Coomeva web January 2018 - Vol.10 - #3

ISSN 2011-3579

A MAGAZINE FOR COOMEVA MEDICINA PREPAGADA HEALTHCARE PROFESSIONALS VOL. 10 • No. 3 JANUARY 2018

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CONTENTS January 2018

18 | Carlos Andrés Lores Orthopedist Technology, talent and teamwork save lives

5 | EDITORIAL 0 ¡10 years of publication and we want to celebrate with you!

6 | MEDICAL ADVANCES 0 10 medical achievements for the future

1 9 | Diana Alejandra García Londoño Pediatrician I am in love with pediatric patients

08 | HEALTH RISK MANAGEMENT

We all participate in the health care system

0 | Alberto Latorre 2 Abisambra Interventionist radiologist Another Alternative within radiology

10

10 | PROMISING COLOMBIAN DOCTORS. COMMITMENT, PASSION AND HEART

11 | Mario Angulo Mosquera Pediatric endocrinologist A fighter for gender discrimation 1 2 | Sandra Marcela Gómez Ramos Gynecologist and obstetrician A friendly voice during a sweet and complex pregnancy

10 PROMISING COLOMBIAN DOCTORS

10

6 | Metabolic Syndrome 2 The modern disease at last has a treatment

1 4 | Sebastián Quintero Oncologic mastologist A warrior on daily battle against breast cancer

8 | Cancer 2 Science has been able to target tumoral cells

General manager Coomeva Medicina Prepagada

Editorial committee Pascual Estrada Garcés, MD Health National Head Martha Liliana Cifuentes National Coordinator of Relationships and Healthcare Providers Bertha Lucía Varela, MD National Medical Audit Chief Julián Adolfo Villegas Health Risk Management National Head Ana María Correa Quality National Auditor Marco Emilio Ocampo Medical National Auditor Juan Fernando Saavedra Publicity and Marketing National Head David Montes Communications National Coordinator

Producción editorial Legis S.A.

0 | Cardiovascular 3 diseases Its prevention is one of the great medical challenge

1 5 | Jorge Enrique Medina Rosas (R.I.P.) Nephrologist and rheumatologist “Medical research is my passion”

17 | Juliana Gutiérrez Quiceno Odontopediatrician The true challenge is long standing and sustained prevention

3 | Aging and the 2 elderly’s health The Challenge of get old in these times 4 | Depression 2 and suicide Mental disorder burden in Colombia

13 | Gabriel Ortiz Intensivist The mistery of an accurate diagnosis

1 6 | Javier Mauricio Lobato Neurosurgeon Above all, devotion to service

2 | THE DECADE’S 10 2 BIGGEST HEALTH ISSUES

Jorge Zapata Builes

2 | Respiratory and 3 Pollution diseases With high impact on life and economies

22 42

THE DECADE’S

10 BIGGEST

HEALTH ISSUES

4 | Mother-infant Health 3 Mother and child are central to medical attention 6 | Child and 3 adolescent health Infant Mortality decrease, a great achievement

www.xpandia360.com

mercadeorelacional@legis.com.co Tels.: (1) 4255255, exts.: 1516, 1312, 1889, 1845 Sales: María Cristina Arévalo Durán Cel.: 3112862724 maria.cristina.arevalo@gmail.com ISSN 2011-3579

8 | Musculoskeletal 3 ailments Modern man carries a very heavy “load” on his back

VOL. 10 • No. 3 ENERO 2018

0 | Oral health 4 A challenge despite the achievements 1 | Humanitarian aid 4 Coomeva in solidarity with victims of Irma

41 4 JANUARY 2018

2 | Towards the future 4 Taking care of yourself is loving yourself

Photo: © 2018 SHUTTERSTOCK PHOTOS

EDITORIAL

10 YEARS OF PUBLICATION and we want to celebrate it with you!

I

n 2007, Coomeva Medicina Prepagada had already reached the privilege of grouping over 6,500 health care professionals to cover the needs of the whole country. They were already well-trained professionals willing to continue studying their fields and updating their knowledge. And the organization felt the need to develop a communications system that would allow us to interact in a more direct way with the doctors, while divulging our identity as well as the positive perception of our organization. This is how what we came to know now as COOMTACTO magazine was born.

We started this road that would take us even closer to our health care professionals, publishing an eight-page newsletter originally intended to share with them all sorts of medical advances, as well as important institutional information. Soon it became clear to us, we also needed an adequate graphical image that could create a business model around it that would make it feasible for the long-term and would also give us an even more interesting editorial structure. So, we forged an alliance with an expert on this type of projects, it was Legis S.A., a strategic and successful alliance until today. Also, Tecnoquímicas, a prestigious and well-respected organization committed to health care professional’s education, supported the project financially.

From the beginning, even though it was not intended to be a textbook, we wanted it to have scientific precision. And it still has it.

So, the readers received COOMTACTO very well from the start. Gradually the page number increased until it got to 24 by 2015. However, the time requirements and the medical community’s need led us to change the product even more. We turned it into to the magazine you are reading right now. Its first number was published on March 2016, with a new editorial design that was also well received. We also felt the need to open the publication, we started acknowledging outstanding medical efforts and initiatives in all the specialties, we created the sections called “Research interview” and “Merits”. And we also gave more relevance to “Medical world”, an interesting section devoted to the academic and gremial activities in every medical area.

Technical and scientific content of the articles improved, while the cover changed, so our doctors became the protagonists. On the other hand, this new beginning of our magazine turned it into an international publication, foreign readers can read it digitally in English.

Ten years have passed since we started this fascinating trip through trustworthy medical information. During this time, we have been able to build a community around this magazine

Jorge Alberto Zapata Builes General Manager Coomeva Medicina Prepagada

while the editorial quality improved. As a matter of fact, in the last satisfaction survey among the readers (October 2017), 63% of them effectively read it, with a 75% acceptance; while, on the other hand, only 1% don’t read it, because either the magazine doesn’t get to them or they lack the time.

In response to this acceptance we decided to give you a special present: a collector’s edition including the most relevant medical topics we published during this decade. This number has been prepared with mysticism and dedication for your enjoyment, but also to make it useful and lasting. We hope you like it.

And another thing: we would like for you to take a few minutes to tell us about your impressions with this issue. Otherwise we won’t be able to fully celebrate this anniversary we are sharing with you.

Finally, COOMTACTO magazine will continue committed to informing on current medical advances. And we also intend to use all technological publishing alternatives available today to make it available where ever you are, making it always a useful tool. We will soon announce these new ways to access its content.

Welcome to the COOMTACTO magazine 10-year celebration, a very attractive issue allover.

JANUARY 2018

5

MEDICAL ADVANCES

COLOMBIA: THE LATINAMERICAN CARDIAC UTOTRANSPLANT PIONEER

From left to right, doctors Albert Guerrero, associate assistant of the Cardiovascular Surgery team at FCI; Juan Pablo Umaña, medical director and head of the surgical team at FCI; Gabriel Mena, anesthesiologist and United to Cure Children Foundation’s director; and Andrés Mauricio Palacio, cardiovascular surgery resident at FCI.

A medical team at Fundación Cardioinfantil performed a cardiac autotransplant, to treat a paraganglioma, with the cooperations of Houston Methodist Hospital, Houston MD Anderson Cancer Center and United 2 Cure Foundation.

This complex surgery has only been performed 16 times in the whole world. It lasted 10 hours. After extracting the heart, the tumor was dissected, then the organ was returned to the patient’s thoracic cavity, where it started working perfectly fine, without complications.

SOURCE: ARTICLE “FUNDACIÓN CARDIOINFANTIL, PRIMERA INSTITUCIÓN EN LATINOAMÉRICA EN REALIZAR UN AUTOTRASPLANTE CARDÍACO PARA EXTRAER UN TUMOR DE CORAZÓN”, PUBLISHED ON FUNDACIÓN CARDIOINFANTIL’S WEB PAGE. COLOMBIA. NOVEMBER 2017.

10

medical achievements for the future

FUSION PROSTATE BIOPSY: MORE PRESICION WITH LESS DISCOMFORT According to Instituto Nacional de Cancerología, in Colombia, 1 out of every 7 men over 50 years will be diagnosed with prostate cancer. So, we are searching for new and more efficient ways to diagnose it, such as the fusion prostate biopsy available at Clínica de Marly. This is a more efficient test, that can be performed either transrectally or perineally, using the new Artemis machine. It allows doctors to fuse real time multyparametric magnetic resonance images of the prostate with its ultrasound, allowing the biopsy needle to be guided to the suspected site of the malignancy. Also samples can be taken, when necessary, from other areas of the prostate. This technology increases the test’s sensibility and the specificity.

SOURCE: ARTICLE “BIOPSIA DE PRÓSTATA POR FUSIÓN. PARA EL DIAGNÓSTICO PRECISO DEL CÁNCER DE PRÓSTATA”, PUBLISHED AT CLÍNICA DE MARLY WEB PAGE. COLOMBIA. SEPTEMBER 2017.

During this past decade, COOMTACTO has recorded medical developments, innovations and achievements in this section, and it has been very well received by our readers. On this opportunity we decided to mention the 10 medical advances that will have the most impact on medical practices in general, and particularly in Colombia’s health care system.

IMPLICATIONS OF BREAST FEEDING ON THE PREVENTION OF SUDDEN DEATH SYNDROME Studies show the many benefits of breast feeding. And now, new research suggests that during the first 2 to 4 months after birth it could reduce the risk of sudden death syndrome in newborns. This conclusion was based on a review of eight international papers, involving in all 2,200 cases and 6,800 control cases. It suggests exclusive breast feeding protects infants, enhancing the immune system it prevents viral infections and reduces the risk of sudden death syndrome.

SOURCE: ARTICLE “DURATION OF BREASTFEEDING AND RISK OF SIDS: AN INDIVIDUAL PARTICIPANT DATA META-ANALYSIS”, PUBLISHED IN PEDIATRICS. HOLAND. OCTOBER 2017..

TASY: CHOOSING BETTER HEALTH CARE MANAGEMENT Efficient management systems are high priorities for clinics and medical centers. Considering this, Philips launched TASY. A tool designed for hospital management. This informatics solution allows a centralized medical, organizational and administrative process management. The system offers 72 models including electronic medical records, personnel assistance, bed management and room programming, stocks, patient attention, supply management, financial reports and invoices.

It also enhances patient’s safety and makes attention optimal with the implementation of guidelines based on science and advanced algorithms that quickly detect sepsis and infections. TASY also offers new oncology tools that include chemotherapy, new guideline implementation and cycle controls.

SOURCE: ARTICLE “TASY, UN SISTEMA DE GESTIÓN DE LA SALUD”, PUBLISHED ONT PHILIPS WEB PAGE. COLOMBIA. NOVEMBER 2017.

6 JANUARY 2018

FEMTO Z8: NEW TECHNOLOGY FOR CATARACT SURGERY A cataract is an eye disease that can appear at any age, however it is more frequent over 60 years. And when it reduces the vision, surgery is indicated in order to extract the cataract and implant an intraocular lens. Femto Z8 is a precise laser at Clínica de Oftalmología de Cali that could render the scalpel obsolete for this procedure. This advanced procedure is called a Z cataract.

The laser performs complex and sensitive aspects of the surgery that used to be hand-made. This procedure reduces corneal asthygmatism and inflammation.

SOURCE: ÓSCAR PIÑEROS, OPHTHALMOLOGIST WITH A SUBSPECIALTY ON CORNEA AND REFRACTIVE SURGERY. CLÍNICA DE OFTALMOLOGÍA DE CALI. COLOMBIA. OCTOBER 2017.

LONG LIVE PROBIOTICS

CARDIOVASCULAR HEALTH CAN BE PREDICTED! Risk factors like hypertension, diabetes, smoking, dyslipidemia and a family history of cardiovascular disease are very relevant for vascular aging, increasing the probability of an acute myocardial infarction and cerebrovascular events.

Today, with a non-invasive biomechanical vascular study it is possible to predict, at least 10 years ahead, cardiovascular health in patients. Also, doctors are able to visualize changes related to aging and detect arteriosclerosis in a subclinical phase, as well as premature aging, in order to delay its effects on the vascular walls.

SOURCE: ARTICLE “ESTUDIO DE BIOMECÁNICA VASCULAR”, PUBLISHED IN CENTRO DE DIAGNÓSTICO INTEGRAL DE BIOMECÁNICA VASCULAR Y CARDIOLOGÍA WEB PAGE. COLOMBIA. SEPTEMBER 2017.

Research grows favoring probitic therapeutic use.

According to Bionutrec, besides it uses in acute diarrhea, probiotics reduce the severity and duration of these episodes. Also, prebiotics and zinc, ether separately or combined, prevent and treat these diseases. S boulardi is the most commonly uses strain. Probiotics can be found in milk and dairy products, as well as in some medicines and supplements. Since it is known that they are heatsensitive, now it is possible to pack them for protection, and they can now be used in children.

These are called intelligent formulas.

SOURCE: DR. LUIS GUILLERMO JIMÉNEZ VILLA, SCIETIFIC DIRECTOR AT PHARMETIQUE LABS. COLOMBIA. OCTUBER 2017.

CT SCANS COULD SHOW CONSCIOUS STATE OF PATIENTS WITH CEREBRAL LESIONS

SOURCE: ARTICLE “EARLY DETECTION OF CONSCIOUSNESS IN PATIENTS WITH ACUTE SEVERE TRAUMATIC BRAIN INJURY”, PUBLISHED IN BRAIN. UNITE KINGDOM OCTOBER 2017.

The coma patient conscience level has been troubling for doctors over the years. Early assessment could help the patient’s family as well as doctors to decide about the patient’s treatment. New CT scans could detect such an activity, according to Neurotechnology Center and Neurologic Recuperation at the Massachusetts General Hospital. They studied 16 severe brain lesion patients at the intensive care unit. Functional magnetic resonance images together with electroencephalograms showed to be very useful evaluating the level of consciousness, particularly when standard neurologic tests could misinterpret certain movements and reactions.

THE FRACTIONED CO2 LASER REVOLUTION

Many people have dreamt to return skin youth, and the fractioned CO2 laser is very helpful to fulfill this wish. It is used to make it tense, improving the fine creases on the eyebrows, the temple, the forehead and the rest of the face.

The idea is to recuperate the vitality of these tissues, reducing pigmentation of the skin on the face, the neck, the cleavage and the hands. And this equipment can be found right now at Clínica de Oftalmología de Cali. This technique is called Resurfacing, and promotes the complete exchange of the facial epidermis. Fractioned CO2 laser mycrocolumns penetrate the dermis, dissecting it, triggering skin remodelation that reduces creases and improves skin color. The laser penetrates the skin, burning a column in a controlled manner that extends to the deeper layers of the dermis, while surrounding cells regenerate the tissue. Finally, the fractioned CO2 laser pixels the treated area and stimulates a quick healing process.

SOURCE: ANTONIO QUINTERO, OPHTHALMOGIST, SUBESPECIALIST IN OCULAR PLASTICS AND REFRACTIVE SURGERY. CLÍNICA DE OFTALMOLOGÍA DE CALI. COLOMBIA. OCTOBER 2017.

REMOTE SLEEP APNEA TREATMENT This ailment is attributed to breath interruption while sleeping, and it could have severe complications. The multinational Phillips Corporation at Colombia presented EncoreAnywhere recently. It is a new web based system designed to treat this condition. It allows the doctor to access patient’s records anywhere, in order for him to follow-up the situation with real time data, so he can decide on whether the mask should be used and adjust it to the patient’s current requirements.

SOURCE: ARTICLE “ENCOREANYWHERE. TODO UN MUNDO DE DATOS DE PACIENTE A SU ALCANCE CUANDO Y DONDE LOS NECESITE”, PUBLISHED IN THE PHILIPS COLOMBIA WEB PAGE. COLOMBIA. NOVEMBER 2017.

JANUARY 2018 7

SPECIALS

HEALTH RISK MANAGEMENT

WE ALL PARTICIPATE in the health care system

H

By: JUAN ADOLFO VILLEGAS GÁMEZ

National Director of Health Risk Management

Coomeva Medicina Prepagada

ealth risk management are activities and processes useful in any sector or corporation, designed to handle, reduce, transfer, eliminate or avoid risks. Risks within the health care system can be classified as primary, technical, operative, public image and financial. And in this particular sector, risk can be faced through different strategies: from the point of view of the government, the insurance company, the health care provider and the person.

