[MUSIC] [MUSIC] [MUSIC] We welcome Dr. Luis Jorge Hernández. Doctor, tell us a little about yourself. >> Well, thank you very much for the invitation. I am a medical epidemiologist, health specialist, I have worked in the models of health systems here in Bogotá, I have also been a consultant for PAHO. I am currently an associate professor of public health At the Faculty of Medicine of the University of the Andes. >> Doctor, could you tell us what the health system is? >> The health system is the way in which society organizes care individual and collective health services, basically health care promotional, preventive, but also external consultation, priority consultation and emergencies, and hospitalization, it is the way in which society provides these services for citizens. >> Associated with healthcare quality, What are the essential components that a health system should have? >> A health system has several components, one is an insurance system that manages individual risk, which is keeping the person healthy, but when that person gets sick they must follow a route of attention that is called individual risk management that is done by providers, outpatient centers, clinics, hospitals, the service network. So, it has a preventive part and a curative part. There is also the governing part of the health system, the health departments, but the most important thing are the citizens, patients, families, who are co-managers of the system, They do quality control, they enforce the right to health. >> It is established in the literature a general neglect of patients with chronic pain. Faced with orphan pathologies, what aspects need to be improved? >> Yes, it is true, an orphan disease is an event in which its incidence, that is, new cases are less than one case per 5,000 people. Although they are few, it is not so uncommon. What is the problem?, that go unnoticed, the doctor does not diagnose them, and does not see them. For example, 20% of consultants must have a cough, the same happens with pain, between 30 and 40% of consultants could have pain but the doctor should investigate, You must deepen, ask for complementary tests. This neuropathic pain, that is, orphan diseases are diseases that we do not pay interest to them, society does not pay attention to them, but we must return to them because they are very important. >> Doctor, in several Latin American countries, and following the recommendations of the WHO, Lists of essential medicines have been established at the national level. The study of the listings shows that there is almost no medications for neuropathic pain, What could we do to improve the content of these listings? >> Several things have to be done, let's remember that our system is called the social protection, then guidelines and protocols must be established. There is an institute that is the Institute for the Evaluation of Health Technologies, then, if it is considered important to involve these drugs, they can be included in the guidelines and care protocols and are evaluated. This is done by expert committees of specialists, however, We draw attention to the fact that the doctor is the first contact with a patient who surely has neuropathic pain or an orphan disease. So, diagnosis is important, attention, following a flowchart, a path of attention. Among these routes is therapeutic, which often requires specialized consultation. So, there are the ways to get to what is called the Institute of Health Technology Assessment, develop guides, protocols, expert consensus, continuing education. >> Thank you, doctor. Finally, doctor, we wanted to ask you if you had any other recommendations for primary care physicians. >> Yes, the general practitioner is the most important, because it is the first contact the user, the patient has with the health system, it is not the specialist. So, it can happen to the general practitioner, just as a cough goes away and he thinks it's just the flu and it could be tuberculosis, you can pass a pain and that pain is manifesting or can manifest more serious diseases such as cancer, degenerative diseases, metabolic, cardiovascular, of neurological origin as well. So don't think that pain is a secondary symptom, inquire, look at what is happening, it could be neuropathic pain, follow the guidelines and protocols, consult with the specialist, establish that patient, a network and a flow of care to improve your quality of life and help you. >> Thank you very much, Dr. Hernández, for talking to us about the health system. [MUSIC] [MUSIC] [MUSIC] [MUSIC] [MUSIC]
