Following the recent outbreak of Wild poliovirus type 1 in the country, she has been helping to prepare her community for a forthcoming vaccination drive, which aims to protect nearly 4 million children in the four most at-risk provinces.
Having been involved in the health sector for decades, Raquelina also spends her days encouraging other older people around her to stay active, eat healthily and to keep serving their community, just as she does.
According to the World Bank, people aged 65 and above represent only 3% of the total population in Mozambique. But Raquelina sees her age and many years of experience as an asset rather than a hindrance.
¨I am not afraid of getting old,” she says. “I feel proud because I am active, and my experience is key when it comes to contributing to the health of the people in my community. ¨
Raquelina doesn’t let her age restrict her ambitions either. “I want to go back to school and further my education,” she says. “I will keep moving forward. I will do whatever I am supposed to do. No one can take that away from me.”
Dr. Folake Olayinka has spent over 20 years working in public health, including at the frontline of efforts to eradicate polio and strengthen immunization.
“At local levels, where the rubber meets the road, we need to make things work. Frontline health workers should be supported with tools that meet their needs, and training that truly values their insights, local innovations and problem solving,” said Dr. Olayinka.
Today, as a global health leader and former John Snow, Inc. (JSI) Project Director for the USAID-funded MOMENTUM Routine Immunization Transformation and Equity Project, she continues to exchange lessons and innovative strategies from the frontlines with other parts of the world impacted by polio and low immunization coverage.
On August 25, 2020, Nigeria, previously the last stronghold of endemic wild polio in Africa, was officially declared free of wild poliovirus. One of the factors contributing to this success was the ability to provide high-quality capacity building and support to improve health workers’ competencies at all levels of the health system.
“The health workers on the frontlines – particularly the community-based workers, many of whom are women – are the backbone of all of these efforts. They operate under incredible circumstances to ensure that their communities have access to life-saving health services,” said Dr. Olayinka.
Dr. Olayinka began working on polio in 2002 in Nigeria. She worked closely with colleagues at the Nigerian Ministry of Health, the World Health Organization, the EU and UNICEF to ramp up health worker training in support of the Nigerian government’s National Program on Immunization.
Her team’s dedication was remarkable. “We were willing to go everywhere to reach the last child. Once I walked four hours to support an immunization team,” she recalls.
Shaking things up
Dr. Olayinka emphasized training quality and the use of feedback to continuously improve the training experience for health workers. She led the development of numerous training guides and materials for polio eradication and developed the country’s first Basic Guide for Routine Immunization Service Providers. She also worked closely with WHO and EU colleagues to develop the first measles campaign field training materials in Nigeria.
Knowing that training of health workers must be continuous, she introduced mentoring as an important post-training approach in Nigeria’s immunization program.
“We needed to move people towards a more interactive approach,” said Dr. Olayinka. “These approaches transfer knowledge while maintaining dignity and recognize that people in the global South have something valuable to contribute.”
Recalling her experience training different types of health workers and trying to promote adult learning methods, she said, “I once walked into a room of senior health commissioners from all over the country. The room was filled with the usual PowerPoints, and people were not engaged – even sleeping.”
“When I went to the front of the room for my session, I introduced myself using my first name and explained the more interactive approach that I was proposing for the training. At first people were silent, but as the training went on, they really came alive. They were engaged and now identifying the real issues and generating the types of ideas that could truly change policy and improve services – you could see their passion coming through. I felt the ship took a turn.”
Dr. Olayinka also tackled training needs at the community-level and strongly promoted the use of local languages in the training of frontline health workers, particularly social mobilizers for polio eradication.
“At local level in northern Nigeria, most people spoke Hausa; however, training materials were largely in English at the time, and many of the women who were able to enter the homes to provide polio vaccinations did not understand English.”
“The polio programme was at a crisis point and was also facing a lot of refusals. As people in the region were not receiving other basic health services, they began not to trust polio vaccination efforts as it was one of the only services they were receiving.”
A pivot was needed, with a closer examination of what was working – and what was not – for all aspects of the eradication effort.
“These women were looking for the basics: how do I answer questions from caregivers, how do I provide polio drops, how do I enter my data?” remembers Dr. Olayinka “With this insight, I developed a flip chart using pictures – I even included a photo of my own son receiving the oral polio drops. We also used the local languages, role play, peer to peer methods, and songs as part of the training methodology.”
In the area of routine immunization, Dr. Olayinka worked with her team and other partners to introduce a stronger supervision system. The system included a checklist with clear standards for supervision of routine immunization, as well as a checklist on training quality as part of the pre-campaign preparedness. This helped National Primary Health Care Development Agency staff to provide ongoing support and mentorship for health workers. Many of these approaches and materials are still being used today and are updated periodically.
At the heart of the response, you will find a woman
Dr. Olayinka worked in a particularly challenging environment in northern Nigeria. “There are gender dimensions tightly linked with socio-cultural and deep-seeded religious beliefs in the northern state”, she recalled.
Oftentimes mothers had to seek permission from their husbands before they could allow the children to be vaccinated or access health services. “Even when they understood the value, women did not have decision-making power.”
The polio programme was able to reach women in new ways. Men originally started out as polio workers, but it quickly became apparent they were missing children under five because they were not allowed into homes due to cultural norms. The solution: hire women to go door-to-door and reach populations being missed.
“The polio programme brought women out into the workforce in an unprecedented way, says Dr. Olayinka. “Women were powerful mobilizers, particularly older, respected women and could enter any home. The polio programme was one of the first programmes bringing the women out, training them how to speak to other women and community members, which gave them a standing in the community. They also received some stipends which empowered them a bit financially.”
Many of these women later transitioned to supporting broader immunization and other health efforts in their communities, leading to higher child survival rates and less disease in communities.
“This is part of my passion when I talk about integration – these women in the communities, after getting a start from the polio programme, can be trained to talk about routine immunization, use of long-lasting insecticidal nets to prevent malaria, breastfeeding, WASH etc.”
“As a result of the polio programme they have social capital that can be expanded to improve health outcomes in their communities.”
To women leaders of the future
Dr. Olayinka remains committed to elevating the contributions of frontline health workers operating in challenging situations across the world.
