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Understanding TB Diagnosis in Haiti

Last week, Tara Kedia ('17) arrived in Les Cayes, Haiti, where she will be working for the next month on two public health projects related to tuberculosis.

By Tara Kedia

Last week, I arrived in Les Cayes, Haiti, where I will be working for the next month at Hôpital Immaculée Conception (HIC), the public hospital for Les Cayes and surrounding regions. Les Cayes is the capital of the South department of Haiti, with a population of over 125,000 in 2009. The official languages of Haiti are French (spoken in more formal settings) and Haitian Creole (the lingua franca). I do speak French, which has been a big help, but I’m still struggling to understand Haitian Creole so I can communicate with everyone here.

Haiti map
Kedia landed in Port-au-Prince and travelled by car to Les Cayes, about a three-hour journey through the mountains and along the coast. Map from Wikimedia Commons/Rémi Kaupp. (Click to enlarge.)

I first learned about Dartmouth’s affiliation with HIC while seeking an opportunity to assist in global health work during the summer between my first and second years of medical school. I was connected with Dr. Peter Wright and Dr. Elizabeth Talbot, who are serving as advisors to my work at HIC. I’ve also spoken a great deal with Kristen Jogerst (Geisel ’16), currently a third-year medical student who worked at HIC last summer and who introduced me to the wonderful family who is hosting me during my month in Cayes.

Les Cayes
The family Kedia is staying with lives outside of the city center. Their home overlooks farm fields and, in the distance, the mountains. Much of Haiti is mountainous but Cayes itself is quite flat.

While here, I’ll be working on two projects concerning tuberculosis (TB). One project is aimed at better understanding the use of GeneXpert at HIC. GeneXpert is a novel diagnostic device, about the size of a desktop computer, with high sensitivity and specificity for TB. Within two hours, GeneXpert simultaneously diagnoses and determines resistance to the first-line TB drug rifampin. GeneXpert is a huge improvement on earlier tests. Previously, labs had to test for TB and drug resistance separately, and there were many more missed TB cases (false negatives). The GeneXpert machine arrived at HIC in 2013 thanks to funds from the Centers for Disease Control and Prevention (CDC) and the Global Fund. Since being endorsed by the World Health Organization in 2010, GeneXpert has been rolled out internationally, and roll-out is in progress in Haiti.

Tara Kedia
Kedia is working in the Infectious Diseases Clinic of HIC.

The other major project I’ll be working on is a study of the causes of delays in TB diagnosis for patients in HIC’s catchment area. The ultimate goal is to use what we learn to mitigate the factors that contribute to diagnosis delays in and around Les Cayes. This work is important because the longer patients with active TB go undiagnosed, the more their TB can spread to those around them. So diagnosing (and treating) a patient sooner effectively stems the spread of TB bacteria and disease.

I’m very glad to be working on these projects at HIC, as I interned in the Stop TB Department of the World Health Organization (WHO) Headquarters in Geneva, Switzerland, for six months in 2012. I assisted in updating the WHO’s recently released 2014 Guidance for National TB Programmes on the Management of TB in Children, 2nd ed. Given my perspective on TB from the level of the WHO, I’m looking forward to learning more about the practical side of TB care and diagnosis at HIC.

Tara Kedia (’17) earned a BA in Anthropology and Biology from Dartmouth College. She previously interned at the World Health Organization and at the DarDar Pediatric HIV Clinic in Dar es Salaam, Tanzania.

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