Tajikistan Diaries, by Lynn Geldof
The measles campaign in Tajikistan, launched 27 September 2004, is targeting almost 3 million children and young people - some 50 per cent of the total population. The two-week initiative is the first ever campaign of its kind in the country.
28 Sept 2004: Day 1 on the measles campaign trail: You don’t expect to come smack up against the mountains so quickly. You may know that 93 per cent of the country is mountain, constituting the main challenge to the campaign here but, surprise, seeing is believing. We’re heading for Varzob District and a rivulet noticed earlier suddenly becomes a torrent. Yet we can’t be more than 15 to 20 kms outside the capital Dushanbe. I look up: the Varzob River has cut a gorge through the mountains. Noisy, blue, sparkling, it rushes past in the opposite direction going about its own important business of supplying 50 per cent of the capital with its generous flood and powering a hydroelectric plant in the process. The UNICEF team hops out of the car and a boy and a girl take in the gawk. They are dressed in bright red with matching cheeks. Radjavova Lola is 11 and she was immunized yesterday, campaign launch day. Husseinov Husseini is 9 and it will be his turn today. Sure they knew about measles. Hadn’t they learnt all about it in a special lesson at school! “No, it didn’t hurt. Not much, anyway,” says Radjavova. Sitting in the hot seat at the Varzob District Ambulatory Family Medical Care Centre is Guryesova Mijgona, 12. The arrival of the team delays the fateful moment. She takes in the preparations of the vaccine, looks confidently around her, presents her skinny upper arm for the health worker, holds our gaze and then ducks out the door to sit in the corridor for half an hour beside a line of silent, if thankful, post-vaccination kids, some parents and the local Mullah, Saido Raupov. They wait in case some child should have an adverse reaction. 24 percent average nationwide coverage in just two days Coming in the door are some skeptical candidates of between 1 and 3. Their antennae have picked up the vibes and they are less than convinced. A wail from inside the vaccination room does not help matters but then they see the owner of the wail emerging upright, dry-eyed. They struggle to interpret these strange contradictory messages. The Mullah is pleased. As a key influential figure in Varzob, he has been part of the effort to mobilize the community. After two hours, they have immunized 70 kids and by close of day they aim to have done 170. “We Mullahs know of the importance of immunization because we were used to it from Soviet times,” Mullah Raupov explains, “but now, for the first time, we know what the symptoms and possible consequences of measles are. I have not only been preaching about immunization during Friday prayers but every day. And I have been visiting parents in their homes as well to explain it to them.” Higher up is the village of Chorbog, the largest of Varzob District with some 11,140 inhabitants, 5,014 of whom are targeted for measles immunization. Here the main mobile post is at the school. As before, the non-school-age children are seriously spruced up for the occasion – bows and frills for the girls, gents’ suits often for the boys. Flasks of boiling water, sugar and a china tea-set are lined up at the back of the classroom-turned-immunization post for those inclined to swoon or feel queasy at the mere sight of a needle. I acknowledge, shamelessly, that I would fit well with that company. English teacher Najmidina Vali says it’s the first time the school has been used for such an occasion. “And every teacher, not just me, has given special classes on the importance of measles immunization,” he says, smiling. “Just yesterday, they immunized 935 children.” The success is felt personally. 29 September 2004: Day 2 on the campaign trail in Tajikistan: Up at cockcrow on the road back to Varzob District. This time to see how the outreach part of the campaign is going. There are three elements to the actual vaccination effort: fixed, mobile and outreach. We had done the other two yesterday.Outreach is the trickiest part and the one to watch when it comes to the possibility of spoiling vaccines through improper management of the cold chain. The Varzob Ambulatory Family Medical Care Centre is spotless. I notice they put a wet cloth just in front of the doorstep, like a welcome mat, to absorb the dust on the soles of your shoes. Learning curve time. I spy that the ice packs are out sitting on a clean cloth on top of the freezer ready to go into the vaccine carriers. I panic mildly thinking they’ve got it wrong, that the ice packs should not be out in the air like that at all. They are sweating - the ice packs, not the health workers. ‘No, you have to take the ice packs out half an hour before they go into the carriers. You let them sweat and then you must dry them off like this.’ says Dr Shamigul Radjabova, the Director of Immunization at the centre. She is a dynamo, this lady. Wonderful. And rightly tipped for greater things in local government. Her team of outreach workers - Dr Nazar Rasulov, 32 and Dr Zubaidulo Abduloyev, 28, and nurse Rajabmo Mahmudova, 25 - line up with their vaccine carriers. Four ice-packs and five vials of vaccine go into each of the two carriers. Then they get a UNICEF bag into which go the waste disposal boxes for the used needles and syringes along with various medicines, all for the inhabitants of a community reached only by foot. They hop into a car and are unceremoniously deposited on the roadside from whence they must climb up and over for about two hours till they reach the community of Fanfarok where 80 children and young people await vaccination. We watch them disappear from view. For all the world a cheery party setting out on a picnic. What heart! On now to a drop-in centre for children living in the streets or working in them – Naslin Navras or New Generation. In fact, it’s a centre for regenerating kids who have had it very tough indeed. It is a lovely place, full of good vibes which is the first thing the children in the catch-up school part mention when I ask what they like best about the centre. They like the way they are treated – a bit of kindness never goes amiss. What subjects do they like best? ‘Everything,’ of course. What a question! None of us can play the piano standing over by the wall. Useful, practical lessons take place in other areas – handicrafts, dress-making, English and computers. The children range in age from around 6 to 17 with more girls, 60 percent. They get one square meal a day here. When they come in first, they are bathed and clothed and given a good medical check-up. On-site there is a doctor, a teacher, two social workers and two volunteers. SCF have funded them to date but it looks like UNICEF will come in soon as the SCF funds are drying up. Chemists without Borders provide them with drugs through the nearby Polyclinic. Yesterday, the Polyclinic mobile team immunized 200 of the children. Well, what a shame we missed it! As if on cue, up the stairs appears a team from the same Polyclinic bearing the familiar UNICEF bag and without ado assembles the accoutrements. But, but…all the kids were immunized yesterday? Again, as if on cue, and from nowhere, a horde of around 20 children appear. Word has gone out in the neighbourhood. Uproar, wails as the team sets to. Social worker and Mum to many, Saniya Asamova, 62, chases after a big boy of about 16 who has decided to make good his escape. In a different direction now, we head out of Dushanbe, past a Russian Army garrison of high white walls. The vegetation is so weirdly similar to Europe’s – chestnuts, poplars, roses and earwig-bearing dalias…and then, lo, cotton. We are going to Kindergarten No. 1 in the Leninskiy District. Things have been moving here, too. Yesterday they immunized 112 little ones from 2-5 years old and their target is 150. A tiresome ring on someone’s mobile interrupts immunization proceedings but I am glad to be called away from the children’s advance fear of the needle. Fantastic! Indigo mobile provider is on-side: ‘Vaccinate all your children, 1-18, free of charge from UNICEF. Take your children to school or to a medical point between 27 Sept to 10 Oct. Protect the health of our children.’ Back in Dushanbe even better news! Dr Tarek Hussain, UNICEF EPI Chief rushes in high on the figures just received: 24 percent average nationwide coverage in just two days! For more information: Lynn Geldof, Regional Communication AdviserTel: (+ 4122) 909 5429 e-mail: lgeldof@unicef.org
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