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Originally produced for UNICEF

To Kaolak

Vaccines move from the central cold store to the regional stores, district stores and on to the health posts and villages. They travel from the capital Dakar along highways that dissolve into roadways, dirt tracks, pathways and sometimes waterways. They are transported in trucks, vans, cars, on motorbikes, mule-carts, bicycles, and sometimes in fishing boats – through lush forests, scattered islands, and across the vast plains of the northern semi-desert.

Along the route, the refrigeration units shrink from the giant walk-in variety managed by Cissé, to deep top-loading freezers found in regional and district centres, to domestic-style uprights, ice chests and vaccine carriers that are small enough for a health worker to sling over his or her shoulder. Solar freezers are used in health posts beyond reach of the electricity supply.

The central cold store holds a six-month supply of vaccines, the ten regional stores have three months supply, and fifty district centres have one-month supply. The immunization units, located in health posts, pharmacies, army barracks and elsewhere – about 1,900 nationwide – usually only stock sufficient vaccines for their scheduled immunization days.

We took just one of the vaccine trails, travelling from Dakar to the regional centre in Kaolack, to the district store in Kounghuel, to the health post at Lour Escale and the “health hut” in the isolated village of Ngouye Diaraf – which is no more than a gathering place under a tree where immunizations are given.

Kaolak (the town has the same name as the region) lies in the heart of Senegal’s peanut belt, 150 kilometres from Dakar. The flat landscape is scattered with thorny acacias and ghostly baobabs. Towards the end of the dry season the soil seems incapable of sustaining a harvest – but looks are deceiving. From June to September the long rains will fall and the scene will be transformed. Kaolak will be revealed as the nation’s groundnut-basket.

Most of Kaolack’s population is scattered in hundreds of villages but the peanut harvest attracts thousands more itinerant labourers and their families who come from other parts of Senegal, and neighbouring countries, especially The Gambia and Guinea-Bissau.

“It does not matter whether Kaolak babies are born to Senegalese parents or to migrants from other countries,” said Seydou Bodjan, regional manager for immunization in Kaolak. “All must have the opportunity to be immunized.”

Ensuring access to immunization in the rural villages and among migrant families posed major challenges. The solution required action on several levels: raising demand, increasing access, improving the quality and safety of immunization services and improving data collection. UNICEF provided new freezers for the regional cold store that Bodjan manages, and supported health education activities in the region, including a weekly radio show.

“It helped a lot,” said Bodjan, while also stressing that he and his colleagues in the health education division have only a shoestring budget to work with. Bodjan helps to make ends meet by stretching the funds he receives in his role as local coordinator for the polio eradication campaign. The day after we spoke he was going to Dakar for a polio meeting and would use the opportunity to pick up vaccines from Cissé at the central cold store. “If I didn’t have the polio meeting I would have to buy the fuel myself. Many of us do this. We know what needs to be done to reach children with immunizations, and people are committed. If we get the support we need we can make real progress.”

Photo: Tom Kelly