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Children First: A Success Story of Collaboration between Pediatric Hospitals in Mexico and Canada

Sample ImageIn 1997, the Oaxaca Children's Hospital in Mexico and the Children's Hospital of Eastern Ontario in Canada initiated a twinning partnership at a time when the Oaxacan facility was just beginning to establish itself as a pediatric care center. Ten years of intense cooperation, based on a bilateral flow of clinical and administrative knowledge and incorporating human resources training and institutional capacity-building approaches, have followed. In the last two years, with support from the Pan American Health Organization (PAHO) and Health Canada, the spirit of cooperation between the two hospitals has been further galvanized as the scope of activities underway has deepened and secured important new ground. This article will highlight the most important of these accomplishments.

icon Children First: A Success Story of Collaboration between Pediatric Hospitals in Mexico and Canada

1997 Twinning partnership begins: the Oaxaca Children's Hospital in Mexico and the Children's Hospital of Eastern Ontario in Canada

 

2006 Twinning agreement is expanded to include: The Hospital Civil Fray Antonio Alcalde, located in Guadalajara, Jalisco state

 

2007 Two children's hospitals based in Guerrero state join the collaborative network: the Hospital de la Madre y el Niño Guerrerense and the Hospital de la Madre y el Niño Indígena Guerrerense

 

"The cooperation has been tremendously beneficial for the training of personnel, both physicians and nurses, in the areas of surgery, research, and continuing medical education."
(Dr. Javier Hernández Contreras, Oaxaca)



"The Ontario visits helped us to study and assimilate a model for the movement of patients and illustrated the importance of establishing a strong relationship between the patient, the patient's family, and the services offered. This contact not only improves overall functioning, but also the quality of relationships established."
(Dr. Dinorath Díaz Rojas, Oaxaca)



"We see the poorest of the poor; the ones who do not have health insurance of any kind"
(Dr. Carlos Rivera, Guadalajara)



"The agreement with the Children's Hospital of Eastern Ontario has permitted us to strengthen the area of diagnosis of viral respiratory infections, now that the staff has been trained in immunofluorescence, a laboratory technique that permits rapid and accurate virus detection and differentiation."
(Dr. Carlos Rivera Mendoza, Jalisco)



"Many of the respiratory infections suggested a viral etiology, but because we did not have the proper diagnosis tools, patients were treated for bacterial infection, resulting in the irrational use of antibiotics and an increase in bacterial resistance."
(Dr. Iván Hernández Cañaveral, Guadalajara)



"We hope to be able to train our staff in a diversity of subjects, including nosocomial infections and management of the newborn. The opportunities for training in our area are few, and specialized professionals often do not want to be transferred here. That is why it is so critical that we be able to provide real incentives for those who are already here to learn new skills."
(Dr. Sofía Caballero Martínez, Guerrero)



"Our hospital is going to benefit from this international experience, and we hope to, in turn, share it with others. We look forward to the opportunity to improve the quality of care, diminish the number of births by caesarean section, and tap into this international channel for training our technical and administrative staff."
(Dr. Raúl López Roque, Guerrero)



"Words cannot express how educational this type of experience is for the Canadians who take part. It allows us to verify the degree of impact that may be achieved in health services delivery in a low-resource environment through the application of effective, efficient, and affordable techniques."
(Dr. Tim Karnauchow, Ontario)



"On a personal level, it is highly motivating and educational to be able to get to know colleagues from other countries who are facing the same challenges, listen to what they are doing to address them, and learn how the current collaboration can be most useful in offering practical solutions. This is our best reward, and when you feel rewarded, you work better."
(Dr. Kathryn Suh, Ontario)



The most important of these lessons is the collective conviction that the health of children must come first.

 

This joint effort has resulted in the overall strengthening of health services at the Oaxaca Children's Hospital through improved managerial planning, health systems integration, and capacity to respond to children and youth with specialized health needs. The experience ultimately has served to bring a better quality of life to children from families who live in extreme poverty and reside in some of Mexico's most underserved geographical areas.

As word of the project's success has spread, the original 1997 twinning agreement has expanded to include new partners. The Hospital Civil Fray Antonio Alcalde, a large and well-established teaching hospital located in Guadalajara, Jalisco state, joined in 2006, and in late 2007, the two children's hospitals based in Guerrero state, the Hospital de la Madre y el Niño Guerrerense and its sister facility, the Hospital de la Madre y el Niño Indígena Guerrerense, joined the collaborative network. This experience will facilitate better communication and exchanges among the various Mexican hospitals at the same time that it will allow all partners to benefit from the solidarity and commitment established between Canada and Mexico a decade earlier, buttressed by the international cooperation funds provided by PAHO.

As the work of this project continues to evolve, the overarching lesson it offers to others is that the fragmentation and isolation that characterize health care delivery and compromise its quality in many countries may be overcome despite the lack of financial resources.

