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Originally produced for UNICEF



To Ngouye Diaraf

The impoverished district of Koungheul (population 107,000) straddles the east-west highway, 150 kilometres east of Kaolack. Adama Diallo has been district immunization officer here since 1987. In 2001, UNICEF backed a 6-month intensive programme, working with Diallo, health workers and community volunteers, aimed at raising immunization levels.

“We called on everyone,” says Diallo. “Not only health professionals but also religious leaders, village leaders, teachers, women’s groups and members of the Association of Sports and Culture (ASC) which are found in every village. We ran training sessions, radio shows, and we went to the weekly markets. The ASC went door to door in every village in the district to carry out a census of children under one and pregnant women so that we could identify our target population. They talked with families about the importance of immunization and followed up to make sure the children had been covered.

“UNICEF provided new refrigeration equipment to our district centre in Koungheul and to health posts, as well as several motorbikes. These allowed the ASC members to take an even more active role. Some were trained to give immunizations.”

The results? In six months, immunization rates for DPT3 in Koungheul district as a whole rose by 15%. In the area covered by the village health post at Lour Escale – the next stop on the Vaccine Trail – coverage improved from 43% to more than 76%.

The cost? About US$6,000 in addition to the cost of hardware (refrigerators, motorbikes etc.)

Lour Escale is a hour and a half by car from Koungheul, along a deeply rutted dirt track. By mule cart, the most common form of travel, the journey would take most of the day. Along the way we pass a group of boys aged 6 or 7 years old, dressed in white robes that signify that they had just been circumcised. A brief conversation with their leader reveals that the boys were circumcised at the health post, and received a tetanus shot before the procedure.

The compound of the clinic at Lour Escale is filled with men women and children of all ages. Inside the cool interior we find Fallou Cissé who has been the health agent in charge of Lour Escale for more than a decade. A poster on the wall details the population in his care: In 2001, in the 43 villages, there were more than15,000 people, including 722 pregnant women, a similar number of infants under one year old and nearly 3,000 children under five years old. Asked how he had such good information, Fallou said he’d had help from young men like Elhadg Sarr, Guede Ndao and other ACS volunteers. It was exactly the kind of information that was needed to ensure accurate forecasting of Senegal’s vaccine needs.

That afternoon, while Fallou tended to his patients, we travelled with Elhadg, Guede and Adama Diallo from Kounghuel to the last stop on the vaccine trail – the village of Ngouye Diaraf. It lay in the middle of a flat, sun-baked plain, a collection of mud-walled thatched houses standing inside mud-walled compounds. The largest compound belonged to the village headman, Serigne Dame Léye. Serigne did not require any prompting to speak his mind.

“I don’t know who you people are,” he said, addressing the UNICEF team, “But you see these people?” He indicated Diallo, Elhadge and Guede. “If we don’t have polio or measles or whooping cough in this village anymore it is due to their dedication. They have saved the lives of our children. We used to have epidemics here. We used to bury two or three children every week because of measles. This does not happen anymore because of these people. I include them in my prayers. I trust that they will be rewarded in heaven.”

As Serigne spoke, women of Ngouye Diaraf, flocked into the compound, and gathered under a massive …… tree where the immunization session would be held. The turnout was impressive but Khady Mbaye, a traditional midwife in the village was not surprised. She remarked, “Every immunization is a celebration because it is one burden less for the mother.”

Equally impressive was the fact that every woman bringing her infant for immunization also carried the yellow record card. Most of the women had not been to school, few could read, few knew exactly what immunizations their children had received, yet they knew the card was important.

Elhadg completed a record card for a one-week old baby, about to receive her first shot, of BCG vaccine against childhood tuberculosis. As he handed the card to the mother he said, “This is your child’s identity card. You should always bring it for immunizations. It explains what immunizations she has received and what is to come. If you don’t bring the card we can still do the immunization but it slows everything down. Bring the card, and then things will go faster.”

While Elhadg organized the yellow immunization cards and the pressing crowd of women and babies, Guede Ndao gave the immunizations. He was swift and careful.

The sun had dropped low in the sky by the time the session was done. It was a stunning end to the journey.

Serigne Dame Léye, headman of the village of Ngouye Diaraf, central Senegal.


Indicating the immunization outreach team he said, “If we don’t have polio or measles or whooping cough in this village anymore it is due to their dedication. They have saved the lives of our children.  We used to have epidemics here. We used to bury two or three children every week because of measles.  This does not happen anymore because of these people.  I include them in my prayers. I trust that they will be rewarded in heaven.”