Tuesday, August 30, 2011

Where Measles dare

Sugata M

When I entered the village, I felt something unusual. I could not find the children flocking and chasing me. There were few of them here and there but not keen to show the kind of attention generally showered on me in the villagers as a stranger.
The village looked surprisingly calm, hardly anyone seen outside their cottages. I could hardly hear the cries of the toddlers from their nests. The women were equally keeping quiet as if they forgot to take charge of their unruly children. I could mostly hear the chirping of some birds as if they were celebrating the silence of the villagers.
I choose the third cottage to trigger off my usual monitoring business. I checked the house marking and date first and then entered the small courtyard in front of the original cottage. An old man sat on the edge of the cottage veranda. He gave me rather ignoring look and even didn’t try to know why I sneaked into his place.
I told him politely the purpose of my visit and asked him if the children below five years of his cottage had been given polio drops in recent days by our house to house moving vaccinators. The old man gave me a blank look and did not make any reply. I asked him again but he remained dumb.
By that time two more men were seen coming from the backyard. They stopped after meeting me. I told them what I previously told the old man. “You must have heard about the door-to-door polio campaign that is on its way now. The Indian government wants to end polio for ever. That’s why every two months we conduct this campaign to give polio drops to all the children below five years. I have come to see if the small children of your village have received polio drops. If any one is left I will give them the polio drops.” I showed them the vaccine carrier that I was carrying.
“Yesterday the local polio-man visited our village. He gave drops to some of the children. But quite a few children were missed” I got the reply from one of the men.
“Why?” I exclaimed.
“They all died. You see this old man sitting here? His 11 year old boy died two days back. Since then he has become absolutely speechless.”
“But how did those children die?” I got a shock of my life.
“Khasra’ (measles) took their lives away. For last one month many of us in the village caught the disease including big and small children.”
“But didn’t you inform the district hospital?”
“Who will do it Babu (Sir)? We don’t know anybody in the hospital. Who will listen to us?”
The two men helped me to make the round of the whole village. I never experienced something worse than this before. There were still several children, big and small, struggling with measles. Some of them already developed complications like severe chest infection, unstoppable diarrhea and ugly infections all over their skin. Few were gasping in front of their helpless parents. When I asked about the number of deaths I could not find the exact figure from any one. It ranged from fifteen to twenty five.
“Is there any doctor treating the children?”
“The ‘jholachhaps’ (unqualified rural practitioners) generally treat us. We are poor people. We can’t afford to visit the big doctors of the town.”
“But these children are very serious. They should be taken to the district hospital immediately” I tried to explain to them.
“What is the use Babu? There is no medicine in the hospital. There is no bed. Patients are lying on the floor. The doctors are hardly seen. They will keep our children in the hospital to die. The ‘jholachhaps’ are at least available in the village. They come to our places whenever we call them to treat our children” A villager reverted back  with a cynical despair and frustration.”
Being a physician myself, I never felt so helpless and hopeless in my entire life.
When we are putting our best efforts to drive polio away, measles is taking away the lives of our children. Most surprisingly, nobody in the district came to know about this horrific crisis in a village which is just 5 km away from the district head quarter.
I rushed to the popular practicing quack in the next village. The man was a sincere informer. When I asked him about the measles mishap, he replied with a gesture of astonishment, “I know about the measles problem from the beginning. I also treated some of those ailing children. You told me to report only the cases of flaccid paralysis suspected to be polio. But you have never told me to report the cases of measles. So I didn’t bother to inform you about it”.
The proud Surveillance Medical Officer of the distinguished National Polio Surveillance Project of India received the biggest jolt of his life.
 I engaged the unqualified rural practitioners in the reporting network because they serve the poor villagers at their door steps and have the potential to report suspected polio cases during their very first contact. But the same system failed  to alert me on another deadly disease named measles because I never thought to equally sensitize my informers to report measles along with polio.
When I was leaving the measles-struck village, an old woman stopped me on the way and asked, “You guys come to our place to deliver polio drops. Why don’t you also give 'chhuiyans' (injections) to our children?”
Somewhere in her illiterate mind there was a strong belief that giving injections are critical to keep their children safe.
She was so true to figure out our massive failure to deliver routine vaccines to their small, innocent and highly vulnerable children.
(Based on a monitoring trip report of pulse polio program in Bihar in 2004)

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