Community Health Initiatives

The social ostracism and economic devastation leprosy patients faced 50 years ago has continued to this day, and now threatens to affect HIV positive patients today in the same way. As history repeats itself, CFHI partners in Mumbai (Bombay), India are hoping to bring social support and healthcare to two communities living with these infectious diseases. Although leprosy patients might be cured of the disease, the disfigurement of their limbs prevents their rehabilitation and limits the kind, and amount of work they can do to support themselves. HIV positive patients can also lead more productive lives if they have access to medication. However, for some who may even be eligible for free medication through government programs, it is impossible to find money for the initial tests that can prove their eligibility. Our partners seek to bring support and hope for an independent life to sufferers of these diseases by providing reconstructive surgeries to 30 leprosy patients, special footwear to another 50 such patients and CD4 count tests for 100 HIV+ patients. We are confident the success of the program will attract ongoing support.

The focus of this project was the training of health personnel and diabetes patients. These trainings were provided by Lic. Santa Cruz, who is a diabetes nurse educator. In her regular meetings with patients, many of whom are illiterate, Lic. Santa Cruz educated them according to whether they were diabetic or at risk. For those who were in the “at risk” category, she designed and implemented preventative strategies—including a color-coded tracking system—and for those who were actually diabetic, she adapted this tracking system to prevent further complications from arising. These meetings ran throughout the year.

The initiative represents a collaborative approach to treating diabetes since Lic. Santa Cruz has been able to work closely with the public health ministry, which started two years ago in this region of the remote Ecuadorian Amazon. The presentation of the results of this study will be made to the local, national and international medical community.

This project has captured the interest of the directors of the public health ministry to the point where the literature associated with the tracking system will be printed on the ministry’s own printing press prior to circulation. It will be developed as a pilot by Pastaza’s public health department and, depending on results, will be replicated in other provinces. The clinical impact has not yet been measured, but the community healthcare providers will have an opportunity to do so later this year.

CFHI’s alumni grant recipient, Clark Baker, was selected to provide support for, and learn from, this project. His support includes the elaboration of a baseline of reference and the collection of a significant sample of 30 diabetic patients.

Mexico: ASSESSING TUBERCULOSIS IN RURAL COMMUNITIES

The World Health Organization (WHO) estimates that one-third of the world's population is currently infected with the TB bacillus (WHO website 6/12/007). In the state of Oaxaca , the coastal region has the second highest incidence of Pulmonary Tuberculosis (TB)—just behind the Isthmus region—with hot spots such as the San Pedro Mixtepec neighborhood. From 2003 onwards, the Oaxacan Public Health Department has been reporting over 100 new cases per year of Pulmonary TB, with outbreaks of the illness being particularly prevalent in the neighborhoods of Benito Juarez and San Miguel.

There has been considerable concern about variant strands of TB developing and gaining a foothold in different pockets throughout the world. One of the single most important approaches to dealing with this situation is to establish baseline data with which to compare current rates of TB prevalence and, from that, to be able to measure and so target preventative strategies, particularly around stemming the growth of Multi Drug Resistant (MDR) strands.

Given the poor hygiene, dilapidated housing and concerns over the nutritional conditions of these two neighborhoods on top of the prevalence of TB in these neighborhoods over the last three years, the medical team decided to focus on tracking the prevalence of pulmonary TB in these neighborhoods from January 1st, 2006 to December 31st, 2006. The team was led by CFHI’s Medical Director in Puerto Escondido, Dr. Pastrana Vasquez.

The main objective of this initiative was to demonstrate the prevalence of pulmonary TB in the neighborhoods of Benito Juarez and San Miguel (Puerto Escondido) within the local population of those aged 15 years or older. In order to achieve this objective, the team conducted a large-scale door-to-door survey to discover those who had an ‘active’ cough. From this data, the team could compare their statistics with the official government statistics. This was significant because this type of data had never been measured proactively due to lack of resources, with the result that the government figures only measured the instances of pulmonary TB according to those who had presented at a clinic to receive testing.

