Ø Despite marked efforts carried out in the 20th century to boost the social development of Guatemala, Guatemala remains one of the poorest countries in Latin America. Ø The cycle goes like this: less income – lower levels of consumerism – more poverty – more basic needs remaining unmet – lower quality of life – lower levels of education – lower health quality – less information about reproductive health – more pregnancies – more children – less possibilities of satisfying basic needs within the family and less possibilities of improving the income level of future generations. Ø Low educational access leads to a high % of minors present in the labour o 13.5% of Guatemalans aged between 7 and 14 are part of the labour Ø According to statistics put forth by the United Nations (2000), o 27% of the population is extremely poor, living from a per capita o 57% of the population is poor, living from a per capita income lower o There is a 75.6% poverty rate in rural regions, almost three times the Ø Guatemala is the third country in the world witnessing greatest inequality Ø Over and above income levels POVERTY refers to: o Lack of resources to satisfy social, cultural, political, ethical needs o Lack of resources to access human development, that is the possibility of living with dignity a long, healthy and creative life, in an atmosphere of respect for oneself and for others, and with access to education and information.1 1 “ El drama de la pobreza en Guatemala: sus rasgos y efectos en la sociedad” Ø 50% of the existing railway system lacks appropriate Ø Less than half of families has access to hydraulic facilities Ø Poor families not residing in metropolitan areas do not have Ø 45.4% of poor families have access to electricity2


1. The presenting problem: HEALTH IN GUATEMALA
Ø The health of the majority of Guatemalans is precarious: o The infant mortality rate is 40 per 1000 born alive (1999) o The mortality rate of fertile women is 190 for every 100 000 births o The infant mortality rate is higher in rural areas3 o 48.8% of children suffer from chronic malnutrition, indicating an enormous vulnerability of contracting numerous illnesses.4 § 1 out of 3 children suffers from global malnutrition Ø The leading causes of death in the population are diarrhoeic illnesses, respiratory infections, and malnutrition. Ø The public health system offers scarce material, human, and technological resources in both rural and urban regions. o 11,678.4115 inhabitants are attended to in 43 hospitals; 7 in the capital city and 36 scattered in the rest of the country Ø It is urgent to strengthen the health system since it is one of the key
axes which will allow to improve the development and the quality of
life of the population.

2 “Estrategia de reducción de la pobreza”. Gobierno de Guatemala. 2001 3 Id. 4 Prensa Libre, 29/04/2002. Ultimo censo de talla. 2002 5 Proyección del Instituto Nacional de Estadística. 2001. o The state, the private sector, the NGOs which are working in this direction cannot take charge alone of this enormous endeavor consisting in elevating the standards of health. o It is necessary that operational networks be established so that an increasing amount of inhabitants can benefit from mutual collaboration between entities. Ø The Cultural Association New Acropolis carries out actions in both urban
and rural areas, in collaboration with governmental and private entities, as well as with NGOs whose work is dedicated to health, with the objective of improving the quality of life of Guatemalans. o On an urban level, New Acropolis is establishing a Medical
Multiclinic in collaboration with ICOS, an NGO working in the Bethania Peninsula. o On a rural level, New Acropolis intends to extend the coverage of its
“Health Days”6 up to the Eastern region of Guatemala, in the department of Chiquimula, municipalities of Jocotán and Camotán, presently the most affected by drought and famine. 2. The situation once the project is finalized: Ø We aim to lower the rate of mortality due to illness and improve the quality Ø We aim to increase the coverage of the urban and rural health systems by offering possibilities of greater medical attention to the population, as well as offering access to medication at a low price to adults and children living in urban and rural areas. The population of adults and children to be attended to at the health center of the Bethania Peninsula The population of adults and children to be attended to during the development of the “Health Days” in the rural regions. Members of the population having scarce means who will be able to buy necessary medication at a low price at the pharmacy of the Bethania Peninsula, or during the “Health Days” in the rural regions. 6 Since 1991, New Acropolis has been carrying out campaigns of preventive and curative health in rural regions, integrating educational workshops on nutrition, on reproductive health, on community organization, and on care of the environment The rural population which will receive medication in donation during the development of the “Health Days”. The families of the patients to be attended to in the rural and urban areas. The communities where the « Health Days » will be carried out. The totality of the Bethania Peninsula once its health indices will have increased.

