Annual Report 2021. Aruba, Curaçao, Sint Maarten, and Bonaire, Sint Eustatius and Saba: Responding to COVID-19 and Preparing for the Future

In 2022 the Pan American Health Organization (PAHO) is celebrating its 120th anniversary. Operating as the independent specialized health agency of the inter-American system, PAHO provides technical cooperation to its Member States to address communicable and noncommunicable diseases and their causes, strengthen health systems, and respond to emergencies and disasters throughout the Americas. In addition, in its capacity as the World Health Organization’s Regional Office for the Americas, PAHO participates in the United Nations Country Team, collaborating with other United Nations agencies, funds, and programs to contribute to the achievement of the Sustainable Development Goals (SDGs) at country level. At the subregional level, PAHO works with integration mechanisms to position health and its determinants on the political agenda. The 2021 Country Annual Reports reflect PAHO’s technical cooperation in countries and territories in implementing the Country Cooperation Strategies, responding to their needs and priorities, and operating within the framework of PAHO’s regional and global mandates and the SDGs. Under the overarching theme of Responding to COVID-19 and Preparing for the Future, they highlight PAHO’s actions on the COVID-19 pandemic and its continuing efforts in priority areas such as health emergencies, health systems and services, communicable diseases, noncommunicable diseases and mental health, health throughout the life course, and health equity. They also provide a financial summary for the biennium 2020-2021.

Annual Report 2020. Universal Health and the Pandemic. Resilient Health Systems. Aruba, Curaçao, Sint Maarten, Bonaire, Sint Eustatius, and Saba

Founded in 1902 as the independent specialized health agency of the inter-American system, the Pan American Health Organization (PAHO) has developed recognized competence and expertise, providing technical cooperation to its Member States to fight communicable and noncommunicable diseases and their causes, to strengthen health systems, and to respond to emergencies and disasters throughout the Region of the Americas. In addition, acting in its capacity as the World Health Organization’s Regional Office, PAHO participates actively in the United Nations Country Team, collaborating with other agencies, the funds and programs of the United Nations system to contribute to the achievement of the Sustainable Development Goals (SDGs) at country level. This 2020 annual report reflects PAHO’s technical cooperation in the territories for the period, implementing the Country Cooperation Strategy, responding to the needs and priorities of the country, and operating within the framework of the Organization’s regional and global mandates and the SDGs. Under the overarching theme of Universal Health and the Pandemic – Resilient Health Systems, it highlights PAHO’s response to the COVID-19 pandemic as well as its continuing efforts in priority areas such as communicable diseases, noncommunicable diseases, mental health, health throughout the life course, and health emergencies. It also provides a financial summary for the year under review.

How do you build back better so no one is left behind? Lessons from Sint Maarten, Dutch Caribbean, following Hurricane Irma.

The Sendai Framework for Disaster Risk Reduction 2015-2030 and the United Nations' Sustainable Development Goals call for action to build back better in ways that leave no one behind. At the same time, ensuring a local voice is increasingly central to humanitarian engagement. These aims contrast with limited analysis of how local actors might be supported in these respects during response and recovery, and how far recommendations are specific or generalisable across richer and poorer national contexts. The paper begins by comparing lessons learnt by survivors and community organisations in Sint Maarten, Dutch Caribbean, following a high-income state-led response to Hurricane Irma in 2017 with the priorities of lower income, humanitarian-led endeavours. The differences reveal the importance of economic resources as the basis for individual self-reliance and a fragmented civil society with limited leadership ambitions in Sint Maarten. Strong cross-cultural alignment nevertheless allows for a globally-relevant and yet contextually-sensitive framework for survivor-led action and reconstruction.

Flood risk management in Sint Maarten - A coupled agent-based and flood modelling method.

Disaster risk reduction is a major concern of small island developing states. Measures to reduce risk should not only be based on the magnitude of physical hazard, but also on the exposure and vulnerability of communities. In this article, we examine flood risk management policies in the Caribbean island of Sint Maarten using coupled agent-based and flood models. The agent-based model is used to model actors' behaviour in relation to urban building development and policies that are designed to reduce flood hazard and communities' vulnerability and exposure. The policies considered in the model are a Beach Policy, a Building and Housing Ordinance, a Flood Zoning policy and hazard mitigation structural measures. The flood model is used to simulate coastal and pluvial floods on the island. Agent behaviour such as building new houses and implementing hazard reduction measures affect the flood model as these actions affect the rainfall-runoff process. The flood maps generated from the updated flood model simulations are then used to assess the impact and update agents' attributes and behaviour. The simulations results show that low-lying areas are populated, which increases the exposure, and the number of vulnerable houses is also high. Hence, out of the four policies, implementing hazard reduction measures is the most important. Reducing the flood hazard by widening existing drainage channels, constructing new ones and building dykes as coastal flood defence would reduce the hazard, hence reducing the number of flooded houses. As it affects all households on the island, the Building and Housing Ordinance is an important policy to reduce vulnerability. In general, the coupled model outputs can be used to inform policy decision making and provide insights to policymakers on the island.

