Perspectives in Health Magazine The Magazine of the Pan American Health Organization Volume 8, Number 2, 2003

The whistle of a teakettle pierces the morning silence, and the clock strikes six. It is June 1, 2003. Today and throughout this week, children in 19 Latin American and Caribbean countries will be the focus of attention for doctors, community leaders, politicians, volunteers, mothers and fathers. Together they will vaccinate millions of children wherever they are, no matter how remote their villages, no matter how difficult to reach.
 
It is a historic effort, a gesture of love for all the region’s children, an investment of hope in their present and future.

Measles is one of humanity’s most contagious diseases and continues to be the main cause of vaccine-preventable death in the world, claiming the lives of some 770,000 children under the age of 5 each year.

Before a vaccine became available in 1963, nearly all children got measles. Then in 1994, two historic achievements were announced at the Pan American Sanitary Conference in Washington, D.C. Latin America was declared free of polio (Luis Fermín Tenorio, a young boy from Pichanaquí, Peru, was the last known case). Second, all the region’s countries united in an effort to interrupt indigenous transmission of measles.

Since then, the region's countries have focused impressive efforts and resources on this goal. The Pan American Health Organization (PAHO) developed a measles eradication strategy based on better surveillance, targeted immunization and improved laboratory capacity.

The sheer magnitude of the problem has meant delays; new outbreaks occurred in the 1960s in Argentina, Bolivia and Brazil, and in 2000–01 in Haiti and the Dominican Republic. But vaccination efforts continued, and between November 2002 and July 2003 there was no indigenous transmission of measles anywhere in the Americas. Keeping the region measlesfree, however, requires maintaining high levels of childhood vaccination.

Andean ministers of health meeting last April proposed an Andean vaccination week. The idea was soon expanded to include South America and later Mexico, Central America and the Caribbean. Eventually 19 countries joined together for the first Vaccination Week in the Americas. The focus was on children who had never been vaccinated: those in hard-to-reach rural areas or marginal urban zones whom earlier campaigns had left behind.

The campaign also helped reinforce key concepts of international public health: that joint efforts can lead to great achievements; that health is a bridge to solidarity, understanding and hope; and that vaccination is an individual right as well as an important tool of public health. In this spirit, countries mobilized their own resources and won support from agencies such as the U.S. Centers for Disease Control and Prevention, the United Nations Children’s Fund and PAHO.

Finally, Argentina, Bahamas, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, El Salvador, Guatemala, Honduras, Jamaica, Mexico, Nicaragua, Paraguay, Peru, Suriname, Uruguay and Venezuela signed on to the historic initiative. Officials and health workers at all levels—ministerial, local and community— met daily through May 30, 2003, to make sure that the required personnel, equipment, vehicles and vaccines would all be in place for the week-long campaign.

Mothers and fathers line up with their children in tow, many dressed as if for a party. Enthusiasm fills the air, disturbed only momentarily by the shriek of a child who has just realized he’s going to be vaccinated.

Day breaks, and the work begins
June 2003

Guayaquil, June 1

After a quick breakfast of fresh-baked bread with butter and guava jam, black coffee and slices of fresh papaya, we leave our hotel in Guayaquil’s Simón Bolivar waterfront along the Guayas River. We head for our first destination, a small health center on the outskirts of town.

We go slowly. The street lights gradually turn off, and street vendors start to take up their positions. Some of them are children.

Before long the sun breaks out. By 7 o’clock the heat is already unbearable, as is the traffic. Our driver, Don Rafael, weaves expertly through a sea of cars, buses and pedestrians who cross the street whereverthey feel like it. This is a city of both old and new, changing from block to block. We pass the cathedral and Las Iguanas Park and begin to see small repair shops, kiosks and sidewalk stands selling fruit and vegetables.

After a sharp turn to the right, we leave pavement behind and enter a narrow dirt road full of potholes. From our jeep we peer out at rickety shacks, haphazard electrical wires and residents looking hesitantly out their windows into the scorching sun.

7:15 a.m.

We arrive at the Fertisa Health Center. A sign announcing Vaccination Week in the Americas hangs prominently over the entrance. Mothers and fathers are already lining up with their children in tow, many dressed as if for a party. Enthusiasm fills the air, disturbed only momentarily by the shriek of a childwho’s just realized he’s about to be vaccinated. The health workers are eager to show and explain everything to us. We ask about their colleagues who are going house to house to vaccinate, interviewing residents and reviewing vaccination records. We’re told they have already left but also where we might find them. We say a quick goodbye and promise to return.

8:15 a.m.

A voice from a distant megaphone at first sounds like someone hawking oranges or pineapples. We see a red truck turn the corner and head in our direction. The megaphone is on its roof. The voice becomes louder and clearer: "Vaccination Week in the Americas....Protect your children....It’s free.…Health workers will come to your house or you can take your children to the health center." The message is repeated over and over. We signal to the truck, and it stops next to our jeep. The campaign poster is affixed to each of its doors. A young nurse tells us, without our asking, "Marita, Lourdes and Joaquín are vaccinating on the next street. Go straight ahead and turn left at the green house on the corner."

We find them there, unmistakable in their white coats, each with an ice chest in one hand and a notebook in the other. We get out of the jeep and walk toward them. We meet as they are knocking on the door of a small wood-frame house. A young woman opens the door timidly. Without hesitation, the nurses get right to the point: "Good morning. We are carrying out a vaccination campaign. Are there children in this home? Are you a mother? May we come in?"

