Field Notes from Nigeria Day 2 – Highs and lows in the global Polio eradication campaign

(This young girl in Kano state, Nigeria is a polio victim.)

(HN, April 29, 2010) --- Today was a roller coaster ride of hope and despair.   Hope because we witnessed an entire community - mobilized by its traditional leader - rally around the cause of polio immunization. At a so-called flag-off ceremony at the remote settlement of Yalwa in Rimin Gado LGA - led by the District Head, Alhaji Shehu Mohammed Dankade - children thronged the polio vaccination point even before it opened.

Two local men beat drums and plucked at a string instrument, while another used a bull horn to announce that the polio vaccine had arrived and was ready to be dropped into the mouths of children.   "It's amazing there seems to be absolutely no resistance to this round of polio vaccination," said a health worker. District head Dankade and religious and political leaders lined up to administer the first double drops to young children while girls and boys thrust their younger siblings forward to receive the two drops of vaccine.  Health workers then drew a line on their fingers with a blue marker, handed them some sweets or a bar of soap and ticked off a box on a tally sheet that they had received the disease fighting treatment.

(Children in Kano state watch a polio vaccination campaign.) 

The enthusiasm and almost carnival-like atmosphere left us pumped up, elated. What we saw was the culmination of weeks and months of high-level advocacy - coupled with excruciating micro-planning at the local level – with a goal to ensure that all 6-million or so eligible children 0-5 years old in Nigeria are protected against polio.

It was during the ceremony that we were introduced to two young polio victims. Actually no one needed to point them out to us. I spotted them through the viewfinder of my SONY camcorder as I panned to capture the scene.  Their legs hung lifeless on the chairs. Their eyes full of sadness as they sat motionless while their friends rushed to the vaccinators for the drops and sweets. Because their parents had failed to get them vaccinated in the first crucial months of their lives they will be deprived of a normal life forever. That's the grim and cruel reality of the invisible polio virus as it travels indiscriminately from child to child - and across borders.

(This young boy is also, a polio victim. Vaccines came too late for him.)

I commented to a UNICEF colleague, Josephine Kamara that parents only need to see these victims first hand in order to take the necessary steps to protect their children. Indeed we are told by health workers that there are few, if any, so-called non-compliance cases in Yalwa. Covering the entire targeted group of kids should be, in theory, a no-brainer.

But then we come face-to-face with what I termed one of the few remaining "weak links" in the global, multi-million dollar effort to eradicate polio.

As we strolled deeper into the labyrinth of mud huts, we decided to conduct a spot check on the homes that had just been visited by vaccination teams. Elaborate codes had been scribbled on the front walls or doors of mud houses, indicating that they had been visited and that all the children inside vaccinated.

But just minutes into our tour, one by one, young children approached us showing the unmarked hands of their younger siblings (mothers - following tradition - stay inside). The further we went into the community, the more children came forward who were missed by the health workers.

Said one government health official, a medical doctor: "It's a miracle that we have been able to contain polio in Kano state. It seems almost 50 percent of the children here were missed."

Eerily there is no sign of the immunization teams but luckily our partners brought along a vaccine carrier and sweets to conduct a spot, unplanned mop-up campaign. A planning meeting later in the day looked into why the area was not properly covered. We later learned that remedial steps had been swiftly implemented and that a new team would be deployed to the area to follow up. I hoped so.

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

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.



Malaria: Africa Carries the Largest Burden

(HN, April 25, 2010) - In a major stocktaking report issued to coincide with Malaria Day today, experts conclude that the African continent disproportionately carries the lion's share of malaria cases.

In 2008, there were about 850,000 deaths due to malaria, and about 89 percent occurred in Africa. Approximately one in every six child deaths in Africa is due to malaria, according to Roll Back Malaria 2010 Africa Update.

The good news is that the global commitment to control malaria remains strong: in 2009 global funding reached nearly $1.7 billion, up from $0.3 billion in 2003. However an estimated $6 billion will be needed in 2010 alone for all targets to be met.

Insecticide treated mosquito nets (ITNs) and indoor residual spraying are the most common and effective ways to protect children from malaria, along with preventative measures such as controlling common breeding sources such as standing water. Experts say the good news is that most African-endemic countries hace adopted national plans to roll back malaria - such as monthly distribution plans for the nets.

