CAMAGÜEY.- The fundamental objective of the creation of the family doctor's and nurse's offices in Cuba was and is the promotion and prevention of health to prevent people from getting sick and the complications generated by chronic ailments in those who already suffer from them .
This definition was in charge of Dr. Livia Quilez Viamonte, specialist in Comprehensive General Medicine (MGI) and Master in Comprehensive Care for Women. She is the family doctor at office number 12 of the Ignacio Agramonte Health area, in Garrido neighborhood, in this city, and with almost 37 years of experience there.
—Where does this health promotion begin?
—Depending on at what time of life we began to care for people. From before a baby is born, we guide the future mother so that she conceives her pregnancy at the best moment, in addition, she takes her prenatal tablets and the vitamin supplement, that she does not stop consuming folic acid, all provided for in the Maternal and Child Care Program (Pami) and thus prevent the baby from being born with anemia or other diseases, even, through prenatal investigations congenital conditions are avoided, but if they still decide to continue the pregnancy, they are attended by the relevant specialist and in this way the complications decrease.
"With the indicated breastfeeding, obesity and the deficiencies of the children's organism are avoided, without forgetting the affection they receive and that is as important as the food itself because obviously those who receive it are more intelligent, keep their teeth healthy and other proven benefits.
"We do not forget the prevention of accidents, which sometimes are not accidents because they can be avoided. We make known what to do from the early stages, we explain to the family how to get rid of them, that is, how to stay alert to the danger of co-sleeping, aspiration, falls and their consequences, and while the child is adding years and, depending on their psychomotor development, there are measures so that they do not suffer unintentional injuries that are the so-called accidents at home, I reiterate, because not always they are accidental. When they are very small they only turn in the cradle, however, as they grow older that changes and the family has to modify the environment.
"In the childcare consultations and field consultations -at home-, both doctors and nursing staff explain the aforementioned details.
—Is vaccination included?
—Of course, it is very important to bring this need to families. They have to know against which diseases they will be immunized from the day of birth and all the risks avoided.
—And the weaning?
—We indicate and follow the steps in the weaning of the child, which must begin at six months of birth to get rid of conditions that can be dragged later throughout life, because they must get rid of excess of sugar, junk food, to feed them in their schedules and respect sleep, and provide them with adequate exercises and games so that they do not abuse new technologies that not infrequently affect the intellect, good psychomotor development, lead to induced autism, and cause obesity. It is recommended that they play interacting with adults and other children, depending on their age.
"Even sitting the child in front of the television for hours is not good, nor is it good with USB with too much time of cartoons, they are not robots and the parents and the rest of the family have to be willing to "fight", and I tell you that in quotes because that role in life chosen by adults must be a pleasure.
-At school age?
—At those ages, other risks are incorporated, which is why they are explained how to prevent those from traffic when crossing streets, falls from heights, just to mention a few.
"They are oriented about the importance of continuing their studies and how to do it from the beginning in school."
-We've reached the teens...
—We work the same way with adolescents. They have to avoid early sexual intercourse and we are talking about unwanted pregnancy and preventing sexually transmitted infections (STIs), especially those we observe are prone to this behavior. Others are consistent with their age and with good family management, we know those details. A pregnant 11-year-old girl is a problem because she is neither mentally nor physiologically prepared to face this situation and the same happens with boys because on repeated occasions only females are emphasized, while the responsibility falls on both. Even the teenager parents who welcome their pregnancy should know that this baby is not a toy and he requires the utmost care.
"Today, care must be greater, because due to resource limitations, the cervical cancer research program is stopped, and even frequent changes in partners can lead to fatal consequences. With the cytological test, we detected the human papillomavirus that causes cancer. Condoms are not found in pharmacies. "It means that preventive measures must be taken to avoid reaching these extremes. If one is not aware of all this, a person with an STI is at the gates of a human papilloma and cancer.
"We also guide patients about behaviors so that the unfortunate rapes or other abuses that can be in both sexes do not occur, then the traumas are forever even if they are alleviated by psychological or psychiatric treatments.
"We make it known that an unwanted child during adolescence can come into the world with a low weight and all its complications, and even abandonment, because they do not take care of him in the correct way and we would already have another problem: a child with affective deficiencies and its consequences, and in these moments of so many economic difficulties everything multiplies.
"Without forgetting that we take care that they do not resort to the consumption of alcohol or other drugs, and neither to smoking, everything that is addictive. Behind a legal drug can come another illegal one, sometimes even without knowing it. We do everything in correspondence with the family.
"We do prevention in terms of loud music and the use of headphones, this action causes accidents even when crossing the streets. The reality is that we "get" into almost everything."
-We are in adulthood...
