Protecting against Tetanus by every means Central African Republic
(MTN) vaccination campaign in the district of Bimbo, a Commune that lies to the west of the capital Bangui.
The district hospital was bustling with the usual morning activities. It is one of many sites chosen to give the maternal and neo-natal tetanus vaccines to girls and women of reproductive age, and that means those from ages 14 to 49. UNICEF has provided all the 1,607,610 doses of the vaccine and the logistics required to the Ministry of Health to get them to every corner of the country.
The Commune of Bimbo has a population of about 444,000 inhabitants, and the vaccination is targeting about one quarter of them over the 5 days. This is the second time in 7 months that an anti-tetanus vaccination campaign is being offered to the girls and women of Bimbo. Similar campaigns are also taking place in all districts across the Central African Republic. “One dose is not enough, full protection begins after a person has received her third dose” says Dr. Edna Doyama – Woza, the young energetic doctor in charge of the Bimbo District Hospital. Explaining the need to organise the TMN vaccination campaigns frequently, Dr. Edna reminds us that each year more girls turn 14 and need to be protected. The 2018-2019 Multi- Indicator Cluster Survey (CAR-MICS6) shows that girls between the ages of 10 and 19 make up 22% of the adolescent population in the country. Pregnancy among children is common in CAR. As many as 42.8% of the young women aged 20 to 24 had their first child while they were under the age of 18. Another important reason for the TMN campaigns is the lack of hygiene is a major risk for both mothers and their children during childbirth. “Some women deliver their babies on the bare floor at home, and they use any thing they can lay hands on - blades, even sharp palm frond edges - to cut the umbilical cords. This happens as we speak today.”
“Once exposed to tetanus, the baby will stop breastfeeding within three days. That is when the muscles begin to stiffen. It is literally a death sentence for that baby.” - Dr. Edna Doyama – Woza
Nancy Nguidia came to the hospital this morning to receive her anti-Tetanus shot. She is visibly tired and close to full term of her pregnancy. The occasional grimace on her face suggests that her labour contractions may have already kicked in.
At age 32, Nancy is not new to the signs. She reveals “this is my fifth pregnancy. I have three girls and a boy, and l hope to get a second boy this time.”
Nancy is a trader. She sells anything and every commodity that is in season. “For my work, I have to travel across the water [river] to buy things to come and sell. Because of my pregnancy, I feel tired easily, so I have had to stop working for some time now. Otherwise l would be picking caterpillars from the forest to sell during this raining season. They are available in abundance now.”
The girls and women in Central African Republic received a first dose against tetanus in a campaign organised several months ago in September. TMN vaccinations continue during ante-natal consultations, but many have lost or misplaced their vaccination card. The doctor in charge says it does not matter if one has been previously vaccinated. “Only few women attend all the pre-natal consultations when they are pregnant. Because of that we are vaccinating everyone, as if it is their first time.”
Peud’homme Nzola Bounde is a volunteer and one of the 187 mobilisers for the MTN vaccination in Bimbo Health District. He and 3,433 others were trained as community mobilisers around the country by the Ministry of Health with funding from UNICEF. He chats with the young girls who come for the TMN vaccination to verify their age. “Because l am with them in the community, I also ask them to come and report to me if they get any unexpected reactions to the vaccine.” Peud’homme himself is a recent father to a son and says that the children in his community suffer from many diseases. That is what motivated him to volunteer.
Dr. Edna Doyama – Woza of the Bimbo District Hospital explains that in addition to the health centres and the hospital, the strategy for the campaign is to set up vaccination points in the community especially in places where lots of people pass during the day. “Our target is to vaccinate some 110,505 people, and were just about halfway, with only two days to go.” She continues “Yesterday was Sunday, so we moved the fixed community outreach posts to the various church premises, and we were able to vaccinate a lot more people.”
Jean Réné Masiketté is the officer for the Expanded Programme of Immunisation (EPI) at the Guitangola Health Centre, the 2nd of three health centres under the Bimbo District hospital. Here, the ante natal and post-natal sessions are another opportunity to vaccinate all the mothers and pregnant women who show up with their babies.
A few days before the campaign started on Saturday, community mobilisers and town criers in Bimbo gave out information about it and sent reminders.
Jean Réné expects a large turnout in the localities where mobilisers reached people in their homes with the necessary information. Each TMN vaccination team takes 250 vaccines with them for a day.
During his supervisory visits to the teams in the field, Jean Réné carries extra vaccines to be able replenish where stocks are low or where the vaccines have run out. He checks on the vaccination teams, to make sure that every one of the five members is present. He also ensures that the vaccines are being kept under good storage conditions in the field.
Dr. Edna is leaving no stone unturned. “By midday, the number of patients who come to the hospital reduces to a trickle. For this Tetanus campaign, we have decided move from the fixed points in the afternoons and go from house to house. We are using every means possible to get every girl or woman who should be protected against tetanus, vaccinated.”