RESUMO
The World Health Organization (WHO) declared coronavirus disease-2019 (COVID-19) a global pandemic on 11 March 2020. In Ecuador, the first case of COVID-19 was recorded on 29 February 2020. Despite efforts to control its spread, SARS-CoV-2 overran the Ecuadorian public health system, which became one of the most affected in Latin America on 24 April 2020. The Hospital General del Sur de Quito (HGSQ) had to transition from a general to a specific COVID-19 health center in a short period of time to fulfill the health demand from patients with respiratory afflictions. Here, we summarized the implementations applied in the HGSQ to become a COVID-19 exclusive hospital, including the rearrangement of hospital rooms and a triage strategy based on a severity score calculated through an artificial intelligence (AI)-assisted chest computed tomography (CT). Moreover, we present clinical, epidemiological, and laboratory data from 75 laboratory tested COVID-19 patients, which represent the first outbreak of Quito city. The majority of patients were male with a median age of 50 years. We found differences in laboratory parameters between intensive care unit (ICU) and non-ICU cases considering C-reactive protein, lactate dehydrogenase, and lymphocytes. Sensitivity and specificity of the AI-assisted chest CT were 21.4% and 66.7%, respectively, when considering a score >70%; regardless, this system became a cornerstone of hospital triage due to the lack of RT-PCR testing and timely results. If health workers act as vectors of SARS-CoV-2 at their domiciles, they can seed outbreaks that might put 1,879,047 people at risk of infection within 15 km around the hospital. Despite our limited sample size, the information presented can be used as a local example that might aid future responses in low and middle-income countries facing respiratory transmitted epidemics.
Assuntos
COVID-19/diagnóstico por imagem , COVID-19/epidemiologia , Hospitais Especializados/organização & administração , Hospitais Especializados/tendências , Pandemias/prevenção & controle , SARS-CoV-2/genética , Triagem/métodos , Adulto , Idoso , Inteligência Artificial , COVID-19/prevenção & controle , COVID-19/virologia , Teste de Ácido Nucleico para COVID-19 , Equador/epidemiologia , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Radiografia Pulmonar de Massa/métodos , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase em Tempo Real , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Fatores de Risco , Tomografia Computadorizada por Raios X/métodosRESUMO
OBJECTIVE: To report the experience of adapting the stomatherapy service during the COVID-19 pandemic. METHOD: Experience report related to adaptations in the work routine in times of COVID-19 pandemic, from March to May 2020, in a specialized stomatherapy center in a city in the South of Brazil. RESULTS: The work routines were adapted to suit the protection measures for workers and users who used stomatherapy services. Some assistance processes were implemented to make users' access to care more flexible, and to modify routines to increase the safety of health professionals and users. CONCLUSION: The need to adapt the physical area, rethink the dynamics of care, use personal protective equipment, and guidance for servers and patients were of fundamental importance to continue attending the population safely in times of pandemic.
Assuntos
COVID-19/epidemiologia , Atenção à Saúde/organização & administração , Estomia , Pandemias , Estomas Cirúrgicos , Bandagens/provisão & distribuição , Brasil/epidemiologia , COVID-19/prevenção & controle , COVID-19/transmissão , Atenção à Saúde/estatística & dados numéricos , Hospitais Especializados/organização & administração , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Estomia/enfermagem , Equipamento de Proteção IndividualRESUMO
BACKGROUND: Chronic kidney disease (CKD) is increasing worldwide, and the majority of the CKD burden is in low- and middle-income countries (LMICs). However, there is wide variability in global access to kidney care therapies such as dialysis and kidney transplantation. The challenges health professionals experience while providing kidney care in LMICs have not been well described. The goal of this study is to elicit health professionals' perceptions of providing kidney care in a resource-constrained environment, strategies for dealing with resource limitations, and suggestions for improving kidney care in Guatemala. METHODS: Semi-structured interviews were performed with 21 health professionals recruited through convenience sampling at the largest public nephrology center in Guatemala. Health professionals included administrators, physicians, nurses, technicians, nutritionists, psychologists, laboratory personnel, and social workers. Interviews were recorded and transcribed in Spanish. Qualitative data from interviews were analyzed in NVivo using an inductive approach, allowing dominant themes to emerge from interview transcriptions. RESULTS: Health professionals most frequently described challenges in providing high-quality care due to resource limitations. Reducing the frequency of hemodialysis, encouraging patients to opt for peritoneal dialysis rather than hemodialysis, and allocating resources based on clinical acuity were common strategies for reconciling high demand and limited resources. Providers experienced significant emotional challenges related to high patient volume and difficult decisions on resource allocation, leading to burnout and moral distress. To improve care, respondents suggested increased budgets for equipment and personnel, investments in preventative services, and decentralization of services. CONCLUSIONS: Health professionals at the largest public nephrology center in Guatemala described multiple strategies to meet the rising demand for renal replacement therapy. Due to systems-level limitations, health professionals faced difficult choices on the stewardship of resources that are linked to sentiments of burnout and moral distress. This study offers important lessons in Guatemala and other countries seeking to build capacity to scale-up kidney care.
