Missing the pulse

 

 

After a recent meeting with state health ministers, the union health minister Anbumani Ramadoss painted a very rosy picture of polio eradication in India. He claimed that by next year “we will have zero cases.” Perhaps, the honourable minister forgot his own statement, delivered a few months ago, in December, when he said that it would take three years to do away with the disease. India could have waited another three years, but then, Ramadoss is not the first health minister who has made such claims – claims that have fallen flat just too many times. Afterall, even after roping in national idols like Amitabh Bachchan and Shahrukh Khan, the contagious strain of polio could not be led to its final rest. It is embarrassing for a country, which in the International arena is being currently dubbed as the fastest growing economy of the world or the next ‘super power’, that it joins the list of Pakistan, Afghanistan and Nigeria – countries where the polio-eradication programme has failed to achieve complete success. It becomes even more embarrassing, and even Ramadoss has acknowledged it, when health advisories are issued by other countries for mandatory polio immunisation of people travelling to and from India. But apart from concerns by the government and international health agencies, what is actually happening on the ground? Muskaan is the youngest of Shamshad’s children. A rickshaw-puller in Aligarh district in Western Uttar Pradesh, Shamshad has not time or affinity to care for his childrens’ health. He leaves it, like everything else, to the ‘most merciful.’ But in Muskaan’s case, God has not shown much mercy. She is among one of the seventeen cases of polio that appeared in the district, last year, and 676 cases that were reported nationwide in 2006. Barely eighteen months old, Muskaan can never walk like a normal girl. When the health workers were doing rounds of their area, Muskaan’s parents hid her away.They believed in the rumours doing rounds that the polio drops could make children impotent or infertile. As a result, Muskaan missed several rounds of polio drops, paying price for her parents’ ignorance. “Our people did not leave any house untraced, but then, you cannot really force parents to get their children immunised,” says Dr. Balkishan, District Immunisation Officer, Aligarh. A doctor working with the World Health Organisation (WHO), who declined to be named, revealed that as many as 750 houses in Aligarh alone have been categorised as ‘resistant.’ Most of these belong to the Muslim community. Actually, there were reports of a fatwa being issued against polio drops, after which people from the Muslim community resisted attempts to get their children immunised against the disease. A health official, monitoring the immunisation programme told TSI that out of 32 Block Mobilization Coordinators (BMCs), only 7 were Muslims. “A Hindu worker finds it difficult to convince an illiterate, poor Muslim mother; only a Muslim can do it,” said the official. Then there is a real problem of follow-up. A Community Mobilization Coordinator (CMC) told TSI that when they don’t find a child at home, they report it to their superiors. “It is the duty of the senior officers to visit the house in the following days, but most of the times, it is only done on paper,” says the CMC. A single child left out of the immunisation ring means that the polio virus can raise its ugly head. But is this problem only restricted to peoples’ ignorance? The polio virus is active in India, mainly in Uttar Pradesh and Bihar. The virus spreads through faeces, and it is no secret that in these parts of the country, millions of people live in abject poverty, without basic health and sanitation facilities. These areas lack supply of clean water, and there is no sewage system. As a result, the virus spreads easily. “It is very easy to blame Muslims for their reluctance. But has anybody paid attention to the appalling conditions they are living in?” asks Zameerulla, MLA from Aligarh. Zameerulla is right. Mahfooz Nagar locality in Aligarh is worse than a slum. There are no drinking-water facilties and the area has an open sewage system. So it’s not only Muslim children who have been affected with polio. 1.5-year-old Sonu, the sixth child of Harpal Singh, is stuck by polio. His father claims that he had been taking his polio drops regularly. This particular case has shaken his faith, and of many others, in pulse polio programme.

In Bihar, three-year-old Sachin has been stuck with polio. But his family members are yet to come to terms with this reality. “A sudden fever gripped him and he began to behave abnormally. We rushed him to a doctor who said that it was polio. We were startled as Sachin had been taking polio drops regularly,” says Sachin’s maternal uncle, Ashutosh. In Rohtas district, the grand-daughter of a noted pediatrician and the district in-charge of WHO’s

polio-eradication programme was found to be infected with polio. A health official, on the condition of anonymity, said that in several pockets, the pulse polio campaign is non-existent. Another problem with the polio vaccine is that it has to be preserved at an optimum temperature of 18-20°C. But TSI found that at several places, these vaccines were kept at room temperature. A vaccinator working at a medical centre in Arrah district said that officials don’t run generators in order to save money that should have been otherwise spent on diesel. The vaccine is transported in trucks with open roof, and transporters have to dump it in cold storage of sub-depots in the block. From here, ice packs are carried by local vaccinators and these are sent to vaccination booths. The Anganwari staff is given three rupees per ice pack for freezing but in some cases they pocket it. It is imperative to use the vaccine within 30 days of coming out of the cold storage. But these guidelines are not being followed. “The health workers have to face all kinds of people when they go on a door-to-door campaign. What do they get? A mere 600-700 rupees per month. Do you think that is enough,” a health official told TSI in Moradabad, Uttar Pradesh.

Statistics suggests that more than 56% of the children between the age group of 1 to 5 years are still out of the ambit of this campaign. More than 60% of the children belonging to the majority community in Bihar and nearly similar percentage of children in the polio-prone western UP are outside its reach. State Minister for Health, Palbana Lakshmi, accepts that people are skeptical of taking their children to community health centre. Nevertheless, she clarifies that nearly half a million ‘Asha Workers’ have been pitched in to carry out the awareness campaign.

The question is: even after spending billions (Central government spent 70 Billion rupees, while the World Bank spent another 17 Billion between 1998 to 2008), why has the campaign gone awry? Palbana Lakshmi says that controlling polio would only be possible if state governments participate enthusiastically in the campaign. Meanwhile, Japan, who had been doing its bit for the programme is slowly pulling out of the campaign because of dismal results. Now even the World Bank has reduced the aid, agreeing to bear only 10 percent of the total expenditure. So is it the end of the problems for the polio-eradication programme? Looking at the events, it seems that it is only the beginning. “Method employed for adulteration Method emploed for x x x x x xadution”

Dr. Harshvardhan. Former Health Minister, Delhi Recipient of many international awards on Pulse Polio Program

Why after so many years of rigorous program we are still facing new cases of polio?

We were on the verge of eradicating polio but it suddenly came back. It has some basic problems such as the program is lacking that killer instinct which is needed to root it out. Then proper monitoring is not there at ground level.

Means there are some loop holes on the part of government also?

I will not a make a political statement, but yes, some where something is missing. I feel there is a need of more and intense consideration which is not there.

You are one of those who initiated the program in the country. How much money we have spent till date? Was it worth while?

Oh...it’s in millions. But you can not say that it is wasted. We have saved so much by avoiding thousands of polio cases. Polio cases require much more money that pulse polio program.

Will we ever be able to root it out?

Definitely. It will surely be the second disease after small pox to be completely eradicated?

How long will it take?

I think another couple of years.

Vivek Asri