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Description sent by the project team. Time after school is critical to the overall development of children and youth. In vulnerable areas, large numbers of children are left without adult supervision when they are not in school, posing a risk to their health, safety and integrity. In these areas, the lack of safe spaces for recreation, violence, vices and insecurity impede healthy development and lead to the deterioration of the social fabric. This brings with it a series of serious consequences for the community, perpetuating the negative cycles that generate inequality.

The Boys and Girls Club is a project focused on providing children and young people, between 6 and 18 years old, at risk, a healthy and safe space that encourages creativity, innovation and physical and intellectual development. It is a space that provides training, artistic and recreational extracurricular activities that generate positive values ​​and community integration.

In order to carry out this project, a location was carefully sought within a crime prevention polygon contemplated by the Undersecretariat of the Interior, likewise, a thorough investigation was necessary to understand the area, its problems and more severe limitations. The focus of this research focuses on the failed relationship between the growth of the city and the well-being of the community, the massive urbanization of the areas of scarce resources of the city, lacking public space and that consequently do not have the necessary conditions. to generate the healthy development of the community, particularly of children and young people.

One of the most relevant challenges was the interaction with the community: it was essential to gain the trust of the neighbors. During the construction process, we were active in the community offering various activities to the inhabitants of the surrounding neighborhoods, to introduce them to the mission and programs of the Club. Another challenge for the execution of the project was the search for the donation in kind of the construction materials, the probono collaboration of specialists and contractors, as well as the support of public and private institutions.

The project was divided into three buildings, corresponding to diverse and very defined needs: Building A is the educational one, which houses classrooms and music, art, computer, kitchen and library rooms. This building is developed in a single-level volume, which has two contiguous central courtyards that are understood as one. The patio allows natural ventilation and lighting without the need for windows on the facades, pursuing the following specific objectives: safeguarding the integrity of children by allowing supervision of what happens in each classroom without the need to make long journeys, protecting equipping the classrooms against possible vandalism and theft and avoiding the distraction of children during class time.

Building B is the arts building, a two-level building that houses more open and playful spaces. Here is the room for dance classes and the room for martial arts, as well as a large multipurpose space. The building also has a semi-open auditorium to perform music recitals, dance and all kinds of lectures, this connects seamlessly with the main staircase that leads to the central esplanade. The building is complemented by an exclusive space for teenagers, where young people can relax in a safe environment. In this place, trainings and talks are given to inform young people about the risk of drug use and other addictions, as well as sexual education issues, among others.

Building C is the sports building, which contains a large covered space where all kinds of activities and sports can be carried out. The building takes advantage of the north orientation to provide natural light through the serrated roof.

The three buildings are connected by a covered corridor that functions as a guiding axis and as an element of spatial organization. This element is the backbone of architecture, made up of 24 arched vertebrae. The Archway is an ingenious geometric game of apparent concrete arches. Each of the 24 modules represents one of the human vertebrae, understanding education and comprehensive training as the backbone of building a better future.

The project is completed with various sports and recreational areas: basketball and soccer courts, squares, parks and gardens, as well as wide esplanades and stairways that sculpt the natural topography of the land and that lead to contiguous, open and program-free spaces.

The building is a reality thanks to the generosity of various companies and people who have contributed to this noble cause.

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4. Apply the paracervical block at time points 3, 5, 7 and 9 on the junction of the vaginal and cervical mucosa, under the cervical mucosa, not on the exocervix (Figure 3). • Insert the needle to a depth of 2.5 to 3.8 mm (do not exceed this depth as it involves risks of bladder injury or hollow viscus). • Aspirate to verify that you are not injecting into a blood vessel. • Administer 1 ml to rule out an allergic reaction. If not, complete the application slowly. • Slowly inject 2 to 5 ml of 1% lidocaine. • Wait 5 minutes, until the anesthetic takes effect. An example of a pain management plan includes the placement of a paracervical block, the administration of oral pain relievers 30

