Costa Rica Hopes For a Healthier New Year

HEALTH authorities struggled this year with strains on an already overburdened health system, two diseases (one age-old, the other yet to materialize here), and abject tragedy.

Perhaps nothing symbolized the woes of Costa Rica’s public Social Security System (Caja) more than a July fire at San José’s Hospital Calderón Guardia. The pre-dawn blaze shocked the nation, leaving 21 people dead, gutting the fourth and fifth floors of the building and revealing deficiencies in the hospital’s fire-preparedness measures. By year’s end, a nursing assistant was under preventive detention for alleged arson.

The loss of beds at Calderón Guardia has diverted patients to the capital’s other two large public hospitals, México and San Juan de Dios, and created caseloads neither can afford. The $50 million required for rebuilding the damaged floors has been slow in coming.

A fuel spill contaminated wells used to develop saline solution – the Caja uses some 20,000 bags per day – requiring the temporary suspension in November of all but emergency surgeries at San José hospitals.

The Caja opened the $36 million San Rafael Hospital in Alajuela to great fanfare a year ago, but equipment failures and faulty construction have plagued the institution since then. A Madrid-based construction consortium has agreed to rectify the deficiencies.

Dengue numbers took a roller-coaste  ride this year. The first trimester saw a reassuring 25% drop in cases over 2004. The Public Health Ministry reiterated warnings to the population not to let its guard down, but with the arrival of an exceptionally heavy rainy season this year, that is apparently what happened. By mid-year, the number of cases spiked 100%, and nearly 300% by October.

Dengue cases began to appear in the Central Valley this year, historically a region little affected by the disease. By early December, numbers dropped by nearly 70%, which authorities attribute to the advent of the dry season. However, Costa Rica logged two deaths this year from the more serious hemorrhagic form of the disease, the first here since 1999.

Small hopes are held out for new ways to combat dengue. The National Biodiversity Institute (INBio) is now experimenting with the development of two types of microfungus that can devour the larvae of the dengue-carrying Aedes aegypti mosquito; genetic modification is being studied in the United States, in hopes of rendering the mosquito incapable of transmitting the virus. The Health Ministry continues to stress to the public the tried-and-true method of destroying breeding pools in places where water tends to collect.

Avian flu captured the world’s attention this year, and Costa Rica was no exception. No cases have been reported here, and no instances of human-to-human transmission have been reported anywhere in the world, but the prospects of a disease with a 52% mortality rate created global fear. Health authorities here sought to reassure the population, providing information without fomenting alarm; at the same time, they are devising a national contingency plan to cope with a possible pandemic.

Costa Rica is in the midst of an election campaign, and previously taboo topics in the health arena have entered political dialogue. President Abel Pacheco called upon the Catholic Church to reverse its longtime opposition to the use of condoms while attending a Central American HIV Congress. Citizen Action Party candidate Ottón Solís proposed that the Church permit condom use in exchange for government opposition to all forms of abortion, including therapeutic procedures, presently the only abortions that are legal in Costa Rica. And the Legislative Assembly is struggling with a proposal to enshrine the right to emergency contraception in the National Health Law.