President’s Comment – 21 May 17

Hi All,

A reminder that we will hold a social GoToMeeting this coming Wednesday, 24th May at 7.00pm EST.  An invitation will be sent to all members. Others wishing to attend need to contact me by email please – johnroberson@bigpond.com .

The article below  shows the need for all Rotarians to continue funding the Rotary Foundation Polio Plus project.

 

Where polio hides

The discovery of the poliovirus in Nigeria last summer shocked eradication efforts. Here’s how Rotary is making sure it doesn’t happen again

By Erin Biba Photos by Andrew Esiebo

When his family finally arrived at the Muna Garage camp for internally displaced people (IDP), they had walked more than 130 miles in three days. They were starving, and the camp was only a temporary setup with inadequate facilities, housing more than 15,000 people. But the worst news was yet to come. Health officials in the camp determined the baby had polio.

“It was heartbreaking,” says Tunji Funsho, chair of the Nigeria PolioPlus Committee and a member of the Rotary Club of Lekki Phase I. Funsho met the boy on a trip he took in August to three of the country’s IDP camps. “At least (the family was) able to escape Boko Haram. The child was able to walk but with a limp, and was quite malnourished.”

If it weren’t for the polio surveillance system that the World Health Organization (WHO) has in place at every one of Nigeria’s IDP camps, Funsho says, the boy’s polio could have easily gone unnoticed. In fact, it was a shock to the entire polio eradication effort in the country that a case existed at all. 

View Slideshow
An estimated 15,000 people live in the Muna Garage camp, an informal settlement on private land. 

 The country hadn’t had a case since July 2014 and had been removed from the list of polio-endemic countries. But in August 2016, routine surveillance methods, which include sampling of sewage and wastewater to look for viruses circulating in the wild as well as monitoring and investigating all cases of paralysis in children, discovered two cases of polio in Borno state – one of them the 13-month-old. (Two more cases were subsequently reported.) Polio wasn’t gone from Nigeria after all. 

“The new cases devastated us. Even one case is unacceptable. It’s very unfortunate we are in this position, but we are recalibrating our efforts to end this disease,” Nigeria’s health minister, Isaac Adewole, told Rotary leaders during a meeting at Rotary International World Headquarters at the time. “We consider this situation a national emergency.”

The importance of surveillance

The polio surveillance system, carried out mostly by WHO and the U.S. Centers for Disease Control and Prevention (CDC), two of Rotary’s partners in the Global Polio Eradication Initiative, consists of several parts. First, doctors and other community health workers such as healers and traditional birth attendants monitor children for paralysis. “Most times cases are not discovered at a medical facility – they’re discovered at home by the volunteer community mobilizers and people who are paying regular visits,” Funsho explains. “They find a child that is limping or unable to use a limb they’ve used before. They’re trained and they know the questions to ask.” If they discover a paralyzed child, the health workers report the case to WHO, which sends a surveillance team to collect stool samples from the child and his or her siblings for testing. 

The second part of the surveillance process involves local authorities collecting samples from sewage systems or, in places that don’t have adequate sanitation facilities, rivers and bodies of water near large settlements. The samples are sent to a lab, one of 145 in the Global Polio Laboratory Network, which looks for the poliovirus. If it is found, the samples go on to a more sophisticated lab where scientists perform genetic sequencing to identify the strain and map where and when it has been seen before.

The worldwide scale of these surveillance efforts is massive and costs roughly $100 million every year. For the most part, these activities take place only in countries that don’t have adequate health systems already established. In the U.S., for example, if a child showing signs of paralysis visits the doctor, the necessary tests for polio are already a part of the working health system. But in countries that don’t have such a robust system, WHO takes on that responsibility. That means investigating more than 100,000 cases of paralysis around the world every year to rule out polio.

In Nigeria’s IDP camps, surveillance is more complicated. Before people enter, they are screened by security agencies (there have been several cases of suicide bombers trying to infiltrate the camps). Next, at the camp’s health facility, doctors evaluate the new arrivals’ overall health and screen them for polio. Volunteers then document what villages they have traveled from, using the information to track who is in the camp, where they are within the camp, and who their family members are.

