Haitian Health Research Articles

Graduate Nurse Education in Haiti: Lessons Taught and Learned.

The plight of the people of Haiti that came to the world's attention following the devastating earthquake there in 2010 has for the most part receded into the background amid other issues despite their continuing economic and health problems. The purpose of this article is to explore the experiences of the first graduate nurse students in Haiti. The program is funded and operated by a nonprofit, nongovernment nursing organization, Promoting Health in Haiti, based in New York City. A narrative was generated by doing focus groups and interviews with 10 of the students in the program. Three themes found in the narrative are pressing on amid uncertainty and unanswered questions, living and learning amid competing responsibilities, and enjoying support while learning new skills that can make a difference. The implications for graduate nurse education in low-resource countries are discussed.

EqualHealth’s visiting professor program: providing continuing medical education and professional development opportunities for haitian health professionals

EqualHealth’s visiting professor program: providing continuing medical education and professional development opportunities for haitian health professionals

“Tèt asanm pou la sante”: apontamentos etnográficos sobre a cooperação internacional para a saúde no Haiti

This article discusses the functioning of a health-oriented development project pursued in an emergency situation and its impacts beyond its stated goals. The tripartite project between Brazil, Haiti, and Cuba was designed to strengthen Haiti's health and epidemiologic surveillance system, introduced in 2010 as part of the aid effort after the earthquake. An essentially ethnographic perspective is taken, with a focus on describing the practices and perspectives of the agents involved in the program. The networks of agents were mapped out, paying particular attention to translators, drivers, and journalists, who were understood as being "cooperation brokers". Finally, the article discusses the project's position in the broader context of international health initiatives in Haiti.

Understanding and Addressing Vulnerability Following the 2010 Haiti Earthquake: Applying a Feminist Lens to Examine Perspectives of Haitian and Expatriate Health Care Providers and Decision-Makers.

Vulnerability is a central concept in humanitarian aid. Discussions of vulnerability in disaster response literature and guidelines for humanitarian aid range from considerations of a universal human vulnerability, to more nuanced examinations of how particular characteristics render individuals more or less at risk. Despite its frequent use, there is a lack of clarity about how vulnerability is conceptualized and how it informs operational priorities in humanitarian assistance. Guided by interpretive description methodology, we draw on the feminist taxonomy of vulnerability presented by Mackenzie, Rogers and Dodds (2014) to examine perspectives of 24 expatriate and Haitian decision-makers and health professionals interviewed between May 2012 and March 2013. The analysis explores concepts of vulnerability and equity in relation to the humanitarian response following the 2010 earthquake in Haiti. Participants’ conceptualizations of vulnerability included consideration for inherent vulnerabilities related to individual characteristics (e.g. being a woman or disabled) and situational vulnerabilities related to particular circumstances such as having less access to health care resources or basic necessities. Participants recognized that vulnerabilities could be exacerbated by socio-political structures but felt ill-equipped to address these. The use of the taxonomy and a set of questions inspired by Hurst’s (2008) approach to identifying and reducing vulnerability can guide the analysis of varied sources of vulnerability and open discussions about how and by whom vulnerabilities should be addressed in humanitarian responses. More research is required to inform how humanitarian responders could balance addressing acute vulnerability with consideration of systemic and pre-existing circumstances that underlie much of the vulnerability experienced following an acute disaster.

Components of a Moral Economy: Interest, Credit, and Debt in Haiti's Transnational Health Care System

ABSTRACTThe concept of “moral economy” has garnered the attention of anthropologists for its juxtaposition of two central dimensions of human experience that are often treated as distinct realms. However, the concept's analytic potential remains limited, in part because of the challenges in identifying what specifically a moral economy might comprise or entail. I suggest that articulating components of moral economies—in this case interest, credit, and debt—brings into relief some of the more subtle features of social processes that involve diverse resources, transfers, and calculations. Specifically, I use this approach to examine the provision of health services in Haiti by foreign clinicians and the emigration of Haitian health professionals, drawing on ethnographic research conducted in and around the city of Cap‐Haïtien. I illustrate how moral economies exist through actions, experiences, and representations, and I shed light on less conspicuous dimensions of international medical interventions, humanitarianism, and “brain drain.”

