thestar.com
Rick Westhead
Jul 11, 2009 04:30 AM
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Poverty, malnutrition, poor sanitation create ideal conditions for virus to breed, spread
BIRWAR, India – From the time her daughter was born last summer in this remote village of rice paddies and mud huts, Parmeshwar Paswan made sure her baby was vaccinated by medical teams who arrived each month. Now 14 months old, Abhi Lasha has received the pink-coloured oral polio vaccine as many as 10 times.
It made no difference.
Seven weeks ago, Abhi Lasha contracted polio, the highly contagious crippler of children. In the days since her diagnosis, six more cases surfaced in villages near her home.
Paswan was inconsolable.
"I did what I was supposed to," the 20-year-old mother said, seated in the middle of the village, surrounded by oxen and chickens and children with tattered clothing.
It is confusing for her to understand how her daughter could contract polio after all the efforts made to prevent it. Poliomyelitis, which affects the nervous system and can cause paralysis of the legs, is a disease that has been eradicated in the Western world due to the pioneering efforts of doctors such as Jonas Salk and Albert Sabin, who developed vaccines to defeat it. But in countries such as India, Pakistan, Bangladesh and Nigeria, where poverty still looms large, polio remains a hideous fact of life, particularly for children.
Doctors with the World Health Organization (WHO) say malnutrition probably played a role in Abhi Lasha's case. She may have been so undernourished that the vaccine couldn't be absorbed properly, even after so many courses of treatment.
Yet Abhi Lasha's tragedy illustrates how polio remains a vexing medical conundrum nearly 30 years after the WHO and its partners began a project to rid the world of the disease.
Polio can spread vast distances very quickly thanks to India's elaborate train network. Someone carrying the virus who lives in a ramshackle village like Birwar may go to Mumbai shortly after they have been infected, thereby spreading the disease outside the village.
Eliminating the disease, says Chris Wolff, an American scientist who oversees the WHO's polio eradication program in India, requires health departments in countries where polio remains endemic to be vastly modernized. And that is near impossible in lands suffering food shortages, civil wars and migrations of people.
While India has become an economic powerhouse, it has struggled to meet the basic needs of its 1.1 billion people. Of the 179 countries on the United Nations' human development index – which considers factors such as child mortality and literacy – India ranks 132. Iceland is first and Canada third.
India's government has an enormous challenge trying to get all of its citizens immunized. It has used everything from elephants and camels to rickety boats and bikes to ferry the vaccine to remote regions where temperatures have topped 40C the past three months. The polio serum needs to be kept at a temperature below 8C. Its efforts have not all been in vain: the number of new cases in the country last year was 559, down from 200,000 in the early 1980s.
Nowhere are India's health-care challenges more evident than in Bihar, a state troubled by lawlessness and poverty and a constant victim of famine and flooding. In Bihar's deeply impoverished Saharas district, where Paswan lives with her daughter, the summer heat suffocates and sanitation is dismal. There are brackish open sewers in the district's cities. Barefoot children play in the streets, grabbing balls and waylaid cricket bats from piles of feces.
Since polio is spread through oral-fecal contact, it's hard to imagine a better breeding ground for the virus, which, in Bihar's wet conditions, can survive as long as two months outside the body.
Conditions are even worse in smaller villages where families live under the same roof as their livestock and monsoon flooding remains a constant worry.
On a recent evening as cicadas chirped outside his office, Saharas's chief medical officer Dr. Azad Hind Prasad met with his staff and supervisors from the WHO to discuss the day's immunization efforts.
India's health ministry is administering close to 1.1 billion courses of vaccine this year to 172 million children. In more than half the country, Saharas included, vaccination drives have been held every four to six weeks since the start of 2006. It's a constant, exhaustive struggle to keep pace in a country that's adding 30 million babies a year.
For Prasad, a rake-thin 59-year-old whose white-washed office walls are decorated with a painting of Mahatma Gandhi, the latest vaccination drive has been extraordinarily difficult.
In parts of his district, teams were distributing vaccine that was useless because it had become too warm. In another area, vaccine wasn't being administered to infants, and Prasad didn't know why.
A local ice factory owner was "extorting" one of Prasad's teams, demanding more money for the ice to keep the vaccine chilled.