The challenge of mobile populations

Before the new cases were detected, the surveillance teams working in IDP camps were vaccinating and searching for suspected polio cases as usual. 

But in the official documents, when they were reporting their findings, the teams weren’t marking the displaced people as being located in their camps: They were being counted by their area of origination. However, surveillance teams and vaccinators weren’t actually traveling to some parts of the state where the displaced people had come from because the presence of the Boko Haram terrorist group made it difficult. 

The Nigerian army escorts people traveling through risky areas. 

“This gave the impression there was good surveillance (in those areas), when in fact there were major blind spots,” says Mark Pallansch, director of the Division of Viral Diseases at the CDC. “We knew this was an area of concern, so we implemented additional measures to try to strengthen surveillance.” 

The extra measures included scaling up environmental surveillance and sampling healthy individuals – including adults – for the presence of poliovirus as they exited inaccessible areas. Teams also searched IDP camps and host communities more frequently and reassigned the acute flaccid paralysis cases by place of onset. It was in part thanks to such strengthened activities that additional polio cases were found.

But the surveillance situation remains volatile, Pallansch confirms. “This really underscores the dangers of any low-level residual polio transmission in the face of any subnational surveillance gaps,” he says. “We still don’t have an exact idea of virus transmission in some areas of Borno. Operationally, we have to therefore assume that it remains an infected area and our focus has to be on reaching the children with the vaccine, all the while plugging the surveillance holes.” 

A major part of the problem is that in the area where the cases of polio were discovered in Borno, the health system is decimated, impeding the discovery and reporting of the poliovirus. In December, WHO health monitors reported that 35 percent of 743 health facilities in Borno were destroyed and 29 percent were damaged. Sixty percent of the remaining health sites have no access to safe water. 

But it’s not just the breakdown of the health system that is causing the problem. Until recent military incursions by the Nigerian government, Boko Haram occupied more than half of Borno. And, unlike the Taliban, which controls areas of Afghanistan (one of only two other countries that have yet to eradicate polio), Boko Haram does not negotiate with vaccinators who want to enter areas they are in. 

This five-year-old living in the camp was one of the four children with polio discovered in Nigeria in 2016 and is now receiving medical attention.

Nigeria isn’t the only area of the world that has regions with limited access. The GPEI has begun an extensive analysis of surveillance in other countries to ensure that the Nigerian “blind spot” isn’t a problem elsewhere. “Boko Haram makes many parts of the area virtually inaccessible. Depending on where Boko Haram is, that can be inclusive of bordering countries,” Pallansch says. “It will take some time to gather information and analyze it properly. But at a first pass it’s not quite as worrying as some may think, except in those areas we already know are problems. In places like South Sudan and parts of the Horn of Africa, the border of Afghanistan and Pakistan, we’re intensifying our efforts.

“In a sense, the situation in Borno is a good comparison to the global situation,” Pallansch says. “Ninety-nine percent of Nigeria is polio-free. But unless you eradicate the disease completely, the rest of the country will remain at risk. The same holds true globally: 99 percent of the world is polio-free. But all countries remain at risk until we finish the job everywhere.”

A surge in vaccinations

Through genetic testing of stool samples taken from the new polio patients, the GPEI traced the poliovirus to a strain that emerged in Chad almost five years ago and circulated through Chad and parts of Nigeria. It had been eliminated from accessible areas, but it turns out that it never left parts of northern Nigeria.

The discovery triggered an increase in vaccinations in other countries that have similarly inaccessible areas. In Nigeria alone, more than 850,000 children were vaccinated in the first five days after the cases were discovered, according to the country’s health minister. And Nigerian border countries coordinated efforts to increase protection of their own polio-free status. 

 The very nature of the GPEI’s system being at once a very large network of worldwide organizations and small groups such as Rotary clubs made up of local residents is what helped the teams respond so quickly to the new information, Pallansch says. “The system itself means there is surge capacity. No one place has to stand on its own. There are always other places within the system that can help,” he says. Because of that, the Polio Eradication Initiative continues on pace – revealing weak points where they may exist and fixing them – but still marching toward that day when polio is gone for good.

After certification, the polio surveillance network is likely to continue providing services. It has already been used to help contain other deadly diseases such as Ebola and measles, and there are ongoing discussions about what the surveillance strategy will be after polio, according to a spokesperson at WHO. The biggest question is how that network can be maintained so that it can go on hunting for other diseases. 

