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 12^th, 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 13^th, 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.

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!

Global Burden of Disease Study: More Free Online Interactive Graphics

In preparing for a journal club I am leading later today on one of the excellent Global Burden of Disease (GBD) study articles I came across some new interactive graphics available online at the Institute for Health Metrics and Evaluation (IHME) site. One particularly nice feature is the "GBD Insight" graphic which provides annotated data by country and displays a variety of different metrics.  Below are some screenshots:

Honduras displayed in the "GBD Insight" program (IHME)

A close up of the data for Honduras (IHME)

The data from the GBD study are really impressive. More impressive still is the excellent way the IHME is able to translate these data into meaningful and easy to understand interactive graphics. Definitely worth taking a look!

Honduras: DALYs in 2010 (IHME); note: high burden of non-infectious diseases (in blue)
including major contributions from violence and road injuries (green)  

GH2DP Featured on VCU News Site

The VCU News center published an article about our work in rural northern Honduras and the Global Health & Health Disparities Program (GH2DP) today. The article can be found here.

VCU's Global Health & Health Disparities Program/ HOMBRE Team Sets Off for Honduras! [Again!]

Tomorrow our team leaves on our medical and public health brigade to the La Hicaca area of northern Honduras. 

Town of La Hicaca; this is one of the sites
where we see patients in Honduras

Since 2008 we have been serving people across a series of 17 villages in and around the La Hicaca area of rural Honduras. This is the 6th consecutive year where we have held large-scale medical clinics in the region.  

Since the inception of our program (the VCU Global Health & Health Disparities Program, or GH2DP), we have had over 8,000 direct patient encounters, and have helped distribute over 200 water filters (each of which will provide clean drinking water to an entire family for 2+ years). We also have provided de-worming therapy multiple times a year according to WHO standards. 

Traveling to La Hicaca

It is important to note we are absolutely indebted to our community partners (see here for an interview with Father Pedro O'Hagen) as well as our non-profit partners the Honduras Outreach Medical Brigada Relief Effort (HOMBRE) and the Golden Phoenix Foundation. The work we do is a collaborative effort across multiple non-profit organizations and involves myriad professional schools and training programs as well as many independent healthcare professionals. Simply put, there are a lot of moving parts to these brigades!

This year our group includes 5 rising 2nd year medical students, 2 rising 4th year medical students, 2 pharmacy students, 3 internal medicine residents, 2 pediatrics residents, 1 pediatric fellow, 2 nurses, 3 attending physicians, 1 PhD microbiologist among others; all told there will be nearly 30 people in our group. 

Drs. Mason, Bearman and Stevens working on the
water filter program, La Hicaca

There are approximately 2,000 people in the area we serve, most of whom have extremely limited access to healthcare (see here for a study we did in 2011 looking at people’s ability to access care in this area). The nearest public hospital is two and half hours away by truck, making routine (and oftentimes even emergent) access to medical care nearly impossible. For the majority of people we see we function as their only access to healthcare. 

We had a small team 'on the ground' in the area back in January (see here for previous blog entries related to that trip). During the January trip we laid the groundwork for our current brigade, meeting with community partners, defining our mission and navigating logistical issues (what services we will provide, where we will set up the clinics, et cetera). 

Scouting out sites for our medical clinics in Lomitas,
January 2013 (these buildings are where we will hold
clinics for several days during our current brigade)

Although a big component of our work is focused on providing medical care, we have multiple public health programs as well. One of these projects is the aforementioned large-scale water filter program. To date, we have distributed 200 water filters and estimate that approximately 75% of the population in the region now has access to clean drinking water. Our data indicates that these filters have both microbiologic and clinical efficacy, and we have incidence data on diarrheal illness from the Ministry of Health that indicates diarrheal disease has been cut roughly in half since we started this program. More importantly, there has not been a single pediatric death from diarrheal illness in the region over the past 18 months. This year we will distribute another 100 water filters; our ultimate goal is to provide everyone in the area with access to clean water. 

