Global Health Blog

  1. Equipping Dominican HIV providers with the tools for best patient care

    August 13, 2014 by Guest Bloggers

    Guest post by Dr. Ramona Bhatia, Clinical Research Associate, Center for Global Health, and Instructor of Medicine, Feinberg School of Medicine

    The Project CURE shipping container arriving at the Clínica de Familia La Romana

    Arrival of the Project CURE shipping container at Clínica de Familia La Romana

    Physicians such as myself practicing in high-income countries are privileged to utilize the latest medical technologies for patient care. In the majority of healthcare settings globally, however, even the most basic medical supplies, such as gloves, gowns, and gurneys, are limited, and more sophisticated technologies are exceedingly rare.

    In my role as a global health clinical researcher in the Center for Global Health at the Feinberg School of Medicine, I had the pleasure of traveling to the Clínica de Familia La Romana in October 2013. Located in the La Romana province in the southeastern part of the Dominican Republic, Clínica de Familia is the second largest HIV clinic in the country. It provides subsidized care to approximately 1,600 patients, including a large proportion of vulnerable Haitian migrants living in neighboring bateyes (sugarcane labor camps). My initial task was to develop and implement a Spanish-language training course on the latest HIV care updates for Clínica providers, but from my conversations with Clínica leadership and site visits I quickly realized that more than a care update was needed. A lack of medical equipment, such as an EKG for heart tracings, was preventing Clínica staff from providing the best care possible to their patients.

    The container was fully stocked with needed medical supplies

    The container: Fully stocked with needed medical supplies

    To address the supply shortage, the Center for Global Health, with support from Northwestern Memorial Hospital, formed a partnership with the not-for-profit group Project C.U.R.E. Project C.U.R.E. is the largest supplier of donated medical supplies to developing countries around the world. One of my responsibilities was to assist with the on-site Project C.U.R.E. needs assessments in the Clínica de Familia and neighboring hospitals, including one in Guyamate, a bateye and Northwestern University Access to Health site. Conducting detailed assessments was important to ensure that donated supplies would be needed and could feasibly be used. We interviewed providers for first-hand accounts of the supplies that were most needed and discussed logistics with Clínica leadership, including availability of regular maintenance for large equipment, proper storage facilities, and personnel to safely and effectively utilize certain technologies.

    Three months later, in January 2014, a large shipment of supplies was loaded onto a shipping container in Denver and set sail from Houston for the Dominican Republic. After travel and customs processing, the shipping container carrying tens of thousands of dollars worth of medical supplies arrived at the Clínica de Familia in July 2014. The community came together for the large undertaking of unloading the supplies at Clínica de Familia.

    Today, just a few weeks after the arrival of the shipment, providers are already utilizing some of equipment: The EKG machine is being used for heart rhythm examinations and the colposcopy equipment is set up to begin women’s health exams, all due to the targeted matching of supplies with the Clínica’s needs.

    We plan to return to La Romana next year with the first group of Feinberg medical students to engage in HIV and primary care medical rotations at the Clínica de Familia. I’m hoping to see these supplies contributing to a sustained improvement in health care for HIV patients in the La Romana community.

    Unloading the container: A community effort

    Unloading the container: A community effort

    CommunityEffort

    Clínica de Familia La Romana staff checking supplies

    Setting up the colposcopy machinery for women's health examinations

    Setting up the colposcopy machinery for women’s health examinations

    Share and Enjoy:
    • email
    • Print
    • Digg
    • StumbleUpon
    • del.icio.us
    • Facebook
    • LinkedIn
    • Twitter
    • Google Bookmarks
  2. A Toxic Cycle

    August 7, 2014 by Haley Lillehei

    As a student of global health, I pride myself on keeping up to date on the various challenges to public health around the world, especially the most potent issues. I know about AIDS and malaria, I know about the problems with health insurance in China, and I know the struggles resource poor nations face in giving care, to name a few. So imagine my surprise when I came across a topic I knew nothing about.

    This past May, over 100 people died in a toxic alcohol outbreak in eastern and central Kenya. Others woke up blind after sleeping off the alcohol’s effects or lost their sight over the course of a few days. In Kenya, and other countries in the area, bootleg liquor is extremely common, as factory made alcohol is too expensive for most people to buy. Many of these locally made brews are laced, both intentionally and unintentionally, with industrial alcohol to increase their potency.

