Wednesday, 22 February 2012

Polio - Nigeria's role in the final push

Every quarter, an Independent Monitoring Board assesses progress towards the attainment of a polio-free world. The Independent Monitoring Board was convened at the request of the World Health Assembly to monitor the plan to interrupt polio transmission globally by the end of this year 2012...yes end of 2012! This is 10 months away and clearly the eradication programme is not on track to meet this goal. The report of the last meeting should be read by everyone interested in public health. It is that important - and can be found here

Below we highlight 2 of the most important sections: 
"Success in India – one of the four polio endemic countries – shows that unswerving political commitment, outstanding public health leadership, clear lines of accountability, intolerance of weak performance and the systematic enforcement of best practice can stop polio."
"Pakistan and Nigeria represent the gravest risk to global eradication.  Nigeria’s 2011 emergency plan had no meaningful impact. Nigeria is not heading for success, unless its plan currently under development is made into something very special."

We as Nigerians, our government, our people, our leaders must pay attention. Every society has to figure out what matters to its people and act on it. At present Nigeria is at the verge of compromising decades of work, billions of dollars, thousands of lives so far spent on making polio only the second infectious disease ever eradicated. 

Polio cases in Nigeria, October 2011
Courtesy GPEI

So what are we doing wrong? There is a lot - and many of these can be read in the report. At this moment - The Nigerian Ministry of Health, the National Primary Health Care Development Agency, the WHO, CDC, Bill and Melinda Gates Foundation are all ramping up their efforts. They will do what they can - but we must do more. There is little discussion in Nigeria - in the 'lay' press and among health professionals on the gravity of the situation. People are preoccupied with security challenges. Maybe it is no coincidence that the areas most affected by the security challenges are also those reporting the most cases of polio. As of October 2011 85% of all the polio cases reported in Nigeria were from Kano, Kebbi, Jigawa and Borno. 

But most worrying really is the little apparent engagement of the Nigerian President, his Vice President, and the State Governors. Where is the political leadership required? Imagine the political capital that would be gained by President Goodluck Ebele Jonathan. This could re-define his tenure so that it seen as that in which the transmission of polio was interrupted in Nigeria. Imagine if we could read the words written about India - written about Nigeria in a year's time....that 
"Nigeria has shown .... unswerving political commitment, outstanding public health leadership, clear lines of accountability, intolerance of weak performance and the systematic enforcement of best practice can stop polio."
Just imagine what it will mean to our children. To these children Those that were missed and now live their lives on sticks. Imagine what it would mean for our national pride and confidence if we can turn this ship around. Can we do it? Yes we can, because it does not require rocket science.  We know what works in terms of the vaccine and how to deliver it. But we must do the one thing that has proved to be our Achilles heal in Nigeria - organise ourselves better to deliver the vaccine, hold our leaders to account, and not stop until the job is done. We cannot afford to fail - we simply cannot. 

Picture courtesy of Immunization Action Coalition  

Sunday, 5 February 2012

From Okada to Keke

I was in Owerri recently and was not sure whether to laugh or cry. The ubiquitous "Okada" motorcycles that ferried (or flew) people around the city in my formative years were gone. One now had to walk relatively long distances to get to a major route. Once there, the easiest and cheapest form of transport  was now a tricycle knowed variously as "Keke NAPEP" or "Keke Marwa". They basically have an engine that is slightly more powerful than a motorcycle's, with 3 wheels and is able to carry anything from three to five passengers depending on their sizes and the dexterity of the driver. They were all over the place...literally everywhere!

The model of ownership is actually quite innovative - state governments import them in bulk and sell them to  people on an extremely low or no interest basis,  payable over a period of time. This is often taunted as a 'poverty eradication' programme created to empower the poor, jobless and underemployed. Keke operators are seen in most towns in Nigeria snaking through every available space, amid vehicles, violating traffic rules and risking the lives of their passengers. But they will never be as risky as the Okadas.

I ran into my friend and colleague Hilary, who was a thriving orthopaedic surgeon in Owerri. The last time I met Hilary he was emotionally distraught. While he admitted to not having the skills in epidemiology, he admitted that detailed studies were actually not needed to show the extent of morbidity and mortality caused by Okada drivers in Owerri. At the time, he invited me to spend a day with him while on-call at the centre where he worked - just to observe the number of patients brought in on any given day with "Okada" related trauma....and did they flow in. They came with all sorts of fractures - many too horrific to describe in detail here. With limited options in restorative surgeries and prosthetics, most of his time was now spent on amputations. When Malam Nasir El Rufai first banned Okadas from the FCT Abuja, most Nigerians thought it would be impossible to cope without them in most other cities. But now it is rare to find a major city in Nigeria where Okada's are still allowed to ply their trade.

But to prevent the Okada problem from being replicated with the Kekes', city planners must step up to their task of regulating the routes of Keke operators - else we may just shift our patients from the orthopaedic wards to the psychiatric wards as they recover from sitting half outside half inside the ever more popular Kekes. My friend Hilary the orthopaedic surgeon may be making a few Naira less, but he is sleeping a lot better these a result of the banning of Okada and emergence of Keke! Naija!