[D9640general] [eFlash_Rotary] Digest Number 569

[Garry & Anne Krischock]

There is 1 message in this issue.

Topics in this digest:

   1.  1162:  New York Times highlights Rotary's work in the battle to eradicate Polio    
         From: "Sunil K Zachariah" sunilkzach at yahoo.co.uk

________________________________________________________________________
________________________________________________________________________

Message 1 
    From: "Sunil K Zachariah" sunilkzach at yahoo.co.uk
    Date: Thu May 18, 2006 6:05am(PDT) 
Subject: 1162:  New York Times highlights Rotary's work in the battle to eradicate Polio

Rumor, fear, and fatigue hinder final push to end polio 

By Celia W. Dugger and Donald G. McNeil Jr; Celia W. Dugger reported 
from India for this article, and Donald G. McNeil Jr. from Nigeria
New York Times 
20 March 2006 

Note: This 20 March 2006 article, reprinted with permission from the 
New York Times, highlights Rotary's work in the battle to eradicate 
polio. Go to the PolioPlus section to learn more about Rotary's role 
in Global Polio Eradication Initiative. 


BAREILLY, India — The cry went up the moment the polio vaccination 
team was spotted — ''Hide your children!'' 

Some families slammed doors on the two volunteers going house to 
house with polio drops in this teeming city's decrepit maze of 
lanes, saying that they feared the vaccine would sicken or sterilize 
their children, or simply that they were fed up with the long drive 
to eradicate polio. 

''We have a lot of other problems, and you don't care about those,'' 
shouted one woman from behind a locked door. ''All you have is 
drops. My children get other diseases, and we don't get help.'' 

Nearly 18 years ago, in what they described as a ''gift from the 
20th century to the 21st,'' public health officials and volunteers 
around the world committed themselves to eliminating polio from the 
planet by the year 2000. 

Since then, some two billion children have been vaccinated, cutting 
incidence of the disease more than 99 percent and saving some five 
million from paralysis or death, the World Health Organization 
estimates. 

But six years past the deadline, even optimists warn that total 
eradication is far from assured. The drive against polio threatens 
to become a costly display of all that can conspire against even the 
most ambitious efforts to eliminate a disease: cultural suspicions, 
logistical nightmares, competition for resources from many other 
afflictions, and simple exhaustion. So monumental is the challenge, 
in fact, that only one disease has ever been eradicated — smallpox. 
As the polio campaign has shown, even the miracle of discovering a 
vaccine is not enough. 

Not least among the obstacles is that many poor countries that 
eliminated polio have let their vaccination efforts slide, making 
the immunity covering much of the world extremely fragile, polio 
experts warn. They compare it to a vast, tinder-dry forest: if even 
one tree is still burning, a single cinder can drift downwind and 
start a fire virtually anywhere. 

Here in northern India the embers are still glowing. And northern 
Nigeria, another densely populated, desperately poor region, is 
aflame. 

In a calamitous setback in mid-2003, Nigeria's northern states 
halted the vaccination campaign for a year after rumors swept the 
region that the vaccine contained the AIDS virus or was part of a 
Western plot to sterilize Muslim girls. Within a couple of years, 18 
once polio-free countries have had outbreaks traceable to Nigeria. 
Though most have since been tamed, Indonesia and Nigeria itself 
remain major worries. In 2001, there were fewer than 500 confirmed 
cases of polio paralysis in the world. Last year, the number jumped 
to more than 1,900 — and each paralyzed child means another 
200 ''silent carriers'' spreading the disease. 

This year in addition to India and Nigeria, cases have been reported 
in Somalia, Niger, Afghanistan, Bangladesh and Indonesia. 

Yet no eradication effort against any disease has been as well 
financed or as comprehensive as the polio drive, which has cost $4 
billion so far. In the balance is not just whether polio will be 
extinguished, many public health officials say, but whether a world 
that could not quite conquer polio will have the stomach to try to 
wipe out other diseases, like measles. The closer a disease is to 
eradication, they say, the harder won the gains. Interest lags as 
the number of cases falls. Fatigue sets in among volunteers, donors 
and average people. Yet even one unvaccinated child can allow a new 
pocket of the disease to bloom. 

