Es que el hospital donde se atendía, Winner Regional Health, se ha sumado recientemente al cada vez mayor número de centros de salud rurales que cierran sus unidades de maternidad.

“Ahora va a ser mucho más estresante y complicado para las mujeres recibir la atención médica que necesitan, porque tienen que ir mucho más lejos”, dijo Hofeldt, que tiene fecha de parto de su primer hijo el 10 de junio.

Hofeldt agregó que los viajes más largos suponen más gasto en gasolina y un mayor riesgo de no llegar a tiempo al hospital. “Mi principal preocupación es tener que parir en un auto”, afirma.

Más de un centenar de hospitales rurales han dejado de atender partos desde 2021, según el Center for Healthcare Quality and Payment Reform, una organización sin fines de lucro. El cierre de los servicios de obstetricia se suele achacar a la falta de personal y la falta de presupuesto.

En la actualidad, alrededor del 58% de los condados de Dakota del Sur no cuentan con salas de parto. Es la segunda tasa más alta del país, después de Dakota del Norte, según March of Dimes, una organización que asiste a las madres y sus bebés.

Además, el Departamento de Salud de Dakota del Sur informó que las mujeres embarazadas y los bebés del estado — especialmente las afroamericanas y las nativas americanas— presentan tasas más altas de complicaciones y mortalidad.

Winner Regional Health atiende a comunidades rurales en Dakota del Sur y Nebraska, incluyendo parte de la reserva indígena Rosebud Sioux. El año pasado nacieron allí 107 bebés, una baja considerable respecto de los 158 que nacieron en 2021, contó su director ejecutivo, Brian Williams.

Los hospitales más cercanos con servicios de maternidad se encuentran en pueblos rurales a una hora de distancia, o más, de Winner.

Sin embargo, varias mujeres afirmaron que el trayecto en coche hasta esos centros las llevaría por zonas donde no hay señal de celular confiable, lo que podría suponer un problema si tuvieran una emergencia en el camino.

KFF Health News habló con cinco pacientes de la zona de Winner que tenían previsto que su parto fuera en el Avera St. Mary’s Hospital de Pierre, a unas 90 millas de Winner, o en uno de los grandes centros médicos de Sioux Falls, a 170 millas de distancia.

Hofeldt y su novio conducen cada tres semanas para ir a las citas prenatales en el hospital de Pierre, que brinda servicios a la pequeña capital y a la vasta zona rural circundante.

A medida que se acerque la fecha del parto, las citas de control y, por lo tanto los viajes, tendrán que ser semanales. Ninguno de los dos tiene un empleo que le brinde permiso con goce de sueldo para ese tipo de consulta médica.

“Cuando necesitamos ir a Pierre, tenemos que tomarnos casi todo el día libre”, explicó Hofeldt, que nació en el hospital de Winner.

Eso significa perder una parte del salario y gastar dinero extra en el viaje. Además, no todo el mundo tiene auto ni dinero para la gasolina, y los servicios de autobús son escasos en las zonas rurales del país.

Algunas mujeres también tienen que pagar el cuidado de sus otros hijos para poder ir al médico cuando el hospital está lejos. Y, cuando nace el bebé, tal vez tengan que asumir el costo de un hotel para los familiares.

Amy Lueking, la médica que atiende a Hofeldt en Pierre, dijo que cuando las pacientes no pueden superar estas barreras, los obstetras tienen la opción de darles dispositivos para monitorear el embarazo en el hogar y ofrecerles consulta por teléfono o videoconferencia.

Las pacientes también pueden hacerse los controles prenatales en un hospital o una clínica local y, más tarde, ponerse en contacto con un profesional de un hospital donde se practiquen partos, dijo Lueking.

Sin embargo, algunas zonas rurales no tienen acceso a la telesalud. Y algunas pacientes, como Hofeldt, no quieren dividir su atención, establecer relaciones con dos médicos y ocuparse de cuestiones logísticas como transferir historias clínicas.

Durante una cita reciente, Lueking deslizó un dispositivo de ultrasonido sobre el útero de Hofeldt. El ritmo de los latidos del corazón del feto resonó en el monitor.

“Creo que es el mejor sonido del mundo”, expresó Lueking.

Hofeldt le comentó que quería un parto lo más natural posible.

