If we’d had to wait even two or three more weeks before responding—to write funding proposals, submit them to agencies and/or governments, and wait for approval—it would have been too late to prevent the outbreak from spreading. We were able to act quickly and effectively because private individuals had already chosen to support us.

The E-Medco is on his way to Paris to do a breakdown of the epidemiological data. This post-intervention analysis should help us to be even more prepared for the next vaccination campaign.

The nurse is staying on for a few weeks to carry on case management and trainings in some of the key medical facilities before taking a well-deserved break. We want to leave the region’s hospitals with the necessary supplies and skilled personnel who are prepared to handle cases of meningitis.

It’s unlikely that we’ll be seeing another outbreak of this magnitude for quite a while, in this region. But we can expect a complex situation next dry season, just five months away. Small outbreaks may occur in areas that may have been missed. So we have to remain vigilant in our surveillance.

The E-LogCo is on his way back to New York to do the PPDL for new logs.

The Field Log is taking a well-deserved vacation in Ethiopia.

Your Emergency Coordinator is going home to Paris for a while, on standby for the next emergency. We think we’ll be sending her to eastern Congo to run our emergency programs for displaced civilians.

And we’re sending the Admin to the Philippines to work in the camps for displaced people there. But not before she’s had a couple of weeks at home in Kenya.

When an emergency strikes, we must be able to respond at a moment’s notice. Thanks to our 3.7 million supporters around the world, MSF is able to mobilize teams in an emergency situation, and works hard to BE THERE FIRST for a population in need.

It’s never too long before the next emergency. So, be well. See you next time.

The person I will miss the most is my driver, Ahmed.  He is in his early 30s, with a wife and five children.  We spent so much time together, and we’d get tired of each other and crabby with each other—then we’d be so happy to see each other again.  We were like an old married couple.

He still calls me every week just to say hello.  We don’t have much to say, but we miss each other.

It was also hard saying goodbye to the cold chain guys.  They worked so hard, and they have so much experience, but jobs are hard to come by for them and it was difficult to think that they would probably now be unemployed.

I took a break back in Ethiopia after the meningitis campaign.  I stayed in Addis Ababa and went swimming in the nearby lake, and saw people from my last assignment.

I would definitely do this kind of vaccination campaign again because vaccination is so effective.  But for now, I am off to Sri Lanka.  And when I am done, I will be sure to take a good break before my next assignment!

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.

The case management team I worked with was great. They never stopped working and never complained about all of the hours on the dusty roads. We had a party at the end where we ate chicken and drank coke and sprite.

I was the last international person in Zamfara with three Nigerian staff to pack up the office and finish everything up—they were fantastic people.  It was worth the 11 crazy weeks to spend time with them; they were so helpful and caring and had a great work ethic. It was a great way to leave.

I called our driver, Abdullaziz, the Professor, because he seemed to know everything. On the way to a meeting, I would say, how do you think I should talk to the MOH about this and he would give me insider advice—and it worked. He was a good honest guy, a well-respected older man in town, who carried a lot of weight.

I ended up doing all the finances at the end for six vaccination teams.  So when our assistant financial person, Lillian, came along, she was a lifesaver because she already had a history of handling finances and I was still learning.

I was the nurse but I ended up doing finances—that’s MSF!  You have to be flexible and adapt to the situation as it evolves.

Grace, the cook, was a hoot. I lost seven pounds at first because I was working and only eating if someone put food in front of me. And then Grace came along and she made sure I did not fade away into nothing. She would tell me, wait, you forgot to eat, and say hello to us in the morning and just generally took care of us.

When I left I thought I would never do it again.  But thinking back now, I realize that in emergency situations there is a need for aid workers with historical knowledge and we know there is going to be another epidemic at some point.  So, yes, I would go back for that reason—and because of those people that I spent time with at the end.  I want to see them again.

That is why MSF brings in Emergency MedCos to work in parallel with the existing MedCo. By the end of the epidemic, I was back to focusing on the bigger picture of all of our medical programs—urban violence, malnutrition, ongoing surveillance for outbreaks of cholera or measles and, of course, meningitis.

Though we were all exhausted, the sense of accomplishment exceeded the exhaustion. I took two weeks off at the end of April. This year was quite an achievement both in terms of rapid response and the scope of the intervention. This intervention also served as a means of reinforcing MSF’s response capacity to the local health authorities, which has not been seen in Nigeria for quite some time.

One of our biggest frustrations is that the current meningitis vaccine only protects for two years. So we can expect to be doing it all over again before too long.

There is a new vaccine in the works, and it should be rolling out in two years to the different countries in the belt. The protection expected to be conferred is upwards of 10 years, AND it stops transmission. Meningitis in epidemic contexts may well become a thing of the past if governments and donor countries adequately fund and prioritize its use. Of course to vaccinate the target population would be a Herculean task, but if history serves us, there are numerous diseases that have been adequately controlled or rendered extinct by this method.

I just needed to be close to people. In the grand scheme of things I didn’t really do that much. I ended up in Zanzibar—checked into an air-conditioned hotel on the beach and ate, slept, swam, ate, napped, swam, ate, read, slept.

