The Alliance for Health Sciences’ Effort to Assist Haitian Healthcare Workers

The Alliance for Health Sciences’ effort to assist Haitian healthcare workers in better treating diabetic foot ulcers is helping to prevent the crippling consequences of amputation.

Rosalind Franklin University and DePaul University are using the power of interprofessional collaboration and its Alliance for Health Sciences to prevent amputations and save lives in Haiti, an effort that, if successful, could improve health around the globe.

“Telemedicine — A Global Solution for Medical Education: An Initiative for Haiti and the United States,” a project funded under the alliance’s pilot grant program, asks a bold question: Can better healing of diabetic foot ulcers (DFUs) be promoted through regular distance education consultations? If the answer is yes, the approach could serve as a model to improve health outcomes in resource-poor areas in the United States, throughout the Caribbean and the world.

“Disparities in global health are complicated by a complex dynamic of infrastructure, resources, human capital and cultural barriers, and this project was no exception,” said Robert Joseph, DPM, PhD, chairman of the Department of Podiatric Medicine and Radiology, whose encounter with a Haitian orthopedist at an international conference sparked the idea for the collaboration.

A lack of affordable internet access posed an immediate challenge. But the alliance anticipated a solution in the person of Olayele Adelakun, PhD, associate professor in DePaul’s School of Computing, who has made several trips to the country to explore and initiate digital infrastructure and to provide technical training to the healthcare team at Hospital Bernard Mevs in Port-au-Prince.

Dr. Adelakun forged relationships with officials at Digicel, one of two major broadband companies in Haiti, which partners with IT company Cisco. Digicel agreed to a steep discount on bandwidth through its Foundation Digicel Haiti and a guaranteed level of internet connectivity for Bernard Mevs.

“We couldn’t have gotten that deal on our own,” Dr. Adelakun said. “Digicel understands the value of what we bring. We’re adding value to the education system — medical education to start — and improving health care in their country. We’re providing expertise that is not available to them.”

Chicago Medical School Professor Mildred Olivier, MD ’88, whose parents were natives of Haiti and who frequently travels there, has shared a wealth of contacts, connections and cultural knowledge.

“Every hospital or healthcare system in Haiti has struggled not only with a lack of infrastructure, but a lack of continual access to medical expertise,” Dr. Olivier said. “Through the pilot grant, we’ve been able to offer both.”

Dr. Adler Francius, the Haitian general surgeon leading Bernard Mevs’ wound care activities, said in a phone interview that he had performed lower extremity surgery during residency training, including amputations related to diabetes.

“I wanted to save as many limbs as possible,” said Dr. Francius, who lost a daughter in the 2010 earthquake. “That’s my passion. That’s why this partnership is so exciting. We want to heal the wounds so we don’t need the amputations.”

The project hinges on the drive and dedication of Bernard Mevs’ clinical staff to improve wound care and, in particular, to document healing rates. They attended a three-day instructional course that emphasized best practices, within local context, taught by RFU wound expert Adam Fleischer, DPM, MPH, associate professor of medicine and radiology. Dr. Fleischer spent five more days at Bernard Mevs looking at records to determine baseline DFU outcomes.

“They’re treating 50 to 60 patients a day,” Dr. Fleischer said. “The charting was very sparse. We explained the importance of identifying and reflecting on bad outcomes. Dr. Francius wants to have a world-class wound healing clinic. But to be the best, you have to look at the ugly and work to improve it. Every patient chart now has a spreadsheet. One person is designated to do wound area calculations. If a patient isn’t making progress, the surgeon reviews the case and comes up with a new direction for care.”

In the United States, where wound care centers measure and photograph every DFU, careful clinical documentation is taken for granted. But that advancement only came, Dr. Fleischer notes, after Medicare implemented penalties for hospital readmissions and failure to meet “meaningful use”.

“In the end, there’s a huge amount of power in having the data,” said Dr. Fleischer, who is pleased that more detailed cases are being presented at the twice-monthly WebEx video conferences between the wound care teams at Bernard Mevs and RFU.

“Our partners are now regularly identifying who their outliers are so that we can discuss them,” Dr. Fleischer said. “Nurses are working with Dr. Francius in presenting two or three cases each session. They’re seeing the whole patient, all the factors, and using that information to make treatment decisions.”

The telehealth initiative and the extensive network of interprofessional partnerships behind it is a result of both shared contacts and good fortune. Dr. Adelakun ran into a Digicel officer at the airport in Port-au-Prince. Dr. Fleischer encountered Scholl College alumni Patrick DeHeer, DPM ’90, founder of Step-By-Step Haiti, which hosts a podiatric surgery fellowship; the surgeon/fellow, now a partner in the project, works regularly with Dr. Francius. Other partners, in addition to RFU, DePaul and Bernard Mevs, include wound care nurses from Advocate Condell Medical Center in Libertyville, IL; and Judy Costner, RN, from Baltimore and Dr. John MacDonald, a cardiac surgeon from the University of Miami, who have worked with nurses at Bernard Mevs since the earthquake.

“The power of remote teleconferencing and communication has fostered new collaborations and allowed others to mature in new ways,” Dr. Joseph said.

Dr. Fleischer also points to the web of collaborations fueling the project and driving its success.

“We had connections with people already working with Bernard Mevs, people we knew, and that gave us instant access and legitimacy in their eyes,” he said. “Our Office of Global Health Initiatives helped us go about the work in a sensitive way. We’re not insisting that what we know about wound care will necessarily improve their outcomes. Instead, we’re looking more at their processes and seeing how they might be tweaked to potentially improve outcomes.”

RFU and DePaul plan to continue to improve internet access for more hospitals and medical schools in Haiti, where sustainability is key to the success of the telehealth initiative and its expansion to other areas in need.

“Haiti depends on a lot of aid,” Dr. Joseph said. “Americans and others come down and we help patch. But through this project, we can improve how we assist the Haitian people in developing skills to optimize health outcomes. We want to model and teach, then let them take over.”

“We hope the project at Bernard Mevs can be used to educate other sites that want to develop programs,” Dr. Fleischer said. “If it can be done for wound care, it can be done for other care. The model has tremendous potential and, so far, huge buy-in.”