A picture of health in Zambia for children under five

BOSTON — It’s been several days since I returned from Zambia. The jetlag has eased its grip and I can sleep past six o’clock in the morning. As I prepare to write about what I saw and heard for our Special Report on child mortality, “The Seven Million,” I’ve been poring over the photographs I took throughout my trip to invigorate my reporting.

As I look through the nearly 1,000 photos I snapped, their thumbnails dotting one scrollable window on my computer, I’m struck by the still images of Zambia’s health system: dusty benches outside a health clinic in the rural northern district of Lufwanyama; tall brick and iron fences bordering a private health facility in a suburb of Lusaka; two pediatric pharmacies housed at the nation’s premier hospital, University Teaching Hospital – one for those who can afford the 750 Kwacha (around $140) “high cost” fee that makes them eligible for expedited services and more plush accommodations, and the other for those who cannot.

Then there are the snapshots of Zambia’s health system in motion – young mothers watching over their babies at the hospital, seated in the plastic chairs they had slept in that night; volunteer health workers carefully counting out pills for one-year-old patients; nurses speaking to crowds of women before a modest collection of medical supplies.

Collectively, the pictures tell a complex story of child health in a country that is full of contrast – there are modern, well-equipped facilities for the few Zambians who can afford it, but for the bulk of citizens, there are too many needs, too few resources, and a constant push to make do with the little that is available. More than 60 percent of the population lives below the national poverty line. 

It may seem odd, then, that the image I keep coming back to tells little of this story at all. The photograph hardly has much visual appeal; it’s of the interior of a light gray box containing several small clear bottles. Dozens of mothers had been waiting all morning outside of a health clinic in part for the tiny bottles in this box – vials filled with injectable vaccines, some, of particular interest to me, to protect against pneumococcal disease, a leading cause of pneumonia.

Just two days before my plane landed in Lusaka, the Zambian government held a national launch of the pneumococcal conjugate vaccine, PCV10, which protects 10 serotypes of pneumococcal disease, a leading cause of pneumonia. 

In a press release dated July 10, the GAVI Alliance, a public-private organization that helped finance Zambia's rollout of PCV10, said that the country's government aimed to give the vaccine to more than 360,000 infants in the next year and that this number would grow to cover nearly every newborn child in Zambia by 2015. For this first year, GAVI will pay for every $3.50 dose provided to children in Zambia; starting next year, it will begin sharing the cost with the Zambian government. (And as GAVI announced yesterday, this price will go down even more, to $3.40 starting in 2014.) 

At the Shimukunami clinic in Lufwanyama, where I took the photograph of the gray box, I was seeing the “rollout” of the pneumococcal vaccine in real-time – an event I’d only reported on before from afar. I must admit, I was prepared for more ceremonial hype than tangible action, and that is why I keep coming back to this photograph. Here, vaccines aren’t just an abstract concept, they are already visibly on the ground.

At the clinic I met with Eveness Mumba, a 24-year-old mother who had brought her youngest child, Blessing, in for vaccinations, including the pneumococcal vaccine. Blessing was six weeks old, the age at which the World Health Organization recommends the first pneumococcal vaccine dose. Eveness had learned of the pneumococcal vaccine during her last trip to the clinic, the month before, and said she was grateful for its protection. She had already endured the loss of one child from diarrhea, at nine months.

I watched as the nurse, Miriam Ngulube, jabbed Blessing with a needle and quickly injected the vaccine; Blessing cried, but as Miriam gently shook her leg, the pain seemed to subside. Within seconds, Eveness stood up with Blessing, and Miriam moved on to the next mother in line. Behind Miriam was a bright green poster that had been hanging since March: “Protect your child from PNEUMONIA,” the sign read. “Our Children, Our investment.”

I’m drawn to the image of the vaccines because it’s a sign of what’s working – across incomes – in Zambia. It symbolizes the country’s broader commitment to health, too; just last week it was reported that Zambia was one of only six African countries to have already reached a 2001 pledge made to spend 15 percent of their annual budgets on health. 

“Immunization has been one of Zambia's greatest public health success stories," said Zambia’s WHO representative back in April. That success story has contributed to Zambia’s significant reduction in child mortality rates over two decades – from 193 per 1,000 live births in 1990 to 83 per 1,000 live births in 2011. 

The country’s health story is still complex, as I’ll be writing about in the coming weeks. But its ambitious immunization program in 2013 – the government aims to launch two other vaccines, nationally, by the time this year is over – is a sizeable step forward in promoting, and ensuring, the health and survival of its youngest children.

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