When asked what advice she would give to women beginning their careers in public health, Dr. Olayinka said, “Be persistent and do not give up on your dreams. Even where you face discrimination because you are a woman, be focused and persist. Ensure that you are constantly building your capacity and equip yourself.”
“Women at all levels can make a difference, so take the leap—there are no limits to what you can achieve.”
Ismail Taxta/Ildoog/WHO Somalia
From 30 August to 3 September, Somalia conducted an integrated measles and polio campaign in the Banadir region – the first immunization campaign held since the COVID-19 pandemic reached Somalia. Over the last seven months, health workers have been fully engaged in fighting the pandemic. This campaign, conducted whilst observing safety measures to prevent spread of COVID-19, was a chance to get back on track to protect children who have missed out on vital immunizations.
Ismail Taxta/Ildoog/WHO Somalia
The campaign was conducted by Somalia’s Federal Ministry of Health, with technical support from WHO and UNICEF, and financial support from the Global Polio Eradication Initiative and Gavi, the Vaccine Alliance. The campaign had initially been scheduled to take place in 2019 as part of a nationwide effort, but was postponed due to technical challenges.
Ahead of the campaign, vaccines were procured and stored in optimum cool conditions. Microplans and maps were updated to help vaccinators reach all children at health facilities and fixed outreach sites. Building population immunity to polio and measles is extremely important in Somalia: Since the start of the year, 744 children in Banadir have contracted measles, accounting for half of the cases nationwide. Two forms of polioviruses, in circulation in Somalia since the end of 2017, have caused paralysis in 19 children across the country.
As part of the planning, 602 teams of health workers were given protective face masks and gloves, and were trained rigorously to keep themselves and their families safe from COVID-19. Every morning, they were checked to see if they had COVID-19 symptoms. Precautionary measures taken during the campaign included washing hands regularly, wearing face masks and ensuring physical distancing.
On the first day of the campaign, health teams set up fixed outreach vaccination sites and health facilities in different locations in Banadir. The aim was to reach as many children as possible: those living in urban and rural locations, those with nomadic lifestyles, and those living in camps for internally displaced persons.
All children under five who visited facilities during the campaign received deworming tablets and vitamin A, in addition to measles and polio vaccines. The inclusion of other health interventions in polio campaigns is a safe and effective way to help parents give their children the best possible protection against childhood diseases. This is particularly crucial in the Somali context, where children have limited access to health facilities, and population immunity is chronically low.
Two hundred and twenty-four district field assistants supervised more than 3000 vaccinators to ensure vaccinations were administered correctly and COVID-19 safety measures were observed. The campaign was also monitored by staff from the Ministry of Health, UNICEF and WHO.
Women and men played an important role in the campaign as social mobilizers, sharing messages on the benefits of vaccinations and COVID-19 prevention measures. Additionally, community volunteers helped to manage crowds of caregivers who visited health facilities and vaccination sites, ensuring that physical distancing was observed.
At the end of the day, all waste products from the campaign, including syringes, sharps and empty vials, were disposed of safely. By delivering multiple health interventions at once, cost savings can be achieved, and environmental impact is reduced when compared to delivering interventions separately.
Vaccination teams provided caregivers with vaccination cards for children, so that monitors could keep track of children who did not receive measles and polio vaccines.
Around 408 000 children aged between six months and five years (92% of those targeted by the campaign) received vaccinations against measles and 459 000 children aged under five (93% of the target) were vaccinated against polio. Ninety-two percent of children also received vitamin A and deworming tablets. This campaign proved that delivering health interventions amid COVID-19 in Somalia is achievable – and paved the way for subsequent campaigns to fill immunity gaps.
Welcome to Pehlwan Goth, Pakistan. A low-income neighbourhood on the edge of Karachi city, it is home to many families from Khyber Pakhtunkhwa province who have moved here for work.
An open sewage drain lined with litter runs the length of the settlement. Cattle are often seen grazing near the heaps of garbage. It is a high-risk area for polio, and virus is regularly detected in the environment.
Samreen, a 25-year-old Polio Area Supervisor, leads a team of four community health workers in the area.
“I started working with the Polio Eradication Programme four years ago and I am happy to say that we have made a lot of progress here. This is my neighbourhood; this is where I grew up and this helps me immensely. People here listen to me, especially the women, and I know most of the children by name,” says Samreen.
Converting refusals
There are around 32,000 children under five years of age in Pehlwan Goth. In April 2019, parents of around 3,000 children refused the polio vaccine. Through the hard work of supervisors like Samreen however, now over 80% of these children have received vaccines.
“I am in charge of an area that has 210 households with 196 children. In 2019, families of more than 50 children refused vaccines. That’s almost one fourth of all the children in my area,” said Samreen.
“Building trust takes time, and we continued engaging with community members, visiting families, listening to their concerns, and explaining the benefits of vaccination. Today, we have only eight refusal cases out of the previous 50. I will try my level best to bring this number down to zero during the polio campaign next month.”
“But for me, it is not just about just converting refusals during every campaign, I want all families to understand the benefits of vaccines in the long run and ensure the immunization of their children against polio and other diseases.”
Her rapport with families is apparent during house visits. A family with three children, who had refused vaccination in previous months, agreed that their children could this time receive the life-saving polio drops.
Confronting misconception
Building trust with the community has not been an easy task. Samreen is supported by a social mobilizer as well as a local religious support person. The team members work together to address misconceptions and raise awareness of good health practices among caregivers in Pehlwan Goth.
“We speak the same language and our homes are in the same area where we work. It is easier to communicate with people when you are part of the same community,” said Maulana Mohammad Hanif, the religious support person in Samreen’s team.
Sometimes, however, it can take only one negative social media video or news item to reignite refusals and overturn all their efforts.
“The process takes time. The work is tough but I am grateful to Allah for this job, which allows me to feed my family, and contribute to a noble cause, which will save future generations of Pakistanis,” added Maulana Mohammad Hanif.
It’s clear that Samreen and her team will do whatever it takes to deliver a polio-free future to all 196 children in their care. Pakistan and Afghanistan are the final two polio endemic countries in the world and there are still many challenges that remain.
It is the local efforts of teams like Samreen’s that will make all the difference – by listening to communities, building trust and ensuring rapport, they are playing a crucial role to bring their country closer to ending polio.
