Humans cannot deny the importance of water as a resource for life, which serves for hydration, daily hygiene, cooking food, and other uses such as irrigation, recreational purposes, and even energy production.

However, when water is contaminated by parasites, it can cause various diseases, especially in the digestive tract.

In the Dominican Republic, it is not uncommon for diarrhea to be caused by parasitic agents detected through stool culture.

“We live with parasites. It is very common in our country that a patient who comes with diarrhea and fever turns out to have a parasitic infection,” said gastroenterologist María Alonzo.

This is due, to a great extent, to four fundamental reasons: impurities that were not eliminated in the source at the moment of drinking water; lack of chlorine; deficient systems of storage of the liquid, and bad hygiene habits on the part of the citizens.

“Many of the pictures we see in the gastro consultation have to do with water that has not been properly processed and transmit parasites, bacteria and viruses,” she added.

According to the specialist at the Center for Advanced Gastroenterology, the most common parasite reports she sees in her practice are from patients infected with amoeba and giardia.

Dr. Maria Alonzo (EXTERNAL SOURCE).

These microscopic agents can cause acute gastroenteritis, consisting of diarrhea with nausea, vomiting, fever, and general malaise.

Alonzo clarifies that it is important to identify which parasitic agent is causing diarrhea, since “each one has a specific type of treatment.” Self-medication is ruled out.

“We cook or clean with non-potable water, thus contaminating the food and then we ingest it. Also, people who do not wash their hands properly, when interacting with food, in the end it is transmitted orally,” the doctor explained about the transmission cycle.

The gastro pointed out that children and elderly people are the most at-risk population, reminding that in case of diarrhea, the main thing is to keep the patient hydrated until he/she receives the corresponding treatment, otherwise, it could lead to renal failure.

More hand washing
Although it may seem a reiterative measure, Alonzo called for more emphasis on hand washing education, a simple action with proven results for the benefit of health.

“The Covid pandemic reminded us of this, but we are becoming increasingly lax. People no longer last the 20 seconds they should be soaping each hand. Only good hygiene prevents these cases (of parasitosis),” she said.

Water crisis
At present, the country is experiencing a water shortage as a consequence of the drought, aggravating the factors that lead to a lack of sanitation, which may cause, in addition to gastroenteritis, an increase of dengue, malaria, and chikungunya due to the storage of water in tanks and gallons that end up becoming mosquito breeding places if they are not hermetically sealed.

Another disease that spreads rapidly due to lack of water is cholera since its transmission is entirely linked to poor hygiene and sanitation habits. It is important to note that cholera cases have decreased and in the last few weeks, Public Health has not reported any new infections.

A direct consequence of the low rainfall is that the Santo Domingo Aqueduct and Sewerage Corporation (Caasd) has stopped producing about 25% less water than it used to, for a deficit of 139 million gallons per day in Greater Santo Domingo.

According to epidemiological surveillance records of notifiable diseases, as of March 25, the system had captured 1,331 cases of dengue, 31% more than last year; 66 of malaria, 24% more and 100 of leptospirosis, 107% more (including 10 deaths).

Also, they report 14 cases of diphtheria, with one death; 12 cases of tetanus in non-neonatal ages, with seven deaths, and two cases of pertussis, including one death from that cause.

While the records for the year 2022 up to the same period, reported 1,007 cases of dengue fever captured by the system; 53 cases of malaria, 48 of leptospirosis and eight deaths; six cases of diphtheria and one death; eight cases of tetanus in non-neonatal age with one death and one case of pertussis.

The data are contained in epidemiological bulletin number 12 of the General Directorate of Epidemiology of the Ministry of Public Health.

The report details that in epidemiological week 12, which ended last March 25, 62 probable cases of dengue were reported, 21% of the cases are distributed in the province of Santo Domingo, and 303 cases were reported during the last four weeks of registration.

In relation to malaria, the accumulated cases as of that date were 66, of which 50% came from the outbreak in the province of Azua.

During week 12, the report indicates that five suspected cases of leptospirosis were reported, in three men residing in María Trinidad Sánchez, Peravia, and Santiago Rodríguez provinces, and one woman in Hermanas Mirabal province.

The provinces with the highest cumulative incidence of this disease, transmitted to humans through contact with the urine of infected animals, especially rats, are Santiago Rodriguez, Peravia, Azua, La Romana, and Monseñor Nouel.

