Health Workers at the Frontline
Health Workers at the Frontline
Since the start of the recent armed conflict in Cameroon in 2016, health workers have been between a rock and a hard place. They have been exposed to different levels and types of violence by both parties to the conflict. This project explores their experiences of violence and the security challenges they face in Bamenda area at the heart of the Anglophone-majority northwest of Cameroon.
Listen here to the audio stories where our storytellers share memories, concerns, fears and hopes.
'As a woman, I am able to reach more children with measles vaccines'
This storyteller is a community health worker focusing on family planning and medicine.
She has been working in northwest Cameroon since 2004. She loves it when people call her a doctor. This makes her feel very proud because it was her childhood dream which was unfortunately too expensive to come true.
Our storyteller feels safe when she is with communities that trust her. However, she is constantly afraid of armed men who sometimes shoot aimlessly. Rumours claiming that vaccines are designed by the government to poison and kill children put health workers at high risk of rape or of being attacked by armed men. These risks force sometimes health workers to pay their way through or to bribe for safety. However, networking with community leaders and being known and trusted by the community are the best protection mechanisms.
She shares one memory from one of her field trips that scared her to death! She was working with a nurse on measles vaccination campaign. A soldier came in full gear threatening and accusing them of coming to kill the children. They managed to convince him to call his superiors who told him to let them continue their work.
In light of all these difficulties health workers face in northwest Cameroon, she calls for a fairer pay that takes these risks into consideration.
Keeping the Cold Chain for Measles Vaccines in times of War
This storyteller is a nurse responsible of the vaccines’ cold chain.
She has been in this position since the start of the current conflict in 2016. She is motivated by the effectiveness of vaccines, and she finds working on vaccination campaigns very fulfilling. She adds that she became a nurse to serve humanity but never imagined that she will end up working in a war zone.
She doesn't feel safe, but she is confident anyway because she is doing the right thing. She sometimes fears for her life and for other lives in the community and children, but she has no guns and she cannot protect herself. However, she believes that everyone should understand that treating the enemy does not make her an enemy.
She also constantly worries about the cold chain being broken because of the war. Vaccines should be kept in cold chain to keep them effective. Once this is broken, vaccines will no longer be useful. To minimise the risks, our storyteller would ask for repeated vaccination if she suspects that the cold chain has been broken. She also asks the vaccinators to take pictures of the security tags on the vaccine bottles before giving. Measles is a big health problem in the area. The ongoing war is making the situation very complicated, and number of deaths due to measles have increased significantly.
She remembers a field trip when she saw many malnourished children in one community that had restricted access to food after their crops were seized by soldiers.
She finishes by calling international organisations to face the reality of the ongoing war in Cameroon: "If this war doesn’t end soon, we might not be able to provide health services. I would like to call on GAVI and WHO to work with people on the ground to face local reality in times of war. I don’t know if it is the first time these organisations are supporting programmes in war areas, but they are doing it in Cameroon as if there is no war."
Coordinating Vaccination Activities in a Community Caught Up in Conflict
This storyteller is a doctor and a district medical officer in the district health service.
He is responsible of coordinating 9 medical facilities in 7 areas covering a population of 40000. Despite many challenges, his motivation continues to be the significant impact of his work due to huge health needs combined with insufficient health work force and ongoing armed conflict in the region.
Health workers are caught up between both sides of the conflict. They work in precarious conditions particularly when they need to move between the government and the separetists areas. The lack of trust between the two parties means that health workers are accused of aligning themselves to one party or the other due to their impartial medical work. This constitutes a real threat to their lives and to the continuity of health provision.
Negotiation is key for the protection of vaccinators. However, they are sometimes forced to bribe soldiers and fighters using their own money to get access to remote communities. GAVI, the Vaccine Alliance which funds vaccination programmes in Cameroon, has not yet acknowledged the difficulties community vaccinators face as a result of the armed conflict. No budget has been allocated for their safety and protection and their frustration is growing. Our storyteller calls for rational and better distribution of resources whereby the security of health workers in conflict zones is always budgeted for by international health organisations.
He recalls an unforgettable memory of a field trip when he went to vaccinate Fulani communities in a remote area but was shocked by the high level of malnutrition there. Food supplies had been cut, and their crops burnt. He was also stopped on his way by the military soldiers who threatened to shoot him.
The Plagues of Measles, Malnutrition, and War
This storyteller has been a district nurse in northwest Cameroon for eight years.
