My alarm goes off at 3am and as I slowly gain consciousness I wonder how the team does this five days a week…
Why does distribution start so early? To keep the crowds organized and to avoid traffic and trouble. A good plan when we are providing 1000-3000 antimalarial family packs at each of five sites in this “no touch” Ebola context. Having a crowd rush the MSF teams is not safe and, therefore, not an option. Our approach is carefully orchestrated and has become a well-oiled machine.
The goal is that of public health, if we treat people for malaria (which is endemic here) we will keep malaria patients out of the Ebola Management Centers (EMCs).
The team training on how to set up the site © Kimberly Larkins
The days leading up to D-day are also well planned. A team (a logistician, nurse, and driver) meet with key people from each community, including the leaders/chief, the malaria team and health workers/volunteers. Alignment is absolutely critical to deliver clear, correct messages. The visits to each community prior to the big day include… one to ensure alignment and understand the population, one to train the community representatives, and one to provide the vouchers to the local health workers.
The messages are multi-fold… why we are providing anti-malarial drugs, why the drugs should be taken whether or not the person feels ill, the different doses for the members of the family, etc. The vouchers are what the representative of the family will exchange for their family pack the next morning.
Additionally, the team determines the right location for distribution which will allow for crowd control… an area to facilitate a queue and that allows our teams to leave quickly if there is a security issue. The cars are packed with all of the supplies, including family packs of drugs, the day before and are kept in our compound for the night.
Briefing the distribution team © Armelle Loiseau/MSF
Distribution days start early… 3:15am is the gathering time in the compound. The local staff sleep at a hotel near the compound so it is easy for the team and convoy to gather. The convoy is long… two trucks for each distribution site as well as the team leader cars (usually two)… so usually 12 cars and 36 people (or so).
At 3:15am there isn’t much traffic (no surprise) and we are able to pass through the checkpoints (for the curfew) quickly. We also go with the idea that “trouble sleeps in” so there won’t be any shenanigans with drunks or groups that might want to disrupt our plans.
Hand washing and good hygiene © Armelle Loiseau/MSF
The team jumps into action to set up the site while the hundreds of people who are already waiting look on. The set-up is critical to keep the queue manageable and the safe zone of 1.5 meters between the line and the MSF team.
As the crowd approaches the table, they drop their voucher into a bucket and pick up their family pack of antimalarial drugs and that’s that. One of the nurses and the community health workers are continually telling the messages. It’s remarkably organized and extremely effective system allowing them to move at a rate of two seconds per person (which includes the set-up and clean-up time!).
Malaria prophylaxis distribution in action in the early hours © Armelle Loiseau/MSF
At this point we have distributed to about 65000 families and have another 15000 or so before we finish round one of distribution. Since the medications will protect individuals for one month, we will be doing another round in four weeks. And then they will rest…