An army of women is fanning out across northern Nigeria, dressed in brightly coloured, ankle-length robes, heads covered with scarves for modesty, each carrying an insulated box with ice packs and an oral vaccine.
They’re heading to the front lines in the battle to wipe out polio from the face of the earth.
Thousands of female vaccinators are walking house to house across eight states in northern Nigeria, one of only a few spots on the globe where polio continues to cripple young children.
It’s part of a drive to stop transmission of the polio virus worldwide by the end of 2003, something that hasn’t happened with a disease since smallpox was eradicated in the late 1970s. Polio was found last year in only seven countries, down from 125 countries in 1988, when a global programme to end the disease was launched.
Health experts say the goal can be achieved, but only if vaccination programmes are absolutely thorough. In northern Nigeria, the obstacles to a thorough campaign are first finding all the children under age five and then persuading their parents to allow vaccination.
Many parents in this predominantly Moslem region believe the polio vaccine is designed to sterilise their children or give them Aids. Their refusal to let their children be vaccinated helped make Kano the epicentre of polio last year in Nigeria, with 49 confirmed cases, more than any other state in the country.
”The problem really in Kano as a state is that we have religious fundamentalists who are very influential,” says Eunice Damisa, chief social mobilisation officer with the National Programme of Immunisation.
”They keep telling people the vaccination is a US plan to reduce the population, that the US wants to eliminate them.”
To try to counter the myths, the organisers of the current vaccination drive have sought support from Islamic clerics and traditional rulers. Moslem scientists conducted lab analyses of the vaccines and declared them safe. The Emir of Kano issued a communiqué supporting the programme. Pro-vaccination messages were broadcast on television, radio and through old-fashioned town-criers.
”The majority of people here, they respect the traditional structures,” says Christopher Kamugisha, technical consultant in Kano from the World Health Organisation. ”That’s a very powerful thing.
”From all the social mobilisation efforts that took place, there was a major breakthrough,” says Rabiu Musa of Unicef. ”Rejection has drastically minimised.”
While the efforts may have brought wider acceptance of vaccination, enough resistance has remained to cause headaches for the organisers.
Every day during the immunisation campaign, monitors reported problems in various parts of the state. A high refusal rate in the town of Danbatta, entire schools where administrators stymied vaccinators, streets where multiple households resisted, right down to the woman who refused to vaccinate her children because her husband hadn’t said whether she should. Similar stories were heard from other states.
”What we have still are pockets of resistance, not whole communities but just pockets,” insists Damisa.
Just finding every child is no easy task in a state where many of its 10-million people live in the densely populated, chaotic slums of Kano city or off the beaten track in far-flung rural areas.
Some 5 500 vaccinators spread out across the state, aiming to place two drops of vaccine into the mouth of each child under five.
All are women, because the culture doesn’t allow men to go inside others’ homes in search of mothers and their children. Each vaccinator is accompanied by a local male guide, who has the approval of local leaders and who knows intimately the crowded alleyways of his neighbourhood or the dusty lanes of his village.
Several of these pairs work as ”sweep teams”, knocking on every door they find. Each child who gets immunised is marked on the left thumbnail with indelible ultraviolet ink and a symbol is scratched on the door with chalk before the pair proceeds to the next house. To try to ensure that no more children are paralysed by this completely preventable disease, the health workers plan to repeat the process in the polio hotspots at least two more times before July, when the transmission ”high season” begins.
Will they succeed?
”That’s something we can’t judge until October or November,” says Kamugisha. – Sapa-DPA