Polio

Photo of the week. Mum teaching son how to fight

Highlight of the week: We get our remote camera set up outside the house

Lowlight of the week: Our kitchen air conditioning unit gives up the ghost

Maximum temperature: A cool 32 degrees Celsius. Winter is coming

Rainfall: Zero. We are reliably informed it will not now rain until November

Edward Jenner is turning in his grave. EJ gives the world a juicy panacea. Yet, Truth Social thinks that the Orange man knows best. The new Pope taketh away.

Vaccines. Most people love them. A few are not so sure. Some definitely hate them. Information is either too readily available. Or there is not enough. Social media. Full of truths. Mistruths. White lies. And huge whopping fabrications. So, what should you believe?  This conundrum runs deep.

Measles having been cancelled in our heyday starts to run riot again, thanks to Chicken-Licken running around in the limelight. A fine mess. Thanks to a researcher wanting more funding. Or notoriety?

Now meningitis B also grabs the headlines. Should we jab, or shouldn’t we? The Daily Mail campaigns both ways. On alternate days. It was ever thus.

We live in a valley of cause and effect. Too recent measles and polio has carved painful voids in Zambian families. Edward Jenner once showed us how to plug those gaps. There is now universal vaccine coverage thanks to him and to Zambian belief in science. Our tree clinics full. It’s a pity that science and history have been cancelled elsewhere. This week we wrestle with an old foe. Polio. Our District is mobilising forces. We march at dawn. But more on this later.

In 1988, the World Health Organisation set an aim to eradicate polio worldwide. To date, cases have decreased by 99%. Wild polio is now only present in 2 countries. There are challenges to complete Polio eradication. But it is feasible. And that is thanks to Mr Salk and Mr Sabin. Mr Salk killed his vaccine. And delivered it with a jab. Mr Sabin made children happy with an excuse to eat sugar at school. His attenuated vaccine goes straight to the gut. Alive. Where polio loves to live.

But Darwin will tell you, if you stop to listen, that wild things are wild. Give them enough time, and a soupy broth to support the possibilities…. And so we have live vaccine virus happy in muck. In the sewerage system in Lusaka.

But the story does not end there. This attenuated live virus can mutate - becoming something of a ninja. In its altered form, it might regain the ability to cause polio. When vaccination rates are high, this risk is contained. But if coverage drops, the door opens for this ninja to spread and a new spark looks for tinder.

Earlier this year, Zambia reported vaccine-derived mutant polio virus to be circulating in the Lusaka sewage system. Without apparent illness so far. But we hear the ticking. The familiar ticking of a timebomb. Public health Zambia seeks to defuse this bomb. With a mass polio campaign. Under-fives hold the key. They are the dry tinder.

Let’s set the clocks back: Its 2021. We are preparing for our first trip to Zambia. We speak to a previous Valley Doc. Light is shone on the unknown. But the doc is essentially disparaging about his role in the peripheral clinics: Twice a week you have to leave the busy clinic where you do worthwhile work. And drive the staff in the doctors car to the under 5 outreach clinics. It’s a really ridiculous clinic. There is nothing for you to do there. You are basically acting like a glorified taxi service. 

It's dawn. Monday morning. Our baboons have lost their role. We beat them with a 5am call to prayer. Yet we pray to the yoga gods. We HIIT the prayer mats to finish the job. Exercised, we move on. And collect the amassed troops at Kakumbi clinic at 08:00.

 Where have you been? You should have been here at 07:30!

News to us. We have 4 teams of staff to distribute to the villages in our area. They eagerly approach the car. And squeeze in. Amoeboid. An extra one in the front with me. 5 squashed on the back row. 5 in the boot. This is no time to tell my mini joke. The nuance is lost on the Nyanja/ Kunda audience. Our white Hilux Mzungu is purpose built for this role.

