Nurse Flora Escourrou has recently returned from eastern Chad where she took part in a measles vaccination campaign.
“It was my first mission for Médecins Sans Frontières/Doctors Without Borders (MSF). I arrived in the capital, N’Djamena, in mid-April. With the other four members of the team sent to Chad, we set off on the road to Abéché. It took two days to cross the country from west to east.
In Abéché, there had been reports of cases of measles for several months and, by April, the epidemic had reached an alarming scale. Measles is a disease which is under control in Europe, but it can lead to serious complications. In the worst-case scenario, when access to care is insufficient, mortality can climb to 20%. Yet, epidemics can be avoided as the vaccine is effective and inexpensive. The previous vaccination campaign in the Abéché region had been carried out in 2009 so, with the subsequent births, the number of unprotected children had been steadily rising.
Two weeks to vaccinate
When we arrived in Abéché, preparations were already well underway as MSF has had a presence in the region for several years. The authorities had given their green light and had confirmed the participation of 26 district health centres in the campaign; we had two weeks to vaccinate nearly 100,000 children.
The first task was to go through the hundreds of CVs that had been submitted to MSF. We also took on a number of student nurses, under an agreement with their college. By the end of April, we had put together and trained 14 teams of six people, which were then completed with members of the local communities. Each team had to vaccinate an average of 500 children a day.
The start of the operation was set for 29 April. Each morning, it was the same ritual: we met at 5 a.m. to finalise the roadmaps; then the 14 supervisors arrived; after that, we checked that the equipment, starting with the refrigerated vaccines, had been properly loaded into the jeeps; finally, the teams set off at around 6 a.m.
Hours of driving
For the first week, my main role was to supervise the operations. The drive to the most far-flung vaccination sites could take up to three hours. Sometimes things had to be reorganised, such as asking the village chief for extra security personnel to avoid crushes.
Only children aged between six months and five years receive the jab, but mothers don’t always know the exact age of their child. As a rule, if they are old enough to have teeth, they are included. As an exception, children from nomadic communities are vaccinated up to 15 years of age, as they often slip through the routine vaccination programmes.
Taking a child to hospital can take some persuading
The second week, I was more involved in treating measles cases that had been flagged by our teams. Mothers didn’t always take their children with measles to the vaccination site, for fear of contagion. There is no specific treatment against the virus; instead, we tackle the symptoms of the illness with antibiotics, paracetamol for the fever and eye ointments. Nutritional support is often necessary too, as measles is a malnutrition risk factor. All those treatments can be administered on the spot.
However, children with complications were taken to Abéché hospital, where MSF ensured that they would receive free treatment. The most upsetting symptoms are respiratory distress and convulsions. When children have these symptoms, it’s easier to convince the parents to take them to the hospital. For people as poor as those we were working with, it can take some persuading for people to go to Abéché and stay away for several days. So, even when we offered to take and bring back the child by ambulance, each successful negotiation was a victory.
This first mission was a very enriching experience for me. I was impressed by MSF’s capacity to set up such a large operation. Managing to vaccinate so many children in such a short space of time creates a tremendous sense of accomplishment and has made me keen to work on another field mission.”
Once the campaign in Abéché had been completed, the MSF teams went on to vaccinate children in the neighbouring district of Abdi; then, until the end of June, they moved the campaign north to Biltine, in the Wadi Fira region. A total of 257,000 children in those three places have been immunised against measles and nearly 800 sick children have been given treatment.