I love being able to work with health care workers. Too often we’d come to a village where there used to be a health worker but they left because they were overwhelmed by the amount of work and the lack of support. So whenever I do come across a Health Worker, I take all the time I can to just chat with them, get to know their challenges, offer support in any way I can, teach them a few things and do a pharmacy review with them. Most Aid post have received a good number of boxes of supplies but the health workers don’t know what the supplies are to be used for. Some supplies come in different packages or with a different name and without a drug book or access to Internet to look them up, the supplies remain untouched while patients suffer from curable diseases.
One of my favourite interactions was definitely in Wasua, where the Sister in Charge had stopped using the Malaria rapid diagnostic tests (RDT) and had boxes of Malaria treatment just sitting on the shelves.
In PNG it is now mandatory to have a positive reading for malaria before prescribing the treatment. In the past the treatment (Chloroquine) was handed out like candy at any “sign” of malaria and when anyone presented with fever. By doing that, the malaria parasite actually built resistance to Chloroquine, rendering it inefficient for most types of current malaria in PNG. Therefore, in order to decrease resistance, treatment is now only given when malaria has been confirmed, brilliant idea!!!
So with each box of Mala-1 (Malaria medication) comes a box of RDT. When the result of an RDT is negative, no Mala-1 is given out to the patient, when positive, you give Mala-1. In the event that the test is negative and that the health worker still thinks that the person has malaria, they’ll treat them with Chloroquine (old inefficient treatment). What actually needs happen is that the health workers would think about other possible causes for the illness, come up with a different diagnosis and possibly find the right treatment for this particular patient. Otherwise that patient goes off and remains sick and can potentially die!
So, in Wasua, they had stopped using the Malaria rapid diagnostic tests and the Malaria treatment that came with them. Their reason being that the test weren’t working as they would read a negative result, despite the patients having fever. Unknown to the health workers in Wasua, Malaria has actually drastically dropped over this last year in Western Province! Due to a very efficient delivery and increased usage of mosquito nets. After a Malaria Treatment Guideline review and a discussion, the staff started using critical thinking to find reasons for fever,which was previously only linked to Malaria. It was so good to see them grasp this simple yet life saving concept that when someone doesn’t have a positive reading for Malaria, there has to be something else wrong with them.