Malaria Treatment & Prevention

Manuel, you frustrations are certainly shared by many. It does seem with
all the money that has been thrown at malaria over the past few years, some
reasonable progress could be made. It's hard though, to express the
frustration without a reasonable answer coming anytime soon.

--
Michelle Kiprop, RN MSN
Family Nurse Practitioner
Empowering Lives International
P.O. Box 6367
Eldoret, 30100 KENYA
+254.711.174720

Excellent analysis, Manuel! .. Thank you for sharing your views. Very
thought-provoking. Would you also be able to share some good resources for
IVM?

Thanks,

Vishal

Vishal:

Thanks for your note. It is very frustrating to have seen so much money being spent with little or no progress made, but we should continue arguing for something better. With regards to IVM, start with "Integrated Mosquito Control Methodologies" by Marshall Laird and James W. Miles, published by the Academic Press. It is a rather old book, but the methodologies have not changed much. You can the technology we have today like GPS and satellite imagery to those mentioned in the book. You could also try to attend the annual meeting of the American Mosquito Control Association. A large portion of mosquito control professionals in the US and many other countries meet there to talk about this subject and mosquito control in general. You can get information at www.mosquito.org.

I hope this is useful.

All the best,

Manuel

Michelle:

Thanks for your note. Perhaps we could get together in some way to start putting some pressure on the "leaders" from the organizations funding malaria control to have them leave their offices and actually see how/if the decisions they make regarding malaria control are implemented. As a multidisciplinary group of malaria control practitioners we can generate our own reasonable answer and presented to the WHO and the others. Which reminds me, during the last WHOPES meeting this past February, Lorenzo Savioli told the attendants that the Director General of WHO told her staff that the "WHO was not there to do. It is there to inspire." I meant to add that to my comments but it was long enough.

All the best,

Manuel

Excellent analysis Manuel, (and good to hear from you again.) Zanzibar was
successful precisely because they used ACTs, Nets and IRS together, coupled
with strong political will and funding. It also cost $3 per capita per
year. Theoretically, any one intervention applied optimally, should be
enough to break transmission, but "applied optimally" and "Africa" don't
always go together.

Best, Charles

--
Charles Llewellyn
114 Marsh Street
Beaufort, NC 28516

US Cell 919 599-2147

Thanks for your note, Charles. Maybe we need to start any malaria control project with the basics: project management and administration. It has been interesting to see many program managers struggle when their budget, staff and operational tempo suddenly quadruples, especially when considering IRS. IRS has been described as the mobilization of small armies, but we don't have the generals to do that. I am sure you've witnessed some of that.

All the best,

Manuel

manuel
I agree with you that  combination approach will essentially help reduce malaria , but we should not forget the mutation capacities of mosquito and the parasite
they also own the earth as much as humans
regards
anil


--- On Thu, 10/5/12, GHDonline (Manuel Lluberas) <> wrote:

From: GHDonline (Manuel Lluberas) <>
Subject: [Malaria Treatment & Prevention] When it comes to malaria control. Are we doing the right thing? Are we doing things right?
To: "Anil varshney" <>
Date: Thursday, 10 May, 2012, 11:53 PM

Manuel Lluberas added a new discussion to the Malaria Treatment & Prevention community.

Title: When it comes to malaria control. Are we doing the right thing? Are we doing things right?

Discussion contents:
"Fearing reprisal and being misunderstood, I need to ask these two basic questions when it comes to malaria control. Are we doing the right thing? Are we doing things right?

I am not convinced the answer to either one is yes. I could go on for some time, but consider the following:

1. There is no integrated vector control in any program I’ve worked with during the past twenty years. The vast majority of the programs ...

manuel
I agree with you that  combination approach will essentially help reduce malaria , but we should not forget the mutation capacities of mosquito and the parasite
they also own the earth as much as humans
regards
anil


--- On Thu, 10/5/12, GHDonline (Manuel Lluberas) <> wrote:

From: GHDonline (Manuel Lluberas) <>
Subject: [Malaria Treatment & Prevention] When it comes to malaria control. Are we doing the right thing? Are we doing things right?
To: "Anil varshney" <>
Date: Thursday, 10 May, 2012, 11:53 PM

Manuel Lluberas added a new discussion to the Malaria Treatment & Prevention community.

Title: When it comes to malaria control. Are we doing the right thing? Are we doing things right?