Pero lograr que el parto se desarrolle según lo planeado suele ser complicado para quienes viven en zonas rurales, lejos del hospital. Para estar seguras de que llegarán a tiempo, algunas mujeres optan por programar una inducción, un procedimiento en el que los médicos utilizan medicamentos u otras técnicas para provocar el trabajo de parto.

Katie Larson vive en un rancho cerca de Winner, en la localidad de Hamill, que tiene 14 habitantes. Esperaba evitar que le indujeran el parto.

Larson quería esperar a que las contracciones comenzaran de forma natural y luego conducir hasta el Avera St. Mary’s, en Pierre.

Pero terminó programando una inducción para el 13 de abril, su fecha probable de parto. Más tarde, la adelantó al 8 de abril para no perderse una venta de ganado muy importante, que ella y su esposo estaban preparando.

“La gente se verá obligada a elegir una fecha de inducción aunque no sea lo que en un principio hubiera elegido. Si no, correrá el riesgo de tener al bebé en la carretera”, afirmó.

Lueking aseguró que no es frecuente que las embarazadas den a luz mientras se dirigen al hospital en automóvil o en ambulancia. Pero también recordó que el año anterior cinco mujeres que tenían previsto tener a sus hijos en Pierre acabaron haciéndolo en las salas de emergencias de otros hospitales, porque el parto avanzó muy rápido o porque las condiciones del clima hicieron demasiado peligroso conducir largas distancias.

Nanette Eagle Star tenía previsto que su bebé naciera en el hospital de Winner, a cinco minutos de su casa, hasta que el hospital anunció que cerraría su unidad de maternidad. Entonces decidió dar a luz en Sioux Falls, porque su familia podía quedarse con unos familiares que vivían allí y así ahorrar dinero.

El plan de Eagle Star volvió a cambiar cuando comenzó el trabajo de parto prematuramente y el clima se puso demasiado peligroso para manejar o para tomar un helicóptero médico a Sioux Falls.

“Todo ocurrió muy rápido, en medio de una tormenta de nieve”, contó.

Finalmente, Eagle Star tuvo a su bebé en el hospital de Winner, pero en la sala de emergencias, sin epidural, ya que en ese momento no había ningún anestesista disponible. Esto ocurrió  solo tres días después del cierre de la unidad de maternidad.

El fin de los servicios de parto y maternidad en el Winner Regional Health no es solo un problema de salud, según las mujeres de la localidad. También tiene repercusiones emocionales y económicas en la comunidad.

Eagle Star recuerda con cariño cuando era niña e iba con sus hermanas a las citas médicas. Apenas llegaban, iban a un pasillo que tenía fotos de bebés pegadas en la pared y comenzaban una “búsqueda del tesoro” para encontrar polaroids de ellas mismas y de sus familiares.

“A ambos lados del pasillo estaba lleno de fotos de bebés”, contó Eagle Star. Recuerda pensar: “Mira todos estos bebés tan lindos que han nacido aquí, en Winner”.

Hofeldt contó que muchos lugareños están tristes porque sus bebés no nacerán en el mismo hospital que ellos.

Anora Henderson, médica de familia, señaló que la falta de una correcta atención a las mujeres embarazadas puede tener consecuencias negativas para sus hijos. Esos bebés pueden desarrollar problemas de salud que requerirán cuidados de por vida, a menudo costosos, y otras ayudas públicas.

“Hay un efecto negativo en la comunidad”, dijo. “Simplemente no es tan visible y se notará bastante más adelante”.

Henderson renunció en mayo a su puesto en el Winner Regional Health, donde asistía partos vaginales y ayudaba en las cesáreas. El último bebé al que recibió fue el de Eagle Star.

Para que un centro de salud sea designado como hospital con servicio de maternidad, debe contar con instalaciones donde se pueden efectuar cesáreas y proporcionar anestesia las 24 horas del día, los 7 días de la semana, explicó Henderson.

Williams, el director ejecutivo del hospital, dijo que el Winner Regional Health no ha podido contratar suficientes profesionales médicos con formación en esas especializaciones.

En los últimos años, el hospital solo había podido ofrecer servicios de maternidad cubriendo aproximadamente $1,2 millones anuales en salarios de médicos contratados de forma temporal, señaló. Pero el hospital ya no podía seguir asumiendo ese gasto.

