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Foundation called Tula, whose goal is to collaborate with the Health Ministry to reduce the maternal infant mortality and to improve the health services of the rural population of the country, emphasizing in the intercultural, the gender approach and the use of the information and communication technologies (ICT). There action are framed within the new branch of health, called E-Health, understood as the practice and strengthening of the health care, supported in the information and communication technologies (ICT). Other related terms are: Tele Health, M-Health, Telemedicine, tele trainings, tele education and computerized health care. Thanks to this modality, the patients move a lot less and the action area of the health services increases, as well as other advantages. Historically, TulaSalud’s actions have as a background the Nursing Promotion Project for the Primary Health Care in Guatemala; a bilateral project between the Guatemalan and Canadian Government, financed by the Canadian Agency of International Development and executed by the Nursing Studies Center of Newfoundland Canada and the National Nursing School of Coban, from 2003 to 2008, which allowed the training of community nursing auxiliaries by tele education in rural zones of the country. During the development of this project, Tula Foundation co-financed actions, specially related with ehealth and when it finished, it was willing to give sustainability to the same through the creation of the TulaSalud Association NGO, which was instituted on July 11 2008 and started its action in January 2009. In May of that same year, TulaSalud signed a cooperation convenient with the Ministry of Public Health and Social Assistance, to contribute improving the health care in rural and neglected areas of the country. TulaSalud Association Mission “We are a Guatemalan non Governmental organization with support from the Canadian Tula Foundation, that cooperates with the Health Ministry, contributing in decreasing the maternal infant and general population mortality, through eHealth, for forming and training human resource and the access to the services in rural and neglected areas of the country; emphasizing in the primary health care, the intercultural, the gender approach and the use of information and communication technologies (ICT)”. TulaSalud’s Association Vision “Reference organization and with international recognition in eHealth, that transfers experience, technology and innovation, to contribute with the health and development of rural and priority areas of the country.” All if its actions are made together with the Health Ministry and its Dependencies, such as the Nursing School in Coban, Health Area Direction where it executes actions as well as prioritized Health Districts. The lines of action of TulaSalud in these years, can be summarized as:
1. 2. 3. 4.
Tele Education Tele Health (or M-Health) or Tele Medicine Tele Trainings Supporting the Risk Management Table in Alta Verapaz
In relation to Tele Education, with the goal to give the rural communities of prioritized towns of the country with nursing personnel that comes from the local level, that can speak the population’s language, with work stability and cultural pertinence, TulaSalud and the National Nursing School in Coban, under the coordination of the Human Resource Training Department from the Health Ministry, execute 3 long distance education programs, using internet and a method package that’s based in the integration of teaching and service and the pedagogical mediation: Formation of Community Nursing Auxiliaries. Next December 14, the IV course in 7 sites and 7 departments and 9 Health Areas selected by the Ministry are going to finalize. (366 students), of which 61% are women. Formation of Nursing Technicians, in 7 sites and 7 departments of the country. (Currently 200 people are studying). Maternal and neonatal certifications, directed towards nursing auxiliaries; this year 70 graduated (65% women) and it was developed in 10 sites of the departments with a high rate of maternal mortality in the country, which are: Alta Verapaz, Quiche y Huehuetenango.
Tele Health or Tele Medicine: a model of innovating health, through which, 125 tele facilitators located in rural communities strategically selected, attend 572 communities and a population of 253,450 inhabitants of 8 Health Districts of Alta Verapaz, prioritized with epidemiological criteria’s by the Health Area Direction. These telefacilitators provide permanent health care, 24 hours a day and 7 days a week, since they are people that belong to the same community; because of this they speak the same local language and are highly recognized for their long year trajectory at the service of the population. Each one counts with a cell phone with access to the internet, basic surgical-medical equipment and a first aid kit with revolving funds, handled in coordination with the COCODE; this service is given at their homes, where he attends the several health problems that the people from their communities present. The cases that exceed their resolution capacity, are consulted to a health specialist (doctor or professional nurse), located in its respectful Health District, in some of the departmental hospitals, the epidemiological doctor of the Health Area Direction, the project’s doctor or the coordinator himself. This way, many people are treated in their own community without the need to travel long distances towards a health service. Although, sometimes, through the cell phone, the health specialist identifies the need of a quick referral of a patient to a second or third level health care service. Thus the transfer process start in which the family, the community organization and the health services participate, with the objective of saving a life.
