Pediatric nephrology workforce in Latin America.

Pediatric nephrology workforce issues were examined in a Latin American survey involving 14 countries. The number of children under 15 years per pediatric nephrologist varied widely among countries: Argentina, Cuba, Venezuela, and Uruguay had an unusually high number of pediatric nephrologists. Guatemala represents the opposite end of the spectrum of values (1,582.6 thousand children under 15 years per pediatric nephrologist). A significant inverse correlation was found between children under 15 years per pediatric nephrologist and national gross domestic product per capita (r=-0.52, P<0.05) and a significant correlation between children per pediatric nephrologist and infant mortality (r=0.82, P<0.005, Spearman's rank correlation coefficient). The same correlations were observed for total population per pediatric nephrologist. However, the pediatric nephrology workforce does not merely reflect national economic status. Official health care policies, market forces, and social regulations also have an influence. A study of the number of pediatric nephrologists necessary for adequate planning of care of children with renal disease in Latin America is urgently needed.

Paediatric nephrology in countries with limited resources.

This paper summarises a symposium concerned with the provision of care for children with kidney disease in developing countries. Better organisation of services is required to prevent waste of resources, with the emphasis on team work between professionals, shared care with local health care personnel remote from the paediatric nephrology unit and good communications. Families need to be educated and provided with appropriate information so that they can care for their child at home. Technology should be simple and robust and the staff using it should be fully trained to maintain it in use. Therapies should be definitive where possible, because long-term supervision of treatment is often difficult. Effective but inexpensive medications should be used where possible. Twinning of developing and richer countries is valuable to transfer technology, help with training and assist in care through the development of personal contacts.

[New challenges for the general pediatrician: high technology applied to the patients]. / Nuevos desafíos para el pediatra general: la alta tecnología incorporada a los pacientes.

New technologies are concentrated and managed in large urban centers at highly developed hospitals. These technologies reach primary health care (HC) level through a "sui generis" intra-national transfer of technology: incorporated to patients. Patients with continuous ambulatory peritoneal dialysis (CAPD) are emblematic of this model of technological transfer. One patient with CAPD is taken as case study for analysis and discussion about problems in HC primary level. The lack of an adequate and efficient primary health care develops a quasi vital dependence on distant hospitals. As a consequence, primary pediatricians are limited to routine and bureaucratic activities to comply with tertiary level staff prescriptions. The outcome is negatif both for patients and health professionals i.e. strict dependence with HC tertiary level, high amount of unnecessary hospitalizations, severe interference with patients and their family social life, frustration, fear, insecurity and potential progressive difficulties in the access to health care. Real participation of all levels of HC staff constitute a sine que non necessity for the attaining of patients rehabilitation through family-centered, community-based care and for equity in the access to HC facilities. The reaching of these goals requires primary pediatricians to become involved in a program of continuous training education on new technologies tailored to their needs, possibilities and wishes if a comprehensive coordination between primary and tertiary health care levels is to be expected.

Appropriate training in paediatric nephrology for developing countries: hypothesis and proposals.

Appropriate training in paediatric nephrology is a comprehensive approach designed to develop skills and capabilities to deal with the following basic components of medical care: (1) medical competence for clinical and research activities; (2) interpersonal relationships directed at maintaining patients' freedom and autonomy; and (3) adequate incorporation of technological, financial and managerial aspects of paediatric nephrology services. Inappropriate training causes frequent, dramatic and paradoxical negative feedback in developing countries: shortage of functioning medical equipment, skilled manpower and trained paediatric nephrologists co-exist with unused high-cost medical equipment and loss of skilled health care professionals. Appropriate training, tailored to the needs and resources of developing countries, could be an efficient way to develop high-quality paediatric nephrology care. Efficient training must develop self-reliant, self-sufficient and skilled health care professionals in the local economic, educational, technological and political context. Regional and international co-operation is essential to promote adequate training in paediatric nephrology. Developing countries lack an effective and accurate information communication network for selecting modern technology for paediatric nephrology. The development of this network through international co-operation, is an urgent requirement.

Desnutricion grave y anasarca en un nino nefrotico. Los errores en la atencion medica primaria y la inaccesibilidad a los servicios especializados, como factores etiopatogenicos. / Severe malnutrition and anasarca in a nephrotic child. Inadequate primary medical care and difficult accessibility to health services as ethiopathogenic factors

La dialisis peritoneal deplectiva y la alimentacion parenteral total fueron efectivas en el tratamiento de la anasarca y de la desnutricion grave en un nino nefrotico. El retardo terapeutico consecutivo a los errores en la atencion medica primaria y a la dificultad de acceso al servicio especializado condicionaron la gravedad de la evolucion. La eficiencia, factibilidad y sencillez de las medidas correctivas de las dificultades de acceso se comprobaron en las establecidas al egreso hospitalario (tratamiento a traves del medico local con orientacion del centro especializado a traves de comunicacion epistolar y telefonica). Se destaca la importancia de la accesibilidad como elemento determinante del pronostico y de la terapeutica de los ninos nefroticos