Addressing the Child and Maternal Mortality Crisis in Haiti through a Central Referral Hospital Providing Countrywide Care.

The neonatal, infant, child, and maternal mortality rates in Haiti are the highest in the Western Hemisphere, with rates similar to those found in Afghanistan and several African countries. We identify several factors that have perpetuated this health care crisis and summarize the literature highlighting the most cost-effective, evidence-based interventions proved to decrease these mortality rates in low- and middle-income countries.To create a major change in Haiti's health care infrastructure, we are implementing two strategies that are unique for low-income countries: development of a countrywide network of geographic "community care grids" to facilitate implementation of frontline interventions, and the construction of a centrally located referral and teaching hospital to provide specialty care for communities throughout the country. This hospital strategy will leverage the proximity of Haiti to North America by mobilizing large numbers of North American medical volunteers to provide one-on-one mentoring for the Haitian medical staff. The first phase of this strategy will address the child and maternal health crisis.We have begun implementation of these evidence-based strategies that we believe will fast-track improvement in the child and maternal mortality rates throughout the country. We anticipate that, as we partner with private and public groups already working in Haiti, one day Haiti's health care system will be among the leaders in that region.

The socioeconomic impact of international aid: a qualitative study of healthcare recovery in post-earthquake Haiti and implications for future disaster relief

ABSTRACTWe assessed healthcare provider perspectives of international aid four years after the Haiti Earthquake to better understand the impact of aid on the Haitian healthcare system and learn best practices for recovery in future disaster contexts. We conducted 22 semi-structured interviews with the directors of local, collaborative, and aid-funded healthcare facilities in Leogane, Haiti. We coded and analysed the interviews using an iterative method based on a grounded theory approach of data analysis. Healthcare providers identified positive aspects of aid, including acute emergency relief, long-term improved healthcare access, and increased ease of referrals for low-income patients. However, they also identified negative impacts of international aid, including episodes of poor quality care, internal brain drain, competition across facilities, decrease in patient flow to local facilities, and emigration of Haitian doctors to abroad. As Haiti continues to recover, it is imperative for aid institutions and local healthcare facilities to develop a more collaborative relationship to transition acute relief to sustainable capacity building. In future disaster contexts, aid institutions should specifically utilise quality of care metrics, NGO Codes of Conduct, Master Health Facility Lists, and sliding scale payment systems to improve disaster response.

‘Jistis ak Reparasyon pou Tout Viktim Kolera MINUSTAH’: The United Nations and the Right to Health in Haiti

AbstractThe Haiti cholera claims are focused upon the UN's violation of the rights of individuals affected by the cholera outbreak to access a remedy. The UN's absolute immunity from jurisdiction of national courts is counterbalanced by its duty to provide alternative dispute resolution mechanisms for private law claims. The UN has not only failed to provide those alternative dispute resolution mechanisms, but has repeatedly stated that no claims are receivable in these circumstances. Here we set out that even if the UN is able to shield itself from private law claims by using the cloak of absolute immunity, the UN might be held responsible for human rights violations arising from the cholera outbreak in Haiti. This article is concerned with the broader issue of whether the UN has violated and continues to violate individuals' right to health in Haiti.

Child and Adolescent Mental Health in Haiti

This article presents an overview of child and adolescent mental health in Haiti, emphasizing the role of structural violence and the factors shaping child protection. The 2010 Haiti earthquake is discussed as an acute on chronic event that highlighted the lack of pre-existing formal biomedical mental health services and worsened the impact of structural violence. Considerations for long-term, sustainable, culturally relevant child and adolescent mental health care in Haiti are also provided.

