Campaigns and Collections: The Five Challenges of Finding Parasites

by Courtney Slanaker

By: Jack Resnik
Over the last weeks, Heathyouth and its volunteers have planned and led two anti-parasite health campaigns in Pilcomayo district and the Santa Rosa slum. The work, which has reached at least 150 people, predominantly children, is extremely cost-effective but not without difficulties. Our ability to navigate and understand these challenges is crucial to the success of the campaigns; based on my first-hand observations, the five most pressing challenges are presented below.
Healthyouth volunteers promoting the Pilcomayo parasite campaign. Their work at Pilcomayo reached over 100 people.
1. Volunteer-Patient Divide
Quite simply, these campaigns could not succeed without the eager participation and tireless assistance of local medical personnel. To transform the earnest intent of our volunteers into meaningful action, we need not only the professional know-how of these doctors, technicians, and social workers, but also the intangibles—the experience that comes only by being a Peruvian in Peru.
Trust and understanding can not be built overnight, just as ingrained perception and language barriers can not be so easily overcome. High school Spanish is not the same as Peruvian Spanish (Castellano they call it). More importantly, in impoverished areas like Santa Rosa, there are ideas that come along with being a white person from the US, that are as often assumed as they are confirmed. Surmounting these stereotypes, enhanced as they are by misunderstanding, is our most formidable challenge, one that would be impossible to overcome without our local allies.

Volunteers stand with local personnel from the Chupaca Medical Center. The eager assistance of these medical professionals has been vital to the success of our campaigns.
2. Gender Roles
One of the first things we learned going door to door in Santa Rosa was who to ask for. To the children, the ones who most often answered our knocks, the question was never “Are your parents home?”, but rather “Is your mother here?”. Fathers, or any male relatives for that matter, were unhelpful, preferring to let us know when the woman of the house would return. In the most surprising instance, a father seemed fairly unsure what his daughter’s name even was.

Gender roles in Peru, especially in areas like Santa Rosa, follow an old dynamic. The men work, while the women handle all domestic responsibilities. It is not the charge of the man to cook or clean, and apparently not to take much interest in the medical care for the children either. What exacerbates this challenge is that, in a slum like Santa Rosa, the women must often work too, leaving the house for long hours in a market stall or in the fields. If the mother is not around, no matter who else might be home, our only choice is to return later, or on another day altogether.

A volunteer speaking with mothers in Santa Rosa about our parasite campaign. Gender roles here dictate that mothers are our only liaison to reach affected children.
3. Sample Preservation
The weather in Huancayo ranges drastically between baking sun and pouring rain, and both create problems for properly preserving samples. Fecal samples, and the parasites that may come with, have a short shelf life. In Pilcomayo, where access to refrigerated storage is minimal, this creates a huge need to examine the samples rapidly before they expire. With ony one microscope and one lab technician, the bottleneck is significant.
In Santa Rosa, the volunteers and our local allies, set up a collection area in the pampa, an open grassy field in the center of the slum. Without any portable coolers, the best we could do was to keep samples in the shade. This necessitated moving them across the field and back, as the day wore on and shade gave way to shining white sun.

Mothers drop off fecal samples at the collection area in Santa Rosa. Without proper portable storage, even the weather presents a challenge to preserving samples for enough time to test for parasites.
4. Campaign Fatigue
As has been previously discussed, parasite infections rank as one of the most pressing health problems among children and in impoverished areas where access to potable water is limited or nonexistent. Healthyouth is not the only organization running health campaigns, local clinics also conduct them throughout the year. During our walk through of the Santa Rosa slum, we found weather worn evidence of past campaigns, conducted in just the same manner. When systemic issues of sanitation and water access are not resolved, the risk for reinfection remains high, and that necessitates more campaigns. However, risk is also high for campaign fatigue. For populations with

little formal education, and certainly not disease biology, it may be difficult to understand why the same activities are repeated time and time again. It is certainly difficult to understand the link between prevention and the absence of disease—after all, there is nothing to see.

During our door to door efforts in Santa Rosa, we encountered more than a few people who greeted us with suspicion, or outright indifference to our work. For these few, no amount of reasoning, of explaining the health benefits to their children could change their minds. No, they would not participate. This is a pressing challenge in many sectors of public health, and it requires time, patience, and careful explanation to overcome.

5. Parasite Detection
With samples collected, testing can begin to diagnose parasite infections. Detection is primarily done using micrscopic examination of fecal samples, but this too presents difficulties. For one, each of our partner clinics have just a single technician and a single microscope to examine samples. With more than 200 samples to be analyzed, this puts a significant burden on the laboratories, which already handle the daily needs of the clinics.
Furthermore, excretion of possible parasites is neither guaranteed nor consistent, which leads to a high rate of false negatives (people with the disease who test negative). Because of this, it is necessary to test multiple samples, which adds cost and time to the campaign. The cost is by no means onerous, but the time burden can be difficult, especially for working mothers who are asked to make multiple trips to the clinic. Late stage no-shows are a risk, and can be especially damaging if that prevents delivery of treatment.

A Healthyouth volunteer examines fecal samples for indication of parasites. Microscopic examination is the primary means of identifying infections.
Jack Resnik is the Global Health Fellow and Peru Coordinator for Healthyouth. He is currently living in Huancayo, Peru, working with schools and medical centers to improve adolescent health through education and health campaigns. Interested volunteers should email for more information. Year-round placements available.
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