Newton Solano, the health center’s director, confirmed that he uses a process of optimizing supplies and medicines, “as provided for the entire Public Network,” so that it is dispatched based on the number of patients admitted, usually doubling figures to account for unforeseen events. “It is a false complaint; reusing syringes is never permitted, and it is the nurses who remove the sealed syringes from the warehouse and place the medicines on the patients,” Dr. Solano said. He explained that he has established controls to avoid waste of supplies and medicines and that the hospital has a 24-hour pharmacy service for the first time. “As a result, if any input runs out, it is dispatched immediately,” he assured.

The doctor reiterated that the Bogaert Hospital, a Cibao Occidental Regional Health Service (SRSCO) center, has all of the necessary supplies to respond to users who seek health care at that facility. Similarly, he stated that the operating room is at total capacity, that “more surgeries are being performed than ever,” and that it has been strengthened with previously unavailable services such as laparoscopy, urological, and endoscopic surgery. Finally, Ramón Rodrguez, the director of the Western Cibao Regional Health Service, stated that Dr. Solano has proven to be a director committed to management who has made every effort to provide quality services to his patients.

Concerning the other complaints from the Nursing union, the SNS stated that they are being investigated, even though it believes some are unfounded, and that the entity is working hard, hand in hand with a dedicated team, to improve the health of the country, and that changes will be made. 

Santo Domingo, DR
In Villa Liberación del Almirante in Santo Domingo East, cholera is “under control” after the area became a focus of concentration of the disease. At the same time, the residents of the crowded sector have heeded the call of the health authorities to be immunized against the disease, registering at least 2,804 people who received the dose.

Of the people inoculated, 1,825 were students of the neighboring schools. In contrast, the rest were inoculated at the Diagnostic Tent, vaccination posts in the Almirante, house-to-house campaigns, and the health area of the district.

Rafael Güichardo, risk manager of this health area, highlighted the municipalities’ receptiveness to oral vaccination at the health posts and house-to-house campaigns.

“They have grasped the message we have for them to get vaccinated, because it is really for their own health,” he said.

Güichardo also highlighted that in the last few days, even though they continue to attend to people in the tent, no people have come with characteristic cholera symptoms such as dehydration, vomiting, and diarrhea.

“Patients come with different pathologies, such as headaches and different pathologies, but we are not really receiving patients with suspected cholera symptoms,” he added.

An average of four people come to the tent every day.

The service remains stable regarding the drinking water supplied by the Santo Domingo Aqueduct and Sewerage Corporation (CAASD) in the water tank in the diagnostic tent located in the Diagnostic and Primary Attention Center of the sector with the assistance of tanker trucks on a daily basis.

In addition, community members are supplied with kits containing, among other things, hand sanitizers and chlorine.

Residents follow protocols

For their part, the residents stated that they follow the hygiene protocols to avoid future contagions, such is the case of María de los Santos, who confessed to having been vaccinated and also to washing the food properly, as well as to close the garbage bags tightly until the garbage collection trucks come to pick up the garbage.

Four children of different ages have been diagnosed with diphtheria at the Robert Reid Cabral Hospital. Diphtheria is a vaccine-preventable disease.

The children come from communities in Barahona and Duvergé.

They are children from two families in two distant communities, implying an active outbreak in both communities.

The hospital said the children range in age from two months to four years. Diphtheria is a severe bacterial infection that affects the nose and throat mucous membranes.

The disease occurs when vaccination schedules fail. The medical literature states that the condition can be treated with medication, and in advanced stages, it can damage the heart, kidneys, and nervous system. However, this disease can be fatal in children.

Symptoms
Signs and symptoms of diphtheria almost always begin two to five days after contracting the infection and may develop symptoms such as a thick, gray-colored membrane lining the throat and tonsils. When you have the disease, you may have a sore throat, hoarseness, and swollen glands in the neck—shortness of breath or rapid breathing, runny nose, fever, chills, and tiredness.