Health care brings together many interests. OMS defines health as “a complete state of physical, mental and social wellbeing, so it’s not only the absence of diseases”. This all-encompassing perspective requires a collective participation in the health care system. Particularly if we consider Lalonde’s health criteria, established more that 40 years ago (Diagram 1).

So, we can consider a general approach to each person’s priorities and obligations within the health care system, including other sectors of the government and the economy.

GOVERNMENT AND PUBLIC POLICIES The government develops the policies that will promote a healthy lifestyle, such as smoke-free spaces, tobacco and sugar drink taxes, public areas devoted to physical activities and the publication of the nutritious facts on the foodstuffs.

• Considering human biology, policies promote care of women, before, during and after conception, while stimulating excusive breastfeeding, maternity leaves, and other procedures that have decreased the newborn and infant biological risks.

• In order to improve the environment, intersectorial policies cover basic needs and guarantee everybody has access to safe drinking water, as well as the elimination of wastes and basic education, among other important health care factors.

• The government designs and regulates a health care system with inclusion and exclusion plans for the users, that covers most common diseases and needs, where everybody has the right to receive adequate health care services. And, in case of an adverse event, people should not have financial risks. All this within a sustainable health care system for the long term.

8 JANUARY 2018

ENSURERS AND HEALTH CARE MANAGEMENT Ensurers are companies that manage benefit plans, and affect the community directly with adequate handling of the health care services and the promotion policies of a healthy lifestyle. This work starts by studying the population in order to identify the primary risks and define health care strategies that will reduce the probability of getting sick or that will decrease the impact on the health of the already sick population.

In order to identify the risks, there are several methods directed to analyze, classify and set priorities straight according to biopsychosocial characteristics of the population, allowing us to establish technical risk management strategies, such as health promotion, induced demand, early disease detection and prevention and disease management.

In order to improve risk management, the companies that manage benefit plans implement integral attention models, including, particular groups. So, for a certain medical condition, they can promote actions to detect and treat the disease early on, and establish practices and other goals. So cure and rehabilitation can be planned adequately, with more efficient administrative processes.

Operational risks are related to negotiations, contracts and management information required to make adequate decisions. They are intended to make an efficient use of resources and allow a healthy sustainable situation for the business end of the company. So recently, business models have been put in place where the health care results and the financial risks are shared in order to improve quality, innovation, health care results and the system’s financial wellbeing.

THE HEALTH CARE PROVIDERS AND ATTENTION SAFETY Health care providers are crucial because of the need for them to offer safe health care services, avoiding or diminishing adverse events during their activities, be it in the hospital setting or in the walk in clinics.

There are several instruments and methods that allow ensurers to implement safe and efficient actions. They can

Diagram 1.

Potential contribution to the morbi-mortality reduction HEALTH CARE SYSTEM

10%

ENVIRONMENT

20%

HUMAN BIOLOGY

LIFE STYLE

51%

19%

SOURCE: ADAPTED FROM “A NEW PERSPECTIVE ON THE HEALTH OF CANADIANS” (LALONDE, 1974) Y “AN EPIDEMIOLOGICAL MODEL FOR HEALTH POLICY ANALYSIS” (DEVER, 1976)

overview the infrastructure, implement clinical guidelines, dependent services and reference processes, use definitions, medicines and other resources warehousing and use, the definition of waste disposal, among other alternatives.

Also, notwithstanding, health care service providers have developed adequate attention processes. People must be treated the same way we would like to be treated themselves, so health care workers should be well selected and trained.

THE PERSON AND SELF CARE EHealth is affected tremendously by the personal life style.

So, the individual is also responsible for his own health, in that sense he manages his own health risks. The person identifies them, orders them by priorities and develops strategies to avoid or diminish them.

But this strategy requires will power. The Psychological American Association defines it as “the capacity to resist short term temptations in order to achieve long term goals”. So, it is very helpful to establish a clear-cut goal, also to be committed and to monitor the behavior. Also, the equilibrium between happiness, on the one hand, and will, on the other, should be considered. Excessive self-control leads to physical and mental fatigue, with emotional alterations, and ultimately depression. It can also, in the end, turn out to be unhealthy.

So, motivation based on beliefs and experiences is important to change. Cultural modifications are required in order not to stop thinking about health only when it is at risk and consider it to be somebody else’s responsibility. Personal care is crucial.

Also, when in trouble, it is important to trust institutions. This is based on the idea that all participants in the health care system are managing their own risks. Therefore people, the users, also audits the health care system. The patient can criticize and offer new ideas in order to improve state policies, as well as the insurers and the health care providers services.

10

promising Colombian doctors.

Commitment, passion and heart

10 JANUARY 2018

MARIO ANGULO MOSQUERA Pediatric endocrinologist

A fighter for gender

DISCRIMINATION He leads a multidisciplinary group that cares for families and children with transgender identity issues, he also educates and guides the community in order to prevent ill-treatment and segregation in this area. The clinic he heads will most certainly change the way we treat these cases in Colombia. emerged on the gender affir-

literature, he has published three

mative model, and statistics

books and is about to publish his

drastically improved.

fourth, it is not difficult to get close

The challenge was to

to children and adolescents in or-

find a way to do it. Doctor

der to understand how they think,

Angulo was interested, as well

feel and what they want.

as several other colleagues and

He studied medicine with two

researchers, and formed a multi-

goals in mind: the wish to serve and the love of

disciplinary team that includes other

science, particularly biology, and he devoted himself

endocrinologists, pediatricians, psychologists, psy-

to the protection of children’s rights.

chiatrist, plastic surgeons and geneticists. Putting

He is Mario Angulo Mosquera, a pediatric endo-

aside their ideologies and religious beliefs, based

crinologist and the head of Clínica de Género para

on clinical evidence, they recently founded at Fun-

el Niño y el Adolescente, Fundación Valle del Lili, “I

dación Valle de Lili, in Cali, the first Clínica de Géne-

studied pediatrics because I like working with chil-

ro para el Niño y el Adolescente in Colombia.

dren, and I chose pediatric endocrinology because

“Our view stems from the gender affirmative

I found it was practical, there were few specialists in

model. It starts by accepting that identity is es-

this area in Valle del Cauca, and also the endocrine

tablished early on, even before birth. But some-

system is beautiful and important. Hormones ex-

times identity and biology do not fit. And when

plain most of what happens in the body”, he says.

they don’t, transgender identity occurs, and we

For 18 years he has worked protecting children’s

must use psychological tools to achieve the best

health, particularly in a controversial area, the trans-

possible fit between body, identity and society”,

gender population, vulnerable people, always at

explains doctor Angulo.

risk of being discriminated and ill-treated. “A time-

After a year we opened the clinic, applying suc-

ly intervention can completely change their lives,

cessful strategies proven elsewhere. “Today we have

as well as their family’s”, adds the doctor, proud of

created guidelines according to international stan-

leading such an innovative project with international

dards”, he says.

acknowledgement.

He knows this is just the beginning: “We want to answer all patients and families questions regarding

LET’S CHANGE HISTORY

gender issues. For those people that, after a care-

For 12 years now several groups have studied

ful and professional evaluation are diagnosed with

transgender identity. In the beginning they used

a transgender identity, we can offer them a wide

reparative strategies intended to direct the identi-

range of medical and psychological tools in order

ty according to biology. But mental complications

to help them achieve a fulfilling life. For instance,

were higher than in the general population: suicide

in the case of a transgender girl, in other words a

was 40% more frequent among these patients, also

feminine identity with a masculine body, favor the

self mutilation was more likely, 35%, and depression,

harmonic development of her life and her body and

anxiety and drug addiction. Only after 2014, evidence

her feminine identity”.

Photo: JORGE MEJÍA

F

or a man that writes children’s

A RESEARCHER AND A CARING FATHER Doctor Mario Angulo Mosquera is the son of a couple from Popayá, but he was born in the United States and he grew up between Bogotá and Cali, where he has stayed for last 15 years. He is now 44, and has become an outstanding researcher with a lot to offer to the community. He graduated from Colegio San Carlos, then he became a doctor at Pontificia Universidad Javeriana, and a pediatrician at Universidad del Valle. After that he obtained his master’s degree in pediatric endocrinology at Universidad de Barcelona in Spain.

Also, he is the father of “two marvelous girls”, enjoys nature, planting trees and horseback riding. He also loves writing children’s literatura. As a matter of fact, he has published three books of this sort: “Palabras mágicas que curan”, “Besos para los que se han ido” y “Tibatí y el día que la comida se volvió ladrillo”.

JANUARY 2018 11

SANDRA MARCELA GÓMEZ RAMOS Gynecologist and obstetrician

10 PROMISING COLOMBIAN DOCTORS

A FRIENDLY VOICE DURING a sweet and complex pregnancy As a daughter, a mother and a doctor she has always been interested in a humane relationship with the patients, and she has been able to grossly improve her communication skills.

W

hen doctor Sandra Marcela Gómez Ramos treated

Studying, and also with her personality, her

to obstetrical patients for the first time in medi-

love and her wish to serve, she discovered the

cal school, she immediately knew that was her

secret ingredient: to empathically understand the

passion, and devoted her life to “the biggest of all

patient. And she has been very successful at this.

miracles: maternity”.

Planned, prepared and controlled materni-

ty, she means, so women need guidance and

This attitude is related to “a better understanding of the disease, more treatment adherence and, therefore, solving medical problems even faster.

a friendly face. She decided to work with “those awe-inspiring women that decide to give it all for a new life”, and started working on humanizing medical care.

Regrettably people are not well informed about hormones and their impact on different

“Humanized medicine is a fundamental

aspects of sexual development throughout the

principle. At the medical school this essential

lifespan”, doctor Gómez clarifies. She considers

aspect of the doctor patient relationship is con-

it necessary “to develop educational policies for

sidered very important, so we are always trying

women in order to teach them early on in their

to improve”, says doctor Sandra Marcela, a gy-

lives about these changes”.

necologist, an obstetrician and a specialist in reproductive medicine at Clínica de Marly.

Photo: PHOTOGRAPH

EDUCATION IS ESSENTIAL

Meanwhile, from reproductive medicine, a specialty covering gynecological endocrinolo-

She has the abilities, the qualities and the moral

gy, she has managed to teach the patients, in

values she received at home from her parents,

intelligible ways, about the hormonal changes,

plus she is an empathic person. “I developed the

making life easier for them, build sort of a bridge

capacity to listen carefully and try and solve prob-

between medical language and the future mom’s

lems. That way I decided I could use these abili-

language, taking into consideration her own per-

ties in medicine”, she warmly says.

sonal experience as a daughter, a mother and a doctor.

A PROUD WOMAN ABLE TO GIVE LIFE Doctor Sandra Marcela Gómez Ramos is a gynecologist, an obstetrician and a specialist in reproductive medicine, born in Bogotá. She thinks of herself as “a proud woman of being a mother and doctor”.

“I am a mother, a wife and a daughter. And I am absolutely convinced that women are the most perfect beings in the creation”, she reflects while she is tending for her first baby of the day, a beautiful girl just a few months old.

She studied medicine and specialized in gynecology and obstetrics at Universidad Militar Nueva Granada. Then she subspecialized in reproductive medicine at Fundación Universitaria Sanitas.

Now she works as a gynecologist and an obstetrician at Reproductive Medicine Group-Clínica de Marly, where she performs endoscopic surgery and works at the delivery room. Also, in her private practice, she works on fertility and gynecologic endocrinology. And on her spare time she enjoys reading, swimming and going to the movies.

Pregnancy involves hormonal changes, she insists, “with humanized medical attention things will be easier for the pregnant women, even though they are beautiful, they can also suffer severe symptoms, even maternal diseases”.

Her message is clear and caring: “pregnant women should be aware that they are changing physically and mentally, and there are doctor who can help them at this time”. As a matter of fact, she has achieved to become a friend guiding patients.

She knows first-hand what it is to be pregnant, she has experienced motherhood, and she is keen on offering patients “more security on topics related to pregnancy, delivery and breastfeeding”.

12 JANUARY 2018

GABRIEL ORTIZ Intensivist

THE MISTERY OF

an accurate diagnosis He started studying medicine at 14, graduated at 20 and by 24 he was already an internist from Universidad Nacional.

Today, at 28, he is a teacher, a student and a researcher…

H

is mother’s family comes from Norte de Santander, while the paternal family comes from Santander, located in the south. Gabriel Ortiz was born in Pamplona, where the church bells still sound at five in the morning. Soon after that, his father’s work, also a physician, took him to Málaga, an even smaller

and secluded town. During the first 6 years of his life he lived with his grandparents and other family members, friends, at school and was exposed to the advanced education his aunts and his mother gave him. So, when he arrived at Bogotá, his was able to

A MARATHON Gabriel Ortiz was only 14 when he entered medical school at Universidad Nacional de Colombia.

By 20 he was a doctor and his residency in internal medicine, he finished it by 24. To this health marathon he added his work within emergency rooms and the intensive care units. He is also a truly motivated researcher. And his next project is to specialize in cardiology. For now, marriage has not ever occurred to him.

finish high school by 14.

He always knew what he wanted to do. His parents worked

depends on it. Diseases might not be ob-

in health-related areas. His father used to be a dedicated student,

vious and can change quickly, and even

he had studied to be a technician on a scholarship at Universidad

become deadly if they are not adequately

Nacional, and then he decided to return home. Medical books

diagnosed and treated. Every night, critical

could be found everywhere at doctor Gabriel’s house, together

patients arrive at the emergency rooms

with the friendly conversations, stories about hospitals, research,

and the intensive care units where he

night shifts, patient gratefulness and also condolences from time

works. His diagnosis and treatments alter

to time. In a nutshell, he grew up in a world full of knowledge used

the course and outcome of their diseas-

to help others. The goal of learning and researching in order to

es. To comprehend what’s happening with

help others, even save lives, gave a purpose to his life.

that person, in that situation, brings happi-

He is now 28 years old, and an experienced internist. An un-

ness to the patients and their families, but

dergraduate teacher at Universidad Nacional that works as an in-

also to Gabriel, who thanks God for that. His

ternist at Hospital Universitario, that also teaches internal medicine

specialty requires him to help people, and even

residents and other related specialties. At Clínica de la Mujer he

to accompany some of them to die in the best

works at the obstetric intensive care unit and at Clínica Miocardio

possible conditions.

he also works at the intensive care unit with patients in the perioperatory stages of cardiac surgery.

He is committed to teaching echocardio-

Photo: LUCERO RAMÍREZ

graphy and other uses of ultrasound to medical specialties

He is passionate about studying and his challenge is diagnosis

other than radiology and cardiology. As we speak, he is involved

precision. Most of his time is devoted to reading and researching,

in four research projects at Clínica de la Mujer, one of them, in the

like he says, the most dangerous thing for a doctor is to stop con-

final stages, shows a correlation between training and adequate

sidering himself a student. It is a requirement to learn something

diagnosis.

every day with the patients, answer questions, solve doubts and fill

Finally, he is also considering cardiology as another specialty

gaps. So, teaching is probably the best way of practicing medicine,

for him in the future, even though he also wants to pursue his

since future doctors and patients depend on it.

career as a teacher and a researcher, just like his father did, an

As an internist, when Gabriel cares for a patient he commits to an accurate and timely diagnosis, it is very important, life

ophthalmologist and a professor at Universidad Nacional. Gabriel Ortiz is always committed to Colombian’s health.

JANUARY 2018 13

SEBASTIÁN QUINTERO Oncologic mastologist

10 PROMISING COLOMBIAN DOCTORS

then was admitted to the general surgery pro-

A WARRIOR ON DAILY

Cancer is one of the most difficult diseases to treat, and this mastologist from Bogotá spends his time searching for the best treatments. This includes becoming their friend. And he has also decided to live fully.

A

mong many things his patients have taught him life is feeble, so you must live fully. When we asked doctor Sebastián Quintero, an oncologic surgeon, a mastologist,

where does he find time to tend for his patients, operate, head his foundation, handle the breast cancer prevention campaign, rest and share with his family, he answers there is always time for everything.

