Jiggers 2014

 The following is a write up for the jiggers outreach project I did, and am still working on. This accompanies the photos found here: 

https://plus.google.com/photos/109970147349795773741/albums/5980991282905692929?banner=pwa

I wrote this because the staff here wanted to send the photos and project information into head quarters. And since I have been so horrible at keeping up with this blog, posting this here at least gives you all a little glimpse of what I've been working on! 

"My first assignment in what would be my home for 2 years, Chebukaka in Western Kenya, was to determine the needs of my community. While walking the villages and attending meetings with my community health workers, several health needs became evident.  Malaria rates are high, the interior villages had limited access to clean water and there was an overwhelming presence of jiggers. I initially learned about jiggers in a graduate course and was fortunate to be able to work closely with another volunteer to learn a great deal more. My community health workers and I agreed that jiggers had to be a priority.

We, members of my community and I, wrote a proposal for a Peace Corps grant opportunity, the PCPP grant. The PCPP grant allows you to present your proposal to family, friends and strangers alike and they are able to make a tax-deductible donation towards your project. This grant allowed us to request more money than other opportunities, which we needed because the medicine required for treatment is very expensive.

I knew this event would have a major impact on the community if implemented properly so I put a lot of effort in planning. First, I created a registration questionnaire for each participant, which was completed before the treatment event. This would allow us to find out shoe sizes of each participant and have a comparison for our follow up surveys.

On January 24^th, a representative from the national jiggers campaign came to train the community health workers as well as the staff of the health dispensary that serves as my host organization. This training lasted five hours and covered everything from exactly what a jigger is, how to treat and prevent them, and how to help those who have been cured of jiggers to reenter their communities and find work or go to school.

January 25^th was our initial treatment event at the dispensary. The 200 registered participants all came, as well as several other members of the community who had heard about the event. The community health workers and staff, as well as four of my fellow volunteers came together to treat the people from the Chebukaka area affected with jiggers.

We opened with a prayer, and gathered up basins of water and diluted one tablespoon of potassium permanganate in five liters of water to create a treatment solution. The area was set up in stages. Each participant waited in shaded areas for their turn to go through the treatment system.  Each participant received a piece of soap for cleaning the affected area, oil to prevent skin cracking, and a towel, which was organized in individual bundles before the event and distributed to the CHW’s who then distributed to the participants they were responsible for. Medicine was also allotted to each household for treatment after our initial event.

To begin treatment of jiggers, the first thing you must do is to wash the affected areas thoroughly. This not only softens the skin but also gives you a clean and clear picture of where the jiggers are. This is done as gently as possible, because jiggers can be itchy and very painful. Next it is important to clip down the finger and toenails if necessary in order to expose the infested areas if they are underneath the nail. After this you soak in the potassium permanganate solution (dark purple in color) for fifteen minutes, three times per day for two weeks. This slowly removes the jiggers from the person’s body, and is not painful. However, the solution can cause the skin to dry out, which is part of the reason you then dry off and apply oil, or Vaseline to the affected area. This also will suffocate and help kill the adult jiggers living in the body, because they breathe through the opening to the environment they have created. This process must be done completely in order to ensure that you fully rid the patient of the jiggers in all affected areas. After treatment of all the participants, everyone was treated to lunch and my health workers and I discussed our timeline for the next two weeks.

Our first week after the event, we proceeded to each household that we registered, and fumigated the home. To do this we used Sevin Dust, which was spread throughout the houses to kill jigger larvae and to help fight bed bugs in the participant’s homes. During these visits, we made sure to check in on the treatment progress, as well as discuss good hygiene practices with the families.

The second week after the initial treatment day, we once again did household visits to each of the participant’s homes. However, this time we were distributing bed nets and Water Guard. Malaria and water borne diseases such as typhoid are a huge issue in our area, and attacking as many health issues as possible while making sure the treatment was faring on well was one of our goals. To ensure bed net use, the community health workers reached each house first with the net to explain its importance and to open it up and give it 24 hours to air out. The next day together we would go and assist the family in hanging the nets over their sleeping spaces, hoping that this would improve proper usage. The community health workers explained the use of the Water Guard provided, and how to use it was demonstrated if necessary.

Exactly two weeks after the initial treatment event on February 8^th, the participants were invited to return to the dispensary. We were now going to distribute a pair of shoes to each of these newly jigger free community members. In order to try and ensure proper usage, we took the shoe sizes previously given in the registration process and purchased them accordingly. Each pair of community health workers was responsible for twenty participants; each CHW received a bag with their participant’s information inside to create a smooth distribution process. This was very successful, and only one or two changes had to be made. At this event, we also took the opportunity the say thank you to all the donors who made this event possible, both individually and as a group. We would not have been able to do this project and help the community without them!

During the campaign we reached over 250 community members, and are continuing to do so, with a goal of up to one thousand before I complete my service. Some extra medicine has been purchased and we have begun to reach out to schools in the community, as well as continuing to go door to door within the most remote parts of our sub location’s villages. We are also doing follow up with our initial 200 participants to see how well the preventative measures are working. With almost thirty well-trained CHW’s and dispensary staff, proper treatment of jiggers will be able to continue in my community long after my departure."