Battered trucks and donkey tracks - vaccinations in eastern Chad
"The area is quite remote, sometimes insecure and very difficult to travel. MSF has hired battered local trucks to reduce the risks of car-jackings. The whole team consists of around 50 people, including logisticians, registrars, nurses, and drivers. We travel in convoy from one base to another, going in seven teams, vaccinating every day. An international team leader is in charge of each team, making sure that we go to the right villages and overlooking the vaccination.
"Another team goes ahead to talk to the village leaders, create awareness, announce our arrival, and find out more about villages, road conditions, etc. This team then gives the coordinator all the details and a list of villages in an area.
"Every day there is a meeting with the team leaders and the coordinator and so the villages are separated in the different teams.
"Of course, logistics are very important. Measles and Polio vaccines need to be kept by a temperature of 2-8 degrees, so a cold chain is involved – in an area in which the average temperature is about 40 degrees! From our base team in Farchana, two logisticians organize this cold chain, take care of the vaccines being transported (every 2-4 days) to the field, together with the other necessary things like needles, food, and water."
A different world
"Being in the area myself, I am so amazed how people can live in remote places like this, with not much food and sometimes no water. Children often look very dirty, but what else can you expect if there is no water nearby? The food is mostly dough made from millet with some sauce. In the market, you only see tomatoes, onions and peanuts. Meat, rice and pasta are a luxury. People get water with donkeys, if they have one, or by foot, carrying the water on their heads.
"We slept with a mattress and a mosquito net on the ground in the villages, so we have been quite close to the people. Often we were looked at by the children, how we would come home after a long and dusty day of vaccinating, take off our shoes and smelly socks and prepare our beds. Because of the lack of water we would often have only drinking water and some water to wash our hands with. This is quite hard if you are used to having showers every day! Of course this was only for a short time but it makes you very aware of how important water really is."
A typical day
"A typical day would start around 5.00, 5.30, when the sun rises. Waking up, packing your bed and private things, putting them on the truck, checking the truck for essentials for the day, then have some tea and breakfast and mobilize the team. Ask them about the security situation, clean the site and then try to be ready to go at 7 o'clock.
"Lots of times we have had breakdowns with the trucks. The roads and wadis [sandy 'rivers'] we had to cross were difficult to travel. Then of course there are car parts breaking and flat tires. A good journey in convoy would take us about three hours from one base to another but we have had days that took double the time. We would try to vaccinate on travel days, but this of course was not always possible. Erecting a new base consists of lots of work: cleaning the place, spreading the plastic sheeting for sleeping, install the kitchen, toilets and showers, if there was a well in the neighborhood.
"The next day we would try to drive off the base with our truck at 7 o'clock, when possible with a guide. He would lead the way - imagine going with the truck over donkey tracks - and coming to the village, speak to the village chief and find the place for a vaccination site.
"In some places lots of children and their mothers gather when we build the vaccination site under a tree on the side of the truck. It is very important the building of the site is done properly, so children can get the vaccination in the right way. They also receive vitamin A and polio vaccination, and it is important that they don't come back for a 'second shot.' Sometimes we would have to change sites more than twice a day because not many children were there.
"We had to make sure to be back at the base again around 5 o'clock. Then do the figures, make sure the truck is cleaned and take away empty vials, needle boxes and other rubbish. Around 6.30 we had a meeting with all staff, then some food and talk about the things that were important for that day. At 9 o'clock everybody was so tired that sleeping was never a problem."
"We would have some time off once a week. Try to get a little bit cleaner, write in diaries, and sometimes walk a bit or find a shop or market. Contact with family and friends was rare because there was often no network and no email facility.
"Still, coming back home after 6 weeks, I look back on the campaign as a really good time with lots of new experiences. I really liked the atmosphere of being part of such a beautiful MSF mission with lots of great colleagues."