2016 Year in Review

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A child who benefits from appropriate medical care generally enjoys a better state of health during childhood and becomes a healthier adult. The right to children’s health also includes pre and postnatal care for mothers.

Following the framework from the United Nations and the World Health Organization on human development, the NPHI Medical Services Department used the Millennium Development Goals (MDGs) as our guidelines in 2016; complementing, but not replacing other goals that each NPH home may have individually.

During 2016, we decided to focus on sanitation and safe water, nutrition, immunization and mosquito-transmitted diseases as our main goals.

nph_mexico_2016_children_7SANITATION AND SAFE WATER
Development and good health begins with having clean and safe water as well as access to health services, food and education. NPH homes monitor water with biannual microbiological and chemical testing and by reviewing their water infrastructure from the pipes to the water tanks. Also homes have added a second barrier to the water purification process with UV light. We are continuously working on improving the water collection process as well.

NUTRplate-of-foodITION
Across NPH homes we have seen improvements in the daily food menus, such as including more fruit and vegetables. This has led to a significant decrease in children with anemia and other deficiencies. Most of the countries have additional nutritional programs as well. NPH clinics monitor growth, development and anemia through biannual screening.

In some of our countries, we are facing a new epidemic that has spread throughout the rest of the world as well: overweight and obesity. Malnutrition is not just low weight but also overweight, as both are signs of not receiving adequate quality intake. NPH ensures adequate management to medical protocols and early detection.

VACCINATIONS AND HEALTH CAMPAIGNSblog_immunizations
Vaccinations are fairly inexpensive when considering the benefits. They protect children against the risk of death and handicaps caused by the most common children’s diseases in poor countries: tuberculosis, diphtheria, tetanus, leprosy, polio, whooping cough and measles. At NPH we vaccinate our children, as well as offer awareness and health education campaigns, which can prompt a significant reduction in health risks. All homes have had done a great job at least once a month for children and caregivers, offering health education discussions that are age appropriate.

In 2016, we administered 3,662 doses of vaccines across all countries. Applying vaccines doesn’t mean the population is well vaccinated according to the age, though it is a good step to reach the goal. The average ratio of vaccination in NPH is 78-80% in most of the basic vaccines, but boosters are needed every year to maintain the protection. Our goal is to be at least 90%. Furthermore, we provide deworming to our entire child population and provide Vitamin A to children under 5 to prevent blindness. Funds from international NGOs and foundations for immunization completion and nutrition have been a key to continue to work and make improvements in the children’s health, as well as receiving advanced medication for children with HIV.

MOSQUITO-TRANSMITTED DISEASES
Countries where NPH works have a high prevalence of high-impact diseases, especially during the rainy season. Cleaning surroundings in our community is important to prevent the breeding sites of mosquitoes. Any collection of water is a threat for disease incubation. Fumigation and mosquito nets are necessary to prevent infectious, transmitted diseases such as Zika, chikungunya, dengue or malaria.

blog_breathingNPH IMPACT
The impact of NPH’s work in developing countries is significant. We work not only for the children living in NPH homes, but also for patients from the community and children attending NPH schools. NPH clinics support these students by providing: annual medical exams, nutrition screening, vision, hearing, dental care, immunization campaigns, one nutritious meal, deworming twice a year, supporting/finding a solution for special cases identified during screening, health education, and therapies according to availability. The most common daily clinic visits are: upper respiratory infections, traumas (from small wounds to broken arms or concussions), skin problems, parasites and gastrointestinal issues (stomachache, diarrhea).


ADDITIONAL SUCCESSESdoc_blog
• Restoration and remodeling of outdated clinics in Honduras and Haiti homes
• Preparing and coordination of three children traveling abroad for specialist treatment
• Implementation of psychology and therapy services in electronic medical records
• Comprehensive care with teams for children with severe disabilities
• Professional development: International NPHI medical workshop and training abroad on mental health care

The Medical Services team and local clinics work hard to apply our mission statement to our daily work: striving to reach an optimum health and wellbeing for children to live as healthy as possible. The success relies on the close cooperation between the Medical Services team and local staff, and establishing collaborative partnerships with local public health facilities and other NGOs.

On behalf of all the children, medical staff and NPHI Medical Services we want to thank all the supporters.

