Ford Leading Project to Fight Cholera in Haiti

(From left) Marie Ange Louis, a nurse and birthing assistant;
head nurse and birthing assistant Val Josette Philomene;
and doctoral student Monika Roy. (Front) Jean Arnaud.

February 1, 2018

Tim Ford, Chair of Environmental Health Sciences and Director of the Institute for Global Health (IGH), supported by a $285,000 grant from the PAHO Foundation, is leading a project to help improve surveillance and response to cholera in Haiti.

“Cholera surveillance and response in Haiti” is a two-part project, Ford explains. “We are taking two different approaches, one on the ground in Haiti in collaboration with Midwives for Haiti and other organizations and agencies there,” he says. “The other part of the work is taking place here on campus and in collaboration with a commercial laboratory in Maryland, CosmosID, which provides sophisticated bioinformatics tools. Contributing towards the cholera eradication plan in Haiti is the ultimate goal.”

According to a student poster from Ford’s group shown at an IGH event, just under 700,000 cases of cholera were reported to the Haitian Ministry of Public Health from 2012 through 2014, and the nation saw 8,534 deaths. Using comparative genomics, experts determined that many strains were likely involved, some of local origin. In February 2013, the Haitian government launched a 10-year cholera elimination plan aimed at limiting cholera transmission by improving access to clean water, sanitation, hygiene and health care facilities for 80-90 percent of the population. Essential to these goals is developing early warning and rapid response systems and cholera awareness campaigns, Ford says.

Ford said, “We sent undergraduate Jean Arnaud and doctoral student Monika Roy, both of whom are fluent in Haitian Creole, to Haiti to work with local health groups including Midwives for Haiti. The students gave workshops on hygiene, sanitation, oral rehydration treatment for MFH student nurses and birthing assistants. They offered another workshop for midwives who work in remote locations on how to make rehydration salt solution from materials at hand for suspected cholera patients.”

The students also met with representatives of the Community Coalition for Haiti, staff of the Haitian National Public Health Laboratory and clinicians, hospital administrators and nurses. They collected water samples from a number of contaminated surface water sites where people bathe, wash clothes and dishes, and children play. Those samples were sent to CosmosID for whole-genome sequencing, revealing a vast number of potentially pathogenic bacteria, including endemic strains of the bacterium Vibrio cholerae. Ford says Arnaud spent part of this January collecting more water samples in Haiti, and IGH is now awaiting results of CosmosID’s analysis.

Ford says that IGH’s cholera surveillance project will rely on midwives to not only provide pre-natal, birth and post-partum care, but also send women back to their communities with knowledge to help others improve sanitation and hygiene, recognize and respond to the symptoms of severe waterborne diseases such as cholera and become an extension of the surveillance network.

The second part of the IGH project involves graduate and undergraduate students working with Ford’s postdoctoral researcher, Cristina Martin, in helping to optimize handheld whole genome sequencing. They are aiding in environmental, and eventually clinical diagnostics for the cholera bacterium, other pathogens and antimicrobial resistance and virulence genes.

This team is working with a device produced in the U.K. known as the MinION, a real-time nanopore-based genome sequencing platform. Ford says, “In addition to Cristina, key people in the lab include master’s students Stephanie Hung and Brooke Stebbins, and honors student Monica Curtin, who with Brooke is also examining the microbiology of the Mill River close to campus.”

They are using Mill River water for MinION optimization. They isolate and purify DNA from the water, then prepare it for whole genome sequencing. Graduate student Sai Swapnika Guttikonda and undergraduate Abigail Lilak are also involved in the project, conducting a literature review on cholera surveillance and response that will form the basis of a white paper for PAHO.

Ford hopes the partnership with PAHO on cholera will serve as a model for future partnerships between campus researchers and PAHO’s other programs in Latin America and the Caribbean. “It’s under discussion,” he says. “The foundation hears the needs in-country, from governments and other non-governmental organizations, but they need academic partners. We hope to make the IGH an area of focus for global health research on campus, and a significant source of training funds for undergraduate and graduate students via training grants and other program opportunities. IGH needs to become nationally and internationally known for its work in global health.”

Ford, who has spent many years working on water and health in Mexico, India, Russia, China and many other countries and with Native American communities in the United States, adds, “I’m reaching out not only to my colleagues in the School of Public Health and Health Sciences, but to every school and college on campus. We want to make sure to offer internships and exchange programs for our students and for students and professionals in the countries of interest, and to also build on the strength of UMass Amherst and our surrounding institutions.”