Delivering lifesaving vaccines on the road less travelled
A health worker journeys to protect children and villagers in Indonesia’s far-flung Aru Islands
Under the glaring sun that Friday, the cool waters of the sea surrounding the Aru Islands in Indonesia’s eastern Maluku Province rippled gently as a motorboat sped through the waters. Among those on board was Immunization Coordinator Yulianus Yanto Tivan, who was carrying a large cooler box containing COVID-19 vaccines.
It had already been a long day for Yanto, who left his home on Benjina Island at 5 am that morning to catch the boat to the regency’s capital of Dobo, where he fetched the vaccines before returning to his village. The trip often takes a total of seven hours to complete.
This was one of the more fortunate days for a man who has spent the past two decades working on the islands where he was born. The father of two has seen weeks where the waves could reach as high as two meters under dark clouds and heavy rains.
“One time the waves were so high, and water seeped into our boat. We almost drowned, but the captain took us to the nearest shore, and we were able to remove the water,” Yanto recalled.
The Aru Islands District is home to nearly a hundred low-lying islands, where much of the commuting is done on foot or by boat. Yanto and his team at the Benjina Health Centre oversee several surrounding islands, which requires spending hours travelling to vaccinate people against COVID-19 and other vaccine preventable childhood diseases.
Besides transportation issues, limited supply chain infrastructure has created significant obstacles to building more equitable vaccine distribution. In Benjina, electricity only runs from 6 pm to 6 am, so the health centre must use solar cells to keep its vaccine cold chain system running continuously. During bad weather, there is usually not enough sunlight for the solar cells to work, so Yanto and his colleagues must bring cold packs from their homes every morning and afternoon and stack them in the freezer. While the work can wear him down, his love for children continues to motivate him.
“I cannot afford to be exhausted. We must take care of vaccines like we take care of babies,” Yanto said.
Joining hands to ensure a long life for all
With a routine immunization rate lower than the central government’s target, any disruptions to vaccination services in Maluku could have severe consequences for its communities. Several regions across Indonesia, including Maluku, have reported outbreaks or cases of vaccine preventable diseases, which could lead to disabilities or even deaths.
In Maluku and other provinces, UNICEF has been providing support and training on effective vaccine management for health workers and staff from the Provincial and District Health Offices. UNICEF also provides technical assistance to help health workers like Yanto with microplanning to deliver immunization services in remote areas.
To improve vaccine uptake, door-to-door immunization services have been carried out, and vaccination posts have been established at public spaces such as mosques, churches, and schools. On the supply side, the Maluku Health Office has been working with other sectors, including the Transportation Office and the Navy, to ensure smooth immunization services by setting up island clusters to improve coordination.
In spite of the pandemic, Maluku has maintained its rate of complete immunization coverage. At the same time, its COVID-19 vaccine drive has been successfully rolled out, with 74 per cent of Maluku’s 1.4 million targeted population having received the first dose as of early May 2022.
With most of Aru Island residents being informal workers who cannot afford to work from home, COVID-19 vaccination has offered critical protection. Antonius Narwadan, 62, spent his own money on a boat ride to take him to the vaccination post so that he could receive his COVID-19 booster shot.
“I don’t want to get infected by COVID-19 and leave my wife and children behind,” he said. “I need to stay healthy and continue working to pay for my kids’ education.”
As the COVID-19 vaccine rollout accelerates cross-cutting coordination across the country, there is hope that future immunization services will also benefit. Governments and the public are more aware than ever of the importance of immunization while cold chain infrastructure has been improved in many parts of the country.
For Irma Lum, a mother of two, the arrival of the routine vaccines brought hope that her children could grow up safe and healthy. “I have seen firsthand how my immunized children rarely ever got sick, and even if they did, they’d get better quickly. That’s why I trust vaccines,” she said after bringing her last child to get the polio vaccine at the Gardakau Health Post, a 30-minute boat ride from Benjina.
Amid the challenges that Yanto faces every day on his journey to deliver lifesaving vaccines, the warm welcome of the villagers helps lift some of the weight off his shoulders.
“I want to continue bringing vaccines and immunizing future generations, so they can stay protected and healthy until the time comes when they too can serve the country,” Yanto said.
COVID-19 vaccine implementation is supported by partners, such as the Australian Embassy, the British Embassy, the Canadian Embassy, the European Union, Indonesia, the Japanese Embassy, the New Zealand Embassy and USAID Indonesia through COVAX. UNICEF Indonesia is grateful for direct support received from key partners, including Gavi, the Vaccine Alliance, the Governments of Australia, Japan, New Zealand and United States of America as well as KOICA (Korea International Cooperation Agency).