Women's Health - Family Health Ministries in Leogane, Haiti

Since 1993, FHM has been working in Leogane, Haiti.  Our focus there has been cervical cancer prevention.  As time goes on, our service to the community is expanding.

ASSESSING HEALTH NEEDS IN THE LEOGANE COMMUNE

CERVICAL CANCER PREVENTION PROGRAM

Statistics on FHM's Efforts

FHM PATHOLOGY LAB

HAITIAN FHM

HAITIAN IRB

LEOGANE FAMILY HEALTH & RESEARCH CENTER

LEOGANE WOMEN'S GROUP

LEOGANE SATELLITE OUTPATIENT CLINIC

PORTABLE COLPOSCOPE (CERVISCOPE) DEVELOPMENT

SPONSOR A CERVISCOPE

   
Above - Jackie Ndirangu (left), FHM's research coordinator, ensures that samples are properly labeled. Patients who are waiting complete consent forms and health questionnaires.

LEOGANE FAMILY HEALTH & RESEARCH CENTER
In Summer 2007, Family Health Ministries purchased land in Leogane, Haiti, to build a health center where we will continue the work of the previous 15 years, fighting cervical cancer in under-resourced communities while enhancing our service to women and children in the Leogane community.

A phased plan for the new center with budget and drawings is available at Leogane Family Health & Research Center Phased Plan. You can also view the most recent architect drawings by Hite & Associates.

LEOGANE WOMEN'S GROUP
Extending the work started by Dr. Rachel Peragallo and Duke Engage students in Spring and Summer 2009, FHM employee Wilkens Oscar has helped a women's group form in Leogane. The group's purpose is to help Family Health Ministries build and sustain healthy families across the community. Their first projects will be focused on neonatal care and a birth registry.

Violette Jean Baptiste (left above), a laboratory medical technician in Leogane, was elected as the group's counselor. Sonala Louis, (middle above) a local manager and the new coordinator. Merlande Nelson (right above) is a dressmaker and was elected as the group's secretary.

Leogane Satellite Outpatient Clinic in March 2009
(First floor is completed and in use.)

LEOGANE SATELLITE OUTPATIENT CLINIC
FHM's satellite outpatient clinic opened on the 22nd of January 2009. This clinic will be the base for Family Health Ministries until the Health & Research Center is open, after which it will continue to be used for emergencies, evening apointments and other FHM activities.

Haiti's infant mortality rate is very high, the worst in the Western Hemisphere, at 60 per 1000 births, per UNICEF, compared to the US at 7 per 1000 births.

FHM aims to improve these dreadful statistics in the new facility which will provide pediatrics and hospital care as well as prenatal care, deliveries, and FHM's cervical cancer prevention program.

FHM's new satellite clinic marks a major step for the people of Leogane, providing free healthcare to mothers who are indigent. After Hopital St. Croix's closing in January 2008, families had to travel to Port-au-Prince or do without expert care. In March 2009, the cervical cancer prevention program moved to the Satellite clinic.

CERVICAL CANCER PREVENTION PROGRAM

FHM's current collaboration in Leogane with Dr. Delson Merisier, OB/GYN has included screening women for the human papilloma virus (HPV), the primary cause of cervical cancer, a curable disease in higher resource countries but one with devastating consequences for untreated women and their families.

In Leogane, women que for the privilege of being tested (below).

Among resource-poor nations, Haiti has one of the highest incidences and mortality from cervical cancer.  Similar findings prompted FHM to partner with the community of Leogane to develop a cervical cancer prevention program 15 years ago, most recently working out of Hopital St. Croix and Hopital Cardinal Leger.  In March 2009, FHM moved the program to their new satellite clinic.

Today FHM’s program is developing and testing novel screening strategies with the goal of expanding access to preventive therapies and reducing the morbidity and mortality of cervical cancer in Haiti.  These novel strategies include liquid-based cytology, HPV DNA screening, and portable colposcopy with a device that FHM invented called the CerviScope (see below). 

FHM is conducting these efforts and making progress with the support of partners like the Duke School of Engineering, Qiagen Corporation & Cytyc Corporation.

The importance of these efforts was recently emphasized by a study sponsored by PAHO & the CDC, which estimated that without better screening strategies, cervical cancer deaths may double in the Caribbean by 2030.

