Carter Center Launches Haiti/DR Malaria Eradication Initiative

  • Posted on: 8 October 2009
  • By: Bryan Schaaf
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Below is a piece by Miami Herald contributor Greg Blustein on a new initiative launched by the Carter Center to eradicate malaria in the Dominican Republic and Haiti within 10 years.  The funding will be used on house to house search for cases, free treatment and mosquito control, repellents for mosquito nets and walls in high risk areas, and for education and social mobilization in both countries.  Malaria is a nasty disease to which children and pregnant women are especially vulnerable.  However, it is preventable, treatable and the international community knows what works.  We hope that this initiative will be a success for both Haiti and the DR.

 

OUANAMINTHE, Haiti -- Former President Jimmy Carter traveled to Haiti and the Dominican Republic to meet political leaders, health workers and malaria victims Wednesday in hopes of jump-starting efforts to eradicate the disease in the Caribbean.

 

The battle against the mosquito-borne disease in the neighboring countries has been frustrating, with health officials complaining of a lack of cooperation between both country's governments.  Carter said on his visit to Ouanaminthe and to Dajabon in the Dominican Republic, just across a river border separating the two countries, that he hopes to expand a $200,000 pilot project established in those towns by the nonprofit Carter Center to curb malaria's spread.

 

The project's funding runs out early next year, but Carter said he hopes governments, nonprofit health groups and private foundations will pick up the tab for a broader effort.

 

"One of the most important developments has been the new cooperation between the two countries," Carter said while touring a Haitian hospital that treats many malaria victims. "And for the first time in history, they are targeting the complete elimination of the disease instead of just treating sick people."

 

An estimated 30,000 people in Haiti and several thousand more across the border suffer each year from malaria, which causes high fevers and flu-like symptoms that kills more than one million people each year, mostly in Africa.

 

It was the second visit to Haiti in a week by a former U.S. president. Bill Clinton, named U.N. special envoy to Haiti in May, attended an investment conference last Thursday in Haiti's capital and spent Friday promoting its tourist sites.

 

Health officials say a 10-year, Haiti-wide program to eliminate malaria by 2020 would likely cost $200 million. Another $50 million would be needed to wipe out lymphatic filariasis, another painful illness carried by mosquitoes that can swell limbs to grotesque proportions.

 

That price tag may seem daunting, particularly in Haiti, the poorest country in the Western Hemisphere. But Carter, who was quickly surrounded at each stop by dozens of Haitians and Dominicans seeking a glimpse of him, said the costs to eradicate the disease pale in comparison to pricier health initiatives in wealthier nations.

 

"A tiny bit of money can completely eradicate these diseases," he said. Ridding Hispaniola's two countries of the disease would also eliminate the threat that it could spread to nearby islands, including Jamaica and the Bahamas.

 

"We want to help both sides raise their sights up from the day-to-day battle," said Dr. Don Hopkins, the director of the Carter Center's health programs. The Atlanta-based center's project distributes nets treated with insecticide to drape over beds, microscopes to help lab technicians and motorbikes so field workers can zip through cramped alleys to test and treat residents.

 

It also helps bolster efforts in both countries to track, contain and treat a disease that spreads from fetid ditches and gullies of standing water.  In the Dominican Republic, for one, health workers journey each night to a foul-smelling farm in La Bomba, a Dajabon neighborhood with the highest infection rates, and test captured mosquitoes for the disease.

 

Across the border in Haiti, residents of the slums on the outskirts of Ouanaminthe greet health worker Jovind Fritzner as he makes his rounds, repeating verbatim his radio warnings on the dangers of malaria. They kid him about when he'll return with heavy equipment to wipe out mosquito breeding sites.

 

"If we had the equipment, I will make sure we kill them," Fritzner said in Creole as he waved his arms in a chopping motion. "It's a little bit frustrating. There's a lot more to be done. We'll need more equipment, we'll need more people - but I'm optimistic."

 

Health workers said it is difficult to develop a strategy that fits both Haiti and the more developed Dominican side. But they said getting leaders of both nations to commit to a long-term program may be the biggest challenge.

 

"We share the same island so it's impossible to eradicate malaria unless we're together," said Dr. Joanel Mondestin, who heads Haiti's northeast regional health office. "For the malaria, there is no border - it's all the same. This is a fight for both of us."

 

Few victims of malaria will venture to dream of a day when the disease is gone from the island. Paulane Antoine, who lives in a cinderblock house with one mosquito net for her and her eight children, said malaria is a constant concern in Ouanaminthe's slums, where barefoot children play on garbage-strewn streets.

