The Death of a Disease: A History of the Eradication of Poliomyelitis

1. The Last Victims

The Last Victims 1 1 1 The Last Victims Burkina Faso, September 2000 Boureima Bagré is five years old. He lives with his family in the village of Seguedin, in the Nanoro district of this West African country. Burkina Faso means “land of honest people.” Boureima helps shepherd the family’s donkeys and goats, but, unlike the other children, he does not tug or pull on the animals to coax them into their pen at the end of the day. He cannot play for long without sitting down. Mostly he leans against the adobe wall, watching his sisters, mother, and aunts as they gather around an enormous flat rock, each woman gripping a stone with both hands to pound millet for the evening meal. Boureima’s left leg is withered and bent, and it turns out unnaturally from the knee. He limps when he walks. Aïnata Kafando lives in the village of Sassa, in the district of Yako, in Burkina Faso. Aïnata, who is six, likes to stay next to her grandmother or near her father as he feeds millet into a machine that crushes it. The noise from the diesel motor that powers the machine, located halfway 2 The Death of a Disease between their concession and the national highway, is deafening. Walking is not easy for Aïnata. Her foot is strapped into a metal caliper that holds her leg straight but hinders her movements. Aïnata and Boureima are victims of polio, a fate that other Burkinabe children should be spared in the future. This little girl and boy are among the last reported cases of polio in the country. Aïnata was stricken by “the Crippler” in November 1997 and Boureima in August 1998. From late 1997 to the summer of 1998, a polio epidemic swept the farmlands that extend from the suburbs of Ouagadougou to the districts of Nanoro and Yako, halfway between the capital city and the border with Mali. At the time this book was going to print, the last documented case of polio in Burkina Faso was that of Salam Kaboré, examined by a nurse from the Nanoro district on September 18, 1998.1 Burkina Faso, polio-free! For people who know this landlocked country, one of the poorest nations in the world, the news is hard to believe. Statistics on the country’s economy and health care speak for themselves: 81.5 percent of the population is illiterate . There is one doctor for every 25,000 inhabitants, and the gross national product is $240 per person. Burkina Faso is sixth from the bottom on the human development indicator . This index was established by the United Nations as a means of measuring human development; rankings are based on life expectancy, standard of living, and access to education. All these factors combined to make Burkina Faso especially fertile ground for the poliovirus to spread. But the global eradication of polio is underway. The World Health Organization (WHO) has already certified the Americas, the Western Pacific Region, and Europe poliofree . From 1988 to 1999, the total number of cases world- The Last Victims 3 wide fell dramatically: from an estimated 350,000 in 1988 to 7,141 reported in 1999; 2,979 in 2000; and 483 in 2001. The number of countries where polio is endemic has dropped steadily, from 50 in 1999 to 20 in 2000 and 7 in 2001. Soon, the stories of all the Aïnatas, Boureimas, and Salams of this world will be history. Doctors in Burkina Faso, India, Peru, and Thailand will base their knowledge about polio on what they have gleaned from books—as is the case today for physicians in France, Canada, and the United States. A disease as old as humanity is on the verge of being eliminated. Boureima and Aïnata live in the Sahel. Water is scarce here. Fetching water from the well is a task that falls to women and to girls as young as seven or eight. They carry jugs or pails balanced on their heads, sometimes walking hundreds of meters. When they arrive at the concession—a group of clay huts where a man lives with his wives, children, and members of his family—the women pour the water into large gourds. Containers filled with water are placed on the ground, in the shadow of a wall. This is the water people use to wash their hands...