I was recently asked to write a guest post for the blog of the UK-based advocacy organization, RESULTS UK. You can see the original post (plus pictures!) here or scroll down to read the post in-full on my blog. Enjoy!
About four months into my service as a Peace Corps volunteer in Mali, West Africa, I started visiting the Centre de Santé Communautaire (CSCOM), or local health center. Before joining the Peace Corps, my work in Washington, DC was primarily focused on health care issues – chronic disease prevention, domestic health care reform, HIV/AIDS prevention and treatment locally and abroad. Although I had not been placed as a health care volunteer, I was curious about the Malian health care system and it seemed that the easiest place to get a read on it was at the ground level.
I met with the resident doctor at the center and he suggested that I come in on one of three days a week women bring their babies to the health center to get vaccines. I agreed and anxiously awaited the visit.
When I arrived, I sat in the corner of the waiting area. My shaky Bambara skills prevented me from having very long conversations with people, so I took the opportunity to simply observe.
The CSCOM was packed with Malian women, dressed to impress, with babies tied to their backs. Although there were many things about the health center that didn’t impress me – including, but not limited to, the chickens who seemed to call the health center home – I was impressed with the shear number of women who were taking advantage of the vaccination services.
It seemed as if they all knew what to do. One by one they would walk into the center and greet everyone, give their baby’s vaccination card to the nurse, and sit, chat and wait until they heard their name called.
Fast forward to now, 17 months into my service, and I can still be found at the local health center each Wednesday and Friday (although not sitting in the corner, but chatting with the women, making jokes and playing with the babies). On each day I’ve gone to the center, there have certainly been no less than 30 women waiting to have their babies vaccinated against nine preventable diseases – Yellow Fever, Tuberculosis, Meningitis, Hepatitis B, Tetanus, Polio, Diphtheria, Rubella, and Measles.
Everyone in my community seems to know that vaccines are important.
This might appear a simplistic observation, but because many things that I would consider health no-brainers, like washing hands with soap and sleeping under a mosquito net to help prevent malaria, are certainly not common practice in my community, it surprises me that having children vaccinated is considered essential.
This fact begs an answer to the question, “How do people just know?”
For the answer I turned to my host mother, who is the birth mother to more than 10 children and, because she is the first of four wives, serves as a mother to more than 30 children. I thought that she would be able to provide an answer with which many women in my community would agree, as she fits the profile of the average woman at my site – not formally educated, mother to many children and very busy with house work. How would she know to prioritize vaccinations to keep her children healthy?
So I asked her, “Munna I be I ka denmisenw taa dokotorso la ka bolo ci?” or “Why do you take your children to the doctor to get vaccines?” I thought that her answer might be short and sweet, but she had too much information to share for a short answer.
She began by saying, “Bolo ci nafa ka bon, de!” or “The importance of vaccinations is very big!” After, she proceeded to tell me six of the nine diseases against which vaccines could protect children; she showed me a scar on her arm as proof that she too had been vaccinated as a child (against small pox, which, thanks to a mass vaccination program was eradicated in the late 1970s); she told me that each of her children has a vaccination card that details which vaccines they were given; and she said that if your children get the vaccines, they won’t get these very bad diseases, “a baana,” or “that’s all.”
I followed up by saying, “Mogow bee b’a don?” and she agreed, “Owo, mogow bee b’a don” – yes, everyone knows.
Although this confirmed my theory that everyone seems to know that vaccines are important, it didn’t point to a direct reason why. I am convinced it is for the following reasons:
- Vaccination campaigns have been taking place in developing countries for decades. Because these programs have been in existence for such a long time, most people making family health care decisions have had access to information about the importance of vaccines. People know the benefits, and there is communal pressure to make vaccinations a priority.
- Vaccines are a silver bullet, of sorts. Although certainly not a silver bullet for attaining overall health or for preventing poverty, vaccines are simple – get a shot and prevent a disease. Because people are able to see the efficacy of vaccines, they believe that they work as advertised.
- In Mali, vaccinating your children is relatively inexpensive and the benefits far outweigh the cost. At the first vaccination, the mother is presented with a yellow card for recording vaccinations in exchange for 750 CFA (about $1.50). After this initial payment the remainder of the vaccines are free, meaning that the cost of each vaccination comes out to about 15 cents.
- Monday, Wednesday and Friday mornings at the CSCOM provide an opportunity to rest and socialize with other women. Vaccination days provide a social outlet for women, who dress themselves and their children in their best clothes to come together, chat and drink tea while waiting for their name to be called. Malians will do anything for an opportunity to socialize…
Certainly my experience with vaccination programs has been at the micro level, but the story of vaccination adoption worldwide is similarly positive – my story could likely be told by Peace Corps volunteers serving throughout the developing world.
The most recently updated World Health Organization (WHO) statistics (http://www.who.int/immunization_monitoring/Global_Immunization_Data.pdf) for worldwide vaccinations, provide staggering proof to back up this claim.
For example, in 1988 the estimated number of global polio cases was 350,000. The number of reported polio cases in 2010 was 1,410. This significant decrease in polio cases is due to the 86 percent global coverage of infants vaccinated with three doses of polio vaccine. I am optimistic that polio will be eradicated in my lifetime – and many believe it will be as early as 2020.
Although this, and many other statistics are encouraging, there is also an notable gap to fill. In 2008, 1.7 million children died from diseases preventable by vaccines currently recommended by WHO. Too many lives are still being lost due to lack of access to vaccines.
As we enter year three of the “Decade of Vaccines” (http://www.gatesfoundation.org/vaccines/Pages/decade-of-vaccines.aspx) there is incredible momentum worldwide to increase access to currently available vaccines and to engage in research that can lead to the next generation of lifesaving vaccines. It is important that we use this momentum to work together and dedicate sufficient funding to these programs.
Preventing, and eventually eradicating, the diseases that have plagued the developing world for generations is within our reach. By funding vaccine programs, we have the potential to help create healthier populations that can learn, work, create and aspire to a life of prosperity. The people of Mali, and all other developing countries, deserve that opportunity.
For additional information on vaccine programs, research and dialogue, turn to the following resources:
- GAVI Alliance (http://www.gavialliance.org/index.aspx)
- Global Health Council (http://www.globalhealth.org/)
- Global Health Magazine’s recent issue, titled, “Invest in Vaccines” (http://www.globalhealthmagazine.com/)
- World Health Organization, Vaccines (http://www.who.int/topics/vaccines/en/)
- Bill & Melinda Gates Foundation, Decade of Vaccines (http://www.gatesfoundation.org/vaccines/Pages/decade-of-vaccines.aspx)