"These efforts are already demonstrating a clear impact on the lives of people at risk of malaria in many countries and areas," the Roll Back Malaria report says. It adds that global production of ITNs has increased five-fold since 2004, rising to 150 million in 2009. The UN Children's Fund - UNICEF - is the largest global procurer of the nets.

Use of ITNs by children in 25 African countries with trend data averaged 22 percent in 2008, which is a major increase from the mere two percent recorded in 2000. Zambia and Sao Tome & Principe have the highest net coverage (62 and 61 percent respectively), while Swaziland, Cameroon and Guinea have the lowest at four percent.

In a statement issued to coincide with World Malaria, UN Secretary General Ban Ki-Moon said: "With commitment and resources, we can eradicate malaria and achieve all of our global development objectives." Two years ago, Ban called for malaria prevention and treatment programs to be made universally available to at-risk populations by the end of 2010.

Polio Outbreak Strikes Tajikistan

(HN, April 25, 2010) - In a potentially worrisome setback in the global fight against polio, the landlocked country of Tajikistan has been hit by a polio outbreak that has already claimed the lives of 10 children. The virus was most likely imported from neighbouring Afghanistan - a polio endemic country.

The World Health Organization says its has deployed a team of experts to investigate the outbreak in the south-west corner of this Central Asian nation, in the area bordering Afghanistan and Uzbekistan.

A sharp increase in early April of acute flaccid paralysis (AFP) cases prompted Tajikistan’s government to contact WHO about a possible polio outbreak. As part of a joint investigation by the Tajik national health authorities and WHO, laboratory tests by the WHO collaborating centre in Moscow confirmed poliovirus as the cause of the outbreak. This is the first outbreak from imported poliovirus in the WHO European Region since it was certified polio-free in 2002. 

As of 22 April, 128 AFP cases have been reported and 10 children have died. Uzbekistan has also reported three AFP cases, which are under investigation. 

Tajikistan’s last case of clinically confirmed polio was in 1997. Even though it is one of the poorest countries in the region, Tajikistan has relatively high vaccination rates - with reported coverage nationwide at 87% in 2008, which is the last year for which complete data are available to WHO. 

At the Tajik government’s request, technical experts from WHO have started a detailed outbreak investigation and response in accordance with standard international guidelines. 

Tajikistan will hold three nationwide vaccination campaigns in a short time frame to halt the outbreak. The campaign will be managed by the Tajik Ministry of Health, with support from WHO, the United Nations Children’s Fund (UNICEF), the United States Centers for Disease Control and Prevention (CDC) and other partners in the Global Polio Eradication Initiative. Rotary International has already offered an emergency grant to begin the vaccination campaign. 

There is a worry that the virus - which travels quickly and easily - may spread to other neighbouring countries. Afghanistan, Pakistan, India and Nigeria are the four remaining polio-endemic countries in the world, although recent outbreaks were registered in several countries in Africa due to importation.

--- Reporting by HUMNEWS Staff, WHO.

A football travels to 22 African countries to kick polio out of the continent ahead of the World Cup

(HN April 9) In the lead-up to the FIFA World Cup in South Africa this summer, a campaign organized by Rotary clubs across Africa are gearing up for the final push to kick polio out of the continent.

 A football will arrive this weekend in Nigeria - one of four polio endemic countries in the world. Earlier this week it was in Sudan, where it was welcomed by the Minister of Health. It will then travel to Juba en route to the neighboring Central African Republic.

 "As Africa celebrates hosting the first world cup in its history, we are using the football theme to finally work together to kick out this terrible disease from our continent,” said Tabitha Boutros Shukaya.

Rotary’s “Kick Polio out of Africa” awareness campaign was launched on February 23rd with the symbolic kicking of a ball signed by Emeritus Archbishop Desmond Tutu, who himself had polio as a child, and has joined Rotary’s campaign as a good will ambassador. 

From Cape Town, one of the host cities to the 2010 World Cup, the soccer ball will travel through 22 polio-affected countries en route to Egypt, and then to the Rotary International Convention in Montréal, Canada in June. As the ball travels through the continent, additional signatures are joining Desmond Tutu's on the ball as prominent Africans lend their support to this grassroot campaign. The journey is being underwritten by DHL Express.

“As the world comes together for the first World Cup on African soil, we invite football fans –especially in the 32 countries that are sending their national teams to South Africa- to support our global campaign to end polio. I believe in the unifying force of football,” says John Kenny, President of Rotary International. 

