“How was your Thanksgiving?”
This may seem like an odd question to ask at the end of January, but I had not seen Ahmed (not real name) and his mother since his last infant well visit in late October. This family moved to central Ohio about two years ago, escaping the ravages of living in a country that has seen a civil war for the better of 20 years. Ahmed’s mom and her three siblings, with their respective families, all left their home country around the same time but unfortunately were not able to settle in the same area, instead being spread out over the Midwest. While not celebrating our Thanksgiving per se, they would be thankful for seeing each other for the first time in 2 years over the long holiday weekend. When Ahmed’s mother shared this with me in October, she was beaming with joy and looking forward to seeing her dear siblings again.
“Unfortunately, not very good,” she replied, trying to hold back tears.
“Why? Was someone ill?” I asked, and after a pause, she replied, “No. Ahmed was quarantined for 21 days after two children in the toddler room of his daycare came down with measles … children who were not vaccinated by choice … so my husband, Ahmed, and I had to stay home.”
By now, the tears were flowing.
“But there will be another day soon when we will all meet …” she stated, showing her always positive self. “But still, these children were from families who came from our land …”
Columbus had a major measles outbreak in the mid-fall this past year, with over 80 cases and hundreds of children tested. The vast majority of cases occurred in a concentrated area where several communities had opted not to vaccinate their children with the MMR vaccine. To control the spread, thousands of individuals were quarantined for up to 21 days these efforts very successfully stopping what could have been a major public health disaster in its tracks. However, the quarantines did affect many lives in our area, most impacting the families with children too young to vaccinate and who live and interact with these communities.
This was a new way to view the impact of not being immunized, especially with a vaccine with a long record of safety and efficacy. When discussing the MMR vaccine with those parents who are hesitant, I have always stressed the risks of the actual illness on their children or of the illness impacting loved ones who cannot be immunized or whose immune systems are compromised. I had never seen it from the perspective of the risks and pains of having other families quarantined, families that otherwise are completely unaware of the decisions of others not to vaccinate.
For those of us who have been at this for a while, we know that things always seem to work out in a specific way, with what may seem to be an “unexpected coincidence” being actually part of a larger plan. Sure enough, early the next week, an established family from the same country as Ahmed’s family (they had escaped the continuous civil war close to a decade ago) came in for annual physicals for their two elementary school-aged children and catchup vaccines for their middle school-aged child. Catchup with all but MMR, of course, for this family was one of multiple that I have tried to convince over the years that the MMR vaccine is safe and effective. I used various methods ranging from logic to giving them incredibly well-written literature from the hospital’s vaccine education center, to showing them pictures of what measles looks like, to finally using the measles outbreak in our area to convince them, all to no avail.
Maybe the visit from Ahmed was a way to reach them, so I gave it a shot. Mom gave her usual cursory exasperated glance at me when we got to the “so, can I ask you to please vaccinate your children with the MMR vaccine” part of the visit.
“No, thank you” was the reply as always, but this time I proceeded to tell them in general terms what happened to Ahmed and his family. Coming from a culture where spending time with extended family is remarkably and commendably valued, this seemed to strike a chord with mom, who stared at me the entire time, not saying a word. I paused for a reaction, but at first, none came.
“Well, that didn’t work,” I thought as I got up to leave the room when mom stopped me.
“About that MMR, let’s do it, please,” mom’s voice tailed off.
Medicine is an art form as much as a science since we interact with humans, who are both soul and body. We all live in a world of feelings and emotions that impact our daily interactions, often shaping our reactions more than logic. This was a reminder that touching a heart is often the best way to reach someone.
Alexander Rakowsky is a pediatrician.
