February 12, 2004
Phone: (504) 865-5714
Ruth Berggren, assistant professor of infectious disease, spent much of her childhood in Haiti and retains a bond with the poorest country in the Western Hemisphere.
But for a long time, she felt helpless to make a difference there. That changed last fall when Berggren got a call from Antoine Augustin, a Haitian physician and director of Management and Resources for Community Health Foundation, or MARCH.
He asked her for help with a five-year project providing health care and medication for HIV-positive pregnant women in rural Haiti in the hope of prolonging their lives and preventing infection in their babies.
In agreeing to help, Berggren comes full circle in her personal and professional life. She is the daughter of Gretchen and Warren Berggren, two influential figures in the field of public health, who moved to Haiti in 1967 to work at the Albert Schweitzer Hospital in Deschapelles.
Among the many people they helped train were Augustin and Tulane's Donald Krogstad, chair of tropical medicine. Ruth, a preschooler at the time of the move, spent about half of her childhood in Haiti. Her experience in Haiti influenced her decision to specialize in infectious diseases as a doctor and researcher. And it bred in her the conviction that the "haves" are obligated to stop averting their gaze from the "have nots" of the world.
Yet conditions in Haiti have only gotten worse in the last 30 years. It has gone from being a poor nation to an utterly devastated one. Along with increasing poverty, political turmoil and environmental destruction, Haiti has been ravaged by HIV and AIDS. For a long time, there were no effective treatments for AIDS, and when highly active anti-retroviral therapies were first developed, they were prohibitively expensive. Recently, however, that has changed.
A number of non-governmental organizations have committed to making resources available to fight AIDS in poor countries. Grants from the World AIDS Foundation, Save the Children, US AID and the Centers for Disease Control and Prevention are helping to fund the MARCH Foundation's project. MARCH is using community-based treatment strategies to conduct HIV screenings for all pregnant women in the rural area round Mirebalais, a small town in Haiti's central plateau.
About six percent of Haitians have AIDS or HIV, but that number may be dropping. "Pregnant women are a good indicator of how much HIV there is in the sexually active population," Berggren said. There are few cars in rural Haiti, so MARCH brings health care to women. "The idea is no woman should have to walk more than five kilometers to get care," Berggren said.
Each day a truck and jeep leave Mirebalais for one of 25 sites in the countryside. There pregnant women can get tested for HIV and syphilis. Those who enroll in the program get health care for the length of their pregnancy plus monthly food rations until their baby is 2 years old. So far, about 95 percent of the women who come to the clinics accept testing, despite the many stigmas and fears that surround a diagnosis of HIV in Haiti.
Berggren attributes that high figure to good pre-test counseling, and to the fact that the women know free drug treatment is available if they are diagnosed. A large part of her job has been training the counselors and helping to dispel their fears and superstitions about HIV, so that they don't pass on misinformation and negative attitudes toward to their clients.
"There's a decade of information about HIV that they've missed," Berggren said. Those women who are diagnosed with HIV will receive anti-retroviral drugs through the course of their pregnancies. MARCH is employing the use of "accompagnateurs" to deliver the drugs to each woman every day, making sure she ingests the pills.
Each woman gets the chance to name her own accompagnateur--a word that implies a friendly peer relationship--who must be someone who lives outside her own household but within a 15-minute walk. Accompagnateurs also must be at least 25 years old, literate, in good health and a stable resident of the area. They are paid a small stipend and may serve up to four or five women. Their oversight helps assure that the drugs are taken correctly and so will be effective. T
he accompagnateurs have the role of administering AZT to the mother every three hours during delivery. In rural Haiti, most babies are born at home without a doctor. But the babies of HIV-positive mothers must receive AZT four times a day, every six hours, for seven days.
"It's a logistical nightmare," said Berggren. "But we think we can reduce transmission from 30 percent to nine percent."
An even bigger logistical problem is providing HIV-positive mothers with formula so they don't infect their babies through their breast milk. There's no running water in rural Haiti, so someone from each household has to spend several hours walking to a well twice a day. Cleaning bottles, reconstituting the powder and keeping flies away represents a huge effort. Holly Murphy, a Tulane fellow in infectious diseases, has received funding to monitor and evaluate the efficacy of their efforts to prevent mother-to-child transmission.
The program will last for at least five years and if successful may serve as a model for replication in French-speaking Africa. MARCH is currently seeking donations to help compensate accompagnateurs. For more information, call (504) 587-7316.
Tulane University, New Orleans, LA 70118 504-865-5000 firstname.lastname@example.org