RRP in Developing Countries Arturo Avila Chávez MD Director Voice Center México

RRP in Developing RRP in Developing CountriesCountries

Arturo Avila Chávez MDArturo Avila Chávez MD

DirectorDirectorVoice Center MéxicoVoice Center México

IncidenceIncidence

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NOT KNOWNNOT KNOWN

Between Between 1500 – 2500 cases around 1500 – 2500 cases around the country the country

Main ProblemMain Problem

CULTURAL

MEDICAL ECONOMICAL

Voice as an IssueVoice as an Issue

Voice is NOT a Health IssueVoice is NOT a Health Issue People IGNORE the problem existsPeople IGNORE the problem exists

Dysphonia = AlarmDysphonia = Alarm

People receive medical care People receive medical care only only when they are completely dysphonic when they are completely dysphonic or with respiratory distressor with respiratory distress

Health ServicesHealth Services

Public Hospitals (subsidized by Public Hospitals (subsidized by government)government)• ISSSTEISSSTE• IMSSIMSS• SSASSA

Most of the general population Most of the general population Not all are freeNot all are free Different levels of medical attentionDifferent levels of medical attention

• 1st – 3d level1st – 3d level Very few centers for high specialized medical Very few centers for high specialized medical

attention in all the countryattention in all the country


80 to 120 consultations per day80 to 120 consultations per day

10 surgeries a day10 surgeries a day

6 -8 moth waiting for surgery6 -8 moth waiting for surgery

Some patients even have to wait to be Some patients even have to wait to be operated until they have respiratory operated until they have respiratory distressdistress


Public HospitalsPublic Hospitals Big gap between first consultation and day Big gap between first consultation and day

of surgeryof surgery Bureaucratic paper workBureaucratic paper work Time consumingTime consuming Centralized countryCentralized country

Private PracticePrivate Practice• The least amount of patients with RRPThe least amount of patients with RRP• Need an InsuranceNeed an Insurance

Otherwise…..Very expensive!Otherwise…..Very expensive!

Medical IssuesMedical Issues

RRP is a third level attention RRP is a third level attention problem! (Highly Specialized)problem! (Highly Specialized)

Some residency programs don't Some residency programs don't have a good laryngological training, have a good laryngological training, which reflects a wrong Dx and Tx. which reflects a wrong Dx and Tx.

• WHY?WHY?


Larynx is ENT´s the most hidden Larynx is ENT´s the most hidden structurestructure


EquipmentEquipment• DiagnosisDiagnosis





SurgerySurgery• Equipment Equipment


Medical IssuesMedical Issues Surgical techniquesSurgical techniques

• MICROSURGERYMICROSURGERY


AntiviralsAntivirals InterferonInterferon VaccinesVaccines Phytosorb DIM Phytosorb DIM I3CI3C PDTPDT RetinoidsRetinoids MytomicinMytomicin

Drugs AvailabilityDrugs Availability

MedsMeds• Very expensive $$$Very expensive $$$

InterferonInterferon CidovofirCidovofir

• Non AvailableNon Available No International Sale RepresentativesNo International Sale Representatives

RRP InformationRRP Information

Pt is not informed about RRPPt is not informed about RRP

• CauseCause• SymptomsSymptoms• Treatment OptionsTreatment Options• No societies or foundations to support No societies or foundations to support

RRP RRP • Patients are all by themselves Patients are all by themselves

Main ProblemsMain Problems

Cultural Cultural The RRP manifestations are almost certainly under-The RRP manifestations are almost certainly under-

described and non existent for general populationdescribed and non existent for general population Lack of Information (educational programs)Lack of Information (educational programs)

Health care systemHealth care system• CentralizedCentralized• Better training residency programsBetter training residency programs

Subspecilized DoctorsSubspecilized Doctors

• DX tools and TX equipmentDX tools and TX equipment• Drug AvailabilityDrug Availability

SolutionsSolutions

Take advantage of Take advantage of RRP IRS´s RRP IRS´s infrastructure as a plataforminfrastructure as a plataform

• Inform PeopleInform People Most of the affected people only know Most of the affected people only know

Spanish and don't have access to internetSpanish and don't have access to internet Language barrierLanguage barrier

SolutionsSolutions

• Expand activitiesExpand activities Create a supportive community network in Create a supportive community network in

Developing Countries. Developing Countries. Creat Creat groups of people, committed people, groups of people, committed people,

specially patients and Doctors to approach specially patients and Doctors to approach RRP IRS as a backup for multipurposeRRP IRS as a backup for multipurpose

Interaction with Meds suppliers for easier Interaction with Meds suppliers for easier access and cheaper pricesaccess and cheaper prices

Thank You!Thank You!

Documents

RRP in Developing Countries Arturo Avila Chávez MD Director Voice Center México