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.

The Barbados Cancer Society (BCS) says while there has been a rapid increase in new breast cancer cases coming through its programme, there has been no Stage 4 diagnoses in the last five years.

There have also been no deaths recorded by the programme from 2018 to December 2022 among those diagnosed at stage 0-1 with the disease.

Medical Coordinator of the Breast Screening Programme (BSP), Dr Shirley Jhagroo, has attributed the absence of stage four patients to the ongoing awareness programme.

“I am not saying that there hasn’t been any, but at the Breast Screening Programme we have not had a new patient at stage 4. And this I honestly attribute to awareness, and the walk (Walk for the Cure) has made the difference. 

“Unfortunately there was an increase in the number of new cases diagnosed per year, from 26 in 2018 to 72 in 2022. I don’t know if we can attribute this to the new [screening] machine, up and running since September last year, that we are getting new patients with earlier diagnoses,” Dr Jhagroo said.

Her disclosures were made on Thursday as she delivered remarks at the presentation of funds raised through the CIBC FirstCaribbean 2022 Walk for the Cure activities to the BSP at the Hilton Hotel.

Dr Jhagroo said that the programme continues to be self sufficient and noted that the funds raised from the walk along with donations, go towards purchasing and maintenance of equipment. The money also subsidises investigations such as breast biopsies, mammograms and ultrasounds. 

The doctor said that the education and awareness campaign to save lives through early detection has made a difference in the attendance numbers at the clinic, as is evidenced, by the number of self-referred patients moving from 15 per cent 10 years ago, to almost 40 per cent in 2022.

She said over 125 000 clients have benefited from the services of the BSP, thanks to the Walk for the Cure fundraising activities.

“Over the past two decades there has been a continuous upgrade in breast imaging technology. We have been very fortunate to have the resources to keep up with this changing technology. The programme is serviced by a $1.2 million state-of-the-art 3D mammogram with special features for imaging male breast. . .,” she said.

Dr Jhagroo said that in 2023, the Breast Screening Programme intends to add a stereotactic attachment to the present 3D mammogram machine. The special attachment, one of the best currently on the market, will allow the BSP to carry out breast biopsies.

“We are hoping that this will improve our early detection. Its cost at the moment is over $170 000. So thank you so much CIBC, we are going to have that.

“I have sort of ordered it, but the [manufacturers] are coming in to meet with us to be committed and for us to give our deposit and give them details of what we really want,” she said.

FirstCaribbean’s Director Retail Banking Channels, Michelle Whitelaw, indicated that in addition to the 2022 Walk for the Cure activity, the financial institution also embarked on a series of fundraising activities which raised BDS$200 000. 

(AH)

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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.

The donation of two ambulances by the Maria Holder Memorial Trust to the Queen Elizabeth Hospital (QEH) has led to the Emergency Ambulance Service (EAS) now being equipped with nine vehicles to respond to the 14 000-16 000 emergency calls it receives annually.

The trust handed over the two ambulances during a ceremony at the EAS Wildey, St Michael headquarters on Monday, where trustee, King’s Counsel, Peter Symmonds, announced that in order to help the service achieve its ideal target of 12 functioning ambulances, the registered charity had agreed to purchase two ambulances in 2024, provided that the QEH purchases one this year.

Symmonds noted that in addition to the two fully-equipped ambulances, the trust also donated two additional stretchers, safety vests, helmets and dispatcher headsets. He said the entire donation cost an estimated $400 000.

“In order to make the appropriate intervention, with equipment should also come training and we have agreed to assist with funding the training of up to 15 dispatchers by April 2023 so that when you call 511 you should be assured that you are speaking to personnel who are continually trained to carry out their duties. This is therefore seen as a complement to the provision of the ambulances and equipment which we fervently expect will be immediately put to good use,” Symmonds said.

The trustee also indicated that the staff of the trust has received presentations on healthcare from EAS Medical Consultant, Dr David Byer.

Dr Byer said while the service responds to 50 to 60 calls per day, the additional ambulances allow for the fleet to last longer while undergoing the necessary servicing and preventative maintenance.

“This bolsters our fleet. Our target is between 10 to 12 vehicles and this allows for the fleet to last longer because it allows us to do the necessary maintenance. I mean not all 10 to 12 would be off the road at the same time, but we would be able to pull them out and do the necessary servicing and the necessary preventative maintenance to allow them to last for a very long time.

“We are working with the trust in terms of supporting training with respect to the dispatchers and that is something that we are looking at in 2023. And further down the road, that is basically very preliminary, we are going to be looking at paramedic training as well as possibly driver training for emergency drivers of the vehicles so that they can function a lot safer,” Dr Byer said.