Otro reto financiero está dado porque muchos partos en los hospitales rurales están cubiertos por Medicaid, el programa federal y estatal que ofrece atención a personas con bajos ingresos o discapacidades.

El programa suele pagar aproximadamente la mitad de lo que pagan las aseguradoras privadas por los servicios de parto, según un informe de 2022 de la U.S. Government Accountability Office (GAO).

Williams contó que alrededor del 80% de los partos en Winner Regional Health estaban cubiertos por Medicaid.

Las unidades obstétricas suelen constituir el mayor gasto financiero de los hospitales rurales y, por lo tanto, son las primeras que se cierran cuando un centro de salud atraviesa dificultades económicas, explica el informe de la GAO.

Williams dijo que el hospital sigue prestando atención prenatal y que le encantaría reanudar los partos si pudiera contratar suficiente personal.

Henderson, la médica que dimitió del hospital de Winner, ha sido testigo del declive de la atención materna en las zonas rurales durante décadas.

Recuerda que, antes de que naciera su hermana, acompañaba a su madre a las citas médicas. En cada viaje, su madre recorría unas 100 millas después de que el hospital de la ciudad de Kadoka cerrara en 1979.

Henderson trabajó durante casi 22 años en el Winner Regional Health, lo que permitió que muchas mujeres no tuvieran que desplazarse para dar a luz, como le ocurrió a su madre.

A lo largo de los años, atendió a nuevas pacientes cuando cerraron las unidades de maternidad de un hospital rural cercano y luego las de un centro del Servicio de Salud Indígena. Finalmente, el propio hospital de Henderson dejó de atender partos.

“Lo que ahora realmente me frustra es que pensaba que iba a dedicarme a la medicina familiar y trabajar en una zona rural, y que así íbamos a solucionar estos problemas, para que las personas no tuvieran que conducir 100 millas para tener un bebé”, se lamentó.

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Former President Joe Biden was diagnosed with an "aggressive form" of prostate cancer that has a five-year survival rate of between 30% and 40%.

The former president's prostate cancer is characterized by a Gleason score of 9 and Grade Group 5 with bone metastasis, indicating that it is "pretty far advanced," Fox News senior medical analyst Dr. Marc Siegel said on ‘Fox Report.’

"It’s the most aggressive type," Siegel said. "That means it has the highest risk of spread — which obviously he has had."

Biden is also presenting with urinary symptoms, which is another sign that the cancer is advanced. Prostate cancer often presents as asymptomatic in its early stages, he said. 

JOE BIDEN DIAGNOSED WITH 'AGGRESSIVE FORM' OF PROSTATE CANCER WITH METASTASIS TO THE BONE

"This was found by physical examination by a prostate exam," Siegel said. "A lot of times we find an elevation in prostate-specific antigen, PSA, and then we go after it… I mean, he must have had the best possible care here. I'm a little taken aback that it's this far advanced."

Siegel said he conducts a prostate-specific antigen, or PSA, test on every male over the age of 45 years old. The test measures how much PSA is in the blood and is primarily used to screen for prostate cancer, according to Mayo Clinic. 

NEW PROSTATE CANCER TEST PINPOINTS DISEASE BETTER THAN PSA OPTION, STUDY FINDS

While the PSA test is not always a perfect indicator of prostate cancer, someone who has a rise in PSA automatically gets an MRI, Siegel said. After the MRI, a decision is made about whether to conduct a biopsy.

More than 80% of men over the age of 80 years old have some prostate cancer cells in their body, according to Siegel.

"It would be really surprising if they weren't doing a very close screening on this because everybody knows in the medical community that this is the one cancer in men you really look out for," he said. "… He doesn't seem to have a lot of risk factors that I would think about other than age, but age is enough and he's 82, so that's a big risk factor."

Doctors will likely treat Biden with hormone therapy, Siegel said. They may also attempt to radiate the lesion found on the bone or remove the prostate altogether.

PROSTATE CANCER DRUG NOW AVAILABLE TO MORE PATIENTS WITH AGGRESSIVE FORM OF DISEASE

"Sometimes they decide to do more than one therapy," Siegel said. "They might try to take the prostate out, do radiation and the hormone therapy altogether. That's not uncommon."

