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Afghanistan: sunshine and showers help eradicate scabies from Afghan jails

13-04-2012 Feature

Scabies in prison can be a nightmare for the inmates. Literally. The itching caused by the highly contagious disease is worst at night. “We even scratch in our dreams,” was how one inmate of a provincial prison put it during a recent ICRC scabies eradication campaign.

Given the growing incidence of scabies in Afghanistan's overcrowded jails, the ICRC launched an eradication campaign six months ago, in agreement with the prison authorities. To date, jails in Kabul, in the north and in the south of the country have been involved in the programme.

In March 2012, the campaign made its second visit to the province of Helmand in southern Afghanistan. The eradication team consisted of an ICRC doctor, a hygiene promoter and six other staff. Some of the detainees had taken part in the first campaign and knew its benefits. "We’re really keen to take part again," remarked one cell leader.

Even when proper care is taken to keep premises clean, it only takes one infected person to spread scabies, which can be transmitted via bedding, carpets and clothes, as well as through direct human contact. This means that every item that can harbour scabies has to be cleaned and disinfected if an eradication campaign is to be successful.

The mites can live for several days without a human host. When she does finds a host, the female mite burrows under the skin of her victim and lays her eggs, which take between two and six weeks to incubate. Once the eggs hatch, the infected person will suffer increasingly severe itching and discomfort until the condition is treated.

Before the latest campaign in Helmand began, ICRC team leader and nurse Avril Patterson explained the procedure to the prison authorities. In addition to the detainees showering and being treated with benzyl benzoate, every cell and corridor would be washed from top to bottom and disinfected. Detainees would be recruited as daily workers to help disinfect the clothes and bedding, and to clean the cells.

The campaign was implemented one block at a time. The prisoners joined in eagerly, packing their clothes and blankets into large orange bags and taking them out into the sunny prison courtyard. Then they gathered up their books and personal belongings and stored them safely out of the way. After showering, the detainees coated themselves with benzyl benzoate and put on clean clothes. Even those men who were not obviously infected went through the routine as a precautionary measure, given the long incubation period for scabies. Men with particularly bad infections received antibiotics.

Once the process was well under way in the first block, it started in the next.

At the same time, cleaning of the cells in the first block got underway, presided over by the ICRC hygiene promoter, Rashid. The cell leaders' rooms were also cleaned, as were the floors and walls of the prison corridors.

Outside in the courtyard, the detainee daily workers sprinkled permethrine powder into the bags of bedding and clothes, sealed them and stacked them in the sun. They also put permethrine on the carpets and hung them up to air for 24 hours.

"It's good that there’s lots of space," remarked Carole Dromer, the ICRC doctor. "Sunshine is an excellent way to get rid of mites, so it’s good to treat everything in the open air. It’s also good for the detainees to sit outside and get some sun," she added.

Sitting in the warm courtyard that afternoon, the detainees chatted amongst themselves. This was a pleasant respite from their cramped cells. “It was good to get the treatment," several of them remarked, "but it's also nice to be out here enjoying the fresh air.”

The whole procedure was repeated the following day. By that time, the campaign had really got going, and work proceeded block by block and cell by cell.

On the afternoon of the second day the detainees from the first block collected their bags of belongings, shook the permethrine powder out of their clothes and carried everything back inside. Rashid went from cell to cell giving the detainees practical advice about personal hygiene. The men sat on their beds, leaning forward to catch every word, as if listening to a story teller.

The work lasted for another four days, until the detainees in every block had been treated and their cells disinfected. By the end, over 1,100 detainees had taken part in the campaign.

“We’re happy you came,” the prison director told the team as they got ready to leave. “I’m trying to change things for the better here. The detainees now receive vocational training, they can play volleyball, and they’re learning to use computers. Helping them to stay healthy is all part of the process."


Photos

Afghanistan. Detainees' bedding and clothes are packed into large bags and taken out into the prison courtyard before the cells are cleaned to rid them of scabies mites. Books and personal possessions are packed separately and stored safely. 

Afghanistan. Detainees' bedding and clothes are packed into large bags and taken out into the prison courtyard before the cells are cleaned to rid them of scabies mites. Books and personal possessions are packed separately and stored safely.
© ICRC / J. Barry

Afghanistan. Dr Carole Dromer of the ICRC discusses the cleaning of the cells with Rashid, the ICRC's hygiene promoter during the scabies eradication operation. Meawhile, the men go off to shower and be treated with benzyl benzoate. 

Afghanistan. Dr Carole Dromer of the ICRC discusses the cleaning of the cells with Rashid, the ICRC's hygiene promoter during the scabies eradication operation. Meawhile, the men go off to shower and be treated with benzyl benzoate.
© ICRC / J. Barry

Afghanistan. Permethrine powder is added to the bags of clothes and bedding to kill any mites. They are then sealed and laid out in the sun. Twenty-four hours later, the detainees collect their belongings, shake the permethrine powder out of their clothes, and put everything back in their cells. 

Afghanistan. Permethrine powder is added to the bags of clothes and bedding to kill any mites. They are then sealed and laid out in the sun. Twenty-four hours later, the detainees collect their belongings, shake the permethrine powder out of their clothes, and put everything back in their cells.
© ICRC / J. Barry

Afghanistan. Dr Dromer and ICRC team leader Avril Patterson discuss the hygiene promotion session with Rashid, who goes from cell to cell to talk to the detainees about personal hygiene as part of the scabies eradication operation. The men sit on their beds, leaning forward to catch every word, as if listening to a story teller. 

Afghanistan. Dr Dromer and ICRC team leader Avril Patterson discuss the hygiene promotion session with Rashid, who goes from cell to cell to talk to the detainees about personal hygiene as part of the scabies eradication operation. The men sit on their beds, leaning forward to catch every word, as if listening to a story teller.
© ICRC / J. Barry