Navigating Buvuma islands in response to a measles outbreak

By Joyce Nguna

The thought of a trip to the Buvuma islands is all about enjoying plenty of cheaper fish and boat rides.

Missing the ferry would never be drawn to your mind, not until you made it an hour earlier but your vehicle didn't. You are then left with no option but wait for the next route which could be three hours later.

A measles outbreak had been going on the islands of Buvuma from February, 2017. Over 40 people had been affected with three deaths recorded.

A team from the Ministry of Health (MOH), of which I was part of, conducted an investigation to inform response to this outbreak. It is a little disturbing to see the number of children and adults that hurry to board the ferry at Kiyindi landing site.

By my quick calculations, it works out to a shocking number in hundreds per day. And since measles is an airborne disease, this was the first driving factor we identified that could actually drive the epidemic.

Disease outbreaks must be investigated and controlled when a certain number of people in a particular area who have the disease exceed the expected levels. Information from Buvuma District Health Office proved that the people suffering from measles were scattered on the islands and could only be accessed by a boat ride.

Some of the affected islands are 1-4 hours away and their accessibility depends on the intensity of the water waves. More so as you prepare for a day's work, there is no assurance of returning to sleep on the main island! More bewilderment was yet to come when we asked for the cost of using a boat to access the islands!

The boat fuel cost was equivalent to the car fuel needed to transport you in a Land cruiser from Kampala to Arua, yet the boat ride would just take one hour depending on the calmness of the lake to reach the islands. We were determined to reach the islands so the next morning after an hour and 20 minutes smooth boat ride thanks to ‘GAVI' for the donation, we arrived at Kibibi Island.

Kibibi has approximately 976 inhabitants with a sunny weather and abundant bird species, with the locals spicing it up with inviting, contagiously funny, seemingly warm and friendly smiles, glorious to a tourist's sight, but that was not what the MOH Officers and Buvuma District Health Team had gone for.

Our movement in the island made us discover some interesting but also sad state of affairs of the social services. Besides the abundant small fish (mukene), there is nothing more for Kibibi to boast about - there is no evidence of a school, not even a kindergarten, no permanent structure and most important to note is that the island has no health facility save for the two wretched drug shops.

All the inhabitants go to Senyi landing site to access medical care at a boat fare of 3000shs and worst of all they go to drug shops and not clinics. My heart went cold, pondering on the lifestyle of these happy and seemingly contented human souls.

After the day's work, we were more than ready for the ride back to the main island for the night. Just 20 minutes into our journey, the waters rioted like the Gods were becoming crazy and could not let us continue. We found some relief when we docked at the nearest landing site, Senyi. Finding accommodation was a nightmare until we found a lodge where the receptionist charged the team from Kampala an ‘expensive fee' of 7,000 Ug shs.

Our short-lived experience in the islands spoke volumes what it takes to provide health services to this population. It's paramount that Ministry of Health plans appropriately if it's to reduce the burden of vaccine preventable illnesses like measles in the islands.

Periodic immunisations of all children should be adopted where a bigger team goes and accomplishes the task within a relatively shorter time as opposed to static units where no health worker may be willing to stay or small outreaches which would not create an impact because of difficulty in accessibility and stay in the islands.

The writer is an Epidemiology Fellow in the Uganda Public Health Fellowship programme, Ministry of Health attached to UNEPI