MALNUTRITION: HAITI: Fighting hunger in hard-to-reach parts of Haiti

TRENTON DANIEL,  May 25, 2011

FURCY, Haiti (AP) — Where the road gave way to trails, the hunger-hunters parked their motorcycle and hiked for more than an hour up a mountain too steep even for mules. There, in a foggy clearing high above the Haitian capital, the Baptist aid workers made their find.
Two glassy-eyed boys stood beside a wood and mud hut. Their low weight made them look half their ages, but their hair, grey and patchy from lack of nutrition, gave them the appearance of old men.
"They looked as though they were ready to die," said Hilaire Etienne, one of the aid workers. "They were merely bones and just skin on their bodies."
Haiti has long struggled with malnutrition as a result of widespread poverty, a dearth of jobs and a feeble agricultural sector. UNICEF says malnutrition is responsible for about 60 percent of all deaths in people under 18 in the country. An estimated 30 percent of Haitian children are chronically malnourished, their growth often stunted.
Health workers believe there are thousands of children like Jameson and David Paul, the starving brothers discovered in Furcy, who are slowly suffering out of sight of the massive humanitarian effort in the capital just 30 miles away.
There's a little more hope for the Paul brothers now, due to the efforts of the Baptist Haiti Mission, which tracks down hungry children in remote areas of the country and feeds them. Etienne and his partner, Michel Raphael, earn about $75 a month trekking into the mountains and banana groves of Haiti with supplies of vitamins and vaccines and a portable scale to weigh children.
In the Haitian countryside, children are seven times more likely to be malnourished than their counterparts in densely populated Port-au-Prince and other cities, said Mohamed Ayoya, UNICEF's chief of nutrition in Haiti. Such remote areas can be difficult to reach because many roads are damaged or dwellings are accessible only by foot, making food delivery a challenge.
The 68-year-old Baptist Haiti Mission is one of Haiti's oldest charities, but it isn't alone in trying to reach poor people deep in the countryside. The U.S.-based Partners in Health has been working in the country's remote areas for years, as has UNICEF, which plans to send workers with the Haitian government later this month to the Grande Anse area, in the country's far west, to investigate a reported spike in malnutrition.
Hunger also is an issue high on the agenda of newly elected President Michel Martelly, who has pledged to revitalize the country's farming sector, devastated by the effects of cheap food imports and deforestation. Much of the country's foliage has been destroyed by Haitians chopping down trees to make charcoal.
Raphael said he welcomes the aid that has come to Haiti since the 2010 earthquake leveled the capital, but laments that he doesn't see much of it in the mountains.
"When I think about how much money comes into the country, I realize that nothing ever comes to the peasants in my area," said Raphael, 35, who followed in his father's footsteps by becoming a health care worker.
On the morning Raphael and Etienne found the Paul brothers, they had left the Baptist Haiti Mission at sunrise, wearing jackets against the chilly air and carrying chewable vaccinations for typhoid and tetanus. They brought their scale with them on house calls, and the villagers referred to them as "doctors," even though they aren't.
The pair urged parents to bring their children to be weighed, but a few of the more agile tots scampered behind banana trees, fearful of vaccinations.
The health workers nabbed one preschooler who squealed as Etienne hung him by his T-shirt from a hook at the end of a scale. He weighed about 20 pounds, far lighter than a normal child his age.
An hour later, the aid workers found the Paul brothers — 6-year-old Jameson and David, 4. The brothers had the gray hair of village elders, and were being raised by their grandmother after their mother dropped them off and left.
Etienne and Raphael gave them vitamins and potatoes that they had grown from their own gardens.
"When I look at these kids and look at mine, it really hurts," said Raphael, a married father of two girls and a boy.
The Pauls' grandmother, Sentina Estime, said they suffer from constant itching — a sign of malnutrition — as well as hunger.
"They itch all the time," Estime said. "They need to go to see a doctor, but I can't bring them because I'm not in good health myself."
Yes, Etienne and Raphael, agreed, they need to see a doctor. Meanwhile, the aid workers promised to return in a couple of weeks with more vitamins and potatoes.
"We do what we can do," Etienne said. Malnutrition brings many complications.
He packed his scale and vitamins and set off to look for more hungry children. http://www.google.com/hostednews/ap/article/ALeqM5hCTaCmXnNpmjkmDV9rBMuiK8q4Zg?docId=5fecf34fae894763bf6e20d435885b07

