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The “Ride” To Eliminating Malaria In Haiti

Posted on by Michelle Chang, MD, Medical Epidemiologist/Director of Malaria Zero
The river that divides Haiti in the background from the Dominican Republic in the foreground. The CDC supports cross-border collaborations between the two countries' Ministries of Health, which will be an integral part of the Malaria Zero project on the island of Hispanola.
The river that divides Haiti in the background from the Dominican Republic in the foreground. The CDC supports cross-border collaborations between the two countries’ Ministries of Health, which will be an integral part of the Malaria Zero project on the island of Hispanola.

CDC works with Haiti and the Dominican Republic to eliminate malaria by 2020. #endmalaria #WMD2016

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The town of Dame Marie on the southwestern tip of Haiti, is 225 miles from the country’s teeming, chaotic capital Port-au-Prince. But getting there by car—on a good day—can easily take eight hard-fought, kidney-bashing, hairpin-turning hours.

That may seem like a random or irrelevant fact until you understand this: Dame Marie is a malaria hotspot and time matters since my job at CDC is to work with the countries of Haiti and the Dominican Republic to eliminate malaria by 2020.

As we celebrate World Malaria Day, my experiences in Haiti can highlight hard-won achievements which are even more precious in a challenging environment. But at the same time, they also serve as a sobering reminder of what’s left to do.

Mathieu Frislin, a Vector Control Brigade Agent in Ouanaminthe, Haiti, with his government vehicle at the site of a mosquito control effort. The Malaria Zero project will continue to support such vector control activities to achieve elimination of malaria from Hispaniola.
Mathieu Frislin, a Vector Control Brigade Agent in Ouanaminthe, Haiti, with his government vehicle at the site of a mosquito control effort. The Malaria Zero project will continue to support such vector control activities to achieve elimination of malaria from Hispaniola.

That’s why the drive to Dame Marie is useful.

And as far as metaphors go, it’s a good one to suggest what we confront in the effort to eliminate malaria. The drive takes longer than it should; for comparison’s sake the distance between Atlanta and Charlotte, NC, is 250 miles and that trip by car usually takes four hours. There’s a lot of other traffic going in the same direction for the same purpose but not always in a manner that’s efficient and cohesive. And there are detours, both literally and figuratively. Most of all, you’re never sure what you might encounter along the way.

Yet we all know that, with persistence, we’ll get there; eventually.

That begins to paint a picture of our efforts to eliminate endemic malaria from Hispaniola, malaria’s last major holdout in the Caribbean. While Hispaniola includes the Dominican Republic and Haiti, Haiti is the frontline. Of the 17,500 cases of malaria on the island, Haiti is home to 17,000.

Anybody who pays attention to global health knows the terrible scourge that is malaria. Nearly half of the world’s population is at risk for getting the disease, with the vast majority living in countries that are poor and ill-equipped to respond. It’s not an overstatement to say that a mosquito, which carries and spreads malaria, is the most lethal “animal” on earth. In 2015, for example, there were 214 million new cases and 438,000 deaths worldwide.

By those standards, the raw number of cases in Haiti isn’t large. But the fact that Hispaniola (the island shared by Haiti and the DR) is the last holdout in the Caribbean means that eliminating malaria there holds symbolic importance and will provide refined practices and tools that will help fight malaria in other places.

Malaria Zero has one bold goal: to eliminate malaria from the island of Hispaniola, which includes Haiti and the Dominican Republic, by 2020.
Malaria Zero has one bold goal: to eliminate malaria from the island of Hispaniola, which includes Haiti and the Dominican Republic, by 2020.

For those reasons and others, an ambitious group has come together to achieve the goal. It even has an official name: Malaria Zero: The Alliance for A Malaria-Free Haiti.

Malaria Zero supports the leadership of the Ministries of Public Health in Haiti and the Dominican Republic in their malaria elimination efforts, and is led by the U.S. Centers for Disease Control and Prevention (CDC), and includes the Pan American Health Organization, The Carter Center, the Clinton Health Access Initiative, the London School of Hygiene & Tropical Medicine, Tulane University School of Public Health and Tropical Medicine and the CDC Foundation.

One other critical partner is the Bill and Melinda Gates Foundation, which provided a $29.9 million grant last year that was used to build this partnership and launch the effort.

Even with so many strong and capable partners, strong commitment from the countries, and the Gates Foundation’s generosity, getting Haiti to zero malaria cases is not easy. Maybe, that’s because we are trying to accelerate the timeline – instead of taking the ten or twenty years to get there, Malaria Zero intends to finish the job by 2020.

We do have some advantages that will make our work a little easier. The mosquito that transmits malaria on Hispaniola is highly inefficient compared to other mosquito species that carry and spread malaria in other areas of the world. Best of all, the mosquitoes in Haiti remain vulnerable to almost all insecticides.