2.2.4 Evacuation procedure with vacuum aspiration The MVA technique is detailed below. Although most of the detailed concepts correspond to the two modalities of vacuum aspiration (electric or manual), emphasis is placed on the manual technique since it is currently available in most of the centers in the country. Depending on gestational age, vacuum aspiration abortion takes between 3 and 10 minutes and can be performed on an outpatient basis, using pain relievers and / or local anesthesia. 1. Prepare the instruments. Provide a sterile auxiliary table with 1 ring clamp, 1 speculum, 1 cervical clamp (Pozzi), 1 bowl with antiseptic, 1 fanny pack, 1 complete set of Hegar plugs, gauze pads, the MVA aspirator (see “Preparation and operation of the manual aspirator ”, page 49) and semi-rigid cannulas (open only the cannula to be used, according to the uterine height) (Figure 4). Before using the vacuum cleaner, make sure it maintains a vacuum; for

Protocol for the comprehensive care of people with the right to legal interruption of pregnancy 42

this, load the vacuum cleaner, wait a few minutes and then release the buttons to release the vacuum. The sound of air entering the aspirator is an indication that a vacuum has been created. If this does not happen, check that the aspirator is properly assembled, inspect the “O” ring for defects or foreign bodies and if it is well lubricated, and make sure that the cylinder is firmly seated in the valve. If the “O” ring is not well lubricated, xylocaine in jelly or water-based gel can be used as used for ultrasound (never use petroleum jelly or other petroleum derivatives).

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This Protocol is intended to guarantee the dignity and rights of every person with the biological capacity to gestate and, therefore, a potential subject of the right to abort when their life or health are in danger, or they are carrying out a pregnancy as a result of rape, regardless of whether or not you have an intellectual or mental disability.

In order to carry out an ILE, a police or judicial report of violation is never required.

Women with a pregnancy resulting from rape need particularly sensitive treatment, and it is important that all levels of the health system are able to offer them appropriate care and support, as well as considering timely referral, if necessary. or

For more information, see the “Protocol for the comprehensive care of victims of rape. Instructions for health teams ”(PNSSyPR, 2015).

Likewise, as mentioned above, this Protocol is guided by the principle of autonomy of the people and, in accordance with it, the attention to the situations of ILEs necessarily implies the informed consent of the user. This is a process that runs through all care and is framed in Law 26,529, on the Rights of the Patient in its Relationship with Health Professionals and Institutions. In the cases of ILEs, the result of the informed consent process is the document by which, after receiving the pertinent information, the person declares to have made an autonomous decision, free from influences and pressures of any kind, and fully knowing possibilities and risks, interrupting the pregnancy in progress (see model in the Annex, page 68). Before requesting your signature, so that the person you are consulting can access the decision-making process, the team of professionals must provide you with the necessary information. The professional must consider the possibility of the woman asking questions and cross-examining the issues that generate doubts or fears, in order to make an autonomous, conscious and informed decision.

Protocol for the comprehensive care of people with the right to legal interruption of pregnancy 16

Regarding informed consent, there are two groups of people who represent special situations: girls and adolescents, and people with intellectual or mental disabilities.

4.1. Girls and adolescents Children and adolescents constitute a vulnerable group given the existing tradition of a paternalistic and tutelary system that tends to supply the will and desire of these people because they consider them not capable of deciding on themselves with autonomy and responsibility. Likewise, it is a group particularly vulnerable to situations of sexual abuse and rape. For this reason, it is very important, during the care processes, to create an environment of empathy in which girls and adolescents can express their needs, fears and shame without being judged or silenced.

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• Provide recommendations on the resumption of sexual activity, indicating the convenience of waiting until the vaginal bleeding completely stops to restart them. • Report on the possibility of getting pregnant again a few days after treatment and providing information on contraception (see “post-interruption of pregnancy interruption”, page 58). After having performed the counseling in contraception, guarantee the delivery of the method in case you have selected one.

