Wednesday, May 12, 2010

An outbreak hits home

Here's something to wrap your head around: Measles.

There's an outbreak occurring in the Mokhotlong district right now.

This is a developing-country reality -- the virus only occurs in tiny numbers in developed countries like the United States, because of vaccinations -- and a far worse reality in a country where lots of infants are HIV-positive.

According to the "HIV Curriculum" of the Baylor International Pediatric AIDS Initiative, a partner of TTL's in Lesotho, "HIV-infected children have an increased risk of developing severe complications when infected with measles. A review of reported cases of measles infections in children with HIV indicates a 40 percent death rate."

"Death is primarily due to pneumonia or secondary bacterial infections," according to the Nelson Textbook of Pediatrics.

I bring this up now because we just found out yesterday that one of the babies in the safe-home, Thapelo, has measles. He's one of the twins who came to TTL at the end of August extremely premature, whose mother died in childbirth and who the TTL caregivers miraculously kept alive without an incubator by using heaters and blankets.

Thapelo and his twin sister, Mathapelo, are basically miracle babies, and are beautiful and -- generally -- healthy. They have lived at TTL their whole lives, and are finally scheduled to head home to members of their extended family this afternoon -- a logistical triumph on TTL's part in its own right. And now Thapelo has measles.

He looks miserable and stares back at you with a look that says, "What's going on and why do I feel like this?" He has socks on his hands to prevent him from scratching himself. Luckily, he's not HIV-positive, and should be OK. Basically, the rash and fever just have to run their course. Naturally, we have him isolated from the rest of the babies, and his family members who are coming to get him today seem like great people who will be able to take care of him well.

Thapelo and Mathapelo being reunited with their family is a fantastic, amazing, never-seemed-possible, miracle-story moment.

Still, we are worried about Thapelo's measles spreading around the safe home. Namely, HIV-positive Ntseliseng, who looks much better than she did when she first arrived emaciated and with scabies last month, doesn't have a medical history we are aware of, as she arrived with a new bukana that doesn't date back very far, so we don't know if she had a vaccination or not.

M'e Mamosa took her to the hospital this morning and got her vaccinated, on the advice of a Baylor doctor and regular TTL contact. Hopefully we acted fast enough, and Ntseliseng won't have to face measles in her already fragile state. She still seemed OK this afternoon.

Hopefully Thapelo has a strong recovery, and none of the other babies get measles. And hopefully, somehow, Mokhotlong district -- and the entire country -- is able to start turning the curve, getting more kids vaccinated.

But that's a tall order, as I saw today. The entire outbreak was put in perspective for me this morning, when I drove out to a rural village on a Village Health Worker Program site visit with outreach. We weighed and measured a ton of kids, basically using the gathering to look for kids in need of TTL's services and chronicle the progress of the others.

Looking through all of the kids bukanas, I was hyper-sensitive to the measles issue and honed in on the spot in the bukanas where the measles vaccination is recorded. The vaccination is given at 9 months here, and about half of the kids of that age had never had the vaccination.

There it was in my face. The reality behind the outbreak. Sometimes parents just don't take their child to the clinic, sometimes they can't make it there for whatever reason, and sometimes they do make the trek to the clinic and the clinic is out of the vaccine. It's a nasty reality.

It should't be this way. We shouldn't have to worry about measles, much less a measles outbreak. Babies shouldn't have to deal with measles. There's a way to avoid it. But here we are.


Unknown said...

Hi Kevin! I'm really glad the Nelson book came to good use. Reading your posts and emails, I am so incredibly impressed with your spirit and approach in Lesotho... I'm learning so much from you!

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