High-risk in Haiti: a novel nutrition program nourishes HIV-positive mothers and their babies by bridging the gaps between clinic and community.
Subject: HIV patients (Care and treatment)
HIV patients (Food and nutrition)
Community health services (Service development)
Author: Fessenden, Marissa
Pub Date: 03/22/2011
Publication: Name: Human Ecology Publisher: Cornell University, Human Ecology Audience: Academic Format: Magazine/Journal Subject: Health; Science and technology; Social sciences Copyright: COPYRIGHT 2011 Cornell University, Human Ecology ISSN: 1530-7069
Issue: Date: Spring, 2011 Source Volume: 39 Source Issue: 1
Topic: Event Code: 970 Government domestic functions; 361 Services development Computer Subject: Company service development
Product: SIC Code: 8399 Social services, not elsewhere classified
Geographic: Geographic Scope: Haiti Geographic Name: Haiti Geographic Code: 5HAIT Haiti
Accession Number: 266957315
Full Text: Mona Maitre was worried. One of her patients, a homeless woman, had not shown up for her appointment. Maitre fretted about the woman, who was HIV positive, and the woman's baby. They both needed medicine, food, and support. Each morning, Maitre drove around Port-au-Prince, Haiti--a vast, sprawling city--to scour the streets for the missing woman and her child.

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When Maitre, a nurse at Cornell's GHESKIO clinic, a center for the treatment of HIV/AIDS and related infections in Port-au-Prince, eventually found the woman, she discovered the baby had a serious respiratory infection.

The nurse's dedication and concern may seem unusual, but Rebecca Heidkamp, a Ph.D. candidate in the Division of Nutritional Sciences in the College of Human Ecology, said it is exemplary of how the clinic cares for the community. "For many of the staff, it is not about the data or the challenges faced in the clinic," Heidkamp said. "It is about caring for people."

Heidkamp spent three years at GHESKIO working on her doctoral thesis, where she designed and implemented an innovative program to meet the nutritional needs of HIV-infected mothers and their babies. Their multi-faceted approach educates these women about the importance of nutrition during a child's first two years of life, offers "mothers' clubs" where the women share advice and connect to the larger community, and provides nutritional supplements for their children. The program, overseen by nutritional experts in Human Ecology and clinical physicians at Weill Cornell Medical College (WCMC), is now in full swing and showing promising results as a behavioral intervention for high-risk mothers.

GHESKIO sees about 300 HIV-positive pregnant women a year. Under the new nutrition program, they meet monthly in a mothers' club and receive one-on-one medical care from clinic pediatricians and nurses. The mothers are grouped according to their babies' ages.

"For example, when the baby is 7 months old, we talk about diarrhea, which starts to be a problem at that age," Elizabeth Fox '09 explained. Fox, a nutritional sciences graduate, currently supervises the program in Port-au-Prince while Heidkamp finishes her thesis.

Working in a developing country with limited resources is not easy. Even before the catastrophic 2010 earthquake that flattened buildings in Port-au-Prince and throughout the region, work in Haiti presented some unique difficulties.

"Food insecurity is a big problem," explained Vanessa Rouzier, head of the pediatric department at GHESKIO. "When the parents ask for money and beg for food, you are tempted to give it to them for the children. We want to empower the community. Our mission goes beyond being a charitable organization."

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GHESKIO formed in 1982, the first institution in the world dedicated to combating the newly described HIV virus. Jean W. Pape, the founding and current director of GHESKIO and professor of medicine at Weill Cornell, along with a group of Haitian colleagues, noticed young men in Haiti dying of unusual opportunistic infections. With Warren Johnson, professor of medicine at WCMC, Pape and his colleagues created the Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO--a French acronym, pronounced guess-key-o) to describe and combat what would be later recognized as HIV/AIDS.

Despite operating in a resource-poor country, GHESKIO has led the way in developing therapies for the major complications of HIV, including tuberculosis and diarrhea. The center's mission has expanded to include community development, with the nutrition program bridging gaps between clinical care and community-level connection.

