“Suddenly you realize it’s here like a tsunami overwhelming everybody.”
Preparing for COVID-19 in Honduras
Dr. Carolina Haylock Loor is an Anesthesiologist and Intensive Care and Interventional Pain Physician from Honduras, and a Council Member of the World Federation of Societies of Anesthesiologists. She is also a true Lifebox Champion, having led on our oximetry work in Central America in 2011 and is now the regional lead of our ongoing work to improve the safety of surgery and anesthesia in four Central American countries. In April, Dr. Haylock Loor spoke with Lifebox’s Kitty Jenkin about how Honduras was responding to the COVID-19 pandemic.
My name is Carolina Haylock Loor. I’m an Anesthesiologist, Intensive Care and Interventional Pain Physician from Honduras. Currently, I’m the Medical Director of the Interventional Pain Unit at the city where I live, San Pedro Sula in Honduras. I also work internationally as a Council Member of the World Federation of Societies of Anesthesiologists – WFSA. I got to know Lifebox in 2011 when I was President of the Honduran Society of Anesthesiologists (SHARD). We did a national Mapping of the Oximeter Gap and achieved zeroing the oximetry need in August 2012 in a project with University of Florida and Lifebox. Since then, we have been working with Lifebox for different Safe Anesthesia projects in Latin America, especially in the most needed countries in the Central America region.
- Where are you now and what is the current situation regarding COVID-19 in your country and city?I’m living in San Pedro Sula, the epicenter of COVID-19 in Honduras. Today (April 17, 2020) there were 442 cases and 41 deaths, one of them a general practitioner and some other health workers have tested positive, two gynecologists are in ICU. There’s a limited amount of PPE, masks, ventilators, medicines, RT-PCR and testing and lack of trained personnel. Since this week, we have had some COVID-19 quick antibodies tests for asymptomatic health workers that are taking care of the positive patients or in triage centers.Lockdown in the country started a month ago and today the authorities said it would continue in our city for two more weeks at least. We live in a poor country, with 68% of our people in poverty. Each day, people have to earn what they need to subsist on that day, which drives us to another situation during the lockdown – more hunger and misery.
- What has the preparation been like for the COVID response in your hospital and region?Well, beside lockdown and general hygiene recommendations, the Health System is just taking care of emergencies and COVID-19 positive and suspected patients. Elective surgeries and specialized medical appointments have been cancelled. This crisis reminds me of the story of Peter and the Wolf, we heard about COVID-19, but it seemed so far from us and our country, but suddenly you realize it’s here like a tsunami overwhelming everybody. As a country, we had a health crisis previous to the pandemic – a breach between health personnel and the health authorities that has aggravated the political crisis and, therefore, compounded the socio-economic impact – like a perfect storm. To make things worse, there is no contingency plan, there is no experience to meet this crisis with national measures and, at the same time, address the economic consequences of lockdown.
- What are you personally working on to prepare for COVID patients?
Personally, trying to keep safe, studying this new disease, tracking, and learning from the experience of our colleagues in other parts of the world that are struggling in this battlefield. On the other hand, in Honduras, we have a very proactive Anesthesia Society. Since we heard there was insufficient PPEs, masks, face shields, etc., we started a fundraising campaign for public hospitals. In the beginning, it was to keep anesthesiologists and their team safe, but after we realized the need for safety in health workers all over. And with these funds, SHARD’s members bought the equipment needed for keeping safe. It is a collaboration, we don’t know how long it will endure for. Money and resources are always scarce. Honduran people, equipment providers, and other stakeholders have collaborated generously with solidarity for this purpose, and we’re grateful for the opportunity.
- Could you explain the role of an anesthesia provider in your country?In Honduras, anesthesiologists are few, and we work as perioperative physicians. It doesn’t matter if you have subspecialties or not, one day you may provide anesthesia care for a C-section, later a newborn, tomorrow a brain tumor, pre-anesthesia assessment, etc. Now, if you are an Intensive care and Interventional Pain Physician, there are two other areas where you also have responsibilities, especially the former in this crisis. A key word in this pandemic is teamwork, and it’s not always easy, which drives us to focus more on this for future educational plans within our society.
- As an anesthesiologist, what are the particular concerns that you have regarding COVID-19?I am especially worried about the pre-symptomatic patient that undergoes anesthesia. Without enough tests and protective equipment in the country, we can’t be negligent in dealing with this risk. So we’re treating everyone as positive until proven otherwise, which brings the situation to another level of complexity – safer but also more costly.
- What are you most in need of right now in your hospital? How can the global community support?We need enough PPEs, N95 or KN95 masks, face shields, plastic gowns, COVID-19 tests (quick tests and RT-PCR) for detecting the suspected or the pre-symptomatic patient, anesthesia supplies (video-laryngoscopes) and medicines, helmets for non-invasive ventilation, high flow nasal cannulas, oximeters, and ventilators of course.
- As you face the COVID-19 outbreak in your country, what do you most fear? What gives you the most hope?Besides what I have already mentioned, fear is the worst pandemic. Still, this crisis has evidenced several aspects like information overload, sometimes confused and manipulated. We lack a clear, competent, and updated national contingency plan with a weak and inexperienced incident command system without a straightforward economic recovery plan.As health workers, we’re feeling very concerned about the shortage of safety supplies, medicines, equipment, validated diagnostic tests, trained human resources for emergencies, critical care. As health workers we see and hear the deficiencies, but the political messages say otherwise.Hope is fuel for human resilience, and for me, this is a spiritual value that dwells in every person. Sometimes you may feel emotional or physically exhausted, but together in unity, the human family is making the difference and will continue to do so – supporting and helping each other. As time goes by, I see my colleagues as other groups working with love for the common good, some in frontline care, some in the back fundraising for safe medical care. All these efforts give me hope and strength to persevere. Love will endure forever.