Amid Colombia's Zika outbreak, Phila. Ob/Gyn sees no panic

Over the past three weeks in Colombia, which has the second-highest number of Zika infections in the world, Philadelphia Ob/Gyn Jack Ludmir noticed something interesting: No fear.

"I haven't seen, 'Oh, my God! I'm not going to go in there' because of that [Zika-infected] patient," said Ludmir, chairman of obstetrics and gynecology at Pennsylvania Hospital, who has been working to improve health care in Colombia for 16 years. "That strikes me the most."

There have been other surprises, too, in a nation where more than 3,100 pregnant women are infected with Zika.

"Here in Colombia, we haven't seen a single case of babies having a very, very small head and having problems," a condition known as microcephaly. "Only Brazil reported a spike. . . . Isn't that incredible, that there hasn't been one case?"

A possible link between birth defects and the mosquito-borne Zika virus in Brazil caused the World Health Organization to declare a public health emergency. Pregnant women are being advised to avoid travel to 30 countries where the virus is circulating. Health ministers are suggesting that women put off having children.

Ludmir is far from alone in noting the absence of microcephaly cases in Colombia. "It's sort of a mystery," Health Minister Alejandro Gaviria told the Guardian last week.

And while the link between the virus and brain damage so far is largely circumstantial, "the association is looking stronger and stronger, and we're not surprised not to see cases of microcephaly in other countries because of the time frame between infection and delivery," Tom Frieden, director of the U.S. Centers for Disease Control and Prevention, said Friday.

The spike in Zika cases occurred first in Brazil. Infectious diseases that cause birth defects tend to have the greatest impact early in pregnancy.

Ludmir, 60, who arrived in Colombia last month, has long been interested in the health of the world's most vulnerable women, both at home and abroad. In Philadelphia, he cofounded Puentes de Salud, a community health center that focuses on immigrant Latinas, and he has worked with women in Africa.

His connection to Latin America began at age 4. Born at Thomas Jefferson University Hospital, the young Ludmir accompanied his father, also an Ob/Gyn, to Peru, where he was setting up a medical training program. Ludmir grew up there through his teens.

In recent years he has focused on Cali, a city of two million people in western Colombia, because leaders there are allowing him to help improve Ob/Gyn training and practices.

He cannot legally do clinical work, but he goes on rounds wearing a white coat, and reviews cases with medical students and residents.

One of his goals is to change the model of health care from a pyramid, where "the doctors are like gods," to "more of a circular model," a team approach in which "the patient should be at the center of health care."

He is also trying to change "the lack of respect for women" that is common in the cultures of developing countries. "Here it is sometimes really sad," he said, and improvements can be so simple: "putting a sheet on top of a patient when examining someone, and making sure that the door is closed," he said. "In the States, we don't think about them."

The medical issues he sees among the very poor women in public hospitals also are rarely seen in the United States. Some have terrible infections or such heavy bleeding, he said, that doctors "have to bring them back. They are almost dead."

On his rounds and case reviews, Ludmir has dealt with eight cases of pregnant women infected with Zika. None had much reaction to hearing the diagnosis, perhaps because news of the potential harm has not registered in poor communities.

It could also be, Ludmir said, that with no microcephaly yet reported in Colombia, there simply is less fear, not just on the part of patients but by doctors and nurses as well. "I'm actually the one who is raising the concerns," he said.

At public hospitals in Cali, rooms are open to the outside air, mosquitoes fly about, and patients infected with Zika are not separated.

Ludmir, who is on sabbatical, mused about the difference - in medical standards and cultural expectations - at Pennsylvania Hospital, where doctors in his department deliver more babies than arrive at any other hospital in the city.

"If I had one patient in Philadelphia who had Zika in my hospital and that patient was not isolated, you know what would happen," he said, reflecting on the urgency, panic, and intensive news coverage that would undoubtedly ensue.

dsapatkin@phillynews.com

215-854-2617 @DonSapatkin