“It’s between 11 a.m. and noon at the moment. Anyone who knows shadows knows that,” says Djeynabou Abdoulaye, smiling. She has come to the village school in Tassakane, Mali, to get her child vaccinated against measles. “We’re lucky it’s not raining today.”
Despite the official end of the war in 2015, the Timbuktu region in northern Mali remains tense, and security incidents and criminality have had a significant impact on people’s ability to access health care. This, in turn, has led to low rates of vaccination coverage, especially among children. A number of measles cases were reported in the area starting in February.
In response, Doctors Without Borders/Médecins Sans Frontières (MSF) worked alongside the Malian Ministry of Health (MoH) to launch a vaccination campaign in September. Working together, the teams reached more than 50,000 children between six months and 14 years old.
Measles is a highly contagious viral disease. The symptoms appear approximately 10 days after exposure and can include a high fever, rash, runny nose, cough, and pink eye. A child with measles can quickly become malnourished or develop other more serious complications that can affect their eyes or their brain. When combined with malnutrition or malaria—both common in this region—the effects of the disease can be devastating.
But there is a safe, cheap, and effective vaccine—one of the World Health Organization’s (WHO) routine childhood vaccinations. The challenge comes in reaching those children who have gone unvaccinated, as well as ensuring that the doses of vaccine are kept at a cold enough temperature to remain fully effective.
MSF and MoH’s vaccination campaign was done in three stages in 12 of the 19 zones of Timbuktu throughout September, with teams basing themselves in health centers or turning schools or other buildings into vaccination sites for the day. The zones ranged from easy-to-access urban areas to rural ones on the opposite bank of the Niger River, where the backwaters, pools, and lakes form a natural barrier.
The campaign also coincided with the beginning of the rainy season, when people move to the river’s edge for fishing and agriculture. The rising water levels make road travel difficult, meaning that the river becomes the only means of access.
“It takes an hour to an hour and a half to get there in a dugout canoe,” says Tuo Songoufolo, MSF’s medical adviser for the project. “People tend to spread out over the area to allow livestock to graze or to grow their crops. And that means we need to follow them to be able to vaccinate.”
This does not deter the mothers, though, who are very aware of the spots on the skin and the fever that signal the arrival of the disease. Some travelled from surrounding villages, such as Aïssata Ibrahim, who rented a canoe to make the journey so that her four-year-old daughter could be protected against measles.
The vaccination site in Tassakane is busy. The team is set up in a classroom, with lessons on a chalkboard in the background. Outside, children and mothers mill around waiting, while others with their yellow WHO vaccination cards are ready to head home.
Mariam Hammadoun Maïga, mother of 16-month-old Amadou explains: “There are people who live far away. And with the [flood] water at the moment, it’s very difficult for them to come for the vaccination. But despite that they came to get their children vaccinated today.”
Amadou, sitting on his mother’s lap, watches cautiously as the nurse slips the needle into his arm. He doesn’t cry. “I came because vaccination is vitally important to protect children against disease,” says Mariam. “We say that prevention is better than a cure, therefore it’s better to vaccinate children than to treat them.”