Statistics on FHM's efforts -
Since Fall 2007, FHM has screened 5,128 women for HPV. About 18% test positive. Followup, including colposcopy, cryogenic treatment and hysterectomies are all being provided by Dr. Delson Merisier, FHM's OB/GYN in Leogane, volunteer Dr. Kris McKain of Nashville, TN, and Dr. Junior Duliepre of Port-au-Prince.

Team members from the Blanchard Clinic, the Cite Soleil Clinic, and volunteer Elizabeth Pritts, MD, Ob/Gyn
collaborated to screen 2100 women in record time in June-July 2009
Read more about the Blanchard/Cite Soleil Project

In March 2009, Duke medical student Michelle Graziano (below left) helped advance the clinical trial for another 1000 women. In June 2008, volunteer Dr. Elizabeth Pritts worked in Cite Soleil Clinic with Jackie and her team. FHM also collected samples in the Blanchard Clinic for several weeks, adding 2100 more women to the screened group. (updated July 2009)

HAITIAN FHM
May 19, 2009 marked the first board meeting to form Misyon Sante Fanmi Ayisyen (Haiti Family Health Ministries in Creole). The purpose of this new foundation is to expand the US Family Health Ministries' ability to serve more patients in Haiti.  Board members include several Haitians, several Americans, and one Haitian American.   The office for Misyon Sante Fanmi Ayisyen is located in Leogane, Haiti.

After the foundation is established, FHM plans to pursue NGO status in Haiti.

HAITIAN IRB FOR FHM
An IRB is a committee of physicians, statisticians, researchers, community advocates, and others that ensures that a clinical trial is ethical and that the rights of study participants are protected. All clinical trials in the U.S. must be approved by an IRB before they begin.  FHM's Haitian IRB will ensure the same consideration for Haitians.

The IRB continues to meet, approving new protocols and reviewing the progress of past approvals. Agreed projects include a survey of the women of Leogane to ascertain their health needs (see story below).

ASSESSING HEALTH NEEDS IN THE LEOGANE COMMUNE
One of the projects approved by FHM's Haitian IRB (above) is third year resident Rachel Peragallo's community survey in March 2009. The survey aimed to obtain the women's assessment of their own health care needs, and the needs of the community. Rachel's assistant and translator is FHM employee Wilkens Oscar (standing below).

In June and July 2009, Duke Engage students advanced the local assessment by interviewing more women and by mapping the healthcare facilities in Leogane.

PORTABLE COLPOSCOPE DEVELOPMENT
Another significant area of FHM's research in Haiti is the development and testing of the portable colposcope.  The colposcope is used to diagnose cervical cancer.

This tool, typically large and requiring electricity to run, is too expensive to operate in low-resource clinic settings. However, the colposcope is critical to diagnosing and treating cervical cancer. 

Therefore, FHM collaborated to develop a portable colposcope that is both lightweight and able to run on batteries.  FHM calls the portable colposcope a "CervisScope."

    July 2009 CerviScope model

FHM is now looking for both financial sponsors and healthcare providers to test the device.  Each prototype costs approximately $1000 to produce.  Contact Jackie Ndirangu to participate.

In early July 2008, FHM received its first sponsor for a colposcope to be used in a clinic in Langano, Ethiopia with the generous donation from a family in Rochester, NY.  The first unit was shipped in early September to nurse practitioner Kim Scheel, of Serving in Mission. FHM's second colposcope was sold to Kristina McCain MD, of Health Talents International, Guatemala. (updated September 10, 2008).

FHM is in the process of completing 10 more colposcopes for distribution around the world. Feedback from the first two users is being incorporated into the revised design.

Kim Scheel, nurse practitioner of Serving in Mission, Ethiopia
January 2009: Keep up the good work in perfecting this unit.  It would be wonderful to eventually get the cost down so that more health care providers in third world settings could have access to them, especially in areas of the world where cervical cancers are fairly common, as in Ethiopia.  The unit is definitely allowing me to identify cervical dysplasia more readily in practice.

Kristina McCain MD, of Health Talents International, Guatemala
January 2009: We lost power at our clinic for ~1 hour so it was great to have battery power. I will take it to Malawi in April and will give you further feedback.

The first of the latest models of the CerviScope (picture above of the improved version) was shipped to Haiti in July 2009 for use in FHM's Blanchard Clinic.

Feel free to share our one-page fact sheet on FHM's portable colposcope project including development history and sponsorship information.

Read principal investigator Dr. David Walmer's short research summary on Non-inferiority Evalution of the Cerviscope (11/07).

Sponsor a CerviScope (portable colposcope) from FHM for $1000.