Vaccines are the most effective mechanism for ending the COVID-19 pandemic. However, reluctance t... more Vaccines are the most effective mechanism for ending the COVID-19 pandemic. However, reluctance to accept vaccines has hindered the efforts of health authorities to combat the virus. In Haiti, as of July 2021, less than 1% of the country’s population has been fully vaccinated in part due to vaccine hesitancy. Our goal was to assess Haitian attitudes toward COVID-19 vaccination and investigate the primary reasons for Moderna vaccine hesitancy. We conducted a cross-sectional survey across three rural Haitian commu-nities, in September 2021. The research team used electronic tablets to collect quantitative data from 1,071 respondents, selected randomly across the communities. We report descriptive statistics and identify variables associated with vaccine acceptance using logistic regression built using a backward stepwise approach. Among 1,071 respondents, the overall acceptance rate was 27.0% (n = 285). The most common reason for vaccine hesitancy was “concern about side effects” (n = 484, 67.1%) followed by “concern about contracting COVID-19 from the vaccine” (n = 472, 65.4%). Three-quarters of respondents (n = 817) identified their healthcare workers as their most trustworthy source for information related to the vaccine. In the bivariate analysis, male gender (p = .06) and no history of drinking alcohol (p < .001) were significantly associated with being more likely to take the vaccine. In the final reduced model, only those with a history of drinking alcohol were significantly more likely to take the vaccine (aOR = 1.47 (1.23, 1.87) p < .001). The acceptance rate for the COVID-19 vaccine is low, and public health experts should design and strengthen vaccination campaigns to combat misinformation and public distrust.
This qualitative study documented the effects of uterine fibroids on the suffering of women in Ha... more This qualitative study documented the effects of uterine fibroids on the suffering of women in Haiti. It makes a unique contribution by re-socializing this disease, by making visible the social inequalities and what is at stake for the women, for their families, and for healthcare delivery. Uterine fibroid is a benign tumor of the uterus, common in gynecology, but profoundly malignant in how it affects women's lives. Little has been reported on their lived experiences. Haiti has historical, social, and economic factors that hinder the search for treatment. The study explores how and why patients seek surgical care for uterine fibroids at Mirebalais University Hospital. Seventeen in-depth interviews with patients and seven accompanying family members were conducted and recorded in Creole and translated into English, along with participant observations in two patients' homes. Content and narrative analysis were done iteratively, and the processual ethnographic method was used to relate our findings to Haitian history, to the context of the study, and to future implications. The women's experience of accompaniment, their suffering in their pèlerinage (care-seeking journey), and the troubling social impact of uterine fibroids make it a socially malignant illness. The study shows that it is critical to address the suffering of women afflicted with uterine fibroids by strengthening the Haitian health system, improving economic advantages, and establishing ways for them to gain access to social goods and participate in community activities.
Vaccines are the most effective mechanism for ending the COVID-19 pandemic. However, reluctance t... more Vaccines are the most effective mechanism for ending the COVID-19 pandemic. However, reluctance to accept vaccines has hindered the efforts of health authorities to combat the virus. In Haiti, as of July 2021, less than 1% of the country’s population has been fully vaccinated in part due to vaccine hesitancy. Our goal was to assess Haitian attitudes toward COVID-19 vaccination and investigate the primary reasons for Moderna vaccine hesitancy. We conducted a cross-sectional survey across three rural Haitian commu-nities, in September 2021. The research team used electronic tablets to collect quantitative data from 1,071 respondents, selected randomly across the communities. We report descriptive statistics and identify variables associated with vaccine acceptance using logistic regression built using a backward stepwise approach. Among 1,071 respondents, the overall acceptance rate was 27.0% (n = 285). The most common reason for vaccine hesitancy was “concern about side effects” (n = 484, 67.1%) followed by “concern about contracting COVID-19 from the vaccine” (n = 472, 65.4%). Three-quarters of respondents (n = 817) identified their healthcare workers as their most trustworthy source for information related to the vaccine. In the bivariate analysis, male gender (p = .06) and no history of drinking alcohol (p < .001) were significantly associated with being more likely to take the vaccine. In the final reduced model, only those with a history of drinking alcohol were significantly more likely to take the vaccine (aOR = 1.47 (1.23, 1.87) p < .001). The acceptance rate for the COVID-19 vaccine is low, and public health experts should design and strengthen vaccination campaigns to combat misinformation and public distrust.