Chikungunya virus outbreak in Sint Maarten: Long-term arthralgia after a 15-month period.

BACKGROUND & OBJECTIVES: The first chikungunya (CHIK) epidemic in the Americas was reported in December 2013. Chikungunya virus (CHIKV) causes an acute febrile illness and is transmitted to humans by Aedes mosquitoes. Although earlier studies have described long-term clinical manifestations of CHIK patients infected with the East/Central/South African (ECSA) genotype, little is known about persistent manifestations in the Caribbean region, for which the Asian genotype is responsible. The objective of this study was to describe the presence of persisting clinical manifestations, specifically arthralgia, in CHIKV-infected patients on the Caribbean Island, Sint Maarten, 15 months after onset of the disease. METHODS: This retrospective cohort study included confirmed CHIK patients that were recorded by the participating general practitioners (GPs) during the chikungunya outbreak in 2014 in Sint Maarten. Between March and July 2015, 15 months after the onset of disease, patients were interviewed via telephone about the presence, duration and impact of clinical CHIKV manifestations. RESULTS: In total, 56 patients were interviewed (median age 47 yr), of which 30 (54%) were females. Out of the total interviewed patients, 52 (93%) reported arthralgia for the first three months after the disease onset, of which 23 (44%) patients reported to have persistent arthralgia, 15 months after the disease onset. Pain intensity of persistent arthralgia was perceived as mild in the majority of patients (n = 14; 60%), moderate in 7 (30%) patients and severe in 2 (9%) patients. During the acute phase of disease, most patients had to miss school or work (n = 39; 72%) due to clinical CHIKV manifestations and reported a negative impact on daily activities (n = 36; 57%). INTERPRETATION & CONCLUSION: Results suggested that persisting arthralgia is a frequent complication in CHIK patients included in the study. Future research on strain-specific clinical long-term manifestations and on their impact on daily life of patients, in the form of a comparative study between patients and controls, is recommended.

Microplastic pollution on Caribbean beaches in the Lesser Antilles.

Here we investigate microplastics contamination on beaches of four islands of the Lesser Antilles (Anguilla, St. Barthélemy, St. Eustatius and St. Martin/Maarten). These islands are close to the North Atlantic subtropical gyre, which contains high levels of microplastics. On average 261 ±â€¯6 microplastics/kg of dry sand were found, with a maximum of 620 ±â€¯96 microplastics on Grandes Cayes, Saint Martin. The vast majority of these microplastics (>95%) were fibers. Levels of microplastics differed among islands, with significantly lower levels found in St. Eustatius compared to the other Islands. No difference in microplastic levels was found between windward and leeward beaches. Our research provides a detailed study on microplastics on beaches in the Lesser Antilles. These results are important in developing a deeper understanding of the extent of the microplastic challenge within the Caribbean region, a hotspot of biodiversity.

Chikungunya virus outbreak in Sint Maarten, 2013-2014.

This report describes the outbreak of chikungunya virus (CHIKV) in Sint Maarten, a constituent country of Kingdom of the Netherlands comprising the southern part of the Caribbean island of Saint Martin, from 22 December 2013 (first reported case) through 5 December 2014. The outbreak was first reported by the French overseas collectivity of Saint-Martin in the northern part of the island-the first site in the Americas to report autochthonous transmission of CHIKV. By 5 December 2014, Sint Maarten had reported a total of 658 cases-an overall attack rate of 1.76%. Actual prevalence may have been higher, as some cases may have been misdiagnosed as dengue. Fever and arthralgia affected 71% and 69% of reported cases respectively. Of the 390 laboratory-confirmed cases, 61% were female and the majority were 20-59 years old (mean: 42; range: 4-92). The spread of CHIKV to Sint Maarten was inevitable given the ease of movement of people, and the vector, island-wide. Continuing their history of collaboration, the French and Dutch parts of the island coordinated efforts for prevention and control of the disease. These included a formal agreement to exchange epidemiological information on a regular basis and provide alerts in a timely manner; collaboration among personnel through joint island-wide planning of mosquito control activities, especially along borders; notification of all island visitors, upon their arrival at airports and seaports, of preventative measures to avoid being bitten by mosquitoes; dissemination of educational materials to the public; and island-wide public awareness campaigns, particularly in densely populated areas, for both residents and visitors. The information provided in this report could help increase understanding of the epidemiological characteristics of CHIKV and guide other countries dealing with vector-borne epidemics.