Dr. Ana Elena Chevez with her medical school cohort in El Salvador. During her career, Dr. Ana has made an immense contribution to polio eradication and broader public health. Credit: Provided by Dr. Ana Elena Chevez
Little Ana first learned about the importance of vaccines from her father, a pediatrician. Growing up during El Salvador’s 12-year civil war meant that electricity cuts were a common occurrence. Whenever the electricity went out, Ana’s father would rush the vaccines he kept in his clinic to the nearby hospital, where generators kept the cold chain refrigerators working. Seeing her father’s dedication to his work, Ana knew she would also become a doctor.
Fast-forward to 2020. Dr. Ana Elena Chevez has dedicated over twenty years of her life to protecting children from vaccine preventable diseases. She has worked in four countries across two regions, and currently serves as a Regional Immunization Advisor for polio at the Pan American Health Organization (PAHO), the Regional Office for the Americas of the World Health Organization, supporting the 52 countries and territories of the Americas to maintain polio-free status.
Throughout her career, she has never stopped dreaming high – advice given to her by family, mentors and colleagues.
Dr. Ana’s first job in public health was as a national immunization manager in El Salvador. Her mentor was PAHO/WHO immunization advisor Dr. Salvador Garcia. “Dr. Garcia taught me everything I needed to know about running an immunization programme. I knew that I could call him at any time, and I would get the answer that I needed,” she said.
The last mile of polio eradication in Nigeria
As polio cases surged in the African region in 2007, Dr. Ana was selected to go to Nigeria to support outbreak response. In a twist of fate, a three-month assignment turned into four years as Nigeria’s Supplementary Immunization Activity (SIA) coordinator.
It was in Nigeria that Dr. Ana refined her skills as a polio eradicator, as well as finding a ‘home away from home’. Credit: Dr. Ana Elena Chevez
This experience was pivotal for Dr. Ana’s career – it solidified her passion for polio eradication and introduced her to new colleagues and a new
country, which would soon become Dr. Ana’s second family and her home-away-from-home.
Dr. Ana was inspired by the constant innovation she saw in Nigeria. “We were always looking for ways to improve quality of the campaigns – improve training, surveillance, cold chain. It was always innovation, innovation, innovation.”
Dr. Ana believes that way of thinking really took Nigeria to the next level. “We started seeing fewer cases, more children vaccinated, and a higher level of acceptance among parents and leaders.”
As SIA coordinator, Dr. Ana oversaw all polio campaigns in the country. During these years, polio campaigns were happening on an almost monthly basis, alongside campaigns for yellow fever, tetanus elimination, and measles. It was overwhelming. “By the time we returned from the field to analyze one campaign, it was already time to start preparation for the next one. It was tiring for everyone – for us (the WHO staff), the partners, for the national/state/local health authorities, and of course for the vaccinators.”
Despite the pressure, Dr. Ana said, “If you were to ask me if I would do it again, I would say yes in a heartbeat. For me, it was being a part of an important moment in history – for the country, for public health, and for the polio programme.”
Maintaining momentum in a region certified free of polio for over 25 years
In 2017, Dr. Ana became PAHO/WHO’s Regional Advisor in charge of polio. The last case of wild poliovirus in the Americas was in 1991 and the region was certified free of polio in 1994. Although more than 25 years have passed since the Americas received polio free status, until polio is eradicated everywhere, the disease is still a risk.
25 years since the Americas were certified polio-free, Dr. Ana emphasizes that the region remains at risk until polio is eradicated everywhere. Credit: Dr. Ana Elena Chevez
Dr. Ana explains, “Even though new generations of nurses, doctors, and epidemiologists have not seen a case of polio firsthand, they understand the risk remains.” There have been 26 meetings of PAHO’s Technical Advisory Group (TAG) meeting on vaccine preventable diseases, and polio has been included on the agenda for every meeting.
It has not always been easy to keep this momentum. In recent years, countries in the Americas have had trouble meeting the indicators required to prove sensitive surveillance systems. For the last few years, PAHO has been holding almost yearly regional polio meetings to sensitize countries on the GPEI’s requirements for eradication and stress the importance of achieving high immunization coverage rates for polio and high standards of surveillance.
Dr. David Salisbury, chair of the Global Certification Commission for Polio Eradication, said at the regional PAHO polio meeting in 2017 that “there will be no free pass” for countries that are polio-free. All nations must provide documentation of certification standard surveillance to back up their belief that polio is eliminated amongst their population.
For Dr. Ana, these words hit home, “The work done by those that here before me has helped the countries to be aware. It has been my role to keep that momentum alive and help countries meet the required goals established in the Endgame Strategy.”
A message for the new generation of women public health leaders
In recent decades, women leaders in public health and immunization made important contributions to a field once dominated by men.
Dr. Ana recalls many of the women leaders that she’s worked with and considers that they have gone above and beyond what is expected. “They have raised the bar and have given the message that other women can work in public heath – it doesn’t matter your religion or colour – it matters that you care.”
Dr. Ana is excited to see more women step into leadership roles. “The new generation is coming. We need them – we need to prepare them. We are close to polio eradication, but we must think about what is next and prepare the new generation to tackle these issues with confidence. I tell my nieces that they can go and contribute to the world and make an impact.”
Reflecting on her own motivation, Dr. Ana says, “I always believed that I could make an impact, I just needed the tools, time and opportunity.”
“Young women leaders: Keep dreaming high. Keep dreaming that you can influence the health of whole populations. Don’t be afraid to set high goals– don’t be afraid to think that it is possible to control, eliminate, or even eradicate a disease.”
In every corner of the world, women leaders in Rotary are leading the charge to make polio history. They are fundraisers, volunteers, polio survivors and advocates from all backgrounds and walks of life with one thing in common: working to ensure that no child ever has to suffer the devastating and paralyzing effects of polio. Meet five women in Rotary whose work is leading the way in the fight to end this disease.
Judith Diment
Diment, of the Rotary Club of Maidenhead Thames, England, leads Rotary’s UK advocacy efforts, and is a passionate fundraiser and International PolioPlus Committee member.
