Statement on the fourteenth meeting of the International Health Regulations (2005) Emergency Committee regarding the coronavirus disease (COVID-19) pandemic

Cristina Mitchell

30 Jan 2023

After writing to the authorities and pointing out that around 10,000 NEET PG aspirants were ineligible to appear for the exam, now a delegation of Federation of All India Medical Association (FAIMA) is going to meet the Union Health Minister Mansukh Mandaviya tomorrow.

Sharing this detail on Twitter, FAIMA mentioned, "A delegation of #FAIMA will be having meeting with Hon'ble Health Minister Shri @mansukhmandviya Ji regarding #NEETPG2023 Postponement issue on 31st January! We hope Sir will listen to our demands & will provide some solution!"

Earlier FAIMA had written to the Union Health Minister and pointed out that around 10,000 NEET PG aspirants will not be able to appear for the entrance test. Therefore, the association had urged the authorities for postponing the exam by 2-3 months and reconsider the eligibility criteria.

National Board of examinations (NBE) had earlier announced that NEET PG 2023 will be held on 5th March 2023. The result will be declared By 31st March 2023. As per the previous eligibility criteria announced by NBE, the NEET PG 2023 candidates must complete their mandatory one-year MBBS internship on or before March 31.

However, Medical Dialogues had earlier reported that due to this Internship Deadline, hundreds of students were facing year loss since they were unable to fulfill the eligibility criteria of completing the MBBS internship within March 31.

Also Read: Around 3,000 NEET PG Aspirants ineligible: KNRUHS Medicos approach State Health Minister seeking postponement of exam

After various representations from doctors and organizations, finally NBE offered to relief to the NEET PG aspirants and extended the Internship Deadline to June 30, 2023.

Even after postponement of the exam, several thousands of candidates remained ineligible for the exam. In Telangana alone, altogether 3000 students remained ineligible since the Kaloji Narayana Rao University of Health Sciences (KNRUHS) extended the internship completion date of MBBS students till August 11. Kakatiya Medical College (KMC) alone has about 200 interns who are now ineligible for writing the PG medical entrance test.

On January 24, 2023, taking up the issue of such candidates, FAIMA had written to the Union Health Minister. "Every year lakhs of post MBBS doctors appear in this exam chasing their dream. Each Medical Specialist doctors add to strength on ground doctor which helps the patient & society in their best possible ways they could they can and also who plays a significant role in providing strength to existing health care system of this country which has also been proved during the Covid Pandemic."

"If the exam is conducted on the official said date, there will be around 10000 potential eligible MBBS doctors who won't be able to write the life deciding exam and will be back in their career for around 1 year which will be a huge loss to the existing resident doctors, work hours, patient load and healthcare system of the country," the letter further added.

Requesting Hon'ble Union Health Minister Shri @mansukhmandviya Ji to work on the basic issues beside opening new Medical colleges!10000 of #Doctors are left ineligible to appear for #NEETPG2023 Exam!Kindly Postpone #NEETPG2023 exam by 2-3 Months!#PostponeNEETPG2023@ANI pic.twitter.com/CmrOqwvcEn

— FAIMA Doctors Association (@FAIMA_INDIA_) January 24, 2023

"Recently regarding NEET PG 2022, stray round counselling was conducted on 10/01/2023 in which many NEET PG aspirants participated in attending the counselling, due to which lots of NEET PG aspirants participated in attending the counselling, due to which lots of NEET PG aspirants aren't able to give ample amount of time to prepare for the said exam on 5th March 2023. We have also noticed a helpful decision by MOHFW in 2022, where NBEMS rescheduled NEET PG on 21/05/2022 & also additionally extended the eligibility criteria for interns due to which lots of intern students of various states were eligible of NEET PG 2022. Even the similar scenario was seen in Covid Pandemic where the NEET PG 2021 was rescheduled from 15/04/21 to 11/09/21," FAIMA had mentioned in the letter.

Therefore, requesting the authorities for postponing the NEET PG exam, the association had mentioned, "Sir, considering the above mentioned facts, FAIMA requests the concern authority to kindly consider the request and do the needful by postponing the exam by 2-3 months & re consideration of eligibility criteria of interns to make them eligible for NEET PG 2023."

Now, in a recent Tweet, FAIMA has informed that a delegation of the association is going to meet the Union Health Minister and request him to postpone the exam.

A delegation of #FAIMA will be having meeting with Hon'ble Health Minister Shri @mansukhmandviya Ji regarding #NEETPG2023 Postponement issue on 31st January! We hope Sir will listen to our demands & will provide some solution!@ANI @PTI_News @DghsIndia@DrAjayRML @MoHFW_INDIA

— FAIMA Doctors Association (@FAIMA_INDIA_) January 27, 2023

"NEET PG Internship Deadline has been extended till June 30. So obviously, the counselling process cannot start before July. So, even after appearing in the NEET PG exam on March 5, the students will have no choice but to sit idle for three to four months. They won't even get hired for such a short period of time. I hope that the Honourable Health Minister takes cognizance of the matter and the exam gets postponed," Dr. Rohan Krishnan, the National Chairman of FAIMA told Medical Dialogues.

"The authorities should consider the case of the PG dental students as well since they are facing the similar kind of problems regarding the eligibility criteria," he added.

Also Read: NEET PG 2023 Applications Edit Window now open, Details

This was announced to Diario Libre by Dr. Yocasta Lara, director of Hospitals of the National Health Service (SNS), after confirming that yesterday three other patients were discharged because they tested negative for the disease, of which 36 cases have been registered at the national level from October to date.

The doctor explained that they are awaiting the results of the tests performed on those hospitalized to confirm or rule out the disease and recalled that stool cultures take three days to conclude.

Of the seven patients, five are at the Dr. Felix Maria Goico Hospital in the National District, one at the Dr. Rodolfo De La Cruz Lora Hospital in Pedro Brand, and one at the Dr. Hugo Mendoza Pediatric Hospital in Santo Domingo East.

Yocasta Lara said that the balance of patients admitted for suspicion of the disease is done every day at 8:00 a.m., so she cannot say if more people have been revealed this Saturday.

Since October 2022, 8,700 cholera tests have been applied in the country. However, so far, the health authorities have not provided information on the post-mortem tests used on five residents of the Villa Liberation sector, Santo Domingo East, who, according to their relatives, died of symptoms associated with cholera.

It is recalled that the authorities began to apply the Euvichol-Plus cholera vaccine to people from one to 60 years of age, residents of vulnerable areas where cases have already been detected.