New focus on maternal-child nutrition

When Johnson and his colleague Dan Fitzgerald heard about the work of Rebecca Stoltzfus, professor of nutrition in Human Ecology and co-founder of the Global Health Program, they knew that she should visit Haiti. Stoltzfus's research focuses on the causes and treatment of malnutrition in women and children in developing countries.

"They were providing state-of-the-art HIV care at the clinic," Stoltzfus said, "and doing a very good job of protecting children from HIV transmission from their mothers. But they said that they were really doing little in terms of nutritional support." Stoltzfus decided to take Heidkamp, a new Ph.D. student in her research group, down to Haiti.

"GHESKIO has an excellent reputation locally," Heidkamp said, "and is backed by strong science and cutting-edge research. So we were able to come in with a different perspective and say, 'How can we make the clinical world seem more like a community?'"

GHESKIO already provided formula for children ages 0-6 months, but no nutritional support for the latter part of infancy. Children are very vulnerable to malnutrition and illness for the first two years of their life; their nutrition at that time has an enormous effect on their cognitive and physiological development.

It was hard for Haitian mothers to get sufficient amounts of high-quality food for their children, often feeding them thin, grain-based gruels before children are ready for solid food. The World Health Organization recommends breastfeeding, which can provide up to 50 percent of the caloric requirements, with supplemental foods for ages 6-24 months. When the GHESKIO study began, however, HIV-positive mothers were encouraged to use formula to avoid the risk of HIV transmission.

New evidence has shown that anti-retroviral drugs actually reduce the likelihood of transmission of HIV through breast milk. Heidkamp's program educated mothers about formula and breastfeeding and provided a dietary supplement called Manba Fotifye, a Haitian-produced, fortified peanut paste supported by a St. Louis-based nonprofit organization, Meds and Foods for Kids. Heidkamp saw a dramatic reduction in stunting and wasting in the children of mothers in this program compared to children who had visited the clinic the previous year.

"It wasn't only the provision of food, but provision in a group context and counseling about infant feeding and infant health," Stoltzfus explained.

Fox found that the mothers' clubs are the most powerful aspect of the program. For many mothers, especially HIV-positive women whose own families may not know their status, the clubs create a safe place where they can ask questions and foster a sense of community and belonging.

GHESKIO's team of nurses, physicians, and community health workers are the heart and soul of the center. Heidkamp's team included nurse Mona Maitre who searched for her missing homeless patient, counselor Ghislaine Saint Louis who once drove more than an hour from the clinic on her Saturday off to meet a woman who was missing her clinic visits because her husband was in jail, and Suzette Fleury and Adeline Bernard--all women whose impressive dedication made the program a success.

Expanding its reach and mission

The success of Heidkamp's study was so impressive that it is now a permanent program at GHESKIO, expanded to include HIV-affected children from birth to 2 years old and a community outreach program for those affected by the earthquake.

The challenges that the program faces are many. Even before the earthquake, the center was pressed for space. Now, with a refugee camp of more than 7,000 people living almost on the doorstep of GHESKIO, the needs of the community are even more urgent. The nutrition program faces increased demand for space and funding.

"We are in the late planning stages for a nutrition center for maternal-child health on the campus at GHEKSIO," said Johnson. "The center will expand the nutrition services we provide and further the mission of how best to approach nutrition problems in Haiti and around the world."

For the past 30 years, GHESKIO has been a leader in the fight against HIV/AIDS in the developing world. With the establishment of the Millennium Goals by the United Nations, global attention and funding have increased for problems of malnutrition, tropical diseases, and HIV. GHESKIO remains uniquely poised to make a difference on those fronts.

Now the nutrition program is continuing and extending GHESKIO's work.

"It is very exciting for us to have an opportunity to work with the world-class nutrition team they have at Cornell," Johnson said.

"The real reward is when you see children who respond beautifully and you really change a life," said Rouzier. "That makes the challenges worth it."

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RELATED ARTICLE: For more information:

Elizabeth Fox

elf23@cornell.edu

Rebecca Heidkamp

rah4@cornell.edu

Warren Johnson

wdjohnso@med.corneIi.edu

Vanessa Rouzier

vrouzier@gheskio.org

Rebecca Stoltzfus

rjs62@cornelI.edu
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