It’s 8 am on a day in late March and a crowd has gathered outside the gate of MSF’s hospital in Kutupalong, Bangladesh. They are all Rohingya volunteers, ready to take part in the final day of a mass diphtheria vaccination campaign in the largest of the refugee camps in eastern Bangladesh, home to an estimated 300,000 people.
In their midst stands MSF nurse Chrissie, with clipboard, rucksack and shalwar kameez, orchestrating the day’s activities. In two minutes they are off, at speed, dodging rickshaws and overloaded lorries, down the busy roadside towards the entrance to Kutupalong makeshift camp, a vast, dense maze of huts that spreads across the hills into the far distance.
"This is the beginning of a seven-hour journey on foot, up and down steep hills, across bamboo bridges, crisscrossing the camp."
MSF nurse Chrissie McVeigh and her team prepare for the day ahead. Photo: Natasha Lewer/MSF
For Chrissie and the outreach team, this is the beginning of a seven-hour journey on foot, up and down steep hills, across bamboo bridges, crisscrossing the camp and reaching its very furthest edges – all at the peak of the hot, dry season.
Preventing the next outbreak
Diphtheria broke out in the camps in December 2017 – the first major outbreak of the disease for decades. Airborne, it spread fast through the crowded camps, infecting 6,000 people and causing 40 deaths, most of them children. The current vaccination campaign, organised jointly by the Bangladeshi Ministry of Health, the World Health Organization (WHO) and MSF, will ensure such an outbreak cannot happen again.
The Ministry of Health has taken the lead on the practical side of the campaign, providing teams of vaccinators, overseeing the cold chain (the vaccines are sensitive to heat and must be kept cool to be effective) and distributing the vaccines. The WHO has provided training and data collection, alert to any areas that might have been missed. MSF’s role has been to provide logistical support and additional vaccination teams, to mobilise the community, and – most importantly – to formulate the plan.
“What exactly is the plan?” I ask Chrissie.
“Simply to vaccinate as many children as possible,” she says.
“If we can vaccinate 25,000 children today, we will have reached our target.”
From every hillock in the camp, you can spot a handful of the 62 vaccination sites, each flying a yellow flag. Each site is staffed by a team of 10, and each team will aim to vaccinate 350-400 children in the course of this final day.
“If we can vaccinate 25,000 children today, we will have reached our target,” says Chrissie.
A line of children wait to be vaccinated against diphtheria. Photo: Natasha Lewer/MSF
Most of the Rohingya refugees in Bangladesh did not receive even basic healthcare in Myanmar. They have no experience of vaccinations. As a result, rumours abound, with some people believing that the needles will tattoo their children’s skin, amongst other things.
Such misinformation and distrust within the community means that the ground had to be prepared carefully before the campaign kicked off. MSF enlisted the help of 100 Rohingya volunteers, all of whom live in the camp and know it intimately.
“As volunteers, we use our knowledge of our culture and customs and how people are thinking to provide support from the community’s side,” says volunteer supervisor Ruhul. “We discuss problems and then we come up with a solution.”
With his co-volunteers Zakhir and Shamshu Alam, Ruhul approached the head imam, followed by other religious and community leaders, to convince them of the importance of the campaign. Only with their approval could they be sure that people in the camps would allow their children to be vaccinated.
"The smaller ones howl, squirming on elder sisters’ laps, but the older ones smile stoically as they receive their jabs."
Ruhul and Chrissie step neatly across a skinny bridge just two bamboo poles wide, heading for a hut with a yellow flag on the hill above. Ruhul carries an umbrella to protect himself from the fierce sun; Chrissie stops at a hand pump to soak her scarf in water and drape it over her head. “On these days, the temperature’s anything from 32 to 40 degrees,” says Chrissie, “and it can be a challenge to encourage people to come out of their houses in the middle of the day.”
Chrissie and her team spend seven hours covering as much of Kutupalong as possible. Photo: Natasha Lewer/MSF
By way of encouragement, a volunteer with a megaphone tours the area, reminding people in a booming voice that this is their final chance to protect their children from diphtheria.
Inside the hut on the top of the next hill, Alif and Sarmin are checking immunisation cards and vaccinating a line of children. The smaller ones howl, squirming on elder sisters’ laps, but the older ones smile stoically as they receive their jabs, then hold out little fingers to have their nails marked with black felt-tip pen.
The aim is to vaccinate all children aged between six weeks and 15 years. As many of the older girls are reluctant to venture out in public to the vaccination sites, female vaccinators like Sarmin gather all the teenage girls in the neighbourhood together in one house and vaccinate them in private.
Chrissie and Ruhul pick their way towards the next site, along narrow paths around the backs of houses, up slippery slopes and around the edges of small valleys planted with rice and other crops. They pass door-to-door salesmen, shops selling groceries and boys hauling sacks of firewood. Everywhere there is activity in the camp, as its residents prepare for the upcoming rainy season – frequently they step aside to make way for men balancing bundles of bamboo poles on their shoulders and children collecting buckets of mud for house repairs.
“To me, walking around the camps and checking in on the vaccination points is just a privilege,” says Chrissie. “You rarely take the main path – you go around the sides of people’s houses, seeing the detail of their lives and being able to stop and say hello. This is what MSF means by proximity – it’s what we believe in and what we should be doing. We don’t sit in an office telling someone else to do the job. To walk around, meet people, hear their concerns, reassure them – that’s what it’s about.”
The last stop is the distribution point back near the main road, where the teams meet to hand over their tally sheets from the day. Dr Jobayer of the WHO puts the data straight into his computer. He confirms that, over the three rounds of the campaign, a total of 340,000 children have been protected against diphtheria in the Kutupalong-Balukhali megacamp – a remarkable achievement.
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