Measles in South Sudan by Sue Averill

Imagine this is your home, your ‘hood, your life.  You struggle to get by, to find or grow or be given enough food.  You carry water for miles from a pump (borehole) some organization has drilled to let you have potable water instead of drinking from a nearby river where you also bathe, wash clothes and water your animals.

Now imagine political factions – some military alliances, some tribal, some national politics and the promises of power and money. Those factions are threatening each other and moving chess pieces now during the dry season.  Before the rains start in May turning the “black cotton soil” into foot-deep muck not even a cow can walk through.

The dry season brings cattle raids, tribe on tribe, and violence escalates. And in this unstable dry season, with populations moving place to place to escape the violence, the dry season has brought a measles outbreak.  Adding to the exposure risk – WFP (World Food Programme) decided to do a registration for families to receive supplemental food (corn/soy blend, oil, salt) and 40,000 additional people converged on measles-stricken Mayom.

Both of our projects are inundated with measles cases – one of the most infectious and virulent viruses, passed through the air just by breathing … and completely vaccine preventable.  Unfortunately, the government has no funds for routine vaccinations of all children. Only for war and government bureaucrat salaries. And the unvaccinated children are dying.  Unvaccinated pregnant women are dying.  It’s spreading fast and our medical facilities put up more tents to isolate and care for these incredibly ill patients.

The only thing that will stop a measles outbreak is a mass vaccination campaign.  We supported GOAL in the Agok region, but are afraid the coverage rate might not be as good as reported. The cases have not diminished.  In Mayom we’re collaborating with Save the Children (their international staff is all ex-MSF) to not only vaccinate and give Vitamin A drops (to prevent blindness which often accompanies measles infections) but do a MUAC measurements for nutritional screening.  As we move further into the “Hunger gap” this baseline will be invaluable for responding to a worsening nutrition crisis.  Often after recovery, children with measles become malnourished.  And a large number have neurological consequences.

Unfortunately, WHO advises the South Sudan Ministry of Health to only vaccinate kids 6 – 59 months, supposing older than 5 years surely must have been caught in previous campaigns.  Yet 30% of our patients are 5 or older.  Half of that 30% is above 15.

Imagine now, in the terrain you see above, no roads, little water, scattered villages, population on the move … Now you mount a vaccination campaign.  42 teams on bicycles, motorbikes, dropped off by Land Cruisers with their cold boxes and vaccine carriers (oh, yes, even in the 120 degree heat, measles vaccine is fragile and must be kept cold).  Ears or fingernails are marked in magic marker so there are no duplicate doses, tally sheets to be marked, Middle Upper Arm Circumference measured and noted, oily Vitamin A drops into crying mouths.  Day after day for 10 days.  Hoping to catch 35,000 children under 5.

It’s the only way to stop the outbreak.

And now I wonder to myself … with all the luxury at home, clean plentiful water, safe homes, soap, cars, intact health systems, nutritious food, ease of obtaining anything at all … Why do some adults refuse to vaccinate their kids against measles?  Apparently, they have never seen a case of goopy eyes, cough, high fevers and misery.  The rash is the least of it.  Blindness.  Brain damage.  Malnutrition.  All because of a discredited “study” and fears of autism.  Wow.

I’ll leave you with a cold drink on this hot day.  With hopes what I see here can influence our lives at home just a bit.