A village doctor goes to great lengths to ensure children are immunized

Sanjiang County, Guangxi Province, June 2009 – For the past 11 years, 32-year-old Wu Jiafu has served as the only doctor for the 1,300 people in Gaonan, a Miao ethnic minority village in Sanjiang County, Guangxi Province.

Dr. Wu's 10-square metre clinic consists of nothing more than an examination bed and a counter with basic medicines for fever, cold and rash. Out of this space, he performs life-saving work, including administering routine immunizations to the children in his village.

Road to getting the vaccines

Once a month, Wu Jiafu and a doctor from a neighbouring village travel to the township clinic to replenish their supply of vaccines. Getting to the township clinic is no easy feat, requiring Dr. Wu to trek along a mountain road for an hour, before hitching a ride with a passing vehicle.

"In the past, we would walk to the railroad crossing. If we were lucky, a cargo train would stop to refill water. We would climb into the carriage and get off when the train pulled into the township station," Dr. Wu smiled. "But now we can't do that. They've set up fences along the railroad tracks, and we will be fined 50 yuan if we are caught."

"We cure people, but we earn less than those who cure animals," said Dr. Wu. "Village doctors receive a government allowance of 30 yuan per month, while the vets get 260 yuan." To support his family, Dr. Wu also runs a small grocery shop and raises pigs. Even with this supplementary income, he earns only 500-600 yuan a month.

Breaking down invisible barriers

The last day of each month is routine immunization day in Gaonan Village. On these days, Dr. Wu hangs a loudspeaker on the branches of the persimmon tree that grows near his clinic. Standing under the tree, he urges the farmers working in the terraced rice fields to take their children to his clinic for vaccination.

According to Dr. Wu, the most difficult part of his job is not the low wages or the long journey required to get the vaccines, but rather, changing entrenched attitudes.

Even with his public service announcements, Dr. Wu has found that most of the time, he has to go door-to-door to remind caregivers to bring children in for vaccination. More often than not, Dr. Wu finds that the person who opens the door is not a parent, but a grandparent. Due to limited farmland in the mountains, about half of the people in the village have gone to find jobs in the cities, leaving behind the elderly and the young.

"Some grandparents wouldn't allow me to inoculate the children, saying they themselves had never been vaccinated and were fine," Dr. Wu recalled.

Though China allows ethnic minority families to have two children, it is not uncommon for villagers in Sanjiang County to have three or more. Especially in cases where the firstborn are girls, parents have children until a son is born. Afraid of being fined for not complying with China's family planning policy, the villagers don't take all the children to the clinic for vaccination.

Another challenge that Dr. Wu faces is his local rival, the local shaman who villagers believe can frighten away disease-causing ghosts. "The villagers would rather pay 3.6 yuan and 10 litres of rice to the shaman than come to see me and pay 0.5 yuan for an injection," Dr. Wu said.

In 2006, a six-year-old girl in the village died of Japanese encephalitis. "On her way to the township clinic, the girl was still breathing. On the way back, the grieving parents brought a tiny, lifeless body." Dr. Wu recalled. "After the tragic loss of their daughter, the parents are now among the first to get their other children immunized."

Getting the message across

Since 2006, UNICEF has been working with the Ministry of Health and the National Centre for Disease Control and Prevention (CDC) to increase awareness of immunization and give more support to the hundreds of village doctors working in Sanjiang County. The county is populated by ethnic minority groups, and is also one of China's poorest.

"Many ethnic minority people, especially the elderly, are not literate and don't understand Mandarin Chinese. Additionally, there is no vocabulary for diseases such as whooping cough, tetanus or measles in the local languages," said Wang Zhong, an officer with the local CDC who works on the UNICEF-supported Expanded Programme on Immunization (EPI).

"To get the message across and help them understand the importance of immunization, we have sent ethnic choral groups to sing songs during holiday gatherings," said Wang Zhong.

A UNICEF-supported vehicle equipped with loudspeakers has also travelled to remote villages to broadcast key messages on free vaccinations and access to services for children left behind by parents working outside the village.

In some remote villages of Sanjiang County, the hospital delivery rate is under 30%, making it difficult to ensure that newborns receive the necessary vaccinations. Working with the Ministry of Health and local counterparts, UNICEF has supported a 12 yuan incentive to help village doctors visit households and administer the first injection of the Hepatitis B vaccine within 24 hours of home delivery. This is needed to prevent chronic infection, which is most commonly acquired during the birth process or immediately afterward.

Additionally, primary school teachers are required to check children's vaccination history on the first day of the school year to make sure they haven't missed any inoculations. "Some families with more than two children are afraid of being penalized, so they don't want to take all of their children for vaccination. But we assure the parents that our programme maintains its own registration system and that the information is not shared with the local family planning office. The important thing is that all children are protected," Wang noted.

Statistics from the County CDC show that since 2006, some 3,000 children each year have benefited from the programme. The coverage rate for basic vaccines against preventable diseases has increased steadily. For example, administration of the first dose of Hepatitis B vaccine for babies delivered at home has reached 76% in 2008, up 40% from 2006.

Dr. Wu also finds that more parents now come to his clinic voluntarily at the end of each month. "I don't quite understand the names of those vaccines but I know from our doctor that they can keep my child healthy," said Wu Chengling, mother of an eighteen-month-old boy. "We hope he can grow up healthy like children in the big cities."