Experiences from the Heart of the Polio Outbreaks
By Amy Pisani
As both a Rotarian and the director of Every Child By Two – Carter/Bumpers’ Champions of Immunization, my commitment to playing a small part in eradicating one of the world’s most frightening diseases stands firm. Today is World Polio Day and people throughout the world are voicing their commitment to putting an end to polio now!
Polio, a disease that few of those in my generation have any recollection of, spread terror through the hearts of families here in the U.S. and around the world until a vaccine was developed. Children were unable to swim in pools, oceans or lakes for fear that they would be “contaminated” with the virus. Sadly poliomyelitis mainly affects children under five years of age and 1 out of every 200 infections leads to irreversible paralysis. Among those paralyzed, 5% to 10% die when their breathing muscles become immobilized.
I met Millicent, and her beautiful 11 month old twin girls Benita and Hilda, on a trip to Kenya organized by the Shot@Life campaign. While there, our team of observers witnessed the heroic efforts being made to contain a recent outbreak of polio in the Horn of Africa.
The trip to Millicent’s home, situated in one of the largest slum neighborhoods in Nairobi, was truly unforgettable. Our team consisted of three United Nation’s vans, driven by some of the most skilled drivers I’ve ever met. The roads throughout Kenya were a hodgepodge of traditional blacktop, gravel, and dirt roads that most would find insurmountable. Along the highways and local roadways thousands of men, women and children traverse dangerously close to traffic, many selling household necessities such as fruit, vegetables and clothing on blankets strewn along the roadside.
Millicent’s neighborhood is located in a slum called Korogocho, a Swahili term meaning “crowded shoulder to shoulder”. It is home to between 150,000 to 200,000 people pressed into 1.5 square kilometers (370 acres). This translates to approximately 473 people dwelling on one acre of land. The dwellings consisted of row after row of one story shacks built side-by-side as far as the eye could see. The walls and roofs consisted of miscellaneous scraps of rusted metal, wood and cardboard. Exposed nails protruded dangerously out from the walls and down through the low hanging eaves.
In order to reach Millicent’s dwelling, we had to jump across a stream of raw sewage, which winds its way along the main alleyway. Dozens of families were cooking food on open grills and fire pits as the mangy dogs ravaged through the sewers for scraps. During our brief hold in the vehicle, my team and I witnessed an older gentleman, who was unsure on his legs, stumble and fall into that horrifying muck. He was eventually rescued by some younger family members, but the impression will stay with me forever.
Millicent is a twenty year old single mother who proudly welcomed us to her freshly swept home. Our visit was intended to help us understand the challenges faced by polio eradication workers who must go door-to-door to vaccinate every child. These campaigns will take place several times throughout Kenya in 2013 as part of a massive effort to squelch an outbreak that was first discovered this past April. Kenya had been polio free since 2011, however cases of the disease are believed to be spreading from the epicenter in Somalia. Since every “known case” of polio represents between 200 and 1,000 often unknowingly infected people; public health officials from around the globe and within Kenya have gone into overdrive trying to ensure that this outbreak is swiftly contained.
At 2:30 in the afternoon Millicent’s windowless home was nearly pitch dark, which explained why the streets were teeming with individuals. By using the lights on our phones we were able to see that there were two areas in her hut, each no more than 7×5 feet. The back area consisted of a “mattress” on the floor which was shared by Millicent, her toddlers and her mother. The front area had a small, low table and a wooden box.
Millicent’s mother wakes up prior to dawn to travel to the local factory where she works as a casual laborer sorting out French beans. Millicent cares for Benita and Hilda in the mornings, feeding them a maize porridge made with either water or a small amount of milk. Millicent explained that the children had been targeted by UNICEF as being at high risk for malnutrition. UNICEF provided the family with a highly nutritious infant food called ugali (maize pap) and plumy nut which she attains from the Provide Clinic. When asked what Millicent had eaten that day she replied that she had one cup of tea without sugar or milk; it was 3:00 in the afternoon.
Each day Millicent drops the children off at “daycare” with a bowl of porridge, before she walks several miles to a local poultry slaughter house. She pays a fee to the butchers who allow her to remove the eggs out of the already slaughtered hens, which she then sells along the roadways. These eggs, which are not yet matured, have little nutritious value and questionable safety. When asked what she hoped for her children, Millicent stated that her dream is that they would grow up healthy and educated so that they could help her and her mother one day.
Thus far the current outbreak in the Horn of Africa has resulted in 197 cases as of October 16th. The rapid responses have been instrumental in containing the outbreak and there is hope that it has neared an end. Having witnessed the challenges in a place like Nairobi, my respect for the intricate planning of door-to-door campaigns and complex implementation of the constant disease surveillance has skyrocketed. Mothers like Millicent expressed the most sincere gratitude for the polio, measles and pneumonia vaccines that have been provided to her baby girls. During our trip we learned that rotavirus vaccine will be introduced in Kenya in 2014 which has the potential to save thousands of lives each year.
That night as I lay in my bed, the acrid smell of burning trash awaked me many hours before dawn, reigniting the burning in my eyes, nose and throat. My mind was filled with thoughts about the day’s journey, the incredibly dedicated health workers and the hopeful families we had met. It occurred to me that in a place like Korogocho there is simply no other method of eliminating the trash which piles up as high as twenty feet. In fact most of the people living in the slums make their living digging through the trash to locate recyclable items, while the slum dogs fight for the scraps of meat and food items. I never did fall back asleep that first night. I lay there teary eyed, thinking of how Millicent, her mother, Benita and Hilda were all crowded on a scrap of a mattress, on the floor of a shack, surrounded by raw sewage.
Over the course of our trip I met people who inspired me beyond words, most of whom are volunteers from the local community who are 100% committed to eliminating polio from the face of the earth. And I knew that I would spend the rest of my life making sure that the hopes of mothers like Millicent, who simply dream of their children having a shot at growing up healthy and educated, can come true.
Stay tuned for the story of Job Alphonse, a little boy who contracted polio in a small village in Kenya in Spring of 2013, and hear how his case sparked a nationwide crusade to keep Kenya’s children from suffering the same fate….