Volunteers Pull Bangladesh Into Campaign to Eradicate Polio

Nasima walks tentatively in a toe-to-heel hobble, clutching a piece of bamboo as thin as her once-paralyzed left leg.

That she walks at all is a testament to her parents’ determination and a nationwide push to finally rid this dirt-poor South Asian country of polio.

“She used to cry because it was so painful,” her father, Shamnul Alam, told several American doctors who came to praise the poor parents for the hours they have spent each day massaging and exercising Nasima’s tiny leg.

“The doctors told us to continue the exercises despite her cries,” Alam explained as Dr. Jeffrey Koplan, director of the U.S. Centers for Disease Control and Prevention, tapped Nasima’s left knee to check her reflexes.

Nasima, 4 1/2, contracted polio last year, not unusual in Bangladesh, one of the world’s last remaining reservoirs for the polio virus.

What is unusual is that she might be one of the last children afflicted with polio in Bangladesh. Not one new case has been reported this year.

Worldwide Risk

Though the last case of polio in the Western Hemisphere was nine years ago, children worldwide remain at risk until the disease is wiped out.

“She sometimes asks why she can’t walk like the other kids,” Alam said, gently bending his daughter’s knee. “But I tell her that she must keep up her exercises and she’ll be just like them one day.”

Nasima likely will grow up to marry a paddy farmer in a village along the monsoon-swept Bay of Bengal. She may one day tell her children how her doctors played a part in eradicating polio from the planet.

The World Health Organization is racing to wipe out polio in the countries where it still thrives. It’s a mammoth campaign that sends volunteer health workers from village to village in search of children to immunize and parents to educate.

The original goal had been to eradicate polio by the end of this first year of the new millennium, but WHO has pushed the target back to 2002.

There’s no question they will succeed; the question now is when polio will become only the second disease, after smallpox, ever to be wiped out.

“There’s going to be hundreds of thousands of children who aren’t paralyzed, who aren’t dead,” Koplan said. “You just can’t beat that.”

Koplan recently spent 10 days touring Bangladesh, taking small planes and canoes and hiking barefoot, jeans rolled up, through monsoon mud to reach village clinics in the hills along the northern border with India and the tropical, wet climes of the Myanmar border to the south.

Koplan’s first assignment with the CDC, as a young “disease detective” with the Epidemic Intelligence Service, was in Bangladesh. He was on the team that shared in the triumph of declaring the world’s last case of smallpox in 1977. That last case was in Bangladesh.

“Look at those rice paddies,” Koplan said as he trudged a spongy trail alongside water buffalo. “I love all that intense green.”

Koplan said not much has changed. One of the world’s most densely populated countries, where nearly 130 million people are crammed into an area about the size of Wisconsin, Bangladesh is still breathtakingly beautiful and painfully poor. Most people live on a dollar a day.

“It still feels like the Bangladesh I left 25 years ago,” he said. “But the children are better educated, and now you see schoolgirls in uniforms with their book bags.”

Some 80,000 health workers and 600,000 volunteers have overcome poverty and political turmoil to bring the number of confirmed polio cases down to 324 last year, an 87% drop since national immunization days began in 1995.

Should the average healthy Western family care, apart from humanitarian concerns?

“Once polio is eradicated from the world, their children will no longer need the polio vaccine,” Koplan said, noting that American parents are still encouraged to have their infants immunized against polio.

As long as the polio virus survives anywhere, the threat of outbreak remains.

The virus mostly targets children younger than 5, causing paralysis, muscle atrophy and death.

Dr. Jonas Salk developed the first polio vaccine in 1955, an injected version made from dead polio virus. Dr. Albert Sabin developed an oral vaccine in 1957 from a live, weakened form of the virus.

Sabin’s vaccine became the accepted one because it was less expensive and easier to distribute. In 1952 there were 58,000 reported cases of polio in the United States and more than 3,000 deaths. By 1991, the last case of polio in the Western Hemisphere was declared in Peru.

The fight against polio and other diseases in poor countries has benefits for industrialized nations, experts say.

“By getting rid of polio, it furthers other things that we’re trying to do,” Koplan said. “It’s in our own economic interest, our own health interest, and it’s in our global development interest.”

An estimated $1.5 billion is still spent worldwide on the effort to administer the polio vaccine. WHO estimates the program needs an additional $1 billion and is facing a shortfall of $300 million.

Since the World Health Assembly in 1988 established the goal of polio eradication by 2000, the number of reported cases each year has dropped from 350,000 to 6,400. The eradication program has been spearheaded by WHO, the CDC, UNICEF and Rotary International.

Polio now is limited to 30 countries in South and Southeast Asia and sub-Saharan Africa, with 10 countries viewed as the worst cases.

Afghanistan, Angola, Congo, Somalia and Sudan are all countries where civil unrest has made it difficult to launch eradication programs and to reach children in need of immunization.

Ethiopia, Nigeria, India, Pakistan and Bangladesh are the last remaining “reservoir” countries, where transmission is easily spread due to packed populations, poor sanitation and hard-to-reach communities.

‘An Unlucky Father’

Bangladeshi doctors who gathered in the northern city of Sylhet to meet Koplan and Dr. David Sniadack, head of WHO’s polio program in Bangladesh since 1996, wondered if there were any recent advances to treat polio.

“I am an unlucky father,” Dr. A.K.M. Hafiz, a surgeon, told the Americans, shaking his head. “Even after giving her the polio vaccine, my daughter contracted polio. Such an unlucky father.”

Sniadack reminded the physicians the polio vaccine is ineffective in 5% to 10% of cases; children may have an inherent resistance to the vaccine, and the vaccine loses its potency if not constantly kept in cold storage.

Much of Bangladesh lacks electricity, so generators fueled by kerosene or gasoline keep the freezers running. On national immunization days, volunteers run up and down hills, across rivers and rice paddies, shouldering ice coolers filled with doses of vaccine.

“I can tell you where every child is in my area,” Dr. Abdul Hamid proudly told Sniadack and Koplan, showing them crude maps on a clinic’s walls indicating where the next round of vaccines must go and where patients with polio-like symptoms are being monitored.

Abdul is one of only two doctors in Gowainghat County, which has a population of 210,500.

“Thank you, thank you. You’re a hero!” Sniadack shouted to Abdul as the Americans jumped on a canoe taking them to the next clinic.

“These are the people who can really motivate the community,” Sniadack told Koplan as they headed up the Sharipian River, greeting startled fishermen along the shore. “I don’t know what we’d do without them.”

WHO also has called on hundreds of physicians from around the world for three-month volunteer rotations in the polio countries to work with local doctors and report any worrisome trends.

Aiding the demise of polio may be the highlight of their careers.

“There’s nothing to compare to it in my lifetime, and to be part of it is such an honor,” said Dr. Calita Richards, a doctor of pharmacy from Emory University who was finishing up a three-month stint in Bangladesh.

Roshanara Begum, a traditional midwife near Garo, where dozens of infants were being vaccinated in a mud-hut clinic on the Indian border, said she’s been encouraging parents to get their infants immunized for years.

She asked if it is true that the polio virus is on its last legs.

“Our children will finally be safe,” Begum said, her smile blackened by years of chewing betel nut. “We know this is our responsibility, not only to the community but also to the other children of the world.”

On the Net:

WHO polio site:

https://www.polioeradication.org

CDC site on polio vaccine:

https://www.cdc.gov/nip/publications/VIS/vis-polio.pdf