A few weeks ago I started my eighth assignment with Doctors Without Borders - right in the heart of Africa, the Central African Republic.
The project I will spend my coming weeks and months in is quite different from my previous missions - this time I am part of a team running a preventive vaccination campaign.
The target group will include all children under five years old in a region in southern Central African Republic - that's an estimated target of nearly 40,000 children! All this will be done in three consecutive rounds, since the protection against the different diseases is much more effective with a second or third vaccination.
If everything goes as planned more than 40,000 children will be protected against eight frequent and dangerous diseases.
Travelling to remote villages. Photo: Vera Schmitt / MSF.
However, much remains to be done by then. Before starting a vaccination campaign, especially one of this size, it is important to plan really well. We'll be orgainising as much as possible and down to the smallest detail, since everything which has not been planned before leads to delays later on and is often difficult to remedy during a campaign.
In the last two weeks we have already completed an important part of this planning, visiting the whole region. We went to almost every small village, for some of them it takes up to 3.5 hours to reach – one way!
Overcoming these limitations to access of health care is one of the top objectives. This is especially true for the vaccination campaign itself, but also for our visits in advance. The area in which we are working is densely wooded. The roads on which we are travelling can often not even be called “roads”, but rather narrow paths.
This is one of the better bridges! Photo: Vera Schmitz / MSF
There are many small creeks and ponds, with bridges which are not always strong enough to carry the load of a car or aren't wide enough to cross. As far and as much as we can, we drive with our land cruisers - and all those villages that we can't reach like this, we go either by motorbike or a small boat. Sometime though, you have to rely on your own feet.
On the road. Photo: Vera Schmitz / MSF
During this planning phase, however, we have not only overcome the limitations given by nature, but sometimes even national boundaries. During our research, for example, we have encountered a village which extends both to the territory of the Central African Republic and to that of the Republic of the Congo.
In order to ensure that that part of the population which is living in the Congolese area can also benefit from the vaccination campaign, we spoke with the village leaders of both parts as well as with the border officials to explain our actions and intentions.
Meeting the responsible and respected persons on site is always of great importance and an essential part of our visits. In all those countless villages we have visited during the last two weeks, we have whenever possible visited the local village leader. Acceptance, communication and cooperation is incredibly important, so that on the planned days of the vaccination campaign, the population is well informed and does indeed bring their children to vaccination.
In some of the larger villages there is usually a health centre, which often gives us valuable information and is going to support us during the actual vaccination campaign.
One of the villages we visited. Photo: Vera Schmitt / MSF.
Informing the local population about the campaign in advance was only one of the reasons to visit the region. Another objective was to gather information and to understand the situation on the ground as much as possible...
Most of the places are not mapped, nor were the streets and paths on the way. Where is the village, how do we get there (By car? By Boat? By Foot?) And how long is the journey?
How big is the population, will a day be enough or will it take two or more to reach all of the children, or can we perhaps send a reduced team, while the other half is proceeding to the next village?
Where exactly can we vaccinate? Rain is coming soon, so the shade among the large mango trees is only the last option, if there is no other possibility. But luckily we mostly find a church or a school which is suitable for our purpose.
Then – are there villagers who can read and write well enough to help us fill the vaccination cards? – Illiteracy unfortunately is quite common.
Who can help in the sensitisation a few days before the vaccination so that all mothers know when they should come and where?
All this information now still has to be merged - which is the actual beginning of microplanning of the campaign. Which team travels to which village and when? How many vaccine doses must be taken and how many vaccine carriers (cool boxes) and ice packs do we need? If the cold chain breaks, this would be a disaster, since the vaccinations are ineffective if they exceed a certain temperature.
Still the team is not complete, in the coming days there are still various posts to be recruited and following this different trainings.
So there is still a lot to do - but the prospect that soon 40,000 children will be protected from diseases such as measles, polio, pneumonia, tetanus, whooping cough, hepatitis and diphtheria is quite enough motivation for some more days' hard work.
PS: The landscape in which we are traveling is an extra bonus. Nearly untouched and often beautiful.