From January 1st to November 30th, 2006, 1005 sputum samples were analyzed from 307 patients. 29% of the samples tested positive. Close to 50% of Pulmonary TB cases were identified through this study that had not been previously identified in government studies. This indicates the importance of targeting healthcare resources at the local level—specifically, at the neighborhood level—in order to prevent MDR TB strains from developing.

2005 – 2006: India: ST. THERESA’S HOSPITAL ( VIRAR, India)

St. Theresa’s was able to purchase a cautery machine and a suction machine for the operating room in order to provide free medical treatment to people in Virar—population: 119,000—a far-flung suburb of Mumbai where 90% of inhabitants live below the poverty line, and even nominal medical fees are prohibitively expensive. This hospital treats a community with high levels of illiteracy (78% literacy rate), and is ill-equipped to deal with even basic hygiene techniques—particularly those that would prevent water-borne diseases, many of which are fatal. This is significant as many of the people living in this community are fishermen, and therefore highly vulnerable to water-borne diseases. The provision of much-needed technology means that these local fishermen, their families, and the wider community can receive treatment locally rather than having to travel many miles to private clinics, which they could not afford anyway.

The effect of these machines on the health of the local population has been significant, with the entire 119,000 inhabitants eligible to receive medical treatment previously inaccessible to them by virtue of cost and distance. Prevention campaigns in addition to the medical equipment have gone some way to alert Virar’s inhabitants to the link between hygiene and infection through water-borne bacteria. However, the scale of poverty and lack of amenities, such as clean drinking water, is such that taking adequate hygiene precautions on a daily basis is unfeasible for the vast majority.

Going forward, further efforts will concentrate on publicizing and promoting the dangers of not taking sufficient care with hygiene, as well as continuing to provide free treatment on demand.

Ecuador: SHUAR HEALTH (Year 2 of a 3 Year Project)

Under the guidance of CFHI’s local Medical Director Dr. Wilfrido Torres, CFHI has sponsored the training of 30 local health promoters in the Amazon region of Puyo, , since 1998. This training has enabled the promoters to serve as primary care givers in remote Shuar Amazon communities. The project impacts the health of 2,000 local community members.

CFHI funding paid for the purchase of a motorized canoe to provide bi-monthly medical visits to communities along the shores of the Pastaza and Kapawi rivers, with a particular focus on anti-malarial vaccinations. Four of the health workers (mentioned above) now help care for sixteen communities, or 1,200 people, who would otherwise have very limited access to healthcare.

The project was designed specifically by community members to address their need for swifter access to preventative and/or emergency healthcare treatment. The aim of the project was two-fold: to provide easier access to vital healthcare treatments, and to alleviate the strain on other under-resourced but expensive emergency air-evacuation service by helicopter. The trainee health promoters—women and men—have acquired practical new healthcare skills and are regarded as vitally important members of their communities.

In addition to motorized canoes, the communities who live along the Amazonian tributaries needed an efficient means of communication; in particular, to communicate with the more out-of-reach places. CFHI provided funds for the purchase of a high frequency two-way radio to enable these communities to relay alerts of when epidemics or other emergencies occur. This communication system is supplemented with the purchase of vital camping equipment for medical teams who are traveling to these remote sites. As a direct result of this, there has been a much better coordinated and more frequent response by the Department of Indigenous Health of Pastaza (DSI-P) to communities where health-related problems have occurred. The project impacts 2,000 people, who are members of six tribes.

Mexico: TYPE 2 DIABETES IN PUERTO ESCONDIO

Type 2 diabetes is one of the leading causes of death in Puerto Escondido, a community which lacks the resources with which to address this common but deadly disease. CFHI provided funds for a grant to purchase blood glucose monitors and strips in a traveling kit format and a refrigerator in which to store insulin in order to offer treatments for diabetes sufferers. These purchases were complemented by an educational outreach campaign, led by CFHI’s medical partner, Dr. Castillo, which has succeeded in encouraging the population to volunteer for diagnostic and preventative testing. The number of people affected by this project is 18,300 (aged 20 years plus) who were hitherto only able to receive curative treatment, which is a considerably less effective strategy.