?While 2012 was set as a deadline? for Nigeria? to eradicate the wild polio virus, the country has continued to witness upsurge in? the virus with 56 cases already reported . In this interview with WINIFRED OGBEBO,? Dr Abdullahi? Bulama Garba, North–West Coordinator, National Primary Health Care Development Agency (NPHCDA),talks on the responsibility of parents and political leaders towards achieving this feat.
WHY IS THERE AN UPSURGE WHEN WE WERE ALMOST ERADICATING POLIO? TWO YEARS AGO?
?When you are close to defeating your opponent and you relax, your opponent will gather strength and come back.? In 2010, God so kind, in support of the present Minister of State for Health, Dr Muhammad Ali Pate, we got the full involvement of the traditional rulers of all the states. A committee was even set up. This committee really worked, involving every emir and mobilized all district heads as well as religious leaders. So the involvement of those people really helped us and that was why we had up to 98 per cent success in polio eradication efforts in 2010. It’s not that they have relaxed but, honestly, there must be a gap somewhere for that to have happened. In 2011, it was due to several factors like immunization fatigue, non- compliance, logistics and, especially, the poor commitment from the local government. They need to tighten their belts because this programme is everybody’s work. The federal government with partners supplies all the vaccines, pays all the personnel, including me, and all the vaccinators. They pay the logistics effortlessly. The only thing needed from the states and local governments are supervision and provision of pluses – biscuits, sweets, etc. Something that will add value to their health and at the same time attracts the mothers and the children to the immunization point. Not only that, sometimes if the resources are there and there are no eyes to watch over how they are utilised, this is contributing to the problem. Take for instance, if election comes, everybody comes out. When it comes to immunization, the children are more vulnerable than election because they are the future leaders. So we need to protect them.
? Most of our states and local government do not come out to supervise and make sure that our children are at immunization points. They leave the work for us and you know the vaccinators are not directly under us so we cannot punish them even if they misbehave. We don’t pay them salary so the worst we can do is to sack them and by then the damage has already been done. So what we are saying is that those that are directly supervising them on their routine services should pay more attention. That is one big gap we are having and that is why we have these setbacks. In Kano State in particular, I can say with even these number of cases, I feel comfortable in terms of the commitment I have seen in the government.
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MOST OF THE COMMUNITIES ARE HOLDING GOVERNMENT TO RANSOM BY DELIBERATELY REFUSING TO IMMUNIZE THEIR CHILDREN. WHAT IS YOUR TAKE?
That is one of our headaches. These excuses they are giving are not acceptable . One cannot say, one cannot take care of one’s child because ordinarily if they are sick, you must take them to the hospital. Then why are they denying these children? Is it because these children are innocent, they cannot speak? Many at times, these parents that are denying their children immunization are members of the opposition. If you find out, its either they have grudge with their chairman or elected House member. You know the cliché that when two elephants fight it’s the ground that suffers. This is most unfortunate and one we cannot accept. In health, we have not started using force like in other countries but I don’t know because if this persists, something has to give because the world cannot continue watching as the country remains the only one battling the virus after investing so much. It’s so embarrassing. Meanwhile, those people refusing, follow them on hajj when they are going to Saudi Arabia, they must vaccinate themselves as demanded by the airport authorities.? However, this part of the country has history of sceptism generally. When western education came then, people were rejecting going to school, same thing with fertilizer and now they are begging for them.
?These 16 children infected with the wild polio virus were the ones that did not accept the vaccine and now the parents are regretting but it’s too late. The signs and symptoms of polio presentation are almost similar to other diseases so a parent cannot tell immediately and it’s the paralysis that will clearly tell you that it was polio. I don’t know of any doctor in the world that reverses paralysis from polio and that is why we are calling on people to come out with their wards for immunization. It is irreversible and it causes permanent disability unlike other preventable diseases, unlike Tuberculosis and measles. That is why we seem to be paying more attention to polio yet people don’t seem to realise this. They are saying-polio, polio, all the time. Yet, the disease eradication is possible because it only affects human being. We don’t have to go chasing animals in the bush, and given the experience of small pox, I strongly believe that we can eradicate another disease like polio. Small pox was even by injection and polio is simply two drops of the vaccine in the mouth. So the ease with which you can give the vaccine, the availability, the proven efficacy of the vaccine, and the fact that the disease is irreversible are the reasons why we embark on polio eradication. We are scientists, we don’t work on assumptions so we are calling on people to cooperate. I have never heard of any government in the world that would deliberately set out to destroy its people. If a government eradicates its people, who will it govern?? So government policies are always good . That is why we health workers and religious leaders hardly frown our faces. We don’t fight people. We feel that if somebody is not accepting medication, maybe the information is not enough to convince the person so we’ll keep on talking because that is our training. There were many places our vaccinators were chased out.? In fact, some were even beaten but with education they have come to regret and apologise. I feel that with time, they would come to their senses.
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WHAT STRATEGIES ARE YOU PUTTING IN PLACE TO ENSURE WE ERADICATE POLIO THIS YEAR?
It’s not only coordinators’ work alone. If it were, I would have done it since.? So it’s me and you. What are we going to do to ensure that we eradicate polio? What I believe is that for every problem, a local solution is always good. If a challenge arises in a place, don’t be annoyed, go there and find out why and you would realise that that challenge is due to one thing or the other. So we are trying to sort of empower the states and the local governments and that is why we are looking for their commitments.
Let them identify the challenges, they may not be able to solve them but let them identify them. I cannot have a generic solution for the whole zone or for the whole country because every community has its own peculiarities.
We are going to have a stakeholders’ meeting which include commissioners for health to review everything. I believe it’s achievable.
?Routine immunization is routine based. It’s to ensure that a child before s/he reaches one year, the mother is supposed to take him or her to health facility five times in order to get all the vaccines. The immunization has to be in the health facility because you cannot carry injections and various types of vaccines from house to house so we expect people to go to the health facilities to receive those vaccines. It’s because the routine immunization is a bit weak that is why we have this supplemental. But if it were strong, say 80 per cent routine immunization coverage, our number of SIPDs would have reduced. We seem to be paying more emphasis on SIPDs but it’s not really true, but because of the time frame. It’s the urgency which we are required to eradicate the disease. Supplemental means to give complimentary to the routine so the routine is still the backbone. We have four strategies; strong routine immunization, SIPDs including Mop up and surveillance. So the government is investing a lot but what is the essence if the people do not know the value? For every penny spent, there must be a value for it. We must not waste public funds procuring vaccines and then people don’t go to receive it at the end of the day.? This attitude of everything government is also contributing to the lapses. People should wake up to their responsibilities.