Thursday, October 6, 2016

Polio immunisation for all

By Mariana Palavra

Maungdaw, Rakhine- Htun Aye failed his matriculation exam but that didn’t demotivate him. The 21 year-old decided he would choose another way. “I decided to postpone the matriculation exam. In the meantime, I wanted to help other people, by improving their health and wellbeing”, he recalls.  “Since then, I have been working in Maungdaw township hospital, helping with the patient admission process and injections administration. Back at my village, I take care of small wounds and non-prescription medicines.”   

Htun Aye visited Ma Shan's house in the different phases of the polio campaign ©UNICEF Myanmar/2016/Mariana Palavra

He liked his work so much that nine months ago, in addition to his job, Htun Aye became a community health worker. And his big test was taken during the 2016 national polio vaccination campaign. To be prepared, he attended three orientation trainings, both at community and townships levels. In his last training session, all community volunteers from both Muslim and Rakhine villages held a discussion together about interpersonal communication with parents and caregivers, vaccines information and administration, as well as data registration.

After these trainings, Htun Aye was ready to conduct polio immunisation community awareness and vaccination in his Kan Thar Ywar village.  “I knocked on every door of my village before and during the campaign”, he explains. “If children up to five years weren’t at home, I would find out the reasons and wait for them to make sure that all children got the three polio doses needed”

He vaccinated at least 120 children in each phase. Although the levels of vaccination acceptance were reasonable, Htun Aye could see the difference along the different campaign phases. “For the first dose I had to wait longer for children to arrive home. For the second and third visits, most children were at home waiting for the polio dose”, he says.  “They didn’t cry anymore and they would immediately open their mouth waiting for the drop.”

Htun Aye can say proudly that he didn’t miss any child in his community. His sister backs this up. A mother of two (15 months and 4 years), 26 year-old Oo Mya Aye says that she now knows off by heart what polio is. Her opinion might be biased, but her neighbour confirms the same increased understanding. Two of Ma Shan’s children were vaccinated thanks to Htun Aye: “It is very good that all my children are now 100% vaccinated, but it’s even better to have a community volunteer around. He can explain everything to us about disease prevention and our children can get the vaccines at home, with no need to go outside”. Ma Shan looks at her children’s vaccination book more frequently, making sure her children don’t miss any dose of routine immunisation. “It won’t happen again”, she assures. 

National Immunisation

UNICEF and WHO have been supporting the Ministry of Health and Sports to conduct national immunisation campaigns after two children contracted the vaccine-derived polio virus infection in 2015, precisely in Maungdaw. “The emergence of such cases is the result of low immunization coverage, which in Rakhine state has been below 80% for the last few years. In fact, in some of the State’s townships  the coverage is very low , to the extent that only three out of ten children received the three recommended doses of oral polio vaccine, which  poses a risk of outbreaks”, explains Daniel Ngemera, UNICEF Myanmar Immunisation Specialist. 

Maintaining routine immunization services, especially in hard-to-reach areas, represents a challenge for the Myanmar health system. As a result, children are less protected from viruses. In Maungdaw, where the majority of the population is Muslim, there are also language and cultural barriers, increasing the distance between the community and the basic health staff and volunteers. The inter-communal violence that erupted in Rakhine State in 2012 has also further complicated community outreach, and as a result all children from all communities are at a greater risk.

As a response to this outbreak, in 2016 vaccination campaigns were organised in all 330 townships of Myanmar, targeting around 4.6 million children under 5 years.

“Throughout the year, UNICEF has been working to fully establish a vaccine management and climate resilient cold chain system across the country, assuring quality immunization services and making sure 100% of children are immunized against polio, including in the border areas of Rakhine, Chin, Kayah, Kachin and Shan States”, explains Daniel Ngemera.

Reaching every child in Rakhine

Tin Aung Soe, a 41 year-old community health volunteer from a Muslim village from Maungdaw Township, was very worried when he heard about the polio outbreak.

“I immediately thought: ‘and what if this happens in my community?’ so, I was very keen to be part of the national polio campaigns. I participated in all five campaigns that took place in 2016”, he affirms.

Each time, he must have vaccinated more than 160 children. But the numbers hide the initial difficulties faced by the health workers. “At the beginning, mothers and girls were reluctant to get immunized”, Tin Aung Soe reveals. “Sometimes, some caregivers even forbade their children to take the vaccines. But later, they started to accept it.”

During the campaigns, there was a village effort to respond to the outbreak: the community leaders joined the health volunteers to influence parents by conducting awareness campaigns. In addition, community meetings led by religious leaders were organised and information and education materials shared.  A door-to-door approach, and interpersonal communication also contributed to building trust and increasing the vaccination coverage. 

Tin Aung Soe and Htun Aye at Maungdaw’s health centre discussing the latest data on immunisation coverage ©UNICEF Myanmar/2016/Mariana Palavra
In fact, Tin Aung Soe is already a veteran. He has been a community health volunteer for the last 22 years. He mainly helps midwives during the monthly immunisation week. He still enjoys it as much as he did on his first day.

“Children are vulnerable and I want to protect them. And immunisation is an important part of that protection”, he says. “Through community awareness and vaccination, I can help people’s lives. I am just one of the many small bricks in society who are contributing to protect children, but I am proud of it. ”

By contrast, Htun Aye is still inexperienced but he already feels the same humble pride: “I feel I have an important role in the community”, he says. “I feel I am much more loved than before. Before the campaign, people wouldn’t even greet me, now everyone says hello”, he says laughing out loud. The polio campaign made him change his dreams. Now, he wants to work and study hard to become a nurse in the township hospital.   


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