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God Made Dirt, But Dirt Still Hurts*

In January of 2013 I went to Uganda for a month for a course in social medicine, called SocMed. As one of the unique components of this experience, half of the medical student participants were Ugandan, and half from developed countries around the world. During our time there, we had the opportunity to go out to some of the local villages with the community health workers in the area, via bicycle. On our way back, one of our Ugandan counterparts rode over a moderate sized rock, lost his balance and fell off his bike into a ditch. While anyone would be stressed over the inconvenience of the considerable scrapes and bruises he sustained, he seemed a lot more concerned than expected.

He was worried about possible exposure to tetanus. Even as medical providers the majority of the Ugandan students said they had never been vaccinated against tetanus, or hepatitis B, or meningitis, or varicella… Despite the risk they were taking to care for others they could not afford to protect themselves, and had constant reminders in their patients of the potential outcomes of this daily risk. What a terrible thing to have to worry about day to day, and what a seemingly easy thing to fix.

I was immediately reminded of this story when visiting the tetanus ward of Fever Hospital, one of the government hospitals here in Hyderabad. We saw one little boy in particular who was suffering from tetanus. In a dark, quiet room with minimal physical stimulation to reduce the amount of painful muscle spasms, he still looked miserable. For those not vaccinated, any injury with a break in the skin and exposure to soil has the potential to cause disease, and thus any active boy’s day out playing. In fact, most of the patients we saw at Fever Hospital were being treated for ailments effectively prevented by vaccinations that are routinely available in many other parts of the world, including measles, mumps and diphtheria.

In India as a whole vaccination rates for children 12-23 months are about 50% of the population (estimated in 2011), which varies greatly by state1. (The graph below estimates these rates lower at around 44%, with the caveat that this is a few years earlier and does not specify age range2, but is useful in demonstrating state differences.) With so many babies, India has one third of the world’s unimmunized children. In contrast, in the United States the rate of vaccination in 2014 ranges from 82-91% for children aged 19-35 months, depending on the vaccination3. Possibly more relevant, in neighboring Nepal 80% of children are immunized by one year of age.

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Many different factors likely play into the vaccine deficit in India: cost, access to medical care, poor health education, vaccine availability and government investment (despite India being a leading producer and exporter of vaccines). The states with the lowest rates are also often the most populous, and have underserved and marginalized populations. The government of India has a Universal Immunization Program that was first established in 1985, however it seems it is not yet reaching those most in need.

*Regarding the title – this is supposed to be a play on words from a saying I heard often as a child: God made dirt so dirt don’t hurt. I asked all of the other members on this trip and no one had ever heard this before. I tried to think back and I am pretty sure I originally heard this saying from my grandma. I googled it to convince others that this was a real thing – the first result, yahoo answers, “why do rednecks say god made dirt so dirt don’t hurt?” Well, there you go….


  1. “Immunization Status of Children (12-23 months)”. Planning Commission, Government of India. 19 April 2014.
  1. Ganguly and Laxminarayan. India’s vaccine deficit: why more than half of Indian children are not fully immunized, and what can–and should–be done. Health Affairs. 2011 Jun;30(6):1096-103
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