'Khar-cruisers" get UNICEF vaccine through to isolated villages

"There are about 120 villages that make up Argo District," says Dr Abdul Fattah, the Kabul University-trained medical doctor responsible for Argo District, Badakhshan Province in northeastern Afghanistan. "You can probably tell from the mountains around us and all the snow that many of them are unreachable by road or vehicle. That’s why we use Afghan 'khar-cruisers' – they’re both reliable and cheap." Measles is the number-one killer of Afghan children, and getting them vaccinated is an enormous challenge – particularly during the winter months in northeastern Afghanistan when narrow mountain roads disappear completely under snow. "They only cost about US $10 per day, they hardly ever break down, and they never complain," says Abdul Fattah outside the Ministry of Public Health-run Argo clinic. "We can load them up with everything we need for our measles campaign: vaccines, cold boxes, syringes, registration tally sheets, safety boxes - everything we need. The vaccinator, health worker, registrar and supervisor walk alongside, and so far we’ve never had any problems." The Afghan khar-cruiser is another example of the high-tech-low-tech combination that Afghanistan's new Ministry of Health and the United Nations Children's Fund (UNICEF) put to good use in their measles campaigns to ensure that the maximum number of Afghan children are vaccinated. In Afghanistan’s Dari language, "khar" means "donkey", - the most common mode of transport in Badakhshan Province. Combined with the latest in UNICEF-provided cold-chain equipment to store the vaccines, this mating of old and new has proved effective in fighting a killer disease in a challenging environment. Over the past 10 years, measles coverage has not been sufficient to cover the needs of the population. This year, the Argo District campaign targets all children between the ages of six months and 12 years, to ensure maximum coverage and protection. "The khar-cruisers are hired locally in the Argo market – we only use the strongest and healthiest donkeys. Sometimes the team of four health workers and the donkey drover will walk for two days over high mountain passes in the snow before reaching their assigned village." Abdul Fattah said. There is no local radio station in Argo District to broadcast news of the vaccination campaign, so other means of communication are used, including the most effective – word of mouth. Every day, people travel to the Argo market from outlying villages to buy and sell goods. The clinic is located directly in front of the market, so when a campaign is being planned, word quickly reaches the traders and then, through them, to the villagers coming to town. Letters are also written to village chiefs and individual mosque mullahs throughout the district, who then inform those in their villages of the upcoming vaccination campaign dates. Also applied is a mosque-to-mosque system, whereby vaccinations will be carried out on a given day at an assigned mosque for everyone in the neighbourhood. On the next day the operation will take place in a neighbouring mosque until the whole town or village has been covered. Each mosque has a loudspeaker system which efficiently broadcasts news of the vaccinations. "People are very aware of measles and the importance of vaccinating their children", said Dr Majeed, the UNICEF Feyzabad officer-in-charge. "Unfortunately, this has in part come about because so many children have died in the past because of measles. The villagers are very welcoming to the vaccination teams," the doctor said. This is already the second phase of measles vaccinations in the district so far this year. The vaccination teams and their khar-cruisers began their campaign in the most remote, outlying villages and will then work their way back towards Argo. A recent seven-day campaign managed to vaccinate about 26,000 Afghan girls and boys in the Argo District. A total of about 120,000 children have been targeted throughout Badakhshan Province.