On a limb

Just hours from the national capital, the scourge of polio is marking a new resurgence

Every year, the changing landscape of Ghaziabad is testament to the Indian economic boom. More apartment blocks come up; new, shimmering malls emerge out of wasteland and markets with big-retail brands sprout and expand. But the incessant construction also causes a strange distortion – series of high rises dwarf a large network of slums, where the construction labourers arriving from all parts of the Hindi heartland make their temporary abode.

The slums suffer from the wretchedness of slums everywhere – families of five or six live in a space not bigger than a small room, sanitation facilities are absent and nutrition for most kids is inadequate. Yet, only now, the disastrous outcome of this state of affairs is becoming apparent, as Ghaziabad becomes the polio epicentre of the world.

In 2008, Ghaziabad reported just five cases of polio – by the end of 2009 that number had shot up to 72, as Uttar Pradesh alone reported 544 cases of polio. UP’s woes have been the reason why India reported 672 polio cases in 2009, more than any other country. This has come as a shock to the government, health officials and development agencies that have set a 2012 target for the eradication of polio.

Health officials at the MNG Hospital in Ghanta Ghar, Ghaziabad’s old commercial district, believe Ghaziabad’s woes are caused by the rising tide of labourers migrating to the township in search of work. “We have got the highest migratory population, as we are in the National Capital Region,” says Dr A K Dhawan, chief medical officer at MNG Hospital. “The rising construction activities also mean the presence of a large number of slums. The migrant labourers coming from Bihar and Uttar Pradesh keep moving and are hard to track down.”

34-year-old Omkar had moved to a slum in Indirapuram’s Gyan Khand area only seven months ago. Originally a resident of Badayaun in eastern Uttar Pradesh, Omkar, a father of five, is a rickshaw puller in the morning, ferrying kids to school; a lunch delivery man in the afternoon and runs a small kiosk outside his house in the evening. His 3-year-old son Jatin suffered from polio. “It makes one sad to see him not able to walk,” says a dejected Omkar.

No one had come to his house to give his son polio drops; yet, the difficulty in tracking down high-risk groups was only part of the problem. In this slum of more than a thousand inhabitants, there was not a single toilet. Nearly all of them relieved themselves at a nearby drain which separates Indirapuram and Vaishali, making transference easier for this deadly disease which spreads from orofaecal contamination.

What is further weakening the fight against polio are UP’s notoriously poor healthcare facilities – the number of cases in the state have risen from 305 last year to 544 this year. On December 26, a UNICEF study released in Lucknow noted that low levels of routine immunization were not only resulting in the resurgence of diseases like polio, but also easily preventable ones such as diphtheria and whooping cough.

The study noted that immunisation levels in 36 districts of the state were less than 20 percent, while in 39 districts, they were between 20-40 percent; only in five districts, the immunisation levels were higher than 40 percent.  This is in sharp contrast to southern states like Tamil Nadu (92 percent) and Karnataka (84 percent).

Nowhere is the manifestation of this apathy more evident than in Dhaulana, the worst-hit rural district in Ghaziabad, that registered 18 cases last year. “We have camps from time to time, but there is no scheme yet for door-to-door routine immunisation,” said Parveen Begum, an 18-year-old volunteer who works as a WHO agent.

Dhaulana is also home to one of two cases afflicted with the P1 virus, a more severe form of polio as opposed to the P3 virus found in majority of the cases, in Ghaziabad district. Four-year-old Reshma, a P1 victim suffered from a deformed left limb, although contingency measures from agencies had been able to contain the damage. “She was born in our village of Siwal, near Meerut,” Mohd Aquil, her father, said. Aquil informed us that for two years after her birth, before they moved to Dhaulana, Reshma had not received any form of immunization.

Yet, there was hope among agencies in Dhaulana as this Muslim-majority village had not seen the kind of clerical diktats issued against polio vaccination elsewhere, that had added a bizarre twist to the fight against the disease. Parveen Begum, who also taught in a primary school in the village, said, “Each of the three mosques regularly makes announcements, exhorting the villagers to vaccinate their children and cooperate with the agencies in every way.”

