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7974: Haiti project calls for much more than medicine (fwd)




From: Max Blanchet <maxblanchet@worldnet.att.net>

Vaccinations require mobilizing and motivating
Haiti project calls for much more than medicine

By Michael McQuestion, 5/13/2001

''Only those who will risk going too far can possibly find out how far they
can go.''

T. S. ELIOT

PORT-DE-PAIX, Haiti - A third polio case was recently confirmed here, in
this small and otherwise unremarkable town in the northern part of the
country. At the request of World Health Organization officials, I was called
in to initiate house-to-house immunizations in hopes of heading off an
epidemic.


Surveys by WHO staff members over the past few months showed that only about
30 percent of the city's 10,000 or so children were immunized against
measles. Estimates for polio ranged as low as 12 percent.


As I arrived at the ramshackle airport, a light rain was falling. Though
there were only six passengers and plenty of room on the plane, my backpack
had failed to arrive. I knew why. The baggage handler in the Port-au-Prince
airport had solicited a bribe which, in a moment of cultural insensitivity,
I had declined to pay. ''Don't worry,'' said the airport manager. ''It will
arrive on a later flight.''


There was no time to wait. I jumped onto the back of a Yamaha 125
motorcycle. For a dollar, the young driver expertly threaded his way through
the perpetual crowds, past the busy wharf, and up the muddy rutted road to
the Direction Departmentale de Sante Publique.


The director and epidemiologist warmly received me. They agreed an
immunization campaign would be a good idea, and that we could begin the next
day. I was jubilant.


The next morning when we returned, the director was gone, not to be seen
again, and the epidemiologist, in Jekyll and Hyde fashion, disavowed herself
of any involvement in the hard work of getting the city's children
immunized. I was shocked.


I found the nominal immunization manager at her desk. A mild-mannered woman
of 50-something, Ms. Gabi registered no emotion as I laid out the gargantuan
task that awaited us. ''Where will we find the people to do this?'' she
asked. ''Well, look around, right here I bet there are five people who can
help,'' I replied. I jumped up and began recruiting - or trying to recruit -
anyone I could find.


Each one declined. ''J'ai mes autres affaires'' [I have other things to do]
and ''J'ai une peine'' [I am burdened] and ''Ce n'est pas mon travail''
[That's not my job] were among their curt responses.


Desperate, I walked outside to scream. There stood two Cuban physicians. All
over Haiti there are hundreds of Cuban health workers in what amounts to a
medical Peace Corps. The Haitians, however, do not know how to use them. So
one finds a superbly trained internist, for example, rotting away in a rural
dispensaire with no tools to work with.


One of the Cubans was the coordinator of the 60 or so others serving in the
area. In a flash, he promised to have eight of his team there the next
morning to help.


Buoyed, Ms. Gabi and I headed to the dispensaire that serves 20,000 or so of
the city's poorest residents to enlist their cooperation, and plot our plan
of action. We asked for a map of the city. Blank stares. ''A map? Why no,
we're health workers, not cartographers,'' came the response.


We headed to City Hall where the mayor and his staff sheepishly admitted
they had no map of the city either. Visions of lost vaccinators troubled me.
In the gathering dusk the driver and I drove through the area, asking people
where we were, sketching a series of crude maps as we went. It would have to
do.


The next morning the eight Cubans were at the Direction Departmental waiting
for us. We loaded the vaccine and supplies into our pickup and headed for
the dispensaire at Trois Rivieres. The local nurses and auxiliaries trickled
in, looking reluctant and wary. We paired them with the Cubans and sent them
out into the teeming slums with copies of our maps.


What would happen when health workers got down to administering the
vaccinations? Would this scheme, which once seemed so simple, work?


I loaded my pack with plastic bags of ''Culligan'' (potable water sold by
the company all over Haiti) and soda crackers for the vaccinators. I hopped
on my mountain bike and threaded my way through innumerable mud ponds,
garbage pits, and hidden warrens, searching for the little chalk marks on
the houses that, I hoped, had been visited by our team, asking mothers if
they had seen them.


Their reactions ranged from open astonishment - ''Who was this blanc on the
bike?'' ''What's going on?'' - to barely concealed ridicule.


By day's end I had found each of the eight teams. Altogether they had
vaccinated about 1,000 children. By week's end it was over 5,000 - more than
the number vaccinated the previous year.


The Cuban volunteers proved to be superb fieldworkers. The Haitian staff
members began showing up on time.


By the time we were done, we had pushed measles and polio coverage up from
20 percent to 70 percent. The cost was, in US currency, all of 35 cents per
vaccination.


Best of all, there's been no epidemic in Port-de-Paix.


A few weeks later, the author returned to Port-de-Paix after working
elsewhere in Haiti.


The locals, to my surprise, have continued vaccinating house-to-house in my
absence, stopping only when they had spent the last few gourdes I'd left
them. This was an important moral victory.


The day I arrived back, a new measles case was found smack in the middle of
one of the neighborhoods we had immunized most intensively. It was a child
whose mother had refused the immunization. The lesson was not lost on the
neighbors nor on the health workers whom I had warned about potential
epidemics.

The day I left, they had formed 15 teams and were already moving into the
rural areas.

Michael McQuestion is a consultant to the World Health Organization's
vaccination initiative.


This story ran on page 02 of the Boston Globe on 5/13/2001.
 Copyright 2001 Globe Newspaper Company.