Saturday, June 12, 2010

Two Steps Forward, One Step Back

During my first few months in my village, Mapha, the vaccinator and I would go out to neighboring villages three times a week -- he to vaccinate the babies and I to weigh them and give nutritional advice to their mothers.

The clinic in our village serves 25 other villages -- the closest of which is 3km away and the furthest over 15km. Under the Malian national health care system, villagers living less than 5km away from the clinic are required to walk to the clinic on fixed vaccination days -- Tuesdays at our clinic. On the other days of the week, the vaccinator should be going out to the more distant villages to give them their vaccinations.

And that is just what Mapha would do. He would start off early on his moto, a bag packed with his register and single-use needles, and a small cooler tied to the back of his moto filled with ice boxes and polio, measles, and yellow fever vaccines. When I went with him, he would ride a little slower on the sandy dirt roads so I could keep up with him on my bike.

During those early months, Mali was new to me and I was new to Mali. I could barely tell a mother her baby was at a healthy weight in Bambara and kept turning to Mapha, exasperated with my own limited Bambara and dependent on Mapha to help me give nutritional advice to the women.

We would arrive in a village and head for a central village meeting location, one with a bit of shade provided by stacked millet stalks or a big tree. Before we had managed to set up and hang the baby scale, the area would be full with fifty women and their screaming babies. At one small village, the town crier began his rounds of the village. In his loud voice, over and over, he announced that the white doctor had come, much to my horror and Mapha's amusement.

Mapha knew everyone and would alternate between screeching laughter -- his head thrown back -- reprimands and looks of disapproval that scared me with their severity when a mother had gotten behind in her child's vaccination schedule. The mothers all knew him too -- go easy today, Mapha, they would say. When the babies would start to cry after the shots, the mothers would point at Mapha. Mapha minen, they would say, Mapha's bad.

But then, perhaps 10 months ago, the vaccines disappeared. Mapha would go to San to get the vaccines to discover that there were none to be had, not only in San, but all of Segou, and maybe even, the rumor went, all of Mali. When the vaccines would come, it was never enough. They would be finished in one day, and the mothers would beg for us to just vaccinate one more child as Mapha tried to explain that the vaccines were simply gone -- boloci fura banna peuw.

After our Monday night radio shows Adama and I would have to announce that vaccinations would not be taking place the next day so that women wouldn't walk 10k to arrive at the clinic at 7am. I retired my radio show on the importance of vaccinations completely. Mapha no loner rode his moto out to the neighboring villages, staying behind to play cards outside the clinic. When we would receive vaccines, the crowd at the clinic would be so large we could not hear each other over the noise. There were fights and more than one black eye among the women over who had arrived first. The pushing and yelling got so bad that I began to dread the days when we did have vaccines.

No one can tell me exactly what the problem is or where the fault lies. At first we thought it was just a problem of getting the vaccines to Bamako and then the regional capitals and then to San and finally to us. But everyone I talk to says the vaccines are in hard to come by everywhere. Then there was the unconfirmed rumor that the Malian government had simply forgotten to order vaccines for 2010, thinking for some reason that the 2009 vaccines would last for two years. And finally there is the logistical problem that there are more people and more babies coming to the clinic for vaccines than the Malian government planned for based on birth certificates in our area.

Meanwhile, every couple of months, in Mali and much of West Africa, a huge door to door polio vaccination campaign takes place, funded by international donors. In every community in Mali, community health workers walk from compound to compound, administering an oral polio vaccine and marking the left-hand pinky finger of each child under five who receives the vaccine. There are t-shirts and paychecks for the community health workers go back and forth to each household, making complicated symbols with chalk on mud houses to signify whether all the children of the house have been vaccinated. There are unlimited boxes of the polio vaccine and white SUVs head into every village to monitor the progress of the campaign.

I am confident in saying that every child under five in my village has received the polio vaccine at least five times, but almost all babies are now behind in their vaccination schedule, if they have started it at all. Its a long walk to our village, and there are some villagers from the outer villages that Mapha has not seen for months. After working so hard and so long to convince villagers of the importance of vaccines, suddenly, Mali and the international community have dropped the ball. How can the polio campaign be so well organized and regular vaccines forgotten?

Those severe looks Mapha used to give? Now he just gives them to me, because we know the mothers are no longer at fault for being behind in their children's vaccinations.

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