Sunday, April 26, 2009

Jornada de Vacunación – The Great Vaccination Campaign

Well, I’ve arrived in my “site” for the next two years, and what better way to be welcomed into a community than with a Tetanus shot?? Not for me, but for all the youth in the municipality. Every April marks the annual Vaccination Campaign in Nicaragua, something that the Ministry of Health despite its lack of resources and organization, does quite well. The Health Center staff is divided up into groups of two to four and “take-on” each small village at a time. There are 24 communities in my municipality, so they do three to four villages a day. After the past nine days of doing this (there are still two more to go), I am exhausted – and I’m not even vaccinating! The Ministry of Health workers have really amazed me with their energy every day, their care in giving the vaccines, and their attention to detail. The records system here consists of old notebooks marked with faded pencil. The dates of past vaccinations are frequently illegible, and often we come across a child whose mother doesn’t remember when he was born, or a child who has not been recorded in the national census. These health care employees have been working for this Health Center for years, if not decades, and they practically can recite the names of all the children in the surrounding villages; no small feat in Nicaragua where women have children almost annually.

So every day, starting promptly at 8 am (in “Nica time” that means about 8:45) all of the workers fill up the American Red Cross donated coolers full of anti-polio drops, Tetanus, DPT, dT, MMR, Rotavirus and Pentavalente vaccines, grab a disposable cardboard sharps container (donated by Norway), paperwork listing all the children and “MEFs” (women of “fertile” age), anti-parasite pills and Vitamin “A” drops. We all climb in the back of the Health Center pick-up truck and take-off for that day’s communities. As we weave along the dirt roads up into the mountains of the north of Nicaragua, we all find ourselves clutching to whatever object is closest to avoid falling out: a shoe, a leg, a shoulder, a vaccination cooler… Crossing small rivers, stopping for cows to cross, and occasionally picking-up a hitchhiker, the trip is anything but uneventful. I really enjoy looking around and seeing all the flora of Nicaragua. Mangoes, bananas, coconuts, limes, oranges, and corn abounded. If we were lucky, some of the mothers or village health care volunteers, “brigadistas” would gift us some of these summer treats. Note from my experience: mango can be a very messy fruit that permanently tints anything it touches (face, hands, clothes) bright orange. Should be avoided when one does not have soap and water…
We are gradually dropped off in our vaccination teams, and we head to the house of the brigadista who is in charge of that year’s vaccines. Ideally, ideally, that brigadista will have already notified all the parents in the village of the date and time that they should come to the vaccination house, and the parents will arrive punctually and with their child, who is no doubt, ecstatic about the thought of receiving his vaccine. But of course, being the real world, sometimes parents wouldn’t come to vaccinate their children, because they forgot, or also because they, like their children, don’t like vaccines. There is a lack of education about preventative medicine in Nicaragua, and most parents avoid the vaccination campaign, not knowing that they are ultimately hurting their child. My role during the vaccination campaign was to support the nurses and doctors doing the vaccinating and tabulating of children. I gave out anti-parasite pills, handed out balloons, helped hold down screaming children, explained to parents what each vaccine was for, and also gave mini-talks about diarrhea, malaria, purification of water, etc.
After we had spent the morning at the designated vaccination house, it was time to track-down those children who hadn’t come to receive their vaccines. This wasn’t always easy since streets here don’t have names, houses don’t have numbers, and people are more peripatetic (yes, I used it in a sentence!) than Humpback whales. This was the part that wore me out usually, since we had to hike up and down windy roads in the 94F heat to search out a lone house which contained perhaps just one four-year-old child who needed her anti-polio drops. However, as one of the nurses told me as we hiked, “We have goals to complete!” (Each municipality has Ministry of Health determined numbers of vaccines given they try and reach). Often, we found ourselves wandering the village, asking passing children if they knew where “Doña María González” lived, and if they knew if her “niño” was with her, only to be met with blank stares or a shrug of the shoulders. We usually ended up returning to the Health Center at 4 pm or so, to do the entire process again the next day in another far-flung village.
Although the heat and the long hours of waiting for mothers to arrive with their children took a toll on me, I really enjoyed getting out into the small communities to see how people live in my municipality. There are 6,000 people living in the immediate town where I live, and 16,500 in the entire municipality. What I saw and heard during the vaccination campaign really helped me gauge the health of the municipality. In some communities, people barely had latrines, and pigs and cows wandered loose, their feces littering the yards of the houses, causing danger for the barefoot children who constantly played in the dirt. Other health volunteers in the villages told me of contaminated well water which they believed was making the children sick. They said that people were bathing in the well and washing clothes, infecting the water. In other communities however, I saw glimpses of hope: mothers that were “planning” (using a method of birth control), children who looked healthy rather than hungry and full classrooms at the elementary school.
I’ve yet to tell you though my favorite memory of the vaccination campaign. One evening, I was at the Health Center making a bulletin board about vaccinations to put up in the Center, when my counterpart realized that we had yet to announce to the city that we were vaccinating tomorrow. “I almost forgot!” she exclaimed, “Let’s get the megaphone quick!” I would have burst out laughing, but I was already familiar with what was coming. In Nicaragua, when you need to announce something to a large group of people (say, a town of 6,000 like mine), you do so not by radio or poster, but by a huge megaphone strapped to the roof of a vehicle with a microphone attached, and you drive all over the city saying what it is you need to announce. “Come on Penny, I need your help.” She beckoned towards the truck. Her voice was almost inaudible because of a bad cold, so I knew it would be me who would be doing the announcing. Great.
We hooked up the microphone to the Health Center pick-up and started sounding the emergency alarm of the vehicle to announce our presence as she pulled us out of the Health Center and down the streets of the city. She had advised me on what to yell: “Attention! Attention! Mothers of children! Tomorrow we will be vaccinating all children under 5 years old at the brigadista’s home in your sector, the house of Don Luis Cruz. After 9 am bring your child with their vaccination card to be vaccinated. There will be candy, clowns and balloons! If you do not bring your child, we will come and find you!” It’s a pretty funny, but actually a very successful way of getting a message out, since most Nicaraguans are always at home with the doors open, chatting with neighbors or watching TV. I can just imagine them thinking, “Where did that gringa come from and where is her voice coming from?” as we drove around the city for about an hour, my voice becoming hoarse by the end.
I’m looking forward to sleeping-in after this whole campaign is over, but I feel pretty satisfied, even if I’m just borrowing the glory of the dedicated Health Center employees. If there remains any child in Nicaragua who has yet to be vaccinated by the end of this campaign, it won’t be because we didn’t try!