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Robbery in the womb

The pregnancies were normal, with hardly a sickness affecting the mothers except the usual aches, pains and discomfort associated with carrying a baby for nine months. The births were joyful, a miracle for both the mother and the father.

The first few days, weeks and months were hectic, bringing all the pleasure and pain babies come with. Not only restive nights, the two-hourly feeds, lives which have changed forever but also the joys of the first toothless smiles, the instant recognition of the mother after awhile, the snuggles and the cuddles.

Through all this, are the nagging doubts at the back of the mind that all is not right. Denial it could be so. Then the sudden and heartbreaking realization that something is wrong with this beloved child, something which had insidiously affected the baby while in the womb, even unbeknown to the mother.

We are talking of a condition that is preventable with a simple vaccine - rubella, which if contracted during pregnancy has disastrous effects on the baby.

"When my son was one and a half years, he didn't respond to music. But we didn't think much about it. One day, when he was playing with his cousins, he dropped this huge brass pot on the floor, making such a loud noise that every other child cowered in fright. But not my son. There was no reaction from him. It was then that we suspected that he couldn't hear," says Latha, hardly able to overcome her emotions even so many years later. Her son is now 13. The anguished search for answers followed. "There was no place to go. We just didn't know what to do. How had this happened?" says this 37-year-old mother of two.

The answers to their puzzled queries came only when they underwent tests in England. "A blood test found rubella antibodies in my system. That's when the doctors told me that I would have got a very mild attack of rubella during my pregnancy. I cannot remember being ill, only having morning sickness," she says. For her, the most joyful moments in those early days were when her little son uttered his first words.

Now many years later, the reality has been accepted, with the parents themselves going through a learning and training process to help their son. After trying out various hearing aids and a cochlea implant, though his hearing is still impaired, he is fully involved in schoolwork and sports.

But his mother's plaintive cry is, "If only I had known, I would have got myself vaccinated and prevented this agony and trauma for my child."

Mala, 41, echoes this cry. For her it is tragically ironic because when her second child was just nine months, long before her youngest was born, she had consulted a doctor to check the need for vaccination against diseases such as measles, mumps and rubella. What she heard from the doctor left her in a state of complacent ignorance. "Don't worry, there's no rubella in Sri Lanka," was the assurance.

Blissfully unaware, she took her second child home and did not give a second thought to rubella. She too had no problems during her pregnancy, the third. She was a healthy woman. She did not even take a panadol for fear of harming the precious baby she was carrying.

After birth came the first indications that things were seriously wrong. She was informed that the baby was born with cataract and questioned whether she had taken any medication during the pregnancy. Later a blood test revealed that she had had a touch of rubella when she was carrying her little girl. Thinking back to her pregnancy, she recalls a slight rash, but it had not caused any worry because she had similar rashes for the other two pregnancies. Then only was she told that her baby's sight, hearing, speech and even development could be severely affected.

The first cataract operation was performed on her infant daughter at just six weeks. "I meet many mothers at the Eye Hospital who are facing the same problem because of rubella," she says emotionally. Her daughter's sight problems became worse and she lost her vision in one eye. The other one too is giving trouble for this talented and pretty 10-year-old with a ready smile and ability to dance and play music beautifully. But with the help of Mala, a fighter against odds, she will soon learn Braille to face any eventuality.

"There should be more awareness about diseases such as rubella. I advise all the young girls I meet that they should take the vaccination before marriage and pregnancy. For those of us who missed out and have to see the suffering of our children, the government should provide facilities to enable them to integrate into society without difficulty. There should be special units in most schools so that parents whether rich or poor would be able to educate these children, who have become victims of circumstances not of their making. There should also be a system of therapy and help," stresses Mala.

A decade to 15 years later, things have changed with regard to congenital rubella in the country. "Around 1994, many paediatricians and gynaecologists reported that they were seeing more and more cases of congenital rubella and the health authorities conducted a survey, which was followed by a decision to introduce a national vaccination programme. Earlier the mumps, measles, rubella vaccination had only been available in the private sector. The national programme got underway in 1996, with the target population covering two categories -- all girls in the 11 to 14 age group and all females in the childbearing 15 to 49 age group. If somehow a woman had missed out, then she was given her shot soon after childbirth, post-natally before she left the hospital," a spokesman for the Epidemiology Unit said.

Such categorization came because the first group could be immunized in schools and the second in field clinics coming under MOH areas across the country.

When by 2000 around 80% of schoolgirls in the 11-14 group and 60% of females in the childbearing age had been immunized, new targets were introduced in 2001. "This was to control rubella infection in general in addition to congenital rubella," the spokesman explained. A decision was taken to give the measles and rubella (MR) vaccination to all children at three years of age and the rubella shot to both boys and girls in the 8-14 group.

All public health midwives have also been instructed to keep a register of females in the child bearing age, so that they would know who has got the injection and who has not. Then they could target those who have not got their shots, he said.

The results have been encouraging, the doctor says, adding that a survey done in Kegalle - such surveys have been carried out in other parts of the country at different times - last year indicated that 69.5% in the 8 - 15 age group and 78.6% in the 16 - 44 age group were immunized against rubella. Immunization numbers look good - for the period 1996 to 2002, 1.04 million had been immunized in the age group 11-15 years and 1.9 million women in the 16-45 years. "Some communities were reluctant to get the vaccine because there is a condition that a woman should not become pregnant till one month after the injection. There were misconceptions that this injection was in some way connected to family planning. But I think we have overcome those fears," says the doctor.

Complaints have also been received that sometimes when women go for the vaccine, the staff tell them to come on another day as many can be immunized with one vial and they do not want to waste it. That shouldn't be the case. Even if one woman comes for immunization, she should be given the injection because congenital rubella can be prevented and should be prevented at any cost, he stresses.

The most urgent need for all young women is to make sure that they get the rubella shot before marriage.

The health authorities should ensure that no one slips through the immunization net. For the effect of this common virus on the babies yet to be born is too tragic to bear.

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