Asking questions, accountability and the epidemic

Four days ago one of Samoa’s top doctors called for a national inquiry into the measles epidemic, which has already claimed 79 lives and logged 5,520 confirmed cases.

Toleafoa Dr. Viali Lameko, currently the Oceania University of Medicine Vice-Chancellor, told Samoa Observer he was speaking in a private capacity and believes a “majority” of local physicians support the call.

In a country of 196,000 people governed by a one-party government that has been in power for 30 years, asking questions of the establishment and how government policies are implemented for the betterment of the people and their constituencies can be frowned upon or even discouraged. 

It is why you have to admire Toleafoa for having the courage to speak out and question the status quo, in terms of the government’s overall health policy, when measured against a deadly measles outbreak that is now close to claiming 80 lives

“As a public health senior medical officer too, I am also interested in the factors which could have led to the current measles epidemic, which claimed the lives of many young children in our country in just a short period of time," Toleafoa said, in response to questions from this newspaper.

“Inadequately resourced hospitals, especially with great I.C.U. (Intensive Care Unit) setups and staff, coupled [with] high and sustained vaccination coverage above 90 percent, strong and well-nourished children [...] good access to clean water and good [...] standard of living of the populations [means that] deaths related to measles is usually unheard of, or very minimal.”

As a medical officer in Samoa with many years of experience, it is incumbent upon him and his colleagues to not only make a diagnosis of illnesses, but to also look at local factors that created a conducive environment for a measles outbreak to occur.

We are not surprised with Toleafoa’s line of questioning, in his response to questions sent by this newspaper. 

He raises questions about basic hygiene and sanitation in Samoan families’ homes, and whether families’ access to clean water could have made a difference, and reduced the risks of measles infection.

Toleafoa said: “We always advised people to cover their mouths with the palm of their hand when coughs or sneezes, which is a good cough etiquette, if you don’t have a handkerchief. 

“But you need to clean your hands with clean water immediately because the measles virus can survive on your hand and surfaces which you touch for at least 2 hours. 

“So if there is no access to clean water, then you are going to pass the virus to everyone whom you meet within that period of time.

“Does everyone in this country have access to clean water? Certainly the health sector cannot fix this issue.” 

Toleafoa also asked about the economic status of ordinary Samoan families and whether the current state of their family houses make them vulnerable to infection.

And he is right in saying that it is not the job of the health sector to address the plight of ordinary Samoan families – who lack the financial capacity to be able to build houses with access to basic services such as water and electricity – and thus be in a better position to protect themselves and their loved ones from deadly pathogens such as measles.

But the Oceania University of Medicine Vice-Chancellor is not the only one to ask questions, two weeks earlier the Salega Member of Parliament, Olo Fiti Vaai called for a special commission of inquiry to get to the bottom of the measles epidemic.

As a politician and speaking on behalf of his constituency, the Salega MP feels he is obligated by the heavy loss of innocent lives and the welfare of his constituents, to call for a commission of inquiry.

But why should the burden of speaking out and holding a government to account over its health policies be left to a senior medical officer and a lone politician? 

The Constitution of Samoa under Section II relating to Fundamental Rights states that all citizens of Samoa have the right to freedom of speech and freedom of expression. Under the laws of the land, you can question anything including government performance, so long as you also respect the rights of others to also hold a different opinion.

Freedom of speech is a fundamental pillar of a democratic state and Samoa as a democracy will and should thrive when there is diversity in thought and opinion. Criticisms of the failure of government policies is not wrong, it is within your rights to express dissatisfaction at failures that can be calamitous and even lead to the loss of life. 

Do you feel strongly about failure in government policies? Write to us and let us know.

Stay safe Samoa and God bless. 

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