MALNUTRITION: Haiti: Heinz nurtures vitamin-deficient Haitian young

Jill King Greenwood : May 19, 2011

When women in Haiti stop nursing their babies, it doesn't take long for malnutrition to set in.
Breast-feeding typically ceases when infants are 6 months old and they are transitioned to a diet high in corn, rice and wheat grains. The children don't get enough iron, zinc and other nutrients and can become malnourished quickly and susceptible to illness and disease, Ian Rawson, managing director of Hopital Albert Schweitzer in Haiti, said on Wednesday.
Rawson -- a Pittsburgh native in the United States to deliver the commencement address on Friday at Goucher College in Baltimore -- is working to change that with a team of researchers at H.J. Heinz Co. Heinz has developed a nutritional supplement called NurtureMate, which it will begin distributing in the poverty-stricken nation this summer.
"With the malnutrition comes the cholera, and the tuberculosis, inhibited growth and cognitive development and so many other things," said Rawson, who has worked since 2009 at the hospital founded by the Mellon family 55 years ago. "They are struggling, and we are so excited about the opportunity to help them and lift them out of that."
The NurtureMate, a sachet similar in size to a sugar packet, is sprinkled on top of food, Rawson said. It is odorless and colorless.
Sixty packets cost just $1.50 to manufacture, said Tammy Aupperle, director of the H.J. Heinz Company Foundation. The first distribution will reach 14,000 children, she said, and the effort aims to target children ages 6 months to 2 years.
"This is such a critical stage in a child's life, and their mental and physical development and growth are critical in that time period," Aupperle said.
The Heinz Micronutrient Fund was started in 2007, and the supplements have been distributed in Indonesia, India, Bangladesh and other developing countries, Aupperle said.
Heinz and Dr. Stanley Zlotkin, of Toronto, developed the supplement, which can be customized to meet the needs of different cultures in different countries, Aupperle said. Children in Mongolia are swaddled in heavy blankets because of the cold weather, she said, and most become Vitamin D-deficient because they lack exposure to the sun.
In Haiti, the biggest need is iron, Rawson said.
Rawson said that when he is in Haiti, he looks past the devastation and sees hope, progress and a bright future.
Though the people still are suffering from the 7.0-magnitude earthquake that struck in January 2010 and the cholera outbreak that followed, Haitians overall are vibrant, hopeful and happy, he said.
"There is so much love and support for Haiti, and the beauty of Haiti is its energy and positive life force," said Rawson. "They've grieved their losses and put it in the past."
Some construction has begun, though many people still live in tent cities, Rawson said, adding that it will take "years and years" before the capital of Port-au-Prince is rebuilt. The city was one of the areas hit hardest by the earthquake.
The Brothers' Brother Foundation in Pittsburgh has raised more than $966,000 in cash for Haiti since the earthquake and has collected $43 million worth of material, medicine and food, said Luke Hingson, director of the North Side-based charity.
Pittsburgh-area doctors routinely travel to Haiti to provide medical services, Rawson said.
http://www.pittsburghlive.com/x/pittsburghtrib/news/s_737849.html

MALNUTRITION: Out of the spotlight, the food crisis worsens

13 May 2011

While the world has its attention riveted on the political events in North Africa and the Middle East or on natural disasters such as those happening in Japan, an unprecedented food crisis is taking place that is affecting millions of people around the world.

Soaring food prices
In December 2008, food prices reached their highest level in 30 years. The economic crisis and market volatility then plunged millions of people into poverty. Yet, according to a report by the FAO in December 2010, new records have now been reached. In March, prices recorded a slight drop for the first time in eight months.

Dramatic consequences
Such volatility may seem innocuous, yet 44 million people will be pushed under the poverty threshold due to these price increases.
One billion people already suffer from chronic malnutrition. In the poorest countries, almost 80% of the family’s budget is spent on food that is often of poor quality. Children and pregnant women are most affected by malnutrition because they become then more vulnerable to infections and illnesses. But, families no longer have the means to seek medical care in such situations. As a result, approximately one third of deaths in children under five years of age are linked to malnutrition!

The crisis is already taking place
This is not simply a case of scaremongering. A crisis is already unfolding in numerous vulnerable countries such as Haiti or Egypt, to name just a few.
In Bangladesh, for example, the delegation from Terre des hommes carried out a survey in five periurban centres. It revealed that almost 33% of the children under five years of age who were examined suffered from acute malnutrition and 18% of those suffered from severe acute malnutrition. According to the World Health Organisation, the threshold for declaring a state of emergency is set at 15%. The projects on the ground were immediately reorganised to deal with this alarming crisis by opening up new structures or increasing support capacities. At the same time, the resilience of populations facing food insecurity was strengthened, and promotional efforts, as well as projects focusing on prevention, clean water, sanitation and hygiene, are now underway.
Terre des hommes is active in the area of health and nutrition with 19 projects currently being run in 15 countries. Its ability to respond to these types of emergencies and implement rapid and appropriate interventions depends to a large extent on donations.
http://www.trust.org/alertnet/news/out-of-the-spotlight-the-food-crisis-worsens

MALNUTRITION: Haiti: New premises to fight against malnutrition

18/04/2011

Like many other buildings of the Hospital of the State University of Haiti (HUEH), that of the paediatric service of the hospital was not spared by the January 2010 earthquake and the Nutritional Stabilization Unit (USN), a unit of the Service, which handles the management of children with severe acute malnutrition, was found devoid of premises.



"UNICEF (United Nations Children's Fund) had to accommodate the USN under tents to ensure the continuity of services for malnourished children," explains Marie-Claude Desilets, Nutrition Specialist of UNICEF But the tents, exposed to the weather, began to be worn. That is why UNICEF has decided to award an amount of 58,000 dollars for the construction of a semi-permanent structure that will be attached to the pediatrics premises. The USN has treated 319 children suffering from severe malnutrition, which represents about 22% of cases handled in 2010 for the whole country. And according to information provided by Mr. Mbakwa, Health and Nutrition Coordinator for Concern Worldwide Haiti, "from January to March 2011, 56 malnourished children were treated at the USN". Children may remain from 7 to 10 days, sometimes up to 15 days in USN, said Marie-Claude Désilets.
The new building will be equipped with two rooms. The largest will host twenty cradles [double the current capacity] as well as beds for parents. The second, smaller, serve as a playground for children. Also, this new structure will be equipped with toilets. The construction of the new premises of the USN was launched Thursday, March 24, 2011 and and work should be completed within one month. This project is implemented by the NGO Concern Worldwide, which, thanks to funding provided by UNICEF, put also available to the USN, eight members of its nursing staff. The international NGO also provides training for all medical personnel. This latest initiative is part of capacity building of the Ministry of Public Health and Population (MSPP).
UNICEF is working with Concern Worldwide Haiti in support of malnourished children in several other hospitals of the capital such as the Hospital La Paix in Delmas 33, the Hospital Eléazar Germain in Pétion-Ville, the Hospital Saint Damien in Tabarre, the Hospital des Petits Frères et Sœurs, the Health Center of Martissant, the Health Center of Bizoton and that of Delmas 75. ccording to Marie-Claude Désilets, UNICEF is currently studying the possibility of providing support to the MSPP for the establishment of Nutritional Stabilization Units in 10 departments.
http://www.haitilibre.com/en/news-2763-haiti-health-new-premises-to-fight-against-malnutrition.html

MALARIA: Climate change prompts debate among experts about spread of tropical diseases

January 10, 2011: Special to The Washington Post
By Arthur Allen [Allen, a Washington-based writer, is the author of "Vaccine: The Controversial Story of Medicine's Greatest Lifesaver" (W.W. Norton, 2007).]

