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This presentation details our
efforts to re-establish a
Lymphatic Filariasis clinic in
Leogane HaitiFOR MORE INFORMATION PLEASE VISIT
WWW.BRINGHOPETOHAITI.COM
Lymphatic Filariasis
Clinic at Hospital St. Croix
Leogane, Haiti
HEATHER HETTRICK PT, PHD, CWS, CLT, CLWT
PROGRAM DIRECTOR
ROBYN BJORK MPT, CWS, WCC, CLT-LANA, CLWT
DIRECTOR OF EDUCATION & CLINICAL DEVELOPMENT
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Stats about Haiti
The people
~10.5 million
Median age 21
Life expectancy 61 M/64 W
53% literacy rate
Health
Infant mort: 52/1000
1.9% HIV/AIDS
37% lack clean water
83% lack sanitation
Economy
Poorest nation in Americas;
54% < $1/day with 80% below
poverty line
~41% unemployment
Education
Half of children do not attend school
1 of 5 attend secondary school
Primary language- Creole and French
Source: povertyresolutions.org
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Lymphatic Filariasis
Lymphatic Filariasis (LF) is a parasitic infection spread
by mosquitoes that is endemic in 83 countries with
over 1.3 billion people at risk of contracting it
Worms reside in lymphatic system where they live 4-6 years producing millions of microfilariae
Circulate in blood and picked up by mosquitoes
Result:
swelling of the limbs and breasts (lymphedema),
and/or genitals (hydrocele),
or swollen limbs with dramatically thickened, hard,
rough and fissured skin (elephantiasis)
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Source: CDC
Labspace.com
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Stages of LF (Stage I)
Swelling reverses at night
Skin folds-absent
Appearance of skin-
smooth, normal
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Stages of LF (Stage II)
Swelling not reversible at
night
Skin folds-absent
Appearance of skin-
smooth, normal
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Stages of LF (Stage III)
Swelling not
reversible at night
Skin folds-shallow
Appearance of
skin-smooth, normal
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Stages of LF (Stage IV)
Swelling not reversible at
night
Skin folds-shallow
Appearance of skin
- Irregular, knobs, nodules
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Stages of LF (Stage V)
Swelling not reversible at
night
Skin folds-deep
Appearance of skin –
smooth or irregular
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Stages of LF (Stage VI)
Swelling not reversible at
night
Skin folds-absent,
shallow, deep
Appearance of skin-
mossy lesions on foot or
top of the toes
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Stages of LF (Stage VII)
Swelling not reversible at night
Skin folds-deep
Appearance of skin-irregular
Needs help for daily activities - Walking, bathing, using bathrooms, dependent on family or health care systems
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LF Diagnosis Since lymphatic filariasis does not always result
in clinical symptoms (may take years), the most
accurate way to determine if someone is
infected is a blood test.
In most parts of the world, the parasites have a
"nocturnal periodicity" that restricts their
appearance in the blood to only the hours of
10pm - 2am.
Therefore, the diagnosis of lymphatic filariasis
traditionally has depended on the laboratory
examination of blood taken between 10pm
and 2am when microfilaria are most common in peripheral blood.
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LF Diagnosis 16
Today, an antigen-detection test that is simple, sensitive and specific,
called an ICT (see graphic below), is now available. The ICT test can detect infection within minutes and -unlike previous tests - can be
carried out at any time of day.
LF Prevention MDA- massive drug
administration
The strategy for interrupting transmission is an annual single co-administration of two drugs for at least five years.
Haiti has been given MDA since 2000 and over 8 million of the 10.5 million people have been dosed.
Fortified salt is also provided to maintain coverage through food consumption.
MDA kills the parasite but does not cure damage to the lymphatics caused by the parasites.
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LF and Haiti Leogane has ~ 200,000 people
with ~10% afflicted by LF
Original LF clinic at Hospital St.
