|TUFH 40TH ANNIVERSARY SPECIAL PAPERS: PRACTICAL ADVICE PAPER
|Year : 2020 | Volume
| Issue : 2 | Page : 66-69
Posta las lilas: A model of integral commitment to the community
Maria De La Paz Grebe1, Angel Martin Centeno2, Soledad Alvarez De Campos2
1 School of Psychology, Faculty of Biomedical Sciences, Austral University, Buenos Aires, Argentina
2 Department of Biomedical Education, Faculty of Biomedical Sciences, Austral University, Buenos Aires, Argentina
|Date of Submission||20-Jul-2019|
|Date of Acceptance||23-Jan-2020|
|Date of Web Publication||08-Dec-2020|
Maria De La Paz Grebe
School of Psychology, Austral University, Av. Pte. Perón 1500 (B1629AHJ), Pilar, Buenos Aires
Source of Support: None, Conflict of Interest: None
Background: The Posta Sanitaria Las Lilas (La Posta) is a health promotion project of the medical school. Its purpose is to improve the health of individuals and the society by fostering qualitative changes in people’s attitudes and habits in relation to every aspect of their health. The project serves a population of 25,000 inhabitants that live in conditions of vulnerability and poverty. It is based on a specific approach to social commitment and accountability that integrates teaching, research, and care with the whole community. Activities: The project activities are oriented toward key dimensions for each person and the community. There are two programs: health and education that involve physicians, students, residents, teachers, volunteers, and community members. Outcomes: The project has increased the number of medical appointments, medical records, and workshop participants. It is difficult to establish objective indicators that may reflect the changes in the life of the community members. In this article, findings of an impact evaluation study are presented. We also describe unexpected results for those who participated in the project. Conclusion: La Posta is part of the University’s agenda and a place of meaningful and formative learning. All program activities are implemented with the support and resources of the institution. A network of various organizations cooperates with La Posta in order to help promote the welfare of the community. They are all committed to contributing to the development of project participants’ personal resources rather than merely addressing their unmet needs. This requires thinking about people in all dimensions (biological, psychological, social, and spiritual).
Keywords: Human development, integral community commitment, social accountability approach, social promotion
|How to cite this article:|
Grebe MD, Centeno AM, Campos SA. Posta las lilas: A model of integral commitment to the community. Educ Health 2020;33:66-9
| Background|| |
Austral University is an Argentinian private institution of higher education, which was founded in 1992. The Faculty of Biomedical Sciences started their activities in 1996 and the Austral University Hospital in 2000. Both institutions form the Health Academic Center that develops teaching, research, and care activities. The Center is located in the city of Pilar, 54 km away from Buenos Aires (capital city of Argentina) with a population of 300,000 inhabitants.
Posta Las Lilas (La Posta) emerged as a social promotion project, very close to the University in 2007. Its main goal was to guarantee and improve the health of the local population at both the individual and the community levels. The project represents an expression of our institutional mission: to serve the society by focusing on each individual considering all human dimensions (biological, psychological, social, and spiritual). Such extension activities are an essential part of the university’s pursuit of its mission by influencing the community not only to promote the holistic development of the people involved, but also to cover the needs of a vulnerable population. Thus, the project’s social commitment is more than addressing unmet needs. It is to encourage others to develop their own resources and potential in order to achieve their individual well-being while learning together.
After more than 10 years, it has made a positive and significant impact on the quality of life of participating individuals and at the same time nurtured deep links with the community as a whole. Its activities are based on a concept of integral health where social health determinants are considered an essential aspect of the development of people.
Focus is also placed on the characteristics of the context in which this project is developed as a key aspect of the social accountability model. Reality provides a complex context that is understood in a broad sense, involving environmental, cultural, motivational, and social aspects.
The purpose of this article is to describe the main characteristics of a project that enlightens how a successful social accountability model has been built by this faculty.
| Context|| |
Argentina is a country with high levels of poverty, so helping to solve this problem is a challenge that requires sustained projects with a long-term vision. With this ambitious goal and with the institutional mission in mind, faculty members, physicians, and students at the Academic Health Center created La Posta in 2007.
