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Melbourne nurse Anthony Flynn writes from Oromiya, the largest region in Ethiopia, where he has been involved in an emergency measles vaccination campaign. This is Anthony’s second mission with Médecins Sans Frontières (MSF). His
first mission was in Uganda.
Measles was first reported in the Oromiya region in December 2007. In response, MSF and the local health authorities completed a regional survey which found that measles cases were prevalent throughout the region in alarming numbers. By January 2008, the teams coordinated to institute a mass vaccination campaign in the two most affected woredas*, Hambella and Gerche. In a kebele** of the Hambella woreda, 120 deaths had already been reported this year. An emergency intervention was required.
Gail, a fellow nurse from Australia, our logistician colleague, Daniel and I were rapidly seconded from our usual activities in the Somali region with MSF and joined the team who had been setting up the project in the regional capital for four days.
Only Daniel had prior experience with emergency vaccination/treatment programs. So Gail and I were pretty 'green' in regards to measles, its complications and emergency vaccination and case management procedures. It was with this experience and a box of date bars that we presented ourselves to the coordination team waiting for us in Oromiya. Daniel and I were allocated to Hambella whilst Gail was sent to support the Gerche team.
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| Populations lining up to be vaccinated in Oromiya, the largest region in Ethiopia. © MSF |
Ethiopian staff recruited from other MSF projects in Ethiopia led 15 teams, each consisting of six nurses and community health workers from the various Ministry of Health-run clinics in the area. Each team was responsible for the daily vaccination activities across almost 50 kebeles in the two woredas. In each of these kebeles they recruited a further six locals to help with crowd control and mobilisation and other important activities of the day. We were asked to support these teams, their movements, management of supplies, management of cases and supervise the daily vaccination activities for seven days, until the international team arrived from the Brussels emergency desk to take over.
It was a brilliant week, albeit full to the brim with medical, administrative and logistical challenges. The first three days were spent finalising and training the staff of each team. In this time we set up the two satellite locations in Hambella and Gerche from where the teams would restock, refuel and leave to the various outlying kebeles, some up to 20km away and some only accessible by motorbike or horseback. Several teams set up camp in these villages after full days of vaccinating in order that they would be ready to start vaccinating early at their next site the following day. These camps ranged from the floor of health posts, to homes of kebele leaders and camping tents.
Each morning we were awake with the rising sun and each night asleep late after regrouping, debriefing, restocking, and replanning in order to achieve our daily targets. Based on census derived population figures and demographic norms, we aimed to vaccinate approximately 50,000 children between the ages of six months to 15 years over a period of ten days. This roughly equated to 2000 vaccinations per day in each site. We expected to see between 5-10 active measles cases per day at each site but instead treated between 50-80 cases.
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| MSF staff preparing for the mass vaccination campaign in the Oromiya region. © MSF |
Complicated cases requiring a level of sophisticated care and ongoing monitoring were referred back to the bases of each woreda, sometimes by horseback across otherwise unpassable terrain. The most common complication requiring this type of referral was severe malnutrition, a typical complication of measles and probably exaggerated because of the remoteness of the villages and the consequent lack of access to effective health care faced by most of the population. As a result, there was always more than one complication; those typical of measles like conjunctivitis and pneumonia combined with various unrelated issues like infected wounds and chronic anaemia. Occasionally severely complicated cases were referred to the regional hospitals and some to Addis Ababa (the capital of Ethiopia).
Three days into the campaign, with our teams demonstrating self sufficiency and our satellite referral centre resourced and functional, I decided to leave the base and visit our most remote team in a kebele called Buku Saissa. The team had been deployed one day prior and on this day they were to be starting activities in this area 16km away, only accessible by foot or horseback. The activities would continue for three days, over three kebeles, with the aim to vaccinate approximately 5000 children and to treat other complications presented to MSF staff. Therefore it was important to evaluate their first day of activity in terms of cases, consumption, conditions of the team and overall their ability to fulfil their objectives without access to the main base.
This was probably the singular most rewarding work-related experience I have had so far. The horse that was arranged for me was too small for me to ride. So I took the opportunity to jog alongside the horse as the incredulous guide rode and carried the supplies. We travelled through some of the most beautiful countryside imaginable for 16km, to Buku Saissa, a beautiful little village situated on a ridge dividing two luscious rolling green valleys, filled with farm animals and grazing horses. I arrived here to find the activity being proficiently coordinated by our skilled team leader, Abdu. Unfortunately as it was my last day and we were to return to Addis Ababa early the following morning, I had to decline Abdu's offer to stay that evening for dinner with the team and the local leaders and instead walked 16km back to Hambella, beside the horse and its confused rider, with a bag full of used sharp containers and other waste. Upon my return to the base I reported back that Abdu and the team in Buku Saissa were doing very well and needed very little in terms of resupply and other support.
The following day we left the Oromiya region for Addis Ababa, exhausted, fulfilled, sentimental and a little disappointed that we couldn’t see the end of the program that we worked so hard to establish. At 8am the following day we boarded a plane which was to make the maiden trip from Addis Ababa to Fiiq, our home in the Somali region, to recommence the activities we were brought to Ethiopia for in the first place.
* Woredas Districts in Ethiopia
** Kebeles Neighbourhoods or administrative units/associations within a Woreda |
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