• Erin Biba is a science journalist whose work regularly appears in Newsweek, Scientific American, and BBC.com.

President’s Comment – 14 May 17

Hi All,

It was suggested at the last GoToMeeting that we meet socially on a second date each month. I will initiate a social meeting on Wednesday, 24th May at 7.00pm EST

This is an interesting new concept that we all should look out for on 13th June when it is released.

Rotary uses virtual reality to inspire others 

Rotary is working with Google’s virtual reality team to offer an experience that showcases the impact of compassion to a global audience. 

 

We’re producing a three-minute virtual reality film that emphasizes the two themes of polio and peace, and how Rotary’s work to eradicate the disease is increasing stability across the world. 

Through the power of virtual reality, viewers will follow the extraordinary journey of a child whose world has been torn apart by conflict. The film will immerse viewers in this child’s world, and they’ll experience for themselves the impact that small acts of compassion, protection, and kindness can have on others. 

We’ll premiere the film on 13 June at the Rotary International Convention in Atlanta, Georgia, USA. It will be widely released in time for World Polio Day on 24 October.

This isn’t Rotary’s first experience with virtual reality. With support from the U.S. Fund for UNICEF, Rotary premiered its first virtual reality film, “I Dream of an Empty Ward,” in October 2016. In that film, viewers visit India, which has been polio-free since 2011, to follow Alokita, a young woman paralyzed by the disease as a child.

Traveling through the streets of Delhi, viewers get a close look at life in India and what’s being done to keep the country polio-free. And, through a visit to India’s only polio ward, at St. Stephen’s Hospital, they witness Alokita’s triumphant first steps after 11 years. 

President’s Comment – 7 May 17

Thanks to all who attended our GotoMeeting last weDnesday

I think we all really enjoyed sharing our experiences and travel goals with each other at the completion. Thanks to Secretary Debbie for initiating this. We should make this a regular  item for our agenda.

 

The comments below on Global Grant projects are great advice for our Project Managers considering initiating a grant.

Rotary members share why their global grant projects worked so well – and what other clubs can learn from their experience.

To celebrate its 100th year, The Rotary Foundation is recognizing 20 global grants that are sustainable, align with one of Rotary’s areas of focus and was designed in cooperation with the community to address a real need. The Rotarians who helped bring these projects to life share advice.

Q: What made your global grant project successful?

Carolina Barrios, Rotary Club of Cartagena de Indias, Colombia
The involvement of the Rotary Community Corps of Leticia, Colombia, was essential. The RCC proposed the project, helped select the beneficiaries, coordinated and supervised the construction of the sanitary facilities, and participated actively in promoting the program to everyone in the community, not only the direct beneficiaries. Our partnership with the Universidad San Buenaventura Cartagena, which provided training and donated educational materials, was also vital.

Stephen Baker, Rotary Club of Key Biscayne, Fla.

  • Read about the 20 noteworthy grants

  • Why Rotary is the best steward for your money

Our methods had been tested in a series of smaller anti-malaria mosquito net projects, so that by the time we were ready to do a global grant, we had a clear plan of what we were going to do and how we were going to do it. 

Patrick Biswas, Rotary Club of Padma Rajshahi, Bangladesh
Establishing an effective working relationship with the community based on understanding and trust, and being aware and respectful of social traditions, especially because the project dealt with village women. 

Patrick Coleman, Rotary Club of Luanshya, Zambia
Rotary participation was publicized from the outset. The Rotary name adds integrity to any project.

Philip J. Silvers, District 5500 (Arizona)
First, the commitment and funding from the Ugandan Rotary clubs: Ten clubs adopted rural health care centers, and the district contributed $10,000 in district designated funds and $20,000 in cash. Second, the blended vocational training team, composed of medical professionals from India, Israel, and the United States, anchored by Ugandan health professionals: The host professionals knew the clients and the health care delivery systems, and the international team members were seen as partners rather than as “missionaries.” Finally, our comprehensive and effective monitoring and evaluation.