Global Surgery Fellowship: A model for surgical care and education in resource-poor countries

Background/PurposeSurgical diseases have recently been shown to be a major cause of global morbidity and mortality. Effective methods to decrease the burden of surgical disease and provide care in resource-poor settings are unknown. An opportunity to meet this need exists through collaborative efforts to train local surgeons in specialty care, such as pediatric general surgery. MethodsWe present a novel model for the provision of surgical care and education in a resource-poor setting via a collaborative Global Surgery Fellowship program. Through Partners in Health in Haiti, this program placed a fully trained pediatric surgeon at an established rural hospital, both to temporarily serve that community and to teach local surgeons pediatric surgical care. ResultsThe Global Surgery Fellow performed the cases presented here during his term, between July 2009 and June 2010. A total of 147 operative procedures were performed on 131 patients over the course of 12weeks in Haiti. A total of 134 of the 147 total cases performed (91.2%) were educational cases, in which the Fellow operated with and trained one or more of the following: American medical students, American residents, Haitian residents, or Haitian staff surgeons. ConclusionThe Global Surgery Fellowship model overcomes many of the traditional challenges to providing adequate surgical care in resource-poor countries. Specifically, it meets the challenge of providing a broad educational experience for many levels of local and foreign physicians, while working within an established locally run health care system. We believe that this model is generalizable to many resource-poor hospitals with permanent local staff that are open to collaboration.

A Needs and Resource Assessment of Continuing Medical Education in Haiti

BackgroundHaiti has a chronic physician shortage, and the country has been facing an increased disease burden since the 2010 earthquake and the subsequent introduction of cholera. In such resource-challenged settings, access to postgraduate medical education often is limited due to inadequate financial, structural, and academic resources. A crucial component to improved health in Haiti is the expansion of continuing medical education (CME). To our knowledge there have been no previous studies investigating the continuing professional development needs of Haitian physicians working in this context. ObjectiveThe objectives of this study are to describe the educational resources available to Haitian physicians and to understand their continuing professional development needs. MethodsWe performed a needs and resource assessment of CME available to Haitian physicians using surveys and focus groups. We surveyed 62 physicians and led 3 focus groups. Questions gathered data on physicians’ access to educational resources. Descriptive statistics were calculated from surveys, and focus group transcripts were manually reviewed for themes. FindingsIn all, 82 conference attendees were invited to participate. Of these, 62 physicians completed the needs and resource assessment survey. Of the participants, 16% had a medical library at work and 31% had access to a computer at work. Educational conferences were available at work for 27% of participants, and 50% attended conferences outside of work. Less than half (45%) identified a clinical mentor. Focus group participants described inadequate tangible and reference resources, lack of colleague support, and lack of avenues for specialty training and employment. ConclusionsIn this needs assessment, Haitian physicians identified lack of support for clinical decision making, poor access to CME activities, limited professional development, and absence of employment opportunities as key areas of need in support of their clinical and professional work.

Neurosurgical educational and training support in DPRK

influence health systems and increase impact at scale. This paper presents a novel conceptual framework through which INGOs can catalyze the integration of community-based maternal, newborn, and child health (MNCH) strategies into existing health systems at the district, national and global level. Structure/Method/Design: The framework is based on practical experiences of INGOs that have been engaged in community-based MNCH programs for over 25 years as well as current literature on scale-up, implementation science, and evidence-informed policy making. We present three complementary pathways that have been shown to be critical to the uptake of community-based MNCH strategies across time and context. Six case studies illustrate the operationalization of the three pathways within the context of community-based MNCH projects. The cases represent six countries from three regions (Latin America and Caribbean, sub-Saharan Africa, and South Asia) and six INGOs ranging in size. Outcomes & Evaluation: The first pathway for integration, “learning for leverage,” was demonstrated by Future Generations in Peru and CARE in Bangladesh. These two INGOs used community health strategies as sources of experimentation, innovation, and demonstration to influence changes in health systems and policy at a national level. The second pathway, “thought leadership,” was made evident by the Haitian Health Foundation in Haiti and Hellen Keller International in Nepal, where they captured and diffused lessons learned to advance better ways of solvingMNCH challenges. The third pathway, “joint venturing,” was exemplified by two INGO consortiums: one in Rwanda and one in Senegal. These two consortiums worked in partnership with one another (as well as other public and private institutions) and used their collective voice to integrate community-based approaches into national health systems at scale. Going Forward: Future community-based MNCH strategies must also address the primary components that drive their integration into existing health systems, including strategic responsiveness to national health priorities, partnership with policymakers and other stakeholde Funding: This paper was supported by the USAID-funded Maternal Child Health Integrated Program, under the terms of Cooperative Agreement GHS-A-00-08-0002-00. The contents are the responsibility of the authors and do not necessarily reflect the views of USAID or the United States Government. Abstract #: 01ETC055

