750

750 cases of measles have been reported in Opuwo district to date.

Seven hundred and fifty. Thats a BIG number.

Looking back two months to the beginning of October, we had 37 cases. At the time we were panicking, wondering how we could contain the outbreak. Our first line of defense was an immunization campaign. Over 800 children were immunized over the course of a week, which we considered a great success. As a second strategy, we set up a treatment center where patients could be kept in relative isolation, which was also a positive move. As a third line of defense, we carried out a mass social mobilization/awareness campaign to help inform the community about measles. And yet the cases continue to rise.

Its disheartening. Despite our efforts on various fronts, this epidemic cannot be quelled. We currently have teams out in the field treating sick villagers and immunizing children, but as one of our physicians pointed out today during our meeting, isolation is key. It is also nearly impossible in this area. People live in very close family compounds, and the highly infectious nature of measles thrives in such conditions.

The key challenges:

1. Measles is a highly contagious disease spread through close contact via mucous droplets.

In my area, most people live a communal lifestyle where many family members are sharing one small hut.

2. Measles is contagious for a relatively long period of time (starting around 4 days before the rash appears, up to 4 days after the rash appears).

3. Most of the Himba and Zemba people (adults and children alike) are not immunized. In some areas of Southern Africa they have carried out mass immunization campaigns, but we were strictly instructed to only carry out target immunization (age 9-59 months). This has left a vast majority of our people unprotected.

4. The Himba move frequently. Despite the fact that people are ill, they continue to travel to other villages and areas. This will be amplified during the holiday season, as many people will be travelling to distant villages to see their relatives, and people working in other areas of Namibia will return to their villages here.

5. Some of our health workers were never immunized against measles. Recently, one of our key health workers who frequently treats patients at the treatment center contracted measles.

6. We have a long-standing shortage of transportation (and resources in general).

So this is where we find ourselves--fighting an uphill battle. The interventions we have in place are quality, and our patients admitted to the hospital are well cared for, but ultimately we are powerless to stop the spread of the disease. We will continue to immunize, we will continue to treat, but ultimately this epidemic has to run its course. Its a hard reality, particularly because in the last week 4 more children have passed away. Three of the deaths came from a village called Okatumba: two children passed away before they reached the hospital and one died in our Casualty ward (ages 8 years, 5 months, and two months respectively). The latest case was an 11 month old baby girl.

If you can, I simply ask that you send positive thoughts our way. I am a firm believer in the power of setting an intention, whether through prayer, meditation, song, or any other way.

Okuhepa tjinene (thank you)...