The disease is reportedly on the rise in U.S. territories in the Caribbean.

Dieciocho meses después de que April Adcox se enterara de que tenía cáncer de piel, el pasado mes de mayo, regresó por fin a la Universidad Médica de Carolina del Sur en Charleston para recibir tratamiento.

Para entonces, la zona rojiza a lo largo de la línea del cabello había pasado de ser un círculo de 2 pulgadas a cubrirle casi toda la frente. Supuraba líquido y le dolía.

“La verdad es que esperaba morir de esto, porque pensaba que eso era lo que tenía que pasar”, afirmó la mujer de 41 años, madre de tres hijos y residente en Easley, Carolina del Sur.

Adcox se había reunido por primera vez con los especialistas del centro médico a finales de 2020, después de que una biopsia diagnosticara un carcinoma basocelular. La operación para extirpar el cáncer requeriría varios médicos, le dijeron, incluido un neurocirujano, debido a lo cerca que estaba de su cerebro.

Pero Adcox no tenía seguro. Había perdido su trabajo en una fábrica de automóviles en los primeros días de la pandemia y, en el momento del diagnóstico, sentía pánico ante la complejidad de la operación y la perspectiva de una factura elevada. En lugar de seguir el tratamiento, intentó camuflar la zona cancerosa en expansión durante más de un año con sombreros y flequillos largos.

Si hubiera padecido cáncer de mama o de cuello uterino, probablemente habría tenido derecho a cobertura por una ley federal que amplía el Medicaid a los pacientes de bajos ingresos diagnosticados con esos dos tipos de cáncer.

Para las mujeres con otros tipos de cáncer, así como para casi todos los hombres, las opciones son escasas, especialmente en Carolina del Sur y los otros 11 estados que aún no han implementado la expansión de Medicaid, según oncólogos y expertos en política sanitaria que estudian el acceso a la atención.

Los estudios demuestran que, a veces, los adultos sin seguro retrasan la atención, lo que puede perjudicar las probabilidades de supervivencia. Pero que los pacientes obtengan un seguro para cubrir el tratamiento se parece un poco al juego de la ruleta, es decir, depende de dónde vivan y del tipo de cáncer que padezcan.

“Es muy aleatorio; creo que eso es lo más desgarrador”, afirmó el doctor Evan Graboyes, cirujano de cabeza y cuello, y uno de los médicos de Adcox. “Vivir o morir de cáncer no debería depender del estado en el que vives”.

La Ley de Cuidado de Salud a Bajo Precio (ACA) dio a los estados la opción de ampliar Medicaid para cubrir a más personas. Poco después de la aprobación de la ley, sólo el 2,6% de los adultos de 18 a 64 años con un nuevo diagnóstico de cáncer carecían de seguro en los estados de Medicaid ampliado frente al 7,8% en los estados sin expansión, según un estudio publicado en JAMA Oncology en 2018.

Investigadores de la Sociedad Americana del Cáncer, que realizaron el análisis, estiman que unas 30,000 personas sin seguro son diagnosticadas con cáncer cada año.

Pero en todos los estados, los pacientes sin seguro, de bajos ingresos, con cáncer de mama o de cuello uterino pueden obtener cobertura, incluso si no califican para Medicaid.

Los adultos con cáncer detectado a través del Programa Nacional de Detección Temprana de Cáncer de Mama y de Cuello Uterino pueden inscribirse en Medicaid durante la duración de su tratamiento contra el cáncer, gracias al activismo y la legislación federal que comenzó hace más de tres décadas.

En 2019, se inscribieron 43,549 pacientes con estos tipos de cáncer, según un informe de la Oficina de Rendición de Cuentas del Gobierno (GAO) publicado en 2020.

“Si te diagnostican cáncer de mama o de cuello uterino, tienes suerte”, dijo la doctora Fumiko Chino, oncóloga radioterapeuta del Memorial Sloan Kettering Cancer Center de Nueva York, que estudia el acceso y los costos del tratamiento del cáncer. “De no ser así, puedes enfrentar obstáculos importantes”.

El importe total facturado a la aseguradora durante el año siguiente a un diagnóstico de cáncer puede ser abultado. Por ejemplo, los costos en 2016 ascendieron a un promedio de $168,730 por cáncer de pulmón y $137,663 por cáncer colorrectal, según un estudio de 2022 que calculó las reclamaciones a la aseguradora por varias neoplasias malignas comunes diagnosticadas en pacientes con seguro privado.

