MOZAMBIQUE

Partners for Pediatric Progress established its first partnership in 2008 in in the capital city of Maputo, Mozambique. Since then we have been working closely with our friends and colleagues at the country’s main medical school, the Faculdade de Medicina, Universidade Eduardo Mondlane, and its adjacent 1500 bed teaching hospital, the Hospital Central de Maputo.

We’re proud to have an In-Country Program Director, Dr. Chris Buck, overseeing all of the activities of Partners for Pediatric Progress in Mozambique.

Mozambique is one of the world’s poorest countries and is thus a country of greatest need. It ranks 180 out of the 188 countries on the United Nations Development Programme’s 2015 Human Development Index.  Nearly 61% of the population lives below the income poverty line of US $1.25 per day. However, income poverty alone only tells part of the story as many individuals living near or above the poverty line suffer deprivations in health, education, and living standards, bringing the true percentage of people living in the conditions of poverty to over 70%. Of these deprivations, lack of resources in the health system plays a significant factor contributing to overall poverty and has an overwhelmingly important impact on children who are the very foundation and future of the country.

 
 

the needs in Mozambique are immense

With approximately 11 million citizens under the age of 15 (45% of the entire population) and extremely high neonatal and childhood morbidity and mortality rates. When Partners for Pediatric Progress started its activities in the country, there were only 10 pediatricians and no pediatric surgeons. Through close collaboration with our colleagues at the Eduardo Mondlane School of Medicine and the Pediatric Department at the Hospital Central de Maputo, we implemented our capacity-building program to train the local healthcare workforce. As of 2015, there are now 67 Mozambican pediatricians. Of particular note, our faculty contributed to the training of the only two pediatric surgeons in the country.

We could not be grateful enough for the partnership and support that we have received for our work in Mozambique from the President’s Emergency Plan for AIDS Relief (PEPFAR), the Centers for Disease Control, the United States Health Resources and Services Administration (HRSA), and the Mozambique Ministry of Natural Resources.

Some of the past Partners for Pediatric Progress’ projects in Mozambique have included:

  • Training and support of care in Urgencia, or Pediatric Intensive Care Unit.

  • Support of the graduate medical education program for Mozambican Pediatric residents.

  • Hospital Infection Control Project to decrease the risk of hospital-acquired infections.

  • Ongoing training and support of pediatric surgical and pediatric surgical subspecialty programs.

 

Demographics

 
 

PERU

Partners for pediatric Progress is operating at several sites in the Peruvian city of Iquitos, also known as the “capital of the Peruvian Amazon.” Located on the Amazon River, Iquitos is only reachable by boat or plane. It is the largest city in the Loreto region, one of the poorest regions in all of Peru where over 60 percent of the population live in poverty. Iquitos is home to the region’s only two hospitals and its only medical school putting a constraint on the ability of the health system to care for the large population it serves.

Children often travel from miles along the small rivers that feed into the Amazon River to reach the clinics and hospitals centrally located in Iquitos.

Children who reach these clinics do not receive appropriate care as there are not enough pediatricians in the region. Ultimately, limited access and lack of pediatric training contribute to the under-5 Mortality rate in the region which is the highest in all of Peru.

The Loreto region is currently facing one of the biggest shortages of pediatric specialists in the country. In Loreto, most physicians are general practitioners who have recently completed a one-year internship after medical school and are now fulfilling a one-year mandatory alignment of rural service. In 2010, there were only six pediatricians and no pediatric surgeons to serve the region’s population of one million. In a study, the Ministry of Health of Peru identified that the region needs at least 41-82 pediatric specialists and three pediatric surgeons to provide basic care to the population of Loreto. Currently there are very few residency training programs available in Iquitos to increase the number of pediatric specialists in the area. Doctors seeking to specialize in pediatrics must leave Iquitos for Lima and other distant areas to train. In addition, very few physicians in Loreto (10%) chose to specialize. Those who leave Loreto to specialize rarely return to the region following their training. This has resulted in an overwhelming disparity in quality of care, leaving the Loreto region with an extremely limited availability of pediatric services.

 
 

Based on AN intensive needs assessment

Partners for Pediatric Progress is sending pediatricians, neonatologists, pediatric critical care experts, and pediatric nurses to the region to train and work closely with our colleagues there and support the effort to increase pediatric training for physicians and nurses to care for children living in extreme conditions of poverty. Our organization currently partners with the Hospital Regional de Loreto in Iquitos, to work with physicians, nurses, and students. Clinician-educators from Partners for Pediatric Progress work directly with colleagues in the inpatient nursery, in the pediatric intensive care unit and on the inpatient pediatric wards.

We are also working with our Peruvian partners in the primary care clinics of Iquitos’ impoverished community of Nanay, and in other more isolated community clinics in the Amazon basin. Nanay is a district that lies at the edge of the city of Iquitos on a tributary of the Amazon River. It is a densely crowded district where most of its inhabitants are poor and many live in extreme poverty. From February through July, the river level rises five to six meters resulting in heavy flooding of the district. During these months the community is connected by an intricate network of planks above the water (as pictured below).

The overcrowded conditions, poor sanitation, and annual flooding create conditions that place the people of Nanay at risk for contracting diseases such as dengue, water-borne illness, and tuberculosis. There is a teaming outpatient clinic in the middle of Nanay, with a high volume of high-risk children seen at this site. The providers at the Nanay Clinic have asked for primary care pediatricians and pediatric nurses from Partners for Pediatric Progress to work with them closely. While there, clinician-educators from the US also work with physicians and public health nurses up river, seeing children in more rural Amazon health centers, and supporting the public health efforts in these settings.

Peru Demographics