Discussion contents:
"Fearing reprisal and being misunderstood, I need to ask these two basic questions when it comes to malaria control. Are we doing the right thing? Are we doing things right?

I am not convinced the answer to either one is yes. I could go on for some time, but consider the following:

1. There is no integrated vector control in any program I’ve worked with during the past twenty years. The vast majority of the programs operating today use either nets or IRS; very seldom both and almost never as equal partners.

2. We have pediatricians, ophthalmologists and other physicians in charge of the vector control programs, starting from the WHO Global Malaria Program through the US President Malaria Initiative (PMI) down to national initiatives. Not one has a public health entomologist at the helm. Moreover, the WHO has a handful of entomologists in all of Africa, about 4 in the Americas and as many in Asia.

3. An obscene amount of money is currently ending up in corruption and other "unintended projects".

4. The world, perhaps because of #2 above, has placed too much emphasis on ITNS and seems to be now claiming victory over malaria because of nets but in countries where IRS has been implemented along with ITNs.

5. As a rule, the private sector has achieved great success after investing in malaria control. Some of these programs include gold mines, copper mines, oil companies, etc. In fact, significant reductions in absenteeism and increases in productivity -and thus revenues- have been reported by many of these private sector organizations less than three years after implementing a comprehensive malaria control program. Yet these projects have not been properly duplicated or funded in the public sector.

6. Net distribution is equated to usage and coverage, but these are nowhere close to being synonymous.

7. Net lifespan is portrayed as 5 years, but the reality is that they last somewhere around 15 months. After that, they end up in a landfill or are reused for fishing, goal posts for soccer fields, and a myriad of other things. However, with thousands, if not hundreds of thousands of them falling apart and ending up in a landfill somewhere annually; nobody seems to be paying attention to them. Considering that each net is somewhere around 4 to 7 square meters of insecticide-impregnated plastic fiber, the amount of plastic alone should be a concern. More puzzling still is that nobody seems to care even when these plastic fibers continue to release insecticide very slowly well after they have been repurposed. Individually, a single net may not be a significant problem. Put several hundred thousand to a few million of them in the ground and it could be a very different story. However, those of us bringing this up have only found deaf ears, even all the way
up to the WHO.

8. We are addressing a full time problem like malaria on a part time basis. Many, if not all national malaria vector control programs around the world (very few from the private sector) operate somewhere between 4 to 7 months of the year with virtually no malaria control-related activity the rest of the time. Moreover, there is no job security or progression afforded to the managers, who usually take the first opportunity for permanent position outside malaria control.

9. Insecticides are drugs for the environment. As such, they need to prescribed by trained professionals and used when needed and as directed. Unfortunately, though the vast majority of the malaria vector control programs are managed by physicians who are trained in the use of prescription drugs and restricted chemicals, many of them fail to make this connection with insecticides and even see them as contaminants. Yet they see no harm in allowing hundreds of thousands of mosquito nets to end up in landfills or in other unintended uses.

While IRS is portrayed as expensive and labor intensive, the combination –IRS & ITNs- has been demonstrated as effective in many areas –see number 5 above. Unfortunately, we are also pushing the vectors outdoors. Yet those in number 2 above maintain space spraying is ineffective against the vector. (And I don’t want to start with larviciding!)

As a public health entomologist I know that if these programs are properly designed and implemented, the combination of ITNs, IRS, ULV and larviciding would wipe out malaria almost anywhere. It is not a popular position, but there are many examples where this combination has worked. The success in the US and the Panama Canal has been properly documented, but there are more recent victories from Ghana, Zambia, Zanzibar and others. Unfortunately, most organizations funding current malaria control programs speak of IVM but would not entertain implementing a truly integrated, mosquito control approach under any circumstances. So, as long as we continue with what we’re doing, we’ll all have job security, but malaria will continue for decades to come.

Meanwhile, let us not forget that the current malaria mortality rate is equivalent to six or seven 747 Jumbo planes crashing every day with the vast majority of their passengers being children under five.

So, I leave you with this politically incorrect position and statement and my original question: When it comes to malaria control, are we doing the right thing and are we doing things right?

Albert Einstein has been quoted as saying something like "If you want different results, do something differently." The World has been engaging in malaria control for at least a decade and has spent billions of US dollars that have produced little significant progress. We need to follow Einstein's advice and modify the plan."

