My first priority was to understand the activities of the mission; their timing, and what stock had arrived in Monrovia to support the activities. Despite this mission just getting underway, parts of the emergency orders from MSF Logistique in Bordeaux had already been shipped. How much anti-malarial medication, central to the distribution activities of the mission, is here? What other medical supplies are here? Have they been organized in any fashion? When is distribution starting? What is required from pharmacy? Is there a pharmacy?
The distribution activity is big and the first activity to get underway in this mission. We will be distributing anti-malarial family packs (free, of course) to four districts in Monrovia, about 50,000 families. We will do this in a very deliberate, organized manner with the goal of having at least 85 per cent of families in the district receiving family packs of antimalarial drugs. We need to get to all of these areas within the month since we will repeat the activity for the next two months. The medications provide about four weeks of coverage for malaria, we want to distribute for the height of the malarial season.
The medication we are distributing is artesunate/amodiaquine which has four doses based on age (or weight). The medication is packaged in blisters and a tablet (or two for adults) is taken each day for three days. We are putting one or two blisters for each age group in the family pack and we hope this will provide enough drug for the family. The contents of the family pack were made by considering the population statistics in Liberia and are based on a public health approach.
Some additional blisters are provided to the chief of the community in case additional medication is needed.
Ideally we would like to individualize the pack for each family (i.e. provide the exact dose necessary for each member of the family) but it is not an option based on the size of the population we are distributing to and the fact that we are distributing in an Ebola context. We developed an educational leaflet for the packets to outline some important points… dosing of the medication by age, take the medication even if you are not sick, side effects that might occur, how to administer to a baby, etc.
Considering the Ebola context, going out into a crowd is considered a risk, especially if it is unruly. With that said, how will we distribute to as many as 7,000 families in 90 minutes and not expose our teams to unnecessary risk? How will the crowds be managed? No worries there… we have a large team working with the chief of the community to sensitize them to the importance of the activity and the logistics are managed to the nth degree. More to come on that…
Needless to say the first few days of my mission were a whirlwind but in true MSF fashion we were working hard to mobilize the plan quickly. The first day of distribution was just a week away…