Meeting with local health minister, Olanchito,
January 2013

Another big project for us over this past year has been assessing the impact of indoor air pollution on the health of people in the region; our local partners noted this was a major issue and asked us to do a formal needs assessment. In June of 2012, Audrey Le, now a rising third year medical student at VCU, did a needs assessment looking at indoor air pollution in the region. She found that indoor air pollution was associated with negative health effects, although many people were unaware of the dangers of indoor air pollution. On further examination of the issue this past January, we discovered that indoor air pollution was at least partly related to improperly installed (versus degraded) stove ventilation pipes. On our current brigade Audrey Bowes, a rising second year medical student at VCU, is leading an education program focused on raising awareness of the negative health effects of indoor air pollution and how stoves can be repaired to improve indoor air quality. We are excited about this project and believe it has the potential to significantly improve the health of the people we serve. 

Example of a properly installed ventilation
pipe; many of the pipes we inspected had
gaps between the pipe and either the stove
or wall (via which smoke could escape and
pollute the indoor environment)

An additional project we are doing on this brigade is a survey on Chagas disease that is being led by Dr. Summer Donnovan, a pediatric infectious diseases fellow at VCU; our community partners have identified this as a major issue in the region. Chagas disease is one of the neglected tropical diseases, and is an insect-borne parasitic infection that affects people in the Americas, especially parts of rural Latin America. It is estimated that 11 million people are currently living with this infection, and untreated this disease persists for life. Chagas disease is associated with major morbidity: over time the infection can lead to heart failure and death from arrhythmias, as well as dilatation of the esophagus and colon with attendant gastrointestinal issues.

Finally, we a have a third project that is looking at people's overall satisfaction with, and the limitations of, the care we provide on our brigades. This is a quality improvement project being led by Dr. Jeffrey Wang and Kate Pearson, a rising 4th year VCU medical student. 

We are very excited about this brigade and are hopeful our efforts will improve the health of people living in the region we serve. For anyone interested in our work, please consider following this blog for updates on the brigade. My friend and colleague Dr. Gonzalo Bearman will also be providing updates on the trip (his blog can be found here). 

VCU GH2DP Honduras Trip: Final Update

Scouting out potential clinic sites
in Lomitas 

Good morning from Olanchito! Here are some additional thoughts from yesterday's activities.

Yesterday we traveled from La Hicaca to Lomitas. Lomitas is an even more remote mountainous village that is also accessible by truck.

We met with local community leaders in Lomitas and learned that this area is significantly more accessible to approximately half of the people in this region (than La Hicaca). Based on our prior experiences in this area (we held clinics at Lomitas in 2009-2011), we estimate we may have a 20% increase in patients during our next relief mission if we set up clinics in both La Hicaca and Lomitas.

We were able to scout out potential clinic sites and committed to holding several days of clinic in Lomitas during our May-June trip.

Overall this has been a highly successful trip. We were able to share information with the local Ministry of Health and community leaders, and hear from them how we can better support their efforts to improve the health of people in this area.

One of our future clinic sites, Lomitas

Our goals are to expand our water filter program to cover every home across the 17 villages we serve, to make our clinical services more accessible, and to follow-up on last year's indoor air pollution survey with an educational campaign. Additionally, as Chagas disease was identified as a major health issue in the area we will push forward with a survey project designed to assess people's knowledge about the disease in the region. Lots of work to do before the end of May, but we leave with renewed energy and purpose.

River in Lomitas; our prior research identified that a large
portion of the population here obtains their drinking water
directly from this river, which, although beautiful,  is
contaminated with animal waste

Today we travel back to San Pedro Sula and, tomorrow, back to the US.

You can learn more about the VCU Global Health and Health Disparities Program (GH2DP) and our work in Honduras here.

