From never treated to behavior change champion: LF treatment in Haiti

Community Connection with Health Facility Inspires Locally-Led Behavior Change 

Majorie is one of the people who has never been treated for LF, and in fact, she strongly resisted taking the medicine every time it was distributed in her neighborhood. She had not heard information about the disease before, and so did not trust the community drug distributors when they were distributing the medicine in her area. In collaboration with Haiti’s Ministry of Public Health and Population, Act | East partner, WI-HER supported interviews with local community members and learned that this is a common reaction among urban residents, who are generally wary of fraud, and of being taken advantage of compared to rural residents.

Due to her history of resistance to LF medicine, Majorie’s local health facility invited her to come in and participate in a focus group discussion. She and about 45 other community members shared with the local nurse why they had not taken the LF treatment before. Many women in the discussion shared concerns that the medicine could cause drowsiness, hindering them from accomplishing their daily responsibilities, and that their male partners feared the medicine would cause them to have prolonged menstruation. Men in Plaine-du-Nord shared that they were afraid the medicine would have side effects for them as well. Both men and women reported not taking the preventive medicine in previous campaigns because they did not know why the medicine was being distributed, and expressed the importance of medical doctors’ guidance in their health decision-making.

During the discussion, the health workers shared with the group how debilitating LF can be, especially when left untreated over many years. They also addressed the misinformation around LF, and explained that the local health facility leads medicine distribution in the community and so it is something they can trust.

Majorie was deeply impacted by the discussion on LF. The information she received about LF and its treatment transformed her from being resistant to taking the medicine to wanting to be part of the solution. Majorie understood that LF is a severe problem and approached the health facility staff after the session to volunteer to be part of the campaign to eliminate LF.

“As someone who strongly refused the drug before, I can understand people's reservations and fear, thus I am able to talk to them and encourage them to get the treatment.” she explained.

The health facility invited her to become a member of a 7-person behavior change team (BCT) composed of community leaders like local teachers and business heads. Majorie was the only member of the team who did not already hold a prominent position of influence in the community. This shift from resisting the LF medicine to becoming part of the BCT and promoting community change, is remarkarble as Marjorie is the only community member to have undergone this transition.

As part of this team, Majorie received further training on LF, and the importance of preventive medicine. Majorie and the rest of the team discussed the common misconceptions, fears and information gaps their community has, and created an action plan for how to address them.

“I wish the health center would have invited me earlier to have more information on filariasis. In the process I learned many people do not take the drug because of lack of information on why it is important.”

Majorie and her fellow BCTs developed and tested solutions to overcome these barriers to medicine acceptance: for example, they conducted door to door visits, phone calls, and one-on-one education sessions with community members who had never been treated before, using their knowledge of the community to answer people’s questions and quell people’s concerns. The BCTs continued to answer community questions in the weeks leading into the medicine distribution through Whatsapp groups, an approach well-suited to urban residents more wary of house visits and interactions with strangers.