Making a tiny impact from Tapachula

La Biofabrica

After taking a slightly tangential detour in Jaltenango de la Paz, I’ve resumed my work in El Equipo de Sueño — El Equipo de Zancudo Estéril con Dra. Ariane, Ana Laura y César y mucho más. After our last reunión in Rio Florido, we had a gathering in the Biofabrica yesterday, which went well. And we have a meeting with the women of Ejido Hidalgo tomorrow. It’s an action-packed week!

The Biofabrica is a special place where the sterile mosquitos will be grown. They are currently refining the techniques of rearing males of the Aedes egyptii vector species. Males are selected based on the size of their pupa using water chromatography. The reason we want males is that they do not bite, so they cannot be a vector. By releasing sufficient quantities of sterile males into the environment, the females should be "occupied" in exchanges that result in no offspring to an extent  that the population goes down, and the incidence of diseases like Dengue go down.

Separation by size... water sprayed at the top
Female pupa are the largest
Male pupas are in the middle
Larvae are the smallest

Me in the Biofabrica

Mosquito Life Cycle

As you may recall from my past post Community Meeting at Rio Florido, two areas I focused on for improving were (1) the question over when should someone with suspected Dengue go to the hospital, and (2) how to generate more dialogue among the group during these meetings. Later, during discussions with Dr. Ariane and Ana Laura, we noticed that more men were speaking up (among those who did speak up) than women. And I offered an idea: what if we had a meeting just for women? And now that’s happening, and I’m in charge of an activity. Oh god, what have I done?

The activity I’m leading tomorrow consists of splitting up the women from Ejido Hidalgo into small groups of 4-5 people and discussing things they like, dislike, don’t understand, or would like to see implemented in order to improve our project. I will start with an icebreaker of talking about our favorite color. I’m excited, scared, and ready to give it my all!

Also, with help, I prepared a handout guide for when to go to the hospital, in response to the lengthy Q&A session we had on this topic at our last meeting. It can be scary or confusing when a member of the family is sick. By collaborating with Dra. Romero and the rest of our equipo, we were able to come up with this table that hopefully clears things up a bit:

Draft of handout I made on when to go to the hospital if you have symptoms of Dengue Fever

That's all for now. Today I thought I finished my blog post summarizing my trip to Jaltenango but it got deleted, so I'll have to rewrite that from scratch. But in the meantime, there's a lot going on in Tapachula, and I'm grateful to be able to play a small role in this public health project.

Salud para la gente!

Tree in the middle of the road near my house in Tapachula

clarifying incidence of Dengue in Chiapas

I've been meaning to write this for over a week. Can't keep ignoring this blog! Thankful that Touro has decided I can use this blog to satisfy some of my requirements for this field study.

Last week, I thought was hearing mixed messages about how bad Dengue is this year. Clearly, it's bad -- many more cases are falling into the serious categories of Dengue Grave ("Serious Dengue" - likely lethal) or Dengue con Signos de Alarmo ("Dengue with alarm signs" - when abdominal pain and vomiting appear with transaminitis from liver inflammation, low platelets - responsible for the potential hemorrhagic/bleeding component of the disease, high hematocrit, third-spacing with fluid in the abdomen or lungs, in addition to the regular awfulness of the least serious classification Dengue no Grave or "non-serious Dengue").

So in my work in the community and hospitals, I've heard the number of cases is much higher this year than last year. Yet, last week when I did the literature search and compiled some information from the Secretaria de Salud's Panorama Epidmiologia de Dengue, I thought it showed the opposite:

As you can see, at the time I compiled this table, it was week 25 of 2018 for tracking the Epidemiology of Dengue in Mexico, which the Mexican government takes very seriously. This is why there are doctors like Dra. Romero at Hospital General de Tapachula whose focus is to track the cases of Dengue and other infectious diseases (e.g. Tuberculosis). But, I was perplexed to see the incidence of Dengue appearing far, far lower this year, even in Chiapas... However, it was my mistake. The 778 should have also been in the far right column under 2018, and that would have shown me that there is nearly double the incidence of confirmed cases of Dengue in Chiapas so far.

