By Leila Abrar and Mariana Palavra
Maungdaw, Rakhine State, January 2016 – A father of seven, Kolimullah will never forget those days of October 2015. His youngest child, 17 month-old Jasair Arafat, had been sick for a while and even after making several visits to the hospital and taking medication, the fever insisted on coming back.
“One day, after attending a celebration in my parent’s village, we came back home with my feverish son, who kept falling over whenever he tried to stand”, recalls the 43 year-old father.
As the child got weaker and couldn’t stand anymore, his parents rushed him to the hospital. After medical examination, the diagnosis came one month later, in those days of October: “The doctors told me it was polio. It was a very hard and complicated moment”, says Kolimullah. “I felt a very useless man.”
Jasair Arafat was one of the two children reported as contracting the vaccine-derived polio virus infection in 2015 in Maungdaw. The emergence of such cases is the result of low immunization coverage, which in Rakhine state has been below 80% for the last few years. In fact, in some of the State’s townships only 27% of children received the three recommended doses of oral polio vaccine.
Maintaining routine immunization services, especially in hard-to-reach areas, represents a challenge for the Myanmar health system. As a result, children are less protected from viruses. In Maungdaw, where the majority of the population is Muslim, there are also language and culture barriers, increasing the distance between the community and the basic health staff and volunteers. The inter-communal violence that erupted in Rakhine State in 2012 has also further complicated community outreach, and as a result all children from all communities are at a greater risk.
“A response is now underway to stop local transmission and prevent further spread says Bertrand Bainvel, UNICEF Representative to Myanmar. “However, the most effective way to stop the circulation of this virus is to increase the immunity of all children, including children living in violence-affected areas, through routine immunization coverage”.
UNICEF and WHO are supporting the Ministry of Health to conduct polio outbreak response vaccination campaigns in all 330 townships of Myanmar, targeting around 4.6 million children under 5 years. The first three rounds of this campaign - which took place on December and January - targeted children in 22 high risk townships in Rakhine, Chin, Magway, Bago and Ayeyarwady. In addition, one national round of polio immunization will be conducted in the entire country starting on 20-22 February.
“UNICEF urges the government to expand routine immunization against all antigens to protect children from preventable and debilitating diseases”, says Bertrand Bainvel. One immediate step to help reach this goal is to prioritise vaccine management and cold chain systems in the government’s health budget, and to increase community outreach in order to create more demand for the vaccination. “The concerted efforts of the government and all health partners will result in improved routine immunization coverage nationwide and low risks of vaccine-preventable disease outbreaks in future.”
UNICEF is also partnering with the Centre of Diversity and National Harmony to bring together communities divided by violence and mistrust in support of one common goal - immunizing all of their children.
Kolimullah also has an important role to play, as he became a community volunteer during the polio outbreak response in Maungdaw. “The community does not receive information on polio and other vaccine-preventable diseases, especially about how they are transmitted or prevented. “I want to change this so that other families in my community can learn about the risks of polio and protect their children”, he affirms.
As a community volunteer he goes door-to-door to inform parents about the immunization campaign dates, and he identifies those children who missed vaccination for various reasons, namely being away from home. He then compiles a list of these children and households so that the health teams can conduct follow-up visits.
In addition, whenever he meets parents who refuse to vaccinate their children, he convinces them about the importance of vaccination. “During the polio campaign, one mother refused to allow her child to be vaccinated and I was called to help”, he says. “I reminded her of what happened to my child and the long struggle we went through. I told her that she was lucky that vaccines are being brought to her house, the same vaccines we could not get in time for our son.” The mother finally understood and all children in that house were vaccinated.
Respected and accepted by his community, Kolimullah is able to break cultural and linguistic barriers as well as touching hearts and minds by speaking from experience. The work of community volunteers like Kolimullah is a key element towards strengthening immunity against polio in Myanmar.