At 2am, I finished the first draft of the Malaria Control and Prevention Program proposal! I expected it to take me at least a week to put together the 9-single spaced page proposal but after visiting the living quarters of the children yesterday, I was moved to do it in a single sitting. For the first time in my life, procrastination was not an issue. When I visited where the children stay, I met all of the house monitors (monitrice). There's one middle-aged mother-like figure in charge of each of the 20 homes. They are all roughly the same size, and hold anywhere from 17-46 children in each. There aren't enough matresses or sheets and the open cuts in the walls that act as windows for ventilation, do little to stop bugs and rain from entering the home. Carol, the monitor of the first house I visited, volunteered to take me around to all of the other houses to meet the other monitors and see what each home looked like. All of them need something. It' s so easy to get lost in all that needs to be done. The truth is, it's impossible to focus attention in just one area when even the most basic needs of the children are not yet being fully secured. We are short by $4,000/month, what it costs to provide the supper meal for the children. Without this meal that only costs US $0.24/child, the already malnourished children will be forced to go 17 hours between meals. With that, comes weaker immune systems, the onset of more sicknesses such as malaria, worms, dengue, TB and HIV. It's a vicious cycle that can only be stopped by attacking its roots.
Here is the abstract for the malaria program I've drafted. Please let me know if you know anyone who may be willing to help fund the project and or any opportunities for grants etc.
The primary objective of the Program will be to reduce as much as possible the health impact of malaria on the population of Vilaj Espwa and neighboring villages. One of the many goals of this prevention program will be to develop a model system for malaria control that can be applied throughout Haiti, where the disease is endemic, and that would be applicable to both children and adults. As our primary setting is contained, it is an ideal environment for this type of project. Data collection, medication administration and follow up can be assured. The malaria prevention program strategy will focus in on three areas. The first is case management (diagnosis and treatment) of all persons suffering from malaria. Malaria is often a debilitating disease that, when caused by Plasmodium falciparum,(the strain found in Haiti) can be fatal. Directly Observed Therapy (DOT) is indicated for all persons being treated for malaria and will prevent the onset of drug-resistant malaria. The second area includes the prevention of infection through vector control. Some vector control measures that will be undertaken include the destruction of larval breeding sites, insecticide spraying inside houses and insecticide-treated bed nets (ITNs), which combines vector control and personal protection. The above strategy will be applied through several components aimed at controlling this endemic scourge, including the development of a malaria case registry, the provision of anti-malarial drugs, provision of equipment and supplies (e.g., microscopes, drugs, bed nets), expert consultation from both local health care providers in Haiti and physicians from the US, disease reporting and surveillance, intensive training of the Espwa clinic health care workers on malaria diagnosis, treatment, follow-up and health education, where the communities are informed of what they can do to prevent and treat malaria.
Friday, May 30, 2008
Thursday, May 29, 2008
Where to Begin?
Yesterday was a busy day. First thing, I brainstormed several ways that I could maximize the usage of the few meds that we have in the clinic, especially those that are in high demand such as those used for treating ringworm, jock itch, fungus, scabies etc. The children will be leaving school soon for the summer and the orphanage will be down to about 100 kids during the summer months. This will serve as a perfect opportunity to sterilize and better equip their rooms to prevent against increased exposure to diseases such as malaria. I'll be heading over to the homes today to take note of things that need to be done.
I'm having 500 Haiti bracelets made that I'll be bringing up with me in August to sell so if you'd like to buy one for $5 please let me know. The money will go towards the cost of making and shipping them, the arts and crafts program here at the orphanage and towards my work on infectious diseases.
Dr. Cynthia, the medical director at Espwa, added a few more duties to my to-do list. These include, coordinating along with the TB program, a malaria control and prevention program to put into action immediately and write up as a grant proposal.