He shares his observations on the deterioration of health situation since 2016 with many suspected cases of Measles as a result of the conflict. His willingness to help the community and to see positive outcomes continue to motivate him despite the challenges he faces. One of these challenges is mistrust and politicisation of health. Some communities in the area where he works do not want to vaccinate their children due to widespread rumours about vaccines being used to sterilize them.
Our storyteller is concerned about his safety due to random gunshots, as well as kidnapping, arresting, and robbing health workers. He thinks that no one is safe in the area. The district hospital was bombed twice using grenades, and it was looted and badly damaged. Another health centre has been attacked several times.
He thinks that the best method of protection is to be vigilant, to be aware of what is happening in the area, and to avoid crossfire. However, soldiers should be trained on international law so they stop attacking health workers. He finds it surprising that they do this despite being trained by the Americans.
He recalls a memory from a field trip where he safely crossed many checkpoints but ended up being attacked by bees. A sign of bad luck in the local culture. He also shares his opinion on the role the government should play in supporting vaccination efforts in his area: "Personally, I think that the government doesn’t have good faith. Otherwise, why wouldn’t they consider extra resources to deliver vaccinations in war-torn areas? They go ahead and make extra arrangements for soldiers and police in these areas."
Reaching Indigenous Communities With Measles Vaccines During Conflict in Cameroon
This storyteller has been a community health worker in Bali / Bamenda for 12 years.
He works on vaccination programmes and on distributing bed nets and medication to the communities. His main motivation is the positive impact of working in the health sector despite not having a medical background himself. He finds his job very fulfilling particularly when working on malaria and vaccination with remote communities.
Safety and security are major concerns of health workers in the region. They receive constant threats from both sides of the conflict due to lack of trust, and sometimes the best method of protection is to run and hide. Moreover, rumours about the poisonous nature of vaccines caused several community members to attack health workers. They believed that the government of Cameroon has orchestrated the vaccination campaigns to eliminate them.
Our storyteller believes that neither the government nor the sponsors of the vaccination programmes care about these risks.
He shares a memory from a field trip where he saw many malnourished children in a village which was cut off the world because of the conflict. The government forces had burnt all the crops and the food accusing the locals of hiding separatists fighters.
He also shares his frustration because of the global inaction towards what is happening in northwest Cameroon: "The government says, it is not a war! But we say: it is worse than war. We feel so forgotten by the rest of the world. We even hear some of the western powers like France are benefiting from this war. The BIR have actually been trained by America. We just need to see an end of this suffering. It is too much … It is really really too much."
It Is Never Secured Even When It Is Supposed To Be Safe!
This storyteller has been the focal person for disease surveillance in Bali / Bamenda since 2007.
He grew up watching the nurses and how they treated children. Therefore, joining the health working force became his dream and passion. The great impact of vaccines on public health and particularly on the elimination of Measles which does not have a cure has kept him motivated. He also enjoys the teamwork spirit despite the armed conflict and the difficult working conditions.
Weapons can be found everywhere in northwest Cameroon, and health workers can become victims of circumstances during field work because of erratic violent clashes and mistrust between the warring parties. To face these challenges, vigilance, teamwork, and the community’s support have been key. However, our storyteller believes that the best solution is the restoration of peace.
He recalls a memory when he was stopped at a gunpoint and his car was ceased during a field trip to Bali. Armed men also came to his house looking for guns and they scattered everything that was there. He is still afraid because a small mistake could have costed him his life.
Our storyteller believes that there is a need for sensitisation campaigns and advocacy in the area to improve awareness and vaccination uptake. There is also a need to increase the number of vaccination teams to face potential outbreaks.
Health Data Is Partial And Political!
This storyteller is an IT specialist who works in health informatics.
He recorded unprecedented number of confirmed cases of measles in 2019 alongside other outbreaks such as Polio. He also works on a local initiative called the Three-dimensional qualitative data concept. This initiative gives voice, time and space to health data, then visualises it on maps and allows timely decisions to be taken. Outbreaks have global significance because they threaten the herd community in other countries as well.
He feels safer than his colleagues who go to the field, but he still lives under the pressure from politicians who want to use outbreaks for political gains. He is sometimes indirectly told how data should look like, and he often receives threats because of that. Vaccination coverage and outreach is a highly politicised activity in the region and data is partial and political. Our storyteller recalls a time when one vaccinator reported that he vaccinated 26 children although he was given only six vaccine vials! it is unclear what his motivation was.
Health workers in northwest Cameroon are between a rock and a hard place. They face security challenges from both sides of the conflict, and they struggle with mistrust and misconceptions. Many of them have been threatened, attacked, and even killed, and many more fled the country.