Background
In 2021, the Ministry of Public Health issued an epidemiological alert due to the occurrence of diphtheria cases in different parts of the country. As of week 14, four have been confirmed.

By week 14 of the year 2021, eight deaths had been reported. In general, when cases occur, children have not been vaccinated or have incomplete doses.

In such situations, authorities urge the population to go to vaccination centers to follow up on the official vaccination schedule. The children admitted coming from Barahona and Pedernales. The provinces of Barahona and Independencia, belonging to the Enriquillo region, have reported several suspected cases of diphtheria and the death of a four-year-old child.

Donation of equipment
In another development, the Ministry of Public Health received a donation of US$160,000 from the Pan American Health Organization. The Government of the United States provided the funds. The donation consists of two waste management kits and two imaging kits.

They will be destined exclusively for mobile hospitals within the Emergency Medical Teams (EMT) program of the Risk Management Directorate.

The donation seeks to contribute to improving preparedness and response capacity.

According to the state institution, the first phase of house-to-house implementation affected neighborhoods in Santo Domingo Este, particularly Villa Liberación, which is currently the main focus of the bacteria that transmits the diarrheal disease and where over a thousand people, including teaching staff, administrative staff, and students from local schools, have gone to get vaccinated.

Rafael Guichardo, the risk manager for Health Area I, reported that students from six schools in the demarcation began receiving the oral dose of “Euvichol-Plus” on Tuesday. While the Minister of Public Health, Daniel Rivera, stated that vaccine doses have been administered in the provinces of Elas Pia, Pedernales, and Dajabón, as well as the La Victoria National Penitentiary in Santo Domingo and the Rafey Hombres Correction and Rehabilitation Center in Santiago de los Caballeros, since yesterday.

“Today we also announce to the country that it is being vaccinated at the border, in Elias Piñas, Pedernales, Dajabón, and Bánica, but say Cesfront, the military corps on the border is also being vaccinated,” he said.

According to Jesus Suardi, the director of Public Health Area IV, approximately 1,300 doses will be administered, with 1,032 of them going to children and the rest to teaching and administrative staff.

Suardi stated that the schools selected were Aida Cartagena Portalatn, Fe y Alegria, and the Molac Study Center. Parental consent will be required for minors to receive the oral vaccine. “We started with the teaching and administrative staff and will continue with the children tomorrow (today),” the doctor explained.

Suardi stated that health personnel continues to work in the area on education, prevention, and assistance and that cholera vaccinations continue in schools and the portable tent installed in the La Zurza play and the Moscoso Puello Hospital.

Santo Domingo, DR
With the introduction of the cholera vaccine, it can be expected that cases will be brought under control. Still, the country must maintain active disease surveillance to prevent new outbreaks.

This is the opinion of the epidemiologist Manuel Colomé, professor of the Masters in Public Health and Epidemiology of the Instituto Tecnológico de Santo Domingo (INTEC) and epidemiology manager of the Dr. Hugo Mendoza Pediatric Hospital, where children are treated for cholera. This disease, in recent weeks, has generated two major outbreaks in sectors of Greater Santo Domingo, one in La Zurza and the other in Villa Liberación.

The specialist understands that the success and the extent of these control measures carried out by the Ministry of Public Health, which he considers adequate, will depend a lot on social and environmental factors, health care, human behavior, public health infrastructure, adaptation, and microbial changes and food management, among others.

Answering questions for Listin Diario, the epidemiology expert, considering that solid waste management, access to drinking water, and proper excreta disposal could be improved at the local level. “I also want to emphasize that the humanitarian crisis that Haiti is experiencing can be an important risk factor because it increases the migratory flow,” he added. He noted that both countries must address Public Health measures to deal with cholera. He pointed out that this gap must also be overcome since cholera is a disease of poverty and social inequality.

