Las misiones médicas al Policlínico PAMS en Chincha: evolución del modelo de misión / The medical missions to the PAMS Polyclinic in Chincha: evolution of the mission's model

RESUMEN Presentamos la experiencia del Policlínico de la Peruvian American Medical Society (PAMS) en Chincha, en la ejecución de misiones médico-educativas en la región Chincha. El Policlínico PAMS presta atención médica general y especializada a la población de la zona, seis días a la semana. Además, recibe misiones médicas que vienen generalmente de los EE. UU. Desde 2011, se han recibido 43 misiones médicas. La composición y la naturaleza de las misiones han cambiado con el tiempo. Los primeros años se atraía a especialistas con el énfasis de traer equipos e insumos para mejorar la infraestructura del Policlínico. Ahora estamos limitados por la renuencia de voluntarios de venir al Perú en parte debido a que el gobierno americano considera que viajes al Perú son de alto riesgo. Esta limitación nos ha brindado la oportunidad de hacer misiones médicas juntamente con dos excelentes universidades peruanas. La experiencia ha sido positiva.

ABSTRACT We present the experience of the Polyclinic of the Peruvian American Medical Society (PAMS) in Chincha, in the execution of medical educational missions in the Chincha region. The PAMS Polyclinic provides general and specialized medical care to the population of the area, six days a week. In addition, the Polyclinic receives medical missions generally coming from the EE.UU. Since 2011, we have received 43 medical missions. The composition and nature of the missions have changed over time. The first years attracted specialists with the emphasis on bringing equipment and supplies to improve the infrastructure of the Polyclinic. We are now limited by the reluctance of volunteers to come to Peru in part because the U.S. government considers travel to Peru to be high-risk. This limitation has given us the opportunity to do medical missions together with two excellent Peruvian universities. This experience has been positive.

La Agencia de los Estados Unidos para el Desarrollo Internacional (USAID) como arma contra la colaboración médica internacional de Cuba

El artículo analiza la labor subversiva asignada por la administración de Biden a la Agencia de los Estados Unidos para el Desarrollo Internacional, para atacar a las brigadas médicas cubanas en el exterior. Especialmente, analiza el nuevo programa denominado Combatir el trabajo forzoso en las misiones médicas cubanas, y paralelamente, corrobora la existencia de una estrategia de boicot a la cooperación médica y a la exportación de servicios de salud, sobre todo dirigida a esta última modalidad, con el fin de cortar los ingresos económicos. El antecedente de este nuevo programa es uno similar financiado por el gobierno de Trump, en 2019, aunque este cuenta con 1 millón de dólares adicionales. Como la principal línea de mensaje que se emplea contra los convenios médicos cubanos internacionales, es que violan los derechos humanos al promover el trabajo esclavo, priorizan la búsqueda de testimonios para sustentar dicha campaña. El programa cuenta con elementos propios de acciones encubiertas y exige que los elegidos incidan dentro de Cuba y en países de América Latina. Esto último es consecuente con la estrategia sanitaria que Biden implementa para retomar su influencia en la región, además de restar protagonismo a Cuba. Finalmente, se demuestra que, aunque Biden le impone su impronta a la estrategia, es un continuador de Donald Trump.

The article analyzes the subversive work assigned by the Biden administration to the United States Agency for International Development, to attack Cuban medical brigades abroad. Specifically, it analyzes the new program called Combating forced labor in Cuban medical missions, and at the same time, corroborates the existence of a strategy to boycott medical cooperation and the export of health services, especially aimed at the latter modality, with the in order to cut off economic income. The background to this new program is a similar one funded by the Trump government in 2019, although it has an additional one million dollars. Since the main line of message used against international Cuban medical agreements is that they violate human rights by promoting slave labor, they prioritize the search for testimonies to support said campaign. The program has elements of covert actions and requires those elected to carry out actions within Cuba and in Latin American countries. The latter is consistent with the health strategy that Biden implements to regain his influence in the region, in addition to reducing Cuba's prominence. Finally, it is shown that, although Biden imposes his imprint on the strategy, he is a follower of Donald Trump.

