Secundino Ortega, 55, from Guantanamo is a pediatrician, Yania Concepcion, 47, from Havana is a nurse specialized in maternal and child health and Norma Fisher, 49, from Santiago is a doctor of gynecology and obstetrics. There are 3 of the 9 health professionals who make up the medical team who, in November 2017, traveled from Cuba as part of a pioneering triangular cooperation initiative between Portugal, Cuba and Guinea-Bissau to work within the framework of PIMI II – Integrated Program for the Reduction of Maternal and Infant Mortality in Guinea-Bissau and who work at the Gabu Regional Hospital, contributing daily to the main objective of this project: the reduction of maternal and infant mortality in Guinea-Bissau.
“Our main function is to train doctors and health technicians in the Gabu region, but we also provide support to Bafatá Hospital, in the area of pediatrics. I believe that the work so far is having good results and we hope to have even better results by the end of the project”, says Secundino Ortega.
The Gabu region was not covered by PIMI I, and in 2017 the project was extended to the entire country, given the encouraging results achieved. This region has 260,628 inhabitants (according to the most recent INASA 2018 projections), corresponding to about 15% of Guinea-Bissau’s population. It is the easternmost region of the country, the Fula and Mandinka ethnicities are dominant and the majority of the population is Muslim.
Since the beginning of the project, several training courses have been held for health technicians at the Gabu Regional Hospital, including Cesarean and Obstetric Ultrasound and Emergency Care in Obstetrics and Neonatology (CONU), whose last training cycle ended in May 2019.
These training actions aim to consolidate the knowledge acquired in previous training cycles and their respective ones, which include providing specific skills in the areas of emergency and emergency care in obstetrics and neonatology and the performance of obstetric ultrasound scans, reinforcing the use of existing technical resources for this purpose and made available by IMVF.
Emma Mango, 43, from Bissau, has lived in Gabu for 2 years and had previously worked in Cacheu. Emma is part of the PIMI II/IMVF team and is a nurse midwife, trainer and monitors the indicators related to children under 5 years old, pregnant and puerperal.
“The PIMI II has had a great influence since it arrived in Gabu in 2017. We have seen a great evolution in our work, as before there were many complicated cases of eclampsia, pre-eclampsia and severe anemia, but now we have been able to improve, and the project has also influenced with the provision of materials for the sanitary areas, such as devices to measure blood pressure [sphygmomanometers], blood glucose and hemoglobin”.
Nurse Emma adds. “With the training we gave to the technicians of the sanitary areas, they now know how to identify the women with high obstetric risk, from there they send those with higher risk to the Regional Hospital to do (in) follow-up; the others themselves attend the sanitary areas with treatment and follow-up, and consultations are done weekly”. And it adds. “Also in the sanitary areas, births are taking place according to the guidelines of the birth programs and the technicians were guided to make the vital signs upon arrival, to evaluate what risks they have and what the evolution is later. The technicians of the sanitary areas are already able to do this work autonomously without influence from any doctor”.
Ema Mango also mentions as an added value of the project the free distribution of medicines in all health areas, as well as the delivery of awards based on the evolution of the performance of each health structure, according to the clinical indicators outlined by the project.
Charlo Gomes da Costa, a 33-year-old nurse from Bissau, has been living in Gabu for 6 years. In 2019 he participated in a 5-week anesthesia formation, promoted by the project. “In this formation we gave our best and learned many things. The project also distributes free medicines necessary for the interventions and we have been able to reduce many evacuations in the region”.
Ronízio Bathy, 31, a general practitioner, was born in Gabu and has been working there as a Hospital Director since 2019. Before that, he was Director of the Maternity Hospital. He highlights the support that the PIMI II project has given to the Hospital and the contribution of Cuban specialists in gyneco-obstetrics, pediatrics and fetal medicine.
“Our hospital [Gabu Regional Hospital] receives many cases of eclampsia, pregnant women with hypertension, who give convulsions, and we also receive many cases of pediatrics, children with anemia and severe malaria and our main goal is to reduce maternal and infant mortality.
In 2018 and 2019, Ronízio Bathy was one of the participants in the Obstetric Echography training, given by Dr. Patrícia Silva, a Portuguese specialist in Gynecology and Obstetrics, at Nélio Mendonça Hospital in Madeira. This formative activity was divided into two phases: the first cycle took place in November 2018 and the second and last cycle took place in May 2019. The objective of the training was to provide specific skills in performing obstetric ultrasound scans, reinforcing the use of existing technical resources for this purpose and made available by the project.
“This training helped pregnant women a lot, we did a lot of ultrasounds on pregnant women, and we ended up detecting some malformations in the fetus, for example, we detected a cardiogenic malformation, a fetus with heart problems,” says Dr. Ronízio Bathy. The family took care of the necessary documentation to come to Portugal, where the baby had surgery”. It should be noted that this type of malformation, when corrected surgically in the postnatal period, allows a greater survival.
Dr. Ronízio Bathy also says that there are some cultural challenges that you have to deal with on a daily basis. “We’re having a lot of problems with some families, the culture is making our work difficult, we’ve detected some malformations, but some relatives don’t want to help.
The objectives of PIMI II are to contribute to the reduction of maternal, neonatal and infant mortality in Guinea-Bissau and, in particular, to achieve the goals set out in the Sustainable Development Goals (SDOs), and to ensure better access to quality health care for pregnant women and women who have recently given birth (up to 45 days after birth) and children up to the age of 5 in Guinea-Bissau.
Guinea-Bissau has particularly alarming maternal and child health indicators, with maternal and child mortality rates among the highest in the world. In this context, the IMVF is responsible for covering the training needs in various areas and assistance in a national universe of 132 regional hospitals and health centres, also ensuring the availability and distribution of essential medicines, equipment and medical consumables and also ensuring the rehabilitation and maintenance of the infrastructure of hospitals and health centres in the country.
The programme will directly benefit around 320,000 children under the age of five, around 400,000 women of childbearing age, and more than 1,200 health professionals from 132 health structures in the country. The action will indirectly benefit the entire population of Guinea Bissau (1,881,005 inhabitants). The IMVF component of this project is funded by the European Union and supported by Camões, I.P.