Category: health

In Colombia, Prenatal and Childbirth Care is often Substandard or even Unavailable

Post author By Jon
Post date May 13, 2010
No Comments on In Colombia, Prenatal and Childbirth Care is often Substandard or even Unavailable

Translated by Alex Moreland.

I chose this text for a number of different reasons. I liked that it was written in and about Colombia. Although I have never been to Colombia, I have a few ties to Colombia through family friends. I find it a little easier for me to translate South American Spanish than I do Spanish from Spain. Since I know more people from South America, it is easier to consult them if I get stuck on a phrase, and having a native speaker around is a great resource for translation.

The other reason I chose this text is I am very interested in childbirth. I want to become a midwife, which would mean working in the health care field that provides care to pregnant women, and then delivers the baby. This text is important to me because it details the hardships that developing countries face in their health care system and why their mortality rate can be so high.

Source text: “La atención del embarazo y del parto en Colombia falla en calidad y oportunidad de atención”

In Colombia, Prenatal and Childbirth Care is often Substandard or even Unavailable

Worldwide, more than half a million women die each year from complications of pregnancy and childbirth. Ninety-nine percent of these deaths occur in developing countries and 70,000 are young mothers between 15 and 19 years old.

These statistics come from a recent report by UNICEF entitled “Maternal and Newborn Health” which emphasizes that the risk of death is 300 times greater in poorer countries. Each year in Colombia, around 600 women die from complications during pregnancy or childbirth. According to the Minister of Social Protection, in December of 2008 the death rate for pregnant women was 44.7 per 100,000 live births.

“Most of these women die during the last stages of labor, right before the birth of the child. Pre-eclampsia and eclampsia, collectively known as hypertensive disorders of pregnancy, as well as postpartum hemorrhage are the main causes of death” says Mary Luz Mejía, sexual and reproductive health advisor for the United Nations Population Fund.

Postpartum hemorrhages, she says, pose a problem for the specialists. These should be handled before they get too complicated and they should have qualified health care professionals to control them in places where normal births are attended, “and therein lies the problem” she says.

This year, for example, 18,173 fetuses and infants died due to obstetric complications and birth trauma. Of these, 8,226 were less than 22 weeks gestation and 5,141 were 38 to 42 weeks gestation.

Quality

The standards that exist for care here during pregnancy and childbirth are good and sufficient. Declines in the quality of care are determined by the ability of the professionals that attend the birth and the equipment and necessary supplies that are available.

According to Mary Luz Mejía, the healthcare system put pregnancy and childbirth exclusively in the hands of doctors, “and if we had the certainty that our recent medical school graduates had the skills to handle normal pregnancies and deliveries, then they would. The regulations of prenatal care should correspond with the excellence of general medical training, which doesn’t happen in certain cases.”

Another element related to the problem of the quality of care, is the access to services. The regulations say that the EPS (health promoting entities) and the IPS (health providing institutions) are obligated to inform users of their rights and how to access them. However, Mejía suggests, this is not always met or known, as the insurers are intent on reducing the cost of care.

“The vast majority of maternal deaths are preventable, but often times we don’t have trained personnel with basic knowledge of when and where they should start appropriate management of complications,” says Mejía.

Furthermore, a recently published study in the journal of Obstetrics & Gynecology says that in recent years maternal complications during delivery such as blood clots, breathing difficulties, shock and need for transfusions have all increased, apparently due to the increase in the rate of cesarean sections.

“In our country, cesarean sections have reached levels above the international standard, and for reasons that are rather questionable. For example, a woman will ask her doctor for this intervention, and without any medical need or reason to support it, he accepts,” says Hernando Villamizar, president of the Colombian Society of Pediatrics. “Prenatal care in Colombia, although different depending on the region, has become better. But during birth, the care is not always as good and the timely detection of a problem is limited…The quality of care that is offered through EPS and different institutions that are linked to the system is not the best,” adds Doctor Villamizar.

On occasion, he says, you can’t even find good information or medical history at the time of delivery that offers the details of the prenatal care.

Maternal Behavior

Adding to all this, pregnant women are afraid to ask for time off of work to go to doctor’s appointments, and this slows the demand of health services.

In Bogotá, for example, there are maternal health social networks—20 for each locality of the city—that seek to place maternal health as a priority, supporting pregnant women in making suggestions, informing them of their rights, and guaranteeing them health assistance.

