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Public Diplomacy and Public Health: Our Experience in Mali

Mali innoculation campaign poster

Photo from Mali innoculation campaign poster (Courtesy, Robert Baker)

Robert Baker

Editor’s note: With PDAA’s February 2015 lunch program discussing health crisis communications, Bob Baker tells how U.S. public diplomacy helped promote an inoculation campaign in Mali, where he served as Public Affairs Officer in the 1960s.

20 January 2015. Our biggest foreign aid achievement in Mali was to inoculate the whole population against smallpox and measles. Those endemic diseases often killed or blinded. Dr. Pat Imperato, an American epidemiologist, administered the program and trained Malians to do the work. His successful campaign used U.S. donated equipment (big Dodge trucks to bring Malian inoculation teams to remote villages, simple pneumatic injection devices, etc.). It took several years, but by 1969 all Malians had been inoculated against smallpox and measles.

I organized the publicity campaign for the program, taking photos in the bush towns, then creating a poster and a pamphlet to encourage people to be inoculated. Back in the capital, Bamako, I searched for a Malian child to be the poster kid for our campaign. I found him waiting in a line outside the Ministry of Health waiting to be vaccinated. He was a really cute little boy with raggedy shorts and white shirt. He was holding his Mom by the hand. I gave her 200 Malian Francs, about fifty cents, and took his picture as the Malian inoculator pretended to give him a shot. The shot guns were ingenious. The operator pushed down on a foot pump to make the inoculation liquid shoot into the patient. No external power supply was needed. That was important as very few towns had electricity. The little boy looked up at the guy pretending to give him the shot. The kid had a trusting, angelic smile. Later, when he got his shot, he cried. When I developed the photo in my little shack darkroom, I knew I had my poster boy. I edited everything out except the boy’s his upper body and the inoculation gun. Not quite right. Then I reversed the negative, shadowed his face a bit and had just what I wanted; see image at top.

I sent the final version of the black and white photos I had taken of the vaccination teams working all around Mali to our U.S. Information Agency publications factory in Beirut, Lebanon. I asked them to print the photo as a poster on Prussian blue paper (Mali’s favorite color for celebratory robes). It came out two feet wide and three feet high. The boy’s picture filled the top 2/3. I ran a slogan in French under the photo, “Get Yourself Vaccinated Against Measles and Smallpox”. At the bottom of the poster, I asked Beirut to leave blank space. Our teams therefore could to write in white chalk the name of the village and the dates when our mobile vaccination teams would appear there. Beirut printed 5,000 copies, enough for dozens of copies for every town. Later, the Lebanese civil war made our factory close.

We mailed the posters to every town with a post office and gave them to the dozen inoculation teams to hand out as they drove around Mali. Malians from the Ministry of Health staffed the program as vaccinators, drivers and refrigeration specialists ( that kept the vaccine supplies cold).

Good thing we had so many copies made. Malian peasants liked the posters so much that they took them down from public places and hung them up in their huts. The government later used my picture for a postage stamp.

I sent copies of the poster to the 16 other American Embassies in West Africa, which were part of the regional vaccination program. Africa was part of a U.N. World Health Organization effort to wipe out smallpox worldwide. Our West African Embassies ordered thousands of copies in English or French. The program worked. Smallpox is contained today in a few laboratories but not raging among populations. Measles still exists.

We got help from the Malian Army as well as the Ministry of Health. Far from the capital one day we waited as hundreds of Peuhl herdsmen with thousands of cattle raised clouds of dust on the other side of the Niger River. We waited with inoculation teams and a squad of Malian soldiers with rifles.. The Peuhl only stopped their march when they made camp each night. The soldiers made them stop. It took all day to inoculate hundreds of the robed and turbaned Peuhl. Their skinny, long horned cattle, looked like the ones in ancient Egyptian murals. I set up a photo in which they waived their vaccination cards proudly.

The Peuhl were a major vector for both smallpox and measles because they crossed national borders on their thousands of miles traditional journey, following the grass which followed the rain patterns in West Africa. When Peuhl tribesmen went into towns to trade on their migrations, they carried with them smallpox and measles infections.

With a passel of photographs ready, I asked Dr. Imperato to write a simple  text for me about the diseases, how to report them at once and how to get vaccinated. We wanted reports about outbreaks sent to Bamako so a vaccination team could be sent immediately in Dodge trucks to before the outbreak could spread. Mali is 487,000 square miles much bigger than Texas, so it was a big job.

Dr. Imperato’s text included a forward for the signature of the Minister of Health. The little boy’s picture was the pamphlet cover. I wanted to show the program had great Malian input. The text gave major credit to the Ministry, but it did mention the American contribution. I could not get pro-American material into the radio or press, but it was there in the pamphlet.

The Minister was pleased with the pamphlet. I ended it with a picture I took  of waving grain, a sorghum, the main cereal of Mali. Under that I wrote in French a ringing declaration that “better health meant better production for a better Mali !“ That was indisputably Marxist sloganeering, but also true, and it helped to persuade the government to distribute the pamphlet.

The Minister saw to it that copies were sent not only to village clinics but also to all secondary schools in Mali. The students were instructed to take the pamphlets home and tell everyone in local tribal languages about the vaccination program. The pamphlet helped greatly to educate Malians about vaccination. The photographs featured Dr. Imperato, identified as an American. The pictures I took of Dodge trucks bringing inoculation teams to villages and towns, showed plainly the U.S. AID emblem on their doors.

Among the remote tribes, one photo showed the King of the Bozo, (no kidding, that’s the name of the small riverine tribe) who was innoculated. The Bozo trade fish up and down the Bonny and Niger rivers and so were important vectors of smallpox and measles until they were all inoculated.

The Center for Disease Control in Atlanta ran the program expertly. It was financed by the U.S.A.I.D. which paid for the program in Mali and the rest of West Africa. It worked. Both diseases were wiped out for the nonce, at any event. Though measles is back, smallpox exists worldwide only in laboratories.

After all Malians had been vaccinated, the U.S. Surgeon General, Dr. W.H. Stewart, came to Mali to celebrate that. After a long day in Bamako, he and I were alone sitting over drinks on my front porch.

I praised the work that had been done and said he must be proud of it. He replied the pity was that the children who were saved from smallpox and measles would mostly die not many years later from unhealthy water supplies, inadequate food and other diseases like cholera and malaria. He was right. Fixing those additional problems would cost huge amounts of money and effort from wealthy countries. They did pay the fairly low cost for inoculations, but had never yet given the massive aid to help the poor live longer and better. Sounds familiar.

However, many people in Mali learned the U.S. was helping to wipe out two terrible diseases in the country.

I requested an official U.S. Information Agency film team to make a documentary film about the vaccination program. They showed up and filmed the script I had submitted. I got to travel with the film team (just two guys– a camera man and a sound man) and helped out a bit with the film shoot. I learned how hard it is to get on film a very dark African face. The dark skin absorbs light. You have to pour on extra light with a spot, even in daylight so I held a baby spot on Africans being filmed. The film was well received in Mali. And America got public credit for a very good medical assistance program. Public affairs work could be great fun and useful as well as hard work.

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