Mobile Clinic Immunization and Local Government Challenges
12:00PM on Thursday. I have been called, right before I am going to eat. The vaccines are not approved by the Ministry of Health (MOH). Even though they were approved the day before, they are now unapproved, which means I have to drive an hour by motorcycle on a very dusty road to resolve the issue.
1:30PM. I am sitting in a meeting room with MOH officials. My failures to navigate the bureaucracy along with the cited reasons for un-approving the vaccines is a tale too long and tedious to retell. An hour passes in one of the most soul-crushing meetings I have ever had. The vaccines are finally re-approved on the condition that Nuru pay for the a nurse from the nearby hospital.
2:30PM. I get back on my bike, and drive the long road home, hungry and tired.
7:30AM on Friday. The day has finally arrived. Everything is arranged, or arranged as well as it could be. My people should be arriving to prepare. The kids should start arriving at 8. And by kids, I mean all of them. We arranged for each and every school kid in the sub-location to take a couple hours off to walk over to the Keborui school to learn about hygiene and get de-wormed. We also invited mothers to come get their children immunized starting at 8.
8:00AM. Most of my officers have not arrived. The medical staff has not arrived. And (fortunately) the kids have not arrived. We’ve made great strides in timeliness here, but we’re not yet as anal about time as Americans; it’s a good thing everyone is a bit late. Everyone except for the mothers. They arrive exactly on time, ready to have their kids vaccinated. So we have to apologize and ask them to wait. The Nuru Water and Sanitation (WatSan) team is arriving, ready to teach many many children.
8:30AM. The first set of kids arrives. About a hundred of them, walking together in uniform with impressive discipline. The WatSan guys are on it and escort the kids over to the field. Two health Field Officers and another Nuru worker aid in giving out the Albendazole tabs, one per child. And the lessons begin. The nurse has still not arrived.
9:30AM the nursing staff arrives. Vivian and Chelsea, my muzungu (white) teammates, meet her as I am on the other side of the campus. I walk back towards the classrooms. Chelsea and Vivian approach me, poorly-suppressed rage in their voices.
“The nurse is here.” Chelsea says.
“And she has news.” Vivian adds.
“She has news, David,” Chelsea emphasizes.
What news? What could news could there be but bad news?
“I was called this morning,” the nurse begins, “and the MOH says that the vaccines are not approved to come here.”
Interesting. I had made a bureaucratic blunder the previous week, and such blunders are not forgiven easily. Why had I not been told to my face 18 hours before? Why weren’t we given time to inform people that there would be no vaccines?
“Alright,” I say, calmly.
Chelsea and Vivian are astounded at my calmness.
Getting the vaccines pulled is interesting indeed, but not surprising. It is so not-surprising, that I had planned on it. We are 3km from the hospital, and I had hired a taxi for the morning to transport people there and back just in case there was a need. And now there is need.
I tell the mothers the situation, apologize, and sent them with the taxi to the hospital to have their children vaccinated.
10:00AM. The day is in full gear. The children from the other schools are cycling in better than we could have hoped. The WatSan team is doing an excellent job of managing the crowds and getting them educated. The Healthcare team is effectively dispensing the de-worming meds. Everything is going according to plan. We have taken 30 children to the hospital for immunizations, many of them who were “defaulters” who had been off their vaccination schedule.
4:00PM. The day is done. All the kids from four schools have been de-wormed and educated. We had gone through 2000 tabs of our de-worming medications. 2000 kids. We have transported every mother who showed up for vaccination. 80 children. The day is done.