The room where 10,000 Anopheles stephensi mosquitoes hatch each week is hot and humid and smells like the tropics - an appropriate surrogate for a warming world. The Johns Hopkins Malaria Research Institute in Baltimore, where the insects are raised, was created with a billionaire's anonymous donation a decade ago, after a map printed in Scientific American suggested that by 2020 malaria could be breaking out in Baltimore, and across the eastern United States and Europe.
The idea that climate change will bring malaria and other tropical killers to our door turns out to be an extremely controversial one among ecologists, climatologists and biologists such as Marcelo Jacobs-Lorena, who runs the "insectary" at Johns Hopkins. "It's a very complicated story," says Jacobs-Lorena.
The malaria map accompanied a 2000 article, written by Harvard biologist Paul R. Epstein, that raised the alarm about the impact of global warming on the spread of infectious diseases. It helped influence a research agenda that last year resulted in more than 4,000 studies of climate change and disease.
Epstein believes that evidence of the disease risks of climate change have only grown in the past decade. "The earlier models did not take into account the dramatic increase in extreme weather that we're seeing," he said.
Extreme weather events such as heavy flooding and drought - thought to be linked to the warming of the oceans and to changes in the precipitation cycle - create conditions for waterborne illnesses that may be becoming more common in the United States, said Jonathan Patz, a professor of environmental public health at the University of Wisconsin at Madison. A cryptosporidiosis outbreak that killed 50 people in Milwaukee in 1993, preceded by the heaviest rainfall month in 50 years, could be a sign of things to come, he said, given that record rainfalls have become more common in recent years.
In 2008, the director of the National Institute of Allergy and Infectious Diseases, Anthony Fauci, warned that physicians should be on the lookout for dengue fever, a tropical disease that has exploded in South and Central America and across much of Asia in recent years. The mosquito Aedes albopictus, which can carry dengue, has extended its range across the United States since arriving in the 1950s, probably in a shipment of tires from Japan.
Cases of dengue have been reported in Texas since 1981, and there have been small outbreaks in Hawaii and, most recently, in the Florida Keys. The disease "threatens temperate zones of the continental United States where mosquito vectors continue to expand," Fauci wrote in the Journal of the American Medical Association.
Biological first principles suggest that warmer weather, by causing organisms to grow faster, will expand the range of disease-carrying insects and microbial pathogens. And some models published in the medical and scientific literature suggest that tropical illnesses such as Chagas, which spreads in Latin America through the feces of a beetle, and leishmaniasis, carried by sandflies, could soon find niches in the United States.

Offsetting effects?
Last year, an article in the journal Ecology raised questions about these theories and suggested that, rather than broadening the range of tropical infectious diseases, climate change would just shift the burden. New outbreaks in some areas would likely be offset by reductions in disease elsewhere, wrote the author, Kevin Lafferty.
"It seems plausible that the geographic distribution of some infectious diseases may actually experience a net decline with climate change," with, say, malaria declining in areas too hot for the malarial mosquitoes to live even as the disease spreads into previously cooler highland areas, wrote Lafferty, an ecologist at the University of California at Santa Barbara. "While this is the reverse of the conventional wisdom, it is consistent with the increasingly accepted view that climate change will reduce biodiversity."
Climate change has not been the main cause of shifts in infectious-disease patterns over the previous couple of centuries, infectious-disease specialists note. Humans have played an important role.
Mosquito-spread diseases such as malaria, dengue fever and yellow fever appeared in the United States as late as the early 20th century, in periods that were cooler than today. There were massive malaria epidemics in places as far north as Poland and Siberia in the mid-20th century. These diseases went away as a result of public health campaigns and improved sanitation and living standards.
In May, an international group of experts published a letter on climate change and malaria in the journal Nature stating that "widespread claims that rising mean temperatures have already led to increases in worldwide malaria morbidity and mortality are largely at odds with observed decreasing global trends." Further warming of the climate appears unlikely to broaden malaria's reach very much, they concluded.
Markers along the C&O Canal towpath memorialize the canal diggers who died of cholera there early in the 19th century. And cholera is still with us, its bacteria colonizing brackish waters of the Chesapeake Bay. If we didn't have water filtration plants in our region, we'd probably still have outbreaks of the disease.
Many biologists say there is little reason to think that climate change will trump human efforts against such diseases in the future. "It's intuitive to think that with global warming there's going to be increasing dengue and malaria or yellow fever, but it's not necessarily so," says Duane J. Gubler, a longtime dengue expert at the Centers for Disease Control and Prevention who now directs the Asia-Pacific Institute of Tropical Medicine and Infectious Diseases in Singapore. "We got rid of these diseases after World War II with good water management, improved standards of living and DDT.
Gubler says that dengue's resurgence in parts of the tropics has resulted from urbanization and the failure of mosquito eradication campaigns, rather than climate change. He sees little chance that dengue, which causes a painful, sometimes fatal infection, will make serious inroads in the United States and points to a 2008 study that compared dengue rates in Brownsville, Tex., and Matamoros, its sister city across the Rio Grande in Mexico. While 32 percent of Matamoros residents had been recently infected, the survey found, only 4 percent of Brownsville residents showed evidence of infection.
Among the likely explanations is that almost all residents of Brownsville have running water, so they don't need to keep it in pots around their houses where mosquitoes breed. They have air conditioning and are less likely to be outside during mosquito-biting periods, and they live in less densely populated houses and neighborhoods, lowering the chances of an epidemic.
Still, some studies have shown an increase in dengue in Puerto Rico, Venezuela and Thailand following particularly warm, wet periods, suggesting that warming could also bring the disease to the United States. Fauci and David Morens, co-author of the JAMA article, don't think it likely that dengue will spread massively around the United States, Morens said in an interview. But smaller outbreaks like one seen in Key West this year are more likely than in the past, he said.