The immunologic is a liquid formula for oral application, single dose, and protects against serotypes 01 and 0139, with protection for three years. It is being applied in the Goico Hospital, the mobile hospitals of La Zurza and Villa Liberación, and the Moscoso Puello Hospital.

It will also be distributed in selected schools in these sectors, including Capotillo and Villas Agrícolas.

At the provincial level, it will be applied in Elías Piña, Dajabón, Independencia, and Pedernales, provinces bordering Haiti, where health authorities have reported 511 deaths from cholera in the last four months.

The main issue at hand, is the amount of time spent on the toilet while using the cellphone. It is likely that the practice will result in one sitting for a longer period of time and simultaneously using the cellphone, which often results in losing track of time. This puts pressure on the veins of the anus in the lower rectum, resulting in haemorrhoids or piles. These often cause severe pain, swelling and/or bleeding.

General, laparoscopic and bariatric surgeon Dr Alfred Dawes told Your Health Your Wealth that using a smartphone isn't the problem, rather it is sitting on the toilet and using the phone for a prolonged period of time.

Veins both on the inside of and just on the outside of the anus become the majority of the swollen mass of tissue we call haemorrhoids. These enlarged veins are filled with blood and stretch the lining of the anus, leading to fleshy looking tissue that protrude from the anus. If the veins in the inside of the anal opening are enlarged, we call them internal haemorrhoids. If it is the veins on the outside of the anus that are enlarged, they form external haemorrhoids. Internal haemorrhoids usually cause painless bleeding when you wipe, but if they get trapped in the anal opening this can lead to excruciating pain. External haemorrhoids become painful when the blood in their veins clot, leading to inflammation and even death of the overlying skin. Long periods of time spent on the toilet can unquestionably result in haemorrhoids. According to Dr Dawes, staying longer and straining to pass stool may cause the haemorrhoids to fill up with blood and create pain, swelling, or bleeding.

Dr Dawes also mentioned the possibility of contaminating one's phone with faecal bacteria when using the restroom. When you flush the toilet, tiny droplets of water may get in the air and contaminate nearby surfaces. E. coli and other microbial nasties may be present on phones and research shows that a smartphone screen is dirtier, on average, than a toilet seat.

While you might take pride in keeping your home spotless, you never know how clean public restrooms are, especially in areas where lots of people congregate, like offices or other workplaces.

So, how should you use the john? Below Dr Dawes gives some tips.

1. Only use the restroom for as long as you need to. Don't force a bowel movement if it doesn't come after a few minutes on the toilet. Get up and move on to something else instead. Return to the bathroom whenever the urge strikes.

2. The time it takes to poop should be between one and fifteen minutes; any longer may be a sign of constipation. Spend as little time as possible sitting still and tensing. If you find yourself becoming sidetracked, try setting a timer to alert you when it's time to stand up and continue if nothing has, so to speak.

3. Invest in a bidet to clean your bottom after using the bathroom (or straining). Your anal muscles may feel better with the help of warm, pressured water from the bidet.

Of course, not just after a bowel movement, you should wash your hands thoroughly after using the restroom.

4. After using, wash your hands with running water for at least 20 seconds.

5. Finally, if you must use your smartphone in the restroom, be sure to close the seat after you flush since every time you flush, faeces contaminated water droplets fly into the air and land on your phone, body parts, even your toothbrush.

6. Use Lysol or Clorox wipes to regularly clean your phone.

For the private sector to play a meaningful role in improving access to health care, we must understand the critical factors that impede access to care and create new sustainable models of care that recognise the existing impediments to inclusive care and health equity. Impediments to access and inclusive health care include poverty and its correlates, geographic area of residence in a poor or low-resource country or community, race and ethnicity, sex, age, occupational status, socio-economic status, education, and disability status. Accessing care— whether it is available, timely, convenient, and affordable — affects health care utilization. Any structure that delays access to care is an impediment to care.

Private sector role in facilitating access to care in a resource-constrained environment

Current models of care are primarily based on methods developed in more affluent societies with more formal economies and robust Government-funded programmes and social safety nets. These models of care are devoid of our cultural context and socio-economic realities and so are mostly unsuitable for lower-resource countries like Jamaica, where most members of the society are engaged in the informal sector and so lack the leverage of large corporations to negotiate inclusive health care coverage with insurance companies or serve as third-party guarantors of payment. Unfortunately, in low-resource nations with poor regulatory oversight, access to reliable and affordable health insurance products is limited for many citizens. While many reputable health insurance companies operate within ethical boundaries, a few are blinded by profits and tend to overreach, especially when they enjoy a relative monopoly, and regulatory oversight is weak or lax. For a health insurance product to be useful in improving access, health insurance companies cannot be directly involved in influencing the utilisation of services by the insured, either by actively encouraging patients to decline services, providing medical advice by untrained agents, or directing patients to facilities that may not be appropriate for their treatment simply to save money. This unacceptable interference with patient care represents a significant conflict of interest and poses a major impediment to access. Furthermore, a health insurance agent engaging in the practice of medicine under any guise is unlawful, unethical, and inappropriate.

The private health-care market is not immune to these calculations. Suppose the goal is inclusive health care that is sustainable. In that case, we can argue that a system that is designed to serve only the minority in the population with adequate health insurance is flawed, especially in a low-resource country like Jamaica, since there is no default position for the majority of the citizens who do not have access to coverage such as Medicare in the USA or NHS in the UK.

A system that ensures that access to care is inaccessible to most citizens in the informal sector is not in our best national interest. Fortunately, out-of-the-box and imaginative health systems innovators are beginning to design new disruptive systems of care that improve access, such as cross-subsidisation models, direct patient care models, capitation models, value-based care models, pay-for-performance models, etc. What these innovations have in common is improving the pool of people with reliable and affordable access to care while also tying compensation to performance and outcomes while limiting the interference from third parties that are more focused on profit rather than patient well-being.

The Heart Institute of the Caribbean (HIC) has been globally recognised as a pioneer and global leader in this reimagination of health-care delivery systems to ensure health equity, universal access, and inclusion. While citizens with health insurance and third-party guarantors of payment, for example, are expected to and must pay the full rate for services and procedures at HIC, we consistently subsidise the uninsured to ensure that most citizens have access to our services. While this does not sit well with some of the wealthy who disdain our subsidisation model for the poor and less affluent, we remain undeterred as we believe that our approach is anchored on a sound moral responsibility to ensure inclusive and equitable health care for all Jamaicans. We cannot justify extending such subsidies to the wealthy or to highly profitable cooperations seeking even more profit. We hope more providers will embrace these new approaches to extend care to the most vulnerable in our society. It must be remembered that the physician's primary role is to the patient. Not to the insurance company or any third-party payer. The centrepiece of what we do as physicians must be the patient, which means all patients and not just a few. This is the basis of inclusive care and health equity. Therefore, we must embrace models of care like cross subsidisation and direct patient care models that ensure expanded access to services beyond those with third-party guarantors. The farmer in the country, the vendor at Coronation Market, the widow, and the pan chicken man, all benefit from subsidised care that grants access to high-quality care.

