Eradicating Polio in Huambo, Angola
March 15, 2004
By Richard Poole, International Medical Corps Country Director
This past December, International Medical Corps Angola hosted two staff members from Child Survival Collaborations and Resources (CORE) in the San Pedro health center in Huambo province. The visit highlighted the impact of CORE's polio eradication program in the area. As CORE is an association of some 35 NGO members operating in 140 countries, its primary aim is to eradicate polio by working through existing Ministry of Health, UN, and NGO structures, providing technical assistance and funding to complement immunization programs already in progress. In Huambo, International Medical Corps' team of six vaccinators have dedicated themselves to educating and protecting children and women of child-bearing age from vaccine-preventable diseases, carried forward through the intermediary of health centers and posts and mobile clinics. During the visit, CORE staff members were pleased by the presence of an enthusiastic crowd of mainly women and children gathered in the reception area outside the San Pedro health center, awaiting their arrival.
Bringing humanitarian assistance to a preliterate society in any part of the world presents a number of interesting challenges. The first and most obvious of these is that public information can rarely be distributed in the form of a written handout; instead, information must be presented in both a visual and aural form. An advantage of this presentation is that preliterate societies are often gifted with a memory capacity and a power of retention that far outstrips our own which has now become debilitated by a dependence on the written word, so that quite often a single presentation of a concept, if effectively done, is sufficient to leave a message indelibly engraved on the consciousness of the average farmer. Teaching these groups how to recognize the symptoms of a particular illness, for example, can normally be communicated successfully in this manner.
Another common characteristic of a preliterate society, and one that is not so easily addressed, is an absence of precision. Those of us who have grown up in a modern technologically advanced society, intuitively understand how important accuracy is when it comes to such things as recording data, tuning a vehicle engine, or more especially, prescribing doses of medication. Such exercises in precision are absent in most preliterate cultures, and so when it comes to teaching an illiterate woman farmer that her young child can be protected against the hideous scourge of poliomyelitis, but that she will need to ensure that he receives three doses of vaccine administered at intervals of one month, it cannot be taken for granted that the key elements of this message will be readily understood. It is oftentimes difficult to convey the importance of the child having three doses as opposed to one or two, and neither will the intervals between them make much sense either, for such concepts will be culturally unfamiliar.
For this reason, when implementing its immunization programs, International Medical Corps uses a participatory approach, one that seeks to convey key messages in a manner sensitive to the values and possibilities of the local culture. This may take the form of a talk accompanied by a skit that clearly places the topic in a local context, illustrating the nature of a particular problem and how it relates to the audience. The skit invariably attracts a great deal of interest and usually provokes considerable amusement at the same time. Following these activities, International Medical Corps' expanded program of immuizaiton (EPI) vaccinators offer an explanation of what the audience has just seen, with special emphasis placed upon certain details such as the symptoms that one should be aware of when confronted with a particular illness. Having successfully shown how to detect the illness, a second skit will illustrate the action that can be taken to cure and/or prevent its spread. This is then followed by a comprehensive explanation emphasizing certain key messages and, finally, a question and answer session.
The importance of group participation of this kind cannot be overstated. Not only does it allow for communication of messages of lifesaving importance, it allows for bridges of friendship and trust to be built among those who are present – a most vital consideration for a country that is just emerging from twenty-seven years of civil war.