results not only validate our strategy but also reinforce our commitment to continue innovating and adapting technologies to address the unique challenges faced by Amazonian communities.”

New Ideas from Collaborations

Successful collaborations have led to new initiatives within Mamás del Río. For instance, an innovative approach is being developed to address teenage pregnancy, a growing concern in the communities served by the program. Dr Lisa Lebita Woodson has worked on this line to understand why teenage pregnancy occurs and how to address it. Additionally, community empowerment has been strengthened through the creation of the Association of Indigenous Community Health Workers (AACOSIL), a platform that promotes local leadership and participation in health-related decision-making.

“Our goal is to ensure that every mother and child in the Amazon has equitable access to safe and effective healthcare.”

- Dr. Magaly Blas, Epidemiologist and Researcher, Director of Mamás del Río

With the right combination of technology, collaboration, and commitment, Mamás del Río has shown that it is possible to significantly improve maternal and neonatal care in the most remote and vulnerable regions of the continent. Despite initial challenges such as technology training and limited connectivity infrastructure, the program has implemented effective solutions in remote environments without constant internet access. The offline-operating application has facilitated adoption by community workers, allowing them to access essential educational resources and monitoring tools.

In conclusion, under the direction of Dr. Magaly Blas, Mamás del Río highlights the crucial importance of technological innovation and strategic partnerships in improving maternal and neonatal health in remote areas. Through public-private collaboration, the program has not only transformed lives and strengthened communities but also established a replicable model for regions with similar challenges. Continuous commitment to research and rigorous evaluation remains essential to guide future interventions and ensure a lasting impact on public health, thereby improving patient safety and quality in healthcare systems.

Interview with Jafet Arrieta, VP at IHI

Transforming Healthcare in Latin America: An Exclusive Interview with Jafet Arrieta

In the realm of healthcare, where equity, quality, and humanisation are imperatives, Jafet Arrieta, Vice President of the Institute for Healthcare Improvement (IHI), offers an inspiring insight into the challenges and opportunities in Latin America. With a passionate and systematic approach, Jafet leads initiatives to enhance the health of populations and transform healthcare systems in the region. In an exclusive interview, she highlighted several key points summarising her approach and vision for the future of healthcare in Latin America.

CHECK THE FULL VIDEO INTERVIEW HERE

In this interview, Jafet Arrieta, Vice President of the Institute for Healthcare Improvement (IHI), shares her unique perspective on the challenges and key strategies for improving quality, humanizing care, and ensuring equity in healthcare institutions in Latin America. From identifying areas for improvement in patient experience to addressing common errors in medical risk management, Jafet provides a comprehensive insight into leveraging technology, enhancing care quality, and preventing medical errors in the region. Join us to explore how principles of healthcare humanisation intertwine with patient safety and medical risk management, and discover how these practices are positively transforming the healthcare landscape in Latin America.

Recognising Challenges and Embracing Opportunities

She emphasises the importance of understanding the scope of the problem to properly prioritise resources and make a real impact on populations. She also underscores the need to adopt a systemic perspective and address the five fundamental goals:

• Improving population health

• Patient experience

• Healthcare staff well-being

• Resource efficiency

• Equity in access to and quality of care

“It is important to be able to truly assess not only what the problem is, but also what impact these problems are having on the population, and on the communities we seek to serve.”

“And in that sense, I would tell you that besides seeing many challenges, I see opportunities. I see opportunities to work, to address those challenges.”

MaximiSing Technology to Enhance Care Quality

When it comes to harnessing technology to improve care quality, Jafet staunchly advocates for a systemic approach. She highlights how technology can enhance medical care by closing access gaps and increasing patient safety, especially during the pandemic. It is crucial to adopt it as part of a comprehensive strategy that includes active patient and family engagement.

Another significant example highlighted in the interview is that of the Hospital Israelita Albert Einstein, which has implemented telehealth to reach remote communities in the Amazon, improving access and health indicators at the population level.

Technology also facilitates communication among medical staff, patients, and their families, creating efficiencies and enabling real-time data tracking to identify important events and understand their causes.

"...there is a lot of room to maximise technology, and it is important to understand that technology is a means to an end and not an end in itself. So, there, I think it is very important for technology to be adopted in the context of a much broader, much more comprehensive strategy to improve quality, patient safety, and to humanize care..."

