Photo from the autor. Namanatai, Papúa New Guinea
In this series of articles, Camila describes the daily routine of an ISGlobal team working to eliminate yaws in the island district of Namatanai in Papua New Guinea. This is the third and last chapter:
18 January, 2019, Namatanai
Before sunrise, we are all up working to recheck everything we have already checked five hundred times before, but there is so much material, so many procedures and so many teams that some detail escapes our notice... and the problem only comes to light after we arrive at a village devoid of telephone coverage located a four-hour drive from the hotel where all the material is stored. We find, for example, that there are not enough dressings in the box for team 7, that there are no batteries in the serology reader in the team 12 box. But that is what fieldwork is like!
The mass drug administration will take approximately one week. Every day the teams in each ward will visit and treat the people in one of the three or four villages located in their area
The mass drug administration will take approximately one week. Every day the teams in each ward will visit and treat the people in one of the three or four villages located in their area. Within four or five days, the people in all the villages should have been "treated" and the rest of the week can be used for the mop-up operation, which involves a quick tour of all of the village communities to look for people who were not present on the day of the mass administration.
Every day, each of the supervisors goes out with one of the vehicles to visit the teams and "activate" them. Activating a team involves helping them get up and running quickly, or modifying certain practices to make the process more effective.
Immediately we arrive, children appear carrying tables and chairs from the school so that we can sit down and organise ourselves. Then they bring out containers and old bottles filled with drinking water. Everything is set out in the shade of a tree, and the work begins
When the team arrives in the village, the team leader explains to the community what is going to happen during the day and how we are going to proceed. In Tok Pisin this explanation is called a “tok save”. We always try to ensure that each team includes people from the villages the team is assigned to visit. If we can do that, the team members are well known to the community and familiar with the place, which makes everything a lot easier. Immediately we arrive, children appear carrying tables and chairs from the school so that we can sit down and organise ourselves. Then they bring out containers and old bottles filled with drinking water. Everything is set out in the shade of a tree, and the work begins.
The villagers queue up to register on the census we drew up some months ago by visiting every house and asking how many people lived there. This will help us to know whether anyone was missing on the day. As the islanders have no identity documents and there has been no official census since 2011, our mini census is the best way to get an idea of the population living on the island. If there have been any births or deaths, the census is modified during the registration process. Then, we administer a questionnaire based on exclusion criteria to find out whether the person can take the medication and whether they have any symptoms or ailments before being medicated.
This time round, we are implementing a major change, a shift from paper to digital records. The registration is being done using an extremely simple application, which makes the process much faster than it was when we used pen and paper and also saves us the work of putting the data for 50,000 people into a computer database at a later stage. We carry portable batteries for recharging the mobile phones. The plan is to switch to solar chargers when the budget is available.
Finally, the drug is administered: in tablet form for adults and in a syrup for the children. We record the number of doses administered and the number of people treated. Needless to say, each person is completely free to decide whether or not they wish to participate and take the drug, but generally everyone welcomes any medical treatment, something that is only rarely available to them.
Whenever I am “activating” a team, I start by doing each operation myself at least once and giving examples of all the problems that may arise. During the first day of work, I explain to the team that (as they well know) many children have no idea how old they are, and although the correct dose of azithromycin will depend on the child’s weight, we use an age rule because it is much easier to implement.
So, we have to use our intuition. One way of assessing age is by looking at the size of the child. When you have treated thousands of children, I can assure you that you become an expert in guessing their ages.
Sometimes, many of the children know the year they were born but have never thought to calculate their age. Isn’t that amazing? It’s another way of looking at life...
Sometimes, many of the children know the year they were born but have never thought to calculate their age. Isn’t that amazing? It’s another way of looking at life... In such cases, the health workers whip out their calculators and quickly subtract the year of birth from 2018 (or 2019 now) to calculate the child’s age. Simple!
On one occasion a mother with a baby in her arms came to ask for treatment for her infant, who had an ugly ulcer on one leg. When I asked “How old is she?” the mother replied “Pife” (five), to which I responded “No, your baby is not five years old”. The woman looked at her infant and, raising a single eyebrow, she asked me tentatively “One?”, as if negotiating her baby’s age. “Okay”, I replied, “one it is”.
When we are activating or visiting teams, it is important to try to make them as independent as possible because we can only accompany them for a few hours before moving on to visit another team. Sometimes we arrive to find a very well organised team that has been working since dawn. More often, we arrive to find that four team members are missing because they did not know we were starting today or because no transport was sent to pick them up, or that the head of the team has decided to start the operation the following day instead.
The first day is always chaotic. We expect that. But after a few hours, things begin to run more smoothly and we become spectators. Papua New Guinea is called “the land of the unexpected”, but for us it has become “the land where everything is possible”.
Diary of a Researcher in Papua New Guinea (1). The Island with the Sky of a Thousand Colours
Diary of a Researcher in Papua New Guinea (2). An Army of 200 People Working to Eliminate Yaws