Dado que los adultos sin seguro pueden tener dificultades para pagar la atención preventiva, su cáncer puede no ser identificado hasta que esté avanzado, por lo que es más costoso para el paciente y el sistema de salud, explicó Robin Yabroff, autor del estudio en JAMA Oncology y vicepresidente científico de la Sociedad Americana del Cáncer.

Los pacientes que no pueden obtener ayuda financiera a través de un centro de la red a veces acumulan deudas médicas, utilizan tarjetas de crédito o lanzan campañas de recaudación de fondos en internet, dijo Yabroff. “Nos cuentan historias de personas que hipotecan sus casas para pagar el tratamiento del cáncer”.

Los pacientes de cáncer pueden adquirir un seguro a través del mercado de seguros de salud de ACA. Pero a menudo deben esperar hasta el período de inscripción regular al final del año, y esos planes de salud no entran en vigor hasta el comienzo del año siguiente.

Esto se debe a que la ley federal fue diseñada para animar a la gente a inscribirse cuando están sanos, lo que ayuda a controlar los costos, señaló MaryBeth Musumeci, profesora de política y gestión de la salud en la Universidad George Washington en Washington, DC. Si un nuevo diagnóstico te calificara para la nueva cobertura, dijo, “entonces se incentivaría a la gente a permanecer sin seguro mientras están sanos y piensan que no van a necesitar cobertura”.

Mientras tanto, el acceso a la cobertura de Medicaid para pacientes de bajos ingresos con cáncer de mama y de cuello uterino, es una historia de éxito que se remonta a una ley de 1990 que creó el programa nacional de cribado de mama y cuello de útero. Las mamografías empezaron a recomendarse de forma generalizada en la década de 1980, y los activistas presionaron para llegar a más personas desfavorecidas, explicó Katie McMahon, directora de políticas de la Red de Acción contra el Cáncer de la Sociedad Americana del Cáncer.

Sin embargo, una investigación demostró que algunos adultos sin seguro tenían dificultades para recibir atención por los cánceres detectados a través de los cribados, dijo McMahon. Una ley del año 2000 permitía a los estados extender Medicaid a estas personas, y en 2008 los 50 estados y el Distrito de Columbia ya lo habían hecho, según el informe de la GAO de 2020.

Para otros enfermos de cáncer, una de las vías de cobertura que les quedan, según Chino, es reunir los requisitos para la discapacidad a través de la Administración de la Seguridad Social, tras lo cual pueden solicitar Medicaid. La agencia federal tiene una larga lista de criterios para los pacientes con cáncer. También cuenta con el programa Compassionate Allowances, (Beneficios por Compasión), que ofrece revisiones más rápidas para pacientes con determinadas afecciones médicas graves, incluidos cánceres avanzados o agresivos.

Aunque las normas varían, muchos pacientes no califican hasta que la enfermedad se ha extendido o el cáncer requiere al menos un año de tratamiento intenso, explicó Chino. Esto supone un dilema para las personas que no tienen seguro pero padecen cánceres curables.

“Para tener derecho a Medicaid, tengo que esperar a que mi cáncer sea incurable”, dijo, “lo cual es muy deprimente”.

Por ejemplo, el programa de Beneficios por Compasión no incluye el carcinoma basocelular, y sólo cubre el cáncer de cabeza y cuello si se ha extendido a otras partes del cuerpo o no puede extirparse quirúrgicamente.

Adcox dijo que antes de su operación de 12 horas, el pasado mes de junio, su solicitud de ayuda económica a la Universidad Médica de Carolina del Sur estaba aún pendiente. Alguien del hospital calculó que su factura ascendería a $176,000 y le preguntó cuánto podía adelantar. Consiguió reunir $700 con la ayuda de sus seres queridos.

Pero pudo optar a una ayuda económica y no ha recibido ninguna factura, salvo de un proveedor externo de servicios de laboratorio. “Se acabó”, exclamó Adcox. Desde entonces ha recibido radioterapia y se someterá a más operaciones reconstructivas. Pero ya no tiene cáncer. “No me ha matado. No me mató”.

Aun así, no todo el mundo encuentra una red de seguridad.

Brian Becker, de El Paso, Texas, no tenía seguro ni trabajo cuando supo que padecía leucemia mielógena crónica en el verano de 2021, según contó Stephanie Gamboa, su ex mujer y madre de su hija pequeña. Su médico oncólogo le exigió un pago por adelantado, dijo, y tardó varios meses en pedir prestado el dinero suficiente.

Empezó la quimioterapia al año siguiente y, con el paso de los meses, perdió peso y se debilitó, volviendo a urgencias con infecciones y un empeoramiento de la función renal, explicó Gamboa. La última vez que su hija vio a su padre, “no podía levantarse de la cama. Era literalmente piel y huesos”, dijo Gamboa.

