Schistosomiasis

Through persistence at our practice in Holland Park, my partner Dr. Pam Rosengren and I have identified a number of cases of Schistosomiasis. The problem in my suburb is occurring in the North African immigrants from countries such as Ethiopia, Somalia, and Kenya. This population group features prominently due to the siting of public (state) subsidized housing in this area.

Our approaches to SZPHU (Southern Zonal Population Health Unit) have accepted the problem occurring but have done little to assist this practice follow up the high-risk population group. All the work in my practice has been done using my private staff to do public health follow up of the at risk population. My practice is still collating its statistics, but as many as 1/3 to ½ of the population group is affected, (similar statistics to those collated from US immigrants from those same countries, by the University of Washington>). The public health interest in the problem is exacerbated by the removal of Schistosomiasis from the notifiable diseases list, in this state at least. The public health approach is hampered by my staff not speaking the ethnic languages involved, politics between the racial groups involved and religion which inhibits contact to the families by myself, (a male).

The at-risk population from those countries comprises several thousand people Australia wide, from these countries alone. The problem is not unique to this group and is likely to affect a number of other immigrant populations. Currently in Qld, there is no systematic program to identify and treat these people. The current programs have either been cancelled or their reach is dubious.

There also exist substantial risks to these people in their poor understanding of nutritional issues and the high endemic incidence of other parasitic diseases. Patients at our surgery from one of the cultural / ethnic subgroups have eaten diets composed “solely” of potatoes during pregnancy and others are unaware of the risks posed in eating raw meat.

I would seek your assistance to:

Add Praziquantal to the NHS PBS pharmaceuticals list. Some consideration should also be given to other pharmaceuticals being made available. We have currently organised better access for our patients through the Princess Alexandra Hospital, due to good cooperation from Dr. James Griffin as well as infectious diseases specialists. This does not solve the problem for many other people outside the PAH’s catchment area.
Organize a Population health based approach to this problem on an Australia wide basis, focusing on case finding in high-risk refugee groups. The approach should be sensitive to the ethnic and cultural conflicts existing amongst some of the immigrants and should seek to involve the communities in recommending the testing of high-risk populations.
Assist with the development of education materials appropriate to a child’s level of education, for dissemination within family groups.
Assist in the translation of these prepared texts.
Assist in destigmatising infection with the parasite. We have had some problems faced by our new Australians due to prejudice from the general population due to fears of the spread of infection.
Organise research on the knowledge that there may be a vector suitable for the parasite transmission in some parts of Australia, (namely snails in the Ord River).
Make available general health and nutritional advice to arriving refugees and immigrants especially from third world countries. These groups have a need for information in addition to learning the English language. I believe we do not realise how much of our knowledge of health is transmitted by mass media and our own culture, from which these people are isolated.
Add disease education as a topic to the school education system with an emphasis on Schistosomiasis, malaria, & worm diseases.
Add Schistosomiasis to the list of notifiable diseases, to allow family group counselling re risks of infection.

My partner and I plan to publicize awareness of the problem in the media soon. We have already received some exposure through a segment on the Channel 7 News in Qld. We are currently negotiating with some leaders in subgroups in the affected community. We hope to galvanize their involvement in assisting the communities themselves becoming involved in promoting awareness of the health issue affecting their communities.

Yours Sincerely,

Andrew Pluta MBBS