Reducing Health Risk from Mercury and Arsenic through Health Promotion Education and Training

in Geita District, TanzaniaDenise Hartsock, MPH Candidate, Colorado School of Public Health, University of Colorado Anschutz Medical CampusElias Charles, MPH, School of Public Health, Catholic University of Health and Allied SciencesLevi Bonnell, MPH Candidate, Colorado School of Public Health, University of Colorado Anschutz Medical CampusDeborah Thomas, PhD, Dept. of Geography & Env. Sciences, University of Colorado Denver

Contact E-mail:denise.hartsock@ucdenver.edudeborah.thomas@ucdenver.edu

6-Year UCD-CUHAS Collaboration & Partnership

Sosprato E. Ngallaba MD, Elias Charles MPH,

Daniel Makerere MSc

Deborah S.K. Thomas PhD

UCD-CUHAS Collaboration

• Objective 1: Building capacity in Tanzania: Basic health & disaster GIS groundwork (conceptual, practical, and technical aspects).

• Objective 2: Establishment of evidence-based projects to support public health, health service delivery, and disaster management decision-making.

• Objective 3: Tanzanian and U.S. student engagement.

• Objective 4: Seeking strategic and sustainable funding sources to support all elements.

UCD-CUHAS Collaboration

• Three primary research-based projects• Two currently funded through NIH and Touch

Foundation

• GIS training module developed and delivered 4 times in open source software

• 29 CUHAS students and 17 U.S. students have participated in activities• 10 independent UCD student projects, including 1

masters thesis, 3 honors theses, 3 capstone projects, 2 undergraduate research opportunity projects, and 1 PhD dissertation

• 4 Tanzanian MPH student theses supervised

6-Year UCD-CUHAS Collaboration & Partnership

CUHAS, MwanzaGeita DistrictApprox 6 hr drive

Work in Geita District • Artisanal gold mining area in Tanzania• Elias Charles’ Thesis, 2011 (Deborah Dewey, Deb

Thomas, and SE Ngallaba; co-supervisors)– Knowledge and awareness of of health risks associated with

arsenic and mercury contamination from artisanal gold mining– Environmental Monitoring– Now the MPH Director

• Mary Joseph’s Thesis, 2012 (Deborah Thomas, Shahirose Premji, and Elias Charles; co-supervisors) – Knowledge, practice and awareness of geophagy practices

among women attending antenatal clinics

• Denise Hartsock’s Practicum/Capstone, June/July, 2013

• Medical Student Fieldwork, August, 2013– community health assessment (sanitation and nutrition)

Outline

• My background/overview• Objective• Exchange with Village Leaders –

Rwamangasa• Rwamangasa Mining Site Visit• Methods• Findings/Themes• Development and key elements of draft

educational materials• Discussion• Next steps

My Background

Burden of Artisanal Mining

• UNEP-Hg emission from small scale gold mining, particularly in developing countries pose a significant and increasing environmental health risk (UNEP, 2012)

• January 2013, UN formed a global treaty to reduce Hg emissions and releases worldwide

• 10-15 million people participate in ASGM worldwide in >55 countries

• In Tanzania, there are 0.5-1.5 million artisanal gold miners, 30-50% of whom are women

• In the Geita District of Tanzania many are unfamiliar with Hg and As toxicity and their symptoms

Objective

• To develop a culturally appropriate first draft of educational materials for health workers in the artisanal gold mining areas of Tanzania, East Africa.

Exchange with Village Leaders -Rwamangasa

• Elias Charles presented his research findings– High levels of Hg in cassava leaves– Water is contaminated in many areas

• Village leaders very receptive– Of all the researchers who have done work in

Rwamangasa village, Elias was the first of to return and present his findings

– Requested education – Offered ideas on how to protect their villagers

moving forward

Methods – Rwamangasa Site Visit

Methods – Rwamangasa Site Visit

Methods – Rwamangasa Site Visit

Methods – Qualitative Data

• 4 focus groups• 1 key informant interview• 1 informal discussion• Questions focused on:

– Why heavy metal toxicity was misdiagnosed?– Questions health workers could ask to

increase proper diagnosis?– What can health workers tell patients

diagnosed with heavy metal toxicity?– Best methods to increase awareness and

understanding of heavy metal toxicity for both health workers and miners?

Themes from the Data

• Barriers – Lack of knowledge of…

• Signs and symptoms of heavy metal toxicity• Methods and importance of protection

• Improving knowledge– Of health workers– Of miners

• Education for Behavioral Change– Using protective gear– Using a retort

Draft Materials – Comparison of Symptoms

Draft Materials – Heavy Metal Toxicity Basics

Discussion

• Lack of knowledge among health workers and miners largely contributes to the problem of heavy metal toxicity.

• Many misperceptions will need to be addressed in order for miners to change their behaviors.

Next Steps

• Meeting/review of training by the CUHAS medical students and the Geita District Medical Officer (DMO).

• Pilot with a group of community health workers.

• Modify as needed.• Begin to educate community health

workers and artisanal gold miners.

Thank You!!