Haiti's epidemic
A clear example of how tricky it is to figure out whether climate change or something else is affecting disease rates is apparent in Haiti, where a cholera epidemic is raging: More than 3,400 people had died and nearly 150,000 had been sickened as of a week ago, according to the most recent Haitian government statistics.
Rita Colwell, a University of Maryland environmental microbiologist and former National Science Foundation director who has spent 40 years studying cholera, believes climate change has played a role in the Haitian outbreak.
Colwell and her colleagues have shown that the cholera bacterium lives, often in a dormant state, in brackish estuaries and on zooplankton. As these tiny organisms multiply rapidly during warm periods, cholera can spring back to life. Colwell's research has convinced most of her colleagues that the zooplankton blooms - and cholera outbreaks - respond to warming periods that will increase with climate change, mainly by lengthening yearly epidemics.
Yet, one leading theory for what caused Haiti's epidemic focuses on humans. U.N. peacekeepers from Nepal, where cholera is endemic, may have caused the outbreak by allowing their septic tank to contaminate a river from which Haitians drink. If proved, this would underline the powerful impact of random events in a world of global travel and overpopulation. Many scientists, in fact, believe that such influences will dwarf the impact of climate change on infectious disease - or, perhaps, exacerbate it.
"Public health systems around the world are fighting a constant battle against diseases," said Joshua Rosenthal, environment and health program director at the National Institute of Health's Fogarty International Center. "Climate change is definitely affecting disease dynamics, but the big question - will diseases be a bigger problem in a warmer, wetter, sometimes dryer world? - can't be separated from the factor of diligent public health systems that are in place."
As a result, many scientists say it makes more sense to spend money addressing public health crises - climate-related or not - rather than greenhouse gases, though others argue it's unsafe to make it an either/or question. Campaigns to fund malaria vaccine research and put millions of bed nets in malarial African villages are expected to have an impact on the spread of the disease larger than any caused by climate change, many scientists agree.

Whether or not human engineering got us into this mess, perhaps it can get us out. That's the idea behind Jacobs-Lorena and his Baltimore mosquitoes.
The Hopkins center is one of many research groups seeking to change the nature of the mosquito and the diseases they carry. Jacobs-Lorena's group intends to infect his insects with malaria-killing bacteria and send them out to live and propagate around African villages.
A British company recently bred millions of sterile male mosquitoes and mated them with wild females in an experiment in the Cayman Islands that reduced the population of potentially dengue-carrying mosquitoes in one area by 80 percent. Still other researchers - at the Walter Reed Army Institute of Research and elsewhere - are getting closer to creating vaccines against malaria, dengue fever and other tropical diseases.
"I think it makes more sense to use our money on research and public health than carbon trading," Gubler said. "We could do an awful lot, around the world, with not very much money."
http://www.washingtonpost.com/wp-dyn/content/article/2011/01/10/AR2011011006063.html

GENERAL: Is the WHO Becoming Irrelevant? Why the world's premier public health organization must change or die.

