Something could have been done

September 17, 2012 BY Gitanjli (Tanya) Arora MD, DTMH

To set the stage -

I wrote this in a dusty hot room with no fan and a generator run laptop in the middle of South Sudan after a difficult day. This was in January 2010 – prior to South Sudan independence. I was emailing friends and family in Los Angeles - many of whom do not realize the privilege it is to have access to vaccines, so I wrote this email largely to convey the importance of immunizations.

Warmly, Tanya Arora

Globally one in every five children do not have access to vaccines. Most of the diseases I treat here daily are vaccine preventable. Never did I think I would see tetanus, polio, meningitis, rabies – things my gray-haired mentors back home and even their mentors had never seen. These diseases had long ago been eradicated in the US, but are part of daily life here. Vaccines in South Sudan are only made available to children less than one year old and because of the poor health infrastructure, most children remain unvaccinated. In my 52 bed unit, I have nine beds always full of infants and children with tetanus. They spasm with the slightest sound or touch. Two afternoons a week, when the United Nations airplane lands at the field nearby, all nine children go into simultaneous spasm. I don't know how to balance controlling their pain versus over sedating and overdosing them. It is the most painful disease I can imagine. It is almost like being continuously electrocuted every minute of every day for weeks. Sometimes when these children die they seem more relieved than sad. The other beds are filled with patients with diarrhea, pneumonia, a few with meningitis and lots of burn injuries. Most of the hospitalizations and most of the subsequent deaths could have been prevented with vaccines. I cannot state strongly enough the impact that vaccination would have in this community.

Today started off great. I delivered a baby and sent home a patient that had been here for a month, but had now shown good recovery from her burn injury.  Then, a lovely baby I had sent home last month came back. His first hospitalization was at seven days of life for neonatal tetanus. He was in the lucky 50% that survive. Now he is back at 3 months old with a second vaccine preventable disease - pneumonia. I gave him oxygen and breathing treatments, but it wasn't enough. I wasn't able to keep up with what he needed and eventually he tired out. We tried to resuscitate him for almost 20 minutes, but I couldn't get him back. The grandmother explained to me that they thought this miracle boy - this baby who had survived the curse of tetanus – would be blessed to be the first boy in the family to live a long life. Many of the uncles, husbands, brothers and cousins had been killed in war or died of disease. Now, with peace coming to South Sudan, the family had placed a lot of hope in this child. He was big and fat, so healthy that you knew he was loved.

The parents here don't usually cry. Here is such sadness and heaviness throughout the country and parents expect their children to die, so when the child does die there are no tears. But this time the mother began to wail – the wail that all mothers all over the world cry when their child is taken from them. I am so sick of saying that there is nothing I can do for their child's breathing, brain infection, seizures, dehydration, spasms for tetanus. After all, there is something that could have been done. These babies should have been vaccinated. They never should have become sick. No parent should ever expect that one in four of their children are destined to die. In all of this suffering and facing the inequity of knowing that more than 1 out of 4 children here won’t make it to their 5th birthday, knowing that back home we live in such safety and comfort that parents feel comfortable actually refusing life-saving vaccines for their children, it make me think of something Henry James wrote that I read the other day: "I confess that I have no philosophy, no piety, nor patience, no art of reflection, no theory of compensation to meet things so hideous, so cruel, and so made, they are just unspeakable horrible and irremediable to me and I stare at them with angry and almost blighted eyes."


POSTED IN: Advocacy

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