Field Notes from Nigeria – Stories from the Polio Eradication Campaign

(HN, April 28, 2010)  Its only 10am and already the outdoor thermometer on the dashboard of the UNICEF 4x4 reads 34 degrees Celsius.

We are a 90 minute drive away from our destination: the Rogo Local Government Area (LGA) in the most populous state in Nigeria, Kano. "This is one of the high risk LGA's in Northern Nigeria for polio," said Josephine Kamara, a UNICEF official in charge of social mobilization for UNICEF.  A native of Sierra Leone, Josephine has been working in Nigeria for the last five years and the last five months with UNICEF.

Josephine describes her job as convincing communities to vaccinate - a seemingly impossible task at times, especially when some parents regard Western-made vaccines as tools for sterilization - or worse.  Others can’t understand why their children need to receive up to a dozen rounds of the polio drops.

Explains Josephine: "One of the things I learned is to blend in...to dress like them, speak their language and being respectful of their religion and customs. Once you get all those things, you get accepted in the community and everything else will fall into place. For me as a foreigner that works for me."

Indeed once we arrive in Rogo and meet with the revered traditional leader of Rogo, Ahmed Muhammad Maharaz - resplendent in flowing white robes - he immediately greets Josephine warmly and asks if she is the same Josephine he used to listen to reporting on Voice of America from several African countries.  (Yes)

Articulate, passionate and warm, Maharaz speaks for about 30 minutes to his citizens about the importance of vaccination.  Later he tells me in halting English that convincing arguments can be made to dispel fears among skeptical parents about the vaccines.  "I tell them do you think these foreigners would spend all this money to get rid of us? There are faster and cheaper ways. I also remind them that when their children get sick the first thing they do is take them to a clinic for life saving medicine, which are made in the West. And then their children get cured."

Listening to Maharaz, it quickly becomes clear why the so-called traditional leaders have become such a powerful, integral component in the battle to eradicate polio. They carry, by far, more moral authority than Nigeria's elected leaders. And because Kano is a state where polio vaccination was opposed some years ago, turning over hearts and minds can be challenging, to say the least.

Josephine explains that while the use of the traditional leaders has proven key to lowering the incidence of polio - there has been only one recorded case in the country so far this year, compared to 193 at the same time last year - fixing other bottlenecks has proven vexing. One frustration is ensuring the integrity of the vaccines as they make their way from regional stores to the mouths of children. In the punishing heat of the desert - where temperatures soar to 45 degrees Celsius and where power outages are frequent - it’s easy for vaccines to lose their effectiveness.

An Expert Review Committee of Nigerians, UNICEF, WHO, Rotary and other partners has recommended a minimum of eight rounds of polio drops - down from 12 doses in previous years.

One WHO field worker said Monday that a freezer generator procured specially for the polio vaccination campaign in Kano state broke within minutes because it hadn’t been installed properly.  In some areas solar powered refrigerators are used but have life spans of only one or two years because they are not maintained properly.

Later, at a meeting of state partners that was held in the dark due to power outages, we heard that a handful of LGAs have delayed vaccination because they haven't put into place supplies of so-called plusses - soap, sweets and other handouts that have been proven to attract mothers and their kids to vaccination days.  Indeed I saw for myself how every mother grasped for the handouts as soon as their children received the polio drop.

Out here in rural areas, where some communities have only a dozen children, health workers need to travel long distances just to reach a small pocket of kids. And when the rainy season strikes, many villages are inaccessible - even by motorcycle. The WHO point person in Rogo LGA told us, "In urban areas reaching 750 children is easily done in one day. Out here some health workers consider a day successful if they have reached 15 children."

He went on to emphatically explain that all it takes is one missed child to infect others. "That one child we missed can be a big problem," he said, adding that he has more than half a million children to track for vaccination in more than 600 communities.

Experts estimate that just one infected child could put another 200 at risk.

The 600,000-plus children targeted for vaccination in this LGA is part of the critical second round of a synchronized effort to stop a polio outbreak across West and Central Africa. In all, more than 77 million children in 16 countries will be vaccinated over the next few months. Each vaccination team will carry the vaccine in special carriers, filled with ice packs to ensure the vaccine remains below the required 8ºC. 

To end this outbreak two drops of oral polio vaccine (OPV) will be administered to every child in 16 countries, including Nigeria.  An army of more than 300,000 volunteers and health workers will work up to 12 hours per day, travelling on foot or bicycles, in cars and boats and on motorcycles, in often trying conditions – dedicated to the ultimate goal of ending polio on the planet as we know it, for everyone.

--- Reporting for HUMNEWS, Michael Bociurkiw is in Nigeria documenting polio eradication efforts for UNICEF.