The Measles Outbreak

We are currently dealing with a measles outbreak. In the previous blog post, I wrote about the beginnings of this outbreak—the first few cases that we identified, and the fear of what was to come. Since then, many other children have been hospitalized and we’ve identified countless others in the community with the disease. As in the last outbreak a few years ago, we will likely begin seeing measles-related deaths soon. And then, we will begin treating measles-related eye problems and malnutrition for months and maybe years to come.

As many of you know, measles is preventable with a simple vaccine. Because of this fact, most in the US will never see this extremely contagious disease. But here, in rural Ethiopia, it is a completely different story. Measles is a leading vaccine-preventable childhood killer with nearly half a million deaths per year worldwide. Despite the WHO’s efforts to eradicate measles with mass vaccination campaigns, most in our area are not vaccinated. As Public Health Director, this means that I am quite certainly failing at my job. In defense, I do feel that the deck is stacked against us… but maybe this is just an excuse.

To explain why I am failing, I started to write paragraphs of painful details as to why it is so difficult to establish vaccination coverage in this area, but then I realized that the problem could be summarized in two simple words: access and resources. With remote populations, few roads, and practically no transportation, getting vaccines to people is a huge challenge. This is complicated by the fact that much of the local “resources” in place to assist with such tasks are content to, well, do nothing.

Let me give you an example: in order to provide vaccines to most places in our area, assigned government health workers must walk many hours to pick up vaccines from our health facility. They must then return to their home and distribute said vaccines within a few hours before their coolers and ice packs become too warm. As a result, this less than desirable duty is often avoided. But this week, if a health worker did choose to make the difficult trek to our health facility, she would go home empty handed. This is because the vaccine distribution site for our zone has not had any vaccines for many weeks. The reason for this is unclear. Some claim that vehicles needed to transport the vaccines are currently broken. Some point to other problems… lack of staff, funding, or accountability; and laziness. Either way, we are anxiously waiting with empty refrigerators for the next vaccine shipment during the height of a measles outbreak.

We therefore take it upon ourselves to assist the government and deliver and administer vaccines, when they are available, to many of the villages which we serve. But as the only health facility for over 100,000 people this is a daunting task especially when we receive no government resources and cannot even afford one full-time person to perform this duty. Resources are just too easily sucked into curative care.

But when everything works out. When we have the vaccines and the people and the transportation and we arrive for a vaccination outreach event there is still more that must be done. The parents must walk… they walk for miles from their home to the outreach site. And they must wait… wait for hours until their turn comes and their child can receive vaccines. We often see long lines of sweaty exhausted mothers with children in tow waiting for their infant’s turn to receive a simple shot. But, still, they come. Because they have seen measles and tetanus and hepatitis and pertussis and they know what’s at stake.

Someone sent us a Time Magazine a few months ago and in it was an article about families in the US who opted not to have their child vaccinated. Now I don’t want to upset anyone who has strong opinions on this issue. But I just thought that I’d point out, from where I sit… these people have no idea what they’re giving up.