Addressing Areas for Improvement in Patient Experience

Jafet points out the need to adopt a holistic approach to identify and address areas for improvement in patient experience. She emphasizes the importance of working from risk management towards risk prevention, integrating elements such as planning, quality improvement, and quality control. She also underscores the fundamental role of effective communication between healthcare staff, patients, and their families, and highlights how simple strategies can have a significant impact on reducing pain and fear in children with cancer.

“The third aspect proposed by Juran's trilogy, which is quality control seeks to generate mechanisms so that once the systems, the processes are set in motion, they reach the desired performance level and can be sustained over time, allowing us to control quality."

-Jafet Arrieta, Vice President of the Institute for Healthcare Improvement (IHI)

A Story of Transformation in Pediatric Healthcare

Jafet shares an inspiring story of transformation in pediatric care, highlighting a collaborative project with St. Jude Children's Research Hospital. Through the "Global Comfort Promise" project, Jafet and her team work with hospitals worldwide to reduce pain associated with medical procedures in children with cancer. She highlights how the systemic approach and improvement science can generate transformative results, not only in patient experience but also in the culture and satisfaction of healthcare staff.

In summary, the interview with Jafet Arrieta offers an inspiring and practical insight into addressing healthcare challenges in Latin America. With a focus on equity, quality, and humanization, she demonstrates how technology, effective communication, and improvement science can transform healthcare systems and improve people's lives in the region.

Interview with Dr. Sergio Meneses, Researcher at INSP Mexico

Challenges and Perspectives in Latin America's Public Health: A Conversation with Dr. Sergio Meneses Navarro

In the field of public health, Latin America faces a series of complex and urgent challenges. To gain a deeper insight into these challenges and explore possible solutions, we interviewed Dr. Sergio Meneses Navarro, National Researcher of Science and Technology Commissioned to the National Institute of Public Health in Mexico. With a distinguished career as a physician and anthropologist, Dr. Meneses Navarro shared some valuable perspectives on topics ranging from structural inequality to the transformative role of technology in healthcare.

CHECK THE FULL VIDEO INTERVIEW HERE

Social Inequalities and Equitable Healthcare

Regarding social inequalities in healthcare, Dr. Meneses Navarro highlighted the profound stratification that characterises Latin American societies. In his own words:

"These structures of inequality, these ideologies that stratify our society and determine forms of mistreatment, are present in all areas of life. To some extent, this also explains why we are so tolerant because we have normalised, for example, violence in our countries in places like Colombia, Venezuela, Mexico, Central America, where we have serious problems of inequality but also various forms of violence."

"All of this is not unrelated to the healthcare system. Within the healthcare system itself, which is embedded in our societies, it is not a separate world; there, too, morphologies and treatments towards others are expressed, and this is a challenge when considering guaranteeing respectful or good treatment for each person we attend to."

Sergio highlighted how inequalities in the healthcare system are evident in the segmentation of the population based on employment status, resulting in unequal access and quality of healthcare. Addressing inequality and violence within healthcare has become imperative in recent years, particularly in Latin America, including Mexico, where deep-seated inequality rooted in discriminatory ideologies like racism and sexism persists. This normalisation of violence extends into healthcare, presenting a challenge to providing dignified treatment for all. Recognising and confronting these structural inequalities within healthcare is essential as part of broader efforts to promote social equity and justice in Latin America.

Technology and Reduction of Inequalities

One of the most fascinating areas of focus is the role that technology can play in reducing inequalities. Dr Meneses Navarro emphasised the potential of using technology to improve the coverage and quality of healthcare but stressed the importance of programming these technologies to avoid the reproduction of discriminatory ideologies. According to his words:

"The technology in medicines, the technology in equipment…for example, that also is having an incredible boom, artificial intelligence, well, it is also a field that can allow us to increase coverage, also improve the quality of care…if we are going to have these kinds of technologies, we are going to program them so that they do not reproduce these ideologies and these practices in which I think we can find a consensus that they are undesirable and that we want to eradicate them from our society. Then we want to eliminate these ideologies that are harmful and that cause damage, that causes violence, and that ultimately also generate mistreatment and generate death, and even in the healthcare system death due to poor, poor forms of care, poor practices."

Quality Management and Accreditation in Health

When discussing quality management and accreditation in health, Sergio Meneses highlighted a crucial point: the need to consider the structures of inequality in these processes.

"The effects of structural inequality have been omitted, forgotten…Our accreditation system must include indicators and specific actions aimed at addressing these forms of mistreatment, and these forms of violence. For example, concrete actions to prevent and eradicate forms of violence against women, specific not only in sexual and reproductive health services or obstetric services but also in the care of chronic diseases. Also, for any reason, include specific actions to eliminate any form of racism, classism, or discrimination based on gender identity or religious reasons, and indeed they occur, or for any other reason including your employment status."