However, there are obstacles faced in the care of pregnant women. “There are three barriers: the decision to use the health services, access to the services, and the care”, says Sandra Patricia Rodríguez, coordinator of the mother-child social network of the District Department of Health.

In the first case, says Rodríguez, there are cultural beliefs and fears that prevent women from approaching doctors, and insurers should be able to identify them so they can motivate them to use the health services.

“There are geographic barriers, such as long distances between the mother’s place of residence and the place where the services are offered, and often they don’t have the money to travel from one place to the other,” says Rodríguez.

There are also administrative barriers: photocopy requirements or insurance problems, that don’t appear in the system or medical examinations in different parts of the city.

“Another barrier is related to the quality of care: the profile of the professionals that give the care, it requires them to have not only the technical and scientific capabilities, but the warmth so that the families feel comfortable, and sometimes this fails,” adds the expert.

The Department of Health of Bogotá has made a significant effort, she says, so that pregnant women, especially those that are not affiliated with the health system, are treated by OB/GYNs and receive adequate care to reduce the risks of morbidity and mortality.

Interesting Facts

In Colombia, on average 720,832 babies are born alive each year. In 2006, 714,450 were born
87% of births are attended by doctors
20-35 is the age range which contains the most pregnancies and births
It is estimated that more babies are born eight or nine months after holidays and long vacations, like the end of the year
In Colombia, 100 girls are born for every 105 boys. However, for every 100 girls that die in the first year of life, 130 boys will die
For every 1,000 live births, 22.5% of boys died in the first year of life in 2006. In children under one, 12,211 died in total. The group of 1 to 5 months had the highest number of deaths (2,850: 1,607 boys and 1,243 girls) followed by infants younger than one day (2,516: 1,429 boys and 1,085 girls)
Neonatal mortality is about 12 per 1,000 live births, or about 8,000 to 9,000 newborns die each year, a good part due to preventable causes and improper handling
Pregnant women, on average, attend their first prenatal checkup in the third month of pregnancy
In Colombia, nearly 200,000 teenage girls become mothers each year

According to figures from Dane, in 2006, 536 pregnant women died. Main causes:

70 cases of hypertension
58 cases of eclampsia
57 cases of postpartum hemorrhage

The Nopal: Tasty, Cheap, and Good for You

Post author By Jon
Post date May 1, 2010
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Translated by Edda Mata

I chose this article because as a Mexican I thought it was important for English speakers travelling to Mexico to understand the benefits of the nopal; an exotic vegetable, and dare them to try it on their next trip to Mexico. Unlike other consumer-oriented articles, this article’s main purpose is not so much to sell a particular branded product to the consumer, but to inform them of the health benefits of consuming a local produce.

Source text: “Nopal: sabroso, benéfico y barato”

The Nopal: Tasty, Cheap, and Good for You
Adriana Hernández Uresti

Its nutritional contributions, its qualities (true or invented) to prevent and/or control some diseases, the possibility of cooking it in different ways and even eating it raw, and its low cost (less than a peso per piece) are enough reasons for this vegetable to have earned a place on the dining table of Mexican families, who in average consume 6.36 kg per year.

The production of nopal has increased over the past decade; not only has its plantings increased, but also the states where it gets cultivated, assured Javier Montes de Oca, president of the Consejo del Nopal y Tuna (Nopal and Pickly Pear Fig Council of Mexico City). According to the farmers’ representative, a key factor in this trend is the organization of the Feria Nacional del Nopal (National Nopal Fair), where the consumption and cultivation of this thorny food is promoted.

Although it is cultivated in 23 states throughout the country, there are four states considered the main nopal producers: the Distrito Federal (303, 755 tones), Morelos (61,110), Estado de Mexico (14,464) and Aguascalientes (13,178). Out of 436, 222 tons farmed each year, 97% is consumed fresh and the other 3% is used as a primary product by food, pharmaceutics, and perfumery industries.

Its demand has also increased outside the country, and even though Mexico is the main exporter, the amount of nopal sold in other countries is still little, less than 1% of the national production. The United States is the main market followed by Japan and some European countries.

For Those With a Big Appetite:

The nopal provides a daring table companion of proteins, calcium, iron, vitamins A and B, and fibre (even though it’s a food with a high amount of humidity, its dietetic fibre content is greater than 20%). These properties can be altered depending on the way it is consumed; for example, cooking it provokes a small loss in all the nutrients, particularly in carbohydrates, potassium and vitamin C.

