As a public health physician that has previously caused Medicins Sans Frontieres in Sierra Leone and Turkey, I've just finished an assignment establishing an urgent situation community health surveillance system in Palorinya refugee settlement, northern Uganda.
Approximately 147,000 South Sudanese refugees have settled in Palorinya over the last couple of months, fleeing conflict and violence. With your high numbers, the reception centers and emergency response systems happen to be stretched. This really is compounded by insufficient use of water, sanitation, shelter, food and access to basic healthcare.
Health surveillance systems help monitor and detect changes within a population to assist inform medical and humanitarian interventions. We also use the information and knowledge to advocate for more services using their company organisations that may offer the refugee population with such things as latrines or hand washing facilities.
The team collects details about births, deaths and sickness from individuals through weekly household interviews, whilst collecting medical data from health facilities around the settlement. Household interviews really are a vital part of our data collection work, as we can develop a better knowledge of peoples lived experiences and requires, instead of only coming in contact with those people who are in a position to visit health facilities.
The importance of emergency health surveillance in large refugee settlements
In acute emergencies such as this, when large communities are in chaotic new environments and new countries, it may be tough to understand their health status, making the population particularly prone to epidemics and diseases. Outbreaks of infectious diseases are typical; in addition, the rainy season increases outbreaks of diseases like malaria, and often hinders use of health services. A functioning health surveillance system helps us detect changes in the healthiness of the population, meaning we are able to respond to identified needs.
We have trained a group of over 100 surveillance officers from inside the refugee settlement with the hope that they are more familiar with local customs, language and culture, and can collect better information on sensitive topics such as deaths. We use this data to inform medical activities, and project trends such as birth and death rates across particular areas and age groups.
These teams also perform a vital job in ensuring that sick people from the community are referred to the centers.
In my previous couple of weeks in Uganda, surveillance teams identified several stillbirths, neonatal deaths and a maternal death within an area of the settlement. This gave us an indication that ladies are facing challenges accessing sufficient look after the antenatal and postnatal period, in addition to emergency obstetric care. In reaction, MSF has expanded women's healthcare services to these areas.
Health surveillance also allows us to identify diseases of epidemic potential quickly, which means that we can respond at an initial phase to reduce its impact. For example, when among the community surveillance teams was on a routine household visit recently, they learnt in regards to a woman who had passed away. Without that visit, her death would unlikely happen to be recorded anywhere, and we wouldn't have been aware of her illness. Our teams found out that she'd developed yellow eyes and symptoms consistent with a hepatitis infection before her death. Identifying this enabled us in order to increase community surveillance in that area on acute jaundice syndrome, which may indicate a hepatitis infection, also it meant that our medical staff and sanitation staff could respond appropriately.
When I arrived within February in the height from the displacement, it was overwhelming even going to imagine how to start with establishing the surveillance system. It was a big task but by mid-March the surveillance team had managed to visit over 10,500 households and surveyed over 41,000 people. Information is delivered every week and it is been hugely gratifying to see the interaction between your community and MSF in shaping the emergency response.
I feel lucky to have been here, to determine emergency surveillance from the beginning of an intervention, and to see it working. Most importantly, it has been great to determine how our overall health surveillance system is enhancing the community.