 

Antoine's 6-year-old boy and 3-year-old girl were infected with malaria this year, but detection and medication saved them from death. Still, Antoine said, she worries about which of her neighbors or family members will contract the disease next.

 

"We already have enough problems," she said. "It's already hard enough to stay healthy here."

Comments

It’s 8:30 at night. The smell is unmistakably bovine as we find ourselves next to a sea of cattle enclosed by a scrap-metal fence. It’s mosquito-catching time in the Dominican Republic. Armed with plastic tubing and Styrofoam cups laced with netting, three of the country’s seven entomologists are hunting for Anopheles albimanus, the country's prevailing malaria vector, to test for resistance to insecticides that have been used to treat bed nets. Unlike their African counterparts who prefer to feed on humans, the malaria vector in the Dominican Republic is decidedly zoophilic, which is why we find ourselves here.
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This is all part of a bi-national pilot project to eliminate malaria in Hispaniola.
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The program is centered six hours from the Dominican capital of Santo Domingo, in Dajabón and neighboring Ouanaminthe, Haiti, where malaria is highly endemic. Each day, goods, people and, of course, disease migrate across the border with ease. But until now, little has been done to strategically address the burden of malaria on both sides of the Massacre River.
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Hispaniola is the last reservoir of malaria in the region. Jamaica, a short distance from the island, is a non-endemic country for malaria. Nearby Cuba is said to not have had malaria since the 1960s. Both countries remain vigilant in their surveillance, particularly in light of outbreaks caused by imported malaria.
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Malaria remains a major problem throughout Haiti. Dr. Joanel Mondestin of the nongovernmental organization CDS, which oversees the Haitian portion of the bi-national program, said Haiti’s malaria program was gaining ground until about 10 years ago, when the country’s health infrastructure and resources deteriorated. "From 2004-2007, Haiti was a jungle," said Dr. Mondestin, "but right now, it is almost ok." Indeed, the Pan American Health Organization’s numbers show that Haiti had about 9,800 cases of malaria in 2001. By 2005 that number more than doubled to 21,700, and in 2006 there were 32,700 cases of malaria in the country. In 2007, the cases of malaria dropped back to 23,400, but most of its population is still considered to be at medium to high risk of contracting malaria.
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The Dominican Republic has been fairly successful in controlling malaria, with only 2,700 cases in 2007. The disease is prevalent in only 14 of its 155 principalities. But the economic impact of malaria is significant, costing $200 million in lost tourist revenue in 2004 alone.
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Both countries recognize that elimination of the disease in one country is impossible if the disease exists anywhere on the island. “We cannot eliminate malaria if it’s not a joint program, we’re very conscious of that,” says Dr. David Joa, malaria coordinator for the Centro Nacional de Control de Enfermedades Tropicaless (CENCET) in the Dominican Republic.
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In 2006, it was determined by the International Task Force on Disease Eradication that it is technically possible to eliminate malaria in Hispaniola. While there was desire on the ground to do something on a bi-national scale, it needed a little bit of a push.
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The Carter Center came to help. In 2008, the Center provided $200,000 in seed money for a pilot project to support bi-national work to eliminate malaria and, to a lesser extent, lymphatic filariasis on Hispaniola. Subsequent funding has brought total support by the Center to $379,000. The funds provided for technical support, support active and passive surveillance, training, treatment, mapping, education and prevention efforts. The Center’s investment also facilitated much-needed tools to implement the bi-national program including hiring of additional staff, and purchasing bed nets, motorcycles for community health workers, microscopes, and computers. A year later, at this visit, President Carter says, “I’ve been really amazed at the progress of the project thus far."
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Why come here, why now? “I’ve been deeply involved in these two countries for the last 20 years. I’ve seen in the last 20 years, and in the island’s 200-year history, they rarely cooperate with each other. And we thought that the influence of The Carter Center might be strong enough of a bridge to encourage the effort,” said President Carter.
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The goal is to eliminate malaria on Hispaniola by 2020. But with the seed money gone, the success of the 10-year program will depend not only on attracting more partners, but also on major donors to support the $194 million effort. That translates to little more than $1 per person, per year of the program. Moreover, striving to eliminate the disease in both countries is less expensive than if each nation merely seeks to control the disease.
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The elephant in the room is Haiti's history of political volatility. Haiti also has an image problem to overcome. It needs to demonstrate opportunities for investment, progress toward peace, relative security, and the government’s dedication to improving the lives of the country’s poor. On the Dominican side, Dr. Joa acknowledges that success of the program hinges on Haiti's stability. "The political, social and economic in situation in Haiti is difficult," he says. But he strongly believes in the commitment and dedication of the Haitian partners to make the goal of malaria elimination a reality.
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The Haitian partners of the project also see hope in their country, and in the program itself. In Dr. Mondestin’s words, "If you fund TB, AIDS and malaria, along with funds for development, in 20 years, Haiti will look totally different."
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It is clear that President Carter and The Carter Center are committed to making elimination by 2020 happen. During his trip, he attended a meeting of partners and prospective funders, first in the Dominican Republic, then in Haiti. He also engaged both ministries of health as well as Dominican President Dr. Leonel Fernandez and Haitian President René Préval to, in President Carter's words, “be sure that both governments commit to making it possible.”