Background Lot Quality Assurance Sampling (LQAS), a tool used for monitoring health indicators in... more Background Lot Quality Assurance Sampling (LQAS), a tool used for monitoring health indicators in low resource settings resulting in "high" or "low" classifications, assumes that determination of the trait of interest is perfect. This is often not true for diagnostic tests, with imperfect sensitivity and specificity. Here, we develop Lot Quality Assurance Sampling for Imperfect Tests (LQAS-IMP) to address this issue and apply it to a COVID-19 serosurveillance study design in Haiti. Methods We first derive a modified procedure, LQAS-IMP, that accounts for the sensitivity and specificity of a diagnostic test to yield correct classification errors. We then apply the novel LQAS-IMP to design an LQAS system to classify prevalence of SARS-CoV-2 antibodies among healthcare workers at eleven Zanmia Lasante health facilities in Haiti. Finally, we show the performance of the LQAS-IMP procedure in a simulation study. Results We found that when an imperfect diagnostic test is used, the classification errors in the standard LQAS procedure are larger than specified. In the modified LQAS-IMP procedure, classification errors are consistent with the specified maximum classification error. We then utilized the LQAS-IMP procedure to define valid systems for sampling at eleven hospitals in Haiti. Conclusion The LQAS-IMP procedure accounts for imperfect sensitivity and specificity in system design; if the accuracy of a test is known, the use of LQAS-IMP extends LQAS to applications for indicators that are based on laboratory tests, such as SARS-CoV-2 antibodies.
This session will appeal to those interested in teaching qualitative research methods using an on... more This session will appeal to those interested in teaching qualitative research methods using an online learning platform. How can we engage our students without ever actually meeting them? How do we make sense of our role as professor while staring at words on a computer screen? Alas! We are qualitative researchers, we love personal interaction! Teaching online creates a peculiar contradiction for us. We are adverse to flat, text based exchanges. We yearn for interaction, dialogue, and connection! Is our positionality different in an online classroom? Is it still our quest to impart our students with our expert knowledge and form meaningful academic relationships, or are we mere guides through a fabricated textual maze? We will share tales of woe and success while on our journeys to become effective online qualitative research professors. We will reflect on instructional strategies, online tools, and feedback loops that we have used in our quest to meet our students’ learning needs w...
The Objective Structured Clinical Examination (OSCE) was introduced in undergraduate psychiatry c... more The Objective Structured Clinical Examination (OSCE) was introduced in undergraduate psychiatry clerkship in 2008. The authors studied the effect of OSCE on the students&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; performance. The ″short case″ (SC) and ″oral examination″ (OE), two of the five components of the previous assessment format, were replaced with the OSCE. Results were compared with those of the 2007 students. The introduction of the OSCE had little impact on the overall scores, but the 2007 students had significantly higher scores on the essay examination and long case, whereas the 2008 group had significantly higher scores on the OSCE (versus the OE for the 2007 group). In comparing the top 10 scoring students from the two classes, the 2007-year students had significantly higher overall scores, both on end-of-course tests and the annual examinations. In particular, the scores for the OSCE exams for the 2008 class were significantly lower than the scores for the OE in the 2007 class. The higher scores on OSCE in Year 2008 suggest that students performed better on clinical skills and professional development than recall on the factual-knowledge domains. Since the changes were introduced in the year 2008, the comparison can best be regarded as qualitative, and it is probably too early to judge the impact of the OSCE. Further studies to determine validity of the OSCE are needed.
Introduction: Heart failure (HF) is a leading cause of hospitalizations in rural Haiti. However, ... more Introduction: Heart failure (HF) is a leading cause of hospitalizations in rural Haiti. However, few patients hospitalized for HF return for outpatient care. The factors that contribute to chronic HF care access are poorly understood. Objective: To investigate the facilitators and barriers to accessing care for chronic HF from the patients’ perspectives. Methods: We conducted three group interviews and one individual interview with thirteen patients with HF. We recruited patients after discharge from a non-governmental organization-supported academic hospital in rural Haiti. We employed thematic analysis using emergent coding and categorized themes using the socioecological model. Results: Facilitators of chronic care included participants’ knowledge about the importance of HF treatment and engagement with health systems to manage symptoms. Strong social support networks helped participants access clinic visits. Participants reported low cost of care at this subsidized hospital, goo...
This study aimed to increase understanding of barriers to cervical cancer prevention and control ... more This study aimed to increase understanding of barriers to cervical cancer prevention and control in Haitian women using photovoice methodology. Consented participants were (1) trained to use a digital camera and encouraged to capture their screening barriers, (2) interviewed to unpack and analyze their images, and (3) invited to participate in follow-up focus groups for refined discussion and data triangulation for content analysis using NVivo software. The sample included women ( n = 25) who were on average 42 years ( SD = 9.8, range: 26–57) and born and raised in Haiti. Results highlighted multiple barriers, including gendered family responsibilities, concerns about quality of care, financial and time constraints, worries about discomfort and exam efficacy, and emotional deterrents such as frustration. Framed by the PEN-3 model’s dimensions of cultural identity, relationships and expectations, and cultural empowerment, women’s recommendations to overcome barriers spanned education...
