Australian nurse Jai Defranciscis joined MSF’s team in Marawi in February 2018 to urgently stem a measles outbreak that had already proven fatal for several children in the community.
“In Marawi, there had been a number of measles cases detected and even a few deaths which resulted in an outbreak being declared by the Ministry of Health. MSF's role was to support the outbreak response. I've unfortunately seen many children suffer with vaccine preventable diseases, and measles is one of the worst. It was a race against the clock to try and get the activity running as quickly as possible to prevent the further spread of this exceptionally contagious disease. So from the day I landed in the country, the planning and preparation work commenced.
"It was a race against the clock to try and get the activity running as quickly as possible"
In Marawi, vaccination coverage had been complicated by the long siege, displacement, and the disruption and destruction of necessary health services. Our target age group was children under five years old, as they are the most at risk. Their immune system isn't developed enough to fight off infection. Just as in Australia, this is why vaccination typically targets babies and children.
It was my second time running a vaccination campaign, so I thought I would be much better prepared and therefore able to mitigate the challenges more easily. But every context is different. The two major issues were vaccine stigma and overall security.
Community perception of vaccination was generally negative, having been affected by the earlier dengvaxia (dengue vaccine) controversy. (Ed: A mass vaccination by the Philippines health department had to be suspended late 2017 in light of reports that the vaccine can increase the risk of severe dengue.) So our teams mobilised all around Marawi to provide educational information sessions about the benefits and safety of vaccination, and the side-effects and complications of measles. Before we had managed to start our campaign I visited the tertiary hospital where children with complicated measles were being treated. When you see these babies and children so sick, it only makes you more determined to do a good job, so others are not put in that same situation.
"We were confined to only working in certain areas, due to the many uncleared zones affected by land mines and unexploded ordnances."
Marawi was still greatly affected from the siege last year, and a huge portion of the city, ‘ground zero’, was completely in ruins. We were confined to only working in certain areas, due to the many uncleared zones affected by land mines and unexploded ordnances. Choosing easily accessible vaccination sites is paramount to a successful campaign, so we had to find mosques, schools, community halls and other prominent buildings that were still accessible. Also, under martial law, a curfew meant visitors, like our vaccination teams, had to leave by 4pm for lock-down.
There are still thousands of people who have no home and have lost everything. Displaced due to the conflict, many families have been living together in very poor and dirty conditions, or in evacuation centres. We see this in a lot of places we work: people who have had to flee their homes due to conflict and instability, facing poor living conditions, overcrowding, malnutrition and related illness, which makes them extremely susceptible to communicable diseases.
All the staff involved, including many Department of Health nurses, worked extremely hard until the job was done. Due to our speedy response, we were able to stem the outbreak from getting out of control and wreaking havoc on an already weak and susceptible population.”