Illiteracy Complicates Effort to Erase the Deadly Threat of Polio in Egypt

Mahmoud Fouli, 4, and Noura Shaaban, 11, wear leg braces and walk with difficulty. They have polio, a disease that is under control in much of the world but still a crippler of children in Egypt.

The reason is that many Egyptian mothers in remote villages are not aware that the disease can be prevented with vaccines, or lack knowledge of the dosages their children need.

Efforts are under way, however, to see that all Egyptian children are vaccinated properly.

Learning to Walk

Mahmoud is one of six young male polio victims who regularly visit the Swiss-backed Terre des Hommes Rehabilitation Center for Girls here to learn how to walk.

A sun-drenched building with swings and flowers in its garden, the Assiut branch of the Swiss children’s charity is also the temporary home for Noura and 23 other girls and young women, also polio victims, who are learning skills to give them a measure of financial independence.

Established in 1983, the center is financed jointly by Terre des Hommes’ headquarters in Lausanne and by the Egyptian government, which is to take over full ownership and management by 1989.

The Salk vaccine, developed in 1954, and the orally administered Sabin vaccine of 1960 have been effective weapons in controlling polio. But it remains a threat in Egypt, although national efforts to vaccinate all infants have been stepped up in the last decade and a national index shows a drop from about 2,800 reported cases a year before 1976 to about 300 in 1986.

Immunization Steps

Immunization requires one dose of oral vaccine for children at 2 months of age, another at 4 months and a final one at 6 months. Two other boosters are administered before the child is 3 years old.

Health officials say the major challenge they face is to make uneducated mothers aware of the vaccination program, “to make immunization as natural as feeding and bathing” children, said Farag Kamel, a U.S-educated social scientist.

Most of the children at Terre des Hommes come from rural and isolated communities where health awareness is low. Health officials say there are 3,600 clinics all over the Egyptian countryside.

“We want to teach people the concept of vaccination and why it is important,” said Kamel, explaining his work in designing media messages for development projects.

Complicated, Confusing

Egyptian culture entrusts the mother with safeguarding a child’s health, but to those who are illiterate the triple-dose polio vaccination followed by booster doses is complicated and confusing.

A 1986 survey indicated that 96.7% of mothers in one area had given their children the first dose but that only 83.8% had followed up.

Care More Accessible

State-run Egyptian television regularly airs health messages, often in the form of three-minute vignettes using movie stars, in an effort to change cultural attitudes and make health care more accessible.

A new TV message shows the father of a newborn excitedly telling his wife about the birth certificate the public health office gave him.

“It has the dates for our son’s vaccinations,” he says. She answers despondently that she can’t read. “But I can, and he is my son too,” the husband says.

Kamel said villagers often bring their children for immunization only after government ambulances come around blaring messages through loudspeakers reminding them of vaccination schedules.

“People have become dependent on the government telling them when to go (to a health center),” Kamel said.

One such woman is Sayeda Abdallah, who waited at Terre des Hommes as technicians adjusted the braces of her son Mohammed, 7, stricken when he was 11 months old.

Ambulances Carry Message

Abdallah, who is pregnant, said she is illiterate and knows only by the roving ambulances when each of her five children must be vaccinated. She was unsure when or whether Mohammed took the vaccine drops but said, “He got a fever when he was 11 months old.”

Maintaining vaccine quality is another big problem. It must be kept at between 32 to 46 degrees in a country where temperatures often are in the 90s and where refrigeration often is difficult because of power outages.

“If there is one case of an ineffective vaccine, the whole village loses faith,” said Catherine Courade, a physiotherapist at Terre des Hommes.

“Refrigerators in health centers are now provided with emergency butane gas bottles that a nurse or clerk can easily switch to in case of power failure,” said Dr. Ibrahim Kerdany, a health officer for the United Nations Children’s Fund, which provides the medicine.