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How RISE provides care for families when it’s needed

12 August 2022

One of RISE’s most important goals through our water-sensitive revitalisation of informal settlements is to improve people’s health by interrupting contamination pathways – pathways through which people are exposed to pathogens and disease vectors in water, food, air and soil. One of the ways we are assessing contamination exposure and health is by analysing stool samples for soil-transmitted helminths and other parasites known to cause diarrhoea and other diseases.

What does RISE do when an infection is found through our periodic field campaigns? We have an ethical and moral responsibility to refer affected families for clinical care, but we have found that on the ground, there is a need to support that process even further.

Autiko Tela, a RISE Chief Investigator and Fiji Assessment Team Lead, discusses some of the ways the team is adapting their methods to offer better care to families.

Our initial technique for searching for parasites in children (the Kato-Katz technique) involved us collecting stool samples from children under five years, and taking them to the RISE laboratory at Fiji National University (FNU) for analysis of soil-transmitted-helminths (STHs).

Until recently, only the children who we found were positive for STHs were given a referral letter for their caregiver to take the child to the nearest health facility to see a doctor, where a prescription would be written and medication for treatment could be collected from the pharmacy.

We had also budgeted to give a small travel allowance to the caregiver for transportation to the health facility and return home.

Something we were seeing in our health assessment work was that many caregivers thought our referral letter was going to speed up waiting times at the health facility to see a doctor. Most had waited for more than an hour at the health facility, but still hadn’t been seen by a doctor, so they decided to return home. Some were honest enough to say that they spent the money to buy food to feed the family.

We were also finding on our next visit to families that many caregivers were asking about their children’s results, as they had not received feedback. These were mostly the children that had negative Kato-Katz results.

From these lessons learned, we came up with some solutions.

Kato-Katz results could be given to all children and families who had submitted their stools – whether positive or negative (everyone is informed of the result of the stools collected).

We realised the importance of informing caregivers of the result, so we developed and printed a coloured show card of the helminths that we are also giving with the results. I thought that it was important for the caregiver to understand more clearly the reason we were collecting the stools.

Fiji's field team has developed and trained in discussing parasitic infections using new show cards.

I had also engaged a medical doctor at FNU to help prescribe the medication for treatment, and I collected it from the pharmacy. This was a ‘duty of care’ light bulb moment, where I thought it was better to provide the service as a one-stop-shop – where I could deliver the referral letter, together with the show cards, and give the medication at once.

Where appropriate we also went a step further to do DOT (Direct Observe Treatment) where we observed that the child took the medication if the caregiver agreed to give the medication on the spot.

Feedback I got was like when the Public Health nurse usually comes around the settlements distributing medication for elephantiasis, anemia, and other health visits. The residents are very happy that they don't have to go to the health facility to wait for long hours to be seen by a doctor for this treatment, followed by more waiting time at the pharmacy.

In terms of our process, only the Assessment Team Leader (myself) delivers the positive results for confidentially, which I explain in detail to the caregiver. I also encourage them to submit another sample the next time RISE field workers visit, to ensure that the soil-transmitted helminths have been completely eradicated from the child.