Qualitative analysis of the care in the family planning services offered quechua-speaking patients in Ayacucho, Peru

OBJECTIVES.: The aim of this study was to address and analyze the medical care provided to low-income Quechua women who use the Seguro Integral de Salud (SIS, in Spanish) (comprehensive health insurance) to access family planning services, and to determine whether there is a significant fear toward contraceptive methods because of the forced sterilizations occurred in the past. MATERIALS AND METHODS.: One hundred (100) in-depth interviews were conducted with 70 women, 10 husbands, and 20 health workers in three health centers in the province of Vilcashuaman in Ayacucho. RESULTS.: It was found that there is no significant fear of family planning due to past sterilizations, as hypothesized. No significant language barrier was found either, as most health workers spoke or were willing to learn Quechua. There were some misunderstandings and abuse between patients and health workers referred to the use of healthcare services provided by the state. A widespread fear of contraception-related cancer became evident. CONCLUSIONS: . No significant fear of past sterilizations was found; on the contrary, women are more afraid of the relationship between cancer and contraception. Health worker training should focus on understanding patient perspectives and reducing stigma around poverty, as well as explaining the reasons for being a recipient of the SIS and the "JUNTOS" program

The genomic landscape of balanced cytogenetic abnormalities associated with human congenital anomalies

Despite the clinical significance of balanced chromosomal abnormalities (BCAs), their characterization has largely been restricted to cytogenetic resolution. We explored the landscape of BCAs at nucleotide resolution in 273 subjects with a spectrum of congenital anomalies. Whole-genome sequencing revised 93% of karyotypes and demonstrated complexity that was cryptic to karyotyping in 21% of BCAs, highlighting the limitations of conventional cytogenetic approaches. At least 33.9% of BCAs resulted in gene disruption that likely contributed to the developmental phenotype, 5.2% were associated with pathogenic genomic imbalances, and 7.3% disrupted topologically associated domains (TADs) encompassing known syndromic loci. Remarkably, BCA breakpoints in eight subjects altered a single TAD encompassing MEF2C, a known driver of 5q14.3 microdeletion syndrome, resulting in decreased MEF2C expression. We propose that sequence-level resolution dramatically improves prediction of clinical outcomes for balanced rearrangements and provides insight into new pathogenic mechanisms, such as altered regulation due to changes in chromosome topology

(Re)produciendo profesionales peruanos: la asistencia social y la ciudadanía-materna de las madres quechuas empobrecidas

Through the discourses of financial-independence and «professionalisation» of offspring promoted by state-provided healthcare and welfare (Juntos), Quechua women living in poverty find that upon entering motherhood their full citizenship becomes conditional on successful behaviours and stewardship of children to a more «desirable» livelihood than their own. This suggests that mothering- while-poor places a moral value on women that the state uses to justify monitoring and governing them.   This paper is based on one-year’s ethnographic-fieldwork in rural communities and health centres or posts in Vilcashuaman province, Ayacucho department, Peru. 100 interviews were conducted with women, men and health-workers, in addition to substantial participant-observation.   Whilst the pervasive discourses overburden women’s freedoms, there are alternatives to «professionalization» of indigenous youth that do not require the financial literacy currently imposed on mothers. This paper suggests that moral values placed on poor-maternities are sometimes used unfairly as a justification for reproductive-intervention and revocation of full-citizenship for poor, indigenous women.A través de los discursos de independencia financiera y «profesionalización» de la descendencia promovidos por la asistencia médica (SIS) y social (Juntos) provista por el Estado, las mujeres quechuas que viven en la pobreza descubren que, al ingresar a la maternidad, su plena ciudadanía se vuelve condicional a los comportamientos exitosos y la administración de los hijos para obtener un medio de vida más «deseable» que el suyo. Esto sugiere que la maternidad, mientras se es pobre, da un valor moral a las mujeres que el Estado usa para justificar su monitoreo y gobierno.   Este artículo se basa en un año de trabajo de campo etnográfico en comunidades rurales y centros o puestos de salud en la provincia de Vilcashuamán, departamento de Ayacucho, Perú. Se realizaron cien entrevistas con mujeres, hombres y trabajadores de la salud, además de una importante observación participante.   Si bien los discursos generalizados sobrecargan las libertades de las mujeres, existen alternativas a la «profesionalización» de los jóvenes indígenas que no requieren la educación financiera impuesta actualmente a las madres. Este documento sugiere que los valores morales asignados a las maternidades pobres a veces se usan injustamente como justificación para la intervención reproductiva y la revocación de la ciudadanía plena para las mujeres indígenas pobres