Sunday, July 13, 2014

Ebola Outbreak in West Africa

Areas involved with current outbreak 
The WHO recently reported on the status of the ongoing Ebola outbreak in West Africa; as of July 8th there have been 888 cases with 539 deaths. Although the outbreak seems to be slowing in Guinea it is still very active in Sierra Leone and Liberia, where 44 new cases and 21 deaths were reported between July 6 and 8.

Ebola Virus Disease (EBV), also known as Ebola Hemorrhagic Fever, refers to a viral infection with several different species of a filovirus. First identified in two outbreaks in the Sudan and the Democratic Republic of the Congo in 1976, Ebola causes a severe acute illness characterized by bleeding and a mortality rate up to 90%.

Most of the Ebola outbreaks to date have occurred in small villages in West and Central Africa near tropical rain forests. The natural host of the virus is believed to be fruit bats. Animals such as chimpanzees, gorillas and monkeys can become infected with the virus after coming in contact with bats; these animals are "accidental" hosts, just like humans. Humans become infected via handling blood and body fluids from infected bats or other animals. Once someone is infected with the virus they then go on to serve as a source of transmission to other humans via their own infected blood, tissues and secretions.

The incubation period for Ebola after being infected is anywhere from 2-21 days; humans are not
infectious until they develop symptomatic illness. Ebola initially is a non-specific illness characterized by sudden fever, intense weakness, muscle pains, sore throat and headache. These symptoms are followed by vomiting, diarrhea, rash, organ dysfunction and sometimes bleeding. Once symptomatic, a person's blood and body fluids are highly infectious and serve as a source for potential human to human transmission of disease.

As noted above, Ebola is associated with mortality rates of up to 90%. There is no specific treatment or vaccine for the disease.

Distribution of different Ebola outbreaks
The ongoing, sustained outbreak of Ebola in West Africa is concerning for several key reasons. This large-scale outbreak in multiple locations is testament to just how 'small' the world has become. A disease that emerges in a rural village can spread rapidly to major cities and, theoretically, to the rest of the world. This is a great reminder that we all should be concerned with and help in the response to outbreaks such as these. Also, this outbreak highlights some of the barriers to enacting the infection control measures that would allow for its control. Specifically, it is believed some cultural burial practices have perpetuated the outbreak via exposing uninfected people to the infected blood, secretions and organs of Ebola victims.

The WHO has terrific information on Ebola available here. Some great information is also available from the CDC.

Friday, June 13, 2014

VCU GH2DP Outreach Trip to Yoro: Pictures Published

Outreach group in La Hicaca 
An overview of our recent outreach trip to Yoro, Honduras has been published on the GH2DP website and can be found here. A slideshow of pictures from the trip can be found here.
Distributing water filters, Lomitas
Dental clinic, La Hicaca

Engineers Without Borders students with water test plates
Medicine clinic, La Hicaca
Medicine clinic, La Hicaca
Medicine clinic, Lomitas

Sunday, June 8, 2014

VCU GH2DP Yoro trip: kissing bugs and a new way to obtain clean water

Here is a brief post from Olanchito, Honduras. I want to share a few more pictures and highlight a few more of the experiences we had on our outreach trip.

Chagas disease is a major issue for the communities we serve in Honduras; this is an infection carried in the gastrointestinal tracts of "kissing bugs." These bugs feed on humans and defecate; the feces is irritating and the Chagas parasite is then inoculated into that person's blood when they scratch. Chronic infection causes significant morbidity and mortality, leading to heart failure and arrhythmias, amongst other complications. Our colleagues from Brock University and the National Autonomous University of Honduras identified these "kissing bugs" for our group-see the picture below.

The picture below is with our colleagues from Brock and the National Autonomous University of Honduras.

The picture below is of a novel rain catchment device that was put into place by VCU Engineers Without Borders students Lucas Potter and Kristina Kelly. They also performed formal interviews to determine the barriers to adopting this technology on the communities we serve. 

More to come, stay tuned! 

Saturday, June 7, 2014

VCU GH2DP Yoro outreach trip: back from the mountains!

This is an early recap of our GH2DP outreach trip to the mountains of rural Yoro, Honduras-blogging from the car on the way back to Olanchito.  We just spent the past 5 days providing medical care to people in a region with little to no access to care. All told, we saw approximately 750 people over 6 days of clinic. We reached people from twenty different villages. All adults were screened for diabetes, hypertension, de-wormed and had acute medical issues addressed, as well. We managed and triaged preseptal cellulitis, new-onset seizure disorder, hemorrhage requiring acute transport to a regional hospital and leishmaniasis.

We distributed 83 water filters (each of which can provide clean drinking water to an entire family for 2 years) and facilitated approximately 90 pap smears and dental extractions for 97 patients. We administered over 460 surveys on topics ranging from women's health issues, barriers to water filter use, new water catchment technology and soil transmitted helminths. Dr. Ana Sanchez and colleagues from Brock University examined stool samples on several scores of people, helping to identify recalcitrant worm infections and connecting these patients to appropriate care.

