India: Expanding Surveillance By Working With A Local Priest
Story From a STOP Team Volunteer in the Field
This last week has been the most rewarding so far and I am starting to see the results of my efforts. I had left for our mid-assignment break in Delhi wondering if I was making any sort of difference, but after a restful and food-filled weekend and another week in the field, I definitely feel like I am contributing, at least in some small way.
My best meeting was with a priest at a temple that is famous for seeing paralysis patients. After some discussion and assuring him that we didn't want to take away any of his business, the priest indicated that he would be more than willing to help us, and if we gave him a register he would keep track of the (paralysis) cases, obtain their addresses, date of onset, and symptoms. He said that if we sent a community health worker each Sunday (when cases come to the temple) he would pass the information along. The next step was to go to the local Primary Health Center. There I was able to round up five community health workers - ANMs (auxiliary nurse midwives) and MPWs (Multi-Purpose Workers). I had a great meeting with them and their enthusiasm was wonderful; they were really willing to listen, learn, and participate in acute flaccid paralysis (AFP) surveillance. It was agreed that Mr. ______, an MPW, would go to the temple each Sunday evening and look for cases. I left there feeling like I had actually reached some key people, but was unsure if I had left a system in place and wondered if the community health worker would really go to the temple on his day off.
I returned from Delhi and went directly to the field without returning to my base, and we arrived at the temple around 6 p.m. Apparently, patients start arriving at the temple Saturday afternoon/evening, rituals are performed Saturday and Sunday. On Sunday at midnight, some final rituals are performed and then the cases must leave. Depending on the case, the patient must come back for several weeks. When we arrived, there were at least 100 people milling around - quite different from the quiet place we had visited in the afternoon the week before. Families were caring for sick family members, and both my driver and translator knew people there who had brought their sick mother or paralytic child (an indication of how famous this place is).
But the most rewarding experience was when I got out of the vehicle. The MPW who
I had trained a week and a half before was standing there like he was expecting us and handed me a register of all the information he had collected last Sunday and this Sunday! I was so happy to see him, and it was clear that he was proud of the work he had done. We proceeded to the nearby public health clinic, found the doctor, and with the District Immunization Officer (DIO), formalized a system where the MPW and the doctor would go to the temple each Sunday, and the DIO would call each Monday morning for a report. Then we all went back to the temple and examined the cases - all of which were chronic cases. But, I really think this will work and that there is great potential here to find cases. I am going to make sure that I return one more time before I go and I am definitely taking that MPW a present!