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    A medical home far away from home

    If the medical home concept of team-based healthcare works for kids and their families in Peru, it will work in your community, too.


    Pediatricians know that coordination and advocacy work. What happens, however, when we are faced with complex cases in conditions that are nontraditional and prohibitively difficult? We all have faced these situations in practice in the United States. For our team, the problem came into sharper focus while working overseas.

    The American Academy of Pediatrics’ policy statement on the medical home states that “medical care of infants, children, and adolescents ideally should be accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective.”1

    We pediatricians strive to make this vision a reality for our patients in whatever environment we find ourselves practicing. Sometimes this involves case management in well-established clinics in tertiary care facilities. Sometimes it involves using a medical home model within a community-based practice. Sometimes, however, it calls for us to create a significantly different model. Although we must adjust our approach, the basic principles of coordinated, family-centered care remain constant.

    Caring for medically fragile kids

    What really makes a difference for medically fragile children in complex, resource-limited environments? This is the question that faces our team daily as we work in the sprawling, informal invasion settlements continually springing up in the South American metropolis of Lima, Peru. We frequently find children living in extreme poverty with complicated disease courses (cerebral palsy, congenital heart disease, sequelae from injury) who are receiving substandard care. This is not only disastrous for them, but it also presents an economic and personal catastrophe for their families.


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