[show abstract][hide abstract] ABSTRACT: Cholera is an acute watery diarrheal disease caused by infection with Vibrio cholerae. The disease has a high fatality rate when untreated and outbreaks of cholera have been increasing globally in the past decade, most recently in Haiti. We present the case of a 28-year-old Haitian male with a history of severe untreated mental health disorder that developed acute fatal watery diarrhea in mid-October 2010 in central Haiti after drinking from the local river. We believe he is the first or among the first cases of cholera in Haiti during the current epidemic. By reviewing his case, we extracted lessons for global health on the importance of mental health for overall health, the globalization of diseases in small communities, and the importance of a comprehensive approach to the health of communities when planning services in resource-poor settings.
The American journal of tropical medicine and hygiene 01/2012; 86(1):36-8. · 2.53 Impact Factor
[show abstract][hide abstract] ABSTRACT: Pathology provides a critical bridge between the patients, their physicians and the therapeutic and surgical interventions that can be provided to them. Clinicians caring for patients in resource poor settings may provide basic healthcare, which does not include access to pathologic services; however, the value of pathology in alleviating health disparities for underserved patients is substantial when implemented. Partners in health is a comprehensive, community-based healthcare organization with clinics in 7 countries-most among the poorest in the world-which has the ability to obtain surgical biopsies and, if a pathologic diagnosis can be rendered, provide treatment, and long-term follow-up. Over the past 5 years, pathologists from the Brigham and Women's Hospital have collaborated with clinicians from partners in health to meet this need which included 129 cases from Haiti and Rwanda and a range of pathology: 64 malignancies, 28 normal tissue or nondiagnostic specimens, 16 infectious or inflammatory cases, 8 benign lesions, and other rare entities. Providing pathology services in resource poor settings through collaboration with clinicians working on-site is only hindered by the establishment of a working collaboration; however, the benefits are enormous and include patient access to curative or tailored therapies, logistical management of treatment resources, and exposure of pathologists to unique and challenging cases.
The American journal of surgical pathology 11/2009; 34(1):118-23. · 4.06 Impact Factor
[show abstract][hide abstract] ABSTRACT: Three decades ago, the world's ministries of health declared primary health care--the delivery of basic preventive and curative services--a top priority. Since then, however, the world's poorest countries have not met most primary health care goals. Twenty-six years after the Declaration of Alma Ata, we are said to be living in a time of "limited resources," a phrase that construes various health interventions as competing priorities. As HIV has become the leading infectious cause of adult death in much of the world, it is difficult to argue that AIDS prevention and care are not ranking priorities for primary health care, yet precisely such arguments have held sway among international health policy makers. We present new information emerging from the scale-up of an established and integrated AIDS prevention-and-care program, based initially in a squatter settlement in central Haiti, to a second site in rural Haiti. The program includes robust prevention efforts as well as community-based therapy for advanced AIDS; three related components--women's health and active case finding and therapy for tuberculosis and sexually transmitted infections--were central to this effort. We tracked changes in key indices over the 14 months following the introduction of these services to a public clinic in central Haiti. We found that integrated AIDS prevention and care, including the use of antiretroviral agents, to be feasible in resource-poor settings and that such efforts may have favorable and readily measured impact on a number of primary health care goals, including vaccination, family planning, tuberculosis case finding and cure, and health promotion. Other collateral benefits, though less readily measured, include improved staff morale and enhanced confidence in public health and medicine. We conclude that improving AIDS prevention and treatment can help to reinvigorate flagging efforts to promote universal primary health care.
Journal of Public Health Policy 02/2004; 25(2):137-58. · 1.48 Impact Factor