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Seven Hours by Foot: Delivering Vaccines in South Sudan

South Sudan has been at war since 1956, with very short interludes of peace. Consequently, the country has become closed to outside influence, with learning and a flow of knowledge inside and out a particular challenge.

We spoke to Silvester Okoth, Country Director for South Sudan at Veterinaires San Frontiers Germany, to find out how critical animal health, and the vaccinations that keep them healthy, is in this war-torn part of the world.

What big initiatives have you been involved in within the animal health sector to help pastoralists boost production?

One initiative is chicken. Traditionally, chicken among pastoralists has not been a key livestock. It was not part of a regular meal of the household, instead it was kept for income.

In these cases, the breeds were quite small and their multiplication is very slow. So, we introduced a new breed, which lays more eggs. At the same time, the population of people from outside South Sudan has been growing very quickly, so the demand for poultry meat is high.

Opportunities for poultry production here were ripe – a ready market, good money and demand was high. The problem was there was no local supply; poultry meat was being imported from Brazil. Since we introduced this new breed, things are picking up. Those who have adopted the breed are doing very well. The birds lay up to four times the number of eggs as previously used breeds.

We have also introduced vaccination programmes to safeguard the health of the birds. The key diseases are Newcastle Disease and fowl typhoid, which local people are now trained in administering.

The other focus breeds have been sheep and goats – animals that are very close to women and children. Sheep suffer mainly from peste des petit ruminants. Here, we’ve adopted a similar approach to that of poultry. We have concentrated first on the indigenous animals, and in areas where there has been peace, we have been able to reduce mortality rates down from as high as 80%. The multiplication has been tremendous, too – up to 500% per year. It has been a great success.

What are the key diseases impacting livestock where you are active in South Sudan?

At the moment, the key diseases in cattle are hemorrhagic septicemia, and then contagious pleural pneumonia. In small ruminants, it is PPR and contagious plural pneumonia. In poultry, it is Newcastle Disease and fowl typhoid.

To address these we need access to two key vaccines. If we can do this then we will have sorted many of the major problems among animal livestock keepers in South Sudan.

In heavily war-affected areas, this is the essential package, but it comes with quality change needs, which can be very tricky, particularly to sustain its integrity in conflict circumstances. There is a lot of work to be done, a lot of due diligence and a lot of resource needs to be invested.

How do veterinarians maintain the cold chain process when delivering vaccinations in South Sudan?

Logistics are not easy at all. There are areas with a road network, but they have been dilapidated since 2013 due to the ongoing conflict. Road transport cannot sustain the cold chain integrity in any part of the country. We have to use aircraft.

At the same time, we have to compete for space within these aircraft and often we cannot get our vaccines onto the plane at the right time, because you have to plan the whole chain, up to the fields. The vaccine must come from the central cold chain, go to the aircraft and get to the field – a process that is frequently interrupted.

For every planned movement only one in four is likely to succeed. This is one of the biggest challenges. Once we are on the ground, the challenges don’t end. In the most affected areas, getting it to the animal in good time involves intricate logistics because the animals are kept in camps, which move a lot.

These interruptions can have a negative impact on the vaccine, but to help limited this we have put in place certain measures. Recently we have introduced fridge tags, which have dramatically improved the integrity of our cold chain – by between 80% to 100%.

In the war-ravaged areas, with no roads, even travel via motorcycle is difficult, so from the fridge to the cattle, the community animal health workers carry them on their shoulders, often walking for up to seven hours to reach their destination. This process has further challenges, too. We have to make sure that the cold time for the cold box is not exhausted before the vaccines are exhausted.

How do you feel these initiatives are helping to overcome malnutrition?

Despite successes, the areas where we have applied this intervention are still limited, but the FAO does want to spread this practice more widely.

In areas where breeds have been introduced, we are hearing remarkable reports from the beneficiaries.

The increase in household income is perhaps the most dramatic – income which is used to access medical services. The most common complaint is diarrhoea, so we would imagine that, to an extent, malnutrition is reduced in this respect.

The second most common use of increased income is for school fees. It has been estimated that poultry kept in the backyard has been able to support up to four children in primary school.

The final one is food, through better access to eggs and poultry meat, which contributes to improved nutrition. If a household has an adequate number of chickens (for meat and eggs), then money can be invested in other income-generating activities, or in livestock. The primary investment is in goats, largely because goats produce milk, they multiply quickly and can be traded for a milking cow.

What can veterinarians, and the international community do to help support livestock keepers there?

I think the big challenge is one of resources. The processes required are resource intensive and in a humanitarian situation resources first go to food, like cereals, oil, and the rest. Then, into health, and maybe shelter. We need to encourage the private sector, and work closely with them. We know they are profit-oriented, but we could do more to work with them to encourage greater collaboration.

Silvester Okoth is Country Director for South Sudan. He originally trained as a vet in high produce areas of Kenya and started working in South Sudan in the late 1990s. He has been working with VSF Germany since 2016.