- The Washington Times - Sunday, July 20, 2003

CALCUTTA — Rani Begum lost her faith somewhere in the wretched slums sandwiched between fetid sewage canals on the eastern outskirts of Calcutta.

Despite her poverty, Mrs. Begum had obeyed the constant reminders of local health workers to take her two little girls to the clinic for oral polio vaccine.

But her youngest, 2-year-old Simran, now sits idly on their woven bamboo mattress, her left leg limp after she contracted the crippling disease last year.

“I have no faith in these people anymore. Despite the polio drops, my child was hit with it,” she said.

Such feelings are worrisome for the international campaign to wipe out polio, which would make it the second disease to be eradicated worldwide, after smallpox.

India saw a sharp increase in polio cases last year, indicating a falloff in the number of children getting the vaccine. Health workers blame distrust of the government, official disgruntlement about the program’s cost, and rumors among Muslims that the vaccine can cause infertility.

Health care workers don’t know why Simran contracted polio, but say it is likely that her mother didn’t follow the correct dosage, or that the vaccine had not been potent owing to improper refrigeration or mishandling.

India reported 1,556 new cases of polio last year — 84 percent of all cases worldwide — the World Health Organization (WHO) said.

The figure represents a better scenario than one during the 1980s, when India had as many as 200,000 new cases a year. But this South Asian nation of 1 billion people is one of the world’s last reservoirs of the polio virus, and each new case increases the chance of its spreading elsewhere.

“We are so close, we cannot allow all our success to go to waste,” said Dr. Anubha Ghose, a pediatrician who contracted polio as a child, before a vaccine was available. “This last push is the most difficult, but we have no option but to move forward.”

Dr. Ghose, director of health for the Cooperative for Assistance and Relief Everywhere Inc. in India, said the government has grown weary of the effort to vaccinate all of India’s children against polio, having spent $300 million on the program since 1996. Officials wonder whether the money may be better spent on diseases that kill more children, such as malaria and cholera.

“The bureaucrats who are allocating the money, they cannot say at the end of the day that they saved so many children,” she said. “We can only say to them: It’s our responsibility to the world.”

Indian Health Minister Sushma Swaraj has said India would be free of new polio cases next year, despite the upturn. She blamed the increase in cases partly on “fictitious reporting” in previous years by some field workers competing for lower figures.

Polio typically strikes before age 5. It can cripple the spinal cord, causing paralysis and, in some cases, death. It is transmitted through food or water contaminated by the fecal matter of an infected person.

Though polio has been suppressed in many parts of the world — the last case in the Western Hemisphere was more than a decade ago — children worldwide will be at risk until the last case is gone.

“If you don’t eradicate it everywhere, it can come back, and then you have to start all over again,” said Dr. Jay Wenger, the WHO project manager for the National Polio Surveillance Project in India.

On May 13, the WHO and its partners in the global eradication campaign announced that they would cut back on immunization programs in many countries to concentrate efforts in India and 12 other nations.

Carl Tinstman of the United Nations Children’s Fund said health officials learned a lesson during the past two years when they cut back efforts in India, thinking the virus was well under control.

“It was a misjudgment,” Mr. Tinstman said.

When the worldwide effort began in 1988, with a goal of wiping out polio by 2005, there were 350,000 new polio cases in 125 countries. Last year, 1,866 new cases were reported, and polio was considered endemic in only seven countries: India, Nigeria, Niger, Egypt, Somalia, Afghanistan and Pakistan.

In India’s West Bengal province, around Calcutta, only one new case was reported in 2001. But last year, 48 cases were reported, and in the first four months of this year, 22 more cases occurred in the densely populated state, which borders Bangladesh and Nepal, both polio-free.

“This should be sending off alarm bells,” Dr. Ghose said.

Such alarm doesn’t filter into the slums of Calcutta, where hunger and disappointment drown out any calls for global responsibility.

Mrs. Begum, whose husband is a rickshaw puller, says there is no way she will get the last of the four polio doses for her older daughter, 4-year-old Pinky.

“The more you give the drops, the greater the chance you’ll get polio,” she said.

Across the city, Mohammed Taher, 14, limps through the sprawling slums around the Park Circus railroad station, along the Ganges River. He doesn’t go to school and is on his way to his job in a shoe factory.

Mohammed, whose left leg is badly twisted outward, believes he contracted polio when he was inoculated for measles as a toddler. “I don’t know anything about these polio drops,” he said with a shrug. “Anyway, it’s God’s will.”

His neighbors, brothers Dawood and Mustaq Hussein, 16 and 14, also believe that their contracting polio was dictated by fate. But they feel it’s their duty to prevent it in others.

“We’ve accepted it, and we couldn’t care less,” Mustaq said. “We tell the mothers that they must get the drops or their children will end up like us.”

Many of the new cases of polio have been among Muslims like the Begums, Mohammed and the Hussein bothers. Some in India’s largest minority community fear that the vaccine is part of a government plot to limit the Muslim population in India, which is predominantly Hindu.

“There’s some distrust of the government in general because they don’t get much from the government,” Dr. Wenger said. “And what little they do get, they tend to be suspicious.”

Prabhakar Chatterjee, director of health services for West Bengal, said such tales are hard to quell.

He went house to house on the last national polio immunization day, April 6, encouraging parents to give their youngsters the drops. One Muslim couple with five daughters and one son resisted.

“I finally convinced them to agree to the five girls,” Dr. Chatterjee said. “But not the son. They worried the family name would die out if the boy was sterile.”

More national immunization days are planned this year, and well-known Indian cricket players have pledged to get involved.

Health care workers nationwide also are reaching out more to Muslim schools and mosques, looking to the clerics who wield much influence in their communities.

Hafiz Gulam Mustafa, an Islamic cleric in the slums of Park Circus where 35,000 squatters live in thatched-roofed brick huts lining sweltering dirt alleys, said ignorance spreads disease.

“There have been rumors that the girl child would not be able to have children, but we don’t believe such nonsense,” he said.

During Friday prayers at the Masjid-e-Mohammadi mosque, Mr. Mustafa tells parents to get their children inoculated, and volunteers at the mosque use loudspeakers to remind people of upcoming immunization days.

Dr. Ghose said India will not meet the goal of eradication by 2005. WHO requires that a country go without new cases for three years before it is certified as clear. “If we get certified by 2010, I’ll be happy. But we are nowhere near that last case,” she said.


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