Rotarian Chris Offer (right) and Dr. Noha Farag from the CDC visit a traditional healer's hut as part of a polio surveillance team in Sudan. A Rotary poster about paralysis appears in the background.

By Chris Offer, past governor of district 5040 and member of the Rotary Club of Ladner, Canada

I have often asked the question: “How do we truly know there is no polio in a particular country?” In January, I had the opportunity to find out.

I arrived in Khartoum, Sudan, on
17 January as the Rotary representative on an Acute Flaccid Paralysis (AFP) surveillance team. AFP leg and arm paralysis is one of the primary indicators of polio. In countries at risk of polio transmission, an AFP surveillance system helps ensure that a polio outbreak is caught early and stopped quickly. AFP has many causes other than polio, including Guillain-Barré Syndrome, forms of tuberculosis, trauma, hypocalcaemia, and others. However, to avoid missing cases of polio, all children under age 15 with AFP should be tested.

Although its last case of polio was in 2009, Sudan is a difficult place to sustain efficient polio surveillance. Sudan has suffered many years of civil war, tribal strife, and poverty. In July, what was the southern third of Sudan officially became the world’s newest country, South Sudan.

Our team’s task was to find out whether the surveillance system in Sudan is sensitive enough to detect cases of polio. After two days of meetings and security briefings, surveillance team members, which included experts from the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC), travelled to each of Sudan’s 15 states. I went to the state of Kassala, which is near the border with Eritrea, and worked with CDC epidemiologist Dr. Noha Farag.

With a driver and local health worker, Dr. Farag and I set off on an eight-hour drive along course, winding highways. We spent the next five days visiting hospitals, pediatric clinics, vaccination centers, refugee camps, health offices, and traditional healer huts. Records were reviewed, ledgers checked, and staff interviewed. We saw Rotary posters printed in Arabic that explained the symptoms of AFP and the importance of reporting cases in every site we visited.

In Kassala, risk groups include nomads who wander between Libya, Egypt, Eritrea, and Sudan, along with migrant workers, refugees, and isolated tribal groups. Tracking AFP cases in these groups requires an extraordinary effort by the local health workers.
While visiting a refugee hospital near the Eritrea border, I had the opportunity to see a child with AFP being examined. Fortunately, this child’s paralysis was most likely caused by acute diarrhoea and malnutrition, which can lead to a severe loss of potassium. Stool-sample analysis and a 60-day follow-up would be done to rule out polio, but this child will recover.

Overall, I was impressed by the commitment to polio eradication of the local health workers I met. My conclusion after two weeks in Sudan is that that there is a good AFP surveillance system in place there. If a polio case is imported, it will likely be quickly found and isolated.

Rotarians should feel confident that their dollars are well spent and soundly invested in polio eradication in Sudan.