Bridgith Freire travels to remote communities so children can get vaccinated

Judith Shiguango (34), a mother from the Santa Bárbara community, a hard-to-reach Kichwa community in the Tena canton, needs more than a half-day's journey to reach the nearest health post. Leaving her home for the health post in Puni Bocana is no easy task: first, she must walk to the river, wait for a canoe to pick her up, get to the other side, and walk once more. However, today she does not have to travel or leave her crops so that her five children, Joao (13), Mikaela (11), Fabián (8), Maricela (6) and Ainara (5 months), have access to vaccinations, medical check-ups and dental care.

It is 8 a.m. and drizzling. Several families from Santa Bárbara gather at the community center, where a table and long benches are transformed into a waiting room. The families are waiting for Bridgith Freire (23), a nurse who works at the Puni Bocana health post and is part of the Ministry of Health brigade that brings care to remote areas. "When we arrive at the communities, they welcome us with open arms. They always ask us what care we are going to provide, whether it will be medical care, vaccinations, dental care or other types of care," says Bridgith, as she removes the vaccines from a container full of cold packs.

Providing vaccinations in remote areas is a challenge, especially in the Amazon region. Distance, rough roads and lack of public transportation are not the only challenges in places like Santa Bárbara. The climate in the Amazon often plays a tricky game. The constant rains not only complicate the transportation of health personnel but can also cause power outages that jeopardize the proper storage of vaccines. Temperature variations can alter them and impair their effectiveness.

Adequate cooling equipment to ensure the cold chain of vaccines is crucial. Through UNICEF, the Japanese government donated almost $1 million to strengthen the National Immunization Strategy of the Health Ministry of Ecuador. The goal is to improve the storage, handling and distribution of vaccines in nine provinces (Carchi, Esmeraldas, Imbabura, Manabí, Napo, Orellana, Pichincha, Santo Domingo de los Tsáchilas y Sucumbíos), that are prioritized by the Ministry of Health.

"Thanks to the generous contribution of the Japanese government, this donation has been used to purchase several types of freezers and thermal boxes that will benefit 609 health facilities. Furthermore, 1,800 health facilities nationwide will have vaccine carriers and cold packs for the safe transport of vaccines. We have assisted in the implementation and distribution of this equipment and have supported the capacity building of Ministry of Health personnel," said Katherine Silva, Health and Nutrition Officer at UNICEF Ecuador.

The health brigades begin their day very early in the morning, removing the vaccines from the refrigerators installed at the Puni Bocana health post. This equipment is essential because it has transformers and voltage regulators that keep the temperature of the vaccines stable so that they are not damaged by power outages. 

"We used to have a regular refrigerator to store the vaccines. We were always taking good care of it, to keep the cold chain, but when there was a power outage or when there were heavy rains, the increase or decrease in voltage usually caused the equipment to burn," says María Elena Zumba, Zonal Immunization Manager of the Ministry of Health.

In an area like Puni Bocana, with a climate that ranges from 25 to 30 Celsius degrees and an average humidity of 79%, the temperature is a challenge. Bridgith explains that reaching nearby communities takes her and her colleagues a long time. "In those four hours, our vaccines can undergo an extreme temperature change," she notes. 

As part of the donation from the Japanese government through UNICEF, 'coolers' or vaccine carriers, small thermal boxes that are slung over the immunizers' shoulders, were also provided to properly store the vaccines and then safely transport them to the remote communities. "This makes my job easier. The vaccine carriers help us keep the cold chain so that the vaccine does not get damaged and we can administer a high-quality vaccine to our patients," explains the nurse, as she treats dozens of children who come for care through the medical brigade set up at the community center.

The arrival of health teams to the communities is key for Judith and other families.  "It is crucial to have comprehensive health brigades, with doctors, dentists and nurses, who work together to provide care to the communities, considering that the houses are located in scattered areas that are not easily accessible. It is easier to organize the population in their communities to provide care and ensure vaccination," says María Elena Zumba, the Ministry of Health's Regional Immunization Manager. 

Judith and her children only had to walk for 10 minutes to reach the health brigade that was set up in the Santa Bárbara community. Her four children received medical attention and her little daughter Ainara, 5 months old, was able to be vaccinated. Timely and high-quality vaccination is one of the most cost-effective strategies in public health because it helps prevent diseases that can be fatal.

Governments, the international community and society as a whole must continue to join efforts to ensure that all children, even in the farthest corners of every country, have access to the full immunization regimen to guarantee their right to health.