The physician must not be intimidated into doing what is not in the patient's best interest to please the payer or enhance the profit for the payer. This principle is as old as time and is enshrined in the Hippocratic Oath. The Hippocratic Oath is an oath of ethics dating back to AD275, historically taken by physicians. The oath is the earliest expression of medical ethics in the Western world, establishing several important principles that continue to guide and inform medical practice today. All modern versions of the oath encompass the principle of responsibility to patients and equitable distribution of care. A current version administered by Tufts University, for example, includes as follows:

"...I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm... May I always act so as to preserve the finest traditions of my calling, and may I long experience the joy of healing those who seek my help."

If the economics of providing appropriate and inclusive care is impractical for Jamaica, then the only access that a Jamaican patient can have is if he is willing and able to foot the financial costs of travelling abroad for care. This again widens the access gap as only the very rich can access the service. Furthermore, the access gap is exacerbated as our limited funds are transferred from Jamaica to a more affluent society like the USA, UK, or Canada by the rich in search of services not accessible in Jamaica.

The effect of resources available for health care spending and access to care can be seen when comparing low- and high-income countries. The United States consistently vaccinates more than 90 per cent of it's children. Across sub-Saharan Africa, complete childhood vaccination averages 56.5 per cent, from a low of 24 per cent in Guinea to 95 per cent in Rwanda. In Jamaica, an upper lower-middle-income country, our childhood vaccination rates are approximately 90 per cent.

If we were to consider manpower issues in terms of the cardiologists, the continent of Africa (54 countries) has approximately 2,000 cardiologists for their 1.2 billion population or one cardiologist for 600,000 people. The United States of America has approximately 26,000 cardiologists for a population of 331 million or one cardiologist for 13,000 people. In Jamaica, we estimate about one cardiologist per 150,000 people. Our next article will look at other issues affecting healthcare access.

Dr Ernest Madu, MD, FACC and Dr Paul Edwards, MD, FACC are consultant cardiologists for the Heart Institute of the Caribbean (HIC) and HIC Heart Hospital. HIC is the regional centre of excellence for cardiovascular care in the English-speaking Caribbean and has pioneered a transformation in the way cardiovascular care is delivered in the region. HIC Heart Hospital is registered by the Ministry of Health and Wellness and is the only heart hospital in Jamaica. Send correspondence to info@caribbeanheart.com or call 876-906-2107

The Toribio Bencosme Provincial Hospital received an Echo Cardiograph for an investment of RD$3,557,615.18, while at the President Estrella Ureña Regional Hospital, an image digitizer or CR and five surgical lamps with rolling feet, valued at RD$2,933,920, were delivered.

Likewise, the Hospital Municipal Licey al Medio was given a table for primary operations for RD$668,197.80, while the Hospital Regional Infantil Doctor Arturo Grullón received four transport stretchers valued at RD$787,296.00.
At the meeting of health indicators, where the delivery of the equipment was announced, the director of the SNS, Dr. Mario Lama, said that the action is part of the commitment assumed by the institution to equip the country’s hospitals and reduce the gap in access to health services.

During the socialization with the hospital directors, which was attended by the director of the North Central SRS, Manuel Lora, and other SNS and regional authorities, Dr. Lama also informed that, as was done in the Metropolitan and Central Cibao health regions, in the North Central region there will also be an increase in the financial advance to the hospitals of eight million, four hundred thousand pesos.

The soaring cost of eggs may be inspiring some people to add a chicken coop or two to their backyard or property. 

The feathery pets, however, come with serious health risks, according to the Centers for Disease Control and Prevention (CDC) — so people should go into such an endeavor with eyes wide open.

"Raising any type of animal or bird is always potentially fraught with communicable disease transmission," Dr. Aaron Glatt, chief of infectious diseases at Mount Sinai South Nassau Hospital on Long Island, New York, told Fox News Digital this week.

PENNSYLVANIA COUPLE STARTS ‘RENT THE CHICKEN’ BUSINESS AMID HIGH EGG PRICES IN STORES

"Proper attention has to be given toward maintaining the good health of these creatures, as well as preventing the spread of microbes they may harbor," added Glatt. He is also a spokesperson for the Infectious Diseases Society of America. 

Last year, there were 1,230 illnesses, 225 hospitalizations and two deaths in 49 states and Puerto Rico as part of a CDC investigation into outbreaks linked to backyard poultry, according to its website.

"In 2022, CDC investigated 13 multi-state outbreaks of salmonella infections linked to backyard poultry," Dr. Kathy Benedict, a veterinarian epidemiologist with the CDC, told Fox News Digital. 

"Backyard poultry can be a reservoir for many diseases, which can spread diseases to poultry and/or humans," added Maurice Pitesky, a cooperative extension specialist with University of California, Davis School of Veterinary Medicine in Davis, California.

"It is our responsibility to raise the birds in such a manner as to reduce the potential for disease transmission," he added.

US FARM GROUP CALLS FOR PROBE OF HIGH EGG PRICES

The CDC gives tips on how to stay safe from the harmful germs that chickens can spread.

"Chickens can carry germs like campylobacter, E. coli and salmonella," Benedict of the CDC told Fox News Digital.

These are all bacterial infections. 

Chickens don’t usually get sick from these germs, she said — so "they can look clean and healthy but still spread the germs to people."

People using a chicken coop can also get an infection known as histoplasmosis, said Benedict. 

It's caused by a fungus found in soil that's contaminated with bird poop. 

Experts emphasize the importance of knowing the health risks of one bacterial infection in particular — salmonella — associated with having a chicken coop.

"You can get sick from touching your backyard poultry or anything in their environment and then touching your mouth or food and swallowing salmonella germs," the CDC notes on its website.

Patients who are sick with salmonella often have a fever and diarrheal symptoms with stomach cramps, the CDC says.

The symptoms often begin as early as six hours up to six days after swallowing the bacteria, but most people get better on their own in one week.

Children younger than five, adults who are 65 and older, and people who are immunocompromised are more likely to be at risk for severe disease from salmonella and may require treatment, including hospitalization.

