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Top doctor calls for measles inquiry

Toleafoa Dr. Viali Lameko has called for a national inquiry into how the recent measles epidemic spread so far across Samoa so quickly and has left a total of 75 people dead. 

Toleafoa is the first member of the medical fraternity to speak out on the issue of a national inquiry. Though he is the Vice-Chancellor of the Oceania University of Medicine he stressed he was speaking in a personal capacity as a doctor and that he believed a “majority” of physicians supported his call. 

“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 the Samoa Observer. 

His call followed a statement from the National Emergency Operations Centre late last night confirming that two more children under five had died from measles in the past 24 hours. 

The new update brings to 5,331 the number of measles cases to have been reported to the Disease Surveillance Team, since the outbreak started, 64 recorded in the last 24 and 109 measles in-patients receiving hospital treatments. 

More than 1,700 patients have been admitted to hospital for measles treatment across the country, of which some 1500 have been discharged.   

Toleafoa told the Samoa Observer measles infections typically only have minor health consequences for infected patients with outbreaks occuring in small numbers every year in smaller communities worldover. 

“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," he said. 

“In addition, the general environment is clean and hygienic, and the education level of the population is generally high.  

“Well that is almost in an ideal situation.” 

He said that any Commission of Inquiry needs to examine not only the medical system but the broader factors outside it which have influenced the health of the population. 

“I am not here to attack anyone or any sector, but perhaps it is time to return to the drawing board and ask some serious questions about the health profile of our population," he said. 

“For instance, measles is spread via direct person to person contact and airborne when someone sneezes or coughs. 

“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.” 

A leading opposition Member of Parliament, Olo Fiti Vaai, was the first to call for an inquiry into the Government's response to the measles crisis earlier this month. Those calls have since been echoed by the newly established Samoa National Democratic Party. Despite initially dismissing those calls as politically motivated, Prime Minister Tuilaepa Dr. Sa'ilele Malielegaoi, has since said an inquiry would be held "in due time".

Toleafoa said measles can cause serious complications for young children who are malnourished and not vaccinated. 

“Several reports and studies have informed us that about 16-17 per cent of bottle-fed children in Samoa are malnourished," he said.  

“Why these kids are malnourished is not something which could be fixed by the health sector alone.” 

He also questioned the why the Komiti Tumamam was dissolved.   

“What happened to the social machinery, such as the Komiti Tumama which used to work in a close partnership with the health sector in the past in the vaccination campaign?," asked Toleafoa. 

He further queried what had happened to the concept of "ownership" of the general well-being of people at the village level.

He also questioned whether economic status and housing arrangements had influenced the population's susceptibility to infection. 

“Is it hygienic and conducive to avoid infectious diseases such as diarrhea, tuberculosis, and pneumonia to name a few? The health sector cannot fix these issues," he said. 

"Has the health sector done its part in the previous years to ensure a high percentage of vaccination coverage for the whole country?"

Toleafoa also questioned why a specialist I.C.U. at the national hospital had been dissolved last year. 

“And why aren’t there enough doctors working at the hospital but we now have twp medical schools in the country? Have you engaged the general practitioners to lift the primary health care in this country of ours?," he said.

Toleafoa  said the determinants of the population's health prompted a litany of questions that needed to be answered in a structured manner. 

He also commended the current administration. 

“I want to thank the Honourable Prime Minister [and] his Cabinet for leading and managing the response to the epidemic," he said. 

"As well as the local [Ministry of Health] staff; doctors, nurses, [the] X-ray department, pharmacy, physiotherapists, porters, drivers, cleaners etc., for [their] hard work

Last but not the least is to thank the members of the overseas teams who came to help Samoa at these difficult times.”

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