Saturday, September 13, 2014

A Personal Side to Dengue

Kelsey Sumner

"Mosquito repellent? Hat? Long sleeves? Pants? Water bottle? Sunscreen?" My classmates and I were rattling off this list while stepping into the OTS coaster to head to the day's activity. We were going to Naranjal for the morning to work with the CCSS and Ministry of Health to raise awareness of the symptoms and spread of Dengue Fever. Dr. Alvarez, a local physician, was leading the project. But why is Dengue so prevalent in this area? It's probably due to the habits of Naranjal's citizens.
Naranjal is one Costa Rica's Dengue hotspots having one of the highest rates of infection in the Sarapaqui region. It is primarily a squatter settlement with the majority of its occupants either illegal immigrants or plantation workers who move with every harvest season. Because families are there for such short periods of time many don't take precautionary measures to safeguard their homes from diseases like Dengue. This apathetic attitude is one of the main reasons why Dengue Fever is remaining so rampant around the world. We were determined to change this mentality and lessen the amount of Dengue infection in Naranjal.
After a short presentation, we set out into the community armed with clipboards and surveys. "Opeee!" we yelled, approaching our first house. "Opeee!" We could hear movement inside, but no one was coming out to greet us. After a few minutes, a middle-aged woman hesitantly opened the door. Dr. Alvarez quickly introduced us. Then we plunged into the survey, asking how many people lived in her house, if anyone had been diagnosed with Dengue, and if we could walk around and look for mosquito larvae. The woman verbally consented, but with some reluctance. We then traipsed about her yard, peering into tires and wells and pointing out any places where improvements could be made to prevent standing water and mosquito breeding.
Throughout this process, I could not help but feel intrusive. Here we were, six American students who could speak minimal Spanish, showing up at this woman's doorstep and instructing her on how she should maintain her yard and protect her children from Dengue. We rushed into the project without stopping to ask the woman how she was doing or if it was a good time for us to be there. The interaction seemed impersonal and I felt like we treated her more like a "subject" than a real person.
During the second week of the semester, we had a lecture on global health ethics. In it we learned that a researcher should always give an accurate debriefing of the intervention to the participant, obtain informed consent, and practice confidentiality. All of these points we upheld during the Dengue activity in Naranjal, but we were still missing a key part of the intervention. Albert Schweitzer, a famous medical missionary, once said, "The first step in the evolution of ethics is a sense of solidarity with other human beings" (Schweitzer). With any type of research or intervention involving people the personal interactions need to be taken into account, because they can affect the study's results.
The Dengue activity with Dr. Alvarez was an amazing and eye-opening experience for me, teaching valuable lessons about disease prevention and awareness. We were able to reach a wide range of people and give them suggestions that could help lower the prevalence of Dengue Fever in Naranjal. I would love to participate in the activity again; however next time, I want to develop a more personal relationship with the participants.

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