Tag Archives: Measles

Ndedu, Province Orientale, DR Congo

In mid-February, a few of us went south from Dungu to Ndedu by motorcycle to plan, prepare, and run three days of measles vaccinations. In the planning phase our job was to try and figure out which vaccination teams would go to which villages at which times, how long they’d stay in each place, and how long it would take to get to the next one. This was all decided with the advice and help of the local chief in each location, as well as other important people like school principals, health centre staff, church pastors, and parents.

At the same time, I made simple maps using my GPS device, as the Google Earth and United Nations maps (which are almost identical) lack all the place names and include several locality names which they’ve mapped as villages. My maps and distance charts are free if you contact me.

Map of the Dungu - Ndedu area, DR Congo

The “roads” through the jungle in this area range from a fairly smooth and wide path in some places to very, very, very bumpy and overgrown in others. Suffice it to say that, at the end of the fourth full day bouncing up and down on the back of a motorcycle in the jungle, I was a bit tired. Here are two of my motorcycle drivers crossing a slippery log bridge:

Motorcycles crossing a log bridge in the jungle outside Ndedu

Map of our second day based out of Ndedu:

Map of the Dungu - Ndedu area, including Kpekpere area, DR Congo

On the second day we visited villages in the area around Kpekpere, and went as far as Bawaku. One motorcycle also got a flat tire, which was soon repaired.

Inflating a flat motorcycle tire outside Ndedu, DR Congo

On the way back from Bawaku to Kpekpere we got caught by heavy rains and had to hide in the nearest large hut we could find. We were there about an hour, of which I spent perhaps 20 minutes sleeping.

Waiting out the rain on the Kpekpere - Bawaku road

Map of our third day based out of Ndedu:

Map of the Ndedu - Libombi road, DR Congo

On the third day we went all the way to Libombi, a three and a half hour drive, meaning seven hours of motorcycle movement that day, plus all the time we had to spend in each place along the way! This was by far the longest and hardest day, but it was still really fun.

On the fourth day I supervised three vaccination teams. Children waiting to be vaccinated in Li-Lungbu:

Children waiting to be vaccinated in Li-Lungbu, DR Congo

Inside a vaccination site in Kpekpere:

Inside a vaccination site in Kpekpere, DR Congo

Children waiting to be vaccinated in Kpekpere:

Children waiting to be vaccinated in Kpekpere, DR Congo

Motorcycling through the jungle south of Dungu:

Motorcycling through the jungle south of Dungu, DR Congo

Soon, we were back in Dungu for a much-needed day off work, followed by similar activities in the other direction: north! More on that later…

Disclaimer: The postings and views expressed on this site are mine alone, and do not represent the position or values of Médecins Sans Frontières.

Faradje, Province Orientale, DR Congo

On January 12th, five of us flew to Faradje, in northeastern Democratic Republic of Congo, to set up and run an emergency measles vaccination campaign for the town. We spent a pleasant, if at times very tiring, two weeks in Faradje. We ate and slept at the Catholic parish, and set ourselves up to work in the office of the Danish Refugee Council, the staff of which were exceedingly kind and welcoming. In Faradje, like many towns in DR Congo, the remnants of the violent Belgian colonial past are still very visible in the perfectly straight, tree-lined streets and a number of old buildings in various states of disrepair.

One of the three main roads in town, the Faradje-Watsa road:

Faradje - Watsa road

L’Administrateur du Territoire de Faradje has his office in an old Belgian administrative building, a facsimile of those in which many of his counterparts in other territories can be found working:

Office of the Administrateur du Territoire, Faradje

Homes in the area are newer than the colonial buildings, but the architectural style is far older, as it’s more closely matched with local needs and locally available and affordable resources for home-building.

Typical homes in Faradje

The last time I worked in DR Congo, I saw Canadian shirts all over the place, including a UBC Thunderbirds jersey in Lubutu. This time around, in a completely different part of the country and nearly two years later, it is apparently still trendy to sport Canadiana. Take, for instance, this dapper young man sporting a vintage 1993 Vancouver Canucks hockey jersey while riding his retro-style single speed bicycle around Faradje (those with a good visual memory will recall that the little crest on the corner of the jersey was worn to mark the 100-year anniversary of Lord Stanley’s Cup in 1993).

1993 Vancouver Canucks hockey jersey in Faradje

The Catholic church in Faradje, as seen from our veranda, including the police ghost, frequently seen in the area, patrolling the grounds of the church:

Catholic church in Faradje

We also went inside the church to have a quick look:

Catholic church in Faradje
Catholic church in Faradje

As for the measles vaccination campaign, which was the whole point of our visit to Faradje, we first had to set everything up. This included setting up a small generator outside the hospital to power the fridges and freezers we brought for the vaccines and ice packs. Apparently the incredibly loud noise of a generator two metres away does not in any way diminish one’s quality of sleep, evidence of which is provided by this friendly sleeping pig:

Generator setup

When I got close for a better photo, I woke him up, but the generator was no problem…

