Making a mark in the fight against polio
Chalk notations help roaming Unicef volunteers track efforts to immunize every child under 5 in Afghanistan
Globe and Mail (Canada)
March 17, 2008
KANDAHAR, AFGHANISTAN — Like Egyptologists deciphering inscriptions inside a tomb, the men peered closely at markings covering the door and traded opinions in bursts of Pashto.
These were not scholars discussing hieroglyphics unearthed in a pyramid, but volunteer health workers in a residential area of downtown Kandahar.
Mud-brick walls loomed close on either side and a trickle of sludgy liquid ran along a trench down the centre of the alley. In front of the men, set into the featureless wall, was a firmly locked metal door covered with chalk notations. Similar markings can be found on doors across the south and each is a message to volunteers who fanned out this week on their latest blitz against polio.
Polio is a viral infectious disease that can lead to paralysis. It has been eradicated in much of the world; Afghanistan, Pakistan, India and Nigeria are the only countries in which it is still considered endemic. In Afghanistan, in the rural areas especially, care for victims is rudimentary or non-existent.
But now, in spite of rising security concerns and the worrying early emergence of new cases this year, Unicef is well on the way to immunizing every Afghan child under the age of 5. It’s a mammoth task made possible, in part, by simple chalk notations that act as a sort of evolving medical chart for the roaming volunteers.
One glance at the door and the volunteers should be able to tell whether the house has been visited, how many children were there on the last visit and whether they were immunized. At least in theory. When the crew rapped on this particular door this week, they found children whose ink-marked forefinger and forehead indicated they’d already been immunized.
The family retreated into their home and the medical crew fell into discussion as they pondered the markings on the door. Eventually one used his chalk to add yet another notation. With a shrug, they walked on.
It’s an imperfect system, but it may be the only way to be reasonably confident of eventually reaching all Afghan children. There is no census from which to tick off names and the constant movement of people has been increased by security concerns.
“This is a very problematic region and the major problem is poor security,” said Dr. Shahwali Popal, who heads the immunization program for southern Afghanistan out of Kandahar’s Unicef office.
In the face of that, helped by a three-year commitment from CIDA for approximately $15-million, volunteers working have managed to immunize about one million young children in the past year, Dr. Popal said.
This week they made a three-day sweep known as an NID: national immunization days. It was their third one this year and will be followed later in the month by a “mopping up” operation. Volunteers fanned out and fixed operations were set up at medical facilities and border crossings.
Fourteen-year-old student volunteers named Nasibulla and Atiqulla were manning a table at the gate to Mirwais Hospital in downtown Kandahar. They sprang into action at the sight of any small child, rushing to flag down entering vehicles. For the most part, parents were easily persuaded and the volunteers administered drops of vaccine into the mouths of children who seemed both curious and nervous.
Over the past year, efforts such as these have allowed volunteers to immunize about 90 per cent of children under five, Dr. Popal said, and they are now keen to cut the remaining number in half.
But although the volunteers have officially been given safe passage by the Taliban, the insurgency is not a cohesive hierarchy and this agreement is not necessarily followed by all fighters. As well, smugglers, bandits and other armed men pose a constant risk in southern Afghanistan.
There have also been occasional problems in the conservative areas with religious leaders counselling against the immunization. But the real concern is the security situation, which can change in an instant.
“In the morning you can go in [to a village] but in the afternoon you can’t,” explained Dr. Rahmatullah Kamwak, who heads up local World Health Organization efforts.
Another concern this year is the earlier and more rapid emergence of polio cases. In 2007 there were 15 cases, but this year there has been three cases already, two in Helmand and one in Kandahar province. That rate could indicate an overall increase and, more worryingly, the first appeared in January, three months before the first case last year.
Health officials are putting an optimistic face on the result, saying that the earlier cases may be the result of more rigorous testing. They also note that the case in Kandahar was in a part of the province that could not before be reached but has since been visited by immunization teams.