This talented 41 year old doctor gradua-

ter that he studied at the European Oncology Institute in Milan, where he met doctor Umberto Veronesi, the father of mastology.

He then specialized in serology technique at Universidad de Barcelona, “but I still felt I was lacking knowledge, so I returned to Fundación Universitaria de Ciencias de la Salud, they gave me the mastology title, so I graduated in 2010”, the doctor explained.

He started working at Clínica del Country and Clínica Reina Sofía, both in Bogotá. “Doctor José Joaquín Caicedo, also a mastologist, invited me to Fundación Ámese to work with him on his social initiative with women with Photo: PERSONAL FILE

battle against breast cancer

gram at Pontificia Universidad Javeriana. Af-

breast diseases. I worked there for three years.

Then I decided to create IPS Integrative, with the goal of offering cancer patients, mental health services, as well as promotion and prevention, nutrition, genetic counseling and physical rehabilitation”.

Then he became the spokesperson for the campaign “More than just touching a tit”, a very well received initiative. And finally, he started a couple of years ago with Fundación Sebastián Quintero, an organization oriented towards cancer education.

“From there I work with related founda-

200% DEVOTED

tions, such as Avon, Ámese and Liga Contra

Today mastologist Sebastián Quintero, a suregeon specialized in the treatment and prevention of mammary benign and malignant diseases, as well as melanomas and soft tissue sarcomas, is the executive president of the council of Fundación Sebastián Quintero and the scientific director of Integrative Ips, an organization that works on the patient’s well-being through integrative oncology. He also works in his private practice and at Clínica Reina Sofía and Clínica del Country.

better”, he says.

ted from Gimnasio Los Cerros in Bogotá. He

el Cáncer. And the more things I can do, the

THE OUTLOOK For now, for doctor Quintero, it is troubling to consider statistics in Colombia are inaccurate, they are derived from 2012 Globocan.

“We don’t have a national population cancer registry, and comparing cities, the real number might be larger than current estimates and most certainly, it will continue growing. Cervical cancer used to be the most frequent cancer in women, but today it is breast cancer”,

confesses he was never very at ease with

La Sabana. “I wanted to be a neurosurgeon

numbers, while biology allured him. In spite

and then a cardiovascular surgeon, but when

According to doctor Quintero the good

his father is one of the pioneer mastologists in

I went to Instituto Nacional de Cancerología,

news is that breast cancer now considered a

Colombia, doctor Elías Quintero, in the begin-

I fell in love with mastology. It is a specialty in-

chronic disease, it is no longer a catastrophic

ning he did not intend to follow in his father’s

volving aspects from several specialties, plas-

disease. Quality of life has improved even for

footsteps. He rather considered being a pilot.

tic surgery, radiology, nuclear medicine”, he

patients with metastasis. “We are witnessing

And he is still convenience someday he will

recalls.

the development of new medicines, with ex-

he concludes.

Then he traveled for several months to

cellent results that will improve the patient’s

Finally he chose medicine, and graduated

Australia and returned for his social service

quality of life, such as immunotherapies and

in one of the first groups from Universidad de

year at Teletón. He graduated in 2003 and

directed therapies”, he explains.

learn how to fly.

14 JANUARY 2018

JORGE ENRIQUE MEDINA (R.I.P.) Nephrologist and rheumatologist Editor’s note A month after COOMTACTO magazine special edition was published, doctor Jorge Enrique Medina regrettably died. All the people that worked with him in the magazine as well as in Coomeva Medicina Prepagada deeply regret his demise. We want now to give our condolences to his family and associates, and to share with them our solidarity during these very difficult time.

The following text is based on an interview doctor Medina gave Betsabé Castro, one of our journalist in Cali on October 2017. We have decided to publish it in its digital format because doctor Medina had already authorized us to do so. We consider it a posthumous homage and also an acknowledgement of his outstanding career as a nephrologist and a rheumatologist for the benefit of the patients. Rest in peace and courage to his family.

“Medical research IS MY PASSION” He was an internist, a rheumatologist and a nephrologist, and enjoys being a researcher and a teacher. He has also been an excellent student, who is committed to clinical work and his students.

H

e was 38 years old (at

in particular diseases, for instance, you can see

the time of the interview

only lupus patients, register the data, and then

in October 2017), and

publish the findings. People respond to treat-

divides his time among

ments in different ways according to where

his patients, students,

they live, even in Colombia”.

research groups, his

HIS GOAL IS TO RESEARCH

athletic activities, the

family and his 4 pets.

His training and experience help his re-

Jorge Enrique Medina Rosas was born into

search, he has been able to document, com-

a family of doctors. “My father is a public health

pare and publish articles in prestigious journals.

specialist, my uncle a cardiologist and my my destiny lies”, says the doctor gleefully.

He was born at Sevilla in northern Valle del Cauca, but he grew up and studied at Popayán.

He works with the research group at CenPhoto: JORGE MEJÍA

brother, a colon surgeon; it’s easy to see where

tro Médico Imbanaco and with the groups he formed in Toronto. Canadian rheumatology guidelines are not like ours, so he wants to study these differences.

He was always an excellent student, and then

“There is a very interesting aspect: European

he studied medicine at Hospital Universitario

and American guidelines do not have some

del Valle, and then became an internist, a ne-

characteristics that are specific to some areas

phrologist and rheumatologist.

in our country. For instance, Chagas and ma-

“While studying, I found what really interes-

laria are very rare in those countries, so they

ted me weren’t the dyalisis, but clinical nephro-

de La Sabana, where one of the main interest

are not considered interesting research topics”,

logy and the immune diseases of the kidney.

areas is this disease.

he explains.

So I worked for sometime as a nephrologist,

“Research on this type of diseases started

He considers an early diagnosis give us the

and then decided study rheumatology”, he

with my teacher, doctor Fernando Londoño,

opportunity to offer an adequate treatments,

explains.

so we were always close to them, that gave me

decreasing suffering and improving the pa-

the opportunity of learning about it”.

tient’s, and his family’s, life quality.

PASSION AND DEVOTION

nada and in the south western Pacific region.

A DEDICATED STUDENT AND A CURIOUS PERSON

So his research is moving along in Ca-

He is an outstanding student and a re-

Also the doctor is an athlete: he runs 15 kilo-

“With my colleagues at Imbanaco, we have 3

searcher. When he was in his second year of

meters 5 times a week. His voyage to Canada

projects: the first one on rheumatoid arthritis,

residency, he was awarded a scholarship as

changed his mind set: he enjoys life, and he

we want to know why some patients develop

the best rheumatology resident by Asocia-

always has time for his mom, his sister and his

cardiovascular disease while others don’t, and

ción Colombiana de Reumatología. With the

three nephews.

we have been following these patients for 10

price money he traveled to study at Univer-

“There I saw the lives of those doctors.

years”. The second research project has to do

sidad de Toronto. And he was also awarded

Teachers were humane and calm, they took

with severe diseases in patients using biological

the Goeff Carr Lupus Fellowship scholarship

time to explain and share their knowledge.

medicines. He would also like to start working

in Ontario.

Now I am at ease with patients and students,

in a new project involving a strategic alliance

And as we speak he is doing an epidemio-

and I try to make it a pleasant experience for all

with radiology. “Some researchers say hand re-

logy master’s degree; he wants to research lo-

of them”. Medicine is his passion. “It’s a way of

sonance can show inflammation even in

cal infectious diseases and is also interested in

life, I love what I do, I am happy doing it”.

asymptomatic patients”.

spondiloarthropaties. He had the good fortune

He dreams of a research center, like the

of specializing in rheumatology at Universidad

one he saw in Canada. “They are specialized

He is very satisfied to know that most medical centers are interested in researching.

JANUARY 2018 15

JAVIER MAURICIO LOBATO Neurosurgeon

10 PROMISING COLOMBIAN DOCTORS

ABOVE ALL, devotion to service He works with a distinguished specialist group at Fundación Valle de Lili. With his hands, talent and professional commitment, he improves the life quality for epilepsy and abnormal movement patients. He is brilliant and humble.

“We have been able to correlate last generation diagnostic images with the epilepsy diagnosis. We have functional magnetic resonance, and we use it with particular guidelines that allow us to identify memory points, as well as language and movement areas, avoiding lesions in these crucial parts of the brain during the procedure. These treatments have changed dramatically”, explains doctor Lobato.

However, these procedures are not indicated for all patients. In epilepsy there are 2 considerations: “first, the patient is required to have had at least 2 failed medical treat-

Photo: JORGE MEJÍA

ments; and second, it must be a secondary epilepsy to a lesion, for instance a tumor or a cortical displasis”, he clarifies. In movement alterations there are also guidelines, as well as an extensive discussion within the

COMMITTMENT TO LIFE QUALITY IMPROVEMENT

interdisciplinary team. According to doctor

Neurosurgeon Javier Mauricio Lobato is an epilepsy and abnormal movements expert, he is also trained in radiosurgery and brain tumors.

He started studying medicine at Universidad del Rosario, Bogotá, and then he specialized in neurosurgery at Universidad del Bosque. Later he was a visiting resident at the neurosurgery department in the Mayo Clinic in Rochester, USA. He was also a functional and radiosurgery stereotactic surgery fellow at Pittsburgh University, also in the States.

Now he is doing a bioethics master’s degree at Instituto Borja de Bioética at Universidad Ramón Llull in Barcelona, Spain.

He is a neurosurgeon at Fundación Valle de Lili in Cali since 2006, and he is also part of their Research Ethics Committee and the Clinical Ethics Committee.

And he teaches neuroanatomy, semiology and neurosurgery at Univesidad Icesi in Cali.

He has published scientific papers and lectured both locally and abroad.

patients with dystonias, essential tremor and

J

Lobato, these procedures are indicated in Parkinson’s disease. “So we work on circuits involved in movement control, even though the disease will not be cured, symptoms will decrease”, he added.

Doctor Lobato and his team use the most recent advances, such as localization of the lesions with a 2 Tesla resonance, identifying precisely the brain nuclei where the electrodes should be placed.

“We want to increase the number of pa-

avier Mauricio Lobato Polo

Today he is 41 years old and a well-known

tients. We want to help a wider range of peo-

was born in Santander. His

expert on surgical treatment of epilepsy and

ple with these diagnoses. However these types

passion is the brain, that

movement alterations. Two abnormalities

of treatments are very expensive in Colombia,

magnificent organ made

that severely deteriorate the patient’s quality

because of the costs and the prolonged ap-

up mainly of neurons that

of life.

proval times within the health care system.

PATIENTS WITH LIFE QUALITY

surer’s administrative personnel about these

Doctor Lobato and his team talk to the in-

regulates the body. When he was young in Barran-

ca he started reading, particularly history

Patients requiring this type of surgeries

procedures, in order to increase the cover-

books. And he discovered neurosurgery in

from all over the country arrive at his office

age and reduce costs. “A patient might spend

a Reader’s Digest article he found once: it

at Fundación Valle de Lili in Cali. “In 2009 we

350 dollars (approx.) monthly in anticonvul-

was about a surgery on the children’s brain

formed a multidisciplinary group, including

sive medicines, and this cost increases for

stems, an exciting novelty in the 70s and

neuropsychologists, neuroradiologists, neu-

people do not live in big cities, because they

80s.

ropsychiatrists, neuropediatricians. We do our

have to travel far away in order to get them.

Since then he was fascinated by the way

best so that patients will have access to state

So the personal and social impact is huge”, he

the body works. His father was the head of

of the art and well indicated surgeries”, says

emphasizes.

Hospital de Ecopetrol at Bucaramanga, so he

doctor Lobato. At least 60 people with move-

For the time being doctor Lobato will con-

spent a great deal of his time reading medical

ment abnormalities and another 60 with epi-

tinue his research while working with the pa-

books at the library there.

lepsy have been operated.

tients with the best available resources.

16 JANUARY 2018

JULIANA GUTIÉRREZ QUICENO Odontopediatrician

THE TRUE CHALLENGE

is long standing and sustained prevention”

Photo: PERSONAL FILE

“There is no day I do not enjoy work, I simply follow my gut instincts no matter what”. She is a committed odontopediatritian in Risaralda.

E

ver since she

passed, and I understood I wanted to serve others in order to

was a girl, Ju-

solve my own conflicts, respecting others, naturally, so my

liana Gutiérrez

choices became medicine or dentistry, and finally I chose

Quiceno, a den-

this marvelous world”.

tist specialized in

For some it was difficult to accept. “A fifteen year old

odontopeditrics

living in a big city by herself, quickly I found that if I did what I

at Universidad

really wished, it turned into an adequate decision and it was

CES, she has had

worth taking those risks. Nothing’s impossible”, she says firm-

2 strengths: “the capacity to defend

ly, and after 2 years working as a general dentist, she studyed

my own ideas, a lesson I got from my

odontopediatrics.

parents, both of them are lawyers,

From the start, she knew she was going to make it. Her

and an inclination towards serving

devotion for children grew every semester, and one of her

people”, she explains.

teachers oriented and helped her a great deal during this

She used to enjoy playing

period. As a matter of fact they are now close friends. “This

doctor. But, “as time went

allowed me to choose this specialty, and start working pro-

by, I stopped being the

perly”, she adds.

doctor”, she started researching for health care

KEY ASPECTS

careers, like physiothe-

Integral attention requires commitment, a particular at-

rapy, psychology, nu-

titude, knowledge and skill, in order to change the point of

trition, medicine and

view of patient’s care. “I am inclined to work more every day

dentistry, as well

on prevention. While parents learn how dental problems turn

as laws. “Time

into diseases, they also find out more about available tools for them. The idea is to give each child the best possible experience, while improving dental health indexes”.

SHE ADORES EXPLORING NEW CULTURES Juliana Gutiérrez is a 29 year old dentist and an odontopediatritian born in Pereira.

She lived 10 years in Medellín. “I am thankful to that city, I was formed there in every sense. And in December 2015 I decided to return to Pereira. I missed my family and my boyfriend. But I also believed in my town’s potential, and decided to return. “It was the right decision”, she says.

Even though she works 12 hours a day, she has an active social life, not everything is work. She sleeps well, because she is very tired when she gets home. Her husband is a doctor, and they share the love of horses. She adores pasta and sangría. But she considers “traveling is the best investment, to be able to explore and meet new cultures, to become familiar with other ways of seeing the world”.

“There is no day, I do not enjoy work, I simply follow my gut instinct no matter what”, she says merrily.

Through her work, she wants to solve problems such as childhood dental cavities and malocclusion. Even though “they belong to different odontopediatric areas, they share environmental factors”.

So prevention is important. “To treat a patient with a problem and particular solution is one thing, but to make it last over the long term is quite another, and that is the real challenge”, she assures. As a matter of fact, her prevention programs covering Eje Cafetero are outstanding.

Parent cooperation is indispensable. “They convey the messages to the child. They are involved in the whole process, so we form teams that help us succeed”.

She also teaches at 2 dental faculties in Pereira, where she lives. “I enjoy academy, I think I will always be a teacher, it helps me help patients”.

JANUARY 2018 17

CARLOS ANDRÉS LORES Orthopedist

10 PROMISING COLOMBIAN DOCTORS

TECHNOLOGY, TALENT and team work save lives Robotic surgery helps bone cancer patients, and that’s this orthopedist’s passion.

