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!

Friday, January 10, 2014

VCU's Global Health & Health Disparities Program Sets Off for Honduras (Again!)


Traveling to La Hicaca 
Our group leaves this Sunday to meet with our community partners and the local Ministry of Health in Yoro, Honduras. We have traditionally used our January trip to meet with our key partners, review information from the prior brigade and to help lay the groundwork for the subsequent large-scale, clinical brigade in June.

Since 2008 we have been serving a series of 17 villages with approximately 2,000 people in rural, mountainous northern Honduras. People in the region have little to no access to healthcare and suffer from fundamental environmental health pressures (such as lack of access to clean water and latrines). 

We have a large-scale water filter program in the region that has been active since 2008. To date we have distributed over 350 water filters, each of which can provide clean drinking water to an entire family for 2 years (or more). We estimate approximately 75% of the people in the region have access to clean drinking water as a direct result
Preparing water filters for distribution 
of this program. Anecdotally, less children are developing (and occasionally dying from) diarrheal illness. More objectively, the incidence of severe diarrheal illness reported to the Ministry of Health has halved since the inception of the program. 

One of our projects this past June, a Chagas disease knowledge and attitudes survey, was performed at the request of the local health ministry. Chagas disease is a parasitic disease that is common in Latin America and is associated with severe cardiac and gastrointestinal morbidity. We will be sharing the results of the project with our partners this upcoming week; we are excited to discuss study implications and next steps.
Working on the indoor air quality project

Two years ago the health ministry and local leaders asked us to investigate the problem of indoor air pollution. A now-third year VCU medical student, Audrey Le, formally assessed the issue and found certain home characteristics were associated with respiratory symptoms. Subsequently we discovered many stoves were in a state of disrepair and not effectively ventilating smoke. This upcoming week we will be meeting with a local non-profit organization who may be able to help repair these defective stoves; we are excited about this potential collaboration.

Additionally, we are excited to discuss several upcoming surveys we hope to administer in June: looking at knowledge, attitudes and risk factors for intestinal helminth (worm) infection and a survey on women's health issues. We also are partnering with a VCU undergraduate group, Engineers Without Borders, to explore a novel rain catchment technology (to help provide clean drinking water) and will be conducting a survey focused on barriers for optimal use of water filters

Clinic in Lomitas
During next week's trip we will also be supplying anti-helminthics to help bolster regional efforts for intestinal worm control. We will also be doing the groundwork for our upcoming clinical mission; figuring out key logistics such as clinic space, how to recruit patients, et cetera. 

I will post about our trip either during the trip or shortly thereafter; stay tuned. Dr. Gonzalo Bearman will also be posting about the experience, be sure to check out his blog. You can also follow our progress on twitter here

Friday, December 13, 2013

Chikungunya: Now in the Caribbean

Map needs to be updated to now include
the Caribbean (cdc.gov)
It's official: Chikungunya has now been reported in the Caribbean. According to the World Health Organization (WHO) there have been 2 confirmed, 4 probable and 20 suspected cases of the mosquito-borne viral illness in Saint Martin (as of 12/10/13).

Chikungunya is a viral illness carried by mosquitoes that was first isolated in Tanzania in the 1950s. The name derives from the Kimakonde language and means "to become contorted." Profound joint pain leads to a 'stooped over' appearance, thus the name.

Symptoms of acute infection are nonspecific and are similar to dengue, with fever, headache, nausea, muscle and joint pains and fatigue. Peculiar to this virus, some people can have longstanding joint pain that can last for months, even years. There is no vaccine to prevent this illness and no treatment (other than supportive care).

Chikungunya is endemic in Southeast Asia and Africa. In recent years the disease "emerged" in these areas; in 2005 there were outbreaks on islands in the Indian Ocean with subsequent spread across India; a related outbreak occurred in Italy in 2007, as well.