Seconds later we’re all in the tiny living room of the modest home. Everything is tidy and clean. While Lourdes reviews the child’s vaccination card, Marita vaccinates the mother. She explains that they are also giving tetanus vaccines to mothers and women of childbearing age. From outside the house, we hear the sounds of a gathering crowd. "Where is that kid? Has anyone seen Chinto?"

As of this week, children will no longer be mere statistics in reports or fodder for public speeches. They will be honored by people who truly care for them through actions that will help them grow up strong and healthy.

He finally appears, sweating and surprised to see so many people in his house. Chinto is 4 years old, with alert eyes, cinnamon-colored skin and jet-black hair. It doesn’t take long for him to figure out what’s happening. He glances at the door, planning his escape, but it’s too late. His mother holds him gently but firmly in her arms.

Now Lourdes explains to the young woman what the pentavalent vaccine is. Chinto fixes his eyes on his mother’s face as she gently strokes him. He stops resisting and takes his shot with dignity. Joaquín, a community volunteer, rewards the brave boy with a sticker on his Tshirt, confirming that he has been vaccinated. As we say goodbye, we leave a mark on the frame of the outside door, with the owner’s permission. Now the next campaign workers will know the children in this house have already been vaccinated.

The three health workers continue their door-to-door mission beneath the hot sun. We follow them for several hours, until Don Rafael reminds us that we had promised to return to the health center.

Huaquillas, June 2

At Huaquillas, a bridge over an invisible borderline links Ecuador and Peru. As at any border crossing, vendors sell their wares from stands on both sides. The two nationalities mix noisily, buying and selling, sharing news and gossip, coming and going with boxes and bags full of fruit and vegetables, CDs and tape recorders, shirts and sandals. On both sides of the border children are being vaccinated. Señora Aminta, a vendor, asks me if I will watch her vegetable stand while she takes her daughter to be vaccinated. She asks me shyly, calling me "doctor," which I am not. Her 3-year-old clings to her skirt. "Of course," I say. "With pleasure. What do I do?" But my question gets lost in the bustle. I sit on some old coffee sacks and contemplate for a moment the symbolism of this campaign: two sister countries, joining forces, have become for this occasion a single community.

As of this week, children will no longer be mere statistics in reports or fodder for public speeches. They will be honored by people who truly care for them through actions that will help them grow up strong and healthy.

Quito, June 3

For an entire day, we visit some of the capital city’s most marginal areas: La Magdalena, Cotocollao, San Golquí and San Rafael. In each of the health centers we visit the pace of activity and efficiency are impressive. Mothers, fathers, boys and girls are everywhere, and health workers tirelessly perform each critical task, vaccinating, reviewing records, taking notes. Others screen visitors to speed up the work: "If you’re not here for a vaccination, please come this way." After the vaccinations comes the parent survey: "How was the experience? How long did you have to wait? How did you learn about the vaccine campaign? How can we improve our services?" Some answer quickly as they head back to their offices, shops and construction sites after taking time off to dedicate to their children’s health. A father kisses his wife and daughter goodbye and jumps on a passing microbus, which heads down the narrow streets leading to the city center.

We visit health centers of all sizes. Enthusiastic health workers show us the iceboxes where the vaccines are kept, the examination rooms, vehicles with megaphones, detailed maps. But they also show us something else: their dedication and love for their work, their joy at being able to provide a little hope for their fellow citizens.

Cusubamba, June 4

The official launching ceremony for the campaign begins at midday. We get an early start and are buoyed by cloudless blue skies and a light breeze. A detour in the road delays us, but coming out of it we soon begin a serpentine upward climb toward Cusubamba. We notice apparent deforestation, which allows for clearer views of the mountainous, arid landscape. We drive on in silence.

When we arrive, a band is playing live music, and people are everywhere, many of them in indigenous dress. The plaza, with its church and small shops, is decorated as if for a festival. Bands of children run noisily after ice cream and candy vendors while adults gather solemnly and attentively for the official ceremony. Between songs, people give speeches thanking all those whose efforts have gone into the vaccination campaign. It’s like a festival—a celebration of health. And just a few meters away from the music and speeches, children are being vaccinated. It is a spectacle of color, goodwill and dedication.

Río Daule, June 6

Slowly the late afternoon sun begins to fade. We drive along a road that parallels the Daule River, whose green waters blend in with the vegetation along its shore. We leave the car behind and continue on foot along a narrow dirt path until we reach a clearing. We hear children laughing and playing, crickets chirping and the sound of a radio. In the midst of it all, I suddenly feel myself surrounded by silence. Someone whose face I never see says, "Do you see over there on the river, in the distance? Those are health workers going by boat up the river. During the rest of the week, they’ll visit all the villages along the river to vaccinate children who can’t come all the way down here." Three boats move gently through the murky waters, each in a different direction: upriver, downriver, onto a tributary—but each with the same goal.

During an entire week, every day from sunrise to sunset, an army of 200,000 health workers will give their best so that 15 million children can receive their vaccines. For the children, this week marks a turning point in their lives. Instead of becoming victims of preventable diseases, they will have the opportunity to grow up healthy and strong. Instead of becoming mere statistics or fodder for public speeches, they will be honored by the actions of people who truly care for them. Instead of being simple survivors, they will be able to wake up each day to the morning sun and do what all children do: go to school, play and be happy.

Manuel Calvit is a radio producer, video editor and scriptwriter in the Public Information Area of the Pan American Health Organization (PAHO) in Washington, D.C. Armando Waak is PAHO’s staff photographer.

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