Las Tunas closed the year 2024 with an infant mortality rate of 6.3 per thousand live births and the strength of a more consensual and multidisciplinary management.
A phone call changed the course of events for a team of doctors from Las Tunas. The seriousness of the 31.3-week-old pregnant woman at the Luis Aldana Palomino polyclinic with hospitalization services, in the municipality of Amancio, activated the Provincial Commission for the Extremely Serious Maternal Condition of Dr. Ernesto Guevara de la Serna General Teaching Hospital. It was Saturday, November 2, and Hurricane Rafael was raging.
After 2:00 p.m., the patient presented acute respiratory failure with the need to permeabilize the airway and ventilate her. The team of experts maintained close communication to advise on the performance of these procedures and was there in the shortest possible time.
The mother's health condition was worsening and the danger to the baby's life was adding to her risks and anxieties. After consulting with professors and intensivists linked to the National Commission for Critical Maternity of the Ministry of Public Health, the necessary conditions were created to bring the child into the world.
It was a stressful few minutes within the green walls, but the maneuver worked. The Neonatology team resuscitated the baby and took him to the ‘Guevara’; the rest of the team spent the early hours of the morning stabilizing the mother. In the morning they returned to the capital city in the advanced life support ambulance, and after several days of sleeplessness, tension, and a lot of joint work, both returned home.
COLLECTIVE WORK
During 2024, this was not the only incursion that tipped the balance in favor of life on Tunisian soil, nor was this team of specialists exclusively responsible for 12 months that closed marked by superior work in the Maternal and Infant Care Program (PAMI in Spanish).
Dr. Viviana Gutiérrez Rodríguez, Director of Publicc Health, shares with 26 the recognition for the ranks of the "white coats" because amid a year of economic tensions, shortages of resources and vital supplies, energy disconnections, climatic events..., the health personnel lived up to the demands and the results speak for themselves.
"The province has worked hard with all its specialists, both in primary and secondary health care, which has led to commendable indicators in care," says the director.
"At the end of December, there were 3,642 births in Las Tunas, 1,744 fewer than in the previous year, and an infant mortality rate of 6.3 per 1,000 live births was achieved, a figure below the national average and lower than the previous calendar. This last fact is no coincidence, it is due to the cohesive work that we are promoting in the territory."
"Primary care, with the action of the family doctor and nurse, has been the main protagonist and this is due to the assurance of benefits, the coverage of all clinics, either with its doctor or using variants such as salary incentives or with nursing staff in charge of these vital scenarios."
Gutiérrez Rodríguez explains that, as a strategy, the new reorganization of the clinics and the improvement of the program allowed for a more effective follow-up of pregnant women and children.
"The maternal homes joined the effort and addressed structural and subjective issues for the transformation of obstetric risks. The control of high blood pressure and the diagnosis and treatment of vaginal discharge syndrome and urinary tract infections, which are the main causes of maternal and infant morbidity and mortality, stand out."
"It is not unusual for the province's maternal mortality rate to remain at zero at the end of the year. Secondary care and integration between specialties also stand out in this respect."
"When a serious maternal death arrives at the Guevara hospital, there is a whole mobilization and support in the emergency department that guarantees comprehensive management. In this process, not only Intensive Care and Gynecobstetrics are involved, but also other disciplines such as Radiology and Clinical Laboratory."
"Likewise, the Integrated Medical Emergency System (SIUM) played an important role in the promptness with which pregnant women and babies were transferred, facilitating timely care. Despite having a depressed park, these technically and professionally trained colleagues provided first aid and care," she stresses.
Meanwhile, an arduous process of revitalization of facilities took place, despite the shortages. Work was carried out in maternity homes, services such as the neonatology ward of the ‘Guevara’, the delivery rooms, and the Guillermo Domínguez hospital, in Puerto Padre, optimized the surgical room, where pregnant women are also attended.
Similarly, resources and manpower were placed in the maternity wards of all the municipal institutions with hospitalization services, such as "Amancio" and "Villa Azul," where the planned repair and maintenance plan were honored, including the consulting rooms.
CALENDAR INSIDE
In the middle of the neonatology ward of the largest health institution in the Balcón de Oriente, Yoania Reyes, a graduate in Integrated Newborn Care, talks to 26 without taking her eyes off the monitor that shows the signs of life of an infant in critical condition.
"This is a service that demands a lot of love, and our strength is a committed team that feels and takes care of the changes in each of the little bodies inside the machines," she remarks.
"In the year just ended, we had a lot of experiences on the edge, and to our delight, most of the children went home. We don't forget a single case here, those who arrive with respiratory depression due to delayed deliveries or other complications associated with placenta previa, high blood pressure..."
"Currently, the ward is almost full, although there is always room for one more. We have around 20 in the incubators and seven of them have a critical diagnosis. The pace is always hectic, but no effort or time is spared to save them."
Yoandra Gutiérrez, head of the Provincial Nursing Group for Neonatology and Pediatrics, speaks with pride about the fruits of the exchange with the group of experts who every morning assess each infant, regardless of the degree of severity, and from this consensual observation, they adopt the course of action to be followed individually.
"2024 was arduous, with a great deal of preparation. We had many complex cases, preterm up to 28 weeks, newborns weighing less than 1,000 grams, and most of them were already with their families. Our service is a national reference and we are all committed to keeping it that way."
In the network of rooms, the most notorious stories that have marked the past calendar abound, and they lead to the indicators that detail the reality of Tunisia. Thus, the Neonatal Intensive Care Unit, with a survival rate of 98.9 percent, reveals a great sense of belonging. It is also commendable that this service of the Mártires de Las Tunas pediatric hospital has an infant mortality rate of zero in children under one year of age.
According to the highest representative of the sector in the province, pediatrics has made a difference in PAMI. Its professionals have trained family doctors in the main diseases and morbidities of infants, which has led to a safer approach to pediatric complications.
Meanwhile, the management of adolescent pregnancy finally demonstrates that multisectoral action can control a major health problem with powerful consequences for mothers and babies.
"A few months ago we had the highest teenage pregnancy rate in Cuba, and although we are not satisfied, we have achieved a reduction of 168 fewer pregnancies compared to 2023. This does not mean that we have eradicated the phenomenon; but we have resized and give it full priority. We don't want girls to continue arriving in intensive care or ruin their plans for the future," says Gutiérrez Rodríguez.
MUCH REMAINS TO BE CONQUERED
"Low birth weight is the most negative indicator in the territory. It has multifactorial causes and adolescent pregnancy has been a catalyst for it to be triggered in 2024."
"Other factors such as high blood pressure, bad habits, and lifestyles that cause nutritional problems in pregnant women, whether due to excess or deficiency, have also played a role."
"In the current year, we aim to organize the strategy of low birth weight from the maternal homes, so that they become transformers of this reality, influencing key points. In several cases, we had to intervene before term due to maternal conditions such as high blood pressure and urinary tract infections," she said.
Among the areas to be strengthened, she lists the training of professionals for treatment the main causes of maternal and infant morbidity, and the training of primary and secondary care in the management of emergencies.
Undoubtedly, the almanac closes here with better indicators than its predecessor does. Even so, the statistics do not mean that the sector is free of difficulties or that PAMI's management has been perfect. The numbers in the mortality rate, however small they may be, carry pain for those who did not make it. Caring for life is also a personal responsibility and must have the greatest support at home, in the support network, thus the baby and its mother are well.
There is still a long way to go, and the brave men in white coats know it. But they carry under their uniform the commitment that translates from sensitivity to protect, at all costs, the joy of celebrating a new birth as a family.
