Dr. Madsen Beau de Rochars of Haiti, left, and Dr. Manuel Gonzales of the Dominican Republic work closely together toward the elimination of malaria and lymphatic filariasis across difficult geopolitical, cultural, and linguistic lines. (Photo: The Carter Center/ G. Noland)
In 2006, the International Task Force for Disease Eradication urged that action be taken to eliminate the mosquito-borne diseases lymphatic filariasis (LF) and malaria from Hispaniola, the island shared by the Dominican Republic and Haiti. Despite a turbulent history of economic disparity, tensions, and bloodshed, both nations eagerly agreed to binational cooperation, and The Carter Center launched the Hispaniola Initiative to assist them.
Hispaniola is the only Caribbean island that still harbors malaria, which kills an estimated 405,000 people each year worldwide. Hispaniola also accounts for 95% of the LF burden in the Americas. LF, or elephantiasis, is a leading cause of preventable disability globally, wreaking devastating economic, emotional, and physical damage. It can cause limbs, particularly legs, and men’s scrotums to swell to enormous proportions. The limb swelling is irreversible; the scrotal swelling, called hydrocele, is treatable with surgery, but surgery is not available to most sufferers.
For nearly 20 years, Dr. Manuel Gonzales of the Dominican Republic and Dr. Madsen Beau de Rochars of Haiti have collaborated to fight these diseases across difficult geopolitical, cultural, and linguistic lines. Countless times, they have exchanged data, coordinated treatments, and put their heads together to solve challenges to ensure success on both sides of the border.
Dr. Madsen Beau De Rochars leans down to inspect records at a mass drug administration (MDA) post at a busy crossroads in Tabarre, Haiti. (Photo: The Carter Center/ H. Emanuel)
Based in the southern Haitian city of Léogâne, Beau de Rochars helped launch Haiti’s LF elimination program in 2000 by conducting nationwide mapping surveys and launching mass drug administration in affected areas. At that time, LF was endemic to all of Haiti’s 140 districts. Today, 4.2 million Haitians no longer require treatment and transmission is limited to 22 districts.
"I think we can make it" to elimination, said Beau de Rochars, who maintains an advisory role with the Haiti Ministry of Health’s LF program through a Carter Center consultancy.
"I’ve been in it from the very beginning," he said, "when eliminating lymphatic filariasis was just a dream. And now you see that it’s real. I could not be more excited. I’m very motivated to see this program succeed."
The program relies on trusted, Carter Center-trained community members to deliver accurate health information and donated medicines to their neighbors. Beau de Rochars believes success against lymphatic filariasis, a neglected disease of neglected people, is breeding success against malaria.
The energy and motivation invested in reducing LF are being applied to malaria as well, yielding promising progress against both.
"There are lessons we learned from LF that we are applying to malaria," Beau de Rochars said.
Dr. Manuel Gonzales discusses health care with Andrean Bon, 69, a native of Haiti who has lived in the Dominican Republic for 35 years. Bon, who cuts sugar cane for a living, has endured years with an enlarged groin, a debilitating and painful condition caused by lymphatic filariasis. (Photo: The Carter Center)
Gonzales, who has led the Dominican Republic's National Program to Eliminate LF since 2001, has overseen similar success on his side of the border. Following nationwide disease mapping and distribution of more than 1 million treatments, all formerly LF-endemic areas qualified to stop mass drug administration in 2018; program experts now are conducting surverys to confirm that transmission of the disease has been interrupted throughout the country.
The Pan American Health Organization recognized the two countries' cross-border partnership with its 2017 Malaria Champion in the Americas Award. The award committee cited the partners' "outstanding achievements and creative response using innovative technologies that involve the private sector and community and traditional health workers to improve surveillance, diagnosis and treatment of malaria in both countries."
Although setbacks are to be expected, both sides of the island are moving toward elimination of both diseases. As far as Gonzales is concerned, national rivalries will not hinder their success in this joint effort.
"Progress for Haiti is progress for us," he said. "I feel a solidarity with them. If they reduce prevalence of lymphatic filariasis, we will reduce prevalence. So, together we will do whatever we have to do."
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