Persevering to Immunize Nigeria’s Most Vulnerable
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. I was tempted to take my Akara and head home but on a second thought,
When I first stepped foot here in 2011, vaccine-preventable diseases and deaths were rampant.
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 and other environmental challenges claimed the lives of around 50 children. Polio was another vaccine-preventable disease that terrorized the village. 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 mai-ngwa (chief), the mallam (religious leader) and the teacher.
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.
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.