During the ball’s four-month journey from the southern tip of the continent to Alexandria, Egypt, Rotary clubs in polio-affected African countries are organizing football related awareness events to mobilize the public for mass immunization rounds this spring. In early March, a total of 19 countries in West and Central Africa participated in synchronized national immunization activities, targeting 85 million children under the age of five. 

Polio knowledge events have been held as the ball has made its way through Angola, the Democratic Republic of Congo, Burundi, Uganda, Kenya and Ethiopia. In Angola, its most popular and revered soccer player, Fabrice Akwa signed the ball to add his support to polio eradication.

Also this week, in a major boost to the campaign, musicians from across Africa signed up to fight polio, led by the African group, Staff Benda Bilili, which means “look beyond appearances” in Lingala. Staff Benda Bilili are a group of eight former street musicians from Kinshasa, whose debut album Très Très Fort has received international media acclaim and won the 2009 Womex Artist award. The core of the band consists of four singers, who are all polio survivors. Their signature song, “Polio”, speaks of the disease that drastically changed their lives, and urges parents to immunize their children. 

Branded the “Kings of the Congo” by a French newspaper, the band pumps out beautiful Congolese rumba-rooted songs.

“Of course we’re happy to be part of the campaign. After all, we’re handicapped by polio, and we are the first group to sing about polio, so naturally we’re ready to help,” says band leader Ricky Likabu after being named Rotary polio goodwill ambassadors. “Our song ‘Polio’ is simply to implore parents to take their children to health clinics to be vaccinated, as the WHO (World Health Organization) recommends. Parents are responsible for their children, and they need to know how to avoid diseases.”

In Benin, pop singer and Unicef ambassador Zeynab Abib has been lending her voice to the polio eradication campaign and childhood vaccination with her song “Sauvons la vie de nos enfants” (Let’s save the life of our children) and with her participation in many local social mobilization events.

Next week, an immunization campaign targeting 2.8 million Sudanese children under the age of five will be staged across Sudan. A total of 45 cases of polio were reported last year in Sudan, mostly in the south.

According to a WHO representative in Ethiopia, Dr. Fatoumata Nafo-Traore, the polio eradication initiative has saved more than 5 million children from being paralyzed. 

“This is a great achievement and we cannot fail now that we are very close to finishing the job.  Sorry we are late for you, but we will not let down your next generation,” said Dr. Nafo-Traore while handing the ball to young polio victims at Cheshire Services in Ethiopia.

Former South African President Nelson Mandela, in his 1996 address at the Organization for African Unity Summit formally kicked off the “Kick Polio out of Africa” campaign.  He declared: “We are calling on the continent's football players to bring their enormous influence to this campaign. Only unified efforts which galvanise whole societies towards these goals will succeed in kicking this virus, that looks so much like a football, out of Africa and eventually, out of the world.” 

In the past two decades, the incidence of the disease has been reduced by 99 percent worldwide and in Africa, only Nigeria remains polio-endemic.  Out of sight, out of mind for many, but the disease still affects children in several other high-risk countries, emphasizing the need to protect all African children against polio.

Through an alliance with the African Football Confederation, leading players from across the continent have participated in the “Kick Polio out of Africa” awareness campaign by distributing posters, conducting radio interviews and holding autograph sessions.

Because viruses do not observe man-made borders, previously polio-free countries remain at risk due to international travel and migration. Following a 2008 outbreak in northern Nigeria, the virus spread into neighboring countries and as far as Angola, Mauritania and Kenya. Of the total 735 polio cases in Africa in 2009, 388 cases were recorded in Nigeria. 

However, progress is being made. The incidence of polio in Nigeria has dropped by more than 50 percent since 2008 and only 13 cases have been reported since August and only one case so far in 2010.

Polio eradication has been Rotary’s top priority for more than two decades. The international humanitarian service organization is a spearheading partner in the Global Polio Eradication Initiative, along with the World Health Organization, the U.S. Centers for Disease Control and Prevention, and UNICEF.   

Great progress has been made, and the incidence of polio infection has plunged from about 350,000 cases in 1988 to fewer than 2,000 in 2009.   Since the campaign began more than two billion children have been immunized in 122 countries, preventing five million cases of paralysis and 250,000 pediatric deaths.

Rotary recently pledged to raise US$200 million to match $355 million in challenge grants from the Bill and Melinda Gates Foundation. All of the resulting $555 million will be spent in support of eradication activities worldwide.

---Staff, files