Stories from the Small Continent- Polio in Madagascar
Madagascar is batting a polio outbreak. There has been 10 cases in the country in the last 12 months. This is a grave concern for the Malagasy government as failure to eradicate polio could result in a future epidemic. There is no cure for polio. It can only be prevented by immunisation.
Along with Pakistan and Afghanistan, Madagascar is one of only 3 countries in the world that has yet to eradicate polio. There is very poor vaccination coverage with one child in 4 not sufficiently immunised against the disease. The sanitation conditions in most parts of Madagascar are dire (50% of the population practice open defecation) and high density populations enable the virus to spread quickly. To stop the contagion there has been a number of national door to door vaccination campaigns over the last few months to vaccinate every child under 15 years of age. However it is not enough to organise vaccination campaigns, but to successfully eradicate this disease, the population must be made aware of the dangers so that every child is reached. Some families refuse to allow their children to be vaccinated for religious or cultural beliefs (taboos still exist in Malagasy society) and it is imperative to encourage behaviour and social change. For example cultural practices such as mifana, in some villages across Madagascar, where a woman must stay in her house for one to three months after giving birth may also prevent babies being given essential vaccines that they should receive in the first few months of life. UNICEF and other partners are working closely with political and religious leaders, communities, schools and national and local media to guarantee the message reaches all households.
Last week I was involved in the supervision of a polio vaccination campaign in the Tulear Region of the country. The week kicked off with an official launch sponsored by the Ministry of Health that was attended by local authority leaders and the media. They had a DJ, traditional dancers and a puppet show to generate awareness and to entertain the hundreds of school children who attended the launch. We were based in the mining outpost of Sakarah for the week. The purpose of our visit was to ensure a successful campaign by certifying funds had been successfully allocated, encouraging participation and commitment from local authorities, and engaging with the local media to make sure the message reaches all families in the region. We collected data by carrying out household, community and communication surveys and visiting heath care centres and interviewing vaccination teams.
The Tulear region is in the south west of Madagascar. It is desert like and extremely hot and has many very remote and hard to reach villages. We travelled to some of the more inaccessible communities by 4X4 and even this was extremely uncomfortable. For the people living in these villages, sometimes the only means of transport is by zebu drawn cart and it can take 2 days to travel to the nearest health care centre. It is no surprise that there are many supply chain issues getting vaccines and supplies to these communities. Keeping the vaccines cool is another challenge and as most villages don’t have electricity, the health care centres rely on petrol-powered fridges however there is a push to replace these with solar fridges.
On our third day we travelled to a sapphire mine. Madagascar supplies 50% of the world’s gems however they are almost exclusively shipped, rough and uncut, to other countries for polishing and sale. Much of the profit and certainly the mark-up occurs over-seas. Corruption is rife and there is little or no regulation. In the Tulear region alone there are over 20 sapphire mines. It is reported that 86,000 children, from the ages of 5-17, work in mines across Madagascar. Visiting one of these mines is an experience that will stay with me. The dusty, arid village of Analalava hosts over a thousand inhabitants who moved there to make a living in the gem rush toiling in extreme heat and very dangerous conditions to earn less than €2 a day. Miners often work in deep holes, climbing far underground and on the day of our visit, there were 3 fatalities with only 2 of the bodies recovered. Some families have been living in this site for over 10 years yet the government has turned its back on them and has not provided any services like health care centres or schools. It was 38 ºC and we spent a morning with the local community vaccinating hundreds of children. I was a bit of a novelty for the children as the village doesn’t get many “vasahs” or white foreigners and they all wanted me to vaccinate them. The children were great fun and I must vaccinated over a hundred.
Today is World Polio day. I hope the work that UNICEF and others are doing will be successful in eradicating polio from Madagascar. No child anywhere should have to suffer from this preventable disease.
Until the next time,