Impact of - IDL-BNC @ IDRC - International Development Research ...

At the community level, the extent of morbidity occurring as a result of
unintentional exposure of farm workers is largely unknown. Field investigations
in 1981 found that all farmers interviewed (30 in the northeast and 30 in
the south) reported symptoms suggestive of poisoning after using pesticides
(Foo Gaik Sim 1985). In a community survey of 10 000 adults in the coastal
province of Rayong, 24% of those who used pesticides indicated that they
experienced symptoms, but 95% of these had never reported to a health-care
worker (Wongphanich et al. 1984). In other Asian countries, incidence of
poisoning among pesticide handlers is about 7% per year (Jeyaratnam 1987).
Hospital records of poisoning cases seldom contain such important details as
the nature of the poison and the route of exposure (Wongphanich 1985). This
is a tremendous loss of valuable information on which practical interventions
and preventive community strategies could be based. Meaningful improvement
can only come about with changes to the current attitude and performance
of health-care workers, especially physicians because of their
important leadership role.
Current physician training consists primarily of diagnosis and treatment of
acute cases of pesticide poisoning presenting at hospitals. Little or no attention
is given to the nature of the problem at the community level or the role a
physician could play in promoting health and safety education programs,
accepting responsibility for data collection, and helping to direct public-health
resources toward preventive strategies.
A second more general concern arising from conventional physician training
is the lack of critical evaluation of diagnostic tests and treatments. In Thailand,
as elsewhere, there has been widespread proliferation of ineffective and costly
laboratory tests, often used with unreserved faith in their accuracy and usefulness.
For example, although the measurement of acetylcholinesterase activity
may help confirm the biochemical effects of organophosphates and
carbamates, sole reliance on this test can lead to gross underrecognition of
cases, because the test currently used in screening has a sensitivity of less than
50%. Proper orientation to the clinical epidemiologic principles needed to
evaluate such tests is essential. The wide range of normal enzyme activity
levels and the inability of a single test to determine the actual decline in activity
(in the absence of baseline measurements) are other factors that require
consideration.
Conclusions
Two Thai medical schools are incorporating the CTPB pesticide module into
their curriculum (Chulalongkorn and Thammasat universities). Both of these
schools have taken on a major commitment to a community-oriented medical
curriculum. If the module proves to be effective, it will be modified and
updated.
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