The agency emphasizes that people should always wash their hands with soap and water after the following: handling any chickens; touching their eggs; and touching anything where chickens live and roam. 

But hand sanitizer is a good second-line option if soap and water are not readily available.

MEET THE AMERICAN WHO INVENTED SLICED BREAD: OTTO ROHWEDDER, HARD-LUCK HAWKEYE

The agency suggests people have a ready supply of hand sanitizer near the chicken coop.

Kissing or snuggling chickens can spread germs to the mouth — which is why the CDC recommends against doing this.

Also, don't eat or drink when around chickens, the CDC says.

Keep chickens, their care supplies such as feed containers, and the specific shoes you wear to care for chickens outside the home. 

"You should also clean the supplies outside the house," the CDC adds on its website.

Kids should also be supervised any time they're around backyard poultry. 

Parents and caregivers should remind them to also wash their hands after handling chickens. 

Children under five years old should not touch chickens. That's because they're at higher risk of getting sick from germs like salmonella.

While "eggs are one of nature’s most nutritious and economical foods," the CDC points out, "eggs can make you sick if you do not handle and cook them properly."

Eggs that stay in the nest for a long time can break or become dirty — so collect eggs as often as you can.

‘SKY-HIGH’ EGG PRICES: HISTORICAL LOOK AT EGG COSTS SINCE 1980

Broken eggs allow germs to enter the egg more easily through the cracked shell. Any eggs with broken shells should be thrown away. 

For unbroken eggs, "rub off dirt on [these] eggs with fine sandpaper, a brush or a cloth," the CDC notes on its website.

For warm, fresh eggs, avoid washing them with water, "because colder water can pull germs into the egg."

Once you've cleaned the eggs, it's wisest to refrigerate them to keep them fresh and to slow bacterial growth. 

While some people believe that fresh, unwashed eggs can be stored safely at room temperature, refrigerating them will help them last longer. 

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The CDC adds, "Cook eggs until both the yolk and white are firm, and cook egg dishes to an internal temperature of 160°F to kill all germs."

Benedict told Fox News Digital, "CDC’s website has information about how to stay healthy around backyard chickens and how to keep your chickens healthy."

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She noted that the agency also includes FAQs and "a printable infographic for people who have chicken coops."

The Host

Julie Rovner
KHN

@jrovner

Read Julie's stories.

Julie Rovner is chief Washington correspondent and host of KHN’s weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.

The abortion debate has changed dramatically in the seven months since the Supreme Court overturned Roe v. Wade and its nationwide right to abortion. Nearly half the states have banned or restricted the procedure, even though the public, at the ballot box, continues to show support for abortion rights.

In this special, two-part podcast, taped the week of the 50th anniversary of the decision in Roe v. Wade, an expert panel delves into the fight, the sometimes-unintended side effects, and what each side plans for 2023.

This week’s panelists are Julie Rovner of KHN, Alice Miranda Ollstein of Politico, Sandhya Raman of CQ Roll Call, and Sarah Varney of KHN.

Panelists

Alice Miranda Ollstein
Politico

@AliceOllstein

Read Alice's stories

Sandhya Raman
CQ Roll Call

@SandhyaWrites

Read Sandhya's stories

Sarah Varney
KHN

@sarahvarney4

Read Sarah's stories

Among the takeaways from this week’s episode:

• Exemptions to state abortion bans came into question shortly after the Supreme Court’s decision to overturn Roe, with national debate surrounding the case of a 10-year-old in Ohio who was forced to travel out of state to have an abortion — although, as a rape victim, she should have been able to obtain an abortion in her home state.
• The restrictions in many states have caused problems for women experiencing miscarriages, as medical providers fear repercussions of providing care — whether affecting their medical licenses or malpractice insurance coverage, or even drawing criminal charges. So far, there have been no reports of doctors being charged.
• A Christian father in Texas won a lawsuit against the federal government that bars the state’s Title X family-planning clinics from dispensing birth control to minors without parental consent. That change poses a particular problem for rural areas, where there may not be another place to obtain contraception, and other states could follow suit. The Title X program has long required clinics to serve minors without informing their parents.
• Top abortion opponents are leaning on misinformation to advance their causes, including to inaccurately claim that birth control is dangerous.
• Medication abortion is the next target for abortion opponents. In recent months, the FDA has substantially loosened restrictions on the “abortion pill,” though only in the states where abortion remains available. Some opponents are getting creative by citing environmental laws to argue, without evidence, that the abortion pill could contaminate the water supply.
• Restrictions are also creating problems for the maternal care workforce, with implications possibly rippling for decades to come. Some of the states with the worst maternal health outcomes also have abortion bans, leading providers to rethink how, and where, they train and practice.
• Looking ahead, a tug of war is occurring on state and local levels among abortion opponents about what to do next. Some lawmakers who voted for state bans are expressing interest in at least a partial rollback, while other opponents are pushing back to demand no changes to the bans. With Congress divided, decisions about federal government spending could draw the most attention for those looking for national policy changes.

And for extra credit, the panelists recommend their most memorable reproductive health stories from the last year:

Julie Rovner: NPR’s “Because of Texas’ Abortion Law, Her Wanted Pregnancy Became a Medical Nightmare,” by Carrie Feibel

Alice Miranda Ollstein: The New York Times Magazine’s “She Wasn’t Ready for Children. A Judge Wouldn’t Let Her Have an Abortion,” by Lizzie Presser

Sandhya Raman: ProPublica’s “’We Need to Defend This Law’: Inside an Anti-Abortion Meeting with Tennessee’s GOP Lawmakers,” by Kavitha Surana

Sarah Varney: Science Friday’s and KHN’s “Why Contraceptive Failure Rates Matter in a Post-Roe America,” by Sarah Varney

Also mentioned in this week’s podcast:

• NPR’s “Doctors Who Want to Defy Abortion Laws Say It’s Too Risky,” by Selena Simmons-Duffin
• The Columbus Dispatch’s “Suspect Indicted in Rape of 10-Year-Old Columbus Girl Who Got Indiana Abortion,” by Bethany Bruner
• Reveal’s “The Long Campaign to Turn Birth Control Into the New Abortion”
• Reuters’ “Alabama Case Over Mistaken Pregnancy Highlights Risks in a Post-Roe World,” by Hassan Kanu
• Politico’s “The Next Abortion Fight Could Be Over Wastewater Regulation,” by Alice Miranda Ollstein
• The Washington Post’s “Abortion Bans Complicate Access to Drugs for Cancer, Arthritis, Even Ulcers,” by Katie Shepherd and Frances Stead Sellers
• The Washington Post’s “A Triumphant Antiabortion Movement Begins to Deal With Its Divisions,” by Rachel Roubein and Brittany Shammas
• NBC News’ “Abortion Rights Groups Look to Build on Their Victories With New Ballot Measures,” by Adam Edelman

Click to open the transcript

Transcript: Part II: The State of the Abortion Debate 50 Years After ‘Roe’

KHN’s ‘What the Health?’Episode Title: Part II: The State of the Abortion Debate 50 Years After ‘Roe’Episode Number: 282Published: Jan. 26, 2023

Tamar Haspel: A lot of us want to eat better for the planet, but we’re not always sure how to do it. I’m Tamar Haspel.

