Three-and-a-half-year-old Osman Gani is a bit of a celebrity in Dakshin Krishnanagar village in West Bengal’s Murshidabad district. The villagers, from wizened old men to young boys, recognize the name immediately.
Last year, young Osman was the only confirmed case of polio in all of West Bengal.
But that’s a far cry from the dismal situation five years ago. At that time, the state had 49 confirmed cases. Of these, 30 were from Murshidabad alone. The district, about 250km from Kolkata, is sandwiched between Jharkhand in the west and Bangladesh in the east.
Muslims make up about 60% of the population of the district, which has traditionally been opposed to polio vaccination because of religious myths, say Muslim leaders.
“It’s not halal and is therefore against our religious tenets, ” says Enayat Ali Mondol, a local of Murshidabad. Halal, in Arabic, refers to anything that is permissible under Islam.
But a programme on since 2003, which has enlisted the help of religious leaders and boards, is making some inroads in getting rid of the scourge in West Bengal.
The virus which causes the disease can damage and paralyze muscles. The disease is contagious; it has been virtually eliminated from the West, but is still found in parts of Asia and Africa.
“In April 2003, soon after the 2002 outbreak, we decided to intensify our efforts in Murshidabad, but faced severe resistance in many booths and in some of them, it was difficult to even enter,” says Jude Henriques, programme communications officer at the Kolkata field office of Unicef, and in charge of the social mobilization campaign for polio vaccination in the state. “But in the four rounds we had this year, the average turnout was 80%.”
The success in containing polio in Murshidabad is a mix of the conventional and unorthodox. So while the administration holds meetings and outreach programmes to raise awareness, Unicef has tried to make inroads by piggybacking on community leaders.
For instance, it roped in Qazi Fazalur Rehman, who leads the Id prayers on Kolkata’s Red Road, to promote its work. These prayers draw a large audience, often up to 200,000.
For the last three years, the Qazi’s fervent appeal during the prayers to the community not to shun the polio vaccine appears to have had the desired effect. Another polio vaccine advocate is Siddiqullah Chowdhury, the leader of the Jamaat-e-Ulema-e-Hind in West Bengal.
At the local level, the social mobilization campaign got a leg-up when it managed to enlist the support of the century-old Jangipur Muniriya High Madrassah. The head of the seminary, Anisur Rahman, says, “The opposition to polio vaccination was largely based on ignorance and illiteracy. People with vested interests used religion to rouse the simple village folk.”
The students of the seminary, drawn from Murshidabad district and beyond, fanned out to the catchment areas to spread the word from their well-respected school. “Our boys and girls did not do it for money, unlike the health department personnel. The modest allowance they got was just about enough for their tiffin (snack),” he says.
“We told the villagers that neighbouring Bangladesh is polio-free. So are Muslim countries such as Indonesia, Iran and Iraq,” says Biswas.
The social mobilization campaigners also enlisted the support of the womenfolk of the community by enrolling them as volunteers.
“We had 3,300 booths in the district and 3,100 volunteers. Of these, 98% were Muslim and 98% women,” says Henriques. The women, according to Shah Alam, secretary of Amanat Foundation, one of seven non-governmental organizations (NGOs) closely associated with the campaign, “are often keener than the men to have their children vaccinated”. They have often been at the receiving end of verbal and physical abuse for defying their husbands’ diktat.
Given this backdrop, the decision to arm the women with an official role as volunteers and give them a small allowance has helped their self-esteem. “I got Rs75 for working as a volunteer for three days. I felt important,” says 29-year-old Anjum Ara of Nimtita.
At an institutional level, the Unicef state office entered into agreements with the entities, such as the West Bengal Board of Madrassah Education and the Waqf Board, as well as NGOs such as Amanat. While the madrassah body controls and funds most of the government seminaries in the state, the Waqf Board is vested with the Muslim religious properties. As per the pacts, these bodies receive funds from Unicef to organize workshops, mobilize volunteers and carry out house-to-house activity.
Given the success in bringing down the count in the district from the 2002 high to no cases at all in the three years in between, Osman’s positive result did stir some debate.
While Osman is now healthy and polio-free, the virus was detected in his faeces during a test, even after 17 doses of the vaccine. That stoked a local campaign labelling the vaccine programme ineffective. “Look what happened to Kabir-ul’s son,” says Said-ul of Gazinagar village nearby, adding, “This vaccine is worthless.”
Of the 49 cases in 2002, 47 were Muslims. In 2003, all 28 cases of polio reported in Bengal were from the community. In 2004, there were two cases, one from a Muslim family.
In 2005, there were no cases of polio in the state while in 2006, Osman, who walks normally now, was the only case. This year, till date, there have been no cases of polio in the state.
But the pro-vaccination lobby feels Osman’s case only goes to show what a difference the campaign has made.
“Osman, who is perfectly normal now, could have suffered from self-limiting acute flaccid paralysis (AFP),” says says Dipankar Mukherjee, regional coordinator (east) of the National Polio Surveillance Project (NPSP), a collaboration between the World Health Organization and the Central government.
“It could have been caused by anything, but the vaccination saved him.” AFP is said to happen when any child below 15 suffers from an acute onset of muscle weakness.
However, the campaign to turn around the people of Murshidabad could very well fall victim to its own success.
“As the number of polio cases in West Bengal in general and Murshidabad in particular have come down dramatically, the funds for social mobilization have been slashed by almost half,” says an official at the Unicef state office, who asked not to be identified. ”Last year, we got $1 million for social mobilization, but this year, it has come down to $600,000,” he said.
According to the official, this is woefully inadequate as the social mobilization campaign for each round costs $125,000 and, on an average, eight such rounds are needed in West Bengal. This includes mop-up rounds.
“We can’t put a number on it as it is dependent on several factors such as the number of rounds in neighbouring states, but it has to be a vigorous process,” says Dr Mukherjee.
“We are already scraping the bottom of the barrel. The funds we have won’t go beyond August,” says the Unicef official.
As a result of the funds crunch, says the official, the Unicef state office has been forced to scale down arrangements with many of its allies in the fight against polio. Similarly, financial support to NGOs has been cut. “We are finding it difficult to maintain the same level of activity as before,” says Amanat’s Alam.
“We believe that the funds have been diverted to Uttar Pradesh and Bihar, as they still have a long way to go,” said the Unicef official.
According to the latest NPSP data on the location of polio virus, Uttar Pradesh had 64 cases while Bihar had 17, out of a national total of 90. According to Henriques, while reduction of funds to states which have been successful in combating polio is not unprecedented, the virus has surged back in states where the routine immunization is not 100%.
“In states such as Gujarat, Rajasthan, Haryana and Maharashtra, the immigration of children from endemic states has caused the cases have come up in these states recently,” says Henriques.
The Unicef country office in New Delhi, however, could not be contacted for a response.
“Osman had received 17 doses, yet the polio virus was detected in his system. This shows the wild polio virus is still present in the neighbourhood and we can’t relax our vigilance,” says Mukherjee.
“It would be unreal to think the job is done. Polio immunization is a continuous process. Children are being born, unimmunized children are coming in from across the porous border with Jharkhand.”