Dr. Miguel Licea Pérez Peña

The problems encountered with the directors and administrators varies according with the Medical Institution. In Nayarit, México there are two types institutions. The Instituto Mexicano del Seguro Social (IMSS) and Secretaria de Salud (SSA). In IMSS the obstacles to the KMC there were related with norms and rigid regulations, since, the program KMC is not within the institution´s national programs; norms do not permit the discharge of babies below 1700g; they have the erroneos idea that the KMC it´s only for poor countries or hospitals, and are underestimating other benefits of the KMC, in the politics of the IMSS Institution everything neccessary is given to the patients. Another obstacle is that administrators are afraid of law suits, should any of the Kangaroo babies die in there homes. The possibility to change the medical areas to Cangaroo is not posible because the norms will not permit it. We propose the KMC within an Investigation Protocol, this last option finally was accepted. In the SSA the KMC was easy accepted because the lack of economical resources, the norms are more flexible, The problems in SSA was because the physical area is too small, but shortly this problem will be solved. In both institutions the nurses wanted to know if their area was going to receive more pay, or if they were going to have more work . All doctors agreed with the KMC, but they do not want to work more. Everybody in the area is afraid about the changes, in the established routines. There are no problems with mothers, except that they get tired sometimes, but in all instances they want to continue.With the family, the major problem was for the "Macho" father, to agree with the KMC, but he would not support it, he thinks these are activities for women.The grand parents, felt that there role in the family was being desplace because of the Cangaroo team, we opted to involve them in all the activities and asked for there anuence, we gave more instructions to the grandmothers and the fathers, but with partial results.The courses that we gave and conferences about KMC was of utility to change there mind except some directors, that did not want to hear about the KMC. The local radio, News and TV agreed with the program and gave us support to inform the community about our activities. In general the society accepted the KMC.