Monday, March 23, 2015

Global Health Resources Guidebook for Students, Residents and Fellows

In preparation for a 'breakout' session at the upcoming 3rd Annual Virginia Commonwealth University Global Health Showcase I put together a resource guidebook for students, residents and fellows interested in global health; this can be found here.

This 'book' contains a number of links to great online resources: from lists of post-graduate training programs in global health to international and domestic volunteer opportunities to lists of great global-health related books and journals. Additionally, it links to a number of free (!!) online training resources for global health.

Thursday, March 5, 2015

Special Guest Blog Post from Nadia Masroor: February GH2DP Outreach Trip to Yoro, Honduras

This is a special guest blog post by Nadia Masroor, who has joined us on the last few health outreach trips to Yoro, Honduras, and who recently returned from Honduras: 

Our February trip to Olanchito and La Hicaca provided some excellent feedback on several ongoing projects. On Thursday February 12th, Dr. Bearman and I had the wonderful opportunity to meet with Padre Pedro and the rest of the Catholic priests in Olanchito for lunch.

Afterwards, Dr. Bearman, Padre Pedro, and I met with the Pico Bonito Foundation to discuss their progress on current projects. Pico Bonito has successfully installed chlorination systems in La Hicaca, Chorro Viento, and Puerto Rico. Those living in these three villages are encouraged to use the chlorinated water cisterns for their water supply. In order to determine the efficacy of chlorination, the 2015 brigade team will plate and incubate chlorinated water to assess microbiological growth. As for those who do not have access to the cisterns, an estimated 90-100 filters will need to be distributed in June 2015.

Hike to Chorro Viento
The Pico Bonito Foundation has recently installed new cook stoves in many of the homes in LaHicaca. According to the foundation, each cook stove costs about $100. We plan to continue this project by funding Pico Bonito to install another 15-20 cook stoves this year. Padre Pedro and Rosa, who is the nurse providing care to the people of La Hicaca and surrounding villages, will determine which impoverished homes are most in need of cook stoves. In conjunction with the cook stoves, the Pico Bonito foundation has also agreed to install new latrines for the people in Sector La Hicaca. Approximately 15-20 latrines, which cost $100 each, are projected to be built throughout the village this year. Lastly, in order to replace the deteriorated school latrines, we have requested 4 new latrines to be constructed as well, which have been estimated to cost $800-$1000. To say the least, our meeting with the Pico Bonito Foundation has enlightened us on the plethora of projects we can initiate in order to improve living conditions in La Hicaca and surrounding villages.

Later that day we met with Dr. Alma Nunez from the Ministry of Health to discuss the June 2015 brigade. Historically, La Hicaca has been the clinic site for 3 days and Lomitas has been the clinic site for 2 days. This year, however, Padre has advised spending 2.5 days in La Hicaca and 2.5 days in Lomitas. By increasing clinic time in Lomitas, Dr. Nunez and Padre hope that the brigade will be able to extend its care to more people. The total number of brigade clinic sessions will remain the same. In addition, Padre Pedro will work with the Ministry of Health to provide dental services for 3 days, covering both La Hicaca and Lomitas.

Based on Brock University’s findings from the June 2014 brigade, the majority of the population suffers from Trichura, which cannot be effectively treated with albendazole alone. Thus during this year’s brigade we will be distributing oxantal pamoate in addition to the albendazole to provide enhanced Trichura coverage. Padre Pedro has taken on the task to inquire and purchase both the albendazole and the oxantal pamoate.

Cistern in Chorro Viento
Dr. Nunez has proposed aggressively promoting the brigade via Radio Catolica broadcast in order to increase awareness and participation. Therefore, Padre Pedro will collaborate with Radio Catolica in order to provide the brigade dates and details about the services offered. We hope to see an increase in the number of people who attend the brigade in June.

On Friday February 13th, we traveled to La Hicaca so that could meet with Rosa in el Centro de Salud. Rosa graciously agreed to continue sanitation education and to take on the latrine and cook stove projects with Pico Bonito. She has also requested an additional 300 speculums for cytology exams.

In the afternoon, we had the opportunity to examine the water cisterns with the new chlorination systems in La Hicaca and Chorro Viento. We drove to La Culatta and climbed up to Chorro Viento. The 45-minute hike was definitely not an easy one and made me appreciate the 5-6 hour journeys many people endure to come to the brigade. Below are some pictures of the cisterns and the chlorination system installed.

New chlorination system in Chorro Viento

We attended Mass on Friday evening, traveled back to San Pedro Sula Saturday morning, and flew back to the US on Sunday. Although a short trip, we have gained a substantial amount of knowledge on current programs implemented in La Hicaca and surrounding villages.

I cannot wait to return in June- to see the progress and of course, to see my friends.

Monday, February 16, 2015

2015 GH2DP-Engineers Without Borders Collaboration

VCU EWB students working with a 
biosand filter prototype 
We are very excited to be collaborating again with VCU's Engineers Without Borders (EWB) chapter for our upcoming outreach trip in June.