    How does this toxic alcohol kill? What makes it so much worse than the ethanol that so many people across the world drink? I spoke with Dr. Patrick Lank and Dr. Vinoo Dissanayake in an attempt to wrap my head around this deadly poison.

    Ball and Stick Model of Methanol. Source: Wikipedia

    Ball and Stick Model of Methanol. Source: Wikipedia

    Dr. Lank, a toxicologist at Northwestern’s Feinberg School of Medicine, explained to me what happens to the body after one consumes methanol. Methanol, or methyl alcohol (CH3OH), is widely used as an industrial solvent and paint remover. It is also commonly used as a component of photocopying fluid, shellacs, and windshield-washing fluid. When ingested, methanol is primarily metabolized in the liver into formaldehyde via alcohol dehydrogenase. Formaldehyde is then metabolized into formic acid, which ultimately breaks down into folic acid, folinic acid, carbon dioxide, and water. Formic acid is responsible for the toxic effect of methanol in the human body.

    In the United States and other developed countries, there are very specific treatments in response to toxic alcohol poisoning. These include hemodialysis, oxygen and breathing support, gastric lavage, and fomepizole, an antidote intended to reverse the effect of the poison. Another remedy is consumption of ethanol, or the alcohol we typically drink, like beer, wine, or whiskey, to name a few. When ethanol is ingested, it competes against the methanol to be metabolized, and the body digests ethanol instead. This prevents the formation of the toxic metabolites that result from the digestion of methanol. Often times when we see alcohol poisoning involving methanol in developed countries it involves individual cases: someone is suicidal, addicted, or another isolated cause. A hospital can focus on using all the available interventions to save a life. This is not the case in developing countries.

    Dr. Dissanayake, a medical toxicologist at Loma Linda University Medical Center in Loma Linda, California, explains that alcohol poisoning is a good example of the struggle behind resource limitations in developing countries. There is often limited access to hospitals and doctors, and if one does make it to one, it is often at the very last possible minute, once they have exhausted all home remedies and they are still alive. Dr. Dissanayake has spent time in Uganda doing global health work. During her time there, she has experienced first hand the burden a methanol-poisoning outbreak would place on communities.

    Uganda Waragi. Source: Wikipedia

    In Uganda, illicit alcohol is called waragi, and was introduced by the British to give Ugandan soldiers courage to impose the Queen’s policy on their countrymen. It has since become the drink of choice for most Ugandans. According to a 2004 World Health Organization ranking of countries based on per capita alcohol consumption, Uganda has the highest alcohol consumption in the world, with adults consuming 19.5 liters of alcohol per year. “If someone in the village is sick from drinking, they are one of many drunk patients, and it would be nearly impossible to determine who may actually be poisoned rather than just drunk,” says Dr. Dissanayake. An additional strain on the already resource-poor medical facilities is created through excessive alcohol consumption.

    With a high number of intoxicated patients and limited professionals, the most common response is to let an intoxicated patient sleep it off, and thus the cases of those who have been poisoned by methanol are often discovered too late. Alternatively, if the poisoning is discovered in time, and if a person does make it to a hospital, the best option is to fight the poison with ethanol. However, methanol has a half-life of 40 to 50 hours, so according to Dr. Lank, a patient must be kept drunk for about 10 days to survive the toxic methanol. Most patients do not have the resources to pay for this treatment.

    The other option is to have the patient transferred to a referral center where hemodialysis can take place. Dr. Dissanayake explains that hemodialysis is a medical procedure that will filter the patient’s blood and remove toxins, preventing toxic metabolites from forming. This procedure would happen without hesitation in the US, however only certain hospitals have this capability in Uganda. “The closest referral center to Nyakibale Hospital [a hospital in Uganda where Dissanayake has volunteered] is 3 hours away by motorbike,” says Dr. Dissanayake. There are very few ambulances available in rural Uganda.

