In 1983, when I started to practice in Ontario, Canada, the routine schedule of immunization covered only a hand-full of infections: diptheria, tetanus, pertussis (whooping cough), polio, measles, mumps and rubella. Twenty-five years later there is now funding for vaccines for Hepatitis B, meningitis, pneumonia/otitis media, chicken pox, influenza, and most recently, cervical cancer. Globally there is ongoing research and development for vaccines against a great number of other infectious diseases, many of which predominately affect the poorest people in the world.
Despite the good news, the situation on the ground in Lankien is grim. No one knows the proportion of children who receive vaccination. What we do know is that we see patients with vaccine preventable diseases: large epidemics of measles, meningitis and pneumonia, neonatal and childhood tetanus, cases of whooping cough, mumps and chicken pox, life threatening forms of childhood tuberculosis, cervical and liver cancer.
The Centre for Disease Control in Atlanta called vaccination, the greatest public health achievement of 20th century America, but all over the world children still do not receive even the most basic immunizations. In Lankien, MSF immunizes against the six vaccine preventable diseases covered by the World Health's Organization EPI (Expanded Program of Immunization); they are diptheria, whooping cough, tetanus, polio, measles and tuberculosis. Recently, we have successfully achieved a large increase in the number of children being immunized, the result of a simple change in our triage plan and led by Helen Galla, nurse midwife, and Francis Gatluak.
The immunization area is simply some chairs and a table protected under a plastic canopy. It is next to the Ante-natal Care (ANC) tukul where Helen and our national staff see pregnant women. In addition to the usual routine clinical exam, MSF provides women with iron tablets, multivitamins and medication to prevent malaria. We also test and treat for syphilis, an infection that causes serious abnormalities in newborns. We vaccinate all women against tetanus with the goal of protecting the newborn infant from this lethal infection. In addition, we provide bed nets and clean delivery kits.
Helen has extensive experience working in Sudan, particularly in the practice of remote area obstetrics. You can’t learn obstetrics for places like southern Sudan in places like southern Ontario. And this leads to one of my regrets as I approach the end of my mission: I will not have more time to spend with Helen.