Santo Domingo.- The Dominican Institute for Quality (INDOCAL) has announced the release of a Technical Standard for Medical Tourism, aimed at establishing quality criteria for the entire value chain of the sector. The standard aims to ensure the best practices and safety of patients and their families while promoting protocols and standards that enhance confidence in the Dominican Republic as a destination for health services.

Lorenzo Ramírez, the general director of INDOCAL, stated that the NORDOM ISO 22525:2020 standard, approved by the Dominican Council for Quality (CODOCA), takes a comprehensive approach to medical care throughout the patient’s journey.

Ramírez further explained that this standard, in line with national development goals, was developed through an extensive consultation process involving the INDOCAL Technical Tourism Committee. The committee consisted of experts from the Ministry of Tourism (MITUR), the Ministry of Public Health (MSP), the Dominican Association of Health Tourism (ADTS), the Association of Hotels and Tourism (ASONAHORES), and other entities. They reached a consensus to promote the standard in order to enhance the security of this thriving market niche.

Dr. Alejandro Cambiaso, president of the ADTS, praised the NORDOM ISO 22525 standard for medical tourism. He highlighted that it incorporates compliance with local licensing and accreditation standards of the Ministry of Public Health, regulatory standards of the Ministry of Tourism, and specialized ISO international standards for medical tourism. These international standards have been validated by numerous countries, representing a significant step forward.

Cambiaso emphasized that this regulation does not replace international accreditations but rather complements and strengthens them. It allows the country to aspire to the development of a culture of quality and compliance in the healthcare sector.

The adopted ISO standard can be applied to various organizations involved in medical tourism, including healthcare providers, plastic surgery centers, dentistry clinics, tour operators, medical facilitators, hotels, and specialized recovery centers.

While littering may not seem like a “big deal” on the contrary, the environmental impact can be quite large. According to the United Nations Environment Programme, the Caribbean is the second most plastic contaminated sea in the world (UNEP, 2019) with plastic bottles being the most common plastics found in our waters (Birds Caribbean, 2019). This can have major implications on marine life, such as lacerations, suffocation and other forms of injury or illness (IUCN, 2021). Plastic waste can be regarded as a “silent killer” leading to the death of seabirds throughout the Caribbean (Bird Caribbean, 2019). Plastic is also known to affect the nesting, breeding and feeding of these animals, which may have consequences for the food chain. While the long term impact is unknown, we owe it to the future generations to minimize exposure as much as possible.

It may seem easy to ignore what occurs in our ocean, after all it’s not always visible to the naked eye, however what happens in our oceans affects both human and planetary health. For instance, a plastic bottle in the ocean can break down over time into microplastics which are then consumed by fish in the sea. When fisherfolks are out in the ocean, they may catch the fish which is then sold at our local fish market for consumption to the general population. Plastics that are inappropriately discarded, can find their way into the human body. The United States National Ocean Service highlights that very little is known about microplastics and their impact on marine and human life (NOS, 2023). Therefore it is prudent that we act now and protect our oceans from plastic pollution, to protect our health and animal health.

Inappropriate disposal of plastic bottles is not only a concern for the marine environment, it also poses a threat on land as it can be used as a breeding ground for mosquitoes when water settles in discarded plastic waste. Mosquitoes are not only a nuisance, but pose many  threats to human health such as the spread of dengue fever, zika virus, chikungunya and other related diseases.

Another critical element to consider when discussing the impact of plastic pollution is the link between plastics and unhealthy foods high in salt, sugar and fat. The Big Food industry uses plastic packaging for many food and drink products and despite some actors’ ‘pledges’ to make their plastic packaging more sustainable, global reports [1] indicate that major players continue to use ‘more virgin plastic’ despite efforts to reduce their use. This equates to more plastic waste; the products and their packaging have long term health consequences for both humans and the planet. These ultra processed products have played a significant role in the nutritional transition that has occurred in the Caribbean fuelling high rates of NCDs and obesity. This is a reminder of the strong interlinkages between health and the environment and the need for synergistic solutions to address both of these issues.