According to the nutritionist, Cecilia Sommer, it is advisable that people with problems such as high glucose (like diabetics) consume raw nopal, given that it controls sugar levels more effectively than in its cooked form. The specialist also warns about the risks of broiling as this cooking method may result in the nopal containing traces of this mineral such as phenolic compounds derivatives, which are harmful for the health. There are no restrictions in regards to consuming it like that, but one of the thumb rules of smart nutrition must not be: a varied and balanced diet.

In regard to dehydrated nopal (in pills or other varieties), nutritionist Sommer, commented that: “when a food is dehydrated, normally the loss of water causes the nutrients content to increase by net weight; another advantage is that it has a longer shelf life, and for many people the fact that it isn’t slimy is important, however, it is precisely in its sliminess where one is able to find a significant source of fibre. In addition, dehydrated nopal is much more expensive than the fresh one.

The Father of all Remedies

In addition to its proven benefits, there are other fictional benefits that can be added, specially those invented by charlatans, who offer this product as “the mother of all remedies,” even for diseases that up to date have no cure. For Cecilia Sommer, the biggest myth that exists about the nopal is related to diabetes; she admits that there are in fact studies that demonstrate that its consumption decreases the level of glucose in the blood, but up to date there is no evidence to consider it a cure, like many people believe.

Its high fibre content (soluble and insoluble) is the main cause of its medical benefits, as it prevents or delays the absorption of sugars. In the book El Poder Curativo del Nopal (The Healing Powers of the Nopal) by Guillermo Murrayhe mentions that it helps control the following disorders:

Obesity: The insoluble dietetic fibre absorbs water and accelerates the passing of food through the digestive tract, preventing or delaying the absorption of sugars, which provoke a sensation of satiety, through which the ingestion of food is decreased; likewise, it helps regulate the intestinal movement.

Gastrointestinal Problems: The fibre and the mucilage (the slime) control the production in excess of gastric acids and protect the gastrointestinal mucous. Also, they contribute to a good digestion, avoiding constipation problems. Cholesterol: The amino acids, the fibre and the niacin avoid that the excess of sugar in the blood turns into fat; on the other hand, they metabolize the fat and the fat acids, thus reducing the cholesterol levels.

Arteriosclerosis: The effect of the amino acids and fibre, including the antioxidants, vitamins C and A, prevent the possibilities of damage in the blood vessels’ walls, like the formation of fat platelets.

Colon Purity: Insoluble fibres help dilute the concentration of carcinogenic agents in the colon, which can help to a degree prevent the appearance of such disease.

There is no doubt that including the nopal in daily diet is very recommendable, due to its nutritional benefits as well as its medical benefits. Although it is worth mentioning that it is not a drug on its own, but an supplement to help control or prevent the problems already mentioned.

The Scientists raise their hands

The innovations in the production and procedure of the nopal are few; actually, the majority of the farmers use traditional sowing systems. Despite what has been mentioned, researchers of different centres work to improve its farming. Three examples are:

Increased resistance: Doctor Candelario Mondragón Jacobo, at the Instituto Nacional de Investigaciones Forestales Agrícolas y Precuarias (National Forest Research Institute of Agriculture and Livestock) works in genetic improvement of nopal in order to increase its protein content and make it more resistant to frost and pests; likewise he develops cactus figs of different colours from the traditional ones in order to make them more attractive. In the case of the forage nopal, he seeks to improve its nutritional content, to facilitate cattle its consumption.

Thorn Free: Engineers at the Instituto Politecnico Nacional (IPN) (National Polytechnic Institute) have designed a machine capable of cutting off 80% of the nopal’s thorns, at a velocity of four seconds per piece. This equipment could help accelerate the process of de-thorning, a task that has been qualified by farmers as slow, tiring and tedious. Engineers Guillermo Cruz Villa, Jacobo Moreno Cruz and Sigfrido Soria Farias, at the Unidad Profesional Interdisciplinaria de Ingeniería y Technologías Avanzadas (Professional Interdisciplinary Unit of Engineering and Advanced Technologies), work with farmers from Milpa Alta to develop a machine at an industrial level.

Strong Bones: The doctor Mario Enrique Rodriguez, at the Centro de Física Aplicada y Tecnología Avanzada (Department of Physics and High Technology) in the UNAM, is the head of the project “Nopal flour as a treatment to prevent osteoporosis.” It is still rather early to offer conclusions, but no one would be surprised that this product could add a new virtue to the ones we already know.