There are two types of medications used to treat this type of advanced prostate cancer — Lupron, which stops testosterone production, and Casodex, which stops testosterone from binding. Side effects of the medication can leave people feeling "fatigued and listless," according to Siegel.

"The other thing I'm concerned about is bone pain, because those metastases to the bone can be pretty painful," he said.

If the cancer is caught early while its still localized to the prostate gland, it’s curable "most of the time," Siegel said.

"The goal is to get it before it leaves the prostate," Siegel said. "When it's left the prostate, it becomes much more difficult to cure."

The downpours can also cause other problems that must be prevented.

The agency also reported a total of 88 confirmed cases of dengue fever. The cumulative incidence is 2.37.

The Ministry of Health confirmed the information in its weekly bulletin for week 18.

No new cases of malaria were reported this epidemiological week, but there have been 192 confirmed cases and 9,895 suspected cases this year.

The cumulative incidence per 100,000 inhabitants is 5.16. Similarly, no cases of leptospirosis were registered this week, and there have been 22 confirmed cases this year, with an incidence of 0.60.

Maternal deaths

During this epidemiological week 18, four maternal deaths have been confirmed, corresponding to three women of Dominican nationality and one Haitian woman.

The cumulative total up to week 18 is 58 deaths, representing a 12.1% decrease in fatalities compared to 2024.

About infant deaths, 38 deaths were reported this week.

44 deaths have been reported so far this year, reflecting a decrease in this indicator. The cumulative total for this year is 605 deaths, while last year’s cumulative total to date was 754 deaths, as can be seen in the data from the Ministry of Health.

On Friday 16 May 2025 the HCC in partnership with PAHO and CARPHA hosted a webinar entitled: Global Updates on Front of Package Warning Labelling showcasing progress and lessons learned, underscoring the efficacy of the evidence-based ‘high in’ octagonal warning label and the critical importance of a robust supportive nutrient profile model. The webinar began with a global overview, followed by sharing of country experiences from Barbados and countries outside of the region including Kenya and some of CARICOM’s key trading partners: the UK, Canada and Mexico.

The webinar had over 450 registrants and rich audience engagement signalling the significant level of interest in advancing this policy measure.

Presenters

The post appeared first on Healthy Caribbean Coalition.

Health leaders from the Americas and around the world gather at the 78th World Health Assembly with a call for unity in health

Cristina Mitchell

16 May 2025

A spike in violent crime, including a record number of gun-related deaths, is overwhelming the Accident & Emergency (A&E) Department at the Queen Elizabeth Hospital (QEH), with senior officials warning that the toll on staff and resources is becoming unsustainable.

The violence is disrupting operations and traumatising frontline healthcare workers, said CEO Neil Clark, describing the effects of the unseen toll of criminal violence on public health infrastructure as far-reaching and deeply felt within the hospital.

“Absolutely. It has a major impact on the QEH,” he said. “The staff clearly will treat anybody who comes in, but having to treat somebody who’s coming with gunshots is not only slowing down everybody else who’s coming without the gunshots, it slows down the whole department and the department moves into lockdown.”

As of Wednesday, Barbados had recorded 17 gun-related deaths.

Clark stressed that while A&E staff remain committed, fear and psychological distress have become routine parts of their job.

“There’s also a fear amongst the staff that that might continue into the department. So they’re treating people and being nervous at the same time,” he said. “Our security team is excellent… but sometimes those injuries are horrific and that has its toll… especially as a child [is] involved in a shooting.”

The emotional burden, the hospital boss added, is compounded by the sheer unpredictability and scale of trauma cases staff must face.

“They’ve got the normal, mild conditions of people turning up with mild illnesses or they’ve twisted their wrist, and then the next minute they’ve got a multiple shooting coming in… and then after that they’re supposed to go back to work normally,” he pointed out.

He called on the public to show greater empathy and understanding, noting that frustration over long wait times should not be directed at individual nurses or doctors.

“They’re doing their best,” he said. “We have to take our hats off to those people who work in A&E and do this day in, day out.”

Director of Nursing Services Henderson Pinder added that the psychological cost of repeated exposure to violent trauma is mounting across departments.

