Going the extra mile with tetanus toxoid vaccinations
By Aderito Docarmo
Ermera, Timor-Leste, December 2010 - “I am afraid of injections because of the pain, but after the injection, there was really not much pain. And I also know it is good for me,” explained Mercia, a 13-year-old student in Ermera district. Either the fear of pain scared her away or health workers never found her during the previous three rounds in the 2008–2009 national vaccination campaign to protect girls and women from tetanus infection.
But the Timor-Leste Ministry of Health was not about to let Mercia or other unprotected girls and women go unreached.
Thus, in a recently completed “mop-up” campaign, health workers targeted pockets of villages in three districts that had insufficient national campaign coverage after the three rounds of immunizations. In such corners they found Mercia and thousands like her who were not fully protected from the deadly bacteria.
Girls like Mercia also helped them in the search. “I encouraged my friends to take the vaccine,” Mercia said.
Although everyone is susceptible to tetanus infection, the campaigns concentrate only on females of child-bearing age who are more vulnerable due to the high risks that childbirth imposes, particularly where home births with unskilled attendants are common.
The Ministry of Health carried out the final-push activity in October and November 2010 with assistance from UNICEF, the World Health Organization and NGOs to accelerate the progress towards eliminating maternal and neonatal tetanus throughout the country.
Focusing on the female population aged 12–45 years in the central highland districts of Aileu, Ainaro and Ermera, the mop-up campaign vaccinated 27,703 people.
Reaching the hard-to-reach areas takes many different hands working together. The mop-up campaign relied on village chiefs and church leaders for strategic help.
“Some mothers do not want to be immunized. Others say they will miss work if they walk to the site, which could be several hours away. And there are also those mothers who say they have heard that after the injection, they can no longer get pregnant,” Terezinha Fernandes explained, a Promotor Saude Familia (community health volunteer) and wife of the suco (village) chief.
Ministry of Health and UNICEF officers approached the local church in the three districts to support the campaign and advocate about the safety of the vaccine. The church leaders enthusiastically supported the campaign by squashing the rumours and allaying the fears about the vaccine.
“I announced in church about the campaign,” said Father Merkondia, the Ermera priest. “I had to help counter rumours about the tetanus toxoid vaccine being a contraceptive.”
The community health volunteers were also instrumental in mobilizing the targeted female population by going door to door to inform them and their families of the benefits of the tetanus toxoid immunization.
The extra-mile commitment was evident in many corners.
“Recording and reporting should be accurate, so it was necessary for me to work at night in the office. This is because there was a problem with our office generator and electricity was only available at night,” said Palmira, the Ermera district immunization manager.
“In addition, there is only one computer in the office and we have to take turns,” she added.
Some village chiefs were so eager to help they offered their homes for the vaccinators to set up the immunizing post. “In this campaign, we cooperated with the Health Ministry. I also observed that the government teams were making special efforts to ensure that no woman is missed, even in far off areas,” explained Faustion, village chief of Hato Udo, in Ainaro district.
Timor-Leste’s experience with its national tetanus toxoid campaign was especially challenging due to the difficult terrain and scattered inhabitants. But the follow-up push showed true grit for overcoming the difficulties so that more babies and mothers’ lives are protected from what can be a fatal disease.