“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.

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.