An important aspect is constituted by the computerized epidemiological monitoring, which allows the tele facilitators to send information about their production and about what’s happening in their community in the moment, through a technological platform installed on their cell phones, called Epi-Surveyor. This system makes sending data (from the SIGSA 3 form) possible, so that the doctor, adviser of the project can download in a data base created by the effect, all of the epidemiological information of the covered area. The epidemiologist from the Health’s Area Direction could also have access to this system. Also, we are monitoring through this mechanism, all the pregnancy and puerperas of the project’s influence area (572 communities of the objective towns), since the tele facilitators have in their cell phones, a control instrument of each one of them, to detect risk signs and symptoms and risk factors. This information is sent by the tele facilitators constantly, in a way that we maintain a timely alert system of risk factors and danger signs. When the system detects a problem, it automatically sends a text message to the tele facilitator to start the attention and referral process to a health service. So this way we pretend to avoid emergencies, by controlling them before they happen and prevent complications and maternal deaths. We have introduced the creation of video consults in health services to strengthen the patient’s referral system, since through the same it’s possible to solve health problems of a greater complexity, without the need of having to transfer the patient to far away health services. For this we have provided computer equipment and internet connectivity, to 1 health post, 6 Health Districts, 1 CAIMI, 2 district hospitals and to Coban’s Regional hospital, (except for Fray Bartolome de las Casas, where we only provided computer equipment since they already had internet connectivity); we intend that through the video consults, the staff of the rural services and far away could have support and advises from health specialists located in bigger resolution services. Another opportunity that this network offers is the use of video conferences with educational purposes. We have also provided cell phones to the emergency services of 7 Health Districts and 2 district hospitals of the department, with the objective of attending the tele facilitators support demand and to lay down communication bridges with the regional hospital of Coban. The hospital from Coban has implemented in coordination with the Health’s Area Direction and the support of TulaSalud, a model of Tele Medicine, to attend the demand of the tele facilitators and the Health Districts, as far as advises and accompanying patients with the objective of optimizing the referral and response of the patients within the services network. This module counts with a health care registry system of rural areas and referral to the Health District through the use of cell phones and video consults. Besides, as part as their strengthening labor, we are developing a tele training process to tele facilitators and other members of the communities, through cell phones and an internet program, that allows the discussion of several health topics, from Coban, until the communities where tele facilitators live, who invite midwives, other liders and members of the community, to spread the health topics. Taking in account the importance of the education and promotion of health, the component “Xbeil li Kawilal” has been incorporated, which is in charge of young leaders that have been selected on behalf of the same community, to form groups of adolescent and young women
with the objective to learn about the auto care of their health, reproductive health and prevent pregnancies. This project will be strengthened in 2012 with the involvement of the Promotion Department, Reproductive Health and Mental Health from the Health’s Area Department. Also, through the technological internet platform elluminate live, we support the long distance trainings through videoconferences for the Health District’s health staff, with the objective of fortifying their performance. This is made through the coordinators of the different Technical Units from the Health’s Area Direction and the Continuous Medical Education Committee from the hospital in Coban. We have also strengthened in this permanent education field the nursing professionals of the hospital of Coban, Nursing Scholl in Coban and health services in general. In the year 2011, thanks to the joint work between DASAV, health care of the 3 health care levels and TulaSalud we have achieved making 27,191 common morbidity consultations that’s presented in the rural communities of the coverage area, besides we have attended 788 pregnancies in 2522 prenatal controls; we have attended or assisted 352 deliveries in the household, there have been 1,124 control to puerperal women; we have transferred 384 people because of serious health complications, of which 247 were woman because of pregnancy, labor, puerperal and neonatal complications; of which and according to the criteria’s of the Health ministry, 55 woman and 51 kids (total 106) were saved. Support to the Risk Management Table of Alta Verapaz: in relation to this aspect, TulaSalud plays an important facilitator roll to provide communication and coordination mechanisms between the Health’s Area Direction and CONRED, with the objective that the health sector, integrated by the Health Area and NGO’s that provide health services in the department, are better organized to confront any kind of disaster. In that sense we have made it available for the Table, a page (MGR) within the TulaSalud’s portal www.tulasalud.org to keep up to date the information about this topic, as well as for the participating organizations and a monthly meeting has been established guided by the Area’s Direction and CONRED to facilitate the communication and update. This year we count with an action plan that will orient the actions. TELEMEDICINE EXPANSION IN ALTA VERAPAZ On January 20th of the present year, after a joint process of planning and management, we have signed a compromise letter between the Health’s Area Direction of Alta Verapaz, Regional Hospital of Coban, National Nursing School of Coban and TulaSalud, for the expansion of Tele Medicine in Alta Verapaz 2011-2015. The financing is from the Canadian Tula Foundation and the input of the partner Organizations, through the optimization of their respecting institutional budgets. This expansion strategy contemplates the progressive endowment of tele communitary tele facilitators, until approximately 330 in 2015, which are the same communitary facilitators with which the coverage extension program PEC counts with in the 19 Health Districts. This year we have already made the first expansion, from 60 that already existed, to 125 recently, with coverage of 585 rural communities and 350,000 approximate habitants.
It has as a action field, the services of the 3 levels of health care of the Ministry within the department, for which it we have defined 4 lines of action that intend to articulate the network of health services from the community, through the coordination mechanisms, the use of information and communication technologies and with cultural pertinence, this way strengthening the referral system and counter referral of the patients. Within the expansion of tele medicine, the care of mothers and children continues to be a priority, to reduce the maternal neonatal morbidity, but we provide health care to the entire population according to local needs. We also pretend to introduce the promotion of health, prevention of malnutrition and early detection of malnutrition cases in a more emphatic and sustainable way through initiatives that strengthen the community’s participation and support from the TIC’s. The lines of action of the Expansion of Tele Medicine in Alta Verapaz project are the following: 1. The expansion of tele medicine to all of the rural and neglected communities of Alta Verapaz. 2. Improve the quality of the second level health care services. 3. The improvement of the quality of the third level health care services. 4. Scientific investigations based on the experience of Alta Verapaz and Guatemala. Recently it is boosting 3 innovating projects in its pilot project phase, within the context of the expansion of tele medicine in Alta Verapaz: 1. Introduction of water to 5 rural communities of the Campur/Carcha Health District, through solar energy. 2. Mobile ultrasound and screening of clinical laboratory tests with dry blood in 30 convergence centers of rural and neglected communities. 3. Digital information and epidemiological vigilance system through the technological platform CommCare in rural communities of Senahu Alta Verapaz. The results that we intend are ambitious, but surely we will achieve them, through the concentrated effort of the different partner Organizations, the communities and the accompaniment of the Health Ministry’s central level; everyone working in favor of health of the neglected communities and specially of the most vulnerable groups like indigenous, rural and woman and children population.
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