Lao PDR’s child health days take life-saving interventions into remote regions
By Simon Ingram
Baan Hin Pan, Ngoi district, Lao PDR, December, 2008: From its lofty mountain perch, the little village of Hin Pan (population 306) commands a majestic view of jagged peaks and thickly wooded valleys. But this spectacular setting, about three hours’ drive north of the historic town of Luang Prabang, also puts this small ethnic Hmong community beyond the reach of health and other basic services. The nearest tarmac road is 8 kilometres down a rough track, and the clinic is even further away.
Which explains why, on this chilly December morning, the local primary school – a simple wooden structure without windows or electricity – has been pressed into service as a makeshift dispensary, implementing Lao PDR’s latest Child Health Days.
The classroom’s simple wooden benches are crowded with mothers and fathers struggling to keep control of babes in arms and scampering youngsters. One by one, they are summoned to a table at the front, where -- in rapid succession -- a local health worker dispenses polio and vitamin A drops, followed by a de-worming tablet, into the open mouths of the often resistant children.
Mrs Jeu, a twenty-five year old mother of three, has brought her two youngest children. “The village health volunteer said we should come today,” she says, cradling her youngest boy, 9 month old Koushong. “She said it was important to protect the children against paralysis and worms, and to receive vitamins, so of course I came.”
Among the group of visitors watching the proceedings is Mr Toshiro Arai, Director General of the Japan Committee Vaccines for the World’s Children, a donor group which has given UNICEF $100,000 to support the Child Health Days.
“Of course it makes us so happy to see how our contribution is making Lao children safe against disease,” says Mr Arai. “In the 1950s and 60s, foreign aid helped Japan defeat polio. Now our private and corporate donors in Japan are helping to do the same in developing Asian countries like Lao PDR.”
The last case of polio in the country was recorded in 1996. Four years later, Lao PDR was officially declared polio free. But the chance of the disease recurring can never be ruled out, especially in areas like Ngoi district where routine immunization rates are low, and where large numbers of tourists visit its spectacular limestone caves and other attractions. This raises the possibility that the polio virus could be inadvertently imported from countries where the disease is still found.
The first Child Health Days were held in Lao PDR in June 2007, to ensure distribution of vital vitamin A and de-worming tablets (mebendazole) to children aged under 5 nationwide.
"The Child Health Days are a great opportunity to reach vulnerable children, especially in remote areas, and with multiple interventions, ” explains Dr Anonh Xeuatvongsa, director of the Expanded Programme on Immunization (EPI) at the Ministry of Health. “This year in addition to vitamin A and de-worming tablets, we’re giving polio drops to children in 57 selected districts. These were chosen because they border other countries and receive many international visitors or are densely populated and are therefore at higher risk of experiencing a recurrence of the polio virus.”
The Lao government’s commitment to this year’s Child Health Days was underlined at a launch ceremony in the capital Vientiane, attended by senior ministers and other guests, including the senior representatives of UNICEF and the World Health Organisation, both of whom are supporting the campaign.
Judging by early indications, the Child Health Days are on track to achieve their target – even matching the achievement of the nationwide measles campaign of 2007, which successfully reached some 96 per cent of children in the target age group.
Sitting at another makeshift dispensary point – near some market stalls on the outskirts of Luang Prabang town -- the local EPI manager, Mrs Soukhtavoun, scans the list of children who have already received their polio doses, de-worming tablets and vitamin A supplements.
“We’ve given drops, de-worming tablets and vitamin capsules to 94 out of 114 children in this community,” she says in a satisfied tone. “And its still only 10.30 in the morning.”
Mrs Souktavoun says the main challenges to ensuring all children are reached is the fact that the families tend to come in one by one, meaning the health teams have to wait a long time before moving on. And, she adds, sometimes the village headmen are too busy to ensure all families actually turn up at the appointed time.
“But it’s getting better,” she says.