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SRI LANKA: Summary of community discussions about the provision and use of antidotes in their communities – Patient and Public Involvement and Engagement (PPIE)

Group A: Rural villagers/farmers who might get poisoned and therefore benefit from the intervention

Location: Hidogama, Anuradhapura

Participants’ demographics: Age between 43-57, 2 women and 5 men, farmers, and all pesticide sprayers.

Participants’ experience with pesticide poisoning: Family members of two participants were self-poisoned and hospitalized. One participant’s partner was hospitalized due to occupational pesticide poisoning. Three members experienced some signs and symptoms after spraying. One member had no poisoning experiences but was aware it is a common public health issue in the community.

Discussion points and summary of findings:

  1. Pesticide self-poisoning: Participants reported that 3-4 pesticide self-poisoning cases are reported in the community in a year.
  • Occupational/accidental pesticide poisoning: 1-2 farmers admitted to hospitals per agricultural season. Treatment-seeking behavior for occupational pesticide poisoning: Participants revealed that occupational pesticide poisoning is a common issue among farmers after spraying pesticides in the field. Most of the occupational pesticide poisoning are mild to moderate cases – normally not hospitalized. Such patients usually try home-based treatments such as drinking coconut milk, taking paracetamols, taking a bath, etc.
  • Delaying hospital presentation:
  • Delaying hospital presentation is identified as one of the major concerns in rural farming communities. (finding a poisoned patient, informing others, transportation, and delays in hospitals).
  • The nearest primary health-care facility is located 4 km away from the village, but the participants were not happy with the facilities and the patient care there. (e.g. lack of medical staff, lack of emergency-care unit, lack of experienced staff, ambulances are shared among hospitals, etc.)
  • All pesticide poisoning cases are transferred to a secondary-care hospital which is located 12 km away from the village.
  • Although patients are initially admitted to the nearest primary hospital, all of them are transferred to secondary-care hospital (THA) which normally further delays the process.
  • Transportation difficulties in an emergency (e.g. finding a vehicle)
  • Priority for poisoning patients in hospitals:
  • Participants complained that poor attention (less priority, use bad words, etc.) is given to self-harm patients
  • Occupational or accidental poisoning patients treat as usual.
  • Provision and use of antidots in communities:
  • Position: All participants were high appreciated the idea
  • Advantages: Reduce the risk of deaths due to poisoning
  • Place/location: Most convenient place in a village (e.g. center of the village)
  • Responsibility: Participants pointed that a person in the community is appointed and responsibility should be given to that person. Community leader (e.g. Grama Niladhari or village headman, president of farmer organization, reputed and educated person in the village, etc.) or health care-worker in the community (e.g. midwife).
  • Implementation challenges: 1). Specific- training should be provided to such trained person, 2). Finding a “trust” would be sometimes difficult 3). All villagers should be aware of the local antidote availability 4). Responsible person/s should be available all the time  5) Villages may concern about the responsible person knowledge and health background
  • Potential risks: Community was concerned on 1). about wrong dosage/overdosage, 2). Suitability for any poison category 3). Side effects / can be allergic 4). Impact for people who suffering other illnesses