T

o be an orthopedist is a privilege. Being able to

AT THE CUTTING EDGE OF TECHNOLOGY

help patients with limita-

Doctor Lores thinks technology has

tions, trauma, infections,

brought him the most satisfying aspects of

tumors, degenerative

his career. He is proud to work at an institu-

alterations, is very grati-

tion with such a group of experts, orthope-

fying”. These are doctor

dists, clinical oncologists, radioncologists,

Carlos Andrés Lores Restrepo’s words, an or-

pathologists, reconstructive plastic surgeons,

thopedist and a bone tumor surgeon at Cen-

interventionist radiologists and palliative care

tro Médico Imbanaco.

specialists, with high tech resources, like navi-

He specialized in oncologic orthopedics

gation systems and smart operating rooms,

and bone transplant reconstructive surgery

putting it on the par with the most advanced

at Hospital Italiano in Buenos Aires, Argenti-

centers in the world.

na, a well known world reference center. He

“I’m always in contact with all the spe-

works with bone and soft tissue tumors, both

cialties, and together we choose the best ap-

in adults as well as in patients with immature

proach for that particular patient. It is profitable

Photo: CENTRO MÉDICO IMBANACO COURTESY

skeletons.

to work with these professionals, we always

Magnetic resonance images together with

He is quite dedicated. He doesn’t pay no

do the best we can for the patients”, he adds.

computer axial tomography, in a Diacom for-

attention to schedules, because he carefully

Advances like navigation or computer

mat –digital imaging and communications in

evaluates each patient, taking into considera-

assisted surgery are available in Colombia,

medicine- are transferred into a navigation

tion his medical records, the physical exam

particularly for bone tumor patients. “It is diffi-

system – Kolibri ENT- that processes it and

and the diagnostic tests, looking for the best

cult to access lesions in locations such as the

combine them creating a 3D model. This

therapeutic alternative. And he is very trou-

column and the pelvis, but navigation allows

technology is used to plan the surgery with an

bled when patient arrive “with big advanced

a precise margin resection, keeping healthy

infrared camera, a monitor and a tracker, so

masses, making everything difficult, not im-

tissue available for reconstruction and a bet-

that the surgeon can now arrive precisely to

possible”, he adds.

ter prognosis”.

the site of the osteotomy.

“This achievement helps patients a great

THE PRIDE OF REPRESENTING VALUABLE PROFESSIONALS

deal, particularly those with cancer lesions in

“I’m from Cali, I grew up here and I love my city, I studied medicine and then orthopedics at the Universidad del Valle, at the University Hospital of the Valley,” exclaims Dr. Carlos Andrés Lores with pride. Then, with the rigor demanded by the career, he specialized in Oncological Orthopedics and Reconstructive Surgery with Bone Transplants.

He’s married; his wife is a pediatric surgeon, and they have two children, ages 7 and 6. “We like to go out to eat, enjoy the children and share with the family,” he says. Friends define him as a consecrated man and with a great spirit of service, the same one that accompanies him as a child and that was accentuated by seeing his father’s love for work. “I have had great teachers whom I admire and decided to continue, like my teacher Dr. Jorge Enrique Navia Giraldo (q.e.p.d.)”.

He is the president of the Colombian Society of Musculo-Skeletal Tumors, a chapter of the Colombian Society of Orthopedics and Traumatology. “It is a source of pride to represent a guild of people so valuable and recognized throughout the country,” he says.

cers, in other words metastasis. While others

18 JANUARY 2018

bone and soft tissues secondary to other canare primary bone and soft tissue tumors in any age patients, explains the doctor.

Knowledge generates more knowledge, and it must benefit society, so doctor Lores teaches and also heads the orthopedic oncology program, an alliance between Centro Médico Imbanaco and Pontificia Universidad Javeriana de Cali. Frequently he travels abroad to operate on particular cases.

“Thanks to this multidisciplinary treatment patients are no longer amputated and mutilated the way they used to”, doctor Lores sums up.

DIANA ALEJANDRA GARCÍA LONDOÑO Pediatrician

“I AM IN LOVE

with pediatric patients” Working with children is her daily joy; and she is particularly interested in nutrition, in order to prevent obesity.

E

ver since her childhood,

children and adolescents are obese. And in

Diana Alejandra García

Colombia, 1 in 6 children are obese, accord-

Londoño has loved to

ing to Encuesta de la Situación Nutricional

share, listen and help.

(Ensin) 2015. She wants to help, offering them

These characteristics lead

and their families the best available tools and

her into the medical world,

knowledge. As a matter of fact she is finishing

particularly with children

right now a specialization on pediatric nutri-

and adolescents, that’s

tion at Boston University.

why she chose pediatrics.

NUTRITION IS A KEY ELEMENT

Also: “when I was 8 years old, I was hos-

Doctor García Londoño considers a se-

at the hospital made me feel at home: they

vere problem of our culture it the associa-

celebrated my birthday and made me forget

tion between childhood, sweets, pizza and

for a moment where I was. So I decided then

burgers. “At school children tend to eat junk

I wanted to be just like them, a doctor that

food because their parents have the belief

could help patients”.

that it is not that important to take care of

She studied medicine and became a pediatrician. “I fell in love with the work with children, their energy and attitude, particularly with the way they cope with problems.

Photo: PERSONAL FILE

pitalized for 2 weeks. I was ill, and the people

their nutrition from childhood and also these food-stuffs are linked in some mysterious way with happiness. That’s where pediatrician start their work”, she tells us.

I learned from them. Their joy is contagious,

She has shifted her work’s focus: “by 6

and it makes it easier to keep them smiling

Nutrition is what interests her the most.

months after birth, I talk to my patient’s pa-

and accompany their parents throughout the

What troubles her is the alarming increase

rents about nutrition’s importance throughout

process”, she says.

in worldwide obesity, more than 223 million

the developmental stages. I answer their questions and give them alternatives”.

ATHLETIC AND ACTIVE Doctor Diana Alejandra García was born at Abejorral, Antioquia, she is 34 years old, single and lives fully every day.

“I enjoy waking up early in order to make the best of the day: I work in my private practice, I train daily for an hour at home with functional personalized exercises and usually I run 10 kilometers every weekend, I love nature”.

She studied medicine at Universidad Pontificia Bolivariana, at Medellín, and is a pediatrician from Universidad CES, also in Medellín, where she has been a teacher for the last 3 years. She has published research papers like “Perfil clínico de los pacientes con trastornos tiroideos y su respuesta al tratamiento” and “Ventilación mecánica en pacientes pediátricos con sepsis en unidades de cuidado intensivo pediátrico”.

But she also enjoys fine food, and likes to discover new restaurants where ever she goes. “I also enjoy history, reading about it, as a matter of fact, I’m reading right now about the cursed french kings”.

Mainly she is fascinated by puericulture, the medical area that studies the development of the healthy child, and provides education, sleep prophilaxis, behavior and positive discipline. “I’m inclined to the Montessori type of education, it offers excellent results”.

It is not only to give them a list of healthy things to eat, it is counseling them on alternatives in order to develop children with proper nutritional habits. “We must explain the international children nutrition guidelines, in order to avoid in the future diseases such as hypertension, diabetes and obesity. And this perspective involves the nutrition of the whole family, simply the best way to teach is practical, through example of good nutritious practices”, she says.

She feels happy when “I see children grow, feeling such a connection with them, as if I were a family member. My work satisfies me a great deal, and I want to do it in the best possible manner. I’m in love with pediatrics”, she says.

JANUARY 2018 19

ALBERTO LATORRE ABISAMBRA Interventionist radiologist

10 PROMISING COLOMBIAN DOCTORS

RADIOLOGY

He is the pioneer of interventionist radiology in the Colombian Caribbean. His perseverance took him along a road towards minimally invasive procedures that used to require surgery.

I

t was hard for doctor Alberto Latorre Abisambra when he first started working as an interventionist radiologist at Barranquilla. Only 20 years ago it was an almost completely unknown medical specialty. So he started teaching about the advantages of minimally in-

vasive treatments for some pathologies that used to require surgeries. It was not easy to accept that a radiologist could do things other than diagnosing through images. “I persevered and performed the first procedure 4 months after I returned to Barranquilla”.

There are several doctors within doctor La-

Photo: HAROLD BAKER

Another alternative within

PROFILE OF A VISIONARY Alberto Latorre Abisambra is a doctor from Universidad del Norte with a specialty in radiology and diagnostic images from Universidad de Cartagena, also trained in interventionist radiology at Clínica de Marly, Hospital San Ignacio and Fundación Santa Fe, Bogotá.

He is certified by Asociación Colombiana de Radiología recertification’s board. Also he is a Sociedad Iberoamericana de Intervencionismo (SIDI) member and an American Radiology Society associate member. And he is the scientific director at Cerid Imágenes Diagnósticas in Barranquilla.

torre’s family, and he chose medicine because of his wish to serve. Since he was a child, he saw his with shorter hospital stays and lesser surgi-

perform every interventionist radiology pro-

He specialized in radiology and diagnostic

cal morbimortality. Doctor Latorre has been

cedure in our country, and sometimes new

images at Universidad de Cartagena. Early on

awarded several times at Congreso Nacional

products arrive here first, because of the legal-

he started performing simple interventionist

de Radiología.

ization procedures in the States and the Euro-

father working “with great devotion to patients”.

procedures, self-taught, the specialty didn’t exist in Colombia at that time. “I found out

pean countries. And he is planning to create

ON THE CUTTING EDGE

about the advantages other diagnostic image

Doctor Latorre explains interventionist ra-

techniques could offer us, such as fluorosco-

diology is a wide field that is continually grow-

py, ultrasound and tomography, and also that

ing with new materials and techniques, either

we could get to parts of the body with direct

diagnostic or therapeutic, for any organ.

vision and a minimally invasive technique for diagnosis and treatment purposes”.

an integral unit for the diabetic foot treatment.

SHARING KNOWLEDGE GRATIFIES Doctor Latorre has lectured on these topics

“It is an evolving subspecialty. Thanks to the

in different institutions, promoting the advan-

industry’s support and the work interventionist

tages and benefits of interventionist radiology

Later on, in 1994, he was trained formally

radiologist do every day, techniques are always

in order to make it easier for the patients to

with doctor Héctor Espinosa García, the pio-

improving. For instance, we are now develop-

get the health care system to approve these

neer of interventionist radiology in Colombia.

ing new technologies for cancer treatment,

procedures.

He had already performed in 1975 the first ar-

as well as aneurism endoprothesis, medicat-

He teaches at the undergraduate program

teriography at Hospital San Ignacio. By 1999

ed balloons, biodegradable stents for arterial

at Universidad del Norte and also helped cre-

the first interventionist radiology program was

occlusive disease, new mycrocatheters and

ate the residence there in radiology and di-

established at Universidad de Antioquia.

embolization materials, always trying to get to

agnostic images. “This experience stimulated

Using several imaging modes “we are able

more peripheral areas, widening our field with

me to keep on researching and teaching”, he

to perform diagnostic and therapeutic mini-

complex procedures with excellent results and

adds. He thinks doctors should have ethics,

mally invasive procedures through access

less morbimortality”, he explains.

respect, humility and perseverance, and these

routes other than incisions”. The point is to

The best part is that in Colombia we have

decrease surgical and anesthesia exposures,

an excellent level in this specialty. “We can

20 JANUARY 2018

are the most important things he can teach students.

T

he disease burden, world epidemiology and the developments to cope with these grave tendencies that

negatively affect public health have quickly changed. On the one hand, morbimortality rates have changed and, on the other, early diagnosis and prophylaxis also modified prevalences, the onset age and therapeutic approaches, as well as the rehabilitation processes.

During the past 2 decades we have become more aware of mental health importance, particularly of depression and stress

10

The decade’s

biggest health issues 22 JANUARY 2018

increased prevalences, as well as aging and dementias, such as Alzheimer’s disease. As a matter of fact, the World Health Organization considers them research priorities.

Also, cancer, metabolic syndrome, heart and brain vascular diseases, together with pain, osteomuscular pathology, oral health and gestational, perinatal, maternal, child and adolescent health issues are considered of the utmost importance.

Minding all these facts, our 10year special edition COOMTACTO magazine includes this overview of the 10 most prominent health issues. We hope you enjoy these readings and that they are also useful for you.

ELDER’S HEALTH

T

he World Health Organization (WHO) launched a global program promoting active and healthy aging. It supports governments around the world to strengthen and increase

of medical and mental health services for the elderlies, integrating these strategies with state policies. It recognizes dementia, depression and substance abuse as high priority public health issue in this age group. They developed conferences, protocols and other tools to pro-

The challenge of

GET OLD in these times

While life expectancy increases, there is mounting evidence on the increase in morbidity, mortality and loss of functional capacity linked to mental disorders in the elderly.

mote geriatric health services.1 The population is living longer. The same organization estimates that between 2015 and 2050 people over 60 will almost double. They will go from 12% to 22% of the population. In other words, the group will grow from 900 million inhabitants to 2 billion. Until 1941, when

Photo: © 2018 SHUTTERSTOCK PHOTOS

penicillin was discovered, the average life ex-

according to WHO projections. A problem of

They can even find research papers that posem

pectancy was around 30 years old.

public health that affects health systems, to the

that up to 20% of people over 55 years have

society and the family.

had problems of this kind, and only 2 of every 3

So mental health at this stage so long, as changing, is such an important aspect as in any

On the other hand, approximately 15% of

other stage of life. Even, some would argue that

adults older people meet the diagnostic cri-

The most common problem in this field is

it is even more transcendental, because during

teria of some mental disorder, disorders that,

the limitation cognitive or dementia, particularly

this time the body and relationships with one-

globally, represent 17,4% of the years of life lost

the disease of Alzheimer’s It is estimated that

self and with others are transformed drastical-

by disability. And the group of anxiety disor-

they suffer from 11% of those over 65 years old.

ly and quickly. At the same time, globally, this

ders manifests itself in 3,8% of these people,

And when adding other types of dementia, the

population group continues to contribute to

while that the use of psychoactive substances

figure grows even more.2,3

family and social life. But also older adults can

contributes 1% of the mental diagnoses in this

On the other hand, it is much more likely

get there to lose autonomy due to limitations in

population. In fact, in this stage of life the risk

that older adults consult for physical symptoms

mobility, chronic pain, fragility, and sometimes

of employment increases of psychoactive sub-

that for mental symptoms. Even so, these disor-

require chronic care It happens that there are

stances. In addition, it’s estimated that about a

ders are have linked with physical disability, dis-

duels, deterioration of socioeconomic con-

quarter of the suicides are present in this age

eases Chronic diseases, dementia, neurological

ditions, disability, isolation, dependence. As is

group. Depression is a disorder that causes ma-

manifestations of diseases in other organs, the

known, health mental affects physical health,

jor disability among older patients 60 years old

environment inhospitable, the losses of loved

and the opposite. This is the case, for exam-

(see article on depression of this edition).

ones, the drug interactions, substance abuse

ple, of the elderly with illness coronary artery, a group that has a higher incidence of depres-

patients receive treatment.2,3

psychoactive, malnutrition.

RESPECT FOR THEM IS HEALTH

So, it’s essential to prepare the workers

sion, while, on the other hand, depression with-

In another order of ideas, an essential as-

in the health area and society in to meet the

out treatment is usually associated with a poor

pect for keep in mind is that older adults often

needs of the population growing, through train-

outcome among coronary patients.

are subject to physical, sexual, psychological,

ing programs of medical and paramedical personnel for the care of the geriatric patient.

On the one hand, neuropsychiatric disor-

emotional, financial and material abuse, as in

ders, without include headaches, represent

the case of abandonment, neglect, situations

But it also involves the design of public

6,6% of morbidity of people over 60 years old.

that they involve loss of dignity and respect. It’s

health policies that are sustainable and that take

Dementia is common in this age group (one

believed that about 1 in 10 adults over 60 years

into account the care long-term and palliative

of the best known types it’s Alzheimer’s) It is

suffer abuse.

for these patients, together with the develop-

estimated that in the world. There are current-

The data about health is amazing mental

ly 47,5 million patients with this disease, and

among the elderly. They can even find research

that by 2050 this figure will reach the 135,5 mil-

papers that pose that up to 20% of people over

lion people affected, most of them they living

55 years have had problems of the data about

in countries with medium and low incomes,

health is amazing mental among the elderly.

ment and construction of facilities and friendly services for them.

REFERENCES Data taken from the yearbooks of the American Psychiatric Society (www.psychiatry.org)

JANUARY 2018 23

THE DECADE’S 10 BIGGEST HEALTH ISSUES

DEPRESSION AND SUICIDE

The World Health Organization published “mental health allows a person to make the best of his potential, and face stressing vital situations, work and contribute to the community”, while mental problems and disorders are linked to incapacity and poor life quality1.

I

Photo: © 2018 SHUTTERSTOCK PHOTOS

MENTAL DISORDER burden in Colombia diagnosis, followed by hyperactivity, separation and generalized anxieties and defiant oppositionist disorders.