Assuntos
Atitude do Pessoal de Saúde , Alocação de Recursos para a Atenção à Saúde , Hospitais Especializados/organização & administração , Ambulatório Hospitalar/organização & administração , Insuficiência Renal Crônica/terapia , Esgotamento Profissional , Tomada de Decisão Clínica , Guatemala , Hospitais Especializados/normas , Humanos , Ambulatório Hospitalar/normas , Diálise Peritoneal , Recursos Humanos em Hospital/psicologia , Pesquisa Qualitativa , Qualidade da Assistência à Saúde , Diálise Renal , Estresse PsicológicoRESUMO
INTRODUCTION: The importance of granting high specialty outpatient services calls for a diagnosis through process architecture in order to measure outpatient services deferral with key performance indicators and to evaluate the opportunity of scheduling appointments at high specialty hospitals. OBJECTIVE: To apply the process architecture model and key performance indicators in high specialty hospitals, in order to analyze outpatient appointment scheduling activities and to improve the quality of medical care and patient safety. METHOD: Quantitative, sequential and deductive reasoning study, with correlational scope, to assess the degree of association between variables, and to establish and define key performance indicators, according to the importance of activities in medical services. A convenience sample in time and by accessibility to two high specialty hospitals in Mexico city was used. RESULTS: Deferral in outpatient services was measured with an emphasis on the analysis of 19 indicators for a proposal of strategies. CONCLUSIONS: The model of priority indicators of the architecture of medical processes is presented through the analysis of activities, which comprehensively visualizes medical care and allows improving the quality of the medical services provided to the patient.
INTRODUCCIÓN: La importancia de otorgar consulta externa de alta especialidad invita a realizar un diagnóstico a través de la arquitectura de procesos para medir con indicadores el diferimiento de consulta y evaluar la oportunidad de programación de citas en hospitales de alta especialidad. OBJETIVO: Aplicar el modelo de arquitectura de proceso e indicadores en hospitales de alta especialidad, para analizar las actividades de la programación de citas en consulta externa y mejorar la calidad de la atención médica y seguridad al paciente. MÉTODO: Estudio cuantitativo, secuencial y con razonamiento deductivo, de alcance correlacional para evaluar el grado de asociación entre variables, establecer y definir los medidores de desempeño, de acuerdo con la importancia de las actividades en los servicios médicos. Se trabajó una muestra de conveniencia en tiempo y por accesibilidad a dos hospitales de alta especialidad de la Ciudad de México. RESULTADOS: Se midió el diferimiento en consulta externa con relevancia en el análisis de 19 indicadores para una propuesta de estrategias. CONCLUSIONES: El modelo de indicadores prioritarios de arquitectura de procesos médicos a través del análisis de las actividades visualiza integralmente la atención médica y permite mejorar la calidad en el servicio médico al paciente.