Here and elsewhere, eradicating polio means finding ways to get 
polio drops into the mouths of every child under 5 — over and over. 
Because it can take many doses to effectively immunize a child in 
parts of the world where the disease circulates intensely, 
eradication requires repeated sweeps. Campaigns are planned to the 
smallest detail. Each lane is mapped. Supervisors shadow vaccination 
teams. Follow-up specialists pursue resistant families. ''Here, 
polio eradication has been going on for 10 years, and that's too 
long,'' said David C. Bassett, 63, an old smallpox hand sent to 
India by the World Health Organization to help with polio. ''The 
public's sick of it. The workers are sick of it. The government's 
sick of it. We're close now. We need to mobilize resources. The 
donors aren't going to keep putting up money for this forever.'' 

Nigeria 's Agony 

Aminu Ahmed's legs are so withered he must lean on something just to 
sit up in the cement courtyard of his home in Kano, in northern 
Nigeria. He ''walks'' by swinging his hips in an arc on his six-inch 
hand crutches. 

But Mr. Ahmed, 45, is a natural leader. He is the president of the 
Kano State Polio Victims Association, which owns the welding shop 
where he builds hand-cranked tricycles for other polio victims. He 
coached Kano's handicapped soccer team to three national 
championships. And he owns a home. It may be at the end of a slum 
alley, where drinking water is sold in cans and the sewers are 
shallow ditches, but he earned enough to pay healthy men to build 
it. 

His wife, Hadiza, whom he met at the polio association, has given 
him six children. The youngest, Omar, 2, was born shortly before 
Kano's conservative Muslim government stopped its polio 
vaccinations. Today, like his father before him, he drags himself 
across the cement courtyard. The joints of his spindly legs are 
covered with calluses. 

He has polio, too. 

''This is why we enlighten people to give their children the 
vaccine,'' Mr. Ahmed said, explaining why he went on local radio 
programs to ask for an end to the vaccination moratorium. ''Because 
we don't want people to be cripples like us.'' 

The collapse of Nigeria's drive has become a lesson in the ways 
eradication campaigns can go terribly awry. '' Nigeria is clearly 
far and away the greatest risk to the eradication effort,'' said Dr. 
Stephen L. Cochi, a senior adviser in the federal Centers for 
Disease Control and Prevention's immunization program. The quality 
of its campaigns is the worst in Africa, he said. ''They're just 
missing lots and lots of kids.'' 

Nigeria's president, Olusegun Obasanjo, who is from the Christian, 
Yoruba-speaking south, has apologized for his country's role in 
reigniting the disease, but officials in the Muslim north are 
defensive. Asked last year whether he had been right to stop the 
vaccinations, Kano's governor, Ibrahim Shekarau, cut off an 
interview. ''We're not saying it didn't spread, and we're not saying 
people didn't suffer,'' he said. ''But I had a moral responsibility 
to our population to stop it until it was clear there was no harm.'' 

His health minister, Dr. Sanda Mohammed, also refused to discuss the 
subject, even sending word into his waiting room that he was out of 
the city, while aides admitted he was behind a locked door. But in a 
brief conversation on his cellphone, he insisted that the decision 
was right because Kano residents had become so suspicious of 
government health workers that they were refusing all 
vaccinations. ''It would have been a bigger disaster if we had 
vaccinated people at gunpoint,'' Dr. Mohammed said. 

As is often the case with rumors, they appeared based on distortions 
of fact amplified by an alarmist media and by politicians and 
clerics absorbed in a religiously divisive presidential election 
campaign. 

