At the end of June, we learned of some reported cases of measles in a village 53km from Daloa, where I was based for the first four months of my time with Doctors Without Borders (MSF) in Côte d’Ivoire. While measles vaccination is a universal practice in places like Canada, the percentage of children vaccinated in developing countries is often low. Measles is a very unpleasant disease; it’s extremely contagious, painful and, for the unlucky ones, deadly. While measles is most commonly seen in children, teenagers and even adults can catch it too. When I visited my travel clinic in Canada in May, I was surprised to hear her advise me to get a second measles vaccination, as the childhood vaccination is no longer fully active now that I’ve grown up and the places I work have very high rates of measles.

So, when someone called us to tell us about several suspected measles cases, we didn’t waste much time in going to the village to see whether it was true or not. The nurse working in the local health centre spread the word so we could see the kids as soon as we arrived from the hour and a half drive. As soon as we pulled up, local kids started crowding around to see these strange white people.

In order for our nurses to check the supposedly sick kids for measles, they needed somewhere without dozens of healthy kids getting in the way. A house with a veranda was volunteered, but still the healthy children ran into the yard to see what was going on. Not only because of the distraction, but because measles is so highly contagious, we had to get rid of them despite how friendly and happy they were. Solution? Find a willing mother and assign her to crowd control, explaining that healthy kids hanging around might soon end up as very unhappy measles patients. This lady fit the bill perfectly and did a great job of keeping healthy kids at a distance:

Vaccination crowd control techniques in rural villages

Some kids were a bit more shy, preferring the safety on the other side of the fence, which posed no problems for us:

Curious neighbour in Gadouan, Côte d'Ivoire

Among the crowd of kids back out on the street, a helper selected those that appeared to have some measles symptoms and allowed them into the yard of the home. In the yard, a trained nurse did a quick check of each of these kids to see if they did really seem to have measles or not. The ones who seemed to have measles were then given a spot on the veranda to wait their turn for treatment. The puffy eyes of the small child in the middle show one of the symptoms seen in measles cases:

A father and some patients wait for their measles treatment

Each kid with measles then received a proper consultation from one or two nurses, who checked the severity of the symptoms, and whether the kid had any other health problems as well. Next, one of the nurses prepared a treatment for each child consisting of antibiotics, vitamin A, eye ointment, and special nutritional supplements. The exact dosages had to be calculated for each child, and a patient health card filled out for the child to keep. In Western countries, that would be the file at your local doctor’s office, but in developing countries it’s very common for patients to keep their own records and take them each time they visit a health centre.

Preparing measles treatment

Two months later when a number of measles cases were reported in some other villages, the authorities decided to run a vaccination campaign. With organisational, logistical, and some financial support from MSF, in September the Ministry of Health vaccinated over 15,000 kids in three areas around Daloa, one of which was the village we had visited at the end of June. It was a LOT of work, but it went relatively well, with excellent cooperation between MSF and the Ministry of Health.

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