Peruvian Maternal-Perinatal Healthcare Jessica Stevens RN, BSN Colca Canyon Machu Picchu Lake Titicaca Nazca Lines 1
1.) Discuss Perinatal/Maternal healthcare practices currently carried out in various regions of Peru Traditional Perinatal/Maternal practices and customs Integration of Biomedicine in traditional practices and customs 2.) Compare past Perinatal/Maternal outcomes to current findings after initiation of healthcare programs Public vs. Private Healthcare Statistical information after initiation of government and foreign aid programs Population: 28 Million Life Expectancy: 73 years Population below poverty line (national) : 57.7% Birth Rate: 584,000 a year Maternal mortality rate: 98/100,000 live births Infant Mortality: 21/1000 live births Under age of 5 Mortality Rate: 25/1000 live births Malnutrition: 31% Highest Diseases: diarrhea, respiratory infections, neuropsychiatric disorders, asthma, cancers, obesity Lower infrastructure and centralization of wealth Political and economic turmoil caused negative effect on infrastructure through long term neglect 1980-1990s struggled to deliver health services; facilities were forced to close, impacting poorer communities 1995 start restructuring healthcare: increase in administration management and quality of healthcare Main flaw: distribution of health care services and inadequate access to any form of health services in rural areas 2
Nurses per 10,000 Physcians per 10,000 Regional Average Country 0 10 20 30 40 50 60 70 100 90 80 70 60 50 40 30 20 10 0 Contraceptive Prevalence Antenatal Care Birth Attended by skilled health personnel Country Regional Average Latin America: 11 million babies born every year Increase rates of C-Section delivery = increased use of antibiotics postpartum, greater maternal morbidity and mortality, and higher fetal and neonatal morbidity C- Section delivery did not improve perinatal outcomes Latin America: increase in fetal death Increase admission to NICU for 7 days due to respiratory distress 35% by caesarean section (up from 15%) which equals 2 million caesarean deliveries per year. C- Section costs $350 more than a vaginal delivery. 3.85 Million dollars that could be used for development of maternal and newborn care and pay for needed research instead of elective procedures. 3
100 90 80 70 60 50 40 30 20 10 0 Rural Urban Poorest 20% 2nd Quintile Middle Quintile 4th Quintile Urban Wealthiest 20% 1992 2004 12 8 1 26 Hypertensive Disorders Hemorrhage Other Causes 13 21 21 Obstructed Labor Abortion Sepsis/Infection Anemia Adolescent pregnancy challenging public health issue Increased incidence of low birth weight infants, preterm delivery, small for gestational age, perinatal death, eclampsia, operative vaginal delivery, and maternal death. Under 16 years were four times more likely to die than mothers aged 20 to 24 from pregnancy related causes 50% increase in risk of early neonatal death due to preterm delivery and low birth weight. Causes of adverse pregnancy outcomes: socioeconomic status, inadequate prenatal care, poverty, unmarried status, low education level, psychological stress, and drug use. Growing mothers compete with the developing fetus for nutrients. Prevention strategies do not seem to reduce the rate of pregnancy in adolescent women. Providing better prenatal and obstetric care reduced morbidity and mortality. 4
10% 1% Neonatal 12% 38% Other 14% Pneumonia 25% Diarrhea Injuries HIV/AIDS 120 100 80 60 40 20 Diarrhea Tetanus Other Congenital Infection Asphyxia Premature 0 Neonatal Deaths Can be defined as is the collection knowledge, skills, and practices based on beliefs and experiences in indigenous cultures. Rich in use of medicinal plants and Shamanic lore Cosmological beliefs : believe that illness stems from lack of harmony between body and soul and its relation to environment and community. Shamans or curanderos guide a person to lead a balanced life from the moment they are born. Inherited rich knowledge which is complemented by natural elemental energies and the spirits from the mountains. Women, young children, and elderly are seen as more susceptible to machu wayaras. Rely on home remedies such as herbal medicine but as time has progressed communities are now mixing western medicine with traditional medicine. Plants with hot virtues and cold virtues. The cold plants are used to cure hot illnesses such as inflammations and hot plants are used to cure cold illnesses such as malaria and bronchitis. 5
Rituals performed in order to at times prevent pregnancy or to have a successful and quick delivery. Illnesses befall the baby before it is born especially urana wayra (a malevolent wind) that causes illness, disease, and death. Common birthing position: standing Travel distance = increased complications and decreased survival rate. Cost and transportation plays a major role as well in the health care access in rural communities. Maternal waiting houses, known as mamawasis insure healthy deliveries and to decrease the mortality rate in rural Peru. Week of safe and healthy pregnancy Maternidad Saludable Breast Feeding Campaign Peru has the highest breastfeeding rate in Latin America Reasons many do not attend healthcare: Fear Cost Embarrassment Distance Waiting time During the conflict between the government and shining path (terrorist group) many indigenous groups were the target of violence including forced sterilization by authority figures, creating an overwhelming distrust for authority. Indigenous people do not have legal identity documentation because they do not have access to administrative services. They do not receive the same benefits as citizens who have identity papers. 6