A controversial 1999 book, ''The River,'' helped raise doubts. Its 
thesis was that the source of human AIDS was an experimental polio 
vaccine used in the Belgian Congo in the 1950's that had been grown 
on a medium of chimpanzee cells containing a monkey virus that is 
considered the precursor of AIDS. Most AIDS experts reject the 
theory. The author of the book, Edward Hooper, has never suggested 
that modern polio vaccines contain any AIDS virus, but confused 
Nigerian journalists raised the possibility that they did. Then 
scientists from a Nigerian university claimed they had found 
estrogen in the polio vaccine. Estrogen is the main ingredient in 
birth control pills, and in Africa any talk of birth control is 
highly controversial. Inflammatory speakers equate it with genocide 
by whites or by ruling tribes trying to eliminate lesser ones. 

Some vaccines are grown in calf serum, and experts say it is 
possible that tiny, harmless amounts of estrogen were found, but at 
levels that are far lower than in, say, breast milk. 

With such rumors circulating during the hotly contested 2003 
elections, in which a Muslim candidate lost to Mr. Obasanjo, ''The 
situation got hijacked,'' said Dr. Barbara G. Reynolds, deputy chief 
of the Nigerian office of Unicef. ''People who had multiple agendas 
ran with it.'' 

Most vocal was a wealthy Kano doctor who was both head of a campaign 
to impose Islamic law in northern Nigeria and a candidate for a top 
job in the national health department. After being denied the post, 
he turned against the polio drive, calling the vaccine ''tainted by 
evildoers from America.'' Governor Shekarau's spokesman publicly 
speculated that the vaccine was '' America's revenge for Sept. 11.'' 

With residents turning vaccinators away and the threat of riots 
growing, Mr. Shekarau — a well-educated rival to southern 
politicians — decided to halt vaccinations until local doctors could 
test the vaccine. That took 10 months. Hearings were held, and teams 
visited vaccine factories in Indonesia, India and South Africa. 
Medical and religious experts from Saudi Arabia flew in to meet 
local clerics. Finally, the case was made that the vaccine was safe. 

In October 2004, at a kickoff of a new round of vaccinations of 80 
million children, Mr. Shekarau allowed Mr. Obasanjo personally to 
give his 1-year-old daughter, Zainab, the drops — a picture that 
became famous in Nigeria. The emir of Kano, who rarely lets himself 
be seen in public, allowed himself to be photographed vaccinating 
children. But by then, the virus was on the loose. 

New Drive, Old Obstacles 

Now that official opposition to Nigeria's eradication drive has 
melted, it is facing its old obstacles, like those in India: Scotch-
tape logistics and pockets of resistance. 

At 7 a.m. on the first day of a vaccination drive last year, the 
dirt courtyard of the public clinic in Kano looked like the deck of 
the world's most bedraggled aircraft carrier. Smashed-up minibus 
taxis, many with their front ends crumpled and doors held closed by 
rope, were waiting to take off. Like F-18's, each had a name painted 
on: Titanic, Dollars, Thank You Daddy. 

By 8 a.m., after some near misses with the wobbly benches in the 
courtyard, most of the minibuses had left, bearing vaccinators on 
their rounds. But problems were quick to arise. The chief of a 
nearby district was unhappy that each of his teams got $23 to hire 
transportation for the day. Last time, he said, the money had gone 
directly to him, and he had made the arrangements. That was changed, 
a World Health Organization official said privately, because half 
the money was pocketed. 

The vaccine must be kept chilled from the time it leaves the factory 
until it reaches a child's mouth, and the clinic's freezers looked 
as battered as the taxis. The day was already hot, and World Health 
Organization officials worried that the ice packs keeping the 
vaccines cold were not fully frozen. A big problem, one confided, 
was clinic officials ''who take the money we give them to buy big 
freezers, and then buy refrigerators to keep their cold drinks in.'' 

Finding enough women for the teams proved particularly tough. Only 
women can enter a Nigerian Muslim household if the husband is away, 
and women with children are better at persuading other mothers to 
vaccinate. But many men refused to let their wives leave home, and 
either wanted the jobs, which pay about $3 a day, for themselves, or 
sent their young daughters. 

