Photo Essays

The Democratic Republic of the Congo is battling ongoing poliovirus transmission. Together with Pakistan and Chad, the Democratic Republic of the Congo is currently on top of the worldwide polio chart, with 87 cases as of 22 November 2011.

The country has successfully stopped poliovirus transmission before and it can do it again. Supplementary immunization activities are held to ensure that each child receives polio vaccine. The country's government is committed to doing what it takes, and each local coordination committee follows the national polio eradication emergency plan set by the Ministry of Public Health. As a result, poliovirus transmission has been reduced to two pockets on either side of the country.

"You have a responsibility to protect your children. They can’t defend themselves if you don’t." At the launch of the vaccination round, a polio-survivor addresses parents and authorities, asking them to immunize their children against the disease that has greatly affected his life.

The mother of a boy who was paralysed by polio in July urges the public to vaccinate their children. Governments and polio eradication partners work with communities to foster a climate of confidence and understanding. When pockets of refusals are encountered, traditional and religious leaders are engaged to help ease parents' fears.

Mabatu, six years old, has been paralysed since he fell sick with polio two months ago. In countries with little infrastructure, polio can affect a child's chances of contributing to household chores, finding work and getting married, creating extra pressure on already overburdened families.

All the vaccines for the160,000 inhabitants of Popokabaka are stored in two fridges which are fuelled by petrol. Every morning, two staff-members at Popokabaka’s health centre fill 800 ice-bricks to help keep the precious vaccine at zero degrees Celsius during the day.

Vaccine carriers preserve the oral polio vaccine throughout the day, aiming to maintain a temperature of zero degrees Celsius in a country where the average temperature is around 40. Each vial of vaccine has a temperature-sensitive label which changes colour if the vaccine is not kept sufficiently cool.

Access to Popokabaka is possible only by dirt track. Four-wheel-drives are a luxury, but even they are not exempt from getting stuck during the rainy season. Poliovirus transmission in the Democratic Republic of the Congo is now limited to just two pockets - one pocket centred in Bas Congo/Bandundu provinces in the country's west, and one pocket in the east, in the sparsely populated north of Katanga province. Popokabaka, the site of several recent polio cases, is in Bandundu province.

Hygiene and polio are closely linked. In the Democratic Republic of the Congo, barely half of the population has access to safe drinking water.

Less than one in seven in the Democratic Republic of the Congo live in acceptable hygiene conditions, and open-air defecation is the norm in rural areas. Given that polio is transmitted through the faecal-oral route, inadequate sanitation facilitates the spread of the virus.

A social mobilization worker calls out to the population of Popokabaka. During polio vaccination campaigns, social mobilization workers travel through towns, using a megaphone to inform parents of the importance of vaccination and when their children can be vaccinated.

A vaccinator administers oral polio vaccine to a small boy. Because it comes in liquid form, oral polio vaccine can be administered by anyone, even volunteers. More than 2.5 million children and 225,000 adults across the country are targeted during November's vaccination drive.

After vaccinating a woman, a health worker marks her left pinky finger with indelible ink. This enables health workers to keep track of who has received the vaccine and who has been missed.

The mobile vaccination team marks each family’s door with chalk, indicating the number of inhabitants who have been vaccinated. If necessary, they return later to vaccinate anyone who was missed.

Every polio campaign is an event. Children who are asked about the vaccine proudly show that they have been immunized.

During each campaign, supervisors follow the mobile vaccination teams to verify that all conditions for a successful campaign have been fulfilled. A mixed team of workers from WHO and UNICEF discuss the round with a local health agent.

A UNICEF car on the way back to Popokabaka after a day of supervision in the field. Every campaign day finishes with a coordination meeting where challenges and results are discussed and problems solved. With high quality polio vaccination campaigns, the Democratic Republic of the Congo can rid itself of polio once more.