She recently spearheaded Rotary’s efforts to create polio eradication champions among UK political leaders, resulting in the country committing up to an additional $US514.8 million to the Global Polio Eradication Initiative (GPEI) to fund the 2019-2023 Endgame Strategy.
In 2019, former UK Prime Minister Theresa May and Queen Elizabeth II both publicly recognized Diment for her philanthropy to polio eradication and other causes. Hear more from Diment.
Ijeoma Pearl Okoro
“Until the last child is reached and immunized, no child in the world is free. Let us all support the cause to end polio now.”
Ijeoma Pearl Okoro is a member of the Rotary Club of Port Harcourt, Nigeria where she directs End Polio Now activities throughout sub-Saharan Africa. She leads efforts to build awareness around the fight to eliminate polio from Nigeria and engages other Rotary members and the public through events and promotional endeavors.
Through a range of activities like government advocacy, celebrity engagement and fundraising, Okoro’s leadership helps ensure that polio eradication is a priority and every child is protected from the disease.
In 2019, Nigeria surpassed three years without a case of the wild poliovirus, and the African Region is expected to be certified as wild polio-free in late August 2020.
Tayyaba Gul
A member of the Rotary Club of Islamabad (Metropolitan), Pakistan, Gul runs a Rotary-funded health center in Nowshera, working with teams of female vaccinators help reach neighborhoods of ethnic Afghan refugees displaced by conflict in tribal border regions. Gul’s teams use cellphones for daily data reporting on immunization progress, which helps health teams analyze data and report back in real time.
As one of only two countries that continues to report cases of the wild poliovirus, fighting polio in Pakistan is key in achieving a polio-free world. “I just contribute my part as a Rotarian. I’m happy to work in remote areas, especially with women, motivating them to play their role in society,” Gul says. Watch to learn more about Gul’s work in Pakistan.
Ann Lee Hussey
Ann Lee Hussey has led Rotary volunteers on nearly 30 trips to places like Pakistan and Nigeria to immunize children against polio, the disease that has affected her since she was 17 months old.
A member of the Portland Sunrise Rotary Club, Maine, USA, she is an outspoken advocate for polio eradication and immunization and has testified at state legislative hearings in Maine on the importance of vaccination.
In January 2019, Hussey spoke of her experience as a polio survivor and her Rotary service at Rotary’s International Assembly, highlighting the role of frontline polio workers: “Without question, the many health workers around the world—most of whom are women—are the unsung heroes on the polio front. Without them, we would not be where we are today.”
Marie-Irène Richmond-Ahoua
Richmond-Ahoua joined the Rotary Club of Abidjan-Biétry, Côte d’Ivoire, in 1991, making her one of the first female Rotarians in Africa.
When a general canceled a national immunization day during a 1999 coup in her country, Richmond-Ahoua appealed directly to the general’s family, pleading that innocent children had nothing to do with the war. Shortly afterward, the general granted her request and presided over the opening of the rescheduled immunization day.
Richmond-Ahoua coordinates national polio immunizations and serves on the Africa Regional PolioPlus Committee. She also spoke at Rotary’s 2018 World Bank International Women’s Day event.
Modified lyrical translation: German to English by Tom House
It was a somber day when Ihsanullah was told that two of his youngest children will never be able to walk again. His two year old daughter Safia, and Masood, his five month old son, were both diagnosed with polio.
When they began running a high fever in December, Ihsanullah rushed them to the nearest hospital in the city of Tank, Pakistan. After a series of tests, doctors confirmed that both children had contracted polio. Further investigations revealed that neither child had been vaccinated during any previous routine immunization or polio campaign rounds.
Like many other parents in his village, Ihsanullah had never accepted the polio vaccine. “I had a negative opinion about vaccination from the start. Many people told me that the polio vaccine was made of haram[forbidden] ingredients and was part of a larger conspiracy to make Muslim children sterile,” he said.
A farmer and labourer by profession, 27-year-old Ihsanullah lives in a village named Latti Kallay in Khyber Pakthunkwa, Pakistan. Polio teams often face hesitancy from communities in Latti Kallay during campaign rounds, with many parents citing religion as the primary reason for refusing the polio vaccine. In Tank city and the immediate surrounding areas, six wild polio virus cases were reported in 2019.
Sadly, it sometimes takes a case of polio for communities to fully realize the importance of vaccinating their children. Asghar and Khadim, neighbours of Ihsanullah, told polio teams that they had started ensuring that their children are vaccinated, despite being staunch refusers of the vaccine previously.
Ihsanullah said, “It pains me to imagine that Safia and Masood will never be able to walk again. If I knew that this would be the outcome, I would never have stopped the polio teams from vaccinating my children. I deeply regret my decision, but I will make sure that my other children are vaccinated”.
For now, the COVID-19 pandemic has necessitated the temporary pause of polio vaccination campaigns. This leaves unvaccinated children who cannot access routine immunization services vulnerable to paralysis. The situation also underlines the vital importance of increasing trust in vaccines amongst parents, so their children are protected from polio no matter what happens.
Gohar Mumtaz, the Union Council Polio Officer of the district, has hope. He says that a routine immunization session with the community, conducted before the pandemic spread to Pakistan, seemed to be more popular than usual. “Although there is still hesitancy, the situation seems to be improving. People will understand the need to vaccinate and no child will suffer like Safia and Masood in the future.”
To overcome barriers to polio eradication, the Pakistan polio programme conducted a top-to-bottom review during 2019. Areas where improvement is required were identified, and innovations introduced. This is vital work, as there are many other children in Pakistan besides Safia and Masood whose futures have been marred by the poliovirus. Last year saw increased transmission of the poliovirus across all provinces with a total of 147 wild cases reported.
The COVID-19 pandemic has added an additional hurdle to defeating polio in Pakistan. It is vital that the programme makes up for lost time as soon as it is safe to conduct house-to-house vaccination activities again. Whilst the pandemic is ongoing, the programme continues to build trust with communities by providing information about COVID-19 as well as the poliovirus. Where routine immunization continues in health centres, polio personnel are emphasizing the importance of maintaining children’s vaccination schedules as far as possible.
In a time when our health feels especially precious, Ihsanullah, Safia and Masood’s story serves to remind us why vaccination is so important.