Michael Grunwald: And I’m Michael Grunwald. And this is “Climavores,” a show about eating on a changing planet.

Haspel: We’re here to answer all kinds of questions. Questions like: Is fake meat really a good alternative to beef? Does local food actually matter?

Grunwald: You can follow us or subscribe on Stitcher, Apple Podcasts, Spotify, or wherever you listen.

Julie Rovner: Hi, it’s Julie Rovner from KHN’s “What the Health?” What follows is Part II of a great panel discussion on the state of the abortion debate 50 years after Roe v. Wade, featuring Alice Miranda Ollstein of Politico, Sandhya Raman of CQ Roll Call, and Sarah Varney of KHN. If you missed Part I, you might want to go back and listen to that first. So, without further ado, here we go.

We already talked a little bit about the difficult legal situation that abortion providers or just OB-GYNs have been put into, worried about whether what they consider just medical care will be seen as an abortion and they’ll be dragged into court. But in Tennessee, doctors would actually have to prove in court that an abortion was medically necessary, which seems a bit backwards. So, basically, it’s do it, see if you get arrested, and then you’ll have to present an affirmative defense in court. But the other thing that we’re starting to see is doctors leaving states, women’s health clinics closing, medical students and residents choosing to train elsewhere. This could really lead to a doctor drain in significant parts of the country, right?

Sandhya Raman: Yeah, I was looking at before where some of the states that have some of the highest rates of maternal mortality, maternal morbidity, and just lower maternal health outcomes overall are some of the same ones that don’t have Medicaid expansion and also do not have access to abortion right now. And it’s one of the things where, looking ahead, there have been people sounding the alarm at how this is going to get amplified. And as folks that might be interested in this discipline that are in medical school, school or readying for residency, or another type of provider that works in this space, if they choose to not train in these states — and a lot of folks that train in states often end up staying in those states — even if there are changes in some of these laws in the near term, it could have a huge effect in the future in terms of who’s training and who’s staying there and who’s able to provide not just abortions, but other terms of pregnancy care and maternal care.

Sarah Varney: And the workaround has become much more difficult because it used to be that if you’re in a state where abortion was very difficult to access or even, say, Texas during S.B. 8, these medical students could go to other states for the training. But now that you have these huge swaths of the South and the Plains and the Midwest where they are not allowed to do abortions, there’s just not enough places for OB-GYN residents and medical students to go to train. I did a story about this last year as well and looked at these students who were in medical school, who were coming up to Match Day and at the end, at the very end before the deadline, actually changed their match altogether or changed their list of priorities altogether because they didn’t want to be in Texas. So instead of doing an OB-GYN residency in Texas, this one young woman changed to a family medicine practice in Maryland. And I think the thing that’s important for people to remember is that these are the future OB-GYNs that will help many of us with our pregnancies and births for many decades to come. And as we have seen, pregnancy is very complicated and it oftentimes doesn’t end well. You know, about 10% of all confirmed pregnancies end in miscarriage; a far higher number end in miscarriage that are not confirmed pregnancies. And these will be the doctors that are supposed to actually know how to do these procedures. So if you’re in a state like Texas and you have a daughter who’s 15 and you anticipate in 15 years she may want to have a baby, you have to think about what kind of medical care she can have access to then.

Rovner: I’ve talked to a lot of people, a lot of women, who want to get pregnant, who want to get pregnant and have kids, but they are worried about getting pregnant because if something goes wrong, they’re afraid they won’t be able to get appropriate medical care. They would like to get pregnant, but they would actually not like to risk their own lives in trying to have a baby. And that’s actually what we’re looking at in a number of these states. I guess this is the appropriate place to bring up the idea of “personhood,” the declaration, not medically based, that a separate person with separate rights is created at the moment of conception. That could have really sweeping ramifications, couldn’t it? They’re talking about that, I know, in several states.

Varney: Yes. You don’t have to probe far to find out that the pro-life movement is 100% behind a federal fetal rights … the Supreme Court last year didn’t take up a case about fetal rights yet, but many of the members of the court have expressed in previous writings, and even in the Dobbs [v. Jackson Women’s Health Organization] decision, you saw [Justice Samuel] Alito using the language of the state of Mississippi that essentially granted to the fetus all of the … even, like, personality of a full human being. So I think this is going to get really tricky because Kristan Hawkins and many of the leaders of the movement, Jeanne Mancini, they do believe that there is no distinction between a zygote and a fetus and a full human being. So now this is really a religious belief. And it was interesting. I really struggled last year. I had to … I was basically assigned to write a story about, you know, when does life begin? And I think it’s an interesting question we have to ask ourselves as journalists: Why should we do that story? Is that, in a sense, propaganda for the pro-life movement? When really what the question should be is, you have a full human being, the woman, at what point should her rights be impeded upon? Right? And that’s essentially what the Roe decision tried to do, was to strike that balance. But now we’re in a whole new world where fetal rights are really the … they almost have supremacy over women’s rights.

Rovner: Yeah, I did two stories on When Does Life Begin? And it turned into one of them is … really the question is when does pregnancy begin? One of the doctors I talked to said, rather, that pregnancy begins when we can detect it, which is in many ways true. A doctor can’t say that you’re pregnant unless they can detect it at that point. But that’s a really important distinction medically between, you know, when does life begin philosophically and when does a pregnancy actually begin. But, obviously, in places that are going to declare personhood, this is going to get really complicated really fast because it would mean that you mostly couldn’t do IVF, that you can’t create embryos and then not implant them. And of course, the way IVF works for most people who are infertile and would like to have children is that you take out the eggs, you fertilize them, you grow them to a certain cell size, and then you implant them back into the woman. But you don’t generally use all of the embryos. And that would be illegal if every one of those embryos was an actual person. Could you take tax deductions for children if the child hasn’t been born yet, but you’re pregnant? I think you can already do that in Georgia, right?

Varney: Correct. Yeah. The Department of Revenue did that there.