• As far as possible, give information written and with graphic support. The process of attention to a person does not culminate with the ILE procedure; In many cases, it may require psychological or social accompaniment, information about its future fertility, its health status or other interventions. Follow-up interviews are an opportunity for the health team to address these issues and / or make the relevant derivations.

• Report on signs and symptoms that may present and require immediate attention: excessive bleeding (more abundant than that of normal menstruation) or persistent (more than two weeks); persistent colic and / or increasing intensity, which do not give with common analgesics; pain before pressure on abdomen or abdominal distension; dizziness or fainting; nausea or vomiting; fever and / or chills; flow of bad smell or purulent; Other situations that generate concern. Explain what to do and where to seek urgent medical attention in these cases. • Offer the woman the opportunity to ask questions and get more support if she needs it. Make the derivations that are considered appropriate (Social Service, Mental Health, Attention to Women Victims of Violence).

Protocol for integral attention from people entitled to legal interruption of pregnancy 48

Preparation and operation of the Manual Endouterian vacuum cleaner The AME device consists of a manual vacuum cleaner and aspiration cannula. The manual vacuum cleaner has a valve with a pair of buttons that open it and close it, which allows control of the vacuum; a lid and a removable coating; a plunger with handle and a ring-o; A cylinder of 60 cc where the content of the endouterin evacuation is deposited, with a clip that holds the safety ring (Figures 8 and 9).

The cannulas are 4, 5, 6, 7, 8, 9, 10 and 12 mm in diameter. The smallest (from 4 to 8 mm) have two openings in opposite situation and the largest (from 9, 10 and 12 mm) have a single largest opening. The printed points in each cannula are used to indicate the position of the main opening. The first point is 6 cm from the tip of the cannula and those that follow are spaced at 1 cm (Figure 9) intervals.

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Accessible and safe because, even when legal as decriminalized, there should be no medical-bureaucratic or judicial obstacles to access the aforementioned benefit that put the health or life of the person claiming it at risk ”(CSJN, 2012: Considering 25) .

The woman’s decision is unquestionable and should not be subjected by health professionals to value judgments derived from their personal or religious considerations.

2.1. Guiding principles The implementation of ILEs must be guided fundamentally by the principle of autonomy. All attitudes and practices of health professionals must be aimed at ensuring that, based on the truthful, adequate and complete information provided, the woman can make the best possible decision for her. For this reason, it is the duty of health professionals to provide the necessary information so that she can understand the process that she is going through and ask all the questions that she deems necessary.

Protocol for the comprehensive care of people with the right to legal interruption of pregnancy 13

lization of this practice upon the issuance of a judicial authorization and it is this procedure that has hindered the implementation of cases of non-punishable abortions legislated in our country since the 1920s ”(CSJN, 2012: recital 18). Confidentiality. It is the woman’s right that any person who participates in the preparation or handling of clinical documentation keeps due reserve. As in any medical practice, nothing that happened in the consultation should be communicated to other people (such as members of the health team, family or judicial or police officials). The Clinical History (HC) and all the information contained in it are the exclusive property of the woman and the disclosure of it constitutes a violation of her right to privacy and professional secrecy. If it is considered necessary to share the information with third parties – including husband, partner, father, mother – it must be done with the express authorization of the woman, freely and clearly granted. Privacy. Services where ILE procedures are carried out must respect the privacy of women throughout the process. This includes, at least, the adaptation of the spaces where they are practiced. Likewise, the privacy of the information requested from the woman and all that is consigned in the HC must be guaranteed, the training of all the institution’s employees so that they are aware of their obligations to respect the privacy of women and information. In relation to the interruption of pregnancy, the exclusive participation of the members of the health team necessary for the practice.

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It is commonly accepted that it is simple to do so in the proximity of the building, not in addition to nature, to consider action, and potential consequences for the environment. One of the main consequences is related to the tendency to (co-) represent the actions of the building that are characterized by the fact that they discriminate between the representations referred to.