International Cooperation Provides the Underpinning

The Oaxaca Children's Hospital functions within a context of major socioeconomic inequities and serious health challenges (see box below); its clients are for the most part poor residents of small rural communities.

Oaxaca: Gaps and Inequities

  • Nearly 76% of the population lives at or below the poverty line.
  • Sixteen or more ethnic groups reside in the state, which has one of the highest proportions of indigenous populations (49%) in the country.
  • Seventy-two percent of the population either has difficulty accessing health services or does not receive them at all.
  • The infant mortality rate is 36% higher than the national average and is double that of the Federal District.

The joint support of PAHO and Health Canada has served as the cornerstone for the strong collaboration between the Oaxaca Children's Hospital and the Children's Hospital of Eastern Ontario and will facilitate the effective integration of the three newer partners into the cooperation network. This support has enabled a series of professional exchanges and on-site visits, strengthened the technical capabilities of the Oaxaca Children's Hospital, and, perhaps most importantly, helped leverage and create momentum for attracting additional resources for the endeavors underway. As a result, the hospitals in Jalisco and Guerrero have been structured into a relationship conceptualized as a "hub and spoke" model, in which the Hospital Civil Fray Antonio Alcalde serves as the central hub, the Oaxaca hospital serves as the initial spoke, and the two Guerrero institutions have become the newest spokes. The design of the hub and spoke framework heightens capacity for health systems integration and ensures greater sustainability of this process by maximizing the effectiveness of available resources in the country, stimulating knowledge transfer, and offering opportunities for ongoing training and professional development.

Over the past two years, the Oaxaca Children's Hospital has focused on the following work areas in its collaboration with the Children's Hospital of Eastern Ontario: infectious and communicable diseases, neonatology, viral respiratory infections, genetics, rehabilitation, and research.

In the words of Oaxaca's Dr. Javier Hernández Contreras, Assistant Director of Teaching, Training, and Research, "the cooperation has been tremendously beneficial for the training of personnel, both physicians and nurses, in the areas of surgery, research, and continuing medical education." Oaxaca care providers who traveled to the Eastern Ontario facility had the opportunity to observe the functioning of emergency services, and a group of their Canadian counterparts subsequently visited the Oaxaca institution.

Dr. Dinorath Díaz Rojas, Oaxaca's Chief of Surgery, adds: "The Ontario visits helped us to study and assimilate a model for the movement of patients and illustrated the importance of establishing a strong relationship between the patient, the patient's family, and the services offered. This contact not only improves overall functioning, but also the quality of relationships established." She further highlighted two areas of collaboration that particularly benefited Oaxaca Children's Hospital and the population it serves. First, the hospital has been able to improve its training and techniques related to pediatric endoscopic procedures and increase its use of new sterilization protocols. Secondly, it has introduced a more organized approach to the scheduling of surgery, resulting in a more efficient use of time and equipment.


María Teresa Calderón Acosta, María de Lourdes Márquez Rojas, and Sor Estela Primero Hernández, nurses from the Hospital Civil Fray Antonio Alcalde in Guadalajara, pose with Dennise Albrecht, far left, and Fanny Zegarra, second from right, from the Children's Hospital of Eastern Ontario.

Better Diagnoses, Better Care

"We see the poorest of the poor; the ones who do not have health insurance of any kind," says Dr. Carlos Rivera Mendoza of the Department of Pediatric Infectious Diseases, referring to the population served by the Hospital Civil Fray Antonio Alcalde. Some 500 children are hospitalized each year with viral respiratory infections. Until recently, it was virtually impossible to ascertain what type of infection the patient had, which meant that children were assigned to the same room based on the symptoms exhibited without the benefit of a diagnosis identifying the particular type of virus affecting them.

"The agreement with the Children's Hospital of Eastern Ontario has permitted us to strengthen the area of diagnosis of viral respiratory infections, now that the staff has been trained in immunofluorescence, a laboratory technique that permits rapid and accurate virus detection and differentiation," Rivera adds. Thanks to the training and materials received, a number of improvements in child care has been introduced. It is now possible to classify and assign patients according to virus type, thus lowering the risk of cross-infection. Also, a better diagnosis allows a higher quality of care through more timely and targeted treatment. "Many of the respiratory infections suggested a viral etiology, but because we did not have the proper diagnosis tools, patients were treated for bacterial infection, resulting in the irrational use of antibiotics and an increase in bacterial resistance," explains Dr. Iván Hernández Cañaveral, of the University of Guadalajara's Department of Microbiology and Pathology.

Hope and Expectations in Guerrero

The newest partners—the two children's hospitals in Guerrero—anxiously await the trickle-down effect of the Canadian-Mexican knowledge-sharing network. As new "spokes," the hospitals—and the large, geographically remote public they serve (see box below)—stand to reap many benefits from a decade-long collaboration based on addressing priority community health needs.

