PAHO Executive Committee kicks off 176th session, addressing key health issues in the Americas

Cristina Mitchell

23 Jun 2025

Over the decades, it has become both an oasis and a lifeline for Dominicans, operating under a public–private, self-sustaining model that grants it a measure of operational freedom.

A recent three-day hospital stay for surgery allowed me to study in depth the pre-operative, operative and inpatient phases. Since 2010, I have applied my hospitality-sector expertise to hospital operations, refining concepts, tools and methods that may translate into meaningful improvements here and at other Dominican institutions—always mindful of our country’s specific context and resource constraints.

During my stay, I noted four key priorities:

1. Reliable clinical protocols
   Every step of care—from post-surgical treatment plans and medication administration to vital signs checks, diagnostic tests, regular physician rounds and specialist consultations—must follow standardized procedures. Consistency in these processes underpins patient safety and trust.
2. Staff professionalism and training
   The competence of nurses, physicians and support personnel shapes patients’ morale and engagement. When staff demonstrate expertise and clear communication, patients feel secure in their recovery journey.
3. Appropriate medical technology
   Modern diagnostic equipment and information systems must support rapid, accurate evaluations. Access to advanced imaging and laboratory tools reduces delays and increases confidence in treatment decisions.
4. Comfort and usability in patient rooms
   Quality beds, furniture, climate control, lighting, entertainment systems and bathroom facilities all contribute to a healing environment. Simple adjustments—adjustable lighting, supportive mattresses and easy-to-use call buttons—deliver tangible benefits to those in care.

I also identified core service roles that directly influence patient satisfaction:

• Shift nurses
  Their interactions shape patients’ perceptions of kindness and responsiveness.
• Routine-care physicians
  Regular check-ups and clear updates reassure patients and create a sense of security.
• Specialist teams
  Their thoroughness and expertise inspire trust in complex treatments.
• Food-service staff
  Attention to meal quality and timing provides comfort during lengthy stays.
• Housekeeping
  Spotless rooms and equipment reinforce a sense of safety.
• Support equipment and supplies
  Ergonomic furniture, durable linens and quality utensils attend to the basic needs of each patient.

To drive measurable improvements, I propose adapting proven service-industry models to healthcare:

• Patient-centric experience
  Borrowing from Customer Experience (CX) principles, hospitals should treat each patient interaction as an opportunity to deliver personalized, respectful service.
• Human-centered care
  Beyond clinical protocols, staff should recognize the emotional, financial and family stresses that accompany illness, offering empathy alongside medical treatment.
• Service-delivery evaluation
  In hospitality and retail, satisfaction metrics guide service standards. Hospitals must define seven essential “public-health servant” skills—courtesy, empathy, responsiveness, reliability, safety, efficiency and tangible support—and measure performance against them.
• Strategic staff training
  A tailored development plan should reach every team member—clinical, technical and support—accounting for the hospital’s unique systems and the nation’s healthcare realities. Imported training modules may require adaptation to our infrastructure, funding levels and patient demographics.

Plaza de la Salud stands as a beacon in Dominican healthcare. Yet, meeting rising expectations demands a deliberate shift toward service excellence alongside clinical quality. Our patients deserve care that restores not only their bodies but also their sense of dignity. By applying these service-management insights, we can forge a new model of patient experience—one rooted in reliability, compassion and efficiency—tailored to the Dominican Republic’s evolving health landscape.

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By Roxanna Marte
Literary Agent, Cultural Manager, Writer.
Autores del Caribe Literary Agency.
Cultural Director of the CuentaRD Literary Project.

New research, presented today at the European Academy of Neurology (EAN) Congress 2025, has uncovered a powerful link between nighttime heart rhythm and future health conditions, even in people with no obvious sleep problems.

The study, which was conducted at the Department of Neurology, Inselspital, the University Hospital of Bern, analysed 4,170 individuals over an observation period of 13,217 person-years, found that heart rate variability (HRV) during sleep can serve as a powerful early warning sign of future health conditions, including stroke, depression, and cognitive dysfunction.

HRV reflects the fluctuation of time intervals between heartbeats. HRV adjusts constantly in response to physical and emotional demands of the body. During the day, HRV is physiologically high corresponding to high levels of activity. At night, and especially during deep sleep, HRV typically reduces, reflecting a shift into a rest and repair mode, where the body focuses on recovery and recharging for the next day.

