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Lessons Learned From Abelines
Kate Halamay, MD Alison Longnion, MD
Katie R. Nielsen, MD
What is CHIMPS?
Children’s Health International Medical
Project of Seattle
• Founded by University of Washington Pediatric residents in 2002
• One-week outreach trips to rural El Salvador, focusing on public health education and sustainable medical assistance
• Address local health problems through ongoing alliance with a local NGO (ENLACE)
• 2004 AAP Anne E. Dyson Child Advocacy Award, 2005 Dyson Community Pediatrics Training Initiative award, AAP I-CATCH grant
Ethics of International Health Projects
• Medical Tourism: – “Short-term overseas work in poor
countries by clinical people from rich countries.”
• Are reasons people engage in international work humanitarian or self-serving?
• Is the objective to promote the U.S. model of “damage care” or to build equitable public health structures?
Bezruchka, Wilderness & Environ Med. 2000
Mission
“To ethically address underlying health issues and to provide sustainable public health interventions and medical assistance for underserved communities in developing countries.”
Where do we go?
Abelines
Los Abelines profile
• Located in Morazan Department– Focal point for 12-year civil war
• Population 1804– 61% < age 19
• Economic productivity– Coffee, beans, corn, chickens, pigs
• Clean water shortage, no electricity or roads, few latrines, 30% homes straw
• Illiteracy rate 70%
What do we do?
• Talk with ENLACE about needs of community
• Meet with local health committee to plan week of clinics
• Daily clinics 8am-5pm-ish + outreach
• Charlas addressing public health issues
A day at a glance
• Intake + Vital signs• Hemoglobin + ZPPH• Charlas
– Nutrition– Parasites– Oral health– Water purification
• Consulta
Intake
• Gathering data from patients– Housing conditions– Nutrition
• Vital signs– BMI– OFC/MAC
Intake
No 79%
Yes 7%
Unlisted 14%
Chimney?
Outside 45%Latrine
41%
Other 14%
Toileting location
IntakeNutritional deficiencies
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Meat Fruit Vegetable
Perc
enta
ge w
ith <
1 s
erv
ing p
er
week
Anemia
• Iron deficiency - most common nutritional deficiency
• Prevalence unknown• Offer Hb, ZPPH screening• Treatment
– Iron supplementation• Follow up with local physician
Nutrition
• Vitamin A– Preventative doses for
birth - 9 years• Zinc
– Treatment doses for persistent diarrhea
• Multivitamins– Prenatal– Malnutrition
Parasites
• Empiric treatment every 6 months reduces Ascaris infection
• Ascaris is a major contributor to malnutrition and anemia
• Education about transmission
Oral health
• Fluoride varnish reduces cavities
• Toothbrushes• Toothpaste
Never 77%
>1 year 9%
1 year 7%
<6 months 1%
Unlisted 6%
Last dental care
Water purification
Water Source
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
River Well/Pipe Other
Perc
enta
ge o
f Popula
tion
Water purification• SODIS
– Effective killing of bacteria & parasites
– Reduces diarrhea in rural third world
No 67%
Yes 18%
Unlisted 16%
Purify water?
Consultas
DiagnosesCommon diagnoses
0%
2%
4%
6%
8%
10%
12%
14%
16%
Mal
nutriti
on
Par
asites
Dia
rrhe
a
Ane
mia
Hea
dach
e
Bac
k Pa
in
Oth
er M
S Pa
in
Pe
rce
nta
ge
of
pati
en
ts
After we leave?
• Health committee home visits• Local physician follow up for
chronic conditions• ENLACE holds
meetings with health committee
Future plans
• Lead toxicity
• Bi-annual projects
• Others?
Thank You!
UW Peds Residency Program
GME staff
Helena Laboratories
Phil Guadagno
HemoCuePontus Nobreus
ENLACEAlfredo Aguilar
Peter DeSoto
Doris Evangelista de Leon
Dr. Mireia Salazar
CHIMPS SupportersAuction item donors
Auction bidders
YOU!
OthersLori Macklin
Amy Wagner
Questions?