Notre Dame Haiti Program Annual Newsletter December 2016 MDA Campaign Success Haiti Entering the End Stages of LF Elimination When partners in the Haiti National Program to Eliminate Lymphatic Filariasis (NPELF) met earlier this year in Port-au-Prince for its biannual meetin, there was much cause for celebration. After 15 years of mass drug administration (MDA) efforts, the mainstay of lymphatic filariasis (LF) elimination, just 28 communes out of a total of 140 communes now require MDA. This means that the Notre Dame Haiti Program can greatly reduce its MDA activities to just two communes, including Léogâne, our home in Haiti for more than 20 years. In 2000, the World Health Organization included LF in its list of neglected tropical diseases that could be eliminated by 2020. LF is a disease caused by a mosquito-borne parasite that affects only the world s poorest citizens, and Haiti has the greatest burden of the disease in the Western Hemisphere. LF results from an attack on a person s lymphatic system that leaves parts of the body grossly deformed and vulnerable to infection. Tiny thread-like worms colonize lymphatic vessels, causing immense swelling of the legs, arms, breasts, and scrotum. It also causes secondary bacterial infections, resulting in inflammation, pain, and fever. This condition is the leading cause Achieved stop-mda criteria Planned TAS* implementation Ongoing MDA Grand Anse Sud Nippes Nord-Ouest Nord L Artibonite Sud-Est Centre Ouest Nord-Est Source: PNELF (Programme National d Elimination de la Filariose Lymphatque), IHSI (Institute Haitien de Statistique et Informatique), and CNIGS (Centre National de l Information Géo-Spatiale) *Transmission Assessment Survey (TAS) of physical disability in the world and results in the inability to work, stigma, isolation, and depression. LF is endemic in 73 countries and Haiti is among 39 countries that have achieved nationwide MDA coverage; this success is all the more remarkable given Haiti s seemingly insurmountable challenges political instability, multiple hurricanes, a devastating earthquake, a deadly cholera outbreak, severe poverty, and poor health systems and public infrastructure.
Haiti Program Restructures Now in its 23rd year, the University of Notre Dame Haiti Program has evolved to keep pace with new research and ever-changing conditions in Haiti. Yet, although closer to achieving its goal to eradicate lymphatic filariasis (LF), the Haiti Program still has much work to do. The Program has used a tripartite approach to tackling LF: mass drug administration (MDA), alleviation of suffering, and fortified salt distribution; however, due in part to the successes achieved to date, the Program is able to scale back its MDA activities and concentrate on the clinical program and salt fortification and distribution. In its infancy, the Haiti Program mapped the 140 communes in Haiti in order to determine where LF was present and implemented the first ever, national mass drug administration program to treat the disease, targeting the hardest hit communes first. The Program is pleased to announce that it is now in the final stages of eliminating LF throughout Haiti. Complete nationwide coverage of MDA was achieved in 2012, and research has shown that MDA can be stopped in all but 28 communes. The Haiti Program continues to be the only organization in Haiti providing services to alleviate the suffering of those affected by lymphedema and hydrocele (the swelling of the genitals in men suffering from LF). Several times per year, three teams of volunteer surgeons visit Léogâne to perform curative procedures on men suffering from hydrocele. In 2014, the Haiti Program also implemented a Mental Health Initiative to provide psychological counseling and outreach to those suffering from the isolating stigmatization caused by LF. In these final stages of eliminating LF in Haiti, expanding the distribution channels of Bon Sel Dayiti, the food-grade salt double fortified with DEC and iodine, remains a priority. This fortified salt, a joint initiative between the Haiti Ministry of Health, the Congregation of the Holy Cross, and Notre Dame, targets both LF and iodine deficiency disorders. Upon the elimination of LF, the Haiti Program aims to leave the Haitian people with a sustainable salt fortification operation that will eliminate iodine deficiency disorders, which negatively impact both maternal health and infant health outcomes. In the past year, the Haiti Program has undergone some significant restructuring to allow the Program to streamline the distribution of its resources in these final stages to eradicate LF. The generous support provided by donors continues to be invaluable and integral to the success of the Haiti Program s endeavors, and the procurement and effective utilization of sustainable funding sources is the target of renewed and more robust efforts. Core Leadership Team Marie Donahue, Notre Dame Haiti Program Director Jean Marc Brissau, Haiti Country Director Martha Desir, Clinical Services Director James Reimer, Salt Project Director Max Rosemund, Haiti Administrator Rev. Thomas Streit, C.S.C., Program Founder & Lead Researcher 2 3