As a result, teenage girls could be seen leaving with empty boxes, 
not understanding that they were supposed to carry ice packs and 40 
doses of vaccine. Others carried tally sheets that they could not 
fill out because they could not read. 

''We wanted to remove males completely from the teams, but we 
realized it would create too much antagonism,'' said Dr. Ahmed Bello 
Sulaiman, a World Health Organization coordinator in rural 
Kano. ''For the program to work, we need each local government 
involved. But many local politicians want to give the jobs to people 
who helped them get elected — and those are mostly men.'' 

Some families tricked the teams, erasing the chalk marks on their 
doorways showing that they had not cooperated, or blackening their 
children's thumbs with the same ink that the vaccinators had used 
and falsely claiming that they had been immunized. 

Still, the government seemed determined to succeed. At the 
campaign's command center in the capital, Abuja, the officer in 
charge of the vaccine ''cold chain'' — keeping it chilled from the 
time it arrives in Nigeria — knew exactly which district leader in a 
remote part of Kano was considered a ''joker'' by his peers and 
arranged for his removal and the shipping of two new freezers. 

Sometimes the new determination was a bit excessive. The chief 
prosecutor of Katsina, another northern Nigerian state, announced he 
would jail for a year any parents who refused drops for their 
children. 

India 's Uphill Campaign 

While Nigeria struggles to restart its campaign, India, whose need 
is such that it uses more than half the world's two billion polio 
vaccine doses each year, has long made an extraordinary commitment 
to wipe out polio. Teams like the one that faced scorn in squalid 
warrens of Bareilly have made repeated sweeps in the state of Uttar 
Pradesh, home to 180 million people, which Dr. Cochi of the Centers 
for Disease Control describes as ''historically the center of the 
universe for the polio virus.'' 

Nowhere are the prospects for conquering polio more intimidating. 
Living conditions are so dense, public health services so awful, 
summer heat so sweltering, and open sewers and monsoon floods so 
common that a more perfect breeding ground could hardly be conjured. 

The state, populous enough to make it the world's sixth-largest 
nation, has endured more than two dozen campaigns in recent years. 
In 2004, teams went door to door eight times. They came eight more 
times last year. Each round requires almost every health worker to 
join in for at least a week or two, local managers say, and each 
time vaccinators must try to get the polio drops into the mouths of 
50 million children. 

International leaders of the global drive were hopeful last year 
that the country would finish off the disease — but it still 
registered 66 cases. That was the lowest tally ever, but not zero. 
And so this year, India must repeat its consuming effort yet again, 
with special focus on Uttar Pradesh and other regions still trying 
to extinguish the last cases. Resistance has persisted where 
services are weakest and distrust of public officials deepest. 

''Please open up,'' pleaded one polio volunteer, Firoza Rafiq, 
outside the locked door in Bareilly during a drive last year. ''We 
won't force you.'' The woman inside first shouted through a crack 
that she had no children, though a little girl had just scampered 
in. Challenged, she changed her story and complained that she was 
sick and tired of the polio drive. Mrs. Rafiq, a Muslim, and her 
team partner, Parvati Devi Rajput, a Hindu, chalked an X on the 
door, marking it for someone to come back later and try again. 

Polio spreads through oral-fecal contact: children can get it by 
drinking well water tainted by sewage, or simply by picking up a 
ball that rolled through a gutter choking with human waste. In warm 
or tropical climates, many similar viruses can attach to the same 
receptors in the intestine as the polio virus does, making it even 
harder to immunize a child. It can take up to 10 vaccine doses, 
spaced months apart. 

With great anticipation, India and other countries began trying a 
new eradication strategy last year, using a ''monovalent'' vaccine 
that focuses only on the most common strain of polio, but gives 
immunity in fewer doses. The old vaccine attacked three strains of 
the virus, two of them less common. ''The great hope was that 
monovalent vaccine would be the magic bullet and melt all polio 
cases away, but that hasn't happened,'' Dr. Cochi said. 