-Dr. Sergio Meneses, INSP Mexico

He emphasised the importance of including specific indicators and actions aimed at addressing the forms of mistreatment and violence present in the healthcare system.

Conclusions and Final Reflections

Throughout the interview, it became clear that addressing inequalities in Latin America's public health requires a comprehensive approach that recognises the complex interactions between social, economic, and technological factors. Dr. Meneses Navarro's words resonated with an urgency and deep commitment to more equitable and just healthcare for all.

In summary, the interview with Dr. Sergio Meneses Navarro provided a revealing insight into the challenges and opportunities in the field of public health in Latin America. His informed perspectives and commitment to equity in healthcare offer a valuable starting point for future research and actions in this crucial area that can be linked to a quality management and safety system for all patients.

Interview with Pedro Delgado VP of IHI

Equity in Health, Technological Access, and Accreditation: In Conversation With Pedro Delgado, VP of IHI

In Conversation With Pedro Delgado, VP of IHI about Equity in Health, Technological Access, and Accreditation in LATAM

In an exclusive interview with MEG, Pedro Delgado, Vice President of the Institute for Healthcare Improvement (IHI), delved into equity and humanisation in healthcare in Latin America. The conversation shed light on the myriad challenges and promising opportunities the region faces in its pursuit of a more equitable and human-centric healthcare system.

Check the full video interview here

Global Mission and Equity

While discussing his leadership role at IHI, Pedro Delgado articulated the organisation's overarching mission to enhance health and healthcare services on a global scale. Emphasising the intrinsic value of equitable healthcare for all, irrespective of financial capacity, Delgado underscored equity as a foundational pillar in their approach. 

He succinctly summarised their mission, stating,

"Our mission is to improve health and healthcare services worldwide, including all populations. This refers not only to those who can pay but to the entire population, linking our work with equity."

Humanisation in Latin America

Addressing the concept of humanisation in Latin America, Delgado expressed enthusiasm for the autochthonous term used in the region. However, he raised a point about the need to remember humanisation in healthcare delivery, highlighting the significance of persistently advancing towards a more profound humanisation of health throughout the region.

"It is being used in very nice ways in Latin America, and I believe there is still much to be done to continue progressing on this path towards the deep humanisation of health in Latin America."

Challenges in Health Humanisation

When asked about the challenges in humanising healthcare, Delgado pointed to obstacles entrenched in the educational and hierarchical framework. He emphasised the need to overcome the pursuit of absolute solutions and a rigid hierarchical mentality, advocating for a departure from a culture of complaints. Delgado urged a shift towards a proactive stance, encouraging individuals to embrace their capacity for change. He identified these challenges and systemic imperfections as contributors to a pressurised healthcare environment.

"The major challenges we have as a health sector in the pursuit of humanisation are related to our understanding of what it means to educate and feel, and our approach to hierarchies."

"...to be protagonists of what is possible and not protagonists of complaints because those are options in leadership, one is to complain about everything that doesn't work, and the other is to understand that there are things that don't work, but we as individuals have the possibility to change some."

Measuring Inequality

Delgado addressed the importance of measuring equity in healthcare from three perspectives: organisational, clinical, and population health. He highlighted the importance of factoring in civility and effective human resource management within organisations, and accessibility, patient experiences, and clinical outcomes in the clinical domain.

"It is important to understand equity from civility, human resource management, access, experience, and clinical outcomes, as well as in population health, both for employees and surrounding communities."

"The journey towards equity requires us to listen more and listen better; if not, the likelihood of success will be much lower."

Technological Solutions and Impact

Regarding the use of technological solutions, Delgado acknowledged the possibilities technology offers to close equity gaps, especially in terms of access and listening. He illustrated two cases in Latin America, highlighting the use of telemedicine at the Albert Einstein Israelite Hospital in the Amazon and the successful implementation of virtual mental health services by the Fundación Santa Fe in Bogotá, Colombia.

"Technology is the tool that opens up many possibilities to close equity gaps, especially in access and listening."

Accreditation Awareness

Delgado emphasised the importance of accreditation within the quality paradigm in healthcare. He identified barriers in terms of accreditation system limitations and costs while highlighting the importance of transparency and feedback in improving care quality. 

"Accreditation is part of quality assurance, but it is essential to address transparency and dare to receive feedback to improve."

"...with assurance also comes what is quality control, having standards under which we operate, so that we can provide an adequate service."

