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Real lives

Tears of joy

© UNICEF Angola/2003/Pirozzi
Theresa Domingos comforts her daughter, Osnaida Jose, who is suffering from measles.

LUANDA, July 2003 – Amid hundreds of screaming children – some at the delight of class being out, others as a way of placating their nerves – Joaquim King gently sings into his daughter’s ear. She is one of the worried ones, unsure of what waits at the front of the queue. Having been brought to a simple primary school in Luanda, Isabel nervously eyes off the vaccinators, their white coats, big grins, and safety boxes full of used needles.

But while three-year-old Isabel hides her head into dad’s shoulder, Mr. King wears a smile befitting a man who is looking after his little girl. It is the smile of a father who knows the value of what lies at the front of that queue.

“I lost my first daughter to measles,” Mr. King says, momentarily breaking from song. “I didn’t know you could have a vaccine for it. But when I heard on the radio that there was a national campaign to prevent measles, and that it was free, well, I was so happy.”

And so here he and Isabel are. It is day five of the biggest health initiative in Angolan history – the National Measles Campaign.

Measles is the leading cause of vaccine-preventable mortality in Angola and remains one of the leading killers of Angolan children. And so in four, hard-working weeks, the National Measles Campaign seeks to immunize 7 million Angolan children; that is every single Angolan boy and girl between the ages of nine months and 15 years. A massive task in any country, UNICEF’s challenge is greatly amplified as Angola is coming out of four decades war.

“The enormity and greatness of this campaign must be seen in the context of two things,” says UNICEF Angola Representative, Mario Ferrari. “Firstly, that war devastated Angola’s health infrastructure and this initiative seeks to rebuild basic health services and establish conditions across the country for routine vaccination. And secondly that it is the first major peacetime step to address Angola’s critical child mortality rate. It is a bold step, but that is what is now required, and it is entirely achievable.”

Short of supplies and comfort

Just a few blocks from the school where Isabel is about to receive her vaccination, three-year-old Osnaida Jose lies deadly still in Luanda Paediatric Hospital. The lone paediatric hospital in Luanda, it is short of supplies and comfort.

Brought in four days earlier by her mother, Osnaida is close to comatose. Her face, pale and scaly, is already showing the signs of the measles disease. Flies rest on her aching body, her exhausted mother seemingly too tired to shoo them away. A nurse comes to give her more fluids. She searches Osnaida’s skeletal arm, looking for a vein. It seems to be taking minutes, and yet it is only upon the fifth or sixth jab of the needle that Osnaida flinches.

© UNICEF Angola/2003/Pirozzi
It’s all over: Isabel is comforted by dad, and protected for life.

Although the measles fatality rate in developed countries is one in 1,000 cases, in Angola it is one in 10. This is because children such as Osnaida are already weak from various bouts of diarrhoea. It is at this time when the disease is at its most dangerous, as the virus weakens the immune system and renders children such as Osnaida very susceptible to fatal complications from diarrhoea, pneumonia and encephalitis. “I don’t know what will happen to her,” says her mother, Theresa Domingos.

Herein lies a crucial aspect to Angola’s National Measles Campaign. Just as the campaign gives life-saving vaccines to children, it also seeks to rebuild the devastated health system. For instance, UNICEF has trained 10,000 health workers in the specifics of safe vaccination. They will now take these skills beyond this campaign, to be used for routine immunization.

On an equally valuable, permanent scale, UNICEF has set up 21 workshops with technical teams in all 164 of Angola’s municipalities. The leaders from this micro-planning exercise will be critical local managers for the areas’ future health needs.

Likewise, all vaccinators are skilled in using one-time, ‘auto-disable’ syringes that are critical to ensure the quality of injection and so as not to spread HIV. Once used, these syringes block, thereby ensuring they cannot be reused.

Of course such safe practices do little to assuage the fears of Isabel, who is now at the head of the line to receive her shot. Almost in tears, she snuggles into her father’s neck. He whispers something, she giggles, the health worker quickly cleans her back, then expertly slides in the needle. It is over in a matter of seconds, but the protection lasts a lifetime.

A lifetime of protection

“Today I am a very happy man,” says Mr, King. “I cannot tell you the pain I went through when Joana [his first daughter] died. In her last days she was so weak she couldn’t open her eyes. And so it means a lot to me to be able to protect Isabel from measles.”

Conducted over four weeks, the National Measles Campaign has three phases: the first lasted one week and was in schools and crèches; the second is in urban areas (health centres, outposts in markets and informal gathering areas) and the third, the most difficult stage, in rural areas.

A week after Isabel had her potentially life-saving shot, figures show that 2.1 million other children were also immunized in phase one. This 20 per cent increase on estimates indicates the resolve of Angolans to have their children immunized and is evidence of the success of UNICEF’s communications drive.

Days later I return to see Osnaida at the Paediatric Hospital. She is still terribly weak, though now opening her eyes and able to look up to her mom. The doctor tells me she will pull through. She is one of the lucky ones.

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