Undoubtedly, plastic does more harm than good and it is time for us to think critically about our use and disposal of plastics and the harm to human and planetary health. We’ve made great strides in technological advancement and infrastructure, but we have the potential to create sustainable solutions to plastic pollution and address this crisis if we act now.

World Environment Day was celebrated on June 5 2023. Plastic production and related pollution presents a major threat to SIDS like those in the Caribbean. The urgency with which we need to collectively address this issue cannot subside.

Healthy Caribbean Youth (HCY), the youth arm of the Healthy Caribbean Coalition, is a regional group of young health advocates with various backgrounds who are passionate about promoting good health and supportive environments for children and youth.

[1] https://ellenmacarthurfoundation.org/press-release-progress-needs-fresh-...

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Hal Dempsey wanted to “escape Missouri.” Arlo Dennis is “fleeing Florida.” The Tillison family “can’t stay in Texas.”

They are part of a new migration of Americans who are uprooting their lives in response to a raft of legislation across the country restricting health care for transgender people.

Missouri, Florida, and Texas are among at least 20 states that have limited components of gender-affirming health care for trans youth. Those three states are also among the states that prevent Medicaid — the public health insurance for people with low incomes — from paying for key aspects of such care for patients of all ages.

More than a quarter of trans adults surveyed by KFF and The Washington Post late last year said they had moved to a different neighborhood, city, or state to find more acceptance. Now, new restrictions on health care and the possibility of more in the future provide additional motivation.

Many are heading to places that are passing laws to support care for trans people, making those states appealing sanctuaries. California, for example, passed a law last fall to protect those receiving or providing gender-affirming care from prosecution. And now, California providers are getting more calls from people seeking to relocate there to prevent disruptions to their care, said Scott Nass, a family physician and expert on transgender care based in the state.

But the influx of patients presents a challenge, Nass said, “because the system that exists, it can’t handle all the refugees that potentially are out there.”

In Florida, the legislative targeting of trans people and their health care has persuaded Arlo Dennis, 35, that it is time to uproot their family of five from the Orlando area, where they’ve lived for more than a decade. They plan to move to Maryland.

Dennis, who uses they/them pronouns, no longer has access to hormone replacement therapy after Florida’s Medicaid program stopped covering transition-related care in late August under the claim that the treatments are experimental and lack evidence of being effective. Dennis said they ran out of their medication in January.

“It’s definitely led to my mental health having struggles and my physical health having struggles,” Dennis said.

Moving to Maryland will take resources Dennis said their family does not have. They launched a GoFundMe campaign in April and have raised more than $5,600, most of it from strangers, Dennis said. Now the family, which includes three adults and two children, plans to leave Florida in July. The decision wasn’t easy, Dennis said, but they felt like they had no choice.

“I’m OK if my neighbor doesn’t agree with how I’m living my life,” Dennis said. “But this was literally outlawing my existence and making my access to health care impossible.”

Mitch and Tiffany Tillison decided they needed to leave Texas after the state’s Republicans made anti-trans policies for youth central to their legislative agenda. Their 12-year-old came out as trans about two years ago. They asked for only her middle name, Rebecca, to be published because they fear for her safety due to threats of violence against trans people.

This year, the Texas Legislature passed a law limiting gender-affirming health care for youth under 18. It specifically bans physical care, but local LGBTQ+ advocates say recent crackdowns also have had a chilling effect on the availability of mental health therapy for trans people.

While the Tillisons declined to specify what treatment, if any, their daughter is getting, they said they reserve the right, as her parents, to provide the care their daughter needs — and that Texas has taken away that right. That, plus increasing threats of violence in their community, particularly in the wake of the May 6 mass shooting by a professed neo-Nazi at Allen Premium Outlets, about 20 miles from their home in the Dallas suburbs, caused the family to decide to move to Washington state.

“I’ve kept her safe,” said Tiffany Tillison, adding that she often thinks back to the moment her daughter came out to her during a long, late drive home from a daylong soccer tournament. “It’s my job to continue to keep her safe. My love is unending, unconditional.”