“These are psychologically hurtful incidents… and they do have an effect on not only nurses, [but] all the staff,” Pinder explained. “We have what we call a huddle after these incidents… but in most instances, it’s more than that. So we need to have outside counsellors and bereavement persons come in to help staff work through this.”

Beyond the emotional fallout, Pinder said that violence consumes precious human and material resources: “We have to use a lot of individuals, specialists, doctors… and we as a small country can ill afford to be using so much resources. It would be better if we could cut out the violence and live as a peaceful nation.”

He also flagged ongoing concerns about security, with fears of retaliation even when patients are hospitalised.

“When they get on the ward there’s always the fear of retaliation… so it places additional strain on our security personnel and puts our nurses… always having to quell these disputes,” Pinder noted.

Clark said the QEH has mental health support in place but recognises the need to scale it up.

“We already have counselling support available for all staff… and we’re hoping to expand that as part of the QEH strategy,” he said. “We’re even looking at mental health first aid training.”

The CEO highlighted a gap in national preparedness around recognising and addressing stress and anxiety, saying: “A lot of people suffer silently… and we have to look after our own staff and each other.”

Speaking more broadly about the A&E, Clarke said the hospital is making progress on a systemic redesign of its A&E Department to ease bottlenecks and improve overall patient care.

“We’re about a quarter of the way through a redesign of our A&E flow,” he said. “It’s not just about the A&E Department… it becomes the bottleneck for the whole healthcare system.”

Clark explained that improving patient flow requires action at every level – from the triage process to diagnostics, ward admissions, and discharges.

“Everybody who arrives at the A&E should be triaged within 15 minutes by a nurse… if not, there’s an escalation process,” he said. 

The hospital CEO admitted that delays persist but insisted patients are not neglected once they enter the system.

“They may be in A&E for two days but they’re still under the care of the specialist doctor,” he said. “It’s no different than if they were on the ward…, but I accept it’s not the right place for that treatment to be taking place, and we hope to change that in the near future.” 

sheriabrathwaite@barbadostoday.bb

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At the Department of Homeland Security, a man was led off the elevator in handcuffs.

But the area housing the regional office of the Department of Health and Human Services was eerily quiet.

In March, HHS announced it would close five of its 10 regional offices as part of a broad restructuring to consolidate the department’s work and reduce the number of staff by 20,000, to 62,000. The HHS Region 2 office in New York City, which has served New Jersey, New York, Puerto Rico, and the U.S. Virgin Islands, was among those getting the ax.

Public health experts and advocates say that HHS regional offices, like the one in New York City, form the connective tissue between the federal government and many locally based services. Whether ensuring local social service programs like Head Start get their federal grants, investigating Medicare claims complaints, or facilitating hospital and health system provider enrollment in Medicare and Medicaid programs, regional offices provide a key federal access point for people and organizations. Consolidating regional offices could have serious consequences for the nation’s public health system, they warn.

“All public health is local,” said Georges Benjamin, executive director of the American Public Health Association. “When you have relative proximity to the folks you’re liaising to, they have a sense of the needs of those communities, and they have a sense of the political issues that are going on in these communities.”

The other offices slated to close are in Boston, Chicago, San Francisco, and Seattle. Together, the five serve 22 states and a handful of U.S. territories. Services for the shuttered regional offices will be divvied up among the remaining regional offices in Atlanta, Dallas, Denver, Kansas City, and Philadelphia.

The elimination of regional HHS offices has already had an outsize impact on Head Start, a long-standing federal program that provides free child care and supportive services to children from many of the nation’s poorest families. It is among the examples cited in the lawsuit against the federal government challenging the HHS restructuring brought by New York, 18 other states, and the District of Columbia, which notes that, as a result, “many programs are at imminent risk of being forced to pause or cease operations.”

The HHS site included a regional Head Start office that was closed and laid off staff last month. The Trump administration had sought to wipe out funding for Head Start, according to a draft budget document that outlines dramatic cuts at HHS, which Congress would need to approve. Recent news reports indicate the administration may be stepping back from this plan; however, other childhood and early-development programs could still be on the chopping block.

Bonnie Eggenburg, president of the New Jersey Head Start Association, said her organization has long relied on the HHS regional office to be “our boots on the ground for the federal government.” During challenging times, such as the covid-19 pandemic or Hurricanes Sandy and Maria, the regional office helped Head Start programs design services to meet the needs of children and families. “They work with us to make sure we have all the support we can get,” she said.