Ø Contribute to the improvement of the quality of life of the Guatemalan population in the capital city as well as in rural regions by offering medical and dental health services to adults and children.

1. Increase the coverage of the health system attending members of the population
having scarce resources in urban and rural areas.
2. Contribute to the lowering of the mortality rate due to illness in the population of
adults and children living in the suburban colony of the Bethania Peninsula and in
the rural areas attended to during the “Health Days”.
3. Contribute to the improvement of the familial economy of the population having
scarce resources by offering the possibility of buying necessary medication at a
low price, and by offering medical donations.

Ø On an urban level, in the capital city, a clinic offering permanent medical Ø On a rural level, “Health Days” are carried out on week-ends, in specific locations in the Oriental part of the country. a) Geographic and socio-cultural context (for more information please see Ø The Bethania Peninsula, one of the suburban areas of the capital, considered to be an area of “high social risk” where its population lives in extreme poverty, was chosen to host the Higia Integral Health Clinic. Ø There is a population of 92 849 inhabitants in an area of 10km2, Having minimal access to water, light, and draining systems. b) The health situation in the Bethania Colony Ø The medical facilities available are a Peripheral Clinic with a 24h emergency service and maternity ward, and the Bethania Health Center. Ø The personnel working in this Clinic are 5 general doctors, 1 paediatric doctor, 1 social worker, 1 nurse, 4 nurse aids, and 10 trained workers. 7 The Bethania Health Center has 1 doctor, 1 nurse, and 3 nurse aids. Amongst the population of the Bethania Peninsula, the principal illnesses encountered are the following: ENFERMEDAD
These data include adults and children aged 1 year or older. Amongst children younger than 1 year of age, the principal illnesses are the following: 7 These workers are women with six years of primary education and a training period of 3 months aiming for them to play the role of an obstetrician when a woman gives birth. In Guatemala, 85% of births in rural regions are supervised by these workers, and in urban regions, 35% of births. Ø To attain the objectives set forth, a Multiclinic is being established to offer • Dental services for adults and children • Gynecological and obstetrical services for the woman and mother • Internal medicine for men and women. • Pharmacy with basic medication to treat the most frequent illnesses in the Ø The pharmacy, located on the grounds of the Institute of Social Cooperation and the only NGO working in the Peninsula located at 38 calle y 32-21, Zona 7. Colonia Amparo II is implementing pharmaceutical services to be offered from Monday to Friday, from 8 in the morning to 4 in the afternoon. Ø The medical services as well as the medication are offered at very low prices for the benefit of the local population. This also meets the criterion of
reciprocity set forth both by ICOS and by New Acropolis Guatemala,
where members of the population help support the services they receive in
light of Education for Development.
Ø To the Multiclinic medical team, health and hygiene customs of the patients must be integrated in order to stimulate the use of natural medicine, herbal medicine, as well as other popular and useful resources in the preservation of health that have been passed on to the local population as part of the mayan and colonial heritage. Ø The collaborators in this project (including professionals and technicians) have a particular inclination towards serving the community, are humanists and accepting of cultural, ethnic, gender, socio-economic, religious and other diversities. All services are given with high quality without any discrimination. Ø New Acropolis Guatemala – OINAG,
Ø New Acropolis Canada - OINACAN
Ø ICOS Instituto de Cooperación Social
Ø Gea_IntiAmistad Foundation.
