Massachusetts General Hospital Vincent Program in Global OB/GYN
Confronting COVID in Central America
Globally, COVID-19 has resulted in devastating morbidity, mortality and economic impacts. The burden has been disproportionately shouldered by marginalized communities. Not surprisingly, the high levels of poverty and inequality in Latin America manifest in increasing number of COVID-19 infection and mortality rates. Brazil and Mexico have reported the highest number of deaths in the region, with over 117,000 and 62,000 COVID-19 deaths respectively at the time of this writing. The response to the pandemic in Central America has been varied, reflecting differences in health infrastructure and political agendas. Nicaragua, the second-poorest country in the western hemisphere, has not yet declared a state of emergency. Its government, led by the Ortega regime, continues to contradict mitigation strategies recommended by the World Health Organization and the Pan American Health Organization. Other countries, like El Salvador, Honduras, and Guatemala, have instituted nationwide quarantine and travel restrictions, and optimized testing and case tracing capabilities. In this article, Dr. Adriana Vallejos describes Costa Rica’s response to the pandemic, considering how its well-established democracy and national health care system, unique for this region, have helped to address health and economic crises of this magnitude. -- Marcela del Carmen, MD, MPH
Dr. del Carmen is a Professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School and Chief Medical Officer for the Massachusetts General Physicians Organization. She is also a gynecologic oncologist at Massachusetts General Hospital's Center for Gynecologic Oncology and the Department of Obstetrics & Gynecology.
Central America Snapshot
Comprised of seven countries: Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama.
Connects the continents of North and South America and is part of North America.
Total population is approximately 50 million.
With the exception of Belize, each country has a representative democracy with an elected president. Belize has a constitutional monarchy with Queen Elizabeth II serving as head of state and an elected prime minister as head of government.
Notes from the Field
Women’s care during the COVID-19 pandemic in Costa Rica
Adriana Vallejos, MD
Initial approach to Hospital Calderón Guardia, San Jose, Costa Rica
Obstetrics COVID Team, Hospital Calderón Guardia, San Jose, Costa Rica
Consequences of the current pandemic hit us differently. At the beginning, while most countries were struggling to accommodate thousands of sick people, we kept our infection rate to less than 20 people per day and until late June we only had 10 COVID- 19-related deaths. From then on, the numbers have increased steadily. Currently, Costa Rica reports almost 40.000 cases and 420 deaths.
In a country of a little over 5 million people with a national healthcare system that covers all types of health diseases and situations, this is a breaking point. Initially, authorities designated hospitals to concentrate exclusively on COVID-19 patients. But, as numbers increased, every hospital in the country had to open special COVID-19 units, and today all hospitals are mostly caring for COVID-19 patients. Furthermore, our specialized hospitals (Psychiatric National Hospital, National Trauma Hospital and Rehabilitation National Hospital) ceased their regular operations and are now exclusively dedicated to COVID -19. In addition, a new seven-floor hospital was built to help with the COVID crisis.
Regular care for people has taken a 180-degree turn. In our field of OBGYN, gynecological and obstetrical services continued to operate normally in the first few months. As COVID cases increased and hospital capacity changed, regular consultations were switched to phone calls for benign gynecological pathologies, and all surgeries (except for emergencies) were postponed until further notice. Obstetrical care was centralized so all patients had to access a tertiary health center. Labor and delivery struggled to adopt social distancing (we do not have private or semiprivate rooms and only a curtain divides the beds) and accompaniment during labor was restricted.
The struggles we have experienced in gynecologic oncology are far different. Initially, we were able to continue our work as usual, but when the hospital ran out of beds for COVID- 19 patients, we lost capacity for our oncological patients, consults decreased and some patients (afraid of getting infected at the hospital) started missing appointments, surgeries, and follow ups. On the “positive” side, other services such as Pathology and Radiology have expedited their work which has allowed us to speed up our diagnostic and staging period. In addition, since non-oncological and emergency surgeries have been suspended, our unit has been able to get increased operating room time, to the benefit of our cancer patients.
