Preventing Polio in the Land of Bricks and Bangles

July 12, 2011 | The Atlantic, Pulitzer Center

Helen Branswell

Firozabad, in Northwestern India, is considered a high risk area for polio transmission. The city is in India’s most populous state, Uttar Pradesh. A combination of issues -- a high birth rate, poverty, poor sanitation, migrant workers and some religious resistance – makes this area a challenge for the campaign to put an end to polio. Image by Helen Branswell. India, 2011.

There is no one-size-fits-all approach to vaccinating against polio in India. Vaccinators have to go to where the children are, whether that’s in bangle sweatshops or on the periphery of brick kilns.

Plans are revisited and revised on a daily basis. Dr. Suhasini More, (facing forward) WHO polio team leader for this part of Uttar Pradesh, discusses the day’s efforts with Dr. Chitra Rathi, a WHO surveillance officer new to the region. Image by Helen Branswell. India, 2011.

Bangle making is a major industry in Firozabad, a sprawling, bustling city in Uttar Pradesh, located about 25 miles from Agra and the famed Taj Mahal. Here it seems everyone is either working on bangles – polishing or firing them, studding them with beads – or making bricks, another big source of employment. Image by Helen Branswell. India, 2011.

Brick kilns attract migrant workers, who come from more remote rural homes. Whole families move to temporary settlements around brick works, putting up makeshift dwellings that will be dismantled when they move home to wait out the monsoons. Dr. Rakesh Vishwakarma (plaid shirt) checks to see that these children have received polio vaccine. Image by Helen Branswell. India, 2011.

A local worker who keeps tabs on temporary settlements for the WHO leads Vishwakarma, the WHO supervisor for Uttar Pradesh, to a new cluster of shanties. Image by Helen Branswell. India, 2011.

In Firozabad, which has a sizeable Muslim minority, vaccination teams are made up of Hindus and Muslims in a bid to break down a historic resistance among some in the Muslim community to the vaccine. Image by Helen Branswell. India, 2011.

This mother has refused to let vaccinators give her baby the polio drops. The baby is sick, she explains. But she’s also refused to allow them to vaccinate another child in the house, who is well. Image by Helen Branswell. India, 2011.

It takes some effort, but Dr. Suhasini More persuades the women to allow the well child to be vaccinated. The mother promises to take the listless baby to get vaccinated once he recovers. Image by Helen Branswell. India, 2011.

The team of vaccinators, which works for the Indian Ministry of Health, picks its way through the city’s narrow and crowded streets. A community leader (in white) accompanies them. Organizers hope his presence will help sway reluctant Muslim families. Image by Helen Branswell. India, 2011.

Vaccination teams mark the doors of dwellings to indicate when they’ve visited and whether they succeeded in finding and vaccinating children. An X means a child has been missed, either because it is away from home or because of parental objections. Teams make repeat visits to houses marked with Xs. Image by Helen Branswell. India, 2011.

Sometimes that perseverance pays off. A little boy whose mother has initially refused vaccine is persuaded to let the boy take the drops. The purple mark on the little finger of his left hand is the sign he’s received vaccine during this vaccination round. Image by Helen Branswell. India, 2011.

This slideshow was also published in The Atlantic.

India is one of the four remaining countries where transmission of polio has never been halted. But the world’s second most populous country appears on the cusp of reaching that goal, with only a single case so far in 2011. India – with the help of experts from the World Health Organization – is attacking the problem hard, mounting extra immunization rounds almost monthly in parts of the country deemed to be of highest risk for continued spread of the paralyzing virus.

One of those areas is the province of Uttar Pradesh, in northwestern India. There high birth rates, large numbers of migrant workers and resistance within the Muslim community combine to challenge vaccination efforts.

Some of those migrant workers toil at in the region’s many brick kilns. And in the city of Firozabad, many families work at the business of making bangles, the ubiquitous glass baubles for which the city is known.

Finding all the children and persuading all the parents requires strategy, sensitivity and perseverance.