Becker inició los trámites para solicitar prestaciones por incapacidad. El mensaje de texto que envió a Gamboa, y que ella compartió con KHN, decía que la revisión de su solicitud comenzó en junio de 2022 y se esperaba que durara seis meses.

La carta de denegación, fechada el 4 de febrero de 2023, llegó más de un mes después de la muerte de Becker en diciembre, a los 32 años. Decía en parte: “Basado en una revisión de sus condiciones médicas, usted no califica para beneficios en esta reclamación”.

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The majority of these procedures are applied to the face. Examples of these procedures include micro-needling, Botox, platelet rich plasma (PRP), high-intensity focused ultrasound (HIFU) and laser energy, just to name a few. These "quick fixes" are long lasting, safe and results in that more "youthful look" desired. Hence, more patients are flocking their doctors' offices to get these procedures done.

Many of these procedures are not only limited to the face but can be expanded to other parts of the body including the female genitalia. In recent times, the term "vaginal rejuvenation" has become topical amongst social media and reality TV, thus sparking an interest amongst females. When one hears the term "vaginal rejuvenation", immediately one thinks of surgically decreasing the diameter of the vaginal canal, to increase sexual gratification. However, "vaginal rejuvenation" now encompasses non-surgical procedures to increase the function and looks of the female genitalia and their surrounding structures.

As women age, the pelvic floor muscles may relax and hormone and collagen levels decrease. This can result in a loss of sensitivity, loss of lubrication, loss of sexual gratification, painful intercourse, stress urinary incontinence (leakage of urine when you laugh, sneeze or exercise), genital prolapse (bladder, rectum or uterus coming out of vagina) and also a sagging external genitalia (vulva) may be present. Non-surgical vaginal rejuvenation aims to correct all of the above effectively thus improving a woman's quality of life.

The most popular forms of non-surgical vaginal rejuvenation includes vaginal energy and PRP (O-Shot) which are often combined to give optimal results. When one hears the term "energy", it's hard not to envision a painful and unbearable procedure, however, this is the furthest from the truth and is the complete opposite.

They are three forms of energy which can be applied to the vagina — HIFU, laser energy and radiofrequency energy.

All forms of energy are supplied to the vagina via a probe (similar to a probe which is inserted into the vagina for an ultrasound) which releases energy throughout the entire length of the vaginal canal. All forms of energy last around 20 minutes, with no downtime and patients tolerate them well and can resume intercourse on the same day. The vaginal tissues are heated to about 40 degrees, and collagen within the vagina is restructured. Additionally, new blood vessels are created. The combined effect can increase sensitivity, improve sexual gratification, decrease painful intercourse and cure stress urinary incontinence and can last up to 18 months.

Of all the energy types, the radiofrequency energy seems to be the most superior as not only is the probe smaller and more tolerable, but can also heat the external vulva and make the appearance more "youthful" looking. Also, this form of energy can be used to treat mild genital prolapse. In addition, some patients may suffer from faecal incontinence (involuntary loss of faeces). The radiofrequency probe is small enough to be placed into the anus to tighten the surrounding tissues, and decrease the incidence of this occurring.

The ideal dosage of all energy is one dose per month for three months, with a top up at six months. The effects are more pronounced when combined with the O-Shot.

Overall, patient satisfaction is high. Ask your OBGYN about your non surgical options for "vaginal rejuvenation".

Dr Daryl Daley is a cosmetic gynaecologist and obstetrician. H
is office is located at 3D Gynaecology Ltd. at 23 Tangerine Place, Kingston 10 and the office number is 876-929-5038/9. He can be contacted at ddaley@3dgynae.com

For the most part, these missions are organised by non-governmental organisations such as churches, health-care organisation and charities with a relatively small component being the result of governmental or inter-governmental agencies. In the past there have not been standards or guidelines as to how these missions should be organised and how to measure their effectiveness, both short and long term on the populations that they seek to help. Several decades of research into short-term humanitarian medical missions has led national and international bodies to propose guidelines for organisations which seek to arrange these missions. Those proposing guidelines include the World Health Organization, The European Esther Alliance, the Catholic Health Alliance, and several private actors such as Merck Fellowship for Global Health. These guidelines vary in their comprehensiveness and areas of emphasis, but several important themes appear commonly. We have listed these below.

