Measles vaccination in eastern Chad is a human and logistical challenge

In the street, dust was swept up by the harmattan (West African trade wind), a gaggle of children run about bare foot, a yellow paper in their hands. Laughing, they show it to the people sitting next to their doors. It is their vaccination card. These children are going home after a visit to one of the 12 vaccination sites set up in the city of Abéché by MSF.

Since February 7, more than 40,000 children have been vaccinated against measles in the city and the neighbouring countryside.

In mid-January, faced with the many cases of measles reported in the district of Abéché, Chadian authorities called on MSF to vaccinate all children between the ages of 6 months and 15 years of age against this contagious disease.

It took less than ten days for the emergency team sent to the site to set up this mass vaccination campaign: leasing of vehicles, establishment of a cold chain to keep the vaccinations at the right temperature, training of personnel provided by the Ministry of Health. The team, specialized in vaccination campaigns, has had to adapt to a difficult environment.

"In addition to the heat – it's almost 40° Celsius in the shade during the day – we have to respect fairly restrictive security measures," explained Dr. Nico Heijenberg, who is in charge of the vaccination campaign. "These measures had to be imposed following the frequent incidents that affect the organizations on site: theft of vehicles, night-time burglaries..."

Wadji, a young woman wrapped in a large multi-coloured veil, brought her children to the Taiba vaccination site in the middle of Abéché. Her two sons, aged three and five, are dressed in their Sunday best. They glance at nurses, somewhat fearful.

"I heard on the radio that there was a vaccination," said the young mother. "The children of two of my neighbours caught the measles in January. I want mine to be protected."

The number of cases of measles has risen sharply in the region since January. Since February 7, the MSF teams have cared for more than 100 children suffering from the disease.

"Measles is a very contagious disease and in order to stop the epidemic, we absolutely must vaccinate almost all of the children," said Dr. Eric Nilles, who is supervising the vaccination in the city. "But this is not easy since we only have an approximate estimate of the number of children from the ages of 0 to 15 in each location. During the dry seasons, many of them leave their villages with their families to live in the city. Moreover, some parents refuse to vaccinate their children."

Finding the village chief

As the first teams completed the vaccination in the city of Abéché on February 14, others started their work in the rest of the district. Florent Uzzeni, a nurse, is in charge of planning the vaccination days per site. To do that, he visits the villages and nomadic camps, makes the people aware of the situation and tells them when the team's next visit will take place.

His all-terrain vehicle must often make large detours to bypass the "wadis," dried rivers and avoid sand deposits. As soon as he arrives in a village, his first task is to find the leader of the community or an elder with whom he will make the first contact.

"We must convince him to assemble all of the children on the day when the team will visit," Dr. Nilles explained. "Generally this goes very well. They clearly understand our message because there have been cases of measles in all of these zones."

As of February 14, the vaccination teams will start going outside the perimeter of Abéché. They will penetrate deeper into the interior of the country, into the zones which are too remote to consider returning from to the city every day. Logistics will have to bring the vaccinations, the ice, the water as well as the food the teams needs in by truck each day. As for the teams, they will have to sleep on site, in the villages, for several days in a row, which represents a challenge today for MSF in Chad.

Other MSF teams are now undertaking, under the same difficult conditions, another vaccination campaign along the Sudan border, in the neighboring district of Adré.