In the shadow of the epidemic that claimed the lives of 83 children, families live with constant reminders of loss. 

APIA, 06 JULY 2020 (THE GUARDIAN) —Early on the morning of 6 July 2018, two mothers living in neighbouring villages on remote Savai’i Island in Samoa took their year-old babies for their routine measles, mumps and rubella vaccinations.

The MMR vaccinations were safe but the nurses administering them – an investigation would later find – wrongly mixed the vaccine with an expired anaesthetic instead of water. Minutes after each injection, the babies stopped breathing.

The deaths sent shockwaves across the tiny archipelagic na­tion, not just on Savai’i, the largest island, but also on Upolu, home to the capital, Apia, and most of the country’s 200,000 people.

Early on the morning of 6 July 2018, two mothers living in neighbouring villages on remote Savai’i Island in Samoa took their year-old babies for their routine measles, mumps and rubella vaccinations.

The MMR vaccinations were safe but the nurses administering them – an investigation would later find – wrongly mixed the vaccine with an expired anaesthetic instead of water. Minutes after each injection, the babies stopped breathing.

The deaths sent shockwaves across the tiny archipelagic na­tion, not just on Savai’i, the largest island, but also on Upolu, home to the capital, Apia, and most of the country’s 200,000 people.

The home Punipuao Siu shares with her husband, Timu’a, overlooks Safotu rural district hospital. The view from her window is a reminder of the day she took her baby son Opalameko, her fourth child, to be vaccinated there. They had celebrated his first birthday two days before he died.

Families here keep the departed close by. It is customary in Samoa to have graves in home gardens, decorated with plastic flowers and photos, or in small, neighbourhood cemeteries.

Opalameko is buried behind the family home in a simple grave next to the tomb where his grandfather lies. His nickname, Opa, is drawn into the concrete.

Two years on, there is healing. Punipuao has a new baby, Tipaulaofaele, but when it was time for his routine vaccinations she was terrified. Her mother and husband persuaded her – and her new son was treated in the room where Opa had died.

“When I gave birth in November I thanked God for the gift of the child,” Punipuao says. “We have managed to move on but we can never forget the one we lost.”

Opa’s death – and that of Lannacallysta Tuisuesue the same morning – fuelled widespread distrust in Samoa about the injections, a fear capitalised upon by a growing anti-vaccination movement online. Across the archipelago, an already-low vaccination rate plummeted fur­ther.

The government suspended its national immunisation programme while the investi­gation was conducted. It wasn’t until April 2019 that the programme resumed again – eight months after the deaths – leav­ing thousands of infants unprotected from the disease when a measles outbreak hit later that year.

Eighty-three children died and 1,868 were admitted to hospital. In total, 5,705 were infected.

The grieving parents are stoic, typically saying they have “moved on”.

But the Samoa’s ministry of health believes differently, estimating that 14% were found to be at risk of developing ongoing mental health issues, such as depression, anxiety or post-traumatic stress disorder.

The country’s only psychiatrist, Dr George Leao-Tuitama, who heads the ministry’s mental health unit, says the true figure could be as high as 20% and affected families may turn to alcohol or substance abuse. Some have struggled to return to work.

Six months on from the last outbreak in Samoa, these are the stories of the parents who lost children in the two mis-prepared vaccinations, and the families left devastated by the measles epidemic that followed.

Most of the grieving families lost one child to measles in the deadly outbreak.

Fa’aoso Tuivale and Tuivale Luamanuvae Puelua lost three of their five children; first their three-year-old son, Itila, then their 13-month-old daughter, Tamara, followed just over a week later by her twin brother, Sale. Their remaining two sons were bewildered, then distraught.

The family’s plight came to the attention of a Samoan rugby international player who paid for a new home for the family. Other donations enabled them to build a wooden mausoleum with a roof and concrete floor.

Here they have placed photos and plastic flowers, and waterfall lights adorn the entrance.

“We love them so dearly we don’t want to put in the rain or the sun,” Fa’aoso says. “We want to protect them.”

Tilomai Alofipo, a mother of six, lost her youngest daughter, Ha­zel – named for the extraordinary colour of her eyes – to measles in November, five days after her first birthday.

With no television or phone she knew little of the outbreak as it unfolded, she says, and when Hazel was placed in an isolation ward in the local hospital, she did not realise the severity of the illness. “I thought the doctors would save her,” she says.

Her death has had a huge impact on Tilomai’s mental health, leading her to contemplate suicide. “It’s broken me into a million pieces, all my dreams are shattered … I can’t believe in the fact that she has gone.

“People say she’s safe in heaven, and I know that, but it weighs heavy.”

