Category Archives: Haiti

Celebrating NTD Success Stories: Good News from Haiti

Caribbean, elephantiasis, END7, Haiti, lymphatic filariasis, NTDs, , , , ,
Emily Conron speaks with patients in Haiti suffering from chronic filarial lymphedema.

Emily Conron speaks with patients suffering from lymphatic filariasis in Haiti

During the month of October, END7 student supporters are celebrating NTD Success Stories — spreading the exciting news that many countries around the world have already made incredible progress towards the control and elimination of some NTDs. In recent weeks, there have been many new successes to celebrate, like the announcement two weeks ago that Mexico has become the third country to officially eliminate river blindness, and the exciting news Monday that William Campbell and Satoshi Omura were awarded the Nobel Prize in medicine for their discovery of ivermectin, a drug used to treat and prevent onchocerciasis and lymphatic filariasis. This month, in addition to these exciting announcements, we want to highlight four countries — Haiti, India, Sierra Leone and the Philippines — that have achieved success fighting NTDs. Each country has overcome their own challenges, ranging from earthquakes to the Ebola epidemic, to make sure communities receive the medicine they need. We think these stories help communicate not just the scope of the suffering caused by NTDs, but the hope we have of ending these diseases for good.

The poorest country in the Western hemisphere, with the highest infant mortality and lowest life expectancy, Haiti is a country with many challenges. But the story of Haiti’s success against NTDs is a powerful reason for hope. Nearly the entire population is at risk of contracting lymphatic filariasis (LF), a mosquito-borne NTD. Caused by thread-like filarial worms that live in the lymphatic system, LF causes painful swelling of the extremities (a condition known as elephantiasis) and genitals (a condition known as hydrocele). The high prevalence of NTDs like LF persists, in large part, because of poor access to water and sanitation. About nine out of ten Haitians in rural areas do not have access to clean, safe water, and almost half lack access to adequate sanitation facilities. These circumstances were compounded in the wake of the 2010 earthquake that killed at least 200,000 people and destroyed much of the nation’s infrastructure. Despite these challenges, Haiti is making incredible progress against NTDs and expanding its national NTD control program with the goal of eliminating LF for good.

Under the leadership of the Haitian government, a range of partners have assisted with the annual distribution of drugs to help prevent the spread of four NTDs: LF, whipworm, hookworm and roundworm. A critical aspect of the success of these efforts has been the training of more than 30,000 local community leaders to organize, promote and carry out mass drug administration (MDA), distributing medicine to everyone in at-risk communities.

Until the 2010 earthquake, Haiti’s Neglected Tropical Disease Control Program conducted MDAs only in the areas of the country where LF was most prevalent. The crowded capital city of Port-au-Prince, with relatively low levels of LF infection, was thought to be too difficult a setting to carry out MDA. But after two million people were left homeless following the earthquake, internal migration threatened to redistribute the disease. The Haitian government then decided to focus on national MDA coverage, with the aim of completely eliminating the disease and preventing redistribution.

By late 2011, at least one round of MDA had been conducted in all endemic areas of Haiti except the capital, Port-au-Prince. From November 2011 to February 2012, an MDA was conducted for the first time in the crowded metropolitan area. More than 80% of the population has now been reached with NTD medications, a tremendous accomplishment in a country facing many health and development challenges. In May of 2014, the U.S. Agency for International Development (USAID), a major partner of the Haitian government’s NTD program, delivered its one billionth treatment worldwide at a ceremony in Saint-Louis-du-Sud, Haiti, a testament to the country’s commitment and progress in the fight against NTDs.

Haiti is also an example of an integrated approach to combating NTDs, having successfully integrated its LF and soil-transmitted helminth (STH) control programs, which previously operated in separate units at the Ministry of Health. To supplement expanded MDA efforts, the country is also scaling up efforts to address the needs of Haitians already incapacitated by LF and to fortify table salt with medicine to prevent LF, an approach that has helped countries like China eliminate the disease. These efforts are supported by dedicated partners including the Pan American Health Organization, the Inter-American Development Bank, the U.S. Centers for Disease Control (CDC), USAID, the University of Notre Dame Haiti Program, IMA World Health and CBM.

