“I was expecting your call” he says as he answers the phone. It was a scheduled appointment in the middle of his then ministerial agenda, but one he did not hesitate for a second to accept an open a space for. On the other end of the line is Julio Daniel Mazzoleni, last Paraguay’s Minister of Health, rheumatologist and, as he says, with a lifelong vocation for serving.
He has several “facets” and when he recalls them, he does not do so as independent chapters but instead as a whole, which allowed him to manage the health of his country “after the worst dengue epidemic”.
He is a doctor, a rheumatologist, a professor, a corvette captain, a minister, a husband, a father, a colleague…He is everything he has built, and he is proud of it all. “Life has been generous to me and has allowed me to have several facets and enjoy each of them, they all have been challenging, but also quite enriching”
Doctor in Medicine, graduated with honors from the Faculty of Medical Sciences of National University of Asuncion. In addition, he completed a residency in internal medicine as well as a specialization in rheumatology at Emory University in Atlanta. "A quite varied perspective", he says when listing his different tasks.
Julio Mazzoleni is Paraguayan, born in Asuncion on December 19, 1971. He is married and a father of two. Before taking over as the Minister of Health, he worked as the Chief of the Division of Rheumatology at the Hospital Central del Instituto de Previsión Social. He was also a doctor at the Hospital de la Sanidad of the Paraguayan Army and after serving as a doctor of the Military Health for 18 years, he retired voluntarily whit the rank of Health Corvette Captain. Additionally, he was a rheumatologist in private practice for 15 years and twice president of the Paraguayan Society of Rheumatology.
CHALLENGES FACED BY PANDEMIC
“It is a challenging situation. One challenge after another. We are coming out of the largest dengue epidemic of the last two decades in Paraguay and we had to face it with a fragile health system and a tired staff”, he says of his experience as minister.
Mandatory shelters to those arriving from border areas, social events cancellation, and later, the incorporation of social distancing and handwashing measures, and quarantine.
One of the hardest decisions he had to make, he says, was to close the country with two cases of covid-19. “This was the result of an honest analysis of our limitations, of the recent dengue and of not being able to rule out a community circulation. Later, as in almost all the countries in the region and around the world, access to supplies, the difficulties in purchasing and, upon arrival, problems with some that did not meet the technical specifications. These are difficult times that you must know how to manage”.
“I never really had a specific interest in medicine” he says about his life. With time, the challenge of academics, but above all, the vocation for service, the path became clear. “That ended up leading me to this, to medicine”, he adds.
Rheumatology, he says, was one of those chance occurrences that happen in life. He discovered it in the United States in the midst of “so many secrets, strange and small letters”. “I fell in love with this specialty and when I was doing internal medicine, I already knew what I wanted to be”, he points out.
From rheumatology he brought a great teaching to his public and his political life, “you should always be based on evidence, but learn to live with a certain degree of uncertainty. Fight for everything that can be changed and accept the realities that cannot. This is a daily practice for rheumatologists, dealing with complex diseases, some of them with no specific treatment. That is the magic of rheumatology, you are always based on evidence, but in the face of little-known diseases there is always a certain degree of uncertainty”, he said.
On his return to Paraguay, he says, “there were very few rheumatologists”, so the field of action was quite broad. “Although my main interest lies in areas such as rheumatoid arthritis, lupus and inflammatory diseases, I also had to see children because when I arrived, there were no pediatric rheumatologists”.
“I have also had the opportunity to set up the Division of Rheumatology at the Instituto de Previsión Social, so I have the honour of educating several generations of rheumatologists”, he says. “That is one of the greatest satisfactions in my professional career. The level of the program has grown exponentially and many of the graduates are better than the teacher”, he adds.
He recalls that on the first day of class he used to tell his students to question everything, especially him. And on the last day, he says, the advice was to “always share your knowledge with anyone. You should not hold back anything you learn, that is the essence of medicine and teaching”.
