Saturday, August 22, 2009

Polio au village

Hello all,

The latest Guinea installment:


I make a knocking motion on the door of the hut in front of me. “Is anyone here?” I grab the strap of the vaccination cooler and hike it higher up on my shoulder.

The wooden door opens slowly, revealing a young woman in a blue pagne, a baby perched on her hip. Seeing a white man, she straightens her shirt self-consciously and stares at the ground.

I do my best to put her at ease, smiling wide and speaking slowly and clearly. My Pular shpiel has been perfected over the past three days’ worth of work. This is the 19th village we’ve hit in the 3rd round of the National Polio Vaccination Campaign, and our mission is to vaccinate every child under five years old in the Sous-Prefecture of Boulliwel.

I put the cooler on the ground and fire off the standard salutations. On djaraama! Tana alaa ton? I introduce myself and my vaccinating partner, Diouhairatou, and launch into my explanation:

“We’re here from the health center in Boulliwel. We’ve come to give your children medicine against a disease that kills people’s legs when they get older.” The name polio is unknown amongst most villagers in my area. “If your kids receive this medicine three times, then God will help protect them from this disease in the future.” In this culture, even the firmest scientific facts are always couched within the worldview of an almighty God who gives and takes away. To say with certainty that a child will never get polio is almost heretical-- only God knows that. “Can we give your children the medicine? All they need to do is swallow two drops of liquid—no needles!” I smile ingratiatingly, hoping my shpiel has been convincing.

The woman shuffles awkwardly, still looking at the floor. My partner Diouhairatou, a lively, smart young woman studying to be a nurse, presses her. “How many kids do you have in your compound that are 0-5 years old?”

The woman responds this time, perhaps less intimated being questioned by another woman. “I just have these two kids.” She moves aside to reveal a little boy who had been hiding behind her leg.

“Can we give them the medicine?” Diouhairatou asks. I open the cooler and pull out the polio dropper to show her.

“My husband isn’t here,” says the woman, looking over her shoulder as if someone was watching her. She looks a little agitated.

I push her a little. “We’ve just come from Thaiel and Woucourde, ma’am, and vaccinated more than 70 children there. Every village in the country is being vaccinated between now and Monday. Our goal is to make it so that this disease doesn’t exist anymore in Guinea.”

She looks left and right and then nods curtly, giving her consent. She holds her baby still as we put two drops in his mouth. He is a trooper—no flailing or crying! Just a very curious look and a hesitant swallow. We give the second boy his vaccination, say our thank yous, and turn to go.

The woman, coming out of her shell a bit, asks us to stay and eat something—Guinean hospitality! We politely decline, as we have dozens of times over the past three days. I mark two children down on the vaccination sheet and ask the woman where her nearest neighbor lives. Having gotten directions, we shoulder our vaccinations and walk out of the compound on the narrow, corn-lined path.

It has been fascinating to participate in a campaign that is so international in scope yet local in its realization. I read in my Economist about UNICEF's efforts to eradicate polio, and read about the various international organizations giving billions to fight these sorts of diseases in Sub-Saharan Africa. Yet instead of reading these articles from the comforts of my college dorm room, I now read them knowing that tomorrow morning I am going to get up early and walk 10 km into the bush, a cooler of vaccinations on my shoulder, to knock on hut doors and convince village men and women in a foreign tongue that they should let me give their children this important medicine. I am, if you will, one tiny straw in the global broom that is sweeping across Africa to eradicate a dread disease. I am a part of the front-line fighting force. What I'm doing matters.

This is important knowledge for a Peace Corps Volunteer who often feels ineffective in his work! Yet it is also an inside look in what an international, multi-billion dollar public health campaign looks like on the ground. It feels less glamorous doing it than it does when I'm reading about it in a magazine, certainly. Yet it also gives me unique insight into the challenges faced by vaccinators and village health workers everywhere.

We had many cases of refusal. Most of these refusals came from local Wahhabites, or followers of the more fundamentalist sect of Islam founded by Saudi Abd Al-Wahhab in the 19th century. There has been a recent resurgence in the Guinean practice of this strain of Islam, resulting in more literal applications of the Qu’ran and a shedding of traditional syncretistic African beliefs like maraboutage and spiritism. The most obvious symbol of Wahhabism is the all-black full-body veil, or burka, being worn by more and more women in Boulliwel and throughout the Fouta Djallon. More often than not, in encountering these veiled women—Wahhabites—we were met with refusals to take the vaccinations.

How exactly these folks have gotten it in their heads that vaccinations are a bad thing is unclear. Some tell me that they believe the vaccinations are a western plot to keep the numbers of Muslims down in countries like Guinea and thus the medicine will turn you sterile. Others say that there is simply a unswerving belief that God has your days numbered and nothing you can do will affect his already-determined plan. This kind of fatalism can, of course, be seen elsewhere in Guinea, and not just with Wahhabism. Many people drive like maniacs here—after all, if you’re gonna die today, you’re gonna die today, and nothing you can do will change that. Ask my dad for more on this one;).

Nonetheless, the prevailing ignorance of many villagers with regards to these vaccinations has been frustrating. One village had over 15 cases of refusal, meriting a visit from our local mayor, M. Diallo my counterpart and the local doctor at the Health Center, and two teams of vaccinators. I went with the team to see the local authorities and, in essence, force the local population to accept the medicine. After all, if Boulliwel ends up having one epidemic-causing case of polio, we are to blame! Guinea had 15 cases last year, prompting this national campaign, and we hope to have zero in the year to come.

So join Peace Corps—be a straw in the broom. ;)

Thanks for reading. Ramadan starts today, ushering in a month of morose greetings and dead afternoons followed by lively, food-filled evening fast-breaking celebrations. I plan to do my fair share of fasting while in my village (when in Rome, right?).

Boulliwel sends their greetings.
Until the next time,
Much love,

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