It is located in the neighborhoods Las Lilas and Monterrey where there are 25,000 inhabitants. In the beginning, a situational analysis was done to identify environmental and demographic characteristics and the most prevalent health problems. Many of the people in these communities live in vulnerable conditions: no garbage collection, no sewers, no running water, and some mud streets. Most of the population is between 15 and 64 years old with sporadic access to health care. Sixty-five percent have not completed primary school and housing is overcrowded in 12%. The most prevalent problems identified were nutritional diseases; respiratory, oral, and dental health; ophthalmologic conditions; violence; and addictions.
The start-up of the project required the establishment of an agreement with the municipality of Pilar that authorized its operation and granted the faculty autonomy in its management. Today, it is the only primary health-care center managed by an educational institution in the total public system of Pilar. The activities take place in a building lent by the local social promotion group. It was conditioned to be suitable for the Posta activities done in a warm, safe, and comfortable place that guarantees patient safety.
The sustainability of the project comes from the interaction and links with collaborating institutions and partners within the same University. Since the beginning, a massive consumer company helps to pay for some operational expenses (secretarial help, power, and water). The faculty–Hospital collaboration makes it possible for some physicians to spend institutional time there (representing specialties such as obstetrics, primary care, internal medicine, dermatology, and ophthalmology). In this way, patient care is provided within the framework of the activities of an academic health center, with physicians, residents, and students-in-training working and learning together. Other resources come from the medical school itself, which has assigned a priority role to this project. The explicit commitments of all these actors provide compelling evidence for the sustainability and long-term development of this project.
| Activities|| |
All the programs are based on a specific health-care and educational approach, which includes:
- Interdisciplinary and collaborative approach to community problems: The goal to improve health is achieved through the working together of physicians, residents, students, teachers, nurses, psychologists, social workers, and the patients too. Each team member has a specific approach to the problem or disease, but the solution is only possible when they achieve a comprehensive and holistic perspective
- Continuous linkage to development and knowledge transfer: Everything that happens at La Posta is considered a “learning opportunity.” Students experience practical learning and the impact of these on themselves and others, in circumstances and scenarios that arise in both formal and informal situations
- We conceive the function of extension as the integration of teaching, research, and health care. In this way, La Posta is not just an extension of the academic center, but is included in the academic agenda and curriculum of the faculty
- Integrated view of each person considering his/her ties and context. The core value is the person, and this is the key to designing and developing programs at La Posta. Solidarity is not only welfare, but also a deep value of reciprocity oriented to the other, considering that while something is being done for someone else, it can, at the same time, enrich the person doing it.
The following specific activities are included:
- Health-care program: Internal medicine, gynecology and obstetrics, pediatrics, nursing, dermatology, child and adult ophthalmology and psychology, child dental care, social work, general surgery, cardiology, and imaging diagnosis
- Program of community education: There are workshops on health promotion based on the most frequent and prevalent problems. The training of community members as health promoters has contributed to engaging people to change their habits and attitudes
- Student volunteers from different careers lead a school support program based on cognitive stimulation for children from 6 to 12 years old and complement this by simultaneously carrying out research on cognitive development. The cognitive assessment of these children and the design and implementation of this stimulation is done by psychology students, but the volunteers in the program are from medicine, nursing, law, and psychology schools [Figure 1]
- Other support activities include pharmacy that delivers free medication to patients, clothing donations, and a school of sports (soccer and hockey). There are three annual campaigns to promote welfare in different aspects of family’s life: bringing basic schooling elements, celebrating the Family Day, and the Christmas celebration.
