Vaccinations, Small pox, Measles, Dona Ermelinda and me.

Dona Ermelinda was a midwife in Colombia with whom I worked. If this had been Appalachia, she would be called a granny midwife; in Benin, a “Sage Femme”, a wise woman. In Colombia where we lived, she was a Partera, technically a woman who delivered babies. But she was far more than that; certainly a wise woman, a keen observer, an empirical scientist, the most trusted and important practitioner in our community. She was the gatekeeper. No new practices would be successful without her approval.

I struggled to make her my partner.Instead, I became her apprentice. As we walked the hills of Cauca, she would grab my hand, and pound her fingers in it, Anne Sullivan to my ignorance. “Juanita”, she would demand, “Ponga se de atencion!” Pay attention.

She explained to me why it was important to massage expectant mothers so that their babies would be in the best position for a normal delivery. She did not like the labor rooms in the hospital that she had visited with a group of women from our prenatal  education classes. The women were laboring alone. That was wrong, she explained, Better that mothers delivered at home where they would receive essential support from their female relatives. She did not agree with formula or early infant feeding. Both practices were promoted as best practices in the sixties, and were part of the health education classes I helped teach.

Dona Ermelina had not been trained in a modern medical facility. Rather she had learned from midwives before her. She had generational knowledge of her technology, precisely the generational experience that our modern technology lacked. That is where we clashed. I wanted her cooperation to convince mothers to bring their babies to the clinic for small pox vaccinations. She said no. She had been receptive to boiling water for drinking; sterilizing the knife to cut umbilical cords to avoid Tetanus; and whooping cough inoculations. But she argued that small pox vaccinations were dangerous and she refused to give her approval.She knew of a woman, two villages away, who had lost her arm due to an infection caused by the small pox vaccination. “Small pox vaccinations were perfectly safe,” I would explain, “citing all the medical experts”. I was patient, but persistent because my Peace Corps training had taught me that peasants were superstitious and resistant to change. I had not been taught that in traditional cultures, knowledge was empirically based, and attention should be paid to those observations.

I thought of Dona Ermelinda and me and our standoff over small pox vaccinations, when I began to read about today’s parents who were reluctant to vaccinate their children, because of perceived dangers.  The parents wanted long term research over the life of those who took the vaccines, not just studies in laboratories. The parents wanted etiological research; under what conditions did side effects occur; how frequent? What was being done to prevent them? And underlying all of those concerns was the fear of autism, a terrible condition, on the rise, with neither cause nor cure.They were not given answers. Their concerns were dismissed, and their motives questioned. They were, characterized as was Dona Ermelinda, as anti-science and ignorant.

It was not my powers of persuasion that convinced Dona Ermelinda to change her mind. Small pox did.  In the Spring of 1965, small pox erupted in epidemic form in Colombia. Everyone was afraid. Small pox was not a distant threat but an epidemic everywhere.  Vaccination stations sprung up at entrance to towns and cities.  If you wanted to enter, you had to show a fresh vaccination or get a new one.  People lined up at clinics and babies were vaccinated, as well.

The risk/benefit in the States changed in the same way. When measles appeared again in the United States, the concern over the vaccinations was replaced with the fear about the real consequences of measles, particularly in infants.  Small pox was finally eradicated as I hope, some day, measles will be.

The encounter between Dona Ermelina and me was of a kind repeated thousands of times in Peace Corps.  Volunteers were the “missionaries” from a technological culture where constant change was the norm; everything new was presumed good, and generational knowledge of our technologies did not exist.  The people so many of us met were from non-industrial subsistence cultures, where change could be dangerous and traditional patterns provided protection against known dangers.

Attention should have been paid to all those interactions between Volunteers and host country people, and captured for research and history. The site reports and observations of Peace Corps Volunteers held that valuable information.  Yet, my search of public records reveals that very little has been preserved and much has been lost.

As for Dona Ermelinda? Best practices for infant nutrition today in the modern world, are precisely the practices that she advocated and protected; nursing until six months without early infant feeding. And small pox?  Science provided the vaccinations that has eradicated small pox in the general public, worldwide. According to the CDC:

“Routine smallpox vaccination among the American public stopped in 1972 after the disease was eradicated in the United States….In the past, about 1,000 people for every 1 million people vaccinated for the first time experienced reactions that, while not life-threatening, were serious…. In the past, between 14 and 52 people out of every 1 million people vaccinated for the first time experienced potentially life-threatening reactions to the vaccine. Based on past experience, it is estimated that 1 or 2 people in 1 million who receive the vaccine may die as a result.”  Here is the text to link to: http://www.bt.cdc.gov/agent/smallpox/vaccination/facts.asp