Pig in Faradje

Freezers on the left for ice packs, fridges on the right for vaccines and solvent, all correctly placed on palettes:

Cold chain setup in Faradje

Inserting frozen ice packs as an insulating layer in an ice-lined vaccine refrigerator, a step often ignored by those setting up such refrigerators:

Inserting ice packs in an ice-lined vaccine refrigerator

With the cold chain in place, and a team of community mobilisers out on the town spreading the message about the upcoming vaccination campaign, it was time to select locations for vaccination sites and get them set up. In four of the five fixed sites we set up, we built temporary shelters against the sun and rain. First, sticks were cut and holes were dug:

Digging post holes for a vaccination site, Faradje

Next, posts were pounded into the holes, cross-beams were tied to the taller posts, and orange plastic fencing was installed to control the flow of people through the vaccination sites:

Installing fencing at a vaccination site, Faradje

Completed vaccination site, minus the roof, with space for two separate vaccination teams to work:

Vaccination site without roof, Faradje

Here’s a vaccination site with tarpaulin roof attached. Children enter to either the right or left of the central dividing fence, generally based on their age (under five years on the left, five and above on the right, for instance). A child first sees a registrar who fills out a vaccination card for the child, then the child is vaccinated and receives a Vitamin A pill and sometimes a de-worming pill.

Vaccination site with roof, Faradje

The long line of people waiting four abreast was quite impressive to see on the first morning of vaccination at this vaccination site:

Long queue at a vaccination site, Faradje

Of course, every single kid who was vaccinated was a happy, smiling bundle of joy:

Child being vaccinated against measles, Faradje

After being vaccinated, each child’s finger was marked with gentian violet to show that he or she had been vaccinated:

Marking a finger as proof of vaccination

Staff for the vaccination sites, recruited locally, were identified by MSF tape around their arms. This was our youngest employee:

Youngest vaccination employee

My motorcycle driver and I were responsible for buying donuts and peanuts for the ten vaccination teams in five different sites. Each day we would buy out the entire stock of several donut sellers, who would laugh uncontrollably at the mundele (white man) with the enormous appetite for donuts.

Buying donuts for vaccination teams

As we had no vehicles in Faradje, we used the hospital ambulance for some needs, but the majority of work was done by a bunch of motorcycles we rented locally. At one point, we had over 20 motorcycles at our disposal. On the final day, we took a group photo with 16 of them:

16 of the more than 20 motorcycles used for the Faradje measles vaccination campaign

As a side project, during and after the vaccination campaign I organised to increase the size of the hospital’s healthcare waste management area, with two new pits dug: one for glass vials and ampoules, the other for the ashes of sharps boxes. We left just before the project was completed, so I had to hand over to another NGO, but we got a good start on it. Each pit was 2m long x 1m wide x 4m deep once completed:

Digging a hole for the Faradje General Hospital waste management zone

We also gave protective clothing for the man responsible for healthcare waste disposal:

Protective clothing, boots, gloves, and goggles for healthcare waste disposal

Each pit needed a reinforced cement slab as a cover. For the glass vials and ampoules pit, the slab would have a simple hole to drop the glass down into the pit, with a lid to keep rain out. For the other pit, a drum burner would be fixed in the cement so that the ashes from sharps boxes would drop directly down through a hole in the bottom of the burner, into the pit. For the cement, we had to buy gravel and sand…

Sand for concrete slab

…plus bricks for the foundation on which the slab would sit…

Bricks for concrete slab foundation

…and of course cement too! We also bought iron re-bar to reinforce the cement, and wooden planks to create the form for pouring the cement.

Cement for concrete slab

Aside from work, there were some lighter moments in Faradje, such as the First Annual Faradje Olive Pit Spitting Competition. This involved eating an olive, but keeping the pit in one’s mouth, then attempting to spit the pit into the hollow tree stump a few metres away (which can be seen in the bottom right corner of the church photo above). For the first round, each participant agreed to put $20 in the pot, and whoever first succeeded at landing the olive pit in the tree stump would get all the money in the pot. I managed it on my second try, immediately winning $40. We then decreased the buy-in to $1 for each participant, increased the number of players to eight, and kept trying for a while longer.

Olive pit spitting competition

Playing around with unused medical equipment (normally, this apparatus is used to transport people from one part of a hospital to another, or particularly in care homes, when a wheelchair or gurney is inappropriate or less convenient. In a hospital where each ward is in a building of its own, separated from the others by very uneven terrain, this patient transportation apparatus becomes more useful as a coat rack than anything else).

Playing with unused medical equipment

A bit of Monday afternoon poker with unused vaccination cards substituting for poker chips:

Poker to pass the time

We also zipped out to the river’s edge one day in Faradje to see some hippos. There were about ten of them, very cool to see! In this photo, three hippos are visible:

Three of the ten or so hippos we saw in Dungu River, Faradje

Disclaimer: The postings and views expressed on this site are mine alone, and do not represent the position or values of Médecins Sans Frontières.

Measles

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.

Disclaimer: The postings and views expressed on this site are mine alone, and do not represent the position or values of Médecins Sans Frontières.