“These different aspects of my life help me a lot. On the military side it orients me towards discipline, solutions, and courses of action. On the scientific aspect I always try that every action we undertake is evidence-based, in addition, the teaching side of my life allows me to have the emotional intelligence that connects me with people and co-workers”, and to this analysis, he adds his role as a former industry advisor, that allows him to have a global view of the scenario and the possibility of creating partnerships in difficult circumstances, like this.
About his colleagues and the front-line medical workers fighting against covid-19 he only has words of thanks. “What I say every time I have the chance is that I am immensely proud to be the visible face of an army of white in Paraguay. In our trenches around therapies and emergencies, which extends to the entire health sector. This situation has given more value to the contribution of health workers and has put into perspective for the country the need to strength the health system, which is still an ongoing challenge” he says.
He declares himself as a “strong believer” in the need of strengthening PANLAR. “I have always felt part of PANLAR, and when I was the president of the Paraguayan Society of Rheumatology on two occasions, we have done everything possible for the growth it has achieved today, which has been really important in the last decade”, he says.
He adds that from Paraguay the work of his fellows has been oriented so that they can publish, follow up the actions undertaken by PANLAR and participate actively. They have also been actively promoting partnerships with other organizations and connections with the ACR and EULAR.
“I am very happy with the work of the organization and I am a great believer in the strength and the future it has”, he states.
The schedule, he says, have not changed much being a physician, teacher or minister, “but the level of responsibility and, above all, the media exposure, has. And that is sometimes difficult for my family to handle, but I count on their support”. Criticism is a daily reality “a reality that is surely experienced in all countries” and that is why family support is essential.
His wife is also a colleague, Shantal Agüero, a phlebologist and the mother of his two children, Lucca and Nicola, aged 19 and 18. Lucca is oriented towards economy, while the youngest is going for liberal arts “and probably something in the field of psychology”.
He concedes that family life have been challenging. “My wife has been able of creating spaces where we can share quality time. At nights or on weekends we connect to each other, seeking for that quality interaction and she is the person who achieves that”.
He is also misses seeing patients and being a teacher. “The opportunity I have had to have an impact on a larger number of people is quite appealing. I think that I would like a management role, perhaps on health diplomacy, preparing for an international organization or continuing serving in my country” he says.
“I really miss the closeness, the scientific debate, the integration. A little bit of that closer interaction with each of my patients. Rheumatologists have the particularity of maintaining a relationship with our patients for years, a very fine connection is established, and those ties are hard to break, I miss that”.
He says that his childhood was really happy. With no particular circumstances. “I was a rather dedicated boy, in love with sports, I love soccer and still play it, so I was very connected to that culture. That marked my life. And in the university, I got involved in the trade union”.
“I am fan of a small team, Nacional, that is modest in its popularity. My father was a soccer officer and that is where the influence comes from, as well as someone who was a politician for a while”, he says.
“I have made many decisions that seemed to define or restrict me, but life has taken different paths. I have had the opportunity to work in Academia, in the military, I never thought that I would become a politician. I would not change anything; I think I am blessed to have had the opportunity to work in almost all the facets that a doctor can have, and I consider myself lucky for that. It has been very enriching, and I feel satisfied with it”, reflects Dr. Mazzoleni. When he was offered the job of health minister, it seemed “a bit surreal” to him, he confesses.
“I had been working with the president of my country, whom I have known all my life, and it seemed quite informal, although I took the job very seriously. So, when he chose a person of my profile, more technical, that knew the system but without political militancy, I really felt the weight of responsibility, but also that it was the right time in my life to take on a challenge of this magnitude, to step out the comfort zone. It was almost irresistible and there were mixed feelings of enormous responsibility and a personal situation that had me prepared and ready for the challenge", he says.
To him, in Latin America, the major challenge is the financing “of low prevalence diseases where medicines are usually expensive”. He adds that “rheumatology is moving ahead at a staggering speed, but many times the complex therapies we offer in our countries are somewhat heterogeneous”.
Photos taken from Dr Mazzoleni's Twitter and Instagram accounts.