While the new vaccine has brought India closer than ever to 
eradication, resistance to the vaccine has persisted in some areas. 

Here in Bareilly, the two-woman team was bolstered by a new, more 
senior volunteer, Mohammad Ejaz Anjum, the vice principal of an 
Islamic school. Mr. Anjum, his eyes obscured by sunglasses, was not 
from the neighborhood, but was a Muslim and spoke with authority. 

''We've come from God,'' he announced as he stepped into the small, 
cluttered home of Navir Ahmed, a bottle scavenger. ''You should give 
the children drops. The government only wants good for you.'' 

Mr. Ahmed snapped back, ''If you give drops for one disease, you 
create others.'' 

''Polio is the kind of disease with no treatment,'' the vice 
principal replied. 

The two continued talking past each other until Mr. Ahmed ordered 
Mr. Anjum out: ''You people keep coming. I don't like it. Go!'' 

As the team walked on, a growing band of children with dusty hair 
and ragged clothes trailed behind them, the patter of bare feet 
echoing in the narrow lanes. At the back of the pack was Sajana, 9, 
a forlorn shadow of a girl with a bedraggled ponytail, her withered 
leg and jerky limp a reminder of the virus that lurked in the muck. 

Big Money, but Also Skepticism 

The world has donated billions of dollars for polio eradication. 
Japan and Great Britain have given more than $250 million, and 
Canada, the Netherlands, the European Commission and the World Bank 
each have given more than $100 million. Far and away the biggest 
donors have been the United States and Rotary International, which 
initiated the ''gift to the 21st century'' idea. Each has given more 
than $500 million. 

But as the polio campaign has dragged on, the voices of skeptics 
have grown louder. Dr. Donald A. Henderson, renowned for leading the 
successful war on smallpox, and currently a professor of medicine 
and public health at the University of Pittsburgh, said he believed 
the polio campaign was all but doomed. He suspects that the official 
caseload figures on www.polioeradication.org are incomplete and that 
the World Health Organization may not actually know every pocket of 
virus in the world. 

But even if it does, and even if all the world's polio cases can be 
wiped out, he argued, problems that are now being nearly ignored in 
the all-out effort to corral the last few cases will suddenly loom 
large. For example, as a precaution, vaccination must be continued 
for many years after the last case is found, polio experts agree. 
(Nearly every American child is still immunized — albeit with a 
killed vaccine given by injection — even though polio was virtually 
wiped out in the United States in the 1960's.) 

But in about one in three million doses, the live oral vaccine used 
in poor countries can mutate back into a wild-type virus that can 
infect and paralyze victims. They are used, however, because they 
give better immunity than the killed vaccine and are easier to 
administer. 

A tiny number of healthy people with a rare immune-system defect can 
keep excreting polio virus for decades — creating a reservoir that 
could, theoretically, cause a new outbreak many years in the future. 
(That is what happened in an unusual case last year in an Amish 
community in Minnesota where some had refused vaccinations.) 

Dr. David L. Heymann, of the World Health Organization, acknowledged 
the concerns, but said the problems were not insurmountable. For 
example, the use of oral vaccine could be discontinued after 
eradication to avoid its mutation into a wild form, he said. 

Through the years — as experts have sparred over strategy — 
thousands of Rotary volunteers have never lost faith in the prize of 
eradication. And they have spread their fervor into the American 
heartland. Dave Groner, a funeral home director from Dowagiac, 
Mich., and his wife, Barbara, a retired schoolteacher, have led 
seven teams of volunteers to India and Nigeria to help out in 
vaccination campaigns. On a recent trip to India, a hog farmer, a 
psychologist, married real estate brokers and a retired obstetrician 
were among those who went along. 

Ann Lee Hussey, an animal medical technician from Maine who had 
polio as a child, got down on the floor with one little girl, and 
compared their deformed feet. 

