Factory Screening and Health Promotion team

Out of half a dozen medical projects in Pakistan by MSF, one is in Machar Colony, Karachi. It is a hepatitis C clinic based in one of the largest urban informal settlement in the largest city of Pakistan. While the teams in the project focus on high quality diagnosis and treatment facilities, another major component is health promotion.

Health promotion team is linkage between the clinic and the community. Since 2018, the HP team has been working on active case finding. It is a major component of HP strategy for 2019, as we focus on fish factories in the area. Not to forget, Machar Colony is located on the fish harbor with a significant population involved in the fishery business.

In Machar colony, there are two types of fish factories; formal and informal. HP team decided to go to the fish factories and screen or test their workers for hepatitis C. It was assumed that the high-risky occupational hazards make them more vulnerable to be exposed to the HepC virus.

Before implementing this pilot programs HP team did a lot of homework, thinking about how to approach and access the fish factories. It was not easy to go and convince their executives for screening of their labour.

HP team reached out to the community leaders and informed them what we were planning. When HP team shares fish factory testing planning with community leaders, they appreciated the idea, believing that the idea will make sense and work well.

One of the elected members of the local body not only created a link between the fish factories, but also came along with the health promotion and the medical teams to start a screening in a fish factory.

During the screening, the people tested were also counseled about Hep C, transmission and prevention. We also considered the language barrier. Machar Colony hosts different communities including Bengali and Burmi; hence MSF ensures the presence of people its team who can speak the same language. We provided pre- and post-counseling to all people tested. For people tested negative we emphasized prevention messages, and the people tested positive were given appointments and explained how to reach our clinic for further tests and treatment. We also talked to supervisors about prevention in work environment to avoid risks of infection of themselves and the workers, and reinfection of workers we will treat.

After a very successful pilot run, HP team get support from many colleagues those were motivated to join next fish factory screening. We planned the second screening drive in January 2019. We were more confident and prepared this time, learning from our experience. HP team one day before the testing held a Hep C sensitization and screening demonstration session in the fish factory. This session motivated the people working there, and builds rapport before testing.

HP team is very optimistic to screen informal fish factories as well, because the informal fish factories have more local employees from the area including females from Bengali and Burmi communities. These communities have very limited access to healthcare: some of the still living with status of migrants.

HP team is playing a major role to engage the communities in Machar Colony for hepatitis prevention. We dream to reach out to every household in Machar Colony to eliminate hepatitis C disease in the area. HP team is also linking people with positive screening results to the MSF clinic. It is also the HP major team’s responsibility not leave anyone behind. For the two formal fish factory screenings done, 13% of them had positive screening tests. For the informal fish factory/ community screening activity, 30% had positive screening tests. The HP team facilitated them to reach the clinic to receive further workup, and eventually take the Hepatitis C medicines.

By building trust through communication with the people, the HP team has a very important role in community mobilization in our efforts to address the Hepatitis C burden in the country. With our results, we can say that fish factory workers have high risks for Hepatitis C transmission.