In recent weeks, payroll and other operational payments have been delayed, and employees have been asked to justify why they need the money as part of a new “Defend the Spend” initiative instituted by the Elon Musk-led Department of Government Efficiency, created by President Donald Trump through an executive order.

“Right now, most programs don’t have anyone to talk to and are unsure as to whether or not that notice of award is coming through as expected,” Eggenburg said.

HHS regional office employees who worked on Head Start helped providers fix technical issues, address budget questions, and discuss local issues, like the city’s growing population of migrant children, said Susan Stamler, executive director of United Neighborhood Houses. Based in New York City, the organization represents dozens of neighborhood settlement houses — community groups that provide services to local families such as language classes, housing assistance, and early-childhood support, including some Head Start programs.

“Today, the real problem is people weren’t given a human contact,” she said of the regional office closure. “They were given a website.”

To Stamler, closing the regional Head Start hub without a clear transition plan “demonstrates a lack of respect for the people who are running these programs and services,” while leaving families uncertain about their child care and other services.

“It’s astonishing to think that the federal government might be reexamining this investment that pays off so deeply with families and in their communities,” she said.

Without regional offices, HHS will be less informed about which health initiatives are needed locally, said Zach Hennessey, chief strategy officer of Public Health Solutions, a nonprofit provider of health services in New York City.

“Where it really matters is within HHS itself,” he said. “Those are the folks that are now blind — but their decisions will ultimately affect us.”

Dara Kass, an emergency physician who was the HHS Region 2 director under the Biden administration, described the job as being an ambassador.

“The office is really about ensuring that the community members and constituents had access to everything that was available to them from HHS,” Kass said.

At HHS Region 2, division offices for the Administration for Community Living, the FDA’s Office of Inspections and Investigations, and the Substance Abuse and Mental Health Services Administration have already closed or are slated to close, along with several other division offices.

HHS did not provide an on-the-record response to a request for comment but has maintained that shuttering regional offices will not hurt services.

Under the reorganization, many HHS agencies are either being eliminated or folded into other agencies, including the recently created Administration for a Healthy America, under HHS Secretary Robert F. Kennedy Jr.

“We aren’t just reducing bureaucratic sprawl. We are realigning the organization with its core mission and our new priorities in reversing the chronic disease epidemic,” Kennedy said in a press release announcing the reorganization.

Regional office staffers were laid off at the beginning of April. Now there appears to be a skeleton crew shutting down the offices. On a recent day, an Administration for Children and Families worker who answered a visitor’s buzz at the entrance estimated that only about 15 people remained. When asked what’s next, the employee shrugged.

The Trump administration’s downsizing effort will also eliminate six of 10 regional outposts of the HHS Office of the General Counsel, a squad of lawyers supporting the Centers for Medicare & Medicaid Services and other agencies in beneficiary coverage disputes and issues related to provider enrollment and participation in federal programs.

Unlike private health insurance companies, Medicare is a federal health program governed by statutes and regulations, said Andrew Tsui, a partner at Arnall Golden Gregory who has co-written about the regional office closings.

“When you have the largest federal health insurance program on the planet, to the extent there could be ambiguity or appeals or grievances,” Tsui said, “resolving them necessarily requires the expertise of federal lawyers, trained in federal law.”

Overall, the loss of the regional HHS offices is just one more blow to public health efforts at the state and local levels.

State health officials are confronting the “total disorganization of the federal transition” and cuts to key federal partners like the Centers for Disease Control and Prevention, CMS, and the FDA, said James McDonald, the New York state health commissioner.

“What I’m seeing is, right now, it’s not clear who our people ought to contact, what information we’re supposed to get,” he said. “We’re just not seeing the same partnership that we so relied on in the past.”

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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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Emrelis, an antibody drug conjugate developed by AbbVie, is now FDA approved for patients whose non-small cell lung cancer overexpresses the protein c-Met. The pharma company said this ADC is its first internally developed solid tumor medicine as well as its first solid tumor FDA approval in lung cancer.

The post AbbVie’s Solid Tumor Strategy Gets a Win With Accelerated FDA Approval in Lung Cancer appeared first on MedCity News.