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09/11/2003: "Kandahar Chronicles #6 - 03/09/2003"

In July, the medical team had successfully identified a disease as it crept through the IDP camp. Young kids were especially vulnerable and three died during these first few days. Diphtheria manifests itself first as a sore throat and can be identified by whitish splotches on the membranes in the back of the throat. After a while, swelling can occur leading to asphyxiation. It can spread quickly through contact and could thrive in IDP/refugee camp environment. The first group that seemed to be hit were kids between eight to fifteen. Kids under five are the most susceptible to infectious disease and therefore, have often been vaccinated against enough nasty diseases to turn them into little, hostile pincushions.

When the medical team identified it, it was like kicking the winning field goal. Days of tension trying to identify and confirm the diphtheria were lifted with a cheer. Now we knew what we were up against, which vaccines to track down, what was our target population, who do we need to get onboard, etc. The medical team worked on their strategy and ran around sticking wooden tongue depressors down people’s throats. On logistics, we worked planning the actual physical functioning of this beast that is a vaccination campaign and trying to keep the medics in wooden sticks. How will a vaccination camp be set up to ensure the most orderly and efficient flow of people? Who has the required vaccine and where in the world is it? A hundred questions that had to be answered for this to work. Fantastic! As an expat, this is what you signed up for.

None of the expats in our team had ever been involved in this type of mass campaign. Our national doctor, head nurse and chief vaccinator were experienced, having dealt with measles and cholera in the past, and were invaluable. We just launched into a run of fourteen-hour workdays and through trial and error and good support from the office we came up a start date at the beginning of August. Throughout this time, we met with other INGOs who managed the individual settlements of the camp and would mobilise the people. I proposed using the various settlements enclosed schoolyards for our mobile vaccination centre to help the crowd controllers. Trying to think what Sun Tzu would do, I had an IDP exit hole knocked through each mud brick back wall to allow a path of least resistance.

The three vaccines needed for the job were found in Indonesia and India. UNICEF got on its horse to get them to Islamabad, Pakistan quickly but there they were stuck for a bit due to an untimely “technical concern” with the plane to Afghanistan. A lack of suitable vaccination cards resulted in a creative session where we designed our own and had a few thousand printed. By now, the diphtheria had continued to slowly spread and had shown up in people as old as thirty five. Our target population was expanded to cover the entire population of the camp as there was a possibility of the disease spreading to Kandahar, forty kilometres away. The prospect of 400,000 plus people with sore throats was not a pleasant one. We established isolation areas in our camp health centre and at the city hospital and jabbed people full of anti toxin that our country logistic coordinator (log co) pulled out of a hat. Finally, the vaccine arrived in Kandahar and we were set to go.

I’ll finish this on a later day when absolutely nothing interesting happens. A day spent reviewing administrative strategies and the budget is a necessary part of the job but not as stimulating as the drama of a first vaccination. I was impressed with the energy and professionalism of many of the people involved. There were problems as can be expected in the preparation phase and the first day of vaccination was a comedy of errors that somehow came off. Different agencies big and small came on board throughout this time and seemed to alternate between being a solid partner and pissing us off. I’m sure we did the same to them because the organization has a reputation of being a tad strong headed when it sets its sights and our team was no exception.