The purpose of this qualitative case study was to explore the cultural and contextual implication... more The purpose of this qualitative case study was to explore the cultural and contextual implications to be considered in the development of a human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) primary prevention curriculum for children in Haiti. A qualitative case study approach was followed. Participants were Haitian professionals from the medical and/or education sector. Data were generated through interviews. A primary prevention curriculum for HIV/AIDS is needed and can be developed and delivered in Haiti with the involvement from the medical and education sectors. The program should include parental involvement in the development of the curriculum, contain a strong training component for those delivering the program as well as for parents, and use multiple educational pedagogies. Haiti’s unique culture, history, and mix of religions must be considered. Curricular materials and instructional strategies must be appropriate for the culture, context, and specific development needs of the children.
Revitalizing graduate medical education in global settings: Lessons from post-earthquake Haiti. A... more Revitalizing graduate medical education in global settings: Lessons from post-earthquake Haiti. Acad Med. 3 Unedited content. Used with permission. Unauthorized reproduction prohibited. training the residents. Recruitment of attending physicians will focus on persons dedicated to both teaching and service of Haiti's rural populations.
The purpose of this study was to examine first-year students’ experiences in a new Master of Heal... more The purpose of this study was to examine first-year students’ experiences in a new Master of Health Information Management (MHIM) program. The first year in a college program is challenging for students. Specifically, first-year students’ attrition from MHIM programs is an area of growing concern because the demand for health information management (HIM) professionals with advanced degrees is growing faster than the supply of graduates. Unfortunately, there is a paucity of research in this area. Data were collected using an open-ended online survey. Results indicated that students chose the program because they felt allegiance to the college, the college had their major of choice, and they wanted an online program. Students were challenged by the workload, the adjustment to online content delivery, and deficits in communication from the instructors and the school. Students were, however, generally satisfied with the quality of curriculum and instruction.
The COVID-19 pandemic has heterogeneously affected use of basic health services worldwide, with d... more The COVID-19 pandemic has heterogeneously affected use of basic health services worldwide, with disruptions in some countries beginning in the early stages of the emergency in March 2020. These disruptions have occurred on both the supply and demand sides of healthcare, and have often been related to resource shortages to provide care and lower patient turnout associated with mobility restrictions and fear of contracting COVID-19 at facilities. In this paper, we assess the impact of the COVID-19 pandemic on the use of maternal health services using a time series modelling approach developed to monitor health service use during the pandemic using routinely collected health information systems data. We focus on data from 37 non-governmental organisation-supported health facilities in Haiti, Lesotho, Liberia, Malawi, Mexico and Sierra Leone. Overall, our analyses indicate significant declines in first antenatal care visits in Haiti (18% drop) and Sierra Leone (32% drop) and facility-ba...
My guiding light throughout this whole process, especially at the beginning, but all the way thro... more My guiding light throughout this whole process, especially at the beginning, but all the way through, was my angel daughter, Alannah Chemay Sadler, forever 13. Her twin, Elissa Menendez, and her older sister, Tatiana Sadler, were my rock for the entire seven years. While I barely spoke to them, they cooked, cleaned, and ran errands so I could sit at my computer and type. It was much harder, in that aspect, to earn my Master's Degree as a single mom with three children under six, but they certainly made up for it as adult children. I want to also acknowledge my sister, Nancy Goss, who passed away six months before my daughter, and my father, Jose Antonio Menendez, who passed away years after the car accident we were all in that took my daughter. I want to thank my mother, Gloria Menendez, who, along with my father, never questioned this crazy idea I had of earning a doctorate at my age, my sister, Marilyn Menendez, and my brother, Nicholas Menendez, who supported me emotionally all the way. I know my brother, Tony Menendez, had me in his thoughts also. I also must thank Dr. Dwight Thompson, whom I met as part of my cohort on the first day and gave me the sign that I should do this. He was the first music teacher for all my daughters and since then my twinless twin daughter has gone on to be a professional musician. He was there for me all the way through. I was also completing this degree to help my remaining two daughters through college. They graduated and I was still a student years later. Finally, I want to thank my dissertation chair, Dr. Mary Clisbee, for all her support and knowledge that I so desperately needed throughout this journey, along with my committee member, Dr. Kathleen Kardaras. They did not know how much reading they would have to do. I also had help from Dr. Silvia Orta for inspiration when I needed it most. And last, I want to thank all of my cohort and the exceptional participants, whom I love, who made this possible.