    So why is this happening in places like Uganda and Kenya? Drinking is a highly political issue, as alcohol is one of the largest sources of revenue. Local politicians are reluctant to partner with law enforcement based on a fear that stricter laws will be bad for business. At the same time, the government doesn’t see toxic alcohol poisoning as a large public health issue. Drinking is viewed as part of the culture in Uganda. However, according to Ioannis Gatsiounis for Time Magazine, some observers estimate the costs of alcohol in the country, both economic and social, are worse than those of HIV and malaria. “It’s a double-edged sword,” Dr. Dissanayake says, “people are so depressed that they can’t make enough money to make ends meet so they drink. But then they can’t go to work the next morning and the cycle continues.”

    Ultimately, the ripple effect of a failing economy is felt in the limited resources of the medical system as well. One answer to the problem lies in global partners to try and educate local providers on the best way to manage these poisonings and stop the cycle. However, enforcement of the policies by the government may play a more meaningful role.

    Share and Enjoy:
    • email
    • Print
    • Digg
    • StumbleUpon
    • del.icio.us
    • Facebook
    • LinkedIn
    • Twitter
    • Google Bookmarks
  3. A New Way Forward

    August 6, 2014 by Elizabeth Larsen

    Chicken - Piura - Peru (1 of 1)

    Though they lie thousands of miles apart, the countries of Guatemala and Peru continue to fight against the same seemingly unconquerable struggle: childhood malnutrition.

    In both countries, nationwide data masks the severity of the problem. In Guatemala, childhood stunting affects around 50% of children under five, yet the prevalence soars to 70-80% in many indigenous communities. The disparities in Peru are equally as stark. In fact, the country is often overlooked by agencies providing nutritional support as the overall prevalence of childhood malnutrition is only about 15%, even though indigenous communities continue to see rates of 40, 50, even 60%.

    As you can see, the problem of childhood stunting in Latin America is extremely prevalent, but it is not widespread. It is concentrated in impoverished indigenous populations that have faced years of racism, marginalization, and abuse. How can we begin to solve the nutrition crisis that was created by decades of political, economic, and social oppression?

    The answer is not easy or immediately obvious. As you can quickly see from examining the data on stunting over the last few decades, the world has struggled to make significant progress despite the best efforts of governments and bilateral aid organizations. For example, malnutrition rates in rural Peru fell 0.3% in the ten years from 1996 to 2005. Even though change seems to be accelerating in the majority of countries, it is not fast enough, nor consistent in its reach. In fact, as of 2010, fifteen countries now have a childhood malnutrition prevalence that is higher than it was in the 1990s.

    Luckily, hidden in the shadows cast by governments and foreign aid, small grassroots organizations have been hard at work achieving remarkable success at improving the nutritional health of their communities’ children. For the past month, I have had the remarkable privilege and honor to investigate some of these programs first hand. Though their strategies are incredibly diverse, their passion for nutrition is identical.

    For example, Wuqu’ Kawoq runs a patient centered nutrition program completely in the indigenous language of Kaqchikel, the language of many Mayan Guatemalans. In one community named Paya, the mothers of the children enrolled run the program themselves, taking all of the height and weight measurements to be recorded in the system. In another one of their communities, the director of the nutrition program was unable to find additional children to be admitted, as they were all growing adequately. This is what success looks like.

    Close by in the highlands around Panajachel, Mayan Families runs an innovative and unique nutrition preschool program. Mothers are able to drop off their children for a daily program of Spanish lessons, supervised playtime, and a healthy breakfast and lunch. Looking at the data, many kids aged three to five years have made substantial growth gains, a big step toward overcoming the infantile malnutrition that many suffered. This is what success looks like.

    An entire hemisphere away in the high altitude mountains of Peru, a young organization called Sacred Valley Health is training women to become health promoters in their communities, providing basic primary care and education about nutrition, sanitation, and disease prevention. They have more than doubled the number of health promoters in the last two years, allowing for important lessons about nutrition to be disseminated to more and more communities. This is what success looks like.

    Toward the middle of the country, Future Generations is proving that a nationally sponsored health program called Community Health Administration Associations (CLAS) can be reformed to provide citizens with first class primary care. By developing accessible and accurate materials to train nurses to train community health facilitators, Future Generations has increased the rate of exclusive breastfeeding in Huancayo from 71.8% to 95.3% and has decreased the rate of malnutrition in children under two by almost 7% in just one year. This is what success looks like.

