Vaccination Situation

“How many?” The local authority leader sat back and scratched his beard. He thought for a moment. The room was silent apart from the rustle of papers. I sat on the plastic chair provided and took a swig of water. “How many days?” he said “five”, “seven thousand in five days?” He verbally regurgitated the figures, wrote something down, then stood up and wished us all the best.



Meeting over, we emerged into the glaring midday sun and into a whole heap of logistical problems. I’d promised the most senior official I’m ever likely to meet here that we would be vaccinating his community by the end of the week. Time was not really on our side. Every day brought a fresh batch of patients some with meningitis some with other things, a significant minority very sick indeed.



As walked back across town to the clinic my head was spinning. Could we really manage to vaccinate a series of villages with a group of people who had never given injections before? We were about to find out.



Whilst hurried preparations to bring in vaccines were made the satellite phone was never out of someone’s hand. The clinic and its staff continued on. We passed an unhappy milestone of seeing more patients than the base site, who have a permanent doctor and two nurses stationed there. This was like nothing I’ve ever experienced.



The best ways to describe how to care for vaccines to put them in the same bracket as vintage bottles of wine or champion race horses. Basically they have to be kept at a constant temperature and not roughed up in anyway. They become like an extra member of the team. Cosseted from the harsh environment by large industrial cool boxes, in the business we call it ‘cold chain management’ or how to keep vaccines at optimal temperature, always. The cool boxes were filled with vaccines and ice packs every morning, a miniature glass vial army arranged in row.



How do you run a refrigerator in a place with no electricity? You don’t. The vaccines were driven for an hour from the base site in the morning and brought back there in the evening. The word palaver doesn’t come close.



As we got up in the morning instead of “how are you?” it was more a case of “how are the vaccines? The level of care given to the cool boxes approached the level of some of our sicker patients, paranoia set in. The cool box temperature started to rise and worried faces abound whilst we tried to reorganise ice packs and move the cool boxes into the shade. If the vaccines were spoilt by the heat the whole thing would be for nothing. And this isn’t the sort of place where a fridge engineer can pop over and help out.



By this time, thankfully, the team had swelled to four. My outreach buddy had returned and there was extra medical help as well. However the main burden of the workload was given over to the guys we had just employed to vaccinate.



In essence we grabbed people off the street and told them that after a mornings training they would be the spearhead of a mass vaccination campaign. The simplest way for this to work was to give everyone only one job. The consequence of this is that you have an enormous number of staff to organise. Everyone from vaccine preparers to crowd controllers to child limb supervisors needed to be instructed. What on earth does a child limb supervisor do? I hear you ask.



The problem here is that it is difficult to get the mothers of children to hold them still. Culturally it seems it is not a done thing. In previous campaigns children have run away mid-injection, with syringe still dangling from buttock, like a porcupine. That wasn’t going to happen this time, not with a child limb supervisor in the team at any rate. This womans’ job was to grab errant children and restrict all unwanted movement. This female became the most feared woman to the villages under fives. In appearance she could best be described as robust.



After a day of training, our new staff were instructed to be ready for eight the next morning.



D-Day arrived. I sat on the airstrip watching the sun come up, cup of tea in hand, ipod on. The only five minutes of the day I got to myself, this day would define the whole campaign, if it went well the momentum would build. If it didn’t the campaign would be over before we had started. In the distance I could hear the megaphone of the local authorities informing the village that today was the day for meningitis immunisations.



Took a last swig of tea, headed over to one of the two vaccination sites. Already a long queue of people was standing around the tent. Seven exhausting hours later more than one thousand people had been vaccinated. Result! Much better than we had hoped for, the main takers were mothers and children.



The young men of the village didn’t seem to see the need. I guess when you carry an AK-47 wherever you go you don’t think something like meningitis will kill you. A twenty year old man tragically disproved that point later that evening.



For a week the pattern was the same and by the end 7758 people had been vaccinated. I had the ‘honour’ of giving the last injection. The child seemed not to even notice. They build them tough out here, they have to, it’s a very harsh place to try and grow up.