Pinworms and Giardia and H. Nana, Oh My!

The final results are in: 49% of the kids in Cambio Puente who are enrolled in our project, have some sort of parasite.  Normally, to get a good diagnosis, three…umm…samples… need to be collected.  Due to the size of the group we were testing we only had the time and resources to collect one sample from each kid.  The problem with this is that often, the parasites will not show up in the first sample or the second sample, but will stubbornly show up in the third sample.  Therefore, we can only assume that more of our kiddos actually have parasites.  This is what the breakdown looks like:

Rather than just providing treatment to the kids that we were absolutely sure had parasites, we decided to make medication available to all our kids in Cambio Puente because of the fact that we cannot be sure that the 51% that showed up negative are actually parasite free.  The tricky part is that we had two different medications we were using because unfortunately one type of medication does not cover both giardia and oxiuros (pinworms).  This is where our sectors came in handy.  Rather than just treating the whole population with one blanket medication, we looked at the parasite prevalence in each sector and treated the kids that came back with a negative diagnosis for the parasite that was the most prevalent in their area.  When it came to actual treatment, we had a complete range of reactions from the kids.  There were some that could not wait to take their medicine while others were climbing over their mom’s shoulders trying to get away from us and spraying the medicine back out as soon as it was in their mouths.

One of the (many) things I love about our project in Cambio Puente is the way it is designed.  In total, the project will be present in Cambio Puente for just a couple years.  After those years, we will leave the community to care for themselves.  In those few years, it is our goal to provide the people of Cambio Puente with the tools they will need after we are gone.  The main way we are doing this is through our community agents.  Every couple months we hold workshops that last for a day or two and talk about different health conditions in kids and what can be done about them.  My co-workers apparently think my Spanish has improved to such a level that I can now more actively participate in these workshops.  Read: lead discussions and give presentations.  There was still a little giggling at my Spanish as we worked our way through talking about infant warning signs, but at the end I think (hope?) everyone understood.  There may be one benefit to my stumbling through the language, though—there was more participation from our group of women than normal.  I think they just felt sorry for me.  Whatever the reason, I had to pat myself on the back for leading a discussion when just six months ago I could barely carry on a decent conversation about the weather.  It is an unbelievable experience to be a part of something that is much much bigger than myself and I count myself lucky and blessed every day I am down here to be a part of it.

The Wonderful World of Nursing

The last time I looked at the data, over half of our kids in Cambio Puente had parasites.  About 90% of what I know about parasites, I have learned in the past week and a half.  People look at me skeptically when I tell them that we don’t really have parasites in the US.  One of my co-workers actually laughed at me when I told her that we can drink the tap water back home.  It took some convincing for her to realize I wasn’t pulling her leg.

Parasites have taken over my life this past week.  Not in the ‘ohdearIneedabathroomNOW’ sense, but in the ‘I get to spend my days testing kids for parasites and working on treatment options’ sense.  Sounds cool, right? Right.  Starting last week, our community agents in Cambio Puente started collecting samples from all our kids.  They were nice enough to do the dirty work and we lugged those stinky coolers off to the lab for processing.  This was the first step.  The second step was left up to the nurses.  As a rule, I don’t like to sacrifice my sleep for much, but those cute kids out in Cambio Puente seem to have a way of getting me to do almost anything.  For three days this week, our team of nurses was out in Cambio Puente before 7:00 in order to get to the kids right when they woke up.  House by house, in each sector of Cambio Puente, we did the scotch tape test on the kids enrolled in our project.  If you have not heard about this test and want to know what it is, you can find a brief description here (just remember, these are intestinal parasites).  The kids were surprisingly well behaved for the uncomfortable position we were putting them in—I only had one avocado sandwich thrown at me!

Parasites are tricky little devils.  Not tricky to get.  Not tricky to identify.  Tricky to treat.  Let me rephrase, we know exactly how to treat the parasites we are dealing with, the problem comes with actually getting the medicine we require.  Anti-parasitics are cheap to buy.  Depending on your source, they cost anywhere from two to seven cents per dose.  From the standpoint of a lot of public health projects, that can really start to add up.  The hope for our project is to be able to carry out two rounds of treatment per year.  Now here’s the real problem, since parasites have been largely eradicated in the developed world, most pharmaceutical companies have little incentive to produce the medication since the majority is given out as donations.  The quantities required are not available.  This is when things get tricky; when we have to acquire said medication.  There is another tricky area—the fact that these kids will almost certainly get parasites again.  It almost feels like we’re just putting a bandaid over the problem.  However, kids who are parasite-free, even for a short amount of time, can reap great benefits.  Since parasites can consume up to 25% of what the host ingests, kids who are parasite-free have more energy, do better in school, grow like they should and are more able to fight off other diseases.  If we want our kids to remain parasite-free, however, we need to do more than just treat them twice a year.  We have to intervene at the home level.  This is why handwashing is so important!  Such a seemingly simple solution to a big problem in much of the world.

These little worms will continue to take up much of my time for the coming month and a half.  I’m looking forward to (hopefully) winning this little parasite battle.

My friend lent me the book ‘Donde No Hay Doctor’ (it comes in English, too).  For anyone interested in really rural health, it is an interesting read and a great resource to have on hand.

I think I have managed to change my settings on here as far as comments are concerned.  So for all (three) of you who have just been dying to get your comments up here and haven’t been able to, you are in luck!  Comment away!