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?