This presentation details our

efforts to re-establish a

Lymphatic Filariasis clinic in

Leogane HaitiFOR MORE INFORMATION PLEASE VISIT

WWW.BRINGHOPETOHAITI.COM

OR EMAIL US AT: INFO@BRINGHOPETOHAITI.COM

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Lymphatic Filariasis

Clinic at Hospital St. Croix

Leogane, Haiti

HEATHER HETTRICK PT, PHD, CWS, CLT, CLWT

ROBYN BJORK MPT, CWS, WCC, CLT-LANA, CLWT

GLOBAL ALLIANCE/US VOLUNTEERISM

SYMPOSIUM ON ADVANCES IN WOUND CARE SPRING 2014

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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 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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18Special 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 20

Haitian Commerce21

LF Lymphedema Training 22

Trainees Practicing 23

Cleaning & Prepping LF Clinic 24

Treating – Calf Reduced 10cm in

2.5 Days

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Before & After 2 Days Modified CDT 26

Sorting & Applying Circaids 27

Home Visits 28

LF Clinic Wound Care 29

Trainees Receive Certificates from

teachers Heather Hettrick & Robyn Bjork (ILWTI)30

Clerge: Master Clinician at

LF Clinic Leogane

The Plan 2014

Ongoing training/support for local clinicians (4-6 trips/year)

Anticipated re-opening of clinic March/April 2014

Clinic space, training/dorm facilities, and supplies have been procured

Patients have been logged and identified (500-1200 in Leogane alone)

Logistics for clinic being developed including modified CDT 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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Thank you!

Together We Can Make a World of Difference

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