Balochistan has the highest number of cases in any province of Pakistan, largely centred on the Quetta area. This drawing shows a vaccination centre, with community members informing each other about polio vaccination at the centre. A polio-affected child with crutches watches children playing and wishes he could join their play.
Drawn by Fazeela, 6th grade

Drawn by an 8th grader from a local government school of Kharotabad, where three cases of polio have been confirmed in 2011, this picture shows a polio-affected child and other children. A mother of a polio survivor talks to a vaccinator, warning her to tell parents, "Never repeat the mistake I committed, my child is crippled. I request all the parents to vaccinate their children against polio.”

Drawn by Fida Mohammad, 8th grade

Fifty students from ten schools of four high risk union councils participated in the drawing competition. Here, religious leaders and tribal members are marching, holding banners with slogans of a polio free Pakistan. The child shows in her art the active community participation from both religious and non-religious communities that is critical for polio to be eradicated.

Drawn by Shakila Khan, 7th grade

Within the five high risk districts of Balochistan, 70 union councils in have been classified as high risk on the basis of persistent transmission, low quality campaigns, mobile population and hard to reach areas due to insecurity. Here, a polio affected child watches other children playing and thinks, “If only my parents had vaccinated me against polio I would have been playing like these children.”

Drawn by Neelam Khan, 7th grade

Nigeria is on the last lap towards polio eradication with tremendous progress over the past two years but the battle is not yet over.

Intensified efforts are underway in Northern communities to mobilize communities for polio campaigns through varied communications interventions

Women’s compound meetings are targeting high risk communities where resistance to oral polio vaccine is strong.

Aminu Ahmad is the President of Kano’s Association for Polio Victims. He runs his own tricycle business where 80% of employees are people with polio.

Aminu is actively involved in community mobilisation efforts in high risk communities to bring about change and acceptance of immunization, both polio and routine.

Traditional leaders play a key role in addressing resistance to immunization thanks to their status and high respect in communities.

During campaign ‘flag offs’ traditional leaders often vaccinate eligible children in the communities including their own children.

Papa Lolos (Village clowns) are actively engaged during campaign flag offs to draw out the crowds while vaccination team waits to capture all eligible children.

Majigi films – locally produced films that include drama and polio facts – are widely used during community dialogue and compound meetings to strengthen the impact of communication.

Majigi films engage their audience and prepare the women for a dialogue with the health educator following the screening.

Aminu does his part in high level advocacy too and was invited to address the Kano Emirate Council.

Certain religious sects still have strong anti-immunization attitudes. With the help of Emirs and religious scholars efforts are underway to overcome them.

Okada bikers (taxis) are used in Zamfara to inform and mobilise communities during the week leading to the campaign.

Nigeria will have to reach every last child in the next six months to be able to stop the transmission of the wild polio virus in Northern Nigeria.

Little Tukur Bello (right) and his older brother Abdullah are from Zamfara State, Nigeria. They are both bright and alert and enjoy playing with each in the small and remote community in which they live. Tragically, both of them are paralyzed by polio.

Five years ago, Abdullah fell sick with fever along with two of his brothers. Both his brothers died and Abdullah has never walked again.

Polio returned to their village in late 2010. Sadly, Tukur Bello had not received any doses of routine immunization and just one dose from a recent campaign. He became the latest victim in this small community to be permanently affected.

It is three months now since Tukur Bello fell ill. Fortunately the polio virus has attacked the nerves in one leg and Bello can still stand.

His brother Abdullah has not been so lucky and must crawl through the dirt on his knees to move around the settlement.

His brother is lively and inquisitive. However, his legs are too weak to carry .

In the village, Bello is still coming to terms with falling sick and the attention it still brings. He is very shy.

It is a busy day in the village and everyone has come out to see the visitors. It is the first national immunization plus day for 2011 and additional focus and attention is being made to ensure all children in the community are reached with both oral polio vaccine and measles vaccine as part of an integrated campaign.

Older girls bring many of their younger brothers and sisters.

It is loud and chaotic as the children gather round the health workers.

Importantly fathers also bring children to the post for immunization.

Bello is fascinated at what is going on and gets a closer look.

He is almost lost in the crush.

An additional dose of bivalent oral polio vaccine is given to all children under five.

And a shot of measles vaccine is also given to all children between 9 months and five years.

As the last children arrive at the post and as the health workers begin to pack up to move to the next village.

