Working with a blindfold
How we vaccinated children without maps. A story with a happy ending.
January 2019. Eight months after the measles outbreak was declared in Chad, it was still going strong. Despite the efforts of authorities and international organisations, and despite the mass vaccination campaign conducted in 2018, Chad registered a new peak of measles cases at the start of 2019.
Measles is a leading cause of death among young children. It is highly contagious – 90 per cent of people without immunity who share living space with an infected person will catch it. Measles is transmitted via droplets from an infected person’s nose, mouth or throat when they cough, sneeze or simply breathe.
Most people infected with measles recover within two or three weeks, but for 5 to 20 per cent it can prove fatal, usually because of complications such as diarrhoea, dehydration, encephalitis (inflammation of the brain) or respiratory infections.
Zara Ramadan, 6, suffers from measles in Almourai village, in Ablelaye District, Am Timan. One day, she came back from the fields where she got in contact with other children with measles. Two days after, their parents realised she was getting tired, was coughing, and felt very sick. Today is the third day she has been having fever and respiratory problems and can’t move.
Most measles cases were concentrated around the capital, N’Djamena, and around Am Timan, in the southeast of the country.
“We arrived in Am Timan in January, when the new peak was declared,” says Theresa Berthold, project coordinator for MSF’s Chad Emergency Response Unit. Teams from international medical organisation Médecins Sans Frontières (MSF) started providing treatment, free-of-charge, for measles patients in Am Timan hospital and three health centres. But to stop the outbreak in its tracks and prevent future outbreaks, a vaccination campaign was also needed. According to authorities, just one in four children under the age of five are fully immunised in Chad, with an estimated 37 per cent vaccinated against measles.
But there was one major stumbling block.
Commercial maps of the area show the city of Am Timan, but not the dozens of settlements around it. Most of the area is simply missing from the maps.
Google Map of the City of Am Timan (Source: Google Maps )
Carrying out an operation like this without a map is like working blindfolded. Reaching the population without a proper map was the one of the biggest challenges of the vaccination campaign.
“We used hand-drawn maps provided to us by the local authorities, we employed local guides to help us find villages, and if we got lost we just asked people,” says Theresa Berthold. “All of these things helped, but sometimes they couldn’t give us all the information we needed. Roads are mostly not tarmacked and are in a bad condition, which means that at times we spent eight hours on the road travelling just 200 kilometres. Finding the villages could also be challenging since we were using hand-drawn maps.”
Actual hand drawn maps of the area around Am Timan, Chad, used for the measles vaccination campaign in January 2019. (Photos: MSF)
Hand-drawn maps can give a general idea of a place, but they have their limits. “Often we scheduled teams to visit several places, which looked like they were close to each other, in one day – only to realise when we got there that they were several hours apart. We also spent quite some time trying to find villages – time which we could have spent vaccinating children,” says Berthold.
MSF community mobilisers travelled around the villages in advance, calling on people to bring their children to be vaccinated, free of charge, at one of the vaccination sites. Then, on the given day, medical teams travelled to the main villages and vaccinated everyone who came forward.
By the end of four weeks, the team had succeeded in vaccinating 107,000 children.
To prevent new measles outbreaks, the World Health Organization recommends vaccinating 90 to 95 per cent of the target population. MSF’s standard is to vaccinate 95 per cent of eligible children. To evaluate the success of a vaccination campaign, a coverage survey is necessary. To do this, a number of households are selected randomly and surveyors go door-to-door to find out how many people have been vaccinated in each. For this, proper maps are indispensable.
Luckily, there is a solution for those who need proper maps: OpenStreetMap, known as the Wikipedia of mapping. These are maps that anyone can edit, allowing the online community to fill the gap left by commercial companies. Lacking proper maps is a problem not just for MSF in Chad, but for humanitarian organisations working in all kinds of contexts. This is why the Missing Maps initiative was founded jointly in 2014 by MSF, the British and American Red Cross and the Humanitarian OpenStreetMap Team. Missing Maps enables volunteers from all around the world to create maps at the request of humanitarian organisations. And these volunteers started mapping Am Timan region for MSF.
City of Mina, south-west from Am Timan, Chad. In April 2019, this city was one of many in the area mapped by the Missing Maps volunteers.
In over four weeks, 221 volunteers mapped 34 120 buildings in the area and created a detailed map of the city of Am Timan and its surroundings.
Take action now: Help put the world's vulnerable people on the map.
“Having proper maps really made a big difference to using our time and resources more efficiently,” says Theresa Berthold. “We could plan according to the confirmed locations of villages and draw up our schedule accordingly. With proper maps on their electronic tablets, our surveyors could easily navigate their way to the villages and the selected households – again making the work much easier and quicker.”
Knowing exactly where the randomly selected households were located, the surveyors were able to conduct the vaccination coverage survey quickly and easily. They concluded that 81.9 per cent of the target population had been vaccinated.
The MSF team will stay in the area, closely monitoring the situation – and it is likely there will be more to do. But with the help of the volunteers from Missing Maps, the battleground in the fight against measles in Chad is a great deal clearer than it was before.
Thank you message from the MSF team sent to the Missing Maps volunteers. (Photo: MSF)
MSF has been working in Chad for the past 37 years. Its Chad Emergency Response Unit provides a rapid medical response to epidemic emergencies, providing free quality treatment and carrying out emergency vaccination campaigns. MSF also runs medical activities in Moissala in Mandoul region. Read more about MSF activities in Chad here .
Missing Maps is an open, collaborative project in which you can help to map areas where humanitarian organisations are trying to meet the needs of vulnerable people. Read more about Missing Maps here .
Taking part in the Missing Maps initiative is one of many examples of the innovation spirit in MSF. Read more about MSF and innovations here .