The research found that certain HRV patterns were linked to future health conditions. Participants who later developed stroke often showed unusually high and erratic HRV. In contrast, low HRV was common in those who further developed depression. High HRV with altered frequency patterns were also observed in individuals who later developed metabolic diseases. Similarly, cardiovascular and endocrine diseases were also associated with high HRV.

“HRV matters for brain and overall health because it reflects how well the body regulates itself – primarily through the activity of the autonomic nervous system”, explained the lead author of the study, Irina Filchenko, MD, PhD. “This system controls vital unconscious processes such as breathing, digestion and muscle tone, helping the body maintain balance and adapt to internal and external demands.”

“While many people are familiar with tracking sleep stages or total sleep time, nocturnal HRV provides a unique window into how the body functions during sleep. This is especially important because sleep is a critical time for many physiological processes underlying long-term health, such as cellular repair, memory consolidation, and the clearance of metabolic waste from the brain.”

Importantly, researchers believe that HRV could act as an early physiological marker, demonstrating subtle changes in body functioning before traditional symptoms or diagnoses appear. This could open the door to prevention and early intervention for diseases like Alzheimer's or stroke, where timely action can improve patient outcomes.

Dr Filchenko noted, “Some participants had ‘normal’ sleep according to traditional criteria, with little sleep fragmentation and the expected balance of sleep stages. However, HRV told a different story, picking up risks that the common sleep metrics missed. This suggests we need to rethink how we define and measure optimal sleep.”

The findings of the study also raise the possibility of using wearable technology to monitor HRV patterns over time. While current consumer devices vary in accuracy and interpretability, experts believe future improvements could allow people to track changes in HRV as part of regular health monitoring.

The research adds to growing evidence that sleep is a critical pillar of long-term health, and that subtle patterns could offer a window of opportunity to prevent serious disease. “The broader message is that sleep is not just a passive state of rest-it is an active, dynamic process that plays a vital role in maintaining long-term health, especially brain health. Our findings reinforce the idea that primary prevention matters, and that health problems start long before the clinical symptoms appear”, concluded Dr Filchenko.

Reference:

Variability in heart rate during sleep may reveal early signs of stroke, depression or cognitive dysfunction, new study shows, Beyond, Meeting: European Academy of Neurology (EAN) Congress 2025.

Individuals currently suffering from respiratory illnesses are more likely to be infected with influenza or COVID-19, the two types of respiratory viruses that have been most prevalent in the country in recent weeks.

Among mosquito-borne diseases, malaria continues to be the most prevalent in the Dominican population, with 435 suspected cases and 12 confirmed cases detected in the first week of June, bringing the total number of suspected cases and 387 confirmed cases so far this year to 13,359.

According to the report for epidemiological week 23, which covers the first seven days of June, 72 samples of respiratory viruses were processed at the Dr. Defilló National Reference Laboratory in Public Health, identifying the circulation of Influenza A (H1N1)pdm09, SARS-CoV-2, and Parainfluenza.

The positivity rates were 4.4% for influenza, 2.9% for SARS-CoV-2 (the COVID-19 virus), and 4.3% for other respiratory viruses. In contrast, no positive cases of syncytial virus (RSV) were reported, the report states, which also highlights that these results indicate the presence of different respiratory viral agents in the population, underscoring the importance of maintaining active and sustained surveillance.

A lot of hygiene

The Ministry of Public Health (MSP) reports that it continues to implement comprehensive measures to reduce the transmission of respiratory diseases, prioritizing early detection, timely treatment, and effective control.

Additionally, the public is reminded to maintain frequent hand washing, wear masks when around people with symptoms, and disinfect surfaces to prevent outbreaks. They are also encouraged to seek medical attention if they experience respiratory problems or other health conditions.

Regarding sentinel surveillance for acute respiratory infections (ARIs), it is reported that 25 suspected cases were reported in the last week, with no confirmed cases, for a cumulative total of 676 suspected cases and 99 confirmed cases so far this year.

Of the total confirmed cases, 76% were in children under 10 years of age. Acute respiratory infection manifests with the sudden onset of a fever of 38°C or higher and respiratory symptoms in the previous 10 days. It can progress to respiratory distress, seizures, or ventilatory failure, which, without prompt intervention, can lead to death.

12 confirmed cases

During the first week of June, the epidemiological surveillance system confirmed 12 cases of malaria and one case of dengue.

Regarding malaria, it is noteworthy that 435 suspected cases and 12 confirmed cases have been reported, bringing the cumulative total to 13,359 suspected cases and 387 confirmed cases so far this year. According to the Ministry of Public Health, this represents a significant reduction compared to the same period in 2024, with a 33% decrease in confirmed cases.

