For the Maternal and Infant Care Program (PAMI in Spanish) in Las Tunas, 2023 was a calendar marked by intentional work on the most worrying indicators. Even so, the numbers do not support the qualitative leap in the approach to the mother-to-be and the newborn, although important steps are being taken to reduce prematurity and low birth weight.

According to preliminary data up to almost the end of the year, the province has an infant mortality rate of 7.3 per 1,000 live births, slightly higher than the previous calendar year, and up to 27 December, there were 4,635 births, 183 fewer than in the previous 12 months.

Dr. Norkis Sánchez Alonso, a second-degree specialist in General Comprehensive Medicine and director of Medical Assistance, Medicines, and Health Technologies, told 26 that the current situation is a combination of variables that hinder the desired benefits, such as low birth weight, as a result of pre-term births or intrauterine growth retardation, and the prevalence of teenage pregnancies.

"The year that ended a few hours ago called on us to find quick and timely responses to the most pressing problems of pregnant women. In addition to the actions of our core teams, factors inherent in communities and even individual responsibility continue to hinder the best outcome of that supreme moment of bringing a child into the world.

"Preterm births were a major contributor to the large number of infants arriving at the neonatal ward at risk of death. And they put to the test the response capacity of our institutions, where, of course, it is essential to work together to ensure the survival of newborns.

In this particular case, the doctor emphasizes that the nutritional status at the time of gestation, due to excess or deficiency (obesity), and the prevalence of cases of anemia in the territory have a significant impact. This, together with infections during pregnancy and unhealthy habits and lifestyles, put the mother-baby pair at risk.

The refusal of patients to stay in institutions, such as maternity homes, to modify malnutrition, has a great influence on these numbers," she emphasizes. This behavior has increased since the covid-19 pandemic and we deal with many cases of absconding throughout the year, even from the wards of the Ernesto Guevara hospital on the eve of childbirth.

The teenage pregnancy rate, one of the highest in the country, is another aspect that conspires against PAMI's performance and has recently become one of the main dilemmas facing the Balcón de Oriente in terms of public health.

ALLIANCES TO STEER THE COURSE

Behind the province's current indices is the concern and anxiety of those directly involved with PAMI's results and their determination to ensure that the dynamics are better developed. With this in mind, specific strategies are being deployed and systematically monitored by the highest authorities.

"From Primary Care, visits to the 14 polyclinics have been promoted to exchange with the professionals of the medical offices, to learn about their achievements, projections, and concerns about issues such as low birth weight and how to proceed to reverse it in each locality," says Sánchez Alonso.

"Amid the current shortage of human resources, we have supported the Gynecobstetrics service with 20 professionals to take care of the evolution of the patients and the visits, while the obstetricians concentrate on the more complex actions.

"We are successfully implementing consultations with national experts from Havana, Holguín, Sancti Spíritus, and Ciego de Ávila. We will receive several during 2023 and we will consult with others virtually, depending on the degree of complication of the puerperas and newborns.

However, the directive states that to achieve better results from PAMI, an inter-sectoral response is necessary and alludes that for the year that has just begun, stronger alliances will be planned with the Federation of Cuban Women, the Community Workgroups and the productive forms to reinforce the nutrition of pregnant women.

We have already traveled a long way in the support search," she remarked. Since the second half of 2023, a strategy has been in place to make PAMI's multi-sectoral approach effective. The competencies and scope of the productive forms, the most vulnerable scenarios in which help is required and the different ministries involved are aware of the actions to be promoted have been defined. So there is already planning in place and we hope it will begin to bear fruit.

In Las Tunas, the work is also directed toward reducing teenage pregnancy and the admission of at-risk pregnant women into maternal homes for comprehensive and differentiated care. However, commitment is not enough if the equation does not include family support and responsibility as essential requirements to ensure and preserve life. Each part counts, and the more they are mutually irrigated, the closer this land will come to giving birth to a context of fewer emergencies.