{"id":1015,"date":"2022-06-18T20:21:13","date_gmt":"2022-06-18T20:21:13","guid":{"rendered":"https:\/\/blog.uantwerpen.be\/global-pen-friends\/?p=1015"},"modified":"2023-08-29T14:43:34","modified_gmt":"2023-08-29T14:43:34","slug":"challenges-within-the-health-sector-in-india-and-nicaragua","status":"publish","type":"post","link":"https:\/\/blog.uantwerpen.be\/global-pen-friends\/challenges-within-the-health-sector-in-india-and-nicaragua\/","title":{"rendered":"Cervical cancer and challenges within the health sector in India and Nicaragua"},"content":{"rendered":"\n
\"\"<\/figure>\n\n\n\n

Correspondence between MD<\/strong> (Pen name – Student in Applied Economics, Universidad Centroamericana) and Harsh<\/strong> Garodia <\/strong>(Student in Financial Management, Xavier Institute of Social Service). For security reasons, the name of the student from Nicaragua was anonymised.<\/p>\n\n\n\n

Apreciado Harsh,<\/strong><\/h2>\n\n\n\n

Es un gusto tener la oportunidad de compartir mis opiniones con vos. Espero que est\u00e9s bien y aprendamos de las experiencias que hemos tenido en nuestros pa\u00edses en los temas relativos a salud.<\/p>\n\n\n\n

En espec\u00edfico, voy a comentarte sobre la forma en que el sistema de salud p\u00fablica trata el c\u00e1ncer cervicouterino. La raz\u00f3n por la cual este tema me resulta muy interesante es porque considero que la pol\u00edtica p\u00fablica que se est\u00e1 empleando est\u00e1 mal enfocada, y se concentra en tratar la enfermedad una vez que se contrae y no en prevenirla, cuando es relativamente sencillo hacerlo.<\/p>\n\n\n\n

El c\u00e1ncer de cuello uterino ha sido la principal causa de muerte en mujeres por tumores malignos entre los a\u00f1os 2017 \u2013 2020, en el a\u00f1o 2021 fu\u00e9 superado por el c\u00e1ncer de mama. En el transcurso de 5 a\u00f1os han muerto 1,231 mujeres por esta enfermedad, sin embargo, el organismo encargado sobre temas de salud, Ministerio de Salud (MINSA) no ha reenfocado sus esfuerzos para lograr la disminuci\u00f3n significativa de estos indicadores.<\/p>\n\n\n\n

Diversos investigadores y m\u00e9dicos que laboran para el MINSA coinciden en que la enfermedad se diagnostica en estad\u00edos muy avanzados, existiendo menos probabilidades de curar la enfermedad. La primera prueba que se realiza para detectar la enfermedad es la llamada Papanicolaou, y est\u00e1 disponible en todos los centros de salud ubicados en todos los territorios del pa\u00eds. Entonces, \u00bfpor qu\u00e9 resulta tan dif\u00edcil detectar la enfermedad en estad\u00edos tempranos?. Mi reflexi\u00f3n me lleva a creer que la disponibilidad para realizarse la prueba de forma gratuita no es suficiente sino existe de forma conjunta la concientizaci\u00f3n sobre la importancia de hacerla.<\/p>\n\n\n\n

A nivel internacional, los investigadores en temas de salud coinciden en que uno de los factores de riesgo para el c\u00e1ncer cervicouterino es contraer una de las variantes del Virus de Papiloma Humano (VPH) que contiene prote\u00ednas que desactivan los genes supresores de tumores. Por esta raz\u00f3n, se recomienda vacunarse contra el VPH preferiblemente antes de iniciar una vida sexualmente activa, y aunque sea menos efectiva si se aplica despu\u00e9s de iniciar a tener relaciones sexuales, tambi\u00e9n debe hacerse.<\/p>\n\n\n\n