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5. Complementary studies In most cases, professionals only need the information obtained through the anamnesis and physical examination to confirm the pregnancy and estimate its duration (WHO, 2012). However, in each case in particular and based on the data obtained in the HC and the physical examination, the need to request additional tests will be evaluated. Bear in mind that this cannot be a requirement or the impossibility of executing them an obstacle to the completion of the interruption.

5.2. Ultrasound Although ultrasound is not considered a routine study to perform an ILE, if it is available it can help define gestational age, rule out an ectopic pregnancy and diagnose other pathologies or the infeasibility of the pregnancy. It is recommended to rule out the presence of an ectopic pregnancy using ultrasound, especially in women with a history of tubal surgery, the presence of an IUD, an ectopic pregnancy or a suspicious physical examination (IPAS 2013). In the case of ultrasound, the woman should be asked if she wants to see her image or hear the heartbeat. If she does not want it, it is extremely important to take the necessary precautions so that this does not happen. At the same time, if possible, facilitate different areas where those women who seek an interruption from those who receive prenatal care can be evaluated separately.

Protocol for the comprehensive care of people with the right to legal interruption of pregnancy 30

• Antibiotic prophylaxis and pain management. • Uterine evacuation therapeutic options: misoprostol and vacuum aspiration. • Indications for discharge.

As mentioned, the therapeutic options to perform an ILE depend on the gestational age, the desire of the woman and the possibilities of the healthcare center. It is essential to carry out adequate prior counseling in which the different possibilities are explained, so that the person can make their decision based on complete information. As these are generally low-complexity procedures, care for women who require an ILE can be performed at the first level of care and on an outpatient basis. However, it is necessary to provide comprehensive care for ILEs at all levels of the health system to care for women who present eventual complications, are in more advanced stages of pregnancy or when there is a health commitment and it is convenient to carry out the procedure under strict medical supervision.

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Includes minipill, desogestrel, depot medroxyprogesterone acetate (DMPA), and implant. Its use can be started immediately, even if there is infection or trauma, after procedures performed in the

The use of the method is generally not recommended, unless other more suitable methods are not available or accepted or there are serious difficulties in adherence.

Protocol for the comprehensive care of people with the right to legal interruption of pregnancy 61

first or second trimester of pregnancy. Its use can be started the same day the uterine evacuation is performed, the next day or after the confirmation of the complete uterine evacuation. In the case of implantation, if adequate counseling or decision-making cannot be guaranteed, it is recommended to defer placement and provide a temporary contraceptive method in the meantime. Emergency hormonal contraception. Giving emergency birth control pills ahead of time could help prevent future unwanted pregnancies. It is recommended to offer this type of treatment at the time of discharge. Condoms There are no restrictions for its use and it can be simultaneous to the beginning of post-interruption sexual intercourse. It is the only method that protects against HIV and other STIs.

Diaphragms and cervical caps. They can be used immediately in cases of abortions occurring in the first trimester. In the cases of the second trimester, it is advisable to wait approximately six weeks, until the neck returns to its normal size. Spermicides. They can be used immediately and simultaneously with the restart of sexual intercourse. Surgical contraception. This category includes tubal ligation and vasectomy. In cases of abortions produced in the first trimester of pregnancy, tubal ligation is similar to an interval procedure, and in the second trimester, to a postpartum procedure. It can be done immediately after stopping treatment, except in cases of severe infection or blood loss; in that case it is necessary to

Protocol for the comprehensive care of people with the right to legal interruption of pregnancy 62

Eligibility criteria for the use of contraceptive methods in post-abortion. Combined oral contraceptive

Continue practice until the infection is completely cured or the injury is healed. Be aware of the importance of providing appropriate counseling and obtaining informed consent, which is often not possible at the time of urgent care. Also inform about the possibility of vasectomy, in cases where there is a partner.