--
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Anil:

Thanks for your note. I am well aware of the mutation capacity of mosquitoes and her rider. You are quite correct that these are a significant factor, but I wanted to focus our attention on the "external factors" that I believe are preventing us from progressing against malaria.

All the best,

Manuel

-----Original Message-----
From: GHDonline (Anil varshney) [mailto:]
Sent: Saturday, May 12, 2012 03:30
To: Manuel Lluberas
Subject: Re: [Malaria Treatment & Prevention] When it comes to malaria control. Are we doing the right thing? Are we doing things right?

Anil varshney replied to the discussion "When it comes to malaria control. Are we doing the right thing? Are we doing things right?" in the Malaria Treatment & Prevention community.

Reply contents:
"manuel
I agree with you that  combination approach will essentially help reduce malaria , but we should not forget the mutation capacities of mosquito and the parasite they also own the earth as much as humans regards anil


--- On Thu, 10/5/12, GHDonline (Manuel Lluberas) <> wrote:

From: GHDonline (Manuel Lluberas) <>
Subject: [Malaria Treatment & Prevention] When it comes to malaria control. Are we doing the right thing? Are we ...

Anil:

Thanks for your note. I am well aware of the mutation capacity of mosquitoes and her rider. You are quite correct that these are a significant factor, but I wanted to focus our attention on the "external factors" that I believe are preventing us from progressing against malaria.

All the best,

Manuel

-----Original Message-----
From: GHDonline (Anil varshney) [mailto:]
Sent: Saturday, May 12, 2012 03:30
To: Manuel Lluberas
Subject: Re: [Malaria Treatment & Prevention] When it comes to malaria control. Are we doing the right thing? Are we doing things right?

Anil varshney replied to the discussion "When it comes to malaria control. Are we doing the right thing? Are we doing things right?" in the Malaria Treatment & Prevention community.

Reply contents:
"manuel
I agree with you that  combination approach will essentially help reduce malaria , but we should not forget the mutation capacities of mosquito and the parasite they also own the earth as much as humans regards anil


--- On Thu, 10/5/12, GHDonline (Manuel Lluberas) <> wrote:

From: GHDonline (Manuel Lluberas) <>
Subject: [Malaria Treatment & Prevention] When it comes to malaria control. Are we doing the right thing? Are we doing things right?
To: "Anil varshney" <>
Date: Thursday, 10 May, 2012, 11:53 PM

Manuel Lluberas added a new discussion to the Malaria Treatment & Prevention community.

Title: When it comes to malaria control. Are we doing the right thing? Are we doing things right?

Discussion contents:
"Fearing reprisal and being misunderstood, I need to ask these two basic questions when it comes to malaria control. Are we doing the right thing? Are we doing things right?

I am not convinced the answer to either one is yes. I could go on for some time, but consider the following:

1. There is no integrated vector control in any program I’ve worked with during the past twenty years. The vast majority of the programs operating today use either nets or IRS; very seldom both and almost never as equal partners.

2. We have pediatricians, ophthalmologists and other physicians in charge of the vector control programs, starting from the WHO Global Malaria Program through the US President Malaria Initiative (PMI) down to national initiatives. Not one has a public health entomologist at the helm. Moreover, the WHO has a handful of entomologists in all of Africa, about 4 in the Americas and as many in Asia.

3. An obscene amount of money is currently ending up in corruption and other "unintended projects".

4. The world, perhaps because of #2 above, has placed too much emphasis on ITNS and seems to be now claiming victory over malaria because of nets but in countries where IRS has been implemented along with ITNs.

5. As a rule, the private sector has achieved great success after investing in malaria control. Some of these programs include gold mines, copper mines, oil companies, etc. In fact, significant reductions in absenteeism and increases in productivity -and thus revenues- have been reported by many of these private sector organizations less than three years after implementing a comprehensive malaria control program. Yet these projects have not been properly duplicated or funded in the public sector.

6. Net distribution is equated to usage and coverage, but these are nowhere close to being synonymous.

7. Net lifespan is portrayed as 5 years, but the reality is that they last somewhere around 15 months. After that, they end up in a landfill or are reused for fishing, goal posts for soccer fields, and a myriad of other things. However, with thousands, if not hundreds of thousands of them falling apart and ending up in a landfill somewhere annually; nobody seems to be paying attention to them. Considering that each net is somewhere around 4 to 7 square meters of insecticide-impregnated plastic fiber, the amount of plastic alone should be a concern. More puzzling still is that nobody seems to care even when these plastic fibers continue to release insecticide very slowly well after they have been repurposed. Individually, a single net may not be a significant problem. Put several hundred thousand to a few million of them in the ground and it could be a very different story. However, those of us bringing this up have only found deaf ears, even all the way
up to the WHO.