Colomé said that society must also support the government in prevention and health promotion activities within the community, as knowledge of the signs and symptoms and the mode of transmission is vital to ensure timely care.

The Ministry of Public Health notified yesterday of seven new cholera cases, six Dominican residents of Villa Liberación and Solares del Almirante in Santo Domingo East.

A communication released through the General Directorate of Epidemiology states that among the positive cases, four males aged 66, 41, 35, and 23 years and two females aged 47 and 22.

The document also adds that the seventh case is imported and corresponds to a 47-year-old male patient of Haitian nationality.

The patients the text refers to were admitted between the 26th and 27th of this month after presenting with watery and whitish diarrhea accompanied by vomiting. They explained that since their admission to the health center, they were hydrated and immediately proceeded to take stool samples, which were positive for cholera.

Patients are stable
The medical report certifies that the patients have been without bowel movements for more than 30 hours, are stable, and remain hospitalized for observation, with possible discharge in the next few hours.

Public Health informed that they are ‘maintaining the epidemiological surveillance’ with the close relatives to whom they applied the corresponding vaccines to avoid new contagions.

The intervention continues in the areas to prevent and investigate any suspected disease cases. In addition, it maintains an installed mobile medical office to treat any emergency in the identified sectors.

The institution urges the population to take care of themselves, maintain hygiene, wash their hands before and after going to the bathroom, cook food well, consume chlorinated water and otherwise boil it to drink before consumption.

Those who have watery diarrhea several times a day are asked to stay hydrated and go to the nearest health center as soon as possible.

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.

Santo Domingo DR
The environment in which many families in popular neighborhoods of Greater Santo Domingo live is clouded by the precarious hygienic conditions in which they develop their daily life.

Dirty and stagnant water in different sectors such as La Zurza, Villa Almirante, and Villas Agrícolas are some of the causes for which the bacterial disease of cholera has taken hold in these places.
According to some community members of La Zurza, the conditions in which they live do not allow them to live in an environment with optimal conditions to prevent viral diseases.

“One tries to be clean in one’s little house, but there are many people here who do not have water and have to go to do their things in the river and they bring the disease to one’s house,” said Monica Peralta, a community member of La Zurza, who was inoculated against cholera.

In the same sector, a journalist of Listín Diario approached a 32-year-old man walking towards one of the pools to wash, and when he answered why he was doing it, he limited himself to express that “it is better to bathe like that.”
“We are used to it, this cholera is not going to hit us because we are immune to it,” said the man.

In addition to the lack of safe drinking water, hand washing, and hygiene in the handling of food, the national territory is also plagued by a lack of education on the subject of neighborhood cleanliness, as commented by a psychologist who resides in the community of Villa Almirante. “Look what happens; many residents here (Villa Almirante) do not have enough hygienic education to be able to fight this type of disease, on the contrary, there are those who believe that living in a very poor way will create an immune system and nothing will ever happen to them,” said Leidy Bautista, a psychologist who attended to be inoculated in the Villa Almirante tent.

The Ministry of Public Health, aware of the seriousness of a probable cholera epidemic, began vaccinating the citizens. Although the number of inoculated people has been fruitful so far, some want to avoid going to the vaccination tents.
Such is the case of Manuel Domínguez, a resident of Villas Agrícolas, who told this newspaper that he does not trust the vaccine because it is oral. “If I have to take it, forget it, I’m not going to take the vaccine,” Dominguez said confidently.

Awareness campaign

Given the increase in cholera cases, the Public Health authorities initiated meetings with community members to discuss the different measures to avoid contracting the diarrheal disease, which is currently registering an outbreak in the sector of Villa Liberación in Santo Domingo East.

Since October, 36 cases of the disease have been confirmed, most of them in Greater Santo Domingo. Yesterday, the Ministry of Public Health teams continued the cholera vaccination campaign for people at higher risk, residents of vulnerable sectors, and provinces.

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.