Assessment of local health-care needs

Often a short-term humanitarian medical mission will start with personnel in a high-income country deciding to offer medical care/services in a low- or middle-income country with virtually no input from the people they seek to help. For example, donors may decide to have a surgical clinic and offer free surgical care; however, from the point of view of the local population the most challenging medical needs may be dental, control of mosquito infestation or the need for a clean water supply, etc. It goes without saying that a short-term humanitarian medical mission should not go beyond the planning stage without local input ideally both from the community and local health-care providers or organisations.

It is important to stress the need for involvement of local health-care providers/organisations. A short-term humanitarian medical mission should be looked at as an alliance between the donor organisation and the local health-care community. The local team can be considered experts in how health care is delivered, what resources are available, the cultural context in which health care takes place, barriers to the delivery of care, and how long-term follow-up can be accomplished after the foreign physicians and nurses have returned home. The relationship between visiting and local health-care teams needs to be based on mutual respect based on what each brings to the table. Visiting health-care providers in particular need to avoid the common "God complex" that they are here to save the native population and know best what should be done on their behalf.

Preparation and plans for implementation

Having assessed the health-care needs and partnered with local health-care providers, the next important issue is planning for the mission. The scope of these plans is extensive but some important issues would include:

1) Is a medical mission needed at all? Can the local health-care need be met by simply donating money or resources to local health-care providers who in many cases will do a better job over the long term in treating their own populations.

2) Is there the availability of appropriate personnel. For example, let us consider a church in a high-income country deciding to run a two-week primary care clinic in Nicaragua. The volunteers are a general surgeon, a dermatologist, an ICU physician and two operating room nurses. This would not be considered appropriate personnel for a primary care clinic in a high-income country, why should this be considered appropriate for a low- or middle-income country? A common theme in many of these guidelines is trying to avoid the mantra that poor care for these populations is better than no care at all. If medical students or residents are going on the mission how are they to be supervised? Are they allowed to assume responsibilities which would not be available to them in their home institutions?

3) Legal/ethical issues: Have the nurses and physicians been licensed to practise medicine in the host country? For some of these missions participants report being told that having a medical licence in their home country is sufficient and they may be unaware that they are practising medicine illegally in the donor country. Have the medications which are brought for the mission been approved by the local equivalent of the Food and Drug Administration? Are the medications labelled in the local language? Have code of conduct and governance issues been discussed with local partners? How are issues of complications and negligence addressed?

Continuity and sustainability

Ideally intervention in the local health care arena should lead to long-term improvement in the health of the population and this inevitably means upgrading of the local health-care system. An overriding question that should be asked is: Is what we are doing sustainable? Is there an opportunity to train local health-care providers to deliver ongoing care in the absence of the visiting physicians? How will the patients fare once the visiting teams have come and gone? An important change in many humanitarian missions has been the recognition that greater and more sustainable impact may be achieved by training and educating local providers as opposed to sending in repeated short term humanitarian missions. A good example is the Charity Resurge which started out doing short-term medical missions for patients with cleft palates and severe burns in Nepal. At first the charity would perform 75-100 surgeries over a two-week period once every year. In the early 2000's with the encouragement of local physicians they changed the model to that of training local surgeons. Visiting surgeons now spend six months to one year with the primary aim being to teach surgical techniques. With these changes local physicians are now doing more than 1,000 surgeries per year.

Monitoring and evaluation

It may be surprising to know that monitoring and evaluation is not a routine part of the majority of short-term humanitarian missions and that when it does occur evaluation is usually done of the visiting medical team. It is rare for the impact on the community or the local health-care team to be assessed. An anecdotal story that is often told is of a church mission who was building a clinic in a rural area. Every night the locals who were helping would have to correct the defects under the cover of darkness to avoid embarrassing the visiting guests. We can only know what we can measure. A medical mission ideally should not just result in the visiting medical team feeling that they have done charitable work but should also having a positive (hopefully long-term effect) on the community that they have visited. This evaluation can be challenging as the local community may be unwilling to comment negatively on their experience for fear of offending the visiting providers and may ideally be done by independent assessors.

Short-term humanitarian medical missions for the most part have a noble goal of trying to help those who are less fortunate and who lack access to adequate medical care. These efforts are increasing and hopefully will result in meaningful change for health-care systems in low and middle income countries.

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.

“When I plan for these cases, it’s very easy for myself to pick out the lenses that I want to use, and especially if it’s a challenging case, having that three-piece preloaded lens in my back pocket is wildly valuable.”

(AFP) – From COVID-19 to Mpox, Mers, Ebola, avian flu, Zika and HIV, diseases transmitted from animals to humans have multiplied in recent years, raising fears of new pandemics.