We screened patients for vision issues and distributed 67 pairs of eyeglasses. A new water catchment system was trialed and microbiological testing was performed on over 30 water samples. Students and residents received didactic and clinical lectures on dengue, soil transmitted helminths, diarrhea, malaria and Chagas' disease, among other topics. We had an absolutely terrific group of highly motivated student and resident physicians. Four students in our GH2DP Student Scholars program completed research projects as did our GH2DP pathway resident. All in all a fantastic trip! Will blog more in the near future with pictures. 

Wednesday, May 28, 2014

June 2014 GH2DP Outreach Trip to Yoro: Preview

Our group leaves for the mountains of the Yoro province of Honduras this coming Sunday, where we will spend over a week seeing patients and participating in a number of public health projects.

Testing for bacterial water contamination (presence of
color = growth of bacteria) 
This marks our 9th large-scale medical mission to Honduras since 2005. Initially our efforts were primarily focused on providing acute medical care. Since that time our work has expanded to include numerous public health projects including a large-scale, filter-based clean water initiative that has led to supplying approximately 1,500 people with clean water. Additional efforts have included regular mass de-worming, an indoor air pollution assessment and subsequent education initiative, several mass anemia screenings, improved access to cervical cancer screening and a large Chagas disease knowledge and attitudes assessment. Our group has been blessed to have wonderful community partnerships which help to direct and facilitate our efforts. In the nearly one decade since we have been active in Honduras we have come along way... but there is much, much more to do. 

Our program (the Global Health & Health Disparities Program, GH2DP) has a tripartite mission: improve the health of people with poor access to healthcare, expose US-based learners to medicine in resource-poor settings and to systematically study our efforts to learn what works and what doesn't. This work has involved the efforts of myriad individuals, non-profit organizations and academic departments here at VCU. 
Medicine clinic, La Hicaca 

Since 2005 we have seen over 10,000 patients. Beyond providing acute medical care we now regularly screen and treat patients for chronic diseases such as diabetes and hypertension. We also screen patients for vision issues and provide eye glasses, help facilitate dental extractions and help support cervical cancer screening, as well. Every person in the 17 villages we serve receives anti-worm medication at least twice yearly; since 2008 we have distributed nearly 20,000 doses of anti-worm medication. 

Assembling and cleaning water filters 
Our clean water program provides water filters that are created in-country and provide clean drinking water to entire families for up to 2 years. Since the inception of the program we have distributed 401 filters and now provide clean water to approximately 1,500 people (roughly 75% of the region we serve). This year we are partnering with a local non-profit organization to provide entire villages with clean drinking water via a chlorination project involving cisterns. It is estimated that 6 of the 17 villages we serve will have access to clean drinking water via this project-without the need for water filters. 

In terms of educational efforts, to date we have provided global health experiences to approximately 80 students and residents. Of these learners, 32 have been afforded advanced mentorship on public health research projects that have led to 10 publications and 15 presentations at national and international conferences. More importantly, their work has advanced our medical and public health missions. Additionally, we have an active GH2DP residency pathway which involves over 150 hours of advanced training in global health as well as a Student Scholars program

Our June trip may be our most ambitious ever. We have assembled a fantastic team of students who have been working hard the past 9 months raising money to help procure medicines and supplies. We also have a terrific group of residents and other staff.

We have 4 survey projects planned: one focused on worm infections, one on women's health issues, one on barriers to water filter use and one on access to clean water. Additionally, we are partnering with researchers from Brock University who will be doing fecal testing to evaluate the regional worm burden and the effectiveness of our mass-deworming program. As well, a group of engineering students from VCU will be traveling with us to trial novel water catchment technology. We anticipate seeing approximately 1,000 patients, or roughly half of the population of the region we serve. 

Stay tuned for updates on the trip. 

Friday, April 11, 2014

VCU Honduras Outreach Projects Presented at Global Health Showcase, International Congress on Infectious Diseases

Audrey Bowes (VCU second year medical student)
presenting on an outreach project on indoor air pollution
in Yoro 
The second VCU Global Health Showcase was held on April 1, 2014, and involved a series of oral presentations as well as a poster session. Multiple students and fellows who have been involved with global health work at our Global Health and Health Disparities Program (GH2DP) site in Yoro, Honduras, presented on their findings.

Audrey Bowes, a VCU second year medical student, presented on an education project focused on indoor air pollution in Yoro.

VCU Engineers Without Borders students
presenting on their work on novel water catchment
technology (left to right: Matt Beckwith,
Katelyn Boone, Viktoria Pretzman,
Kristina Kelly, Lucas Potter)
VCU undergraduate engineering students from the group Engineers Without Borders (EWB) presented on their work creating novel water catchment technology. Members from the EWB group will be traveling to our Yoro, Honduras site in June to trial this technology.

Additionally, Summer Donovan, a pediatric Infectious Diseases fellow at VCU, presented on her 2013 project looking at Chagas disease knowledge and attitudes in Yoro.

With Dr. Gonzalo Bearman at Gaby Halder's
poster on clean water storage, International
Congress on Infectious Diseases, Cape Town,
South Africa 
Gaby Halder (a 4th year medical student who will be graduating in May) also had her research on clean water storage presented at the International Congress on Infectious Diseases meeting that just concluded in Cape Town, South Africa.

