From Hanover To Haiti

Pediatrics in Port-au-Prince

De Sousa will graduate in June with an MD degree from Geisel School of Medicine at Dartmouth. Her work in Haiti was supported by Dartmouth’s Dickey Center for International Understanding. She is the fourth student in four years to work on faculty-mentored research as part of the collaboration between Dr. Peter Wright and GHESKIO.

Spending six weeks in Port-au-Prince, Haiti as part of the Global Health Initiative Fellowship program was the highlight of my medical school experience.

Eager to apply my skills, I conducted faculty-mentored research with Dr. Vanessa Rouzier, Chief of Pediatrics at GHESKIO Centers, which included assisting with a research study focusing on pneumonia in children under five years of age; creating educational materials to improve health literacy among HIV patients; and conducting preliminary analysis to assess the performance of GeneXpert in the detection of pediatric tuberculosis (TB) from gastric aspirate specimens.

I also had an opportunity to work in a pediatric clinic alongside Dr. Rouzier and two other Haitian pediatricians—Dr. Jean and Dr. Thermil—providing medical care to children infected with HIV, infants exposed to HIV in utero and patients screened for or undergoing treatment for TB.

One of my responsibilities at GHESKIO was assisting Dr. Rouzier with the study to better understand the etiology and progression of pneumonia in children under five years old. Given that pneumonia is the top cause of under-five mortality worldwide, I was particularly invested in this project because of its potential to impact childhood survival rates in Haiti and the other international sites participating in the study.

Death from pneumonia is largely preventable. In Haiti, children are now routinely immunized against H. influenzae type B as a component of a pentavalent vaccine, but there is a need for improved access to vaccines.

Verbal communication of health information, supported by the use of simple pictures, is essential in a country with an adult literacy rate at 49 percent—most patients served by GHESKIO are poorly educated and likely to have rates lower than the national average. I worked with Dr. Rouzier and the pediatric team to develop an HIV curriculum and materials featuring culturally adapted pictures that I drew with my finger using ArtStudio, an application on my iPhone.

The materials illustrate basic principles about HIV pathophysiology and treatment, and explain to HIV-positive pregnant woman interventions for preventing mother-to-child transmission (PMTCT). They will also be used in clinic for PMTCT counseling and to explain to parents the rationale for taking antiretroviral drugs (ARVs)—this is particularly important for pediatric ARV compliance issues when the responsibility of maintaining treatment falls on the primary caregiver, rather than the pediatric patient.

Developed in English, and translated into French and Creole, the curriculum will be made available to Dartmouth for use at another site in Haiti, and possibly in Tanzania and Rwanda.

My final research project involved pediatric TB diagnosis, which is particularly challenging in children who are HIV-positive. The gold standard for TB diagnosis is by sputum culture, but waiting for culture results delays the initiation of definitive treatment.

The development of GeneXpert technology has helped to revolutionize diagnosis of TB in low- and middle-income countries and is now used to detect pediatric TB from gastric aspirate specimens of patients too young to produce sputum samples. I assisted in a preliminary analysis of a data set of gastric aspirates tested for TB at IMIS to compare the yield of TB detection by GeneXpert versus culture.

Working in Haiti allowed me to gain a deeper understanding of the unique challenges faced by pediatric patients and their families. Working with poverty-stricken parents who are struggling to provide for their children—and who are grateful for your help—was an incredibly humbling experience.

The resilience demonstrated by even the youngest patients was inspiring as they bravely tolerated crippling symptoms without the slightest complaint.

Sharing in a mother’s joy when she discovers that her child is HIV-negative after weaning, is a reminder that an HIV-free generation is possible with continued international commitment to PMTCT programs.

I hope to exhibit a similar unwavering determination as a pediatric resident. I envision myself as an advocate for equitable healthcare for all children and strive to translate public health research to effectively address community needs and make a sustainable impact on my patients’ lives both locally and abroad.

By Chiquita Palha De Sousa

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GHESKIO Centers, a Haitian non-profit organization, is dedicated to providing clinical services, research, and training in HIV/AIDS and other diseases. GHESKIO also provides maternal and child healthcare and nutrition services and management of tuberculosis (TB) and sexually transmitted infections (STIs).

Their mission includes improving access to clean water and sanitation, promoting primary education, and coordinating micro-finance programs. The organization continues to provide integrated health services for underserved families in Haiti. They have been providing free medical care since 1982.

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