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HEALTH-PARAGUAY: Hospitals on the Critical List

David Vargas

ASUNCION, Jun 26 2008 (IPS) - Paraguay’s public hospitals are on the verge of collapse, due to a lack of resources for responding to the wave of southern hemisphere winter illnesses. The first measure to be adopted by the new government that will take over in August will be to declare a “social emergency” in healthcare, the future health minister told IPS.

In the past few weeks, unusually low temperatures have resulted in a significant increase in hospital visits, especially for children requiring paediatric services. While the illnesses are common for this time of year, the number of patients is much higher than in previous years, according to the Health Ministry.

In late May there were 2,000 cases a week of acute respiratory infections, which leaped to 8,000 a week in mid-June. So far this year 60,000 patients with influenza and lung problems have been treated, nearly 20 percent more than in the whole of 2007. But there are not enough hospital beds, doctors and nurses, or medicines and other necessary materials. Several hospitals, like the Ñemby District Hospital on the outskirts of Asunción, have asked people living in that area to come to the hospital only in extremely urgent cases.

The Ñemby Hospital has only one paediatrician on duty per shift, who must treat between 200 and 300 patients a day. The World Health Organisation (WHO) recommends no more than 20 patients per doctor per day, in order to ensure the quality of healthcare.

The authorities admit there is a 40 percent shortfall in the number of paediatricians in the public health system.

Only four of the 28 public health clinics and hospitals in Asunción have paediatricians on call 24 hours a day. According to official figures, Paraguay has six doctors and 1.2 nurses per 10,000 population, far below the levels in neighbouring countries.

“We’re going to try to get more personnel. We must acknowledge that the number of paediatricians is too small to cope with the demand we are seeing right now,” Deputy Minister of Health Antonio Barrios told IPS.

The ministry has instigated a plan to reinforce the availability of doctors on call in health centres where they are most needed. But the basic problem is that doctors have little interest in working for the state because of the low salaries, Barrios admitted. The average salary of a paediatrician at a public hospital is two million guaraníes (500 dollars) a month.

In addition, the public hospitals only have 67 paediatric intensive care beds, and 32 for adults, less than half those required for this country of 6.7 million people.

“We still have a 50 percent deficit in paediatric beds. For adults, the situation is even worse: the deficit is 67 percent,” Dr. Carlos María Romero, the director of Health Services at the ministry, told IPS.

In June 2006, when Health Minister Óscar Martínez was appointed, he promised to increase the number of intensive care unit beds by 60, but only 21 have been incorporated. Nearly all available intensive care beds are in the metropolitan area of Asunción, while the rest of the country is unserved.

Given this scenario, the first measure will be to declare a “social emergency,” health minister-designate Dr. Esperanza Martínez told IPS.

“We must urgently improve logistics and the distribution of resources, make the tendering process for buying medicines transparent and institute more efficient control of supplies,” said Martínez, who will take up her post on Aug. 15, the day president-elect Fernando Lugo, of the centre-left opposition coalition, takes office.

Martínez plans a major overhaul of the system, based on decentralising the country’s health services, reallocating the budget and creating an incentives policy to optimise human resources.

“In primary health care, we want to institute the model of family health teams in 100 to 150 extremely poor locations,” she said.

This model consists of teams of social workers headed by a doctor, who will begin by taking up residence in the communities and mapping out a social diagnosis.

“It’s a way of identifying people with high blood pressure or diabetes, cases of domestic violence, poverty, illiteracy and so on, from the viewpoint that health means quality of life,” Martínez explained.

Another pillar of the reform will be a new human resources policy.

“We want to improve salaries and overall management, because some doctors earn just one million guaraníes (250 dollars) a month, and have to run from job to job to earn a decent salary,” she said.

But the future minister admits that the reform will be a long-term challenge.

“The country is 60 years behind the times in the area of health, and the health service structure is based on sinecures and political favouritism, so we can’t expect miracles,” she warned.

Meanwhile, people are going frantic. Rosa Martínez had a fit of rage in mid-June at the hospital in Fernando de la Mora, on the outskirts of Asunción, when doctors would not come to examine her four-year-old daughter, who was suffering from respiratory problems.

After waiting for several hours, the toddler went into convulsions and lost consciousness in the hospital corridor. Her mother had to break windows to get the doctors’ attention.

The hospital is simply bursting at the seams. At the moment, even secretaries’ offices and other administrative departments are being used for patient care.

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