This statement arose from discussions during the Global Health Fieldwork Ethics Workshop held in ... more This statement arose from discussions during the Global Health Fieldwork Ethics Workshop held in Atlanta, Georgia, USA in April 2018, co-sponsored by Agnes Scott College, The Taskforce for Global Health, and Emory University Rollins School of Public Health. As participants from a wide range of academic and global health implementation organizations discussed ethics challenges in fieldwork settings, it became clear that gender-based violence was an issue of vast importance that has not been adequately considered for global health fieldworkers and participants. This statement highlights key themes on gender-based violence that emerged from our discussions and calls for further action.
Following the massive 7.0-magnitude earthquake that devastated much of the Haitian capital city o... more Following the massive 7.0-magnitude earthquake that devastated much of the Haitian capital city of Port-Au-Prince on January 12, 2010, the Haitian health system and its medical education programs were fragmented, fragile, and facing a significant, overwhelming demand for clinical care. In response, the authors of this paper and the institutions they represent supported the development of a teaching hospital that could fill the void in academic training capacity while prioritizing the health of Haiti's rural poor-goals aligned with the Haitian Ministry of Health (MOH) strategy. This bold initiative aimed to address both the immediate and long-term health care needs within post-disaster Haiti through a strategic investment in graduate medical education (GME). Here, the authors describe their approach, which included building consensus, aspiring to international standards, and investing in shared governance structures under Haitian leadership. The Haitian MOH's strategy and pri...
This study aimed to increase understanding of barriers to cervical cancer prevention and control ... more This study aimed to increase understanding of barriers to cervical cancer prevention and control in Haitian women using photovoice methodology. Consented participants were (1) trained to use a digital camera and encouraged to capture their screening barriers, (2) interviewed to unpack and analyze their images, and (3) invited to participate in follow-up focus groups for refined discussion and data triangulation for content analysis using NVivo software. The sample included women (n = 25) who were on average 42 years (SD = 9.8, range: 26–57) and born and raised in Haiti. Results highlighted multiple barriers, including gendered family responsibilities, concerns about quality of care, financial and time constraints, worries about discomfort and exam efficacy, and emotional deterrents such as frustration. Framed by the PEN-3 model’s dimensions of cultural identity, relationships and expectations, and cultural empowerment, women’s recommendations to overcome barriers spanned education, ...
Background: Lot Quality Assurance Sampling (LQAS), a tool used for monitoring health indicators i... more Background: Lot Quality Assurance Sampling (LQAS), a tool used for monitoring health indicators in low resource settings resulting in "high" or "low" classifications, assumes that determination of the trait of interest is perfect. This is often not true for diagnostic tests, with imperfect sensitivity and specificity. Here, we develop Lot Quality Assurance Sampling for Imperfect Tests (LQAS-IMP) to address this issue and apply it to a COVID-19 serosurveillance study in Haiti. Development: As part of the standard LQAS procedure, the user specifies allowable classification errors for the system, which is defined by a sample size and decision rule. We show that when an imperfect diagnostic test is used, the classification errors are larger than specified. We derive a modified procedure, LQAS-IMP, that accounts for the sensitivity and specificity of a diagnostic test to yield correct classification errors. Application: At Zanmi Lasante health facilities in Haiti, the...
Background: Lot Quality Assurance Sampling (LQAS), a tool used for monitoring health indicators i... more Background: Lot Quality Assurance Sampling (LQAS), a tool used for monitoring health indicators in low resource settings resulting in "high" or "low" classifications, assumes that determination of the trait of interest is perfect. This is often not true for diagnostic tests, with imperfect sensitivity and specificity. Here, we develop Lot Quality Assurance Sampling for Imperfect Tests (LQAS-IMP) to address this issue and apply it to a COVID-19 serosurveillance study in Haiti. Development: As part of the standard LQAS procedure, the user specifies allowable classification errors for the system, which is defined by a sample size and decision rule. We show that when an imperfect diagnostic test is used, the classification errors are larger than specified. We derive a modified procedure, LQAS-IMP, that accounts for the sensitivity and specificity of a diagnostic test to yield correct classification errors. Application: At Zanmi Lasante health facilities in Haiti, the...