BY JACK C. CHOW
DECEMBER 8, 2010


Joe Raedle/Getty Images


Among the many victims of Haiti's deadly cholera outbreak may be an unexpected casualty: the World Health Organization. As the epidemic broke out on the island, spreading quickly from rural areas to the capital, Port-au-Prince, the World Health Organization (WHO) and its regional division, the Pan American Health Organization (PAHO), sent expert teams, mapping the epidemic and advising the government on how to best defeat the outbreak. Relief workers hustled to contain the disease in rural areas before it spread to the capital, where living spaces are more compact, sanitation systems are overwhelmed with raw sewage, and more than a million earthquake survivors are still huddled in tent camps. But reach Port-au-Prince it did, and today at least 1,800 Haitians have fallen victim. Cholera, like most any outbreak, demands a nimble, fast-moving, and adaptive response. Unfortunately, that's just about everything the WHO is not. The 11 months since Haiti's earthquake, coupled with the relentless rise of pandemics in impoverished countries in recent years, have made painfully clear that the agency can no longer adequately perform the job of being the world's chief defender against disease.
More... The WHO -- for 62 years the world's go-to agency on all public health matters -- is today outmoded, underfunded, and overly politicized. In a world of rapid technological change, travel, and trade, the WHO moves with a bureaucracy's speed. Its advice to health officials is too often muddied by the need for consensus. Regional leadership posts are pursued as political prizes. Underfunded and over strapped, the organization has come under attack for being too easily swayed by big pharma. In a world where foundations, NGOs, and the private sector are transforming global health, the WHO has simply not adapted. This isn't just about the WHO losing its edge. Taken together, these myriad dysfunctions are rendering the WHO closer and closer to irrelevancy in the world of global health.
How did it get so bad? When the WHO was created as a U.N. technical agency shortly after World War II, governments' health ministries were the predominant global health authorities. The new U.N. body was meant to serve as a reservoir of expertise and knowledge at the service of countries needing a hand. The WHO essentially became a health consultancy to developing countries, supplying advice, analyses, and best practices, though stopping short of directly implementing health programs. That was an invaluable service at the time. But today, its mission and operations remain largely unchanged.
The WHO's stagnation is juxtaposed with a world of public health that is changing more and more quickly than ever. Legions of new drugs, vaccines, and diagnostics have fortified the medical profession. Governments are no longer the sole stewards of public health; new players are entering the field, both public and private. The eight-year-old Global Fund to Fight AIDS, Tuberculosis and Malaria, for example, is now the go-to coordinator for international funding to combat these diseases. The Bill and Melinda Gates Foundation has revolutionized global health, investing $13 billion in health grants in everything from research into malaria vaccines to treatment of tuberculosis to HIV/AIDS programs on the ground. Even the U.S. government has gotten in on the world of change, forcefully responding to HIV/AIDS in Africa with a $25 billion program that has put some 3.2 million people in treatment in just half a decade. What differentiates these pioneering efforts from the WHO is that they are nimble, well-funded, and less encumbered by red tape. It's hard to see how the WHO can compete.
In fact, in this new atmosphere, where organizations are taking health into their own hands, it's unclear exactly what role the WHO should even play anymore. Offering up its expertise is not as straight forward as it once was; the biggest players in global health aren't asking for assistance as governments once did. Nor can the WHO set its own advising priorities, since its funding comes from donors, primarily national governments. In recent years, the agency's $2.3 billion annual budget has been increasingly divvied up before it ever reaches the WHO, earmarked by donors for their favored causes, be they specific diseases or treatments to fight them. With its limited resources, the WHO is caught in a trap, appealing to donors' interests in fighting specific diseases such as polio, HIV/AIDS, or malaria, while giving broader health priorities -- notably, the development of basic health-care infrastructure -- short shrift. The WHO is no longer setting the agenda of global health; it's struggling to keep up.
The problems extend to personnel. The WHO's greatest resource is its ability to leverage its objective expertise -- to bring in knowledge, draw conclusions, and disseminate them quickly in a way that is unthreatening and apolitical no matter the location. Unfortunately, that very expertise is starting to fade away. Today the organization is critically short on experts to cover cancer and diabetes, two of the most common diseases in an aging world. The WHO's network of HIV/AIDS advisors is at risk of being disbanded altogether if more funding cannot be found. Even with more funding, there would be roadblocks. The U.N. personnel system pushes the organization to uphold a linguistic and geographic balance, which can obstruct and delay the hiring of key experts. Those not hired by the WHO will be quickly snatched up by the new global health players.
The WHO's governance system is also archaic, stemming from an era in which transportation and communications between continents were slow. The WHO is not a singular entity but operates more akin to a federation of six regional offices, each headed by a director who is elected by the countries in such groupings as Africa or Southeast Asia. These six directors wield authority within their zones that can conflict and compete with that of the Geneva-based director-general, complicating messaging and policy coordination. For example, the Pan American Health Organization considers itself to be the dean among the six regions, with a lineage going back 100 years and an independent financial base; PAHO chafes at the thought of being lumped in with WHO and pushes its moniker over the WHO's when operating in the Americas. Most recently, PAHO announced a global health technology initiative with the U.N. Development Program, a broad mission that arguably ought to have been originated from Geneva.
With competition between branches and body, the assignments of WHO country representatives often involve extensive negotiations between the power in Geneva and the power in the region. Key appointments have many a time been blocked not by qualifications of the individuals but for political reasons. Recognizing the need to knit better relations among the regions and Geneva, WHO Director General Margaret Chan and her senior team spend significant amounts of time jetting to consult with the six regional directorates. Progress is being made, but it is precious time that could be saved in a streamlined organization.
Perhaps what's needed is a move away from the region-centric approach toward a strategy that would allow the WHO to devote more resources to country-level work. As it stands today, the WHO staff are typically housed in a country's ministry of health. The WHO could empower its country-based staff to deliver timely, accurate, and actionable advice where it is needed most -- not just at the national policymaking level, but to local health workers in communities. The WHO could become the go-between for donors, facilitating and sharing information and resources between multiple sources in such countries as Ethiopia and Tanzania. In the field, the WHO could offer its product -- expertise -- to the full range of NGOs, bilateral programs, and even private-sector entities. Rather than just advising ministries of health about how to defeat cholera in Haiti or ebola in Africa, for example, a more robust WHO country team could give that advice to the NGOs, both local and international, that are on the ground fighting outbreaks.
Another advantage of this local focus would be the opportunity to forge stronger relationships with the private organizations, such as Doctors without Borders and Partners in Health, that actually implement health programs. Rather than being pushed out by new players in public health, the WHO could bring them under its technical wing now. In fact, the WHO might consider inviting representatives of independent health groups to assume a set of rotating seats on its executive board. It's an idea that has been successfully tried before: The policy committee for UNAIDS, the U.N. agency that advocates for action on the AIDS epidemic, includes five NGO members, including a representative from communities ravaged by the disease. Likewise, the board of the Global Fund to Fight AIDS, Tuberculosis, and Malaria includes voting members from the private sector, foundations, NGOs, and affected communities. Both organizations enjoy greater legitimacy as a result.
For now, the WHO will continue to be tested, both on acute crises and on long-term problems. Today, it is responding to the cholera outbreak in Haiti; next year it might be another crisis. In many of the world's most difficult places, the WHO does still retain its prominence as the chief reference body on health matters. But it is no time for complacency. The recent barrage of health crises has revealed the WHO's value, yet its weaknesses as well. The agency cannot remain underfunded and understaffed, struggling with a system whose origin dates back to the dawn of the antibiotic era. For the WHO to be revived as the world's foremost health authority, it now needs intensive therapy itself.
http://www.foreignpolicy.com/articles/2010/12/08/is_the_who_becoming_irrelevant?page=full

MALARIA: Mississippi Fish Fight Malaria in Haiti

by: Elizabeth Prann

September 21, 2010
After Haiti was rocked by an earthquake that killed more than 230,000 people, millions donated food, water and supplies to the country.
One group sent marine life.



