Haiti

Trauma System Development in Northern Haiti

Challenge

Trauma accounts for 10 percent of the global burden of disease and in Haiti 12 percent of deaths each year. For those who survive trauma, the disability and psychological consequences are substantial, and the socioeconomic impact to the individual and population are potentially catastrophic. Trauma systems have been shown to significantly improve trauma care; implementation of components of a trauma system in Haiti has the potential to save lives and reduce trauma-related morbidity.

Where We Started

Collaboration with partners at three facilities in North Haiti and the North Department Director of Health (Ministry of Health) was initiated.

Our Impact

In partnership with our Haitian site lead investigators, we analyzed the quantity and type of traumatic injuries at one facility. This work led to multiple abstracts accepted for presentation at international surgical conferences. This data provides important information to the ministry of health to plan for the needs of patients and communities.

Moving Forward

We plan to expand our study of traumatic injuries to two additional public hospitals. At these facilities, we will also implement context-specific surveys to understand the financial burden of trauma. In addition, we plan to implement components of trauma systems at all three hospitals and evaluate the effects of our intervention.

Contact

Program in Global Surgery and Social Change

Building Surgical Research Capacity and Equity in Haiti

Challenge

Following the 2010 Haiti earthquake, there was a significant surge in research output from Haiti; however, the majority of this was foreign led and published in journals inaccessible to those most affected by this event. This disparity represents the substantial lack of research equity and led to a call for action. In January 2020 the Haitian Ministry of Health established The National Health Research Policy, defining the national research priorities and strategic plan including epidemiological, health systems, and clinical research. To support this policy, immediate efforts must focus on the development of in-country research training, aimed at equipping physicians with the essential skills and resources necessary to conduct independent research of a high standard.

Where We Started

Our involvement in research development initially commenced with local engagement at facility level, supporting local physicians with study designs, data analyses, and writing manuscripts.

Our Impact

Opportunities for international podium and poster presentations and manuscript publication have occurred as a direct result of these partnerships.

Moving Forward

Centre d’Information et de Formation en Administration de la Santé (The Center for Information and Training in Health Administration), a division of the Ministry of Health, have partnered with Unité Médicale de Recherche et de Formation Permanente (Research and Continuing Training Medical Unit), an existing local research training program, and the Program in Global Surgery and Social Change to develop a pilot research curriculum for physicians. The aim of this pilot is to determine proof of concept and develop Haitian research training faculty.

Contact

Program in Global Surgery and Social Change

The Burden of Pediatric Surgical Disease and the Perioperative Morbidity and Mortality for Congenital Anomalies

Challenge

Children in the poorest countries in the world are often without safe, affordable surgical care. In Haiti, children represent up to 33 percent of the population. In low- and middle-income countries it is estimated that 85 percent of children’s lives are improved or saved by surgery before the age of 15. To date, little is known about the burden of pediatric surgical disease in Haiti. In order to improve access to pediatric surgical care, we need to understand the burden of pediatric surgical disease.

Where We Started

Partnerships with local pediatric surgeons and fellows in Port-au-Prince, as well as with general surgeons around the country, has led to the development of studies assessing the pediatric surgical burden. 

Our Impact

We are currently working on a project to explore the types of pediatric surgical diseases that present to hospitals in Haiti to help inform and improve pediatric care.

Moving Forward

In addition to understanding the surgical burden, we plan to perform a geospatial mapping analysis of proximity to a facility with pediatric surgical care available. This will help identify where more pediatric care may be needed.

Contact

Program in Global Surgery and Social Change

Train the Trainer: Helping Babies Breathe

Challenge

The infant mortality rate in Haiti is about 50 per 1,000 live births, higher than most countries. Many of these deaths may be prevented by uncomplicated measures such as keeping the baby warm and suctioning the baby’s mouth after delivery. In Haiti, most babies are born in rural areas with limited health care resources; deliveries are often facilitated by birth attendants, many of whom have no training in newborn resuscitation. Recent political unrest has made travel within the country difficult, and hospitals and clinics were closed or nurses worked without pay. Birth attendants may not have access to a telephone, further increasing the challenges to delivering mothers and care providers who may be unable to call for help when complications arise.