International cooperation Brazil-Cuba-Haiti: the role of community radios in strengthening social mobilization in the public health context in Haiti

The present article investigates the role of Haitian community radios in strengthening social mobilization, with the aim of supporting the actions undertaken in the field of public health in Haiti, based on the development of the Workshop for community radios, as part of the Tripartite Cooperation Brazil-Cuba-Haiti. The qualitative methodology is justified because of the study content, an analysis of documents and direct observation, through a case study presented at the Workshop held in the department of Hinches, in Haiti. This meeting was held in the context of the Working Group on Tripartite Communication, under the responsibility of the Health Channel/Fiocruz, in partnership with the Department for Health Promotion and Environmental Prevention of the Ministry of Health and Population of Haiti (DPSPE/MSPP/Haiti), with a proposal to better structure a network of multipliers in health promotion.

International aid and natural disasters: a pre- and post-earthquake longitudinal study of the healthcare infrastructure in Leogane, Haiti.

The reconstruction of healthcare systems in developing countries after natural disasters is poorly understood. Using data collected before and after the 2010 Haiti earthquake, we detail the response of aid agencies and their interaction with local healthcare providers in Leogane, the city closest to the epicenter. We find that the period after the earthquake was associated with an increase in the total number of healthcare facilities, inpatient beds, and surgical facilities and that international aid has been a driving force behind this recovery. Aid has funded 12 of 13 new healthcare facilities that have opened since the earthquake as well as the reconstruction of 7 of 8 healthcare facilities that have been rebuilt. Despite increases in free, aid-financed healthcare, private Haitian healthcare facilities have remained at a constant number. The planned phase-out of several aid-financed facilities, however, will leave Leogane with fewer inpatient beds and healthcare services compared with the pre-earthquake period.

