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.

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

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! 

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!

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!!!

Update on VCU's Global Health & Health Disparities Program (GH2DP) Presented at Infectious Diseases Grand Rounds

With Dr. Bearman

Today my friend and colleague Dr. Gonzalo Bearman and I presented an update on our work in Honduras at VCU's Infectious Diseases grand rounds.

We provided a brief overview of the evolution of our work in the Department of Yoro, Honduras, since 2005, highlighting our 4 part mission (direct patient care, public health, student and resident exposure to global health concepts and research) and discussed the evolution of the Global Health and Health Disparities Program here at VCU.

Since 2008 we have distributed 400 water filters and now provide clean drinking water to approximately 1,500 people living across 17 villages. The incidence of severe diarrheal illness being reported to the local Ministry of Health has been halved since the inception of our program, and no child deaths from diarrhea have been reported in the past 18 months. Although our program is small in scope we believe it is having a positive impact on the communities we partner with.

To boot, we now support a residency track within VCU's Internal Medicine Training Program designed to give particularly motivated residents robust education in and exposure to global health concepts. As well, we have started a Student Scholars program that will afford similar opportunities to medical students.

To find out more please visit our website. To find out how to support our program ($25 dollars will buy a family a water filter that will provide clean drinking water for 2 years or more!) please follow this link.

Congratulations Gabriela Halder-Manuscript Published on Research in Honduras

Here is a blog post (used with permission) from my friend and colleague Dr. Gonzalo Bearman about work one of our students did in Honduras (great work Gaby!); the original post can be found here.

Congratulations Gabriela Halder! As a member of our Honduras research and clinical team (2011), Gaby has successfully published a manuscript on water sanitation, access and self reported diarrheal illness in rural, mountainous Honduras.

For the full manuscript in PDF, click here.

Gaby's work was presented at the American Public Health Association national conference in 2011 where she was recognized with a research award.

Fantastic work!

Dr. Gonzalo Bearman

Inaugural VCU Global Health Symposium

VCU Global Health and Health Disparities research team reunion
(from left to right: Dr. Bearman, Kate, Jackie, Gaby, Audrey)

Today the inaugural VCU Global Health Symposium was held in Richmond, Virginia, bringing together faculty and students from across the university who are involved in global health efforts.

One of the key goals of the meeting was to provide a platform for sharing ideas, networking and developing the framework for future collaboration. The meeting featured short talks focused on research at both the community and international levels, and a poster session.

Dr. Moskowitz presenting on a national rheumatic fever
project in the St. Vincent and the Grenadines

Researchers presented on both local community health projects (including our clean water project in northern Honduras, as well as a skin cancer prevention project in Peru and a dental project in Jamaica) and a later session focused on country-wide global health efforts. These included a project focused on rheumatic fever surveillance in St. Vincent and the Grenadines, trauma infrastructure development in Latin America, student education projects in India and medical simulation education in Poland. The meeting was capped off with an inspiring talk on global health research by the dean of the VCU School of Medicine Dr. Jerome Strauss.

Twenty students and residents presented 22 posters related to global health research and health outreach. Our northern Honduras group was well represented with 4 students presenting 5 posters (way to go Jackie/ Gaby/ Audrey/ Kate!).

I left the meeting inspired, re-charged and with some fresh ideas; better yet, our group now has some potential new collaborators. I am already looking forward to the 2014 symposium!

VCU GH2DP Honduras Trip Update: Potpourri

Up early in Olanchito, working on our report for the Health Minister and waiting for the day to ramp up.

Here are a few additional (somewhat random) thoughts on some of the things we saw yesterday. 

One of the key pieces of advice I give my travel clinic patients is to be very careful not to ingest municipal water in developing countries (this is a major risk factor for developing diarrheal illness). This includes not eating fresh vegetables (which likely have been washed in bacterial-contaminated municipal water). The caveat to this is that these foods may be okay to eat if you know they were washed with clean water. 

Here is a picture of the lettuce for yesterday's lunch meeting being washed using a water purification system; I went for it, so far so good. 

Lettuce being washed by water purification system

Picture from local pharmacy

Another thing that always surprises me is how many antibiotics one can buy over the counter at pharmacies here; one can find almost anything, including injectables. You only need money to access these medications: they are available without prescription. 

I have never seen local data on antibiotic resistance, but I imagine it is high (at least in the cities) for some of the most common, cheapest antibiotics (such as amoxicillin, which is available here in supermarket checkout lines, like gum and candy are in the US). 

Beyond driving antibiotic resistance, inappropriate antibiotic use can lead to drug toxicity and treatment failure (prescribing the right antibiotic for the right condition for the right amount of time is often tricky for physicians; if the antibiotic is chosen without professional guidance the likelihood its use will be appropriate is low). 

