The iSA Project International Support Action International Web-based Diagnostic & Therapeutic Support for Infectious Diseases and Oncology
HOSPITAL REGIONAL DOCENTE DE TRUJILLO (Regional University Hospital of Trujillo) Trujillo, Peru Dr. Angélica García Tello Medicine Department Doctor
Geographic location •
•
The HRDT is located in the city of Trujillo in northern Peru, Department of La Libertad. Characterized as a seismic zone. The city temperature fluctuates between 15 º C in winter and 30 º C in summer, influenced by the Humboldt Current and El Niño. The soil is characterized as sandy clay and plain.
www.regionlalibertad.gob.pe
DEMOGRAPHIC INDICATORS LA LIBERTAD REGION- PERU •
Indicators
Measure unit
Period
La Libertad
PerĂş
Population
Inhabitants
2008
1,698,162
28,807,034
Population density
inhab./km2
2007
63.4
21.3
Population < 15 years old (i)
%
2007
31.1
30.5
Population > 64 years (I)
%
2007
6.7
6.4
Crude birth rate
X1,000 inhhab.
2005-2010
21.4
21.4
Annual births (*)
Births
2008
36,273
615,318
X l,000 inhab.
2005-2010
5.1
5.4
1993-2007
1.7
1.5
2005 - 2010
2.6
2.6
2007
75.4
75.9
Crude mortality rate Annual average growth rate
%
Global fertility rate
child x woman
Urban population
Expectancy at birth
% Total
Years
2005-2010
74.7
73.1
Male
Years
2005-2010
72.3
70.5
Female
Years
2005-2010
77.3
75.9
Sources: Health Basic Indicators 2008. La Libertad, MINSA, DGE, *Estimate based on population 2008. **Estimate based on 2007 and crude mortality rate.
Hospital History •
• •
• • • •
Founded on May the 29th, 1963, by Dr Guillermo Ganoza Ríos (first director), Dr Heraclio Holguín Ríos, Dr. Rafael Donsi Rojas Operative since December the 18th, 1963. It was created at the request of the community from Trujillo, teachers and students at the Faculty of Medicine, National University of Trujillo, who held the "March of the White Aprons." Staff training was conducted by The Hope Project (USA). In 1965 medical residency begun. It is a regional and macro-regional referral hospital. Serves people with fewer economic resources and increased morbidity and mortality.
Medical Services • Assigned population to direct care: 62,000 • Employees: 796 (639 and 157 administrative assistance) • Doctors: 182 • Nurses: 138 • Beds: 259 (Medicine: 76, Psychiatry: 16, ICU: 6, Surgery: 78, Paediatrics: 44, Gynaecological Obstetrics: 39) • Optical microscopes, conventional X-ray equipment, ultrasound, upper and lower gastrointestinal endoscopy • CT and MRI are provided by third parties • Internet connection
Assigned Population PIRÁMIDE POBLACIONAL DE LA JURISDICCIÓN EN EL H.R.D.T. , SEGÚN SEXO Y EDAD (GRUPOS QUINQUENALES) - 2008
80 + 75-79 70-74 65-69 60-64 55_59 50_54 45_49 40_44 35_39 30_34 25_29 20_24 15_19 10_14 5_9 0-4
47.6%
6%
N = 62000
4%
52.4%
2%
0%
2%
4%
6%
Hospital discharges HOSPITAL DISCHARGES AT H.R.D.T. 2004-2008 12600 12400 12200 12000 11800 11600 11400 11200 11000 10800 10600
12405 12212
12263
11471 11205
2004
2005
2006
2007
2008
YEARS
HOSPITAL DISCHARGES BY SERVICES AT H.R.D.T. 2008 6000 5000 SURGERY
4000
MEDICINE
3000
PAEDIATRICS
2000
GINE-OBST.
1000 0 2004
2005
2006
2007
2008
HOSPITAL DISCHARGES AT H.R.D.T. CIE 10 â&#x20AC;&#x201C; 2008 Listado de capĂtulos 1 2 3 4 5 6 7 8 9
Egresos
%
Complications of Pregnancy, childbirth and postpartum
3439
30.3
Diseases of the Digestive System
1919
16.9
Injuries, poisonings and certain other consequences
1247
11
Diseases of the Respiratory System
832
7.34
Certain conditions originating in the perinatal period
717
6.32
Diseases of the circulatory system
592
5.22
Diseases of the genitourinary system
563
4.96
Certain Infectious and Parasitic Diseases
522
4.6
Tumors (Neoplasms).
