After months of planning, we started the implementation of our scabies and lice eradication plan. Both scabies and head lice are endemic in the villages here and we have not been able to obtain enough permethrin to treat them on a daily basis. It seems that as soon as we get the problem under control in one village, it crops up or explodes in another one. Several months ago, we started to try and think outside of the box on another approach and came across a couple of studies that were carried out by the World Health Organization. These infestations were approached by treating the village as a whole in order to eradicate the problem. The numbers looked pretty good - 80+% reduction at nine months - and so we thought that we would give it a try. It obviously requires the cooperation of the villagers and a lot of planning and logistics in order to treat a whole village at one time.
A public health intern from Baylor University, Meagan Young, is here with us for a few months and has helped me outline our protocol as well as helped with contacting the alcaldes (mayors) and the community health workers in the villages. She and I also met with officials in the Public Health Department and the Ministry of Health to discuss our plan and seek their approval. San Marcos is one of the closer villages and when both the Alcalde, Mr. Sho, and Community Health Worker, Mr. Carlos Mes, were excited about our proposal, we decided to have it be our pilot village. The village leaders thought that Sunday would be the best day as the men would not be out in the fields working but in the village with their families.
So we gathered all of our students and volunteers with us right now, divided everyone into four teams and drove out to San Marcos early Sunday morning. Each team had a village member with them as we went door to door and treated all six hundred plus villagers. We weighed everyone and treated those fifteen kilograms and larger with oral Ivermectin at the time and then gave them a dose to repeat in seven days. All of the children less than fifteen kilograms were treated topically with 5% Permethrin with instructions for mom to wash it off the following morning. We handed out baggies of laundry detergent and instructed them on washing their bedding and clothes. We also gave them large trash bags so that they could bag items that were not essential for the next 3 days and leave them in the sun. Many of them sleep in hammocks and a few have mattresses so we treated all of the sleeping surfaces with a 0.5% Permethrin mixture.
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| Weighing in |
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| Bedding and clothes needed to be treated as well |
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| Mr. Sho, the Alcalde, and Meagan Young |
Almost all of the villagers seemed receptive and willing to be treated. It was a long day and I have to admit that when we stopped for lunch, I did not think it would be possible to finish in one day, but we did! We gave out every last pill of Ivermectin that we brought with us and fortunately the Permethrin spray lasted through all of the hammocks. We were able to take a census of the village at the same time as well as a count of the number of houses that have functioning outhouses. This is information that will help Mr. Mes in taking care of his village. Everyone was hot, grimy and exhausted at the end of the day but left with the feeling that we had done something to make a difference in the village of San Marcos.
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My team, Team #4, with our guide the Community Health Worker, Mr. Carlos Mes as we finished our part of the village and the sun is setting
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