In detail

The nopal is endemic of America; there are 258 species, out of which 100 exist in Mexico, the main producer at a national level. Nopal is the name given to several species of the Oputina genre, of the cactus family. The Nopalea Cochenillifera is the species that we normally consume and the one referred to in this text.

Multiple Possibilities

Nopal mole, nopal pizza, nopales y cheese sauce, spaghetti with nopales or with cream, dirty beans with nopales, Jell-O, marmalade, ate, nopal cake, tamales with nopales and cattle brains, nopal cookies with cinnamon and a tuna salad, are only some of the 112 recipes that the Recetario del nopal de Milpa Alta, D.F. & Colima (number 48 of the collection Popular Indigenous cuisine of the General Cultures Directorate of CONACULTA). The recipes were collected among the people of the Distrito Federal, the majority producers of Milpa Alta. This culinary jewel can be found in Educal bookstores (www.librosyarte.com.mx) and in the National Museum of Popular Cultures.

Nutritional Facts

Every 100 grams of nopal contain: Energy: 27 kcal Proteins: 1.7g Fat: 0.3g Carbohydrates: 5.6g Calcium: 93 mg Iron: 1.6 mg Retinol (Vitamin A): 41 mcg Thiamin (Vitamin B1): 0.03 mg Riboflavin: (Vitamin B2): 0.06 mg Niacin: 0.3 mg Ascorbic Acid (Vitamin C): 8 mg Source: Instituto Nacional de Nutrición (National Nutrition Institute).

Tips for Nopal Lovers

Pick nopals with firm thorns (a sign of their of freshness) and without brown-orange stains (a symbol of oxidation). When eating them raw, asides from washing them it is indispensable to disinfect them. Boil them with little water, and avoid overcooking them as this decreases its nutrimental benefits. Use a copper pot to cook them if you want them to keep a lively green colour. If possible, buy and consume them the same day. If you want to store them, put them in a plastic bag inside the fridge; they will preserve well for three days. Grilled nopales tend to have some white spots after a couple of days of storage; these are due to the vegetable reactions and signs of decay. Source: Nutricionist Cecilia Sommer.

analysis health politics Spain

Grandchildren of the Transition

Post author By Jon
Post date May 1, 2010
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Translated by Jeanette Anderson

For my final project I wanted to do something related to the medical field because of my interest in becoming a medical translator. So I went onto Spain’s Ministry of Health website to see what kind of materials were available and I came across this research presentation related to youth drug use and abuse in Spain. It talks about cultural issues that are related to the current situation in Spain, as well as historical changes that have taken place over time and have had a direct impact on this situation.

Source text: Salir de marcha y consumo de drogas. Plan nacional sobre drogas. Madrid: Ministerio del Interior.

Grandchildren of the Transition

Young people today have been socialized by a generation who grew up during the democratic transition in Spain. This generation of people, who are now between the ages of 35 and 50, entered into adulthood pursuing certain dreams, such as personal and individual freedom, because they were so repressed by the ruling morality of the time when they were growing up. There was also this idea of taking different substances and indulging in different pleasures that Spain, as a country behind the times, saw in its neighbouring European countries. These ideals that today’s adults share have evidently been passed onto their children, and young people today have taken these ideals and given them a meaning of their own.

The generation of young people from the transitional period has given rise to very tolerant and permissive parents and teachers because they want to make it easier for today’s youth to have a lot of life experiences, which is something they fought for but were somehow denied. The parents of today’s youth have tried to overcome their parents’ moral prejudices which made them repressive and intolerant towards aspects related to sexuality, recreation and having fun. Andrés Sopeña published two books that give us a better picture of the era in which the parents of today’s youth were socialized.

However, this tolerance for young people’s actions when it comes to sex, recreation and having fun also has its limitations and paradoxes. To be young, according to the adults, is to be ready for fun and excitement, and experimentation . This same concept of youth is in itself a reflection of reality. According to official organizations, this category encompasses anyone between the ages of 15 and 29 years old. It’s likely that this age range seems quite extensive and we have probably never had the definition of ‘youth’ extend quite this far in the history of mankind. We could also go as far as to say that adolescence begins at 13. Despite all of this, if we consider that someone is no longer ‘young’ once they have passed through a serious of stages that Gil Calvo proposes, many young Spaniards would still be considered ‘young’ even though they are already in their 30’s. Calvo proposes that “someone who is physiologically mature and still does not have a steady, productive job, a spouse, their own home or dependants is considered young.” (1984). In fact, the concept of youth has not changed much since the age of feudalism, when the youngest sons of the royal families, who were excluded from the family wealth and any decision-making, were considered young, regardless of their age. Many of them were allowed to live pleasant yet dissolute lives, dedicated to courting and pleasing the romantic desires of many bored ladies . (Turner 1989).

