The faces behind a vaccination campaign in Chad.
Increasing children’s immunity, stopping the cycle of outbreaks in Chad through children vaccination.
For many years now, Chad has experienced several measles outbreaks followed by poor response campaigns. In 2019, 123 of the 126 districts in Chad reported suspected measles cases, while 30 districts were in epidemic. In addition, 26,623 suspected measles cases were reported, including 259 deaths, representing a case fatality rate of 0.9%.
Thanks to vaccination campaigns carried out with the support of UNICEF, WHO, Gavi, Kfw development bank and other partners, it is expected that outbreaks of measles and other diseases will remain a bad memory in Chad.
The official launch of an immunization campaign is usually the most mediatized moment. While it is important, its success depends on a machine that, although important, remains hidden for most of the time. This machine is made up of men and women who have chosen to devote their time and energy, often voluntarily, to the health and well-being of children in their communities. In the following lines, let's discover some of these important actors.
1. Adoum, the town crier: he walks through the neighbourhoods under his responsibility, passing on information about vaccination.
"Vaccination campaign starting Monday. The vaccination is free. Bring your children aged 9-59 months under the tree of Saleh Souloum. They will be vaccinated against measles; they will also receive Vitamin A against infections and Albendazole against intestinal worms. Measles is a dangerous disease that can kill your children. Bring them in to be vaccinated, everything is free!"
In the heart of a quiet end of day scene, a voice from a hand-held loudspeaker rises, drawing the attention of the residents of the Agat Chaway neighbourhood. We are in mid-March, in a Saturday afternoon. It is 4.30 p.m. in Abeche, in the province of Ouaddai, in north-eastern Chad. The temperature is slowly dropping, much to the delight of the inhabitants: from 42 degrees Celsius in the shade, it is now 38 degrees, a relatively acceptable temperature for the end of the day. At this hour, people are back home, waiting for the 5.30 pm prayer. This is the moment that Adoum chose to start his information and awareness-raising activity on the measles vaccination campaign that will start two days later.
Adoum is a 25-year-old young man with a passion for sports journalism. He is part of the mechanism for the measles vaccination campaign scheduled to take place between March 22 to 28, 2021 in 13 provinces of Chad.
The joint campaign is also the right time for the Ministry of Public Health and National Solidarity, with the support of UNICEF, WHO, Gavi, Kfw development bank and other partners, to administer Vitamin A and Albendazole to children aged 9-59 months.
To inform and sensitize communities against the harms of measles, Vitamin A deficiency and intestinal worms, the young journalism fan has chosen to work as a town crier. For nine days, Adoum will walk around the streets of the three neighborhoods under his responsibility, explaining to both children and parents the importance of measles vaccination, while pointing out vaccination sites.
"I spend an average of 3 to 4 minutes at each stop to explain, because some people do not know that measles and these diseases exist and that they are very dangerous. Most of the time, as the children move with me and are very fast, I explain to them and they in turn run to explain to their parents." he says, proud of himself."
2. Rakhiè, the community volunteer: By going door-to-door, community volunteers like Rakhiè are helping to inform people at a grassroots level.
Another place, same time slot, almost similar scenario. We are in Amsiogo, another district of Abeche. Rakhiè Moukhtar does a similar job to Adoum, with one tiny exception. She goes from house to house.
During her rounds, Rakhiè talks directly to parents. With years of experience as a vaccinator and volunteer at a health centre in Abeche, she usually finds the right words to convince reluctant parents. Her task is not always easy, but she is hopeful that thanks to immunization, measles, vitamin A and albendazole deficiency will no longer afflict children in Chad.
"When I arrive in a courtyard. I greet people, introduce myself and explain why I am there. Then I ask if there are any children aged 9-59 months. If yes, I invite mothers to have them vaccinated against measles, as well as to be given Vitamin A and Albendazole. For those who know nothing about the diseases, I describe them their manifestations and encourage them to vaccinate their children. I also encourage parents to let their children take preventive medicines against infections and worms."
3. Rachit Moustapha, the very committed neighbourhood chief: he is very involved in the community, and he will also make sure that his children are vaccinated.
"Dads don't like to hear about vaccination, but without vaccination you don't have health. Vaccination helps prevent diseases, but the children don't know this because they are small. We adults have to save them because they know nothing."
These words, spoken with great conviction, are those of 60-year-old Adam Rachit Moustapha. Moustapha is the chief of the Agat Chaway neighbourhood, located in the centre of Abeche. He is very involved in everything related to health, and is also a member of the management committee of his community's health centre. He is an important link in the vaccination chain in these communities where prejudices are still entrenched and where ignorance does not always facilitate the task of health care.
As a neighbourhood chief, Moustapha is a great support, especially when it comes to convincing people of the merits of vaccination. In this patriarchal society, his word is respected by both men and women. Moustapha, who has seen "many sick children suffering from measles", wants to see an end to this. For that to happen, he does not hesitate to do his part. Thanks to the support of chiefs and leaders, both traditional and religious, small steps are being taken every day.
4. Better training and coordination for better results
The vaccination campaign cannot be launched without several essential points, such as vaccines and well-trained health workers (and auxiliaries). Without these crucial points, the campaign itself would be a failure, which the team consisting of the Provincial Delegate and his collaborators, UNICEF, WHO and other partners cannot afford.
On the agenda of the training sessions: tasks within the teams, calendar of activities, preparation and organisation of an immunisation post, crowd management, conservation procedures, reconstitution, administration of the vaccine, management of MAPI, management of waste from the vaccinations and completion of management tools and supervision sheets, etc.
In order to ensure that everything is in order, a team is responsible for checking the stocks of vaccines and various inputs, ensuring that the distributions correspond to the targets, making arrangements for the respect of the cold chain, and then delivering the expected material to the various points.
Alongside training and stock checks, this team holds daily briefings to review progress. The agenda for the various meetings includes progress, areas for improvement, potential difficulties and ways of overcoming them. Everything has to be ready before the D-day.
The organization of a follow-up campaign for children aged 9-59 months is part of a set of interventions aimed at increasing the measles immunity of Chadian children, administering Vitamin A and Albendazole and thus stopping the current cycle of recurrent epidemics. For this campaign, whose target population was estimated at 133,624 children in Moussoro, Bokoro and Mao, vitamin A was administered to 134,422 children, while 134,382 children received albendazole, thanks to funding from the Kfw development bank. In addition, in the 13 targeted provinces, 1,723,378 children were vaccinated against measles as a result of support from UNICEF, WHO, Gavi and other partners.