Starting the case registry for all of the children, has already proven more difficult than I anticipated. The food riots and manifestations that just happened in Haiti, put everything at a standstill including the country's healthcare and with that, medical records were discontinued and now the latest information I have on the TB drug regimens is from January of this year. the last 3-4 months have gone unrecorded. Currently, the 640 or so children at the orphanange are split up into one-room concrete buildings with several dozen in each. They share 4-5 to a bed and have no screens on the windows or bednets to protect them from the swarms of mosquitos that come at dawn and dusk. Malaria is like the common cold here, but that is not to downplay how terrible of a disease it truly is. Muscle pain, nausea, headaches, diarrhea, dehydration, neck and back pain, fevers, chills and blurred vision are all symptoms of Malaria. This is a completely preventable and treatable disease, but because of the lack of resources (mainly financial resources) we're forced to watch these kids fall ill and suffer unjustly.
There is so much I want to write but never enough time to do it. I feel guilty sitting at my computer, knowing how much has to be done. I've decided that the best way for me to go about getting things done day to day is by setting a large number of small goals each day so that something is always being accomplished.
Today's goals:
*Inspect children's living quarters for areas of concern regarding malaria prevention and draft a proposal and prevention plan
*Meet with the Assistant Director of the orphanage to try and develop an updated list of all the children so that I can match their medical profiles and or start one for them.
*Question people about the missing 50 dose PPD vial that is gone from the storage refrigerator. We still have roughly 45 children who have yet to be tested for Tuberculosis and I need the PPD serum to do so.
*Create a more user-friendly database for INH treatment and begin entering the treatment numbers for the 350 or so children who tested positive for latent/active TB over the last two years
Ok, so maybe these aren't necessarily "small" goals, but I'm feeling the time crunch and the to-do list continues to grow...
I'm having 500 Haiti bracelets made that I'll be bringing up with me in August to sell so if you'd like to buy one for $5 please let me know. The money will go towards the cost of making and shipping them, the arts and crafts program here at the orphanage and towards my work on infectious diseases.
Dr. Cynthia, the medical director at Espwa, added a few more duties to my to-do list. These include, coordinating along with the TB program, a malaria control and prevention program to put into action immediately and write up as a grant proposal.
Starting the case registry for all of the children, has already proven more difficult than I anticipated. The food riots and manifestations that just happened in Haiti, put everything at a standstill including the country's healthcare and with that, medical records were discontinued and now the latest information I have on the TB drug regimens is from January of this year. the last 3-4 months have gone unrecorded. Currently, the 640 or so children at the orphanange are split up into one-room concrete buildings with several dozen in each. They share 4-5 to a bed and have no screens on the windows or bednets to protect them from the swarms of mosquitos that come at dawn and dusk. Malaria is like the common cold here, but that is not to downplay how terrible of a disease it truly is. Muscle pain, nausea, headaches, diarrhea, dehydration, neck and back pain, fevers, chills and blurred vision are all symptoms of Malaria. This is a completely preventable and treatable disease, but because of the lack of resources (mainly financial resources) we're forced to watch these kids fall ill and suffer unjustly.
There is so much I want to write but never enough time to do it. I feel guilty sitting at my computer, knowing how much has to be done. I've decided that the best way for me to go about getting things done day to day is by setting a large number of small goals each day so that something is always being accomplished.
Today's goals:
*Inspect children's living quarters for areas of concern regarding malaria prevention and draft a proposal and prevention plan
*Meet with the Assistant Director of the orphanage to try and develop an updated list of all the children so that I can match their medical profiles and or start one for them.
*Question people about the missing 50 dose PPD vial that is gone from the storage refrigerator. We still have roughly 45 children who have yet to be tested for Tuberculosis and I need the PPD serum to do so.
*Create a more user-friendly database for INH treatment and begin entering the treatment numbers for the 350 or so children who tested positive for latent/active TB over the last two years
Ok, so maybe these aren't necessarily "small" goals, but I'm feeling the time crunch and the to-do list continues to grow...
Tuesday, May 27, 2008
The TB plan
The TB prevention program strategy will focus in on two areas. The first is diagnosis and treatment of all persons with active pulmonary TB. Prompt diagnosis and appropriate treatment of those persons are essential to limiting the spread of TB. Directly Observed Therapy (DOT) is indicated for all persons being treated for pulmonary TB. The second area includes the public health investigation of close contacts of all cases of pulmonary TB. All household members and close contacts of a patient with active TB will receive appropriate treatment in order to reduce the risk of future TB disease. These investigations are critical to identify likely sources of transmission and to limit the spread of TB. The consistent application of the above strategy will reduce the transmission of TB and decrease the population of infected persons at risk of developing TB disease, ultimately leading to the control of the disease.