''The girl ran her hand on Ann's foot and scars and all the other 
kids scooted up,'' Mr. Groner recalled. ''No one snapped photos. 
Everyone swallowed their Adam's apple.'' 

Thousands of such volunteers have offered testimonials at club 
meetings back home and constitute an extraordinary grass-roots 
network of fund-raisers. When $93,000 was needed for balloons, 
whistles and other materials for an immunization campaign in the 
north Indian state of Bihar, Mr. Groner sent an urgent e-mail plea. 
In 72 hours, he had pledges for $115,000. 

'A Load on My Heart' 

Success is tantalizingly close in India, but still too late for 
those like Amitkumar whose daily torments are a testament to polio's 
cruelty. A brainy, square-jawed 15-year-old, he has been paralyzed 
from the waist down since he was a year-old baby whose plump, sturdy 
legs steadily wasted away. 

At 11:30 one morning at the Amar Jyoti School in New Delhi, the bell 
rang for recess and rambunctious children — both able-bodied and 
disabled — went out to play. Amit, on crutches, swung his shrunken 
legs at high speed, using his broad chest and shoulders to propel 
himself. He balanced on legs of skin and bones, held stiff and 
straight by heavy braces. 

He has since childhood suffered the taunts of ''cripple,'' and 
toughened himself to play cricket with neighborhood children. He 
positioned himself smack in the middle of the field this day. As a 
ball flew by, he lifted his powerful hand, big as a catcher's mitt, 
to pluck it from the air. 

That afternoon, his father, Jaganath, a genial railway worker with a 
big belly, picked him up at the bus stop on a rusty old bicycle. The 
son rode sidesaddle, his legs dangling over the back wheel. Mr. 
Jaganath confided that he was never at peace because of his eldest 
son's suffering. Some years back, he and his wife stood outside the 
hospital door while attendants straightened their boy's twisted legs 
using brute force. They listened to his screams of agony. 

''I feel a load on my heart,'' Mr. Jaganath said. Amit's mother, 
Arti Devi, confessed, ''It's a torture for me every day to watch 
him.'' 

Once home from school, Amit shed his painfully tight braces, lifting 
his legs, lifeless as sausages, and stuffed them into a pair of 
pants. His four younger brothers and sisters treat him with awe and 
a measure of fear. He is a stern big brother who insists that his 
siblings study hard, as he does. He is one of the best students in 
the slum. 

''I want to become a doctor,'' he said fiercely. ''I want to 
eradicate polio so that no other child faces the problems that I 
do.'' 

The Disease 

Polio, famous for withering limbs, is caused by the poliomyelitis 
virus. 

There were 1,936 cases in 2005. 

While most victims experience only minor flu symptoms, in 1 of 200 
cases, the virus attacks the brain and spinal cord, causing 
paralysis or death. 

On the Brink 

Articles in this series will deal with five diseases — polio, guinea 
worm, measles, blinding trachoma and lymphatic filariasis — that are 
extinct in the developed world but stubbornly persistent in some 
poor nations. As the diseases hover on the brink of eradication, 
doctors and scientists face daunting obstacles as they struggle to 
finish the job. The articles will be online, along with a primer on 
the five diseases and video interviews with Celia W. Dugger and 
Donald G. McNeil Jr.: nytimes.com/health. 

Source: R I Website
Courtesy:eFlash_Rotary

________________________________________________________________________
________________________________________________________________________

_______________________eFlash is an electronic newsflash on Rotary edited by PDG Sunil K Zachariah, D 3200, India.

Kindly feel free to disseminate the information in eFlash_Rotary to any Rotarian or Rotary Club. Kindly acknowledge eFlash_Rotary while forwarding such information. Rotarian or Rotary Club. Kindly acknowledge eFlash_Rotary while forwarding such information.  

------------------------------------------------------------------------
-------------- next part --------------
An HTML attachment was scrubbed...
URL: http://rotary9640.org/pipermail/d9640general_rotary9640.org/attachments/20060519/e66c2d1f/attachment-0001.htm