I’ve seen hundreds of cases of measles in one day. It is a luxury to be able to vaccinate your child | Saschveen Singh | Global | The Guardian4 Luglio 2019
No child should die of measles, whether in Australia, the Democratic Republic of Congo or elsewhere
When I travelled to the Democratic Republic of Congo (DRC) as a doctor, I was prepared for confronting conditions.
I could not imagine what I actually found there.
Earlier this year I joined a Médecins Sans Frontières/Doctors Without Borders (MSF) emergency team heading to Mayi Munene, a town in a remote and neglected region of Kasaï-Central in the DRC.
We were already shocked by the situation in other villages. Health workers spoke to us of the difficulties since the outbreak of violence in that part of DRC, not only in providing routine preventive healthcare such as immunisations and safe deliveries of newborns, but also in treating current measles cases, or common illnesses such as malaria, pneumonia and gastroenteritis.
The region is a conflict zone and at least half the children under five years old suffer acute malnutrition, which puts them at much higher risk of severe complications with any infectious disease: particularly with measles as it depletes their immune system. The mortality rate during a measles outbreak can reach up to 20% among malnourished children.
Local health workers were unable to provide appropriate care due to lack of medications; their pharmacies were empty, with many essential items out of stock for months. They spoke of people fleeing burned villages to live in makeshift huts, exposed to the elements with no food or healthcare. They described how armed groups had even stolen the primary hospital’s solar panels, cutting off power to the cold-chain fridges and thus crippling its ability to store vaccines.
Despite all this, we weren’t expecting the number of cases we saw that day in Mayi Munene. We found people waiting for us under an outdoor shelter that replaced the destroyed health centre. Together with the local nurses we set up a makeshift clinic using a few plastic tables and chairs and the consultations began.
By this time, the crowd waiting had doubled, then tripled, and before we knew it there was a huge crowd of desperate parents jostling to get in line to seek assistance for their unwell children. Within the first few hours we saw 70 patients, of whom 68 undoubtedly had measles. More than 30 had severe complications including pneumonia, malnutrition, malaria and dehydration.
To put this into context: I’ve been working as a doctor in Australia for 13 years, and until seeing my first case in a Perth emergency department a few years ago (when we saw a resurgence of measles in Australia due to returned travellers and an increase in the anti-vaccination movement) I had only seen measles in textbooks. So, when I saw the burden of this very infectious, deadly and yet preventable disease – hundreds of cases within a single day in a single village – it was shocking. No child should die of measles in this day and age.
Almost all the children we saw were under the age of five. I will never forget a grandmother who arrived holding a severely malnourished and dehydrated baby. The baby’s skin was peeling, and she was barely breathing. Her mother was behind her in line holding her older child who was looking very unwell. The look of pain I saw in these women’s eyes will forever be etched in my memory. We did the best we could, but sadly despite emergency resuscitation it was too late – the baby died within the hour.
In an emergency assessment phase we don’t have all the resources to stay behind at each village. Although we had given training and support to the local staff, and had left boxes of medications, we felt a huge pit in our stomachs. Judging by the overwhelming crowd of patients still waiting, we knew the medications would likely run out after only a few hours.
Even the patients’ families must have known, as when we bid goodbye to our local colleagues, several mothers came over to us crying, tugging on my clothes, and even trying to stop the car from driving away – pleading with us to stay and send word for more urgent help. It was a silent and sombre drive back to the camp as four experienced field workers: a driver, a logistics manager, a nurse and doctor were moved to tears knowing what we left behind. We had reached a new low.
Our aim was to visit the villages worst affected by measles, take blood samples and confirm the diagnosis, and then provide treatment. The diagnoses would allow the official confirmation of a measles epidemic in the region, which would in turn allow a coordinated epidemic response.
We also trained local health staff on how to best manage complicated measles cases; deliver much-needed medical supplies; and collect information on rates of infection and malnutrition which often is one of the many life-threatening consequences of measles. MSF teams would then be able to deliver vaccines and set up emergency field hospitals and clinics to take care of complicated cases.
In Australia, under the National Immunisation Program, vaccination is available free for all children as well as for adults born after 1966 who are not already immune. The MMR (measles, mumps, rubella) vaccine is safe, effective and two doses provide up to 99% protection against the three infectious diseases.
In the DRC, however, access to lifesaving measles vaccines is significantly limited. Now they are in the throes of a huge measles epidemic. This year, more than 1,500 measles-related deaths have been officially recorded in DRC. At the time of writing, MSF teams had vaccinated 361,079 children there.
Vaccination is the best form of protection against measles and even after the disease has begun to spread it can still reduce the number of cases and deaths. However, at least 95% of people need to be immune in order to prevent new outbreaks. Vaccines work best if we all join together.
No child should die of measles, whether in Australia, the DRC or elsewhere. Yet many people have no idea what a luxury access to free immunisations is. I am pleading with parents to never take that for granted. You cannot imagine what it’s like to see the conditions we see in the field.
Start at home: vaccinate your children. And support firm policies on climate change, the environment and the eradication of extreme poverty that work to make health global for all, and not just another privilege of western society. Healthcare is a human right, but tragically so many people are deprived of this basic need.
- Dr Saschveen Singh is a medical doctor from Perth who works with Médecins Sans Frontières/Doctors Without Borders specialising in emergency medicine, adult and paediatric medicine, and refugee health.