Barriers & Swamp Areas
In 2017, the Global Polio Eradication Initiative renewed it’s focus on identifying and reaching children that had not yet received a vaccine. Thanks to this effort, more than 4.5 million children under five received vaccines through the vaccination campaigns in Chad. Among those vaccinated were the more than 215,000 children who reside on the difficult-to-access islands within the geographical boundaries of Nigeria.
Heading one of the vaccination teams in the Lake Chad Basin Region is Dr. Adele Daleke Lisi Aluma. Her day is filled by trying to reach the 45% of children that live in one of the most geographically challenging areas of Africa. These remote islands are surrounded by geographical barriers such as sand dunes and swamp areas, violence, insecurity, and poverty. Because of this, the people on these islands usually do not receive health care or other government services. Furthermore, the vaccination team needs to make sure that the program makes the best use of resources to reach the most children every day. This job is a tough one, to say the least.
The first step for every campaign is to plan the route. The team spends time studying maps and comparing information in order to find the most efficient way to reach the islands. Dr. Adele explains, “The team often plans campaigns to take place at the same time as the weekly market on the islands, to vaccinate children when they are with their mothers buying and selling necessities.” Additionally, in order to increase acceptance of the vaccines, a few days before each campaign the team telephones village elders and leaders to explain why protection against polio and other vaccine-preventable diseases is so important. This helps to improve the program’s reach and awareness.
The journey to the islands is the most difficult part of the process. Lake Chad is made up of waterways filled with reeds, trees, wildlife, and insects. To get to the islands, the team uses a paddle canoe, which requires them to navigate difficult terrain for several hours. Aside from the terrain, they also have to make sure that the vaccines are stored properly. It is extremely important that the vaccines be stored and distributed at the accepted cold chain temperatures. The World Health Organization states, “Oral Polio vaccines can be stored until expiry date at −20 Degrees or at +2 to +8 degrees Celsius. The injectable liquid Polio vaccines can occupy the same compartments as the oral vaccines during transit but can be damaged by freezing, so special precautions are needed to ensure vaccines do not reach that point.“ That means the team has to make monitoring the storage temperature a priority. In order to keep the vials cool, the team uses a solar refrigerator at the healthcare base, and during transit uses vaccine storage coolers filled with ice packs. However, a cooler’s temperature can fluctuate throughout its interior. It’s a prime example of why the monitoring of temperature controlled goods, especially those that are so volatile to changes in environment, is critical to keeping patients safe.
Upon reaching an island, the vaccination process begins. A majority of children in these remote island villages have received less than three doses of the oral polio vaccine, leaving them vulnerable to the virus. One by one, the team works to protect them, and also looks out for signs of the virus in the community.
On one trip to the islands, Dr. Adele discovered a child with acute flaccid paralysis, a potential signal of polio, who had not been reported to the polio surveillance network. While the child didn’t have polio, this exemplifies the crucial need for the program to continue to access these difficult to reach places, vaccinate children, and encourage communities to report any suspected polio cases. Dr. Adele is helping to strengthen surveillance through training community members in each village to recognize the signs of a potential polio case.
Despite the many challenges that come with the vaccination campaign, the team, especially Dr. Adele, finds a huge sense of achievement in their work.