Immunizing Angola’s children against measles
|© UNICEF Angola/2003/Pirozzi|
|UNICEF regards needle and syringe safety is as important as the immunization.|
LUBANGO, July 2003 – Beads of sweat drip from her brow. It is just shy of 11a.m., the Angolan sun has been burning for hours, and Teresa Alcino is happy to be in the shade.
While Teresa looks sprightly, her cargo is only just waking up. In one swift, yet skilled movement Teresa swings her baby sister from her back and into the vaccinator’s arms. Teresa is seven. Her little sister, Joana, just two. Joana is young, but heavy, and this immunization post at the central market in Lubango, in Angola’s south, is two kilometres from Teresa and Joana’s small village.
Teresa has brought Joana here to be immunized against measles. It is the second phase of Angola’s National Measles Campaign, the biggest health initiative in the country’s history. Joana is one of 3,150,000 Angolan children who UNICEF and Angola’s Ministry of Health aim to immunize at informal urban gathering areas such as this market during this phase of the campaign. (And because Joana is under five years of age, she and 3 million others in the same age range will also receive a Vitamin A capsule to boost their immune systems.)
“I had my [measles] shot 10 days ago at my school [during phase one],” says Teresa. “My mother was going to bring Joana in to the market today but she is ill. At my school we spoke a lot about sarampo [Portuguese for measles], and so I realized how dangerous it is. That is why I have brought my sister here.”
For her part Joana may not fully appreciate the sacrifice her sister has made. She is stirred by the quick prick of the vaccinator’s needle. It is over in a matter of seconds, though the shock has brought Joana to tears. “A few tears are a small price to pay,” says the vaccinator Juliana Balombo, who gently gives Joana back to Teresa and prepares for the next child.
This is a smooth, yet quick process. It has to be. Over the course of the three phases of Angola’s National Measles Campaign, UNICEF and partners are seeking to immunize 7 million Angola children; that is every single Angolan boy and girl aged between nine months and 15 years of age. It would be a tough task anywhere, though it is made especially challenging in a country where distances are vast, transport limited, communications simple and where the basic health system has been devastated by four decades of war.
Juliana Balombo is one of 10,000 vaccinators – trained by UNICEF for this campaign – who hope to be the key element in restarting Angola’s health system.
“I am a nurse, though UNICEF gave me new safe-injection training for this campaign,” says Balombo. “I can’t tell you how good it feels to be able to use my skills to prevent children getting sick, rather than simply treating their ills.”
Routine immunization is the goal
Balombo’s skills will not only ensure successful implementation of the campaign, but also lay the groundwork for UNICEF’s broader goal in Angola: routine immunization.
Measles is the leading cause of vaccine-preventable mortality in Angola. The National Measles Campaign is part of the formulated Strategic Plan 2003-2007 for Measles Mortality Reduction, headed by UNICEF, the Ministry of Health and the World Health Organization.
Precious funding from the governments of Canada (who was the campaign’s major donor), the United States, Netherlands, Norway, Sweden and the European Union has meant the campaign will extend to each and every of Angola’s 18 provinces and all 164 municipalities. But campaigns like this are costly and demand enormous amounts of time. The goal must be routine immunization.
“The entire health system must be strengthened and conditions established across Angola for routine vaccination,” says UNICEF Angola Representative, Mario Ferrari. “If this is done, then we will look back in five years time when child mortality rates are falling, and 2003 will be recognized as the year Angolan children were put first on the agenda.”
Around 10,000 Angolan children die each year from measles, with 95 per cent of cases occurring in children below 15 years of age. This translates to 30 children dying every day from a disease that means little more in the developed world than a few days off school.
As Rita Ferraz would attest, these are the heart-breaking numbers UNICEF and Angola’s Ministry of Health are trying to reverse. Hailing from the centre of Angola, Ferraz came to Luanda 10 years ago. At the height of Angola’s bloody civil war, her home suffered greatly and so Ferraz brought her four children to the capital. Although Luanda was spared fighting during the war, its basic services were terribly neglected.
A woman alone with five children has few options in a city like Luanda and the only accommodation Ferraz could afford was in Roque Santeiro, bordering Angola’s largest and most dangerous market.
Within five years of being in Luanda, two of Ferraz’s children had died from measles. Today, with her surviving children grown up, Ferraz looks after her grandson, 18-month-old Marcelo.
To visitors and foreigners, Angola vacillates between desperately sad and staunchly inspiring. Roque Santeiro seems locked into the former. Here the dirt and mud streets are carpeted in rubbish. Indeed the only thing you see in comparable quantity to the rubbish are children. Vivacious, screaming, laughing, wailing children. Here raw sewerage lies under their bouncing toes. Here disease finds an open door.
And yet it is here, during phase two of Angola’s measles campaign, that Rita Ferraz (despite recovering from a bad bout of malaria) finds hope. In between caring for Marcelo, Ferraz works 12 hours a day, selling bits and pieces so that she can feed her family and afford their $30 per month rent. And now, having brought Marcelo back from a dangerous bout of diarrhoea, Ferraz is waiting to have him immunized at a nearby outpost bordering the market and her home.
Ferraz is testament to the success of the Angolan Governments and UNICEF’s information campaign. Although she has no money for newspapers, and certainly does not own a TV, a few weeks ago Ferraz heard “a funny song” on the radio. It was one of 12 indigenous-language broadcasts that UNICEF organized so as to spread the measles message …to places as removed as Roque Santeiro.
It is in Roque Santeiro, and in similar regions across Angola, where UNICEF and Ministry of Health immunization teams are reaching. So often these are the forgotten areas. Places people speak of, but don’t visit. Yet UNICEF is here in force.
Vaccinators, health workers, mobilizers, even enthusiastic teenagers dressed up in the Measles mascot, trying to assuage the fears of waiting children.
I ask Ferraz if Marcelo is scared. “Everything he has to be scared of is right here,” she says, pointing to the filthy chaos of Roque Santeiro. “This injection is his friend …that’s what I have been telling him. You have to understand,” she continues. “Every mother, every grandmother wants to protect her children, but there are many problems we face here. This is not a place for children…this is not a place for anyone, but I find hope when UNICEF tells me they will protect Marcelo from a death I have felt too much. Sarampo has caused me too many tears. Today Marcelo will beat it.”
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