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This article was published in 1974
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Health Education in Hydatid Control - the First Step
by W.T. Wilson.
It is a pleasure for me to be with an audience who does know what hydatid disease is - a group who does not believe it is spread by rabbits or the "Only the Boongs Get It". In roaming around rural New South Wales selling the cause one gets so many odd views that its a soul restoring situation when one has the chance to work with professionals who are familiar with the problem.
All of us present here today will view hydatid disease as a problem caused by a tapeworm parasite. We should all be familiar with the life cycle and the relatively simple methods needed to break that cycle.
In a scientific outlook our views are correct but when looking at the problem of hydatid disease we must take a new look at the problem.
It is not the complexities of the parasite's life cycle that we must consider but the complexities of factors that have allowed the disease to spread unchecked for generations. We cease to worry about the parasite and look to the real problem - that of the human behaviour that allows hydatid disease to remain a health and economic danger to our rural dwellers.
In this paper I do not intend to spend much time in looking at the parasite - that is the job of the parasitologist. You will know more about the animal hosts to the disease than me so I would be foolish to develop an argument there. What I am interested in and I hope where my value lies is in designing methods by which this behavioural problem in hydatid control can be overcome.
Hydatid disease is difficult to cure but relatively simple to prevent. Study of the life cycle of the parasite shows several points where control measures are possible - the only complex problem is in obtaining active public support for the necessary control measures.
In 1970 my Division - the Division of Health Education became involved in developing an experimental educational programme aimed at developing methods by which public support for hydatid control could be obtained. In the early stages of our planning a review of hydatid control on an international basis was made. It was thought that if we expected to gain community support for a programme we had to convince them that such a programme had been tried elsewhere and been found to be successful. We hoped to obtain this information or plan from countries where hydatids had been controlled or eradicated.
Our first review was made of Iceland where at the turn of the century one person in four was thought to have hydatid disease. As a result of intensive control measures no new human cases have been detected in the last fourteen years and post-mortem examinations of 350 farm dogs have shown no hydatid tapeworms. Abattoir checks of 25,000 sheep from 1948 to 1953 revealed only six infected animals. In Iceland the disease is a problem of the past and control measures have been successful.
We thought we were on a good thing until we examined the control measures. In Iceland the formula for the means of control was a Government subsidy which made it uneconomic to kill on the farm. This scheme ensured good prices for fat lambs rather than old stock. They also made it possible for farmers to buy meat at subsidised prices and gave them employment at abattoirs during slack farming times. It then became uneconomic for farm killing to take place. Legislation also played a part as dog taxes were raised so high that few people kept dogs. Laws also banned dogs from towns and villages. Iceland's scheme succeeded because the areas were small and relatively few people were involved. In New South Wales our large numbers and areas and the high cost of such a subsidy would make such a scheme impossible.
Next we looked at Great Britain where again control was claimed. Few cases of hydatid disease are found in England. Farm killing was banned during the war and as farms are relatively close to towns and villages, most farmers buy their meat from butchers, rather than kill for their own use. A government subsidy on stock sold from farms helps to reinforce this practice. In Wales and Scotland, although farm killing is illegal, some small isolated farms still kill for their own use and the chances of offal being fed to dogs are high. The chances of dogs having access to dead stock are also high as in many of the old mining areas sheep are grazed around the old slag heaps. Should these die they may well be eaten by stray dogs.
In looking at Britain as a whole, British control measures relied mainly on legislation banning home slaughter of stock. While this has been effective in England where supervision is possible, control has failed in the more remote areas of Wales and Scotland where these is often resistance against compulsive measures of Government origin. It is probable that in Australia legislation banning home killing would arouse similar resistance and supervision would not be possible due to large areas involved.
Following the failure of England and Iceland to provide an answer for our problem, we moved closer to home and looked at New Zealand which has had an active control programme in operation for fifteen years. In 1946 prior to a new campaign being launched there were 96 new human cases of the disease. In 1966 after the campaign had been in operation for ten years 41 human cases were reported, a drop of over 50%. At the start of the campaign it was estimated that one dog in five carried the disease. In 1966 this figure had dropped to 0.73% of the rural dog population. New Zealand is particularly interesting as it demonstrates what can be achieved by a co-operative effort of well informed graziers. Their programme was built up and designed as a co-operative effort by farmers and has been most successful.
