MSF-USA: Juba, Sudan: A Day of Meningitis Vaccinations in Juba

March 14, 2007
Juba, Sudan: A Day of Meningitis Vaccinations in Juba

People wait in line for meningitis vaccination in Juba, Sudan. Photo © Anne Yzebe

Doctors Without Borders/Médecins Sans Frontières (MSF) began a meningitis vaccination campaign in Juba, the capital of southern Sudan, on March 14. MSF is currently vaccinating the population at risk in three health zones in the capital city. Approximately 160,000 people between the ages of 2 and 30 will be vaccinated. Below is a synopsis of the second day of vaccinations, March 15, from one of the 12 sites.

6:30 AM:

An early workout for the entire team. Logisticians begin by checking all necessary materials and equipment is counted; they remove it from storage and place it in cars. Each team takes a blue freezer (RCW25) containing vaccines packed in ice. A second freezer is filled ice packs to maintain the cold chain. Each container weighs 40 kilograms (88 pounds). The teams must be able to plan for unavoidable problems like the breakdown of a car and find immediate solutions to ensure all needed materials reach the vaccination site.

7:00 AM:

The team arrives at Konyo-Konyo primary school, 1 of the 12 sites. In front of the school, colored ropes mark two distinct lines for the coming crowd. Members of the local staff finalize the details for crowd control allowing for two simultaneous vaccination lines for the next 8 hours. Everything must be finalized prior to the arrival of the first group. The goal is to have at least 300 syringes ready to be used. Luc, a logistician, ensures those waiting in line will be sheltered from the sun and water is made available for them as women and children await their turn.

Meningitis vaccination in Juba, Sudan. Photo © Valeria Bonanome

8:00 AM:

Before the first group makes its way to the vaccination tables, two health assistants open the syringe packages and cut cotton to make small balls. At their feet, two preparers have small coolers containing the vaccines packed in ice. The process is easy: a solvent is added to dissolve the powdered vaccine. Then, the needle is inserted in the vial and filled to the 0.5 L line. One vial contains 10 vaccines. They maintain the "cold chain"–all vaccines must be kept within a temperature range of 2 and 8 degrees Celsius (35 and 46 degrees Fahrenheit)–by immediately placing them into refrigerated boxes directly into freezer-bags for the vaccinator to use. The vaccinator dabs each patient's arm with alcohol, injects the vaccine and throws out the syringe in specially designed containers. This setup allows for five to six vaccinations per minute.

9:00 AM:

Amina, 15 years old, is waiting patiently among hundreds of people. She proceeds for a few meters but she is stopped by one of the guards. She will be able to proceed as soon as the dozen people ahead of her advance. She has returned from Uganda and heard from her mother that vaccinations were taking place in town. She knows that meningitis kills people and asks whether the needle will hurt. After a 20-minute wait, it only takes a few seconds to finish. She then proceeds to the registration table where she is asked for her age.

11 AM:

While the crowd continues to grow in this site, a public-awareness campaign is taking place around town, as cars drive through the different districts of Juba. With the help of a megaphone, they are reading a message in English and Arabic urging people to be vaccinated for free. The day prior, additional information and messages also appeared in the local newspapers and were dispersed over the radio. Owen, one of the drivers, also alerts the public of the cholera treatment center run by MSF that is now open in Juba. In addition to the meningitis epidemic throughout southern Sudan, cholera has also been on the rise in the areas around Juba.

4 PM:

Marc, the MSF head of mission, meets with some of the health authorities of Juba to address some questions regarding the meningitis campaign.

In the absence of treatment, MSF's task in this context is to collect the data necessary for the evaluation of the situation and to vaccinate in order to decrease the mortality linked to this potentially life-threatening infection. In Juba, the worst cases are referred to the teaching hospital.

5 PM:

With the closure of the vaccinations sites, the teams pack the materials and return to the compound. The day is far from over, however: waste materials from the vaccinations needs to be packed and brought to a specific location to be burned. They also need to ensure enough power is generated to keep the vaccines cold overnight. Cecile, the medical coordinator, analyzes today's data: 33,000 vaccinations were carried out throughout the 12 sites. Later tonight, the coordination team will meet to discuss the findings. There are still three to four hours of work however and the day begins once again at 6 AM.