For her part, Rebecca is pragmatic about the move planned for July: “It’s sad, but it is what we have to do,” she said.

A close call on losing key medical care in Missouri also pushed some trans people to rethink living there. In April, Missouri Attorney General Andrew Bailey issued an emergency rule seeking to limit access to transition-related surgery and cross-sex hormones for all ages, and restrict puberty-blocking drugs, which pause puberty but don’t alter gender characteristics. The next day, Dempsey, 24, who uses they/them pronouns, launched a GoFundMe fundraiser for themself and their two partners to leave Springfield, Missouri.

“We are three trans individuals who all depend on the Hormone Replacement Therapy and gender affirming care that is soon to be prohibitively limited,” Dempsey wrote in the fundraising appeal, adding they wanted to “escape Missouri when our lease is up at the end of May.”

Dempsey said they also got a prescription for a three-month supply of hormone therapy from their doctor in Springfield to tide them over until the move.

Bailey withdrew his rule after the state legislature in May restricted new access to such treatments for minors, but not adults like Dempsey and their partners. Still, Dempsey said their futures in Missouri didn’t look promising.

Neighboring Illinois was an obvious place to move; the legislature there passed a law in January that requires state-regulated insurance plans to cover gender-affirming health care at no extra cost. Where exactly was a bigger question. Chicago and its suburbs seemed too expensive. The partners wanted a progressive community similar in size and cost of living to the city they were leaving. They were looking for a Springfield in Illinois.

“But not Springfield, Illinois,” Dempsey quipped.

Gwendolyn Schwarz, 23, had also hoped to stay in Springfield, Missouri, her hometown, where she had recently graduated from Missouri State University with a degree in film and media studies. She had planned to continue her education in a graduate program at the university and, within the next year, get transition-related surgery, which can take a few months of recovery.

But her plans changed as Bailey’s rule stirred fear and confusion.

“I don’t want to be stuck and temporarily disabled in a state that doesn’t see my humanity,” Schwarz said.

She and a group of friends are planning to move west to Nevada, where state lawmakers have approved a measure that requires Medicaid to cover gender-affirming treatment for trans patients.

Schwarz said she hopes moving from Missouri to Nevada’s capital, Carson City, will allow her to continue living her life without fear and eventually get the surgery she wants.

Dempsey and their partners settled on Moline, Illinois, as the place to move. All three had to quit their jobs to relocate, but they have raised $3,000 on GoFundMe, more than enough to put a deposit down on an apartment.

On May 31, the partners packed the belongings they hadn’t sold and made the 400-mile drive to their new home.

Since then, Dempsey has already been able to see a medical provider at a clinic in Moline that caters to the LGBTQ+ community — and has gotten a new prescription for hormone therapy.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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armacyclics, Janssen) and obinutuzumab (Gazyva, Genentech) in older patients with CLL.“This was one example where we learned that when we balance all factors, safety and efficacy, it turns out

The Dominican Medical Association (CMD) revealed that it is investigating a person with an apparent false registration operating as a doctor in a health center in the province of Puerto Plata.

The president of the association, Senén Caba, did not give details of the person being followed so as not to hinder the investigation process.

He added that a false doctor had been brought to justice in the same province, but the authorities “did nothing” about it.

The doctor said that he has collaborated with journalist Nuria Piera, who has denounced dozens of doctors working in the country’s health centers with false qualifications in several of her investigative programs.

The investigation of the alleged neuroscientist
Recently Nuria Piera investigated Elizabeth Silverio Sillien, an alleged neuroscientist, educator, and pastor, who was the director of the closed Kogland Neurocognitive and Psychopedagogical Therapy Centre, a space located in Gascue and created in December 2021, which she ran with her husband and partner David Báez Zorrilla under the object of pedagogical therapies.

According to what the journalist found out after her investigation, the woman claimed to have a doctorate in Neurosciences in the modality of cognitive-brain intervention in clinical and pedagogical areas, claiming to be a graduate of Cambridge University in England.

