Be There 1st MEDECINS SANS FRONTIERES DOCTORS WITHOUT BORDERS

I came back from Nigeria before the campaign was over because Jordan, the new Log Co, arrived to take over from me.  We had a day of handover—where I explained to him how far we had gotten, how far we had to go, who our contacts were, all the management of the logistics, and HR for the logistics.

Then I came back to the New York office. Yes, a vaccination campaign is quite demanding.  You have short nights, but the feeling when you get back is not one of physical fatigue.  Your life has been so intense and stressful, in a good way, and then you are back to your old routine.  So being back in the office is a bit depressing, in a way, and it is difficult to adjust to the different rhythm.

Then there are all the other projects waiting for you—all the emails in your inbox.  I couldn’t check them in the field because I was so busy and anyway there was no internet connection.  A colleague had checked for any emails that could not wait, but there were plenty I had to respond to.

I took a week’s vacation a little while after I got back. I stayed in New York.  I’d done enough traveling.

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Our biggest logistical challenge in Nigeria was when 800,000 vaccines arrived in ten dose vials rather than 50 dose vials. This meant that the storage space we had calculated for was not big enough—we needed 30% more capacity than we had originally estimated.

So a team of four people had to take out every single vial and repack it without its original packaging, being sure that it did not spend much time out of refrigeration, and that it was kept with the batch it came with so we could track it properly.

Basically we repacked 800,000 vials—vial per vial—in just a few hours. We had to work fast.

I say “we….”

I was not in the cold chain the day the supplies arrived, and I felt pretty sorry for my colleagues.

And it was me who made the mistake in calculation. I should have known because the packaging was different, coming from a different producer, and I know that different producers manufacture vials in different doses. We were moving so fast, I just didn’t think. But we managed because you always plan for a 10-20% margin at each step to allow for things like this.

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One of the biggest challenges at the beginning of an emergency response is designing the logistics support for the campaign and getting the appropriate human resources (both national and international) on the ground as soon as possible. For MSF, the important thing in a vaccination campaign is to act as quickly as possible and to target the most affected regions—and the most densely populated areas within those regions first—to have maximum impact. But your overall goal is 100% coverage.

In Nigeria it was very smooth, but three years ago in Uganda it was a lot trickier because in the first or second week of the meningitis outbreak the health authorities asked us to double the number of vaccination sites we had planned for. This had a huge impact on the cold chain and the organization of the teams in general. You have to anticipate problems and have a Plan B and a Plan C and always build in a margin for your calculations. If you are too exact and only stick to your calculations and to what you want, if you can’t be flexible, then you risk not being able to respond in an appropriate way.

In Uganda, we had anticipated this and we had some additional cold chain capacity. And we could invest less in the management of the sites because, having more sites with fewer people coming for vaccinations meant crowd control would be that much easier to handle.

We vaccinated close to 400,000 people in the area—in Arua, in the north, close to the border with the Democratic Republic of Congo. At max we had 50 teams—when we had only planned for 20. You always have to be ready to switch your strategy at a moment’s notice during a vaccination campaign.

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I was in the New York office managing the logistics for all of our desk’s projects—Nigeria, Haiti, Somalia, Uganda. So I was very involved in directing what our logistical response was likely to be in Nigeria as reports came in of an impending epidemic.

I knew that we might have an issue at the coordination level on the field. The guy who was currently in the position was an interim replacement for the departing coordinator, and so we decided I should go to Nigeria for a month to lend him support and run the emergency logistics coordination.

I had just renewed my visa because I was planning to go to Nigeria soon to visit our projects there—a trauma center in Port Harcourt, in River State, and an emergency obstetric and vaginal fistula surgery program in Jahun, in Jigawa state. But because of the emergency, I spent a month there doing nothing but facilitating the vaccination campaign. It was so consuming, there was no time to visit the other programs.

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