On this day: first measles case recorded

Today marks one year since the first case of measles was identified at the Tupua Tamasese Meaole Hospital on August 28 2019.

It was six weeks before the Government declared there was an outbreak and two and a half months before a state of emergency was ordered, and measles vaccinations were made mandatory.

Between August 28 and October 13 when measles claimed its first infant victim, Samoa recorded 137 cases but had yet to publically announce any cases at all.

On October 12, the Samoa Observer published its investigation that confirmed 16 people were being treated in an isolation ward at T.T.M. Hospital.

Four days and another 80 cases later, the Ministry of Health officially declared there was an epidemic, and when a state of emergency was declared on November 15 there were at least 700 cases of measles, a number which swelled to 1,174 just four days later.

But Samoa did not know there had been so many cases until 15 November, when a Situation Report distributed by Government media revealed surveillance had been recording confirmed measles cases since the end of August.

Asked why he had not announced the outbreak sooner, Director General of Health Leausa Dr. Take Naseri denied the early cases had been confirmed.

“We don’t want to panic the people, we were not sure,” he said in a press conference in November.

“There is no need to cause unnecessary panic amongst the population.”

The next month, it was revealed that in March 2019 Samoa received a warning from the World Health Organisation and United Nations Children’s Fund, that the Pacific is especially susceptible to a measles outbreak.

“A single case of measles constitutes an outbreak,” the letter stated. Leausa did not respond to questions asking what action was taken on receipt of this letter.

By early January when the epidemic was officially declared over, Samoa had suffered at least 83 deaths, mostly of children, and at least 5,700 people had been infected with 1,868 of them hospitalised. 

A rapid and widespread vaccination programme successfully inoculated 95 per cent of the population, according to the Ministry of Health.

World Health Organisation data on vaccine coverage suggests that 87 per cent of eligible children received their first dose of M.M.R. and 44 per cent received their second.

During the epidemic, hundreds of local and international volunteers were mobilised to help stop the spread of measles through vaccinations and educational awareness programmes across Samoa.

The country also had the largest international deployment of Medical Assistance Teams from a dozen countries. 

One of those organisations was the Samoa Red Cross Society, who reached around 19,500 people with outreach activities, a vaccination programme, and their blood donation drive during the epidemic.

Their blood donation drive was so successful, with 299 donors, that the laboratory had to ask the campaign to stop because there was no room left in the blood bank.

Secretary General Namulauulu Tauatala Mauala said until today, the S.R.S.C. continues to visit the families and villages affected by the epidemic, and is helping them prepare for COVID-19 should it ever reach Samoan shores.

They have been following up with 85 households that had measles fatalities or serious cases, with 2,018 households altogether where measles cases were reported.

This includes hygiene kits and advice on handwashing, but also ongoing psychological support with the support of the Head of the Mental Health Unit of T.T.M, Seiuliali'i Dr. George Tuitama, for hundreds of families.

Namulauulu said in the year since the epidemic began, families that were found at the time to not have a regular water connection still do not, which is a concern with the threat of COVID-19 looming. 

“We came across families living in areas without water supplies and when we ask if they are handwashing and all of that, their mentality is how are we going to do that when our water is for drinking.  

“Health is everyone’s responsibility, it’s not just the Ministry or the hospitals, it’s everyone’s responsibility and that is why Red Cross stands up and tries to assist along the way.”

The entire Red Cross operation in Samoa cost T$119,477.

In total 77 volunteers were mobilised to help with hygiene promotion activities and the SRCS outreach work, many of whom lived on the Red Cross campus during the operation to make the work easier. But it took an emotional and physical toll on the volunteers, as they had less rest or privacy than they might have done at home. 

The volunteers distributed 306 hygiene kits with soap, laundry detergent, toilet paper, disposable menstrual pads and more were distributed to 170 households, 138 mosquito nets, 16 ten litre water bottles and 183 kits for new born babies. 

Another organisation that joined the measles response efforts was the youth advocacy group Brown Girl Work. Founder Maluseu Doris Tulifau said the group continues to take food, water and sometimes even money to the victim’s families, and until today they struggle to talk about what they went through.

“I met two families for whom it was their first child, they were heartbroken and blaming themselves,” she said.

“I guess when you don’t know who to blame you just blame yourself.”

She said these days when they return to families, they are grateful for the support and chatty enough but Maluseu senses they are avoiding talking about their loss.

Visiting these families has highlighted just how impoverished some Samoans still are, Maluseu said.

One mother they visited lost two of her children to the epidemic. At the time, when B.G.W. visited her, the mother mourned to Maluseu that she blamed herself for her children’s deaths because she had not been able to breastfeed them.

Looking around the small empty home, Maluseu said she suspects the mother couldn’t breastfeed because she herself was malnourished.

Other families they met lamented that they had not taken their children to the hospital sooner but that they had never needed public health services for their children’s ailments before and did not know how bad measles was.

“A lot of the families were used to living with what they had, if they got sick they said oh well, we’ll get better, but it wasn’t like that.”

Majority of the families who lost infants or toddlers to the epidemics were young couples just starting their families, or with several other young children who also got sick.

In their small fale style houses there was nowhere to isolate one child from another to stop the highly infectious disease from spreading.

One family had all five of their young children catch measles, one of which was bad enough they needed hospital care. Maluseu said this family had neither running water nor an electrical connection to the house. 

This year in April, B.G.W. began what would become a two-month-long mission to get the home connected to power and install electrical fittings for the which involved weekly trips to the Electrical Power Corporation and thousands of tala in expenses.

“It was such a difficult thing to do, it’s crazy, a total nightmare for two months,” Maluseu said.

“It takes all this paperwork, offices were blaming other offices for not getting something from another office, I can’t imagine any family already that vulnerable coming back to town every day, I would have quit.”

Today B.G.W. is still visiting around 30 families who lost children to the epidemic and helping them with groceries and phone credit. Many of them have lost their jobs amid the COVID-19 state of emergency. 

Maluseu, who at the time was still travelling between American Samoa and Samoa frequently, said she noticed in late September that American Samoa had begun screening for measles at the airport well before Samoa had.

She said the neighbouring islands also moved more quickly to close their borders to unvaccinated travellers and became stricter on incoming passengers before Samoa did.

“It was crazy, I would fly over to American Samoa and get screened there but not get screened here where cases were at. And they (American Samoa) didn’t have one case yet).”

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