8. We are addressing a full time problem like malaria on a part time basis. Many, if not all national malaria vector control programs around the world (very few from the private sector) operate somewhere between 4 to 7 months of the year with virtually no malaria control-related activity the rest of the time. Moreover, there is no job security or progression afforded to the managers, who usually take the first opportunity for permanent position outside malaria control.

9. Insecticides are drugs for the environment. As such, they need to prescribed by trained professionals and used when needed and as directed. Unfortunately, though the vast majority of the malaria vector control programs are managed by physicians who are trained in the use of prescription drugs and restricted chemicals, many of them fail to make this connection with insecticides and even see them as contaminants. Yet they see no harm in allowing hundreds of thousands of mosquito nets to end up in landfills or in other unintended uses.

While IRS is portrayed as expensive and labor intensive, the combination –IRS & ITNs- has been demonstrated as effective in many areas –see number 5 above. Unfortunately, we are also pushing the vectors outdoors. Yet those in number 2 above maintain space spraying is ineffective against the vector. (And I don’t want to start with larviciding!)

As a public health entomologist I know that if these programs are properly designed and implemented, the combination of ITNs, IRS, ULV and larviciding would wipe out malaria almost anywhere. It is not a popular position, but there are many examples where this combination has worked. The success in the US and the Panama Canal has been properly documented, but there are more recent victories from Ghana, Zambia, Zanzibar and others. Unfortunately, most organizations funding current malaria control programs speak of IVM but would not entertain implementing a truly integrated, mosquito control approach under any circumstances. So, as long as we continue with what we’re doing, we’ll all have job security, but malaria will continue for decades to come.

Meanwhile, let us not forget that the current malaria mortality rate is equivalent to six or seven 747 Jumbo planes crashing every day with the vast majority of their passengers being children under five.

So, I leave you with this politically incorrect position and statement and my original question: When it comes to malaria control, are we doing the right thing and are we doing things right?

Albert Einstein has been quoted as saying something like "If you want different results, do something differently." The World has been engaging in malaria control for at least a decade and has spent billions of US dollars that have produced little significant progress. We need to follow Einstein's advice and modify the plan."

--
View this post online:
<http://www.ghdonline.org/malaria/discussion/when-it-comes-to-malaria-control-...>

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<http://www.ghdonline.org/contact/>

You can reply to this discussion by responding directly to this e-mail; it will be shared with all community members and posted as is. Files cannot be added via email attachment and must be uploaded directly to GHDonline."

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Success in malaria basically all boils down to quality of people managing
the programs. We were very fortunate in Zanzibar to have a Minister of
Health who was former head of the Zanzibar Malaria Control Programme, a
dedicated Permanent Secretary and head of the ZMCP and finally an inspiring
Chief of Party from RTI, who was able to marshal that IRS army. Another
factor in the success was coordinated funding from the Global Fund for
Fighting AIDS, TB and Malaria and the President's Malaria Initiative.

Thai team was able to harness the funding and apply the tools that were
effective at the time: IRS, ACTs and LLINs. As Anil points out, both the
parasite and mosquitoes adapt quickly to our tools and they become
ineffective over time. There is still a window of opportunity to knock
down malaria in Africa with a coordinated and concentrated application of
these tools, but that window is closing.

Best, Charles

On Mon, May 14, 2012 at 9:12 AM, GHDonline (Manuel Lluberas) <
> wrote:

> Manuel Lluberas replied to the discussion "When it comes to malaria
> control. Are we doing the right thing? Are we doing things right?" in the
> Malaria Treatment ...

Success in malaria basically all boils down to quality of people managing
the programs. We were very fortunate in Zanzibar to have a Minister of
Health who was former head of the Zanzibar Malaria Control Programme, a
dedicated Permanent Secretary and head of the ZMCP and finally an inspiring
Chief of Party from RTI, who was able to marshal that IRS army. Another
factor in the success was coordinated funding from the Global Fund for
Fighting AIDS, TB and Malaria and the President's Malaria Initiative.

