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Week of March 26: The initiation of global immunization has been a major breakthrough for children and healthcare throughout the world. In 1985 when Rotary initiated PolioPlus, the average immunization coverage for children in world was only around 30%, and this included the developed countries. The average Routine Immunization Worldwide is now 80%. The term PolioPlus was intentional -- the plus representing the other needed immunizations, which was a natural spin-off of the polio campaign. One thing that made the big difference was the "Cold Chain" -- the succession of refrigeration units needed to store the polio vaccines. Since this infrastructure was developed for polio, the other vaccines could now also be stored and this meant availability of vaccines in the most remote areas. Below is a picture of one of the refrigeration units that serve as an outreach cold chain storage unit. It runs on electricity, liquid gas or kerosene.
 ( Click on pictures to enlarge them )

   K.K. Ansu, Technician for the Cold Chain units     Keeping them functioning       

Siaka Braima, in the first and second picture below, was one year and 4 months old when he was given a shot for malaria in the left anterior thigh. Ironically, even though he had received some immunization coverage to protect him against the poliovirus, it obviously did not produce the serous convergence needed and the irritation of the chloroquine induced the polio virus to leap into action and paralyze his leg. Of course, everyone assumed it was an infection from the shot, since the paralysis occurred a couple days afterwards. But a doctor who was trained to detect AFP and report it ordered stool samples to be sent to the lab for viral studies. Yes, he had the Wild Poliovirus, type 1, and the only child in the entire Region (like a State) to become a victim of this virus. Fortunately, the prior immunizations seemed to have provided some protection, since he has recovered completely after a few weeks of being paralyzed.

 ( Click on pictures to enlarge them )

In the third picture above we are in a remote village getting information and doing an examination. We actually drove over 4 hours to get to this village, because a report of AFP was made and a stool specimen was sent for lab evaluation. Unfortunately, there was no information about the child and there was no functioning telephone in the area, which meant we had to go and investigate. Fortuntately for the child, he merely had a hyperflexive ankle that is not uncommon and resolves as the ankle joint matures. This, once again, underlined the need to provide more training to those individuals in the field that are looking for cases of AFP -- to avoid investigation of false AFP reports.

The last picture above is a 10 year old girl with typoid. She is obviously malnourished, but to make things worse she was so anemic that she required a blood transfusion. Now, after two weeks of intravenous hydration and no feedings, her bowel sounds are coming back and she actually had some small stool just before I examined her. Her rapid heart rate of 140 was almost shaking her frail body, but there is hope she'll survive, if the next blood transfusion isn't contaminated with HIV.

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