EHS-COVID (74) Q1 How has COVID-19 affected the delivery of essential health services? (13) Impact on surgery in Honduras

20 November, 2020

Greetings from Honduras. In regard to the question of how the COVID-19 pandemic has affected the provision of essential health services (Q1), I share another example of Honduras reflecting an important negative effect of the pandemic by imposing new challenges in providing these essential health services.

In an article recently published in the Revista Médica Hondureña (https://revistamedicahondurena.hn/), Roberto Esquivel, surgeon, in his paper entitled Tiroidectomía por cáncer: Abordaje trans-disciplinario como factor fundamental para optimizar la calidad de atención en Honduras (Cancer thyroidectomy: Transdisciplinary approach as a key factor in optimizing the quality of care in Honduras), makes a historical account of the care of thyroid nodular disease in Honduras, its approach at the Hospital Escuela, the most important public care center in the country and located in the capital city, Tegucigalpa.

The article is available at the following link: https://revistamedicahondurena.hn/assets/Uploads/Vol88-S1-2020-18.pdf

Dr. Esquivel stands out how a better articulation between clinical services (internal medicine, endocrinology, surgery) and support services (radiology, pathology) has had a positive effect to speed up patient care. This continuous improvement had reached one of the highest points but has suddenly suffered a significant setback due to the COVID-19 pandemic.

Here are some excerpts from the article (translated using automatic translator):

"Honduras has a high prevalence of goiter thyroid disease... The Hospital Escuela (HE), Tegucigalpa, is a high volume center of thyroid surgery, with more than 100 procedures per year performed in care for benign and malignant diseases.....

....As of 2008, led by the Endocrinology Service, and to address the deficiencies of the system, the physicians involved by each of the Clinical and Support Services built more fluid communication channels that certainly had the effect of a frank streamlining on the management of the patients....

....The development of the above dynamics has had a dramatic effect on reducing "times" for patient care, in such a way that, as of 2017 and until the end of 2019, in general terms the journey of a patient from the time he/she arrived at the specialized external consultation (endocrinology, surgery) until he/she had a surgical plan took about one-fifth of the time it required in the past, except in cases that warrant stabilization or control of associated conditions (hypo or hyperthyroidism, vitamin D deficiency, etc.).

The unfortunate development of the COVID-19 pandemic has conditioned a pause in the efficient route of care we had achieved for this group of patients, causing a complete cessation of thyroidectomies in HE during the last 7 months, similar to the situation in other countries, resulting from concern for safety, both of patients (there is evidence of unfavorable postoperative evolution in asymptomatic infected surgically intervened) and hospital staff.

As of early October 2020 our Group has counted more than 80 patients pending surgery (source: registration of the HE Endocrinology Service). Undoubtedly such behavior will have consequences on the prognosis of some of the people who have thyroid cancer

... Although telemedicine is a consistent proposal, another aspects to consider are the difficulties involved in their implementation in the clinical route of care of these patients, since it includes moments that cannot be performed remotely: preoperative physical evaluation, ultrasound, aspirational biopsy intakes and early postoperative evaluation. Also, due to the economic-social context, our patients who warrant radio-iodine must still undergo a period of hypothyroidism of 3-4 weeks pre-application, which causes immune dysfunction that makes them vulnerable in case of viral infections, in addition to the effects of radiation, although on the latter aspect there is still no evidence....."

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Jackeline Alger, MD, PhD

Servicio de Parasitologia

Departamento de Laboratorio Clinico

Hospital Escuela Universitario

Tegucigalpa, HONDURAS

HIFA profile: Jackeline Alger works in the Parasitology Service, Department of Clinical Laboratories, Hospital Escuela Universitario, and at the Faculty of Medical Sciences, Universidad Nacional Autonoma de Honduras, Tegucigalpa, Honduras. She is a Country Representative for HIFA and CHIFA and is the 2-time holder of HIFA Country Representative of the Year Award 2015 and 2018. http://www.hifa.org/people/country-representatives/map

http://www.hifa.org/support/members/jackeline

Email: jackelinealger AT gmail.com