S.M.L., who supports himself by selling bottles of water and soft drinks in the vicinity of Parque Enriquillo, assured that since last Friday the 17th he has suffered constant diarrhea, although he has not undergone laboratory tests to identify its origin. His neighbors, a family of three made up of a grandfather, his daughter, and his adolescent grandson were on their way to the Félix María Goico Hospital at the time for the same reason: acute diarrhea for several days.

In Villa Francisca, they receive two types of water in the pipeline, one fresh and the other brackish. “Today fresh water came to the tap,” said the lady. Upon noticing the presence of reporters in the area, Ana, another community member, commented that some people do not have bathrooms in their homes, and they throw fecal matter and garbage out into the open, contaminating the environment. The fetid smell corroborated the affirmations of the young mother, who asserted that she could not open the windows to ventilate her home.

A few meters away was Cirilo, a vendor of yaniqueques and boiled eggs, who assured that he had adopted very hygienic-sanitary measures, although “sales are not very good.” “Very clean hands,” he said as he showed them as a sign that they were clean. “Look at the showcase, not a fly gets in there,” he added.

Rivera indicated that only through the Directorate of Access to High-Cost Medications, some RD$9 billion have been made available annually to benefit around 15,000 patients with chronic diseases, which in two years adds up to more than 18 billion in that area. While an amount of RD $5,126,266,797 have been invested in infrastructure (construction, reconstruction, and equipment of 179 health centers).

Likewise, he highlighted the investment of more than RD$3 billion in the budget increase of the Essential Medicines and Central Logistics Support program (Promese/Cal), which went from RD$1,568 million in 2022 to RD$3 billion in 2023.

Deep leaks in the walls, areas infested with humidity, and meeting rooms without tables or chairs. Bathrooms with pipes about to collapse, among other problems that the building presents.

It is thought that a building of more than 50 years of construction drags the absence of maintenance as governments usually do. If that is true, so is the lack of funds that would be affecting the Directorate of Medical Emergencies, where, despite the fact that retired General Juan Manuel Méndez was appointed in June 2022, the administration does not start because the funds destined for the management are not arriving, nor has the general’s work team been approved: administration, human resources the spinal cord of the control and the employees who were appointed to it have still not been paid in seven months.

The teams of doctors and paramedics that provide emergency medical care services, which are reported through 9-1-1, are even worse off.

“People think that whenever they get cholera, they will get diarrhea, no. There are 25% who do not feel anything, who can walk without any problem. There is a 25 % that does not feel anything, that can walk without any problem. This is a disease that can be largely asymptomatic,” said the Health Minister.

Rivera assured that there is reasonable disease control in the border area and recalled that the bulk of active cases in Haiti is in Port-au-Prince.

“The control is day by day. If there is a good vaccination there (in Haiti), we believe it will help us in this care,” said the minister.

The head of the Health Cabinet assured that out of 1.2 million cholera vaccines sent to Haiti, 800 thousand people have already been immunized.

“It will help us less. The more of their population is vaccinated, the less risk for us,” he said.

Market visit

The minister made a tour of the Santo Domingo East Municipal Market, located in the El Almirante sector, to verify the sanitary conditions and the handling of the products offered there and to ensure the maintenance of hygiene measures and good food handling to prevent cholera.

The official indicated that most of the food consumed in this area, which is currently the focus of attention for cholera, is dispatched from this market.

La Zurza declares itself free of cholera after a month without infected persons.
“With the cases of cholera that have been registered we have called attention to the care and handling of food and mainly the consumption of safe drinking water, where there is drinking water and good hygiene with vegetables and other products, there will be no contamination by cholera,” said Dr. Rivera.

He said that as of today, there were only four cholera inpatients and that surveillance is being maintained in the hospitals and the tents set up for the detection and attention of suspected cases in the different sectors of the country.

At the end of the visit, he congratulated the workers and administrative personnel of the market for the favorable conditions in which it is located. At the same time, he asked not to neglect and maintain these levels to avoid the spread of the bacteria.