|Figure 1: Increase in the time of the participants in the school support program|
Click here to view
| Outcomes|| |
- Growth in the number of people that received health care and education programs [Figure 2]
- Adherence to treatment: In mental health care, 90% of the patients are completing their therapeutic process. In this area, we observed one of the unexpected results: three patients became monitors of the community after completing their treatment in some relevant problems: family violence, self-esteem, and environmental care. They became full partners in the health-care team, including in the health program; they can positively influence in attitudes as well as skills and knowledge in the social determinants of health to the whole community
- In 2015, a study of impact of the project was completed and developed new indicators, as follows:
- Accessibility and proximity of the people: Nearly 82% goes to the clinic when they have a health problem, and 83% considers it more accessible in timing. Forty-two percent have been going to La Posta for over 2 years, and 73% has recommended it to family or friends
- Health-care quality: Proximity to their home makes it easy for them to attend, and the warmth of the physicians and all the health-care team has been remarked. They feel they are listened to, are understood, receive clear explanations, and, most of all, they are treated well
- Integral and personalized care that goes beyond medical or health care. Respect for each person is recognized. Collaboration is seen not only as a material thing (they mention free diapers, milk, and medication), but also how they are cared for as a person, considering his/her welfare and health
- Patients feel they own the Posta, facilitating the accessibility, commitment, and openness to the community. It is a place where they can learn about health care and change their habits. This has a multiplying effect in the community. They also highlight the comprehensive care and the knowledge transmission through workshops that generate empowerment
- The professional team recognizes that personalized and humanized treatments are the key factors in providing care. In addition, an interdisciplinary approach and effective team functioning are essential.
The impact of the project on student learning and attitudes was examined through students’ (volunteers) respondents in relation to the meaning of the activity they do in La Posta [Figure 3].
|Figure 3: Graphic N°3 main reasons why students (volunteers) go to the Posta|
Click here to view
In addition, they say that during this work in La Posta they gain significant but unexpected experiences. In the students’ own words: “It helps you to be a better person,” “enriching both personally and professionally,” “helps you to be more humble and to see reality.”
| Future Directions|| |
This project is already consolidated and is now at the amplification stage, with the objective to function 6 days a week in 2020, expanding the reach and providing more services to the community. The availability of more resources to sustain and expand this proposal will be necessary. A new sponsoring model of the planned expansion is being analyzed.
The academic health center needs to work more collaboratively with the whole University community to develop better efforts to help solve the problems of a vulnerable population. It needs to strengthen the relationships between all stakeholders, both externally to all of the La Posta community and internally to the Austral University to envision new activities, and to amplify the work already being done. A further challenge has been to work with the public health system to address limitations and to take advantage of resources.
From the management of the project, better indicators and tools for measurement are needed.
Lastly, it is necessary to develop a research model to evaluate the impact of the unexpected significant learning on all actors, which has been a challenge for the academy. How little actions can change the life stories of students, faculty members, doctors, and community people is a real and frequent occurrence for which scientific evidence and measurement is still lacking.
| Conclusion|| |
La Posta is a significant project based on an institutional decision and in the core of the mission, reflects a comprehensive and contextual approach to the social accountability of this academic health center. The mission to “serve the community” is backed up by real institutional support and investment, not just a mandate.
This initiative shows a systematic effort to address the social determinants of health through a structured program organized around a logical plan. The project history involved the development of a new and wide range of educational and transformative experiences. These experiences promote meaningful changes for students, teachers, other professionals, and patients.
The project develops in a bidirectional sense. What happens at La Posta mirrors what happens at the mother institution (the faculty) and viceversa. In an increasingly complex reality, the project’s ability to demonstrate more efficient and effective new initiatives is tested continuously.
Institutional logic requires developing a horizontal model of decision-making, and problems are shared and solved through teamwork. A multidisciplinary and interdisciplinary working team is necessary to achieve effective functioning.
Establishing connections with all members of the community, with the public health system, and with other companies and institutions will guide all future interactions, building a strong and sustainable impact on the community.
Financial support and sponsorship
There are three sources of funding. The main is from the medical school that assigned a priority role for this project. It pays for the salary of the professionals that work exclusively for la Posta (director, nurses, and psychologists) and the rest of operational expenses. Secondly there are funds from the Austral University Hospital that pay for health providers time. And thirdly from a private massive consumer company that supported the project since the beginning.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Wartman SA, Steinberg MJ. The role of academic health centers in addressing social responsibility. Med Teach 2011;33:638-42.
Koens F, Mann KV, Custers EJ, Ten Cate OT. Analysing the concept of context in medical education. Med Educ 2005;39:1243-9.
Boelen C, Dharamsi S, Gibbs T. The social accountability of medical schools and its indicators. Educ Health (Abingdon) 2012;25:180-94.
Brunelli MV, Centeno AM, Desmery C, Sayal M, Moll F, Morandi J, et al
. Evaluation of interventions in health at the Posta, internal working document 2015, unpublished.
[Figure 1], [Figure 2], [Figure 3]