I caught this error while checking up on week 26 this morning, which now shows a clear increase in the incidence of Dengue within Chiapas this year:

From week 25 to week 26, the % increase in annual incidence up to that week between 2017 and 2018 has increased from 92% to 93%. The Dengue season has started earlier this year, the cases are more severe, and the children are affected most. Below, the graph to the right shows a much higher prevalence of more serious cases of Dengue among children aged 5-9 years old:

Panorama Epidemiológico de Dengue 2018, Publicación Actual (05 julio 2018), Semana Epidemiológica 26

This unfortunate view of the problem helps to highlight the serious nature of this disease for the people of Chiapas. It provides motivation to me to do what I can to contribute to the success of the project to use Sterile Insect Technique to reduce the population of mosquito vectors in this area. I hope to further clarify the situation using local/regional data soon.

Community Meeting at Rio Florido

español: Comentario sobre la reunión comunitaria con Rio Florido el 30 de junio de 2018

La reunión se llevó a cabo en un "centro comunitario" en un formato que parecía normal. Había 28 personas presentes, como cuentan en la asistencia principio. El presidente de Río Florido dio palabras de introducción y luego Dr. Ariane y Ana Laura anunció el plan para la reunión.

La presentación fue sin problemas. Las hijas de Dr. Ariane y Ana Laura eran jóvenes y enérgicas, lo cual es saludable, y esto no interrumpió la presentación, que se centró en las actualizaciones del Proyecto Zancudo Estéril.

Hacia el final, tal vez 20 minutos después, hubo tiempo para preguntas, comentarios y preocupaciones de la comunidad. Esta parte de la reunión fue interesante porque escuchamos cómo se siente la comunidad, lo cual es importante porque la gente de la comunidad son esencialmente nuestros jefes, ya que nuestro equipo trabaja para la gente de Río Florido y Ejido Hidalgo (además del público en general, que tiene un interés en controlar estos mosquitos vectores).

Una preocupación recibió más atención de lo que esperaba: ¿cuándo es apropiado enviar a alguien con sospecha de fiebre de dengue al hospital? Creo que este es un área lista para una "intervención," como la creación de un folleto promocional para regalar a las personas que deja en claro cuándo llevar a alguien al hospital. tal vez esto ya se haya hecho. Si no, quizás es algo en lo que puedo trabajar para crear.

En general, la reunión fue exitosa y eficiente en la comunicación de información importante. Si pudiera cambiar una cosa, agregaría algún tipo de componente interactivo durante la mitad de la reunión, para probar la comprensión y obtener ideas de la comunidad sobre cómo hacer que el proyecto sea aún mejor.

íngles: Commentary on the Community Meeting with Río Florido on June 30, 2018

The meeting took place in a "community center" in a regular format (it seemed like they held similar meetings frequently). There were 28 people present, as counted at the beginning attendance. The president of Río Florido gave introductory remarks and then Dr. Ariane and Ana Laura announced the plan for the meeting.

The presentation went smoothly The daughters of Dr. Ariane and Ana Laura were young and healthy, which is healthy, and this did not interrupt the presentation, which was focused on the updates of the Sterile Mosquito Project.

Toward the end, maybe 20 minutes later, there was time for questions, comments & concerns from community. This part of the meeting was interesting because we listened to how the community feels, which is important because the people of the community are essentially our bosses, since our team works for the people of Río Florido and Ejido Hidalgo (as well as the general public, who have an interest in controlling these vector mosquitos).

One concern received more attention than I had anticipated: When is it appropriate to sent someone with suspected Dengue Fever to the hospital? I think this is an area that is ripe for intervention, such as creating a promotional brochure to give to people that makes it clear when to take someone to the hospital. Maybe this has already been done. If not, maybe it's something I can work on to create.

