30 Aug Persevering to Immunize Nigeria’s Most Vulnerable
August 30, 2016
In Nigeria’s urban slums, where diseases are easy to pick up and health care facilities are hard to reach, prevention with vaccines can be the difference between life and death. One advocate tells her story.
By Chika Offor, Chief Oversight Officer, Vaccine Network for Disease Control
Photography by Ijulu Wonodi
A colorful blur of children jumps over open sewage snaking along dirt roads and paths in Damangaza, an urban slum clinging to the outskirts of Abuja, Nigeria. They play between hundreds of make-shift homes held upright by wood, mud and corrugated metal sheets. The lack of electricity, running water or plumbing makes it difficult to protect the children, among 6,000 vulnerable inhabitants, from diseases. But it’s not impossible—as my team at the Vaccine Network for Disease Control has worked hard to achieve over the past five years.
When I first stepped foot here in 2011, vaccine-preventable diseases and deaths were rampant. Immunization was nonexistent. Our fierce optimism, unyielding determination and creativity changed the status quo for this community, whose trust we have cultivated to teach them how to keep their children alive with vaccines. As a member of the Women Advocates for Vaccine Access (WAVA), a coalition of organizations pushing for greater vaccine access, the Vaccine Network team knew the key: empowering the women. We knew that women are the driving force for health, the advocates for their children.
But this trust did not come easily or quickly. Women selling fruits on the side of a road were the first to introduce me to this village. I explained my intention to conduct a health-related visit, and they agreed to lead me back to their home of Angwan Hausa Damangaza, a Hausa Fulani settlement located at Garki ward of the Abuja Municipal Area Council.
At the time, there were over 1,000 children living in the settlement, with more than 500 of them 5 years of age or younger. A measles outbreak was underway, pneumonia was prevalent, and polio terrorized the village. The combination of vaccine-preventable diseases, malnutrition, and illnesses related to poor access to clean water and sanitation took the lives of around 50 children. The Vaccine Network team rolled up its sleeves and began the work to educate families and connect children to health services—a tall order in a remote urban slum.
Language was the first barrier we encountered. We needed a translator who spoke Hausa and English. Another major barrier to starting a conversation with the mothers was bashiga, the cultural restriction for men to enter homes where women live. We learned quickly that we had to go through three men in particular: the mengwa (chief), the mallam(religious leader) and the influencer (a trustworthy and well-known member of the community). While none of the families immunized their children, the chief of the village did. We were able to convey to him the importance of vaccinating more children in the village. When a large part of the community is protected, it’s harder for a disease to spread, especially to those who are not or cannot be vaccinated, like newborns. This herd immunity could protect everyone and less lives would be lost.
Gaining the men’s acceptance had a domino effect. When they told the village that our team could be trusted with their health, we gained the assurance of the families. But simply telling parents that they needed to vaccinate their children wasn’t enough.
We got creative. With support from the International Vaccine Access Center for our World Pneumonia Day advocacy efforts, we threw a colorful and textured fashion show, where the children from the settlement were the models. We let them keep the traditional Nigerian clothes and outfits. Afterwards, we were welcomed into their lives; they considered us part of the village family. They did not hesitate when we brought health workers from Abuja Municipal Area Council to immunize their children. The team succeeded in immunizing 441 children under 5 years old against measles and polio in one day, with only about five families refusing immunization.
Still, the best scenario is for mothers to seek care, rather than wait for anyone to come to them. That required money. The Vaccine Network donated machines for grinding and we taught the women how to make soap and cream that they could sell at markets. These workshops also taught sewing skills. We used the time to speak with the women about health and immunization. Empowering the women economically helped a great deal; they could generate their own income and decide how to spend it, and they also knew now that child health was a good investment to make.
Our team took our advocacy work another step further: we hired a bus to transport the mothers and children to the health center for immunization. Paracetamol, also known as acetaminophen, was also provided at the health center. These trips led the families through the logistics of how to get there in the future. The Vaccine Network’s ongoing efforts to improve access to vaccines paid off: In 2013, no child died of vaccine-preventable diseases in the community.
Nigeria’s Basic Immunization Schedule
- BCG (Bacilli Calmette Guerin)—at birth or as soon as possible after birth
- OPV (Oral Polio Vaccine)—at birth and at 6, 10, and 14 weeks of age
- DPT (Diphtheria, pertusis, tetanus)—at 6, 10, and 14 weeks of age
- Hepatitis B—at birth, 6, 10, and 14 weeks
- Measles—at 9 months of age
- Yellow Fever—at 9 months of age
Nigeria began PCV (pneumococcal conjugate vaccine) introduction in phases by region in December 2014, and children in Damangaza have received it. The country is graduating from Gavi eligibility starting in 2017, with a 5-year transition plan that would cut 20% of funds each year. Gavi provides low-income countries financial support for immunization.
Poor health records in the urban slum make it difficult to compare 2011 to 2016, but we know from regular visits with the chief and the families that awareness and behavior have dramatically shifted—and less children are dying. The women now seek out routine immunization themselves, and they even complain when health workers go on strike. Mothers will travel with their children to the closest health facility, 3-4 kilometers away in Dutse, a trip costing around NGN 150 one-way—a steep price for families living in poverty. The closest hospital is even further, 15 kilometers away in the Asokoro area. It’s a wonderful sight to see the health facility full of patiently waiting women who brought their children on their own terms. It’s a scene of pure perseverance and love.
In a place like Damangaza, where diseases are easy to pick up and health care facilities are hard to reach, prevention can be the difference between life and death. Any organization that comes through our network now can easily gain access to the community because of the relationship we have built and established with them. The numerous barriers we faced—trust, access to mothers, language, health education, distance to health services—were all brought down, one by one. Vaccines are just the beginning of what these children need to improve their quality of life. With health comes hope, and with hope comes the will to pursue education and economic stability for a better life.
Chika Offor is chief oversight officer at the Vaccine Network for Disease Control. Their mission is to save and improve the quality of life of the poorest communities in Nigeria using unique strategies to create permanent change by fostering community partnerships and ownership, helping communities identify and devise lasting solutions to their own problems. The network strives to transform the health and educational status of rural communities across Nigeria through partnerships with the public and private sectors, leveraging on their passion and resources to turn their good intentions into measurable results. Learn more about them on Facebook and Twitter.