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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.

_________________
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.