In April 2015 a major earthquake struck Nepal. A year later people in one village recall their struggles, in its aftermath, to keep their children safe through immunization.
Near mid-day on 25 April 2015, Ratna Kumari Biswakarma, who lives in Bigu, in Nepal’s Dolakha district, was busy preparing lunch. Her 9-month-old daughter Sushmita was asleep in her cradle.
“Suddenly the whole house began to tremble and there was a terrifying loud noise,” she recalls. “I picked up my daughter and ran out of the house without a second thought. Once I got outside, I saw that the house was literally gone.”
Ms Kumari was fortunate – her entire family survived an earthquake that took the lives of more than 9000 people and left nearly 3 times that many in need of medical attention. Dolakha, which is about 130 km northeast of Kathmandu, has an impressive record of providing comprehensive health services. But the earthquake destroyed 52 of the district’s 58 health centres.
In the days leading up to the earthquake, district health workers in Dolakha had been absorbed with raising awareness about vaccines and immunizing children in the context of World Immunization Week, which falls each year during the last week of April. Now they had to turn most of their attention to wounds and broken bones.
Steps to avert a measles outbreak
Despite the urgent need to care for the injured, local health authorities and experts from aid agencies knew that continuing vaccination was crucial because of the risk of disease outbreaks, especially measles.
Measles is a highly contagious disease caused by a virus. In 1980, before widespread vaccination, measles killed an estimated 2.6 million people each year. Although a safe and cost-effective vaccine is available, measles remains one of the leading causes of death among young children in many countries.
Two doses of measles vaccine are administered to ensure full immunity. The second dose is needed because a small percentage of children miss out on full protection against the disease with a single dose.
WHO has identified measles outbreaks as a serious threat after earthquakes, other natural disasters and any emergency situation that leaves people displaced. The Organization recommends the immediate vaccination of all children affected by humanitarian emergencies.
Local health authorities began measles vaccination campaigns in communities that remained accessible and where vaccines could be maintained at stable temperatures during transport.
In villages like Bigu, however, it looked as though vaccination campaigns would have to be postponed.
A shortage of available health workers was not the only challenge to vaccinating children in the area. Landslides and piles of stones on roads made transporting the vaccines nearly impossible. Bigu and many other villages in the hills were cut off from all contact, except by people able to walk there.
And community health workers did walk there, making the 3 to 4-hour trip to the village and going door-to-door providing information about hygiene and vaccination.
Second quake foils plans
On 12 May, another shock hit the region, and health workers had to once again turn their efforts to treating acute injuries. The measles immunization campaign was delayed once more. In July, an effective measles campaign could at last be carried out – but under extraordinary circumstances.
“It is never easy to run a vaccination campaign in Bigu,” says Leela Bahadur Thami, who manages Bigu’s health post. The village is without electricity and has no cold storage facilities. Vaccines have to be carried in a cold box from Singati, which has refrigerators, to Khopachaku, a half-day’s journey away. Then, they must be carried one way or another, and this time, on foot, to Bigu.
The entire community around Bigu joined together to make the campaign a success. Students at the Gauri Shankar High School formed a committee to raise awareness on immunization. Local political leaders made immunization part of their routine messaging.
“WHO’s technical support and assistance with vaccine transportation made our job much easier,” says Rajaram Karki, Immunization Supervisor of Ministry of Health in the Dolakha district. Thanks to the collaboration between the Ministry of Health, WHO and UNICEF, and financing through the Measles and Rubella Initiative, the entire village was immunized. Not a single child in Bigu became sick with measles.
Meeting global targets
It costs just US$ 1.00 to immunize a child against measles. Although 9 out of 10 children in Nepal are being vaccinated today, the country still faces hurdles to achieve measles elimination – which would mean no active spread of the disease for 12 months or more.
The main challenges are making sure all children are fully immunized and that any measles case that occurs is reported. The WHO Strategic Advisory Group of Experts on Immunization has set the target of eliminating measles in the WHO South-East Asia Region, where Nepal is located, by 2020.