Measles in Gogrial West

After a series of progressively shrinking airports and UN planes, I landed on the dirt runway in Kuajok. Waiting at the airport-- if you can call four sticks with a tin roof an airport, were Wori and Simon from my team. I was joining a team of 9 people that had already been in the field for about a week, 7 from the ERT health team, and 2 from the ERT nutrition team, to respond to a measles outbreak in the area. Already there had been over 100 suspected cases of measles and one death in Gogrial West County. We were setting out to vaccinate over 75,000 kids for measles, and at the same time screen them for malnutrition. Even by ERT standards, this is a big project. The whole effort would take 99 teams of 8 people, 6 days of vaccination. Medair took responsibility for implementing vaccination, with support from the Ministry of Health, World Vision, and UNICEF. 

Coldbox for vaccine and icepacks being stored in a Tukul.

Measles vaccine is very particular; it has to be kept between 2-8 degrees C. If it is too cold or too hot, the vaccine will be useless. So before we could begin, we had to establish a cold-chain- or a way to deliver vaccine while keeping it at the right temperature. Keep in mind, in this area of the country, most locations do not have electricity, and in most places refrigeration is non-existent. The only way to transport the vaccine is through small vaccine carriers with ice packs that can be carried to remote villages, and through larger insulated cold boxes with ice-packs that can be kept in a central location to refill the vaccine carriers. If the 100 degree temperatures weren't enough to make cold-chain difficult, our plans were further disrupted by a shortage of freezers, and some generator malfunctions.

Once the teams were trained, the ice-packs frozen, and the supplies distributed to each payam (sort of like a township), we were ready to begin. 99 teams set off into the field, literally carrying the vaccines to the kids that needed them. Now that the campaign was under way, our team tried to supervise and support as many teams as possible. Unfortunately, in the area we are working, many villages are not accessible by car. There are basically two real gravel roads we use, both referred to as the main road. While they are significantly more built up than the remainder, they are washed out from the rainy season. They are potholed, and washboarded, and about half the time the drivers decided driving in the ditch was the better option. From the main roads you can find some dirt trails that test our suspension and lead us to more rural areas, then the trails turn to vague tire tracks, then eventually it is just the bush. We drove across fields, and rivers, trying to reach the teams. We saw many and provided guidance and supplies, but unfortunately some areas were only accessible by foot, and even then they were often too far for us to reach in one day. We experienced vehicles getting stuck, breaking down, and overheating in our efforts to reach these areas.

Truck got stuck in the long grass.

Looking for a place to cross the river.

Mobilizer engaging community to receive vaccines.

Each team had a community mobilizer, who travelled from village to village with a megaphone, to invite families to bring their children. The response was astounding. Women carried their children for miles and miles to come to the vaccination points. They were so thankful to have the opportunity to protect their children from measles. These are people that have seen, in their own families and communities, the devastating effects of this very dangerous disease. Some in developed nations, including the U.S. have forgotten the impact this disease can have, and how rapidly it can spread when there is not herd immunity.. When speaking with one Payam Supervisor for EPI (Expanded Program on Immunization), he said that for him this campaign isn’t just his job. His own nephew was one of the measles cases, and had been hospitalized.

The children too impressed me. Often it was an older sibling that brought a toddler to receive their vaccination. The children held still for their injection, followed instructions, and even rolled up their own sleeves from time to time. Of course in some cases there were tears, but not very often and not for very long. When I think back to healthcare in the U.S. there hardly seems to be a comparison. There, to give a child an injection, the parent or a nurse may hold the child, sometimes they had to be wrapped burrito style in a blanket to keep them still. There were tantrums, and screams, and in the end there were bribes of stickers, teddy bears, and maybe even a lollipop. In South Sudan the only reward sought is protection from disease. 

So far Medair's Emergency Response Team has vaccinated over 79,000 children for measles in Gogrial West county, South Sudan.

Life in the field

The Big One is For the Cows...

Tukuls are the traditional building and home. The walls are made of clay and they roofs are made from long savanna grass. The grass roof needs to be replaced every few years due to sagging, and the harsh rainy season. Often, the family will form a raised platform of pressed dirt (almost cement-like) for during the rainy season. Even though they are made of dirt, and everything is always dusty here, it is common to see the women sweeping them in the morning. In most groups of tukuls, there will be one or two smaller ones to live in, one small pantry raised on stilts to protect food stocks and seeds, and one large tukul for cattle. Cattle are a big part of the lives and cultural traditions of South Sudan, and thus are carefully tended and given shelter in the same style and near the family.

After making a deal with the tree's owner, the team could pick fresh mangos.

Never Pass Up Mangos or Chickens...

In this remote area, access to fresh food is very limited, particularly in the present dry season. This time of year is entering "the lean season" or the time between when food stores run out, and the harvest has not yet come in. So when we pass a mango tree, or see a chicken for sale, we stop and buy it for the team.

Before you ask, I have no idea how they got up there.