The WHO report is significant in that this is the first time we have seen sustained transmission of this disease in the Caribbean. It's not surprising that we are seeing this (see here for a blog post I wrote about the potential for the disease to emerge in the US) as one of the primary mosquito vectors (Aedes aegypti) is the same for dengue and Chikungunya, and Aedes aegypti mosquitoes and dengue are already widespread in the Caribbean and Latin America. Disturbingly, Chikungunya is also transmissible by Aedes albopictus ("Asian Tiger") mosquitoes; this species has a wider geographic range than Aedes aegypti and can thrive as far north as Chicago.

Unfortunately the Chikungunya outbreak in Saint Martin likely heralds future sustained transmission throughout the region. Although rarely deadly, the disease can be associated with significant morbidity (long-term joint pain and fatigue). Aggressive surveillance and mosquito control efforts are needed.

Click here for the WHO report.

Tuesday, December 3, 2013

Drs. Lee, Collins and Bucheit Honored for Their Work with the Stewardship Interest Group of Virginia

The blogger with Drs. Lee, Collins and Bucheit in April 2013
Congratulations to Drs. Kim Lee, Rebeccah Collins and John Bucheit who were honored with the Clinical Pharmacy Practice Achievement Award at the Virginia Society of Health-System Pharmacists' Fall meeting for their work in creating the Stewardship Interest Group of Virginia (SIGoVA). SIGoVA is an interest group for people involved in Antimicrobial Stewardship in (and around) Virginia, and is a forum for people to come together to share ideas and best practices in stewardship.

To find out more about SIGoVA please visit the SIGoVA website or email stewardship@vshp.org.

Congrats again to Drs. Lee, Collins and Bucheit!

Sunday, December 1, 2013

World AIDS Day: Many Gains, Much to Do

Today is World AIDS Day; this is the 25th anniversary of the event. In the past quarter century there have been incredible gains in both HIV prevention and treatment, turning the disease into one that was nearly universally fatal to what is for many a chronic illness with a near-normal life expectancy. On the patient level the gains that have been made are due to antiretroviral drugs ("ART"); access to these life-saving drugs is still a major issue in much of the world, however.

In 2012 there were 2 million new HIV infections and 1.6 million HIV/AIDS related deaths. There are an estimated 35 million people living with HIV globally, with approximately 75% of all new infections occurring in sub-Saharan Africa.

I volunteered providing medical care in a small village in rural Kenya back in 2001. I remember having a conversation with a local health worker about HIV in this particular community and was amazed when she told me the HIV prevalence was over 40%. At the time the people living in the area had essentially no access to life-saving ART and many of the patients I saw had findings consistent with advanced HIV/AIDS and more likely than not are now dead. HIV/AIDS absolutely has devastated many communities in sub-Saharan Africa.

cdc.gov
The picture is not entirely grim, however. The President's Emergency Plan for AIDS Relief (PEPFAR) has led to millions of people in Africa receiving ART, and it is estimated that one million new infections in children have been prevented over the past decade. Many people who once had little to no hope of obtaining ART (such as those living in the community I described above) can now do so.

In the United States it is estimated that 1.1 million people are living with HIV, with 1 in 5 people
cdc.gov
unaware they have the infection. There are an estimated 50,000 new infections per year. There are racial disparities in HIV infection risk that are believed to be due, at least in part, to differences in access to care, poverty and discrimination. Although the incidence of new infections is going down in some subgroups (such as black women), it is increasing in others (such as men who have sex with men).

Much more needs to be done to prevent new infections, identify new infections early and to get patients with HIV into care. Health disparities need to be addressed both in the U.S. and globally. New therapies need to be developed (including a preventive vaccine).

See here for some terrific resources on HIV/AIDS, including more about World AIDS Day.

Tuesday, November 26, 2013

Medical Literary Messenger: Inaugural Issue Now Available

Congratulations to my friend and colleague Dr. Gonzalo Bearman, whose brainchild The Medical Literary Messenger has published its first issue! Special congratulations also go out to Brie Dubinsky and Rachel Van Hart, as well, whose phenomenal editing has produced a terrific product.

The Medical Literary Messenger is an online literary journal focused on the "healing arts," publishing works in a variety of formats. The first issue can be found here.