Public Health

Basic Health International and Cervical Cancer Screening in El Salvador

Our friends at Basic Health International (BHI) are have been in the news quite a bit lately. Last month, Dr. Miriam Cremer and BHI were written-up in the New York Times for their efforts to combat cervical cancer in El Salvador. BHI is using a new screening technology called careHPV to detect early signs of cervical cancer, especially in rural and under-resourced populations. Dr. Cremer says BHI plans to screen 30,000 Salvadoran women over the next two years.

Yesterday they held an event with the Ministry of Health and MD Anderson to sign a memorandum of understanding (MOU) that will “strengthen their commitment to work cooperatively to impact cancer and especially highly preventable diseases like cervical cancer.” The event yesterday was part of a cervical cancer prevention symposium taking place this weekend in San Salvador.

BHI is a non-profit organization striving to eradicate cervical cancer and improve women’s health in Latin America and the Caribbean, with a large presence in El Salvador. They focus on four areas: patient care, medical training, health policy, and research. BHI offers women training on how to use the careHPV screening, and for those with abnormal cells they offer free treatment, including housing, transportation, and meals while at the clinic San Salvador. The BHI staff also trains local health promoters on how to give cervical cancer education, and local doctors in the low-tech see-and-treat VIA and cyrotherapy.

BHI is partnering with Ministries of Health in Latin America to improve cervical cancer screening programs and education, and help Ministries develop training manuals. Their research focuses on cervical cancer screening methods, cervical pre-cancer treatment, screening and treatment service-delivery, and contraception methods.

Cervical cancer is one of the leading cancer killers of women worldwide. Gynecological visits and pap-smears have worked to reduce the numbers of cervical cancer deaths, especially in the developed world. Low-resource areas of the world do not always have the availability of equipment, trained medical professionals, and funding to administer these life-saving exams. Additionally, gynecological exams may be frowned upon or discouraged in some cultures, which make the administration of such tests extremely difficult. Traditional tests require multiple visits and this poses problematic for impoverished and rural women because of logistics, time constraints or finances to return to the clinic or doctor.

CareHPV is a screening method developed by Quiagen (a Dutch Company). It’s a DNA swab test that identifies the papillomavirus that causes cervical cancer. The test is revolutionary because it can be self administered by women in their comfort of their own homes. The test does not require running water or electricity, which is ideal for impoverished women in rural communities. Results are available within two and half hours so if administered in a medical office setting, screening and treatment can happen in the same visit.

BHI is one of those international organizations that really impacts quality of life for women throughout El Salvador and Latin America. Dr. Cremer and her teamwork tirelessly to make sure that fewer and fewer women die of a treatable disease.

Corruption, El Salvador Government

Arrest Warrant Issued for Former ISTA President, ARENA Party Executive

This week El Faro reported that the Attorney General’s office of El Salvador issued an arrest warrant for Miguel Tomás López Iraheta, former president of the Salvadoran Institute for Agrarian Transformation (ISTA), as well as Armando Zepeda Valle and Magdaleno Guzmán, also former presidents of the Institute. Each of the men is charged with abusing their power and dereliction of duty. Authorities believe López is out of the country and forwarded his arrest warrant to Interpol.

ISTA is the state controlled land reform institute that is charged in part with implementing land reforms passed in the 1980s and 1990s. The charges allege that López Iraheta gifted state-controlled land to his political allies, personal security personnel, and even his driver. They also allege that plots of farmland were distributed to ISTA employees, which is a violation of the laws governing ISTA that prohibit the distribution of land to government employees. The prosecuting attorney is also seeking the dismissal of eight other ISTA officials for their roles in signing off on the allegedly illegal gifts.

Karla Albanez took over ISTA in 2009 when the current administration of President Mauricio Funes took office. When she took over ISTA she uncovered documents that recorded the distribution of Grade 1 and Grade 2 lands to employees of ISTA, as well as the Presidential House and the Ministry of the Interior during the Administration of President Tony Saca.

Albanez recently commented that “the ISTA law is very clear: the lands distributed by ISTA are for campesinos without land, not for public employees, and the Court of Auditors has made that clear to directors of ISTA.” She also states her belief that both López Iraheta and Magdaleno Guzmán appear to have violated this law. The documentation her office provided to the Attorney General’s office contains sufficient evidence to establish that there was indeed corruption and dereliction of duty. She specifically cites the existence of a list of ARENA party members and activists who were given land by ISTA, noting also that López Iraheta was a member of the National Executive Council of ARENA.

Almost exactly four years before the arrest warrant was issued, López Iraheta resigned from ISTA to dedicate himself fulltime to party activities. He was also accused at the time of authorizing the distribution of part of the La Hoya and Tehuacán-Léon de Piedra nature preserves in the province of San Vincinte as a favor to his unlce Luis Rolando López Fortiz and other ARENA party members.

This case comes less than two months after Salvadoran police arrested former Minister of Health José Guillermo Maza Brizuela on corruption charges stemming from the reconstruction of hospitals in El Salvador.  While these arrests are important first steps, the Attorney General has a lot of hard work ahead of them in prosecuting these cases and securing convictions. Government prosecutors do not have a good track record when it comes to tough political cases, and the arrest of former Presidents of ISTA and the former Minister of Health are as about as political as they come.

Corruption, El Salvador Government

Former Minister of Health Arrested on Corruption Charges in El Salvador

On Tuesday, April 5, the Salvadoran National Civil Police (PNC) arrested ex-Minister of Health José Guillermo Maza Brizuela and seven others on charges of corruption. Ex-Minister Maza was the Minister of Health under President Tony Saca, who left office on June 1, 2009 when the current President Mauricio Funes took office promising to root out corruption within the government agencies.