Ø The International Association New Acropolis – OINA – of which OINAG
and OINACAN form part – is a private humanistic, philosophical, and socio-cultural entity, which, since its foundation in 1957, promotes Philosophy as global knowledge, bringing together Sciences, Arts and Ethics in an ideal of human realization. New Acropolis is a non-profit association and does not have any political or religious aims. o New Acropolis carries out its activities through a wide range of cultural activities and its spirit of fraternity leads it to develop voluntary work projects at the service of the most vulnerable populations within society. o New Acropolis Guatemala (OINAG) carried out substantial work in
rural regions through its own projects and in collaboration with the Fondo de Inversión Social in the domains of health and community organization. o Since 1991 OINAG has been carrying out “Health Days” in uninterrupted form, and has collaborated with National Emergency with regards to Hurricane Mitch in the Oriental and Southern regions of the country.
o New Acropolis Canada (OINACAN) is taking part in this particular
humanitarian project through several actions aiming at; - coordinating along with CSI (Collaboration Santé International: the collection and shipping of the required medical material ; - gathering complementary funds needed in Guatemala; - facilitating the complicated administrative process inherent to this kind of shipping; - developing and following up the Canadian contacts involved in this project. Ø The Institute of Social Cooperation (ICOS) is a non-profit civil entity, which
executes activities benefiting society without any ethnic, religious, or political discrimination. ICOS is legally authorized to operate on national territory (estatutos aprobados en Diciembre de 1988, mediante Acuerdo Gubernativo 12-88). ICOS works to reduce poverty of children and their families, empowering the family nucleus with a focus on human development. Ø The foundation Gea_IntiAmistad contributes to improving the life quality of
poor rural and urban people in developing countries, providing them with medical equipment and medicine useful for establishing and maintaining medical centers in regions which are very poorly supplied. Ø These 4 entities (OINAG, OINACAN, ICOS and GEA_INTI_AMISTAD) acknowledge common principles from which can spring actions useful for the transition of Guatemalan society towards a future of equity, justice, democracy and quality of life. • Absolute respect of human rights in their different social, ethnic, economic, generic, political, and cultural dimensions. • Confidence in local potentialities and resources as fundamental elements • Application of resources with criteria of priority, efficiency, and • Confidence in the capacity of the present humanity to form a culture of e) Basic requirements for the Multiclinic

List of requirements for the Clinic

