Oct 7, 2019

Africa set to be declared polio free as Nigeria marks three years without the disease

A baby receives a polio vaccination in Kano State, Nigeria 
A baby receives a polio vaccination in Kano State, Nigeria  CREDIT: ANDREW ESEIDO
Nigeria is set to mark three years since it saw its last case of polio on Wednesday – an important landmark on the road to official eradication of this deadly childhood disease. 
Nigeria is the last country in Africa to record wild poliovirus infections, but if no more cases are found in the next few months the whole continent could soon be declared polio free. 
Wiping out the disease in Africa is a huge milestone as there were still around 20,000 cases every year at the beginning of the millennium.
The last reservoir of the disease was the conflict-riven Borno State in north eastern Nigeria, where the presence of militant group Boko Haram prevented health workers from getting out to vaccinate children – the only way to eradicate polio.
Dr Tunji Funsho, chairman of Nigeria’s polio committee for Rotary International, said that the liberation of the area from Boko Haram had been key to ensuring no new cases of polio surfaced.
"The challenge was in the north east, particularly in Borno State, but in the last three years we have been able to access more than 90 per cent of children that we were not able to access in 2016," he said.
Three years ago 600,000 children under the age of five missed out on vaccination, compared to 60,000 today, he said.
"Even in the areas where we cannot easily access the children we have eyes on the ground to detect cases of acute flaccid paralysis [a key symptom of polio] and samples can be taken and sent to the appropriate lab.
"These inaccessible children are scattered across a wide geographical area, which would not be able to sustain circulation of wild poliovirus. However, that does not preclude us from trying to get to these children," he said. 
Since Nigeria’s last case of the disease in 2016, the government has implemented more than a dozen extra vaccination campaigns and improved surveillance and routine immunisation.
It has conducted satellite imaging of isolated communities on hundreds of islands on Lake Chad to work out which are inhabited. Vaccinators have also set up clinics in markets and at border posts to try and catch all unvaccinated children.
But while outbreaks of wild poliovirus have been wiped out there are still cases of the vaccine-derived poliovirus – a rare form of the virus that only arises in under-immunised communities. 
There have been 51 these cases of this form of the virus globally so far this year, compared to 104 in the whole of 2018. The largest number of cases has been in Democratic Republic of Congo. 
To begin the process of certifying the continent polio free a team of independent scientists will examine data from all 47 countries to look for a sign of an overlooked case or gap in surveillance. 
Dr Pascal Mkanda, head of polio for the World Health Organization Africa region, said the process would take some time and would not be complete until next year at the earliest. 
He added: "This is a great milestone and achievement. It will give encouragement and a confidence boost to other programmes - if polio, a huge public health problem, can be eradicated it will show that some of the other problems we have in Africa can be dealt with too."
He added that other disease programmes could learn from the fight against polio.
"One of the important things we have learned is how to mobilise communities and populations to ensure that they are committed to a particular health issue," he said. 
With Nigeria reaching this important milestone there are now just two countries in the world where the disease is still endemic – Pakistan and Afghanistan. 
Afghanistan has made great strides in eliminating the disease with just 12 cases this year. However, there has been a resurgence in Pakistan where there have been 53 cases of the disease so far this year, compared to just 12 last year. 
A poor security situation in Pakistan has hampered eradication efforts and three vaccinators were shot in April.

A review of progress against the disease, commissioned by the Global Polio Eradication Initiative in 2018, said “access limitations due to insecurity continue to represent the biggest threat to polio eradication and progress towards interrupting transmission has stalled".
Dr Michel Zaffran, director of polio eradication at the WHO, told the Telegraph earlier this year that as the number of cases was declining it was harder to persuade people of the importance of vaccination.
“Parents are saying why do you keep coming to my house when there is no polio here and we have no water or sanitation and my children are falling sick with measles and other diseases,” he said.
Dr Funsho said it was vital now to guard against any sense of complacency - polio vaccination efforts have to continue as before.
"The challenge now is to make all those who are concerned about polio - the government at every level, partners and donor agencies and countries - to appreciate that the job is just going into another phase. It has not ended. 
"The race is not about getting to this milestone. The race to about getting to the child with the vaccine before the virus gets to the child," he said. 
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Were the “Good Old Days” Really That Good?