Rovner: Yeah. This could be really, really far-reaching.

Varney: I mean, that’s what’s been going on in Alabama for years. … When the Alabama state Supreme Court years ago agreed with this argument that a law that was put in place to try and go after parents who were bringing their children to meth labs, that the notion of the environment was no longer just the meth lab, but the womb itself. And a child also then meant a fetus in the womb. Now you’re in that territory already. So Alabama’s a very good way to look into the future, in a sense.

Rovner: So basically, if you’re pregnant and go into a bar, you could be threatening the fetus.

Varney: I mean, there’s kind of no limit, right? Like, did you drive recklessly? Did you slip or did you fall on purpose? I mean, that’s what I was saying earlier about it’s really going to be up to these local prosecutors to figure out how far they want to take this.

Rovner: And that’s not hypothetical. We’ve seen cases about a woman who fell down the stairs and had a miscarriage and was prosecuted for throwing herself down the stairs.

Varney: Or a woman who was pregnant and got into an altercation in a parking lot of a big-box store and got shot and the fetus died. And then she was arrested. I mean, eventually they dropped the charges, but. yeah.

Rovner: Well, moving on. So with narrow majorities in both houses of Congress for the party in charge, changing federal law in either direction seems pretty unlikely for the next two years, which leaves the Biden administration to try to reassure people who support abortion rights. But the Biden administration doesn’t have a long list of things that can be done by executive action either, beyond what they’ve done with the abortion pill, which we mentioned already — the FDA has loosened some of those restrictions. How has the Biden administration managed to protect abortion rights?

Alice Miranda Ollstein: First, along the lines of the FDA, the FDA has been called on by the pro-abortion rights side to drop the remaining restrictions on the abortion pill. So they’ve dropped some, but they still require a special certification for the doctors who prescribe it, a special certification for the pharmacies that are just newly allowed to dispense it. Patients have to sign something saying they understand the risks. These are called REMS. These are on drugs that are considered dangerous. And a lot of medical groups and advocates argue that there isn’t evidence that this is necessary, that the safety profile of these drugs is better than a lot of drugs that don’t have these kinds of restrictions. And so they said that it would improve access to drop these remaining rules around the pills. Some have even called for them to be available over the counter, although I don’t see that happening anytime soon. Along the lines of preventing unwanted pregnancies in the first place, the FDA also is sitting on a decision of whether or not to make just regular hormonal birth control available over the counter. So that’s one to watch as well. But the Biden administration have more things they could do. They have looked at providing abortions through the VA [ Department of Veterans Affairs]. That was a big one. Earlier this year, the president signed a memo just over the weekend directing the health secretary and others in the Cabinet to look at what they can do to improve access. We’ve seen similar statements and memos before. It’s not really clear what they’ll mean in practice. But I also want to go back to you saying that nothing is likely to happen in Congress. I agree on the legislative side, but I am watching closely on the appropriations side, because I think that’s where you could see some attempts to pull things in one direction or another in terms of where federal spending goes. And going back to the group’s wastewater strategy, one piece of that they want to do, the anti-abortion groups, is pressure Republican members of Congress to hold the FDA’s funding hostage until they do certain environmental studies on the impacts of the pills. That’s where I would watch.

Rovner: Yeah, and spending bills over the years have been the primary place to do legislating on abortion restrictions or take them off. It’s not just the Hyde Amendment that banned most federal spending for abortion. There are amendments tucked into lots of different spending bills restricting abortion and other types of reproductive health care. And when Democrats are in charge, they try to take them out. And when Republicans are in charge, they try to put them back in. So I agree with Alice. I think we’re going to see those fights, although it’s hard to imagine anything happening beyond the status quo. I don’t think either side has the ability to change it, but I suspect that they’re going to try. The administration has gone after some states on the federal EMTALA law, right? The Emergency Medical Treatment and Active Labor Act, which basically says that hospitals have to stabilize and take in women in active labor. And basically, if that conflicts with an abortion ban again, like with the FDA and drugs, federal law should supersede the state law. But we haven’t really seen any place where that’s come to a head, right?

Raman: Idaho has been the main one to watch with the lawsuit there. And the Justice Department did a briefing this week before their reproductive rights council met. And they had said that that was one of the cases they’re still doing — the Idaho, in addition to the lawsuit on the VA rule that Alice mentioned, and then also an FDA rule that we talked about earlier. But they’re monitoring different things going forward. But I think one of the interesting things is that they haven’t cast a very huge net in terms of the different things that they’ve been involved with in states. It’s mainly been these three situations. And even Idaho, they’ve already in that legislature introduced a bill that would amend their law as it is now, to deal with some of the nuances so that they would adhere to EMTALA. I don’t know how far that could go through or any of the logistics with that, but I mean, that sort of thing, the Idaho situation could be solved more quickly if they’re able to get that done. And DOJ [the Department of Justice] thinks that that aligns. But it is interesting that they haven’t dug into a lot of the other state efforts yet, but that they have that on their radar.

Varney: We have seen a sort of political battle being waged, of course. So on the anniversary of Roe v. Wade, Vice President Kamala Harris was in Florida, in Tallahassee, making the 50th-anniversary-of-Roe speech. Clearly, she wants [Gov. Ron] DeSantis to be on notice that should he become a candidate in the presidential election, that Florida is very much in play. And Florida is interesting because they still have a 15-week ban. So it would not have been allowed under Roe, but it’s not as draconian as what these other states have, which is essentially nothing.

Rovner: Most of the surrounding states, too.

Varney: Correct. Yeah, exactly. So Florida has really become a receiving state for abortions, particularly in the last six months. I’m going to be interested to see if somebody like a DeSantis can even run for president from a state with a 15-week ban. I mean, he’s going to be under a lot of pressure, not simply just to do a six-week ban, but to do an outright ban altogether. So I think if he tries to thread that needle and try and get anti-abortion groups on board to support him, he’s going to have to show them more.

Rovner: That’s just about what we’re going to get to. But before we leave, what the Biden administration has done, I need to mention, because it’s my own personal hobbyhorse — that the FDA has finally come out and changed the label on the “morning-after pill” to point out that it is not an abortion pill, that it does not cause abortion, that the way it works is by preventing ovulation. So there is no fertilized egg and that at least we can maybe put that aside, finally. That label change happened in Europe 10 years ago, and for some reason it took the FDA until now to make that clarification.

