Black dots

It's not just developing countries like Nepal that struggle with measles, a viral disease whose complications include pneumonia, bronchitis, brain inflammation and even death. There has been a recent spike in the number of reported measles cases in the UK for instance. It appears that many parents their don't want to vaccinate their children as they fear the common MMR vaccine (against measles, mumps and rubella) can result in debilitating side-effects like autism, deafness and epilepsy. Although recent research suggests that the vaccine causes no such side-effects, many parents are unconvinced. The problem in Nepal is not so much fear about possible side-effects of the vaccine but the failure of government immunization teams to reach all rural pockets, even in areas that have been declared 'fully immunized'. One such black spot is the Somdiha VDC of Kapilvastu, which has been declared a fully immunized district, but where five children have died within a month from measles. This is scandalous because people don't die of measles per se, but from complications of untreated measles.


If patients can get timely treatment, mortality falls to fraction of a percent of all those infected. Apparently, the Kapilvastu District Health Office didn't take the first reports of measles outbreak in Somdiha seriously. Health workers reached the site a full month after the first reported cases. Locals complain that their health post has neither medicines nor health workers. So even though around 60 children were showing measles-like symptoms, they could not be treated on time. As a result, now nearly half of them are in a critical condition. Somdiha thus represents all that is wrong with our public health care system, the kind of problems that Dr Govinda KC has been repeatedly flagging through his hunger strikes. Another problem with districts like Kapilvastu that share an open and porous border with India is that they can never be quite sure if someone is not bringing measles or polio from across the border. In fact, our health authorities suspect that most recent measles and polio infections in Nepal have been imported. So unless there is a mechanism to screen for tale-tell signs of these diseases at least the major border points with India, it will be hard for Nepal say for sure if certain pockets are completely disease-free.

This, of course, won't matter if everyone in Nepal is immunized. The presence of pockets like Somdiha suggests that the government's universal immunization campaign is far from comprehensive. There have to be more boots on the ground, visiting even hard-to-access pockets, and encouraging all recent parents to vaccinate their children. Then there is the need to expand immunization to the urban slums which are currently not covered by existing immunization programs since many of their residents don't have proper identification papers. But lack of papers is really irrelevant in this context. Every human being has the right to a healthy life. Once again, the main problem is shortage of manpower to visit these pockets, inform people about the importance of immunization and to actually vaccinate them. Young children dying of this entirely preventable—and in most cases treatable—disease paints a grim picture of the health of the Nepali state. With a little more focus we can (and should) eradicate measles.

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