– What is a zoonosis? –

A zoonosis (plural zoonoses) is a disease or infection transmitted from vertebrate animals to people, and vice versa. The pathogens involved can be bacteria, viruses or parasites.

These diseases are transmitted either directly during contact between an animal and a human, or indirectly through food or through a vector such as an insect, spider or mite.

Some diseases end up becoming specifically human, like COVID-19.

According to the World Organisation for Animal Health, 60 per cent of human infectious diseases are zoonotic.

– What types of diseases are involved? –

The term “zoonoses” includes a wide variety of diseases.

Some affect the digestive system, such as salmonellosis, others the respiratory system, such as avian and swine flu as well as COVID, or the nervous system in the case of rabies.

The severity of these diseases in humans varies greatly depending on the disease and the pathogen’s virulence, but also on the infected person, who may have a particular sensitivity to the pathogen.

– What animals are involved? –

Bats act as a reservoir for many viruses that affect humans.

Some have been known for a long time, such as the rabies virus, but many have emerged in recent decades, such as Ebola, the SARS coronavirus, Sars-CoV-2 (which causes COVID-19) or the Nipah virus, which appeared in Asia in 1998.

Badgers, ferrets, mink and weasels are often implicated in viral zoonoses, and in particular those caused by coronaviruses.

Other mammals, such as cattle, pigs, dogs, foxes, camels and rodents, also often play the role of intermediate host.

All the viruses responsible for major influenza pandemics had an avian origin, either direct or indirect.

Finally, insects such as ticks are vectors of many viral diseases that affect humans.

– Why has the frequency of zoonoses increased? –

Having appeared thousands of years ago, zoonoses have multiplied over the past 20 or 30 years.

The growth of international travel has allowed them to spread more quickly.

By occupying increasingly large areas of the planet, humans also contribute to disrupting the ecosystem and promoting the transmission of viruses.

Industrial farming increases the risk of pathogens spreading between animals.

Trade in wild animals also increases human exposure to the microbes they may carry

Deforestation increases the risk of contact between wildlife, domestic animals and human populations.

– Should we fear another pandemic? –

Climate change will push many animals to flee their ecosystems for more livable lands, a study published by the scientific journal Nature warned in 2022.

By mixing more, species will transmit their viruses more, which will promote the emergence of new diseases potentially transmissible to humans.

“Without preventative strategies, pandemics will emerge more often, spread more rapidly, kill more people, and affect the global economy with more devastating impact than ever before,” the UN Biodiversity Expert Group warned in October 2020.

According to estimates published in the journal Science in 2018, there are 1.7 million unknown viruses in mammals and birds, 540,000 to 850,000 of them with the capacity to infect humans.

But above all, the expansion of human activities and increased interactions with wildlife increase the risk that viruses capable of infecting humans will “find” their host.

The post Animal-to-human diseases on the rise appeared first on Barbados Today.

Santo Domingo, DR.
A one-year-old girl died after she was given an injection in a health center located in the Canastica sector in the province of San Cristobal.

The infant was taken by her relatives to the First Level Care Center Canastica (CPN) last Tuesday, where she was medicated, and after her health situation worsened, referred to the Robert Read Cabral Children’s Hospital, where she died last Wednesday.

The director of the Regional Health Service of Valdesia (SRSV), Marcelino Fulgencio, reported that they are carrying out the necessary investigations to determine the reasons for the death of the infant.

Fulgencio regretted the death of the infant and explained that she was taken to the CPN by her mother and an aunt, with an indication of medication from another health center, so the nursing staff first proceeded to perform a subdermal test on the compatibility of medications, to determine if the girl was allergic to it.

According to the doctor, the test was negative, so the medication was applied.

According to a press release, the girl’s relatives handed over the prescription indicating the medication Diamine 633, prescribed by a pediatrician, which after being applied, the minor began to present difficulty in breathing, weak pulse, and cyanotic.

“According to what could be observed, it was an anaphylaxis,” said Fulgencio.

The head of the SRS Valdesia said that they immediately applied first aid and proceeded to transfer her to the Juan Pablo Pina Regional Hospital, where she was stabilized and later referred to the Robert Read Cabral Children’s Hospital because she required immediate admission to the Pediatric Intensive Care Unit. Last Wednesday, the girl died at the said health center.

Dr. Marcelino Fulgencio reiterated his condolences to the family, with whom he has been in communication, and affirmed that they would continue to investigate the incident in order to apply the corresponding measures if necessary.

Finally, he said that the person who provided care to the minor always remained at the health center.

Message from PAHO Director on World Health Day 2023

Cristina Mitchell

7 Apr 2023