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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
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PERU
WHY WORK IN THE AMAZON?
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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
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HEALTH POST DURING AND AFTER RAINY SEASON
HOW FAMILIES ARRIVE TO THE HEALTH POST
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HEALTH POST DURING RAINY SEASON
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FRACTURED SERVICE DELIVERY
Community Community health agent
Health post
Medical ship
INTERCONNECTING THE SYSTEMS
Community health agent
COMMUNITY HEALTH AGENTS SENDINGHEALTH INFORMATION
MEDICAL SHIP RECEIVING HEALTH INFORMATION
LORETO: PARINARI DISTRICT
Loreto
13 COMMUNITIES WERE TARGETED
Distrito de Parinari -Loreto
Río Marañon
SEARCH FOR PHONE SIGNAL
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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
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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
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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)
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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
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TEAMPRINCIPAL INVESTIGATOR
MIDWIFE
ICT COORDINATOR
DIRECTOR AMAZONHOPE MEDICAL SHIP
DIRECTOR HEALTH DIRECTION LORETO
MAJOR OF PARINARI
ODK PROGRAMMER
MEDICAL STUDENT
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COMMUNITY AGENTS
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OPPORTUNITIES
WE ARE APPLYING FOR A SCALING-UP OF THE MAMA RIVER PROJECT
• With Grand Challenges Canada and the National Council of Science and Technology
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)
Telecommunications coverage in the Peruvian Amazon Region
Prototype Mama River application (based in Open Data Kit)
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WHATSAPP IN COMMUNITY AGENTS CELL-PHONE
THERE ARE DIFFERENT HEALTH SYSTEMSIN PERU
Arzobispo Loayza National
Hospital (MOH)
Edgardo Rebagliatti Hospital
(ESSALUD)
Militar
Hospital