Topping off the day's concerns were rumblings from the doctors that some Muslim families in the area were refusing to have their children vaccinated for fear it would cause impotence.
Arvind Dabass, one of the dozen doctors assigned by the WHO to oversee the polio eradication effort in Saharas, ran a hand through thinning hair and sighed.
"The fact is, we aren't going to beat this until we address problems like sanitation and nutrition," he said. "They are all too closely linked."
Every year that passes without a conclusive victory over the disease generates more scrutiny of the WHO's polio eradication program. The Indian government alone is spending $325 million a year, and the eradication effort worldwide has ballooned to more than $1 billion annually. Earlier this year, Germany and the United Kingdom, and charities including the Gates Foundation, pledged $740 million toward wiping out polio.
And even as the number of cases worldwide fell last year to 1,652 from 350,000 in 1988, critics argue it's impossible to eradicate the disease – in the same way the world's medical community failed during the 20th century with efforts to wipe out hookworm disease, yellow fever and yaws, a disease that causes painful skin ulcers. Better to simply try to control it, critics say, scheduling regular but less frequent immunization for children worldwide, freeing up money for other pressing causes.
A recent article in the American Journal of Public Health suggests India's district polio eradication teams have become demoralized and everyday health-care concerns are being overshadowed by the large-scale polio vaccination effort.
Wolff, the polio specialist, acknowledges the criticism and worries the world's appetite for attacking the disease may wane.
"Eradicating this disease is a huge idea, on the scale of going to the moon, and as we get closer, it requires more investment, which prompts more criticism that we are spending too much for that final 1 per cent," he says.
Could funding nations and charities pull the plug?
"It's not unfathomable," Wolff said. "There's an executioner's sword hanging over us, but it's been there now for a number of years."
Back in Birwar, Paswan sat with her ailing infant, whose left leg has already lost its muscle tone and definition. Abhi Lasha was in obvious pain and her mother knew she was helpless to ease her child's suffering. For a minute, the vaccination team and onlookers stood quietly. They understood there was nothing more they could do.
A doctor standing nearby broke the silence. "We're racing against the clock now. We can only keep this fight up for so long. It's exhausting everyone."
http://www.thestar.com/world/columnist/article/664485
Rick Westhead
Jul 11, 2009 04:30 AM
---
Poverty, malnutrition, poor sanitation create ideal conditions for virus to breed, spread
BIRWAR, India – From the time her daughter was born last summer in this remote village of rice paddies and mud huts, Parmeshwar Paswan made sure her baby was vaccinated by medical teams who arrived each month. Now 14 months old, Abhi Lasha has received the pink-coloured oral polio vaccine as many as 10 times.
It made no difference.
Seven weeks ago, Abhi Lasha contracted polio, the highly contagious crippler of children. In the days since her diagnosis, six more cases surfaced in villages near her home.
Paswan was inconsolable.
"I did what I was supposed to," the 20-year-old mother said, seated in the middle of the village, surrounded by oxen and chickens and children with tattered clothing.
It is confusing for her to understand how her daughter could contract polio after all the efforts made to prevent it. Poliomyelitis, which affects the nervous system and can cause paralysis of the legs, is a disease that has been eradicated in the Western world due to the pioneering efforts of doctors such as Jonas Salk and Albert Sabin, who developed vaccines to defeat it. But in countries such as India, Pakistan, Bangladesh and Nigeria, where poverty still looms large, polio remains a hideous fact of life, particularly for children.
Doctors with the World Health Organization (WHO) say malnutrition probably played a role in Abhi Lasha's case. She may have been so undernourished that the vaccine couldn't be absorbed properly, even after so many courses of treatment.
Yet Abhi Lasha's tragedy illustrates how polio remains a vexing medical conundrum nearly 30 years after the WHO and its partners began a project to rid the world of the disease.
Polio can spread vast distances very quickly thanks to India's elaborate train network. Someone carrying the virus who lives in a ramshackle village like Birwar may go to Mumbai shortly after they have been infected, thereby spreading the disease outside the village.
Eliminating the disease, says Chris Wolff, an American scientist who oversees the WHO's polio eradication program in India, requires health departments in countries where polio remains endemic to be vastly modernized. And that is near impossible in lands suffering food shortages, civil wars and migrations of people.