The report indicates that 31.5% of confirmed malaria cases in the Dominican Republic are Haitian, which has prompted increased active case-finding in migrant and agricultural communities.

The Ministry of Public Health reports that it is strengthening strategies for early detection, timely treatment, and vector control to advance the elimination of diseases. These efforts aim to create an effective and sustained response to eradicate malaria in the country.

Dengue on the decline

Between January 1 and January 7, 38 suspected cases of dengue fever were reported, along with one confirmed case, for a total of 947 suspected cases and 120 confirmed cases so far this year.

The report indicates that, compared to the same period in 2024, there was an 88.1% decrease in suspected cases and an 87% decrease in confirmed cases, reflecting a significant reduction in the incidence of the disease.

As of epidemiological week 20 of 2025, the Region of the Americas reported 2,902,500 suspected cases of dengue, with a cumulative incidence of 286 cases per 100,000 inhabitants. This figure represents a 71% decrease compared to the same period in 2024 and a 13% decrease compared to the average of the previous five years.

Leptospirosis

Another disease under surveillance is leptospirosis, which is transmitted by a bacterium that infects humans when they come into contact with the urine of infected animals and are exposed to contaminated water.

In the country, during epidemiological week 23, three suspected cases of leptospirosis were reported, bringing the total to 205 suspected cases and 23 confirmed cases for the first six months of the year.

27%, or approximately 55 cases, are patients of Haitian nationality, and 73%, or approximately 149 cases, are Dominicans.

Among the prevention strategies being developed by the Ministry of Health are rodent control and sanitation measures, including improving access to drinking water, reducing exposure to stagnant water, and promoting good hygiene practices. Animal vaccination campaigns are also being conducted, particularly in areas where livestock can serve as a reservoir for the Leptospira bacteria.

The report, issued by the Epidemiology Department (DIEPI), indicates that 72 samples were processed at the Dr. Defilló National Public Health Reference Laboratory and tested negative for common respiratory viruses, including influenza A (H1N1) pdm09, SARS-CoV-2, and parainfluenza.

There were also no new cases of leptospirosis, cholera, or COVID-19.

Regarding dengue, one confirmed case was reported. The total for the year reaches 120 confirmed cases, representing a decrease of 88.1%. There is no epidemiological alert for dengue in 2025. It is a viral disease transmitted through the bite of the Aedes aegypti mosquito. Dengue is an endemic disease, with the highest incidence among children. It is recommended to keep water containers covered and avoid accumulating them in residential yards.

Malaria and Leptospirosis

Twelve positive malaria cases were reported, a 33% reduction in confirmed cases. Regarding leptospirosis, no new cases were reported this week. These are notifiable diseases monitored by the Directorate of Epidemiology.

Mortality

Three maternal deaths were reported (two Dominicans and one Haitian), for a cumulative total of 78. Regarding infant deaths, 21 were recorded, which represents a decrease compared to the 38 reported in the same epidemiological week of 2024.

From July 6 to 8, 2025, CARICOM leaders will gather in Jamaica for the 49th CARICOM Heads of Government (HOG) Meeting, under the theme: People, Partnerships, Prosperity: Promoting a Secure and Sustainable Future.

As health-focused civil society organisations across the region, we are compelled to ask – What does a healthy Caribbean look like in CARICOM’s vision of a secure and sustainable future?

• Does it reflect the lived realities of our children, who are growing up in environments flooded with ultra-processed foods and limited access to safe spaces for physical activity?
• Does it account for the voices of our youth, many of whom are navigating mental health challenges with little support and even fewer services?
• Does it prioritise the needs of people living with non-communicable diseases (NCDs)—those who require continuous care but face fragmented systems and financial hardship?
• Does it include persons living with disabilities and our indigenous and rural communities, which have long been underserved and which continue to experience some of the greatest health inequities?

As we prepare for another CARICOM HOG meeting—this time against the backdrop of the 4th UN High-Level Meeting (UNHLM) on the Prevention and Control of NCDs and the Promotion of Mental Health to be held in September 2025—we are reminded of the CARICOM leaders’ vision of a healthy and secure future set almost 18 years ago.