Dr. Aníbal Zambrano: un médico peruano con corazón de oro / Aníbal Zambrano, M.D: a Peruvian physician with a heart of gold

RESUMEN El objetivo del artículo es describir y analizar la trayectoria de vida y las contribuciones humanitarias del Dr. Zambrano, médico egresado de la Escuela de Medicina de San Fernando, quién fue presidente del Centro de Estudiantes de Medicina en una época políticamente álgida en la educación universitaria pública. Emigró a los Estados Unidos en 1970, bajo el contexto de crisis sociopolítica económica en el Perú y en el mundo, donde se convirtió en un renombrado médico internista y cardiólogo del St. Luke's Hospital. A pesar de su lejanía, mantuvo un lazo estrecho con el Perú organizando múltiples misiones médicas para el beneficio de poblaciones vulnerables, capacitación al personal médico e implementación tecnológica del Hospital Regional de Cajamarca. En 2011 se inauguró el Centro Médico Educativo en Chincha, siendo Zambrano uno de los líderes para su construcción. A pesar de padecer una enfermedad invalidante dedicó hasta los últimos días de su vida a brindar ayuda a los más necesitados. Su trayectoria de vida nos muestra un ejemplo de compromiso con el Perú y de un ejercicio de la medicina comprometida con la solidaridad y el desarrollo de la medicina en su país de origen.

ABSTRACT The objective of the article is to describe and analyze the life trajectory and the humanitarian contributions of Dr. Zambrano, a physician who graduated from San Fernando Medical school, and was president of the Center for Medical Students at a politically critical time in public university education. He emigrated to the United States in 1970, in the context of sociopolitical crisis in Peru and the world, where he became a renowned internist and cardiologist at St. Luke's Hospital. Despite the distance, he maintained a close relationship with Peru, organizing multiple medical missions for underserved populations, training medical personnel, and providing technological implementation to Cajamarca Regional Hospital. In 2011, the Educational Medical Center was inaugurated in Chincha, with Zambrano being one of the leaders for its construction. Despite suffering from a disabling illness, he dedicated until the last days of his life, providing help for those most in need. His life trajectory shows us an example of commitment to Peru and practice of Medicine committed to solidarity and the development of Medicine in his country of origin.

Cooperación internacional ¿en qué estamos y hacia dónde vamos? / International cooperation. Where are we, and where are we heading to?

Unmet needs in global health are important issues, not yet solved by the international community. A variety of individuals, non-governmental organizations (NGO) and government institutions have tried to address this situation, developing multiple types of international cooperation (IC), such as humanitarian aid (HA), cooperation for development (CD) and medical missions (MM). In the last decades, we have witnessed an exponential growth in the creation and participation of these projects. Moreover, in the last 20 years, Chile has experimented a real paradigm switch, from a receiver to a provider of IC. Due to the recent surge in interest and relevance of the topic, we performed a narrative revision of the literature related with IC. In the present article, we characterize the different types of IC, with emphasis in MM: we address the risks, controversies and ethical problems associated with these activities. We finally propose some guidelines for the future development and promotion of MM.

Caracterización de niños operados por labio y paladar hendido en la orinoquía colombiana entre 2008 y 2014

La patología congénita de niños con labio y paladar hendido es frecuente en la región, pero no ha sido caracterizada en la Orinoquía. El objetivo de este estudio fue describir las características de los niños intervenidos en un programa quirúrgico de labio y paladar hendido en Villavicencio. Tipo de estudio: Corte transversal descriptivo. Criterios de inclusión: menores de 18 años operados por labio y paladar hendido. Escenario: Hospital Departamental de Villavicencio, Colombia. Temporalidad: enero de 2008 a junio de 2014. Se realizó una evaluación descriptiva de la distribución de las variables, análisis bivariado y un mapa de georreferenciación del sitio de procedencia de los pacientes. Resultados: Se encontraron 340 registros de niños intervenidos quirúrgicamente por labio y paladar hendido, mayormente de sexo masculino. La mayoría de los casos fueron procedentes de Villavicencio, pero también de otros municipios y departamentos circundantes. El 49% de los procedimientos fueron primarios y las niñas fueron intervenidas más tempranamente. Conclusión: El estudio permite caracterizar el número considerable de pacientes intervenidos, la mayoría de ellos de forma temprana, especialmente en los casos cercanos de Villavicencio y el Meta, aunque puede mejorarse la oportunidad a los primeros meses de vida.

Cleft lip and palate is the most frequent congenital pathology but it has not been characterized in the Colombian Orinoquia. The aim was to describe the characteristics of children that had surgery in a program for cleft lip and palate in Villavicencio. Design: cross-sectional descriptive trial. Children under 18 years old that had cleft lip and palate surgery at Hospital Departamental de Villavicencio from January 2008 to June 2014 were included. Distribution evaluation of the variables was performed, as well as a map with the housing location of patients Results: Three hundreds and forty records of cleft lip and palate surgeries were reviewed, mainly male children. Most of the cases were from Villavicencio, but also from other towns and states around. Fortynine percent were primary surgeries and female children had interventions earlier. Conclusions: the study established the considerable number of patients surgically operated, most of them in an early way, especially when they were close to Villavicencio and Meta, but opportunity can be improved to early months of life.