Attracted by the noise and commotion another child arrives at the immunization post. From a neighbouring settlement, Muhammad was also paralyzed five years ago at the same time as Abdullah.

Brave and strong but with the need of a permanent crutch to help him walk, Muhammad is just one more reminder of the devastating affect this virus has had on local families.

It is these three children who leave a lasting impression.

On their way homeward.

I realize like my memories, their paralysis will be with them always. One village, five lives devastated.

Oral polio vaccine is stored in refrigerators at a health facility. The rainy season has flooded the area but the refrigerators are intact, keeping the vaccine chilled.

A child is given the vaccine at the Torti camp for internally displaced people.

Frequent travel between Chad and Sudan makes it easy for the poliovirus to spread. In the Darfur region, displaced children are particularly vulnerable.

Dr Salah Haithami of WHO checks that a vaccinator knows her tasks – giving two drops of vaccine to every child, marking their fingers with indelible ink, and storing the vaccine safely in her cooler box.

Dr Tayeb EL Saied, in charge of Sudan's immunization programme, demonstrates house marking.

These marks tell vaccination teams and monitors whether a house has been visited and whether the children under five years of age have been vaccinated.

A team of vaccinators waits to be driven out to a remote community.

More than 90% of vaccinators are women, as only women have access to private households.

Vaccinators – often volunteers – are recruited and trained in the days before a vaccination campaign.

These women are the critical entry point into a household, as men are not usually allowed inside.

Posters on cars, buses and walls remind people of the importance of vaccinating their children.

Radio and television announcements invite parents to immunize children.

A vaccination team sets out in Sana'a city, the capital of Yemen.

Across the country, such teams will drop vaccine into the mouths of 3.8 million children. The vaccine is monovalent, protecting the child against the type 1 poliovirus, which circulates in the area.

Equipped with maps that show all the houses in a neighbourhood, vaccinators knock on every door to find children.

One team member climbs the stairs to the upper floor of one of the city’s traditional houses, while another waits below with the cooler containing the vaccine.

Every morning, these teams pick up vaccine from a central location and load it into their coolers. A special monitor on the vial changes colour if the vaccine has been out too long and is no longer useable.

Newborn Sifa is given her first dose of the vaccine. As polio vaccine has to be given repeatedly before the body develops immunity, she already has a good chance of escaping polio.

Children run enthusiastically out of their houses to take the vaccine.

Their fingers are marked with indelible ink to show that they have received their dose and they proudly show off their finger marks to passers-by.

A community leader helps the vaccinator and father to give the vaccine to a child.

These leaders are highly respected in their communities – elders, teachers, doctors, preachers, spiritual figures, business people. They encourage parents to have their children immunized.

The outside of a house is marked with chalk to show that vaccinators have visited. The marks tell vaccinators whether children in that home were vaccinated or not. If not, a second visit is arranged.

A monitor looks through the vaccination team's maps and tally sheets, which record the details of every visit.

Monitors fan out over the same areas as the vaccination teams, double-checking their work and making sure each household has been visited successfully.

Northern Nigeria is one of the last areas in the world with endemic poliovirus.

In 2008, 798 children were paralysed by polio in Nigeria – more than any country in the world. This is because not enough children are vaccinated.

Once a child is paralysed by polio, it is for life. There is no cure.

There is a solution to ending polio. The oral polio vaccine is safe and effective and has successfully stopped polio in over 190 countries.

Vaccinating every child under five years old builds population immunity. If every child is protected, the virus can no longer survive.

To reach every child, adequate vaccine and logistics must be sourced and distributed to local government cold stores.

Each and every village in Nigeria must be accurately mapped to show all households.

Teams must be trained to vaccinate around 41 million children under five years old.

Just as important, parents must be told of the threat that polio presents to their children, and how to protect them.

Politicians and law makers must visibly support vaccination campaigns and commit themselves publicly to eradicating the virus.

Success in other countries has proven time and time again that we have the tools to finish the job.

So take a moment to think about how lucky you are to have the full use of your arms and legs, and put your hand up for polio eradication!

Together we can “KICK POLIO OUT OF NIGERIA FOREVER”.