292
2.57
Endocrine, nutritional and metabolic diseases.
261
2.3
10
N= 11341
Source: Statistics Unit at HRDT
Outpatient OUTPATIENT LEADING CAUSES OF MORBIDITY AT HRDT IN 2008
DISEASES
11.19%
DIGESTIVE SISTEM
10.54%
GENITOURINARY SISTEM
10.12%
RESPIRATORY SISTEM
MUSCULOSKELETAL SISTEM AND CONJUNCTIVE TISSUE
9.75%
ENDOCRINE, NUTRITIONAL AND METABOLIC
7.46%
SKIN AND SUBCUTANEOUS TISSUE
7.38%
CERTAIN INFECTIOUS AND PARASITIC DISEASES EYE AND ANNEXES INJURIES, POISONING AND CERTAIN OTHER CONSEQUENCES OF EXTERNAL CAUSES CIRCULATORY SYSTEM
5.83% 5.51% 5.28% 5.15%
MORTALITY HOSPITAL GENERAL MORTALITY HRDT-2008
DISEASES
0.3 0.3 0.8 0.8 1.1 1.4 1.4 2.0
Skin and Su Tissues Blood and organisms Nervous system Genitourinary System
4.5 5.6
Tumors (Neoplasms)
7.8 8.1
Digestive System
10.1
Respiratory Sytem
13.7 18.8 23.2
Certain infectious and parasitic
0
5
10
15 %
N=357
20
25
HOSPITAL DISCHARGES BY INFECTIOUS AND PARASITIC DISEASES AT HRDT - 2008 Nยบ
DIAGNOSIS
Number
%
1
Tuberculosis
146
27.96
2
Septicemia, unspecified
120
22,99
3
Diarrhea and gastroenteritis of presumed infectious disease
98
18.77
4
human immunodeficiency virus [HIV] viral Hepatitis AH
48
9.19
5
Pertussis
15
2.87
6
Hepatitis A
8
1.53
7
Varicella virus
8
1.53
8
Typhoid fever
6
1.15
9
Congenital syphilis
6
1.15
10
Encephalitis virus.
5
N=522
0.96 Source: Statistics Unit at HRDT
AIDS CASES BY YEAR OF DIAGNOSIS HRDT (2005-2008) 120 100 80 60 40 20 0 SIDA VIH
2005
2006
2007
2008
111
68
75
112
41
40
39
65
Source: Statistics office and HRDT TARGA
iSA STAFF - HRDT •
General Project Manager : – Angélica Victoria García Tello
•
Medical assistants : – Milagros Elizabeth Trujillo Neciosup – Félix Alberto Evangelista Montoya
•
Computer Technician: – César Francisco Cortez Vega
•
Management: – Juan Gutiérrez Alfaro
Cooperation links in Peru • • • •
Instituto Nacional de Enfermedades Neoplásicas (INEN) Instituto Regional de Enfermedades Neoplásicas (IREN) Hospital Belén of Trujillo Institute of Infectious and Tropical Diseases at the National University of Trujillo • Hospitals and health centres in other provinces in the region • There are difficulties in transporting patients, especially from most places in the mountains. • The tele-consultation would not be difficult between the HRDT and hospitals in Lima and the coast of La Libertad, however it would be difficult with care centres in the mountains (power interruption).
iSA Training • • • •
Update in Clinical Microbiology Training in molecular biology HIV resistance to antiretroviral drugs Management of opportunistic infections in HIV • Management of children with HIV • IT in Medicine
Cooperation with academic institutions • Conducting collaborative research projects in networking, involving HRDT, Institute of Tropical Medicine and Infectious Diseases, National University of Trujillo • Exchange of teachers and medical students, undergraduate and graduate. • Teaching with Web 2.0
General needs • Equipment for diagnosis with digital imaging • Module comprehensive care of patients with HIV / AIDS • Drugs for treatment of opportunistic infections and neoplasms in people with AIDS • Equipment for flow cytometry and molecular biology • Videoconference equipment
Conclusions • Communication with centres in other continents • Regional and national institutional integration • Exchange of experiences with access to experts • Greater solving capacity for diagnostic and therapeutic problems • Ongoing training of health personnel • Reduction of inequity in health care