A patologia congénita em crianças com fenda labial e palatina é frequente na região, mas no tem sido caracterizada na Orinoquia colombiana. Objetivo: Descrever as características das crianças intervindos num programa cirúrgico de fenda labial e palatina na cidade de Villavicencio. Tipo de estudo: descritivo-transversal. Critérios de inclusão: pessoas menores de 18 anos operados por fenda labial e palatina. Lugar: Hospital Departamental de Villavicencio, Colômbia. Tempo: janeiro do 2018 até junho do 2014. Realizou-se uma avaliação descritiva da distribuição das variáveis, análise bivariada e mapa de georreferenciamento no ponto de procedência dos pacientes. Resultados: Encontrou-se 340 registros de crianças intervindos cirurgicamente pela fenda labial e palatina, sendo maior os processos no sexo masculino. A maioria dos casos foram feitos em Villavicencio, além de outras cidades menores. O 49% dos procedimentos foram primários e as meninas foram intervindas cedo. Conclusões: O estudo permite caracterizar o número de casos, pacientes intervindos, na maioria deles tiveram a cirurgia cedo, especialmente nos casos perto da cidade de Villavicencio e no estado do Meta, embora podem melhorar-se a oportunidade nos primeiros meses de vida.

Kanho Kyokwaseo (Textbook of Nursing), the First Published Korean Nursing Books / 한국간호교육학회지

PURPOSE: The purpose of this study is to extend the knowledge about two volumes of Kanho Kyokwaseo (Textbook of Nursing) published in 1908 and 1910. METHODS: The books were investigated from the first to the last pages and compared with other textbooks published during the same period. RESULTS: The origin of these books was from Hubinyaoshu (Manual of Nursing) published in China in 1904. They were translated by Edmunds, a missionary nurse from America, and Chang Chai-Sun, a teacher at the first nursing school in Korea, along with inspection by Korean teachers who were fluent in English. Kanho Kyokwaseo are user-friendly textbooks in that they are written mainly in Hangul; Chinese and English are added in cases of explicating western scientific terminology and medical terminology, with notes at the top, on the left, and on the right of the page. The contents emphasize reporting and submission to supervisors and doctors. Surgical nursing occupies the largest chapter. Disinfection and hygiene, the advantages of western modern medicine, are dealt with repeatedly and importantly. CONCLUSION: Kanho Kyokwaseo was widely used as the first and only nursing textbook published before Japanese occupation and as a publication having upgraded the level of textbooks.

Conflicto armado en Colombia y misión médica: narrativas médicas como memorias de supervivencia / Armed conflict in Colombia and medical mission: medical narratives as survival memories

Antecedentes. Elaborar memorias que permitan afrontar la violencia ejercida contra la misión médica en el contexto del conflicto armado facilita la creación de estrategias de diálogo en busca de la reparación y el perdón en el marco del proceso de paz que se realiza en la actualidad. Objetivo. A través de las narrativas de los médicos colombianos entrevistados, identificar los casos que tipificaban una violación a los protocolos, tratados y normas del Derecho Internacional Humanitario (DIH) en relación con la misión médica. Materiales y métodos. Se realizó un estudio con enfoque cualitativo hermenéutico adoptando los presupuestos teóricos de la función narrativa ricoeuriana, y analizando la trama del relato de la experiencia, las circunstancias, el tiempo y el sentido de la narración. Resultados. Se identificaron las siguientes tipologías de infracciones contra la misión médica: normas en el papel, violación a la neutralidad, actividades sanitarias o territorio de guerra, soledad del médico, victimas en busca de un refugio: la población civil y el médico, y la crudeza de la guerra. Entre las infracciones que se evidenciaron están la violencia que se ejerce contra las instalaciones de salud, los heridos y enfermos, el personal de salud y los medios de transporte sanitarios. Conclusiones. En el conflicto armado colombiano se han presentado violaciones que atentan contra la misión médica por parte de actores estatales y no estatales. Prevalece una falta de información y conocimiento del DIH y la misión médica. A pesar de esta circunstancia, los médicos que compartieron sus narrativas lograron solventar situaciones relacionadas con crímenes de guerra en la mayoría de los casos.