SANITARY PANORAMA
On 10 April, Listín Diario reported that the first three months of this year, between medical protests, cholera outbreak, dengue cases, Covid-19 surveillance, and epidemiological alert for the presence of chikungunya in the region, were the topics that occupied the most attention in the sanitary field in the country. While the health system maintains important challenges aimed at maintaining a low incidence of other diseases.

The doctors leading the associations believe that many specialists feel impotent when they realize that the drugs required to manage and avoid the complications of diabetes are not affordable for the Dominican population.

To address the issue, SODENN and SODODIAN have deposited the scientific evidence, adjusted to the latest knowledge on diabetes mellitus treatment, to the General Directorate of Medicines, Food and Sanitary Products. They hope that the country will update the medicines used for treating diabetes based on the latest recommendations from international organizations. The associations believe that the changes can improve diabetes management in the country and change the history of pain caused by the chronic and acute complications of the condition.

In another initiative, the country is set to host the First International Diabetic Foot Congress, “With Feet on Earth” – ALAPID 2023, in Punta Cana from May 18 to 21. The congress will bring together researchers from Latin America, the Caribbean, and other parts of the world to discuss innovations in the field of diabetic foot complications. The congress aims to unify international clinical, medical-scientific, and surgical concepts and efforts on diabetes, and address topics related to clinical endocrinology and nutrition in patients suffering from diabetes mellitus.

However, the Onamet explained that the effects of a trough to the north over the Atlantic Ocean associated with a weak frontal system will originate in the afternoon until early evening cloudy increases with isolated downpours, thunderstorms, and possible wind gusts in the northwestern portion and the Central Cordillera, with greater frequency in the provinces: Dajabón, Elías Piña, Puerto Plata, Valverde, Espaillat, Santiago Rodríguez, Santiago, among other nearby areas.

Temperatures will continue to be quite hot during the day due to the combination of the dust coming from the Sahara and the wind blowing from the southeast. Therefore, the recommendation to the entire population to drink enough liquids (water), wear light clothes (preferably light colors), and not expose themselves directly to the sun, especially from 11:00 a.m. to 4:00 p.m. without sunscreen, is maintained.

For tomorrow Sunday, in the morning hours, there will be isolated showers on the Caribbean coast and the northeast of the country. However, in the afternoon, the trough will bring more moisture and instability to our forecast area, generating cloudy conditions with locally moderate to heavy downpours, thunderstorms, and wind gusts over the northwest, northeast, Central, Central Cordillera, and the border area until the early hours of the night. Cloudy skies and scarce precipitation will continue to prevail for the rest of the country.

The hospital building has an area of 748 square meters and has an imaging center, sonography, physiotherapy, laboratory, gynecology, internal medicine, dentistry, pediatrics and pharmacy, 6 general specialty clinics, among other services.

The president was accompanied by the vice-minister of construction of Mived Danny Santos and other representatives of the entity. Santos explained that the health care center had an investment of 121 million pesos in construction and equipment.

He highlighted that the construction of this project was stopped since 2018 (with only 20% of execution) and was resumed in this management to finish its materialization.

Aerial view of the Diagnostic Center in Ciudad Juan BoschMIVED.

He added that the residents of this housing complex “will no longer have to move to another place to receive a quality hospital service” and that “the Dominican government is committed to health, because you, our people, come first.”

On his departure, the first head of state was seen off by community members carrying banners with the phrase “four more.”

The sectors that will mainly benefit from the opening of this Health Center are Las Aguas, La Ureña, Jerusalén, Nuevo Amanecer, Residencial Las Américas, Ciudad Satélite II, Los Paredones, and Paraíso III.

The head of state, together with Mived, delivered around 7 kilometers of asphalted streets and 3.5 kilometers of sidewalks and curbs.

Other activities

Abinader also presided over the inauguration of the new emergency room of the Robert Reid Cabral Children’s Hospital, where he gave instructions for the remodeling of the burn unit of the hospital and the intensive care and pediatric area.

The burn unit will be put out to tender and would be ready between April and May 2024, said the director of the National Health Service (SNS), Mario Lama, who added that the areas currently being refurbished had been abandoned for a decade.

He detailed that the expansion and refurbishment carried out in the Emergency Room is valued at RD$76,523,581.80, which was completely equipped with an amount of RD$13,280,590.29.

In addition, he indicated that the readjustment of the spaces comprising the areas of the emergency office, suit with two cubicles, cure, plaster, nebulization with six stations, pharmacy, observation with 23 compartments (two isolated), waiting room, emergency area with 12 pieces, trauma shock with four cubicles and doctors and nurses station.

