Polio Eradication, Part 1

January 6, 2007 at 10:15 pm (Sarah's Posts)

My brain is likely to be polio-centric for a bit because of India’s kick to eliminate polio.  Today was a national immunization day (NID), where the goal is to vaccinate the entire population of children under age 5 with a dose of oral polio vaccine (OPV).   Advertisements direct people to booths set up all over the city while teams go out into the community with ice boxes of vaccine to try and get everyone in one swoop.  Mop up teams continue for a few days after.

I was in a car today with a group of six 14-year olds from a local Interact club.  Honestly, they were the best vaccine team that I could have asked for—enthusiastic, smart and mature.  It was interesting to watch how well they inherently understood epidemiology.  They were asking families to identify other possible areas where children stay and making mental maps naturally. 

I’m honestly a bit shocked at how haphazardly the whole day was.  We drove around to construction sites (because migrant workers are thought to mainly be responsible for the spread of polio in India) in an assigned area and asked for kids.  But what about the kids who weren’t around?  Or who were in places inaccessible the SUV that we were in?  (One of the arguments for OPV over the injectable heat-inactivated form is that the live virus in OPV is shed in fecal material, which passively vaccinates anyone who come sin contact with it.  But that only works with people in close proximity to each other, so if a whole community is missed, OPV doesn’t help.) 

There are all sorts of communication barriers.  Migrant workers often don’t speak the local language or Hindi.  Some women told us that they were afraid that the vaccine would harm their children (there is a really small chance that the virus in the vaccine could mutate and they’d be right).  Some Hindus don’t want to take vaccines from Muslims and vice versa. 

All of this makes me think about how much more flexibly things run on the ground than in the WHO handbook.  They didn’t necessarily do a bad job, but it was hardly a textbook tightly-run vaccination machine.  The challenge for the people organizing this sort of program is to not only anticipate challenges but also to train people to be able to address any other obstacles that arise on the ground.  Particularly in the final stages of eradication (where the world purports to be—another discussion), I suppose I expected more rigor and planning.  If this is how things are in Pune, a very accessible and cosmopolitan city, I wonder how things go in the slums in Mumbai.

If I ever complain about corporations and McDonald’s again, someone remind me that McD’s gave us the ice for our cold box because nobody got ice packs.

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3 Comments

  1. msoule said,

    I really hope Lee reads this post and responds because I bet his work with the Clinton Foundation in Pnom Penh highlights similar issues. Tanya Seghal (a friend of mine from Brown) is working in Bhopal and experiencing similar things. Working in situations like the one you’re in requires a lot of flexibility and thinking on one’s toes. It’s one of the reasons that people get frustrated fast and want to fall back on their top-down instincts (i.e. “Just do what I say!” instead of, “What can I do differently?”) It’s hard work you’re doing.

    From my experience in India (however short in the grand scheme of things), it’s partly a lack of infrastructure and partly a lack of communication between parties who ought to be communicating. I have no idea if the communication is better in the global North and whether the communication issues extend to other countries in the global South. I’d be interested to know that. Ideas?

    My bet for causality lies with the bureaucratic structure in India. I do know that the Indian bureaucracy leaves a TON to be desired in terms of cooperation and connectivity and I bet that that’s one of the reasons for the difficulty in coordination. A good bureaucracy acts as a centralizing force and it’s difficult to perform large-scale operations without solid bureaucratic support. Not because it’s important to have local government sanction but because they potentially have access to the breadth of services and contacts that are needed to marshal the resources and people that are needed.

    How did those 14 year olds get hooked up with you??? Sounds like a very interesting initiative…

    And a parting word. Mickey D’s is as much a locally-operated thing as a global, homogenous entity (there are arguments in international relations theory that say that the huge uproar about the destructiveness of McDonalds on local cultures is overblown because they really become unique to the localities they operate in. For instance, Chinese schoolchildren hang out after school at McDonalds and in India, they serve no beef). That is to say, I bet the local allegiances far outweigh any global-monster-corporation culture. And it’s comforting that that’s true.

    I’d be curious to have a second look at the experience a week or so later after you’ve processed it and contextualized it in the rest of your experience there.

  2. misarita said,

    Michael–I’ve thought a lot about the bureaucratic structure here and what it means for the delivery of services throughout India. This place baffles me daily with how much diversity there is. The differences between Kerala (a primarily Christian state with a communist party in power) and Punjab (Sikhs who still have border squabbles with Pakistan) and their needs are so vastly different. You can see that by looking at the inconsistencies in health indicators across the country. Aggregating these statistics hides a lot.

    But, many of the state gov’ts aren’t well equipped/have the resources to truly address the healthcare needs of their state. There is a dearth of data to tease out what needs to be done and a scarcity of public health professionals trained to make it happen. That is changing slowly… but it still isn’t yet on the ground.

    The 14 year olds were a group of Interact students, which is the branch of Rotary International that is geared towards school aged children. Each Interact branch is partnered with a Rotary club, who act as mentors and include the children in community service activities. They were awesome…

  3. msoule said,

    How can we get good numbers from India? And how can we get public health work to happen? This is the problem with bad bureaucracy. How can we enforce good bureaucracy externally? We can’t. Only voters can do that. Or a total restructuring of the culture of corruption and excess in the bureaucracy (something left over from the British Raj and probably even the Mughal era where the chains of bureaucrats were a great place to position oneself to take bribes on the way to the Emperor). So… it’s old. Change will probably be glacial. But it must happen. In my understanding, it’s one of the major roadblocks to successful health work and development in India.

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