Background. Developing memorials to face violence against medical missions in the context of armed conflict facilitates the creation of dialogue strategies to seek for reparation and forgiveness within the ongoing peace process. Objective. Through the personal narratives of interviewed Colombian doctors, to identify the typical cases of violation of protocols, treaties and rules of the International Humanitarian Law (IHL) in relation to medical missions. Materials and methods. A study was conducted with a qualitative hermeneutic approach by adopting the theoretical assumptions of the Ricoeurian narrative function, and analyzing the story plot of the experience, circumstances, time and sense of narrative. Results. The following types of offenses against the medical mission were identified: rules on paper, violation of neutrality, health activities or battlefield, the physician's loneliness, victims seeking refuge: civilians and the physician, and the harshness of war. Among the evidenced violations are the violence perpetrated against health facilities, the wounded and the sick, health staff and medical transportation. Conclusions. In the Colombian armed conflict, state and non-state actors have carried out violations that threaten medical missions. The lack of information and knowledge of the IHL and medical missions is prevailing. Despite this fact, in most cases doctors who shared their narratives were able to solve situations related to war crimes.

Resident Participation in International Surgical Missions is Predictive of Future Volunteerism in Practice

BACKGROUND: Interest in global health and international mission trips among medical student and resident trainees is growing rapidly. How these electives and international mission experiences affect future practice is still being elucidated. No study has identified if participation in international surgical missions during residency is a predictor of participation in international surgical missions in practice after training completion. METHODS: All trainees of our plastic surgery residency program from 1990 to 2011, during the implementation of optional annual international surgical missions, were surveyed to determine if the graduate had gone on a mission as a resident and as a plastic surgeon. Data were compared between graduates who participated in missions as residents and graduates who did not, from 1990 to 2011 and 1990 to 2007. RESULTS: Of Plastic Surgery graduates from 1990 to 2011 who participated in international missions as residents, 60% participated in missions when in practice, versus 5.9% of graduates participating in missions in practice but not residency (P<0.0001). When excluding last 5 years, graduates participating in international missions in practice after doing so as residents increases to 85.7%, versus 7.41% who participate in practice but not residency P<0.002. CONCLUSIONS: Results reveal plastic surgeons who participate in international surgical missions as residents participate in international surgical missions in practice at higher rates than graduates who did not participate in missions during residency. International missions have significant intrinsic value both to trainee and international communities served, and this opportunity should be readily and easily accessible to all plastic surgery residents nationwide.

El desempeño de enfermería: Profesionalismo en el hospital Universitario. República de Haití / The infirmary acting. Professionalism in the University hospital. Republic of Haiti

Se realizó un estudio prospectivo y longitudinal en 51 enfermeras recalificadas, seleccionadas mediante muestreo aleatorio simple de un universo en iguales condiciones, que prestaban servicios en el Hospital General Universitario de Port au Prince, República de Haití, entre mayo y octubre de 1999, con el objetivo de valorar el desempeño y profesionalismo en el grupo que recibió educación continuada por personal de Enfermería de Cuba. Los datos se recogieron mediante la observación y fueron plasmados en formularios que se aplicaron de forma individual. La información se procesó por medios computadorizados y se usó la prueba de diferencia de proporciones para su validación. El análisis de los resultados reveló que fue significativa la cifra de las enfermeras evaluadas con calificación satisfactoria en la autorregulación profesional con los estudiantes, equipo clínico, usuarios y demás enfermeras; en el desempeño, un alto número obtuvo una valoración satisfactoria, con relevante significación estadística, al igual que en las intervenciones de enfermería en las diferentes técnicas y procederes básicos para la atención al paciente y en el profesionalismo. Se concluyó que todos estos logros pudieron alcanzarse con la intervención de las autoras en el cumplimiento de la misión médica internacionalista en ese país(AU)

A prospective longitudinal study was made among 51 requalified nurses selected by simple random sampling from a group of nurses that worked under the same conditions at the University Hospital of Port au Prince, Republic of Haiti, between May and Ocotber, 1999, aimed at assessing the performance and profesionalism of the group that received continuing education from Cuban nursing personnel. Data were collected by observation and included in questionnaries that were individually applied. Information was processed by computer and the test of difference of proportions was used for its validation. The analysis of the results revealed that a significant number of nurses got a satisfactory evaluation in the professional self-regulation with students, medical team, patients and nurses. As to performance, nursing interventions in the different techniques and basic procedures for patient care and profesionalism, a considerable amount of nurses also had a good assessment with a remarkable statistical significance. It was concluded that all these achievements were possible thanks to the internationalist medical mission fulfilled by the authors in that country(AU)