Battling AMR at the Community Level
By: Wilma Z. Mui
May 30, 2017
The issue of antimicrobial resistance (AMR) is a growing problem that has the potential to spread rapidly around the globe. In my personal experience as a Peace Corps Volunteer in Senegal, I saw the factors that are contributing to the rapidly evolving AMR. I would see the “medicine man” who would bike into my village with a wide assortment of medications—some marked, others in mysterious packages—promising a cure for a wide range of ailments. Upon closer inspection, these medicines included ibuprofen and acetaminophen, but also an assortment of antibiotics. I strongly discouraged my community from purchasing these medications, but as a medical consultation and medications at health centers could easily exceed the cost of feeding a family for a week, the medicine peddled from the back of a bike was highly tempting.
I saw firsthand the thought processes of not completing a course of antibiotics. Imagine this: A family takes their son to the health center and is prescribed an antibiotic to treat the disease. The family finds the money to purchase the expensive course of medicine. They give it to their son and after a few days, he gets better. The family stops giving him the medicine, deciding to save this expensive medicine for the next time a child gets sick. This scenario occurred during my service, and because the mother was a close friend, I was able to convince her and her husband to complete the course of medication.
In the world of global health, where a wide and diverse group of actors are engaged, cooperation and communication is key. The WHO provides technical assistance to countries in creating their national action plans, working to strengthen systems so that countries can adequately prevent and manage AMR. Faith-inspired organizations (FIOs) often link international and governmental programs to communities, acting as the implementation partners for large multi-country programs. FIOs create curricula and conduct trainings for healthcare workers, discussing best practices, new strategies, and current technologies.
There is not a lack of information, but gaps exist in communicating it at the community level, particularly in very rural areas. Even if all healthcare professionals are trained and have all the necessary information, places where access to healthcare is limited or non-existent are excluded from this knowledge. Thus, information sharing cannot just come through the health structures. Faith networks and religious leaders can bridge the information gap, providing critical information to communities. Formal and informal faith networks exist in many communities, and with increased access to radios and cell phones, those networks are in constant communication. Working within the established networks to share critical information can be an asset. Religious leaders are powerful voices within the community and strive for the well-being of the community. Important health issues, including AMR, align with their goal of maintaining a healthy community.
The challenge is in identifying the informal networks. Despite their crisscrossing countries and regions, these vast networks are not easy to find. Working closely with communities to identify the networks is important and can open many doors to the dissemination of information. Another challenge is making sure not to instrumentalize religious leaders. Rather than simply using religious leaders to spread messages and reach community members, religious voices should have a place during the development of action plans. Their intimate knowledge of community needs could and should be included at the ground level.
AMR, as with other global health challenges, is evolving and changing. In order to not only catch up with the issue, but to get out ahead of it, timely communication and dissemination of information and a willingness to involve and work with religious leaders and communities is necessary.