Haiti is one of just four countries in the Americas where LF remains endemic, accounting for 80% of people at risk of the disease in the region. If the country can succeed in their effort to eliminate LF by 2020, it would be a major milestone in global efforts to end the disease. As Dr. Patrick Lammie, an immunologist with the CDC, told NPR, “If a country like Haiti, with all of the challenges that they’ve faced over the last few years, is able to achieve full national coverage, I think that is an important example for other countries, which are struggling to scale up their programs as well.”

Certainly, a country that has not just maintained, but expanded efforts against NTDs in the face of political instability and crippling natural disasters is a powerful example to the rest of the world. Haiti’s success demonstrates the power of country ownership, government leadership, partnerships and integrated and holistic public health programs in the fight against NTDs.

END7 supporters are excited to celebrate Haiti’s unfolding success story, a narrative of perseverance in the face of challenges — and the first of four inspiring NTD Success Stories in a month that’s already offered many reasons to celebrate!

A Wish List for 2015: 7 Achievable Victories in the fight against Neglected Tropical Diseases

BRICS, Haiti, Latin America and the Caribbean, NTDs, post 2015,

 

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By Dr. Mirta Roses Periago

A new year always brings about new hope and renewed commitments. 2015 is a pivotal year for the international community and also for the call to end neglected tropical diseases (NTDs). So, here goes my “wish list” for 2015, which includes seven achievable yet ambitious victories for the global health and development community.

1. A step closer to declaring Latin America and the Caribbean free of river blindness

In 2013, Colombia became the first country in the world, as declared by the WHO to have eliminated river blindness transmission, and Ecuador followed shortly after in 2014. These countries show what can be achieved with unwavering political will and sustained action.

Mexico and Guatemala have stopped transmission of river blindness and are already in advanced stages with the WHO to take the final steps towards verifying elimination.

So, I am confident that Brazil and Venezuela will be successful in targeting the Americas’ final cases of river blindness, located along their borders among the indigenous Yanomami community. Through south south cooperation, they have joined forces to ensure that the all the Yanomami receive access to the treatments they need – tackling the last stronghold of river blindness in the region.

2. Progress towards eliminating lymphatic filariasis in the Latin America and the Caribbean

About 13.4 million people across the Latin American and Caribbean are at risk of lymphatic filariasis (LF), nearly 80 percent of them in Haiti. Despite challenges in recent years, including a cholera outbreak and earthquake, Haiti has been able to reach the entire population – about 10 million people – through mass drug administration (MDA). I hope to see continued support from the Haitian government and partners to interrupt the transmission of LF.

Additionally, I hope to see Brazil eliminate LF from the last active site in the country, located in the state of Pernambuco. Brazil has already eliminated LF in 8 states; this success is a clear reflection of their longstanding commitment and dedication to disease control and public health

3. The Inclusion of NTDs as part of Canada’s Maternal, Newborn and Child Health (MNCH) policies and programs

Many of Canada’s priority partner countries carry significant burdens of malnutrition and NTDs, including Haiti, as well as Indonesia and Tanzania, posing a serious threat to maternal, newborn and child health. NTDs lead to stunting, wasting and the loss of Vitamin A and iron – hindering child growth and causing adverse pregnancy outcomes.

That is why I traveled to Ottawa last fall and called on Canadian policymakers to make sure that they integrate NTDs into their development strategies. Canada can help save lives and make a real difference for women and children by making sure that they have access to NTD treatments. This is a smart policy choice, one that could be financed through the Global Financing Facility for Every Woman, Every Child.

4. Regional Bodies translate promises into concrete action

Canada, Costa Rica and Brazil are among the 35 countries that passed a resolution in the Organization of American States in 2013, pledging to end the suffering of the 100 million people impacted by NTDs in the Americas. Health Ministers from Central America have also recognized the burden of NTDs, most recently at their 2013 regional meeting of the Council of Ministers of Health of Central America and the Dominican Republic (COMISCA).

I hope that the OAS, COMISCA and other regional organizations will leverage these important policy commitments to catalyze greater financial support and partnerships – just as COMISCA did for malaria. In addition to discussing NTDs during their 2013 regional health summit, several countries rallied together to eliminate malaria in the region.

Partners followed suit and the Global Fund invested $10.2 million to support this regional initiative, adding to the national malaria grants already approved.  The results of these commitments are clear: malaria rates have been falling, often times dramatically, across Latin America– and the region is just steps away from eliminating this disease as a public health threat. This is an excellent example of how strong, united regional commitments can accelerate global health efforts – and one that can be applied to the fight against NTDs.