This had been a problem in Moradabad, almost 100 kms away from Dhaulana, which has been a traditional epicentre of polio, until Ghaziabad displaced it for this unworthy distinction. But Moradabad still recorded 71 cases, and the intransigence of several families in not receiving vaccinations was the result of rumours that polio drops were part of a larger conspiracy to sterilise their children.

In 2008, there was trouble after Sahafat, Moradabad’s leading Urdu daily, published an article voicing concerns expressed by some religious clerics who alleged conspiracy behind the concerted polio campaign. “The people destroyed our camps in anger,” says Ranpal Singh, a surveillance medical officer with Project Concern International, a non-profit agency that has been working in Moradabad since 1996.

But, health officials and development agencies have increasingly joined hands with clerics to create consensus for the fight against polio. And most clerics, like the city imam Masoom Ali, have played an important and progressive role. Masoom Ali explained how the refusal to receive polio drops was a perverse articulation of anti-Americanism. “The initial boycott was in anger against Bush, who was at the height of his misdemeanours,” he said. “But we made regular announcements in mosques to allay fears and anger and explained the importance of polio drops to people.”

A sustained campaign in the press helped a great deal, as Masoom Ali made regular appeals in local papers asking residents to cooperate with development agencies. Moradabad’s press has been robustly behind efforts to eradicate polio. “We have been supporting the campaign since the very beginning, and are ready to help in any way we can,” said Zakir Ali Baig, a journalist for the Hindi daily Awam-e-Hind.

Yet, Masoom Ali had hinted at something else that was part of the reason why about 300 families in the city were still refusing vaccination. “Some people come to us and say – you’re only focusing on this,” he said. “There are so many other problems, but this intensity is not matched in other areas.”

In Pukhtasarai, a walled neighbourhood with three grand, fort-like entrances, close to 40 per cent of the families had not allowed their kids to be vaccinated. 38-year-old Safdar Azam, who was unusual in owning a computer in this poor neighbourhood, had embraced one aspect of modernity while rejecting another. “I am not opposed to vaccination, but what is the reason behind giving the same drops every time?” he asked.

35-year-old Suleiman Farooqi, a small-time mechanic, had other objections. “If there is no disease, there is no need for medicine,” he opined. “I believe this is a conspiracy for making our kids impotent.” This neighbourhood had been a pocket of resistance against polio vaccination, because of a series of diktats issued by Maulana Naseem Farooqi, the cleric at the local Marhaz mosque. He had finally been persuaded to stop speaking against vaccination in 2005, but the fears raised by him had left an imprint that continued to pose an obstacle.

Meanwhile, health officials and development agencies are putting out all the stops to eradicate polio. The World Health Organisation (WHO) has 7 surveillance medical officers in Moradabad itself as compared to one in most other districts, while UNICEF had 5 district coordinators in the area.

The introduction of a new bivalent oral polio vaccine (bOPV) has provided cause for optimism. The monovalent vaccine that is currently being used attacks the deadlier P1 virus – the result has been the sharp rise in P3 cases. The bOPV will attack both the P1 and P3 viruses. “The bivalent is ideal, as it targets P3 as well,” said Dr Amar Singh, deputy information officer at Moradabad’s district hospital. “It is possible to eradicate polio with monovalent vaccine, but bivalent will make that process much faster.”

As reported in The Indian Express on January 1, the Indian expert advisory group on polio has given its sanction for the use of bOPV in 2010 in UP and Bihar, the two chronic states that once again propelled India to the top of the polio chart with the maximum number of reported cases worldwide.

The eradication of polio in UP and Bihar, with its high population density and poor sanitation, will be not be an easy task. “There are multifactorial elements at play in these areas that are making eradication difficult,” said Dr Neeraj Singh, WHO’s surveillance medical officer. It is clear that polio’s defeat will be as dependent on the socio-economic climate as on a rigorous, ruthless vaccination drive that seeks to banish this monster into the annals of history.

A version of this story appeared in The Indian Express.

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