27-29th October was Ghana’s National Immunisation Day (like all UN things, this has been acronymised to NID). For these three days, every child under 5 is vaccinated against Polio and given a Vitamin A supplement. Ghana is not the only country vaccinating, it is a global scheme under the World Health Organisation to eradicate Polio. There have been no cases reported in Ghana since 2008, and the country is well on its way to proclaim it has been eradicated, globally the last eradicated disease was smallpox back in 1980.
The days are an amazing feat in themselves. Volunteers from the community are equipped with a small esky, ice-packs, vaccines, marking sheets, an indelible ink pen, chalk, and targeted area maps. They set off on foot early in the morning to their specified community and literally door-knock from house to house to find every child. The polio vaccine is a 2 drop liquid dose, once orally administered, the child’s left pinky finger is marked with the ink pen and then the liquid vitamin A is given as well. This ink lasts a few days, and helps identify the children who have and have not had the vaccine during the 3 days.
My job was to monitor the reach of the volunteers in the Upper West Region. Doing spot checks in the communities, and cross checks against the paperwork submitted. We set off for a few hours drive to reach a far off district near the Burkina Faso border. We came to the Lawra local clinic to find the targeted areas and immunisation numbers for the day and if there were enough supplies. The blue Vitamin A capsules had run out, these were 1000IU (international units), for the small children. They were left with plenty of red capsules, 2000IU for the older children. The volunteers were suggesting they just use half of the red capsules for the small children, however this was
not suitable as Vitamin A overdoses are serious, and this was a supervisor talking. So we advised against this method (my co-worker lectured actually, loves a good rant).
We went to a small, almost inaccessible community and looked for marked houses. Houses with a chalk ‘W4’ with a circle around it are classified as completely vaccinated houses. If it says ‘W4’ with no circle this means the volunteers have been but the vaccinations were not complete (ie. a child was not at home when the volunteers came). We entered some houses, however it was the middle of the day so everyone was out in the field somewhere. Children were at school. We found a house with plenty of elderly people, who said the volunteers had been the previous day. There was a circle around the ‘W4’. Chalking people’s walls in the name of health!
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Visiting a house marked with a 'W4' to check all children actually are vaccinated |
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'W4' tagged house in Wa |
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Out in the communities |
Driving past a small single room building maybe 4m x 3m, lots of children came to the door (the sound of a car is foreign, and so it is always worth a look). We drove in, and as we did lots of children scattered, running away out into the field (!) or back inside. As my colleague put it we were ‘causing some confusion’. We got out of the car and the teacher came to the door. This tiny building was a school for children all ages. No ventilation, no segregation between years/age, all jammed in together. Most of the children had the black fingernail, but we found one that had been missed. Possibly not at school yesterday.
The next school was larger, in a different community. 1 teacher came out, with his earphones in, listening to the radio. All the children in the school were milling about. We entered the classrooms looking for the children under 5’s, we came to a classroom with about 30 small children, all covered in chalk! they did not have a teacher, so they had been playing all day and now were covered in war paint and huge smiles. We were told the head teacher was away today, so school was closed. No learning, teaching or supervision. We once again found a missed child, and noted their details. This was disheartening seeing a school so useless and so many children willing to learn, well behaved and respectful of us, in their uniforms but with noone leading them or stimulation them.
We stopped along the way back to the clinic every time we saw a child. The response to us (and particularly me being white) was either intense curiosity, or complete fright. A small family was in their groundnut (peanut) field, harvesting the season. There were two small albino children helping out their father and siblings. It was amazing to see, they were freckled and out in the sun, so white, yet all African features. Their sibling came over and proclaimed his love for me. He was 6 year old! The father had known about the vaccination day, yet had taken one of his sons out to the field and therefore was not vaccinated. This child’s details too, we took.
You may wonder why we did not vaccinate the children that had been missed, it was my question too. However the vaccines come in a 20 dose vial, so opening it for one child is not effective. The volunteers will have to go back with correctly refrigerated vaccines to reach these children. I still think we could have reached 20 children in our day, however I don’t believe this is our job.
Day 2 as I was purchasing my morning staple of egg and bread at the bus stop, I witnessed a child being vaccinated by some volunteers. They were coming to hotspots like this to reach transient children, and ensure even these were vaccinated. The volunteers would return every hour here, or when they were close, to find new children.
I imagine if this was implemented in Australia. Would we get dedicated volunteers to work for 3 days straight for long hours, in the heat, walking tens of kilometers per day for
free? Never. And we could never cover the
entire country in this way. True, Ghana may be the size of Tasmania with the population of the entire Australia, but there are some truly remote communities and plenty of unregistered and therefore unaccounted for children. All in all it was a great snapshot and insight into the great lengths people go to vaccinate the children of Ghana.