About 2,000 tiny fish have been flown from Mississippi to Haiti to help control the spread of malaria and the West Nile virus. They are called Gambusia or mosquito fish. One lone minnow can devour several hundred mosquitoes and mosquito larvae each day. Health experts deployed the fish to control the mosquito population in post-Katrina New Orleans when flood waters ravaged that city.
A humanitarian organization called Operation Blessing International sent members to Haiti during the relief efforts. That's when it was clear to the group's president Bill Horan, the threat of disease through mosquito bites could be much worse in Haiti than in New Orleans five years ago.
"I came to Haiti in May of 2009 and right away I noticed a lot of mosquitoes here," Horan said. "And they have malaria [in Haiti]. I thought, wouldn't it be great to bring mosquito fish to Haiti."
OBI has worked with the fish before. In 2005 the group placed fish in more than 5,000 swimming pools that had been contaminated after the Hurricane Katrina. Horan told Fox News the pools were turning into a breeding grounds for the West Nile virus and other deadly diseases. The Centers for Disease Control had alerted city and state officials to a potential outbreak.
"We knew what the solution was," Horan said. "We needed to populate the swimming pools with the mosquito fish."
Horan believed the same bug-eating fish that helped spare New Orleans from virus outbreaks, could also help prevent disease in Haiti.
This week, about 2,000 minnows were transported from Mississippi to Haiti where they live in a 6,000 gallon open water tank. The fish need to acclimate and breed before they are stocked in standing water, lakes and pools. Horan hopes that ideal breeding grounds in the tanks will help the fish population soar from just 2,000 to around 200,000 in a matter of months.
"We’re not going to start planting until we have a substantial number," he said. "I estimate within 90 to 100 days we’ll have hundreds of thousands of fish so we can start planting."
This is just the latest project by OBI to improve health conditions in Haiti. They have been working on HIV/AIDs preventive programs and care since 2005. The group also provided clean drinking water shortly after the earthquake to stop the spread of water-borne disease.
http://liveshots.blogs.foxnews.com/2010/09/21/mississippi-fish-fight-malaria-in-haiti/#ixzz15kM0SNF2

TUBERCULOSIS: HAITI: Combating TB in Port-au-Prince's tent cities

Photo: Tamar Dressler/IRIN
Thousands are still living in tiny tents in the capital, Port-au-Prince

PORT-AU-PRINCE, 17 November 2010 (PlusNews) - Health workers in Haiti are concerned about the spread of tuberculosis (TB) in the tent cities that have housed more than one million people since the massive earthquake in January.
"With the quake this became an emergency," said Macarthur Charles, a doctor with Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), one of the largest HIV- and TB-focused NGOs in Haiti.
"The main TB hospital, the sanatorium here in Port-au-Prince, collapsed and [the GHESKIO] hospital in Leogane [about 29km west of Port-au-Prince] for treating multi-drug resistant TB [MDR-TB] also collapsed."
GHESKIO suffered losses to its health infrastructure worth an estimated US$10 million, and the two government TB sanatoriums were also destroyed by the quake.
"TB is an extremely important situation because transmission is facilitated by the situation of people living under tents," said Jean William Pape, director and founder of GHESKIO.
Across the capital, people are crammed into tiny tents, with 6-10 people sharing a single tent made for two people, while others live in six-by-six or ten-by-ten metre tents.
"There is a delay in care. There is the issue of malnutrition or of having untreated HIV that allows you to have more TB, and then there's the question of you being in small areas with other people," said Megan Coffee, a US infectious diseases specialist who has been running an expanded TB ward at Port-au-Prince's General Hospital since January.
Drug-Resistant TB
The spread of MDR-TB is also a concern. The condition often develops as a result of patients on first-line TB drugs not completing the initial course of treatment. Treating MDR-TB can cost 50-200 times more than first-line treatment. An estimated 2 percent of newly diagnosed TB patients and 12 percent of previously treated TB patients in Haiti have MDR-TB, according to the UN World Health Organization (WHO).
After the earthquake, GHESKIO was able to trace all its MDR-TB patients and continue their medication; some are being treated as outpatients while others are being housed in isolation tents in the capital. GHESKIO is building a new 30-bed centre for patients with MDR-TB, and is strengthening its laboratory capacity to improve TB surveillance.
Shortly after the quake, health workers saw a spike in TB cases, but some think this could have been as a result of increased screening by volunteer organizations. "A lot of the foreigners who came to Haiti to help, they had TB on their mind, they were screening for it... I think that drove the referrals we saw early on, and now I think we've gone down because there is less active screening," said Charles.
A pre-existing epidemic
While the earthquake has destroyed TB infrastructure, stretched limited health resources and worsened living conditions, the disease is not new to Haiti. According to a new WHO report on TB, the current prevalence in Haiti is 312 cases per 100,000 people, by far the highest in the western hemisphere. Like much of the developing world, it is closely linked to HIV; Haiti's HIV rate is 2.2 percent. With 30 percent of the global HIV positive population likely to contract TB in their lifetime, the joint TB and HIV burden in Haiti is heavy.
The patients I've been seeing in the aftermath of the earthquake had nothing to do with the earthquake - there's no way that TB developed in two weeks.
"Living conditions for those in tents are visible now, but they existed long before the earthquake. I would say 60 percent of people now living in tents lived in the same conditions before," said Anany Gretchko Prosper, head of medical operations for Partners in Health, another long-standing health NGO.
"The patients I've been seeing in the aftermath of the earthquake had nothing to do with the earthquake - there's no way that TB developed in two weeks," said Coffee.
Ahead of Hurricane Tomas in October, the expanded TB ward Coffee runs was transferred from tents to a room in the hospital, with 27 beds for in-patient care; hundreds of outpatients also frequent the clinic. About 25 percent of Coffee's patients are HIV-positive and some 40 percent of in-patients are HIV-positive.
However, GHESKIO's Charles acknowledged that these new centres could quickly reach capacity, and providing adequate treatment and care would remain "a challenge".
Following the quake, UNAIDS released a situation assessment which named some of the priority areas for action in Haiti as: rebuilding the health system, restoring networks for people living with HIV, and protecting internally displaced people from HIV. It noted that a new national strategic plan for HIV would be needed, taking into account the country's new realities.
http://www.plusnews.org/Report.aspx?ReportId=91113

POVERTY: Cholera in Haiti: "a disease of poverty"

