Miguel Cunha interviews Dr Cristián Gallardo, colorectal surgeon in Santiago, about the global impact of the pandemic in South America and about the major consequences for benign and malign coloproctology diseases.
Short bio: Cristián Gallardo
- Medical graduate: Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile (2008)
- Residency General Surgery: Hospital Clínico San Borja Arriarán, Facultad de Medicina Universidad de Chile, Chile (2009-2012)
- Clinical Fellowship Colorectal Surgery: Hospital Clínico San Borja Arriarán, Facultad de Medicina Universidad de Chile, Chile (2013-2015)
- ESCP Fellowship: Unité de Chirurgie Colorectale, Hôpital Haut Lévèque, CHU de Bordeaux, France (2019).
- Currently: Colorectal Surgeon at Hospital Clínico San Borja Arriarán, Clínica Redsalud Providencia, Santiago, Chile
Interview
Miguel Cunha: Dear Dr Cristián, first of all thank you for agreeing to speak with us about such an important subject. We really think that a global perspective on the South America way of dealing with the pandemic is of great value. Muchas gracias por su contribución!
Cristián Gallardo: Thank you, Miguel, for giving me the opportunity to speak about how we are dealing with this crisis here in South America.
MC: We would like to begin by asking you to give a brief resume about the global impact of the pandemic in South America?
CG: This week, South America has surpassed both the United States and Europe in the daily number of COVID-19 infections, earning the distinction of becoming the world’s newest epicentre of the global pandemic crisis. The actual dimension of the pandemic in the region remains somewhat uncertain, as cases are under-reported and accuracy for data collection varies considerably within this part of the world. The pandemic is shifting from the developed world and into the developing world. Each of these countries has a unique story to tell. But this pandemic exposes and speeds up many of the problematic existing political trends in the region. Crowded people at home and unstable jobs make it hard for people to distance - even when the government orders it - and underfunded, overstretched health systems potentially exacerbate the crisis. Unstable jobs in some groups of the population in South America, combined with a stressed health care system, means that low-income citizens are very likely to bear the brunt of the crisis.
MC: During this week we've seen interesting reports from two different countries in South America, Brazil and Argentina. In your point of view, is the pandemic affecting all South American countries the same way? Can you identify some differences?
CG: South America benefitted by being a few months behind the initial outbreak, giving it some time to register the scale of the challenge to come and prepare accordingly. Of course, different countries still took the threat more seriously than others, which can be partially seen in the cases and fatality rates to date. While virtually every country in the region has instituted social distancing measures to combat the health crisis and some degree of government stimulus to combat the accompanying economic crisis, the effectiveness of both ultimately depends not just on the size and quality of these emergency measures taken, but each country’s contexts (political, healthcare, social, and economic) going into this crisis.
MC: As you know, the pandemic wave is affecting different countries in different timepoints. Right now, in Europe, one of the main concerns is to try minimise consequences concerning the non-COVID diseases. Looking at South America, where the pandemic wave seems to be in its bigger force, are the governments and the healthcare organisations already planning a recovery strategy for these patients?
CG: While the pandemic seems to have gone beyond the peak in many European countries and most of the restrictions have been relaxed, the situation is becoming increasingly worrying in South America. Because of that, the main objectives that our governments and health authorities have nowadays are to support national initiatives to create sufficient resources and facilities to care for patients with COVID-19 requiring hospitalisation. I believe we are, as you said, under the biggest force of COVID-19 infection and the main priority right now is the pandemic. Some strategies, however, are being planned for recovery time to treat patients with non-COVID diseases.
MC: Regarding coloproctology surgery, can you give us a brief perspective of the major consequences concerning benign and malign disease?
CG: COVID-19 pandemic is stressing healthcare systems in every aspect and the greatest priority currently is the treatment of COVID-19 cases. Meanwhile, the population is still suffering from all the diseases that existed before this pandemic. In coloproctology, the most affected cases are those patients diagnosed with cancer and for that reason several measures have been implemented in South America to optimise the management of colorectal cancer patients following different protocols to prioritise surgeries, endoscopic and adjuvant treatments.
In relation to benign diseases and proctological diseases, they have been completely ceased and postponed since the beginning of the pandemic and some strategic plans are being made in each country to re-schedule them gradually once COVID-19 cases have diminished.
One important consequence of the pandemic is the postponement of a large number of endoscopies, particularly colonoscopies, because they imply a moderate to high risk of COVID transmission and their postponement will produce undoubtedly a delay in the diagnosis of new cancers and because of that, probably, a worse prognosis of those newly-diagnosed cases.
MC: What about the long-term effects of the pandemic? In your opinion, what will be the main issues regarding the recovery of surgical healthcare, and what are our weapons to deal with them?
CG: That is a really difficult question to answer Miguel. COVID-19 will not disappear in the next few months, hopefully no more than a year, until a vaccine is made so we will have to manage to work with it. While some patients may reasonably be deferred for a time, it is imperative that an exit strategy is made for re-introduction of surgical services for elective cases. Many advices have been given in relation to this but I believe the most important factors to take into account are elective prioritisation of colorectal surgery assigning priority levels to each case, setting and protecting 'cold sites' to operate elective surgery safely and developing a preoperative pathway for each patient in terms of self-isolation, negative screening questions, negative SARS Cov-19 tests less than 48 hours before surgery.
MC: Can you give us your personal example on how the pandemic affected your life?
CG: COVID-19 pandemic has affected my life in many ways, and I think it is not so different as the way it has affected others. I have become isolated from my family, especially from my parents, whom I have not seen since March, I have had to change my daily activities specifically in terms of work, having to cope with the situation of postponing surgeries in oncological patients who see how time goes by waiting for their disease to be cured and that really has not been a nice feeling.
MC: That brings us to the end of the interview! I would like to thank you for giving us a global South American surgical impact perspective about the pandemic. I would like to ask you a final question: what is the most important lesson we can take from this pandemic so far?
CG: In my opinion, the pandemic has left several lessons to be taken into account, first, that the ability to adapt and react to unexpected situations such as the current one must be well-recognised and taught, second, that research is essential and must be considered a priority within government policies as seen in the search of the development of a new vaccine, and third, and third, that given the appearance of important changes, new opportunities appear as observed in the use of new platforms to communicate information, as seen in the large number of conferences via streaming that have been held during the period of the pandemic.
