A team armed with Polio vaccines travel door to door in India

Polio is still endemic in India but it is almost in remission. That remission is due to a polio vaccination effort jointly operated by the World Health Organization. A team of vaccinators go from house to house, neighborhood to neighborhood to make sure every child receives the vaccine. It is the complete opposite of the Western world where the parents take the children to the doctor for the shot.

From the Pulitzer Center, writer Helen Branswell followed a team of vaccinators on their journey.

In recent years Uttar Pradesh—or UP as it is commonly known—and the neighboring state of Bihar have been the source of all the polioviruses that have crippled children in India. As such, they are considered high risk areas, marked for more frequent vaccination rounds than states where polio appears to have been quelled.

Nearly every month the effort is mounted. An army of vaccinators tries to find every child five and younger. Teams visit each house, shanty and tent on their routes, dripping orange polio vaccine into grimacing mouths. In some homes, they meet parental resistance. To those homes they make repeated calls, trying to work through the fear, dispel the misinformation.

The team marks its progress on house doors in chalk. The markings look like hieroglyphics to the uninformed, but to those on Team Polio, there is much to be learned from the chalk scratchings.

Dr. Suhasini More—her surname rhymes with foray—is the World Health Organization’s polio team leader for the Agra sub-region, into which Firozabad falls. She deciphers the chalk marks on one door across from an open lot where water has pooled and garbage festers.

“T means team number. Team Number 7. X is because maybe one or two or all the children are not vaccinated due to any reason. Maybe he’s not at home. Maybe he’s sick. And this,” says More, pointing to an arrow that punctuates the markings, “is the direction the team in going.”

An X can also mean a parent has refused to let a child be vaccinated. That has traditionally been a problem among some in UP’s sizeable Muslim minority. But More says the number of families that reject vaccine for their children has been declining.

Muslim women vaccinators are meant to help overcome what remains of this resistance. In some cases, a community leader—a person of influence—also trails around with the team, a presence meant to persuade those wary of the vaccine that it’s OK from a religious point of view.
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In 2001, most homes did not have electricity, running water or indoor bathrooms; 63 percent got their water from a communal hand pump, 67 percent lit their houses by kerosene and 68 percent did not have indoor latrines.

Some improvements have occurred over the past five years, but sanitation here is still very poor, Vishwakarma says. That lack of infrastructure helps explain why polio has been so hard to root out here. Polioviruses travel from one person to the next via what’s known as the fecal-oral route. In places where people defecate in the open or dump feces into gutters or drains, there are many ways for polio viruses to leach into water and make their way into the guts of the vulnerable—especially during the monsoon season, which is now underway.