Los profesionales de la salud tienen claro que la problem\u00e1tica debe abordarse desde otra perspectiva, sin embargo, no se hace. Es aqu\u00ed donde me surgen los cuestionamientos, \u00bfse trata de menosprecio hacia la vida de las mujeres?, \u00bfhay problemas m\u00e1s urgentes que impiden que este tema sea abordado de una forma distinta?, \u00bfno hay voluntad pol\u00edtica para desarrollar un sistema de prevenci\u00f3n de esta enfermedad cuando claramente se nota que es un problema estructural?. Son preguntas que requieren m\u00e1s investigaci\u00f3n para poder responderse, pero en mi carta quiero expresarte mis opiniones.<\/p>\n\n\n\n

Nicaragua tiene una tasa de embarazos adolescentes alta en comparaci\u00f3n a otras regiones del mundo, lo que significa que las ni\u00f1as inician su vida sexual en edades muy tempranas. Si esto es conocido por el estado y la poblaci\u00f3n, es necesario iniciar a educar a las ni\u00f1as y ni\u00f1os sobre la importancia de tener relaciones sexuales responsables, cuando est\u00e9n f\u00edsica y psicol\u00f3gicamente preparadas y preparados, cuando conozcan c\u00f3mo protegerse frente a enfermedades de transmisi\u00f3n sexual. La forma en que yo propondr\u00eda que se trate la enfermedad, para reducir la tasa de mortalidad por c\u00e1ncer cervicouterino contiene cuatro pasos fundamentales:<\/p>\n\n\n\n

1. Concientizar sobre la importancia de tener relaciones sexuales responsables.<\/p>\n\n\n\n

2. Vacunar a ni\u00f1as y mujeres contra el VPH.<\/p>\n\n\n\n

3. Explicar la necesidad de tener consultas ginec\u00f3logas peri\u00f3dicas.<\/p>\n\n\n\n

4. Fortalecer el sistema de salud para que existan m\u00e1s m\u00e9dicos capacitados para tratar el c\u00e1ncer una vez que se vive con la enfermedad.<\/p>\n\n\n\n

Te comento que el tema al que te estoy haciendo menci\u00f3n no es el \u00fanico que aqueja a las mujeres en Nicaragua, existen muchos otros problemas que deben resolverse, pero en este momento mi objetivo es reflexionar sobre este tema en espec\u00edfico. Me resulta curioso conocer tu opini\u00f3n al respecto, tambi\u00e9n tus preguntas, porque eso enriquece el proceso de an\u00e1lisis.<\/p>\n\n\n\n

S\u00e9 que vos tambi\u00e9n est\u00e1s interesado en los temas de salud en la India, por eso te planteo las preguntas que me surgen sobre eso:<\/p>\n\n\n\n

1. \u00bfEn la India hay una atenci\u00f3n m\u00e9dica diferenciada para hombres y mujeres?<\/p>\n\n\n\n

2. \u00bfExiste voluntad pol\u00edtica para escuchar lo que los habitantes tienen que decir sobre los servicios p\u00fablicos, como salud y educaci\u00f3n?<\/p>\n\n\n\n

3. \u00bfQu\u00e9 otras soluciones se te ocurren para poner en marcha un plan de acci\u00f3n que disminuya la incidencia del c\u00e1ncer cervicouterino en Nicaragua?<\/p>\n\n\n\n

Espero con ansias tu carta y nuevamente te expreso que es un placer compartir ideas convos. Sin m\u00e1s a qu\u00e9 hacer referencia, me despido, un gran abrazo.<\/p>\n\n\n\n

Atentamente,<\/p>\n\n\n\n

MD<\/p>\n\n\n\n

Jinotega, Nicaragua. <\/p>\n\n\n\n

16 de abril de 2022.<\/p>\n\n\n\n

Dear MD,<\/strong><\/h2>\n\n\n\n

It is a great opportunity for me to have a conversation about the healthcare system in two different nations and their shortcomings. I will be sharing my experiences regarding the same and the achievements of our healthcare system.<\/p>\n\n\n\n

