Thursday, March 27, 2008

Brigadas! (Tropical Medicine Community Trips)

Today has been the best clinical week in my opinion. We're traveling with the public health teams here in Puerto Escondido to outlying communities to learn about the programs that are being undertaken in Oaxaca to reduce the numbers of Malaria and Dengue. Since the program was started in 1999, the number of malaria cases in this region has gone down from 20,000 to 250. Seriously remarkable!

Mexico has one of the most extensive public health programs in the world. In this state alone of Oaxaca, they employ more than 3000 workers not including the administration and coordination officers.

We followed officers who work with the initiative called Patio Limpio. In this program, the officers visit every house in the state to assess the cleanliness of the area to prevent tropical disease carried by arthropod vectors. This includes dengue (Aedes aegyptis - mosquito), malaria (Anopheles vivax - mosquito), and Chagas disease (triatomes).

Although the cases of malaria have decreased in the region, dengue is becoming more prevalent (ick). A. aegyptis likes to stick around the house so the cleanliness and lack of stagnant water is a huge deterrent to keeping these bugs away.

Monday - stayed at the Jurisdicción de Puerto Escondido to see the malaria laboratory that they have there. The lab techs identify the cases of malaria with microscopes using slides sent in by volunteers in the community. Each community has a "notificante." When someone is sick or has symptoms that could indicate malaria, they visit the notificate who takes a blood sample which is then sent to the lab to verify whether or not it was malaria. The interesting this is that the notificante gives a precautionary dose of chloroquine as soon as the symptoms are suspicious and when the case is verified, the full dosage is given. They taught is how to identify malaria using the microscope and showed us the various stages of the parasite's life cycle. Not going to lie, it was kind of nice because the lab was air conditioned and it was the first time that I had been in air-conditioning while in Puerto Escondido.

Tuesday - One of the community workers took us to a small town called Tometal to show us a house that had cases of both dengue and malaria. They had also seen the bugs that transmit Chagas in their home, but luckily no one had been infected. The reason that I like this week is that we get the chance to talk to the people in the communities to ask them what they think of the program and the services available to them. The officer who took us out into the country was really nice and decide to give us a mini-tour. He took us to buy watermelon where I got a bunch of mangoes for free because there are so many that they can't get rid of them and don't eat them... (no way!!!) anyways, he also took us to see some iguanas or something (random) and to a point that is a great lookout over Puerto and has some religious memorials.

Wednesday - We went to learn about how they educate people on the Patio Limpio program. We went to a couple of houses with some of the officers here in Puerto. It was interesting because in the first house we went to we found A. aegyptis larva inside of a water feeder for one of their roosters that they forgot was there. There were also some in the water tank that they use to conserve water. In many parts of Oaxaca, they only get water one day a week. Therefore, people save it in tanks. Well, of course this is the perfect breeding ground for mosquitoes if it isn't kept clean or treated. They rate each of the houses according to how well they follow the plan. When they find a house that has problems they always return within one to one and a half months to check up on how well they are following the suggestions. They don't tell people when they're going to return because they want them to do it all the time and not only when the health officers come. Afterwards, we went out into the country again because after there has a been a case of dengue or malaria they spray insecticide as a ring around the house so that those mosquitoes that carry the disease can't spread. They told me that they used to spray everything but it wasn't working very well which is when they decided to start community capacity building programs instead. Pretty awesome! Especially because the newer programs that involve the community have been much more effective.

Thursday - Today was a very awesome day. We went out to meet a woman that is the health capacitor of her small town of 120 people. She gets together with the women of the community to set up programs for the health of the families. It's amazing that in her town there have been no cases of malaria or dengue and none of the children are malnourished (not so in Puerto Escondido). She was a very cool lady and explained how she works to set things up for the community. While we were in the community, people were amazed that we had come from the US to their small farms pretty much in the middle of nowhere. We were like local celebrities. We got free bananas from the store (the best I've EVER had btw) and Aureliana made us a delicious lunch of chicken soup•. very, very fresh chicken soup!

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