Vaccines are the most effective mechanism for ending the COVID-19 pandemic. However, reluctance t... more Vaccines are the most effective mechanism for ending the COVID-19 pandemic. However, reluctance to accept vaccines has hindered the efforts of health authorities to combat the virus. In Haiti, as of July 2021, less than 1% of the country’s population has been fully vaccinated in part due to vaccine hesitancy. Our goal was to assess Haitian attitudes toward COVID-19 vaccination and investigate the primary reasons for Moderna vaccine hesitancy. We conducted a cross-sectional survey across three rural Haitian commu-nities, in September 2021. The research team used electronic tablets to collect quantitative data from 1,071 respondents, selected randomly across the communities. We report descriptive statistics and identify variables associated with vaccine acceptance using logistic regression built using a backward stepwise approach. Among 1,071 respondents, the overall acceptance rate was 27.0% (n = 285). The most common reason for vaccine hesitancy was “concern about side effects” (n = 484, 67.1%) followed by “concern about contracting COVID-19 from the vaccine” (n = 472, 65.4%). Three-quarters of respondents (n = 817) identified their healthcare workers as their most trustworthy source for information related to the vaccine. In the bivariate analysis, male gender (p = .06) and no history of drinking alcohol (p &lt; .001) were significantly associated with being more likely to take the vaccine. In the final reduced model, only those with a history of drinking alcohol were significantly more likely to take the vaccine (aOR = 1.47 (1.23, 1.87) p &lt; .001). The acceptance rate for the COVID-19 vaccine is low, and public health experts should design and strengthen vaccination campaigns to combat misinformation and public distrust.
This qualitative study documented the effects of uterine fibroids on the suffering of women in Ha... more This qualitative study documented the effects of uterine fibroids on the suffering of women in Haiti. It makes a unique contribution by re-socializing this disease, by making visible the social inequalities and what is at stake for the women, for their families, and for healthcare delivery. Uterine fibroid is a benign tumor of the uterus, common in gynecology, but profoundly malignant in how it affects women's lives. Little has been reported on their lived experiences. Haiti has historical, social, and economic factors that hinder the search for treatment. The study explores how and why patients seek surgical care for uterine fibroids at Mirebalais University Hospital. Seventeen in-depth interviews with patients and seven accompanying family members were conducted and recorded in Creole and translated into English, along with participant observations in two patients' homes. Content and narrative analysis were done iteratively, and the processual ethnographic method was used to relate our findings to Haitian history, to the context of the study, and to future implications. The women's experience of accompaniment, their suffering in their pèlerinage (care-seeking journey), and the troubling social impact of uterine fibroids make it a socially malignant illness. The study shows that it is critical to address the suffering of women afflicted with uterine fibroids by strengthening the Haitian health system, improving economic advantages, and establishing ways for them to gain access to social goods and participate in community activities.
Vaccines are the most effective mechanism for ending the COVID-19 pandemic. However, reluctance t... more Vaccines are the most effective mechanism for ending the COVID-19 pandemic. However, reluctance to accept vaccines has hindered the efforts of health authorities to combat the virus. In Haiti, as of July 2021, less than 1% of the country’s population has been fully vaccinated in part due to vaccine hesitancy. Our goal was to assess Haitian attitudes toward COVID-19 vaccination and investigate the primary reasons for Moderna vaccine hesitancy. We conducted a cross-sectional survey across three rural Haitian commu-nities, in September 2021. The research team used electronic tablets to collect quantitative data from 1,071 respondents, selected randomly across the communities. We report descriptive statistics and identify variables associated with vaccine acceptance using logistic regression built using a backward stepwise approach. Among 1,071 respondents, the overall acceptance rate was 27.0% (n = 285). The most common reason for vaccine hesitancy was “concern about side effects” (n = 484, 67.1%) followed by “concern about contracting COVID-19 from the vaccine” (n = 472, 65.4%). Three-quarters of respondents (n = 817) identified their healthcare workers as their most trustworthy source for information related to the vaccine. In the bivariate analysis, male gender (p = .06) and no history of drinking alcohol (p < .001) were significantly associated with being more likely to take the vaccine. In the final reduced model, only those with a history of drinking alcohol were significantly more likely to take the vaccine (aOR = 1.47 (1.23, 1.87) p < .001). The acceptance rate for the COVID-19 vaccine is low, and public health experts should design and strengthen vaccination campaigns to combat misinformation and public distrust.
Background Lot Quality Assurance Sampling (LQAS), a tool used for monitoring health indicators in... more Background Lot Quality Assurance Sampling (LQAS), a tool used for monitoring health indicators in low resource settings resulting in "high" or "low" classifications, assumes that determination of the trait of interest is perfect. This is often not true for diagnostic tests, with imperfect sensitivity and specificity. Here, we develop Lot Quality Assurance Sampling for Imperfect Tests (LQAS-IMP) to address this issue and apply it to a COVID-19 serosurveillance study design in Haiti. Methods We first derive a modified procedure, LQAS-IMP, that accounts for the sensitivity and specificity of a diagnostic test to yield correct classification errors. We then apply the novel LQAS-IMP to design an LQAS system to classify prevalence of SARS-CoV-2 antibodies among healthcare workers at eleven Zanmia Lasante health facilities in Haiti. Finally, we show the performance of the LQAS-IMP procedure in a simulation study. Results We found that when an imperfect diagnostic test is used, the classification errors in the standard LQAS procedure are larger than specified. In the modified LQAS-IMP procedure, classification errors are consistent with the specified maximum classification error. We then utilized the LQAS-IMP procedure to define valid systems for sampling at eleven hospitals in Haiti. Conclusion The LQAS-IMP procedure accounts for imperfect sensitivity and specificity in system design; if the accuracy of a test is known, the use of LQAS-IMP extends LQAS to applications for indicators that are based on laboratory tests, such as SARS-CoV-2 antibodies.