Robert Reid Cabral Children’s Hospital Emergency Department

The Robert Reid Cabral emergency room also saw the construction of a front gate, a new ambulance canopy, a perimeter sidewalk, asphalt tarpaulin, exterior painting, and the construction of a gas control booth.

He also inaugurated in Brisas del Este, Los Frailes, 7 kilometers of asphalted streets and 3.5 kilometers of sidewalks and sidewalk repair, construction of scuppers and speed bumps, and painting of streets in this community for a value of RD$220 million.

Luis Abinader greets the students during the event.

The last activity in this area was the delivery of the Basic School Tomas Taveras Educational Center (Mandinga) with a capacity of 980 students and built with an investment of more than RD03 million.

The Minister of Education, Angel Hernandez, spoke of the importance of artificial intelligence in education today and explained that the Ministry of Education would soon launch the Decennial Education Plan which should take into account the changes in technology.

After various complaints were presented, including one about altering the gestational age of deceased newborns to modify statistics, a vote was taken to create a collegiate department in the Perinatology area of the hospital to audit the records of births and neonatal mortality.

The proposed interim collegiate management would be made up of a representative of the CMD, the maternity hospital management, and the National Health Service (SNS). Senén Caba, the president of the Dominican Medical College (CMD), along with several other medical professionals, led the meeting and declared that the situation had to be addressed immediately for the benefit of the patients.

The activity was attended by Yocasta Lara, the director of the SNS Hospital Centers, Dr. Martin Ortiz, and the director of the Los Mina Maternity Hospital, Leonardo Aquino.

Barahona, DR
The emergency area of the Jaime Mota Regional University Hospital (HRUJM) was busy this Good Friday due to the number of patients who arrived for various reasons, mainly due to traffic accidents involving motorcycles.

Injured in motor vehicle accidents were Eleodoro Medina Matos, 66, Nashla Ramirez, 6, Elias Cuevas Rubio, 26, Brayelin Peña, 14, Luis David Rodriguez, 26, Nelson Daniel Peña Segura, 37, and Luciano Jimenez, 28.

Ramón Urbáez, 32 years old, a resident of the La Peñuela sector of Cabral, was taken to the local hospital’s emergency room because of a fishing spear stuck in his back, accidentally caused by a companion when they were both fishing on the “El Curro” hill.

The cases are from Batey VIII, belonging to Cristóbal and others from the provinces of Independencia, Bahoruco, and Barahona, as well as from the municipality of Tamayo. Many of them were admitted to this health center.

So far, in Barahona province, there are no records of deaths within the Easter Week: Conscience for Life, 2023 operation, except for the death of a man from Azua de Compostela who hit the motor he was driving with a vehicle near the Vicente Noble intersection.

Dozens of people moved toward the different communities of the coastal area, many of them to visit beaches, rivers, and mountains. However, despite the large number of vehicles that moved towards that part of the province, there are no reports of traffic accidents.

In addition, the different neighborhoods have remained calm during this Good Friday. In the early hours in other sectors, citizens took out their swimming pools for children and adults to bathe, despite the prohibition due to the drought affecting the country.

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.

Rivera stated that walk-in pools should not be used since they require a significant amount of water. When asked about the risk of cholera associated with these pools, the minister said they would only pose a risk if installed in sectors where previous cases were reported.

He cited the example of La Zurza, where surveillance measures are maintained despite no new infections reported, and where community members continue to bathe despite signs prohibiting it. Rivera reported that, as of Sunday, April 2, only one patient with suspected symptoms was under observation for cholera, and there were no hospitalizations for cholera or COVID-19.

As a result, he said the coverage strategy for Easter would focus on traffic accidents during the holiday, with hospitals in the public network and Farmacias del Pueblo supplied by Promese/Cal and the National Health Service (SNS).

Doctors María Arias Peña, Raymundo Hernández, and Plutarco Arias indicated that difficulties in falling asleep also cause poor work performance, increase the chances of suffering strokes and create greater obesity.

Medical professionals said that most road accidents happen because drivers and conductors fall asleep. They indicated that the sleep disorder causes apathy toward sex and that on several occasions it ends in divorce between couples. They explained that sleep apnea, which manifests itself in snoring at night, is more common in people aged 40 and older.

Doctors highlighted that the ARS provides coverage to people who suffer from this health problem. Dr. Plutarco Arias, president of the National Sleep Apnea Institute (INAPS), stressed that this entity continues to advance in the development of its specialized personnel to treat patients suffering from sleep disorders.