January 2024
In the forested regions of Ucayali and Amazonas in Peru, health depends on factors such as quick access to medical care and the proper training of healthcare professionals and community agents. This situation can pose greater risks to pregnant women. Against this backdrop, the Pan American Health Organization (PAHO) is working hand in hand with national and subnational counterparts to ensure broader and more equitable access to quality health services, as demonstrated by the story of Aída Ugkuchpiitug.
The joy of Aída and Leoncio, her husband, was short-lived after the birth of their seventh child in the native community of Kusu Chapi, several hours away from the city of Bagua in the Peruvian Amazonas region. Fear quickly settled in Leoncio's eyes as he watched his wife fade away minutes after giving birth, due to the retained placenta that remained in her body. Even more so when he realized that the nearest health post was almost three hours away.However, as a trained Community Health Agent, Leoncio knew how to act and did so quickly. He ran to ask for help from his brother, who went down to the village in search of a telephone signal to call the health facility. “I was worried, and they told me to go wait by the riverside for the Imaza health brigade. From there, we headed to the town of Imacita, where they began to stabilize my wife,” Leoncio recalls.
Aída’s life was in danger due to placental retention, a condition that led to hemorrhage and weakened her entire body. Aída later confessed that she could barely remember anything from that moment. “I felt intense pain, then I passed out and have no idea what happened next.” She was not aware of the exact duration of her trance nor that the nurses had placed a non-pneumatic anti-shock garment (NASG) on her —a low-cost, evidence-based tool that reduces complications and obstetric emergencies caused by hemorrhages, including maternal deaths, by applying pressure to the torso and limbs to decrease blood loss. This is one of the first strategies in the care of bleeding patients, ensuring that the heart can pump the blood necessary for the functioning of vital organs.
“We have saved many lives thanks to this garment,” Édgar Lara Vallejos, director of the Imacita Health Micro Network, said. With the support of key partners, PAHO has acquired over 120 NASG suits for various regions in the country. This supports healthcare personnel and trained Community Health Agents during obstetric emergencies, following national guidelines for these situations.
The interventions from Leoncio and the healthcare professionals, who had been trained as part of the technical cooperation with PAHO, was crucial to address this obstetric emergency. According to Dr. Ivy Lorena Talavera, PAHO Advisor for Family, Health Promotion and Life Course in Peru, this type of emergency occurs in several countries in the Americas, where health challenges are very similar. PAHO therefore works to strengthen the competencies and capacities of local healthcare personnel who directly serve such populations – especially those that live in remote conditions and have difficult access to health services. This includes the implementation of modern medical tools such as the antishock garment that helped save Aída’s life, as well as spaces to empower community agents, local leaders, and decision-makers, supporting their culturally embedded knowledge on the subject.
This information transfer is not only useful during the delivery of a child, but also serves to raise awareness about possible risk conditions in pregnant women, and to notify professionals for timely actions that can saves lives. “It is essential to raise awareness about the importance of all stages of pregnancy: from effective prenatal care within the first twelve weeks to recognizing signs that may indicate a risk to the pregnant woman and ensuring a safe delivery,” explains Talavera, who also leads the implementation of the project Improved Health of Women and Adolescent Girls in Situations of Vulnerability in Peru, which is supported by the Government of Canada and is implemented in six countries in the region.
The work carried out by PAHO within the framework of the project requires continuous effort, but above all, a collective commitment with national authorities, local governments, healthcare personnel, and communities, Talavera said, adding that its activities also address other issues, such as teenage pregnancy prevention and telemedicine services. She highlights the importance of strategic partnerships such as the one between PAHO and the Government of Canada, based on the conviction that it is possible to achieve a positive change in women’s health.
Distance and geographic characteristics continue to be challenges for healthcare delivery in some parts of Peru. “Some pregnant women live in remote areas and when night falls, they cannot go to the hospital because they must cross the Marañón River, which is very dangerous. In addition, transportation is not always available,” Deisi Santa Cruz, an obstetrician in the Imaza Micro Network, acknowledged.
Despite these challenges, PAHO persists in its efforts to ensure access to quality health services for pregnant women, newborns, and communities, incorporating cross-cutting approaches such as interculturality, gender, and equity. “We have many tools and the evidence for actions that work to reduce maternal deaths, to prevent the preventable. It is about closing gaps in access, reducing the inequality, and continuing to develop competencies in people,” Dr. Talavera concludes.