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Global Health, Haiti, Infectious Disease, Public Health, Technology

A sanitation solution: Stanford students introduce dry toilets in Haiti

A sanitation solution: Stanford students introduce dry toilets in Haiti

sanitation-toilet-movedIn the United States, we often take for granted the relationship between health and sanitation. Not so in Haiti, where some people dispose of their feces in plastic bags they throw into waterways. As a result, waterborne diseases like cholera are common.

But what’s to be done? Flush toilets guzzle gallons of water and depend on an entire sewage system — an unfeasible option in many developing nations. To fill the gap, a pair of Stanford civil and environmental engineering graduate students have developed a program called re.source, which provides dry household toilets, and empties them for about $5 a month.

From a recent Stanford News story:

Unlike most sanitation solutions that only address one part of a dysfunctional supply chain, container-based sanitation models, such as the re.source service, tackle the whole sanitation chain. The re.source toilets separate solid and liquid waste into sealable containers, and dispense a cover material made of crushed peanut shells and sugarcane fibers that eliminates odors and insect infestations. The solid waste is regularly removed by a service, which takes it to a disposal or processing site to be converted to compost and sold to agricultural businesses.

The re.source students — Kory Russel and Sebastien Tilmans — work under the guidance of Jenna Davis, PhD, an associate professor of civil and environmental engineering. They started small, with a free pilot phase in 130 households in a Haitian slum, but the service has expanded to include 300 additional households with plans to introduce a service in the capital, Port-au-Prince.

The project is part of a larger Stanford focus on water issues ranging from safe drinking water to environmental concerns.

Previously: Waste not, want not, say global sanitation innovators, Stanford pump project makes clean water no longer a pipe dream and Award-winning Stanford documentary to air on PBS tonight
Photo by Rob Jordan

Global Health, Haiti, Research, Stanford News

Health care in Haiti: “At risk of regressing”

Health care in Haiti: "At risk of regressing"

streets of Haiti - smallAs an undergraduate at Duke University, Maxwell Kligerman stumbled into an amazing scientific opportunity. He spent the summer of 2009 collecting data on the availability of health-care facilities in Leogane, Haiti, a coastal city with a population of about 50,000 to support the work of Family Health Ministries, a non-profit founded by Duke reproductive endocrinologist David Walmer, MD.

With a guide, Kligerman walked every street in Leogane, tabulating the location and characteristics of even the most modest doctors’ offices.

His tally was important for local residents and some global health scholars, but certainly not anything with worldwide relevance.

We still need to keep Haiti on our radar. It’s been five years since the earthquake, but now is really the tipping point.

Then, on Jan. 12, 2010, the magnitude 7.0 Haitian earthquake struck, its epicenter just five miles from Leogane. Kligerman had unique, pre-earthquake data that could show the effects of the quake on local health-care opportunities. He could see what happened when the city experienced an influx of foreign aid and how the quake affected the trajectory of its development.

Taking advantage of his rare opportunity, Kligerman returned to Leogane in both 2011 and 2013, collecting information about the availability of health-care facilities.

Now, Kligerman is a third-year medical student at Stanford and recently published his findings in The American Journal of Tropical Medicine and Hygiene, in collaboration with Walmer and Stanford’s Michele Barry, MD, senior associate dean for global health, and Eran Bendavid, MD, assistant professor of medicine.

He has a critical message for those interested in global health: “We still need to keep Leogane and Haiti on our radar. It’s been five years since the earthquake, but now is really the tipping point.”

Before the earthquake, Leogane had 25 health-care facilities, ranging from a small doctors’ offices to large hospitals. Eleven of those buildings collapsed during the earthquake.

But soon, the international community swooped in, upping the number to 28. By 2013, Leogane had 34 healthcare facilities, many offering free care. Yet although the numbers look rosy, change is on the horizon.

Doctors without Borders, which operates the only full-service hospital, has announced plans to close the facility in 2015. That alone will dramatically reduce the availability of health care to Leogane residents, Kligerman said.

Continue Reading »

Emergency Medicine, Global Health, Haiti, Stanford News, Videos

New Stanford Hospital team ready to mobilize for disaster relief

New Stanford Hospital team ready to mobilize for disaster relief

When Stanford Hospital staff members volunteered to participate in a relief mission to post-earthquake Haiti last year, they were stunned over the number of deaths that could have been prevented had emergency medical services been available just a few days sooner. As highlighted in the video above, their initial shock led to the creation of the Stanford Emergency Medicine Program for Emergency Response, a team that will be able to mobilize immediately in response to a global disaster.

