KANO, Nigeria - Children with lifeless legs roll themselves up to intersections on wooden dollies, begging motorists for spare change. A workshop makes and sells dozens of colorful tricycles with hand cranks instead of foot pedals.
But even in a place where the ravages of polio are so visible, parents such as Binta Sani, 18, have repeatedly refused to allow their children to be protected against the disease.
Twice health workers came to her home, asking to place drops of polio vaccine on the tongue of her 2-year-old daughter, Hasfat. Twice Sani refused, saying she had heard that the vaccine causes sterility. On their third try last week, she finally relented, but only after a man she knew and trusted persuaded her that no harm would come to Hasfat.
"My neighbor convinced me that it was safe," Sani said, waiting inside her house while the man carried the screaming child out to receive the drops. "He has lived here for years. He would never do anything to hurt my child."
Household by household, Nigerian health officials are making slow but steady headway against the misinformation and mistrust that for two years have sabotaged efforts to eradicate polio here. The crippling disease, wiped out years ago in much of the world, is spreading swiftly through Africa, and this ancient Muslim city in northern Nigeria is at the epicenter of the epidemic.
Over the past several months, a barrage of radio and television messages from doctors, clerics and politicians has begun to overcome popular rumors - fueled in part by rising anti-Americanism - that the imported vaccine contains anti-fertility drugs or the virus that causes AIDS.
As a result, officials said, the number of children being vaccinated is rising, and the number of rejections by fearful parents is dwindling. In July, a first round of immunizations reached 56 percent of the children younger than five in Kano. In September, a second round reached 65 percent. Last month, a third round reached 81 percent - close to the level needed to prevent the disease from taking root in a community. Each child needs three or four doses of vaccine to be fully protected.
With the rate of vaccinations rising so swiftly, global health officials are now predicting that polio will be eradicated by 2005 or 2006.
"We need only one or two years, and we'll finish it," said Abdulwahab Al-Anesi, a Yemeni physician from the World Health Organization who recently took over the vaccination program here.
Not long ago, public hostility in this bustling but traditional city had brought the anti-polio campaign to a virtual halt. On the streets, children hurled stones at teams of high school girls hired to deliver the vaccine and chanted, "Don't take it! It's not a remedy. It's a disease."
The job, for which the students are paid $3 a day, amounted to hazardous duty. "There were so many stones thrown at us, and the kids were booing," recalled Mariya Nafi'u, 17. She rolled up her right sleeve to show a scar where a rock had gashed her. "Some of us didn't have the courage to go out."
Kano, a dusty metropolis with a distinct Arab flavor, is fertile ground for the spread of polio. The virus is spread via feces, especially in dense, dirty residential areas, and it can lead to paralysis and even death. Vaccines eliminated the disease from the developed world in the 1970s, but in 1988 there were still 350,000 cases in 125 poorer countries.
A massive international campaign ensued, and by 2003, the virus remained endemic in just six countries: Nigeria, Niger, Egypt, India, Pakistan and Afghanistan. Efforts were getting underway to immunize children across Nigeria when politics intervened.
The U.S. invasion of Iraq exacerbated hostility toward the United States among Muslims in the region, where women cover all but their faces in public, T-shirts of Osama bin Laden are popular and the dominant source of news is al-Jazeera, the Arab satellite television network. Religious leaders and even doctors began questioning the safety of the U.S.-promoted vaccine.
Sadiq Sulaiman Wali, a medical school professor, said people saw images of children in Iraq being killed by American bombs. "To them, it looked very contradictory," he said.
Opponents also questioned the intense focus on polio when other health problems, including cholera and meningitis, were also taking a high toll. When tests revealed that the vaccine contained trace amounts of the hormones used in birth control pills, opposition grew fiercer, and the state government suspended vaccinations last year.
The hiatus allowed the epidemic to spread. So far this year, there have been 682 cases of polio reported in Nigeria, up from 355 the year before. In Kano alone, there have been 159 cases, up from 89.
The program was revived in July, after officials visited vaccine factories in Indonesia, which is largely Muslim. The new approach stressed Islamic values as well as health benefits, and Al-Anesi, an observant Muslim, brought both urgency and sensitivity to the flagging effort. Young single women were hired to deliver the vaccines since, unlike Muslim men, they may enter homes and meet women who are neither relatives nor family friends.
Al-Anesi said he cited passages from the Koran that showed Muslims had a duty to support immunization programs. He changed his attire to a long white robe and traditional cap, declining the green smock worn by vaccination workers elsewhere, after Muslims expressed suspicion of an emblem on the smocks denoting the U.S. Agency for International Development.
He also tried logic. "Why are people getting sick from something that can be defeated so easily?" he demanded. "It is just two drops!"
Despite significant recent progress in the eradication campaign, some still harbor suspicion about the imported vaccine.
Three weeks ago, a baby girl in Kano named Fatima Hassan came down with fever. By the third day, she couldn't move her legs. Health officials are listing the case as suspected polio, though tests have not been completed.
Yet the girl's father, an English teacher, insists that the government was right to suspend the immunization campaign that could have protected his daughter. "I was really suspicious of the vaccine," said Hassan Danjuma, 40. "I wouldn't have allowed them (to vaccinate her) if they had come."
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