Víctor Orellana is a general practitioner in a small village in the mountains of Argentina. Working with health promotion and prevention, he says: "our aim is to promote healthy lifestyles and to avoid irrational use of antibiotics". He thinks the government must not forget the ideological component in health care - that is to understand health as a right - and not see health care as a commodity.
Learn more about Víctor's work as a health-care worker addressing antibiotic resistance - in a place where mules are the main means of transportation.
Could you tell us little about your work and where you work?
– I am a general practitioner and a healthcare worker at the first level of care in the High Mountain Operational Area, in the province of Tucumán inArgentina. I work in the village of San José de Chaquivil located in the hills of Tucumán. It has no access road, to get there we travel by mule, this is also the transport used by local people.
– The population belongs to the Diaguita Calchaquí community and their livelihood mainly comes from animal husbandry (cattle, sheep) and their main fuel is firewood.
– There is also a school (primary and secondary), a justice of the peace, a communal seat (government delegation) and a chapel. San José de Chaquivil is located at an altitude of 2400 meters above sea level, usually has very rainy summers and harsh winters with snowfalls.
What does the first level of healthcare mean in Argentina?
– In a health system organized into levels of care, the first level of care is considered the entry point for people into the health system. It is the level of care that is closest to the people – simply because it is located in the villages.
– It is also the place where 85 % of health situations should be resolved. It is at the first level of care that the highest level of social complexity is found.
In your region, what is the role of primary healthcare workers in context of community health care?
– The role of health workers in community health care is of fundamental importance.
– First of all, the imprint of teamwork must be paramount. This teamwork of health workers allows us to provide comprehensive care, health promotion. We can work with longitudinally care – we can accompany patients in the different stages of life – and we can follow-up patients as they go through different levels of care.
What are the main problems in the communities that you have been able to identify in terms of antibiotic use?
– In general, in the high mountain communities there are not so many problems regarding the use and abuse of antibiotics, as we work a lot with them on the rational use of antibiotics. We always explain the importance of proper prescription of medicines, because of the problems resistance can cause. We also emphasize avoiding self-medication.
– However, we do observe a different situation in urban and peripheral communities, with greater use of antibiotics and self-medication.
What is the role for public healthcare workers workers when it comes to proper use of antibiotics and containment of resistance?
– When working on health promotion and prevention, the aim is to promote healthy lifestyles and to avoid irrational use of antibiotics, often self-prescribed. This in order to prevent the emergence of diseases linked to antibiotic resistance. Inter-sectoral work, especially with educational institutions and the community, is of vital importance.
What are the challenges for staff at the primary healthcare level regarding proper use of antibiotics and containment of resistance in the community?
– The health teams at the primary health care level are facing a great challenge at the moment, as the COVID-19 pandemic has triggered irrational use of antibiotics, often even encouraged by the Ministries of Health themselves. This implies that we will have consequences in terms of the impact on community health, which we may not see in their full magnitude yet.
– Therefore, it is the primary health care teams that will have to reinforce their work in terms of education and health promotion, as well as detecting complications from the current situation – as early as possible.
What should be done in health systems now and in the post-pandemic future? How can governments and health agencies strengthen public health care?
– The pandemic revealed many hidden problems and challenges and put light on a discourse that concealed many structural problems in many health systems in several countries.
– In Argentina today, the need for a reform of the health system has begun to be discussed, moving towards a single comprehensive health system. This reform must be based on primary health care, where the first level of care must be strengthened. This with corresponding investments – distributed in an equitable manner – and to be accompanied by social and economic policies.
– Governments and health organizations must ensure that those at the head of these organizations not only have the corresponding technical and theoretical knowledge, but also the ideological aspect to understand health as a right – and not as a commodity.
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