During the 28th CARICOM HOG Meeting in July 2007, regional leaders committed to “full participation in the Summit on Non-Communicable Diseases, to be held in Port-of-Spain, Trinidad and Tobago, on 14 September 2007.” That September 2007 meeting led to the landmark Declaration of Port of Spain —a turning point in the global NCD movement. It marked the first time a group of countries took collective action at the highest political level to address NCDs, placing the issue on the international agenda and laying the groundwork for the first UN High-Level Meeting on NCDs in 2011.

Since then, the world has witnessed two more UNHLMs on NCDs, in 2014 and 2018 during which time civil society has advocated fervently to ensure NCDs remain prioritized. This pressure has been captured by key policy wins including the School Nutrition Policy implemented in Barbados and tabled in Jamaica.

Now, in 2025, we are preparing for the 4th UNHLM under the theme, “Equity and Integration: Transforming Lives and Livelihoods through Leadership and Action on Noncommunicable Diseases and the Promotion of Mental Health and Well-being.”

This moment presents a critical opportunity for CARICOM to once again lead from the front, guided by previous commitments and aligned with the Caribbean Cooperation in Health IV and other key Caribbean SIDS-focused Declarations, including the 2023 Bridgetown Declaration on NCDs and Mental Health. Informed by consultations with Member States, the Bridgetown Declaration calls for “double- and triple-duty” actions to tackle NCDs. These include stronger linkages between climate and health agendas, building climate-resilient health systems, institutionalising public participation, protecting policy spaces from Industry interference, and implementing clear, effective policies such as front-of-package warning labelling. These key actions are aligned with the Healthy Caribbean Coalition’s (HCC) Advocacy Priorities for the 4th UNHLM co-developed with HCC member organisations.

The under-addressed issues highlighted in the Declaration and the Advocacy Priorities resource are matters of survival and sustainable, equitable development for Caribbean nations.

Three out of every four Caribbean lives lost are due to preventable and manageable non-communicable diseases. CARICOM leaders must keep the prevention and control of these conditions central to their vision of a secure and sustainable future during discussions at their upcoming meeting.

In the lead up to the 4th UN High-Level Meeting on NCDs and Mental Health and in light of the growing burden of NCDs in the region; we ask CARICOM Heads of Government and State to urgently:

1. Commit to continued leadership on NCD prevention and control and commit to attendance at the 4th UN High-Level Meeting on NCDs and Mental Health (HLM4) on September 25th, 2025 in the official Communiqué emerging from the Forty-Ninth Regular Meeting of the Conference of Heads of Government of the Caribbean Community (CARICOM).
2. Support the twelve Caribbean civil-society led advocacy priorities for inclusion in the official Communiqué from the Forty-Ninth Regular Meeting of the Conference of Heads of Government of the Caribbean Community and in the HLM4 Political Declaration.
3. Support one or more CARICOM Heads of Government or State to have a lead role in at least one of the multi-stakeholder panels at the HLM4.
4. Support the hosting of a high-level side-event on the margins of the HLM4 led by CARICOM Heads of Government and State as was done in past UN HLMs on NCDs.
5. Endorse the inclusion of a representative from a Civil Society Organisation (CSO) representing people living with NCDs and a youth representative in country delegations to the HLM4 in recognition of the whole-of-society response to NCDs.

History will remember whether CARICOM simply echoed past declarations, or delivered bold, lasting action. CARICOM leaders must ensure that the voices and unique needs of people with, and at risk of, NCDs in Caribbean Small Island Developing States are meaningfully represented and addressed at this High-level Meeting.

CARICOM has been globally recognised for its leadership on NCDs. Now is the time to lead again.

Authors:

Dr. Kenneth Connell
President, Healthy Caribbean Coalition

Ms. Danielle Walwyn
Advocacy Officer, Healthy Caribbean Coalition

Ms. Charity Dublin
President, Antigua and Barbuda Diabetes Association

Ms. Kim Simplis Barrow
President, Belize Cancer Society

Dr. Jane Noël
Chair, Grenada National Chronic non Communicable Disease Commission

Ms. Greta Yearwood
Chief Executive Officer, Heart and Stroke Foundation of Barbados

Mrs. Deborah Chen
Executive Director, Heart Foundation of Jamaica

Shannique Bowden
Executive Director, Jamaica Youth Advocacy Network

Ms. Abi Begho
Founder and Director of Program Management, Lake Health and Wellbeing (St. Kitts and Nevis)

Dr. Kedhma Dorh
President, St. Lucia Diabetes and Hypertension Association

Ms. Chelsea Antoine
Healthy Caribbean Youth (Trinidad and Tobago)

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