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Medical Thursday Doors Zambia

Thursday Doors at School

Zambia’s National Immunisation Schedule is very similar to that in the UK. After three injections in infancy against tetanus, there is a booster at school entry and another for school leavers. This isn’t so good for children who don’t go to school, but you have to cut corners sometimes. And children who have to repeat their first year may end up getting an additional jab.

We have been doing the fourth and fifth tetanus (with a small dose of diphtheria) in the local schools over the past few weeks. My job here is to help, support and assist, not to take over the programme. We sometimes end up running out of vaccine or syringes, bringing the wrong kind of syringes (BCG syringes are just 0.05ml, the other vaccines need 0.5ml syringes), forgetting to inform the school that we are coming or have had to alter the date. But we got the job done. I don’t know the precise figures, but we vaccinated about a thousand school children.

Door on its side

Here is a door in a classroom in Mfuwe. It may have been taken off its hinges, or it might have been pushed off by the scrum of schoolchildren crashing through the doorway. So this satisfies inclusion of this post in Thursday Doors.

The health inspector in charge of the programme has not been trained in vaccinations. I asked the nurse in charge of the clinic if it was ok for me to train the health inspector and he said he thought it was a good idea. Now in mass vaccination campaigns, speed is of the essence. You don’t take your time slowly inserting the needle, pulling back, injecting, then looking around for a cotton wool ball to place over the injection site.

It took some time for the health inspector to gain confidence, but after a couple of schools, he was able to inject at speed.

Drawing up the vaccine

Now some of you may have seen a clip on YouTube of a paediatrician playing with a baby before he vaccinates them. This looks marvellous and the doctor is to be congratulated. However, he isn’t trying to vaccinate 200 children in school without their parents being there to comfort and support them. This calls for military-like precision. You line ’em up and jab them.

We had a gang of young men and women who volunteered to help with the school campaign. They did some health education while I was injecting. They helped fill the syringes, recorded the children’s names and wrote out vaccination cards. One young lady’s help was invaluable when dealing with youngsters. They would fling their arms around her thighs, she would cover their eyes so they couldn’t see the needle, she would distract them by asking them questions and she made sure their left upper arm was immobilised.

Last week, there was a thunderstorm brewing and I started vaccinating as the rain started. Lightning flashes at the same time as injections was a double whammy for the children. My assistant was brilliant in this situation.

Ouch!

Sometimes the children would not feel the vaccination, other times they would jerk when the needle entered their skin. On a few occasions, this led to the needle going in deeper and hitting bone. Older girls could become hysterical and if we didn’t deal with this properly, it could become infectious, with all the students panicking.

Lining up for vaccination

We hadn’t reckoned on schools having a two shift system, with some pupils coming in the morning, and the remainder coming in the afternoon. I would return to the clinic, see patients about whom the nurse wanted my opinion, then return to the school.

Health education

We need to give the students a booster in a month’s time. The nurse in charge of the clinic felt that the students should come to us for their boosters, but this would overload the clinic with the risk of students being unwilling to wait and leaving before they had had their jabs. I suggested that we go back to the schools and do the vaccinating there instead. We all agreed that this was a great idea.