We’re also benefitting from new ways of thinking about malaria elimination and applying better tools and technology, such as using GPS to map areas of malaria transmission and new laboratory methods to identify people who are infected with the malaria parasites and have no symptoms, but who still contribute to ongoing transmission.  An example of the exciting opportunities we have to use the latest scientific innovations to reach the countries’ 2020 goal, is the use of new serology lab techniques that can help us identify communities of people that have a higher risk for malaria transmission.  Being able to map where people are most likely getting infected is especially important in a country like Haiti where zooming in on these “malaria hotpots” will allow us to focus our efforts and resources.

A Malaria Field Agent conducts malaria rapid diagnostic tests (RDTs) during his daily surveillance efforts in the community of Dilaire in northeastern Haiti. Going forward, such testing will provide the framework for Malaria Zero.
A Malaria Field Agent conducts malaria rapid diagnostic tests (RDTs) during his daily surveillance efforts in the community of Dilaire in northeastern Haiti. Going forward, such testing will provide the framework for Malaria Zero.

But challenges persist. Even with the new technology and practices, we still don’t have the complete surveillance system that we need. It’s why there are still “hotspots” in Haiti where transmission rates are high. And because Haiti has very limited resources, the health care system is stretched thin which adds to the gaps in our knowledge that we must close if we are going to end malaria for good. All of these are real life challenges in a country that is the poorest in the western hemisphere.

That’s not to say we can’t do anything about it. We are constantly finding ways to have impact despite the constraints.  One example of how we’re doing this is by making sure that diagnostic tests for malaria are available and in use at all the clinics and hospitals across the country.  We worked with our Ministry colleagues in Haiti to adopt the use of malaria rapid diagnostic tests – simple tests that can be used in settings without a laboratory.  We worked together to do a field trial of the tests, and then developed a sound national policy using this local experience along with the best evidence from global studies.  Now, we see that most people are getting tested for malaria at the clinics and not simply getting treated based on symptoms alone.  In fact, we saw a 65% drop in the use of chloroquine—the main medication to treat patients suspected to have malaria—because the clinicians could more readily diagnose people with malaria, and therefore didn’t need to treat everyone who had a fever (the most common sign of malaria and many other diseases). In the end, people get the right treatment, and our surveillance for malaria hotspots is much improved.

This is all hard work that takes time, commitment, and partnership. As hard as it is, as incremental as success might be, seeing the impact on people who no longer have to live with and fear malaria instantly removes any doubt about why we’re doing this work. This effort demands our attention, pure and simple.

Because we know that successfully eliminating malaria from Hispaniola will lead to a better life for people who live there, not just a healthier life. Eliminating malaria will help the Dominican Republic and especially Haiti to grow their economies and attract foreign investment. It will erase malaria from the last place in the Caribbean, which means we will be one step close to the ultimate goal—eliminating this terrible disease everywhere.

These are inspiring thoughts to have on World Malaria Day and every day, and it’s something that will sustain me on those long and bumpy drives to Dame Marie.

Posted on by Michelle Chang, MD, Medical Epidemiologist/Director of Malaria ZeroTags , , , , ,

3 comments on “The “Ride” To Eliminating Malaria In Haiti”

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

    Yesssssssssssssss! What an uplifting article. The details make it standout. I think it must be humid there also which makes life miserable when you have malaria!
    mlm

    Glad to know !! Fight and eliminate malaria from Hispaniola(Haiti and Dominican Republic),:improving lives..
    Thank you..

    http://unitid.uonbi.ac.ke/
    Tropical and infectious diseases remain the most important health problems in developing countries. In children, measles, diarrhoea, malaria and acute respiratory infections kill millions worldwide whereas in adults, sexually transmitted diseases, HIV/AIDS, parasitic and other protozoal infections, tuberculosis and malignancies associated with viral infections are major causes of morbidity and mortality.
    The impediments to the control of these diseases in developing countries are many. For many immunizeable diseases, solutions exist but have not been implemented for financial or logistical reasons; for others such as waterborne diseases, we have solutions but do not yet know how best to apply them; and for a third category such as HIV/AIDS, solutions remain a hope for the future.
    The ultimate control can be achieved through further research on identifying novel strategies for control of these diseases in developing countries and on implementing effective intervention programmes fully integrated with other health programmes.
    The Faculty of Medicine of the University of Nairobi (UoN) has been involved in research in various areas of tropical and infectious diseases since its inception in 1967. Diseases such as malaria, acute respiratory infections, diarrhoeal diseases, sexually transmitted infections, various malignancies such as cervical cancer, malnutrition etc. are just but a few. Many of the research activities have been through efforts made by various departments in collaboration with foreign institutions and although the faculty had been training in tropical and infectious diseases, there had been no focus in the respective disciplines.
    The University of Nairobi Institute for Tropical and Infectious Diseases (UNITID) was established in 2003 with the mandate of harnessing research activities within the College of Health Sciences in general and the Faculty of Medicine in particular; and initiate training programmes geared towards management and control of infectious diseases. The establishment of the institute in a tropical setting is meant to attract scholars and researchers from diaspora who are interested in studying these conditions in their natural environment. The institute through pooling of the expertise in areas of epidemiology and biostatistics, laboratory, medical and social sciences, should improve on the quality of research and training.
    http://unitid.uonbi.ac.ke/

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