Assuntos
Assistência Ambulatorial/organização & administração , Hospitais Especializados/organização & administração , Ambulatório Hospitalar/organização & administração , Qualidade da Assistência à Saúde , Assistência Ambulatorial/normas , Agendamento de Consultas , Acessibilidade aos Serviços de Saúde , Hospitais Especializados/normas , Humanos , México , Ambulatório Hospitalar/normas , Fatores de TempoAssuntos
Hospitais Especializados , Transtornos dos Movimentos/diagnóstico , Transtornos dos Movimentos/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Distúrbios Distônicos/diagnóstico , Distúrbios Distônicos/epidemiologia , Distúrbios Distônicos/terapia , Feminino , Honduras/epidemiologia , Hospitais Especializados/organização & administração , Hospitais Especializados/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos dos Movimentos/epidemiologia , Doença de Parkinson/diagnóstico , Doença de Parkinson/epidemiologia , Doença de Parkinson/terapiaRESUMO
Patients with complex palliative care needs can experience delayed discharge, which causes an inappropriate occupancy of hospital beds. Post-acute care facilities (PACFs) have emerged as an alternative discharge destination for some of these patients. The aim of this study was to investigate the frequency of admissions and characteristics of palliative care patients discharged from hospitals to a PACF. We conducted a retrospective analysis of PACF admissions between 2014 and 2016 that were linked to hospital discharge reports and electronic health records, to gather information about hospital-to-PACF transitions. In total, 205 consecutive patients were discharged from 6 different hospitals to our PACF. Palliative care patients were involved in 32% (n = 67) of these discharges. The most common conditions were terminal cancer (n = 42, 63%), advanced dementia (n = 17, 25%), and stroke (n = 5, 8%). During acute hospital stays, patients with cancer had significant shorter lengths of stay (13 vs 99 days, P = .004), a lower use of intensive care services (2% vs 64%, P < .001) and mechanical ventilation (2% vs 40%, P < .001), when compared to noncancer patients. Approximately one-third of discharges from hospitals to a PACF involved a heterogeneous group of patients in need of palliative care. Further studies are necessary to understand the trajectory of posthospitalized patients with life-limiting illnesses and what factors influence their decision to choose a PACF as a discharge destination and place of death. We advocate that palliative care should be integrated into the portfolio of post-acute services.
Assuntos
Hospitais Especializados/organização & administração , Cuidados Paliativos/organização & administração , Assistência Terminal/organização & administração , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Humanos , Tempo de Internação , Pessoa de Meia-Idade , Planejamento de Assistência ao Paciente/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Alta do Paciente , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores SocioeconômicosRESUMO
The dissemination of specialty hospitals throughout the urban centers has revolutionized the full spectrum of care for cardiology, oncology and orthopedics during the last decades. To centralize care, from translational and basic research to clinicians and surgeons, in the same dedicated institution leads to a decrease in complications rates, mortality and possible reductions in the length of hospital stays. Moreover, there has been a significant impact on hospital costs and on the quality of care. The Insituto Estadual do Cérebro Paulo Niemeyer (IECPN, in the Portuguese acronym) was opened in June 2013 in Rio de Janeiro, Brazil. It is the very first high-volume neurosurgical institution in the country. The core foundation of this institution is that the anesthesiologists, intensive care practitioners, nurses, pathologists, radiologists and rehabilitation staffs are trained and live the full management of neurosurgical lesions at the same facility on a daily basis. The present paper seeks to analyze the circumstances in which the institution was planned and opened as well as its complexity, infrastructure and initial results following its first 24 months of operation.
Assuntos
Humanos , História do Século XXI , Estrutura dos Serviços , Capacitação de Recursos Humanos em Saúde , Hospitais Públicos/organização & administração , Hospitais Especializados/organização & administração , Neurocirurgia/estatística & dados numéricos , Brasil , Laboratórios Hospitalares , Serviço Hospitalar de Emergência , Programas de Pós-Graduação em Saúde , Hospitais Especializados/história , Unidades de Terapia IntensivaRESUMO
OBJECTIVES: Although disparities in stroke care and outcomes have been well documented nationally, state-based registries to monitor acute stroke care in Florida (FL) and Puerto Rico (PR) have not been established. The FL-PR Collaboration to Reduce Stroke Disparities (CReSD) was developed to evaluate race-ethnicity and regional disparities in stroke care performance. The objective of this study was to assess and compare hospital characteristics within a large quality improvement registry to identify characteristics associated with better outcomes for acute ischemic stroke care. METHODS: Trained personnel from 78 FL-PR CReSD hospitals (69 FL, 9 PR) completed a 50-item survey assessing institutional characteristics across seven domains: acute stroke care resource availability, emergency medical services integration, stroke center certification, data collection and use, quality improvement processes, FL-PR CReSD recruitment incentives, and hospital infrastructure. RESULTS: The rate of survey completion was 100%. Differences were observed both within FL and between FL and PR. Years participating in Get With The Guidelines-Stroke (8.9 ± 2.6 years FL vs 4.8 ± 2.4 years PR, P < 0.0001) and proportion of hospitals with any stroke center certification (94.2% FL vs 11.1% PR, P < 0.0001) showed the largest variations. Smaller hospital size, fewer years in Get With The Guidelines-Stroke, and lack of stroke center designation and acute stroke care practice implementation may contribute to poorer outcomes. CONCLUSIONS: Results from our survey indicated variability in hospital- and system-level characteristics in stroke care across hospitals in Florida and Puerto Rico. Identification of these variations, which may explain potential disparities, can help clinicians understand gaps in stroke care and outcomes and targeted interventions to reduce identified disparities can be implemented.