Eisenhower and Congress Leaders
The current election cycle has revealed a craving among a large segment of the U.S. population for a return to the way things used to be, to go back to the "Good Old Days." As a person who has lived more than eight decades in this country, I am not sure what part of the past these individuals want to restore. I suspect the time that they yearn for is the 1950s.

Why the 1950s? Perhaps that was the last decade in which people with only a high school education could aspire to get a well-paying job and enter the famed middle class. In the 1950s, activity was booming in the industrial cities of the North. If a person were a sharecropper, whatever your race, opportunity beckoned in the factories of the North. If you have read John Grissom's book, A Painted House, or seen the Hallmark Hall of Fame movie, you have witnessed this phenomenon from the viewpoint of poor white farmers. All across the South, cotton fields fell fallow or switched to mechanized farming while hundreds of thousands of farmworkers headed north. The "American Dream" was alive for large segments of the population. 

Despite stresses of the "Cold War," peace prevailed in the U.S. for most of the 1950s. After the Korean War ended, American troops were not actively involved in combat. 

In the 1950s, the Federal Government actually worked. President Eisenhower often conferred with the leaders of both parties in Congress to address national concerns. Compromise positions were hammered out in these discussions, and acceptable legislation was then proposed and enacted. "Compromise" was not a dirty word in those days. Our leaders still realized that compromise is the very lifeblood of a functioning democracy.

Peace, economic opportunity, and a functioning government are all worthy of nostalgia. Unfortunately, there are other factors about that era that are not worthy of restoration.

Rigid gender definitions still divided society. There was "men's work" and "women's work." Men were expected to work and earn the family's living. "Bringing home the bacon" was their primary task. Women were supposed to marry, have children, and become homemakers. Almost all of the myriad duties of maintaining a household fell to the woman: providing meals, childcare, housekeeping, and assuring clean clothes for the family. Just keeping up with family laundry during those days before modern washing machines was an exhausting process. In the 1950s, boiling clothes in an outdoor wash pot and scrubbing them on rub-boards was still commonplace. Soaking garments in starch and ironing them with flatirons could be tiring as well. My mother-in-law always said, "There never were any ‘Good Old Days' for women."

In the 1950s, the Southern states of the old Confederacy remained rigidly segregated by race. African-Americans were decidedly second-class citizens. Segregated schools for blacks were often starved of resources needed to provide a reasonable education. The Ku Klux Klan was still active in some areas. Many white parents still taught their children that blacks were inherently inferior. Finding a better way of life was another motivator for the mass migration to northern cities. 

Medical care in the 1950s was primitive compared to what we have today. Preventive medicine was chiefly limited to smallpox vaccination. The current inoculations to prevent childhood diseases had yet to be invented. Most children endured Chickenpox, Measles, Whooping Cough, and Mumps at some time. Some died of these diseases. And in the background always lurked the specter of polio, the crippler, and killer of hundreds each year. Many parents would not let their children take swimming lessons because of polio concerns. 

Most people only saw a doctor when they got severely sick or injured. Doctors did make home visits in those days, but the treatments available to them were only a fraction of what exists today. Standard treatments still included prescribing laxatives for just about everything to "purge the body." Bed rest was recommended for most ailments. Smoking, on the other hand, was viewed as a good way to relax from stress. Almost all doctors were heavy smokers. Alcohol was considered a stimulant, although it is actually a depressant. The number of hospitals was limited. In those that did exist, privacy was given limited priority. Most patients were confined in large open wards. 

At least in the early 1950s, many country families still lacked indoor plumbing. Use of outhouses remained a necessity. Chamber pots were used at night. Of course, emptying these every morning usually fell to the woman of the household. Bathing usually occurred on Saturday night so people would be clean for church the next day. Galvanized washtubs in the kitchen were the usual bathing place.

I believe that the human mind tends to retain and augment the good things about the past while conveniently forgetting the not so pleasant ones.  Widespread opportunity, functioning government, and peace are all objectives toward which we need to strive, but I do not personally desire a return to the 1950s. There are many aspects of the current situation that need to be changed, but we need to hammer out new solutions in keeping with the realities of the world today rather than seeking to go back to the past. 

FROM http://warrenbellauthor.blogspot.com

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