5. BRICS fight NTDs at home and abroad

Last December, the BRICS Health Ministers gathered in Brasilia for the 4th Health Ministers meeting, where they added NTDs to their collective agenda for the very first time. I am very excited to see the BRICS countries work together to help see the end of NTDs by 2020.

I encourage the BRICS to build on this commitment by continuing to prioritize NTDs within their own countries.  I also hope they will explore ways to fight NTDs across the globe. The New Development Bank could offer a venue for the BRICS to finance NTD control efforts as part of their broader sustainable development projects.

6. G7 leaders make financial commitments to end NTDs by 2020

The G7 is off to an excellent start in 2015. Neglected and poverty-related diseases made it onto the G7 agenda for the upcoming June 2015 Summit. This year is critical for the G7 to take immediate action to close the books on their unfulfilled promise to expand access to NTD treatments.

7. Post-2015 Development Agenda Includes NTDs

I’m looking forward to seeing how the post-2015 development agenda takes shape this year. We absolutely must utilize existing global health solutions – including the NTD treatments generously donated by pharmaceutical companies. I am happy that NTDs were included as a health priority in the final Sustainable Working Group framework. However, they were not specifically mentioned in UN Secretary General Ban Ki-Moon’s recent synthesis report. If NTDs are not clearly identified in the final post-2015 development agenda and the corresponding sustainable development goals, they will once again remain as forgotten and invisible as the people and communities affected by them. Let us make them a health priority so that we can see the end of NTDs by 2020.

Haiti’s National Program for the Elimination of Lympathic Filariasis Prevails Despite Adversity

Haiti, Latin America and the Caribbean, lymphatic filariasis, , ,

 

Photo by Olivier Asselin

Photo by Olivier Asselin

Haiti has made remarkable progress against lymphatic filariasis (LF), a disfiguring and stigmatizing neglected tropical disease (NTD), despite facing many challenges. A recently published PLOS NTDs editorial highlights the perseverance and support displayed by the Haitian government and development partners, resulting in scaled-up mass drug administration (MDA) across the country, integrated programs with soil-transmitted helminths (also known as intestinal worms) and increased morbidity management. With these successes, the Haitian effort to eliminate LF can certainly be a model for other countries.

The Haitian Ministry of Public Health and Population (MSPP) established the National Program to Eliminate LF (NPELF) in 2000 to stop LF transmission and reduce the suffering of infected people. Key partners include the Bill & Melinda Gates Foundation, United States Agency for International Development (USAID), Centers for Disease Control and Prevention (CDC), CBM, Inter-American Development Bank (IDB), Abbott Foundation, PepsiCo, Frank Eck Family Foundation and others.

In the first MDA, conducted in Léogâne in 2000, the NPELF and local partners trained community leaders and health volunteers on medicine distribution techniques and educated them about LF treatment, transmission and prevention. Social mobilization was another integral component, spreading messages by banners, posters, radio and megaphones to increase the number of people participating in MDA.

Efforts then focused on scaling up the program to reach all people in need. However, over the course of many years, natural disasters and political and social unrest challenged expansion of the LF program. Just some examples include random acts of violence, devastating hurricanes and flooding, an earthquake and a vicious cholera outbreak.

Yet, increased advocacy, new funding and reinvigorated planning provided the necessary boosts to scale up and achieve results. One of the meetings that jumpstarted new progress was organized by the Global Network, Pan American Health Organization (PAHO) and IDB. As the PLOS NTDs paper explains, “The partners affirmed their support for NTD control and elimination of LF, and the donor community responded. With new funding for MDA in Port-au-Prince from CDC and others, Haiti was finally poised for the first time to achieve full coverage of the entire country with MDA, with a population in excess of 10 million.”

Now, Haiti has achieved full national coverage, and it must strive for interrupted LF transmission. With strong partnerships and continued political commitment, this milestone is in Haiti’s grasp.

To read the full paper, “Haiti National Program for the Elimination of Lymphatic Filariasis — A Model of Success in the Face of Adversity,” click here.

The Neglected Aspect of NTDs

Haiti, Latin America and the Caribbean, lymphatic filariasis, , , morbidity management

 

Emily speaks with patients in Haiti suffering from chronic filarial lymphedema.