    And last, but certainly not least, Feed the World is re-imagining agriculture in Northern Peru, one of the world’s most arid areas. By distributing loans of seeds and agricultural tools to farmers, along with providing extensive education on dry farming techniques, Feed the World equips farmers with the tools necessary to cultivate nutritious crops to feed their families even working within difficult circumstances. After the first year of the program, the regional and local government, along with the local university have taken over 74% of the project’s costs, a substantial investment in a previously ignored problem. This is what success looks like.

    As I hope is clear by the examples above, the power and impact of small community based organizations to affect change cannot be underestimated. If we wish to make a profound difference in the prevalence of malnutrition around the world, we must not only wholeheartedly embrace the lessons on how to achieve large scale impact with a small scale, community approach, but we must continue to invest in these grassroots organizations and their fearless leaders who are working day in and day out to create a way forward.

    If you are interested in learning more or inspired to support one of the causes above, you can access their websites at the embedded links throughout this post. 

    Share and Enjoy:
    • email
    • Print
    • Digg
    • StumbleUpon
    • del.icio.us
    • Facebook
    • LinkedIn
    • Twitter
    • Google Bookmarks
  4. The Ebola Outbreak: Fast Facts and Resources

    August 4, 2014 by Emily Drewry

    The global health world is abuzz this summer with the frightening spread of Ebola, a deadly virus that has emerged in frightening force over the past few months in West Africa. Officials are labeling the outbreak responsible for 826 deaths as of August 4, as organizations across the globe are stepping in to try and contain the spread before the count grows.  As the media coverage continues to escalate, so does the challenge of keeping up with it, especially the quick facts. Read on to get a quick overview, then follow the links under each question for further information.

    Ebola Virus

    Ebola Virus. Source: Associated Press

    What is Ebola? Ebola is a group of viruses that cause deadly hemorrhagic fevers. According to the WHO, the virus has a case fatality rate of 90%. It can be transmitted by direct contact with blood, body fluids, and tissues of infected people or animals, and is known to be one of the world’s most virulent diseases. The current strain is considered to be the most lethal strain of the group, but in many cases, can be treated if identified.

    (More: http://www.who.int/csr/disease/ebola/en/)

    Background information: Ebola is named after the river in Zaire where it first emerged in 1976. The virus produces a protein called ebolavirus glycoprotein that attacks the body’s cells and creates the hemorrhagic symptoms that often appear in patients. However, not all cases of Ebola are identified with extreme hemorrhaging – instead, the cases generally begin with flu-like symptoms. Therefore, much of the danger of the outbreak lies in the challenge of containing those who carry the virus and avoiding exposure, which often takes place in funeral circumstances or through the work of health care providers.

    (More: http://www.huffingtonpost.com/2014/08/02/ebola-symptoms-infection-virus_n_5639456.html)

    Where is the outbreak? The cases of this summer’s outbreak have been located along the shared borders of the West African countries of Sierra Leone, Liberia, and Guinea. There is fear of the virus spreading after an infected man flew on a commercial airliner from Liberia to Nigeria last week, but as of now, officials have yet to report any cases. On July 31 the CDC issued a travel advisory for the three countries where Ebola has been identified, urging a temporary halt to nonessential travel.

    (More: http://abcnews.go.com/Health/ebola-/story?id=24733669, http://time.com/3065176/ebola-outbreak-cdc/)

    How does this outbreak compare? This year’s outbreak is now officially the largest in history, with over 1,300 infected this year. Past outbreaks have been reported across the world since the first recognition of the disease in 1976. An outbreak in 2000-2001 in Uganda infected 425 individuals, with a 53% death rate reported.  Ebola has been identified in three continents since 1976, and has been a collaborative research project for the CDC and various national health departments for years.

    (More: http://www.cdc.gov/vhf/ebola/resources/outbreak-table.html)

    What is happening in the US? Two Americans, who were infected with the Ebola virus while working in Liberia, are being transported to Emory University Hospital in Atlanta for treatment this week. A 33-year old American doctor arrived in Atlanta on Saturday and a 59-year old aid worker is scheduled to arrive in the US tomorrow. The news created a stir of responses from individuals afraid of the healthcare system’s abilities to keep the virus contained. A Pentagon spokesman confirmed the move, acknowledging that specially trained teams will be handling the cases. This is the first time an Ebola patient has been brought to the US, according to the CDC.

