Interview with M.D. Sofia Posadas: Pediatrician in Guatemala
So who are you Sofia, what do you do?
"Good Afternoon, my name is Sofia Posadas I am a general pediatrician with a masters degree in nutrition. I work in the national hospital in Guatemala, we are located on the South Coast, like 16 miles away from Guatemala city we are a teaching hospital. And I also coordinate the pediatric residency program in my hospital, and I am the chief of the pediatrics department."
How do vaccinations work in Guatemala?
"They are not administered in the hospital, it has a very good structure in the Ministry of Health. We provide the patients in general clinics outside the general hospitals and they can come for free for the first immunizations: the basic ones. Not included for example is Hepatitis A, or sometimes Pneumococcal, or Rotavirus. When they are out of stock they just have to search for private attention and pay for that, but the more frequent vaccines are available and free for them. So we provide under 5 years old, a scheduled appointment and we cover pretty much the whole vaccination. With the pandemic though, we have found very very low amounts of patients being vaccinated so we are dealing right now with searching for them and just encouraging them. Saying “we have taken the safety measures so you will not get COVID-19”. Because most parents are afraid of getting to a clinic but then getting COVID"
What shots are offered free of cost through the Guatemalan healthcare system?
"Measles, Rubella, Pneumococcal for the first three doses is free, Haemophilus influenzae, Rotavirus the first two doses are free. Really all the basic ones!"
For the vaccinations that are not considered basic, how is that paid for from a parent/family perspective?
"Our population doesn’t have good insurance, but we offer the first 5 years free and then when the [non-basic vaccinations] are in stock and there is a good control within the clinic, patients may receive the 5 year old booster or the 10 year old booster for free as well. But that is quite rare, parents just come when the kid is sick, so normal controls of weight gain, and [healthy] patients are not normal in our country."
What are the most common child vaccines administered?
"We provide every two months the hexavalent vaccine, or for example when they are in a public clinic we provide the two doses of Rotavirus. But when they come to our private office we offer the 3 doses of Rotavirus, Rotatech. A different brand because for Guatemala it is cheaper to offer just two doses rather than three of them. So it is more accessible for [the families]."
Why is the vaccination distribution and stock more limited in Guatemala?
"I think it's a storage problem, because most of the general hospitals in the city have enough stock but in the rural areas they don't and I think it's because of transportation and refrigeration limits. Sometimes you know, it's 7-12 hours to transport by car to small towns so they have to put the vaccines in a special storage and travel with them with no quality refrigerator change, so the quality of the vaccines sometimes is not really good enough."
How is the distribution setup for vaccinations in Guatemala, where is it more accessible to get immunized?
"Health workers in rural areas have to go home by home knocking on doors to see the vaccination cards of the kids asking if they want to get vaccinated and it's very hard because they have to walk a lot to search for medical attention we have one doctor for every 100,000 people in Guatemala, and most of the doctors are located in Guatemala City so medical attention is very very difficult to reach in that area. And the income for physicians in general is very very low so we have to do multiple things. Work in a public system and in a private office."
Where could a family find information about required immunizations and safe vaccine practice?
"In Guatemala they can go to ask for the clinics in the system, to the public clinics, and they offer information for them, just like brochures with information printed and offer the vaccination. No we don’t [have any digital form of vaccination information]. We just have the vaccination cards. There was one time I had one patient with 10 Poliovirus vaccines. So there is no digital record we can find in the computer and we just say “you’ve had enough” and if they wanted more they could get more if they asked because we don’t have an actual record."
When is this vaccination card given? At your child’s first immunization?
"Yes we give the card the first time they come to the clinic but if they lose their card, we can replace it, but we lose all the information on that card."
Would you say vaccinations for commonly preventable diseases are readily available and promoted for the young populations?
"Available but not promoted because we don’t teach in schools the importance or teach to the mothers that just gave birth that they have to go to search. It's because you have to be educated about it, but in our schools we don’t have anything. They don’t ask for vaccination cards to go to school, they just open the doors to every child that wants to be educated but they don’t ask for the vaccination cards. In private school it's different though, they ask [pediatricians] to write a medical certificate with the vaccinations and everything. Public schools don’t have this though."
What are the most common preventable diseases in children prevalent in Guatemala?
"Not anymore, we don’t have spreads of preventable diseases, we just have like 1 every 5 years of Tetanus and Haemophilus influenzae we are not seeing. We have a spread of a virus with COVID at the beginning, but we are pretty much controlling the diseases. But Dengue fever is endemic in Guatemala. Very much yes, we have patients all week, and especially this week that has been very warm and rains 80% of the year, we have it endemic. For example my husband had it 3 times, and I had 1 and it's very common. And we have no vaccine here in Guatemala."
- There exists a Dengue vaccine though, why does Guatemala not utilize it?
"It’s a vaccine, not every pediatrician recommends it though, because you have 1 bad side effect, and if you contracted Dengue in an endemic region you might have serious hemorrhagic Dengue and it's not well investigated yet so we don’t recommend it yet."
When do you administer vaccinations routinely? At well-checks?
"Yes. At both well-checks and for other reasons. If vaccines are available we can offer them those. Or we can make another appointment, ask the vaccine to be delivered and administered. As a newborn, vaccinations are administered every month, at 6 months old it’s every 2 months, and then every year or 6 months. Then just check the vaccination card to see if they are updated and if not we offer the opportunity to get the vaccines that they need."
Are there any NGOs, organizations, or other initiatives you know of that are promoting child vaccination?
"We have UNICEF and PAHO in Guatemala, and they are strong with social media but to be honest with you I don’t see them working in the rural areas to encourage the populations to get vaccines. I don’t see that much, I think that’s a weakness and we have to work on that."