Emily speaks with patients in Haiti suffering from chronic filarial lymphedema.

The physical and economic effects of NTDs are obvious and well-documented: they stunt growth and cognitive development, cause anemia and malnourishment, prevent children from attending school and parents from working – the list goes on. But perhaps the most neglected aspect of NTD research and programming concerns the psychosocial impact of these diseases. As today is World Mental Health Day, it seems fitting to highlight this connection.

In June, a study shared data that indicates conclusively that Haiti has achieved nationwide coverage in its mass drug administration (MDA) campaign to eliminate lymphatic filariasis (LF). This milestone puts Haiti on track to achieve its goal of national elimination within the next four years. This is welcomed news for Haiti and the world, as LF is a particularly devastating NTD. Unlike most NTDs, its most advanced condition, known as chronic filarial lymphedema, is irreversible past a certain stage. At this stage, LF-infected individuals are afflicted with painful, debilitating, and disfiguring swelling of one or more limbs. While the early stages of LF infection can be prevented and treated with widely available and affordable drugs, once the condition progresses to later stage lymphedema, the swelling can only be contained – not reversed. 40 million people around the world are currently living with this devastating condition.

I had the privilege to meet 30 of these patients this past January when I traveled to Lèogâne, Haiti to conduct research on the impact of chronic filarial lymphedema on mental health, and how this impact could be mitigated by religious beliefs and practices. With the support of the Notre Dame Haiti Program, which has been fighting LF in Haiti for almost twenty years, I interviewed these patients to assess their mental health, social support, and spiritual life.

For these 30 individuals, the swelling of their limbs often limited their ability to work in an economy already burdened by high unemployment. The acute adenolymphangitis (ADL) attacks caused by LF infection sometimes left them bed-ridden with and fever for hours or days. But perhaps the most difficult aspect of their condition, even worse than the financial burden of their illness or the physical suffering it caused, was the social isolation these individuals experienced as a result of their gwopye – the Haitian Creole term for “big leg,” and the colloquial term for lymphedema.

As their swelling progressed, relationships with friends and family members, who believed they could catch gwopye from them or that they were suffering from a curse, became strained. Often, husbands abandoned their wives when they developed the condition, leaving them to care and provide for children alone. These individuals told me over and over again that the hardest part of their condition was their isolation from family and friends and the shame they felt when they went out in public, where strangers would stare at their affected limb and make cruel comments. Unsurprisingly, many of the individuals I interviewed showed signs of anxiety, depression, and even suicidal ideation. But in a country with roughly 1 psychiatrist for every 200,000 people, mental health care is nearly impossible for most Haitians to access – and the additional economic hardship and stigma caused by lymphedema makes it even more difficult for these highly vulnerable individuals to receive such care.

Establishing morbidity support programs in LF-affected areas – programs like the aptly-named “Hope Clubs” currently operating in Lèogâne with the support of the Global Network, the Christian Blind Mission, the University of Notre Dame, and the Hospital Sainte Croix – can help individuals with chronic filarial lymphedema cope with the significant psychosocial impact of this disease. Such support programs combine morbidity care, or treatment for lymphedema-infected limbs, with the social support of forming relationships with other affected individuals. Such programs are a community-centered, sustainable approach to mental health care in areas like Haiti where such care is currently beyond the reach of many individuals most in need of it, and ought to be replicated in many areas of the world where LF is endemic.

Large-scale interventions to control and eliminate LF in Haiti are underway, but as a recent study on the psychosocial impact of LF put it, such programs must make a special effort to reach the “highly vulnerable category of patients in advanced stages of the disease [who have] low visibility.” On the whole, “The inclusiveness and the caring quality of a health strategy for any given disease has to be judged by its capacity to reach out to the most vulnerable groups affected.”

As we progress towards our goal of worldwide control and elimination of the seven most common NTDs by 2020, we cannot forget the individuals with chronic filarial lymphedema, or those already blinded by trachoma or onchocerciasis, for whom this dream will be realized too late. The vulnerable individuals afflicted with chronic filarial lymphedema, and others like them already suffering from the irreversible symptoms of some NTDs, should be at the heart of our efforts to rid the world of these preventable diseases and their effects. Only then can we truly hope that “Together, we can see the end.”