Although we are still facing the worst part of the COVID 19 pandemic, our country feels extremely proud of most of our government’s actions to counteract the pandemic´s effects. This crisis made us realize the great medical capacity of our nation, as demonstrated by our 99% recovery rate. Hopefully, we will maintain a low mortality rate and resume oncological care by achieving better control over the coronavirus in the new reality we are facing worldwide.
Author Biography: Adriana Vallejos, MD is a gynecologic oncologist at Hospital Calderón Guardia in San Jose, Costa Rica and an assistant professor at the University of Costa Rica. She is currently working on developing the National Oncological Protocols and database.
Curandera: A female healer/shaman who uses traditional folk practices to treat illness and impart wisdom.
October is National Domestic Violence Awareness Month
In 1989, the U.S. Congress designated October as National Domestic Violence Awareness Month, a time for advocates and survivors of domestic violence to come together in solidarity and support of efforts to eradicate domestic violence across the nation and the world. The goal is for action and change, not only to improve DV policies and laws, but also to reduce the stigma associated with being a DV survivor, and to raise awareness of the prevalence of DV in every sector of society.
It’s not just experts and scholars advocating for change; it’s young people, too. Teens and college students are utilizing their platforms to share their stories and build domestic violence awareness. They are writing policy proposals and meeting with policy makers. Groups like the Coalition to End Abuseare hosting discussionsto educate their peers about the steps they can take to move their communities forward. Young people are recognizing that silence is violence. Choosing to be ignorant is violence.
During this month, let us celebrate the advances that advocates and survivors have already made in building awareness of domestic violence, and let us use our platforms to educate ourselves and our loved ones on this issue. If young people teach anyone anything, it's that all it takes is one Google search and a passion to push the world towards a better, more equitable space. -- Fahima Begum
Fahima Begum is a junior at Harvard College and an intern at Strength and Serenity Global Initiative to End Gender-Based Violence.
When great trees fall,
rocks on distant hills shudder,
lions hunker down
in tall grasses,
and even elephants
lumber after safety.
When great trees fall
small things recoil into silence,
eroded beyond fear.
When great souls die,
the air around us becomes
light, rare, sterile.
We breathe, briefly.
Our eyes, briefly,
a hurtful clarity.
Our memory, suddenly sharpened,
gnaws on kind words
Great souls die and
our reality, bound to
them, takes leave of us.
Our souls, dependent upon their
now shrink, wizened.
Our minds, formed
and informed by their
radiance, fall away.
We are not so much maddened
as reduced to the unutterable ignorance of
And when great souls die,
after a period peace blooms,
slowly and always
irregularly. Spaces fill
with a kind of soothing electric vibration.
Our senses, restored, never
to be the same, whisper to us.
They existed. They existed.
We can be. Be and be
better. For they existed.
National COVID-19 Remembrance Sunday, October 4, Washington D.C. and streamed virtually.
An event to elevate the voices of families and victims of COVID-19 from around the country and from communities that have been disproportionately impacted by the pandemic. Learn more here.
Virtual Seminar Series: Gender-Based Violence in Disasters & Humanitarian Settings Provided by Massachusetts General Hospital, Global Health & Mass General Brigham
Sessions from 12:00-1:00 pm ET on these dates:
For more information and to register: firstname.lastname@example.org
Virtual Workshop: Forensic Evaluation of Asylum Seekers Provided by Society of Refugee Healthcare Providers
October 24-25 from 12-5 PM (EST) each day. Register for the course.
Pandemic Policython October 23-25 A virtual student-run competition to produce policy solutions to America’s most pressing challenges, such as public health, economic equity, criminal justice and voter rights. Learn more and apply.
Deep thank you for funding support
Karen Johansen and Gardner Hendrie, Al and Diane Kaneb, Vincent Memorial Hospital and Vincent Club, Westwind Foundation, Bank of America Foundation, Wyss Foundation
The Strength and Serenity Global Initiative Against Gender-Based Violence seeks to create a worldwide consortium to share best practices, develop training programs, and publish on issues pertaining to sexual exploitation and abuse with the goal to end gender-based violence. To learn more, visit our Web site. We welcome your feedback about this newsletter. Please e-mail questions/comments to email@example.com.