Fully-laden, Mzungu, with a slow puncture hissing from the left rear tyre, rises and falls through the ridges and gouges of the ungraded roads. We dodge the larger pot-holes of the main, tarmac road. But the dusty morning light, random bicycles and competing road users make the preferred line tricky. Inevitably our three and a half wheels jar into craters. Somehow, we rise from the sink-holes to regain flat asphalt. Staff sway and blend together like tetras. Apologies punctuate the chatter.

A shout, too late, advises of a missed stop. An extra body impossibly squeezes in. Turn offs. Drop offs. We reach the last village. Agreements are made for the later pick-up. The first run is complete. Then repeat.

The polio taxi service. Not resented. Unlike some docs before us. Part of the process. Vital cogs that drive the chain that prevents polio.

Rising early, missing lunch, finishing late. Our team tread the trail. Moving house to house. Finding small mouths. Dropping in Sabin’s elixir to ward off future palsies.

So what are the teams doing in the bush? They have a target. To vaccinate every child under the age of 5. Having previously sent out word to the village elders. Informing them of the campaign. The staff traipse door to door. Village to village. By foot. A motorbike improves access to far flung pockets. To squeeze a drop of polio vaccine into every child’s mouth. They mark the child’s pinkie finger nail with indelible ink once vaccinated. No double doses allowed. Chalk marks on houses. A code. Parents saying yes. Children unable to say no. The campaign kicks off.

Eventually we return to clinic. Via the garage. A flaccid rear tyre is our first resuscitation of the day. A puff of air or two. Our mechanic reports the prognosis: It’s respiring Doc. We agree it has a chronic respiratory issue. We add it to the non-communicable disease hit list. We agree to use puffs as required. And schedule a tyre transplant further down the road.

We find a skeleton staff at Kakumbi. And flesh out the numbers. Adding four hands to Kennan’s capable two. Our six hands risk infestation, as we inspect Lilian’s little mitts. Scabies is the consensus. But mum is not happy. Her agenda is to secure the polio vaccine for her little mite. She’s six, but small enough to pass as five she claims. Ageism isn’t fair. Our hands are tied unfortunately. Under-fives are the chosen ones. Age just a number. But the number 6 is unlucky today.

The campaign trail marches on. Numbers populate audit sheets. Describing doors entered. Chalk marks. Sour baby faces. Smiling mothers. Collection at 15:30. The team receive a pat on the back. Day one is on target. Our boss deserves plaudits. Saulos gets a pat on the back.

Day two sees District oversight. The boss’ boss wants more. 15:30 becomes 17:30. Food an afterthought. Keith collects exhausted staff from the dregs of the day. No perks. Save for pride. He takes spent staff home. Rashly offering emergency food and taking a short-cut to village homes. Double whammies land in Keith’s solar plexus. The empty stash of emergency food in Mzungu insults empty bellies. The muddy village trails clutch Mzungu’s wheels. A diff lock and 4 wheel drive save the day, but paint the village reddy-brown. As well as Mzungu’s whiteness.

The long days sap. Day 3 brings resignation. Day 4 steely determination. Heavy legs trudge through day 5. Shoulders sag as Day 6 dawns. Those chattering positive voices from Day 1 converted to proud weary reflections. Polio put to bed for another year. Our small army of volunteers and under-paid staff hungry and thirsty. Allowed to rest on Sunday.

We pay homage to our idols. Those figures from history who left an indelible mark on our planet. For good. Jenner amongst them. 2,236 under-fives now bear the stigmata of polio vaccination. A blackened little pinkie nail. 94% of our under five population now wear a shield against a paralysing unseen virus. South Luangwa protected by a virtuous belief system and a week’s hard graft. We turn our backs on false idols.

Bushcam photo of the week. A bushbaby comes for a sundowner

Saulos instills passion in his team

Mzungu is filled to bursting front and back

Day 1 and our teams are full of energy and enthusiasm at drop off.

A blackened pinky nail. Only 1 dose of vaccine per child