Pakistan’s ongoing war against polio

In the killing fields of Pakistan’s northwestern region where 175 polio workers, including nine policemen, have been killed by the  Pakistan Taliban, the dogged resolve of Pakistani Rotarians, led by its National PolioPlus Chair Aziz Memon, and supported by the Nawaz Sharif government, came through at the various polio sessions held at the Chennai Institute.

Earlier, in an interview to Rotary News, Memon said that Rotary’s persistent and aggressive approach to eradicate polio from Pakistan has been “a double-edged sword. When we pushed the top politicians, the bureaucracy woke up, worked hard and full security was provided to polio workers.”

But simultaneously “the Taliban also got energised because their funda is to oppose anything the Government does. But if we don’t make this high profile, we don’t get results.”

The encouraging thing, said Aziz, is that recently after four polio workers were killed by the Taliban, “and we went to Quetta to offer condolence to the families, they came forward to offer more polio volunteers. With every killing our resolve to eradicate polio becomes stronger.”

Memon said the earlier misinformation by the Taliban that polio vaccines disturb fertility and the workers are “American agents” has been blown “because the last $275 million for polio campaign came from the Islamic Development Bank and the UAE Government is openly funding the Khyber Pakhtunkhwa (KPK) polio vaccination.

Endangering his life

Introducing Memon at the Institute session on polio, PRIP Kalyan Banerjee paid a tribute to the relentless work he has done when he said, “sometimes he even takes risks and puts his own life in danger. The Pakistan army has told him there are certain areas in Karachi he should not be going to because the Taliban is very active there.”

Memon told the Institute participants that Banerjee had travelled to Pakistan one day after the recent Wagah blast in which 60 people were killed. “He called and said ‘I am being asked not to travel, what should I do.’ I said, ‘you come, we’ll take care of you.’ The ground reality is different from what the media reports and misreports. Our battle against polio has become a geo-political battle, we spend more time with the ministries of Defence and Interior (Home) and less with that of Health.”

Today Pakistan has 268 polio cases, of which 168 are from the FATA (Federally Administered Tribal Areas) “where war is going on and where the Pakistani Constitution doesn’t run. Polio vaccination was banned here for four years after the killing of Osama bin Laden. The army went in there in June but some parts are still with the Taliban.” About 3,80,000 children were trapped in these areas and couldn’t get a single shot of OPV for 3-4 years. The virus broke out here and when the affected children were driven out, they became potential virus carriers. Almost all the affected children are Pashtun.

There are 168 cases in FATA and 60 in the adjoining KPK, and Sindh and Balochistan have cases from migrants who travel from around Pakistan, taking the virus with them. Even Karachi has 22-24 cases. But Punjab, the largest province with 68 percent of people, has only three cases and even those are Pashtun children.

While the reservoir of FATA throws up polio infections, “Prime Minister Sharif and the Army are helping us and we are taking full advantage of the low transmission season and immunising children,” he added.

Memon added that 25-26 polio cases are reported out of Sindh and but for two cases, the rest are from Karachi because “one third of Karachi is with the Taliban. They have their hub here and in one small area there are 16 cases. Earlier we used to go there, clean the place, and run schools, but today we cannot even enter that area.”

Pakistan is one of the three countries in the world where polio exists; but the other two — Afghanistan and Nigeria — have barely 14-18 and 7-8 cases respectively. Ironically, once upon a time Pakistan got the virus from Afghanistan, today it is the opposite.

India’s success

Addressing the polio session, INPPC Chair Deepak Kapur recalled how when Rotary set about to eradicate polio from India, “they said it was a midsummer night’s dream, an impossible quest, and many of us believed them.”

He admitted that on occasions he too harboured doubts. “But there was always Raja Saboo pushing me forward, Kalyan Banerjee saying shun pessimism, Sushil Gupta coming up with new initiatives, Ashok Mahajan interacting with the Muslim Ulemas, Yash Das who kept pushing me towards enthusiasm.”

And “Uncle Google” came up with inspiring quotes from celebrities such as Nelson Mandela who said ‘it always seems impossible until it is done’ and Superman Christopher Rees and super boxer Mohammed Ali who said ‘impossible was just a big word thrown around by small men who find it easy to live in the world they’ve been given than to explore the power to change it.’

“Indeed the dream of yesterday is the hope of today and the reality of tomorrow. And when on March 27, 2014 India was declared polio-free, years of your relentless efforts, tons of sweat and tears of mothers and the support of partners like UNICEF, and film stars, cricketers, the media, paid off.”

But, cautioned Kapur, even though India had been declared polio-free, “as Saboo keeps saying there is no room for complacency. Success breeds complacency and complacency breeds failure. At one time or another India has exported the polio virus to every continent and there is no reason why it can’t come back the same route. So we need an emergency preparedness plan in place and ensure that in case the virus returns there is no local circulation.”

