“How do we begin when we take our first breath? When we shape our first word? We don’t know because we can’t remember. But throughout our lives, for others, we begin when we arrive. When our face is the new face, when our past is untold to them, our shared future still unknown. One day, we’ll look back and say, ‘Do you remember when…?’ But we are always beginning somewhere, in somebody’s eyes.” 

Season 14, Episode 4 dealt with several storylines: the arrival of a new nun/midwife (Sister Catherine); a child impacted by the measles and the advocacy for the new vaccine by his mother (Andrew and Mrs. Jill Trottwort); an older mum’s (Mrs. Peggy Wrigley, age 46 years old) unplanned pregnancy and the tragic loss of her life after a pulmonary embolism during her tubal ligation; and Peggy’s daughter (Mrs. Gail Mason) who has her first baby with the support of her father.  

As a modern-day midwife, I want to focus my blog post on the measles storyline. Early on in the episode, we had Dr. Turner and Miss Higgins discussing the low level of interest and lack of individuals signing up for the measles vaccination clinic. We then go on to meet young Andrew. He had the measles at age two and experienced “a brain infection” and seizures with subsequent disabilities, which left him in a wheelchair. 

Mrs. Jill Trottwood is his mother and cares for Andrew completely on her own. Her husband had abandoned them. He could not accept Andrew and his disabilities; the stresses, obstacles, and challenges were just too much for him. Jill felt isolated and alone as she navigated Andrew’s physical care and educational needs. He had been in a specialized program and doing well, but then the district would not continue to fund that schooling. They said Andrew needed to attend a program like that closer to home – closer to Poplar; however, there was not one available. 

In our storyline, Jill is a fabulous advocate for the vaccine. She distributes flyers and shares her lived experience in order to help others see the value in the vaccination. She loves her son, but the vaccine was not available when Andrew was born, leaving him vulnerable to illness. 

As a modern-day midwife, I was interested to know some historical insight into the measles vaccination. I found some information on the Center for Disease Control (CDC) website (see the link below if you want to read more about the measles). 

In the United States, the measles vaccination was licensed in 1963. It was developed at the Boston Children’s Hospital by a team led by Dr. John F. Enders. Another more effective vaccination with a varying strain was then licensed in 1968. It was called the Schwarz strain. It was not until 1971 that the combination vaccination for the measles, mumps, and rubella (known as the MMR) was introduced. I did look to see that the first measles vaccination for Britain was not introduced until 1968 and the MMR was not available until 1988!

It is hard to believe that, prior to the vaccine, this communicable disease was common, with approximately 3-4 million cases each year that resulted in approximately 48,000 hospitalizations in the US. About 1,000 of these cases had individuals who suffered from swelling of the brain, which is known as encephalitis (experienced by Andrew’s character in this episode). Sadly, it was also often a deadly disease with 400-500 annual deaths. 

With the widespread vaccination programs in the United States, its success was evident with the eradication of measles in the year 2000. That is quite an achievement. But, after 15 years, we saw a comeback and have noted pockets of outbreaks in the country each year. It is like wildfire when it is in a nonimmune community. It can increase exponentially, and it is hard to contain. 

A story that I heard on a podcast (the link to the podcast is below) really highlighted how measles can spread in an unvaccinated community. They referred to the Texarkana measles outbreak of 1970-1971. The story highlighted how mandatory vaccination policies can impact the spread of this disease. 

There was a community that straddled both Texas and Arkansas (hence, the name Texarkana). About two-thirds lived in the Texas county and one-third in the Arkansas county. Being so close, the community was very close socially and often crossed between county lines. However, where you went to school was based on which state line and zone that you lived in. 

Less than 60% of the Texan kids were vaccinated while, in contrast, 95% of the kids in Arkansas were vaccinated due to the school vaccination mandates. In 1970 there was a measles outbreak. There were approximately 630 cases of measles with 600 of them in the Texas community. That demonstrated a 96% protective impact. 

Vaccination isn’t just something we do for ourselves, but it’s something that we can do for our communities.

In our storyline, we witnessed the Poplar community experiencing some vaccination hesitancy, and we see this in our current time as well. There is a range from hesitancy to what is termed “an anti-vax movement.” It is a complex web with varying elements for different individuals or communities. For some, it can entail distrust in science but for others, it can be varying values and ideology. There can also be misinformation but then people can also just have their own biases. 

One thing that the COVID-19 global pandemic taught me was that people struggle with research and science, particularly research into health and medicine. It is hard as things can seem “progressive” when we are learning about things that are new or novel. We can begin with speculations, and then investigations can bring about and offer incremental insights. We are adjusting as we are learning, and we note things, but there are rarely conclusions that are 100% definitive. Things change as we know more. This can be hard for people to understand if they do not have a science background or have spent a lot of time developing critical thinking skills from reading research trials. 

Things can progress and change and often, when things are novel, it is not a linear process but cyclical knowledge and advancement. Things can change quickly as things are evolving, and it can be difficult for people to understand why – and they may also only receive bits and pieces of information. 

This can lead to a sense of mistrust or considering the source as non-credible. The information can also be contrary to what they think is true or even valuable. I have also met individuals that self-identify as anti-science. 

As a modern-day midwife, I try to be somewhat like our Call the Midwife leaders. They engage with their community. They try to find the best way to bridge the gulf. They attempt to find common ground. I love watching the show as it teaches me things and at other times reaffirms things that I may be doing or educating my students to really practice. 

We try to engage in a shared decision-making model of care. You can let someone know about a situation; discuss the options with the pros and cons (you are really engaging in informed consent); and you can give your professional views based on the evidence. But it is essential to get their views, values, and preferences, too. 

I will continue to advocate for finding common ground and bridging information. In our episode, they were successful with their message. And, just like Call the Midwife, we must continue to search for the message, the messenger, and have hope in the new day for connecting. I loved when they went the extra mile and worked on the paperwork to get Andrew back into the school program. They pulled the mother and son into the community and Andrew even became a Scout. 

There is always hope when we engage, listen, share, help, and foster growth!
 

“Sometimes a new beginning is unlooked for. Seldom are things entirely pure, and flawless. Yet seldom are we left without any hope at all. We say, ‘There’s always tomorrow.’ But tomorrow can start today. When we choose change, when we choose connection, when we choose a different path. For that is how we meet each other, and the things we long for. That is how we learn, and move ahead. We watch, we listen, we look, we share.  But nothing is of consequence apart from this: simply begin, and begin, and begin. And then the story will unfold exactly as it should.” 
 

RESOURCES 

Big Brains Podcast (Feb 20, 2025). Why measles is resurging and the rise of vaccine hesitancy, with Adam Ratner. https://news.uchicago.edu/big-brains-podcast-why-measles-resurging-and-rise-vaccine-hesitancy

Center for Disease Control: History of Measles. Website: CDC.gov