Among teenagers, approximately 1 in 10, that is 11,6%, have more than 3 anxiety symptoms, especially young females, while 15,8% have 4 to 6 depression symptoms, females

n Colombia, like in most other countries, problems and men-

also predominate with this disorder. But, on the other hand,

tal disorders are a large health care burden, and they tend to

only 2% have epilepsy symptoms and 10,1% suggest the pos-

increase. Together they are the fifth leading handicap cause,

sibility of a psychosis. The prevalence of any mental disorder

and when suicide is considered they become the third.

increases a bit in adolescence when compared to the infant

The World Health Organization has declared mental

population, it reaches 7,2%. Anxiety and social phobia are the

health care an urgent matter. It estimates 300 million people

most common, particularly among females, with a ratio of 2:1.

are diagnosed with mental disorders and problems. While

Among teenagers suicidal ideas occur in 6,6%, suicide plan, in

suicide is the second death cause between 15 and 29 years.

1,8% and suicide attempts in 2,5%. Is worthwhile to consider

Yearly, around 800 thousand people commit suicide.

that more than a third, 37,6%, of those who thought about

Encuesta Nacional de Salud Mental (National Mental

committing suicide, in fact have tried it.

Health Survey) 20152 describes the Colombian situation.

This a critical issue. It needs a proper approach by the

Almost half of the pediatric population, that is children be-

health care system. Suicidal ideas are thoughts about com-

tween 7 and 11 years, require evaluations by mental health

mitting suicide, while a suicidal plan goes even further, the

care professionals. Around a fourth of them, 27,6%, have one

patient makes a detailed suicidal plan and finally the suicide

symptom, while 10,35% have 2, increasing the probability

attempt is to carry out the plan, certainly a much more com-

of a mental disorder in the future; and 6,6% have 3 or more

plex circumstance.

symptoms. Among them, the most common are language abnormalities, anxiety, unexplained headaches, isolation and various learning disorders.

SUICIDE ATTEMPTS ARE MORE FREQUENT AMONG WOMEN In young adults, that is people from 18 to 44 years, this

DEPRESSION AND SUICIDE ARE THE MOST PREVALENT

survey found that 6,7% of them have 5 anxiety symptoms, while 4,17% have 7 or more depression symptoms, 1,2% epi-

The prevalence of structured mental disorders in the in-

lepsy and 7,01% psychosis. Also the prevalence of any mental

fant population is 4,07%, they are more frequent among girls.

disorder doubles, it reaches 9,1%. If you look at it this way, 1 in

In addition, attention deficit disorder is the most common

10 people in this age group meets these diagnostic criteria.

24 JANUARY 2018

As a matter of fact, it is estimated that in this group there is a

been exposed to at least one violent or traumatic event. And

higher mental disorder incidence.

of them, almost half, 46,8%, have one post-traumatic stress

In addition, diagnoses are more frequently made among

symptom, so the risk of developing the full disorder later on in

women, except for bipolar disorders. The most

life is close to 9,2%.

common are affect disorders, 6,7%, including

In contrast, a little more than a quarter of

the various types of depression. And it is also

the surveyed adolescents, 29,3%, has been

interesting to consider that the prevalence of

exposed to this sort of experiences, and their

these mental disorders is twice as much in the

consequences persist afterwards. The most

cities as it is in rural areas. They seem to be re-

common symptoms are: intrusive memories,

lated socioeconomic variables, suggesting so-

avoidant thoughts, talking or having active feel-

cial determinants are linked to mental health

ings related to the violent experience. Many

and illness in young adults.

patients continue having flash-backs and con-

With regards to suicide rates in this age

centration alterations.

group, 7,4% of the respondents thought about

Lastly, almost 1 in 10 young adults, 12,5%

suicide, especially women, while 2,4% planed

of them, has been exposed to a traumatic

it and 2,6% tried it. About a third, 35,9%, of the

event. This trend remains in older adults, 11,5%

people who have thought about it also planned

of them have been exposed to violence. The

for it and finally committed suicide. A very simi-

prevalent traumatic events in these two age

lar tendency to what happens with the teens.

groups are traffic accidents, violence by orga-

Suicide attempts are more common among women. About half of the people who have tried to commit suicide were involved in serious events. About a quarter of the women who try to commit suicide did it as a means to ask for help.

THE GRIM SITUATION OF THE ELDERLY Things change again among people over 45. At least 9,6% have 5 anxiety symptoms, 8,9% have 7 or more depression symptoms, while epilepsy is at 1,2% and psychosis symptoms is at 6,7%, they remain stable.

EATING DISORDERS AND PSYCHOACTIVE DRUG USE Eating disorders, such as bulimia, binge eating and anorexia, has a stable prevalence throughout life. Risk behaviors

According to the latest mental health survey in Colombia, in the group of women the suicidal tendency is more diagnosed.

nized and common crime, the armed conflict and family violence. Women tend to be more symptomatic.

In is also worth mentioning that in spite of the low perception of mental disorders, the few people that look for professional services to cope with mental health issues, among those who do, 90% of the receive some type of intervention in all age groups. So there is a lot to do for mental health in Colombia. Educational campaigns for the community are required, in such a way that Colombians can achieve a fuller and more satisfying way of life.

REFERENCES 1. WHO. Mental health: a welfare state [internet]. [cited 2014 Jun 3]. Available at: http://www.who.int/features/factfiles/mental_health/en/ 2. Ministry of Health and Social Protection, Colciencias, Pontificia Universidad Javeriana, Datos, Procesos y TecnologĂ­a SAS. National Survey of Mental Health 2015. BogotĂĄ: Javegraf; 2015.

can be identified in 9,1% of adolescents, 9,1% young adults and 9,5% of the elderly. The most prevalent risk behavior was binge eating.

With regards to psychoactive drug use, alcohol is the most commonly used. A fifth of the adolescents, 20,4%, drink, while almost half of the young adults, 45,8%, do and a third of the older adults, 33%, use it.

Tobacco is the second most used psychoactive drug.

And it increases with age: 5,8% of the teenagers smoke, while 15,9% of the young adults do and 20,9% of older adults use it.

Males account for the majority of smokers, while daily use is the most frequent pattern.

With regards to other psychoactives, marijuana is the most commonly employed after drinking and smoking. Other substances have a much lower consumption than cannabinoids.

It is estimated that 3,5% of adolescents use marijuana, 6,3% young adults and 2,6% of seniors.

Also the mental illness burden in Colombia is closely linked to national reality. Around 11,7% of the pediatric population has

JANUARY 2018 25

METABOLIC SYNDROME

THE DECADE’S 10 BIGGEST HEALTH ISSUES

Metabolic syndrome is a global threat.

Although a century has passed since it was first time described, good eating habits and regular physical activity remain the ways to prevent it.

The modern disease

AT LAST HAS A TREATMENT or 40 mg/dl for a man, and the blood glucose is over 100 mg/dl”, doctor Rico explains.

These diseases affect even children. Obesity triggers insulin resistance and, physi-

S

opathologically, this seems to be most

ince the late 20th cen-

important metabolic syndrome feature.

tury, metabolic syn-

It is often related to excess calorie in-

drome is the first

take and not exercising.

mortality causes in

AN EXPENSIVE DISEASE

Colombia. It involves ischemic heart and cer-

Metabolic syndrome is a pandemic

ebrovascular diseases, type

involving even type 2 diabetes mel-

2 diabetes mellitus and arterial hypertension

litus. It’s estimated that 400 million

(DANE).

patients around the world have it, so

Diagnosis depends on the used criteria.

that by the year 2035 there will be

Definitions appeared since the early 1970s,

600 million. In Colombia, according

but it is not easy, metabolic syndrome involves

to International Diabetes Federation,

several diseases. And that’s why its precise

there are more than 21 million affect-

epidemiology is so difficult to establish, ex-

ed patients.

plains endocrinologist Álvaro Rico, head at

Also it’s one of the most expensive

Fundación para la Investigación en Diabetes,

diseases. A survey by Fundación para

Endocrinología, Metabolismo, Obesidad y

la Investigación en Diabetes, Endocri-

Salud (Findemos).

nología, Metabolismo, Obesidad y Salud Photos: © 2018 SHUTTERSTOCK PHOTOS

This condition could affect around 30% of the adults, according to Consenso Colombiano de Síndrome Metabólico. It results from

in 2012 in 4,500 patients in Sogamoso, found that a diabetic patient costs the health care system around $13,800 USD

several metabolic abnormalities, increasing

yearly, close to 40 million pesos, on av-

cardiovascular disease and diabetes risks.

erage, in lab tests, visits to the physician,

Its awareness started with observations that

Diabetes Federation based its definition on

medication and hospitalization. “Diabetes

linked these diseases around the 1920s. “And

abdominal obesity, and it is now the most ac-

treatment remains deficient all over the world,

for a hundred years we have been confirming

cepted worldwide.

for every diagnosis of diabetes there are 3 of

the relationship between high blood pressure

Although abdominal perimeter varies

hypertension. And it is a disease with devas-

and increased blood glucose and lipids with

around the world, for Colombian, and the Lat-

tating consequences such as blindness and

cardiovascular diseases”, says Dr. Rico.

in American population in general, 90 cen-

chronic kidney failure”, emphasizes Dr. Rico.

But in spite of that only until 1966 endocrinologist Gerald Reaven noted the im-

timeters is the cut point for women and 94 centimeters for men.

Data from Fresenius suggests that there are 300 thousand people on dialysis in Co-

portance of the relationship between these

Recent evidence suggests that if obesity is

lombia. Diabetes alters life quality and shortens

factors. And in the 1980s he called it X syn-

added to at least two other metabolic altera-

life expectancy by 11 years. A high percentage

drome X, now known as metabolic syndrome.

tions, it is a metabolic syndrome. “For instance,

of the country’s health care budget (12,5% of

And only by the 1990s the World Health Or-

if the patient has high triglycerides, over 150

22,2 billion) is used to treat its complications.

ganization included it as a disease, and its

mg/dl, and blood pressure over 130/85 or HDL

“The resources are not going be enough,

criteria were extended, until the International

cholesterol less than 50 mg/dl, for a woman,

because diabetes, hypertension, obesity and

26 JANUARY 2018

dyslipidemia work together. Prevention is important, because not only does metabolic syndrome have severe complications, but also the economic consequences are grave”, insists the doctor.

Endocrinologist Enrique Ardila says death secondary heart attacks are related to overweight, no exercise, bad dietary habits and stress. While cerebrovascular diseases are linked to hypertension and diabetes, among other risk factors. “Metabolic syndrome has to do with them all, and it is increasing.”

Among adolescents and schoolchildren metabolic syndrome is also diagnosed and it is related to lifestyle and lack of exercise, youngsters spend ever increasing amounts of time in front of the TV set or playing with their electronic devices. “Although overweight and obesity management laws and prevention campaigns try to reduce sweet drinks intake

coronary and cerebrovascular events. “Obesity

measures, encouraging good eating and phys-

by increasing its price, they are not working

and insulin resistance contribute to vascular

ical activity habits.

that well. Nor have they controlled processed

dysfunction, they inhibit nitric oxide synthesis,

But obesity is increasing. Encuesta Nacion-

foods consumption”, says Ardila.

it promotes endothelial integrity, It’s the me-

al de Situación Nutricional (National Survey of

“Overweight prevalence in the United

diator of vascular homeostasis. As the body

Nutritional Situation) 2015, showed more than

States is 69%, and in Colombia habits are be-

mass index increases, vascular reactivity be-

half of the population is overweighed. Around

coming very similar. If obesity previously af-

comes abnormal, vasoconstriction increases,

80% of the population is urban, increasing the

fected the third and fourth life decades, during

as well as the tendency towards coagulation

metabolic syndrome risk. Diabetes is more fre-

the past 15 years it has become much more

and cardiovascular events”, writes internist and

quent in the cities.

frequent in children”, comments endocrinol-

endocrinologist Eric Hernández Triana in his

ogist Amanda Pérez, president of Asociación

endocrinology booklets for doctors published

Colombiana de Endocrinología.

by the Colombian association of his specialty.

According to World Health Organization (WHO), cardiovascular disease is the first death cause worldwide. In Colombia it is 16,7% of all

TREATMENTS Metabolic syndrome is an epidemic related to current lifestyle, such as not exercising,

THERE IS NO OTHER WAY BUT PREVENTION

urbanization, increased calorie intake and stress.

deaths, approximately 16,076 deaths are due

Metabolic syndrome prevention starts

In addition to pharmacological treatments

to heart attacks and other related diseases,

during pregnancy, embryonic nutrition affects

for each of the metabolic syndrome diseases,

according to DANE. Patients with metabolic

adult life. Ideally, according to specialists, we

exercise is the most important. Insulin resist-

syndrome have 1,5 to 3 times greater risk of

should act through effective public health

ance decreases 72 hours after starting daily physical activity. Also, improving eating habits

ARE HORMONE INVOLVED?

helps a great deal. As a matter of fact, some-

Marcelo Rubinstein, interim researcher at Research Institute On Genetic Engineering and Molecular Biology, studies the satiety mechanism. The culprit of its alteration is the POMC gene, he said about obesity in an interview for IntraMed (September 4, 2017). “We do not eat the primarily food sources, and in this sense edibles cannot be called food, so leptin and insulin receptors tend to desensitize, and we do not perceive satiety. So in metabolic syndrome there is a resistance to insulin, but also to leptin.”

According to the scientist, “the body asks for what we do not have and we eat what we have in sight. Few people have genetic metabolic syndrome. Doctors should ask type 2 diabetes patients about what they eat. Five meals a day should be demystifyed.”

Children tend to eat junk food because it tastes richer. But we live in a society that doesn’t teach the how to eat. “We have improved many aspects, but we still have to mind the way we eat”, suggests Rubinstein.

duce the risk and improve the physiological

times only these changes are enough to reand clinical conditions.

The World Health Organization says that for the first time in the last few decades life expectancy could decrease. “New generations could have shorter lives than the previous ones, “says Rico.

While diseases account for 60 million deaths, overall 40 million of them occur because of non-communicable illnesses, and 36 million are related to cancer, diabetes and cardiovascular disease.

JANUARY 2018 27

CÁNCER

THE DECADE’S 10 BIGGEST HEALTH ISSUES

Photos: © 2018 SHUTTERSTOCK PHOTOS

Science has been able to target

TUMORAL CELLS

S

It will be an increasingly common diagnosis, but, at the same time, there will be new developments that will help doctors fight it, reducing its mortality. And the World Health Organization says modifying habits is “cancer control most cost-effective long-term strategy”.

here are more than 14 million

been able to reduce these figures despite the

So cervical cancer is now second after

cancer patients worldwide,

fact that “between 30% and 50% of all cancers

breast malignancy, when 25 years ago it was

and during the next 2 decades

can be prevented with healthy habits, such as

the first, and in third place women have to-

this number will increase to

avoiding cigarettes, as it happens with other

day gastric cancer. On the other hand, gastric

22 million (Globocan, 2012).

public health measures, even though immuni-

cancer is the most common among men, fo-

The incidence of almost every

zations can work against infections that cause

llowed by respiratory and prostate malignan-

type of cancer is growing, and

certain cancers”.

cies, according to figures by the World Health Organization.

although some have decreased, such as male gastric cancer, the fact of the matter is that it will become a more and more common di-

COLOMBIA IS FOLLOWING THE GLOBAL TREND

Doctor Posso explains “gastric cancer remains the leading cause of death in men in

sease. Also 8,2 million deaths yearly are attri-

We make 71.000 cancer diagnoses each

Colombia, although it has decreased when

buted to neoplasias, according to the World

year in Colombia (Globocan, 2012). Doctor

compared to other years”. Also there is an in-

Cancer Observatory of the World Health Or-

Héctor Posso, a cancer epidemiologist, says

crease in lung cancer, “presumably an after-

ganization (Globocan, 2012).

our country is following the

math of smoking habits during the 1970s and

global trend. “Cervical can-

1980s, also related to gastric, lung and

improved things. As more is known about tu-

cer has been decreasing, even

mouth cancers”. Fortunately, smoking

mors and new therapies appear, some of them

though prevention has been

has declined, and that will

go directly to the DNA of the tumor cell while

difficult to imple-

probably reduce the num-

others prepare the immune system against the

ment. Mean

malignancies, during the last decade cervical

while, since the

cancer has declined, and now breast cancer

1970s, the risk and

has become the most common in women.

incidence of

gist Pedro Ramos,

This is a topic full of ambiguities. Today the

breast cancer tri-

director of Onco-

World Health Organization says we haven’t

pled in women”.

c a re a n d e d i t o r

But, on the other hand, research has also

28 JANUARY 2018

ber of related cancers.

