A promotora de salud heads out to a banana finca in central Puerto Rico to give education on mosquito-borne illnesses. The agricultural workers there appreciate the basic information on Zika, chikungunya, and Dengue Fever. The promotora (often translated as a Community Health Worker in English) gives some basic education on mosquito bite prevention, including around the farm measures like dumping out stagnant water that can serve as breeding grounds and personal approaches like wearing long sleeves and applying repellents properly. But a question was coming up regularly: What about DEET? Is it safe? What about for pregnant women? In an area where some people remain unconcerned about Zika or harbor mistrust toward public health authority recommendations, the promotora plays a critical role in providing empathetic yet scientifically sound responses.

Community Health Workers (CHWs), who gather each month for MCN’s Zika ECHO learning collaborative, shared these community concerns about DEET with MCN. Using video conferencing, MCN hosts CHWs from around Puerto Rico, providing basic information on a topic of relevance in Spanish, and providing a space for collaboration and peer-to-peer networking and learning. Responding to the needs of the CHWs, MCN’s June learning collaborative session was dedicated to DEET, providing a full breakdown of the CDC’s recommendations, the risk factors that may be pertinent to CHW’s patients, and a discussion around communicating and balancing risk.

Thirty-two participants, including CHWs from across the island and MCN staff, tuned in to hear the presentation by MCN’s Alma Galván, MHC, Senior Program Manager of Environmental and Occupational Health. She covered the Centers for Disease Control and Prevention’s recommendations, and spoke to the many risk factors that outdoor workers and others may face. “A major concern is that people reapply, and reapply, and reapply,” she noted, when the directions are clear that reapplication is only necessary after a certain amount of time. Constantly reapplying may increase the risk of overexposure.

After her presentation, the participants got a chance to ask questions and engage with each other. One participant asked, “DEET crosses the placenta -- but what are the possible negative effects on the fetus?” Another asked about using natural products like eucalyptus oil. Galván responded with the results of the limited research that has been conducted on fetal exposure to DEET, and then delved deeper into the CDC recommendations outside of DEET. One respondent noted that many of his patients were hesitant to use DEET, for various reasons, so he encouraged them to try other EPA-registered and CDC-recommended repellents like IR3535 and Picaridin. Oil of lemon eucalyptus (the synthetic compound from lemon eucalyptus, not the essential oil which has not been sufficiently tested for efficacy) is also recommended by the CDC.

This peer to peer learning program allowed rural CHWs separated across the island but facing similar struggles to come together. The hour-long session is repeated every three weeks, with the hopes of growing the CHW network, establishing a space for collaboration, responding to new concerns or threats, and providing much-needed support to rural health workers who may lack ongoing educational opportunities in their communities.

Learn more about the CDC’s mosquito repellant recommendations for consumers here.

Read MCN’s clinician guide to mosquito-borne diseases for mobile populations, including a section on preventing mosquito bites.

Read more about MCN’s ECHO learning collaboratives.

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