Thousands of women work in the Pakistan polio eradication programme as scientists of many specialties, managers, data experts, vaccinators, front-line team supervisors and social mobilizers. We asked a few of them about gender equality in their work.
Dr. Maryam Mallick: The Medical Rehabilitation Specialist
“Women face extra difficulties in trying to prove themselves and often compete in an outnumbered male dominated work environment. But with the right support, they persevere and excel in their tasks.”
Dr. Maryam Mallick is one of the first female technical advisors for disability and rehabilitation at the World Health Organization in Pakistan. Her job involves assessing children with polio paralysis to ensure that they receive medical and social rehabilitation care.
Dr. Mallick works to ensure that all children, especially girls, are given access to quality healthcare as well as equal opportunities in society.
“There were many instances where parents did not want their polio affected daughters to be sent to the schools. We need to start perceiving gender equality as a fundamental human right inherently linked to sustainable development, rather than just a women’s issue,” she says.
“Women’s empowerment in achieving sustainable development has now been globally recognized as the centrality of gender equality. It does not mean that men and women become the same, rather it means that everyone can have equal rights and equal opportunities”
Under Dr. Mallick’s supervision, one thousand children have been assisted by the Polio Rehabilitation Initiative since 2007.
Dr. Iman Gohar: The first female Provincial Rapid Response Unit Lead in Sindh province
“Many women in the programme have enormous talent and endless potential. These women are key to enabling success across the polio eradication effort.”
Dr. Iman Gohar joined the Pakistan polio eradication programme six years ago, working as a Polio Eradication Officer in Peshawar and then as the Divisional Surveillance Officer in Hyderabad. Today, Dr. Gohar is the first woman to lead the Provincial Rapid Response Unit in Sindh.
Dr. Gohar’s work involves leading investigations into suspected polio cases and organising case response campaigns. An increased number of environmental samples found positive for the poliovirus in Sindh in the 2019-2020 period has meant a busy workload.
“Polio eradication is an incredibly demanding job. I work for long hours and enjoy one day off in the week. While performing my job, I work hard to take complex goals and convert them into high quality deliverables,” she says.
“The programme has provided women with a very conducive environment to grow, learn and voice their opinion. For this, I am very grateful.”
When talking about how the programme can improve gender equality, Dr. Gohar stressed the role and support of her male colleagues.
“I believe for us to achieve true gender equality, it is essential that our male co-workers become advocates for equality. Men and women must both hold each other up, celebrate each other’s successes and recognize that each and every person, regardless of gender, is playing an important role in safeguarding the health of Pakistan’s children.”
Salma Bibi: A Health Worker in Killa Abdulla district, Balochistan province
“Nothing gives me greater satisfaction than knowing how I have helped people through my duties. I believe that creating opportunities for women is one of the best ways to empower them.”
Salma has been a community health worker for over a decade, working in Killa Abdullah district in Balochistan province. Around 90% of the district is overseen by male health workers, so Salma is one of the few women who go door to door to ensure that children are vaccinated.
Salma often feels greater resistance from community members than her male counterparts. “I hear a lot of negative comments from community members, especially when covering vaccine hesitant families. These words can sometimes de-motivate and de-moralize us from our duties,” she says.
Despite this challenging environment, Salma recognizes that her role is integral to get parents to understand the importance of vaccination.
“When our male colleagues cannot enter the homes, we play an important role in filling that gap. We go in and we sit with the mothers to help them understand that vaccinating against polio is the only way to protect their children. Often, the time spent talking to them is enough, and this makes us feel good, like we are truly helping our nation’s children.”
Saba Irshad: The first female Programme Data Assistant in Multan district, Punjab province
“The greatest challenge that the majority of the professional women face is the perception that they are not as qualified or competent as their male colleagues, irrespective of their experience, education, potential or achievements. Because of this, women often have to work twice as hard.”
Saba Irshad has worked with the Pakistan polio eradication programme for eight years. She is known by her colleagues for her quick problem-solving skills and meticulous work. As a Programme Data Assistant, Saba is responsible for collecting and analyzing data from campaigns implemented in Multan district, in Punjab province.
Saba emphasizes the need for the polio programme to continue to support and encourage their female workforce, and promote an inclusive work environment.
“On average, 62% of the vaccinator workforce in Pakistan are women. This shows just how important women are to polio eradication.”
“Without these women, the programme would be unable to reach thousands of children with the vaccine.”
To learn what the Global Polio Eradication Initiative is doing to promote gender equality, visit the gender section of our website.
The nomads of the Lake Chad Basin account for 3%–5% of the population and are one of the most underserved communities when it comes to health.
When Chad had to respond to the detection of wild poliovirus in Nigeria in 2016, it was crucial to vaccinate nomadic children. The World Health Organization, the United States Centers for Disease Control and Prevention and partners created a database of population numbers, movements, and immunization records. ‘Lake Chad response teams’, each with four specialists – an epidemiologist, a social mobilizer, a vaccinator and a data recorder – fanned out, data in hand, to reach every nomadic child with polio vaccines.
Often teams began by speaking to nomads in a market or on a road and then asking to follow them to their temporary camp. The Lake Chad Basin covers almost 8% of the African continent and trying to find groups amongst the vast expanse of semi-arid savannah was almost impossible without this kind of time-consuming work.
Upon arriving in a camp, the social mobilizer in each response team explained to family elders and parents the purpose of the vaccination and the benefits for their children. The response teams asked for permission to begin vaccination.
“They see themselves as neglected in society,” explains Ajiri Okpure Atagbaza, a GIS consultant in the WHO Regional Office for Africa Geographic Information System Centre, who spent three years as part of the Chad response team working with nomads. “When you came with aid, they welcomed you. As long as you spoke their language, they were open to it.”
Children received all immunizations for their age alongside polio vaccine, as part of an integrated approach to health delivery. The parents were given an immunization card recording which vaccines had been administered.
Each team carried a smartphone application used to capture the locations of the nomadic camps, the results of acute flaccid paralysis case surveillance, and information gained through conversations with the community, such as how long they had been in their current location, previous and future camp locations, the population size and vaccination rates. This information was uploaded to bolster the database to help plan future health services.