During the dissertation, the official highlighted that during the two years of administration (2020-2022), some RD 5,126,266,797.59 had been invested in infrastructure and equipment in 179 health centers, saving the State some 5 billion pesos.

He said that in the Directorate of Access to High-Cost Medicines, the government currently invests some 9,000 million pesos annually to benefit about 15,000 patients with chronic diseases.

He stated that the current authorities found the country in a state of emergency, as a result of the COVID-19 pandemic, without an efficient protocol, so they sought a rapid and strategic response to implement, given the challenges and needs faced by the nation at that time.

In that sense, he explained the strategies implemented that resulted in the current development of the health sector.

“The health system did not have an emergency plan, and the regulatory and training framework was made more efficient to respond to any pandemic; the first level of care is being renovated, we increased the diagnostic capacity, implementation of mobile hospitals, relations with international organizations and public-private partnership and high training in human resources in health. Through all these initiatives developed by order of our President Luis Abinader, we have achieved what we are today in terms of health,” indicated Dr. Rivera.

In this context, Dr. Rivera said that the government responded quickly to any epidemiological situation that could arise after the passage of natural phenomena, such as the passage through the country of storm Fiona, as well as with preventive actions for smallpox, cholera, and other viruses.

He also detailed the investments made in remodeling, emergencies, new constructions, first-level centers, and specialties such as hemodialysis, oncology units, and diabetic foot, among others.

During his presentation, the official pointed out that President Luis Abinader has a great strategic vision to continue strengthening the health system in the Dominican Republic, such as the healthy municipalities programs with the implementation of the “Change your Lifestyle” Health Routes and the creation of healthy cities in the provinces of San Francisco de Macorís, San Pedro and San Cristóbal.

“From our Ministry of Health we have impacted more than 100,000 people with the Health Route journey in 17 provinces, with some 35 services such as: evaluations, general consultation, pediatric, blood typing, diagnostics, treatments and prevention oriented to non-communicable diseases, psychosocial support, delivery of medicines, National Health Insurance (SeNaSa) affiliation among other services.”

The also president of the Health Cabinet highlighted the achievements made in the face of the COVID-19 pandemic, with which the country guaranteed vaccination for all citizens and was the third country to apply the third dose. Likewise, the government decided to use the drugs Tocilizumab and REGEN-COV in severe patients and was one of the first in the world with the lowest lethality of the disease.

He also highlighted that the country was one of the five nations with the best vaccination rate, the sixth in Latin America in implementing immunization in children, and the third in the region in carrying out Genomic Sequencing, being recognized by the World Health Organization (WHO/PAHO), for the strategies implemented during the pandemic.

The Minister of Health highlighted the different social programs implemented in the area of health, in which he highlighted the budget increase made in the Essential Medicines Program and Central Logistical Support (PROMESE/CAL), which went from RD 1,568 million in 2022 to RD 3,176 million in 2023 for essential medicines, benefiting around 17,000 low-income patients.

He also mentioned the work carried out by entities such as the National Health Service (SNS), SeNaSa, Uniendo Voluntades, the National Institute of Drinking Water and Sewerage (INAPA), the Ministry of Housing and Buildings, among others.

The Minister of Health held the conference at the UTESA University Convention Center at the invitation of the New Democrats External Sector movement, which officials attended, collaborators of the Ministry of Health, members of Congress, and special guests, among other personalities.

The official assured that the ministry’s and the community’s joint interventions, vaccination, house-to-house visits, and the epidemiological fence will be maintained.

“Thank God, many of these cases that appear are mild, which is why hospitalization remains well controlled and low,” he said, adding that this does not mean that the disease’s overall situation has been resolved. “We’re not going to say it’s under control; that’s impossible,” the minister declared. Rivera stated that “it depends on people washing their hands before and after going to the bathroom, and before each meal, cooking food well because many of the people we have detected with cholera consumed poorly cooked food or in inadequate outlets in order to achieve control levels”.

“We’re doing well, the population is cooperating with vaccination,” he said. The goal is to have 24 thousand doses applied by the end of this week. The official reiterated that it is “an individual decision” and praised those who “take care of cleanliness and hygiene in their homes.”

