The Amazon Hope: A qualitative and quantitative assessment of a mobile clinic ship in the Peruvian Amazon

<div><p>The Loreto region of the Peruvian Amazon faces many obstacles to health care delivery. The majority of the population is river-bound and lives below the poverty line, with some of the worst health indicators in Peru. To overcome these barriers and fill a gap in health services, an NGO-based provider known as the Vine Trust has been providing care since 2001 via a mobile ship clinic called the Amazon Hope. This study presents an assessment of the Amazon Hope, first reporting health indicators of the program´s catchment area, services provided, and program utilization. It then describes perceptions of the program by community members and health workers, the program’s strengths and weaknesses in contributing to health service delivery, and provides recommendations addressing limitations. The qualitative analysis included 20 key informant interviews with community members and health service providers. In the quantitative analysis, 4,949 residents of the catchment area were surveyed about medical histories, experiences with the program, and suggestions for improvement. The survey showed poor indicators for reproductive health. The AH clinic was the main provider of health care among those surveyed. Community members reported satisfaction with the program’s quality of care, and health workers felt the program provided a unique and necessary service. However, community members requested prior notification and additional services, while health workers described misunderstandings in community-tailored care, and difficulties with continuity of care and coordination. Data show that the program has been successful in providing quality health care to a population but has room to improve in its health service delivery. Suggested improvements are provided based on participant suggestions and relevant literature. The study sheds light on the important role of mobile clinics in Peru, and the methodology can serve as a model for assessing the role of mobile clinics in other remote settings.</p></div

Follow up of PREVEN Network members in 10 intervention cities, (2003–2006).

*<p>Percent in relation to 2003 PREVEN Network participants from each category.</p

Number of cases of STDs reported by PREVEN Network.

<p>The number of cases of urethral discharge, vaginal discharge, genital ulcer disease, and pelvic inflammatory disease reported by the PREVEN Network of pharmacies or boticas for 2004, 2005, and 2006 was substantially higher than the numbers reported by Network physicians and midwives, especially for urethral discharge, less so for suspected PID.</p

Amazon Hope’s performance within the WHO components of service delivery.

<p>Amazon Hope’s performance within the WHO components of service delivery.</p

Knowledge, attitudes and practices related to tuberculosis in pharmacy workers in a cross-sectional survey in El Agustino, Peru

<div><p>Introduction</p><p>Although the worldwide incidence of tuberculosis (TB) is slowly decreasing, annual infection rates in Peru remain among the highest in the Americas. Pharmacies could play an important role in facilitating early detection of TB. However, the awareness, expertise and cooperation of pharmacy workers is fundamental. This study explored the TB-related knowledge, attitudes and practices of pharmacy workers in a district with one of the highest incidences of TB in Peru.</p><p>Methods</p><p>This cross-sectional study applied a questionnaire that was administered face to face using smartphones with one pharmacy worker at each of 45 randomly selected pharmacies in the El Agustino district of Lima, Peru.</p><p>Results</p><p>Participants were primarily female (78%) and had an average age of 31.3 years old (range 18–57 years old). Only 11% of participants were pharmacists with complete university training. The pharmacy workers’ knowledge was adequate; however, workers had important knowledge gaps and myths regarding prevention of TB transmission. Most pharmacy workers (77%) reported they would send a client with a history of cough for more than two weeks to a healthcare center, while 23% reported they would offer them antitussive medication or antibiotics. Almost all workers reported talking with clients about diseases and reported respiratory symptoms as one of the most common causes for consultation (60%). Most participants expressed interest in learning more about TB and expanding their involvement in the fight against TB in their community.</p><p>Conclusion</p><p>Pharmacy workers have adequate knowledge about TB. However, we identified gaps in knowledge with respect to prevention of TB transmission. Pharmacy workers commonly see patients with respiratory symptoms and some offer recommendations, including for treatment. Pharmacy workers are willing to learn more and contribute to TB control and could be a valuable asset in the control and prevention of TB in Peru. To achieve this integration of pharmacy workers into TB control and prevention, more research is needed.</p></div

Results of evaluations by Simulated Patients.

<p>Evaluations to pharmacy workers at baseline both at intervention and control cities showed no significant differences in STD management or referral, or in recommendations for use of condoms or partner treatment. Subsequent evaluations at three, six and 18 months showed significantly better performance for all measures in intervention cities.</p

Baseline census and training of pharmacy/botica workers, physicians and midwives in private practice in the 10 intervention cities.

*<p>Certification required attendance at all four seminars and passing the peer evaluation test and at least 60% correct answers to the written test.</p>**<p>Certification required attendance at two seminars, completion of homework and at least 60% correct answers to the written test.</p

Sexual and reproductive health of 958 women 15–49 years of age who live in communities visited by the Amazon Hope program.

<p>Sexual and reproductive health of 958 women 15–49 years of age who live in communities visited by the Amazon Hope program.</p

Participants’ TB-related knowledge as demonstrated by the percentage of correct answers per question, pharmacy workers, El Agustino, Lima, Peru (N = 45).

<p>Participants’ TB-related knowledge as demonstrated by the percentage of correct answers per question, pharmacy workers, El Agustino, Lima, Peru (N = 45).</p

Participants’ demographic characteristics, pharmacy workers, El Agustino, Lima, Peru (N = 45).

<p>Participants’ demographic characteristics, pharmacy workers, El Agustino, Lima, Peru (N = 45).</p