According to Daphne Namusoke, the people fleeing conflict in neighbouring Democratic Republic of the Congo aren’t truly secure until they are vaccinated.
17 October 2024
- by John Agaba
Nurse Daphne Namusoke needed to come up with a plan if she was going to improve the uptake of vaccines among the refugees at Kyaka II settlement in western Uganda, to protect them from measles and the other vaccine-preventable diseases (VPDs) that had a tendency of cropping up.
Amid conflict in eastern Democratic Republic of the Congo (DRC), thousands of refugees, including children and young women, were arriving at the settlement, which currently hosts about 113,000 people. Hundreds of the newcomers were still missing out on vital vaccinations – in part because of the language barrier: few nurses and village health team (VHTs) members spoke enough Swahili or French – let alone Lingala – to explain the need for vaccination to the displaced Congolese.
Knocking down the language barrier
“Most of the refugees spoke Lingala, Swahili or French,” said Namusoke. “Yet most of our VHTs and other health educators spoke Runyakitara [a local dialect] and English.”
Determined to find a way around the communications block, Namusoke – who is a nursing officer and immunisation focal person for Kyegegwa district – approached UNICEF and UNHCR, to ask the humanitarian agencies for nurses who could speak Swahili or French. After the agencies approved her plan, Namusoke lobbied to recruit VHTs from within the refugee community who could translate immunisation messages, mobilise parents to take children for vaccination, and track kids who weren’t up to date on their shots.
It was a game changer. Understanding what vaccinations can do created trust, and that, in turn, improved coverage for key vaccine antigens in the settlement.
“If a baby contracts TB and they were not vaccinated, chances are [higher that] they will die because they don’t have the immunity to fight off the disease. The disease will affect their lungs, they will start coughing, get difficulty breathing, lose appetite and die – which would be sad. Someone has survived war, conflict and bullets to come here and die of TB.”
– Daphne Namusoke, nursing officer
For instance, coverage for the first dose of the pentavalent vaccine (Penta 1) – which includes vaccines that protect children against diphtheria, pertussis and tetanus plus hepatitis B and Haemophilus influenzae type b – improved to somewhere between 334% and 467% of the targeted population between 2020 and today, according to figures from the Ministry of Health. Those figures might sound outlandish, but what they really mean is that many more children were immunised than had been thought to need vaccination – accurate projections are hard to come by in populations in great flux.
That vaccination coverage over the last four years outstripped expectations likely reflects population growth in the camp, but also improved understanding of the population, and consequently, massively extended reach.
Lessons in self-defence
But Namusoke didn’t stop there.
After rustling up a cadre of VHTs and nurses who could speak Swahili or French, Namusoke coined an effective message to explain how vaccines helped induce immune responses to build antibodies, said Latif Bataringaya, a VHT for Musoba village near the settlement.
The message goes like this: “If a stranger suddenly enters your house, you react by fighting them. But when you realise that the stranger came to train you to fight a real enemy that’s already in your village, you befriend them and learn their fighting tactics.”
The metaphor has helped the VHTs to understand the science behind vaccines and explain it better to patients, he said.
In fact, Namusoke has helped to vaccinate thousands, “if not millions”, of children, including refugees, against these VPDs, said Mathias Wekha, senior clinical officer at Kyegegwa hospital. Those many children included his own five kids, Wekha added.
“She has vaccinated children from Congo, children from Rwanda, Ugandan children… children from basically across Africa,” he said. “She is assiduous… so friendly and full of energy whenever she’s vaccinating children or talking about how vaccines can protect children.”
“I have seen how devastating these diseases can be”
Namusoke is just getting started.
“I have seen how devastating these diseases can be if a child isn’t immunised,” said Namusoke in an interview with VaccinesWork at Kyegegwa Hospital. “I have seen babies die of pneumonia, children die of measles because they were not vaccinated.”
“Some people hear of TB, measles and tetanus and think these are simple diseases. They are not,” she continued. “If a baby contracts TB and they were not vaccinated, chances are [higher that] they will die because they don’t have the immunity to fight off the disease. The disease will affect their lungs, they will start coughing, get difficulty breathing, lose appetite and die – which would be sad. Someone has survived war, conflict and bullets to come here and die of TB.”
Born in central Uganda, Namusoke developed interest in vaccination after receiving her certificate in nursing in 1999. Later – after earning her Bachelor of Public Health – she supervised storage, handling and transportation of vaccines in Kyegegwa district. In 2010, the district appointed her as its immunisation focal person.
“Like in other refugee settlements across the country ]there are 13 settlements across Uganda hosting about 1.7 million refugees] the biggest challenge when it comes to vaccinating children in humanitarian settings has always been finding VHTs and nurses who are fluent in various languages and can mobilise refugees to get vaccinated,” said Namusoke.
“I really get heartbroken when I hear that a child died of measles in any of our communities… [or] that someone died of pneumonia, when we have free vaccines.”
– Daphne Namusoke, nursing officer
“Yes, UNICEF and UNHCR are helping us to recruit nurses who can speak Swahili or French but we could do with more,” she said. “We have refugees who speak Lingala and other languages.”
Apart from this challenge, refugees are generally receptive to vaccines, said Namusoke. “Some of them come with vaccination cards [from their countries of origin] and it is easier to track which antigens they have already received,” she said. Those who don’t have vaccination cards, start [the vaccination process] afresh… and, usually, get their first doses [of whatever vaccines they are eligible for] at the border crossing.
“We use both static and outreach strategies to vaccinate children in the settlement,” said Namusoke. “And because the numbers are high-volume and unpredictable, we are always vaccinating more children than the targeted population. That is why vaccine coverage in the settlement is mostly above 100%.”
“For static [sessions], parents will bring their children for vaccination at the health facilities within the settlement. We do this daily. For outreaches, VHTs will mobilise the community and identify central places where people can gather and be vaccinated. It can be at a church, school or central place in a trading centre,” she said.
To try and reach every child, Namusoke has lobbied for the increase of VHTs from one to three per village. These grassroots health workers, together with the village’s chairperson, help to register children for vaccination and to track “defaulters” who don’t turn up.
“The VHTs will go and look for these children in the communities and remind them to get vaccinated,” said Namusoke.
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Apart from this, the VHTs conduct house-to-house registrations to look for under-immunised kids and children who have never been immunised or ZDC and refer these to health facilities.
“In all this, it is important that we continue to emphasise the importance of vaccines and show mothers how individual vaccines protect their children to counter vaccine misinformation,” said Namusoke. “For instance, if a nurse is going to give BCG to a baby, it is important they tell the mother that the particular vaccine will protect their baby from TB… and if the mother has never heard of TB, the nurse can then talk to them about the disease and how it presents.”
Namusoke dreams of a world where every child – refugee or Ugandan – is vaccinated against these VPDs. “I really get heartbroken when I hear that a child died of measles in any of our communities… [or] that someone died of pneumonia, when we have free vaccines.”
This article was originally published on
VaccinesWork