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.