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Arrieta, Jafet

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Arrieta

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Jafet

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Arrieta, Jafet
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    Service, training, mentorship: first report of an innovative education-support program to revitalize primary care social service in Chiapas, Mexico
    (Co-Action Publishing, 2014) Van Wieren, Andrew; Palazuelos, Lindsay; Elliott, Patrick F.; Arrieta, Jafet; Flores, Hugo; Palazuelos, Daniel
    Background: The Mexican mandatory year of social service following medical school, or pasantía, is designed to provide a safety net for the underserved. However, social service physicians (pasantes) are typically unpracticed, unsupervised, and unsupported. Significant demotivation, absenteeism, and underperformance typically plague the social service year. Objective: Compañeros en Salud (CES) aimed to create an education-support package to turn the pasantía into a transformative learning experience. Design: CES recruited pasantes to complete their pasantía in CES-supported Ministry of Health clinics in rural Chiapas. The program aims to: 1) train pasantes to more effectively deliver primary care, 2) expose pasantes to central concepts of global health and social medicine, and 3) foster career development of pasantes. Program components include supportive supervision, on-site mentorship, clinical information resources, monthly interactive seminars, and improved clinic function. We report quantitative and qualitative pasante survey data collected from February 2012 to August 2013 to discuss strengths and weaknesses of this program and its implications for the pasante workforce in Mexico. Results: Pasantes reported that their medical knowledge, and clinical and leadership skills all improved during the CES education-support program. Most pasantes felt the program had an overall positive effect on their career goals and plans, although their self-report of preparedness for the Mexican residency entrance exam (ENARM) decreased during the social service year. One hundred percent reported they were satisfied with the CES-supported pasantía experience and wished to help the poor and underserved in their careers. Conclusions: Education-support programs similar to the CES program may encourage graduating medical students to complete their social service in underserved areas, improve the quality of care provided by pasantes, and address many of the known shortcomings of the pasantía. Additional efforts should focus on developing a strategy to expand this education-support model so that more pasantes throughout Mexico can experience a transformative, career-building, social service year.
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    Understanding Depression in Rural Chiapas: Contextualizing Quantitative Measures and Patients’ Experiences
    (2015-06-08) Arrieta, Jafet; Franke, Molly; Raviola, Giuseppe
    Depressive disorders are highly prevalent in primary care settings and are associated with severe physical and social impairment. However, it is a challenge for primary health care providers to identify depressive disorders early. The Patient Health Questionnaire-2 (PHQ-2) and PHQ-9 have been widely used for screening and diagnosis of depression in primary care settings. We used a mixed methods design to assess the validity of the PHQ-9 for diagnosis of depression; to assess the sensitivity and specificity of the PHQ-2 for screening of depression; and to characterize the experience of participants living with depression in rural Spanish-speaking settings. The study was conducted in a rural community of Chiapas, Mexico. Quantitative data was collected using the PHQ-2, the PHQ-9, and the WHO Quality of Life BREF (WHOQOL-BREF) scales during an active case finding activity (n=223). Qualitative data was collected through semi-structured interviews (n=20). The internal consistency of the PHQ-9 was good (Cronbach’s alpha >= 0.8) for the overall PHQ-9 and by subgroups. The PHQ-9 also had good construct validity: participants with a PHQ-9 diagnosis of depression had statistically significantly lower scores on the overall WHOQOL-BREF scale and each of its domains. The optimal PHQ-2 cutpoint score for screening of depression when compared with the PHQ-9 was 3 (sensitivity 80.00%, specificity 86.88%). Four main categories were derived from the qualitative analysis, including life events as triggers for depression; common feelings of sadness and desesperación, thinking too much, and somatization; a experience seeking care influenced by the local conceptualization of depressive illness, the lack of availability of health services, and physicians’ failure to recognize symptoms of depressive illness; and a experience of accompaniment perceived as therapeutic. Evidence supports the validity of the PHQ-2 and PHQ-9 to screen and diagnose for depression in rural Spanish-speaking populations, and the association of depression with lower quality of life. The study findings highlight the role of the local context on triggering depression and influencing care-seeking behavior, and on how depressive illness is experienced by patients. Therefore, in order to improve mental health care delivery strategies, strategies and interventions should be adapted to the local context.