Guerrero: Gaps and Inequities

  • The state's maternal mortality ratio—281 females per 100,000 live births—is among the top three highest in the country, and, according to UNICEF, one of the highest in the world.
  • The illiteracy rate (62%) is Mexico's highest.

The Mountain Region:

  • The majority of the population is indigenous and living in extreme poverty.
  • It is one of Mexico's most marginalized regions.
  • There is a serious lack of basic public services and highway infrastructure; most of the area is served by dirt roads.

     

  • The Hospital de la Madre y el Niño Indígena Guerrerense, located in the Mountain Region, plays a key role in the provision of health services to nearly 400,000 residents. Dr. Sofía Caballero Martínez, who heads the facility, is very enthusiastic as she reflects on the numerous benefits the recently signed agreement can potentially bring to the hospital and its users. "We hope to be able to train our staff in a diversity of subjects, including nosocomial infections and management of the newborn. The opportunities for training in our area are few, and specialized professionals often do not want to be transferred here. That is why it is so critical that we be able to provide real incentives for those who are already here to learn new skills."

    Martínez's counterpart at the Hospital de la Madre y el Niño Guerrerense, Dr. Raúl López Roque, is likewise filled with expectation. "Our hospital is going to benefit from this international experience, and we hope to, in turn, share it with others. We look forward to the opportunity to improve the quality of care, diminish the number of births by caesarean section, and tap into this international channel for training our technical and administrative staff."

    A Growing Experience for Canada

    For the Canadian participants, the collaboration has brought new insights and a deep admiration for the passion and commitment of their Mexican colleagues. Despite limited resources and working under difficult conditions, their steadfast spirit and energy have kept the cooperation agreement strong and dynamic. On the other hand, on-the-ground experiences with the hub and spoke model have provided valuable input for fine-tuning the train-the-trainers strategy, and the support of Health Canada and PAHO is facilitating the project's expansion and serving as a catalyst to attract resources and commitments from additional sources.

    Dr. Tim Karnauchow, Chief of Bacteriology at Children's Hospital of Eastern Ontario, recently returned from Guadalajara, where he chaired a round table on viral respiratory infections at the Hospital Civil Fray Antonio Alcalde. "Words cannot express how educational this type of experience is for the Canadians who take part. It allows us to verify the degree of impact that may be achieved in health services delivery in a low-resource environment through the application of effective, efficient, and affordable techniques."

    Karnauchow's colleague, infectious diseases expert Dr. Kathryn Suh, sees the impact of the hospital's collaboration with Mexico on two levels: the institutional and the personal. The Eastern Ontario facility is one of Canada's few hospital centers focusing exclusively on pediatrics, and the visit of Mexican professionals was, according to Suh, a particularly enriching experience because she sensed that the Mexicans left with a deep sense of belonging and solidarity. "On a personal level," she continues, "it is highly motivating and educational to be able to get to know colleagues from other countries who are facing the same challenges, listen to what they are doing to address them, and learn how the current collaboration can be most useful in offering practical solutions. This is our best reward, and when you feel rewarded, you work better."


    The twinning agreement permitted many professional exchanges and visits from Canada to the hospitals in Mexico, as well as training of Mexican health workers in Ontario.

     

    The New Goal: Replicate the Success

    All the participants in this project, whether Canadian, Mexican, or representing PAHO, agree that the experience to date has been enlightening and enriching. The incorporation of new hospitals in the collaborative network and the leverage of support from additional institutions can make an enormous difference in the quality of life for disadvantaged children with special health needs. Simple, well-designed interventions, sustained by professional commitment and passion, provide the necessary tools to ensure rapid and accurate diagnoses and timely treatment. This information can also lead to better epidemiological control of pathogens present in the environment and provide the basis for the design of future vaccines. Thanks to the model adopted for knowledge transfer, the many lessons learned to date by the participating hospitals can be shared with other facilities in Mexico facing similar challenges.

    The most important of these lessons is the collective conviction that the health of children must come first.


    For more information about this project, please contact:

    - In Health Canada:
    Kate Dickson
    Senior Policy Advisor, Americas
    International Affairs Directorate
    International Health Policy and Communication Division
    Phone: (613) 948-9409
    Email: Cette adresse email est protégée contre les robots des spammeurs, vous devez activer Javascript pour la voir.

    - In PAHO:
    Sandy Summers
    Program Officer
    Office of the Deputy Director
    Pan American Health Organization
    Phone: (202) 974-3332
    Email: Cette adresse email est protégée contre les robots des spammeurs, vous devez activer Javascript pour la voir.

     
    Health Agenda for the Americas 2008-2017
    Virtual Campus of Public Health
    Improved Health and Increased Protection from Communicable Diseases for Women, Children and Excluded Populations in LAC

    Bureau régional de l'Organisation mondiale de la Santé
    525 Twenty-third Street, N.W., Washington, D.C. 20037, Etats-Unis d'Amérique
    Tél. : (202) 974-3000 Fax : 974-3663