Rosie Scribble

Vaccinations, delivery suites and thoughts of home

On the last full day of our field trip to Cameroon, we attended a vaccination session at the health centre in Bertoua and visited the regional hospital where I really hoped the delivery suites would be better than those we had seen so far.

The vaccination session confirmed what I had already learnt during my week in Africa: the message about tetanus was getting through and women were turning up to be vaccinated even if that meant travelling long distances.

Yet the birthing conditions at the hospital, considering they were supposed to be the best in the area, were alarming. Although the gynaecologist’s consulting room looked highly clinical and hygienic, the delivery suites (one of which could accommodate three women giving birth at the same time) were hot, unhygienic and contained metal beds which looked horrific. As I left one room I noticed a dirty red rag lying on the floor. Again, there were no resuscitation facilities, no oxygen, not even a bag and mask for those babies needing extra help.

It seemed then running water and a metal bed was the best on offer in Cameroon when it came to giving birth. A delivery at the regional hospital cost US$12. A full ante-natal check and basic health screening cost US$50 which is beyond what the majority of women can afford. Living in conditions of extreme poverty, it is not surprising that the majority of women have to give birth at home with no professional support in conditions which are unhygienic at best and life-threatening at worse.

Having spent time with new mothers, expectant women, traditional birth attendants, social mobilisers, doctors and a range of health professionals, and having witnessed the conditions in which the majority of families live and the conditions in which women give birth, it is clear that to be vaccinated against tetanus is an absolute necessity.

As we returned to the relative luxury of our hotel in Yaoundé, my thoughts returned to home, to my child and my life, a world away from this one. The field trip had been an amazing experience -- emotional, educational, shocking, sobering, thought-provoking, life-changing. Within 24 hours I would be back in the familiar surroundings of home, yet knowing I would never forget these communities.

Today, in mid-October, I think of them often.

I always will.

The Pampers and UNICEF campaign runs from October to December. For every Pampers product purchased with the “1 pack = 1 life-saving vaccine” logo, Pampers will donate the cost of one vaccine to UNICEF.  Additionally, by visiting the Pampers Village website and clicking on the Big Kiss button, a ‘virtual kiss’ will be sent to Pampers and UNICEF. For every ‘virtual kiss’ sent, Pampers will make an additional donation to UNICEF. Helping to eliminate a disease as deadly as tetanus really is as simple as that.

Tetanus and the work that still needs to be done

I travelled to Cameroon with the Pampers and UNICEF team to see the success of their partnership in helping to eliminate maternal and newborn tetanus and to see for myself the work that still needs to be done. During our time in Ngamboula we met two women and their families who had not been vaccinated against tetanus because they believed the injections would harm them in some way. As a result, they all remained at risk of contracting the disease.

Between them Madame Pelagie and Madame Yvonne had had 17 pregnancies. Fourteen of their children were still alive. Madame Pelagie, the younger of the two women, was holding her seven month-old twins when we spoke to her outside her mud hut. She did not know her age but her husband said he was 23. She looked little older. Her eldest child was ten years old. It seems that when girls start having their periods here, they start having children. Many of the pregnant women we had seen in the village looked very young.

 

Madame Pelagie had received no vaccinations and had never visited a hospital, nor had any of her seven children. As she had her first five children at home alone in unhygienic surroundings, the risk of them contracting tetanus would have been very high. She explained that once her babies were born she would leave them on the floor and go and get help from a relative who would cut the umbilical cord with bamboo. She received some help from the village’s traditional birth attendant for the birth of her twins but still went through a high-risk birth with no professional support on hand.

Tetanus is caused by bacteria that lives in dead and decaying matter in soil, animal dung and faeces and develops when bacteria contaminates an open wound. The bacteria works as a nerve toxin (poison), affecting the central nervous system and causing painful and uncontrollable muscle spasms. Anyone can contract maternal and newborn tetanus if they are not vaccinated; however, it is usually women and newborns living in remote areas with no access to antenatal care or immunisation that become affected.

All Madame Pelagie’s children will have been put at risk of contracting the disease and remain at risk while they remain unvaccinated. She explained to us that she was scared of needles and worried that the needle would break and end up in the body.

