Chris: managing measles in Malawi


I am a Registered Nurse. I’ve worked in paediatric infectious disease in Darwin, indigenous and remote communities throughout Australia, and ski fields here and overseas. I’ve also worked in a few war zones, which are often reservoirs for communicable diseases, so when I come home I can see the benefit of the vaccination programs we have here and feel pretty lucky.

I few years ago I was sent to East Africa to work as a Vaccination Nurse to try and combat and contain a measles outbreak. It was one of the hardest things I’ve been involved in, and the first time I had seen deaths from preventable diseases other than tetanus and cervical cancer.

I was part of a bigger team. My journey started with a surprise phone call from the Medicins Sans Frontiers (Doctors Without Borders) office in Sydney, which saw me on a plane that night to Paris, and two days later I was in the African bush. We set out in teams of two visiting Remote Health Clinics, identifying measles victims, treating them and counting the fresh graves of the victims.

We then mapped together a plan where we set up points where we could vaccinate as many people as possible. They had to be within walking distance of a village. It may be a church, a village hall or even the shade of a tree. A mother there often has four very young children so you have to be strategic as walking with 4 kids under 6 can be hard on a mum. I was in charge of a team of about 100 African health workers who were divided into 12 teams and sent to remote areas. Between us we would vaccinate about 20,000 kids a day.

I told my teams I wanted them to have left the base by 05:15 each morning, but most were gone before 04:45, such was the dedication of my health workers. We would then return at night fall, restock the vaccines and ice bricks, and prepare to start all over again in a different location. Bed time was often 01:30 for me and the French logistics guy. A shower was a bucket of brown cold water pulled by a long 20m rope from a dark deep well.

During the day I would drive around to my teams and check how they were going and help them organise themselves, check the vaccine cold chain, negotiate with village chiefs, and make sure they were working safely. Malawi has a 20% HIV rate, so the potential for needle stick injury is an ongoing concern. Some things I will never forget. As I moved further south over a period of two weeks the incidence of measles was increasing. I drove to the top of a hill above a dry river where a mud walled church with a thatched roof was sitting alone in the baking sun. Here one of my teams had set up their vaccination station. The church had a separate entrance and an exit. The people would walk in one way and out the other getting vaccinated in-between. I remember a large wooden cross with Jesus Christ looking down over us as we worked. I am not religious, but I stood there wondering if he was helping us in any way. Such is the way thoughts can travel in desperate situations.

Out the front of the church sheltering in what was left of the morning shade were two mothers cradling the limp bodies of their teenage boys. Their eyelids were swollen and shut, lips swollen and airways nearly closed. I pulled out my stethoscope and listened to their chest. There was barley a whisper of air going in and out of their lungs.

I popped an drip in, ran some fluid, and gave the kids some medication to help open their airways, though it was a token effort as they were nearly gone. I arranged for the kids to be taken 100 miles away to a catholic hospital that was already barely coping. “Where do you send a sick kid to in a county like Malawi?” I asked myself.

After the ambulance left I then wondered if instead I should have just organised for the teenagers to go back to their homes to be with their families to die, or if they had even a slim chance they could fight back. I then went to the village cemetery to count more fresh graves, and spoke to the health worker about the teenagers he had been managing. A few hours later the car returned with the bodies of the two boys, who had died on the way to hospital. I lost it at the health worker and asked him why he didn’t contact a hospital earlier as it was one of the few villages that had phone reception. He told me it was because he didn’t have credit for his phone.

I contacted the MSF base, and sent another team down to that village to teach the health workers how to treat measles, and I gave him some phone credit. Transport in these villages is often a bicycle or an ox cart which is slower than walking pace. Vehicles are few and far between so you have to take the referral of patients in context with the situation. Someone gets sick, where do you refer him or
her to? About this time my driver had to return home, as his 30 year old brother had died of measles.

A week later I found myself trying to negotiate with Christian Elders who didn’t believe in modern medicine. That’s another terrible story. This was just the start of many frustrating episodes on that mission and why I’m passionate about community health.

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