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East Timor: Slight prick of pain yields protection against measles

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Dili, 12 November 1999 -- "I'm very happy because this is something I am doing for my people," said Merce Petronela, a youthful nurse-midwife. She was looking tired, though, at the end of an evening vaccination session at a transit centre known as Don Bosco, where returning East Timorese are brought at all hours of the day. "Also, I am earning a salary, which is still fairly rare. I hope soon more Timorese will have jobs."
Merce is one of 110 East Timorese - all of them nurses, midwives or former nursing students - who were trained at the beginning of October for a measles vaccination campaign in Dili for children under five years of age. Twenty-four of these individuals were selected for four teams, to continue the measles vaccination effort with returning East Timorese, those who fled the violence by the Indonesian militias throughout September.

Vaccination against measles is important because of the highly contagious and severe nature of the disease. Once a measles outbreak occurs, it hits especially hard those children whose bodies are already weak from poor nutrition and other illnesses such as diarrhoea. For these children, measles is often fatal. That is why UNICEF and Médecins sans Frontières (MSF) organized a one-day measles vaccination campaign in Dili, the capital, on 19 October 1999, and why UNICEF has continued to vaccinate children returning to Dili and, more recently, children in towns outside the capital.

In Dili, three teams work during the day, from early morning until well past four or five o'clock in the afternoon; often, one team begins work at four in the afternoon and continues until the last child disembarks the flight or boat trip sponsored by IOM (International Organization for Migration) and UNHCR (Office of the United Nations High Commissioner for Refugees) and has been vaccinated. For five consecutive nights in early November, the teams vaccinated returning children until half past one in the morning. Team members receive the equivalent of US$5 per day for their work.]

UNICEF staff member Dr. Myo Zin Nyunt puts in a back-breaking 16 hours each day, ensuring that measles does not break out amongst the children of East Timor. For five weeks, Dr. Myo has picked up the teams at a pre-arranged location and has taken them to the vaccination sites. One team stays permanently at a Catholic-run social centre on the outskirts of Dili. The other three are mobile, setting up their tables and chairs daily at the seaport, airport, stadium or other area designated by UNHCR or IOM, the two agencies responsible for moving the people from West Timor back to East Timor. (When East Timorese return from West Timor or other parts of Indonesia on their own, either on foot or by vehicle, their return is considered a 'spontaneous return'.)

In addition, the teams work in rotation at the Balide and Motael Clinics in Dili and at the Lahane Primary School on the outskirts of Dili. Run by a Jesuit community using Portuguese-speaking teachers who had not taught since the Indonesian annexation of East Timor in 1974, the school has mushroomed to 1,900 students from an initial enrolment of 200. Bit by bit, the students have been marched from their makeshift classrooms under the trees or in a shed to Father Joao Figueiras's porch, where they receive vaccination cards and then march bravely up the stairs for the injection.

"Aiee!," whispers nine-year-old Ana Lisa das Dores da Silva Carvalho as the needle is inserted skilfully and quickly by Alcia da Silva. Ana Lisa rejoins her waiting friends at the bottom of the stairs. They compare their needle pricks and some try not to whimper as they walk back to their classroom under a tree.

According to Dr. Myo, the introduction of a new Expanded Programme on Immunization (EPI) for all six childhood killer diseases (diphtheria, measles, pertussis, polio, tuberculosis and tetanus) is difficult to accomplish with a highly mobile population, as is the case in East Timor. Over 50,000 East Timorese have returned home in the past five weeks, either in organized or spontaneous movements, giving an estimated total population of 600,000.

"We are already pre-placing all the necessary injection equipment throughout East Timor, and putting cold-chain equipment to keep vaccines cool into Darwin (Australia)," Dr. Myo said. "Then, when the population has stabilized a bit more, we can launch routine immunization fairly quickly. We hope that will be in early December."

In the meantime, the measles vaccination campaign has expanded outside Dili to Manatuto and will soon cover Viqueque, Liquica, Los Palos, Ermera, Ainaro and Aileu. NGO partners for these areas are AMI (Aide Medicale Internationale), MDM (Médecins du Monde)-France, MDM-Portugal, Oikos and MSF (Médecins sans Frontières). In a show of solidarity amongst the humanitarian and peacekeeping forces, the Philippines Military Medical Unit of INTERFET (International Force in East Timor) and the Portuguese Mission in East Timor are also participating in the vaccination exercises.

"The best part of all this is that we've so far avoided an outbreak of measles in East Timor," Dr. Myo said. "Only two measles cases have been reported in six weeks, and both of those came from West Timor. But we've also built a strong team of local health workers, who will become part of the regular EPI team."

From 19 October to 9 November 1999, 10,347 children under 15 years old were vaccinated against measles. UNICEF's input into the programme has been in the training of the vaccination teams and in logistics support, and in providing the cold-chain and vaccination equipment. Initially, MSF-France provided the vaccines; now, UNICEF has picked up all vaccine procurement costs. About US$5,000 has been spent on measles vaccination in East Timor - this means that less than 50 cents has been spent on each child, a small cost by any measure.

For more information on UNICEF, visit its website at http://www.unicef.org