The twins sit with their uncle under the palm-thatched roof of a makeshift shed in the compound of the regional headquarters of the Togo Ministry of Health. They are 3 years old, the spitting image of each other in their pretty cotton dresses. Tete Dagan was born first, the uncle says through an interpreter. She is not the older one, though. Her sister, Tete Davi, the second born, is considered the older one—the guardian who pushed the younger one out first. As in the rest of Togo, here in Kpalimé, capital of the relatively cool Plateaux Region, it is okay to have twins, even triplets. Traditional taboos have long since vanished.
It is market day in Kpalimé and day one of the long-awaited joint assault on the diseases that are the biggest cripplers and killers of children in Africa. Like the hundreds of children and babies around them, the twins have come to be vaccinated against measles and poliomyelitis, to be dewormed with mebendazole and to receive the specially treated bed nets that will protect them from malaria-carrying mosquitoes. “Bed nets reduce child mortality by 25 percent,” says Mark Grabowski, who is on loan from the Centers for Disease Control and Prevention as a senior adviser to the International Services Department of the American Red Cross. “Less than 10 percent of children in Togo sleep under bed nets. Of these, most are rich kids,” he adds.
Togo is the pilot site of this ambitious endeavor. The government is able and willing, the roads are good and the Red Cross is strong here. Banners hung and draped all over the nation proclaim in French, “Grand National Integrated Campaign: Vaccination, De-Worming, Distribution of Repellent-treated Mosquito Nets to All. December 13-19.” It is the first and largest campaign of its kind anywhere, costing some $6 million, roughly $6 per child. In just seven days, 1,910 vaccinators and 2,680 volunteers will distribute more than 800,000 nets and vaccinate 1 million children in cities, towns and villages in even the remotest areas. “Integrated campaigns are the wave of the future,” says Grabowski.
Nearly 1 million children under 5 years of age die of malaria in Africa. The disease is the No. 1 cause of child mortality on the continent. Ninety percent of the deaths due to malaria worldwide occur in sub-Saharan Africa. In Togo, it is the leading cause of child illness, responsible for 43 percent of medical consultations and 44 percent of the children treated in hospital. Six percent of children under the age of 5 die of the disease. Combating and treating malaria consumes 40 percent of the country’s public health budget. Victims of polio—children and adults with withered legs—are a common sight in Lomé, the capital. Intestinal parasites abound, causing malnutrition, severe anemia, delayed puberty and learning problems. “We have to shake up Africa for the sake of the children,” Health Minister Suzanne Aho declared at a press conference announcing the launch of the campaign.
The campaign is a high-stakes operation, a test of a unique partnership in international public health. Success depends on mobilizing neighborhood health committees and religious and traditional leaders to encourage mothers to bring their children for vaccination. “We will learn valuable lessons from this pilot partnership,” says Tchamdja Romain, director general of the Togolese Ministry of Health and a surgeon. “It’s a solid lesson in partnering.”
Many organizations, like the American Red Cross, have stepped up to the plate. The Norwegian Red Cross and Norwegian Aid provided seed money; the Canadian Red Cross provided seed money and planning and implementation expertise; the Canadian International Development Agency provided resources to buy 735,000 insecticide-treated mosquito nets; Vestergaard-Frandsen, Danish manufacturer of the nets, provided materials for social mobilization and community education; DHL helped ship the nets and other supplies from Europe to Togo as well as within Togo; the International Federation of Red Cross and Red Crescent Societies helped with social mobilization and the handling of the nets.
Other contributions came from The Vaccine Fund, the Gates Foundation, the Vodafone Foundation, Sanofi-Synthelabs, the New Zealand Red Cross, the Roll Back Malaria Partnership and Rotary International. Volunteers from the Peace Corps and Freedom From Hunger joined their peers from the Togo Red Cross in educating traditional doctors, religious leaders and village elders and mobilizing families to take their children to be vaccinated.
Winning the trust of the village elders and the mothers took months of mobilizing. “We addressed the mothers through the village leaders. There was a traditional doctor in one of the villages who was violently opposed to the vaccinations. Now, he supports the campaign,” Minister Aho says. “No mother in the world will accept a handicapped child or a dead child in her arms because of measles. They have been sensitized. They understand the need to sleep under mosquito nets. They understand the importance [of the campaign],” she says.
The measles component of the campaign was launched in February 2001. It is led by an American Red Cross partnership comprised of the United Nations Foundation, the U.S. Centers for Disease Control and Prevention, the United Nations Children’s Fund and the World Health Organization, with support from African national Red Cross societies and government agencies and the International Federation of Red Cross and Red Crescent Societies. Air France donated 90 airline tickets.
Africa sees more than 12 million cases of measles annually. The disease results in the death of more than 480,000 children—more deaths than are caused by HIV, tuberculosis and malnutrition. Since the start of the measles initiative, however, more than 140 million children have been vaccinated against the disease, reducing cases and deaths by 50 percent. Togo dropped its measles mortality rate among children by 99 percent after a 2001 vaccination campaign, but half of the children born recently are still at risk.
“If you can get rid of measles, you can close the ward; if you can get rid of malaria, you can close the hospital,” Grabowski quotes an Ugandan doctor as saying.
In Kpalimé, the entire compound throbs. There is excitement and eager anticipation of the arrival of the officials who traveled from Europe, the United States, Canada and other African countries to witness the results of months of planning and logistical engineering. Gerry Jones, vice president, American Red Cross International Services, is ecstatic. “I love social mobilization campaigns all over the world. Lines are long, but the mothers are willing to stay,” he says. “They said 600 kids are here today. Even more mothers.”
Peter Striebel, a South African-born medical officer with the CDC’s National Immunization Program, hovers over a vaccination station, watching a nurse closely. After a few minutes he moves away. “The proper procedures for the use, storage and disposal of the syringes are being followed to a T,” he says with smile.
The mothers and their children are dressed to the nines. The children range in age from 9 months to 5 years. Some of the little girls wear organdy dresses with puffed sleeves and sashes tied in a big bow at the back. They carry pocketbooks that are almost as big as they are. The boys wear traditional suits made of bright cotton prints; the tops and bottoms match. Their mothers, too, are in their best cotton prints—the superwax—and gold jewelry. “Most of them are farmers. It’s Christmas, so the mothers want their children to look their best. It doesn’t matter whether the minister is here or not. They dress their children up normally when they are going out, even if it is to the hospital. They have saved all year for this, and if they cannot dress up their children, then what was all the saving for,” explains the interpreter.
There are the cries of frightened children and of children feeling the sting of the needles. A few mothers bicker over who is jumping the line. “I’m very impressed. With this small drug, this small syringe—it’s hard to believe you are making life happen for the next generation. This has to be replicated all over Africa. This is the model we have to share. Partnership is very important here,” says Richard Marcel A. Hunlédé, who heads the Africa Department of the International Federation of Red Cross and Red Crescent Societies.
Have you ever seen the look in a mother’s eyes when you tell her that her child is not going to die? Heard the tickle of relief in her voice as she comforts her baby, who has just taken a measles or polio shot? Last December I did, during five days I spent in Togo.
By Rosalind McLymont