India is a country with 67% of the population living in rural areas and the rest in urban areas. The private healthcare system amounts to 70% and serves only 30% of the population and the major issue is with the government hospitals in rural areas, with most of the doctors preferring to live in an urban city the rural people are unable to get the professional healthcare nearby or at a lower cost. India has been an example of eradicating POLIO from society, but with only one achievement India since that time is unable to provide proper health care.<\/p>\n\n\n\n

Cervical cancer is on the declining trend in India according to the population-based registries, yet it continues to be a major public health problem for women in India. Out of every four women who die globally from cervical cancer, one is from India. Multifactorial causation, the potential for prevention, and the sheer threat it poses make cervical cancer an important disease for in-depth studies, as has been attempted by this paper. The peak age of incidence of cervical cancer is 55\u201359 years, and a considerable proportion of women report in the late stages of the disease. Specific types of oncogenic HPV- 16, 18 have been identified in patients with cervical cancer. Other epidemiological risk factors are early age at marriage, multiple sexual partners, multiple pregnancies, poor genital hygiene, malnutrition, use of oral contraceptives, and lack of awareness. A multipronged approach is necessary which can target areas of high prevalence identified by registries with a combination of behaviour change communication exercises and routine early screening with VIA. Every year in India, 122,844 women are diagnosed with cervical cancer, and 67,477 die from the disease.5 India has a population of 432.2 million women aged 15 years and older who are at risk of developing cancer. Thus, the peak age of occurrence of cervical cancer in India is between 55 and 59 years, and the highest age-adjusted rates are in Aizawl in the north-eastern part of India at 24.3 per 100,000 women. Mortality statistics and trends in cervical cancer are lacking due to inadequate and incomplete information on deaths. HPV infection prevalence is 87.8%\u2013 96.67% among women with cervical cancer and 9.9%\u201336.8% among women with no cancer or other gynecological morbidities. There is evidence that cervical cancer incidence is greater among women of lower classes, those less educated, and those with a larger number of children. Screening levels are low in the general population. In order to increase this, it is necessary to carry out specific health education sessions for men and women to facilitate care-seeking. The national program NPCDCS has a plan of implementation at the primary, secondary, and tertiary levels where the screening is opportunistic. There are resource limitations to establishing cervical cancer screening programs as a priority program all over the country. Simultaneous behaviour change communication exercises and routine<\/p>\n\n\n\n

screening in registry areas with a high incidence can perhaps accelerate the decline. In addition to this, prudent measures to vaccinate adolescent girls can be carried out after getting consent. Research needs to be carried out in making HPV tests cheaper and accessible to the entire population through the national program. <\/p>\n\n\n\n

The Parliament system that we follow allows us a democracy but due to a huge political and cultural rift between the parties most of the issues with healthcare take a huge turn on a religious basis, so the delivery of proper healthcare in India is a huge task. With corruption rigged deep in our system doesn\u2019t allow the money allocated for such activities to reach the needy citizen.<\/p>\n\n\n\n

The major issue with HPV is detection if it is detected early then the chances of curing it would be easy. This is just one aspect of a particular disease, I would love to talk about more such aspects and I have a few questions for you:-<\/p>\n\n\n\n

1) How did your country survive after the covid 19 pandemic?<\/p>\n\n\n\n

2) What are the steps taken to improve the healthcare system?<\/p>\n\n\n\n

3) How does the government get itself involved in the healthcare system?<\/p>\n\n\n\n

In India due to a population, low land area and highly congested space the medical health care delivery is a huge task, the average estimated time for a professional to reach a spot during an emergency is 1 hour which is a make or breaks situation, so for the same reason, I have founded a start-up named as First Help which provides 2 wheeler ambulance services under 5 minutes.<\/p>\n\n\n\n

Looking forward to a reply and having more conversations about the difference in healthcare.<\/p>\n\n\n\n

