Public health concern, Social Issue

Helping Haitian Futures: A focus on health

This op-ed article was originally published in the Carribean Journal 

Across the globe, the number of migrants has risen in the recent years. This phenomenon is exacerbated by the growing poverty in regions like Sub-Saharan Africa and wars in others like Syria. We can recall the images of Aylan, the 3-year-old Syrian boy drowned in the Mediterranean sea while his family attempted to flee their war affected country. Closer to us, the story of Sonia has been related, fleeing deportation threats and intimidation in the Dominican republic where she lived.

She was not alone on her journey. As of July 2015, a significant number of Haitians and Dominicans of Haitian descent fled the Dominican Republic for similar reasons. A large part gathered in cardboard-made tents, at Anse-a-Pitres, southeastern commune of Haiti. With a minimal assistance, these migrants are left vulnerable to important health risks in a hostile environment, considering the promiscuity, lack of resources and medical assistance. Let’s go around some of these health risks.

Young boy at the migrant camp of Anse-a-Pitres Source: Etant Dupain. Twitter @gaetantguevara

Young boy at the migrant camp of Anse-a-Pitres
Source: Etant Dupain. Twitter @gaetantguevara

In Haiti, the rainy season extends from April to November. As the millimeters of rain accumulate, the risks of cholera outbreaks also rise since this infectious disease is evolving towards an endemic one in the country. At the Anse-a-Pitre’s camp, an adequate sanitation system to prevent the occurrence and spread of a cholera outbreak is definitely nonexistent, thus an exacerbated risk. However, cholera is not the only infectious disease to take into account as a health threat in this particular situation.

Tuberculosis- also endemic in Haiti- is spread by the means of promiscuity and enhanced by a poor nutritional state. In reference to the testimonies of Etant Dupain and Roxane Ledan, this describes precisely the catastrophic living conditions of the migrants. The context of promiscuity and lack of preventive medical care also stands as a large ground for the occurrence of HIV/AIDS and other sexually transmitted infections.

Simultaneously, potential women’s health issues can develop. In general, the pregnant women are exposed to countless pregnancy-related illnesses like anemia because an appropriate medical examination during the pregnancy is minimal, nay, totally unavailable. Plus, the context is favorable to high-risk delivery since an adequate medical equipment is absent.

On another side, unwanted pregnancies may result from the absence of birth control initiatives in the camp, such as an adequate education coupled with effective contraceptive tools. In the worst cases, women may arrest their pregnancy, in precarious conditions as it is often the case in Haiti where voluntary interruption of pregnancy is not supported by the law. These women’s health issues are not isolated from the risks of infectious diseases discussed above. They might come also in interactions with other health risks or propel their occurrence.

Among them, depression and substance abuse are rarely emphasized. No matter the cause of migration, whether forced or voluntary as for Aylan’s family and Sonia, the process remains traumatizing. The migrant or deported status itself carries a pejorative connotation, impairing the dignity of the person. For many, the current situation may appear like a defeat or a torturing humiliation, especially if the process involved the separation of family members or loss of material goods. This emotional pain is opportune for the development of neurosis and abuse of drugs, alcohol, cigarettes and sleep inducing medication. As consequences, violence against girls and women may occur and infections may be sexually transmitted, perpetuating the vicious circle. Unfortunately, the living conditions at the migrant camp can only worsen the risks of mental ailments.

Women and children at the migrant camp of Anse-a-Pitres Source: Etant Dupain. Twitter @gaetantguevara

Women and children at the migrant camp of Anse-a-Pitres
Source: Etant Dupain. Twitter @gaetantguevara

Despite this alarming situation, these health risks ultimately refer to the future, even if it means the next minute, hour or day. Therefore, they give us the possibility to act upon them. As organized social groups, as the government, let us come together to reinvent the future of a growing number of Haitians, desperate and abandoned. A safe environment  where food, water, adequate shelter and medical assistance are available is a must to begin with. Based on these assets, an oriented and appropriate education should pave their way into a complete integration of the social life. In the face of this mighty challenge, we are left with little choice but unity and compassion.day. t upon them. As organized social groups, as the government, let us come together to reinvent the future of a growing number of Haitians, desperate and abandoned. A safe environment  where food, water, adequate shelter and medical assistance are available is a must to begin with. Based on these assets, an oriented and appropriate education should pave their way into a complete integration of the social life. In the face of this mighty challenge, we are left with little choice but unity and compassion.

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Public health concern

Drug resistance: What can we do?

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Bucket of drugs sold on the streets of Port-au-Prince, Haiti

This article originally appeared on Woy Magazine

Throughout history, mankind has suffered from several devastating epidemics caused by pathogens (disease-causing microbes). Even the bible speaks of the occurrence of epidemics such as leprosy and tuberculosis, millennia ago. Among the deadliest known in history, the plague epidemic, from 1347 to 1351, killed half of the European population. Centuries later, the Spanish flu of 1918-1919 has claimed more lives than World War I. On the American continent, around the same period, the epidemic of polio in the United States has killed 6 000 persons. For many years, Haiti has been known for the spread of deadly microbial epidemics and is still currently fighting one of the highest rates of tuberculosis, HIV/AIDS (despite the dropping prevalence) and malaria in the hemisphere.