Varney: But as you said, Julie, it doesn’t matter because it’s just what you believe about the drug. You know, and just to remind listeners that that drug I did — I mean, we’ve all done stories on Plan B over the years — but the one I did recently was how Plan B is actually owned by a private equity company, actually two private equity companies. And they would not go to the mat to the FDA to get this thing changed. They could have done it years ago. So now that the FDA has made this … it’s just like anything, any kind of misinformation, that people who don’t support it can just simply say, well, the FDA is biased or that’s not actually how it works.

Rovner: True.

Varney: But I don’t think it will put it to bed.

Rovner: Well, quickly, let us turn to 2023 and what we might see for the rest of this year. We’ll start with the anti-abortion side. Obviously, overturning Roe was not the culmination of their efforts. They have some pretty ambitious goals for the coming year, right? Things like travel bans and limiting exceptions in some of these states. Sandhya, I see you nodding.

Raman: There are so many things, I think, on my radar that I’m hoping to watch this year just because we are in this whole new era where it might have been three years ago a lot easier for us to predict which things might be caught up in litigation, which things might be struck down. But I think now, after the Dobbs decision, even after the Texas S.B. 8 law that we mentioned earlier, it’s a lot more difficult to see what sort of things will go in effect that might not have been able to go into effect before. And one thing I think has been interesting is that the anti-abortion movement had been in unison before this on some of their traditional Hyde exceptions — that abortions to save the life of the mother, in cases of rape and incest were something that was broadly on board, that those would be allowed. And I think we’ve seen a lot increasingly in different states, things that have been brought up by different state lawmakers that would chip away at that, that vary by state, whether or not what defines is medically necessary to save a life. And even when we were talking about Idaho earlier with the EMTALA requirements or … there was a great piece in The New Yorker last year about the anti-abortion activist who really wants to lobby against rape exceptions because she was born as a product of rape and is using her own experience in that. And so I think that will be a very interesting thing to watch because there is not a uniform agreement on that. Whereas some of the things that have been taken out, there’s a lot more strong backing for across the board.

Rovner: Yeah, that’s actually my next question, which is we’re starting to see not only a split within the anti-abortion community about what to pursue, but a little bit of distance between the Republicans and the anti-abortion forces. And I think there’s a lot of Republicans who are uncomfortable with going further or who are uncomfortable even in some of the states that don’t have exceptions. I mean, are we looking at a potential breakup of this Republican anti-abortion team that’s been so valuable to both sides over the last few decades?

Ollstein: I wouldn’t call it a breakup, but the tension is absolutely there. I mean, I wouldn’t call it a breakup just because, where else are they going to go? I mean, the Democratic Party is much more supportive of abortion rights as a whole than even just a few years ago. And so, really, they know Republicans are their best bet for getting these restrictions passed. But there is this interesting tension right now. I think a lot of it is competing interpretations of what happened in this most recent election. You have anti-abortion groups who insist that the takeaway should be candidates didn’t run hard enough on banning and restricting abortion and were too wishy-washy, and that’s why they lost. And then you have a lot of other Republicans and party officials, party leaders who feel that they were too aggressive on promoting abortion restrictions and that’s why they lost. Also, you know, I will say this isn’t purely, purely cynical politics. A lot of Republican state lawmakers have told us they’re genuinely concerned now that they’re actually seeing the laws they drafted and voted for take effect and have consequences that they maybe didn’t intend. And they’re hearing from these state medical groups who are pleading for changes to be made. And so some of them say, OK, we want to get this right. We want to go back and make fixes. And the anti-abortion groups are telling them, no, don’t create loopholes. Don’t water down these laws. And so you do have this really interesting tug of war playing out at the state level right now. And because of what you said about the federal level, the state level is really where it’s at.

Varney: And I was going to make two points. One is that the split is also really developing between the national groups and the state and local groups. So while the national groups may say, yes, we support a 15-week ban in Florida as a step to get to something else, the local groups are gung-ho. I mean, they’re in extremely gerrymandered districts. You look at Florida and Texas, they elected the most anti-abortion state legislature in history so far. And, you know, these are people coming from extremely safe seats. And then you’ll see that the city level — the city sanctuary of the unborn, I believe it’s called — that movement, they really see them going down to even the local-local level to try and get that in effect.

Rovner: Well, I think in a lot of places, states that are very affirmatively supportive of abortion rights or have it in their constitution, are trying to move that down to the local level, to the city level, to see if they can actually have success in limiting abortion locality by locality. All right. Well, meanwhile, what’s the other side doing? What’s the agenda for the abortion rights side? It’s going to be, as we pointed out, it’s gonna be kind of hard for them to advance very much.

Ollstein: Yes. I think that there is a lot of excitement around the results last year using state-level ballot initiatives in red and purple states, putting the question of abortion rights to the general public, because on all six ballots last year, the abortion rights side prevailed. Some of those were more offensive, some of those were more defensive. But in all six, they swept. And so they are really excited about trying to replicate that this year. Of course, it’s not possible in every state to put a constitutional amendment on the ballot for a popular vote. But in states where it is possible and where it could make a difference, including some states where abortion is already banned and they could try to unban it through the popular vote process, that’s really something they’re looking at. And then, of course, even though our federal judiciary has become a lot more conservative over time with the appointments, courts have still been convinced to block a lot of these state abortion restrictions. And so there are efforts to bring lots of different, interesting legal theories. You know, one that caught my attention is trying to make religious freedom arguments against abortion bans, saying these abortion bans infringe on the rights of religious people who believe in the right to abortion, which is sort of flipping that narrative there.

Rovner: There have been a bunch of Jewish groups who have filed cases saying that.

Ollstein: Exactly. Judaism, Islam, certain Christian denominations, all support abortion rights. And so there’s an interesting tactic there. Also pointing to language in state constitutions about privacy rights and arguing that should extend to abortion. And so a lot of interesting stuff there.

Raman: I would add to that, in terms of another tactic that’s kind of flipping what the other side has been doing, a long-term strategy of the anti-abortion movement has been prioritizing judicial elections and a long-term thing of … just in the Senate, we saw, you know, wanting to get a lot of judges confirmed that had pro-life beliefs. And you can even look to where the women’s march over the weekend, that the state … one that they were prioritizing was in Wisconsin, which was held there, to jump-start the fact that they have a state Supreme Court race coming up. They were 4-3 conservative majority right now. And the judge that is retiring is conservative. So getting a new judge that supports abortion rights could really open a path to overturn the ban there. Even though judicial elections are considered nonpartisan, there are often ways to tell clues about where someone might rule in the future. And so, I think, looking at things like that in different states as a way to dial back some of the things that the other side has been doing will be an interesting thing to watch, too.

