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Summary of Mission

Polio Eradication was only a dream when, in 1985, Rotary International resolved to take up the challenge to provide free oral polio vaccine for 500 million children in the world. It was my privilege to have been a Chairman of the PolioPlus Committee in our Rotary Club of Simi Valley then and help raise part of the $240 million that when to purchase the vaccines to minimize polio. Rotary's efforts sparked a 1988 resolution by the 166 member nations of the World Health Assembly to eradicate polio, and we set our sights higher -- not just minimization, but global eradication of the disease.

During the last phase of this 15 year effort I had the privilege of going to India last year and to participate in the massive NID -- National Immunization DAY -- witnessing 150 million children immunized in one weekend. This year I was privileged to have been trained by CDC to participate in the final push and to serve as a Special Surveillance Consultant in an effort do detect the last unfortunate child and victim afflicted by the poliovirus. I'm pleased that the polio initiative is on track for certification of global eradication by 2005 (the 100th birthday celebration of Rotary). However, it is not a "done deal" and as a Rotarian I realize that we are now faced with even greater challenges and we need to accelerate our support to finish the job that we started all those years ago. The following is only a thumbnail sketch of our activities as Special Surveillance Counselors, but it will provide you with some of the essentials.

Purpose of Mission:

Our CDC/WHO STOP Team were composed of three physicians. We were sent to Ghana for a three month period to provide technical assistance to the Ministry of Health (MoH) on their Polio Eradication Initiative (PEI) activities. The mission focused on accelerating acute flaccid paralysis (AFP) surveillance and strengthening integrated disease surveillance (IDS) at regional and district levels.

Key Activities:

We had three main areas of activities:
      1. Training / sensitization of health workers
      2. Active surveillance for AFP and strengthening integrated disease surveillance
      3. Community Mobilization

Key Findings:
      · The structure of the integrated surveillance system is in place and incorporates AFP surveillance.
      · There were 19 AFP cases identified in the 6 regions visited by the STOP Team, out of the total 23 identified in the         country (19/23=80%) during the period of our mission.
      · We found great variation between regions and districts, but in general, active surveillance is sub-optimal.
      · Disease Control Units are constrained in active surveillance by limited material and human resources.
      · Insufficient understanding of 'AFP Case Definition' among health workers in facilities and some DHMTs.
      · Irregular supervisory support and deficient information flow between operational levels.
      · Inadequate social mobilization for AFP surveillance. Key Recommendations:
      · There is a need for an organized continual program for onsite, participatory training of clinical / technical health workers,         district and regional disease control/surveillance officers.
      · There is a need for increased mobilization of the community, traditional healers, and prayer camps and private health         care practitioners to help identify AFP cases.
      · There should be periodic supervisory support from WHO and National MoH to regions, from regions to districts and         from districts to sub-districts to build capacity in all activities related to disease surveillance
      · Resource needs, such as staffing, transportation and office support, should be assessed for each region and addressed         accordingly.

Accomplishments:

The following table provides a quick report on our visits to the various districts within the regions assigned to us, as well as the number of institutions where presentations were made and, most important, the number of staff that were sensitized to detect and report cases of AFP. Of interest, during our work period in Ghana 23 cases of AFP were reported and 19 of these cases came from the regions in which we worked, which might underline the success of our efforts.

Acknowledgments:

The privilege of serving as a 'STOP' Team member was made possible with the support of the CDC of Atlanta, Georgia, the WHO and Ministry of Health of GHANA and the encouragement of Rotary International. I especially thank Dr. Linda Quick, Virginia Swezy and Dr. Messeret Eshetu for their guidance and assistance in helping me be a part of the Polio Eradication Initiative.

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