The above strategy will be applied through several components aimed at controlling this endemic scourge. The first component is the development of a Tuberculosis case registry. This registry will enable us to track diagnostic information on patients with TB and monitor their clinical management and response to therapy. Second, is the provision of anti-tuberculosis drugs. Thirdly, laboratory services including increased utilization of sputum specimens will be employed for early detection of infectious pulmonary TB. A fourth component will be expert consultation from both local health care providers in Haiti and physicians from the US that will be made available through telephone and online consultation between the Espwa clinic and the Providence TB clinic. The fifth component is disease reporting and surveillance. The sixth component will include intensive training of the Espwa clinic health care workers on TB diagnosis, treatment, follow-up and epidemiology in southern Haiti.
Key activities of the TB prevention program will include direct medical care to patients. The evaluation and treatment of patients with suspected or documented active or latent TB infection will be conducted by health care providers at the Espwa clinic. Chest radiographs will be obtained at the public hospital when a specific medical indication exists (ie, symptoms, relevant history, or candidate for treatment of latent TB infection). With the assistance of health care personnel at the Espwa clinic, the program will monitor and encourage patient compliance with medical treatment and with clinical follow-up. Finally, we intend to present and share our results with the Public Health Ministry in Les Cayes. Preliminary discussions with the Minister of Health in Southern Haiti have occurred. The public health officials are interested in reviewing our data, yet remain unconvinced of the practicality and efficacy of treating latent TB. By presenting a well-designed and carefully executed program, we hope to persuade the local medical community to accept and embrace the concept of TB prevention in Haiti.
The above strategy will be applied through several components aimed at controlling this endemic scourge. The first component is the development of a Tuberculosis case registry. This registry will enable us to track diagnostic information on patients with TB and monitor their clinical management and response to therapy. Second, is the provision of anti-tuberculosis drugs. Thirdly, laboratory services including increased utilization of sputum specimens will be employed for early detection of infectious pulmonary TB. A fourth component will be expert consultation from both local health care providers in Haiti and physicians from the US that will be made available through telephone and online consultation between the Espwa clinic and the Providence TB clinic. The fifth component is disease reporting and surveillance. The sixth component will include intensive training of the Espwa clinic health care workers on TB diagnosis, treatment, follow-up and epidemiology in southern Haiti.
Key activities of the TB prevention program will include direct medical care to patients. The evaluation and treatment of patients with suspected or documented active or latent TB infection will be conducted by health care providers at the Espwa clinic. Chest radiographs will be obtained at the public hospital when a specific medical indication exists (ie, symptoms, relevant history, or candidate for treatment of latent TB infection). With the assistance of health care personnel at the Espwa clinic, the program will monitor and encourage patient compliance with medical treatment and with clinical follow-up. Finally, we intend to present and share our results with the Public Health Ministry in Les Cayes. Preliminary discussions with the Minister of Health in Southern Haiti have occurred. The public health officials are interested in reviewing our data, yet remain unconvinced of the practicality and efficacy of treating latent TB. By presenting a well-designed and carefully executed program, we hope to persuade the local medical community to accept and embrace the concept of TB prevention in Haiti.
Vilaj Espwa and TB
Hope Village or in Creole, Vilaj Espwa, encompasses over 125 acres of land and is home to 640 children with hundreds more coming to its two schools each day from poor neighboring communities. Volunteer physicians from the US began testing the children of Espwa for TB four years ago and began a treatment program in the fall of 2006 after discovering that about 350 of the children (45%) and 120 of the staff (60%) were positive for latent TB. The actual infection rate (persons with active TB) was last known to be 2% in 2006. In the last two years, several hundred individuals have began a 9-month treatment course with an 85% success in terms of therapy compliance as older teens and staff are more likely to refuse treatment.
First day back
After waking up for 3am the day after graduation, I arrived in Les Cayes around 5:30pm, just in time for dinner. I just finished unpacking, and am ready to get started! I'm going to try and update this blog daily but because of the shortage on electricity that may not be possible. Nonetheless, check back weekly for updates on how and what I'm doing. Feel free to respond to any of my posts and I'll try to write back. Thanks!
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