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Photos: James Austin V.
Alaska is delivering vaccines by sled, boat, plane, and snowmobile. Flashback to the Iditarod origins — when diphtheria antitoxin was rushed to Nome by dog sled.

It’s so interesting to me which states are doing well with vaccine distribution and why! West Virginia was ahead of the pack because it used local pharmacies but also had a central sign-up site. Now Alaska seems to have taken the lead, and its techniques are completely different.

Cathy Free writes at the Washington Post, “Alaska, the state with the largest land mass in the nation, is leading the country in a critical coronavirus measure: per capita vaccinations.

“About 13 percent of the people who live in Alaska have already gotten a shot. … But the challenge for Alaska has been how to get vaccines to people across difficult, frigid terrain — often in remote slivers of the state.

“ ‘Boats, ferries, planes, snowmobiles — Alaskans will find a way to get it there,’ said the state’s chief medical officer, Anne Zink, 43.

“Alaskans are being vaccinated on fishing boats, inside 10-seater planes and on frozen landing strips. Doctors and nurses are taking white-knuckle trips to towns and villages across the state to ensure residents are protected from the coronavirus.

“Contributing to Alaska’s quick speed in getting the vaccine to its residents is a federal partnership that allows the state, which has more than 200 indigenous tribes, to receive additional vaccines to distribute through the Indian Health Service.

“Other reasons include the state’s small population of 732,000, as well as a high number of veterans, Zink said. The U.S. Department of Veterans Affairs is working with the Centers for Disease Control and Prevention to ensure that high-risk veterans receive priority for the vaccine.

“But one big reason is the state is practiced in delivering precious cargo by transport not often used in the Lower 48. Sometimes that even means adventures by sled. One all-female medical crew of four in December used a sled pulled by a snowmobile to deliver vaccine to the village of Shungnak in the state’s remote Northwest Arctic Borough.

‘It’s just an easier way to get around when you don’t have a lot of roads,’ said Kelli Shroyer, public communications director for the Maniilaq Health Center in Kotzebue, Alaska, where the crew started their journey. …

“Zink was so impressed by the sled crew’s delivery in December that she posted about it on her Facebook page. ‘I love the pictures of vaccination distribution in Alaska,’ she wrote. ‘Recipients expressed how grateful they were that even though they are so remote, they are getting this vaccine. They are not forgotten. …

‘One chief told me how his grandmother took his mother out to the wilderness for a year so that she would be safe. When they returned, they learned that most of their village had died.’ …

“Thousands of Alaskans are playing a role in getting people vaccinated, Zink said.

“Curt Jackson used to employ his water taxi, the Orca, to shuttle tourists from the small city of Homer to villages across Kachemak Bay that aren’t accessible by roads. In late December, Jackson received a request to take three nurses across the bay to Seldovia, a town with about 450 residents, including members of the Seldovia Village Tribe. Planes couldn’t fly that morning because of weather, and the water was rough.

“When the women climbed aboard his 32-foot aluminum landing craft and took seats in the windy darkness, Jackson said, he noticed that the woman in the middle, Candace Kreger, was clutching a bright blue cooler. That was when he realized that the women were traveling with the precious doses. …

“For Ellen Hodges, a doctor from Bethel, Alaska, the coronavirus vaccination effort is the most rewarding project in which she has been involved, she said. Hodges, 46, has flown to several villages in a six-seater plane to vaccinate medical workers and elders, who meet her on the runway.

“ ‘We land in the isolated tundra, and they’ll be lined up waiting,’ she said. ‘Some places have up to 30 people, and some have only one.’ “

More at the Washington Post, here.

An all-female medical crew from Alaska’s Maniilaq Health Center took a sled to deliver vaccine to the isolated village of Shungnak in December.

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Photo: Peter Yeung
One African country has made impressive strides in reducing the child mortality rate.

Sometimes it’s the poorest countries in the world that lead the way in solving a problem. Recently I learned that Rwanda, for example, is on track to be the first country to wipe out cervical cancer, thanks to its massive roll-out of HPV vaccine.

And as Peter Yeung reports at National Public Radio (NPR), Mali has drastically cut child mortality rates.

“Imagine a world in which pregnant women and little kids get regular home visits from a health worker — and free health care,” Yeung writes. “That’s the ground-breaking approach that’s being adopted in one of the world’s poorest countries: the West African nation of Mali.

“And it’s already underway in a pilot program. Nana Kadidia Diawara is one of many community health workers who do daily rounds through the sprawling, dusty streets of Yirimadio, a neighborhood on the outskirts of the capital city of Bamako. …

” ‘I know everyone in my area, and it’s a system that works very well,’ she says, while measuring the skinny arm of a child to check for signs of malnutrition. The child lives in a one-story concrete compound that is home to ten families.

“A nurse who’s joined the country’s cadre of community health workers, Diawara visits each of the homes in her designated area, which contains roughly 1,000 people, at least twice a month. She diagnoses, treats and refers patients. It’s part of a free door-to-door health-care plan that began in Yirimadio in 2008 as a trial by the government.

“When data from a seven-year trial was compiled by a team including researchers from the University of California, they found that child mortality for kids under age 5 in Yirimadio dropped by an astounding 95%, according to findings published last year in BMJ Global Health. …

“Now the program will be extended to the entire country. This spring, President Ibrahim Boubacar Keïta announced a target date of 2022 for nationwide coverage — at a cost of $120 million. This localized, free health care for pregnant women and children under age 5 could help the West African nation meet the U.N. Millennium Development Goals. A key factor will be the provision of community health care workers who’ll be trained to do the door-to-door work. …

“Astan Koné, a 28-year-old mother of two in Yirimadio, [offers praise]. During Mali’s hot season last year – which regularly exceeds 100 degrees Fahrenheit – one pregnant relative was diagnosed with stomach ulcers.

” ‘It makes me very happy that the government will do that for the rest of the country,’ says Koné. ..

“[Currently] Mali’s planned reforms rely on external funding, secured with help from the Clinton Health Access Initiative, to supplement government spending. But there is no guarantee this supplemental funding will last in future decades, and Mali will need to find a long-term solution that may involve restructuring its budget. …

“The key to long-term success, according to [Robert Yates, an advocate for universal health care coverage at the U.K.-based think tank Chatham House,] will be political support – which Mali already has – and a long-term funding plan. ‘Clearly countries need more public finances to do it,’ he says. ‘But it’s perfectly feasible – by allocating a greater proportion of the budget to the health sector.’

“The cost of the Mali’s reforms, averaging $8 per person a year, could reasonably be covered by what the region’s governments are already spending on healthcare, Yates believes. …

“Community health workers — who in Mali are trained for at least a year and are able to carry out basic medical procedures — are so important.

” ‘The leading causes of maternal, newborn and child death are curable,’ says Dr. Ari Johnson, a medical doctor and co-founder of Muso. The nongovernmental organization, which aims to end preventable deaths, has supported the trials in Yirimadio with staffing and training. ‘Diseases like malaria and newborn sepsis can kill within hours. … But in status quo health-care systems, poor patients face many barriers that delay their access to care: fees they can’t afford to pay, distance they cannot travel to the nearest provider.’

“Back in Yirimadio, one 6-month-old girl in a white dress calmly awaits treatment on her father’s lap under the shade of a mango tree. ‘She is suffering,’ says Naba Fané of his daughter, who has pain when urinating. Community health worker Diawara writes the family a referral to the local health clinic in a matter of minutes.”

More at NPR, here.

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