Sales Director of NASSCO Limited, Roger Moore, who sourced the ambulances, said that a down payment for an additional vehicle has already been made and suppliers have already started manufacturing it.

“In the next couple months you should be receiving that. We hope that it would not take as long as these last two took, but this is a quieter time, the end of the year is always a busy time, so I think that this time you should be receiving it much sooner so that you can get the other one ordered before the year is out,” Moore said.

Minister of State in the Ministry of Health and Wellness, Dr Sonia Browne, extended gratitude to the Trust for the donation and the pledge to train staff of the EAS.

She said the trust’s contribution adds to the care and treatment of patients, specifically due to the decrease in waiting times and availability of ambulances and provision of-well trained staff.

“All these of course will impact positively on morbidity and mortality rates from injury and illness throughout the island,” Dr Browne said. (AH)

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Adopting a healthy lifestyle in Barbados can be achieved without excessive spending.

So says vice-president of the Dietitians of Barbados, Meshell Carrington who said, contrary to popular belief, eating healthy could be achieved at an affordable price.

Speaking during an event hosted by the Alexandra School Alumni Association at the school’s, Queen Street, St Peter, grounds over the weekend, Carrington said ground provisions and legumes were inexpensive, healthy options.

She pointed out that breadfruits could be purchased for around $3, while some legumes were on the market for even cheaper at around $1.60. Foods such as green plantain, yam, sweet potato, cassava, eddoes and brown rice were all available on the local market.

However, Carrington said a 2019 food survey done in Barbados revealed that sugar-sweetened beverages, poultry, ground provisions, rice, bread, cake, sweetbread, pasta, dairy products and fish were the preferred foods of Barbadians.

“The common theme was that the Barbadian diet was characterised by high sugar intake, with most of the sugar coming from added sugars. There are also high intakes of fat and salt and the dietary intake of fibre is inadequate…along with low intakes of fruits and vegetables,” she said.

“Meats are one of the major foods found to be consumed but we don’t need that much meat. People could probably reduce the meat consumption a bit and eat more legumes which are cheaper. Staples are the main source of carbohydrates, provide energy and also provide the body with dietary fibre.”

Additionally, she said a Barbados Food Consumption Survey done in 2000 revealed that on average, Barbadians ate out twice weekly.

Carrington also urged Barbadians to stay away from “ultra-processed” foods. She said a 2015 survey showed that 65 per cent of adults in Barbados were classified as either overweight or obese.

She told the session that the most consumed ultra-processed foods in Barbados included soft drinks, sandwich bread, salt bread, french fries and cereal.

“It [ultra-processed food] is defined as the formulation of ingredients, mostly of exclusive, industrialised use. So they are highly processed and they are typically created by a series of techniques and processes…There is no real nutritional value in them and all they provide are calories,” Carrington cautioned.

“The goal is really trying to get some energy balance, so the energy or calories that you are taking in, needs to equal the energy or calories that are going out. It is necessary to control energy because it is necessary to control weight.”

The dietitian explained that poor diets were the primary causes of hypertension, diabetes and some forms of cancer.

Carrington said it remained a concern that a large number of children in Barbados were obese.

“One out of every three children in Barbados between the ages of nine and 10 are either obese or overweight. That’s concerning because the earlier you start the more complications you will have because of the ill effect of the disease,” said Carrington. She also pointed out that 12 per cent of those children had elevated systolic blood pressure. (RB)

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By Shamar Blunt

A leading medical consultant believes the impact of Barbados’ growing Non-communicable Disease (NCD) epidemic has become an even more dire problem for the island’s acute healthcare facility because of COVID-19.

Dr Kenneth Connell said: “I probably would have said it is more dramatic than that,” in response to recent assertions by Acting Director of Medical Services Dr Chaynie Williams that NCD sufferers were contributing significantly to delays in the Accident and Emergency Department. 

Dr Connell, the Deputy Dean in the Faculty of Medical Sciences at the University of West Indies Cave Hill Campus and Consultant Physician at the QEH, noted:

“The emergency [department] pre-COVID was already a difficult place in terms of waiting time… What has happened post-COVID, is an increase in the NCD emergencies – stroke, heart attack and heart failure. COVID has been the propellent for a lot of this. So patients admitted with emergencies can sometimes remain in A&E department for two, three days waiting to be placed on the ward,” he explained.

Dr Williams recently told the radio call-in programme Down to BrassTacks on which callers raised the issue of the delivery of service at the hospital: “The emergency department’s challenges are a health system challenge as it represents one geographic location. We have many complications of non-communicable diseases – kidney, heart, and others – that patients need in-patient care [for] and many times persons spend days in the Accident and Emergency Department trying to access in-patient care because they are very ill or in hospital and can’t get out of hospital because they are not well enough.”

