Saturday, November 13, 2010

Leptospirosis Outbreak

Since the beginning of my service, I’ve seen the Nicaraguan Ministry of Health (MINSA) handle several public health emergencies: the fight to prevent swine flu (whose name was later changed to H1N1 Influenza), Dengue fever (a viral disease spread by mosquitoes with symptoms similar to malaria), and Chagas disease (a parasitic infection transmitted by a small bug known in Nicaragua as chinche through its infected feces deposited on the skin and later rubbed into the eyes, mouth or a wound). For each of these outbreaks, MINSA has had to mobilize their community health volunteers, organize educational campaigns and depending on the disease, distribute medicine and vaccinations to those who most need them. Often, those who suffer most from these diseases are the most poor who live in the dirtiest conditions and lack the education to prevent infection. In the past month, a disease already well-known among developing countries and Latin America – Leptospirosis – has surged with 510 cases nationwide, 16 deaths and 17 hospitalized patients. Below: educational posters in the health center about Chagas disease, Influenza H1N1 and Leptospirosis (I made the last one) :) Leptospirosis is a bacterial disease which affects humans as well as a variety of animals – most common in Nicaragua domestic animals (cats, dogs), cows, pigs, donkeys, mules, rats and mice. It is transmitted to humans through contact with infected water, soil or food through an open wound or through ingestion. Because of recent heavy rains due to intense tropical storms, rivers have overflowed, homes have been flooded, and fields washed away. All of this extra water only facilitates the transmission of this disease as wells become contaminated with animal urine and feces and people walk barefoot through rivers. Most diseases increase during the rainy season, such as diarrheal diseases, mosquito-borne illness and respiratory infections – Leptospirosis is no different.

Leptospirosis presents flu-like symptoms (fever, chills, body pain, and headache), also bleeding out of the nose and other orifices, vomiting, diarrhea, and dry cough. If untreated, the second stage is characterized by renal failure, meningitis, and liver damage. Antibiotics are used to treat the disease such as amoxicillin and doxycycline. The latter can also be used as a prophylaxis – when taken weekly, it can prevent the disease. MINSA has been working on educating the public and distributing doxycycline to the entire population above 2 years old. I have been helping in this effort as we go out to every one of the 24 outlying villages of my community walking house to house giving out medicine and explaining to residents what Leptospirosis is. Below: two girls in a village waiting for their medicine. They were VERY interested in me and my tattoo.
The Police, the local cabinets of “Citizen Power” and all the Health Center personnel have been helping in this effort. Every day a group takes off in the Health Center worn-down pick-up to forge rivers and drive down unpaved roads to deliver the medicine to every last house. Since the outbreak began, MINSA has distributed prophylaxis to 2,828,512 individuals and also rodent venom to 167,950 families. The nurses here are assigned to different villages and they know their assignments well. I look out at the hills and see nothing but green, but they can tell me where every house is, how many children live there, and what the best way to walk there is. When we show up at their house, most residents already seem to be expecting us. Although they may not have a television, most families have a radio and have been following the spread of the disease religiously. Everyone dutifully takes their medicine – even the young children. Nicaraguans have come to expect this treatment from their socialized medicine system – healthcare that comes to your door. Below: a baby hanging out in a hammock in one of the communities - what a face!
I give quick talks to the families about precautions they should take (tie up domestic animals outside of the house and do not let them near water sources, avoid walking barefoot or bathing in rivers and pools of water, clean-up debris in and around the house to avoid creating places for rats and mice to hide, and washing hands with water and soap. They nod diligently, but I know that most of these suggestions will go in one ear and out the other. When they have no running water – it is much easier to bathe and wash clothes at the river rather than hauling water from the well, and how can they move the entire herd of cow that is living right outside their front door? Where would they move them to? I see many barefoot children running around the yard, playing with the dog – I tell them they should get some shoes on, but I normally get an odd look. “What is this crazy gringa telling me to do?” but a stern look from their mother usually gets them to do it. Yesterday all the parents were buzzing about something they had heard on the radio that morning – a three year old had recently died in the neighboring municipality from Leptospirosis. Now they knew it was serious.

The community health volunteers of the villages are always willing to help. I have mentioned them in previous blog posts. They are community leaders who have been trained by MINSA to give educational health information, give injections, provide basic first aid and support MINSA activities. They accompany us on the doxycycline rounds and give us the inside information on the community and who is at risk. Although they receive no pay and frankly, very little support from MINSA, they are always at the ready and a valuable asset.

MINSA’s reaction to the Leptospirosis outbreak has been swift, and hopefully prophylaxis will suppress the numbers of people who contract the disease. Most of MINSA’s normal activities have been put aside (as they were in the H1N1 outbreak) to devote all resources to Leptospirosis. Although there have been no confirmed cases in my municipality, people are operating on red alert. Everyone in Nicaragua is talking about Leptospirosis. I do realize the importance of this disease, but at the same time I wish that the same attention could be given to other public health issues, such as HIV/AIDS or teen pregnancy. I have no doubt that if all government, public communications and MINSA resources were mobilized to distribute family planning and educate the public house-to-house, it would make a substantial dent in those high statistics. Of course, swallowing a pill is an easier solution, a less complicated behavior to change, and more culturally acceptable than limiting sexual partners or using a condom – which is what would be required on a national level to cut down on HIV levels.

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