However, the era of microbial epidemics has observed a halt since the development of antimicrobial drugs begun with the discovery of penicillin, an antibiotic, by Alexander Fleming in 1928. Nonetheless, in his Nobel lecture in 1945, he had to warn: “The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.”

Antimicrobial resistance is the fact by which, the pathogens become insensitive to the drugs used to kill them or to inhibit their growth. It is known as a natural phenomenon, but can as well be propelled by humans through overdose and improper use of drugs. In line with Fleming’s projection, antimicrobial resistance is an actual fact and a global health issue especially in our era of globalization and mass commercialization. As a result, in a near future, we may lack the most essential drugs to cure the simplest infections.

How is it today? In its 2014 report, the WHO has revealed that the Influenza A viruses (susceptible to cause the flu) are resistant to all available preventive drugs. Worldwide, 450,000 new cases of resistant tuberculosis have been reported.  And in Africa, resistance to a specific class of drug used in the treatment of AIDS has been observed since 2009. Concerning malaria, several countries on different continents experience some level of resistance to chloroquine (Main drug used in the treatment).

Imagine a world where anybody can die of a single skin cut, where more children under 5 years old die of pneumonia. Imagine a country like Haiti in such a world, with no available drugs to treat malaria and AIDS. Imagine a world where tuberculosis is an incurable disease, where doctors can’t practice surgery -because most of the time, there’s no surgery without antibiotics- and where children die of mother-to-child infections. To avoid such catastrophe, key attitudes are recommended in the face of this new global epidemic of resistance to antimicrobial drugs. Let’s lay down a non exhaustive list of four realistic and reliable precautions we can adopt in Haiti.

Encourage consumption of local foods

Most of the meat consumed in Haiti is imported from the Dominican Republic and the United States. In larger economies, antibiotics are used in animals, despite the advice of the WHO to cease such practices (Press Release WHO/39. September 11, 2001). When a person ingests meat containing antibiotics, they also consume the drug. This improper use of antibiotics contributes to bacterial resistance in humans. As a result, these drugs will lose their ability to produce the desired effect in sick people. The lack of antibiotics is one of the advantages of purchasing local Haitian agriculture. It is, therefore, recommended to consume local foods in order to decrease the spread of antibiotic resistance.

Fight self-medication

Concerned state authorities should take responsibility by enforcing the article 19 of the August 10th, 1955 law forbidding the sale of antibiotics without medical prescriptions. According to a study I conducted in March 2015 at the outpatient clinic of the General Hospital of Port-au-prince, almost half of the patients (45.4% of them) buy their antibiotics without any medical prescription from street vendors tubs, public transport buses and sometimes pharmacies. While we wait for a more modern law on the pharmaceutical sector in Haiti, the one cited above should absolutely be enforced in the meantime.

Typical meds vendor in the streets of Port-au-Prince, Haiti

Typical meds vendor in the streets of Port-au-Prince, Haiti

Practice better medical care

From the doctors, it is required to decrease the careless use of antibiotics and other microbial drugs. The choice of the most accurate drug to treat a specific infection, the appropriate dosage and duration, should be done with the utmost care. In all circumstances, following a well-conducted physical exam, the clinical judgement of doctors need to be accurate. It is best, however, to objectify an ongoing infection before initiating a therapy even if in most of the cases, the medical practice is challenged by the inability of the patients to pay for basic exams. No matter the limitations, it is the doctor’s duty to make the best decisions for their patients and for society as a whole, based on their judgement and scientific evidence.

Increase awareness and health literacy

As it is often said, prevention is better than any cure. It is in the best interest of the general population to increase their awareness of the situation and their health literacy. Unfortunately, in Haiti, information and health education campaigns are only held in times of severe outbreaks, and are transmitted in a language that excludes the majority of the population and fails to take advantage of the best communication channels. Basic health knowledge should to be taught throughout people’s lifetimes, beginning in elementary schools.  IntegrAction, a non-profit organization I co-founded, is totally engaged in this fight for effective health literacy for the Haitian population.

Awareness and a culture-oriented health literacy coupled with the best medical care can make a profound difference, in regard to this alarming situation. The state and local authorities should join their hands to enforce the existing law and encourage the consumption of local foods. With enough political will and global awareness, it is possible to get around the dramatic fate. One behavioral change at a time, let us, Haitians, unite for this cause!

