At the Simão Mendes National Hospital in Guinea-Bissau, they have begun to make daily visits to patients, take their vital signs and record their medical histories. These routines, so basic in any modern health center, were hardly practiced in that African hospital until recently. A team of doctors from Osakidetza, the Basque health service, has been working since last March to improve the quality of care and train native health personnel. “Very subtle” advances are being made, says the Basque internist Ignacio Fernandez, one of the doctors who leads the cooperation project: “The results will be seen in several years; much remains to be done here. The work of three doctors in a 700-bed hospital has a very limited effect, ”he says in a telephone conversation from Simão Mendes.
Ignacio Fernandez and Joana de Miguel, both internists, and the nurse Maria Feu lead the health mission in this country. Its mission is to strengthen the capacities of the staff of the main hospital in the African country, where there is a shortage of specialist professionals and there are significant shortages in equipment, materials and medicines. The permanent medical team is reinforced with other specialists who carry out stays of between four and five weeks. Four surgeons, four nurses, an anesthesiologist, a specialist in laboratory microbiology and a midwife have traveled to Bissau, the country’s capital, in shifts. One of these is Borja Cuesta, an anesthetist at the Hospital de Cruces (Barakaldo, Bizkaia): “In the morning he did care work and in the afternoon he led training sessions for new graduates in the world of anesthesia and resuscitation. In a hospital with very little means, I have found very motivated doctors, eager to learn”.
Two-thirds of Guinea-Bissau’s 1.9 million people live in poverty. His life expectancy is 58 years. There is no health system that responds to the needs of the most vulnerable. There is a high incidence of HIV, malaria or tuberculosis infections. “We are focused on improving the area of medicine and nursing and emergencies”, says Fernandez: “Diagnosis and treatment protocols have been drawn up for the most prevalent diseases. The objective is to create work dynamics that remain for the future. Added to the difficulties due to the lack of resources and the seriousness of the pathologies is the situation in the country and the problems of hiring, wages, strikes, political instability”
Javier Gila, president of AIDA, the NGO that acts as ambassador in the cooperation program, highlights the progress that is being achieved in such a short time: “Internment times have been greatly reduced and the use of medication has decreased, because They teach patients to medicate better. [Los medicos vascos] They are preparing hospital management protocols that are giving very good results. Many lives are being saved, and this is only the beginning.” The bilateral agreement with the Government of Guinea-Bissau has a duration of four years, extendable for another four if the parties agree and depending on budget availability.
Assistance to children with complex pathologies
The intergovernmental agreement contemplates the transfer to the Basque Country of Guinean minors with complex pathologies that cannot be operated on in their country. The experience has not started well, says Gila: “The first one we brought arrived with much more serious complications than those he had been diagnosed with and unfortunately he died after the operation. He suffered from heart disease and they tried to save him by all means, but it was not possible. It has been a very hard blow for us”. At the moment, adds the person in charge of AIDA, the documentation is being prepared to treat two other children in Osakidetza, one with heart disease and the other with a narrowing of the esophagus (esophageal stenosis).
Lorena Lauzirika, an operating room nurse in Cruces, spent four weeks at Simão Mendes in October, where she was in charge of “improving asepsis” in the surgical suite in coordination with the nursing area supervisor and gave classes to two trainee nurses. “We miss you, we continue to do what we learned with you”, is one of the messages that she has received from her on her return to the Basque Country.
The central hospital of the African country, equipped with just over 700 beds, lacks specialist doctors, except for three gynecologists and obstetrics trained abroad. The work of the Osakidetza doctors focuses on “establishing daily routines” in the operating rooms, consultations, the hospitalization floor and in the emergency room. “The objective is to train Guinean professionals,” explains the internist Fernandez, which will result in “a lower mortality rate” of those admitted. The intervention of these Basque professionals has allowed until now “to prepare medical protocols that facilitate the diagnosis and treatment of the most relevant diseases, as well as facilitating access for the most disadvantaged people”, he adds.
Diagnoses are basic at the Bissau health center, says Borja Cuesta: “There are no means to perform imaging tests and only pathologies that can be seen in physical examinations are operated on. Diagnostics are very basic. If there is no scanner to do resonances, nor radiologists prepared to interpret those tests”. Added to these difficulties is the political instability of a country “with several coups d’etat, with Parliament dissolved, with frequent strikes,” says the anesthesiologist.
The Basque Executive will contribute 461,000 euros to defray the cost of personnel and the operations to be carried out in Euskadi and the public entity eLankidetza (Basque Agency for Development Cooperation) has allocated another 500,000 euros for program management, travel, purchase of equipment, medicines and medical supplies, as stated in the agreement that the Basque Government Council is expected to approve this Tuesday.
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