Assuntos
Disparidades em Assistência à Saúde/etnologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Hospitais Especializados/organização & administração , Colaboração Intersetorial , Acidente Vascular Cerebral/etnologia , Acidente Vascular Cerebral/terapia , Florida , Fidelidade a Diretrizes , Pesquisas sobre Atenção à Saúde , Disparidades em Assistência à Saúde/tendências , Hospitais Especializados/tendências , Humanos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Porto Rico , Melhoria de Qualidade/organização & administração , Melhoria de Qualidade/tendências , Sistema de Registros , Acidente Vascular Cerebral/epidemiologiaRESUMO
OBJECTIVE:: To show that the administrative regime of specialized hospitals has some influence on the administrative processes to operate the Mexican Fund for Catastrophic Expenditures in Health (FPGC, in Spanish), for providing health care to breast cancer, cervical cancer and child leukemia. MATERIALS AND METHODS:: The variable for estimating administrative efficiency was the time estimated from case notification to reimbursement. For its estimation, semistructured interviews were applied to key actors involved in management of cancer care financed by FPGC. Additionally, a group of experts was organized to make recommendations for improving processes. RESULTS:: Specialized hospitals with a decentralized scheme showed less time to solve the administrative process in comparison with the model on the hospitals dependent on State Health Services, where timing and intermediation levels were higher. CONCLUSIONS:: Decentralized hospitals administrative scheme for specialized care is more efficient, because they tend to be more autonomous.
Assuntos
Administradores de Instituições de Saúde , Seguro Médico Ampliado , Adulto , Idoso , Institutos de Câncer/organização & administração , Eficiência Organizacional , Feminino , Acessibilidade aos Serviços de Saúde , Hospitais Especializados/organização & administração , Humanos , Entrevistas como Assunto , Masculino , México , Pessoa de Meia-Idade , Modelos Teóricos , Programas Nacionais de Saúde , Neoplasias/economia , Neoplasias/terapia , Política , Mecanismo de ReembolsoRESUMO
Resumen: Objetivo: Mostrar que el régimen administrativo de hospitales de especialidad influye en la eficiencia de los procesos administrativos para operar el Fondo de Protección contra Gastos Catastróficos (FPGC), para la atención de cáncer de mama, cáncer cérvicouterino y leucemia linfoblástica aguda. Material y métodos: La variable para estimar la eficiencia del proceso administrativo fue el tiempo entre la notificación del caso y el reembolso. Para su estimación se realizaron entrevistas semiestructuradas con actores clave involucrados en la gestión de casos financiados por el FPGC. Se organizó también un grupo de expertos para emitir recomendaciones de mejora. Resultados: Los hospitales de especialidad con un esquema descentralizado mostraron menor tiempo en el proceso administrativo en contraste con el modelo administrado por los Servicios Estatales de Salud, donde los tiempos fueron mayores y donde hubo mayores niveles de intermediación. Conclusiones: El modelo de hospitales especializados con un esquema descentralizado es más eficiente debido a que tiene mayor autonomía.
