Like most things in the Central African Republic, the vaccination system is decidedly low-tech. Most vaccines are transported over dirt roads and stored in kerosene fridges. Volunteers walk from house to house with loud-speakers (or sometimes just loud voices) to inform families about campaigns. Mothers go by foot, carrying their children on their backs to the clinic.
Even health workers in the capital Bangui face huge logistical challenges. The Bimbo Health Centre has a coverage area that includes villages on the outskirts of the city. Some of these villages are blocked off by impassable roads, others are in areas controlled by armed groups and nurses have to negotiate at road blocks before being allowed to pass.
The Oubangui River, which divides CAR from the Democratic Republic of Congo is sometimes the safest and fastest route for vaccination teams. The river is a trade thoroughfare for beef from eastern CAR, fish, sand, goods from DRC… And polio and measles vaccines.
Every month, the team from the Bimbo Clinic will travel more than an hour in a wooden canoe to vaccinate children living in villages along the river. They get to work in the early morning darkness so that they can beat the heat of the day on the river. They pack the cooler boxes with vaccines, buy petrol for the canoe engine, transfer their supplies to the riverbank, load the canoe and set off.
But a simple process like this can always be thwarted in CAR. When I was with the team, the canoe owners were late to the clinic, and due to a shortage of fuel in Bimbo, the nurse manager only found petrol at the third station she visited.
At the destination, the families living in the villages have been prepared for the visit by volunteers called ‘social mobilisers’ who tell them the place and the time of the vaccination clinic, and urge them to come.
The mothers have delayed their day’s work at the farm or the market to get their children vaccinated, and it’s a relief when the nurses arrive. They set up under a tree on the river bank and get started. The final step is easy – a drop in a pink mouth or a needle in a chubby baby’s leg, and lives are saved.
During two years of conflict in CAR, the immunization cold chain was largely destroyed and many medical staff fled their posts. UNICEF has been distributing refrigerators and cold boxes, and we’re the biggest supplier of vaccines in the country.
But vaccination campaigns wouldn’t happen without the Central African health workers and volunteers travelling by foot, on bicycles, or in wooden canoes, to reach the children in the furthest pockets of this ravaged country.
Madeleine Logan blogged from the Central African Republic since January 2014. This is her last post from CAR.