This session will appeal to those interested in teaching qualitative research methods using an on... more This session will appeal to those interested in teaching qualitative research methods using an online learning platform. How can we engage our students without ever actually meeting them? How do we make sense of our role as professor while staring at words on a computer screen? Alas! We are qualitative researchers, we love personal interaction! Teaching online creates a peculiar contradiction for us. We are adverse to flat, text based exchanges. We yearn for interaction, dialogue, and connection! Is our positionality different in an online classroom? Is it still our quest to impart our students with our expert knowledge and form meaningful academic relationships, or are we mere guides through a fabricated textual maze? We will share tales of woe and success while on our journeys to become effective online qualitative research professors. We will reflect on instructional strategies, online tools, and feedback loops that we have used in our quest to meet our students’ learning needs w...
The Objective Structured Clinical Examination (OSCE) was introduced in undergraduate psychiatry c... more The Objective Structured Clinical Examination (OSCE) was introduced in undergraduate psychiatry clerkship in 2008. The authors studied the effect of OSCE on the students&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; performance. The ″short case″ (SC) and ″oral examination″ (OE), two of the five components of the previous assessment format, were replaced with the OSCE. Results were compared with those of the 2007 students. The introduction of the OSCE had little impact on the overall scores, but the 2007 students had significantly higher scores on the essay examination and long case, whereas the 2008 group had significantly higher scores on the OSCE (versus the OE for the 2007 group). In comparing the top 10 scoring students from the two classes, the 2007-year students had significantly higher overall scores, both on end-of-course tests and the annual examinations. In particular, the scores for the OSCE exams for the 2008 class were significantly lower than the scores for the OE in the 2007 class. The higher scores on OSCE in Year 2008 suggest that students performed better on clinical skills and professional development than recall on the factual-knowledge domains. Since the changes were introduced in the year 2008, the comparison can best be regarded as qualitative, and it is probably too early to judge the impact of the OSCE. Further studies to determine validity of the OSCE are needed.
Introduction: Heart failure (HF) is a leading cause of hospitalizations in rural Haiti. However, ... more Introduction: Heart failure (HF) is a leading cause of hospitalizations in rural Haiti. However, few patients hospitalized for HF return for outpatient care. The factors that contribute to chronic HF care access are poorly understood. Objective: To investigate the facilitators and barriers to accessing care for chronic HF from the patients’ perspectives. Methods: We conducted three group interviews and one individual interview with thirteen patients with HF. We recruited patients after discharge from a non-governmental organization-supported academic hospital in rural Haiti. We employed thematic analysis using emergent coding and categorized themes using the socioecological model. Results: Facilitators of chronic care included participants’ knowledge about the importance of HF treatment and engagement with health systems to manage symptoms. Strong social support networks helped participants access clinic visits. Participants reported low cost of care at this subsidized hospital, goo...
This study aimed to increase understanding of barriers to cervical cancer prevention and control ... more This study aimed to increase understanding of barriers to cervical cancer prevention and control in Haitian women using photovoice methodology. Consented participants were (1) trained to use a digital camera and encouraged to capture their screening barriers, (2) interviewed to unpack and analyze their images, and (3) invited to participate in follow-up focus groups for refined discussion and data triangulation for content analysis using NVivo software. The sample included women ( n = 25) who were on average 42 years ( SD = 9.8, range: 26–57) and born and raised in Haiti. Results highlighted multiple barriers, including gendered family responsibilities, concerns about quality of care, financial and time constraints, worries about discomfort and exam efficacy, and emotional deterrents such as frustration. Framed by the PEN-3 model’s dimensions of cultural identity, relationships and expectations, and cultural empowerment, women’s recommendations to overcome barriers spanned education...
The purpose of this qualitative case study was to explore the cultural and contextual implication... more The purpose of this qualitative case study was to explore the cultural and contextual implications to be considered in the development of a human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) primary prevention curriculum for children in Haiti. A qualitative case study approach was followed. Participants were Haitian professionals from the medical and/or education sector. Data were generated through interviews. A primary prevention curriculum for HIV/AIDS is needed and can be developed and delivered in Haiti with the involvement from the medical and education sectors. The program should include parental involvement in the development of the curriculum, contain a strong training component for those delivering the program as well as for parents, and use multiple educational pedagogies. Haiti’s unique culture, history, and mix of religions must be considered. Curricular materials and instructional strategies must be appropriate for the culture, context, and specific development needs of the children.