From April to August 2019, the Lake Chad response teams reached 1067 nomad groups in 17 districts in Chad alone and vaccinated more than 27,000 children. Across all five countries making up the Basin, more than 40,000 children in 3451 nomadic camps in 62 high-risk districts received their routine immunizations, including protection against polio. The information recorded during these activities will be used in routine immunization planning to ensure that children continue to receive all their vaccinations according to the schedule.
2010: Dr Ni’ma Abid and the Pakistan Polio Programme
Following flood damage “beyond imagination” in Pakistan, all polio-funded technical staff – polio epidemiologists and surveillance officers – were relocated to the worst-affected areas of the country to assist in the recovery and run vaccination campaigns for displaced populations. While controlling outbreaks of disease and conducting immunizations were a necessary focus, team leader Dr. Abid noted that “the priority is still for food and shelter more than anything else”. Over months of relief and rebuilding, the polio team rallied around to work with humanitarian colleagues on the ground.
In November 2011, five vaccination teams in Karu ward, AMAC Local Government Area in Nigeria took part in an innovative pilot study. Equipped with Geographic Information Systems (GIS) devices, their movements were tracked and mapped. Analysis of real-time data on which homes they had visited with vaccines allowed for the immediate identification of possible missed children. Since that first trial, GIS software has been rolled out globally to thousands of vaccinators and disease surveillance officers, transforming data insights in some of the world’s most remote locations.
2012 saw a United Nations-backed effort aiming to vaccinate 111 million children against polio in just four days across west and central Africa. Blaise was one of tens of thousands of polio volunteers taking part across twenty nations. Reporting live from the campaign for UNICEF, he described the reaction from the community, "Today I was able to immunize 384 children. My team encountered no problems. When some children were sleeping, we wanted to come back later but their mothers didn’t want us to leave. ‘Let us wake them up; there is no way we could miss this opportunity to get them vaccinated’, the mothers told us.”
2013: Ali Maalin, the last individual to contract smallpox
Ali Maalin passed away in 2013 after a truly exceptional life spent eradicating first smallpox, and then working to eradicate polio as a vaccinator in Somalia. Never vaccinated against smallpox himself, he was determined that his experiences would serve as a powerful reminder of why immunization is so important. “When I meet parents who refuse to give their children the polio vaccine, I tell them my story,” said Ali in 2006. “I tell them how important these [polio] vaccines are.”
Feria, a trained social worker, fled violence in Syria to find shelter at an Iraqi refugee camp alongside her two young sons. At the time, in response to a polio outbreak in Syria, WHO and UNICEF, along with the Regional Government, were launching an accelerated series of polio vaccination campaigns to protect every child. Describing her new role as a polio vaccinator, Feria explained, “Polio campaigns are very important for children under the age of five. The oral vaccine is the only way to make sure they won’t be infected and to avoid polio spreading into the camps. After what these children have gone through they should not be sacrificed. One day, they will go back to Syria. One day, we’ll all go back to Syria.”
2015: Sajid Ali, a volunteer inspired by his studies
Sajid Ali, a student in his early twenties, was one of thousands of volunteers who committed to fight polio after attending the Jirga – a Pashtun tribal assembly of elders – in Lahore in 2015. At the same time as pursuing his religious studies in Lahore, Ali volunteered his time going door-to-door to reduce family and community hesitancy to vaccination. Nearly 80% of the polio-affected children in Pakistan at the time came from Pashtu speaking communities, rendering the work of trusted religious scholars from the community crucial. The situation is little changed today, and the work of religious leaders is more important than ever to build trust.
2016: Martha Dodray, vaccinator for hard-to-reach communities in India’s Kosi River Basin
2016 marked five years of polio-free India. This enormous achievement was possible thanks to the efforts of individuals like Martha who personally overcame exceptional hurdles to reach children with vaccine. “Sometimes I’d have to walk by foot or travel by boat and reach these areas, and sometimes I’d have to wade through water to reach my destination. It was quite challenging to face the elements,” she remembers. Innovative thinking led to huge progress however, with Martha’s colleague Dr. Sunil Bahl remembering, “Within a few months we had accelerated from vaccinating children in hundreds of field huts, to reaching 250,000 of them."
2017: Abdullah Khalid, vaccinator at the border between Afghanistan and Pakistan
The poliovirus knows no borders, making children on both sides of the border between Afghanistan and Pakistan vulnerable to contracting the debilitating disease. In 2017, Abdullah Khalid led a team responsible for vaccination at the Torkham crossing. He had been working for the polio programme for 14 years. “I wanted to join the eradication programme when I heard that polio is a contagious disease that affects children. I wanted to serve children and our community. I learned about polio on the TV and radio and the health workers who came to our home to share information about the virus,” he said. “I am proud when we can reach every child and when I see my team vaccinating children, making sure that no child is missed. This makes me very happy.”
2018: Dr Adèle Daleke Lisi Aluma, consultant for the Lake Chad Task Team
Dr Aluma spent 2018 working in one of the most challenging areas of the world in which to vaccinate. On Lake Chad, 45% of children live on difficult-to-access, remote islands, where geographical barriers, violence, insecurity, and poverty mean people usually do not receive health or other government services. Canoeing through reeds for hours at a time, Dr Adele reached villages never before accessed with vaccines. In February 2018 in Bol District where Dr. Aluma worked, 83 settlements were reached and 15,600 children under ten years of age were vaccinated. In June, the campaign reached more than 53,200 children in almost 500 settlements.
2019: Rahane Lawal, polio vaccinator and unsung hero
Rahane Lawal is a polio worker in Nigeria, and winner of the 2019 Unsung Hero Award at the Reaching the Last Mile Forum in Abu Dhabi. She has shown exceptional bravery and dedication towards keeping her community safe from polio, despite being kidnapped and witnessing the murder of a family member. Her abductors knew she worked for the polio programme, and assumed she earnt a lot of money. Despite her horrific experience, she remains fully committed to ending polio in Nigeria.
When we talk about PolioPlus, we know we are eradicating polio, but do we realize how many added benefits the programme brings? The ‘plus’ is something else that is provided as a part of the polio eradication campaign. It might be a hand-operated tricycle or access to water. It might be additional medical treatment, bed nets, or soap.
