The cries of sick children echoed down the hallway as Gilbert Handal walked into the measles ward for the first time. It was 1964 in Chile, and the young medical student had been assigned to Manuel Arriarán Hospital's pediatric infectious disease unit.
Dozens of beds were crammed into the building, each holding a small, feverish body. Some children were struggling to breathe; others lay frighteningly still. Their parents waited helplessly, often outside the doors, while nurses and doctors moved solemnly through the ward. There was little they could do.
"That was just immediately before we had the measles vaccine," Handal said. "I was just a student, and you're just studying medicine, trying to save humanity and trying to save the children.
"We tried to save those kids but many of them died," he added.
Now 82 years old and a professor of pediatrics and pediatric infectious diseases at Texas Tech Health in El Paso, Handal is sounding the alarm over low vaccination rates in West Texas, where a measles outbreak has infected 717 people and killed two school-aged children as of May 13. Though measles was declared eliminated in the U.S. at the turn of the century, rising vaccine hesitancy has fueled the largest surge of the disease in Texas in more than three decades.
"All the outbreaks we've had in this country have been associated with the lack of immunization," he said. "People stopped immunizing their kids, and that was an error."
Back in Chile, the second floor of the pediatric infectious disease unit was secluded, reserved for children infected with measles. Measles spreads primarily through the air, when infected people sneeze or cough.
The atmosphere was one of anxiety and exhaustion. As part of a team of six doctors, Handal spent up to 120 hours per week tending to rows of children battling high fevers, painful coughs and the signature red rash covering their bodies. According to Handal, the surge in measles cases was so overwhelming that the hospital's internal medicine unit was often repurposed to care for sick children.
He says most of the children were infants and toddlers.
"The children know they're sick, and that's all they know," Handal said. "They don't know what's going on, they don't know anything, and the sicker they are, the more disconnected they get from you."
Some children suffered from encephalitis, a dangerous swelling of the brain, while others had gone deaf and blind within days from unrelenting conjunctivitis, or pink eye. The emotional toll was enormous, especially for young trainees like Handal, who struggled with the psychological burden of facing death so regularly.
"When you lose a child, you remember that child the rest of your life," Handal said. "I still remember the first child that died … He was about five months old and weighed the weight of a two-month-old baby.
"I mean, dear God, you try to really go on, and going on with life is difficult the way it is after you lose a child," Handal added. "You keep mulling and mulling in your brain: what else could I have done? What didn't I do?"
Before the vaccine, about three to four million people in the U.S. were infected annually, according to the Centers for Disease Control and Prevention (CDC). Around 48,000 required hospitalization and about 1,000 suffered encephalitis. Between 400 and 500 people died each year. But in Chile, where countless children were malnourished, that number was higher.
Handal said he lost count of how many children died during his time in the ward. But he never became numb to it — just learned to manage the grief.
"You don't get hardened, that's a bad word to use. You kind of cope with it better, I guess," he said. "I mean, it's just – the pain is too much."
Handal spent six relentless weeks in the measles ward before getting assigned to another unit in the Chilean hospital. Eventually, the measles vaccine reached Chile and everything changed.
"The acceptance of vaccination was massive," Handal said. "The acceptance was dramatically making a huge change in the number of cases."
That's why the current outbreak in Texas is so troubling to Handal, likely one of the few remaining medical professionals who remembers a world before the vaccine.
Measles is one of the most contagious viruses on the planet. One case can quickly multiply into dozens if not enough people in a community are vaccinated. In West Texas, the epicenter of the current outbreak, immunization rates are strikingly lower than the rest of the state.
Handal fears the world is backsliding. He warns that falling vaccination rates could bring us back to a time when measles spread widely and claimed many lives.
"Measles is an unforgiving disease," Handal said. "Every single outbreak that we've had has been associated with the poor immunization rates."
For Handal, the memory of those lost children isn't just a chapter in medical history.
It's a warning.
"It strengthened my own ideas about diseases in general and what we can do about it, what we should do about – which is prevention," Handal said. "The one message that's essential is please immunize, immunize, immunize … protect yourself and protect the community and the other children that cannot be immunized.
"I hope we will not see the measles that I saw," he said.
The Texas Newsroom is a public radio journalism collaboration that includes NPR, KERA in North Texas, Houston Public Media, KUT in Austin, Texas Public Radio in San Antonio and other stations across the state.