Routine and supplementary immunisation levels also have to be kept high; “we have to ensure Rotary continues to work as before.”

Rotary Spirit

The Rotary spirit came to the fore and it was touching to see Kapur comforting Memon when he said, “Our friends from Pakistan can take heart from the India experience. It was widely believed that India would be the last country in the world to do it.” Large numbers, density, lack of water, sanitation, malnourishment, endemic diseases…. these are the factors that create a fertile ground for the polio virus to survive.

Reeling off statistics Kapur said that against India’s 1.2 billion, Pakistan had only 187 million; its density of population was 236 against India’s 421; 15.3 million don’t have access to safe drinking water in Pakistan against 91.5 million in India. “But one crucial difference is that in India at no time in the history of the campaign was a polio worker killed. And yet, if India can do it, so can Pakistan with people like Aziz willing to put their lives on the line.”

Pak government’s resolve

Ayesha Raza Farooq, Pakistan Prime Minister’s focal person on Polio and Member of the National Assembly (akin to a Lok Sabha MP in India), lauded Rotary for “touching millions of lives across the world with compassion and portraying the indomitable spirit of the human mind, transcending borders, cultures and religions.”

She recalled that she was present when in March, 11 nations of the world were declared polio-free including India … a total of 1.8 billion people. “I said it then and say it again that your triumph against polio reflects the victory of hope, perseverance and improvisation. We have all learnt a lot from the Indian experiences. Polio paralyses lives, traumatises families and communities. Pakistan embarked on this journey in 1994 and there were times during these two decades when we were so close to stopping transmission … yet too far.”

But, she assured the gathering, the swinging fortune of this programme “has done little to dampen our spirits and with partners like Rotary and the unflinching support of our leadership, our march towards our goal will gain momentum. Polio has been eliminated from 90 percent of Pakistan; the security dimension rooted in geo-politics remains Pakistan’s last battle.”

Ayesha Raza added that the supreme sacrifice rendered by polio workers and the resolve of the entire nation to fight against ignorance that allows a child to become a victim of such a horrendous disease will ensure the defeat of the polio virus. “Our armed forces have launched decisive operation in FATA where polio teams were either banned or denied entry … we will defeat the forces of darkness who oppose either the education of girls or polio vaccination,” she said.

As the Institute Convenor and RID P T Prabhakar welcomed the Pakistani delegates and lauded them for their spirited fight against polio, the Pakistan MNA said to thunderous applause: “Thank you Chennai, thank you Rotary, for housing us with warmth and for the opportunity to be part of this wonderful conference of the most amazing people who have, through their ideas and actions, made a real difference.”

Later, answering a question she said the Pakistan government gave a financial package of Rs 2 million to families of the killed polio workers and a job to a relative of the deceased. Memon added that RI had announced USD 2,200 to each polio victim’s family and a fundraiser is being organised on January 31 towards an Endowment Fund for the affected families.

Mobile clinics for Nigeria

PRIP Rajendra K Saboo recalled his experiences in Nigeria where for long years he has been involved in conducting polio corrective surgery camps. At the last polio meeting the WHO representative said that it is time the Indian prime minister got in touch with the Pakistan PM for polio eradication. But such direct dialogues do not happen for several reasons. So the idea came “why don’t we take it up at the SAARC summit. We tried but it was too late to put it on the agenda. So on behalf of Rotary we wrote a letter to PM Modi and Foreign Affairs Minister Sushma Swaraj and believe it or not, six days later, Modi announced in Myanmar that he was going to take up polio eradication at the SAARC summit.”

We will defeat the forces of darkness opposing education of girls and polio vaccination.
Ayesha Farooq

Now the Nigerian Government wants health camps without much publicity about polio immunisation, and has asked for three mobile clinics to carry doctors, paramedics, diagnostic tools and medicines. “I talked to AKS members J B Kamdar and Sajjan Goenka for Rs 12 lakh each and collected more money for not three but four vans, after getting a discount from Tata Motors for the chasis of the vans.” (What Saboo did not disclose at the session was that he has personally donated Rs 12 lakh to make up the shortfall.)

Next came the rigmarole associated with shipping. This was overcome by involving TRF, and now the donation will be made and the vans acquired directly through the auto major’s Nigerian agency.

“After hearing this, the Australian High Commissioner in Nigeria said ‘I’ll give $50,000, get us a discount too,’ so I am working on that!”

TRF Trustee Sushil Gupta said Pakistan was a unique case. “At one time it was being said that India would be the toughest nut to crack. But now Pakistan is proving to be that tough nut! But no nation can remain polio-free till the world is polio-free.”

PRIP Kalyan Banerjee said the fight against polio in Pakistan is a huge challenge that no other country has. “And that they are continuing the work despite such huge challenges is also remarkable. We’ve also seen that the commitment of the people becomes stronger when the workers get shot.