Previously: Treating the injured amid the apocalypse of Haiti, Reports from Stanford medical team in Haiti and Stanford sends medical team to Haiti

Emergency Medicine, Haiti, Infectious Disease, Medicine and Society

Haiti, a year after the quake

At Hospital Albert Schweitzer (where I traveled last February to write about the hospital’s struggle to care for the wounded in the quake’s aftermath), the staff paused today to “honor what Haitians have lost,” according to Ian Rawson, managing director of the hospital in Deschapelles.

In the past year, the hospital has treated thousands struck by the cholera epidemic, and served tens of thousands of displaced persons in addition to their daily work of caring for some of the poorest patients in the Western Hemisphere. Rawson writes on the hospital blog:

Despite all this, the Haitians never give up. Therefore never can we. We draw strength from their forbearance and resilience. Everyday we learn again about the reservoirs of strength which come from hope.

The hospital has planned a prayer of remembrance, followed by presentations from caregivers who were on the front lines treating the victims of the quake. The hospital will also pause to celebrate Hanger Klinik, the clinic built virtually over night and where new limbs for more than 800 earthquake victims have been built and fitted.

Photos will be posted on Flickr throughout the day.

Previously: Haiti day 4: Life after the quake, Haiti: In pictures, Haiti day 3: Amputees, Haiti day 2: At the hospital, and Haiti day 1: Arrival
More entries can also be found in the Haiti category.

Global Health, Haiti, Videos

MIT students test low-cost wound-healing device in Haiti

From plug-and-play hospital tents to the water-disinfecting SteriPEN, physicians and aid workers have used a number of simple yet innovative technologies in treating earthquake survivors in Haiti.

Another such interesting tool, which I learned about today, is a $3 wound-therapy device designed to speed up the healing process.

The device was designed by MIT mechanical engineering students and originally scheduled to be field tested in Rwanda. But Partners in Health requested prototypes of the tool be brought to Haiti, according to a release.

MIT doctoral student Danielle Zurovcik demonstrates how the device is applied to wounds in the above video.

Global Health, Haiti, Media, Technology

On crowdsourced relief efforts in Haiti

Lukas Biewald discusses the crowdsourced relief efforts in Haiti:

The advantages of a flexible crowdsourcing workflow to managing disaster relief are huge. Businesses like crowdsourced work because they don’t have to plan unknown work capacity in advance, and managing a crisis is an extreme version of this problem. There would be no practical way to have thousands of trained Kreyol speakers ready to handle emergency text messages, but through viral channels and a microtask framework it was possible to have thousands of people around the world doing mission-critical work within days.

Of note, FrontlineSMS: Medic is mentioned in the piece, which was co-founded by Stanford medical student Nadim Mahmud.

Previously: Using cell phones to save lives

Global Health, Haiti, Stanford News

Haiti day 4: Life after the quake


On a workbench in the backroom at the new rehabilitation facility is a brown plastic foot, about a woman’s size 6, with a carefully carved notch between the big toe and its neighbor.

It’s about 7 p.m. on March 1. Ania Antoine, a pretty 15-year-old in a short denim skirt, who is waiting for her turn with the physical therapist, likes to wear flip-flops. Right now, she’s only wearing one.

She smiles when she hears the new foot will fit nicely into a flip-flop. And has toenails to paint as well.

Ania (pictured above) lost her right leg – and most of her family – in the Jan. 12 earthquake that nearly leveled the capital city of Port-au-Prince and killed more than 200,000 people. She and her father alone survived.

Sitting along the walls of the rehab room in white plastic chairs are five young adult amputees, all healthy enough to leave the hospital but housed near the Hospital Albert Schweitzer at L’Escale, a former tuberculosis village, a short walk from the rehab facility. They are among the first of Haiti’s estimated 4,000 amputees to get prosthetic legs and begin the difficult process of learning to walk all over again.

They need a week or two of practice before they go off on their own, navigating the difficult Haitian terrain. Most are from Port-au-Prince and have lost their homes or schools and don’t know where they’ll go from here.