Vasudha Rajasekar, Rotary Club of Madras East, India
Identifying a nongovernmental organization already well-ensconced at the grassroots level that we could cooperate with; working hard at fundraising; and, as an old and well-networked club that has been doing Foundation grants for more than a decade, having methodical systems and processes already in place.

Rotarian Action Groups are also a good place to start: The connection between Uganda and Arizona was through Rotarians for Family Health & AIDS Prevention, a Rotarian Action Group.

Philip J. Silvers
District 5500 (Arizona)

Q: What are your tips for finding a partner club? 

Stephen Baker, Rotary Club of Key Biscayne, Fla.
There is no substitute for face-to-face contact when it comes to working with Rotarians in other clubs on a big, complicated global grant. 

John Braun, Rotary Club of Austin, Texas
Districts 5170 (California) and 4130 (parts of Mexico and Texas) have a conference each year to present projects from our clubs. It is a great experience for making friends and exchanging ideas. 

Mario Nasard, Rotary Club of Baabda, Lebanon
Past district governors, with their network of fellow governors from the same year, are always helpful. Clubs should ask for their involvement.

Patrick Biswas, Rotary Club of Padma Rajshahi, Bangladesh
Inviting overseas visitors to the club and getting them interested in the community work already being done by local Rotarians can be very useful for finding partners.

Gus Oppermann, Rotary Club of Los Angeles, Calif.
Attend Rotary conventions and project fairs to meet people; nothing beats a face-to-face meeting. Do makeup meetings when you travel. Use Rotary Showcase and Rotary Ideas at Rotary.org to connect with other clubs, explore what they are doing, and find clubs that are looking for a partner for a global grant project. 

Philip J. Silvers, District 5500 (Arizona)
Rotarian Action Groups are also a good place to start: The connection between Uganda and Arizona was through Rotarians for Family Health & AIDS Prevention, a Rotarian Action Group.

Q:  How did you find out what the community needed?

Carolina Barrios, Rotary Club of Cartagena de Indias, Colombia
The RCC of Leticia is our eyes and ears in the community. We also had two university students who carried out a census of the community that included asking about their needs. 

Steven Caine, Rotary Club of Burnt Hills-Ballston Lake, N.Y.
This was the first time that my club and district sponsored a global grant where the beneficiaries were here in the United States. We reviewed Rotary’s suggested list of projects and did a community assessment by contacting local service organizations. The Albany Medical Center’s Cleft-Craniofacial Center initiative needed startup money and was scaled appropriately for a global grant.

Do a pilot project – a small version of what you intend to do for the global grant. This will give you the chance to prove the concept…

Stephen Baker
Rotary Club of Key Biscayne, Fla.  

Philip J. Silvers, District 5500 (Arizona)
The Uganda health care summit in November 2014, which was funded by a district grant, brought together health care practitioners, the Ugandan Ministry of Health, and the U.S. Centers for Disease Control and Prevention to establish priorities for Rotary to pursue in Uganda. 

Q:  What do you wish you had known before you started this project?

Patrick Coleman, Rotary Club of Luanshya, Zambia
As the international sponsor, the initial step was to learn exactly what the “craniofacial and congenital anomalies” included, because little is known about such medical procedures in Zambia. Once this was explained to our members, we saw an enthusiastic partnership develop. We are still learning more about this medical procedure and looking forward to seeing the expansion of this technology to Zambia.

Julio Grazioso, Rotary Club of Guatemala Vista Hermosa, Guatemala
How to make better alliances.

Steven Caine, Rotary Club of Burnt Hills-Ballston Lake, N.Y.
The amount of red tape required to get it done.

Philip J. Silvers, District 5500 (Arizona)
The knowledge of the vocational training team participants was less than we anticipated. Only 37 percent could identify the eight body parts of the female reproductive system from images.

Vasudha Rajasekar, Rotary Club of Madras East, India
The legal framework for vehicles is quite a complicated one in India. The design of the bus and its technical specifications that had to adhere to local laws and also meet medical requirements was easily the biggest challenge. While we were able to surmount it, we could have been better prepared. 

Q:  If you could do it again, what would you do differently? What wouldn’t you change?

Carolina Barrios, Rotary Club of Cartagena de Indias, Colombia
Instead of relying on the community to do the construction, we would have used a contractor to ensure quality and meet deadlines. We were not aware that the community did not have the necessary skills to do the work.