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Global Health, Public Health

Insights from a surgical prowess

Founded in 1703, Mirebalais is a small commune situated in the Plateau Central, approximately 60 km Northeast of Port-au-Prince, the capital of Haiti. Birth place of the Haitian combatant Benoit Batraville, it is a 88.899 inhabitants, vivid locality where agriculture and livestock are predominant despite the many difficulties of commerce and daily life. Fortunately, the Peligre’s hydroelectric dam, opened 59 years ago in the Centre department, provides energy to the whole city. I first visited the town five years ago, immediately after the 2010 earthquake, with a team of medical students who volunteered at the hospital Bon Sauveur of Cange (village located near Mirebalais) run by the international NGO Partners in Health and local sister organization Zanmi Lasante.

In this 330 square kilometers town, five years later, a surgical team led by Dr Henri Ford, Haiti-born renowned surgeon, successfully separated six-month-old abdominal conjoined twin sisters. Being the first of its kind in the country, the successful operation marked a turning point in the history of Haitian medicine. This prowess, which took place at the recently erected University Hospital of Mirebalais, has drawn many insights on Haiti and the future of medical cooperation among which: the benefits of global health and surgery for the resource-limited country, the need for a paradigm shift in international medical cooperation and the opportunity to share an accurate image of Haiti.

Marian's surgical team wore red bandanas, while Michelle's wore yellow ones as they worked in an HUM operating room on Friday, May 22. Source: Partners in Health

Marian’s surgical team wore red bandanas, while Michelle’s wore yellow ones as they worked in an HUM operating room on Friday, May 22.
Source: Partners in Health

Let’s consider first, the benefits of global heath and surgery for Haiti. Defined as the area of study that places a priority on improving health and achieving equity in health for all people worldwide, global health stands as a common ground, where international and local health professionals perform together in order to overcome enormous challenges usually unconquerable by a sole performer. As noted, surgery can help reduce the burden of disease by 11-15% globally, but unfortunately, the poorest people have little access to surgical care for malformations and pregnancy-related conditions like it was the case for Ketan, mother of the conjoined twins Marian and Michelle Bernard.  In a context of economic insecurity and shortage of medical professionals, global health and global surgery, in Haiti, can be considered as one of the most accurate vehicule to strengthen the health care system by providing affordable access to care and sharing of knowledge and experience in the respective fields. The separation of the conjoined twins at the University Hospital of Mirebalais is a typical experience of the opportunities provided by surgery used in a context of global health.

These open doors consequently foster the need to look at the future through different lenses. They emphasize the vision that the new way of considering international medical cooperation should privilege sustainable partnership over mere assistance. This paradigm shift, in the case of Haiti, may come very gradually. Hence, the need of courageous visionary people here and abroad to challenge the status quo and be the change they want to see. The surgical prowess of Mirebalais is undoubtedly a milestone in the future of medicine in Haiti. It offers a fresh look on what is possible here where weaknesses are overly pictured. In the path of Dr Anténor Miot who introduced orthopedic surgery in Haiti, the vision and work of pioneers will definitely have an astonishing impact in the future. Not only will it lead to better care for the Haitian people but it will also propel a more accurate image of the country which is striving to build a resilient health care system.

In fact, as of the early years following the earthquake, Haitians recognized the need to share a new and appealing image of Haiti in the global scene. It comes in reaction to negative news, often spread by international medias through shocking headlines and repulsive photographs, emphasizing the state of poverty of the western part of the Hispaniola island. In the context of the separation of the siamese sisters, Haiti has retained a new kind of attention. There was extensive media coverage both prior and after the surgery by the Haitian newspaper Le Nouvelliste and international medias. The Huffington Post and CBS News among others have instantly released the positive news of the successful seven-hour surgery. As Dr Jon Lapook, CBS News chief medical correspondent, present at the event, stated “This is a country that’s trying to rebuild the health care system”. In fact, since positive changes are happening home, positive feedback will surely counteract destructive attempt.

Ultimately, leadership can be defined as the ability to inspire people to dream more, to accomplish more and to be more. It is a matter of influence through innovative ways to look at the world. No matter the field of action, no initiative will be sustainable without the necesssary amount of cooperation and knowledge sharing between people of different academic and cultural background. Therefore, the majestic surgery of Marian and Michelle Bernard at the University Hospital of Mirebalais has cast a bright light on Haiti’s future particularely in medicine despite the remaining challenges. It also outlined the power of taking impactful initiatives inside to bring a positive image outside of Haiti. In 2010, as I assisted my first surgery at Cange, I couldn’t imagine that such an astonishing event would take place at Mirebalais, little town where we used to stay not more than a few hours, the time to jump in a bus to Port-au-Prince. Next time you come across the astounding country of Haiti, make sure you pay a visit to the Hospital of Mirebalais which stands today as a cornerstone where history was written.

Manoucheca Ketan holds her conjoined twin daughters before their separation at University Hospital in Mirebalais, Haiti, on Friday, May 22. Source: Partners in health

Manoucheca Ketan holds her conjoined twin daughters before their separation at University Hospital in Mirebalais, Haiti, on Friday, May 22.
Source: Partners in Health

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