“Two people were dead next to me in the rubble,” Ania (shown again, right) explained earlier in the afternoon, speaking through a Creole interpreter. She was walking around on crutches in L’Escale, a desolate place of scattered cinderblock homes housing about eight amputees. The grounds are dirt, the residents wash laundry in a pump at the center of the village. The smell of burning piles of garbage drift through the air. A Haitian community group, led by Luquece Belizire along with the help of the hospital, provides bottled water, and members come by to cook meals at an outdoor barbecue. Belizire’s mother and sister often cook the meals. Belizire drives the amputees back and forth to the hospital for rehab where the physical therapists work long days that continue late into the night.

Despite the desolate surroundings, the young people find comfort with each other. They flirt and answer cell phones and laugh and joke.

Denise Jacques, 16, said it’s not very difficult learning to walk on the new leg. She described the horrible pain of suffering with a crushed leg for four days before a team of foreign doctors set up a tent at a nearby town where she finally had it amputated. She lives in one of the cinderblock homes with her brother. Jean McKinley, 19, lost his leg and four fingers in the earthquake. He also lost his school where he was learning to be a mechanic.

“He’s really good,” said Cynthia Racine, MD, a Haitian-born physiatrist from the United States who came to Hospital Albert Schweitzer to volunteer after the earthquake. She points out that McKinley can’t use one of his hands because of the amputated fingers where skin grafts are healing. “He’s trained as a mechanic and understands when we talk about center of gravity and vectors.”

At the end of the day about 10 p.m., the young amputees finish their 40-minute rehab by kicking a soccer ball with their new legs, and even attempt to dance with each other.

It’s just one small room in one small town way out in the Haitian countryside, but it’s an amazing sight and a sign of hope for the future of Haiti.

On March 2, I headed back to the airport in Port-au-Prince from the hospital in Deschapelles, driving 80 miles through some of the poorest communities in the Western Hemisphere. Trucks overloaded with Haitian passengers and piled high with mattresses rumble past, heading away from the tent cities and destruction of the capital, looking for new homes in the country.

My traveling companion, an American hydrologist who has worked and lived at the hospital for more than a decade, describes how the Haitian people have organized themselves to survive this earthquake. In the tent cities they provide community patrols to keep the women safe. They share whatever food they can find.

She says there are rumblings among the Haitians about how the much-stronger 8.0 earthquake in Chile on Feb. 27 caused fewer deaths and less destruction than the 7.0 earthquake here. And she talks about a fierce determination to rebuild the country better than before.

“It’s not, ‘We have to rebuild Haiti,'” said Ian Rawson, the heart and soul behind this hospital, whose mother and stepfather, Larimer and Gwen Mellon of Pittsburgh, founded it more than 50 years ago. “We have to build Haiti. Together, with the Haitian people.”

Tracie White is a Scope contributor and writer in the medical school’s communication office. She just returned from Haiti, where she wrote about the situation there. You can see all of her updates in our Global Health category. More details on Stanford’s Haiti relief effort are available here.

Global Health, Haiti, Stanford News

Haiti: In pictures


This is David Charles, one of just a dozen Haitian physical therapists in the entire country. David works at Hospital Albert Schweitzer. He trained in the Dominican Republic.


This child is one of 132 people staying at a refugee center near the hospital. The center is a half-built hotel.


This is Ania Antoine, age 15, an amputee who was one of the first refugees to get a new leg.


These are Deschapelles schoolgirls walking past the hospital.


This is a girl collecting water from a stream that runs between the hospital and L’Escale, a former tuberculosis village.

Tracie White is a Scope contributor and writer in the medical school’s communication office. She is presently in Haiti to write about the situation there. You can see all of her updates in our Global Health category. More details on Stanford’s Haiti relief effort are available here.

Haiti, Patient Care, Pediatrics, Videos

Haiti earthquake relief by Packard Children's team

This new video from Lucile Packard Children’s Hospital shows footage shot by a team of doctors and nurses who went to Haiti Feb. 2 – 16 as part of the earthquake relief efforts. The caregivers traveled by boat to a remote village where most people had never been seen by a Western physician. They established a clinic now being run by other volunteers in the international relief effort.

The team, led by pediatric hospitalist physician Daniel Imler, MD, also included pediatric hospitalist Joseph Kim, MD, and nurses Rich Ramos, RN; Katie Purdy, RN; and Elena Hopkins, RN.

More coverage of the team’s trip to Haiti is available here.

