Saturday, April 27, 2013

Journal: Week 7

I have not found the time in the past month or so to write about this course, Investigations and Diagnostics for midwives.  The work of midwifery, as well as what's generally called 'family commitments', have occupied me fully.

Today I have worked on a quiz that is due for submission at the end of the week.  The first question was about Rubella - German measles.  Another question about drinking unpasteurised milk, eating soft cheeses, and the like.  Another about notifiable STDs.

Of course the questions about rubella in pregnancy require an answer that universal screening, and vaccination (of non-pregnant women, and children, particularly) prevents the horrible fetal deformities, blindness and deafness, that are likely if an un-immunised mother is exposed to someone with rubella.

Of course we want to prevent miscarriage or premature birth of a fetus infected with listeria, which can be found in deli products that are not heat treated, or unpasteurised milk.

Yet, I have to acknowledge that frequently in my practice mothers tell me that they do not vaccinate their children; that they will not be vaccinated against rubella, even if their immunity level is low; or that they use unpasteurised milk.

These mothers and their children have become 'controls' in a mass, uncontrolled experiment.  The stakes are high.

Vaccination has been one of the topics in The Conversation this week, in an article Six Myths about Vaccination, and why they are wrong, by Rachel Dunlop.  The concerns about potential harm caused by the vaccine, or a potential weakening of the immune system - these are very serious concerns.

I have seen children with the blindness and deafness from rubella; I have seen children with brain damage from measles; I have known of death from tetanus; infertility caused by mumps; and the horrible illness of pertussis (whooping cough).  I have cared for one of my own children, critically ill from a streptococcal infection that entered his body through chicken pox, and gave him scarlet fever, osteomyelitis, and cellulitis.  Vaccination is not perfect: I have also seen the tragedy of a 'bad batch' vaccine.

With deepest respect for those who have made choices to avoid vaccination because they believe this is the way to ensure optimal health for their families, I must counsel against avoidance of vaccination.  Public health data support the eradication or minimisation of many diseases through mass vaccination.

Without vaccination we would see frequent epidemics of some infectious diseases, and the lifelong consequences.  Children who had polio being nursed in iron lungs, or walking with callipers; faces and bodies scarred deeply from smallpox; rows of little graves in the cemetery after diphtheria epidemics - these are pictures from the past.

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