Dengue control agents suffer from refusals in SP – 11/28/2023 – Health

“The boss isn’t there and I don’t have authorization to tell you to come in,” says an employee. “Don’t worry, no. There’s no dengue here,” says a resident. “I don’t have a potted plant,” claims another.

These were some of the phrases that agents fighting endemic diseases from the São Paulo Municipal Health Department heard over house intercoms during an action in the Cidade Jardim neighborhood, in the south zone of the capital of São Paulo.

During visits, professionals provide guidance and eliminate stagnant water in tires, bottles, gutters, slabs and other places that serve as mosquito breeding sites. Aedes aegypti.

Last Thursday (23), the Sheet followed part of the work of a team of agents in Cidade Jardim, a place where the refusal rate is around 30%. The unofficial estimate was made by Covisa (Health Surveillance Coordination).

During the action that the report followed, of the 15 properties approached, six of them residents or employees refused service. In another three, those who answered agreed to the inspection. In the others, there was no one home at the time or the property was closed.

“This work is great and should always be done. Especially us, in this region that is very wooded and has many swimming pools, we should allow agents to come in and provide guidance. Guidance is the main thing”, says economist José Luiz, 71, one of the residents who accepted the guidance.

In the opinion of infectologist David Uip, dean of the Centro Universitário Faculdade de Medicina do ABC, the population needs to understand the importance of the agent’s work and serve him well.

“Field work is fundamental. But, before doing so, it is necessary to raise awareness among the population. They have to know that they will be visited by health agents who are looking for prevention, not culprits”, says Uip.

“In parallel to this, there is the insecurity of the population. People don’t want to open the doors when they don’t know if it’s an agent or if there’s another individual there”, he adds.

Another factor that Uip raises is the population’s disbelief regarding the possibility of dengue fever being serious.

Experts are already warning about the presence of dengue serotype 3 in the country after being missing for around 15 years. Anyone who has contracted types 1 and 2 may have a severe form of the disease if they contract type 3.

“Dengue is more frequent, more prevalent, more serious, with clinical forms that we didn’t see before. In the past, the severe form was hemorrhagic. Today you have myocarditis, an important inflammatory process of the heart, and dengue encephalitis. People die from dengue. When there is dengue, what does the doctor do? Try to sustain life. You don’t have the medicine that goes there and kills the virus. The seriously ill person has to be admitted to the ICU and treated”, says Uip, who was state secretary of Health of São Paulo and also of Science, Research and Development in Health.

In the residences where it was possible to enter, the agents found a disused toilet that had stagnant water and used dishes under vessels that had accumulated water.

The ideal is not to leave any container under the plants, but if you have to, it is necessary to fill it with sand to the brim. In the Cidade Jardim region, it is common for agents to encounter inappropriate situations, especially with bromeliads —which also accumulate water— and swimming pools.

The endemic disease agents, Luciana Pacheco Lima, 44, and Rafael Carvalhais Régis, 40, work in Capela do Socorro, also in the south zone of the capital. In the role for many years, the two report that the number of refusals is currently the highest. And it’s the population’s insecurity to blame.

“The first barrier we need to break is the trust of the house’s employee who we need to enter to carry out the action. When the owner is difficult to let him in. The population is afraid and we need the media to help us”, says Lima.

“Once, I went to a house and the owner didn’t allow us to enter. A week later, her son became ill, positive for dengue fever. The lady was crying a lot, desperate, because she had banned us from entering a week before. Today she is a collaborator and opens the door for the agents to enter”, says Lima.

Luiz Arthur Caldeira, coordinator of Health Surveillance in the municipality, states that the refusals are linked to safety problems, but the main reason is the low perception of risk in relation to dengue.

“We went through this Covid drama, a serious illness, which ended up lowering in people’s consciousness and perception the level of severity of almost all other illnesses,” says Caldeira.

The professional states that acceptance varies according to the season. At times of high transmission, health workers face less resistance when entering homes.

“The perception of risk changes when you are in contact with the disease or in times when there is no transmission and dengue is not close to you. So this low perception of risk, of prevention, leaves people in a kind of comfort zone to not let the agents enter the houses”, he adds.

Until November 16, the city of São Paulo registered 12,814 cases of dengue, 9.9% higher than the same period in 2022 (11,658). Ten people died in 2023 and two last year.

In the administrative district of Morumbi, where the Cidade Jardim neighborhood is located, the incidence rate is 90.7. In 2022, it was 102.5 and in 2021, 37.5.

The index in the capital of São Paulo is 106.7 per 100 thousand inhabitants, the number used to make the calculation. There are three incidence levels: low (less than 100 cases), medium (100 to 300 cases) and high (more than 300 cases).

How to identify a team of agents to combat endemic diseases

Throughout the city, there are around 2,200 agents working. They arrive in groups, boarded in official cars from the City of São Paulo – white minivans stickered with logos of the Department of Health and SUS (Unified Health System). They always wear an identification badge and blue uniform. On the pants and vest it says Health Surveillance.

If in doubt, simply call 156 or check the secretariat’s website for the phone number of the nearest health surveillance unit, call and confirm that it is the team carrying out the action on site at that time.