This series looks at the ‘pluses’ that Rotarians worldwide help to provide. Our first article looked at prevention of other diseases, and in part two we investigated how Rotary contributes to clean water provision. In our final article, we consider how Rotarians support those who have contracted polio, and who now live with permanent paralysis.
Creating jobs
Polio paralysis left Isiaku Musa Maaji, who lives in Nigeria, with few ways to make a living. At 24, he learned to build hand-operated tricycles designed to provide mobility for adults and children with physical disabilities, and later started his own business assembling them. His first break came, he says, when his local government placed a trial order. Officials were impressed with his product, and the orders continued.
Rotary’s Nigeria PolioPlus Committee recently ordered 150 tricycles from Maaji to distribute to polio survivors and others with mobility problems. The relationship he has built with local Rotarians has motivated him to take part in door-to-door polio vaccination campaigns.
“It is not easy to be physically challenged,” he says. “I go out to educate other people on the importance of polio vaccine because I don’t want any other person to fall victim to polio.”
Aliyu Issah, another polio survivor, feels lucky; he’s able to support himself running a small convenience store. He knows others with polio paralysis who have attended skills training programmes but lacked the money to start a similar business. In the absence of ready employment, some of them were forced to beg on the street.
He notes however that the polio eradication programme provides a job that is uniquely suited to polio survivors: educating others about the effects of the disease.
“Some of my friends who used to be street beggars now run their own small business with money they earn from working on the door-to-door immunization campaign,” Issah says.
Improving health care
In Maiduguri, Nigeria, Falmata Mustapha rides a hand-operated tricycle donated to her by Rotary’s Nigeria PolioPlus Committee. She is joined by several health workers for a door-to-door immunization campaign, bringing polio drops to areas without basic health care.
UNICEF data show that polio survivors like Mustapha have a remarkable success rate persuading reluctant parents to vaccinate their children — on average, survivors convince seven of every ten parents they talk to. In places where misinformation and rumours have left people hesitant to vaccinate, the survivors’ role in the final phase of the eradication effort is critical.
“Since working with the team, I have seen an increase in immunization compliance in the community,” Mustapha says. “I am well-regarded in the community because of my work, and I am happy about this.”
When we talk about PolioPlus, we know we are eradicating polio, but do we realize how many added benefits the programme brings? The ‘plus’ is something else that is provided as a part of the polio eradication campaign. It might be a hand-operated tricycle or access to water. It might be additional medical treatment, bed nets, or soap.
This series looks at the ‘pluses’ that Rotarians worldwide help to provide. Our first article looked at prevention of other diseases. In part two, we look at another lifechanging intervention: providing clean water for communities.
Providing clean water
Addressing a critical long-term need such as access to clean water helps build relationships and trust with community members. Within camps for displaced people in northern Nigeria, the polio vaccinators who regularly visit communities are sometimes met with frustration. “People say, ‘We don’t have water, and you’re giving us polio drops,’” Tunji Funsho explains. Rotary and its partners have responded by funding 31 solar-powered boreholes to provide clean water in northern Nigeria, and the effort is ongoing.
Supplying clean water to vulnerable communities is a priority of the PolioPlus programme not only in Nigeria, but also in Afghanistan and Pakistan — the only other remaining polio-endemic nations, where transmission of the virus has never been interrupted.
“Giving water is noble work also,” says Aziz Memon, chair of Rotary’s Pakistan PolioPlus Committee.
Access to safe drinking water is also an important aspect of the The Polio Endgame Strategy 2019-2023, which aims to “ensure populations reached for polio campaigns are also able to access much-needed basic services, such as clean water, sanitation, and nutrition.” The poliovirus spreads through human waste, so making sure people aren’t drinking or bathing in contaminated water is critical to eradicating the disease. Bunmi Lagunju, the PolioPlus project coordinator in Nigeria, says that installing the boreholes has helped prevent the spread of cholera and other diseases in the displaced persons camps.
Communities with a reliable source of clean water have a reduced rate of disease and a better quality of life. “When we came [to the camp], there was no borehole. We had to go to the nearby block factory to get water, and this was difficult because the factory only gave us limited amounts of water,” says Jumai Alhassan, as she gives her child a bucket-bath. “We are thankful for people who provided us with the water.”
By looking holistically at the needs of communities, Rotarians are ending polio, and making a significant contribution to overall health.
This story is part of the Broader Benefits of Polio Programme series on our website, which originally appeared in the October 2019 issue of The Rotarian magazine. Read part one.
The polio eradication campaign needs your help to reach every child. Thanks to the Bill & Melinda Gates Foundation, your contribution will be tripled. To donate, visit endpolio.org/donate.
Reposted with permission from Rotary.org When we talk about PolioPlus, we know we are eradicating polio, but do we realize how many added benefits the programme brings? The “plus” is something else that is provided as a part of the polio eradication campaign. It might be a hand-operated tricycle or access to water. It might be additional medical treatment, bed nets, or soap. This series takes a look at the ‘Pluses’, starting with prevention of other diseases. A 2010 study estimates that vitamin A drops given to children at the same time as the polio vaccine had at that time already prevented 1.25 million deaths by decreasing susceptibility to infectious diseases.
We take you to Nigeria, which could soon be declared free of wild poliovirus, to show you some of the many ways the polio eradication campaign is improving lives.
Polio vaccination campaigns are difficult to carry out in northern Nigeria, where insurgency has displaced millions of people, leading to malnutrition and spikes in disease. When security allows, health workers diligently work to bring the polio vaccine and other health services to every child, including going tent to tent in camps for displaced people.
The Global Polio Eradication Initiative (GPEI), of which Rotary is a spearheading partner, funds 91% of all immunization staff in the World Health Organization’s Africa region. These staff members are key figures in the fight against polio — and other diseases: 85% give half their time to immunization, surveillance, and outbreak response for other initiatives. For example, health workers in Borno use the polio surveillance system, which detects new cases of polio and determines where and how they originated, to find people with symptoms of yellow fever. During a 2018 yellow fever outbreak, this was one of many strategies that resulted in the vaccination of 8 million people. And during an outbreak of Ebola in Nigeria in 2014, health workers prevented that disease from spreading beyond 19 reported cases by using methods developed for the polio eradication campaign to find anyone who might have come in contact with an infected person.