Pilar Silverman, MD, NPHI Medical Services Director

NPHI Medical Services Team members are:

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Dr. Corinna Lawrenz, Regional Medical Coordinator of NPH Mexico and Bolivia; Dr. Pilar Silverman, Medical Director NPH International and Regional Medical Coordinator of NPH Haiti and Dominican Republic; Marta Garate, RN, Regional Medical Coordinator of NPH Honduras, Guatemala and Peru, Julia Spettel RN, Regional Coordinator of NPH Nicaragua and El Salvador, Nelly Fernandez, Psychologist, Mental Health Coordinator

Hands Up – World Aids Day

At NPH we currently care for 56 children who are HIV +, 25 female and 31 male.

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All incoming NPH children are tested for HIV.

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There is no stigma or discrimination; all our children live among others and they are owners of their destiny and to choose to whom and if they disclose or not their condition. They receive emotional and psychological support.

NPH HIV children have access to treatment either available in the country or abroad (through collaboration between NPHI Medical Services and another organization from New York). We make sure they get the medication they need. All children receive follow-up to make sure or prevent any harm from the medication side effects and evolution of the infection.

 

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2,137 children from the community from low-income households attend NPH schools, with about half being girls.
sex_edNPH children receive age appropriate sexual education to make the right decisions. HIV is considered a basic STD.

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NPH not only supports HIV children but also supports several patients from the community in need of unreachable ARVs in the country.

Additionally, the NPH Haiti St. Damien Pediatric Hospital has a program for elimination of mother to child transmission (PMTCT) of HIV. Read more at: 

Making an HIV Free Future a Reality in Haiti

International Hand Washing Day

October 15th is the assigned day by Unicef to raise awareness about the importance to wash our hands. Each year more than 300,000 children under 5 years old die of diseases related to bad hygiene.

NPH homes dedicated the week of October 15 th to do activities to strengthen good hand washing habits among our children.

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The Challenges of Epilepsy

 

phototake_rm_photo_of_brain_wavesEpilepsy is a chronic neurological disease characterized by recurrent seizures. These seizures are due to abnormal electrical discharges of brain cells of one area or in the whole cerebral cortex. This causes episodes of involuntary movements which can vary in different types of seizures. However most affected people can lead a normal and healthy life.

NPH has 64 children and young people with epilepsy across all nine homes who are under periodic control of specialists (usually neurologists) and receive medicine and appropriate care within the homes. To keep control of epileptic seizures, caregivers keep a diary of seizures under monitoring of the NPH doctor. Nurses are responsible for delivering the medicine at the correct time as indicated by the doctor.

Types: It can be distinguish between partial or focal seizures and generalized seizures. Partial seizures manifest depending on the brain function of the affected area. They can be with or without loss of consciousness.
Generalized seizures affect the entire body. They can be very brief episodes of absence or prolonged seizures with muscle contractions of the whole body.

Complications: As a result of seizures people with epilepsy tend to have more physical problems, as they may suffer trauma when a seizure occurs such as fractures, bruises, accidents, burns, drownings, but also anxiety, depression and other psychosocial problems play an important role.

Causes: Epilepsy is not contagious! There are different causes of epilepsy: genetic diseases, brain damage, tumors, pre- or perinatal brain injuries, accidents, infections… But more often there is no identifiable cause of epilepsy, i.e. epilepsy is idiopathic.

Frequency: Today about 50 million people suffer from epilepsy, in which 10.5 million are children. Almost 80% of epileptic people live in low- and middle-income countries due to the increased risk of endemic diseases such as malaria or neurocysticercosis.

Diagnosis: A person who has one seizure does not have epilepsy. Epilepsy usually is diagnosed after two or more seizures without triggers (ex. fever). Febrile seizures in children are not related to a higher risk of future epilepsy.

There are 3 main diagnostic methods to determine the type of epilepsy:
– Personal and medical history of the patient
– Electroencephalogram
– MRI / CT

Therapy: There is a large number of medicines for all different types of seizures. In 70% of patients seizures can be controlled with a single drug administered in an appropriate dose. It is of particular importance to follow the doctor’s instructions regarding how and at what time of day to take the drug and if accompanied or not with food. When medicine does not work, an alternative may be a high fat (ketogenic) diet or a neurological surgery. However, many children with idiopathic generalized epilepsy are cured and do no longer need medication after a period of 2 to 5 years. In middle- and low-income countries, an estimated three quarters of patients do not receive the necessary treatment, although many of the drugs are low priced (annual cost of about $5.00 according to WHO).

Social impact: In many parts of the world patients and their families are still victims of stigma or discrimination and sometimes it is more difficult to overcome that fact than the seizures themselves.