75% of the population live in urban areas led to concentration of medicals facilities in these regions while rural areas have minimal contact with these services Lack of assistance and services leaves rural areas vulnerable to high rates of maternal mortality. 60% of the communities covered by the census did not have access to a health care facility Ministry of Health (Minsa) is responsible for the health sector and is charged with ensuring the healthcare of Peru is satisfactory Mission is to protect personal dignity, promote health,and prevent disease to ensure comprehensive health for all Plan: Universal Health Insurance, Increase health standards, and widen health coverage. MINSA PROGRAMS 40% population relies on these services Essalud Social Security is responsible for providing care to poorer elements of population. Overcrowding and long waiting periods Basic Health For All Program Strengthen health services and provide access to public focused on areas with highest poverty rates. Make payments for procedures and services Serious hindrance for large proportion of Peruvian society with low incomes Universal Health Care : Seguro Integral De Salud (SIS) Distribute fair and more accessible healthcare services to all social groups in Peru Established in 2002 to offer free healthcare to all citizens Hidden costs such as travel and highly priced prescription drugs Used in conjunction with Social Security System Public sector comprised of national hospitals, regional hospitals, and primary health clinics. Primary healthcare in Peru is delivered in health clinics managed by Physicians, Nurses, and Medical Assistants. Referral Hospitals 3 major hospitals located in Lima Provide comprehensive medical facilities for citizens following referral for specialist medical treatment from a primary or regional hospital. Publicly run facilities longer waiting periods for patients seeking medical consults. Private Healthcare : 12% population use these services Take advantage of opportunities for growth in the wake of poor quality of healthcare services provided by Peruvian government starting in 1990. Not fairly distributed across the country being concentrated in the more densely populated regions. 7
Completely run by the government No insurance necessary Serves what people can afford Mixture of poor population and insured being served Used many government assistance programs such as social security if people did not have insurance Nicest of the facilities Had the most supplies and equipment available for patient use Most patients seen at this level have insurance 8
USAID Supporting efforts of Peru s government to decentralize the healthcare system of the nation Address financial barriers in health system that keeps the poor from accessing services UNICEF Promote the health of children in different regions Basic education with emphasis on children, children s rights, and child hiv/aids. National Plan of Action for infants and adolescents to reduce child mortality MSF Is an independent neutral body that seeks only to provide healthcare in armed conflicts and provide services in epidemics, malnutrition, and exclusions from health care, and natural disasters. Health treatment to under privileged areas Partners in Health Treat diseases and members of the community to provide care and preventions for areas around Lima Botiquines Rural health posts to provide maternal and obstetrical care for women Salud Infantile Brings healthcare professionals to the community to provide treatment and check ups for children in the poorest areas CARE Focused on isolated Peruvian regions Established mamawasis Developed a foundation to enhance management of maternal emergencies Comprehensive policy for combining traditional and biomedical practice FEMME Averting maternal death and disability program Funded by Bill and Melinda Gates Focused on obstetric Care One of the most successful project in reducing female mortality AIDESEP Supports and helps indigenous women in the realm of maternal health Functions as a voice for indigenous people Educates women on their rights and also focus on incorporating women in the organization on a national and local level The government and foreign programs have proven that there are great attempts at reconciling traditional and modern biomedical practices and medicine, especially in the realm of reducing maternal and child mortality. There has not been significant outreach to collaborate with indigenous groups and understand their culture and tradition. These types of high conflict disputes make indigenous groups feel vulnerable and give them confirmation that they should not trust the government, giving them credence to rely heavily on their immediate communities rather than government, especially in the realm of healthcare. 9
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