Where We Started

The Haitian Ministry of Health decided to educate birth attendants with nonformal education in safe delivery and newborn care, including neonatal resuscitation practices. Kierrah Leger, Boston Children’s Hospital Global Health Nursing Fellow, partnered with the local rural clinics to provide Helping Babies Breathe (HBB) training, encompassing both safe routine care practices as well as neonatal resuscitation. Nurses were trained, and they will then train birth attendants in the region. In June 2019, Leger traveled to Haiti and trained an 16 sixteen health care providers in HBB, who then, with local staff, trained 17 birth attendants. The providers continue to provide HBB to the birth attendants in the region.

Our Impact

To date, 22 providers, 18 community workers, and 149 birth attendants have received HBB training.  Birth attendants reported 350 deliveries performed since the training. Out of these, 34 of the babies required stimulation/oral suction — lifesaving skills that they had received in the HBB course — who survived.

Moving Forward

Boston Children’s staff will continue to collaborate with the local health care providers to support expansion of HBB training in rural Haiti.

Contact

Kierrah Leger, Global Nursing Fellow

Improving the Care of Sickle Cell Disease for Children in Haiti

Challenge

In Haiti, 1 in 150 babies are born with sickle cell disease (SCD). Without treatment, up to 90 percent will die before their fifth birthday. No national newborn screening and SCD management and education programs exist in the country.

Where We Started

Boston Children's Hospital hematologist Natasha Archer, MD, collaborated with Partners in Health to develop a SCD screening program at the Hospital University of Mirebalais in 2013, focusing on newborn screening and early treatment for children with SCD before they developed complications. The program has struggled to provide accurate screening for newborns and consistent followup care for children diagnosed with SCD. Rose Mintor, 2018 Boston Children’s Hospital Global Nursing Fellow, and Dr. Archer developed a pilot quality improvement (QI) initiative to improve the diagnosis and early followup of Haitian children with SCD in 2016.

Our Impact

Despite challenges to data collection, this initiative has improved timing and accuracy of SCD diagnosis, increased the use of penicillin prophylaxis among children younger than 5 years old with SCD, and increased the availability and use of hydroxyurea in SCD patients. Patient/family education days have been established to ensure regular follow-up and standardized education.

Moving Forward

A point-of-care test for SCD to decrease time to diagnosis and penicillin prophylaxis uptake will soon be introduced, with a goal to screen 100,000 children by 2022 and have 80 percent uptake of penicillin for children with SCD younger than 5, saving lives among these children. Interactive education materials for patients with either sickle cell trait and sickle cell disease are in development. A platform for research at our collaborating institution in Haiti is being planned.

Contact

Natasha Archer, MD, and Rose Mintor, MSN, RN

NICU and PICU training

Michelle LaBrecque, Anna Gluckman, and Alexis Schmid led a group of 41 nurses, one pharmacist, one physician, and one project coordinator from Boston Children’s Hospital in on-site project implementation of a Neonatal Intensive Care Unit (NICU) and Pediatric Intensive Care Unit (PICU) certificate training course in Haiti for Haitian nurses. This course was developed to provide a comprehensive continuing education curriculum in NICU/PICU and to improve knowledge, skills, and attitudes. The course provides Haitian nurses with specialized knowledge on critical care and promotes professional development. It is a 6.5-month course with a one-year follow-up to determine whether the improvement is sustained over a one-year period. For this course, 48 Haitian nurses, representing 11 hospitals, were chosen to learn the curriculum and gain skills necessary to teach their colleagues. Nurses selected for course participation were identified as leaders in their respective areas. Upon completion of course nurse participants provided training at their local hospital.