Emergency Medicine, Global Health, Haiti, Stanford News

Haiti day 3: Amputees


Bel Jean still hopes to be a priest. But there is a problem. “You need two arms to elevate the mass,” explains the 29-year-old, raising his stump in the air.

The young man (pictured above, left) was in Port-au-Prince studying for the priesthood when the earthquake struck on Jan. 12. During the night that he spent trapped beneath the roof of his school, he mostly cried. Then he prayed. The loss of his arm has him devastated. What he wants, though, is to replace his missing right arm with a new one so that he can hold high the sacrament during Sunday mass.

I’m in a ward at Paul Farmer’s hospital in Cange, a 2.5-hour bumpy car ride further north deep into the island nation from Hospital Albert Schweitzer in Deschapelles, where I have been staying the past few days. I’m traveling with members of the newly-formed rehabilitation team from HAS, to fit prosthetics for four of five of the amputees at Farmer’s hospital, which is similar in size and mission to HAS.

In a mad dash to begin to meet the overwhelming demand for artificial limbs in this country, where amputations have become the defining injury of the quake, HAS has quickly built a prosthetics lab, working with the Bethesda, Md.,-based Hanger Orthopedic Group Inc., a provider of prosthetic and orthotic products and services. The effort began 10 days ago. Within five days they had made 10 prosthetic limbs, and had five amputee patients up and walking.

Ian Rawson, who runs HAS, describes the situation during the earthquake on his blog:

Patients who arrived at HAS with crushing injuries to the extremities were managed by a specialized nursing wound care team, and the surgeons were very conservative in their management of these cases, exercising limb salvage strategies to the greatest extent possible. Only 15 long-bone amputations were required for the patients at HAS, but soon after the earthquake, we began to receive referrals from other hospitals for patients who required revisions of their original amputations.

HAS is an 80-bed hospital with an all-Haitian staff of 16 doctors and about 50 nurses. Today’s patient count hovers around 120 patients. Most of the amputees at the hospital are newly homeless. They’ll need to stay at least a week for fitting of prosthetics and then rehabilitation therapy to teach them to walk or to use their new prosthetic arms. Since most have no home to return to, the hospital is housing them at a place called L’Escale, a former tuberculosis village, a short walk past a village market from the hospital. Where they’ll go from there, no one really knows, but at least they’ll be able to walk away when they leave. Most will try to return to jobs in the fields or as laborers.

Estimates of crushing injuries that resulted in the emergency removal of limbs within the week after the quake range from 2,000 to 4,000. Eleven patients at the hospital are at some step of the limb making process right now. Today, the HAS rehabilitation team will add four more from Farmer’s hospital.

As the news gets out that HAS has perhaps the only functional prosthetics laboratory in the country – two were destroyed in Port-au-Prince during the earthquake – the demand is likely to spiral out of control. “Soon we’ll start to get people showing up at the hospital doors,” said Shaun Cleaver, one of two foreign-trained physical therapists in the entire country. He works at HAS. “It could get a little crazy.”
The rehabilitation team, including Cleaver and John “Jay” Tu, a prosthetist with the Hanger company, measure Bel Jean’s stump, then examine how well the stump has healed to determine if he’s ready for the casting process. That’s the first step. The cast will be taken back to the lab to create a mold that can be used to design a limb to fit the patient. Often the stumps of the earthquake victims have to be repaired surgically before being fitted because the initial operation was done under emergency situations in tents in the first few days after the quake.

“It was my last year in college to be a priest,” Bel Jean says. He shrugs. Now he doesn’t know what his future will hold. “You have to able to write if you’re a priest in Haiti, to run schools,” he explains. He lost the hand he writes with. His amputation is described as “above elbow.” The girl beside him is a double amputee, both “BK,” or below knee. The girl in the bed next to her is a single amputee, below knee. The plan is to transfer all three to HAS after their new limbs have been fabricated. They’ll stay there for the weeklong rehab process. After that, no one’s sure.

“I’m Roman Catholic,” Bel Jean says. “I used to love to see the Priest celebrate the mass when I was a child. I had one year left of school to become a priest.” He shrugs again and smiles. “Now, I don’t know.”

Tracie White is a Scope contributor and writer in the medical school’s communication office. She is presently in Haiti to write about the situation there. You can see all of her updates in our Haiti category. More details on Stanford’s Haiti relief effort are available here.

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