MEDICINA 3 Escritorios 3 Sillas 2 Archivos 3 Camillas para exámen físico 3 Camilla para exámen ginecológico 3 Lámpara de cuello de ganso 12 Recipientes de metal para algodón, gazas, bajalenguas, hisopos 2 Equipo ¨multicuff¨ para medición de presión arterial 3 Esfigmomanómetro aneroide con ruedas 5 Esfigmomanómetros aneroides portátiles 3 Esfigmomanometro de mercurio para pared 5 Otorrinolangingoscopios portatil 3 Otoscopios de pared 5 Oftalmoscopio portatil 3 Oftalmoscopio de pared 5 Estetoscopios (adulto) (Littmann Master Cardiology) 3 Estetoscopios (pediátrico) (Littmann) 3 Estetoscopios (infantiles) (Littmann) 3 Fetoscopio 3 Doppler portatil para obstetricia 5 Cintas métricas 4 Balanzas (pediátricas) portátiles 3 Balanzas con metro para adultos (scale) 2 Cartabón/ Infantómetro 5 Termómetro auricular digital 10 Termómetro oral de mercurio 5 Termómetro rectal de mercurio 5 Martillo de reflejos 2 Diapasón 4 Glucómetros (Acu Check Advantage) 20 frascos de tiras para glucómetro 2 Hematocritómetros 5 Lámparas de mano 5 Espéculos vaginales pequeños 5 Espéculos vaginales medianos 5 Espéculos vaginales grandes 5 Riñones de cada tamaño 5 Caja de metal para termómetros 3 Mesa con rodos para clínica (Instrument Trolley) 3 Mesa para equipo quirúrgico (Mayo) 3 Laringoscopio con hojas de diferentes tamaños 4 Negatoscopio 3 Equipos para nebulización con compresor 5 Atriles 5 Jeringas para lavado de oído 1 Autoclave 1 Esterilizador de instumental portatil 1 Computadora 20 Cajas de guantes de látex tamaño L 20 Cajas de guantes de látex tamaño M 5 Cajas de mascarillas 3M sin pantalla 5 mangos para bisturí 3 portaagujas MayoHegar medianos 5¨ 3 portaagujas MayoHegar medianos 6¨ 3 portaagujas MayoHegar medianos 7¨ 5 pinzas rectas Allis con dientes 10¨ 5 pinzas rectas Allis sin dientes 10¨ 5 Splinter forceps rectas 4 ¼¨ 5 Splinter forceps curvas 4 ¼´¨ 5 Pinzas mosquito recto 5¨ 5 Pinzas mosquito curvo 5¨ 5 Pinzas Kelly rectas 5 ½¨ 5 Pinzas Kelly curves 5 ½¨ 5 Pinzas con dientes 4¨, 6¨, 8¨ 5 Pinzas sin dientes 4¨, 6¨, 8¨ 5 Pinzas Ballenger sin dientes 9¨ 5 Tijeras de cirugía rectas 5¨ 5 Tijeras Mayo medianas 20 cajas de hojas de bisturí No. 10 20 cajas de hojas de bisturí No. 15 5 Batas blancas medianas 5 Batas blancas grandes 100 hilos para sutura Vycril 6-0 100 hilos para sutura Vycril 5-0 100 hilos para sutura Vycril 4-0 100 hilos para sutura Vycril 3-0 100 hilos para sutura Vycril 2-0 50 hilos para sutura Catgut 4-0 10 Cajas de cintas adhesivas Micropore 3M 10 Cajas de cintas adhesivas Transpore 3M 50 Angiocath No. 16 50 Angiocath No. 18 50 Angiocath No. 20 50 Angiocath No. 22 50 Angiocath No. 24 50 Angiocath No. 27 50 Pericraneales 100 Equipos de Venoclisis (Venosets) 5 Atriles 1 Caja de sondas nasogástricas No. 10 French 1 Caja de sondas nasogástricas No. 16 French 1 Caja de sondas nasogástricas No. 14 French 1 Caja de sondas nasogástricas No. 7 French 1 Caja de sondas nasogástricas No. 5 French 1 Caja de sondas de Foley No. 14 1 Caja de sondas de Foley No. 16 1 Caja de sondas de Foley No. 18 1 Caja de sondas de Foley No. 20 1 Caja de sistemas de colección de orina 1 Caja de sondas orogástricas para recién nacidos 2 Microscopios de luz (espejo y corriente eléctrica) 1 Centrifugador para laboratorio 50 cajas de portaobjetos 50 cajas de cubreobjetos 50 cajas de lancetas 5 Cajas de jeringas de 3 cc 5 Cajas de jeringas de 5 cc 5 Cajas de jeringas de 10 cc 3000 agujas No. 18 3000 agujas No. 20 5000 agujas No. 22 3000 agujas No. 24 2000 agujas No. 27 ODONTOLOGIA 1 Silla dental con unidad incorporada (braquets con bandeja, lámpara dental, escupidera y eyección) 2 Gabinetes dentales organizadores para instrumental y materiales 1 Aparato de rayos X con gabacha de plomo protectora 1 Autoclave 1 Lámpara de fotocurado 1 Turbina de alta velocidad (pieza de mano) 1 Micromotor de baja velocidad 1 Contraángulo de baja velocidad para adaptar al micromotor 1 Cavitrón adaptable a la unidad dental 2 Taburetes (odontólogo y asistente) 1 Escritorio con sillón y archivo 1 Computadora 1 Amalgamador 1 Caja para revelado Borgatta 1 Articulador Wip-Mix con arco facial 1 Diseñador dental 1 Localizador de ápice 1 Pulpovetalómetro 1 Equipo para TCR rotatorio 1 Eyector quirúrgico 5 Forceps 150 5 Forceps 151 5 Forceps 18R 5 Forceps 18L 5 Forceps 16 5 Elevadores rectos pequeños 5 Elevadores rectos medianos 10 Exploradores No. 5 20 Espejos dentales 10 Pinzas multiusos 10 Jeringas aspiradoras con lanceta 3 Portaamalgamas doble extremo pequeño/mediano 3 Condensadores pequeños 3 Instrumentos porta plásticos metálicos 3 Instrumentos porta plásticos plásticos 3 Dycaleros 5 Sets de Grapas dentales completo 3 Porta grapas 3 Perforadores de dique 3 Arcos de Young 3 Alicates No. 139 3 Alicates para curvar coronas de acero 3 Sets de abrebocas de hule ( 3 tamaños) 3 Sets de coronoas de acero completo piezas primarias 3 Sets de coronas de acero premolares y molares permanentes 2 Acentador de coronas y bandas 2 Endo-ice 20 Campos para esterilización de instrumentos endodónticos 6 Exploradores DG-16 1 Organizador endodóntico autoclaveable 1 Mechero para Canfina 1 Tirapuentes con 3 puntas intercambiables 1 Calibrador de metal 2 Plano de Fox 2 Pinzas mosquito 2 Portaagujas Mayo 2 Mangos de bisturí 2 Tijeras Rectas 2 Tijeras curvas 10 Cajas de agujas dentales calibre 27 largas 10 Cajas de agujas dentales calibre 27 cortas 20 Cajas de anestesia lidocaína al 2% con Vasoconstrictor 5 Cajas de anestesia Mepivacaína sin vasoconstrictor 10 Spray tópico sabores para niños 10 Cajas de rollos de algodón (1000 unidades) 50 Paquetes de gaza dental 10 Paquetes de algodón en Rama 1 Caja de Alvogil 50 Cajitas de fresas No.557 de diamante alta velocidad 50 Cajitas de fresas No. 330 de diamante alta velocidad 50 Cajitas de fresas redondas No. 2 diamante alta velocidad 50 Cajitas de fresas redondas No. 3 diamante alta velocidad 50 Cajitas de fresas troncocónicas punta plana diamante 50 Cajitas de fresas troncocónicas punta redonda diamante 10 Cajitas de fresas endo-Z 50 Cajitas de fresas cono invertido No. 34 y 32 alta velocidad diamante 50 Cajitas de fresas redondas No. 8 carbono alta velocidad 50 Cajitas de fresas punta de lápiz diamante alta velocidad 50 Cajitas de fresas cono invertido No. 6 y 7 alta velocidad diamante 50 Cajitas de fresas redonda baja velocidad No. 4, 6 y 8 carburo 50 Cajitas de fresas cono invertido baja velocidad carburo No. 32 y 34 20 Cajitas de Limas (K) 15-40 21 mm 20 Cajitas de limas 15-40 25mm 20 Cajitas de limas 15-40 31mm 20 Cajitas de limas 45-80 21 mm 20 Cajitas de limas 45-80 25mm 20 Cajitas de limas 45-80 31 mm 3 Cajitas Fresas Peeso 1-6 4 Cajitas de lentulos 4 tamaños 10 Cajitas limas Hederstrom 15-40 21 mm 10 Cajitas limas Hederstrom 15-40 25 mm 10 Cajitas limas Hederstrom 15-40 31mm 10 Cajitas limas K 25 mm No. 6 10 Cajitas limas K 25 mm No. 8 10 Cajitas limas K 25 mm No. 10 10 Cajitas limas K 25 mm No. 15 10 Cajitas limas K 31 mm No. 6 10 Cajitas limas K 31 mm No. 8 10 Cajitas limas K 31 mm No. 10 10 Cajitas limas K 31 mm No. 15 2 Cajas de limas K 90-140 25 mm 20 Cajitas de condensadores endodénticos Finger Spreaders 1 al 5 2 Galones de Canfing 5 Cajas de cera rosada láminas 20 Cajas de gutapercha calibradora 15- 40 10 Cajas de gutapercha calibradora 45-80 2 Cajas de gutapercha calibradora 90-140 2 Espátulas de Glick 3 Cuchillas pequeñas 3 Cuchillas medianas 3 Cuchillas grandes 3 Frascos