Polio surveillance in South Sudan

 

 

Top: Chris Offer (far right) and Ann Buff (far left) meet with health workers outside a primary care unit. Bottom: A recently vaccinated boy. Photos courtesy of Chris Offer

A phone call from International PolioPlus Committee Chair Robert S. Scott brought me to South Sudan in April. The region, which became a country in July, was to be the site of a polio surveillance operation. The Technical Advisory Group on Polio Eradication for the Horn of Africa, part of the Global Polio Eradication Initiative, was concerned with the quality of polio data from South Sudan and wanted a team on the ground to assess the campaign.

No confirmed polio cases have been reported in South Sudan since June 2009, but the strife there has hampered efforts to obtain reliable information. After more than 20 years of devastating civil war, South Sudan is one of the world’s poorest countries, with millions living in refugee camps.

As my flight landed in Juba, now the nation’s capital, I was struck by the sight of 30 United Nations aircraft on the runway – from small planes to helicopters to a Hercules transport. Juba is the staging location for the UN’s humanitarian mission. After two days of planning and security briefings there, the teams from the World Health Organization, UNICEF, USAID, and the U.S. Centers for Disease Control and Prevention dispersed to their assigned areas. 

I travelled with Ann Buff from WHO on a UN flight to Rumbek, which landed on the dirt runway. Our task was to examine medical records in isolated clinics to see if all suspected polio cases are being reported. I also wanted to see how Rotary’s polio eradication dollars are being invested and what recognition Rotary receives.

An important indicator of polio is children with paralysis of legs or arms. Childhood paralysis has many causes; however, to eliminate polio as a possibility, it is critical that every case be examined. When a case is reported, a health worker often bicycles 50 kilometres or more on dirt roads to collect stool samples from the child, the child’s siblings, and the other children in the village. The samples are flown to a lab in Kenya. If the sample is positive for polio, a mass immunization program is launched.

At the remote clinics we visited, I met dedicated medical staff from the government, nongovernmental organizations, and religious groups as well as traditional health workers. These amazing professionals and volunteers work with limited infrastructure in tough surroundings to eliminate polio.

Our conclusion is that suspected polio cases in the places we visited are being adequately investigated. However, because of security concerns such as land mines, violence, and the vast transient population, we were unable to visit all areas and cannot confidently conclude that there are no polio cases in South Sudan.

I found the Rotary emblem on local polio posters, banners, hats, and shirts. The people of South Sudan may not always know what Rotary is, but they know that we care about their children. I came away with deep respect for WHO and the local health-clinic workers. These committed people are a key component of polio eradication. They work under extremely difficult conditions to get the job done. Rotary is privileged to have such partners.

Rotarians should be confident that their dollars are being well spent and well managed in South Sudan. We will keep our promise to the children of the world.