APIA, Samoa — Jennie Montijo, a 42-year-old pediatrician from Maui wearing dark blue scrubs, rubbed sanitizer on her hands, put on plastic gloves and grabbed a syringe.
“Relax your arm,” she said to Aele Solomona, a 53-year-old Samoan fisherman wearing a bright green lava lava. She pressed her fingers into the tattooed skin on his upper right arm and counted to three before sticking him with a syringe filled with the measles vaccine.
It was a ritual she would repeat again and again throughout the day at dozens of homes until she lost count of how many times she did it.
Montijo is among about 75 health care professionals from Hawaii who flew to Samoa this week to aid in a mass measles immunization effort. More than 60 people, mostly young children, have died of the highly contagious disease, bringing the country effectively to a standstill.
After the first 16 children died, the government declared a state of emergency. This week, all schools and businesses are closed for two days. The public has been ordered to stay home and government employees have been diverted to aid the immunization efforts.
About 150 immunization teams fanned out into the villages. The groups were made up of nearly 200 health care professionals from the U.S., New Zealand and Australia, in addition to local Samoan medical professionals and volunteers. The goal was to immunize 50,000 people.
Day one of the Hawaii medical mission was organized chaos. Some teams administered hundreds of vaccines; others, just a few. Vaccine carriers — insulated containers that are used to keep vaccines cold — that WHO officials expected didn’t materialize. One team even included a volunteer who wasn’t vaccinated himself.
It took hours for volunteers to tally up how many people were effectively immunized. It would be just a few more hours before volunteers got up at dawn to begin the process again.
The vaccine carriers in particular are essential given Samoa’s sweltering heat. In order to be effective, the measles vaccine must be diluted properly and kept cool. Even a properly mixed solution is only effective for six hours and 10 doses. The wrong mix of ingredients can be fatal and undercut the already shaky trust some have in the efficacy of vaccines.
That’s what happened two years ago, when two young children died after receiving badly mixed vaccines. Their deaths fueled fear, causing Samoa’s vaccination rate to plummet from about 70% to about 30%.
The goal is to get back to that higher vaccination rate and stem the rising death toll. Already, most kids have been vaccinated and now anyone between six months and 60 years old can receive the shot.
Still, some people are refusing vaccines, which Samoa’s prime minister Tuilaepa Malielegaoi said makes him very angry. He was optimistic, however, as he addressed Hawaii volunteers and thanked them sincerely for their assistance.
“God will reward you in heaven,” he said.
A Major Effort
Jodie Toward didn’t know she would be in Samoa this week. The Maui pediatrician had gotten an email at around 7:45 a.m. announcing a medical mission to the islands in less than 24 hours. She had never been to Samoa, or even on a medical mission. But she had heard about the measles crisis and wanted to go.
“When I see kids dying for something that’s preventable, I want to do something about it,” she said. She bought a flight to Oahu that night.
If the trip felt last minute, it’s because it was. Less than a day earlier, Lt. Gov. Josh Green got a call from Sean Casey of the World Health Organization asking if he could send a big team of medical professionals for a major immunization effort.
Green, an emergency room physician, had already been organizing medical supplies to donate to Samoa, but had only planned to send a handful of health care providers along with them.
Still, he agreed — and the response from the medical community was overwhelmingly supportive. Queen’s agreed to send 50 people, and Hawaii Pacific Health and Kaiser sent health care providers, too. By Tuesday afternoon, Green held a press conference announcing at least 65 doctors and nurses were scheduled to fly to Samoa early Wednesday morning.
A Hawaiian Airlines chartered five-hour flight arrived around 8 a.m. Thursday, Samoan time. It was a 45-minute drive to the medical operations center in Apia where the immunization teams were organized.
The shuttles drove by sweeping coves, serene blue ocean and colorful stores, schools and churches. But the tropical scenery was largely devoid of people — every single place was closed, as everyone had been ordered to stay home. A handful of people could be seen cutting the grass or sitting outside their homes.
“There’s a kind of eerie feeling here in Samoa,” said Brian Alofaituli, a history professor at the local university, of the mass closures. Alofaituli sat in a van waiting for a group of volunteers to drive to the villages. Soon the voice of his wife came on the car radio urging people in Samoan to get their shots.
Fighting a Fatal Disease
As the day wore on, many families welcomed the medical volunteers into their homes, offering oranges, bananas and other fresh fruit to thank them for their work. Many of the homes were traditional fales, open-air structures with tin roofs and ceilings decorated with colorful fabric.
But not everyone was supportive. One woman at first declined to get immunized by Toward, saying her religious faith would protect her. A local team member eventually convinced her and her son to get the shots.
Others didn’t need the vaccine because they had already been sick. Siana Anea said her 7-month-old son was hospitalized for a week for pneumonia after catching the measles in November.
“I was so scared at that time,” she said. She smiled hugely as she described how her firstborn pulled through.
And still, sometimes the doctors came too late. When Green and another team of volunteers drove up to one village, a man told them that a baby there was very sick.
“There’s a kind of eerie feeling here in Samoa.” — Brian Alofaituli, local history professor.
Dr. Nadine Tenn Salle, who heads pediatric care at Queen’s Medical Center, rushed in to check on the child. Her body was warm with her recent fever, but she had probably been dead for about 15 minutes, Green recounted later that day.
Some volunteers started to cry. Her parents were stoic, Green said. The team came up with about $200 to donate to the family. Friends and relatives started showing up at the house to mourn the child’s death.
“That was tough because that was pretty early in the day and we had a lot of immunization to do,” he said a few hours later. The team encountered at least 10 kids with measles as they drove through the rural villages.
Later, an ambulance carried away a 13-year-old girl just as Green and his team arrived at the child’s house. She had been sick for at least four days.
Limited resources forced the team to make tough decisions. Green and his team evaluated a 5-year-old boy who had a fever and a rash and decided it was OK to wait to bring the boy to the clinic the following day.
“It was just a matter of triage because there are so many other sick people,” he said.
The plan is to wake up at 5 a.m. Thursday to begin the process again.
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