de quelante para gutapercha y resina 10 cajas de radiografías dentales para adulto Kodak 10 Cajas de radiografías dentales para niño Kodak 10 Kit revelador/ fijador (líquidos de revelado) 100 Rollos de papel Mayordomo 50 Cajas de guantes latex small 20 Cajas de marcarillas 3M con Pantalla 2 Lentes protectores 2 Lentes para fotocurado 10 Filipinas talla M 10 Galones de solución germicida de Glutaraldehido 5 galones de alcohol etílico 20 onzas de amalgama Disperralloy 2 kits completos de resina Z-100 o Z-250 3M con ácido , bonding de un solo paso y colores A2, A3, A3.5, B2, etc. pínceles 3 Frascos de barniz de copal 3 kits fonómetro de vidrio (Ketac-Cem, Vitremer u otro) 3 Kits policarboxilato 3 Kits fósforo de cinc 10 Kits Temrex (oxido de zinc y eugenol mejorado) 2 Frascos de Paramonoclorobenol alcanforado 2 Frascos de Fromocresol 4 Cajitas de Otosporín 4 Cajitas de Hidróxido de Calcio USP 4 Cajitas de dycal, urbical u otro 2 Kits de ionómero de vidrio para cementación 1 caja de libritos de papel de articular 1 caja de cajitas de seda dental 3 Kits de Selladores de Fosas y fisuras fotocurado 100 Suturas seda negra 3-0 10 Cajas puntas de papel 15-40 10 Cajas puntas de papel 45-80 5 Piedras Heatless 10 Discos de hule variados 1 Kit de discos Soflex 2 Kits completos de puntas de Silicona para pulir resinas 2 Cajas de tiras de lija mediana y gruesa 3 Fresones para cortar acrílico llama 3 Fresones para cortar acrílico pera 3 Fresones para cortar acrílico redondos grandes 3 Fresones para cortar acrílico redondos pequeños 1 Fresero organizador de para alta y baja velocidad 1 Kit de Resina Fluida (compules) 1 Pistola para Compules 1 Kit de Compules de Resina para postenores 3 Cajas de contraangulos desechables para profilaxis 5 Botes de Fluoruro para aplicación tópica NUTRICIÓN 2 Goniómetros 2 Infantómetros 3 Kaliper 2 Kits de réplicas plásticas de alimentos MEDICAMENTOS Analgésicos/antiinflamatorios/antipiréticos: Acetaminofén tabs 500mg Antibióticos/antiparasitarios/antimicóticos/antivirales Penicilina cristalina amp 1 000 000 U Antihistamínicos/antialérgicos Hidrocortisona amp 100mg Mucolíticos/broncodilatadores/antitusivos Carboximetilcisteína jarabe 250mg/5ml Antihipertensivos Hidroclorotiazida tabs 25mg Med Dermatológicos Acído Salicílico pomada al 3% Hexacloruro de benceno loción con lindano al 1% Vitaminas/nutrición Multivitamínicos para niños Gastroenterología Hidróxido de aluminio tabs 234mg Hidróxido de aluminio líq 6.15g /100ml Subsalicilato de bismuto susp 225mg/15ml Soluciones Solución salina fisiológica 500ml Endocrinología Insulina cristalina 100U/ml


This Provisional PDF corresponds to the article as it appeared upon acceptance. Fully formattedPDF and full text (HTML) versions will be made available soon. Estimated financial and human resources requirements for the treatment of malaria in Malawi Malaria Journal 2007, 6 :168 Article type Submission date Acceptance date Publication date Article URL This peer-reviewed a

Nonostante non abbia ancora incontrato ufficialmente il suo futuro sposo, ma l'abbia semplicemente spiato da lontano, la giovane Shira Mendelman non potrebbe essere più ansiosa e felice all'idea di sposarsi; anche solo la prospettiva di cominciare una vita propria, di vivere le emozioni del corteggiamento prima e del matrimonio poi, è una ragione più che sufficiente per attendere impaziente c

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