Gastric cancer is troubling. Hemato-oncolo-

CHILDREN CANCER Cancers usually appear in people over 60 years; except for breast cancer that tends to manifest under 40.

“Around 5% of the cases are related to inherited genetic mutations. They have unknown causes, and it has been difficult to identify related environmental factors”, experts say at National Cancer Institute, USA. And during the past decades, according to the World Health Organization, there have been significant advances in children cancer treatment.

“For instance, acute leukemia was considered fatal only 30 years ago, and, even though it’s still the most common cancer in children, today it has a 70% survival rate in five years, so most of the patients do fairly well.”

tumoral cells. “When there are cancer cells, they have evaded the immune system, so medicines are being developed that will avoid this interference. Today there are molecules available for lung and bladder cancers, as well as for melanoma. Drugs that are used in advanced metastatic stage treatment, but in the future we will be able to use them early on”, he explains.

It is also stimulating that many more research groups are working and developing innovative protocols with the use of new drugs, exciting alternatives with a lot of potential against aggressive cancer forms.

And recently, the project Centro para el Tratamiento y la Investigación sobre el Cáncer (CTIC) was launched in Bogotá. It will be ready

of the Revista Colombiana de Hematología

“Isotopes are used to treat metastasis, for

in three years, with an approximate investment

y Oncología, has been researching risk fac-

example in lung cancer. The radiopharmaceu-

of 330 million dollars, announced entrepre-

tors in Nariño and the southern region of the

tical is combined with a protein, and this com-

neur Luis Carlos Sarmiento Angulo. He had

country, not an easy job. “Studies, mostly by

bination is used for diagnostic and treatment

the idea and also committed the funds for the

Universidad del Valle, find a link between en-

purposes”, explains doctor Posso.

project. Early diagnosis is an evident goal, but

vironmental variables and the incidence of

There are ample possibilities for these new

this type of pathology. Food produced there

tools. Already clinical trials are on their way

seems to increase the risk of gastric cancer in

on breast cancer treatment with radium 223,

that region.”

radium 226 and lead 212, for instance.

Although, prevention has advanced, the-

Oncology has evolved. It has a promising

re are concerns about it. It hasn’t reduced

future, while current therapies will disappear.

mortality. Doctor Ramos says it’s critical “to

More alternatives for patients will certainly im-

make an early diagnosis, because, except for

prove their life expectancy and quality. Doc-

cervical cancer, there has not been much

tor Ramos also pointed out a field that has

progress in this area in other tumors. Prostate

been researched for years: the stimulation of

cancer, for instance, is still diagnosed in ad-

the immunological ability of the host to attack

cancer prevention and research within the Colombian context are also crucial.

Recommended readings 1. wwww.globocan.com.fr 2. OMS, OPS, AIEPI. Early Diagnosis of Cancer in Chilhood.

Washington; 2014.

3. OMS. Oncological Profile by Countries. 2014. Available in: http://www.who.int/cancer/country-profiles/col_ es.pdf?ua=1 4. http://www.who.int/cancer/prevention/es/ 5. Guide to cancer early diagnosis. Available in: http://www. who.int/cancer/publications/cancer_early_diagnosis/en/ 6. https://www.cancer.gov/espanol/tipos/infantil/genomicainfantil-pro-pdq

vanced stages.”

MODERN THERAPIES For many years surgery, chemotherapy and radiotherapy used to be cancer treatment, and lately things have been changing.

Hormone therapies are now treatment alternatives for breast and prostate cancers, for instances, since they are hormone dependant malignancies. Medicines that affect hormone physiology can interfere with tumoral growth, improving survival rates. But these types of therapies do not work for all cancers.

New alpha-directed therapies are promising. As a matter of fact, they have good results on metastasic prostate cancer. They act directly on tumoral cells in areas of bone turnover. Since 2012 nuclear medicine has been using isotopes combined with certain drugs that have proven useful for the treatment of

IT IS TIME TO PREVENT CANCER RISKS Reducing cancer risks factors helps diminish up to a third of the all cases, but this strategy requires awareness and modifying habits and lifestyles. World Health Organization says it is “the most cost-effective long-term strategy for cancer control”.

Doctor Hernando Jaime, a specialist in sports medicine, highlights physical activity’s role, just to mention one of the main prevention aspects. He makes it clear, physical activity it protects against certain types of cancer, such as breast and colon. While physical inactivity is related to obesity, and it increased risks of breast, esophagus, endometrium, colon, rectum and kidney cancers.

Also, the World Health Organization refers to smoking. A risk factor related to 22% of all the annual cancer deaths worldwide. It has been linked to lung, esophagus, larynx (vocal cords), mouth, throat, kidney, bladder, pancreas, stomach and cervical cancers”.

advanced cancers.

JANUARY 2018 29

THE DECADE’S 10 BIGGEST HEALTH ISSUES

CARDIOVASCULAR DISEASES

Its prevention is one of the great

MEDICAL CHALLENGES Its morbidity and mortality have declined, but not as much as they should have. There are new treatments and devices, but not enough change in lifestyles.

D

espite all the progress in medicines and diagnostic equipment, together with the prevention and promotion campaigns, still a great challenge remains ahead for health authorities and governments in order to decrease cardiovascular diseaPhotos: © 2018 SHUTTERSTOCK PHOTOS

se, the main death cause worldwide.

World Health Organization indicates “every year more

people die because of cardiovascular disease than for any other reason, more than 18 million people on average, grossly 37% of all deaths”.

Many factors are involved. Some of them related to the modern way of life. Obesity is the 21st century epidemic, and inadequate diets, lack of physical activity, smoking and harmful drinking, are linked to it.

Others, says doctor Enrique Melgarejo, president of Sociedad Colombiana de Cardiología, are due to a “promotion and prevention insufficient impact”. As well as a relatively serious problem, that is doctor’s therapeutic inertia, together with patients that lack treatment adherence, particularly those that who have had diseases such as high blood pressure, diabetes, dyslipidemias or those who already have cardiovascular disease, such as a heart attack.

A FAVORABLE DECADE Despite the troubling cardiovascular disease worldwide situation, during the last decade there have been many technological advances and new medicines have appeared that help improve treatments. Minimally invasive surgeries are available for heart failure, synchronizing heart devices and even artificial organs. Doctor Antonio Figueredo Moreno,

SOME FIGURES ∞ According to DANE, the main death cause in Colombia is ischemic disease, including heart attacks. Out of 202.199 deaths in 2016, 16,3% were linked to it. ∞ Quality of Life Survey DANE-ECV suggests 8,3% of the population over 10 years smoke. This figure reached 8,6% in the cities, while it was 7,1% in rural areas. ∞ Daily, 857 heart attacks occur in Colombia, and annually there are 312 thousand cases. ∞ The main risk factors are dislipidemia, 49% are linked to high cholesterol levels, followed by obesity, diabetes and hypertension. ∞ According to World Health Organization, worldwide there are 223 million overweighed or obese children and adolescents. And, Nutritional Condition Survey 2015, found 51% of the population in Colombia is overweighed, 1 in 6 children satisfy this criteria.

head of the surgery department at Fundación Cardiovascular, Santander, says there are many innovations: “we have minimally invasive surgery so patients recover quicker, with less

Colombia is considered a pioneer in many of these de-

bleeding, pain and infection risk. Also, from the surgical point

velopments, particularly in artificial organs implementation.

of view, devices, such as valves, have evolved considerably.

Doctor Leonardo Salazar, head of the extracorporeal mem-

Heart failure improves with them, for example. And soon

brane oxygenation program and artificial heart at Funda-

we will be able to implant miniature mechanisms. Likewise,

ción Cardiovascular, explains that in 2007 he started using

stents have developed considerably”.

this technique. “After that, it become the hospital with more

30 JANUARY 2018

COMMUNICATION IS KEY

patients that use this technology in Latin America -on average, 80 users yearly-, and with excellent results.”

Then, on April 2014, Instituto Cardiovascular at Fundación Cardiovascular de Colombia became the first in South America to successfully implant a HeartMate II, an artificial heart that is now in its third generation. “These are devices designed to last for many years. The first one of them in the world was implanted 13 years ago, and the person doing well. Now we have patients at home, in their towns, with artificial hearts safely connected, living normally, without heart symptoms”, says doctor Salazar.

Heart disease diagnosis has also come a long way.

Non-invasive image techniques study arteries, coloring them according to their particular properties.

Also, during the 1950s there were only two antihypertensives medicines, and today we have nine.

Vascular biomechanics non-invasive studies have also improved substantially. These allow us to visualize changes

In 2014, the Cardiovascular Foundation of Colombia became the first hospital institution in Latin America to install an artificial heart.

It’s about the Heart Mate, which is already in its version III.

During the last decade several programs have intended to prevent cardiovascular diseases, but they haven’t been as successful as most would expect. Doctor Enrique Melgarejo supposes that “doctors do not communicate properly”. So he suggests medical coaching, in order to teach keys communication abilities to health care professionals, so that they will be capable of transmitting knowledge to the patient and his family, on topics like medicines and how to use them.

Although diagnostic equipment, devices and drugs have evolved, and together with prevention campaigns, they have achieved a reduction of the morbidity and mortality rates for cardiovascular diseases, there is still a long way to go. And this is linked to education, in order to change the lifestyles. That’s why the World Health Organization insists that “Most cardiovascular diseases are preventable, by changing behavioral risk factors, such as smoking, unhealthy diets and obesity, physical inactivity and harmful drinking, with strategies directed towards the whole population”.

And for those who are already ill, they should carefully follow the treatment.

Otherwise, arterial hypertension, diabetes, smoking, improper stress handling, dyslipidemias (that is, an increased bad cholesterol, a decreased good cholesterol or extremely high triglycerides), inadequate diets leading to overweight and obesity, in addition to genetic predispositions, will continue to cause vascular damage and their accelerated aging. All of these factors increase the risk of an early acute myocardial infarction, a stroke or kidney failure.

linked to aging and detect subclinical atherosclerosis, measuring the thickness of arterial walls, looking for cholesterol plaques, establishing arterial rigidity and other alterations.

This data helps predict a heart attack, up to 10 years ahead, and modify risk factors early on”, adds doctor Cristian Gabriel Ponce. He is a cardiologist and the founder of Cardiomec,

are treated with anticoagulants. “Today we have a whole new

the first Centro de Biomecánica Vascular, Hipertensión Arte-

generation of safer anticoagulants, with less side effects”,

rial y Cardiología.

notes doctor Figueredo.

AT A HIGHER RATE

in order to treat that particular form of arrhythmia. It is also

And also there are cases where pacemakers are required The probability of arrhythmias increases as the heart

interesting to consider these devices have evolved tremen-

ages. And of them the most common is the atrial fibrillation.

dously, as a matter of fact they are no longer external, they

An alteration derived from abnormalities of the heart’s elec-

can be implanted, they are miniaturized. Currently a research

trical conduction system. The biggest risk of this situation is

team lead by doctor Jorge Reynolds is testing a nanopa-

thrombi formation that can even get to the brain, causing a

cemarker: it weighs an eighth of what it used to weigh six

cerebrovascular event. That’s why people with arrhythmias

decades ago; it’s smaller than a rice grain.

JANUARY 2018 31

THE DECADE’S 10 BIGGEST HEALTH ISSUES

RESPIRATORY AND POLLUTION’S DISEASES

WITH HIGH IMPACT on life and economies Asthma and chronic obstructive pulmonary disease have become serious public health problems. Smoking is linked to them. There are advances in therapies and Colombia has been awarded for its smoke free spaces programs.

D

iseases that affect lungs are aggressive. During the last decade they have increased all over the world. They are mainly related to pollution, chemicals and dusts at workplaces, as well as smoking.

World Health Organization predicted 12 years ago this would be the fourth death cause by in 2030. Today chronic obstructive pulmonary disease is “the most

prevalent respiratory illness and with the highest global socioeconomic impact, even though it’s a potentially preventable disease”.

Despite multiple prevention campaigns all over the world, smoking continues to be the main chronic obstructive pulmonary disease risk factor. As World Health Organization explains, it is not a single disease, but a concept that involves several pulmonary ailments that tend to chronically limit the airflow in the lungs.

So, the 2030 agenda for a more sustainable human development, have given high priority to the fight against smoking. After all, it causes more than seven

32 JANUARY 2018

Some data that could take our breath away!

1. 20 to 40% of smokers have chronic obstructive pulmonary disease.

2. The National Institute of Health reported that by 2030 smoking will be linked to the deaths of 10 million people each year, and 70% of these deaths will happen in underdeveloped countries.

3. In the meantime, in a chronic obstructive pulmonary disease publication by Ministerio de Salud y Proteccion Social (2014) says that 325 million people worldwide are asthmatic while 64 million have chronic obstructive pulmonary disease.

4. In Colombia, the Prepocol (2008) research calculated an 8,9% chronic obstructive pulmonary disease prevalence in people over 40 years. It also says, “smoking is highly related to it, while wood smoke is not very far away from it, both in women and in men”.

million deaths yearly worldwide. It also strengthened Convenio Marco para el Control del Tabaco.

During the World Day without Tobacco, José Fernando Valderrama, deputy head of Chronic Noncommunicable Diseases at Ministerio de Sa-

According to official MinSalud data, in our country smoking is related to 20 thousand deaths yearly.

lud y Protección Social (Colombia), says “chronic noncommunicable diseases cost 24 trillion pesos annually to the healthcare system in Colombia, and tobacco is one of the direct causes of this disease burden”.

TOBACCO IS THE ASSASSIN According to official MinSalud data, smoking is related to 20 thousand deaths yearly, that is 10 to 12% of the total mortality rate in Colombia.

It’s worth remembering that this problem includes exposure to second hand smoke, the one that emerges from a smoker and reaches somebody else. For Mayo Clinic specialist, Steve Ames “second hand smoke inhalation is as risky as smoking directly, because it contains the same chemicals smokers inhale directly”.

Doctor Amy Pollak, a specialist at the Mayo Clinic, says “chest pain or lacking air with effort are

The whole point is to strengthen programs,

symptoms that can be related to several diseases,

campaigns and strategies, raising public awa-

no only cardiovascular. It can be a manifestation

reness about smoking. It’s worth noting that

of a pulmonary disease, such as a pulmonary

during the last 10 years Colombia has won inter-

embolism, but also esophageal spasm or other

national recognitions for its programs, involving

underlying lung diseases, such as chronic obs-

companies, health care personnel, citizens and

tructive pulmonary disease, asthma and physical

the government. With 2009 Law 1335, Law on

unconditioning”.

Tobacco Control, part of the Ten-Year Public

To go to the doctor in time is one major re-

Health Plan (2012-2021) and the Ten-Year Can-

commendation; to get an accurate diagnosis,

cer Control Plan (2012-2021), that establishes

start an adequate treatment and avoid compli-

goals for tobacco control, also in the National

cations. Diagnostic techniques have improved

Development Plan 2014-2018, one of the soca-

tremendously in recent years, for example, stress

lled 4x4 strategies, “involve the four main risk

tests, with or without nuclear medicine.

factors of chronic noncommunicable diseases, including smoking”.

Likewise, Practical clinical guidelines based on evidence for prevention, diagnosis, treatment and monitoring of chronic obstructive lung disease in adult populations, includes activities to quit smoking.

Guidelines explain “although smoking is the main cause, only 20 to 40% of smokers develop chronic obstructive pulmonary disease”, there are other risk factors, in addition to the genes. Another global concern, particularly increasing pollution in the cities. Only in 2015, 16% of deaths worldwide were related to diseases linked with pollution. These are data that appeared in a paper by 40 international researchers, in a number that just appeared a month ago, of The Lancet, a British medical journal.

SUGGESTED READINGS 1. Ministerio de Salud y Protección Social, Dirección de Promoción y Prevención, Subdirección de Enfermedades no Transmisibles.

Enfermedad pulmonar obstructiva crónica (EPOC). Bogotá; 2013.

