Well, you have to live with it! / Sam Adjei

Well, you have to live with it! This is what Dr Sam Adjei's mother told her son when he was ten years old and realised that, because of a handicap left by polio, he could never become a goal-keeper. Or Adjei instead became an epidemiologist, and now works with the Ministry of Health in Ghana. A delegate of his country at the last World Health Assembly, Or Adjei was interviewed by Ruth Landy for World Health. World Health: Dr Adjei, could you tell me briefly how immunization rates have changed in Ghana in recent years? Dr SAdjei: Well, we have had very low immunization coverage for some time since feasibility studies were done in Ghana in the 1970s. We had levels of even less than one per cent, and it took us quite a time to raise that level to 5 per cent in 1984-1985. At the moment we rate a polio vaccination level of about 40 per cent in our system, so we have had a dramatic change within a very short time. We were challenged to try and double this up to 80 per cent by mid-1989 . . Or Sam Adjei is a specialist in epidemiology at the Ministry of Health in Accra, Ghana. u.H· These are remarkable growths in figures. What is really involved in trying to make a big jump from 5 per cent to 40 per cent or from 40 to 80 per cent in immunization coverage? SA: It requires a lot of efforts and input and mobilisation and getting people together. Basically there are two components. The first is to provide information and create awareness. Secondly, you have to have your logistics and your systems ready to provide the services that you have been discussing with them. You have to have your vaccines ready, and your Most young polio victims in the Third World have no access to rehabilitation services. This African boy is lucky, but he will still have to struggle to lead a normal life. 22 personnel trained. You have to have your needles arranged, your transport network and all the supportive system to carry the services right from the centre of service delivery to the very communities and villages, sometimes under very difficult and trying condi- tions. In special instances, people have to travel by boat on turbulent rivers, and they get lost, because they are trying to find villages and islands. Sometimes they have no transport, or the only transport available is to just hang on to a tractor through trackless fields and try to reach the next com- munity. You cross a bridge and, when you come back, the rain falls in torrents and the bridge is washed away; you are lost out in the field for some time until the river subsides and you can walk or wade through. These are the sort of difficult conditions in some of our countries. WORLD HEALTH, December 1989 WH: You have also to make people want to have their children immunized. VVhat is the challenge there, especially in the rural areas of Ghana? SA: The conventional way of getting information to people has been either through television, ne\NSpapers or the radio, but these have a very limited reach in our circumstances. ONnership of radio would be limited to not more than half of the people in the commu- nities, the ne\NSpapers circulate only in the towns, and television sets are very limited. So this means that you have to work out innovative ways of meeting with community leaders and discussing matters. Then you get the chiefs and other people to pass on the informa- tion in their villages, and try to con- vince them of the need to immunize their children against diseases that they are so used to and have become very fatalistic about. WH: Dr Adjei, you are a doctor, a scientist and a specialist on polio in a professional way You are also some- body who has personal experience with the disease. Can you tell me about this? SA: My mother told me that, just when I was beginning to walk, I had a fever and was taken to a doctor, who gave me an injection. Injections in certain circumstances can precipitate paralysis, and that was exactly what happened in my case. So just when I was beginning to walk, I got paralysed in both legs. It was only through intensive health work and physiotherapy that I was able to walk on one limb, and then the other limb got paralysed. In a way it affected my growth as a child. At the age of ten, I watched my colleagues and fellow students. One of my ambitions was to become a footballer, or else to be a goal-keeper and run the hundred yards. But I realised that I could not do that. I talked to my mother about it and she said: "Well, you have to live with it." As I grew older and got into high school and started reading about the disease, I remember very clearly telling my mother that one of my ambitions would be to get rid of the disease that had affected my childhood development, and affected my ability to play and jump about like the other children. And so, when she found out that I was working in immunization and that the target was polio eradication, she was not sur- prised in the least. WH: Is polio a common problem in Ghana; do you regularly see it in the community? SA: Yes, definitely. There is evidence to show that seven out of every 1,000 schoolchildren have a residual paraly- sis. Now what that means, is that in every class of about a hundred you will W ORLD HEALTH, December 1989 Preventing polio through immunization is rewarding work. It will ensure that children need never suHer the hardship of being crippled by polio. see at least one child who is paralysed. And those are the ones who have suffered paralysis, not counting those who develop the fever and tenderness in their limbs but who manage to escape the paralysis. It is a common sight in our rural communities to see people who are paralysed or disabled in one way or the other. WH: Are you beginning to see the results of all the work that has been done to convince the communities that polio can be prevented? SA: Certainly. With even the modest coverage of about 40 per cent, most mothers are beginning to realise that their children don't have to be para- lysed by this disease. But we know we will make much more progress if we get the immunization levels to cover everybody. Mind you, paralysis is something which is permanent, so it takes a long time for it not to be seen again. We need more time and a higher coverage level to completely demonstrate the effect to everybody. WH: Dr Adjei, what is the greatest challenge for you as a scientist and epidemiologist in Ghana, in terms of the goal of eradicating polio in your country by the year 2000? SA: I think it is to be able to put on the world map that, after smallpox, one more disease has been removed from the face of the earth. • 23