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Tuesday, December 9, 2003
Villagers' fears an obstacle for anti-polio push
WAZIRGANJ, India -- A 12-year-old boy with dark, haunted eyes and withered legs leans on crutches at the doorway, unable to squeeze inside the crowded hut.
Visiting health workers are pleading with parents to get their children immunized against polio. They point to the boy -- a living example of the ravages of the disease.
But it's a tough sell.
"They are still hiding many of the children from us," one of the health workers whispered to Archana Pandey, a UNICEF official serving as the team's translator.
In poor villages like this, ancient remedies are trusted more than modern medicine. Black handprints stamped on doors are supposed to ward off vampires. Over many of the prints are white chalk marks -- notations left by health teams indicating families that have refused the polio vaccine.
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 | Mike Urban / P-I | |
| Health workers descend upon a home in a north India village while all the adults are out and begin vaccinating the children. | ||
"Tell them what we are trying to do is to make sure the village never has any more kids with these problems," Dr. Marzio Babille, UNICEF's health chief in India, told Pandey.
Babille leans forward, hands clasped, silently begging for understanding. A few of the women laugh coyly at the handsome Italian doctor's melodrama.
Moments later, the hopeful mood is shattered. A man in the predominantly Muslim village angrily expresses his distrust of the Hindu-dominated government. The rumor circulating in this community of 6,000, about 100 miles east of Delhi, is that the polio campaign is making children sterile.
The ugly truth is, the campaign has unwittingly undermined India's public health.
With the government focused on polio, routine vaccination efforts have frayed, especially in rural areas lacking rudimentary public health systems. As a result, children have been increasingly exposed to highly preventable diseases. And that means more kids are dying.
Polio has been eliminated from all but seven countries worldwide: India, Egypt, Pakistan, Afghanistan, Nigeria, Niger and Somalia. Nigeria currently has the most cases -- nearly 200 so far this year.
But India typically has the lion's share, having reported a total of more than 1,600 cases last year -- a startling increase over the 268 cases in 2001. That's a huge embarrassment to a nation that considers itself a world power.
The Bill & Melinda Gates Foundation has given $75 million to the global polio-eradication campaign and supported Rotary International's ongoing efforts to make it only the second human disease, after smallpox, ever to be wiped out. In India, Gates is also backing longer-term efforts to improve basic public health services.
To stem the polio epidemic, the Indian government earlier this year sent out more than a million health workers and vaccinated 165 million children -- an impressive achievement.
"We want India to be polio-free," said Dr. Sobhan Sarkar, India's deputy health commissioner and head of immunization.
But Babille said there wouldn't have been an epidemic if the country had been doing an adequate job of providing basic immunizations. The polio vaccine is one of the "routine" six given to children worldwide.
"Because of all the resources devoted to the polio campaign, much of India's routine immunization system has collapsed," the doctor said. "I'm a little pissed off about it."
Dr. Tej Walia, the World Health Organization's top man in India, likened the "polio paradox" to the effect AIDS has had on other Third World health concerns.
"AIDS is just one of many killers," he said. "But the West tends to worry only about the diseases that affect them. Most donors want to give to AIDS more than other diseases."
Polio gets attention because failure is visible -- the boy on crutches. Children who die from measles -- about 800,000 a year worldwide -- just disappear.
Sarkar agreed that India's polio campaign is a stop-gap measure.
"If we can develop a system that regularly delivers these services such as routine vaccinations, we won't need the campaigns," he said. "But you do what you have to do now, with what you have."
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PART ONE:
Becoming parents gave world's richest couple a new mission in life
Life in a Delhi slum: 'We are always in God's hands'
PART TWO:
It takes more than a billionaire's money to make a difference
In India, progress has been stunning
In Cambodia, results have been mixed
A preventable disease shatters ambitions
Every year, birds bring fear -- and danger -- to a village
PART THREE:
Seattle is becoming a new center for global health research
Gates Foundation is creating markets for drug innovators
Health pioneer PATH putting ideas into practice
Gateses inspiring others, counters 'defeatist mentality,' doctor says
Dispensing Hope
Science and health reporter Tom Paulson and photographer Mike Urban previously visited Gates-funded programs in Africa and reported their findings in a P-I series published in 2001.
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