2. Caballero A, Torres-Duque CA, Jaramillo C, Bolívar F, Sanabria F, Osorio P, et al. Prevalencia de EPOC en cinco ciudades colombianas situadas en baja, media y elevada altitud (Estudio Prepocol). 2008.

3. Organización Mundial de la Salud. Enfermedad pulmonar obstructiva crónica (EPOC). 2016.

4. www.who.int/respiratory/asthma/es/ 5. http://gpc.minsalud.gov.co/gpc_sites/Repositorio/Conv_500/ GPC_asma/gpc_asma.aspx 6. Hamid Q. Pathogenesis of small airmays in asthma. 2008.

7. Wieshammer S, Dreyhaupt J. Dry powder inhalers: which factors determine the frequency of handling error? Respiration; international review of thoracic diseases. 2008.

8. Nicoli G, Scichilone N, Bizzi A, Papi A, Fabbri LM. Beclomethasone/formoterol fixed combination for the management of asthma: patient considerations. Therapeutics and clinical risk management. 2018.

9. Scichilone N, Contino A, Figlioli GB, Paglino G, Bellia V. Patients perspectives in the management or asthma: improving patient outcomes through critical selection or treatment options.

Patient preference and adherence. 2010.

1 in 10 Colombians have asthma Every decade asthma world prevalence increases by 50%.

This fact gives an idea of the dimensions of the problem. It has been related to genes, but also to environmental stimulus, smoking, contaminated environments and mites are the most common. World Health Organization estimates there are about 325 million asthma patients worldwide.

In Colombia, Clinical practice guide for the diagnosis, comprehensive care and follow-up of children with asthma diagnosis says “14,2% of the population could have the disease, it can start at any age, with several causes”. But one of the problems is incorrect diagnosis.

Doctor Flavia Logrado, Respiratory and Pain Line medical advisor at Mundipharma Argentina, recently visited our country. She said “asthma affects all countries, both children and adults, even though it has certain variability, so it is not the same during the day.

Symptoms manifest suddenly. It’s key to establish if they appear after exercise, at night or during the day, if the lack of air interferes with activities, that is, how much it affects life quality “.

With current treatments it’s possible to control it, though not cure it. Doctor Logrado explains patients can count on “medications that control symptoms and treat the cause, particularly the central small airway inflammation; and there are also rescue drugs, that treat symptoms, while combined therapies control and rescue patients with the same device”.

She insisted it is required to study the patient and make a diagnosis. “Many cases improve with a proper treatment. A child could have no more asthma symptoms until adolescence or maybe never again, and many patients do lead perfectly normal lives”. There is a huge difference for these patients.

JANUARY 2018 33

MOTHER INFANT HEALTH

THE DECADE’S 10 BIGGEST HEALTH ISSUES

MOTHER AND CHILD are central to medical attention

Prenatal care is fundamental to life. There are guidelines and campaigns that truly help, but they are not homogeneous over the whole country.

I

t is important to establish preeclamp-

of the mother developing preeclampsia “, ex-

while 97% of the births ocurred in hospital set-

sia risk during pregnancy, for the mo-

plains the doctor.

tings. Also these findings are related to impro-

ther and the child’s sake. Following it

The World Health Organization –Who- has

vements in prenatal care, benefiting 97,5% of

and the maternal urinary proteins after

made it clear “among pregnancy hyperten-

the women between 13 and 49 years, 98,9%

the 20th week of gestation, can lead

sive disorders, preeclampsia and eclampsia

of them in the cities and 93,7% in rural areas.

to a safer birth.

are related to major morbidity and mortality

Also 95,9% of them received specialized at-

Specialized monitoring and care

for the mother and the infant”. In spite of that,

tention during childbirth, 99% of them in the

reduces risks of premature birth and major

they can be prevented. “Providing a timely and

cities, while 88,1% did in rural areas. And 99,4%

complications. “It is the combination of a

effective assistance during pregnancy”, points

received postnatal care, while 97% of the births

medical history, the obstetric ultrasound and

out the publication “Prevention and treatment

took place at hospitals”.

blood markers measured in the clinical labora-

of preeclampsia and eclampsia (suggestions)”.

research director at Fundación Cardiovascular of Colombia.

During the last decade Colombia has improved its care system during the pregnancy.

tory”, says geneticist Norma Serrano Díaz, and

PROGRESSES THAT SAVE LIVES

They became the focus of medical services

National Survey Demography and Health

and the communities. In 2013, Ministerio de

Among the currently studied blood prote-

(ENDS 2015) shows certain progresses in heal-

Salud y Protección Social took an important

ins, there is the placental growth factor. “Low

th care: “90% of the pregnant women have

step these matters, it published: Clinical Prac-

levels of this marker suggest a high probability

access to four or more prenatal check-ups,

tice Guide (CPG) for the Prevention, Early

FOR THE MEDICAL PERSONNEL

Photos: © 2018 SHUTTERSTOCK PHOTOS

Clinical Practice Guide of Pregnancy, published by Ministerio de Salud y Protección Social on 2013, recommends warning all pregnant women about the need to visit doctors if they have some of the symptoms linked to preeclampsia, eclampsia and HELLP syndrome: • Severe headache • Visual alterations, such as blurred vision or phosphenes • Epigastric pain • Vomit • Pelvic pain • Face, hands or feet morning edema.

Also, it recommends the first prenatal check-up appointments should last at least 30 minutes.

34 JANUARY 2018

THERE’S STILL A WAY TO GO

Detection and Treatment of Compli-

In order “to have a healthy preg-

cations of Pregnancy, Childbirth or

nancy, mothers and fathers must

Puerperium.

be healthy. Both, mother and father,

So, maternal health care is now

should go together to the precon-

a public health priority in Colombia.

ception appointment and then to the

As a matter of fact, one of the objec-

prenatal checkups, ensuring a healthy

tives for the year 2021 is “95% of the

pregnancy, and after giving birth also

pregnant women between 13 and 49

for the follow-ups that will come”.

Technology supports all these pro-

years old will have at least four prenatal checkups”.

cesses, with tests such as “the obste-

The national goal is to prevent

tric doppler, a widely used study that

pregnancy risks. It’s important for

diagnoses and monitors risky patho-

“future mothers to control their preg-

logies during pregnancy. Also fetal

nancies on each of the 3 thirds of

echocardiography, it details the fetal

gestation. Only then can timely atten-

heart in search for abnormalities, whi-

tion, adequate risk management and

le the neurosonography assesses fetal

proper pathology detection, can be

nervous system. And amniocentesis is

effective”, says doctor Fernando Gó-

performed in order to study the fetal

mez Corredor, head of the obstetrics

karyotype or to diagnose intrauterine

service at Clínica de Marly (Bogotá,

infections”, explain experts at Clínica

Colombia).

Marly.

MILLENNIUM OBJECTIVE 5 “Improve maternal health” is the 5th Millennium Objective, for UN According to the WHO, progress is considerable. “Since 1990 the maternal mortality rate has decreased 45% worldwide, most of it after the year 2000. More than 71% of the births by 2014 were cared for by trained health care personnel, while in 1990 it was only 59%”.

OPS-CLAP (Centro Latinoamericano de Perinatología y Desarrollo Humano) and World Bank, found in 2012 Haiti had the highest perinatal death rate in Latin America, 25 deaths per 1.000 live births, followed by Bolivia and Guyana, with 19 per 1.000 live births each, and Dominican Republic with 15 per 1.000 live births.

While in Colombia the rate fell from 24 per 1.000 live births on 2.000 to 17 in 2005 and then to 14 per 1.000 live births in 2015.

The latest epidemiological reports by the National Institute of Health (week 20, 2017), says throughout the year 185 cases of maternal deaths have been reported to Sistema Nacional de Vigilancia en Salud Pública (Sivigila).

Caring for maternal health is a high priority in Colombia.

By 2021 it is expected that 95% of all the pregnant women between 13 and 49 years have at least 4 prenatal controls.

Even though during recent years there have been improvements in the attention for future mothers, doctor Miguel Barrios Acosta, a pediatrician a puericultor and a professor at the pediatrics department at Universidad Nacional, considers “these maternal mortality figures should go together with those of perinatal mortality. And this is not the case”.

Perinatal mortality, that is infant deaths occurred between 28 weeks of pregnancy and 7 days after birth, has decrease, but not as it was been expected.

In the public health surveillance protocol “perinatal mortality and late neonatal mortality”, is 14 deaths per 1.000 pregnancies over 7 months of pregnancy. It’s been cut in half since the 1990s, when it was 28, while it came to be 14 by 2015, even though this is not a homogenous figure all over the country. Chocó is over of 39, San Andrés and Providencia, as well as Caldas are around 25.

“The main challenge at this time is to decrease perinatal mortality rates”, he adds.

According to MinSalud, the first five perinatal mortality causes are: respiratory distress syndrome, respiratory diseases, birth hypoxia and asphyxia, digestive ailments, as well as placenta and umbilical cord complications.

JANUARY 2018 35

THE DECADE’S 10 BIGGEST HEALTH ISSUES

CHILD AND ADOLESCENT HEALTH

Infant mortality decrease, a

GREAT ACHIEVEMENT There are advances like the consolidation of the vaccination scheme, but low breastfeeding rates and young people suicide are major concerns.

T

he infant mortality rate decrease from 18 to 14 deaths per 1.000 live births under a year, as shown by National Survey of Demographic and Health (ENDS 2015), is encouraging. While in the 1990s, this rate was 27 cases per 1.000 live births, “a 48% decrease”, says Alejandro Gaviria, the then Minister

of Health and Social Protection.

“Some indicators have improved significantly, parti-

cularly those related to the decrease of the child mortality rate. That really makes a difference. We now are honoring international commitments in this area”, says Miguel Barrios Acosta, a pediatrician and a puericultor, and a professor at the pediatrics department at Universidad Nacional.

He refers to point 4 of the Millennium Objectives (United Nations): “To reduce the children under 5 mortality”. Colombia has advanced during the last decade. The UN 2015 report states the global mortality rate for children under 5 has decreased by than half, from 90 to 43 deaths per 1.000 children born alive between 1990 and 2015. Since the 90s this mortality rate has decreased by a third worldwide.

A report of the program Así Vamos en Salud (In Health we go by this way) says “Colombia has a tendency decreasing deaths in children under 5. Since 1998 mortality related with acute diarrhea has declined to 3.31 deaths per 100 thousand children under 5 by 2015”. At San Andrés y Providencia, Cundinamarca, Guainía and Guaviare there were no deaths of this type; while Vaupés, Vichada, Amazonas, Chocó, Cauca and Magdalena were way above the national average.

VACCINATION, A NEW FACE During the last decade Colombia has implemented successfully its Programa Ampliado de Inmunizaciones. And today it is an example to follow for the rest of the region. It was a difficult process. As a matter of fact it had a crisis between 1990 and 1999, when vaccination rates fell.

Technology has helped. Through web pages, applications and social media, campaigns were strengthened and made

36 JANUARY 2018

THE CHALLENGE OF PROMOTING BREAST FEEDING Doctor Miguel Barrios Acosta refers to an embarrassing reality “the breastfeeding reduction”.

“In 2010, the national average of exclusive breastfeeding was 2,2 months, while the World Health Organization recommends 6 months, and a recent update (ENSIN 2015) suggests a decrease to 1,8”.

Although, Colombia is committed as one of the Friendly Institutions to Women and Children, and designed Ten-Year Plan for Breastfeeding (Plan Decenal de la Lactancia Materna a 2020), in order to encourage this healthy habit, creating breastfeeding rooms and implementing National Strategy de Human Milk Banks (Estrategia Nacional de Bancos de Leche Humana), 9 in all in the country, and the goal has not yet been achieved.

E

NDS 2015 showed a two-percentage points decrease in teenage, 15 to 19 years, pregnancy rate. It went from 19.5% in 2010 to 17.4% in 2015. An important achievement that benefits youngsters.

Juan Carlos Vargas, scientific advisor at Profamilia, highlights it and explains this goal has required a lot of work: “ the young taught us how to do it, in a sense they said: ‘Don’t scare use telling us what we already know, instead give us appropriate tools to protect our sexuality’. And when we stopped handling

their sexuality, and began giving them pertinent information, they started taking care of themselves, and we saw the results”, explains the expert.

In 2015 came “I take care of my future; my dreams instead of a pregnancy”, led by the ICBF and supported of Profamilia. The idea was to inform youngsters about having a life project, without missing out on opportunities nor losing them because of an unwanted pregnancy.

For doctor Vargas the right way is to listen and commit young people in these strategies.

TEENAGER’S HEALTH

known. Such is the case of Jornada de vacunación de las Américas, on the last week in April for the last 15 years. Together with messages like “Vaccines protect and love you too”, “If I’m in the cradle, I got to get a shot”, and Bogotá became a nationwide leader on the subject with “Every day is vaccination day”.

So, after adding the vaccine against chickenpox into Programa Ampliado de Inmunizaciones in 2015, it came to include 21 immunizations against 25 diseases.

“We are doing well on vaccines, even though there is still

On the other hand, a topic that has not been as successful is decreasing violent death rates among adolescents.

“Homicide is by far the first death cause among adolescents, 12 to 18 years. A real public health challenge”, says doctor Barrios.

In the last Medicina Legal report, by the closing of this edition, 1,541 youngsters had died between January and August 2018, because of causes related to homicides, car accidents, accidentally and suicide.

Also, another alarming issue is the high incidence of ill-treatment and child abuse. According to Medicina Legal, every two hours a child is brought there because of these issues. With a huge impact on physical and mental health, see the article “Load of mental illness in Colombia” within this edition.

“Abuse can seriously harm the brain.

It also causes deformities, blindness, disability, enduring emotional scars, cognitive, emotional and social development impairments, even death”, says Carlos Alberto Montoya Marín, a pediatrician at Red de Afecto Manizales Contra el Maltrato Infantil.

DATA SHOWS THE OUTLOOK • Through resolution 2465, issued on June 14th, 2016, Ministerio de Salud y Protección Social adopted anthropometric indicators to establish references and cut points for the girl nutritional status, as well as adolescents, adults up to 64 years and pregnant women. These are the World Health Organization’s recommendations for children growth and development.

• According to National Survey of Nutritional Situation in Colombia (ENSIN 2015), 1 in 6 children has overweight or is obese.

• Between January and August 2017, Instituto Nacional de Medicina Legal y Ciencias Forenses reports 1,816 children and young people died of:

room for improvement on some issues: for instance, on

AGE

CAR ACCIDENTS

ACCIDENTS

the human papilloma virus vaccine against serotypes

10 to 14 years 53

66

89

67

16 and 18, covering well over 85% of cervical cancers.

15 to 17 years 390

197

74

98

18 to 19 years 457

181

61

83

Despite that, coverage has declined because of beliefs”, says Barrios, for whom “this is a huge challenge”.

HOMICIDES

SUICIDE

Source: Reporte de tasa de homicidios del Instituto Nacional de Medicina Legal y Ciencias Forenses. Consolidado a agosto de 2017.

JANUARY 2018 37

MUSCULOSKELETAL AILMENTS

THE DECADE’S 10 BIGGEST HEALTH ISSUES

MODERN MAN CARRIES a very heavy “load” on his back Due to different factors, including stress, the loads in bones, tendons and muscles increase, causing deformities and incapacitating injuries. You have to know “how to walk”.

T

he sedentary lifes-

of life, few people stop to review how

tyle, obesity, and

they walk, sit, sleep, or pick up objects,

poor postural hygie-

and, what is worse, they uncounsciously

ne have become a

adopt postures that produce increased

very dangerous triad

load on the spine, disappearance of nor-

for the health of the

mal physiological curves, injuries, devia-

musculoskeletal sys-

tions and pain.

tem, a set of problems that is increasing in the colombian population.