Photo: United Nations
By Peter Costantini
Ansel Herz has filed three stories so far for Inter Press Service on the cholera epidemic in Haiti.
His reporting has given voice to the perspectives of some of the estimated 1.3 million internally displaced people stuck in over 1,350 tent camps, who are now threatened by the disease. He has visited hospitals that are treating cholera patients, and draws on several frontline medical-care providers as sources.
These stories look through the eyes of people confronting a horrifying yet preventable public-health breakdown. They also put the epidemic in the wide-angle context of underlying systemic crises dating back long before the January 12 earthquake.
For example, Herz reports that the percentage of Haitians without access to safe drinking water actually increased 7 percent from 1990 to 2005, according to Partners in Health. This international medical organization, which has a long history in Haiti, observed in a 2008 report: "Combined with unsanitary conditions, the lack of water is a major factor in exacerbating Haiti's health crises."
As PiH Chief Medical Officer Joia Mukherjee put it, cholera is "a disease of poverty" . During the previous government of Jean-Bertrand Aristide, she pointed out, Inter-American Development Bank loans for a public water supply in the Artibonite Valley, where the cholera originated, were blocked by international donors on political grounds.
In rural areas, where most of the country's population lives, fewer than 8 percent have access to safe drinking water, according to the International Fund for Agricultural Development.
The dearth of potable water and sanitation facilities not only in the camps, but also in many permanent communities, are now major factors contributing to the spread of the deadly disease.
http://www.huffingtonpost.com/crossover-dreams/cholera-in-haiti-a-diseas_b_776565.html

MALNUTRITION: Providing Child Malnutrition Services in Haiti

Haitian children have suffered increasingly from malnutrition over the last decade. To address these needs, the U.S. Agency for International Development (USAID)-funded Santé pour le Développement et la Stabilité d ‘Haiti – (SDSH) project led by Management Sciences for Health (MSH) integrated nutritional monitoring into maternal and child health services in all 147 health centers sponsored by USAID.
After the severe 2008 hurricane season in Haiti, however, many more Haitian children suffered from severe malnutrition. The Management of Severe Acute Malnutrition Program was introduced with additional funding from the USAID, to provide malnutrition services for the affected areas. After the January 2010 earthquake, the program continued to provide nutritional interventions to children in need.
Begining in 2009, advanced therapy for severely malnourished children under the age of 5 was introduced in 20 health facility sites in the 8 areas most affected by the storms. A three-step protocol is used to diagnose and treat malnutrition: affected children are diagnosed and stabilized at a stabilization center; then the child receives Ready-to-Use Therapeutic Food (RUTF) as outpatients; and finally, they benefit from a regimen of nutritional supplementation using dry food rations provided by the World Food Program (WFP).
For Ti Jean, an 18-month-old boy, this program saved his life. His mother brought him to the Saint Louis du Nord health center in Haiti – he only weighed 16 pounds and the health workers were able to diagnose him with malnutrition, but were unable to provide services. Ti Jean and his mother were referred to another medical center called House of Hope in La Pointe Beraca Palmistes. The House of Hope received some of the funding and was able to provide malnutrition services to Ti Jean. After only a few weeks of care, he quickly gained weight and became well-nourished.
Through this supplemental program, 14 hurricane affected sites were rehabilitated and 837,000 children benefited from child health services within a year. Over 204,000 children were diagnosed as Low Weight for Age (LWA), with 45,200 (about 5%) suffering from moderate to acute severe malnutrition. Treatment was provided to 3,700 malnourished children (56% girls) and over 16,200 (58% girls) received food supplementation.
SDSH offers a basic integrated package of services in Haiti: maternal and child health care, including growth monitoring, reproductive health, and prevention and control of infectious diseases including HIV & AIDS and tuberculosis.
SDSH is an MSH-led collaboration of Johns Hopkins Bloomberg School of Public Health/Center for Communications Programs (CCP), AIDS Healthcare Foundation (AHF), JHPIEGO, and Fondation pour la Santé Reproductrice et l’Education Familiale (FOSREF) with USAID, the Government of Haiti, local NGOs, community leaders, and the commercial private sector.

For additional information or to arrange for a press interview, please contact Barbara Ayotte, Director of Strategic Communications, at 617.852.6011 or bayotte@msh.org.
http://www.blogger.com/post-create.g?blogID=3604033512937490051

General: MSF video of activities July 2010

Haiti, sub-Sahara, Kyrgyzstan
http://www.msf.ca/news-media/video/

POVERTY: Phillipine statistics

One of my colleagues at Care.com, Mike Nagel, just returned from an earthquake relief trip to Port-au-Prince. Mike spent a week working in an impoverished tent community called Ktadb, giving away supplies our team helped collect (tarps, school supplies and light construction materials), helping with food and medical distribution, and laying the groundwork for other relief teams to continue delivering much-needed aid.
Five months have passed since the earthquake, and there are still thousands of people living in shelters made of bed sheets. Families are still split apart with children searching for parents and vice-versa. There are still so many children in need (nearly half of Haiti's population is under age 20) with many orphaned or struggling to provide for themselves. International aid is still pouring into the country, but it's slowed dramatically from the weeks following the January disaster as the world's attention has shifted.
After seeing his pictures and hearing his stories, I couldn't help but think of my own home country. Before immigrating to the States, I grew up in the Philippines. It's a beautiful country with a rich history and culture, but it's experiencing the pains of development. Nearly one-third of the population lives below the poverty threshold in the Philippines, and 44 percent of the country subsists on less than two dollars a day.
Growing up in a place where poverty confronted us on a daily basis profoundly impacted my life. My parents taught my siblings and I that if we were successful, we were supposed to use our position in life to give back to those in need. It's a lesson I'm trying to impress on my own boys, as well.
The Philippines, Haiti and other underdeveloped countries have been on my mind lately. It's especially due to Adam (our 10-year-old) asking more questions. He's at the age where he's starting to think beyond the borders of our home and his school, and consider the rest of the world. He watches the news with us and we encourage him to talk about what's going on. When the earthquakes hit Haiti and Chile, he had a lot of questions, including why those countries experienced so much devastation when a similar quake shook Los Angeles but didn't cause nearly the same amount of damage. Asking him what he thought and providing guidance helped give him a new perspective on the needs of others.
It's easier for parents to talk to their kids about poverty when they see it more often. You have more opportunities for those precious "teachable moments" that we parents love. Here in America, where Ron and I have raised our two boys, those sorts of opportunities don't just happen; you have to create them.
One of the biggest ways we've encouraged Adam to think about the circumstances of others is through an activity he loves--the Boston Children's Chorus. The Chorus is a local choir made up by children from all social, economic and racial backgrounds. Its mission is to "serve as a catalyst for community-building and social healing." It's a way for our little guy to not only do something he loves, but also be a part of a true community where kids from all backgrounds can connect to work and sing together. The chorus has helped him move beyond our neighborhood and dip his toes into real world. It's a small step, but it's a start.
I believe that wherever you are and whatever you do, you can find ways to help others. As parents, we have to take hold of every opportunity and use them as teaching tools to open our children's eyes to the global community. It can be as simple as a conversation after watching a news story about another country, sponsoring a child and starting a pen pal relationship, helping your kids organize a neighborhood food drive, or pausing your daily routine to acknowledge those less fortunate. Whatever you choose, teaching your children about poverty will put them on track to become better, more socially conscious global citizens so one day they'll work hard to give back, too.
http://www.huffingtonpost.com/sheila-lirio-marcelo/the-value-of-teaching-kid_b_611813.html

