Robert DeWolfe, Ivory Coast RPCV, is the point man for the West African launch of Bill Gates' Children's Vaccine Program
Robert DeWolfe, Ivory Coast RPCV, is the point man for the West African launch of Bill Gates' Children's Vaccine Program
Civil unrest stalls vaccination drive in Ivory Coast
Once among the most stable in West Africa, the nation is now rent by political turmoil, and its immunization effort is in shambles
Thursday, March 22, 2001
By TOM PAULSON
SEATTLE POST-INTELLIGENCER REPORTER
Ivory Coast - Sekou Koita's goat resists a bath
Sekou Koita's goat resists a bath in The Lake at Yamoussoukro, the capital. Ivory Coast was one of 13 countries selected for the first round of grants from the Global Alliance for Vaccines and Immunization. Mike Urban / Seattle Post-Intelligencer
Click for larger photo
ABIDJAN, Ivory Coast -- This was to be a beachhead for Bill Gates' worldwide assault on childhood disease. But the effort has been stalled by a menace as crippling as polio and, in Africa, as pervasive as malaria: violent political instability.
Riots and killings exploded on the streets of Abidjan, the financial hub of Africa's international coffee and cocoa trade, after a flawed national election last fall.
Civil unrest continues to erupt sporadically like a festering boil.
From the windows of his office in downtown Abidjan, Robert DeWolfe watched as soldiers, accompanied by armored personnel carriers, patrolled the street. Watching, waiting, are about all he's been able to do here for half a year.
DeWolfe is the point man for the West African launch of the Children's Vaccine Program, a $100 million project funded by the Bill & Melinda Gates Foundation. He came here to help the government introduce the hepatitis B vaccine, improve vaccine safety and boost immunization rates beyond 50 percent.
DeWolfe
Robert DeWolfe
Instead, DeWolfe has had to struggle just to open a functioning office in Abidjan, stymied for months from even opening a bank account.
"Everyone's been afraid to make a move, or approve anything, for fear it might get them in trouble," said DeWolfe, an ex-Peace Corps worker who moved his wife and two children from Seattle last summer to set up the West African office. "This job is difficult enough without all this."
Ivory Coast was supposed to be easy; it had always been one of Africa's most stable nations.
But the country began to unravel after a military coup in December 1999 and exploded last fall when the coup leader seized control of election offices as returns showed him losing. Even with a new president in place, the political unrest continues, seriously undermining the public health system.
Ivory Coast claimed to have been immunizing about half of its children against diseases such as neonatal tetanus, diphtheria, pertussis, measles and yellow fever.
But the percentage of children receiving vaccines "dropped significantly after the coup," said Dr. Clementine Anderson, head of immunizations for Ivory Coast.
Even in good times, it doesn't take much to upset vaccination systems in poor countries. They are seldom the highest priority of politicians and government officials because the benefits of immunization are largely invisible.
A successful vaccination system means a lack of disease. Politicians prefer accomplishments voters can see.
Upcountry, in Ivory Coast's capital of Yamoussoukro, immunization coordinator Bekrou Loueba, slender and studious behind his black plastic glasses, understands that well.
Across the street from the shabby, one-story concrete compound of the Yamoussoukro Health District clinic is the Presidential Palace, a sprawling complex protected by high walls, a moat and guardian crocodiles. The palace was built for Felix Houphouet-Boigny, father of the liberation and the nation's president for 30 years.
Ivory Coast - $300 million basilica
In a nation with a frail health system -- vaccination clinics in the capital lack money to buy gasoline for their vehicles -- former President Felix Houphouet- Boigny spent $300 million to build the Basilique de Notre Dame de la Paix, a full-size Mike Urban / Seattle Post-Intelligencer
Click for larger photo
Down the road in the other direction is the pearl white dome of Houphouet-Boigny's Basilique de Notre Dame de la Paix, a full-size replica of St. Peter's in Rome. Completed in 1989 for $300 million, it costs about $1.5 million a year to maintain.