Assembly Presents Courage Award, Takes Other Actions

Back to table of contents Next article Association NewsFull AccessAssembly Presents Courage Award, Takes Other ActionsKen HausmanKen HausmanSearch for more papers by this authorPublished Online:5 Dec 2014https://doi.org/10.1176/appi.pn.2014.12a15AbstractThe Assembly honors psychiatrist Marie-Claude Rigaud, M.D., for her work after the Haitian earthquake and takes action on key issues.Soon after two natural disasters took the lives of more than 200,000 Haitians and laid waste to much of her native country of Haiti in 2010, including much of its mental health system, psychiatrist Marie-Claude Rigaud, M.D., knew she had to step in and lend her expertise to help relieve the mental health crisis that was sure to develop. Marie-Claude Rigaud, M.D., has been active in organizing an international mental health response in her native Haiti. Shown with Rigaud are Scott Benson, M.D. (left), and Ken Busch, M.D.David HathcoxShe quickly became the prime mover behind the first Haitian Mental Health Summit, held in Miami in June 2010, which she organized with the help of APA, the World Psychiatric Association, and the World Health Organization. This summit soon led to the formation of the nonprofit organization, Rebati Sante Mentale Haiti, the goal of which was to oversee the building of a mental health system that is focused on evidence-based treatments. She now chairs the organization. She has helped organize two additional summits on mental health care in Haiti in the last four years, which have led to psychiatric medications and other relief supplies being delivered to Haiti.For her contributions to remedying the many ills that beset Haiti’s mental health system as it faced a painful recovery and rebuilding process, the APA Assembly last month honored Rigaud, who lives in Aurora, Ill., with its annual Profile of Courage Award. The award “recognizes an APA member who has taken, at risk to her or his professional and personal status, an ethical stand against intimidating pressure for the good of patient care. ...” Other Actions TakenAlso at the November meeting, Assembly members approved nominations for the offices of speaker-elect and recorder. Nominated for speaker-elect are Assembly Recorder Daniel Anzia, M.D., of Illinois, and Robert Roca, M.D., a representative of the Maryland Psychiatric Society. The nominees for recorder are Ludmilla De Faria, M.D., of Florida, who is the Minority/Underrepresented Group representative on the Assembly Executive Committee, and Theresa Miskimen, M.D., a representative of the New Jersey Psychiatric Association.The election will be held at the Assembly’s next meeting, which will be in May 2015, in Toronto. At that time, current Speaker-elect Glenn Martin, M.D., will succeed Jenny Boyer, M.D., as speaker.The Assembly also voted to Approve the Practice Guideline for Psychiatric Evaluation of Adults, which the Board of Trustees will address at its meeting later this month. Approve an APA position statement on “firearm access, acts of violence, and relationships to mental illness and mental health services.” The statement has been forwarded to the Board of Trustees, which must approve all proposed APA position statements before they become APA policy. Among the topics addressed are actions that can minimize firearm injury and violence, need for research on the causes of firearm violence, reasonable restrictions on firearm access, and a discussion of the relationship between gun violence and mental illness.Endorse a proposal concerning e-prescribing of controlled substances that urges APA support “for the option for electronically prescribed controlled substances as aligned with federal regulations and express the importance of adopting such standards. ...” The Assembly recommended forwarding this issue to APA’s delegation to the AMA and that APA develop a position statement on this issue.Urge APA to have the Council on Advocacy and Government Relations develop a plan to address the issue of compensation and benefits of psychiatrists employed at medical centers run by the federal Bureau of Prisons, where pay and benefits are “substantially below community levels, including other federally employed physicians.” The paper noted that this pay discrepancy hampers the bureau’s ability to recruit and retain psychiatrists.Support formation of an APA task force to focus on including buprenorphine as an integral part of treatment for substance abuse disorders in psychiatric and primary care settings and on integrating buprenorphine training into residency programs. ■Most action papers passed by the Assembly are not final until voted on by the Board of Trustees. Assembly meeting archives can be accessed here. ISSUES NewArchived

Knowledge, attitudes and practices regarding cervical cancer and screening among Haitian health care workers.

It is estimated that Haiti has the highest incidence of cervical cancer in the Western Hemisphere. There are currently no sustainable and affordable cervical cancer screening programs in Haiti. The current status of screening services and knowledge of health care professionals was assessed through a Knowledge, Attitudes, and Practices survey on cervical cancer screening and prevention. It was distributed to Project Medishare for Haiti health care workers (n = 27) in the Central Plateau. The majority (22/27) of participants stated pre-cancerous cells could be detected through screening, however, only four had ever performed a pap smear. All of the participants felt a screening program should be started in their area. Our data establishes that knowledge is fairly lacking among healthcare workers and there is an opportunity to train them in simple, cost effective “screen-and-treat” programs that could have a great impact on the overall health of the population.

Bottles to breastfeeding in rural Haiti.

In 1987 exclusive breastfeeding (EBF) in Haiti was rare. Most rural women deliver at home. The Haitian Health Foundation (HHF) provides family- oriented, practical education and, home visits. By 1998, 66% of women completed six months of EBF; 80% by 2010. In 2011, HHF and two villages were certified “baby friendly.”

