Soma Basu
MADURAI, May 21 2006 (IPS) – Subhadra Santosham, a retired schoolteacher, was about to turn in for a siesta when she noticed a gang of school children entering her yard. Thinking they were probably trying to solicit money for a cause, she was all ready to shoo them off, when one of them asked: Isn t your granddaughter visiting from Chennai?
Every day, Santosham reads the newspaper and watches TV too. But she had entirely missed the daily ads and TV spots urging people to make sure that all children under five are immunised on May 21, she admitted. She would most likely have missed taking her four-year-old granddaughter to the polio booth between 9am to 4pm.
India s nation-wide 12-year-old Pulse Polio Immunisation (PPI) campaign has enlisted everyone from iconic Bollywood actor Amitabh Bachchan to schoolchildren in Madurai, the second largest city in southern Tamil Nadu state after the capital Chennai, to canvass support.
Health officials countrywide are not taking chances. No slip-ups seems to be the official mantra for what the government hopes will be the final phase of the polio eradication campaign. Nearly 15 percent of India s over a billion population -an estimated 160 million children below the age of five -will be targeted to orally receive the polio vaccine on the day dubbed as Polio Ravivar (Polio Sunday in Hindi) .
India has been trying to attain polio-free status, shifting the deadline from 2000 to 2005. Now, officials are chasing a 2010 deadline, but that too may be elusive. Already 26 polio cases have been reported this year, but this is a great improvement on the position in 1994 when 4,791 polio cases were reported, despite availability of the vaccine.
What has brought about the dramatic change is the government-led campaign which has stepped up surveillance, intensified door-to-door surveys, enlisted special teams to track down nomadic groups, floating population, tourists and visitors with children below five in transit. Tens of thousands of government health workers and volunteers set up mobile and fixed booths to ensure that not a single child is left out on the designated immunisation day.
We have been ordered to ensure there is no laxity in administering the drops and to take every precaution against resurgence of polio, confirmed deputy director of health services in Madurai, S. Shanmuga Sundaram, who is also the chief polio officer of Madurai district.
While this district capital, an ancient temple town to which pilgrims throng round the year, has remained polio-free for several years now, neighbouring Tiruchirapalli and Tirunelveli districts have reported three cases over the last two years. The last polio case in Chennai was reported in 2003. Sixty six cases were reported countrywide in 2005.
Overall, Tamil Nadu state has made impressive strides in immunising its children against the disease spread by the poliomyelitis virus, but it has to achieve zero-polio status. The highly contagious polio virus thrives in insanitary conditions, affecting poor communities more often than the rich.
India, Nigeria, Pakistan, Niger, Afghanistan and Egypt are the only countries, which remain to eradicate the disease. To be declared polio-free by the World Health Organisation (WHO), a country must establish that no new cases have been reported for five successive years.
In India, the problem areas continue to be the two northern states of Uttar Pradesh and Bihar where the Type 1 virus survives in pockets. The single case in Tamil Nadu last year had been traced to Moradabad district in Uttar Pradesh. Last year, newspapers reported that wild polio cases in Angola were traced to India.
It is not unique for the poliomyelitis virus to get transmitted from people in transition. We have a highly advanced genetic and molecular epidemiology facility in Mumbai Endemic Diseases Research Laboratory that can track the origin and route of travel of polio virus. This helps in identifying the problem areas, pointed out Prof NK Arora of the paediatrics department in New Delhi s All-India Institute of Medical Sciences.
Arora, who has been a key member of a national investigation team appointed to assess the campaign in 2000 and 2003, believes that more polio-free areas have emerged in south India than in the north since 2000. Uttar Pradesh and Bihar continue to pose a greater challenge even today with its pool of unprotected children, he said.
According to the doctor, this could be because the involvement of state government machineries and local participants is very fragile .
Dr Kalyana Sundar is the director of public health and preventive medicine in Chennai. She has assessed the programme s performance in different states, and concluded that variations in the quality of the service, and coordination between different organizations, failure to reach remote and inaccessible areas and a sense of fatigue and complacency among the workers are probably some of the reasons for India s failing to meet the deadline.
Arora and Sundaram back her evaluation.
Arora blamed an element of distrust and suspicion, and lack of awareness and information among parents and people about the importance of polio drive . Socio-cultural and communication barriers have introduced constraints in the service delivery, he said.. New-born babies and children in transit are missed by the health workers. Even children of daily-wagers, who leave early in the morning for work.
Sundaram pinned responsibility for the campaign s success and failure on health workers. From his experience there are dedicated and trained health workers who knock on every door and ensure that no child is left out. Then there are those who simply go lane-visiting and miss children because not all respond to their shouts. Some use pressure tactics that only scares away parents and children who hide or run away.
In addition, socio-cultural obstacles have hobbled the programme. Some Muslim-dominated communities have been slow to respond because of rumours encouraged by conservative clerics that the PPI was a covert government programme to implement family planning methods and restrict the Muslim population.
However, with more supporters than detractors, the polio immunisation campaign is a movement in India that will succeed, eventually.