VCU GH2DP Honduras Trip Update: Days 3-4

Sharing data with the Health Minister, Olanchito

Yesterday morning we got up early and met with the Health Minister in Olanchito. We shared data from the projects we undertook on our June 2012 trip, including our water filter testing project, anemia point prevalence survey and indoor air quality project. We discussed current health issues facing the communities we serve in and around La Hicaca, and discussed ways we can support the Ministry of Health improve the health of the communities we serve.

Dr. Patrick Mason doing an impromptu
clinical consultation 

We then traveled up to La Hicaca where we had a busy day; we visited with local community leaders where we shared the results of the aforementioned projects, and also did a few impromptu clinical visits, inspected the local cistern (a fairly sophisticated structure that pipes in water from two or so hours away, but that has fallen into disrepair) and also inspected several indoor stoves and water filters.

Sharing data with local community
 leaders in La Hicaca

Examining the cistern above La Hicaca

Inspecting water filters

We found out some very interesting things in our conversations with the Health Minister and local community leaders. In our indoor air quality survey we identified that, in general, there was poor understanding about the connection between smoke inhalation and respiratory problems. Our in-country contacts confirmed this, and also helped us identify that indoor smoke is often generated by poorly maintained stove chimneys. This is important as these chimneys can be repaired relatively cheaply and be made to more efficiently ventilate smoke. We were asked to conduct an educational campaign during our next brigade highlighting the relationship between indoor smoke and respiratory health.

School in La Hicaca

We also visited the school where we typically set up our clinic and learned the roof has fallen into disrepair.

Here is an example of a well-connected
chimney entering a stove; we found that
many chimneys were not attached
to the stoves at all, allowing smoke to
freely enter into the home 

We were welcomed into local homes to spend the night and then traveled on to an even more remote village, Lomitas, today. I will blog more on today’s events in a future post. 

You can learn more about the VCU Global Health and Health Disparities Program (GH2DP) and our work in Honduras here. 

VCU GH2DP Honduras Trip Update: Day 2

Honduran countryside

Today we traveled from La Ceiba to Olanchito and met with some of our local community partners.

Our medical and public health work is focused in and around the rural mountain village of La Hicaca. This area includes 17 villages and approximately 2,000 people; as previously noted, these people have very limited access to medical care.

Olanchito, Department of Yoro

Olanchito is the nearest city with a public hospital; this is a good 2 hours away from La Hicaca via truck. This distance is a major barrier to accessing care for people in and around La Hicaca, most of whom do not have access to vehicles.

Today we met with our colleagues from the local Catholic church (which has a major regional presence) as well as a few local volunteers. We discussed the results of last Summer’s water filter project, indoor air quality survey and our anemia point prevalence survey, as well. More importantly, we started to lay down the ground work for this June’s medical and public health trip.

Sharing the results from our June projects with our
community partners (photo credit: Dr. Gonzalo Bearman)

We were able to better identify how many households in the region we serve have water filters; at this point we have 141 water filters 'in the field' that are active (each water filter has to be replaced every 2 years). As there are 248 families in this area we now have provided a source of clean drinking water to approximately 57% of families. Our goal-an ambitious one-is to distribute water filters to the remaining 107 families this Summer. Ultimately we would like to help the local communities in this region develop more sustainable water sources (such as wells), however, local infrastructure (roads, especially) have precluded such projects to date.

We also discussed ways we can provide more people in this region with direct medical services during our June trip. Only 3 of the 17 villages we serve are accessible via truck, and we estimate we only provided care to approximately 20% of all of the people in this region during last year’s trip. By setting up our clinic at multiple villages during this upcoming trip we may be able to provide care to more people. We will drive to Lomitas on Wednesday to see if having a clinic there will be feasible.

Tomorrow we meet with the Minister of Health and then travel up to La Hicaca. I will update the blog when we get back to Olanchito (no WiFi in the mountains).

You can learn more about the VCU Global Health and Health Disparities Program (GH2DP) and our work in Honduras here.