Rovner: All right. Well, I think that’s it for our discussion. Thank you, for those of you who have hung with us this long. I hope we’ve given a good overview of the landscape. Now it’s time for our extra-credit segment. Usually that’s when we each recommend a story we read this week we think you should read, too. But this week I’ve asked each of the panelists to choose their favorite or most meaningful story about reproductive health from the last year. As always, don’t worry if you miss it; we will post the links on the podcast page at khn.org and in our show notes on your phone or other mobile device. Alice, why don’t you go first this week?

Ollstein: Yes, I think I’ve promoted this story before, but I just can’t say enough good things about it. It’s really stuck with me. It’s from the New York Times Magazine by Lizzie Presser, and it’s called “She Wasn’t Ready for Children. A Judge Wouldn’t Let Her Have an Abortion.” And it really digs into what happens to teenagers who need to get their parent’s consent and can’t in order to have an abortion. They have this judicial bypass process where their lives, the fate of their lives are in the hands of an individual judge, who, in many cases, as this article demonstrates, come with their own biases and preconceptions about abortion. And then it just follows this one teenager who was denied an abortion, ended up having twins, and just completely struggled financially, her mental health. And she in the end said, you know, I knew what was right for me. I knew I needed an abortion. And it’s a very moving, painful story that shines a light on a piece of the story that I think is overlooked.

Rovner: Yeah. Sandhya.

Raman: For my extra credit, I picked a story that also has stuck in my head for a long time, kind of like Alice. So it’s “‘We Need to Defend This Law’: Inside an Anti-Abortion Meeting with Tennessee’s GOP Lawmakers,” from Kavitha Surana from ProPublica. I really thought this was one of the most interesting pieces on this topic that I read last year. The author got audio from a webinar in Tennessee hosted by the Tennessee Right to Life on strategy on the movement going ahead in their state. They talk a lot about the Tennessee ban and how it has narrow life exceptions as a model for other states and how the burden of proof would be on the doctor. And then they have some quotes from a Tennessee lawmaker who suggests things that I think the other side has sounded the alarm about: mining data to investigate doctors, how to push back against rape and incest exceptions. And I think one of the things that really struck me was when they brought up IVF, some of the advocates during the meeting that they had said that two years from now, next year, or three years from now, IVF and contraception can be regulated on the table. But that’s like next steps.

Rovner: Absolutely. That was a great scoop, that story. Sarah.

Varney: So I actually picked a radio segment. It’s about a 12-minute-long radio segment that I did with Science Friday. On “Why Contraceptive Failure Rates Matter in a Post-Roe America.” So one of the things I kept hearing was, well, women are just going to have to really double up on contraception or make sure that they’re being responsible about taking their contraception. So it turns out that there’s a textbook on contraceptive technology and in that is a whole page on contraceptive failure rates, which show you what contraceptive failure rates should be in a laboratory and what they are actually out in the real world. So, for instance, the typical-use failure rate for birth control pills is 7%. So that means that seven out of 100 women on pills could experience pregnancy in the first year of use. So then I went and found the data that shows us the number of women ages 15 to 49 who are on specific methods of birth control, everything from the Depo-Provera to the contraceptive ring and patch to male condoms, to IUDs, to birth control pills. And you’ll see on both the Science Friday and the KHN website, we have these wonderful graphics where you can see that in one year of people using male condoms, because of their failure rate is about 13% in the real world, that could lead to up to 513,000 wanted pregnancies. Birth control pills, based on the number of women using birth control pills, up to 460,000 pregnancies a year in people who are actually using contraception to not get pregnant. So I think these data visualization is really important. And you can hear interviews that I did with the researcher and the physician who actually is the author of this textbook, as well as one of the world’s leading reproductive endocrinologists who talks about what’s next in contraceptive efficacy.

Rovner: Yes, I loved that story. Well, my story is also a radio story. It’s from NPR by Carrie Feibel. And it’s called “Because of Texas’ Abortion Law, Her Wanted Pregnancy Became a Medical Nightmare.” And it’s from July. And the events that it chronicles happened before the overturn of Roe v. Wade, because, as we’ve said, Texas’ abortion ban was already in effect. By now, we’ve heard this story many times. A woman with desired pregnancies, water breaks prematurely, which would normally result in a quote-unquote “medical termination.” Except the doctors and hospitals aren’t sure how sick the mom needs to be before the pregnancy actually threatens her life. And any other abortion is illegal, and they could get in legal trouble. So they put her through days of hell and sickness before she starts to show signs of sepsis and just before she and her husband were actually going to fly out of the state to get the pregnancy terminated. But this was the first of these stories that I read. And it hit me very hard. And I have such respect for the couple here who were willing to come forward and publicize all that the women called these gray areas of abortion, which lawmakers often think of as black-and-white. It was just one of those stories that sticks with you.

All right. That is our show for this week. As always, if you enjoyed the podcast, you can subscribe wherever you get your podcasts. We’d appreciate it if you left us a review; that helps other people find us, too. Special thanks, as always, to our ever-patient producer, Francis Ying. Also, as always, you can email us your comments or questions. We’re at whatthehealth — all one word — @kff.org. Or you can tweet me. I’m @jrovner. Sandhya?

Raman: @SandhyaWrites

Rovner: Alice?

Ollstein: @AliceOllstein

Rovner: Sarah.

Varney: And @SarahVarney4

Rovner: Will be back in your feed with our regular news rundown next week. Until then, be healthy.

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Clemente Terrero, the health center’s director, stated that as a result of the cholera outbreak that erupted in Haiti at the end of last year, the hospital “has handled several patients with cholera who have come from different parts of the country” and that they realized it was “prudent” to have an exclusive unit for the reception of symptomatic patients. “Our hospital has prepared to continue providing first-class care to children affected by illness, with the highest quality standards and humane treatment,” he said.

This health center received seven suspected cholera cases, four confirmed as positive and three negative. Five of these cases involved minors from La Zurza, San Carlos, and Ocoa. The patients were between one and four years old. Irma Coradin, the hospital’s in-charge of infectious diseases, explained that not all patients require intravenous hydration because some recover with oral hydration. “It is a disease that, if not treated promptly, ruins people’s lives due to the dehydration it causes,” she explained. Similarly, she stated that “no mortality has been recorded thus far, thank God.”

The hospital has not yet been added to the list of medical facilities where vulnerable patients can get the cholera vaccine. Cholera is a highly contagious bacterial disease that causes severe acute watery diarrhea. Symptoms can appear between 12 hours and 5 days after consuming contaminated food or water. Cholera affects both children and adults and, if left untreated, can be fatal in a matter of hours.