Congrats to all of these outstanding student/ fellow researchers!

Tuesday, January 21, 2014

VCU GH2DP Honduras Group's Work Featured by VCU's Division of Community Engagement

Earlier this month our group traveled to the Yoro area of northern Honduras to meet with our community partners and ministry of health officials and to lay the groundwork for our June 2014 trip. The VCU Division of Community Engagement is now featuring our work on their site (this can be found here).

Also, the VCU undergraduate chapter of Engineers Without Borders was awarded a Quest Innovation Fund grant to support their development of novel rain catchment technology for use in Yoro. Congratulations to all of the students involved in this project!!!

Wednesday, January 15, 2014

VCU GH2DP Honduras Trip: Final Post

17 villages we serve in Yoro; the villages appearing in color
are those that may benefit from the new water chlorination
system (see text) 
This will be my final post prior to coming home tomorrow; this has been a whirlwind trip filled with productive meetings and some great new potential projects.

One of the projects we are most excited about is a new water chlorination project; piggybacking on older technology that is currently in place, new chlorination systems may, once installed, provide clean drinking water to 6 of the 17 villages we are currently supplying with water filters. We hope the chlorinated water will provide more consistent access to clean water in a more sustainable, community-driven way.

The map above unfortunately is not high resolution but provides a sense of the potential impact of the chlorination systems. The villages that appear in color are those that would be supplied clean drinking water via the new systems; the villages in gray are those in which clean drinking water will continue to be supplied by our current water filter project.

VCU GH2DP Honduras Trip: A Day in the Mountains

Hiking to Chorro Viento
Yesterday we got up early and left Olanchito to drive out to the rural, mountainous area where the people we serve live. This is a large area that consists of 17 villages and roughly 2,000 people. Because of logistical issues we have only visited 2 of these villages in the past (La Hicaca and Lomitas) and have coordinated with our community partners to have people from the outlying villages come see us in these places. Practically speaking, this means that some people have to walk 6 hours (each way) over mountains in the hot sun (it's typically in June and we are near the equator = hot, hot, hot) just to see us in clinic.

We were excited yesterday to have the opportunity to visits a few additional villages we have never
En route to Chorro Viento
been to: La Culatta and Chorro Viento. Our primary goal was to assess older water catchment infrastructure and to see if a new chlorination project is feasible and acceptable to people living in areas that would be served by the new technology.

We could drive to La Culatta but had to hike out to Chorro Viento; this was a 30 minute "walk," at least for people living in the area. For us it was more like 60 minutes and was as strenuous as any serious hike I have ever been on in the United States. Keep in mind this was the easiest village to reach and it's January-far cooler than June. I have always respected the mental and physical toughness of people living in the area but this has given me profound new respect. It is not uncommon to see a woman in her 70s walk 3-6 hours to come see us wearing what amounts to plastic shower sandals; I am confidant I could not keep pace with these women.

When we reached Chorro Viento we also got to see a project that was created in partnership with a group from the European Union: a working turbine that supplied power to this village. This is the only village in the region with power and was made possible by their proximity to a local river/ waterfall. The project was incredible and people in the village had enormous pride in the
Cistern in La Culatta; there are 4 of these
in the region supplying water to 5 of the
17 villages we serve; the water is not
safe to drink but a new chlorination
project may be able to provide clean water 
technology. What was truly amazing is the power poles-every bit as large as those found in the US-were carried up the mountain by people from the village. No heavy equipment could reach the village so the poles were planted by hand. The work must have been unbelievably strenuous.

People do so much with so little in the area, and a little really
does go a long way. I left yesterday with a renewed sense of admiration for the people living in the area and with a strong desire to do more to help people in the region. We are hopeful we can continue the many productive partnerships we have established in the region to help improve the health of its people. It is a great privilege to be able to come here, to be welcomed into the communities, and to be given the opportunity to help.
The region has traditionally had a problem with poor indoor
air quality related to poor stove ventilation in homes. Many homes have
now had improved ventilation systems installed and are
effectively ventilating smoke from homes
We also brought enough anti-worm medication
to provide another dose to everyone living
in the region (this is part of a long-term longitudinal
regional project to decrease the intestinal
worm burden) 

Tuesday, January 14, 2014

VCU GH2DP Honduras Trip: A Day of Meetings in Olanchito

Meeting with the local Minister of health and his staff

Our first full day in Olanchito was a whirlwind but very productive.

We met with the local Minister of health and his staff and discussed our work to date and future collaboration.

Meeting with our local community partners
We then met with our local community partners and thereafter with staff from the Pico Bonita Foundation. We discussed collaboration on new water chlorination systems that can provide clean drinking water to 5 of the 17 villages we serve; we are very excited about this potential project.

Meeting with the Pico Bonita Foundation
Today we are traveling to the mountains and will be hiking out to several villages (Chorro Viento and La Culata) to meet with people and investigate old water procurement infrastructure. Will then meet with our community partners in La Hicaca.

More to come!