relief, I could finally get out to do some outreach and sort out a
much-neglected clinic. Things were looking up. 'No, I think it's much better
if we just do a vaccination campaign'.
This sentence may just have well have been accompanied with the sound of a
horse, carriage and sherman tank being driven right across the plans I'd
spent a reasonable amount of time and effort sorting out. I've just
recovered from the last one, not again. Please, for the love of God no! My
head hit the keyboard meaning that the reply began 'dear
dfjrfdkvhemrfldkgj,/fdgkfqwjhkdkf;flbv,me#%. Which is probably a good thing.
The sun was just up, and still a very dark orange colour as we left. The
dirt track up to the first village was reasonably smooth, but with a few
vertebrae jangling ruts and divots. Along the way children ran from huts to
wave, the more brazen older ones made reasonable attempts to jump on the
back of the car. We managed to outrun them, but in some cases it was close
The plan for the day was to work out how we could vaccinate the three
villages that were home to our current meningitis riddled inpatients.
For those who think assessment needs to be complicated I would refer them to
our current method.
Step one - See which village the patients with meningitis come from
Step two - Visit the village
Step three - Vaccinate
In no way rocket science. But it seems to be working. We are already seeing
a real drop in cases in the first villages we vaccinated three weeks ago.
The vaccine takes two weeks to become fully protective. When I was a
slightly hard-up staff nurse I took a job giving out flu jabs to city
workers. This experience of vaccination has been altogether more challenging
but also a whole heap more rewarding.
The first village we visited already had not only a clinic but also (drum
roll) another NGO with expat staff. In many areas of the developing world
effective collaboration between different organisations is as likely as the
Pope converting to Buddhism, however in this case we actually get on very
well. I brought a few canned drinks, which helped.
Obviously there are parts of this NGO's programs and how they run things
that make me wince but I'm sure the same is true of them with us.
They don't have the sort of medical program we are able to offer, however
they have trained vaccinators coming out of their ears. Staffing issue
solved.
The chiefs in this location needed no convincing that vaccination was a good
idea. The eleven people who had been struck down with it in the month had
ensured that. They spent the next fifteen minutes criticising the NGO who
ran their clinic. All a little embarrassing, particularly since a few of
their representatives were present. I spent a long time finding a slowly
moving gecko ambling across the floor very interesting.
Anyway on to the next village, which was pretty much the first village in
microform. Easy to vaccinate, community very pleasant, no problem.
We then struck out for the third village. The road deteriorated with every
kilometre and finally evaporated into dense, low, scrubby undergrowth. The
Landover pitched and tipped down deep ditches and it was impossible not to
bang you head on the windows/seats/various other bits of the car, when I
emerged hours later I felt like I'd done a few rounds with an angry Mike
Tyson.
Finally we found a route through to the dried bed of a large river. This had
the advantage of being relatively smooth and easy to drive down it had one
major disadvantage in that it was impossible to see where we were. After
more than an hour of driving and frequent, 'lets try down here' detours we
finally arrived at the village.
A meeting with the village elders identified that they had indeed had cases,
though it was difficult to separate meningitis from other causes of death.
With the time it would take to walk to the nearest clinic of any
description, six hours, I find it pretty inconceivable that all the cases
made it to any form of health care.
There is absolutely no way of knowing how many people have had, or will have
meningitis. This village's inaccessibility makes it especially vulnerable
but it also acts as an awful catch twenty-two. The reason this village has
such a problem is it's inaccessibility, but it is this inaccessibility that
makes it, sadly almost impossible to vaccinate. The airstrip is too short to
land a plane, and the road is so poor it would break the car if we tried it
again. We also can't get there in less than three hours and the security
situation means we can't use another village as a staging post. Paranoia
about how cold we have to keep the vaccines has also reached new heights
I guess a year ago I would have thought that if you really wanted to
vaccinate an area it would be possible by some means. However just as this
area has no access to healthcare so healthcare has no access to it. We
returned back to base with the sun orange, but at the opposite horizon. A
vaccination campaign planned on the way back on the back of an envelope (I'd
forgotten my notepad). It was going to be a busy week.
