“Why did you wait so long to come back for more vaccines?” It took me a minute to answer the Health Surveillance Assistant, then I remembered. “We needed to wait 6 months between the pentavalent vaccine, and the mother wanted to get all the catch-up shots at one time.” At this point, the community health workers administering the Malawi government vaccines looked at me like I was a bit crazy. “But we only wait 2 months between those vaccines in children” she said. “I know, but this child needs to follow the North American guidelines.” I summarized. In truth, this sixteen-year-old with no past history of vaccination was adopted by a Canadian mother who wanted to follow the Canadian guidelines in case he traveled back for school. Every province in Canada has a different vaccine schedule, mostly giving 5 of these types of vaccine and finishing by 6 years old, but they don’t publish how to catch a child up in his teens. So I’ve been using the CDC schedule, which recommends only three doses of these vaccines if the last dose was given after the child’s first birthday. Today, he was finally catching up. We caught him up on Measils and Rubella, but we had to skip Mumps because only the MR, not the MMR was available in Malawi. I was very thankful that we had gotten this child a rabies vaccine, since the situation can be dangerous around here. I have to admit, even with my research and expertise, I wasn’t sure what to do with polio. Malawi gives 5 doses, finishing by 14weeks. Canada gives 4 doses, finishing at 6 years. And the CDC recommends 3 doses if the child is more than 4 years old and if there has been 6 months since the last polio vaccine. But then there was the fact that we are in the midst of a polio epidemic in Malawi and I want him to have the most protection possible, and there aren’t really polio vaccine recommendations for children in countries where there is actual polio in the water systems. I hadn’t made a note for more polio today, so I wondered whether that was a mistake, or whether he had gotten the vaccines but we had written them down elsewhere.
I finished clinic so early that Greg was surprised to see me home. But it actually took me a couple hours to write up vaccine recommendations, double check the Canadian websites, and find a place where the mother could ask a Canadian public health official about further recommendations. I helped another family with vaccines this morning, and so I also wrote up a list of vaccines the child had received in Florida and here, which they planned to send to their US-based pediatrician to ask if anything else was needed. Between the initial long consultation making plans for these kids, the sourcing and delivery of the vaccines, and the follow-up paperwork, it isn’t unusual for me to spend three hours helping each of these families. I think I’m the only doctor in the country who is willing to take the time to figure out the puzzle of vaccinations for multinational families. Even pediatricians and other family medicine doctors in town refer to me for this. It fits into my scope of a preventive medicine doctor, but I had a lot of help from a handover from my friend who was doing this before me. Even knowing where to source the vaccines and which nurses are comfortable giving a subcutaneous injection didn’t come easy.
So I didn’t see many patients today, but I believe I helped these families who might have struggled to protect their children otherwise. Even though I’m not busy seeing all the patients who come through the clinic door, it is nice to know that I have a role which no other doctors are willing to take the time to solve. Now, if only I could figure out what to do with the polio shots….
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