Agreeing that the NCD situation at the Queen Elizabeth Hospital is severely impacted by the NCD situation, Dr Connell said this is due directly to the influences of the pandemic. In fact, he suggested to Barbados TODAY that the pressure being placed on the island’s healthcare system from Barbadians being treated for NCDs is being understated.

Noting the importance of expanding the A&E Department in order to cater to the island’s emergency health needs, Dr Connell insisted that any such expansion would not be the answer to Barbados’ out-of-control NCD war.

“Expanding the A&E Department, which there has been a lot of talk about, I am not sure is the actual solution. What would happen, the beds from the expanded department would just be basically holding more patients with NCD emergencies.

“I think that the country needs to have a serious conversation with all stakeholders – from the Ministry of Health and Wellness, civil society organisations, patient advocate groups – so that we can decide how best we can manage or better manage NCDs before they reach the hospital. If we do not do that, then what we are likely to see is what I would describe as a slowly growing pandemic.”   

The World Health Organisation’s (WHO) 2022 Non-communicable Disease Progress Monitor report states that the percentage of deaths from NCDs in Barbados in 2019 stood at 83 per cent or 2,800 total NCD deaths, which is above the world average of 74 per cent.

Dr Connell suggested that education surrounding the nation’s NCD fight needed to be increased significantly if the current situation at the QEH and other healthcare facilities is to ever be addressed.  shamarblunt@barbadostoday.bb

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By Emmanuel Joseph

After two years of administering the COVID-19 National Vaccination Programme, Government’s Immunisation Unit is about to cease operations and one of the coordinators has lamented that not enough was done to counter misinformation about the vaccines in the early stages.

Joint coordinators of the programme Major David Clarke and retired senior medical officer of health Dr Elizabeth Ferdinand confirmed on Monday that their tenure will end on Tuesday and the Ministry of Health and Wellness will take over administering COVID-19 vaccines and issuing certificates for overseas travel.

Dr Ferdinand said that about 59 per cent of the local population has now been fully vaccinated and though that figure was “not bad”, she is disappointed it had not reached about 70 per cent.

“When we started giving the children five to 11 [the vaccine], the number of people eligible increased. Right now, it is the whole population only minus those children under five. So you can understand that as time has gone on and we increased the number of people who are eligible… the percentage [of people vaccinated] fell because not as many younger people were having the vaccine,” she told Barbados TODAY.

Dr Ferdinand said that apart from the early unavailability of vaccines, many of the challenges experienced over the past two years related to a lack of public awareness and knowledge regarding the efficacy of COVID-19 vaccines.

“People were bombarded with all kinds of information and not all of the information was accurate. So there was a lot of false information around, and to get over that I think we didn’t do enough. We didn’t have enough finances to do the social media blasts that would have been necessary. We did what we could on a shoestring [budget] but maybe we could have given everybody more information and counteracted the negative publicity and knowledge,” she said.

“People were undecided and wanted more information to make the decision, especially with the childhood vaccine…they were brought in during the last phase. We did a little bit, but we didn’t do enough to allay parents’ fears and encourage them to get the children vaccinated,” added the retired top public health officer.

Despite this, Dr Ferdinand reported the general success of the work of the unit which was set up in the Ministry of Health in February 2021, at the height of the pandemic, to manage the vaccination programme.

“We have done a lot better than a lot of other countries, and I would say yes, we have been successful,” she declared.

“We were able to vaccinate people to get them fully vaccinated and hopefully to prevent many of them from having cases of serious disease and death. It is not measurable. You can’t measure how many deaths you prevented, but according to facts and figures, I think we did prevent many deaths. I can’t give you a figure. Maybe if they had not been vaccinated, some of them would have died or had serious complications. So saving lives was what we set out to do, and I think we accomplished a lot of that.”

Major Clarke, who will return to the Barbados Defence Force (BDF), said the highlight of the programme was witnessing hundreds of people turning up at centres to be immunised against the virus.

“When we started out we were a little rocky but I think as time went on we got better and better at the process. And as we got better and better at the process, the experience of the clients got better and better,” he said in an interview with Barbados TODAY.

The programme will now operate like any other adult vaccination system.

Declaring that most of those who wanted to be immunised have already been taken care of, Major Clarke explained that people would now have to go to the polyclinics if they wanted to be inoculated against COVID-19.

The Ministry of Health said the COVID-19 vaccine “will be available at all polyclinics as per the weekly schedule”.

Reflecting on his work with the Immunisation Unit, Major Clarke described it as very enjoyable.

“I would say I had a very enjoyable time. It was something different to do and also I enjoyed the interaction with the staff and members of the Barbados public health system and the different volunteer groups,” the army major recalled.

emmanueljoseph@barbadostoday.bb

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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.