Alga Toetu, 24, lost her 13-month-old daughter, Blessing – her only child – to mea­sles at 9am on 1 December. She now wears a bright pink badge with a photo of Blessing celebrating her first birthday, and never takes it off.

On the wall of her home there is a poster with the same image. Blessing has been given photoshopped wings, with the message “Fly High Our Beloved Angel”.

As in many Samoan families, Alga’s husband works in New Zealand and sends money home. She lives with her father, Manuele, a former bus driver, and her mother, Faiane.

The love for Blessing is evident in the efforts that have been made to decorate her last resting place, despite limited funds. She is buried in their yard, surrounded by local Fala plants potted in brightly coloured corned beef tins. The grave boundaries are marked out by plastic water bottles strung together.

Oli Lefauaitu, a security officer, was living with his wife, Moana, and their nine children in the swampland area outside Apia when the youngest, their 14-month-old daughter, Si’iae, became ill.

Si’iae, which means “lift up”, was sick for days before Lefauaitu real­ised she had symptoms associated with measles. She was admitted to hospital but died a week later. Oli buried her under a guava tree in his garden.

Looking at the grave, covered by an old blue tarpaulin to protect it from the heavy seasonal rain that floods their plot, his describes how his family is adjusting to life without her. “Sometimes we can’t do anything but think about her,” he says.

“Most of the time we watch her grave, it’s like we are looking at her sitting there, imagining her.

“We always feel her presence. Sometimes the other children will ask where she is, or we catch them kissing her picture. That’s why we know they are missing her.”

Peter von Heiderbrandt died on White Sunday, Samoa’s national children’s holiday, on 13 October, aged 13 months. His last resting place is a peaceful cemetery surrounded by palm trees overlooking the Pacific Ocean.

His mother, Lanuola Mulipola, a po­lice officer, says while he was not the first child to catch measles in the outbreak, he was the first to die.

“It was heartbreaking,” she says. “I was shattered. Christmas didn’t feel like Christmas that year; we just went to church and came home. We did not feel like celebrating.”

Lanuola hasn’t been able to work since her son’s death and busies herself with her three other children. “I tried to go back but I couldn’t concentrate.”

She’s seen a counsellor, which helped. “I explained what I had been through. I would like to see them again. I’ve got their number.”

Marieta and Samuelu Tuisuesue’s one-year-old daughter, Lannacallys­ta, was the first of the two babies to die from the mis-prepared MMR vaccination in 2018. She was a longed-for child – the couple had been trying to conceive since they married seven years previously.

Eventually, fearing it was impossible, they adopted a daughter from Marieta’s sister – weeks later Marieta became pregnant with Lannacallysta.

The day Lannacallysta was buried in the garden of their home, they again adopted a six-month-old baby boy from Marieta’s sister, Laa­uoleola junior, now two.

Marieta says: “I asked my sister if we could adopt again to keep our minds off what happened.”

Lannacallysta’s grandmother Tala Tualesi said the infant’s death put in place an awful chain of events the following year. “If their baby hadn’t died, all these other children may not have died.”

Christol died on her 15th birthday – one of the oldest children to die from measles during the outbreak.

With a pre-existing heart condition, she was always vulnerable to infection, and as result had had both doses of the MMR as a young child.

She was a happy teenager, with a strong spiritual side and had ambitions to work in IT when she finished school. She was known for her willingness to help with chores and look after her seven siblings, including five-year-old Shelly.

Just before she died in the local hospital, her parents noticed her heart rate was dropping. Her father, Seumanu, began calling her name and it went back up, briefly.

“After that, she quietly slipped away,” he says, weeping.

Because she had been part of their lives for so long, the parents say it is particularly hard to live without her. She was buried in their garden with her clothes, schoolbooks and all her belongings. “I love you” is written in the concrete.

Seumanu, who sells hot drinks and snacks at the local ferry terminal, is happy to be asked about Christol. “Not so many people come to us to ask what happened. This was a chance to let out my emotion and retell the story of my daughter and how I miss her so much.”

Fuatino lives a middle-class life in her traditional Samoan fale, or “open house”, which is open to the elements. Inside she has a microwave and fridge freezer, and the house sits on an eight-acre plot where pineapple, yams, grapefruit and mangoes grow. The family sells coconuts, bananas and breadfruit to earn extra money. She is proud of her son Simiani, a police officer.

Last year Simiani caught measles from a co-worker and passed it on to his children Solovi, 15, Kaio, five, and 14-month-old Adriana.

They were all treated in hospital and, while the older boys pulled through, Adriana died after two weeks on 21 November, despite having had the first dose of her routine MMR vaccination.

Fuatino describes Adriana’s death as “the biggest tragedy to happen to this family”.

“We asked the doctors if she was going to make it and we knew she was not coming back.”….PACNEWS 

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