Revitalizing graduate medical education in global settings: Lessons from post-earthquake Haiti. A... more Revitalizing graduate medical education in global settings: Lessons from post-earthquake Haiti. Acad Med. 3 Unedited content. Used with permission. Unauthorized reproduction prohibited. training the residents. Recruitment of attending physicians will focus on persons dedicated to both teaching and service of Haiti's rural populations.
The purpose of this study was to examine first-year students’ experiences in a new Master of Heal... more The purpose of this study was to examine first-year students’ experiences in a new Master of Health Information Management (MHIM) program. The first year in a college program is challenging for students. Specifically, first-year students’ attrition from MHIM programs is an area of growing concern because the demand for health information management (HIM) professionals with advanced degrees is growing faster than the supply of graduates. Unfortunately, there is a paucity of research in this area. Data were collected using an open-ended online survey. Results indicated that students chose the program because they felt allegiance to the college, the college had their major of choice, and they wanted an online program. Students were challenged by the workload, the adjustment to online content delivery, and deficits in communication from the instructors and the school. Students were, however, generally satisfied with the quality of curriculum and instruction.
The COVID-19 pandemic has heterogeneously affected use of basic health services worldwide, with d... more The COVID-19 pandemic has heterogeneously affected use of basic health services worldwide, with disruptions in some countries beginning in the early stages of the emergency in March 2020. These disruptions have occurred on both the supply and demand sides of healthcare, and have often been related to resource shortages to provide care and lower patient turnout associated with mobility restrictions and fear of contracting COVID-19 at facilities. In this paper, we assess the impact of the COVID-19 pandemic on the use of maternal health services using a time series modelling approach developed to monitor health service use during the pandemic using routinely collected health information systems data. We focus on data from 37 non-governmental organisation-supported health facilities in Haiti, Lesotho, Liberia, Malawi, Mexico and Sierra Leone. Overall, our analyses indicate significant declines in first antenatal care visits in Haiti (18% drop) and Sierra Leone (32% drop) and facility-ba...
My guiding light throughout this whole process, especially at the beginning, but all the way thro... more My guiding light throughout this whole process, especially at the beginning, but all the way through, was my angel daughter, Alannah Chemay Sadler, forever 13. Her twin, Elissa Menendez, and her older sister, Tatiana Sadler, were my rock for the entire seven years. While I barely spoke to them, they cooked, cleaned, and ran errands so I could sit at my computer and type. It was much harder, in that aspect, to earn my Master's Degree as a single mom with three children under six, but they certainly made up for it as adult children. I want to also acknowledge my sister, Nancy Goss, who passed away six months before my daughter, and my father, Jose Antonio Menendez, who passed away years after the car accident we were all in that took my daughter. I want to thank my mother, Gloria Menendez, who, along with my father, never questioned this crazy idea I had of earning a doctorate at my age, my sister, Marilyn Menendez, and my brother, Nicholas Menendez, who supported me emotionally all the way. I know my brother, Tony Menendez, had me in his thoughts also. I also must thank Dr. Dwight Thompson, whom I met as part of my cohort on the first day and gave me the sign that I should do this. He was the first music teacher for all my daughters and since then my twinless twin daughter has gone on to be a professional musician. He was there for me all the way through. I was also completing this degree to help my remaining two daughters through college. They graduated and I was still a student years later. Finally, I want to thank my dissertation chair, Dr. Mary Clisbee, for all her support and knowledge that I so desperately needed throughout this journey, along with my committee member, Dr. Kathleen Kardaras. They did not know how much reading they would have to do. I also had help from Dr. Silvia Orta for inspiration when I needed it most. And last, I want to thank all of my cohort and the exceptional participants, whom I love, who made this possible.
This statement arose from discussions during the Global Health Fieldwork Ethics Workshop held in ... more This statement arose from discussions during the Global Health Fieldwork Ethics Workshop held in Atlanta, Georgia, USA in April 2018, co-sponsored by Agnes Scott College, The Taskforce for Global Health, and Emory University Rollins School of Public Health. As participants from a wide range of academic and global health implementation organizations discussed ethics challenges in fieldwork settings, it became clear that gender-based violence was an issue of vast importance that has not been adequately considered for global health fieldworkers and participants. This statement highlights key themes on gender-based violence that emerged from our discussions and calls for further action.
