By Susan Cullinan, IFRC

As the measles outbreak in the Philippines claims more lives, a massive social mobilization is underway, working among those who are most vulnerable to try and ward off a threatened explosion in the highly infectious disease.

The numbers are shocking. Since the start of the year there have been 12,736 cases and a total of 203 deaths, with those most affected aged between one and four years. Only 39 per cent of Philippino children are vaccinated (Philippines Department of Health, 24 Feb 2019)

The Philippine Red Cross is drawing on its huge reserves of volunteers – which number more than two million – to run tent hospitals, carry out vaccinations, and educate people about the value of vaccinating their kids.

We tagged along for a couple of days to have a closer look.

Mobile wards

Philippine Red Cross has erected six tents at hospitals around Manila to care for the patients – mostly unvaccinated young children and babies and their parents. It’s heartbreaking.

The mothers give several reasons why they haven’t vaccinated their children. They were afraid of the vaccine. They didn’t have time. They move around too much. Their child was sick the day they took them to the clinic.But there’s one thing they all have in common. They’d now strongly encourage all parents and parents-to-be to have their children immunized.

“I’m very worried for my baby,” 24-year old Delijoy says, holding 10 month old Dave who’s been in the Red Cross Measles Care Unit at the San Lazaro Hospital for three days.  “My mother insisted I should not get him vaccinated because she was scared about the vaccine but now I think it’s very important. I am going to encourage all mothers to vaccinate their children.

“If they have any doubts they should consult the doctor or nurse at the health clinic and learn more.”

Angie, 39 has two children with measles in the unit. “I’m very worried and nervous,” she says. “It’s hard to see children in this situation and so unwell.

“My advice to parents is to get their children vaccinated.”

Meanwhile in the Amang Rodriguez Memorial a second tent has been erected. By this time tomorrow it will be full of patients. Specialist Dr Deanne Demesa says the outbreak has spread quickly; she’s seen more than 500 patients already this year.

She’s grateful to have the tents so measles patients can be kept separate from the rest of the hospital community. Until a few days ago there’d been two to three patients to a bed in the isolation ward.

She’s seen how quickly the outbreak spreads. Already this year this hospital alone has had more than 500 cases.

Mobile vaccination teams

Red Cross is supporting the Philippine government in reaching out to 2.4 million children with measles, mumps and rubella vaccinations, along with oral polio and Vitamin A, in the next six months. They’re the most at-risk; aged between six and 59 months, never been vaccinated twice and are susceptible to the virus. It’s a massive task.

Red Cross is uniquely placed to mobilize mass volunteers, and to reach deep into communities, known here as barangays.

Across the country are 102 chapters, or branches. Within each chapter are numerous barangays – some 42,000 nation-wide – extending from the most remote villages to inside the huge metropolises. Barangay volunteers and staff wear, alongside the Red Cross emblem, the distinctive 143 branding, a representation of I love you, and the fact that each has a team leader and 43 volunteers. The volunteers are all trained and responsible for discreet activities – health, disasters, first aid, blood and so on.

Today we’re having an early start in the chapter in the historic Intramuros part of Manila and it’s a text book example of how social mobilization works.

This chapter has relationships with seven partner hospitals, and several universities. Today nursing students and their faculty supervisors gather for briefings on their roles in the vaccination teams.

There will be seven teams and they’ll go into the poorest, most densely populated area of the city, Parola. Each team has vaccinators, recorders, health educators, a logistician and a team leader. The recorders check consent, previous vaccination and health history; the vaccinators measure the dose, check it’s right for the child’s age and previous vaccinations; the logistician has the chiller, with needs, vaccines, dispensers; the team leader is responsible for everyone’s safety.

There’s a staggering 72 student nurses in the briefing room, alongside 11 clinical instructors. They have a series of briefings, split into groups, get trained in the recording gear then head off.

Inside the Parola, it’s a riot of noise and smells. It’s teeming with people, cars, trucks, bicycles, cats and dogs. Six teams head into the housing, one is stationed at the health clinic.

We enter a housing complex through a narrow door, into long a dark hallway off which are doors into people’s homes. Passing through an open cooking area, stepping over open drains, we come to a small concrete courtyard, surrounded with barbed wire and rubber tyres.

In no time, mothers start to arrive with their babies and infants. Many come carrying their health records. There’s plenty of talk between the mothers and the educators as the vaccinators set up on two rickety tables. Someone brings a couple of stools.

This is an area where there have already been three deaths, officially, and 90 cases. It’s clear the mothers are keen to have their children vaccinated, despite their kids’ protests. They hold them as the needles are administered and help administer the oral vaccines.

By the end of the day the teams have vaccinated more than 1000 people. After their vaccinations they’re entitled to receive a free nutritious meal, also served by red Cross volunteers. Those who turn up without proof of the vaccinations are directed to the clinic, where the stationary team has been busy with mothers and young children all day.

And so ends another day in what’s shaping up to be to be a very large-scale operation.

The Philippine Red Cross, supported by the International Federation of Red Cross Red Crescent, is working alongside the Department of Health and other agencies to ramp up efforts to contain the outbreak. With 2.4 million children unvaccinated, there’s a pressing need for more volunteers and more money to tackle this outbreak unless it becomes something catastrophically worse.