Reflections from the field- Fiji MDA
- Friday, November 25, 2022 - 12:00 PM
The first round of the national ivermectin-based MDA in Fiji has begun. Recently a team from Melbourne spent a day out in the field with the nurses that are administering the medication in the island of Taveuni in the Northern Division of Fiji. Here are some reflections from one of the team members.
During our day out in the field with the nurses administering the medication for the integrated scabies and lymphatic filariasis MDA, I gained a completely new perspective on how arduous the task is. The island is divided into zones and there is a nurse’s station and nurse for each zone as well as a couple of community health workers that assist them. I spent time in the Vuna medical region which is in the south part of Taveuni, the nurse there has 1,960 people in her zone, 300 live in the village around her station and the rest are all scattered about in stand-alone residences stretching over many kilometres. In the clinic there was a poster on the wall which lists the number of people being treated for Rheumatic Hearth Disease and I wonder how many of those began with scabies infestation and if they could have been avoided.
The MDA is a door-to-door affair made more challenging as the residents are all going about their normal business so not everyone is home when we visit, meaning a return visit will be required later to dose the remaining household members. How she manages to get to everyone in her region and ensure doses are 7 days apart I will never know! We visit a village on the main island which takes an hour of serious 4wd climbing up a mountain and a river crossing. Surely there was not a village up here we thought, but yes, indeed there was. We met a woman with her newborn baby, there are no baby monitors or microwaves or sterilisers or infant formula yet the baby was perfectly healthy and happy. After the people in that village had been treated, the community health worker explained there were more people living further up the hill where there was no road. That is where we left them as they set out on foot in the rain to reach those people living deep in the rainforest.
The nursing manager explains to us that there are a couple of smaller islands off Taveuni which the nurses access by boat but bad seas earlier this week made it too dangerous for the nurses to make the return trip to distribute the 7 day dose, fortunately one of the local resorts was able to offer a small plane and flew the team in to complete the course. The week before a nurse and community health workers were left stranded on an island due to bad weather and so they stayed for the week, administering the two rounds of ivermectin and sleeping on the floor of the village community hall.
We were tired after just one day in the field and the nurses and community health workers are doing this day in day out usually working through to 8pm at night because the later part of the day is better for catching people at home. Seeing all of the work being done on the ground and hearing the genuine appreciation of the villagers was a reminder of why we do this work.