Field Notes from Nigeria Day 4 – Scenes from the global polio eradication campaign, child by child

("Non compliant" Umar Kwangwaro in Maraku Ward)

(HN, April 30, 2010) -- We first spotted our “non compliance case” at the end of a motorbike path deep in Kano state, in Kiru Local Government Area (LGA).  The 4x4 was hardly able to negotiate the dusty, bumpy terrain. It was Friday and we were eager to verify the situation before the men left for prayers at the local mosque.

Upon arriving though at the local health post to be briefed by officials, an ice cold cola was thrust into our hands. I thought to myself:  if they can keep cola this cold in this searing heat then their vaccine cold chain which keeps the Polio vaccine live for the eradication campaign, must be in tip-top shape.

This area inhabited by the reluctant villagers is almost completely disconnected from the outside world. No electricity reaches the settlement, people rely daylight, fire and each other for daily living and information, and there is no bore hole for water extraction for the community.  During the rainy season, roads and paths are generally inaccessible, and the children exhibit various signs of malnutrition. The fields are so dry they are hardly able to sustain crops.

Little wonder the locals here have a litany of complaints to share with anyone who will listen.

(Josephine Kamara of UNICEF tries to persuade people in Makaru Ward of the need for polio vaccination.)

It was a demand for better government services that led Umar Kwangwaro to refuse polio vaccination for his own two children. And because he is the de facto village head, no other families brought their children forward to the vaccination team. After about 90 minutes of sometimes passionate persuasion by UNICEF’S Josephine Kamara, it was abundantly clear Kwangwaro wouldn't budge from his position.

In some ways Kwangwaro is no fool. He realizes that the desire among officials and aid workers to vaccinate and eradicate polio is very high. So why not use his demands for water, power and basic infrastructure improvements as a bargaining chip?  Kwangwaro says as soon as a bore hole they have been demanding for fresh springs water is dug, he will allow the vaccination team - which has been sitting patiently all morning - to administer the polio drops.

Clearly there is no issue with the quality of the vaccines. But when Josephine asks this hold-out about the threat of a polio outbreak he is exposing his children to, he shrugs his shoulders and says “it’s God’s will”.

At first Kwangwaro, as the village leader agrees to allow Josephine to speak privately with other villagers. He then quickly retracts the permission when he realizes she is prepared to spend the entire day here, if that's what it takes.

“If one child here gets infected, the whole world is at risk,” says Josephine to Kwangwaro. She continues through a translator: “Tell him he’s really hurt my feelings. I feel very bad for the children. Tell him I love children and he’s really hurt my feelings for the children.”

I comment to Josephine that should this form of blackmail catch on, it could spread like wildfire. But she and others are confident that quick high-level intervention - by the District Head or Traditional Leader - will yield swift, positive results. The current round of vaccination ends in a day or two and there is little inclination to arrange a special mop-up campaign for this settlement.

Later I ask Josephine how she felt to have left the settlement and the unvaccinated children behind: “I left that community with my head down....I felt frustrated that we were not able to make a break-through”.

I ask the district EPI Manager if there is any issue with the vaccine itself. “No - before they used to take it. We have never experienced a case of such non-compliance except for today. It’s only this round; previously they have been receiving it.” 

Some observers say that in order to boost enthusiasm for polio vaccination - which requires several rounds-a-year, extreme micro-planning, detailed social mobilization and a full-proof cold chain - the approach needs to be shifted to address the economic concerns of communities, as well as other child killers such as malaria and water-borne diseases.

But if there is one thing this non-compliance case showed, it's that a rapid response is required to address hold-outs like Kwangwaro, as well as the moral suasion of traditional leaders, or district heads.

(This girl in Kano State contracted polio at a young age.)

Postscript: The following day, after the direct intervention of the traditional leader, Kwangwaro allowed all the eligible children in the settlement to be vaccinated.

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