Two Pieces of Poo

I imagine that many people in America believe that the disease of polio (a crippling paralytic disease) is a disease that is now only found in history books—like smallpox or the plague. In fact, polio has been eradicated from most western countries for many years now. But despite expensive efforts to do the same across the world, polio has not been eradicated in Africa.

If the world wants to eradicate a disease like polio, then they must invest a lot into doing so. The must vaccinate all children, catch every polio case, and respond quickly to outbreaks. In Ethiopia, for example, where we have not seen a case of polio for a few years, we are still widely distributing vaccines and investigating every possible case of polio.

This is a story about how we became unintentionally and directly involved in the eradication effort. A few weeks ago, a child presented at our health center with something called “acute flaccid paralysis.” While there can be many causes of this, the most concerning is polio. When a health facility suspects polio, emergency response steps must be put in place immediately. Appropriate government agencies must be contacted. Detailed forms must be completed in quintuplicate. And most importantly, two stool samples must be collected from the patient and transported immediately to the capital for analysis.

It just so happened that we were traveling to Addis the next day to bring our friends to the airport. So we loaded up the car with seven ferenjis, lots of luggage, a patient and his father, and two pieces of poo on ice for the national laboratory.

How do the public health folks ensure that this happens? How do they convince health providers, in rural communities, hours away from Addis to hop in a car, or on a bus, with a bag full of poo? Well, the answer, of course, is money.

We were shocked to find that when we arrived in Addis and handed over our two pieces of poo, we were handed, in return, thousands of birr—reimbursement for our travel and diesel, as well as hundreds of extra birr which is given directly to the health-care provider to ensure that they come.

Who knew that poo could be so valuable?