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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