Following the massive 7.0-magnitude earthquake that devastated much of the Haitian capital city o... more Following the massive 7.0-magnitude earthquake that devastated much of the Haitian capital city of Port-Au-Prince on January 12, 2010, the Haitian health system and its medical education programs were fragmented, fragile, and facing a significant, overwhelming demand for clinical care. In response, the authors of this paper and the institutions they represent supported the development of a teaching hospital that could fill the void in academic training capacity while prioritizing the health of Haiti's rural poor-goals aligned with the Haitian Ministry of Health (MOH) strategy. This bold initiative aimed to address both the immediate and long-term health care needs within post-disaster Haiti through a strategic investment in graduate medical education (GME). Here, the authors describe their approach, which included building consensus, aspiring to international standards, and investing in shared governance structures under Haitian leadership. The Haitian MOH's strategy and pri...
This study aimed to increase understanding of barriers to cervical cancer prevention and control ... more This study aimed to increase understanding of barriers to cervical cancer prevention and control in Haitian women using photovoice methodology. Consented participants were (1) trained to use a digital camera and encouraged to capture their screening barriers, (2) interviewed to unpack and analyze their images, and (3) invited to participate in follow-up focus groups for refined discussion and data triangulation for content analysis using NVivo software. The sample included women (n = 25) who were on average 42 years (SD = 9.8, range: 26–57) and born and raised in Haiti. Results highlighted multiple barriers, including gendered family responsibilities, concerns about quality of care, financial and time constraints, worries about discomfort and exam efficacy, and emotional deterrents such as frustration. Framed by the PEN-3 model’s dimensions of cultural identity, relationships and expectations, and cultural empowerment, women’s recommendations to overcome barriers spanned education, ...
Background: Lot Quality Assurance Sampling (LQAS), a tool used for monitoring health indicators i... more Background: Lot Quality Assurance Sampling (LQAS), a tool used for monitoring health indicators in low resource settings resulting in "high" or "low" classifications, assumes that determination of the trait of interest is perfect. This is often not true for diagnostic tests, with imperfect sensitivity and specificity. Here, we develop Lot Quality Assurance Sampling for Imperfect Tests (LQAS-IMP) to address this issue and apply it to a COVID-19 serosurveillance study in Haiti. Development: As part of the standard LQAS procedure, the user specifies allowable classification errors for the system, which is defined by a sample size and decision rule. We show that when an imperfect diagnostic test is used, the classification errors are larger than specified. We derive a modified procedure, LQAS-IMP, that accounts for the sensitivity and specificity of a diagnostic test to yield correct classification errors. Application: At Zanmi Lasante health facilities in Haiti, the...
Background: Lot Quality Assurance Sampling (LQAS), a tool used for monitoring health indicators i... more Background: Lot Quality Assurance Sampling (LQAS), a tool used for monitoring health indicators in low resource settings resulting in "high" or "low" classifications, assumes that determination of the trait of interest is perfect. This is often not true for diagnostic tests, with imperfect sensitivity and specificity. Here, we develop Lot Quality Assurance Sampling for Imperfect Tests (LQAS-IMP) to address this issue and apply it to a COVID-19 serosurveillance study in Haiti. Development: As part of the standard LQAS procedure, the user specifies allowable classification errors for the system, which is defined by a sample size and decision rule. We show that when an imperfect diagnostic test is used, the classification errors are larger than specified. We derive a modified procedure, LQAS-IMP, that accounts for the sensitivity and specificity of a diagnostic test to yield correct classification errors. Application: At Zanmi Lasante health facilities in Haiti, the...
The purpose of this qualitative case study was to explore the cultural and contextual implication... more The purpose of this qualitative case study was to explore the cultural and contextual implications to be considered in the development of a human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) primary prevention curriculum for children in Haiti. A qualitative case study approach was followed. Participants were Haitian professionals from the medical and/or education sector. Data were generated through interviews. A primary prevention curriculum for HIV/AIDS is needed and can be developed and delivered in Haiti with the involvement from the medical and education sectors. The program should include parental involvement in the development of the curriculum, contain a strong training component for those delivering the program as well as for parents, and use multiple educational pedagogies. Haiti’s unique culture, history, and mix of religions must be considered. Curricular materials and instructional strategies must be appropriate for the culture, context, and specific development needs of the children.
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Papers by Mary Clisbee
A qualitative case study approach was followed. Participants were Haitian professionals from the medical and/or education sector. Data were generated through interviews.
A primary prevention curriculum for HIV/AIDS is needed and can be developed and delivered in Haiti with the involvement from the medical and education sectors. The program should include parental involvement in the development of the curriculum, contain a strong training component for those delivering the program as well as for parents, and use multiple educational pedagogies. Haiti’s unique culture, history, and mix of religions must be considered. Curricular materials and instructional strategies must be appropriate for the culture, context, and specific development needs of the children.