At Loueba's clinic, the vehicles he needs to deliver vaccines sit idle. "We don't have enough money for gasoline," he said.
The government has never spent much on transportation for its public health system, he said. It has depended instead on donations of supplies and equipment from industrialized nations.
Japan and Germany, for example, donated most of the motorcycles and four-wheel-drive vehicles for delivering vaccines.
Because nobody was trained to maintain them, nearly all have broken down. The few vehicles still working need fuel. As a result, rural families too poor to travel to the clinic in Yamoussoukro cannot get their children immunized against even the most basic diseases.
Estimated coverage rates for standard vaccines such as measles, diphtheria and yellow fever in Loueba's district are only 30 percent overall -- and zero in some villages.
With the current political unrest and disarray, the situation is unlikely to improve soon.
Sylvie Ahoud's son was one of the children Loueba and his public health colleagues couldn't reach.
The boy's name is Parfait. Perfect, in French.
He's 6 years old but looks half his age. His left leg and foot are twisted by polio -- a disease that was supposed to have been in the history books by now.
When Parfait was born, Ahoud was living in the rural Mbatto region of central Ivory Coast, 150 miles north of Abidjan. She made sure her son got vaccinations at birth, including the first of three doses needed to protect against polio. But she said she couldn't afford the rest.
"But the vaccines are free," said an exasperated Dr. Nable Coulibaly, a physician with the Ministry of Health.
Ahoud, speaking quietly in her tribal language of Baoule, said meekly that that wasn't what she meant. She "couldn't afford to get to the clinic" in a distant town.
Ivory Coast - Open air tailor shop
A tailor's shop on the outskirts of Abidjan is a testament to both the poverty and the enterprising nature of the region. A major goal of the Gates Foundation is to break the cycle of poverty and disease in the Ivory Coast. Mike Urban / Seattle Post-Intelligencer
Click for larger photo
Even if she had, there is no guarantee that the vaccines would have been there. Supplies are erratic, even in good times.
"If we don't have vaccines when they come, we don't see them again," said Dr. Yao Aline, a physician who runs a mother and child clinic in Yamoussoukro.
Ahoud and Parfait live on a dollar or two a day now in the crowded, reeking slum of Abobo on the outskirts of Abidjan, the "Paris of West Africa."
They share a metal-roofed, concrete room the size of a closet with Ahoud's aunt. It has no electricity or running water.
Parfait, if he lives to adulthood, is likely to remain in poverty -- to get and spread disease, to be an economic burden for his mother, his aunt and his community.
"This is the cycle we're trying to break," said Dr. Gordon Perkin, director of the Global Health Program for the Gates Foundation. "It's a pretty simple idea, really, that assumes if you are poor and you get sick, you're going to stay poor."
Last year, Ivory Coast was one of 13 countries selected for the first round of grants from the Global Alliance for Vaccines and Immunization (GAVI), the Gates-financed consortium of public health agencies, foundations and industry.
Ivory Coast - Rat for sale to passing motorists
In the village of Dougba, Anicet N'Dri peddles a rat that he killed with a slingshot to passing motorists. N'Dri gets about 70 cents each for the rats he sells to truckers, who roast them roadside on an open fire. Mike Urban / Seattle Post-Intelligencer
Click for larger photo
The nation was awarded $1 million in aid over the next two years -- a recognition of its past efforts and an incentive to improve immunizations so it can qualify for additional money.
DeWolfe finally gained official recognition from the government and has opened a bank account. But he has spent most of his time working to improve the immunization systems in Togo and other West African nations so they can qualify for assistance from GAVI.
With so little progress and continuing political unrest in Ivory Coast, future aid here is in jeopardy.
Ivory Coast's children are in jeopardy, too. Although it's difficult to quantify, said Anderson, the country's immunization chief, it's clear that lives are being lost because of the unrest. Children who otherwise would have been healthy are falling ill. Many of them will die.
Their bodies won't get the attention given the dead on Abidjan's streets after the riots. But these are political casualties, as well, greater in number but hidden.