This year there are plans on trialing a new biosand filter that may ultimately provide clean drinking water to people in very remote regions of Honduras. The EWB group has created a prototype device and has plans to systematically study this over the next few months and on the ground in Honduras this upcoming June. The group also will re-trial a novel water catchment device first deployed in Honduras in June 2014.
EWB students Lucas Potter and Kristina Kelly deploying a
novel water catchment device in La Hicaca, Honduras, June 2014

Friday, November 7, 2014

Ebola Outbreak Update: Updated WHO Information through November 4th

The WHO has released updated information regarding the current outbreak of Ebola.

As of November 4th there have been 13,268 cases with 4,960 deaths.

Although there have been declines in new cases in some districts in the three countries hardest hit by the outbreak (Guinea, Sierra Leone and Liberia) other districts have seen sharp increases.

In the United States there have been no new Ebola cases and of the 177 people who may have come in contact with an infected individual only 16 are actively being monitored (161 have completed 21 days of monitoring without developing Ebola).

Thursday, November 6, 2014

Congratulations to our GH2DP Student and Resident Researchers!

GH2DP Student Scholar Nehal Naik
in New Orleans
Congratulations to our GH2DP student and resident researchers who presented their research projects this week at the American Society of
Tropical Medicine & Hygiene's annual meeting in New Orleans
GH2DP Pathway Resident
Dr. El-Yafawi in New Orleans

Nehal Naik, now a second year medical student at VCU, presented his data on risk factors and knowledge about soil transmitted helminths in Yoro, Honduras. He also presented data on a novel water catchment device that was developed at VCU by students in the local chapter of Engineers Without Borders

GH2DP Student Scholar Rachel Pryor
Dr. Rama El-Yafawi, a senior global health pathway resident in VCU's Internal Medicine residency program, presented her data on barriers to use of water filters in Yoro, Honduras. 

Rachel Pryor, a GH2DP Student Scholar and MPH candidate at VCU presented her data on knowledge about and access to cervical cancer screening in Yoro, Honduras. 

Congratulations again to all of these terrific student and resident researchers!

Friday, October 31, 2014

WHO Ebola Update: 10/29/14

The latest WHO Ebola update document has been posted and can be found here. As of 10/27 there have been 13,703 cases with 4,922 deaths. Mali had its first case on 10/23, a 2 year old girl who traveled there with her grandmother from Guinea. In the US there have been 4 cases and 1 death. The outbreak remains uncontrolled in Guinea, Sierra Leone and Liberia.

Friday, October 24, 2014

WHO: Updated Ebola Outbreak Information

The latest WHO Ebola situation report can be found here. Key points:

1) As of 10/19 there have been 9,936 cases and 4,877 deaths
2) The outbreak in Senegal was declared over on 10/17
3) The outbreak in Nigeria was declared over on 10/19

Up until 10/19 there had been only 3 cases in the US (now 4 given the physician who has developed Ebola after returning from Guinea-not on the latest WHO document). For the 3 reported on in the WHO document there were 172 possible contacts of these patients 60 of who were past the 21 day incubation period and therefore deemed non-infected.

Saturday, August 16, 2014

West Africa Ebola Outbreak: August 15th Update

The WHO has released updated information on the total number of people affected by the Ebola outbreak in West Africa: as of August 15th there have been 2,127 suspected and confirmed cases with 1,145 deaths.

Cases are being reported in Guinea, Sierra Leone, Liberia and Nigeria.

The CDC has a lot of very nice, targeted health information about Ebola: see here.

Monday, August 4, 2014

Ebola Outbreak Update: July 31-August 1
The World Health Organization has posted updated information on the Ebola outbreak in West Africa.

Between July 31 and August 1 there were 163 new (presumptive) cases with 61 deaths; cases are being reported from Guinea, Liberia, Sierra Leone and Nigeria.

The total number of presumptive cases is now 1,603 with 887 deaths; at this point the outbreak is nowhere near contained and current infection control efforts appear inadequate. Unfortunately there are no Ebola-specific therapies available; treatment is supportive in nature and the disease carries a very high mortality rate (71-86% based on a recent report in the New England Journal of Medicine).

Total Ebola Cases/ Deaths Per Country to Date
As noted recently by CDC director Dr. Thomas Frieden "Ebola poses little risk to the U.S. general population." From an infection control standpoint preventing disease transmission is relatively easy, at least on paper and in resource-rich environments. The disease can be prevented by preventing contact with potentially infected blood and body fluids in people with suspected infection, coupled with aggressive contact tracing, monitoring and isolation of people who may have been exposed. This said, there are many barriers to effectively controlling the current epidemic, not the least of which is access to critical infection control resources and personnel.

One of the factors that promoted the expansion of the current outbreak was the long time it took for the outbreak to be recognized. Cases of people with a disease characterized by vomiting and diarrhea with a high mortality rate were first identified in clusters in Guinea in December 2013; the outbreak was not reported to international authorities until March 2014. As a global community we need to promote access to resources and technology that support the rapid detection and diagnosis of key infectious diseases; this is in all of our best interests. This current outbreak is yet another reminder that new (and old) diseases will continue to emerge and that something that emerges in a 'remote' part of the world can rapidly become a global issue.

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.