—With adults we make an effort so that they do not suffer from arterial hypertension, diabetes and other diseases. We know that we have stress, but there are mechanisms to deal with it and we explain that you should go to yoga exercises, tai chi, meditation, walks, and tune in to programs broadcast by the media like the one I recommend to my patients: With the permission of the moon on Radio Progreso at 10:40 p.m., there they offer topics on health promotion, meditation and relaxation, and at dawn another relaxation program on Radio Enciclopedia, although those are not the only ones.
"The population that we serve here is privileged to do physical exercises because we have the "pistilla" —a small track for running and walking—, the Multipurpose Room with two gyms, a therapeutic area with two specialist teachers in care for people with chronic diseases, there is a tai chi group and a yoga group in the Revolution Square Ignacio Agramonte, in the morning and afternoon, and in the vicinity of the Casino there is another yoga group, even the Casino itself is appropriate to walk and to exercise which can decrease stress, even more so in these times with so many difficulties with medications, but if you exercise, use natural and traditional medicine and everything oriented, we avoid high blood pressure levels and in fact cardiovascular conditions and cerebrovascular accidents.
"All linked to food indications such as avoiding excess of salt, carbonated soft drinks, not eating the whole loaf of bread and toasting it, among others.
"We let diabetics know that exercise is essential, not only to lower blood glucose levels but also to prevent diabetic polyneuropathy and avoid angiology conditions that can cause various and serious problems. Foot care is vital in these people and they are oriented so that they do not suffer from fungus, injuries, how to dry them well and put on a talcum powder, what shoes to wear, sleep with socks without elastics due to circulation and at the same time maintain the appropriate temperature.
"We teach women how to do a monthly breast exam, here we do it at least once a year, those who menstruate must wait seven days after passing it, and those who do not only choose the same day each month and we recommend that they take as reference an event that reminds them of the exam, such as the collection of their checkbook.
"Men over the age of 50 are tested for PSA—Prostate Specific Antigen is a protein produced by both normal and malignant (cancer) cells of the prostate. It is used to measure its concentration in the blood and diagnose prostate cancer early— and it is once a year, although those patients with certain risks are tested every six months and are evaluated by a specialist in Urology.
"We order microalbuminuria —simple urinalysis— for diabetics and hypertensive patients, and if they are disturbed, we refer them to the nephrologist to find out if they are in the first stage of renal vascular disease and with a specific diet and treatment we managed to prevent it from reaching chronic and terminal illness, we even indicated it to those who face repeated urinary sepsis.
"In our consultations we say what the symptoms of various types of cancer are so that they are attentive to the behavior of their own organism."
Nursery Bachelor Lídice Navarro Castro applies the booster vaccine against COVID-19 to people between 19 and 69 years of age.—In this tour of consultations we reached the elderly...
—With the elderly we have a lot to do, we must prevent accidents. They should sleep with a lamp or a light on, just in case they wake up at dawn and find their way without stumbling. When they get out of bed, do not do it abruptly because it can cause a cerebrovascular accident, we teach them to get up little by little after a while. We indicate not to change the furniture due to the visual deficit typical of age and also to maintain their habits. They must do exercises where they can and to the extent their faculties allow them, even they can practice exercises sitting down.
"They are told that they should not go out at night and if they do, not to go out without company, that they use the cane if they need it, and if they do not want them to use an umbrella as a point of support. At bath time it is good that the elderly sit down and do not bend down to avoid dizziness. The tiles are slippery and they must put grids or carpets.
"Just as you get old on the outside, it happens on the inside and grandparents should not eat the same strong meals at certain times, you have to take care of them. At the latest they should eat at seven at night and light food, so we avoid digestive complications not only because they go to bed, many doze sitting up, it is very good that they walk a little in their houses. Those who live alone are very well oriented.
"If they keep their intellect in perfect condition, their privacy and economic independence must be respected, otherwise they get depressed.
"Some lose their hygienic habits and you have to be aware that they bathe or bathe them, always with love, while the bedridden require prioritized attention so that they do not suffer from bedsores, those who care for them have to know how to move them and also how to hydrate them."
-It might seem like we've covered it all; however, what can you tell me about the caretakers?
—We have to guide them and do everything possible so that the family supports them and helps them from time to time, they need a break; otherwise, they would end up suffering from the caregiver syndrome, another health problem.
—I know that this is a very busy office and recognized by its population, with a universe of 915 inhabitants, what do you think about it?
—Although all work can be perfected, I think that it is also something won by my nurse. We have seen some born and they are already grandparents. They ask us for help even in family matters, for many we are already part of their own families and we help in everything within our reach. That is our main endeavor.
Translated by Linet Acuña Quilez