Thanking You,<\/p>\n\n\n\n

Harsh Garodia<\/p>\n\n\n\n

RANCHI, JHARKHAND<\/p>\n\n\n\n

17 April 2022<\/p>\n\n\n\n

Querido Harsh,<\/strong><\/h2>\n\n\n\n

Es un gusto comunicarme nuevamente con vos, quiero disculparme por la demora en mi respuesta, espero que est\u00e9s muy bien. Continuando con nuestro intercambio de ideas sobre el sector de salud en nuestros pa\u00edses, te comento mis apreciaciones sobre las preguntas que formulaste en tu carta anterior. Las autoridades p\u00fablicas en Nicaragua tomaron medidas muy distintas a las que se tomaron en otros pa\u00edses respecto a la COVID-19. No se realiz\u00f3 cuarentena obligatoria, dentro de mis conocimientos no se di\u00f3 una explicaci\u00f3n p\u00fablica sobre la raz\u00f3n, pero lo que suponemos es que se debe a la gran cantidad de personas que laboran en el sector informal, para las que no es posible trabajar desde casa y a\u00fan as\u00ed seguir disponiendo de ingreos y dem\u00e1s beneficios de los empleos formales, como seguro social. Por ese motivo si se analiza el PIB de Nicaragua durante la pandemia y antes de ella, el decrecimiento no es tan alto como en otros pa\u00edses de la regi\u00f3n. Aunque eso solo hace referencia a una perspectiva macroecon\u00f3mica y no sobre la situaci\u00f3n real de las personas tomando en cuenta la desigualdad de ingresos y acceso a servicios p\u00fablicos, como salud. Algo que me gustar\u00eda decirte es que muchas personas en Nicaragua venden productos comestibles o de otros tipos en las calles de las ciudades, no tienen ingresos fijos y est\u00e1n sujetos a obtener ingresos en relaci\u00f3n a lo que logren vender cada d\u00eda. \u00bfEsta es una situaci\u00f3n com\u00fan en la India tambi\u00e9n?.<\/p>\n\n\n\n

Desde una \u00f3ptica m\u00e1s general sobre el sistema de salud en Nicaragua, me preguntabas sobre las medidas que se toman para mejorarlo. En este punto no quiero hacer afirmaciones sin informaci\u00f3n, me parece que es inapropiado responderte eso sin hacer uso de fuentes de informaci\u00f3n confiable. Asumo que dentro del sistema de salud, los m\u00e9dicos y el resto del personal deben tomar medidas para mejorar las debilidades que se presentan todos los d\u00edas, lo que yo he logrado observar cuando he hecho uso del sistema de salud p\u00fablica, es que hay insuficiencia de equipos y peronal, que son necesarios para brindar una mejor atenci\u00f3n, disminuir el tiempo de espera e indagar m\u00e1s en los malestares de los pacientes, el personal al parecer est\u00e1 consciente de esto pero es una decisi\u00f3n gubernamental si se otorgar\u00e1 m\u00e1s presupuesto a este sector o no. A simple vista es f\u00e1cil notar que hay debilidades en la coordinaci\u00f3n entre los hospitales y centros de<\/p>\n\n\n\n

salud p\u00fablicos, y dentro de cada uno de ellos. La forma es que el estado se involucra en el sistema sanitario es brind\u00e1ndole un monto espec\u00edfico cada a\u00f1o que se establece en el Presupuesto General de la Rep\u00fablica, entiendo que el Ministerio de Hacienda y Cr\u00e9dito P\u00fablico lo elabora y es enviado a la Asamblea Nacional para su aprobaci\u00f3n. Como te explicaba antes, no todas las personas tienen seguro m\u00e9dico, por eso existe un sistema de salud p\u00fablica que atiende a todas las personas que busquen atenci\u00f3n m\u00e9dica en los centros de salud u hospitales, sin cobrar nada de forma directa. Eso ocasiona que el sistema se sature y sea m\u00e1s dif\u00edcil lograr eficiecia. En mi opini\u00f3n, para mejorar esta situaci\u00f3n, no se deben ofrecer soluciones de corto plazo, debe haber una estrategia global que implique la mejora del mercado laboral, para lograr mayor nivel de formalidad, lo que significa que mayor cantidad de personas tendr\u00e1 seguro m\u00e9dico y aportar\u00e1n de manera mensual una cantidad de dinero espec\u00edfica de la que se podr\u00e1 disponer para hacer mejoras dentro del sistema. Me queda claro que proponerlo es una tarea sencilla pero la pr\u00e1ctica es mucho m\u00e1s compleja, a\u00fan as\u00ed, contin\u00fao creyendo que hace falta voluntad pol\u00edtica para lograr cambios en la administraci\u00f3n p\u00fablica que repercutan directamente en la mejora del bienestar en la poblaci\u00f3n.<\/p>\n\n\n\n

