September 27, 2021
Group B: Health-care workers
Location: Anuradhapura, Sri Lanka
|Occupation||No. of experiences in health services (in years)|
|Provincial Health Education officer||22|
|Nurse – Secondary-care hospital||30|
|Nurse – complementary medicine||24|
|Public Health Inspector – Non-communicable disease||27|
|Public Health Inspector – General||26|
|Public Health Midwife||14|
Key discussion points and summary of findings:
- Pesticide self-poisoning: Participants reported that pesticide suicides are less common now due to HHPs ban, improvement in health-care facilities and following specific protocols for management of poisoning patients.
- Occupational pesticide poisoning: Occupational pesticide poisoning is a common issue in farming communities but most of such patients are non-hospitalized.
- Challenges in pesticide poisoning patient managements in primary health-care facilities:
- Lack of intensive care facilities
- Lack of trained staff
- Sharing ambulances among several hospitals
- Identified issues in pesticide poisoning management at primary health-care hospitals:
- Without managing patients at primary-care hospitals, almost all patients (including mild to moderate cases) are transferring to secondary-care hospitals.
- Unnecessary delays for treatments
- Pressure from families on patient transfer
- Sometimes, medical doctors’ unwilling to take risks to manage patients at primary health-care hospitals
- Provision and use of antidots in communities:
- Position: All participants were supportive for availability of antidotes at the community-level because it is beneficial to treat poisoning patients at the earliest opportunity, thereby reduce deaths.
- Other examples (successfully implemented such programs in communities): Distribution of prophylaxis for leptospirosis among farmers through farmer organization at the beginning of an agricultural season.
- Suggestions for implementations: The participants suggested three potential scenarios to provide atropine autoinjector antidotes to the community to initiate the treatments within the “golden hour” – first hour after the event.
- Scenario 1: Provision of antidotes directly to the community through already existing community-based organizations (CBO). Examples: “farmer organization”, “mother supportive groups”. Several community members would need to be trained and antidotes should be available in a most convenient place in the village. Alternatively, a community-based health-care worker can be allocated and trained for supervision of this process.
- Scenario 2: Provision of antidotes to 1990 “Suwa Sariya” ambulance service. This is a recently started ambulance service in SL which is free and popular throughout of the country including rural areas. Ambulance staff are well-trained to work in emergencies and within a very short period they reach to the patient.
- Scenario 3: Provision of antidotes to primary health care facilities which are normally distributed throughout of a province. Most of the acute poisoning patients initially admitted to primary health care facilities within first few hours after the event and then get transferred to secondary-care health facilities.
- Implementation challenges/barriers:
- One of the identified challenges was getting support from medical doctors for the proposed intervention as they ultimately treat/take the responsibility of these patients.
- The participants believe that self-injections may not work for SL communities, instead they propose another person/s needs to be trained. Also, they believe that patients with high suicidal intent will not interest on self-treatments.
- Use of community-based organizations or community-based health workers in emergencies (e.g. poisoning event) would be less effective due to lack of specific training such persons, availability of people etc.
- Recommendations for successfully implementation:
- Move forward with multiple approaches i.e. provision of antidotes to communities through CBOs, 1990 ambulance service, and primary health-care facilities.
- Building-up “trust” through broad health promotion strategies at the beginning of the intervention.