How Kenyan volunteers search for the hidden ways of polio | Story

Samburu County, Kenya – A motorcycle roars, kicking up gray dust in the June heat of northern Kenya.

Eroi Lemarkat runs down the dirt road after reports of a child who has suddenly lost the use of one or both legs. It could be polio. It could be another disease. Either way, he can’t afford to wait.

Each report takes him to rural areas, often hours from the nearest hospital.

Across Africa, the wild polio virus has been eradicated, and Kenya hasn’t recorded a case since 2013. But the vaccine-derived virus can still spread where young children are born, allowing the weakened virus used in the oral polio vaccine to spread and mutate. It poses a threat in under-vaccinated areas, especially in remote and nomadic areas of the country.

To prevent the spread, Kenya relies on two monitoring methods.

Silent hunting

In Nairobi, health officials regularly test wastewater for the presence of the polio virus, often detecting it before anyone develops symptoms.

“The information collected by health volunteers in high-risk districts, such as Turkana and Samburu, allows the ministry to respond quickly with what it needs,” Dr Galm Glelo, who is the Ministry of Health’s national coordinator for polio monitoring, told Al Jazeera.

However, wastewater management has its limitations. It only works where a drainage network exists.

In Kenya’s sparsely populated north, where there are no sewage treatment plants, the search relies on health volunteers.

Instead of waiting for sick children to arrive at hospitals, volunteers investigate reports of acute flaccid paralysis (AFP) and take stool samples to determine whether the polio virus is spreading in areas where medical care is rare.

Run against the clock

For Lemarkat, every investigation starts with a rumor.

The news that a child has suddenly stopped walking or lost an arm or a leg spreads quickly in villages and nomadic communities, passing from neighbors to elders and community leaders long before it reaches health workers.

Lemarkat follows every lead, often traveling for hours to remote families. Before meeting the parents, they first ask for the help of village elders, ruling chiefs or religious leaders to confirm the communities and trust them.

Time is important. Health workers must collect two stool samples within 14 days of the onset of symptoms to detect the virus.

“It’s a race against time. If we arrive late, we may lose the chance to prove whether polio is the cause,” Lemarkat told Al Jazeera.

A missed case allows the spread to continue undetected, especially in areas where children do not reach the hospital.

Successful trust

Monitoring is particularly difficult along the Kenyan-Somalia border, where pastoralist families regularly cross in search of water and grazing land.

“Nomadic herders roam these invisible borders in search of water and pasture,” Dr Emmanuel Okunga, who oversees disease at Kenya’s Ministry of Health, told Al Jazeera. “They don’t even think about the areas that are affected by health.”

Gaining the trust of those communities is often as important as reaching them.

Parents may be wary of outsiders or unfamiliar medical procedures, making it difficult to convince them to allow stool samples to be taken from their children.

Lemarkat has spent over five years building relationships with families across the community and knows how easily that trust can be lost.

He said: “If a volunteer fails to negotiate this respectfully and carefully, the family may simply pack up their shelter and flee into the forest before they make an example.”

“This would leave a problem that could be unmapped and unbounded.”

Containment also depends on cooperation beyond Kenya’s borders.

“Communities on both sides of international borders must work together to ensure that no migrant child slips through unknown cracks,” Dr Pius Mutuku of the Ministry of Health’s Public Health Emergency Operations Center told Al Jazeera.

Last miles

Each report Lemarkat analyzes helps health officials determine whether the polio virus is spreading and respond before it spreads.

For all the laboratory testing, water pollution monitoring and cross-border communication, Kenya’s last push against polio still relies on people willing to follow rumors far away, often in places where roads end and telephones go dead.

At Lemarkat, there is always another report to investigate, another family to visit and another region to reach.

“It’s a lot of work, but it’s worth the effort,” Lemarkat said. “We have to save every child. Children are our future.”