Dengue virus infections among Haitian and expatriate non-governmental organization workers--Léogane and Port-au-Prince, Haiti, 2012.

In October 2012, the Haitian Ministry of Health and the US CDC were notified of 25 recent dengue cases, confirmed by rapid diagnostic tests (RDTs), among non-governmental organization (NGO) workers. We conducted a serosurvey among NGO workers in Léogane and Port-au-Prince to determine the extent of and risk factors for dengue virus infection. Of the total 776 staff from targeted NGOs in Léogane and Port-au-Prince, 173 (22%; 52 expatriates and 121 Haitians) participated. Anti-dengue virus (DENV) IgM antibody was detected in 8 (15%) expatriates and 9 (7%) Haitians, and DENV non-structural protein 1 in one expatriate. Anti-DENV IgG antibody was detected in 162 (94%) participants (79% of expatriates; 100% of Haitians), and confirmed by microneutralization testing as DENV-specific in 17/34 (50%) expatriates and 42/42 (100%) Haitians. Of 254 pupae collected from 68 containers, 65% were Aedes aegypti; 27% were Ae. albopictus. Few NGO workers reported undertaking mosquito-avoidance action. Our findings underscore the risk of dengue in expatriate workers in Haiti and Haitians themselves.

Epidemiology of sexually transmitted infections in rural southwestern Haiti: the Grand'Anse Women's Health Study.

The study attempts to define socioeconomic, clinical, and laboratory correlates in vaginitis and other sexually transmitted infections in rural southwestern Haiti. A convenience sample of subjects recruited from a rural women's health clinic and attending an established clinic at the Haitian Health Foundation (HHF) clinic was studied. A standardized history and physical examination, including speculum examination, and collection of blood, urine, and vaginal swabs were obtained from the women at the rural clinic. Additional vaginal swab samples only for Nucleic Acid Amplification Test (NAAT) testing were obtained from women at the HHF clinic in Jérémie. Laboratory results from Leon subjects were positive for Gardnerella vaginalis in 41% (41 of 100), Trichomonas vaginalis in 13.5% (14 of 104), Candida sp. in 9% (9 of 100), Mycoplasma genitalium in 6.7% (7 of 104), Chlamydia trachomatis in 1.9% (2 of 104), and Neisseria gonorrhea in 1% (1 of 104) of patients. Human immunodeficiency virus (HIV) antibody tests were negative in 100% (103 of 103) of patients, and syphilis antibody testing was positive for treponemal antibodies in 7.7% (8 of 104) patients. For subjects from the HHF, 19.9% were positive for T. vaginalis, 11.9% were positive for C. trachomatis, 10.1% were positive for M. genitalium, and 4.1% were positive for N. gonorrhea. Infections with G. vaginalis, T. vaginalis, and Candida were the most common. N. gonorrhea, C. trachomatis, Candida sp., T. vaginalis, and M. genitalium infections were associated with younger age (less than 31 years old).

Epidemiological characteristics of malaria in the village of Corail, Grand'Anse, Haiti

Malaria is considered to be a major problem of public health in Haiti. However the impact of Plasmodium falciparum on health is poorly known in this country. The objective of this study is to verify the incidence of malaria as the cause of hospital consultation and to evaluate the rate of P. falciparum gametocytes carriage among the population living in a municipality within the Department of Grand'Anse where the prevalence of malaria is considered one of the strongest in Haiti. Analysis of hospital statistics of Corail (Grand'Anse) showed that only 17.4% of consultations of patients presenting with fever are due to microscopically confirmed malaria. The fraction of the population most affected is that of adults aged 15-39 years (55% of cases). Children under five represent only 11% of the cases. A community survey showed the rarity of the carriage of gametocytes in asymptomatic persons (0.9%). In Haiti, the epidemiological characteristics of malaria must have specified and documented field studies in order to adapt a strategy for fighting against this parasitic disease with greater efficiency.