Thai team was able to harness the funding and apply the tools that were
effective at the time: IRS, ACTs and LLINs. As Anil points out, both the
parasite and mosquitoes adapt quickly to our tools and they become
ineffective over time. There is still a window of opportunity to knock
down malaria in Africa with a coordinated and concentrated application of
these tools, but that window is closing.

Best, Charles

On Mon, May 14, 2012 at 9:12 AM, GHDonline (Manuel Lluberas) <
> wrote:

> Manuel Lluberas replied to the discussion "When it comes to malaria
> control. Are we doing the right thing? Are we doing things right?" in the
> Malaria Treatment & Prevention community.
>
> Reply contents:
> "Anil:
>
> Thanks for your note. I am well aware of the mutation capacity of
> mosquitoes and her rider. You are quite correct that these are a
> significant factor, but I wanted to focus our attention on the "external
> factors" that I believe are preventing us from progressing against malaria.
>
> All the best,
>
> Manuel
>
> -----Original Message-----
> From: GHDonline (Anil varshney) [mailto:]
> Sent: Saturday, May 12, 2012 03:30
> To: Manuel Lluberas
> Subject: Re: [Malaria Treatment & Prevention] When it comes to malaria
> control. Are we doing the right thing? Are we doing things right?
>
> Anil varshney replied to the discussion "When it comes to malaria control.
> Are we doing the right thing? Are we doing things right?" in the Malaria
> Treatment & Prevention community.
>
> Reply contents:
> "manuel
> I agree with you that combination approach will essentially help reduce
> malaria , but we should not forget the mutation capacities of mosquito and
> the parasite they also own the earth as much as humans regards anil
>
>
> --- On Thu, 10/5/12, GHDonline (Manuel Lluberas) <>
> wrote:
>
> From: GHDonline (Manuel Lluberas) <>
> Subject: [Malaria Treatment & Prevention] When it comes to malaria
> control. Are we doing the right thing? Are we doing things right?
> To: "Anil varshney" <>
> Date: Thursday, 10 May, 2012, 11:53 PM
>
> Manuel Lluberas added a new discussion to the Malaria Treatment &
> Prevention community.
>
> Title: When it comes to malaria control. Are we doing the right thing? Are
> we doing things right?
>
> Discussion contents:
> "Fearing reprisal and being misunderstood, I need to ask these two basic
> questions when it comes to malaria control. Are we doing the right thing?
> Are we doing things right?
>
> I am not convinced the answer to either one is yes. I could go on for some
> time, but consider the following:
>
> 1. There is no integrated vector control in any program I’ve worked with
> during the past twenty years. The vast majority of the programs operating
> today use either nets or IRS; very seldom both and almost never as equal
> partners.
>
> 2. We have pediatricians, ophthalmologists and other physicians in charge
> of the vector control programs, starting from the WHO Global Malaria
> Program through the US President Malaria Initiative (PMI) down to national
> initiatives. Not one has a public health entomologist at the helm.
> Moreover, the WHO has a handful of entomologists in all of Africa, about 4
> in the Americas and as many in Asia.
>
> 3. An obscene amount of money is currently ending up in corruption and
> other "unintended projects".
>
> 4. The world, perhaps because of #2 above, has placed too much emphasis on
> ITNS and seems to be now claiming victory over malaria because of nets but
> in countries where IRS has been implemented along with ITNs.
>
> 5. As a rule, the private sector has achieved great success after
> investing in malaria control. Some of these programs include gold mines,
> copper mines, oil companies, etc. In fact, significant reductions in
> absenteeism and increases in productivity -and thus revenues- have been
> reported by many of these private sector organizations less than three
> years after implementing a comprehensive malaria control program. Yet these
> projects have not been properly duplicated or funded in the public sector.
>
> 6. Net distribution is equated to usage and coverage, but these are
> nowhere close to being synonymous.
>
> 7. Net lifespan is portrayed as 5 years, but the reality is that they last
> somewhere around 15 months. After that, they end up in a landfill or are
> reused for fishing, goal posts for soccer fields, and a myriad of other
> things. However, with thousands, if not hundreds of thousands of them
> falling apart and ending up in a landfill somewhere annually; nobody seems
> to be paying attention to them. Considering that each net is somewhere
> around 4 to 7 square meters of insecticide-impregnated plastic fiber, the
> amount of plastic alone should be a concern. More puzzling still is that
> nobody seems to care even when these plastic fibers continue to release
> insecticide very slowly well after they have been repurposed. Individually,