Como siempre te expreso, es un placer para m\u00ed poder compartir mis reflexiones y vivencias con vos.<\/p>\n\n\n\n

Con cari\u00f1o,<\/p>\n\n\n\n

MD<\/p>\n\n\n\n

Jinotega, Nicaragua.<\/p>\n\n\n\n

23 de abril de 2022<\/p>\n\n\n\n

Dear <\/strong>MD<\/h2>\n\n\n\n

Sorry for the late reply.<\/p>\n\n\n\n

The issues that you mentioned in the letter were not seen in India but the death toll was far beyond than reported according to many reports published. India was the first country to act during the first wave of COVID-19 crisis imposing a 3 month long lockdown which drained the pockets of many middle class and lower class people. Still Covid was not dominant but during the second wave a havoc was caused. As of July 20,2021 there are more than 31 million cases of COVID-19 in India and more than 400,000 people have lost their lives, according to government estimates. There were more than 105,000 deaths in May alone, averaging more than 3,300 deaths every single day throughout May. In other words, 3,300 families, tens of thousands, if not hundreds of thousands of people have lost someone they loved every day in May. No one has been left untouched. Sadly, according to numerous local and international experts, the government figures are a gross underestimate, and estimated deaths are probably in the millions, with tragedy still unfolding.<\/p>\n\n\n\n

The images of rows upon rows of funeral pyres for people who died due to a lack of oxygen, of makeshift cremation sites being set up in empty parking lots, and of bodies floating down the holy Ganges have been terrifying and haunting. What is even more horrifying is that a vast majority of these deaths were entirely preventable. In India, patients without basic supportive care like oxygen stand little or no chance of recovery in case of severe COVID-19 disease. Unfortunately, while extremely saddened, we are not surprised by this current crisis. Growing up in India, I saw my father, a physician, work with limited resources every day. It was routine for him to ration thrombolytic therapy for patients with heart attacks, triage multiple patients to limited ICU beds and administer lifesaving treatments in the living room of our little home.<\/p>\n\n\n\n

He had to make the same difficult choices every day that the world is now witnessing doctors having to make in India. My parents, multiple family members and friends have been infected with COVID-19. In May, there were no vacant COVID-19 hospital beds in my hometown, and many hospitals in New Delhi ran out of oxygen. I have had multiple deaths in the family, have spent countless hours on the phone listening to desperate family members plead for help.<\/p>\n\n\n\n

In the end, while we know that one\u2019s birth coordinates determine their life expectancy, what we are currently witnessing is a livestream of deaths due to global socioeconomic and health care disparities. What is happening in India and in many other areas of the world was, and is, entirely preventable. Without massive vaccination availability and dissemination, and global support of supplies and personnel, the casualties in India and areas around the world will continue to skyrocket.<\/p>\n\n\n\n

This was a race against time, and prayers alone are not enough. This letter is to ever be mindful of our global responsibilities and is dedicated to the patients we could not save, and to the health care professionals at the front line of this pandemic who tried.<\/p>\n\n\n\n

With Love,<\/p>\n\n\n\n

Harsh Garodia<\/p>\n\n\n\n

RANCHI, JHARKHAND<\/p>\n\n\n\n

03\/05\/2022<\/p>\n","protected":false},"excerpt":{"rendered":"

Correspondence between MD (Pen name – Student in Applied Economics, Universidad Centroamericana) and Harsh Garodia (Student in … <\/p>\n

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