With regards to recreation, some social scientists consider that today’s youth is the result of the adult population’s imagination coming to life. (Comas, 1995, 1996). The adults’ attitudes are not passively tolerant; they encourage the young people to have fun. They tell them to go out at night and to go after this idea of freedom which includes being spontaneous and daring. They even allow them to be disobedient, they excuse them from their responsibilities, they encourage them to drink , and when they start acting like narcissists, which is common for their age, they make excuses for them. The parents and teachers of this generation, as well as the media, have all contributed to developing and giving off this idea of what it means to be young, which is very much like the current phenomenon.

The way in which Gil Calvo expresses the paradox of young people today is very descriptive. He states that the adults insist that they be disobedient, in such a way that when the young people go out at night to overstep the boundaries, they are actually obeying their parents’ wishes. But this kind of obedience is not exactly what the adults had in mind. However, the young people are not passive either. They have taken the adults’ ideals and given them a meaning of their own. It is true that this gives way to a “double bind,” as Gil Calvo proposes, because during the week the young people are obedient at school or at work, and during the weekend they are disobedient, partially because the adults encourage them to be that way. When it comes to obedience and disobedience, young people contribute to and develop their own ideals and strategies for life. In the adults’ idea of fun, recreational drug use and abuse was not what they had in mind. They fear heroine, which wreaked havoc in their generation, but they are not overly alarmed when it comes to recreational drugs, either because they don’t know enough about them or because they value their own experiences from when they were young and used to do drugs. What they don’t realize is that drug use is changing and becoming commonplace in the recreational lives of many young people today; something which is only made possible by the generous financial support of their parents. Recreational drug abuse is the evil consequence of extreme partying , which is also the focus in young people’s minds. What we have here is a paradox of the adults. On the one hand, they have promoted this idea of what it means to be young, and on the other, they are surprised when they find out the consequences. The adults find it hard to understand and conceptualize some of these changes, which is something they need to do in order to take over their role again and recreate the process.

The New Drug Culture

Parties, music and dancing are all key elements that define youth in Europe and in Spain, and something that has taken centre stage in all this is drug use, including both legal and illegal substances. Young people, as part of the social structure, rely on these drugs, use them on various occasions and therefore they take what society has created for them, and it helps them achieve their goals. Drugs are readily available , just as there are a wide range of recreational activities available . Young people have been socialized to believe that fun should be taken to the maximum; an ideal that has been developed through the various generations that overcame limits and repression to achieve this. Therefore, going out partying is not something that the young people invented, but what they do is use this socially acceptable freedom that they have to develop their own language, identity and strategies.

What is happening in Spain is very similar to what is happening in the rest of Europe and in other industrialized countries. Shapiro (1999) analyzes a substantial change in the role of drug use in social life, basing the study on the situation in England. He states that compared to studies carried out in the 70’s, drugs are no longer something that people use to escape from ordinary life; drugs have become a part of daily life. This change is fundamental to the growing importance of nightlife, partying (club culture) and the new trend of raves, where a lot of young people are developing their own new fun culture.

Recreation, which has always been important to young people, is now the focus of social research. In recent years, in England, Germany and Holland, different studies have been carried out on the connection between young people, recreation and drug use (Klee 1998, South 1999, Tossmann 1996, 1997). A longitudinal study carried out in Manchester (Measham et al. 1998) presents the importance of drug use in the transition from adolescence to young adulthood . It concludes that drug use is becoming acceptable as a part of recreational activity, not only by the ones who do drugs, but also by the non-drug-users as well. This situation shows how recreational drug use is becoming more commonplace.

One of the characteristics of these different studies is that they are confined to local and national areas. However, we must also keep in mind that in this day and age, there is a real interconnectivity between the different European countries. Through cyber communication or at recreational facilities across Europe, thousands of young people become cultural ambassadors and diffuse cultural interests.