Okemena’s Legacy: A Resident’s Fight for Vaccine Advocacy Free

Okemena’s birth is etched in my memory. I was 7 years old, and I recall sitting outside my aunt’s house on a starlit night. Suddenly, she clasped her abdomen, moaning.

I ran as fast as my legs could carry me to my parents’ bedroom to fetch my mother. She immediately called for the midwife, and they proceeded to attend to my aunt’s labor. I was pacing outside the dimly lit hut and suddenly, the cry of a baby filled the compound. In my curiosity, I jumped through the window into the room. My aunt was carrying a baby swaddled in a yellow and black snail patterned adire cloth. The adire culturally is used only on special occasions, such as the birth of a child. Seeing the baby overwhelmed me; tears of joy dripped down my cheeks. The room suddenly turned silent. “I will call her Okemena,” my aunt announced. She, who’d had several miscarriages, and who’d been mocked for many years as barren. Okemena, whose name means this is my gift in Urhobo, truly was a gift to our household.

But too soon, tragedy struck.

On an otherwise unremarkable Sunday, Okemena was having her hair braided when she said, “I’m sick.” Malaria is endemic in Nigeria, so, instinctively, I gathered the roots of the quinine tree and mango leaves to make agbo, the herbal remedy used to treat malaria. I soaked the ingredients in hot water until they released their signature ethanol scent and, once ready, I took the remedy to Oke. By then, however, everyone’s favorite boisterous 2 year old, whose hazel eyes always burst with joy, had spiked a fever to 41 °C.

Still, the worst was yet to come. The next morning, I woke up petrified to shrill screams. Okemena was having a seizure. She was unresponsive, her eyes rolled backward, and she jerked uncontrollably. Immediately, we hopped in a taxi heading for the hospital. On arrival, Okemena was whisked away, and shortly afterward, we were joined by our family. It was silent, we struggled to process the uncertainty of Okemena’s outcome.

Soon, we received a diagnosis: meningitis. The prognosis: poor.

The once vibrant child who’d lit up our lives with her beaming smile and her dancing to the tune of the talking-drum slipped away. Within weeks, she no longer responded to voice: the infection made her deaf. In time, she became paralyzed. Okemena passed before her third birthday.

Following this tragedy, we lived in fear and felt guilt: what if the same fate befell the other children? Could we have done more to prevent Okemena’s death?

On the one hand, of course we could not have. Illness, suffering, death—these are out of any person’s control. On the other hand, maybe we could have. She could have been vaccinated.

The introduction of vaccines into our community embodied hope: other families would not have to suffer the same fate. Shortly after Okemena’s death, vaccination drives were advertised all over local media. They were advertised on billboards, and the popular image of an infant being vaccinated by a nurse with a sign that read “stop meningitis” is imprinted in my memory. Make we join hand stop all this nyama nyama weh dey kill our pikin local radio stations and local television channels urged in 1 voice. The media’s full-court press was working, Nigerians were proceeding en masse to the vaccination centers to get their children vaccinated.

Africa is a culturally diverse continent: there are >250 languages spoken in Nigeria alone.¹  The language barrier coupled with low adult literacy rates made vaccine implementation in Africa uniquely challenging.^1,2  As I got older, it was evident that vaccine preventable diseases (VPDs) were a national epidemic across the continent, with breakthrough cases of polio/measles constantly making news headlines. The plight of the children in my country served as the focal point that drew me toward a career in medicine. In my community, I resolved I would address the problem of VPDs.

After I graduated medical school from St Kitts, I returned to my hometown to serve my community as a general practitioner. Yet, more than 10 years since Okemena passed, VPDs still held my community in a chokehold.

Take, for example, Ese. I was an intern working in the pediatric unit when I met her. By the time she arrived at our hospital on that hot summer day, the 14-year-old garbed in a jade green floral-patterned dress was already rigid as a board, gasping. Tetanus.

Despite limited resources, we did everything we could: antitetanus serum, antibiotics, oxygen, and fluids. However, our efforts were futile. Ese’s diaphragm became still, and the teenager succumbed to the tetanus toxin that had hijacked her nervous system. I still remember her family’s ear-splitting cries from the bedside evoking memories from my past.

The memories bring back sorrow. They also bring back rage. Her death, like Okemena’s, and that of so many others, was preventable.

I moved to Corpus Christi in the heart of the COVID-19 pandemic in June 2020 for my pediatrics residency. And, soon after arriving, I vividly recall the grief and fear felt by American families during that time: emotions that mirrored those felt by families back in Nigeria.

Andrea, a 2-year-old girl who was admitted to the floor in respiratory failure from COVID-19, remains memorable. Her mother was distraught. Eventually, Andrea was transferred to the PICU for a 2-week stay requiring mechanical ventilation, steroids, and anakinra. Though her outcome was favorable, COVID-19 gripped us all in a vise.

Once again, hope was around the corner. The release of the COVID-19 vaccine represented promise for a future free of potentially needless suffering.

Despite this, negative rhetoric around the safety of the COVID-19 vaccine sparked vaccine hesitancy in the media; I needed to act. My life had already been shaped enough by vaccine-preventable suffering. I wanted to do my part to protect other families from the devastation my own had experienced.

The World Health Organization endorses educational interventions tailored toward improving vaccine confidence as critical/effective methods for addressing vaccine hesitancy, messages further promoted during the pandemic.^3,4  Looking on, a group of my coresidents and I were motivated: soon, we had developed a curriculum for vaccine education, and within weeks, we were giving our lecture to hundreds of middle-schoolers in Corpus Christi at least once a month. Today, my colleagues and I are still scaling the initiative: since the initial pilot, we’ve expanded to 5 schools across the state and counting.

My lived experiences have catalyzed my engagement on the issue of vaccines. But my work is not enough.

Pediatric training programs should educate trainees on how to navigate vaccine hesitancy through didactics and simulation. They should support their trainees in establishing local initiatives for vaccine advocacy in clinics, schools, and elsewhere. They should invest in their trainees pursuing efforts around vaccine promotion nationally, via engagement with the American Academy of Pediatrics. They should also advance vaccine diplomacy internationally, via collaboration with nongovernmental organizations doing the work on the ground.

Only when the next generation of pediatricians are prepared and empowered to have these difficult conversations around vaccines can we make a real difference in preventing needless suffering for children in our hometowns, and beyond. Only then will we honor the legacy of children like Andrea, Ese, and Okemena.