A small group of women is already gathered at the modest two-room brick health care unit upon our arrival. Each holds nothing more than a baby in their arms. There are no diaper bags, no shiny plastic keep-the-baby-happy toys, no pacifiers. It is a simple landscape of babies and breasts bared for feeding. The children are dressed in matching T-shirts and shorts or frilly dresses and pretty headbands, their hair in braids, their feet in flip flops. All are oblivious as to what will come on vaccination day in the village.
But first there are procedures. A small lecture about the necessity of vaccinations is given by the smiling county health department worker. A formal group prayer is presented by a mother, everyone bowing their heads in respect. The women sit hip-to-hip on the benches, the first giving the registrar her child’s name, age and past immunizations before taking the center seat of pending torture, the next woman scooting forward. The assembly line has begun.
The shrieking screams start with the needle’s plunge into flesh. A shot to the upper arm prevents measles and one shot to the thigh prevents diphtheria, tetanus and pertussis. Three quick drops of an oral vaccination into mouths wide open with shock and awe prevent polio. It doesn’t take long for the babes in wait to become wise. We watch for the ones who begin crying when yet six stops down the line. These are the ones who kick so fiercely that Martha must hold their legs in place. Mothers who aren’t grasping their children securely enough to prevent wiggling are given a terse finger waiving by the needle-carrying vaccinator who otherwise looks as bored as if she were waiting to pay her taxes.The wailing wall is heavy with action for four hours. The ringing in my ears has me sure I have witnessed hundreds of babies receiving immunizations. The final tally: 65 children have been vaccinated and about 60 mothers have been given bed nets to protect against malaria-carrying mosquitoes during the night. I am exhausted and I have done nothing but watch. “Congratulations, Martha,” I say, as we seek shade. “You have done good work, even if you have made every child in the village cry today.” “Yes, we have come to receive the noise,” she laughs.
It costs only $20 to fully immunize a child. In helping Kara with her health assessment survey in the neighboring county of Tambura, we learned that only 16.5% of the children under the age of 1 had received all recommended vaccinations, and 15.7% had never received a single immunization of any type. The importance of immunizations cannot be overstated. Only two months ago an outbreak of meningitis killed 11 people here in Yambio County.
Frankly, it is all easier said than done. Travel is difficult here, so sending an advance team to notify the community of vaccination days is often not feasible. Having routine immunization days would provide continuity and perhaps increase attendance. Furthermore, vaccines must be kept cold until administered. The county health department vaccinators carry small coolers to sites for special immunization days. But to allow the regular staff of the primary health care units to provide immunizations on any given day, vaccinations must be supplied regularly – a nearly insurmountable task during the rainy season. Without electricity, refrigerators here are fueled by kerosene. But this too can prove problematic if kerosene is in short supply or the refrigerator begins malfunctioning.
But on this day, 65 children have been immunized. It’s not the country, nor the county, not even the entire village, but it’s a start. Many on this continent teaming with infectious diseases have not been reached. Back in the vehicle for the return trip, Johnny Cash says it all - “Precious Lord, take my hand, lead me on, help me stand, I am weak, I am tired, I am worn…”
