Bilharzia, or schistosomiasis, is a waterborne disease that causes ill-health and can kill, if left untreated. Lakeside communities, especially children, are most at risk, as they fish and play in the waters. But many community members do not take treatment. What is the best way to raise awareness?
Becky McCall sheds some light on ‘Acting Against Worms’ in Uganda
A young girl, Auma, lived with her family on the shores of Lake Victoria, Uganda. Auma fished, washed and played in its waters. One day, the Ministry of Health visited the village and gave the local children drug treatment for bilharzia, a debilitating worm disease common among lakeside communities. Fearing the medicine was harmful, Auma’s school friend told her to refuse it. Auma became ill with bilharzia and eventually died. This sad story is being acted out by children, just like Auma, from Busiabala primary school, Uganda as part of a local health education project called Acting Against Worms (AAW).
Worm parasites, which cause bilharzia, or schistosomiasis, live part of their life-cycle in snails found in freshwater and part in humans. Lake Victoria, a 68,800 km2 stretch of freshwater, supports a thriving fishing community around its shore and due to regular contact with the water, the local community has the highest prevalence of bilharzia in Uganda.
A lakeside district called Busia has one of the lowest uptake rates for annual drug treatment of bilharzia. Prevalence rates dropped by just 75 per cent compared to other parts of Uganda where it reduced by up to 90 per cent. AAW chose Busia as the Ugandan district most likely to benefit from activities aimed at changing behaviour related to bilharzia infection and transmission.
The Schistosomiasis Control Initiative (SCI) aims to control levels of the disease through drug administration and supports the AAW project. AAW aims to provide appropriate information, education and communication to widen the knowledge and ultimately change behaviour of individuals at high risk. The project primarily connects with school-age children, who are most at risk and are more likely than any other group in a community to be infected. As well as swimming in the lake, many follow family tradition and fish for a living, in addition to attending school. Similarly, school children are also most prone to other parasitic and bacterial diseases such as giardiasis, cholera, typhoid and trachoma, so efforts to improve hygiene could help reduce these diseases too.
Drama workshops with schools
AAW began work in Uganda with a series of drama workshops in October 2009. Nine schools were chosen to
participate in developing short plays or ‘skits’ based on bilharzia transmission and prevention. These were then performed at a Busia drama festival in April 2010. School children, parents and other people from the local community were invited to watch, discuss and judge the plays. Nine further schools participated as controls. They completed questionnaires and collaborated in focus group discussions, but did not receive any drama training. AAW will conduct an evaluation exercise to both learn, and hopefully expand, the project.
AAW is working with a drama production company called ‘Theatrescience’, which is based in the UK. Aimed at engaging new audiences with medicine and science, drama practitioners, Rebecca Gould and Jeff Teare aim to spread relevant health messages outside the immediate scientific and medical communities. Gould and Teare are helping school children in Busia to structure their stories for performance.
“Unlike a list of facts, a story leads us somewhere; it takes us on a journey and in this case the journey is incredibly important. The stories are also about their own lives and tell us about their feelings, preoccupations and hopes for the future. Sharing their stories with their communities is very important. Their mums and dads, brothers, sisters and neighbours will be able to see what they have learnt about bilharzia but also what their concerns and views are about improving the situation,” said Gould.
Science and health often suffer from being taught in a rigid and formulaic way. Drama helps pupils to see a topic in a new light, which may mean more in the context of their daily lives. During a week of drama workshops in Uganda, Theatrescience encouraged the children to become less inhibited and express concepts and behaviour relating to bilharzia through mime, song, and dance. Gould explained what was happening while the children imitated people suffering from the disease by rubbing their swollen bellies, and walking with exaggerated pain. “This makes them think about how the disease might affect their bodies and make them move, so they can use this in the play. It helps them understand how to see a character in a play,” she said.
Robert Mulimba leads the Ministry of Health community health work for Busia district. Whilst assisting with the drama workshops, he explained the issue of disease control in the area. “Getting treatment is one thing, but instantly stopping the way people use water [infected with bilharzia] is another. We need to keep giving information to schools and the community because we know that behaviour takes time to change. We need to discuss how people can get bilharzia and the activities that transmit the disease: so, humans defecate in the water, transferring the worms to snails, which then release more worms into the water, to infect other humans and repeat the cycle.”
In Uganda, effective worm control is led by local district and sub-county leaders, health institutions and community based organisations working at the grassroots. It is a combination of all their efforts that will make the reduction of bilharzia a success.
Medical journalist and researcher for Acting Against Worms
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