In general, the meeting was successful and efficient in the communication of important information. If I could change one thing, I would add some kind of interactive component during the middle of the meeting, to test for understanding and get ideas from the community about how to make the project even better.

a public health challenge

Today I woke up having slept perfectly for about 7 hours. This is no cupcake given the constantly humid 80-degree air (in fahrenheit... equal to 26.7 celsius). Although I lucked out by arriving in Tapachula a little bit late -- late for the hottest weather of the year in April/May -- I unfortunately also arrived late for a golden opportunity in community engagement at the schools of Rio Florido and Ejida Hidalgo. Kat & Peter were lucky enough to participate in the Puppet Show Patas Rayadas Enamorados and explain through puppet-acting to the children in these communities how mosquito lifecycles work and how they (right now... as kids of the community) can help reduce the incidence of mosquito-born illnesses like Dengue Fever, Chikungunya, and Zika Virus. That said, I take solace in having slept soundly through the night without being drenched in sweat. This is in part thanks to the heavy rain of yesterday afternoon, captured below:

~4:30pm on 27 Jun 2018 at Hospital General de Tapachula 

But I am left with a predicament. ECOSUR's Equipo de Zancudo Transgénica (Dra. Ariane Dor, Ana Laura Pacheco y César) have concluded their Puppet Shows, because the schools are no longer in session due to summer break. There are a couple of community meetings planned, but I am here to work "full time" as a public health professional; this means I must find ways to gain experiences in Public Health outside of the pre-arranged means. Thanksfully, I am connected with Dr. Rogelio Danis at INSP/CRISP. This opens the door for other opportunities in public health experiences.

Every afternoon I can work with Dra. Daenna Romero in Hospital General de Tapachula. As an epidemiologist in México, Dra. Romero is both a physician and a public health professional. Each day we collect information on patients' progress, particularly those with Dengue Fever (which is currently experiencing a large outbreak in this region). Although the incidence of dengue in México may appear unimpressive at first glance, and it's true that the incidence has gone down considerably since 2015, this year it is highly concentrated in the state of Chiapas:

From Panorama Epidemiológico de Dengue 2018 - Semana Epidemiológica 25

And that is why making information accessible to the people in the affected communities is so crucial, and I'm so sad that I don't get to make a fool of myself puppet-acting in Spanish at the schools in Chiapas. But maybe there will be other opportunities for health promotion activities soon. Right now we're waiting for the election (this Saturday) before doing more outreach. In the meantime, enjoy this PSA:

Campaña de Prevención del #Zika, #Chikungunya y #Dengue 2017

Beginning words

Writing from my apartment in Tapachula, a bustling city near the very southwest tip of Chiapas, the southernmost state of Mexico. I have spent the past week here, and it is with much excitement that I still have another 5 weeks of living and working here, as part of my Public Health Field Study.

There are a number of established sites around the world where public health students at my school may go, but I have wanted to come to Chiapas ever since reading my step-grandmother June Nash's essay in Cultural Anthropology. So I am the first student from TU to complete an MPH Field Study in Chiapas. That said, about a year ago, Martha Benitez (an OG) did a Global Health rotation here as part of the College of Osteopathic Medicine (COM). The difference between that and what I'm doing is the intended nature of the work. For a medical rotation, the goal is to see healthcare in action internationally, to gain clinical experiences. In a public health field study, the work is generally anything but clinical. For me, I'm helping build a community engagement project to use the Sterile Insect Technique and help reduce the population of Aedes egypti mosquitos, the vector for Dengue Fever, Chikungunya, and Zika Virus.

This is actually my second time in Chiapas. After planning this trip, my partner Diana and I visited this past January for a few days in San Cristóbal and an excursion to Hospital San Carlos in Altamirano. I would say it is half coincidence, half intention. It's nice to be back and It's a lot easier having some experience of the way things move here.

On my arrival this time, there were two other students here from Touro already: Peter & Kat. They started an awesome blog for the COM Global Health program during their month here. Below is a multidisciplinary team photo after breakfast with some folks at ECOSUR, some folks at INSP/CRISP, and us medical students from TU.

Upper Left: Peter & Kat. Upper Right: Erica and myself

Bottom Left: César and Ariane. Bottom Right: Ana Laura and Iliana.

So this morning: I woke up, cleaned up, created this blog... all before 8:45am !!! And now it's time to start the day.... more on what that entails to come!