Health work and skills in the last mile of disease elimination. Experiences from sleeping sickness health workers in South Sudan and DR Congo

摘要

Human African trypanosomiasis (HAT) is considered a highly promisingcandidate for elimination within the next decade. This paper arguesthat the experiential knowledge of frontline health workers will becritical to achieve this goal. Interviews are used to explore the ways inwhich HAT workers understand, maintain, and adjust their skills amidstglobal and national challenges. We contrast two cases: South Sudanwhere HAT expertise is scattered and has been repeatedly rebuilt, andthe Democratic Republic of Congo (DRC) where specialised mobiledetection teams have pro-actively tested people at risk for almost acentury. We describe HAT careers where skills are built throughparticipation in HAT technology trials and screening programmes; in theDRC expertise is also supported through formal rotations in screeningteams and HAT referral centres for new health workers. As cases fade,de-skilling is a real threat as awareness of populations and authoritiesdiminishes and previously vertical programmes evolve, re-configuringprofessional development and career paths and associatedopportunities for HAT practice. To avoid repeating the mistakes of the1960s, when elimination also seemed close at hand, we need torecognise that the ‘last mile’ of elimination hinges on protecting thefragile expertise of frontline health workers.