You’ll need to do something similar (the sleeping eating swimming reading napping part, not the breaking security rules part).

You’ll get a phone call from our Peer Support Network—MSF aid workers who volunteer to call their colleagues and check in with them—a couple of weeks after you get back, to see how you are doing.

Everyone responds differently to emergency work. If you find yourself having nightmares or are unable to sleep or concentrate or find yourself behaving in ways that are troubling to you—or if you hear that your colleagues are having problems—you can ask your peer support colleague what kind of mental health support MSF offers.

Being on a beach and swimming, napping, eating, reading, and sleeping some more usually works for me…

We were supposed to wait two days and leave and then I got information that I was leaving at 6.30 the next morning and I had to close up everything in a short time. I spent the whole night trying to find 1,000 Sudanese dinars that we couldn’t account for. The Financial Coordinator said, ”We are not going to break our backs looking for 1,000 dinars (about $4 US)!”

It was not my wish, but I had to leave with the team—the flight cannot wait for me.

I don’t know how I lost the money but I think it was probably a miscalculation. We were counting the money at three in the morning using a flashlight—not a head lamp, but a regular one—and the batteries were going down, so it’s likely that our calculations were off that night.

Then five of us—three Kenyans and two Europeans—traveled back together by road, in a group because of security. When we got to Akuem, the team received us very well but it had rained so the plane we were supposed to take could not land. So by the time we got to the MSF logistics hub in Lokichokio, all the flights to Nairobi were fully booked.

So I got an evening flight on the 26th of December and finally got back to my kids. After Christmas day.

We stayed together for five days before they went back to school. They were happy to see me back home and I did my best though I was very tired. On the 27th I took them out for swimming, for Christmas dinner, and we had fun together.

My children asked me a lot of questions when I came back from this assignment. I told them how I slept outside on the veranda with a lot of dust and how for a dining area we had just a fridge carrier under a tree. I told them about our FieldCo sleeping under the tree with a mosquito net, and how chameleons were coming down from the tree and walking over her net. And they know I fear chameleons and so they laughed at me. They also laughed at what I like to call our only security incident—the frog inside my sleeping bag.

They were very happy for me because they knew why I was out there.

One person picked up a couple of sharps boxes at the same time and somehow a needle came through that way. Another person was reaching to dispose of a needle and hit someone else’s hand in front of the sharps box. One needle-stick was the result of a frightened child fighting the injection…

Three of the five victims chose to take the post-exposure prophylaxis (PEP) after the nurse in charge explained the risks. Luckily in the capital city of the state they also have free testing—but the risk of contracting HIV this way is very low.

I wasn’t involved in vaccination directly. There is always a nurse in charge to train the teams, to identify which regions to set up in based on the epidemiology of the disease, and to liaise with the MOH authorities and staff.

My colleagues on the vaccination team were doing an amazing job. One team of two vaccinators, two preparers, two crowd control people, and someone to write down the names and record the vaccinations, could vaccinate up to 1500 people in one day.

The vaccinators always have a medical background. In our case, we were using nursing students. We had to do this because we needed to be sure there was always at least one female vaccinator on each team. In some places, for religious reasons, women can only be vaccinated by women, and the qualified vaccinators in the rural areas we worked in were mostly men. The hardest to reach population can be the 15-30 year old females—and sometimes we even vaccinated them inside the village elder’s home to maintain their privacy.

So the Field Log drove 40 miles to bring one from the storage base in case the injured vaccinator wanted treatment.

HIV has a relatively low prevalence in this part of the world. A vaccination needle stick is unlikely to transmit the virus and there is virtually no risk of direct contact with blood. But it is nevertheless important to be vigilant.

The vaccinator had applied betadine to the spot right away—he followed all of the precautions.

This is the only reported injury we’ve had—out of almost 800,000 vaccinations to date.

Our sites were featured in some radio advertisements last week. People weren’t turning up for vaccines in one region, despite our initial grassroots outreach. So we decided to broadcast through the airwaves. It paid off.

We had lines spanning all along the main village street. Despite the unbearable heat, some people waited there for several hours. So our teams also distributed water that was carried by donkey cars from the village well and created shade with tarp where the patients could rest.

I know the days must be exhausting, and they are only becoming more difficult with the increasing number of patients coming in. But I know you are giving these people hope for survival – you see it in their faces – and that this is what is pushing you all to work harder and stay in high spirits.

Despite the pressure and stress, our team members were all very, very nice and we did everything to help each other, especially with the cold chain.

When the teams came back in the evening they had a list of requirements for what they needed to take in the morning. We were helping them to pack syringes and cotton at night and then we all packed the vaccines in the morning.

I will always remember that team. Momo, our Field Co, and Didier, in charge of the cold chain, both did a wonderful job. Didier was sleeping in the cold chain storage room every night, and sleeping an additional two hours every morning at the house, from 10 am to 12 noon, when I would wake him up. He did this for a month because they were making ice onsite, as there was nowhere else to get it, and this required close monitoring and supervision.

I remember two days after the Log Admin handed over to me, he had to be in bed for one full day to recover from too much work and lack of sleep. Poor log! No one on the team would get to sleep before midnight and by 5:30 in the morning usually the show was on.