Jean Marc Brissau, In-Country Director More than 2 decades ago, Jean Marc Brissau brought his uncle for treatment to the Notre Dame Haiti Program s LF clinic in Léogâne. Rev. Thomas Streit, C.S.C., instantly recognized Jean Marc s talent and recruited him to serve as his translator. Since then, Brissau has been involved in the Haiti Program in various capacities over 22 years. Brissau has been an integral part in all aspects of the Program, including logistical planning for MDA, research activities, and Marie Donahue, Notre Dame Haiti Program Director Marie Donahue brings a wealth of clinical and global health experience to her role as director of the Notre Dame Haiti Program. As a nurse practitioner, she cared for children and families in underserved communities, and when pediatric HIV was virtually 4 helping to develop the salt program. In the aftermath of the 2010 earthquake, Brissau was instrumental in coordinating relief efforts for Notre Dame medical volunteer teams at the field hospital in Léogâne. Today, as the country director of the Haiti Program, Brissau is part of the core leadership team and acts as the Program s liaison with the Haitian Ministry of Health, businesses, NGOs, and other Notre Dame programs in Haiti and he provides indispensable insight into the Haitian context for the U.S.-based team. Brissau is a graduate of the Notre Dame Law School, where he earned an L.L.M. in international human rights law. Residence Filariose: more than a guesthouse Built with funds from the Bill and Melinda Gates Foundation in 2000, the Residence Filariose (RF) initially served as a training and conference center and a home away from home for researchers from Notre Dame, the Centers for Disease Control and Prevention (CDC), and others partnering with the Haitian Ministry of Public Health and Populations to eliminate LF in Haiti. When the RF was built, despite worries about the mounting costs of the construction, Rev. Tom Streit, C.S.C., insisted that the structure be built with a seismically sound design. Because of his foresight, the residence was one of the few buildings that survived the devastating earthquake in 2010 and served as a center to support relief efforts and as a home to medical personnel who came to serve the Léogâne community. Since then, the RF has been the base of operations for teams of Notre Dame alumni physicians who travel to Haiti seven times per year to perform surgeries for patients at the LF clinic, as well as teams that work in mobile clinics throughout Léogâne. NGOs from across the country also use the RF for a variety of development projects that serve Haitians. Given its location just 18 miles from Port-au-Prince, the town of Léogâne has been an ideal location for Notre Dame students, researchers, and programs from across the University, including Engineering to Empower (E2E) and the Center for Social Concerns Common Good Initiative. Program director Marie Donahue said, Haiti is in the end stages of elimination of LF, and we are starting to think about how the infrastructure that the Program has built in Léogâne over the last two decades can continue to be used to further the University s mission of research and social justice for the most vulnerable among us. Visitors will soon be able to make reservations online at haiti.nd.edu. eliminated in the US, she served as technical advisor for HIV treatment and prevention, as well as health systems strengthening programs in nine African countries. Just prior to joining the Program, she worked for Partners in Health as an Ebola response clinician in Sierra Leone during the 2014-15 Ebola outbreak in West Africa. 5
Haiti Program welcomes students from the Common Good Initiative In May 2016, a group of Notre Dame s graduate students made an eight-day social justice immersion trip to Lèogâne, Haiti. The trip was an element of their Common Good Initiative (CGI) course on global health, education, and the preferential option for the poor in Haiti. The multidisciplinary group consisted of students from across the University, including two MBA students, two law students, and one biomedical science student. The class, comprised of oncampus coursework alongside a weeklong immersion trip, enabled students to integrate the premises of the Catholic social tradition with their various disciplinary interests. Its intended outcome was to transform and illuminate students perspectives of social justice and the