Children protected from polio still face other illnesses. In Borno, malaria kills more people than all other diseases combined. To prevent its spread, insecticide-treated bed nets — such as the one Hurera Idris is pictured installing in her home above — are often distributed for free during polio immunization events. In 2017, the World Health Organization organized a campaign to deliver antimalarial medicines to children in Borno using polio eradication staff and infrastructure. It was the first time that antimalarial medicines were delivered on a large scale alongside the polio vaccine, and the effort reached 1.2 million children.
Rotary and its partners also distribute soap and organize health camps to treat other conditions. “The pluses vary from one area to another. Depending on the environment and what is seen as a need, we try to bridge the gap,” says Tunji Funsho, chair of Rotary’s Nigeria PolioPlus Committee. “Part of the reason you get rejections when you immunize children is that we’ve been doing this for so long. In our part of the world, people look at things that are free and persistent with suspicion. When they know something else is coming, reluctant families will bring their children out to have them immunized.”
Rotarians’ contributions to PolioPlus help fund planning by technical experts, large-scale communication efforts to make people aware of the benefits of vaccinations, and support for volunteers who go door to door.
Volunteer community mobilizers are a critical part of vaccination campaigns in Nigeria’s hardest-to-reach communities. The volunteers are selected and trained by UNICEF, one of Rotary’s partners in the GPEI, and then deployed in the community or displaced persons camp where they live. They take advantage of the time they spend connecting with community members about polio to talk about other strategies to improve their families’ health.
Nigerian Rotarians have been at the forefront of raising support for Rotary’s polio efforts. For example, Sir Emeka Offor, a member of the Rotary Club of Abuja Ministers Hill, and his foundation collaborated with Rotary and UNICEF to produce an audiobook called Yes to Health, No to Polio that health workers use.
This story is part of the Broader Benefits of Polio Programme series on our website, which originally appeared in the October 2019 issue of The Rotarian magazine.
The polio eradication campaign needs your help to reach every child. Thanks to the Bill & Melinda Gates Foundation, your contribution will be tripled. To donate, visit endpolio.org/donate.
Compared to the busy streets of Hargeisa, Somaliland, just 20 kilometres outside of the city are broad stretches of barren land—home to the nomads. Nomadism is part of Somalia’s culture, and there are thousands of families throughout the country who lead pastoral lifestyles, raising livestock and moving their animals and families as the seasons change. Their frequent movement means that children are not always nearby a health clinic to receive their scheduled vaccinations on time. Such disruption or delay in receiving vaccines can result in low or no protection against common childhood infections.
If children are not immunized against polio, they risk contracting the virus and developing paralysis. They also risk passing polioviruses to other under-immunized children. But the polio eradication teams are committed to reach every last child with polio vaccine notwithstanding challenging terrains.
Look through the lives of polio vaccinators in Somaliland on the third day of the vaccination campaign activities as part of the larger efforts to reach over 1.1 million children with the oral polio vaccine.
It’s 7am, and a late August dawn is stretching across a broad, sparsely populated landscape. At the side of the dirt track road, a man herds a group of camels to their grazing land for the day.
Today, their focus is the children living among nomadic communities.
Parking up amongst stones and tree roots, with arid scrub-land stretching away behind the 4x4, the vaccination team pull on their Somalia Polio Programme vests, which identify them as health workers, and retrieve their vaccine cold box from the back of the car.
The team is tired from the early start, but excited to provide vaccine to these communities.
Tiny newborn fingers are too small to mark with indelible ink to show that the child has received a vaccine today, so instead, Suad stains Abdirisaq’s big toe before he is tucked back into his warm blankets.
Suad discusses with the family that there are other vaccines that are essential for Abdirisaq to receive to stay well. She encourages his parents to take him to the nearest health clinic when the time comes for his next scheduled doses.
When he is 14 weeks old, he should receive the injectable polio vaccine, which will ensure he is fully protected against all polio virus strains.
As they vaccinate, the health workers are also busy greeting the local community and strengthening awareness of the importance of vaccination.
Being willing to have a discussion about the vaccine helps to build trust with families and gives health workers an insight into the lives of the children they are vaccinating.
By 11am, the teams have vaccinated every child under age five in this nomadic community.
Along the way, they’ve attracted interest from excited children, encountered curious goats and camels, and increased awareness of the importance of polio vaccination for every child.
The next time polio vaccinators encounter this community, they might be residing in a completely different spot.
Close community relationships help the Somalia polio programme know where nomadic groups are moving to, meaning that they can be visited again when the next vaccination campaign happens.
This campaign was the third round to take place as part of the latest stage of polio outbreak response in reaction to virus detected in the north of Somalia. The next campaign, using a different vaccine, is scheduled for this coming autumn.
Back in the car, the vaccinators set off for their next destination, driving slowly on the bumpy roads.
They are dedicated to delivering vaccines to all children, no matter where they live.
Since its inception in 1988, the Global Polio Eradication Initiative (GPEI) is driven by a singular purpose: defeat the poliovirus and secure the world from this disease.
While there may be no cure from polio, it is preventable and eradicable. Thanks to global immunizations efforts of national health authorities backed by international partners – WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC), UNICEF, the Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance — cases of wild poliovirus have dropped from 350 000 in 1988 to 33 cases reported in 2018, and four Regions of the world have been certified free of wild poliovirus.
Another milestone was achieved last week: Nigeria crossing three years without detection of wild poliovirus. With this, the African Region can now possibly start the official process to certify the WHO African Region free of wild poliovirus.
This milestone was a slow and steady win, which would not have been possible without the people who make up the very fabric of Nigerian communities. Trust-building efforts by traditional leaders and the network of women making household visits across the country, made it possible to overcome socio-cultural and operational barriers to vaccination.
Read about the innovative practices for polio eradication in Nigeria.
A member of the Rotary Club of Islamabad (Metropolitan), Pakistan, Gul runs a Rotary-funded health center in Nowshera, working with teams of female vaccinators help reach neighborhoods of ethnic Afghan refugees displaced by conflict in tribal border regions. Gul’s teams use cellphones for daily data reporting on immunization progress, which helps health teams analyze data and report back in real time.