Madame Yvonne, aged 42, was convinced that vaccinations would make her children ill. Her children were aged between seven weeks and 22 years. None of them had been vaccinated and, in fact, she had little understanding of what tetanus was or why vaccination was important. While her husband had some understanding, he was also unaware of the risks of remaining unvaccinated.

Again, Madame Yvonne had had all her babies at home alone, apart from the time she had given birth in the bush. She had been working on a nearby farm when her contractions started and there was no time to find shelter. The risk of herself or her newborn baby contracting tetanus would have been extremely high. One of her children had received a vaccination in the past but Madame Yvonne explained that it had given him a fever for two days so she had decided against any further vaccines for any of her children.

A crucial part of the MNT elimination campaign in Cameroon involves educating women, like Madame Pelagie and Madame Yvonne, about tetanus, the importance of being vaccinated and dispelling any inaccurate beliefs they may have. It was obvious from our visit that further work still needs to be done in this area. Fathers, too, needed to appreciate the importance of their wives and children being vaccinated.

As I watched many children during my time in Cameroon playing happily in the soil, it was worrying to know that there will be many who remain at risk from the bacteria that lives there. A simple course of vaccines could eliminate that risk and give them a much brighter future.

Maternal and newborn tetanus (MNT) still threatens the lives of 170 million women and their newborn babies in 40 countries around the world. In 2010 (according to WHO), it has been calculated that approximately 59,000 newborns die annually from newborn tetanus, and thousands of women from maternal tetanus. Even though MNT is easily preventable with a simple vaccine, one baby till dies needlessly of newborn tetanus every nine minutes.

Together we can change that.

Pampers and UNICEF

The harsh reality of motherhood in Cameroon

Our visit to the health centre in Bazzama highlighted the importance of outreach services in transporting essential supplies and vaccinations to the surrounding villages and refugee camps. From there we travelled on to Ngamboula, 7km away, to see these outreach services in action and speak to pregnant women who have just received their tetanus vaccines.

The villagers were extremely warm and welcoming and the children joined in with a celebratory song they had prepared for our arrival.

    

The children were particularly excited to see us and it was wonderful to see them gathering round, smiling and chatting. They were fascinated by our cameras and amazed to see images of themselves for the first time.

Jemma’s iPhone proved a huge hit. The children were amazed by the technology and loved touching the screen.

Once again their homes were very modest yet there was a strong community spirit and a much livelier atmosphere than had been evident in the other places we visited.

It was in Ngamboula that we met Madame Adrienne Ndande who had come to talk to us about the vaccination session she had just attended. There turned out to be a great deal more to her story than we had realised and proof that you never really know what someone is going to disclose until they actually start talking to you.

Madame Adrienne, aged 25, was half way through her fifth pregnancy. She explained to us that she felt proud that she and her baby were both protected from tetanus and her eyes lit up when we asked her what she liked best about being a mother. She said she loved caring for her children, being called Mum and seeing her family grow.

Then Adrienne said that she had lost two of her children, one aged 18 months from malnutrition and the other aged 19 months from asthma. Her last bereavement had been two weeks previously.

The conversation quickly changed from a positive, upbeat discussion about the benefits of vaccinations, to a more sombre one as the reality of infant death in the developing world and the dreadful distress this causes was sitting there in front of us.

Madame Adrienne’s situation, sadly, is not untypical. The infant mortality rate in Cameroon is 74 per 1000 live births*. One child out of seven in Cameroon will not celebrate its fifth birthday. Many of the women we spoke to during our time in Africa reported they had lost babies and young children too.

The Pampers and UNICEF campaign is helping women like these.

*UNICEF Cameroon statistics

The day everything changed

I was aware that this field trip would impact on me, cause me to reassess my life, look at the world differently and appreciate what I have. I knew it would change me. Yet nothing could have prepared me for the day I found myself discussing childhood malnutrition in a nutrition centre with a doctor from a developing country.

The nutrition centre was part of the main health centre in Bazzama. On our way in we had been shown sacks of corn syrup blend and cans of oil supplied by the World Food Programme. They were for malnourished children, pregnant woman and lactating women in the surroundings villages, many of them refugees from the Central African Republic.

I had seen food supplies such as these on news programmes but never firsthand. It was alarming to see them and to hear of the children in desperate need of nutrition. The Chief of the health centre, Mr Simon Sembong, explained that malnutrition was primarily due to poor quality food as many children survived on a diet of cassava, but that the quantity of food available was also an issue.

