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Building a Primary Care Center Through Interdisciplinary Collaboration 

Disruptive Innovations
Typography

Background 

La Posta Sanitaria “Las Lilas” (La Posta) is a social extension and promotion project, founded in 2007 by the School of Biomedical Sciences of Austral University. It is located in the district of Pilar, north of the capital of Argentina. Pilar is the second locality with the greatest social and economic disparity in Buenos Aires, that is to say, the people who live there lack purchasing power and face conditions like extreme poverty and a lack of access to health care and education. La Posta is located just 5 kilometers south of the University that provides care for a population of 25,000 residents whose problems are related to unemployment, homelessness, hygiene and food, family violence, addictions, crime, teenage pregnancies, malnutrition,  dropping out of school, and a lack of access to health care. 

There is a health team that works on a strategy focused on providing primary care, developing actions for health prevention and promotion based on education, health care, control of the healthy population, and identification of risk factors and the monitoring of chronic patients. This team includes specialties such as internal and general medicine, nursing, pediatrics, obstetrics and gynecology, social work, and psychology. 

This project has its roots in an institutional mission that seeks to serve society and its goal is to promote and ensure individual and collective health of the community through the integral development of the people. That is, the focus is on strengthening the people and community capacity to address their health problems and not only unmet basic needs. It is a primary health care center within the network of the municipality that is fully managed by a biomedical school. 

Since its inception La Posta involved a growing number of students and faculty members of graduate courses (medicine, psychology, nursing, and nutrition) and postgraduate students from the biomedical school. In 2015 the project was expanded to include students from other areas such as business administration, law, communication, and engineering. 

Building Interdisciplinary Student Collaboration 

La Posta fulfills a natural and necessary formative role for students from biomedical schools. Adding to the different curricular activities that students are involved in, it enables them to help in social and voluntary campaigns that include a health fair, family day, Christmas party, and providing primary care for school children. Furthermore, it serves as a services and training field for residents. All that happens in La Posta has an impact on the students and teachers in different ways; they acquire knowledge, clinical skills, and learn how to plan community education while discovering new realities and learning about those in need. The passage through La Posta leaves an indelible impression on students. 

In order to generate a greater link between the biomedical school and the rest of the University, in 2015 we decided to invite to La Posta students from other disciplines. The aim was to broaden the scope of this project so that their formative roles could reach an interdisciplinary quality.  

To achieve this goal, we designed a strategy based on: 

  • Contextual and holistic orientation: Students are invited to walk the neighborhood to interact with the community that they serve there. Students visit the families to talk and interview the people who attend the clinic at La Posta.
  • Horizontal, interprofessional collaboration: Students are integrated as peers of the health team. This means, for example, that psychology and administration students together share activities such as: team meetings, receiving patients, and workshops. They have access to information about the programs that take place there and can openly consult with community members to discuss their concerns.
  • Relevance of the social determinants of health: Many of the problems addressed in La Posta are complex, so the interventions need to be interdisciplinary. Given the identification of the social, economic, and psychological dimensions of the diseases, all perspectives and disciplines can contribute to their resolution. What is valuable then not only comes from the medical or health professional perspective, but everyone helps to create an understanding of the issue to solve problems.
  • Leading role of students: According to their interests and motivations students choose the problem that they will work on, design the proposal for improvement, and then implement and evaluate their results. That is, they are allowed to play the full game.
  • Promotion of a culture of reflection at all levels: Students are encouraged to think and re-think what is being done, listening and discuss difficulties, and express the feelings and emotions that come from confronting these different realities. Assessing the results and the monitoring of activities is promoted, with the goal of the students seeking a greater level of learning while correcting mistakes. This applies to the La Posta team, students, and their teachers, and the faculty as a whole. It is about learning from, and with, the community and integrating effective and cognitive dimensions of learning and becoming aware about the hidden curriculum too.

Some of the innovations that result from the contributions of the students are: 

  • Design and implement identification cards for people in the community.
  • Design and start-up of a monitoring and control panel for pregnant women.
  • Pharmacy drug stock management.
  • Design of a tool to evaluate transversal team competences.
  • Design of a logo and the painting of a distinctive mural of La Posta.
  • Installation of hot water for families in the neighborhood.
  • Design and implementation of the social networks (Facebook and Instagram) of La Posta.

Distinctive Elements of Interdisciplinary Students Collaboration 

The purpose that guides the development of La Posta as a social promotion project is to "serve" the surrounding community. Programs that are carried out materialize the model of social responsibility and accountability of the University, differentiating care and training. In this way, the comprehensive training of students is promoted from a focus on each person and his/ hers potential, which does not only seek primarily the resolution of unsatisfied basic needs.  

The actions are framed in the "promotion" of the quality of life of people through "developing" each one according to their potential. Needs are met from providing new resources to the community so that they can face their situation and not through welfares. This is also valid for all the actors involved in the project: in this case the students. It seeks to actively engage and confront reality, experience it, and value both formal and informal tasks as a training opportunity. As they recognize themselves in a different situation from their usual reality, students can discover and recognize new aspects of themselves and others, thus enriching their identity as future professionals. 

The main challenges can be described as follows: 

  1. Starting with the participation of students in the health sciences careers, the scope was extended to almost all of the University careers: law, business sciences, communication, engineering, and family sciences. Postgraduate students of business from the University were also included.
  2. From a focus of programs based on community health care and education, there has been an expansion and enrichment of the new programs such as the stimulation of school learning, the evaluation of transversal team competences, the management of the pharmacy, and the monitoring of pregnant women.
  3. From the emphasis on formal learning, structured and based on the objectives of the curriculum, informal learning results from other significant experiences that occur in contact with the community, with the team and in the activities they carry out. Although these learnings are unexpected by students and faculty members, however, it does have a broad effect and long range in the lives of them.

La Posta Financing 

La Posta is a project whose funding comes mainly from the school of biomedical sciences. There are some contributions and other resources such as donations of equipment and medicines from laboratories and companies. 

Discuss the Implications and Risks 

This project was enriched by including views and contributions from other disciplines. It was evident that students from different careers and academic levels can share motivations, concerns, and together contribute to solve problems of a vulnerable community and provide opportunities for improvement to La Posta. This allowed them to innovate and acquire skills and resources that they did not previously have. 

In real practice scenarios, the level of training of students does not affect the ability to solve problems. From different disciplines they propose projects that arise from the vocation of service to others, the central aspect of the institutional mission that seeks to address the specific needs of community members. 

For the team, interaction with students from different disciplines, involved in the challenge allowed the sharing of different viewpoints, understanding the perspectives of others, and proposing new recommendations and instruments to use. The students further enriched the project because they identified problems that had not been initially recognized by the La Posta team. 

Now we have new questions: Did the lense of the discipline detect these new problems or was the daily work hiding it? What impact does implemented innovation have on these problems and how do we measure it? 

Another emerging factor to think about is how to teach interdisciplinarity during the training process: the complex problems that are related to specific and real situations. The solution requires a holistic perspective; all students needs to develop common skills for future professional practice. Finding the solution to problems requires understanding them in depth and being able to talk about them. This is possible in a context of an authentic search for truth and when the students can commit to the well-being of the community. 

The progress of a primary care center based on service and social commitment requires building bridges between both the academy and the community it serves.  

 

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