These three factors are of great im-

their spine to overexertion and modern

portance in the genesis of spinal pain,

life, centered on the digital age, cyber-

now the leading cause of pain consulta-

netics, in which the number of people

tion. “The sedentary lifestyle decreases

who work hard in front of a computer for

muscle power so necessary to main-

whole days, of children sitting in front of

tain its proper functioning, preser-

the electronic devices and games, with

ving its curves and phsyiological

poor adoption of the correct postures

axes. These physiological curves,

and in prolonged sedentary position,

which are observed mainly in the

have repercussions in the organism, be-

saggital plane, that is, when loo-

ginning with the damage of the inverte-

king at the person on the side,

bral discs.

are fundamental for biomecha-

With all this, we are facing a worrying

nics of the spine, when some of

reality: “There are more musculoskele-

them are altered due to insufficien-

tal problems in the current population

cy in muscular work, an imbalance is

that have been growing progressively

produced, which is the cause of the

in the last decade, some of them rea-

pain”, explains Dr. Luis Padilla Dra-

ching chronic or incapacitating cases,

go, orthopedist, specialist in Surgery

with levels of pain that affect the quality

and Vertebral Pathology.

of life”, says Dr. John Jairo Hernández,

The obesity that has increased

coordinator of the Clinic for Pain Relief

in children and adults, within its

and Palliative Care of the University of

Photos: © 2018 SHUTTERSTOCK PHOTOS

many complications, ostensi-

38 JANUARY 2018

Experts agree that industrialization, the increase in people who daily expose

Rosario –Méderi-.

bly affects the musculoskeletal

And a fourth factor could be inclu-

system, especially the back and

ded in this list and it is the increase in the

lower extremities.

life expectancy in the population, which

The third aspect is postural

entails not only that people live longer,

hygiene, related to the adoption

but that the impact of injuries and bad

of a correct posture when perfor-

postures is greater given the aging of the

ming the different activities of daily life;

muscle itself. Hence the fundamental

what happens now is that, because of

thing that is to take care of oneself from

the immediacy or the accelerated pace

an early age.

SOLID ADVANCES

procedure and the hospital stay. In

While the physical problems in the

many of these techniques, especially

population grow, medical science is

in the case of vertebral deformities,

on the lookout for options to mitigate

permanent monitoring of the nervous

or reduce its impacts. In this decade

system, central and peripheral, is used

we can speak of great advances in ima-

during the surgical procedures, which

ging that have enriched the methods

warns of the danger of injury to them”,

to make a good diagnosis and, there-

explains Dr. Padilla.

fore, define a good treatment. Among

There was also an advance by leaps

today´s options, which accompany

and bounds in the placement of screws

traditional X-rays, are high-resolution

and now there are methods that gui-

tomography, magnetic resonance,

de its introduction. “Before we did it with Rx and this sometimes led to a

musculoskeletal ultrasonography and

wrong placement”, complements the

nuclear medicine.

specialist.

Another favorable aspect has been given in the issue of pain ma-

Regarding the pharmacological

nagement, with evident progress in

treatment of pain, today there is a new

recent years. “There are excellent al-

generation of medicines that are more

gesiologists who have contributed

efficient and, for chronic cases, there

to its relief with innumerable means,

is a range of opioids with fewer side

including invasive methods, such as epidural and facet blocks, the use of radiofrequency and the implantation of “pumps” that are placed inside the vertebral canal to make a continuous analgesia”, explains Dr. Padilla, for whom “Asociación Colombiana para el Estudio del Dolor (ACED) has contributed to these advances. The same applies to the Spine Chapter of the Colombian Society of Orthopedic Surgery and Traumatology”.

In the surgical field, science has

THE CHALLENGE OF CARING FOR THE BACK

The most important thing is to make an accurate diagnosis, given that multiple structures are involved in the lumbar area.

effects if they are properly managed.

In his opinión “analgesic interventionism has increased considerably , but the prevalence of the situation has not diminished , progress is still dramatic, all efforts are aimed at improving the quality of life of patients, especially in chronic cases.” The challenge then is very great: “Maintaining physical activity and work with adequate control of symptoms, using analgesics for a short time”, says Hernández, for whom “part of the challen-

offered many advances in recent

ge is that staff become aware of the

decades.

importance of improving the quality

Some of the interventions are less invasive and reduce the time of the

of life, and not just focus on removing the pain at any price”.

“VERTEBRAL” FIGURES According to VIII National Pain Study of Asociación Colombiana para el Estudio del Dolor, in the last six months, 76% of the people surveyed said they had presented some type had presented some type of pain and “64,5% of the causes of pain were related with the musculoskeletal system”.

In those who presented acute chronic pain associated with musculoskeletal etiology (bones, tendons and joints), the most frequent pains were of lower limbs and back with 28,8% and 23%, respectively, followed by upper limbs (13,2%), neck (11,9%) and hip (11,5%).

70% of patients with chronic pain received treatment for pain. And this was related to taking medicines (94,5%), domestic remedies (46,6%), physiotherapy (40,9%), alternative medicine (29,7%), surgery (17%) and blockages (12,6%).

32% of the people surveyed with chronic pain reported having had work incapacity for this cause: between 1 to 10 days, 73%, and more than 10 days, 27%.

SOURCE: ACED. VIII National Pain Study (Colombia).

Back pain continues to occupy the second place in the world in the prevalence of pain.

“This area of the body is one of the most important, because a large part of the support and motor movement of the body revolves around it”, says Gerardo Casas, orthopedist, spine specialist at the Imbanaco Medical Center. He also explains that the most common origin of this pain is usually physical, due to bad postures; emotional factors, such as stress, anxiety, depression; and even overweight and chronic constipation.

It is a disabling condition, in up to 70% of cases, which demands high costs for treatment in disabilities, “At this moment, it is the second cause of disability pensions for active-duty personnel. Physical efforts continue to be the most frequent cause in the working population” says Dr. John Jairo Hernández, coordinator of the Clinic for Pain Relief and Palliative Care of the University of Rosario - Méderi.

In 90% cases are benign and 10% of them can be caused by more complex or larger lesions, such as herniated discs, rheumatic diseases, fractures or tumor processes.

“The use of analgesic drugs, muscle relaxants and forms of therapy are indicated in most of the acute processes, behavioral therapies, improvement of physical condition, changes in working and psychological conditions, are determinants in the management of recurrent or chronic lumbago”, indicates the Imbanaco orthopedist.

JANUARY 2018 39

ORAL HEALTH

THE DECADE’S 10 BIGGEST HEALTH ISSUES

O

ral diseases affect 3.900 million people and between 60 and 90% of children worldwide suffer from tooth decay. The figure is from the Atlas

of Oral Health 2015, from the World Dental Federation.

Current data show that untreated caries in permanent teeth has a global prevalence (averaging all ages) of 40%. In Colombia, the Natio-

A CHALLENGE

despite the advances Caries is considered to be the most widespread chronic disease in the world and is still a public health challenge. The good news is that during the last decade there have been great advances in odontology.

nal Study of Oral Health (Ensab) IV 2013 - 2014 recorded that 56% of the population had an un-

care for the European Union was estimated

treated caries and 11% had lost a tooth for that

in 79 thousand million euros (annual average

reason. Although the figures are not the desired

2008-12), while in the United States alone more

ones, they do show ample progress in the re-

than 110 thousand million dollar were spent.

duction of the disease, but it does take into ac-

Dental spending also adds up to investment

count that in the previous decade (Ensab 2005)

in medical matters in homes. In all the countries

this figure reached 36,9% and caries affected

of the Organization for Economic Coopera-

95% of the population , over 20 years old.

tion and Development (OECD), the average

Precisely, the dentist Christian Salazar, reha-

payment of dental care paid by the patient re-

bilitation specialist, affirms that the panorama of

Photos: © 2018 SHUTTERSTOCK PHOTOS

presents about 55% of the total expenses of

oral health has improved in the country in the

tooth loss, according to the Ensab. “Oral health

dental care.

last ten years, in par, due to the population´s

campaigns have been aimed mainly at the child

In addition, mouth and tooth pro-

access to information about the importance

and school population, with little or no conti-

blems share common risk factors with other

of taking care of the teeth, especially through

nuity and sustainability to educate in oral care

non-communicable diseases (NCDs), such as

the media. However, he points out that there is

for young people and adults. It has also been

cardiovascular, respiratory, cancer and diabetes,

still much to be done, because more than tech-

identified that people perceive that the respon-

which increases the burden. These factors in-

nology in treatments, in which Colombia is at

sibility of oral care is individual and they are not

clude unhealthy diet (rich in added sugars) and

the forefront, it is about promoting preventions,

always provided with information to improve

tobacco and alcohol consumption..

especially in the vulnerable population. It should

their conditions and they do not have resources

be remembered that for some time (in the 80s)

(social and economic) to have the proper care”.

it was believed that a good alternative to decrease caries was the fluoridation of the aqueduct in

The burden of the disease

Colombia, but the disposition ended in the early

World Health Organization (WHO) estima-

90´s. Since then, salt is the only food that con-

tes that oral diseases rank fourth in terms of

tains fluoride, a measure also questioned today.

treatment costs. The annual value in oral health

Not only tooth decay…

The oral health of Colombian people in these times is also affected by periodontal diseases, which increase as age advances; traumas, congenital anomalies such as cleft lip and/ or palate, infections, cancer and premalignant lesions.

For the case of periodontal disease that begins with gingivitis and has a prevalence of 70% (year 2014), the problem is that it can progress towards periodontitis, with the consequent destruction of the maxillary bone. In 15% of the population ends in tooth loss (edentulism) and after 65 years of age occurs in 30%.

There are multiple reasons that lead to

40 JANUARY 2018

RECOMEMENDED READINGS 1. IV National Oral Health Study (ENSAB IV) https://www. researchgate.net/publication/306646030 IV Estudio Nacional De Salud Bucal – ENSAB IV Situación de Salud Oral 2. Atlas of Oral Health of the FDI, April 2015 http://www. fdiworldental.org/media/77552complete _oh_atlas.pdf 3. IQUEN National Biweekly Epidemiological Report http:// www.ins.gov.co/iqen/IQUEN/IQEN%20vol%2019%20 2014%20num%206pdf

ODONTOLOGY IN THE DIGITAL AGE The advances in dentristy for Colombia have been enormous in recent years: we went from having analog to digital odontology, and advance that ensures greater precision and quality.

This allows, for example, that today, imprints with molds can be replaced by a digital scanner with an intraoral camera that records the images of the teeth and configures a virtual model of the patient´s mouth. In this way the procedures can be planned more accurately. One of them is digital surgery for the replacement of dental pieces with implants. With the new tools it is possible to review the digital imprint and combine it with a TAC, to have a better guide that ensures the precision when locating the tooth before placing the permanent implants. The best thing about these procedures is that they ensure effectiveness in the long-term results”, adds Dr. Salazar.

Another modern technology is known as Cerec, which, through a latest generation software, designs and prints dental restorations in a few hours in 3D (with the use of computer-aided design, CAD). This tool is ideal during smile design, because it reduces the processes almost half the time and makes them less painful.

While it is true that technology and research in odontology in the country goes hand in hand with developed countries, the costs limit access, but beyond overcoming this barrier, greater health promotion and prevention of the oral disease is needed.

HUMANITARIAN AID

Coomeva in solidarity with

VICTIMS OF IRMA The Medical Management of Coomeva Prepaid Medicine International Business, in alliance with Sarpa, has offered humanitarian aid since last September for those affected by hurricane Irma in the Caribbean islands.

O

n September 6th (2017) the hurricane Irma, category 5, lashed the island of Saint-Martin, leaving in its wake a large number of serious damages and human and material losses. The following day at the request of the Ministry of Netherlands, the Management of the Insurer ZUK (BES Health Insurance) and Fundashon Maradial Hospital of Bonaire, Coomeva Prepaid Medicine International Business and Sarpa (air ambulance company) began a humanitarian aid operation under a principle of cooperation, in order to provide support to the victims of the Caribbean islands.

In this effort, the Internal Business Area, represented by professionals from BogotĂĄ, MedellĂ­n and the Medical Management of Coomeva Prepaid Medicine, joined the logistical coordination group of local evacuations in order to collaborate in the support of communications and addressing of the efforts among the different islands: Curacao, with the St Elizabeth Hospital (Sehos); Aruba, with Dr. Horacio E. Oduber and the HOH Hospital; and Bonaire , with Fundashon Mariadal. All of them worked together in the locative management of the victims, in order to speed up and optimize remissions of the most complex cases to Netherlands, country to which the islands belong.

Since then, more than 30 flights have been organized to carry hundreds of patients among the islands of Saint

Photos: PERSONAL FILE

Eustatius, Aruba, Curacao and Bonaire with the aim of guaranteeing the continuity of their medical care and the transportation of supplies to Saint-Martin, which is recovering little by little from the disaster and works in the reopening of its local medical center and in the restart of the activities its insurer. Meanwhile, Coomeva MP remains attentive to what those affected by Irma may need.

JANUARY 2018 41

TOWARD THE FUTURE

TAKING CARE OF YOURSELF IS LOVING YOURSELF: promises of value of Coomeva MP More than a campaign, the concept of “Taking care of yourself is loving yourself” is a real commitment with our affiliated families for the future of their well-being, the fulfillment of their goals and their lives in general. Our promise of value is based on: Author: Mauricio Castillo Pérez Strategy and International Business Manager - Coomeva Medicina Prepagada

1

Prevention as a central axis: It is the reason for our actions and our projection.

We bet in all our efforts to the health industry, rather than to the disease.

2 Capacity of resolution: Everything revolves around the customer; it means that processes , accesses, and procedures are not barriers, but facilitators, insofar as they minimize time, maintain accompaniment and develop multiple and efficient access channels, weighed in 100% compliance.

5

4

Network of benefits: Select, quality, committed, timely, close and, above all, knows its customers, close to their places of influence with preferential entry for our patients, turned into a true ally .

7

Flexible rates: “If I take care of myself, you reward me”. That would be the phrase that summarizes the new orientation of the organization, which is based not on thinking from the corrective cost, but from the demand with preventive mission.

Taking care of yourself is loving yourself.

It rewards your care and your fidelity: based on the stimulus- response model and under the technological systems that allow the permanent follow-up of our users. “Taking care of yourself is loving yourself” always will reward those who think about themselves, their families ad their environment.

Therefore, the rate plan is in accordance with your goals. The idea is that the balance of body-mind-health to be real

Opportunity: The goal is always to respond to customer´s times and his/her expectations on time.

Products: Segmented by life cycles, they allow from the prevention, the handling of each patient according to what he/she needs.

Modern brand: We are a brand that goes to the rhythm of life and the change of consumers. We are “taking care of yourself is loving yourself” a kinesthetic brand aimed at patients who love themselves and therefore take care of themselves.

10

8

6

Focus in the life cycles of customers: With special emphasis on the young population, we facilitate access to everything that allows them to take care of themselves and have well-being.

9

In the market towards the next 10 years • Vertical integration strengthened as a

differentiating variable in the supply of collective plans, more competitive rates for companies, a functional model that generates demand for the benefit.

• Decrease in category players by the

acquisition of populations and infrastructure to be more competitive versus each bidder, guaranteeing population growth.

• Growth of insurance policies and PACS

and high level of competitiveness for the

42 JANUARY 2018

3

Technology: It is in the service of the customer´s needs in order to overcome the competitor´s supply and make it a fundamental part of the service.

population that seek to migrate to these subcategories.

- Development of products tailored to customer needs by consumption regions.

- Creation of differentiation models through risk management in healthy service models and memorable customer experiences to generate a real and tangible value to the user.

Tenemos la fórmula

para protegerte Póliza RC Médica Coomeva

En Coomeva conocemos y entendemos los riesgos a los que estás expuesto, por eso te protegemos con nuestra póliza RC Médica.

Algunos beneficios: Asesoría y acompañamiento de abogados expertos en defensa de los médicos, desde la etapa pre procesal hasta el fin del proceso.

Cubre los perjuicios patrimoniales (lucro cesante) y extra patrimoniales (perjuicios morales, fisiológicos y de vida en relación), sin afectar el amparo básico por errores u omisiones involuntarios.

Cubre los eventos que se presenten durante la vigencia de la póliza o el periodo de retroactividad contratado.

Adquiérela en nuestras oficinas y asegúrate hasta por $1.500 millones.

Cooperando es posible Línea Nacional: 01 8000 950 123, Cali: 333 0000, Bogotá: 748 1515, Barranquilla: 361 9800, Pereira: 316 9300, Medellín: 415 7700, Palmira: 273 3302. Opción 4.