Source: Voice of America (VOA)
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Kane Farabaugh, Atlanta, Georgia
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Haiti and the Dominican Republic are the last two countries in the Caribbean region with known cases of malaria, and former U.S. President Jimmy Carter says he hopes to see an eventual eradication of the disease in both countries. VOA spoke recently with the former president and to members of his Carter Center staff in Atlanta, Georgia about their efforts to curb the mosquito-borne illness.
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Poverty and instability are part of life on the Caribbean island of Hispaniola, shared by Haiti and the Dominican Republic. And, says former President Jimmy Carter, they are conditions that contribute to malaria infections in both countries, along with a lack of cooperation between the two neighbors
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"The Dominican Republic government and the Haiti government, have never got along well. But both trust me, and trust the Carter Center," Mr. Carter said.
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That trust enabled Mr. Carter to make a visit to the island in October in an effort to get both countries to cooperate to rid the island of malaria once and for all.
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"Having him there focuses attention on the problem," says Dr. Donald Hopkins. Dr. Hopkins is the director of the Carter Center's health programs, and oversees the organization's efforts on the island of Hispaniola. He credits Mr. Carter's recent visit with progress on an unprecedented cross-border eradication effort.
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"(It) Gave us leverage in helping to encourage both countries to develop a bi-national plan with a budget and with a target date for getting rid of malaria on the island all together by 2010," Dr. Hopkins said.
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This year, malaria infected about 30,000 people in Haiti and several thousand more in the Dominican Republic. A pilot program established by the Carter Center in 2008 helped to curb the disease by donating insecticide treated nets for beds and microscopes to diagnose malaria samples.
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Dr. Hopkins says in the wake of Mr. Carter's visit, the emphasis on fighting the disease is shifting. "What we sought to bring that was value added was a focus on elimination, not just on continuing to treat and control the malaria problem," he stated.
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The Carter Center is seeking to eradicate malaria on Hispaniola by 2010, and to rid the island of Lymphatic filariasis, a painful swelling disease also spread by mosquitos. Haiti and the Dominican Republic are two of the last outposts in the western hemisphere for the disease.
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"The Dominican Republic expects to eliminate lymphatic filariasis by the year 2010. Haiti also announced a plan to eliminate lymphatic filariasis on their side of the island by 2020 because they have much more lymphatic filariasis remaining," Dr. Hopkins said.
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"Which means when we are successful, there won't be any more of these diseases anywhere in the Western Hemisphere," Mr. Carter said. To reach that goal, Mr. Carter says much depends on the willingness of both sides of the island to continue their cooperation.

4/28/2010
Science Direct
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In an editorial in the May 2010 issue of the journal The Lancet Infectious Diseases, Tulane University malaria researchers urge action to eliminate malaria from Hispaniola, the last island in the Caribbean where the disease occurs regularly.
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On Hispaniola, home to the nations of Haiti and the Dominican Republic, malaria is caused by a single mosquito-borne parasite, Plasmodium falciparum. The authors say success in eliminating malaria from Hispaniola would demonstrate that it is possible to defeat malaria in other regions of the world where it remains a dire threat. There is also evidence in Haiti that the parasite is becoming resistant to chloroquine, an inexpensive treatment for the disease. Eliminating malaria now would save these impoverished nations from having to resort to more expensive drug therapies.
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The authors advise that Haiti and the Dominican Republic should advance from basic mosquito control to more intensive methods. "Key to the successful elimination of malaria on the island will be the strategic use of combinations of methods," say the authors. "Malaria elimination will require that every suspected case on the island be diagnosed and treated."
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The authors recommend developing a system for quickly locating and diagnosing new cases; using control methods including insecticide-treated nets and spraying to prevent the spread of malaria; and educating the community to seek treatment for all fevers and support the elimination effort.
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Success will require the "unwavering political will" of both governments on the island, and will "set a precedent for health diplomacy," say the authors.
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The authors, all from the Tulane University School of Public Health and Tropical Medicine, are Joseph Keating, assistant professor of International Health and Development; Thomas Eisele, assistant professor of International Health and Development; and Donald Krogstad, professor of Tropical Medicine.

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