-Pedro Delgado, VP of IHI

In summary, this interview with Pedro Delgado provided valuable insights into the challenges and opportunities in the pursuit of more equitable and humanised healthcare in Latin America, highlighting the importance of technology, equity measurement, and quality awareness through accreditation.

Patient Experience in Latin America: Challenges and Opportunities to Ensure Safety

Healthcare is an essential part of our lives, aimed at preventing diseases, treating conditions, and improving our quality of life. However, in this noble effort to care for our health, healthcare systems can sometimes make errors that result in harm to patients. These errors not only cause physical and emotional suffering but also negatively impact people's trust in the healthcare system. In Latin America and around the world, patient safety has become a critical issue requiring urgent attention. In this blog, we will explore the current landscape of patient safety in Latin America, addressing common challenges and the solutions that organisations can implement to ensure optimal care.

Where Are We in Latin America?

Patient safety is a topic that cannot be overlooked. Harm to patients occurs even in advanced healthcare systems due to increasing complexity and the possibility of human errors. Process errors, lack of communication, and the absence of active patient involvement can be underlying factors in these issues. It is crucial to recognize that solely blaming the active provider does not address latent system errors. Instead of expecting individual perfection, it is necessary to create a safe environment with well-designed systems. This is where a shared and transparent safety culture comes into play, an essential component for preventing and improving healthcare errors.

Patient Safety: What Does It Mean?

Patient safety is not just an abstract concept but a concrete focus in healthcare. As healthcare systems become more complex, the likelihood of risks and errors associated with healthcare increases. The purpose of patient safety is simple yet fundamental: to prevent and reduce hazards, errors, and harm that patients may face during their healthcare. The foundation of this initiative is continuous learning from mistakes and adverse events to continuously improve and evolve.

Latin America: Confronting the Burden of Healthcare-Related Harm

Millions of patients in Latin America experience harm or even die due to unsafe healthcare. The situation is alarming, with examples including medication errors, healthcare-associated infections, and risky surgical procedures. Unsafe practices such as unsafe injections and misdiagnoses contribute to this burden. These problems not only jeopardize patient safety but also affect the overall quality of healthcare in the region.

The Data Speaks for itself 

• Medication errors result in an annual cost of approximately $42 billion worldwide. Healthcare-associated infections affect 7-10% of hospitalised patients. 

• Up to 25% of surgical patients experience complications, with one million surgical patients dying annually. 

• Unsafe injection practices lead to 9.2 million years of disability-adjusted life lost. 

• Diagnostic errors affect 5% of adults in outpatient care, with more than half of them potentially causing serious harm. 

• Errors in radiation and septicemia cause preventable harm and deaths.

• Venous thromboembolism is responsible for common and preventable harm.

Sources: WHO, IBEAS Study, IBEAS, OPS

Transformative Technology: Improving Patient Safety

In the digital age, technology plays a crucial role in healthcare improvement. Implementing patient safety and quality systems can make a difference. Through specialised software, effective audits can be conducted, and accreditations of high standards like those of the Joint Commission International (JCI) can be tracked. These systems not only monitor quality but also identify areas for improvement and prevent future incidents.

MEG: Offering Solutions

Through MEG, we present effective solutions to address common challenges in patient safety in the medical field:

1. Medication Management: We offer the Antibiotic Administration Survey to address common errors in medication administration.

2. Surgical Errors: To prevent surgical errors, responsible for 10% of preventable harm, we provide efficient access to the World Health Organization's Surgical Safety Checklist, available digitally in the context of Safe Surgery for Latin America and Spain.

3. Healthcare-Associated Infections: In response to healthcare-associated infections, accounting for 0.14% of cases, we implement measures to reduce antibiotic resistance and control infections in the medical field.

4. Sepsis: Sepsis is a critical concern, with approximately 23.6% of cases occurring in hospitals. We offer specialized audits in infection prevention and control to address this issue.

Looking to the Future

The data confirms that patient safety is a critical priority in Latin America and globally. Preventing and reducing adverse events in healthcare is possible through effective strategies and global collaboration. Our ultimate goal is to ensure that every patient receives safe and high-quality care. Through awareness, a focus on vulnerable groups, robust health policies, a safety culture, and ongoing research, we can move towards a future where patient safety is constant. The adoption of advanced technologies, such as audit and tracking software, will be crucial for continuously improving the quality and safety of care provided. Ultimately, we all play an important role in this process, from healthcare professionals to informed patients, collaborating to achieve optimal and safe care for patients.