From surviving smallpox to preventing measles / by Edna Adan Ismail

From surviving smallpox to preventing measle$ by Edna Adan lsmail Mrs Edna Adan lsmail is a Technical Officer in the unit of Maternal and Child Health at WHO's Regional Office for the Eastern Mediterranean in Alexandria "Why do children die of mea- sles when a vaccine exists and the disease is prevent- ab!~?" The person asking this question was no ordinary man. It was Ali Maow Maalin, the Somali hospital cook who, 11 years ago, became the world's last-ever case of endemic smallpox. The spots that blossomed on his face back in October 1977 resulted in photographs that have been re- produced around the world. He was "the exception that proved the rule ; " smallpox had finally been backed into a corner, in this case the small Somali port of Merka; Ali Maow Maalin-the world's last case of smallpox 11 y~ars ago-is today a health worker in Somalia campaigning against another communicable disease. Photo WHO/E. lsmail the chain of transmission had been well and truly broken, and a disease that had scourged mankind for mil- lennia no longer existed on the planet Earth. Ali was lucky in that he survived, but he was ill enough to spend some time in a quarantine camp. Today, aged 34, he says: "I was so weak that I was sure I was going to die, and wanted to be near my fam- ily." Gradually, he regained suffi- cient strength to resume working his family's land in the Lower She- beli region. He knew he had had a near miss from a serious diseas~ and that smallpox was now eradi- cated. But he was unaware that vaccines also existed to prevent otherwdiseases. "During the last ten years, our village and community have lost many, many children. Usually each family loses half of the children born to the women- and often the mothers die as well," he explains. "Women and children are so weak that I thought perhaps the world was still searching for a vaccine that was strong enough . t() protect them against all the diseases that fre- quently afflict them and which kill them so easily. " Tragedy struck once wore this year when · the little sister of Ali Maalin Maow died from complica- tions following measles. Just before she died, the child was taken to the nearest primary health care unit for help. At that stage, nothing could be done to ·save her, but her family were told that she could have been protected through immunization against measles as well as against whooping cough, diphtheria, polio, tetanus and tuberculosis. The day after they buried the girl, Ali walked to the District Medical Office and volunteered to be trained how to administer immu- nizations. He needed no training in promoting the idea of immuniz- ation since he was far more moti- vated than some of his trainers. He was the living witness, and a survi- vor, of one of the" oldest and most virulent "plagues"-one which had been eradicated through single- minded and international efforts and actions. For the past few months, Ali has actively lived up to his pledge to devote his life to the eradication of measles. When he is asked "Why only measles? ", his angry answer is : · "Because it killed my sister! Be- cause it occurs so frequently ! Be- cause it spreads in the same way as smallpox and has a rash ! And fi- nally, if I succeed in convincing parents to protect their children against measles, then I can explain and also give the other immuniz- ations that are available. First of all, I need the people's trust. I don't want them to lose a sister or a daughter before they discover too late that the child need not have died!" This trust, Ali certainly enjoys. Being from the village and speaking the same dialect as the people he serves; the world's last smallpox case is now a dedicated primary health care worker whom any com- munity would be lucky to have. Mahadsanid (Thank you), Ali Maalin Maow. • WORLD HEALTH, July 1988