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Discussion with Sri Lankan community healthcare workers about provision of pesticide poisoning antidotes in theIR community

Group B: Health-care workers
Location: Anuradhapura, Sri Lanka
Participants’ background:  

OccupationNo. of experiences in health services (in years)
Provincial Health Education officer22
Nurse – Secondary-care hospital30
Nurse – complementary medicine24
Public Health Inspector – Non-communicable disease27
Public Health Inspector – General26
Public Health Midwife14
people meeting

Key discussion points and summary of findings:

  1. 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.
  2. Occupational pesticide poisoning: Occupational pesticide poisoning is a common issue in farming communities but most of such patients are non-hospitalized.
  3. 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
  4. 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

      ambulance car
  5. 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:
      1. 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.
      2. 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.  
      3. 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:
      1. Move forward with multiple approaches i.e. provision of antidotes to communities through CBOs, 1990 ambulance service, and primary health-care facilities.   
      2. Building-up “trust” through broad health promotion strategies at the beginning of the intervention.