Day 5 in India (Written Jan. 11)

I remember worrying about polio as a child. Victims were put in an iron lung machine to preserve their lives. Many of those who lived had crippling disabilities.

My mother took me to a school where we stood in a long line to be immunized. It was part of a national immunization campaign. The vaccine was delivered by putting drops in a sugar cube.

Now, 50 years later, the polio virus is gone from the United States because of aggressive public health efforts to eradicate it. However, it has continued to ravage other nations. If it is present anywhere, it is a danger everywhere, so our government, in combination with others, has committed to eradicate it from the earth. Only four countries: Nigeria, Pakistan, Afghanistan and India continue to see cases. India is critical because it has the largest number of cases. As of December, 452 cases were reported in India, which represents 55% of the total 832 cases worldwide.

The primary strategy for eradicating polio is the immunization of every child, but it is a lot more complicated in India than it was my hometown 50 years ago. They have to reach 175 million children, multiple times.

I spent a portion of a day in India learning about the strategy and organization of the effort. It is a daunting challenge. Organizers have developed 1.2 million teams of people who go into every nook and cranny of India, searching house-by-house with the objective of reaching every child.

Neighborhoods are charted with hand-drawn maps. Trained volunteers then wade into broken-down, sometimes scary housing areas. They explain immunization to parents. Many are untrusting and wary. Women seem to be more effective as volunteers because they can enter the homes, which is not culturally appropriate for a man.

Two drops are put in the mouth of each child. A check mark is put on the hand-drawn map and the results are recorded in chalk above the doorway.

Drops are squeezed into the mouths of 25 children from the same bottle. It values efficiency and reach over perfection by accepting some risks as inherent when balanced against the greater good. This is raw public health.

I joined the volunteers in a slum area of New Delhi. The homes are made of homemade bricks, sticks, cardboard, sheet metal or any other material they could get. Most had no doors, just drapes. When the drape was pulled back, enough light would flood into the room to reveal a hut-like atmosphere with mats for beds and crudely made furniture. In some cases, the rooms were three or four feet wide and six feet long. Raw sewage ran in a small ditch that weaved a path through the area.

Children ran about, made curious by these unusual visitors. Mothers wore a quiet dignity that I observed as nearly universal among Indian woman. Nearly all of the women wear long flowing saris that provide a sense of elegance even in poverty. They are such attractive people.

Most of the older children understand what is happening and cooperate. However, the smaller ones have to be held with their head back and their mouth opened by pinching their cheeks together. Understandably, they cry and squirm.

As I held those children in my arms, I was a close witness to the filth they live in. Some had puffy eyes and a smell that follows poverty. They were, however, simply beautiful and I felt gratitude for being able to hold them and deliver a potentially life-preserving gift.

During my time at HHS, I have learned a profound appreciation for those who choose to serve the down-trodden of our nation and the world. Many of them work for the Centers for Disease Control and Prevention, the Indian Health Service or National Institutes of Health. They serve with an easily recognized spirit of goodness. They live significant periods of their lives in conditions far below what they could, while accepting risks and personal hardships. God bless them.

Comments

Respected Secretary,

I didn't see any post after this one, so I suppose you visit is over.
I salute to take time to share tour thought on everything you saw in an organized manner.

It would be great if you could write one more post about your overall experience, changes in feelings before and after your visit and some recommendations from your experience.

This is just a request if you get time from your busy schedule. Anyway I will be following your blog to know your opinions about what is happening around us.

Thanks and Regards,
An Indian

Posted by: Robins Tomar | January 17, 2008 at 05:06 AM

Thanks for the report on polio. You honored “those who choose to serve the down-trodden of our nation and the world.” Compare these statistics. For the countries mentioned, Nigeria has 1 physician for 3,571 population, Pakistan has 1 physician for 1,351 population, Afghanistan has 1 physician for 5,263 population, and India has 1 physician for 1,666 population. For comparison the U.S. average is one physician for every 454 Americans.

Source http://www.who.int/globalatlas/dataQuery/reportData.asp?rptType=1
Global Atlas of the Health Workforce Category: Human Resources for Health, Topic Aggregated data 2006, density per 1000, physicians total, world

Posted by: J.I.M.C. | January 28, 2008 at 04:07 PM

A beautiful post, Mr. Secretary. One can only imagine the monumental challenge it will be to immunize the world population against HIV/AIDS once a vaccine has been developed.

Posted by: Jodi | January 28, 2008 at 06:11 PM