Deepest, darkest and furthest away - vaccinating 100,000 in the DRC

The current map It will begin with a series of exploratory missions, visiting the health posts to prepare the ground for the vaccination. The map we had was virtually useless, but we did an estimation that it would be possible to visit all 18 health posts in one week. Planning the campaign On August 14, I left the pollution of Kinshasa, the capital of the DRC, to head to Oriental Province where I will be running a measles vaccination for the next six months. The heat is really striking. Mbandaka, the provincial capital is situated right under the equator. The dampness in the air rots everything fast and it is impossible to keep anything dry. The seasoned expats have told me that the clothes start to rot on the shelf if they are not used fast enough. I am here to coordinate a measles vaccination campaign here. Over the past year and a half, MSF has vaccinated over 500,000 children and now, with my project, we are trying to reach another 100,000. The Basankuso area is where we will do the vaccination. There are 245 villages along the forest trails, accessible by motorcycle. There are 251 small villages (that we know of) by the rivers, with an additional 41 extremely inaccessible villages hidden deep into the forest. It all adds up to 540 villages in total, although we suspect that there are a lot more along the rivers. All these villages have to be visited, even if there is only one single child in a village of just a few people. The aim of the campaign is to track down 100% of the target population. But before this can even get started, we have to plan; identify the villages; routes; staff and all. So it will begin with a series of exploratory missions, visiting the health posts to prepare the ground for the vaccination. The map we had was virtually useless, but we did an estimation that it would be possible to visit all 18 health posts in one week. We left Mbandaka in the small MSF Cessna plane that does all the tours in the area. Before we left, I had been to the office to pick up the survival kit and camping gear that you get when working in the bush. I really do not like flying, but through the front window I was able to have a good look at the terrain where I am going to work for the next few months. As I sat there and watched everything pass by I really understood why this area was a white spot on the map long after all other continents of the world had been explored. It is just dense rainforest. As the pilot said, "like a green broccoli mass". Home on the river bank But that day I seemed to attract injuries. Later I was bitten in the head by a large insect, possibly a spider, that had crawled inside my helmet. It swelled up a bit and it hurt for a while, but it is OK. Into the bush The morning of our departure we had our first motorbike accident before we even left the MSF compound. The driver injured his thumb so badly that I thought I would have to stitch it up. And we had to leave the nurse behind because of a foot injury. At this rate, I thought, we might not have enough bandages so I quickly raided the office emergency box and stuffed some more bandages into my backpack. In the end there were five motorbikes with eight people. My team consisted of three: Congolese logistician; a driver; and me. With all the luggage, you sit jammed between it and the driver. In fact, it is quite difficult to move at all. Some of the rivers we cross are so deep we have to use a pirogue. Sometimes there are the remnants of a bridge, but they are usually half sunken and so narrow that they are useless, even on foot. As for the bike travel, I hurt my knees from constantly crashing through branches and vegetation. I finally had to stop and put bandages over my jeans as protection. After I put some big leaves in the bandages, it worked quite well. At one point in the days we spent covering the territory, my motorcycle and I almost crashed. We were pretty close many times but, on this occasion, my foot got caught in a root and my leg was twisted from the knee. It was terribly painful and I thought something was broken. Luckily it turned out not to be serious. But that day I seemed to attract injuries. Later I was bitten in the head by a large insect, possibly a spider, that had crawled inside my helmet. It swelled up a bit and it hurt for a while, but it is OK. Piroques on the river The mothers of the children who are sick just do not remember, or know, if the child was vaccinated for measles or not. That is why we try to give different vaccinations in different places of the body; a mark on the bottom means measles and on the arm, polio. Finding the health posts Throughout the journey, we stopped at different health posts and talked to the staff to find out about the population, complete the number of villages on the map and ask about distances, if it is possible to use motorcycle, pirogue, or if you have to go by foot. You rely on the map for basic information, but everything has to be checked with the locals. We also have to try to identify if there are people in the villages around the health posts that we might use in the campaign; people with medical background, or people who can simply