Some Lessons in Health Communication Come with Ice Packs

There are places that never quite leave you. Tanzania is one of them—not because I visited it for a project, took a few notes, and came back with a suitcase full of stories and a slightly inflated sense of field experience—but because  I lived there in the early 1990s.
First in Bukombe, in the northwest of the country, not far from the border with Burundi, and later in Dar es Salaam.
And living somewhere—really living somewhere—has a brutal way of dismantling every neat assumption you thought you had about healthcare access.

When my daughter was only a few months old, we were living in Dar es Salaam. There was a hospital in the city, of course. On paper, that should have meant access. In practice, it often meant… logistics, improvisation, and a surprising amount of ice.
Early in the 90’s, vaccines were not always simply available, so I would sometimes get them through the embassy, transport the vials inside a thermos packed with ice, and carry them across the city trying to keep the cold chain intact. Not exactly the kind of parenting manual most people receive.
My condition as an expat made that possible. I had contacts, mobility, information, and perhaps something even more important: I came from a context where vaccines were never perceived as optional. Their importance had already been built into my mental model long before I became a mother.
Years earlier, when I was living in Bukombe, the situation was even more basic. I carried disposable syringes with me because even that could not be taken for granted. Before you discuss vaccine hesitancy, sometimes you first have to discuss whether the syringe exists.

Looking back, I realise something uncomfortable: I was able to work around an infrastructure problem because I arrived with knowledge, networks, and a health culture that had already shaped my decisions long before I got there. I knew what vaccines were, why they mattered, and what could happen without them. I had options. I had agency.

But what happens when neither of those things exists?
What happens when access is limited and knowledge is fragmented, when healthcare systems are fragile and the information people receive comes through rumours, inherited beliefs, or generations of mistrust?

That is usually the moment global health communication enters the conversation—with beautifully designed campaigns, carefully chosen slogans, and phrases that sound impossible to disagree with. “Vaccination protects communities” or “Early detection saves lives“. Scientifically, that sentence is absolutely correct. Communication-wise… it depends.
Because that sentence quietly assumes something enormous: that people can reach a clinic, trust the healthcare system, afford transport, and believe that an early diagnosis will actually lead to treatment. That assumption is doing far more work than most campaigns realise.
In public health initiatives trust often matters more than messaging. In vaccine outreach programmes, progress has often come not simply from translating information into local languages, but from involving community health workers, local leaders, and trusted figures who already had relationships with families long before any campaign arrived.

And that makes perfect sense when you think about it. If a mother has heard for years that vaccines may cause infertility, if her closest source of advice is a grandmother, a pastor, or a respected elder in the village, why would a poster from the Ministry—or a visiting team in matching branded t-shirts—suddenly become the most trusted voice in the room?

Science may provide the evidence, but trust determines whether that evidence is even allowed through the door.

That’s what intercultural health communication often misses: access is not just about infrastructure. It is about trust, history, relationships, and lived experience. A hospital can exist. A vaccine can exist. A poster can be perfectly translated. And still, communication can fail—because the message assumes a reality people may not actually live in.

And honestly, after carrying vaccine vials through tropical heat in a thermos, I learned something that has stayed with me ever since: in global health communication, information is rarely the first barrier. Reality usually gets there first.