Abstract: Objective: To show that the administrative regime of specialized hospitals has some influence on the administrative processes to operate the Mexican Fund for Catastrophic Expenditures in Health (FPGC, in Spanish), for providing health care to breast cancer, cervical cancer and child leukemia. Materials and methods: The variable for estimating administrative efficiency was the time estimated from case notification to reimbursement. For its estimation, semistructured interviews were applied to key actors involved in management of cancer care financed by FPGC. Additionally, a group of experts was organized to make recommendations for improving processes. Results: Specialized hospitals with a decentralized scheme showed less time to solve the administrative process in comparison with the model on the hospitals dependent on State Health Services, where timing and intermediation levels were higher. Conclusions: Decentralized hospitals administrative scheme for specialized care is more efficient, because they tend to be more autonomous.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Administradores de Instituições de Saúde , Seguro Médico Ampliado , Política , Mecanismo de Reembolso , Institutos de Câncer/organização & administração , Entrevistas como Assunto , Eficiência Organizacional , Acessibilidade aos Serviços de Saúde , Hospitais Especializados/organização & administração , México , Modelos Teóricos , Programas Nacionais de Saúde , Neoplasias/economia , Neoplasias/terapiaAssuntos
Hospitais Especializados , Centros de Informação , Doenças Neuromusculares , Doenças Raras , Região do Caribe , Comportamento Cooperativo , Bases de Dados Factuais , Hospitais Especializados/organização & administração , Hospitais Universitários/organização & administração , Humanos , Centros de Informação/organização & administração , Comunicação Interdisciplinar , Cooperação Internacional , Laboratórios Hospitalares/organização & administração , Martinica , Medicina , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/genética , Doenças do Sistema Nervoso/patologia , Doenças do Sistema Nervoso/reabilitação , Doenças Neuromusculares/diagnóstico , Doenças Neuromusculares/epidemiologia , Doenças Neuromusculares/genética , Doenças Neuromusculares/patologia , Doenças Neuromusculares/reabilitação , PesquisaRESUMO
This document presents four stages in the history of the Centro Médico Nacional Siglo XXI (Centro Médico Nacional XXI Century) of the Instituto Mexicano del Seguro Social. The first stage started at the end of the third decade of the twentieth century and ended in 1961, it corresponded to the conception, planning and construction of what was to be the Centro Médico del Distrito Federal (Centro Médico of the Distrito Federal) belonging to the Secretaría de Salubridad y Asistencia (Ministry of Health and Assistance). The second stage began when the Center was acquired by the Institute, then was known like Centro Médico Nacional (Centro Médico Nacional ), being put into full operation in 1963, more than twenty-two years later, in 1985, an earthquake virtually ended it, immediately began its reconstruction, finishing the second stage. In 1989 began the third stage, different and new buildings complemented or replaced the structures damaged or destroyed by the earthquake which formed the now Centro Médico Nacional Siglo XXI (Centro Médico Nacional XXI Century). In 2004 the fourth stage opened when the four hospitals of the Center were categorized like Unidades Médicas de Alta Especialidad (High Specialized Medical Units).
En este documento se presenta en cuatro etapas la historia del hoy Centro Médico Nacional Siglo XXI del IMSS. La primera etapa se inició a fines de los años treinta del siglo XX y terminó en 1961, correspondió a la concepción, planeación y construcción de lo que iba a ser el Centro Médico del Distrito Federal que pertenecía a la Secretaría de Salubridad y Asistencia. La segunda etapa inició cuando el Centro fue adquirido por el Instituto Mexicano del Seguro Social, conociéndose como Centro Médico Nacional, el cual fue puesto en funcionamiento completamente en 1963; más de veintidós años después, en 1985, un sismo prácticamente lo acabó, aunque de inmediato se inició su reconstrucción, la cual terminó en 1989, año en que comenzó la tercera etapa. Fue entonces cuando diferentes y nuevas construcciones complementaron o sustituyeron a las edificaciones dañadas o destruidas por el temblor, que son las que hasta el día de hoy conforman el Centro Médico Nacional Siglo XXI. En el año 2004 se abrió la cuarta etapa, al categorizarse a los cuatro hospitales que configuran el Centro Médico Nacional Siglo XXI como Unidades Médicas de Alta Especialidad (UMAE).
Assuntos
Centros Médicos Acadêmicos/história , Hospitais Públicos/história , Hospitais Especializados/história , Programas Nacionais de Saúde/história , Centros Médicos Acadêmicos/organização & administração , Academias e Institutos/história , Academias e Institutos/organização & administração , História do Século XX , História do Século XXI , Hospitais Públicos/organização & administração , Hospitais Especializados/organização & administração , México , Programas Nacionais de Saúde/organização & administração , Previdência Social/história , Previdência Social/organização & administraçãoAssuntos
Academias e Institutos/história , Hospitais Especializados/história , Previdência Social/história , Academias e Institutos/organização & administração , História do Século XX , História do Século XXI , Hospitais Especializados/organização & administração , México , Previdência Social/organização & administraçãoRESUMO
The Tinea hospital in Granada, Spain, was a charitable health facility founded in the 17th century and still treating patients well into the 20th century. The hospital accepted patients from anywhere, not only those residing in the surrounding area. We describe the hospital's founding and the characteristics of the patients and caregivers. We also discuss how tinea was considered at the time, including the typology and treatment protocols applied as well as diet and hygiene measures used. It is striking that a hospital so focused on treating a single disease did not produce studies on the condition or on the application of contemporary knowledge to guide treatment.