    (More: http://www.washingtonpost.com/national/health-science/us-confirms-2-americans-with-ebola-coming-home-for-treatment/2014/08/01/c20a27cc-1995-11e4-9e3b-7f2f110c6265_story.html)

    What does the WHO have to say? The WHO has kept their updates quite frequent, updating their website with response plans and resources as the outbreak has progressed.  Most recently, they informed the public of an intensified Ebola outbreak response plan to be put in place by Dr. Margaret Chen, Director-General of the WHO and the presidents of the West African nations affected.  The $100 million response plan will “require increased resources, in-country medical expertise, regional preparedness and coordination,” says Dr. Chen.

    (More: http://www.who.int/mediacentre/news/releases/2014/ebola-outbreak-response-plan/en/)

    Where can I get more information? All the links above will bring you to articles with coverage of the current outbreak. In addition, the CDC (cdc.gov) and WHO (who.gov) websites contain valuable background and updated information.

    Share and Enjoy:
    • email
    • Print
    • Digg
    • StumbleUpon
    • del.icio.us
    • Facebook
    • LinkedIn
    • Twitter
    • Google Bookmarks
  5. Community Health Administration Associations: Community Health empowerment for Peruvians

    July 28, 2014 by Kathleen Ferraro
    San Jeronmino CLAS center

    San Jeronmino CLAS center

    I am currently researching the community health worker model in Peru, a project which has necessitated extensive background research on Peruvian health care and the community health worker model’s past, present, and potential in the country. This background research included information on the Community Health Administration Associations (CLAS) program, a program that diverges from the conventional community health worker model but provides community-based primary care nonetheless.

    As a background, the community health worker model is a primary care model wherein local community members are trained to administer basic health services to other members of their community. This model is steadily gaining popularity worldwide, often commended for its potential for community empowerment and accessibility. In Peru, studies of the community health worker programs in place acknowledge the efficacy of the model on paper, but criticize the fact that the bulk of Peruvian community health workers are males with little to no education that exhibit high dropout rates from their community health work (Brown et. al. 2006).

    However, the CLAS program, implemented in 1994, is proving to heighten the potential of efficacious community health work. The WHO defines the CLAS program as a system of “private, non-profit civil associations [(legal non-profits)] that enter into agreements with the government and receive public funds to administer primary health-care (PHC) services applying private sector law for contracting and purchasing” (CITE). These individual community CLAS associations effectively identify local social determinants of health and health inequities, and then reinvest their Ministry of Health-supervised budget in community outreach programs and infrastructure development.

    As it relates to the community health worker model, the CLAS program is essentially a government health initiative with authorized and integral community participation. Health personnel working at CLAS associations are formally hired by CLAS and are held accountable by the community members their center works with, thereby necessitating transparency and communication with service recipients. In that way, community members influence the health services offered, and CLAS associations respond to the needs and health disparities specific to their localities.

    All in all, the CLAS model has proven to have favorable impacts on health, health services development, and community outreach. CLAS association clinics boast significantly higher numbers of staffing physicians in comparison to non-CLAS clinics (and therefore shorter waiting times and more personalized treatment) with a higher average of annual clinic visits among their target populations. The centers also exhibit higher access and more customized primary care, especially for poorer rural populations that tend to be dissuaded by unaffordable fees. They do so by focusing on what the individual community needs and responding to only the relevant inequities and necessary services–in short, affording accessibility by efficient service development and implementation.

    Government and organizational initiatives continue to develop in the hopes of further strengthening the CLAS program by monitoring impact, fostering community-based education, broadening the reach of CLAS centers, and increasing CLAS partnerships with schools, organizations, and other relevant institutions.

    With initiatives like this in place to strengthen a program that already demonstrates significant impact, it is exciting to see where this community-based primary health care system goes in the future. Likewise, it will be interesting to see how non-CLAS community health worker programs interact with, borrow from, and impact the CLAS model to continue to expand the reach of community-based health care in Peru.

    Share and Enjoy:
    • email
    • Print
    • Digg
    • StumbleUpon
    • del.icio.us
    • Facebook
    • LinkedIn
    • Twitter
    • Google Bookmarks
Page 1 of 4312345...102030...Last »