> a single net may not be a significant problem. Put several hundred thousand
> to a few million of them in the ground and it could be a very different
> story. However, those of us bringing this up have only found deaf ears,
> even all the way
> up to the WHO.
>
> 8. We are addressing a full time problem like malaria on a part time
> basis. Many, if not all national malaria vector control programs around the
> world (very few from the private sector) operate somewhere between 4 to 7
> months of the year with virtually no malaria control-related activity the
> rest of the time. Moreover, there is no job security or progression
> afforded to the managers, who usually take the first opportunity for
> permanent position outside malaria control.
>
> 9. Insecticides are drugs for the environment. As such, they need to
> prescribed by trained professionals and used when needed and as directed.
> Unfortunately, though the vast majority of the malaria vector control
> programs are managed by physicians who are trained in the use of
> prescription drugs and restricted chemicals, many of them fail to make this
> connection with insecticides and even see them as contaminants. Yet they
> see no harm in allowing hundreds of thousands of mosquito nets to end up in
> landfills or in other unintended uses.
>
> While IRS is portrayed as expensive and labor intensive, the combination
> –IRS & ITNs- has been demonstrated as effective in many areas –see number 5
> above. Unfortunately, we are also pushing the vectors outdoors. Yet those
> in number 2 above maintain space spraying is ineffective against the
> vector. (And I don’t want to start with larviciding!)
>
> As a public health entomologist I know that if these programs are properly
> designed and implemented, the combination of ITNs, IRS, ULV and larviciding
> would wipe out malaria almost anywhere. It is not a popular position, but
> there are many examples where this combination has worked. The success in
> the US and the Panama Canal has been properly documented, but there are
> more recent victories from Ghana, Zambia, Zanzibar and others.
> Unfortunately, most organizations funding current malaria control programs
> speak of IVM but would not entertain implementing a truly integrated,
> mosquito control approach under any circumstances. So, as long as we
> continue with what we’re doing, we’ll all have job security, but malaria
> will continue for decades to come.
>
> Meanwhile, let us not forget that the current malaria mortality rate is
> equivalent to six or seven 747 Jumbo planes crashing every day with the
> vast majority of their passengers being children under five.
>
> So, I leave you with this politically incorrect position and statement and
> my original question: When it comes to malaria control, are we doing the
> right thing and are we doing things right?
>
> Albert Einstein has been quoted as saying something like "If you want
> different results, do something differently." The World has been engaging
> in malaria control for at least a decade and has spent billions of US
> dollars that have produced little significant progress. We need to follow
> Einstein's advice and modify the plan."
>
> --
> View this post online:
> <
> http://www.ghdonline.org/malaria/discussion/when-it-comes-to-malaria-control-...
> >
>
> Unsubscribe or change your email notification settings:
> <http://www.ghdonline.org/users/anil-varshney/edit/>
>
> Contact the GHDonline team:
> <http://www.ghdonline.org/contact/>
>
> You can reply to this discussion by responding directly to this e-mail; it
> will be shared with all community members and posted as is. Files cannot be
> added via email attachment and must be uploaded directly to GHDonline."
>
> --
> View this post online:
> <
> http://www.ghdonline.org/malaria/discussion/when-it-comes-to-malaria-control-...
> >
>
> Unsubscribe or change your email notification settings:
> <http://www.ghdonline.org/users/manuel-lluberas/edit/>
>
> Contact the GHDonline team:
> <http://www.ghdonline.org/contact/>
>
> You can reply to this discussion by responding directly to this e-mail; it
> will be shared with all community members and posted as is. Files cannot be
> added via email attachment and must be uploaded directly to GHDonline."
>
> --
> View this post online:
> <
> http://www.ghdonline.org/malaria/discussion/when-it-comes-to-malaria-control-...
> >
>
> Unsubscribe or change your email notification settings:
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>
> Contact the GHDonline team:
> <http://www.ghdonline.org/contact/>
>
> You can reply to this discussion by responding directly to this e-mail; it
> will be shared with all community members and posted as is. Files cannot be
> added via email attachment and must be uploaded directly to GHDonline.
>



--
Charles Llewellyn
114 Marsh Street
Beaufort, NC 28516

US Cell 919 599-2147