Steven Caine, Rotary Club of Burnt Hills-Ballston Lake, N.Y.
I wouldn’t do anything differently. The effort was worth it – helping establish a valued, sustainable center, which might lead to training teams for partner countries. We picked a great project for a global grant and had great professionals at Albany Medical Center to work with.

Yoshimasa Ishii, Rotary Club of Amagasaki West, Japan
We would like our next vocational training team to have much better Japanese-language skills. We would also extend the training from 45 days to at least three months. 

Gerald Sussman, Rotary Club of Coral Springs-Parkland, Fla.
We would have had a more realistic view of the time necessary to carry out a large-scale project: to do the community assessment, setup, testing, evaluation, correction, implantation, expansion (if required), and phasing out by Rotary as the program is adopted by the government. 

Vasudha Rajasekar, Rotary Club of Madras East, India
I would not change a single thing. It is a pleasure to work with our club members, who are all so focused on service to the community. 

Q:  If you could give one tip for other clubs considering a global grant, what would it be?

Stephen Baker, Rotary Club of Key Biscayne, Fla.
Do a pilot project – a small version of what you intend to do for the global grant. This will give you the chance to prove the concept for the people you want to serve and will allow you to get a clear-eyed view of the other clubs, national and local governments, and NGO partners you might want to work with. 

John Braun, Rotary Club of Austin, Texas
Always get to know your partners at the host club. Projects are time-consuming, so you need committed people to ensure success. 

Julio Grazioso, Rotary Club of Guatemala Vista Hermosa, Guatemala
Having a good collaborating organization is very important, as is good communication among all involved.

Mario Nasard, Rotary Club of Baabda, Lebanon
Host clubs need to be efficient in the project execution and accurate in sharing information with partner clubs so they are assured the project is in good hands. 

Patrick Biswas, Rotary Club of Padma Rajshahi, Bangladesh
International sponsor clubs don’t necessarily have to make large contributions. Their involvement is more important. We always encourage our partner clubs to visit us, and we do everything possible to help with their stay. The experience they take back with them helps us establish continued relationships and collaboration on multiple projects. 

Steven Caine, Rotary Club of Burnt Hills-Ballston Lake, N.Y.
Choose a worthy and compelling project; do a broad-based appeal for funding, on a face-to-face basis; and clearly describe the value of the project.  

Gus Oppermann, Rotary Club of Los Angeles, Calif.
Make sure the needs assessment, with community involvement, is done properly and that the plans to address the need are well-defined. Make sure your project fits clearly into at least one of the six areas of focus, and if it doesn’t, redesign your global grant or consider whether the project should be funded from different sources. 

Patrick Coleman, Rotary Club of Luanshya, Zambia
Ensure that what you want to do is not only needed but wanted by the community. This was a vital component to this success. In our case the Albany Medical Center was ready, willing, and able to participate. Having excellent partners helps to have an excellent outcome.

Philip J. Silvers, District 5500 (Arizona)
Start very early: Processing can take months. If you are doing a vocational training team, consider doing a blended one with local professionals. This is not only a PR move; it can be absolutely critical for the validity and effectiveness of the training.

Q:  Why do you think it’s important for Rotarians to give to The Rotary Foundation?

Philip J. Silvers, District 5500 (Arizona)
We have Rotarian hands, hearts, and minds in the host countries to ensure that our contributions are doing what we intend. Also, we have the Foundation’s Cadre of Technical Advisers to support our clubs in all phases of the grants process and to ensure accountability.

Gus Oppermann, Rotary Club of Los Angeles, Calif.
The answer is simple: We, Rotarians, can’t do the good we do globally unless we give to The Rotary Foundation!

Steven Caine, Rotary Club of Burnt Hills-Ballston Lake, N.Y.
The Rotary Foundation represents the core of what we stand for – helping individuals and communities achieve better living conditions and better futures. When you give to the Foundation you know it is one of the most well-run foundations in existence.  

Patrick Coleman, Rotary Club of Luanshya, Zambia
The synergy of The Rotary Foundation brings Rotarians from around the world together to accomplish more than we can do individually. It is not just about the money. It is about the partnerships.