While India has become an economic powerhouse, it has struggled to meet the basic needs of its 1.1 billion people. Of the 179 countries on the United Nations' human development index – which considers factors such as child mortality and literacy – India ranks 132. Iceland is first and Canada third.
India's government has an enormous challenge trying to get all of its citizens immunized. It has used everything from elephants and camels to rickety boats and bikes to ferry the vaccine to remote regions where temperatures have topped 40C the past three months. The polio serum needs to be kept at a temperature below 8C. Its efforts have not all been in vain: the number of new cases in the country last year was 559, down from 200,000 in the early 1980s.
Nowhere are India's health-care challenges more evident than in Bihar, a state troubled by lawlessness and poverty and a constant victim of famine and flooding. In Bihar's deeply impoverished Saharas district, where Paswan lives with her daughter, the summer heat suffocates and sanitation is dismal. There are brackish open sewers in the district's cities. Barefoot children play in the streets, grabbing balls and waylaid cricket bats from piles of feces.
Since polio is spread through oral-fecal contact, it's hard to imagine a better breeding ground for the virus, which, in Bihar's wet conditions, can survive as long as two months outside the body.
Conditions are even worse in smaller villages where families live under the same roof as their livestock and monsoon flooding remains a constant worry.
On a recent evening as cicadas chirped outside his office, Saharas's chief medical officer Dr. Azad Hind Prasad met with his staff and supervisors from the WHO to discuss the day's immunization efforts.
India's health ministry is administering close to 1.1 billion courses of vaccine this year to 172 million children. In more than half the country, Saharas included, vaccination drives have been held every four to six weeks since the start of 2006. It's a constant, exhaustive struggle to keep pace in a country that's adding 30 million babies a year.
For Prasad, a rake-thin 59-year-old whose white-washed office walls are decorated with a painting of Mahatma Gandhi, the latest vaccination drive has been extraordinarily difficult.
In parts of his district, teams were distributing vaccine that was useless because it had become too warm. In another area, vaccine wasn't being administered to infants, and Prasad didn't know why.
A local ice factory owner was "extorting" one of Prasad's teams, demanding more money for the ice to keep the vaccine chilled.
Topping off the day's concerns were rumblings from the doctors that some Muslim families in the area were refusing to have their children vaccinated for fear it would cause impotence.
Arvind Dabass, one of the dozen doctors assigned by the WHO to oversee the polio eradication effort in Saharas, ran a hand through thinning hair and sighed.
"The fact is, we aren't going to beat this until we address problems like sanitation and nutrition," he said. "They are all too closely linked."
Every year that passes without a conclusive victory over the disease generates more scrutiny of the WHO's polio eradication program. The Indian government alone is spending $325 million a year, and the eradication effort worldwide has ballooned to more than $1 billion annually. Earlier this year, Germany and the United Kingdom, and charities including the Gates Foundation, pledged $740 million toward wiping out polio.
And even as the number of cases worldwide fell last year to 1,652 from 350,000 in 1988, critics argue it's impossible to eradicate the disease – in the same way the world's medical community failed during the 20th century with efforts to wipe out hookworm disease, yellow fever and yaws, a disease that causes painful skin ulcers. Better to simply try to control it, critics say, scheduling regular but less frequent immunization for children worldwide, freeing up money for other pressing causes.
A recent article in the American Journal of Public Health suggests India's district polio eradication teams have become demoralized and everyday health-care concerns are being overshadowed by the large-scale polio vaccination effort.
Wolff, the polio specialist, acknowledges the criticism and worries the world's appetite for attacking the disease may wane.
"Eradicating this disease is a huge idea, on the scale of going to the moon, and as we get closer, it requires more investment, which prompts more criticism that we are spending too much for that final 1 per cent," he says.
Could funding nations and charities pull the plug?
"It's not unfathomable," Wolff said. "There's an executioner's sword hanging over us, but it's been there now for a number of years."
Back in Birwar, Paswan sat with her ailing infant, whose left leg has already lost its muscle tone and definition. Abhi Lasha was in obvious pain and her mother knew she was helpless to ease her child's suffering. For a minute, the vaccination team and onlookers stood quietly. They understood there was nothing more they could do.
A doctor standing nearby broke the silence. "We're racing against the clock now. We can only keep this fight up for so long. It's exhausting everyone."
http://www.thestar.com/world/columnist/article/664485