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Colorado School of Public Health

“The clinic is interactive and innovative, it is mothers helping mothers. The clinic gives them a chance to come together, support one another, and learn how to provide the best care for their children from pregnancy to early childhood. We are focusing on 1,000 days – except we are really a ‘1,365 Days’ initiative.”

Gretchen Domek, MD, DrPhil, Assistant Professor of Pediatrics and Senior Investigator at the Center for Global Health

 

Residents & Fellows: Interested in a Global Health Elective in Guatemala?

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What you need to know when traveling to Guatemala.

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Trifinio Center for Human Development


“For years I have dreamed of building a health clinic in rural southwest Guatemala where I grew Up. The Trifinio region is the poorest part of the county where more than 60 percent of children test positive for parasites because of contaminated water and poor sanitation. It is exciting to think of the possibilities we have here to improve the health of not just our community but also to create an innovative health model that can be replicated around the world.” 

 Edwin Asturias, MD, Director of Latin American Projects, Center for Global Health

 

Addressing a Critical Need

Children and families living in the surrounding communities of Trininio, a rural and impoverished region located in the southwest of Guatemala have limited access to medical care for women, mothers and children. As a result, neonatal mortality rates related to asphyxia and infection are also extremely high.

The strategic planning process focused on developing a community based program targeting mothers, neonates and children. Using nurses and auxiliary nurses this program called “Creciendo Sanos: madres y ninos” (Growing up healthy for mothers and children) is enrolling mothers early in their pregnancy and providing four group prenatal care visits, making newborn home visits during a baby’s first two months of life, and then providing monthly group child group sessions that integrate health, development, nutrition, and hygiene education and track height and weight measurements through age 3 years.

The Center for Human Development also has built a birthing center with two delivery rooms and a nursery. Our Center staff is training the traditional birth attendants so that births can be shifted from the home to the birthing center and if needed the local hospital where more skilled staff will be available.

The Trifinio Center for Human Development has also designed and built with Foundation funding a family medical clinic facility that has six clinic rooms, a dental clinic, a clinical and a research laboratory, pharmacy, central nurse station, new computers, and an electronic medical record system. The clinic is designed to be a place for excellent patient care that meets the standards of United States medical practices in rural Guatemala.

The Foundation has hired a Guatemalan physician medical director and all facility staff. University of Colorado faculty and clinical trainees from the schools of Medicine, Nursing, and Dentistry rotate though the facility throughout the year.

 

Program Overview

In 2011, the Center for Global Health and Children’s Hospital Colorado entered into an agreement with the Guatemalan Foundation created by the Bolanos family, the owners of AgroAmerica to create the Trifinio Center for Human Development.

The goal of the agreement was to create a Center for Human Development that would improve the lives of the children and families of the employees working in the banana and palm oil plantations run by Agro America, as well as people living in the surrounding communities. These are impoverished communities with high rates of maternal illiteracy, food insecurity, maternal depression, child malnutrition and child developmental delay. There is a lack of clean drinking water and inadequate sanitation.

The initial phase of the project included a rapid needs assessment using a home survey as well as qualitative assessment with focused interviews. The needs assessment found that the communities had very limited access to medical care for women, mothers, and children.

As a result these communities had high rates of maternal mortality and morbidity with approximately half of deliveries occurring in home with an unskilled traditional birth attendant. As a result, neonatal mortality rates related to asphyxia and infection were also extremely high. Under 5 childhood mortality related to pneumonia, febrile illness and diarrhea were also quite high.

The findings and recommendations were then presented back to the communities through a community engagement process and a strategic plan was developed and implemented with the financial support of the Foundation.

 

Current Impact/Results

Nurses and auxiliary nurses are providing programming called “Creciendo Sanos: madres y ninos” (Growing up healthy for mothers and children) to enroll mothers early in their pregnancy and providing four group prenatal care visits, making newborn home visits during a baby’s first two months of life, and providing monthly group child group sessions that integrate health, development, nutrition, and hygiene education and track height and weight measurements through age 3 years.

Within a short two-year time frame the Center for Global Health and the foundation have designed, built, and fully operationalized the health care facility and Creciendo Sanos community program. A sophisticated data collection system using smart phone technology allows for rapid cycle evaluation and quality improvement interventions.

Our specific aims include:

     1. Increase safe delivery practices by providing prenatal screening and education, increasing referrals for high-risk pregnancies, decreasing birth complications and lengthen birth spacing though reproductive health programs through the maternal-neonatal segment of a program called Creciendo Sanos.

     2. Decrease neonatal morbidity and mortality by identifying neonatal danger signs and increasing clinic/hospital referrals for sick babies.

     3. Decrease childhood mortality and improve early childhood growth and development outcomes through Creciendo Sanos. 

The Center for Human Development decreased the cost barrier to families,which is important to families that may make only enough to put food on the table and have little left over for anything else. A visit at the clinic is less than $5 versus at least $25 at the closest hospital plus the cost of transportation and the loss of a day's wages.

Center for Global Health

13199 East Montview Boulevard, Suite 310
Mail Stop A090
Aurora, CO 80045


303.724.7430
globalhealth.ucdenver.edu

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