The consequences of having an unsafe abortion, whether because the woman ingested pills or another substance or because it was induced by another person, can range from emotional consequences to permanent anemia, mutilations, irreversible damage to the uterus, and even death.

This is how Dr. César López, president of the Dominican Society of Obstetrics and Gynecology, explains it, noting that in cases like this, where a woman’s life is put in danger, especially if she is an adolescent, no one is innocent, and there are responsibilities from all sectors, including a lack of sexual education in schools and the family itself. “Provoking or inducing an abortion will always be dangerous, and even more so if all the conditions that must be met, such as asepsis, correct anesthesia, and the expertise of the doctor who performs it, are not met,” he explained.

However, recent studies have shown that abortions are safe if performed between 70 days of gestation. Abortions are considered safe when they are “performed using a method recommended by WHO that is appropriate to the pregnancy duration and the person providing or supporting the abortion is trained,” according to experts such as Fathalla. “The WHO definition recognizes that the people, skills, and medical standards considered safe in the provision of induced abortions are different for medical abortion (which is performed with drugs alone), and surgical abortion (which is performed with a manual or electric aspirator), and that skills and medical standards required for safe abortion also vary depending upon the duration of the pregnancy and evolving scientific advances”.

The same studies state that abortions are considered less safe if they meet either the method or the provider criterion but not both. As a result, abortion is considered less safe when performed using outdated methods such as sharp curettage, even if the provider is trained, or when women using tablets lack access to proper information or a trained person if they require assistance.

The infections correspond to three men aged 79, 51, and 27, as well as three women aged 28, 31, and 13 and a three-year-old boy, the Deputy Minister of Collective Health, Eladio Pérez, explained at a press conference. All those affected are stable, the official said.

The Dominican Republic confirmed the first case of cholera last October, corresponding to a 32-year-old woman of Haitian nationality who had then returned from the neighboring country, where the outbreak of the disease has already caused at least 560 deaths. In Haiti, 27,434 suspected cases of cholera have been recorded, of which 2,057 have been confirmed, and 23,540 patients have been hospitalized, according to the latest official data.

A total of 11,097 people have already been vaccinated against cholera in the Dominican Republic.

According to Pérez, the vaccine is called “Jynneos”, belonging to the “Bavarian Nordic” brand, it is of a “fairly known and tolerable technology, with very low adverse effects”, and only those over 18 years of age may be inoculated.

“We have been able to access an emergency stock that the World Health Organization has for cases of seismic smallpox. They are already in the country. Several months ago it was announced that vaccines had been purchased, they arrived and will be available to the vulnerable population, ”he assured, adding that the State investment for the acquisition of the medicine was more than 32 million pesos. The vaccine will be applied in two different doses and initially, the Ramón de Lara Hospital and all health personnel “who will face the disease if more cases occur, will begin to be immunized since they must be duly protected.”

In addition to this, the representative of the Health Administration indicated that the medicine is stored at temperatures above 50 degrees and can take up to five years to expire.

For the feminist organization, it is an “obligation” of this legislative body to assume its commitment to the protection of women’s rights and to resist pressure from the “more retrograde” interests of political party structures “kneeling” before “powers that be” of a religious nature. The entity stated in a note that the Senate should not continue to ignore the social claims of thousands of women, particularly poor women, who demand three exemptions from abortion penalties across the country.

She went on to say that, like many other institutions and spaces for social and community struggle, the defense of women’s rights is the bedrock of critical social transformations in today’s Dominican society. Cudem described as “unacceptable” the “dogmatic” and “anti-humanist” thought, in the strict sense of the concept, which means the defense and protection of human life of beings born “alive and viable,” as established by international recognition of human rights. She reiterated her call to legislators to remove all conditioning factors and pressures, as well as to accept social and political responsibility by siding with those who, “with our work and efforts,” bear the essential burden of families, which are women.

“It is the responsibility of congressmen and women to legislate in favor of women’s rights so that women can be free to make decisions about our lives and our bodies when a pregnancy poses risks, is not viable, or is the result of rape or incest,” Cudem said.