Croix has been closed since
2009 and now only provides
‘social counseling’
Training of local clinicians began
in December of 2013 through
efforts of Brazilian embassy
Follow up training and clinic
logistics established January
2014
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19Special thanks to:
-Bandages Plus
-Circaid
-Project Medishare
Port-au-Prince, Haiti
Hospital Bernard Mevs Wound Clinic
John Macdonald, Robyn Bjork, Edaine, Clerge, Heather Hettrick
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Haitian Life 21
Haitian Commerce22
LF Lymphedema Training 23
Trainees Practicing 24
Cleaning & Prepping LF Clinic 25
CDT Management– Calf Reduced
10cm in 2.5 Days
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Before & After 2 Days Modified CDT 27
Patients 28
Volunteers 29
Sorting & Applying Compression
Devices
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Home Visits 31
LF Clinic Wound Care 32
LF Clinic Wound Care 33
Trainees Receive Certificates from
teachers Heather Hettrick & Robyn Bjork (ILWTI)34
Clerge: Master Clinician
Yves: Patient Care Coordinator
Muracile: LF Tech
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Ribbon Cutting Ceremony
LF Clinic Hospital St. Croix
Leogane Haiti, 2014
Overview of Clinical Operations
Dr. Luccene Desir (University of Notre Dame) is the Medical Director
of the LF Clinic and is on sight as needed to see patients and
prescribe medications; he can also assist with medical emergencies.
Jean Marc Brissau (University of Notre Dame) is the Administrator
and coordinates all the Massive Drug Administration efforts for Haiti.
He is on sight and can assist with clinical logistics as needed. He
works closely with Dr. Hettrick the Program Director.
Father Tom Streit (University of Notre Dame) coordinates all vector
related research and has been involved in the LF Clinic since the
late 1990s.
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Overview of Clinical Logistics
LF Clinical Team
These individuals are employees of Hospital St. Croix yet their salaries are
provided by ILWTI Medical Missions
Clerge: Master Clinician and LF Physiotherapist. Responsible for patient care
(modified CDT, wound care) and documentation
Yves: Patient Care Coordinator. A trained pyscho-social worker and LF
patient himself, he conducts patient intake, history and coordinates with
Animatrices (LF community advocates) to arrange patient care at the clinic
Muracile: LF Tech and LF patient herself. Assists in the clinic and provides
direct patient care under the direction of Clerge.
Clinical staff report directly to Dr. Hettrick . We communicate frequently
and they provide weekly reports of patients seen and activities
performed.
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Volunteer Medical Missions
Volunteer missions are schedule throughout the year
Inaugural cohort Oct 3-12, 2014
Next trip March 2015
Teams spend 1-2 week in Leogane providing education, training
and treatment
Master Clinician/Team Leader is paired with 2-4 volunteers
Seeking volunteers with wound and/or lymphedema experience or
experience can lead to dual certification in lymphedema and
wound care
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The Plan
Re-launch of clinic September 1, 2014
Ongoing training/support for local clinicians (4-6 trips/year)
Two satellite clinics in Northern Haiti planned to open in 18 months
Clinic space, training/dorm facilities, and supplies have been procured
Patients have been logged and identified (500-1200 in Leogane alone)
The process: Animatrices, Patient Care Coordinator, Master Clinician and LF Tech
Logistics for clinic being developed including modified CDT, protocols, algorithms, severity score and wound care
Working on funding for sustainability
Opportunities for volunteers, research, international dual certification in lymphedema and wound care
Goals: eradication of LF by 2020; patient independence with LF management by 2020
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How You Can Help
Visit www.ILWTImedicalmissions.com
Bring Hope to Haiti Initiative
Volunteer
Make a donation
Razoo (www.razoo.com)
Crowd source funding site
Please donate to ILWTI Medical Missions Inc.
Ziggedy (www.ziggedy.com)
Online shopping where percentage of purchases are donated to your determined non profit or charity- please select ILWTI Medical Missions Inc.
Spread the word and raise awareness!
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How Your Support Helps….
Your donations will help fund:
The salaries of our local Haitian clinicians
Clinical operations (clinic utilities, maintenance, laundry, etc.)
Supplies to support the management of patient’s with LF
Volunteer travel
Our goal is to make the clinic self-sufficient with sustainable
funding…every donation counts and is appreciated!
Tax deductible receipts can be issued through our Fiscal Sponsor Medi for Help
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Thank you!
Together We Can Make a World of Difference
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