Prevention: Idiopathic epilepsy is not preventable. However preventive measures can be applied against the known causes and should also be fulfilled in the NPH homes:
– Prevention of accidents and injuries
– Prevention of infectious diseases of the nervous system. Vaccinate!
– Elimination of parasites, prevent parasitic infections, hygiene!
– Adequate perinatal care

Action during a seizure:
– Keep calm
– Stay with the patient until the end of the seizure
– Protect the patient from injuries
– Remove hard or sharp objects
– Turn the patient gently to one side to open the airway
– DO NOT try to stop the convulsive movements
– DO NOT open the mouth or put anything in it
– DO NOT give any drink until the patient is completely awake and conscious

It is very important that the staff of the NPH homes – teachers and caregivers spend most of the day with the children – know these measures because a child with epilepsy can convulse at any time.

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Epilepsia

La epilepsia es una enfermedad neurológica crónica que se caracteriza por convulsiones recurrentes. Estas convulsiones se deben a descargas eléctricas anormales de células de una zona del cerebro o de toda la corteza cerebral que causan episodios de movimientos involuntarios. También pueden afectar el sistema sensorial, sensitivo o psíquico: existe una gran variedad de diferentes tipos de crisis epilépticas. Sin embargo la mayoría de personas afectadas puede desarrollar una vida normal y sana.

En todas las casas de NPH actualmente viven 64 niños y jóvenes con epilepsia que están en control periódico por el especialista y reciben el medicamento y la atención adecuada dentro de las casas. Para tener un control de las crisis epilépticas, los encargados llevan un calendario de convulsiones y el médico de NPH da seguimiento. Las enfermeras se encargan de entregar el medicamento siempre a la hora correcta, indicada por el médico.

Formas: Se distingue entre las crisis parciales o focales y las crisis generalizadas. Las crisis parciales se manifiestan según la función cerebral de la región afectada. Pueden ser con o sin pérdida de conocimiento.
Las crisis generalizadas afectan todo el cuerpo. Existen episodios muy breves de ausencia hasta convulsiones con contracciones musculares de todo el cuerpo prolongadas.

Complicaciones: Como consecuencia de las convulsiones las personas con epilepsia tiendan a padecer más problemas físicos por traumatismo al sufrir la convulsión: fracturas, hematomas, accidentes, quemaduras, ahogamientos, pero también ansiedad, depresión y otros problemas psicosociales.

Causas:
La epilepsia no es contagiosa! Hay diferentes causas de las epilepsias: enfermedades genéticas, daño cerebral por lesiones pre o perinatales, traumatismos y accidentes, infecciones y tumores. Pero aún más frecuentemente no hay causa identificable de la epilepsia, es decir que la epilepsia es idiopática.

Frecuencia: Hoy día unos 50 millones de personas padecen epilepsia, bajo ellos 10,5 millones de niños. Casi el 80% de las personas epilépticas viven en países de ingresos bajos y medianos debido al mayor riesgo de enfermedades endémicas como la neurocisticercosis o el paludismo, el gran número de accidentes de tránsito y riesgo más alto de traumatismos derivados del parto etc.

Diagnóstico: Una persona con una sola crisis no tiene epilepsia. Se habla de epilepsia cuando un paciente tiene dos o más crisis convulsivas sin factores desencadenantes (por ejemplo fiebre). Las convulsiones febriles en niños no están relacionadas con el riesgo de futuro epilepsia.
Hay 3 métodos principales de diagnóstico para determinar el tipo de epilepsia:
– la historia personal y médica del paciente
– el electroencefalograma
– la resonancia magnética/ tomografía computarizada

Terapia:Existe un gran número de medicamentos para los diferentes tipos de crisis epilépticas. En un 70% de los pacientes las crisis pueden ser controladas con un único medicamento administrado en la dosis y forma adecuada. Más que en ningún otro caso, se deben seguir las instrucciones del médico referentes a cómo y en qué momento del día tomar los fármacos y acompañados o no con la ingesta de alimentos.

Cuando los medicamentos no dan resultado, una alternativa puede ser una dieta rica en grasas (cetogénica) o una cirugía. Sin embargo muchos niños con epilepsia generalizada idiopática se curan y no necesitan más medicamento después al cabo de un periodo de 2 a 5 años.

En países de ingresos medianos y bajos alrededor de tres cuartas partes de los pacientes no reciben el tratamiento necesario, aunque muchos de los medicamentos son económicos (costo anual de unos 5 $ US según WHO).

Repercusión social: En muchas partes del mundo los pacientes y sus familias pueden ser víctimas de la estigmatización o discriminación y a veces esto es más difícil de vencer que las propias convulsiones.

