More on Measles

For me, the last few months have been all about measles. As our team wrapped up the campaign in Gogrial West County for 6-59 month old children, we were given the green light to expand our vaccination to cover some remote missed villages, and children up to 15 years old. This meant starting again from the beginning and trying to reach far more people. We were excited though, because more vaccinated people means a better chance to control the outbreak.

So we got the vaccines, did some refresher training with the vaccination teams, and set to work. I've gotten a few questions about how a measles campaign works, so I'll lay it out. As Medair, our job is planning, support, training, and supervision. Usually, we aren't the people actually giving the vaccine. But together with the State Ministry of Health, we had to recruit and train 99 teams people who would be vaccinating. However, the vaccinators are only one person on the team. Each team has 8 people, one person to vaccinate, one person to mix the vaccine and prepare syringes, one person to register the children on vaccination cards, one person to tally each child that receives the vaccine and to mark their fingernail with henna, one person to screen for malnutrition (MUAC), one person to record the result of the MUAC, one crowd controller, and one social mobilizer. 

When we first started the campaign, I wasn't sure about this team design. Surely, it would be more efficient to have a larger portion of the team actually giving vaccine? Fortunately, my misgivings were misplaced because this team design was tried and true. It allowed for flow of patients and reduced the need for the vaccinator to stop to record or prepare vaccine. It also allowed community members with very low educational status and literacy to participate in the campaign. Having specific and simplified jobs means that the role can be filled by people who may not have gone to school, or in some cases may not be literate. This way, only the vaccinator and the vaccine preparer needed prior training or health care experience. Everyone else could be trained in 2-day sessions before the campaign began. Because there is a shortage of educated professionals in South Sudan, a campaign this size has to recruit people with varying educational status in order to have enough people. 

One of the more important roles on the team is the social mobilizer. They are the ones responsible for going village to village, and home to home to convince families to bring their children for vaccination. They have to know the area, be trusted in the community, and able to speak accurately about why vaccination is important. And they have to travel long distances to try to reach every village so that each household hears their announcement. 

In the campaign targeting 5-15 year olds, I also learned the importance of having a good crowd controller. It sounds like a simple job, but most of the vaccination sites are just set up under the shade of a tree. There is no clinic, no lines, no walls. There is nothing that we would normally think of to help manage the flow of a large number of people. That challenge becomes even greater, as the age group shifts to school-aged kids. When was the last time you tried to get a bunch of 8 year olds to stand in line? I'm guessing it wasn't easy. Unlike the campaign for younger children, these kids are usually showing up for vaccination without a parent. So now we have crowds of kids that simultaneously want to received the vaccine, and also may be a bit afraid of the needle. 

 

Early on in the 5-15 year old campaign, we found a team that had set up near a school. They were completely over-run by kids. They had nearly 150 kids crowding around them, each trying to be the next to receive the vaccine. One of the interesting things about being one of the only white-people in this county, is that I tend to attract a lot of attention. Particularly from kids. And this day I happened to be traveling with another Medair staff member, Victor, who was temporarily helping out the health team but usually works with the Non-Food-Items team. I was lucky to be paired with him today, because the NFI team is used to doing large supply distributions, and likely has the more experience in crowd control than any other sector. So when we got to the vaccination site, we quickly set to work trying to organize the crowds. Victor used all his experience sort out the kids, first at registration, and then for vaccination. Meanwhile, I was trying to use the fact that the kids were semi-scared of me to get them to stay in lines. Once the crowds were more managed, I jumped in to help with vaccination, and Victor kept the lines flowing smoothly. We worked with this team for 2-3 hours, before being called away to bring more supplies to another team. In the short time we were working there, we vaccinated almost 200 more kids.

The campaign in Gogrial West went smoothly, or as smoothly as can be expected in this remote environment with such a large target population. We all was said and done, we vaccinated 193,958 children, and based on the assessment conducted, achieved 97% vaccination coverage. While we are thankful that we saw progress in Gogrial West, right now there are many ongoing outbreaks across South Sudan, and around the World. We hadn't even wrapped up this campaign, before we began planning for another mass vaccination in Gogrial East- an area that is less accessible and to which the outbreak has now spread. So as the saying goes, out of the frying pan, and into the fire (so long as the frying pan is Kuajok, and the fire is an area that will turn largely to swamps when the rains begin in the next few weeks).