Up a windy, steep set of steps, I went; a UNICEF worker behind me and a polio coordinator ahead. I could hear the cry of children growing louder as we got closer. And then I saw her, the resistant parent, holding her child closely, hiding behind a wall and a herd of children, ranging from four to ten years of age—all clamoring for attention.
The UNICEF workers politely introduced me to her. They’d already been here, at least three times before. She was what we referred to as a case of resistance, a parent who was unwilling to let us immunize her child. She worried that he already had polio; one of his legs was a bit limp already, she told us. World Health Organization (WHO) workers had already visited as well to collect a stool sample to see if in fact it was polio. This time she refused to budge. This round we wouldn’t get to immunize the child.
As the UNICEF workers pulled out diagrams in Urdu, picture-based stories in Hindi, and illustrated how polio worked, why it was so important for them to vaccinate, why the leg didn’t appear limp, why it couldn’t be confirmed that he had polio, why they were the “good” guys not “bad” for doing these vaccinations, I quietly slipped away.
The small apartment sat on the third story, sectioned off into cramped rooms that were divided between two families and their countless children. It had a bathroom that was on its balcony, one that connected with the sewage below, an open sewer. The waste gathered at the base. Nearby children played, tossing an old soccer ball around and hopping in and out of chalk boxes in a game of hopscotch.
The polio coordinator stepped aside as well, joining me on the balcony. And he told me that during Ramadan and other religious holidays, blood pours from these sewers when animals are butchered. He was Muslim himself and well-acquainted with the neighborhood. He’d been doing this work for nearly a decade in this small city in Uttar Pradesh. He’d guided me in and out of its streets, exposing the challenges that he faced daily. Both of us, though, were well aware of them, almost immune to them.
“Chale? Aaj kuch nahi hoga yaha.” (Let’s go. Nothing is going to happen today.) One of the young UNICEF workers leaned into the balcony and gently nudged us towards the set of steep steps.
As I came out, I looked up. I could see the bottom of that balcony and something dripped downward, slowly, making its away along the side of the building before it coalesced at the bottom. A few school boys collected around me, asking me to join them in their games.
And I did.
I’d been traveling to India regularly to take part in national immunization rounds for the Global Polio Eradication Initiative. I’d seen these resistant households. I’d seen the mounds of garbage piled next to a butcher, the lady walking barefoot through stagnant water, the children entertaining themselves along these open sewers; I’d smelled the stench of a public maternal ward treating ill newborns. I’d visited the regions that even the locals avoided and many which they’d never heard of. In fact, many of us, traveling from California, ventured into these areas. I did with more frequency and could engage with the locals because I spoke Hindi and understood Urdu.
So, I knew their woes—no clean water, no clean toilet, no money for basic food, infested rations, and medical ailments.
When I asked the local politicians about the poor water situation (which could have been a strong indicator for the severe cases of diarrhea and other abdominal diseases), he told me of all the wells that he’d installed, of the good quality water available in his city, of how he could do little about the stagnant water (that was just the lay of the land—shaped like a valley), and, so, little changed.
In the face of all this adversity, how could one immunize every child and erase the footprint of polio in India?
But that’s exactly what’s so inspiring about this story, what compels me to go back each year, to get even more deeply involved, to come back to the States and rally for this cause. These health workers have eliminated polio from many communities and this April when I returned I found that in the last ten months there had not been a single new case of polio in Uttar Pradesh. The state that had become the hotbed for the virus had not seen a single case leading up to the monsoon months. That was an astounding feat.
That’s when I recall the incredible health workers who keep visiting those resistant homes, who stand at chaotic train stations and check for marked pinkies (an indication that they’ve been vaccinated), who travel to the fringes of the city, exploring areas that few others dare to visit, who create a roadmap for tackling the most challenging neighborhoods, and most of all, who do so year after year.
When I ask them why they do it they speak so humbly of their work.
In April 2011, when I returned to India to take part in another immunization round, I focused my efforts on those who have already been afflicted by the disease. I know that the vaccinations will continue and I know that the health workers will continue to cover these densely populated areas. But what can we do for those who already have polio?
Standing at a platform in Delhi, I noticed a man sitting in a corner, his legs missing. He held out his hand to everyone who passed by, hoping for a few coins. I couldn’t help but think of the polio victims. The most striking image is seeing them on all fours; with their legs gone limp, they walk on their hands, legs trailing behind. As someone who’s been deeply involved in this eradication effort, I couldn’t help but think that we must do something for these individuals as well; their prospect of a job or even education is limited. Many families see them as a burden.
With these thoughts in mind, I found myself at St. Stephen’s Hospital in Delhi where I’d met an ambitious and empathetic doctor earlier, one who performed a little cost-shifting in order to provide free-of-cost surgery to polio patients. He’d also managed to set aside about eight beds and create a small polio ward at the hospital. And after doing this for 20 years, he’s eager to do more. He assured me that he could handle more patients.
In the coming weeks and months I’ll be working on how we can use mobile phones to identify polio patients in the field and connect them to a doctor in Delhi where they can receive treatment. I’m constantly on the search for other creative ideas.
It’s tough for me to imagine that I’d ever be doing such work. Four years ago, I had no knowledge that polio still existed. It was the Rotary Ambassadorial Scholarship that introduced me to this effort that Rotary and the Gates Foundation and its many partners have been doing for twenty years now. For my generation, polio has been largely a forgotten story.
But for many in the endemic countries (of Afghanistan, Pakistan, India, and Nigeria), it’s still a scare. That’s why I applaud the health workers who keep going back and the many Rotarians here in the United States who honor their work by going to the field, seeing it first-hand, and lending their support.
I’m grateful that I got to get a glimpse of this massive effort as it enters its final stage. We may not be able to wipe out the other tangential problems—water, sanitation, diarrhea. But this is certainly a stepping stone. And if polio is eradicated, we’ll be able to tackle other diseases with this incredible infrastructure that’s now been tested and perfected over the last two decades.
That’s a challenge I look forward to.
Esha Chhabra was the 2010 Rotary Ambassadorial Scholar to the London School of Economics where she received her Master’s in Global Politics and Global Civil Society. She’s been an active participant in the Global Polio Eradication Initiative and is interested in how mobile telephony can be used for public health. http://www.polioeradication.org/