Wednesday, March 11, 2015

Reaching the hard to reach - Fighting measles and rubella in Rakhine State

©UNICEF Myanmar/2015/Thiha Htun
Wading through streams carrying iceboxes containing measles and rubella vaccine, Ministry of Health staff make great efforts to reach the hard to reach
 By Virginia Henderson
Rakhine State, February 2015: Wading barefoot through streams, climbing over steep narrow hill paths, crossing wobbly log bridges and walking hours over parched dusty plains- teams from Myanmar’s Ministry of Health, UNICEF and WHO went to great lengths to reach children in out-of-the-way places around the country.
In tiny villages and large towns around the country, 12,000 vaccination teams were part of Myanmar’s largest ever public health intervention. The National Measles and Rubella (MR) vaccination campaign, aiming to reach more than 17 million children aged nine months to 15 years, covered nearly 65,000 villages and 45,000 schools over two-phases.

Mya My Thein, has been a Township Health Nurse for 23 years in Rakhine State. It is only her second time in Upper Timma village, where she came to support the campaign’s second phase, primarily community-based. “Things went smoothly here, though some could not come because of transportation issues, which is the biggest challenge, for both health staff and the local people”, she explained. Indeed, to reach that village it takes three hours driving across vast unfenced flats, past tiny villages of bamboo and rattan, followed by a one hour walk through rice paddies dotted with haystacks, oxen and goats.
A labyrinth of arms of rivers and islands, Rakhine State poses logistical challenges for the outreach effort. Transport is an issue. Propellers, wheels and feet are needed to get the dedicated health workers to far out isolated villages. Such outreach could only be undertaken in the dry season.

©UNICEF Myanmar/2015/Thiha Htun
Myanmar Ministry of Health vaccination team walk over one hour from their vehicles to reach Upper Timma village, Kyauktaw, Rakhine State.

 “I’m used to working in hard to reach places”, said Aye Win, a very pregnant midwife in charge of administering the vaccinations in Kant Kaw Kyang village.  “This village is doing well because the IEC [Information, Education and Communication] materials were distributed effectively so people knew about it.”
Community mobilisation is key to overcoming the difficult challenge of inaccessibility, especially in the country’s northern townships. The widespread campaign using leaflets, TV, radio, posters, vinyl banners, and mobile broadcast units announced details and encouraged people to participate. The Ministry of Health and UNICEF trained people to spread the word.
The vaccination campaign began in January 2015 with school-based children from 5 to 15 years old. At the end of February, phase two of the campaign focused on reaching all the children not covered in phase one, including out-of-school children and pre-schoolers.
Proud of the 92 percent coverage of school children, Deputy State Health Director, Dr Aung Thurein, explained that nearly 32,000 children were immunised in Sittwe area. “The school phase was comparatively easy. The next stage was the IDP camps, then the community mobilisation phase aiming to reach isolated villages,” he summarised.
In fact, Rakhine authorities have reasons to be proud. The information about the campaign reached almost every corner of the State.

©UNICEF Myanmar/2015/Thiha Htun
A father holds one of his twin daughters while midwife Aye Win administers the measles and rubella vaccine in Kant Kaw Kyun village, Rakhine State.
Mae Lon Gyi, 30, brought to Upper Timma Village her two children Sandar Moe, 3, and Moe Ee Zan 18 months to be vaccinated. “The health staff came to my house to give me some information and told me to come to the vaccination centre”, she explained. “Now, I know that measles can cause small blisters on the skin and fever, and understand that this vaccine can prevent measles”, she said.
At Zaw Ma Tet village, thirty minutes by speedboat up the river from Sittwe, village headman U Lu Gyi, explains how traditional healers are crucial. “For common illnesses, people here usually consult local traditional healers”, he said. “When the basic health staff, nurses and midwives came to discuss the vaccination programme, they included some of these village traditional healers, making them part of the campaign. It’s all part of community mobilisation”, U Lu Gyi concluded.
In internal-communal violence-affected areas, populations can have limited access to healthcare services. As Yosi Echeverry Burckhardt, Chief of UNICEF Sittwe field office explains: “In order to break the disease transmission chain, when introducing a new vaccine such as against rubella, we have to do a major push to ensure all children up to 15 years of age are vaccinated, especially girls, as the disease is particularly dangerous during pregnancy”.
UNICEF has supported the Ministry of Health and its partners to ensure the success of Myanmar’s largest ever vaccination campaign, namely by procuring vaccines, reinforcing the cold chain infrastructures, and monitoring to ensure micro-plans were followed.
Country-wide, the exceptional mobilisation of nurses, teachers and countless community leaders has resulted in an excellent coverage that is currently estimated at approximately 95%. Even in areas of conflict and intercommunal tensions such as Rakhine and Kachin States, the unprecedented commitment of health and education workers and community leaders has helped reach levels comparable to the national average.
Nevertheless, the recent violence in Kokang Self-Administered Zone, which has forced thousands of people from their homes, forced schools and health centres to close down, and put children at additional risks of separation from their families, has also impeded the movement of supplies and health personnel essential to the immunisation campaign. UNICEF calls for a resumption of immunisation activities, to make sure the remaining 35% of children aged between nine months and 15 years in Kokang Self-Administered Zone are protected from the risk of contracting measles or rubella.

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