Tasmania borrowed the idea of farmer participation following education and, guided by a country general practitioner, set up hydatid control groups in all sheep rearing areas of Tasmania. The drop in the disease in humans, dogs and stock in Tasmania has been most dramatic and their programme has world wide recognition. In 1970 I visited Tasmania to examine their programme and to steal as many ideas from them as possible. They certainly had a lot of information to contribute but again the use of this was limited as a central and vital feature of their programme was the routine testing of dogs. In Tasmania, the Health and Agriculture Departments spent over $200,000 a year on their control programme. In New South Wales this money would have been useless as our sheep areas were too large and isolated for such a testing programme.
What we had to do was to take the basic concepts out of the New Zealand and Tasmanian schemes and attempt to apply them in New South Wales, adjusting them to local conditions. Our plan consisted of selecting areas where hydatid disease was a problem running an educational programme in the area to arouse local interest and support, and then suggesting the local residents think about setting up a hydatid education and control committee to investigate the disease problem at a local level - carry out an educational programme and set up a system by which local graziers could be helped and guided in putting into operation hydatid control measures.
This system depended on the level of support of the local community. In some areas control committees were most successful in all stages of the programme, in others only the educational programmes were carried out. In general the whole programme certainly seems to have aroused public attention and the level of public understanding of hydatid disease has risen greatly in the last few years.
To show just how we have operated in the past I would like to state the example of the Jindalee Shire scheme which has been one of the most successful projects. In the Jindalee Shire area around Cootamundra the incidence of hydatid disease in sheep has been very high. The Shire Health Surveyor gained council support for a programme to control the disease and it was hoped that a dog testing service would be set up by a certain state government authority.
Unfortunately this didn't happen so a request was made for advice and assistance from the Health Commission. On our suggestion a local committee was formed to investigate the local problem and to examine ways in which an educational control scheme could be carried out. Members of this committee included local government staff and councillors, graziers, a doctor, the newspaper editor, all under the leadership of the Shire President. Because of the size of the area, it was decided early in the project to seek extra help in the form of local opinion leaders - well known and respected people who could assist by visiting properties in the district and obtain the owners support for the programme. Training sessions were conducted for all personnel associated with the programme. Information was obtained from the local abattoir on the disease incidence in stock over a six month period.
At the public opening of the local campaign a special newspaper supplement was issued - a large public meeting was held; visits to schools and a full coverage of the programme were given on T.V. and radio. As well as supporting the educational aspects of the programme, Jindalee council decided to assist graziers in the design and installation of offal disposal pits. The Public Works Supervisor designed an offal pit cover made of concrete and reinforced with weld mesh. These were made at the council works depot when rain prevented the council staff working on normal duties. The council also arranged to use a backhoe on the programme in the digging of offal pits. For $50.00 a grazier could have the council dig an offal pit on his property and then have it covered by a concrete pit top. This $50 barely covered the cost to the council but it was cheaper than a grazier could do the job himself. Some 80 pits were ordered in the first few months of the programme. Pits were also placed at all rubbish dumps near main towns and villages in the Shire as it was known that some of the local residents were killing for their own use and dumping offal at the tips.
The Jindalee Council did a grand job in supporting the programme and were willing to back the programme financially, using money obtained by dog registration fees. Cootamundra Town Council were willing to support the idea in Cootamundra itself but this was mainly on an educational basis.
One change occurred in the general direction of our policy during the Jindalee project. At first the campaign was directed solely at hydatid disease but we found that the health and economic dangers of this disease didn't provide sufficient motivation for many people to support us. At this time the American meat market for our boneless mutton was blocked and a claim was made that this was due to parasites in the meat. The parasite was in fact cysticercus ovis or sheep measles. A study of this life cycle revealed its similarity to hydatid disease. So We added sheep measles to our cause. This meant that we couldn't recommend the use of carcass meat as a safe food so we investigated the nutritional values and economic costs of processed dog foods and became strong supporters of dry complete dog foods, of which there are many on the market. We arranged the distribution of samples of these foods to local graziers and we are now amazed at how quickly the sales figures of this type of product rose. We didn't let the pet food companies get away with their complete profits as they have given financial support to many control groups through the state.
