SCORE is a giant. All of its different projects require immense amounts of manpower, more villages to study than can be found, and the cooperation of those being tested and treated. It seems like all the larger studies have smaller studies tacked on; for the major drug interventions going on in several countries at once, some have subtle morbidity studies attached.For the drug interventions in Kenya alone, 225 villages were needed. With this much data being collected, coordination and community cooperation are key for researchers. One reason schistosomiasis is difficult to control is because water provides a livelihood for many, or plays an integral part in daily life. So even if you treated every positive Kenyan for schisto, they are likely to get reinfected very quickly. This is precisely why SCORE seeks to understand the best plan for drug administration, both as a preventative to reinfection and to treat currently infected people. And while the drug interventions in Kenya are just that, strictly drug administration, it doesn’t mean that communities aren’t involved in the process. Without consent, local acceptance and the help of certain community members, no drugs would reach any mouths. A unique aspect of these studies is that the researchers work with the Ministries of Health and Education to sensitize communities to the disease and the drugs used to treat it.
Pap Kodero Health Centre, Rariera, Bondo District
Villagers receive health counseling at Pap Kodero Health Centre
They realized that involving them would increase public acceptance; the results of the studies will likely influence how the Ministries approach community health anyway. “Health interventions are not a one-man show,” said Pauline Mwinzi, the principal investigator for the community-wide comparison study. “Once they [the Ministries] owned their participation, we just facilitated.”
She just finished eating her porridge.
Teachers and community health workers attended workshops to be trained by the Ministries of Health and Education to take stool samples, educate on schisto and administer the medication. Meetings were held with teachers and parents for the school-based treatments, and with local chiefs, elders and other district stakeholders for the community-wide treatments. During these meetings they explain what bilharzia is, how you get it and why the drugs will help. Many had seen the symptoms but did not connect them to the disease. Teachers might have thought that a distended belly was from simply from eating well. But once community leaders knew what to look for, they could identify the disease and tell the victim to seek treatment.
A village teacher hands out Praziquantel to his students.
The cooperation of health teachers is crucial; they are the ones who know the children, are best suited to giving them the drugs, and they are the ones who must deal with parents. Researchers stressed that keeping students healthy was already part of the teachers’ work, and that they were just helping them do it.
The community-wide treatments involved a more integrated approach to gaining acceptance from villages. The study made use of community health workers already present in the villages, which meant they were already well-known in the community, had knowledge of existing illnesses and wanted to help their peers. In one village, locals were concerned about the side effects of the medication as well as the possibility that it was some kind of birth control in disguise.A community health worker, Mary, knew how to handle such reservations by going personally with brochures to talk to them, several times if needed. “I know their health status(es), and now I see that the health standard in my village has improved,” she said.
Walter, a community health worker.
Not only do the health workers learn how to give Praziquantel, but now they can identify schistosomiasis in villagers, counsel them and teach them how to prevent getting the disease in the first place. And beyond helping their communities, they can help themselves as well. “It helped me personally to keep myself safe from this and other diseases,” said Walter . “Now I am well informed about it.”
So not only are communities getting immediate relief from a tricky disease, they are also potentially getting better school performance out of children and a healthier workforce.
“A secondary benefit to these studies is that they [communities] can learn how to take responsibility for their own health,” said Mwinzi. “It’s important for them to know they can do it themselves.”
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