Distrusted Government needs new plan

The outbreak of an epidemic, a person on the frontline of Samoa's measles outbreak said recently, brings to mind a quote by a famous boxer: “Everyone has a plan until they get punched in the face."

The inadequacy of the Government's preparation for an epidemic became stark once the recent measles outbreak struck. That it came after so much warning it raises questions about what anticipatory action Samoa was taking while measles spread like wildfire around the globe. 

Thousands of children died in the Philippines; Auckland had its worst outbreak for 20 years; and rates of infection in Europe have doubled despite their immense vaccine coverage. 

We have been advocating for transparent disclosure from the Ministry of Health about the state of the vaccine to be issued immediately and daily not after six weeks and 200 suspected cases as we revealed last week (“Samoa defends long wait on measles admission”).

The provisions of fridges, masks, gowns and expertise now holding treatment could have been in place: as we revealed on Wednesday a medical team from New Zealand was ready to fly over last month but the invitation was not taken up. 

But setting aside the health consequences of not pro-actively disclosing measles hotspots, the Health Ministry has helped create a vacuum. It has been filled by people with mixed intentions but whose interventions can often lead to the same deadly consequences and drive people away from hospitals. 

We applaud the Government’’s measures announced yesterday in the form of a crackdown on people who actively discourage people from seeking vaccinations and making them compulsory. 

The Director-General of the Ministry of Health, Leausa Take Naseri, drew an important distinction last week between some of the people offering treatment: some are ill-intentioned and driven by the profit motive with promises of miracle cures, some are genuine in offering assistance. 

We don’t blame traditional healers practising centuries-old Samoan methods, even though parents prioritising treatment from them is doubtlessly causing the deaths. 

We also empathise with the parents seeking out these opportunities in the hope of saving their children from an epidemic that has claimed at least 17 lives.

This has all been enabled by an environment of mistrust in the health system and it's time the Government tried a new approach to getting messages through to people who  have long since stopped listening. 

The terrible events in Savai’i involving a wrongly prepared and administered measles vaccine that killed two babies (and led to two nurses being jailed for five years) could not have come at a worse time for public trust in the health system. 

But that only compounded existing cynicism about the Samoan health system. As Dr. Dina Tuitama, the former director of intensive care at the national hospital, told an international conference last month hospital was often seen by Samoans as a place you go to die.

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We do condemn the snake oil salesmen promising miracle cures online completely unbacked by evidence, not borne of any tradition and giving parents false hope and possibly even leading to children's deaths. Action should be taken against them. 

But the reason people are spurning hospital treatment for these options says something about what has to be incorporated into the Government’s next plan for such an epidemic. 

In the villages traditional healers have been offering treatments for centuries and they occupy a position of trust among the very people the Ministry of Health is trying to reach but failing. 

The Government should consider reaching out to the Taulasea* and bring them to the negotiating table to see if they can form part of a public health campaign. 

To be painfully clear, the only cure we endorse is the Government-approved guidelines for measles. Keeping one’s vaccines up to date; isolating those in the suspected early stages of the disease; and taking those who show advanced symptoms, such as laboured breathing, to hospital.

It is precisely traditional healers’ patients who are at most at risk of dying from measles: they are either not being reached or not trusting Government information on how it should be treated. 

A certain portion of people are avoiding seeking treatment for measles until it is too late, many of whom, no doubt placed faith in traditional healers.

But when an epidemic of the Ebola virus spread through sub-saharan Africa and AIDS spread across South Africa, international aid agencies enlisted traditional healers to allow vaccinations be established in their clinics. 

The programmes significantly helped to contain the spread of epidemics. 

This explains why the mortality rate in New Zealand was zero after more than 20,000 cases and it stands at 17 after just over 1,100 in Samoa.

If the healers can be convinced of the benefits to their patients’ welfare they could play a complementary role with Government in terms of promoting administering vaccines or alerting doctors when a patient’s symptoms start to deteriorate.  

Those healers who agree to the complementary mixture of modern and traditional medicine in this way will be saving lives.

Amd it’s not just healers whom the Government should be reaching out to; it’s also village councils, High Chiefs and women’s committees, in recognition of the fact that too much of the community is simply not responding to its messages. 

It’s more than worth the Government making such an approach before the next time it is caught by surprise.  

What do you think Samoa? Have a great weekend and God bless.

*Taulasea is a Samoan term for traditional healer. 

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