She claimed to have a master’s degree in Academic Management Administration and Educational Corporate Modeling from the West Indies University Campus.

Silverio Sillien also claimed to have a Ph.D. in child and general neuroscience, specializing in the intervention of developmental disorders, syndromes, and comorbidities. She also specializes in neurobiological, neurocognitive, and neuropathological areas from the University of Florida.

The fraudulent doctor claimed to have a Master’s degree in ESD model of inclusion, special education at the West Indies, Barbados campus, a specialization in the therapeutic structure of intervention treatment creation at the University of Valencia, Spain, and a postgraduate degree in updating millennial psychological modality.

Following the investigation, the Ministry of Public Health reported that the center was closed, and Elizabeth was ordered to submit an exequatur.

Tips to prevent mosquito-borne diseases this hurricane season

IT wouldn't be the hurricane season without rain, and that comes with a threat — dengue fever.

And as the island experiences increased rainfall, the Ministry of Health and Wellness is reminding Jamaicans to expect an increase in the breeding of mosquitoes, especially disease-carrying types such as the Aedes aegypti that transmits dengue.

The Atlantic hurricane season started on June 1 and will continue until November 30, 2023.

Dr Jacquiline Bisasor-McKenzie, Jamaica's chief medical officer (CMO), noted that members of the public have a role to play in preventing a possible increase in the transmission of dengue.

Bisasor-McKenzie urged individuals to be active in "searching for and destroying all potential mosquito breeding sites in and around their surroundings".

She said Jamaica's high dengue transmission period coincides with the hurricane season annually, as is the case with the rest of the Caribbean.

"In anticipation of that the ministry will activate an enhanced public education programme, home inspections, and the destruction of breeding sites by vector control workers, and [will implement] islandwide fogging by the parish health departments."

The US National Oceanic and Atmospheric Administration has predicted a "near normal" hurricane season, with 12 to 17 named storms packing winds of at least 39 mph (63 kph). Of those, five to nine could become hurricanes, with one to four developing into major hurricanes.

Additionally, according to the Centers for Disease Control and Prevention (CDC), each year, up to 400 million people are infected by the dengue virus and approximately 100 million people get sick from infection — with 40,000 dying from severe dengue.

In a release on April 17, 2023 the CDC cautioned travellers to protect themselves from contracting the dengue disease as cases trend upwards in four Caribbean countries.

The CDC listed Cuba, the Dominica Republic, as well as French Caribbean territories Guadeloupe and Martinique.

The Aedes aegypti mosquito breeds in any containerised environment — that is, anything that can hold water.

Some of the common breeding sites for the Aedes aegypti mosquito are drums, tyres, buckets, and animal feeding containers.

Last month, health promotion and education officer Gerald Miller said the Westmoreland Public Health Department would be increasing its efforts to educate citizens about how to avoid contracting the virus.

During last Thursday's monthly sitting of the St Ann Municipal Corporation, the St Ann Health Department served notice that it has no problem throwing the book at people who allow mosquitoes to breed on their premises despite repeated warnings to address the health threat.

Meanwhile, the health ministry said members of the public are encouraged to search their surroundings at home and work at least once per week to ensure there are no Aedes aegypti breeding sites. This, the ministry added, is the best strategy to mitigate against a possible outbreak of dengue later in the year.

The public is also being encouraged to take protective action to reduce their contact with mosquitoes.

There are no confirmed cases of dengue in Jamaica thus far for 2023.

Dengue-prevention tips:

*Stop Aedes aegypti mosquito breeding by looking for anything water can settle in and cover it/ keep it dry/ clean it regularly/ fill it with soil or sand/ punch holes in it/ recycle it/dispose of it.

*Avoid being bitten by mosquitoes.

*Use insect repellent containing DEET, IR3535 or Picaridin.

*Use mosquito nets.

*Use mosquito destroyer.

*Put screens on windows and doors.

*Take community action regarding prevention.