With the assistance of Canberra College of Advanced Education and in particular, a Mr. Tony Hawkins a well known authority on hydatid disease, a number of dog testing field days were held in the Jindalee Shire area to determine the incidence of the disease in dogs. In four days the average positive figure was 24.4%. It will be interesting to repeat these tests in a few years time to see what change has occurred.
From reports from the Local abattoir there is already a decrease in the number of infected lamb and hogget carcases being examined. While some of this may be due to changes in stock density I have been told that the control programme is also responsible. Figures on this will be published in the Australian Veterinary Journal later this year.
Education and control programmes were set up in many different areas of the State. Many have copied Jindalee's plan of action and while dramatic advances are few it is obvious that the message on hydatid disease has reached thousands of graziers. With displays on control at many rural shows each year one can tell from the types of questions being asked that people are now becoming aware of hydatid disease and the need to support control measures.
Special products are on the market now to help in control. One firm markets a special working dog food; another has designed an offal incinerator for areas where soil types are unsuited pits (sic). Other dog food manufacturers use hydatid disease and sheep measles in their advertising.
Education programmes now operate in some 50 local government areas of the State. Most programmes are self starting and self supporting. The stage has long since been reached where I have been unable to work on all programmes and more staff are required. A health education officer has been appointed to the Riverina where nine new projects start this year. It is hoped that another officer will be appointed to the Central West where the whole region has a requested that a programme be started. It would appear that the concept of hydatid control has been accepted and will be supported.
From my experience I consider that the Health Commission will have to narrow its role solely to the educational aspects of the programmes. In terms of introducing full control measures we haven't the staff or technical resources. However, I consider the educational aspect a most important one as this provides the basic motivation for the desired change in behaviour that is needed if full control is ever to be obtained. With the regionalisation of health services we hope to have Health Education officers in all areas of the State. Hydatid disease education will be one of their duties.
Our Division has also been aware of the need for up to date training of professionals in hydatid control. We jointly sponsored a seminar at Goulburn in 1972 for that purpose. We are also co-operating with the Canberra College of Advanced Education in the running of a two week school based on the control of cysticercosis. We keep in close contact with research teams on a national and international level and feed back information into the programme.
In reviewing the area covered I have seemed to have neglected a very important aspect of the programme. I have mentioned the Health Commission's role, but not that of the hundreds of professional officers that have worked with us. I realise that there is not official programme in the Department of Agriculture due to the demand for control or other animal diseases with higher economic priority. However, I must stress that without the support and advice of their field staff we would never have been able to operate. In all the areas of the State I have never been knocked back when I have asked for assistance. In many areas they have been the main force in the programme and I have greatly appreciated their assistance. I would also like to stress our debt to local government, especially to health surveyors. Again, their support has been freely given and has been vital to the project.
Hydatid control has developed to a stage where I feel I can safely say we have proved our point that a change of human attitude and behaviour can do much to lessen the high incidence of the disease. We have proved the value of well planned educational programmes. What must now be decided is just where we go from here. I do not think that full control will be possible until a full national control programme is put into operation. The large sheep areas of New South Wales, Victoria and Queensland make an intense Tasmanian-style programme impractical. A national programme will have to rely on community self help generated by an educational and motivational programme over a long period of time. It would appear that national planning is not likely for some time.
The educational programmes will be continued in New South Wales but will be operated on a regional basis rather than under a central control. It is also hoped that hydatid disease will be included in school agricultural and science programmes. It is hoped over time that more and more graziers will realise the health and economic benefits of control are well worth the effort and hydatid disease control will receive equal attention to such disease control measures as drenching or inoculation. I hope that all of us here today will work as equal partners in this rewarding project.