Sunday, 1 September 2013

Bye-bye Polio

Until Anthony Karaffa died, it had never occurred to me that children could die in real life. Even today, I can still visualise the hearse travelling down West Derby Road from St Michael’s church after his requiem. A child’s death only happened in books, or so I thought at the age of 10. His sister, Ann, was in my primary school class, so the polio epidemic which hit Liverpool in the early 60s had some immediacy. The fact that Anthony was the first child to die in that particular epidemic made him unique on that occasion but, sadly, far from unique in the history of the disease which has had such devastating effects on individuals and families down through the ages.

Those were the days when the emergence of a successful polio vaccine held hope for millions of children and their parents; when the ugly cylindrical contraption known as an ‘iron lung’ kept people alive long after the disease itself had gone, breathing for those whose paralysed lungs could no longer function. It literally made the difference between life and death for thousands of children. Today, by contrast, St Thomas’ Hospital in London has only five of the machines with only one used for its original purpose.

The Australian writer Alan Marshall, in his book I Can Jump Puddles, described his life before and after his own sickness, in those days more often known as infantile paralysis than as polio. "I was the only victim in Turalla, and the people for miles around heard of my illness with a feeling of dread. They associated the word 'Paralysis' with idiocy, and the query 'Have you heard if his mind is affected?' was asked from many a halted buggy". Alan’s father attempted to explain to the local baker just how his son contracted the disease. “They say you breathe the germ in,” he said. “It's just floating about in the air – everywhere. You never know where it is. It must have been just floating past his nose when he breathed in and that was the end of him. He went down like a pole-axed steer. If he'd been breathing out when that germ passed he'd 've been right.”

Thanks to a monumental global effort to eradicate polio, the number of reported cases has fallen from 350,000 in 1988 to 222 in 2012. Today there are just three countries where the disease is still endemic - Pakistan, Afghanistan and Nigeria – which “face a range of challenges such as insecurity, weak health systems and poor sanitation. Polio can spread from these 'endemic' countries to infect children in other countries with less-than-adequate vaccination.”

The world owes a huge debt of gratitude to Rotary International which, in 1985, launched its campaign to vaccinate every child in the world against polio and to consign the disease to history. Enlisting the help of others, they have almost succeeded in achieving a goal which has involved raising many millions of pounds and travelling to the most remote places on earth. In some conflict areas the immunisation of children has been regarded as so important, even to combatants, that the warring factions have declared a temporary ceasefire and allowed safe passage to women and children heading towards some previously agreed central vaccination point.

The anti-polio campaign is not straightforward. As far as humanly possible, a whole country is mobilised in a single day and perhaps a group of neighbouring countries makes one united and simultaneous effort so that children living in border areas are not missed out. In addition to administering the polio vaccine, vitamin A is also given to every child. It is a massive operation.
During my time in Zambia, we catered, not only for the smallest and most isolated villages on land, but also for fishing camps in the vast expanse of the Bangweulu swamps. As the ‘Bye-bye Polio’ day drew near, advance messages would go out, advising women to bring their children to wherever they normally assembled for the Under-5 clinics. Hospital staff would travel out on bicycles, motor bikes, canoes and with the Land Rover which acted as our ambulance. The vaccine came from the District Medical Officer’s headquarters about 40 miles away from our mission hospital, but its timely arrival depended on many factors, the condition of the dirt roads being the least important consideration. Far more significant was whether or not the electricity supply (always precarious) had kept fridges cold and whether or not the vaccines would be delivered on the right day and at approximately the right time. Hundreds of baby-carrying women and toddlers would be walking for many miles in the hot sun: if the vaccines did not come punctually, there was no way of telling them not to come until the following day.

Those women were amazing. Regardless of the distance they had walked and their own tiredness, before presenting themselves with their little ones, the babies were bathed – even in the nearby lake – and dressed in the finest clothes the family could afford. Each baby literally shone, its tiny black curls glistening in the sunshine as each mother proudly showed off her son or daughter to others. The women stood patiently in line, waiting for registration and the few seconds it took to place a few drops of vaccine on the tongue of the (often protesting) baby and then began the long walk home. If ever anybody needed a concrete example of the heroic dedication of a mother, it is supplied by the effectiveness of the ‘Bye-bye Polio’ campaign.

Sadly, one of the possible reasons why polio has not already been eliminated in Pakistan is because of the alleged CIA abuse of the system: a vaccination day was apparently used in order to discover the whereabouts of Osama Bin Laden. Now, rumours that the campaign is accompanied by American spies have severely limited its effectiveness in Pakistan, where the Taliban banned vaccinations in some areas. The UN said in March that some 240,000 children had missed vaccinations since July 2012 in parts of the country's tribal belt, the main sanctuary for Islamic militants. Several health workers have been murdered because, instead of being seen as dedicated health workers trying to eliminate polio, they were regarded as CIA collaborators. In Afghanistan, security risks and the Taliban also limit the effectiveness of the anti-polio campaign. Nigeria? The rumour went around the villages that the vaccination programme was intended to sterilise babies and thereby eliminate Muslims. In areas of high illiteracy, such whispers easily gain importance and spread like wildfire.

13 January 2012 marked the last report of a child in India with polio, whereas, in 2009, there were 741 reports or almost half of the entire global incidence. Hopefully the disease has now been eradicated from India. It has taken time, commitment, energy, generosity, faith and love. If polio could be eliminated, what else might unite the world? In a new era, with a Pope who daily challenges us to care for the ‘little ones’ of this world, could people come together more effectively against hunger or poor drinking water? With polio out of the way, could malnutrition be the next ‘public enemy’ to go? As well as saying, “Bye-bye polio”, might we also say, “Bye-bye hunger”?