How the truck that travels through municipalities to provide primary medical care to 400 children per week works

The mobile pediatric unit consists of an adapted truck that is installed for a week in a locality

Among the health services that were relegated for months by the pandemic is pediatric care. This deepened the lack of attention of many boys and girls from localities in Argentina with difficulties in accessing a consultation. It is for these cases that the Mobile Pediatric Unit works, a program of the Casa Ronald de Argentina.

Casa Ronald is an independent non-profit organization that has been dedicated, for more than 25 years, to accompanying children and adolescents who require highly complex medical care and their families. Its best-known program is the one that gives it its name: it has four “houses”, spaces close to hospitals that provide support to relatives of minors who receive medical treatment for highly complex illnesses. They are in the City of Buenos Aires, Córdoba, Mendoza and Bahía Blanca. In a similar vein, the organization has “family rooms”, where fathers and mothers have a space to rest while the patient is hospitalized, in four hospitals in the country (two in the Federal Capital, one in La Plata and another in Córdoba). ).

“The function of the houses is limited to children with highly complex treatments, but the intention is to impact as many children as possible. This is how the family rooms emerged and then the mobile pediatric unit, which focuses on prevention. We work not with diagnosed pathologies but with primary care for communities with difficult access to the health system”, explains Julieta Cortijo, executive director of Casa Ronald de la Argentina.

The country’s second mobile pediatric unit began operations this year, two decades after the program began. (Image: courtesy Casa Ronald)

The mobile pediatric unit consists of an adapted truck that is installed for a week in a locality and within which health professionals provide primary pediatric, ophthalmological and dental care free of charge.

This Ronald McDonald House program operates in 9 countries, with 50 mobile pediatric units. In Argentina, the initiative began in 2002 and in these 20 years, according to the organization on its website, it has provided more than 100,000 free medical benefits to children in the poor area of ​​the Metropolitan Area of ​​Buenos Aires (AMBA), Salta, Jujuy, Santiago del Estero, Chaco, Mendoza and Río Negro. In total, the mobile pediatric unit has traveled more than 250,000 kilometers in the country.

The Casa Ronald Program is developed in nine countries, with 50 mobile pediatric units.  (Image: courtesy Casa Ronald)
The Casa Ronald Program is developed in nine countries, with 50 mobile pediatric units. (Image: courtesy Casa Ronald)

a new truck

Argentina was the first country, outside the United States, that had a mobile pediatric unit: the team arrived in these lands in 2001 and was put into operation the following year. At the end of last year, two decades later, the Casa Ronald Argentina received a new truck. “The previous unit already had many kilometers traveled and a new one was necessary. Now we have a team with first class technology”, says Cortijo.

The truck is 13 meters long and has three offices: pediatric, dental and ophthalmological. Among the equipment of the unit, a monitor stands out to visualize physiological parameters; slit lamp, autorefractometer and portable visual acuity meter —to measure refraction in very young children, including babies, and detect possible vision problems—, ophthalmoscope and two dental chairs.

The mobile pediatric unit is installed for a week in a location to provide care from Monday to Friday from 9 a.m. to 5 p.m. This is what the program calls an “operative”. The paediatricians, dentists and ophthalmologists who are part of the team hired by Casa Ronald (they rotate, but there are always three per day), are joined in each operation by residents and medical students from the area visited, to support the doctor and I can serve as many kids as possible.

This year, Casa Ronald scheduled 18 operations, mainly concentrated in three areas of Greater Buenos Aires: Pilar, La Matanza and San Miguel. “We seek to be more than once a year in the same place,” adds Cortijo.

The mobile pediatric unit has the capacity to care for 80 children per day, which totals 400 in a week. Before their arrival in a municipality, shifts are granted.

“We always seek to finish with the full payroll. Although there is some absenteeism, this gives us room to meet the spontaneous demand, which is generated especially towards the end of the week, when the neighbors notice the presence of the truck”, explains the executive director of Casa Ronald de Argentina.

Most of the referrals from the mobile pediatric unit are for caries treatment or provision of eyeglasses.  (Image: courtesy Casa Ronald)
Most of the referrals from the mobile pediatric unit are for caries treatment or provision of eyeglasses. (Image: courtesy Casa Ronald)

The joint, the key

When describing how the operations are put together, Cortijo emphasizes something that he considers central: the articulation with the authorities of each municipality. “To ensure good care, some preconditions are important. For example, that the municipality provides shifts in advance, which allows doctors to come directly to attend, ”he says.

On the other hand, he explains, the municipality must collaborate with logistical issues related to the operation of the truck, such as providing a space (which usually requires cutting streets) and that this place is close to a health center that can offer medical support and connections. electric if you need them.

“And the most important thing —Cortijo adds— is that the municipality has to guarantee us that if a pathology is detected, a referral can be made. Because the mobile pediatric unit provides primary care, but if something more complex is identified, we have to guarantee the child’s mother or father referral to a reference center”.

In the work carried out so far in 2022, the percentage of boys referred to other specialists is 64%. The vast majority of these are referrals to the area of ​​dentistry to fix cavities and extractions, to ophthalmology to provide glasses, to nutrition for overweight problems and —in equal proportions— to cardiology, speech therapy, psychopedagogy, traumatology and dermatology. 25% of referrals are multiple.

The doctors at Casa Ronald share the work in the mobile pediatric unit with residents, medical students and health professionals from each municipality they go to.  (Image: courtesy Casa Ronald).
The doctors at Casa Ronald share the work in the mobile pediatric unit with residents, medical students and health professionals from each municipality they go to. (Image: courtesy Casa Ronald).

The relationship with the municipalities also influences the choice of direction that the mobile pediatric unit will take. Because Casa Ronald evaluates that it is an area where there is a need for its resources, but it also privileges working with locations where there is an oiled relationship. “At some point, we choose the places that can guarantee us those necessary conditions. And this arises from a job that takes years, it is not that we started relationships yesterday, but that over time bonds are generated, “explains Cortijo.

“The first thing we do when we contact Casa Ronald is agree on a date and assign the district health center that will provide support. Then, we define logistical issues, such as the location of the truck, seeking to make it as close as possible to the center, because sometimes it offers health workshops and we can provide them with space. Also, if there is going to be a need to lower electricity or which streets to cut, ”reinforces Luis Costan, Secretary of Health of San Miguel, where today an operation of the mobile pediatric unit ends (the second of the year in this Buenos Aires town).

“Generally, the operations are an enriching experience thanks to the exchange between professionals from the municipality and those from Casa Ronald,” says the official. And he adds that today they work together to make digital medical record programs compatible: “So that queries during the operation are recorded in our system,” he explains.

Costan also clarifies that the operations help people who approach the pediatric care offered by Casa Ronald also visit the municipal health center to, for example, access vaccination.

And he concludes: “From the municipal State we consider dialogue with civil society to be fundamental. With Casa Ronald it is very simple: we have a similar vision of support in health. There are excellent results, thousands of families received care, always focused on disease prevention and promoting healthy habits”.

This note is part of the Solutions for Latin America platform, an alliance between INFOBAE and RED/ACCION.