El Faro reports that the corruption charges stem from efforts to rebuild seven hospitals damaged in the 2001 earthquakes. In 2003 the World Bank approved a $169.4 million loan package to rebuild the hospitals, and CPK, a large Salvadoran contractor, won a contract with the Ministry of Health. Though the project was to be finished by 2006, only two hospitals are complete and the project is $73.4 million over-budget.

The charges filed against ex-Minister Maza include fraud and falsifying documents involving several aspects of the CPK contract. According to El Salvador, the type of contract between the Ministry and CPK prohibited altering the value of the contract or the deadlines for completing projects. On several occasions, however, ex-Minister Maza approved an increase in the amount of the contract, increasing the amount for rebuilding the Santa Theresa Hospital in Zacatecoluca, La Paz by $1.8 million.

Charges also claim that ex-Minister Maza approved payment for work that was never completed. Though CPK had only completed 47% of the work on the Santa Theresa Hospital, Maza approved payment for 70% of the value of the contract – a loss of almost $3.3 million.

Another charge stems from the purchase of $1.1 million in medical equipment for the Santa Theresa Hospital that was paid for but never received. CPK claimed that they had purchased the equipment and that it was in their facilities. Though the contract stated that they would receive payment when the medical equipment was installed, the Ministry approved payment because CPK claimed it was in their possession.

Among the others arrested with ex-Minister Maza is César Rolando García Herrara, an attorney who negotiated the contract between the Ministry of Health and CPK. Mr. García was the sub-director of the PNC under President Calderon Sol (1994-1999). He is accused of falsifying documents and fraud. The other six detained are Arturo Ernesto López Mejía, René Arturo Portillo Montano, José Mauricio Serrano Martínez, José Alexander Ramírez Jiménez, Herbert Leonel Perdomo Ulloa, Guillermo Rafael Alfaro García, all of whom are accused of corruption-related charges.

Ex-Minister Maza has faced allegations of corruption in the past. While he was Minister of Health, the two CT scan machines that were owned by the public health system were broken, and instead of having them repaired, hospitals sent patients to Maza’s private clinics. The Minister admitted that there was a conflict of interest, but insisted that he gave patients from the public system a discount, and he was not charged with any wrong doing.

These arrests were made as Attorney General Romeo Barahona has been coming under fire for his office’s inability to take on organized crime and prosecute politically sensitive cases. In recent weeks, President Funes has indicated that his administration is taking the steps necessary to form an international investigative body that will investigate organized crime and take on cases that the Attorney General’s office has been unable to prosecute. El Faro also reports that Barahona is currently seeking financial support from the U.S. Embassy to support their efforts in taking on organized crime.

If the ex-minister and executives from CPK are guilty of corruption in building hospitals it will have meant that tens of thousands of people in Zacatecoluca and other cities around EL Salvador have gone without adequate health care. Arresting ex-Minister Maza and the others was a good first step, but the real challenge lies ahead in successfully prosecuting them.

Public Health

Epidemic of Bacterial Conjunctivitis Declared in 12 Departments

In addition to the increase in cases of dengue and repertory illnesses the Ministry of Health has stated that El Salvador is also experiencing an epidemic of Bacterial Conjunctivitis, commonly known as pink-eye. Conjunctivitis is a microbial infection involving the mucous membrane of the surface of the eye.  It is usually a benign, self-limited illness, but can be serious or signify a severe underlying systematic disease. Occasionally, significant ocular and systematic morbidity may result.

The Ministry of Public Health and Social Welfare (MSPAS) reports that the increase in cases of Bacterial Conjunctivitis led them to them to declare an “alarm” in 12 of the 14 departments of El Salvador. The only departments not included in the declaration were San Salvador and San Miguel.

As of August 2, 2010, 38,358 cases of Bacterial Conjunctivitis have been reported, compared to only 2,400 cases in 2009. Additionally, authorities have noted that the greatest increase in cases observed has occurred in the last few days. The Director of Health Surveillance, Julio Armero explained, “just on Sunday (August 1st) 76 cases were reported and on Monday we had 56.” In response the ministry has begun to work on a campaign to prevent further spread of this illness.

Violet Menjivar, the Vice Minister of Health clarified that the alarm was only declared in the 12 departments where an epidemic of Bacterial Conjunctivitis is present. People living in these departments should therefore undertake proper precautions to avoid catching the illness these include, washing ones hands and not touching ones eyes or mouth. These precautions are similar to the ones recommended to prevent respiratory illnesses.

Public Health

Number of Cases of Dengue Fever Increase in El Salvador

So far this year, El Salvador has reported 2,431 confirmed cases of dengue fever, which constitutes a significant increase from last year’s 927 cases. This increase has brought to mind the dengue epidemics of 2006 and 2007 when there were 6,181 and 6,131 confirmed cases respectively. Out of fear of another epidemic the Ministry of Health has urged doctors to act proactively and detect cases of dengue fever early.

The Ministry of Health estimates that 4% of the country’s population has contracted dengue fever, with the majority cases being concentrated in San Salvador and Sonsonate. The Ministry also cemeteries, churches and kindergartens are the places where infections are most likely to occur.

Though the numbers are far less than in previous years, the Ministry of Health has stressed the importance of following certain procedures such as prescribing appropriate medicine and registering cases. The registry of cases is especially important because it will allow the government identify geographic zones in which dengue is a problem and eradicate it.

Additionally, 3 people have died of hemorrhagic dengue fever, up from 0 in 2008.