Assuntos
Dermatologia/história , Hospitais Especializados/história , Tinha/história , Dieta , História do Século XVII , História do Século XVIII , História do Século XIX , História do Século XX , Hospitais Religiosos/história , Hospitais Religiosos/organização & administração , Hospitais Especializados/organização & administração , Humanos , Higiene , Orfanatos/história , Espanha , Tinha/classificação , Tinha/terapiaRESUMO
This article analyses the organisation of cancer control in Argentina, with a special focus on the initiatives, institutions, and models that targeted female or gynaecological cancers. It identifies and examines the main factors in the process of elaborating a national policy to control the disease drawing on a series of actors and instruments such as the state, medical professionals, institutions and services, and the use of technology (notably diagnostic tools) for the detection of the disease. It traces the developments in the organisation high lightingits transformations from a centralising to a decentralised model of service provision. Using the concept of «path-dependence» the article examines the continuities and changes observed in the organisation of female cancer critically signalling the particular time at which a path was taken where «fragmentation» became consolidated within the health system. It also argues that it was within the field of cancer diagnosis that Argentinian doctors first sought to create the foundational structures of cancer organisation. The article contends that thepath-dependence analytical approach helps us acknowledge the importance of historical analysis in the identification of factors that led to the lack of service coordination, including the persistent strain between national/provincial states that hampered the development of comprehensive programmes, aspects that have continued to mark efforts in the elaboration of cancer policies to the present day. (AU)
Assuntos
Saúde Pública/história , Neoplasias/diagnóstico , Neoplasias/prevenção & controle , Mulheres/história , Hospitais Especializados/história , Hospitais Especializados/organização & administração , Argentina , História do Século XXRESUMO
OBJECTIVE: Prior to the devastating earthquake in Haiti, January 12, 2010, a group of Haitian physicians, leaders and members of Project Medishare for Haiti, a Non-governmental Organization, had developed plans for a Trauma Critical Care Network for Haiti. DESIGN: One year after the earthquake stands a 50-bed trauma critical care and rehab hospital that employs more than 165 Haitian doctors, nurses and allied healthcare professionals, and administrative and support staff in Port-Au-Prince. Hospital Bernard Mevs Project Medishare (HBMPM) has been operating with the following two primary goals: 1) to provide critical-care- and trauma-related medical and rehabilitation services and 2) to provide clinical education and training to Haitian healthcare professionals.(1) RESULTS: These goals have been successfully accomplished, with more than 43,000 outpatients seen, 6,500 emergency room visits, and about 2,300 surgical procedures performed. Daily patient care has been managed by Haitian medical staff as well as more than 2,400 international volunteers including physicians, nurses, and allied healthcare professionals. With the continued assistance of weekly volunteers, many programs and services have been developed; however, many challenges remain. CONCLUSIONS: This article highlights the development and progress of HBMPM over the last year with emphasis on developing inpatient and outpatient services, which include surgical, clinical laboratory, wound care, radiology, rehabilitation, and prosthesis/orthotics programs. Some of the challenges faced and how they were managed will be discussed as well as future plans to conduct more training and education to increase the building of medical capacity for Haiti.
Assuntos
Fortalecimento Institucional , Terremotos , Hospitais Especializados/organização & administração , Cuidados Críticos , Haiti , Humanos , Organizações/organização & administração , Desenvolvimento de Programas , Reabilitação , Centros de Traumatologia/organização & administraçãoRESUMO
The organization and management of specialized cleft lip and palate centers in developing countries are challenging because of the lack of financial resources devoted to the national health care system. The treatment of cleft lip and palate is of low priority for health care and budgets; however, gradual progress is possible. As an example of how care might be improved in the developing world, we suggest guidelines to strengthen the local cleft lip and palate centers in Brazil based on the ideal geographic distribution of cleft centers around the country, to achieve the following objectives: first, avoid patient's migration; second, facilitate patient's adherence; third, focus on a global and continuous multidisciplinary treatment; and fourth, avoid indiscriminate opening of nonprepared cleft lip and palate centers in our country. This ideal scenario would put the cleft lip and palate health attention on the right path in Brazil.