MALARIA: Haiti

Recent calls to eliminate malaria from Hispaniola — the last Caribbean island with endemic transmission of Plasmodium falciparum — are timely and important, write Joseph Keating, Donald Krogstad and Thomas Eisel from Tulane University in the United States in The Lancet Infectious Diseases.
It would provide proof of principle that malaria elimination is possible in complex environments. But elimination is also needed because there is now evidence of chloroquine resistance in Haiti and fast action is needed before the country is forced to switch to a more expensive combination therapy.
Lessons learnt in Haiti will be critical for informing other countries seeking malaria elimination. If elimination cannot be achieved on this small Caribbean island, there is little hope that it can be achieved in Sub-Saharan Africa where the malaria burden is higher and its control more complicated, say the authors.
But they add that elimination strategies used on the island should not be oversimplistic adaptation of control measures used in Africa or other endemic areas.
The key to eliminating malaria in Hispaniola lies in using a combination of methods to eliminate the parasite reservoir in human beings, prevent transmission and mobilise the community to seek out diagnosis and treatment.
All this requires unshakeable political will.
The cost of eliminating malaria in Hispaniola may be high — but it would set a precedent for health diplomacy and is a prerequisite to any global malaria elimination campaign.
http://www.scidev.net/en/opinions/why-we-must-eliminate-malaria-from-hispaniola.html

MALARIA: Haiti

On top of the almost unimaginable devastation caused by January's earthquake in Haiti, the nation is bracing for the ravages of the rainy season. Torrential downpours have already flooded homes and turned tent cities into muddy misery. Ominously, the number of cases of malaria, which is spread by the bite of mosquitoes and which was endemic in Haiti even before the earthquake, is increasing.
To reduce the incidence of malaria, various aid groups are planning to distribute more than 3 million bed nets, an ultra-low-tech, only modestly effective intervention. What is really needed is the chemical DDT, an old, cheap and safe tool to control the vector -- the Anopheles mosquito -- that spreads the disease.
Malaria is a scourge of humanity, particularly for the inhabitants of poor tropical countries. Forty-one percent of the world's population live in areas where malaria is transmitted, and each year 350 to 500 million cases of malaria occur worldwide. The disease imposes huge costs on individuals, families and governments, which are a crushing economic burden on malaria-endemic countries and impede their economic growth. It has been estimated that economic growth per year of countries with a high incidence of malaria was 1.3 percentage points lower than that of similar countries without malaria.
A drug called chloroquine is a useful preventive but many strains of the malaria parasite in Haiti have developed resistance to it. Other drugs called artemisinins are safe and exhibit potent, rapid antimalarial activity, and in combination with other anti-malarials they have been used effectively for several years to treat multiple-drug-resistant malaria. But resistance has arisen and is increasing, so that in the absence of a vaccine elimination of the mosquitoes that spread the disease is the key to preventing epidemics.
Unfortunately, flawed public policy limits the available options.
In 1972, on the basis of data on toxicity to fish and migrating birds (but not to humans), the U.S. Environmental Protection Agency banned virtually all uses of the pesticide DDT, an inexpensive and effective pesticide once widely deployed to kill disease-carrying insects. DDT was subsequently banned for agricultural use worldwide under the 2001 Stockholm Convention on Persistent Organic Pollutants, which stigmatized the chemical and effectively constituted a prohibition.
Although DDT is a (modestly) toxic substance, there is a vast difference between applying large amounts of it in the environment -- as farmers did before it was banned -- and using it carefully and sparingly to fight mosquitoes and other disease-carrying insects. DDT remains largely near where it is sprayed, and no study has ever linked environmental exposure to DDT to harm to human health.
When DDT is used at all now, it is sprayed indoors in small amounts to prevent mosquitoes from nesting, so exposures would be low. A basic principle of toxicology is that the dose makes the poison, and with modern regimens, both environmental and human exposures would be very low.
The regulators who banned DDT failed to take into consideration the inadequacy of alternatives. Because it persists after spraying, DDT works far better than many pesticides now in use, some of which are toxic to fish and other aquatic organisms. With DDT unavailable, many mosquito-control authorities are depleting their budgets by repeated spraying with short-acting, marginally effective insecticides. Read more: http://www.miamiherald.com/2010/05/03/1610610/ddt-can-stymie-malaria-carrying.html#ixzz0oqSp6Fr8

MALARIA: Haiti post earthquake

A member of the International Federation of Red Cross Red Crescent working in Petit Goâve reports that malaria is now the primary health issue among earthquake survivors, noting that approximately 30 percent of patients being treated are diagnosed with malaria. On April 21st we elevated the alert status for malaria to a WATCH following multiple, credible reports of steadily increasing prevalence in several foci of Port-au-Prince. http://biosurveillance.typepad.com/haiti_operational_biosurv/2010/05/red-cross-volunteer-reports-malaria-primary-health-threat-in-petit-go%C3%A2ve-.html