As he explained that children brought to the health centre were given an appetite test to see if they were able to eat and given high-calorie plumpynut if they could, my thoughts drifted back to the times I had spent in hospital being fed high-calorie nourishment drinks as a result of my anorexia. For completely different reasons I knew what it was like, as an adult, to feel the effects of starvation. I could imagine nothing worse than a child experiencing that level of suffering.

Seeing the scales on the consulting room floor, the diagram on the wall showing how acute malnutrition should be treated, and hearing about the vast numbers of children who die each year simply because they do not have adequate nutrition, it hit home that these children have no choice whatsoever in what they eat or whether they eat, and this is the reality for large numbers of the communities in Africa and across the developing world.

My thoughts turned to my own daughter and how different her life is in comparison. She has access to more food than she will ever need. We are both fussier about food than we need to be, and I am certainly more conscious of my size than I need to be. Yet we have our health and we take it for granted. There is no such luxury here.

As the emotion of the occasion overwhelmed me, I stepped outside to compose myself and gather my thoughts. To my left was a boy lying next to his mother suffering from malaria, too weak to sit up. He was seven years old, the same age as my daughter.

Something changed in me that day and I knew from that point on I would appreciate what I had, alter my attitude towards food, continue to look after my health and never ever put it at risk again.

We cannot solve all the problems of the developing world, but eliminating tetanus is one thing we can achieve in our lifetime. It is just one small step. Life is hard here, really hard. All children deserve the best start in life they can possibly have. For children in the developing world, a life with no risk of contacting tetanus is a step in the right direction.

If you can help these communities and others like them, please do.

Pampers and UNICEF campaign website

UNICEF UK

Facing the reality of tetanus in the developing world

Tetanus is not something I had given a great deal of thought to before my field trip to Cameroon. The last recorded case in the UK was over 80 years ago and children are now routinely vaccinated against the disease. Yet in Africa, and many parts of the developing world, maternal and newborn tetanus is still a reality.

From Lembe village we made the twenty minute drive to Akussa village, home to Madame Ngans Sophie and Mr Nkodo Tongo Isodore. They were the grandparents of the baby treated for newborn tetanus by the District Medical Officer we had spoken to that morning. He died in 2008, aged just three weeks, before there was even a chance to give him a name.

Despite the heat and their obvious poverty, Mr Isodore had dressed for our visit in a suit and tie and immaculately polished shoes. It was moving to see the effort he had gone to on our behalf and the importance he clearly placed on our visit. As his wife sat quietly in the corner of their very basic home, Mr Isodore told us the story of his grandson, born to one of his daughters, Madame Christelle when she was just 14.

His daughters had been told that any new boyfriend must be introduced to the family so they could get to know him. However his fourteen-year-old had not done this, and on discovering she was pregnant had fled the family home, concealing the pregnancy from her parents.

She returned home months later, unsure of exactly how many months pregnant she was. The father of her unborn child was told to take responsibility for her, but instead he disappeared and was never seen again.

During that time the girl received her first tetanus vaccine. However, the outreach motorbike delivering the second crucial vaccine broke down. So when she gave birth to a baby boy at home shortly afterwards, she was not fully protected against the disease. Her mother cut the umbilical cord using a razor blade dipped in alcohol to sterilise it and tied the cord with thread used to plait hair that had been bought from the local market. The thread was not clean.

For three days the consequences of the unclean thread were not obvious, but then the baby became stiff, changed colour and refused to breastfeed – all classic signs of newborn tetanus. The girl’s father borrowed money and took them both to the local health centre where they were sent home with medicines to inject.

By the evening the baby’s condition had deteriorated. Mother and baby both went to the district hospital where they remained for seven days. After that time, and showing no signs of improvement, they were sent home. The baby boy died the same day.

Tetanus is known as the silent killer. It is still a reality in the developing world. Pampers and UNICEF have been working in partnership since 2006 to help work towards eliminating the disease and raise money for tetanus vaccines to protect the millions of women who are still at risk from the disease. It is a goal which can be achieved in our lifetime, with our help. For every pack of Pampers products purchased with the “1 pack = 1 life-saving vaccine” logo, Pampers will donate the cost of one tetanus vaccine to UNICEF.

Preventing unnecessary deaths, like this one, really is as simple as that.