Making the Impossible Possible, Through Health Care Delivery Science | World Bank Institute (WBI)

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  • WBI brought experiences from the First Global Symposium on the Right to Health to the World Bank.
  • Dr. Jaime Bayona speaks about his experiences working in Peru with Partners in Health.
  • The case of Partners in Health in Peru illustrates the holistic approach to the treatment of tuberculosis. 
(c) World Bank, Lab specialist testing for viruses

May 29, 2013—One last picture with her son. That was Paulina’s only desire when the doctor confirmed that the treatment to combat the tuberculosis she suffered from was not working.

Paulina lives in Carabayllo, a district in northern Peru about 30 Km from Lima, the capital. She had a son, Percy, and her dream was to be committed to her son and watch him grow up, and do whatever was needed to make his dreams come true.

But the appearance of the disease, together with her scarce resources to afford a lengthy and expensive treatment, became an obstacle for her dreams. When she received the news, the only thing she wanted was to have a picture with her son. She wanted him to treasure a vital moment, a sad one, but vital nonetheless.

Doctor Jaime Bayona remembers that day as if it had been yesterday. Bayona went with Paulina to the emergency center and there he helped her try to find a second chance. Until recently he was the Director of Global Health at Dartmouth College, and at that time was the Director of the organization, Partners in Health. Partners in Health gave Paulina a new treatment that took into account the resistance pattern of the disease. She started it and after two months, the culture was negative. She continued the treatment until she was declared healed.

This experience was shared by Dr. Bayona last November in Salzburg during the First Global Symposium on the Right to Health, organized by the World Bank Institute’s (WBI) Health Practice, The Dartmouth Center for Health Care Delivery Science, and the Global Salzburg Seminar. WBI brought this experience to the World Bank to share with all staff and explore the synergies between delivery science and the realization of the right to health. 

Bayona is adamant that TB should not kill anyone. It is a curable disease, if a timely and comprehensive treatment is undertaken. The treatment against the disease lasts six months on average, and it is free of charge in Peru through public healthcare centers. However, lots of people who have been infected do not start the treatment and if they do start it, they do not finish it, due to other factors such as poverty, malnutrition, overcrowding, lack of basic services, depression, and marginalization.

By carrying out an irregular treatment against TB, the risk of the bacillus creating resistance to pharmaceuticals rises together with the appearance of a more aggressive type of the disease: the Tuberculosis Multi-Drug-Resistant (TB-MDR). It has stronger secondary effects in the organism and its treatment not only requires an average of two years, but is also much more expensive.

The community, a key player

To work on health problems beyond the borders of a hospital was not a new experience for Dr. Bayona. As a young graduate he was the doctor in charge of a health care center in Trujillo, on Peru’s North coast.

”Despite having the medicines and the facilities of a hospital, very few people visited the healthcare center, so instead of waiting for them I decided to visit them, to see what their lives were about, what worried them,” he said.

Leaving the hospital, visiting patients’ homes, and sharing their daily lives helped Bayona to better understand patients’ needs and demands, but also their ideas to improve their living standards.

But, why should a doctor promote activities beyond the hospital? For Bayona, the answer is clear: the solution to many development problems requires a comprehensive look at not only the problem, but also its surroundings.

The case of Partners in Health in Peru is paradigmatic in many ways. One of them is the holistic and comprehensive approach to TB treatment. The patients that come to Partners in Health not only receive medical treatment, but also economic help to reimburse the cost of their travel tickets and and get involved in recreation activities and training for a productive life after treatment.

Learning from failures

An imperative for delivery science is to learn from mistakes. Bayona explains that from the beginning everything Partners in Health worked on had to be measured.

 “We had to document our interventions, document lab results, the clinical evolution, the radiological evolution of patients,” he said.  Successes and failures, everything was documented with the objective of learning from practice and correcting what was not working. I believe it’s good that from the beginning, a space to share successes and failures is created. I believe that one can learn very useful lessons from failures.”
open-quotesDespite having the medicines and the facilities of a hospital, very few people visited the healthcare center, so instead of waiting for them I decided to visit them, to see what their lives were about, what worried them.close-quotesDr. Jaime BayonaBayona finally states, “I believe that the participation of the community is key, the health care personnel’s perspective is just not enough to deal with a problem such as TB that is very linked to poverty. If we want to undertake an in-depth fight against TB, it requires us to summon regional authorities, the central government, the civil society, businesses and the different government sectors that can provide a  contribution. These could be improving housing conditions, creating more job opportunities, guaranteeing food for school children, thinking in a more holistic way to help members of the community get out of poverty.”

These were the keys that helped Paulina overcome her disease. Today she is cured. She went back to school and will soon return to the hospital, but this time to work as a nurse.  She also has a new happy picture with her son Percy. The picture she thought was the last one was simply the beginning of a new path.

Comments (1)

Slum health awareness program

Iam working in india in NCR delhi for the slum dwellers of Ghazipur which manages 1/3 solid waste of delhi. the community of about 500 slum HHs is there, your experiences seems interesting do you have some idea about making para extension worker from a poor slum community??

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