Enlisting Student Nurses in a Lebanese National Campaign to Immunize Children Against Polio

Friday, 20 July 2018

Christine W. Abbyad, PhD, RN, WHNP
Division of Family, Public Health and Nursing Administration, University of Texas at Austin School of Nursing, Austin, TX, USA

Introduction: There is a dearth of published articles reviewing the role of student nurses in the global immunization effort. Yet student nurses under faculty supervision are an ideal resource for national ministries of health. This project employed nursing students in a collaborative effort with the Lebanese Ministry of Public Health (LMOPH) to immunize Lebanese and Syrian children against polio.

Background: The recent Syrian civil war created massive challenges for neighboring Lebanon. Within the first two years of the conflict an estimated 600,000 Syrians flooded across the border into Lebanon. For the most part they were housed in make shift refugee camps. Others lived in cities, towns, and villages or wherever they could find a place to live. The Lebanese government, itself in a perpetual state of crisis, could not agree on what measures should be taken to provide humanitarian assistance for these refugees who suddenly represent 25% of the total Lebanese population. Many non-governmental organizations (NGOs) stepped up to try and provide for basic needs – tents, clean water, food supplements, medical care, etc. To be sure the assistance was minimal. As everyone had predicted, it was a health catastrophe waiting to happen.

In October of 2013 reports surfaced that several cases of polio had been confirmed in Syria, a country which up until the beginning of the armed conflict had an almost 100% vaccination rate of children. The LMOPH immediately worried about spread of polio to Lebanon. Local and international NGOs were quickly enlisted to fan out across Lebanon and immunize all children under 5 years of age. The call for volunteers was also broadcast to schools of medicine and nursing.

The project: It was a beautiful November Saturday when 6 volunteer junior and senior nursing students and their instructor from the American University of Beirut boarded a minivan for the village of Aramoun. They left early to arrive at the local clinic for a quick orientation. Upon arrival they received instructions to immunize all healthy children between 7 days of age and 5 years. They were given identifying badges and ice chests in which to carry the oral vaccinations. Also issued was a warning to never go into homes even when invited. Accompanied by clinic staff, the participants were divided into four teams of two to three people each and headed down the assigned streets. Two teams took one side of the street and two the other. Constant contact was maintained with each other through the use of cell phones.

Arriving at the first building it was discovered that there was no electricity and the group would have to climb seven flights of stairs. This they did, proceeding to knock on doors, explain their mission and ask occupants if they knew of any neighborhood children. Most families had heard of the immunization campaign through TV, radio or newspaper announcements. Most welcomed the students. Some however seemed suspicious and said they preferred to have their children immunized through their primary physician. Students did their best to try and convince doubters that although polio immunization was not compulsory it was: urgently recommended by the LMOPH, free, and a protection for small children. It was suspected that because names and contact information were being recorded, some families did not want their presence to be known. Although the nationality of the children being immunized was not elicited, it was well known that there were an estimated 100,000 undocumented refugees in Lebanon. The sectarian nature of the political conflicts in Syria and Lebanon forced people to worry about repercussions. Vulnerable children paid the price by not being immunized.

As the day progressed team members heard many stories. They learned that the concierges (hired building attendants) were the best sources of information. Concierges were keenly aware of how many children lived in each apartment, whether they were at school, and whether the schools already had an immunization campaign. These building attendants assisted the students by sending word to families to bring all their young children and meet the immunizing team outside. Concierges were aided by a small group of boys who followed the teams around the neighborhood. As candidates for immunization were identified, the concierges would bark orders to the boys to go and bring the children for immunization. The boys seemed to be delighted at the responsibility of assisting in such an important endeavor.

By one pm the health teams were already exhausted having carried the ice chests up and down only one street in the hot sun, climbed many flights of stairs and knocked on many doors. The students decided to rendezvous at a local bakery for a quick bite to eat. The students in particular were beginning to fade as the enormity of the time and energy needed for this project became clear. At the entrance to the bakery a woman with a 7 day old newborn asked to have her son immunized. The baby was wrapped in multiple layers of blankets his little red face the only thing that could be seen. The group immunized the baby but were unable to convince his mother to remove the blankets. Soon other children came to the bakery to be immunized.

The afternoon was conducted in much the same manner. The head team member was very excited that so many children were being immunized. She frequently looked at the data sheets and counted up the numbers immunized. As the healthcare teams moved down the second street they were less successful in entering homes. Many families lived in gated apartment complexes and thus inaccessible to the group.

Finally by four pm the students had finished their assignment. Walking back to the clinic the students could see a mother with two small children. As the mother approached she asked if she had arrived too late. She was reassured that her children would be immunized and the usual instructions about possible flu like symptoms and the need to return in a month for follow up conveyed.

In conclusion, the students expressed great satisfaction in participating in the polio campaign. They learned first-hand the facilitators and barriers to implementing such a program in a rural health setting. The students stated that the lessons they learned were superior to anything they could have read in a textbook.