Prevención: La epilepsia idiopática no es prevenible. Sin embargo se pueden aplicar medidas preventivas frente a las causas conocidas también a nivel de las casas de NPH:
– prevención de accidentes y traumatismos
– prevenir infecciones del sistema nervioso. Vacunar!
– eliminación de los parásitos, evitar infecciones por parásitos, higiene!
– atención perinatal adecuada

Actuación frente a la crisis:

  • Mantener la calma
  • Quedarse con el paciente hasta que concluya la crisis
  • Proteger el paciente de cualquier lesión
  • Retirar objetos duros o cortantes
  • Girar el paciente suavemente hacia un lado para que tenga libre los vías respiratorias
  • NO tratar de detener los movimientos convulsivos
  • NO abrirle la boca ni introduzca nada en ella
  • NO dar ninguna bebida al paciente hasta que esté despierto y consciente

Es muy importante que el personal de las casas, más que nada maestros y encargados que pasan la mayor parte del día con los niños, sepan estas medidas ya que un niño con epilepsia en cualquier momento puede convulsionar.

S.O.S. Haiti -
 Your Help Gets Where it is Needed

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2.1 million Haitians have been affected or are victims of Hurricane Matthew. No shelter, no food, no safe water, and without medical attention. Cholera and other infectious diseases are now on the rise.

Infrastructures and communications were devastated. Repairing bridges and restoring power and telephone lines are priorities to reach people who are still isolated. After a disaster of this magnitude, violence, rape and murders increase with children, women and elderly being the most vulnerable

1.4 million people need immediate help and NPH is on the front line delivering food and water. So far 23,000 kg of rice, 30,000 kg of beans, 5,000 kg of pasta and clean water have been given to the most devastated communities.

Soon we will be able to send the first container from Europe with clothing and medicine, including treatment for cholera and other infectious diseases. More than 11,000 people will get direct help from NPH!

Please consider donating just $35 for a 25 kg bag of rice, beans or corn meal at: https://www.nph.org/emergency

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ZIKA Virus Continues to Spread – August summary from ProMED

 

UntitledA report from ProMED, a program of the International Society for Infectious Diseases http://www.isid.org gather the latest updates from WHO and PAHO and other global health partners.

In this update, there are new cases of microcephaly in Brasil and Puerto Rico. New evidence of transmission through mother to child, blood transfusion, sexual transmission (zika virus remains in the semen for several months) and platelet transfusion transmission.

The incidence and trends of Zika virus during the last few weeks is that 45 countries and territories have confirmed local, vector-borne transmission [that means people without travelling got the virus from infected people in the country where they live] of Zika virus disease in the Region of the Americas since 2015. In addition, 5 countries in the Americas [Argentina, Canada, Chile, Peru, and the United States of America] have reported sexually transmitted Zika cases.

Countries and territories in the Americas with confirmed autochthonous (vector- borne) Zika virus cases, 2015-2016: Anguilla; Antigua and Barbuda; Argentina; Aruba; the Bahamas; Barbados; Belize; Bolivia ;Bonaire, Sint Eustatius, and Saba; Brazil; Cayman Islands; Colombia; Costa Rica; Cuba; Curaçao; Dominica; the Dominican Republic; Ecuador; El Salvador; French Guiana; Grenada; Guadeloupe; Guatemala; Guyana; Haiti; Honduras; Jamaica; Martinique; Mexico; Nicaragua; Panama; Paraguay; Peru; Puerto Rico; Saint Barthélemy; Saint Lucia; Saint Martin; Saint Vincent and the Grenadines; Sint Maarten; Suriname; Trinidad and Tobago; Turks and Caicos Islands; the United States of America; the United States Virgin Islands; and Venezuela.

All countries where NPH works are highlighted and with Zika virus in the country. Testing is mostly done only for pregnant women. Others with high evidence of symptoms are treated to palliate the fever and pain and observe that there are no further complications.

All NPH homes are doing their best to keep the windows screens intact with no holes, fumigate more often than usual, provide repellent for all children and workers as well as health education on prevention of mosquito bites. Doctors and nurses are also on alert to detect early symptoms and do early intervention. Some NPH staff and children have presented with zika symptoms but there have been no confirmed cases by testing.

Mexico has presented a decreasing trend in confirmed Zika virus disease cases, while the United States of America has reported its 1st outbreak in an area of the Miami-Dade County in the state of Florida.

