Who Really Controls Haiti\u27s Destiny? An examination of Haiti\u27s Historical Underdevelopment, Endless Poverty, and the Role played by Non-Governmental Organizations (NGOs)

The presence of NGOs and development agencies is often considered an apolitical phenomenon, and that the very presence of NGOs within a country is a symbol of a global humanity in action; in short, NGOs equal charity which equals good work. Unfortunately, the reality is often much more complicated as NGOs can also be found to be self-serving, anti-democratic and strictly in pursuit of their next funding source. In this thesis I advance the central hypothesis that the international community’s continued pursuit of an NGO-led neoliberal economic development model has systematically failed to contribute to the sustainable development of Haiti because they pursue the wrongs means of achieving poverty alleviation goals. Throughout its history, Haiti has continuously been caught between the aspirations of its people and the legacy of foreign interventions. The recent trend of implementing neoliberal development goals and strategies, supported and executed by NGOs, has focused on the promotion of economic growth as a means to eradicate poverty. However, this strategy is an ineffective method at producing positive changes in well-being, the economy, or the environment (Edmonds, 2010; Shamsie, 2012). I argue that the relationship between NGOs and their donors continuously undermines the Haitian’s right to self-sufficiency that would lead to self-determination and enable the Haitian people to control their own destiny. A new approach for addressing extreme poverty in Haiti must be rooted in a different set of values and beliefs; a different outlook that puts morality, humanity, equality and the environment at the forefront. A new development path that is not based on a growth economy but focused on human well-being and environmental conservation. NGOs will need to enact increasingly participatory and transparent practices that allows for a development path that can regulated and determined by the Haitians themselves

Severe sepsis in two Ugandan hospitals: a prospective observational study of management and outcomes in a predominantly HIV-1 infected population.

BACKGROUND:Sepsis likely contributes to the high burden of infectious disease morbidity and mortality in low income countries. Data regarding sepsis management in sub-Saharan Africa are limited. We conducted a prospective observational study reporting the management and outcomes of severely septic patients in two Ugandan hospitals. We describe their epidemiology, management, and clinical correlates for mortality. METHODOLOGY/RESULTS:Three-hundred eighty-two patients fulfilled enrollment criteria for a severe sepsis syndrome. Vital signs, management and laboratory results were recorded. Outcomes measured included in-hospital and post-discharge mortality. Most patients were HIV-infected (320/377, 84.9%) with a median CD4+ T cell (CD4) count of 52 cells/mm(3) (IQR, 16-131 cells/mm(3)). Overall mortality was 43.0%, with 23.7% in-hospital mortality (90/380) and 22.3% post-discharge mortality (55/247). Significant predictors of in-hospital mortality included admission Glasgow Coma Scale and Karnofsky Performance Scale (KPS), tachypnea, leukocytosis and thrombocytopenia. Discharge KPS and early fluid resuscitation were significant predictors of post-discharge mortality. Among HIV-infected patients, CD4 count was a significant predictor of post-discharge mortality. Median volume of fluid resuscitation within the first 6 hours of presentation was 500 mLs (IQR 250-1000 mls). Fifty-two different empiric antibacterial regimens were used during the study. Bacteremic patients were more likely to die in hospital than non-bacteremic patients (OR 1.83, 95% CI = 1.01-3.33). Patients with Mycobacterium tuberculosis (MTB) bacteremia (25/249) had higher in-hospital mortality (OR 1.97, 95% CI = 1.19-327) and lower median CD4 counts (p = 0.001) than patients without MTB bacteremia. CONCLUSION:Patients presenting with sepsis syndromes to two Ugandan hospitals had late stage HIV infection and high mortality. Bacteremia, especially from MTB, was associated with increased in-hospital mortality. Most clinical predictors of in-hospital mortality were easily measurable and can be used for triaging patients in resource-constrained settings. Procurement of low cost and high impact treatments like intravenous fluids and empiric antibiotics may help decrease sepsis-associated mortality in resource-constrained settings

Derivation and validation of a universal vital assessment (UVA) score: a tool for predicting mortality in adult hospitalised patients in sub-Saharan Africa.

Critical illness is a leading cause of morbidity and mortality in sub-Saharan Africa (SSA). Identifying patients with the highest risk of death could help with resource allocation and clinical decision making. Accordingly, we derived and validated a universal vital assessment (UVA) score for use in SSA. We pooled data from hospital-based cohort studies conducted in six countries in SSA spanning the years 2009-2015. We derived and internally validated a UVA score using decision trees and linear regression and compared its performance with the modified early warning score (MEWS) and the quick sepsis-related organ failure assessment (qSOFA) score. Of 5573 patients included in the analysis, 2829 (50.8%) were female, the median (IQR) age was 36 (27-49) years, 2122 (38.1%) were HIV-infected and 996 (17.3%) died in-hospital. The UVA score included points for temperature, heart and respiratory rates, systolic blood pressure, oxygen saturation, Glasgow Coma Scale score and HIV serostatus, and had an area under the receiver operating characteristic curve (AUC) of 0.77 (95% CI 0.75 to 0.79), which outperformed MEWS (AUC 0.70 (95% CI 0.67 to 0.71)) and qSOFA (AUC 0.69 (95% CI 0.67 to 0.72)). We identified predictors of in-hospital mortality irrespective of the underlying condition(s) in a large population of hospitalised patients in SSA and derived and internally validated a UVA score to assist clinicians in risk-stratifying patients for in-hospital mortality. The UVA score could help improve patient triage in resource-limited environments and serve as a standard for mortality risk in future studies

Clinical features of HIV-1-infected patients with subtypes A, D, and AD recombinants.

<p>Clinical features of HIV-1-infected patients with subtypes A, D, and AD recombinants.</p

Enrollment procedure.

<p>Enrollment procedure.</p

Cox proportional hazards analysis of factors associated with 30-day mortality.

*<p>compared to negative blood cultures.</p

Distribution of HIV-1 subtypes among patients with severe sepsis.

<p>Subtype A (n = 81), D (n = 29), AD (n = 53), C (n = 3), AC (n = 2), AB (n = 2), BD (n = 3), CD (n = 2).</p

K-M survival curves comparing mortality between HIV-1 subtypes A vs. D vs. AD recombinants.

<p>K-M survival curves comparing mortality between HIV-1 subtypes A vs. D vs. AD recombinants.</p