Measles in Dadu: Gulann’s Story
The 16 of November is a warm sunny day in Dadu, southern Pakistan. It is also the day before Eid, the biggest religious festivity in the country. However, the WHO team approaches the village of Karampur, where Gulann and her daughter Sapona live, with a heavy heart. Their visit’s objective is to do a follow up of this small community, which has lost nine of their children to Measles in the past three weeks, and to make sure that all children in the village have been vaccinated in the ongoing emergency campaign. Dadu district has reported 53 cases of measles in three weeks, 11 of which are deaths.
Gulann watches with empty eyes as the WHO doctors check the children’s arms for the vaccination mark. Her five year old daughter Sapona, half asleep, holds her tightly, as if afraid that she too would vanish from her life. Gulann has lost three of her four children in the measles outbreak, and Sapona all her siblings. Despite the sadness that grips everyone in Karapur, the women bring colorful fabrics and drop them on a “charpai” - a low wide hammock- for their WHO guests to sit, attesting the resilience of Pakistani hospitality. Dr Laghari uses the charpai as his examining coach to check Sapona’s temperature, her skin and her arm. “She is doing fine, and she has been vaccinated”, he says, his face openly relieved.
On 11 November, just six days before the team's visit, Dr Tasleem Junenjo of the Aga Khan Medical camp in Tent City Bus Terminal in Dadu had called WHO's DEW’s surveillance officer in Dadu to report that that a case of post-measles complications had been identified. Following standard procedure, WHO immediately sent a team to investigate. The team found two deaths in the camp, and nine others in the nearby village of Karampur that could be attributed to measles. As they tried to establish whether the deaths were connected, they discovered that a family had been traveling to and from Karampur and the tent city camp. This impoverished family was trying to find some relief to the hardship that also strikes some of the residents of Dadu, even if they were not directly affected or displaced by the flood. Two of the children in this family had died a few weeks ago most likely due to measles. Their new born girl didn’t make it through either and died at 12 days of birth, “possibly a case of neonatal tetanus” says Dr Laghari.
The team's report shook WHO's Disease Early Warning System (DEWS) coordination team in Islamabad. WHO deployed staff to immediately begin vaccinating all children in camps and nearby villages in Dadu against measles. WHO and Ministry of Health counterparts worked throughout Eid to organize and implement the vaccination campaign. On the15 and the 20 November a total of 3904 children between six months and five years old were vaccinated. WHO plans to conduct a second mass vaccination in the entire district in December.
Measles is a highly contagious disease that combines very badly with malnutrition as it undermines the immune system. It is a concern in any IDP situation where people from different places come together to live in a reduced space, enhancing the risks of spread of communicable diseases. The population that was affected by the flood in Sindh was rather underserved, and therefore, many of the children displaced had not been vaccinated. 168 cases of measles have been so far reported in the flooded areas, with Dadu, Ghotki and Kashmore presenting concerning outbreaks.
“It is worrisome that some of these deaths in Dadu occurred three weeks ago, and that we didn’t know anything about them earlier”, reflects Dr Iliana Mourad, head of WHO's office in Sukkur Hub. There are two main reasons for this gap of reporting: “Urruri (the local name for measles) is very stigmatized”, comments Dr Suhail, a DEWS surveillance officer. "People are very scared of the symptoms of measles. Often urruri victims are left in isolation, to sweat it off or die if God has decided it is their time. Ovbiously these cases are not reported. But even if families take the sick children to a health practitioner, some of them do not report the case to the Ministry of Health or DEWS. In fact, many health practitioners are not even qualified to practice medicine” he says. WHO is aware of this gap in reporting and is working to build a stronger network that includes private health practitioners. For DEWS to be effective, it is paramount that every single case of these communicable diseases is immediately reported and promptly investigated.
Gulann explains to the team that she had brought her kid to a doctor in the fish market “Aneela, woke up one day with a high fever and diarrhoea, and then I saw that she could not breath normally, I knew it was bad so I took her to the doctor. He gave her medication and admitted her in the hospital but she died. Ayaz and Kajul got sick later, and they died last week. They were not even admitted to the Hospital”. Too often hospitals are overcrowded and do not have a proper isolation room for contagious diseases. Admitting a case of measles could put at risk the rest of the patients. Gulann looks at her daughter with painstriken eyes “I have only Sapona left with me now” she whispers, caressing her daughter’s fingers softly.
“Measles, like other communicable diseases we are seeing in Pakistan, is extremely contagious and can kill children but it is easily preventable with vaccination. Impeding the spread of these diseases is one of main objectives of WHO in Pakistan. For that we need the collaboration of all health service providers including private medical practitioners”-says Dr Guido Sabatinelli, WHO Representative in Pakistan – “Stories like Gulann’s should not occur again”.