Frontliners in Measles Outbreak
Beset with challenges, health workers in Lanao del Sur share their stories of strength
Marawi City, Lanao del Sur, 22 April 2024 – “I walk under the sun, enduring hunger and thirst, and then some parents would just turn me away,” says Cairon Guro while stifling her tears. As the midwife of a barangay (village), she has to visit houses to give vaccines to children as measles cases continue to surge in the Bangsamoro Autonomous Region in Muslim Mindanao (BARMM).
The region’s Ministry of Health has recorded 668 measles cases for the first quarter of 2024, more than half of the 1,175 cases recorded for the entire 2023. The latest immunization drive has been particularly challenging to healthcare workers because it started during Ramadhan, observed by Muslims worldwide as the holy month of fasting.
“Aside from being hungry at daytime, we lacked sleep,” explains Guro. “We had to take our meals at nighttime, and in the last 10 days of Ramadhan, we had to wake up at two in the morning to pray.”
I endure the hardship because I love my job. I’m here to take care of my community.
The Ministry of Health organized the immunization drive with support from the Department of Health and several nongovernmental organizations, including UNICEF. The target population is 1.3 million children aged 6 months to below 10 years in three areas with the highest number of measles cases – Marawi, the capital and component city of Lanao del Sur; the municipalities of Lanao del Sur under the Integrated Provincial Health Office; and the province of Maguindanao del Norte.
Guro serves Dimalna, the most populated barangay in Marawi City, about 800 kilometers from the national capital, Manila. With the nurse assigned to the barangay, the midwife has to vaccinate 1,787 children, just within 12 days at first, but the immunization drive has been extended. Also, the City Health Office often augments the workforce of the barangay. “When the other vaccinators are done in their assigned areas, they are sent here to help us,” says the midwife.
Reasons for refusals
Guro and her fellow health workers have to deal with vaccine hesitancy on a regular basis. “Usually, parents are afraid of the side effects or they wrongly believe that vaccines are haram (forbidden by Islamic law),” says Dr. Jalilah Mascara, health officer of Masiu, Lanao del Sur, about 35 kilometers south of Marawi City.
“Sometimes, if only the mother is home, she would not give consent,” says Naima Imam, the midwife of Barangay Macabangun Imbaba in Masiu. “In many households, it’s the father who makes the final decision.”
“Some residents of BARMM are experiencing vaccine fatigue,” says Amina Rafia Zeina Lim, UNICEF social and behavior change officer. “The Ministry of Health has been conducting mass immunization against measles since last year, but the first round was only for children aged 9 months to 59 months who had not received measles vaccine. Now that the coverage has been expanded, some parents feel that the process is repetitive.”
“Controversies surrounding dengue and Covid-19 vaccines contributed to parents’ fears,” adds Dr. Amador Catacutan, UNICEF health consultant. “It was easier before to convince parents to have their children vaccinated. Now that fake news, misinformation and disinformation can spread easily on social media, some parents suspect that the vaccinators are giving Covid-19 vaccines instead of measles vaccines.”
To combat vaccine hesitancy, health workers need support from community leaders. “UNICEF engages the help of Muslim religious leaders,” says Dr. Catacutan. “They join the vaccination team and explain to their community that vaccination is halal (sanctioned by Islamic law). In most cases, they can change the mind of parents who refused before to have their children vaccinated.”
He adds, “In BARMM, most health services are administered by the Department of Health or the Ministry of Health and not devolved to local government units, but through the years, UNICEF has encouraged local chief executives and other line agencies to be more involved. The same degree of support, or even more, is needed from them in this battle against measles. Public health is a responsibility not just of healthcare workers but of everyone.”
Infected children
In some cases, the parents would only be convinced of the efficacy of vaccines when their children have been infected. In Barangay Pagalamatan in Saguiaran, Lanao del Sur, all five children in a family had to be brought to the hospital after exhibiting symptoms of measles, including high fever, runny nose, cough, watery eyes and rash.
“When we first went to their house, the mother told us that the children had been vaccinated in Marawi,” says Johaira Macatanong, a barangay health worker. Saguiaran shares a border with the city, and the children’s parents are transient traders. “We learned that the children had serious symptoms when their family took them to the hospital and the hospital informed the health office of Saguiaran,” adds Macatanong.
With the barangay chairperson, Wahab Pangcoga, health workers of the municipality and the barangay go back to the family’s house, and after a talk with the chairperson, the family agrees to have the children vaccinated. “Parents here are convinced more easily if elected officials or doctors wearing their uniform join us,” says Janisah Pangcoga, a barangay nutrition scholar
Health workers in Barangay Pagalamatan also have to deal with lack of facilities. The barangay health station remains unfinished, almost obscured from view by a dense growth of grass and vines. The barangay health workers have to work at the rural health unit of the municipality, a ride away by tricycle, hindering fast delivery of services to the residents of the barangay.
Better than cure
Amai Pakpak Medical Center, the government hospital in Marawi that serves the entire Lanao del Sur, has never run out of measles patients since last year. “For two months late last year, the cases reached more than 200,” says Dr. Abdul Nasser Maca-alin, head of the hospital’s public health unit. “The number was so much more than our facilities could accommodate, so we moved the patients to a nearby gymnasium.”
Dr. Maca-alin stresses the importance of prevention. “Our focus is on the treatment of patients, although we also provide vaccines in our outpatient department. Vaccine remains to be the most effective means to prevent measles. We should try to reach people even in far-flung areas and spread more awareness about vaccination.”
Back at Barangay Dimalna, Guro visits an area that is so crowded, it’s difficult to tell where an alley ends and where a family’s living room begins. Every so often, she would be greeted by new occupants of a house or a room, and they would refuse vaccination. Sometimes they would refuse to give her even just their names, but she says, “I endure the hardship because I love my job. I’m here to take care of my community.”