common good and inspire them to become contributors to the wellbeing of the global community. Rev. Kevin Sandberg, C.S.C., Ph.D., who oversees the program, explained that during the immersion trip in Haiti students were asked to check their assumptions [about social injustice] at the border and instead to listen and to learn about what Haiti has to teach about social justice and the Haitian perception of the common good. Through their engagement with the Haiti Program the students gained an illuminating insight into global health issues in the country. They had the opportunity to witness the Program s efforts to eradicate lymphatic filariasis (LF) in action, to see how the Program provides care for the Haitian people, and to learn from the Program s founder, Rev. Tom Streit, C.S.C., Ph.D., and its director, Marie Donahue, about the dynamics of the Program s collaborations with the Haitian Ministry of Public Health and Populations, the Léogâne community, and Haitian-led businesses and NGOs. The students also visited the Program s Hope Clubs: social clinics providing LF patients with employment and emotial support. The students not only listened to the patients first-hand accounts of everyday experiences of social injustice in Haiti, including poverty, limited access to healthcare, and political instability, but also to the patients perspectives on the structural responses required to address these issues. Fr. Sandberg credits the Haiti Program with laying the foundations and providing the necessary pathways for the CGI trip to Haiti to be a truly immersive experience for students. In essence, he said, the students were enrolled in a class with a field assignment, and the Haitians were their instructors. Expansion of salt operations Since its inception in 2006, the Notre Dame Haiti Program s Salt Project has received funding from a broad network of foundations, companies, NGOs, and individuals. This project has served as a model for the cofortification of salt with a drug that kills the filariasis parasite (DEC) as well as iodine, a micronutrient necessary for the cognitive development of infants and young children. Earlier this year, the project received a $250,000 grant to support its operations and is seeking a matching donation of $250,000 to support Phase 2B of its facility expansion. The aim of Phase 2B is to permit the purchase and processing of greater quantities of local raw solar salt and allow the plant s operations to run uninterrupted. Before salt can be fortified with iodine and DEC, it must first go through a multistage process of washing, sizing, and sifting. Raw salt is washed in saturated brine to remove impurities, chlorides, and sulfates, and then it is dried for four to six weeks, sifted and sized through a screen grater, fortified, and packaged for sale and distribution. Under the leadership of Jim Reimer and Jean Marc Brissau, increasing salt production has allowed the expansion of distribution channels to include bakeries, food-processing, and food service markets, as well as nutrition programs such as the World Food Programme and Food For The Poor. By using our salt in their food production operations, these Haitian entities can greatly improve access to DEC and iodine for more Haitians than retail sales alone. Phase 2B began in October 2016 and is slated for completion in June 2017. 6 7
Haiti program Nonprofit Org. U.S. Postage PAID Notre Dame, IN Permit No. 10 305 Brownson Hall Notre Dame, IN 46556 You Can Make a Difference Help us eliminate lymphatic filariasis (LF), decrease iodine deficiency, and alleviate the suffering of those who already have LF. Visit haiti.nd.edu or contact NDHP Program Director, Marie Donahue at (574) 631-5526 or mcdonahue@nd.edu. Staff Spotlight: Martha Desir becomes director of clinical services at the LF Clinic and Reference Center Martha Desir has been appointed director of clinical services for the Lymphatic Filariasis (LF) Clinic and Reference Center in Léogâne, the only site in Haiti that currently provides care for LF patients. Since 2014, Desir has been working as the Program s psychosocial nurse, counseling patients and overseeing community-based Hope Clubs in 10 regions in Léogâne. The outreach workers leading each group are patients themselves and are well poised to support patients who are struggling with the physical debilitation, psychological devastation, and social stigmatization that comes with LF. Desir completed her nursing education at the only baccalaureate program in Haiti and was class valedictorian. She held a teaching post at her alma mater and then worked alongside our Notre Dame alumni physicians, providing trauma care for survivors of the 2010 earthquake. Before joining the Program, Desir worked as a surgical nurse with Doctors Without Borders for four years.