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Trust Greases Wheels in Race against Lymphatic Filariasis

  • Mirlande Joseph, left, is a well-known figure in certain areas of Port-au-Prince, Haiti. She and other Carter Center-supported health workers such as Maudeline Florient, right, go door to door spreading information about lymphatic filariasis and providing medicines to prevent it.

Mirlande Joseph walks the blistering hot, dusty back alleys of Port-au-Prince, greeting people as if she were a politician running for re-election.

“How are you? How is your family? Anyone sick? Did everyone take the medicine when we came by before?”

Joseph supervises six Ministry of Health medicators who administer medicines to counter lymphatic filariasis in one section of Haiti’s teeming capital city. The Carter Center’s Hispaniola Initiative provides technical support to Haiti and the neighboring Dominican Republic to eliminate both lymphatic filariasis and malaria all across their shared island.

Lymphatic filariasis, called LF for short and filaryoz in Haitian Kreyol, is a tropical parasitic disease that thrives among impoverished populations, both rural and urban. When a mosquito draws blood from an infected person, it also draws out microscopic worm larvae living in the blood. The larvae are then deposited in the next person the mosquito bites, spreading the infection. A sufficient load of the worms will impair the human lymph system, causing severe swelling in the limbs (a condition called lymphedema) and genitals (scrotal hydrocele). It is painful, debilitating, and disfiguring. Hydrocele can be corrected through surgery, which few can afford; lymphedema – also called elephantiasis – is irreversible.

The Hispaniola Initiative aims to eliminate LF in both countries by 2020 through mass distribution of the drugs albendazole and diethylcarbamazine (DEC), which kill the worm larvae. The tablets have to be taken once a year for several years to reduce the parasite population to the point where there’s not enough in anyone’s blood to cause problems, said Dr. Gregory Noland, a Carter Center epidemiologist.

  • Health workers Maudeline Florient and Harry Hilaire flank Carter Center Initiative Manager Dr. Luccene Desir and Mirlande Joseph as they canvass a back alley in Port-au-Prince where lymphatic filariasis is declining after a multiyear effort.

It’s taking longer than initially expected, but good progress is being made: Prevalence of LF in this area of Port-au-Prince was 51 percent at the beginning of the campaign; after six years of treatments it was down to 17 percent, said Dr. Luccene Desir, the Carter Center’s initiative manager in Haiti. 

Tackling LF in an urban environment comes with significant challenges, among them high population density, poor sanitation, crumbling infrastructure, shaky security, and lack of access, Desir said.

Mistrust also is a major factor, as many people in downtrodden Haiti believe the world is against them.

“Sometimes people say we are giving them pills to stop them from having children or even to kill them,” said Joseph, who is known in the neighborhood as Madame Filaryoz. “People wonder why we are still doing mass drug administration after seven years, when they had been told at the beginning it would be five years.”

  • Auto mechanic Richard Etienne is a respected businessman in his neighborhood. He had a startling reaction to medication he took to ward off lymphatic filariasis, but he came to understand that the treatment was good for him in the long run.

An incident involving a prominent neighborhood businessman illustrates the power of trust.

Richard Etienne is the respected owner of Don de Dieu (“Gift of God”) Garage, a large open-air auto repair shop that employs about 10 mechanics and technicians. The first time Joseph and one of her proteges, a young man named Harry Hilaire, came around with the drugs, Etienne hesitated but they talked him into taking the tablets. Within days his scrotum swelled up “to the size of a cantaloupe,” he said.

“It was so painful, even a breeze made it hurt,” Etienne said. “I was very scared.”

He was sure he had been poisoned. He lashed out, threatening to harm Joseph and Hilaire, vowing never to take the pills again and to warn all his neighbors. Hilaire calmed him down with facts.

“I tried to build hope and trust with this man,” Hilaire said. “I told him that these side effects were normal, that they meant he had an infection and the drugs were working and this was actually good for him. He was upset at first, but after a few days of ice the swelling went down and he was fine.”

  • Health worker Harry Hilaire inspects Richard Etienne’s auto repair yard for mosquito breeding sites. Mosquitoes spread lymphatic filariasis; controlling their population is key to containing the disease. The Carter Center supports the program through its Hispaniola Initiative. (All photos: The Carter Center)

“In the end, we joked about it,” Etienne said. “I was really mad at him at first. When he comes by, I tell him to get out of my house, but I’m just joking.”

Etienne not only dropped his opposition to taking the drugs, he became an advocate.

“Now I go around with a bullhorn and tell people in the neighborhood they need to take these pills,” he said. “If people come to me with questions, I just refer them to Madame Filaryoz’s team.

“It’s not embarrassing to talk about this,” he went on. “It’s good to know about this disease and what you can do about it. Madame Joseph’s team needs to keep up the effort until all of Haiti is rid of filaryoz and malaria. They should get all the support they need.”

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