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Early on a winter morning, Marta Dodri, a maternity ward nurse, trudged 20 kilometers through a frigid, pre-dawn gravy of dust and fog, crossing a patchwork of rivers and streams in rickety boats to reach Tilkeshwar. During the summer rainy season, when the streams swell to rivers, the swamps to lakes and the fields to mud, the villages become islands reachable only by long boat rides.

She has made the trip every month for five years to vaccinate the children here.

“I’m doing this because I want to get rid of polio. I want to do something good for society,” she said.

Since 2009, the government, which runs this $300-million-a-year campaign with help from the WHO and UNICEF, has shored up efforts to finish off the disease.

It set up satellite offices across the Kosi floodplains, began monitoring every newborn to ensure they get the vaccine repeatedly and strengthened their surveillance so anyone with polio symptoms is swiftly tested.

During immunization drives, vaccinators in yellow vests go to schools, train stations, bus depots and roadside nomadic enclaves. The vaccinators are often female so mothers will trust them with their children. Health workers give zinc and oral rehydration solution to stop diarrhea and help children absorb the vaccine.

When they encounter resistant parents, vaccinators enlist community leaders _ a neighbor, a teacher, an imam _ to persuade them to relent. These efforts cut the number of children missed by each campaign from 14 percent before 2009 to less than 1 percent, said Dr. Ashish Satpathy, a WHO doctor assisting the program in Kosi.

“Nothing has been left to chance,” he said.

When Dodri first started coming to Tilkeshwar, people ignored her. Now, they greet her and rush out to find their children.

“People understand that what we are doing is for them, and they help us, encourage us,” she said.

The village is so poor, the children can’t even find a ball to play cricket with, using an old plastic milk bottle and a stick instead. Half-naked children defecate by the road.

Dodri and her colleague Sanjana Shoba take along a cooler filled with ice packs and vaccine vials delivered by couriers who rode bicycles for hours over pitted trails to arrive here. The women methodically work their way to 60 homes of mud and cow dung.

In a small courtyard, 8-month-old Mousam Kumari is pulled off her mother’s breast and given two quick drops of vaccine as she starts wailing. On a nearby rope bed, 5-month-old Gaurav Kumar sits with his grandmother. Shoba squeezes open his mouth and drops in the vaccine. Gaurav’s brother, 5-year-old Neranjan, wanders in and gets a quick dose. Shoba colors their left pinky nails with an indelible purple marker to keep track of who has received the drops.

Dodri paints the date and a “P” on the house, signaling all the children who live there are protected. She marks another with an “X,” showing some have been missed. A supervisor follows to ensure no houses have been wrongly marked.

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