Some good information from the WHO on the appropriate use of antibiotics (including in developing countries) can be found here.

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

VCU's Global Health & Health Disparities Program Sets Off for Honduras

Drs. Mason, Stevens and Bearman meeting with community
leaders and the minister of health, Olanchito, Honduras,
January 2012

Today our team leaves to meet with community leaders and the ministry of health in Yoro, Honduras. 

Traveling to La Hicaca

Since 2008 we have been serving people across a series of 17 villages in and around the La Hicaca area of rural Honduras. There are approximately 2,000 people in this area, 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). We have a large-scale water filter program in the area, and participate in direct medical care, as well. We work closely with our community partners to support health projects they identify as being high yield (some past examples of such projects include a water chlorination education campaign, an anemia point prevalence survey and a survey project examining indoor air pollution).

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

Every January a small group of us goes down to meet with our community partners and the ministry of health. Our purpose with these trips is three-fold: to prepare for our (larger) June medical trip, to identify new ways in which we can support the people we serve, and to report back on our findings from the previous trip’s work. This year we will be presenting our data from the anemia point prevalence survey, from our survey project on indoor air pollution, and from our study examining the clinical and microbiologic efficacy of our water filter program. Of note, the 2 lead student researchers on the two latter studies just presented their data at yesterday's Virginia ACP Associates' meeting. 

Working on the anemia point prevalence survey, La Hicaca,
June 2012

Since the inception of our program (the VCU Global Health & Health Disparities Program, or GH2DP), we have had over 8,000 direct medical and pediatric encounters, and have distributed over 200 water filters (each of which will provide clean drinking water to an entire family for 2+ years). We also provide de-worming therapy and have been involved in numerous other projects since 2008.

Providing clinical care, La Hicaca, June 2012

For anyone interested in our work, please consider following along as we conduct our planning trip. I will attempt to blog "from the field," and will provide updates in as close to real-time as I am able.

Congratulations Jim, Audrey and Jackie! VCU Students and Residents Present at the VA ACP Associates' Meeting

Congratulations to Audrey Le, Jackie Arquiette and Dr. Jim Pellerin, all of whom have done research with our group, who presented their respective research projects at the Virginia American College of Physicians Associates' Meeting today. Their research really spans the gamut of "Bugs, Drugs & Global Health."

Audrey Le presenting her research 

Audrey Le, a second year medical student at VCU, presented her project looking at indoor air pollution in and around the remote village of La Hicaca in northern Honduras. She found a link between stove location and respiratory symptoms, and her data will inform our future efforts to improve indoor air quality in this area.

Jackie Arquiette presenting her research 

Jackie Arquiette, also a second year VCU medical student, presented on her research looking at the clinical and microbiologic efficacy of our water filter program in this same area. She found decreased self-reported diarrheal illness in patients with water filters, and she found little diarrhea-genic bacteria in the water she tested from our water filters. Her findings support the continuation (and expansion) of our water filter program.

Dr. Jim Pellerin presenting his research 

Dr. Jim Pellerin, a VCU medicine resident, presented his findings categorizing and assessing compliance with antibiotic stewardship recommendations at our medical center. His findings are compelling and will help us refine our stewardship program efforts moving forward.

I know I speak for my research collaborators when I say we are very proud of all three of these very talented student and resident researchers.

Household Chlorination Program to Improve Drinking Water Quality in Rural Haiti

Local creation of sodium hypochlorite solution in Haiti (http://www.cdc.gov/safewater/chlorination.html) 

This is an interesting article on a long-term program in Haiti using household chlorination to improve drinking water quality by Harshfield and colleagues. They evaluated the utility of a Safe Water System (SWS) program that was established in a rural part of Haiti in 2002. In 2010 they conducted a survey with concurrent water testing of 201 SWS program participants as well as 425 control households. These authors found that 56% of participants were correctly treating their water with chlorine (as opposed to 10% of controls) with a 59% odds reduction in diarrheal illness in children under 5 (OR 0.41, 95% confidence interval 0.21-0.79). The interesting thing about this study is the SWS program was sustainable and was having a positive impact 8 years after its creation.

We have been working in the Yoro area of northern Honduras since 2008, with our efforts focused in and around the remote, mountainous village of La Hicaca (find out more about our work here). Our public health work is primarily focused on improving access to clean drinking water via a water filter program. The above study is intriguing in that it could provide an alternative, potentially sustainable mechanism to improve access to safe drinking water for the population we serve. However, Gaby Halder conducted a large survey on access to technologies to treat drinking water in 2011 of our population and found very few people used chlorine. This was largely due to poor chlorine access due to financial and geographic barriers. If a SWS program is to be employed in a rural, remote setting such as the one we practice in, addressing these key barriers will be critical.