just read and write. The DRC is a conflict zone with a lot of displaced, so many have not had the opportunity to learn. Since there has been a small measles epidemic recently in the Basankuso area we asked at each health post about how many cases were reported. The information given was usually an estimate and many of the children who had suffered from measles had, in fact, already been vaccinated. This is not a good sign as it indicates that the previous vaccination had been done badly. Another factor may be that the mothers of the children who are sick just do not remember, or know, if the child was vaccinated for measles or not. That is why we try to give different vaccinations in different places of the body; a mark on the bottom means measles and on the arm, polio. A bed for the night By the time we finish in the evening it is usually dark and we still have to find somewhere to sleep. We sleep wherever we can, in consultation rooms, tents and in people's huts. One night I stayed in one of the two rooms of a villager's house that was close to the health post. Since it was quite a large family, there were people coming and going all the time. I was so tired I wasn't even bothered that people were standing looking into my tent through the mosquito net. It was actually quite cozy to lie there and listen to the whole family talking, singing and getting ready for bed. You get filthy after riding on the roads on bike. My once white MSF t-shirt is always brown and my body covered in a layer of dust. In one place they gave me bucket of cold water and I found a spot to take a shower. It was a bit out in the open, but nice to be outside in the moonlight. The noise always wakes me up early. It almost seems to be forbidden to sleep after half past five here. The sounds and the light of the jungle grow stronger and stronger. It is as if the whole jungle wakes up at the very same time. By the time the five day journey ended, we had visited all the health posts and we have a better idea of the challenge ahead of us. There are already some reasons for concern about how difficult this project will be. Some villages are deep in the forest, only accessible after an entire day by pirogue. No one seems to know how many people are staying in all the different villages along the rivers, since they are a moving population. This could potentially be a very difficult to try to reach all these villages and maintain the cold chain with only ice packs and cool boxes for the vaccines, which have to be kept between 2 and 8Ã?°C. Plotting the campaign will be a geographic and logistical challenge. Back in town Back at Basankusu town, we have to organise the data collected during the 5-days. This is not easy since we have a lot of contradicting information. The health authorities here have some data on the map that I jotted down before we headed out. But now we have done the long journey, it turns out that they have different data in their files. Plus, it is always difficult to get the information out of the villagers when visiting the health posts. But the map has improved. We have changed a lot of things on our original as well as the information we started out with. In the end we just decided to trust what we had seen during the explo. Over the next days we will sit from morning to evening to try and organize the info in a structured way. My evenings are spent putting everything in Excel files. I spent some hours to compare some different maps and then drawing my own with the correct distances on it. We have started to make lists of all the villages. There are hundreds of them. We will use this when we start drawing up all the different teams and how we will work for the stockage sites, preparation sites and so on. Karl, a logistician on the campaign, and I need to go to Mbankdaka to prepare all the things that have arrived from Lukuto. It takes two days. On the way back we will probably go together with our vaccination materials (fridges, cool boxes, generators, gasoline). If we do this, we will be able to see that everything is put on the pirogue and we will also be the ones to unload it. We just received word that the pirogue going from Mbandaka to Basankuso and Djolo has tipped over and all the things sunk. They tried to get the military and the villagers to help out to retrieve everything. For the hospital here this means that all their medical supplies probably has been destroyed. Maybe it is possible to save some of the medical things, but most likely not. The plan for the moment is to try and start the campaign in two or three weeks. We will divide it in three zones and cover each one in about 10 days. The last zone to the north we will probably not be able to visit beforehand. It is smaller than the one we visited in this explo mission and the only way to get there is by pirogue. This will consume a lot of fuel so, for the moment, it is not possible. Jesscia's diary will be updated regularly as she continues with the vaccination campaign, but her updates will not be frequent. The plan is for her to update whenever she manages to surface from the effort and have access to a telephone where she can send her mail. Gaps up to a few weeks might pass between updates.