Avoiding mosquito bites:

  • Wearing clothes that completely cover the arms, legs, neck, and head (long sleeves,
    pants, and skirts, and a head covering).
  • Use natural repellents like citronella, neem oil, or basil leaf. Or use chemical repellents that have one of these ingredients: DEET, Picardin (KBR 3023, icaridin), PMD and other oil of lemon eucalyptus compounds, or IR3535. Repellents are especially important for children because they can prevent mosquito bites even when other preventive steps are not taken, but read the label carefully to make sure the product is safe for children. The label will also say how often to reapply. Usually repellent needs to be reapplied every few hours, but some last less time.
  • Use screens on windows and doors. Repair or patch any holes.
  • The moving air from a fan can keep mosquitoes away.
  • Use bed nets. Tuck the edges of the nets under the bed or sleeping mat so there are not open sides.
  • If pregnant do not travel to the countries with high incidence of Zika infected cases!!!

Dengue and Chikungunya are still around with more than 6,000 cases in El Salvador, 4,049 in Guatemala, 16,000 in Honduras, 41,000 in Mexico, 53,00 in Dominican Republic and 3,500 in Bolivia.

The list of countries and territories that have reported cases of congenital syndrome associated with Zika virus infection to PAHO/WHO, or those that have been published are: Brazil 1,806, Canada 1, Colombia 22, El Salvador 4, French Guiana 2, Martinique 8, Panama 5, Paraguay 2, Puerto Rico 1, and United States 21.

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International Day of Hepatitis – July 28th


webmd_rf_photo_of_liver_and_hepatitis_virusHepatitis is an inflammation of the liver, most commonly caused by a viral infection. There are five main hepatitis viruses, referred to as types A, B, C, D and E. These five types are of greatest concern because of the burden of illness and death they cause and the potential for outbreaks and epidemic spread. In particular, types B and C, lead to chronic disease in hundreds of millions of people and are the most common cause of liver cirrhosis and cancer.

WHO informs that Hepatitis A and E are typically caused by ingestion of contaminated food or water. Hepatitis B, C and D usually occur as a result of parenteral contact with infected body fluids. Common modes of transmission for these viruses include receipt of contaminated blood or blood products, invasive medical procedures using contaminated equipment and for hepatitis B transmission from mother to baby at birth, from family member to child, and also by sexual contact.

Acute infection may occur with limited or no symptoms, or may include symptoms such as jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, nausea, vomiting and abdominal pain (WHO, 2015).

Our daily challenges in the NPH homes include to ensure the basic vaccination, evaluation and improvement of the water systems in the homes, such as regularly testing of the water quality. Additionally kitchen staff to trained on how to prepare food hygienically and the regular evaluation of the hygienic safety measures in the kitchen and where the food is stored. With success in the last years, we only record two cases of Hep C, 6 cases of Hep B and 6 cases of Hep A in all homes. We consider this a good result based on the local rural situations of some of our homes.

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Día Mundial contra la Hepatitis – 28 de julio

La hepatitis es una inflamación del hígado causada generalmente por una infección vírica. Se conocen cinco tipos principales de virus de la hepatitis, designados como A, B, C, D y E. Estos son los que mayor preocupación generan debido a la gran morbilidad y mortalidad que conllevan y a su potencial para causar brotes y propagarse de forma epidémica. En particular, los tipos B y C dan lugar a una afección crónica en cientos de millones de personas y son en conjunto la causa más común de cirrosis y cáncer hepáticos. OMS, 2015

Tambien informa la OMS que la hepatitis A y la E son causadas generalmente por la ingestión de agua o alimentos contaminados. Las hepatitis B, C y D se producen de ordinario por el contacto con humores corporales infectados. Son formas comunes de transmisión de estos últimos la transfusión de sangre o productos sanguíneos contaminados, los procedimientos médicos invasivos en que se usa equipo contaminado y, en el caso de la hepatitis B, la transmisión de la madre al niño en el parto o de un miembro de la familia al niño, y también el contacto sexual.

Aunque a veces es asintomática o se acompaña de pocos síntomas, la infección aguda puede manifestarse en forma de ictericia (coloración amarillenta de la piel y los ojos), orina oscura, cansancio intenso, náuseas, vómitos y dolor abdominal.

Nuestros retos diarias en las casas de NPH también incluyen asegurar la vacunación básica de cada niño, la evaluación y mejoría de los sistemas de agua en los hogares, como también prueba con de la calidad del agua regularmente no olvidar las charlas de salud para el personal de cocina como preparar los alimentos de forma higiénica y la evaluación periódicamente de la higiene en la cocina y las tiendas de alimentos – con éxito -en los últimos años sólo se han presentado dos casos de la hepatitis C , seis casos de la hepatitis B y 6 casos de la hepatitis en todos nuestros hogares, que es un buen resultado pensando de cual orígenes nuestros hijos están llegando y las situaciones locales ruralmente/económicamente de nuestros hogares.

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