Follow-up Day Monday 25th February 2013

Sunday was vaccination day when every child was vaccinated. Monday is follow-up day when every household is visited and the children there are checked for the magic “Purple Pinkie” mark. Then the house is “chalked” with the result of the visit.

We checked out of the hotel and headed off to the village of Mustafabad Jaretha which is in the Dahgawan Block of the Badaun District. According to the Indian 2011 Census this village has 274 houses and a population of just over 1800 of whom 43% are female – it is small by any measure.

A few kms out of the town, we crossed the Ganges and because it was an

“auspicious day” (Purnima – a full moon), lots of people were bathing in the river because it is regarded as a holy river.

We also passed lots of people heading towards the river using every possible mode of transport.

These people were waiting for a tractor cart and whilst resting, a monkey decided to sit down with them – monkeys are regarded as a bit of a pest in this area because they eat the crops.

We also passed someone who appeared to have suffered from polio and hence had a hand propelled tricycle to get himself about.

 

The countryside gradually became even more

rural and undeveloped and the reactions of the people we passed expressed more and more curiosity but as soon as they saw the magic words (in Hindi) which said Polio, great smiles appeared.

We reached what we thought was the village because we had turned off the main road and stopped in what appeared to be a very undeveloped place, but this simply was a pause to pick up a guide for the next section of track which took us far out into the countryside down an unmade track to Mustafabad.

This village is certainly undeveloped and it must have been

a bit of a shock for the villagers when 11 brightly dressed Europeans appeared with numerous health workers and started to spread out around the village.

The children of course were curious and the least shy about coming to see whom we were.

The monkeys observed us from the roof tops

whilst the cows decided to get friendly and sniff Pat out.

The village is hoping to improve its water supply with this water wheel made out of some old cast iron parts and tin cans fixed in an appropriate shape. Nothing is ever wasted in India.

  

We wished we were brave enough to try some food from a

local stall – this one was selling Samosas but our caution over hygiene stopped us.

We were able to see inside of a couple of houses,

the inside of this house is typical of many of the poorer houses in the village

and this one was only a few yards away and was even more basic.

The village is typical of many in UP and the living standards vary from very basic through to very comfortable,

one or two people obviously having got money from somewhere.

India is a puzzling country with significant wealth being side-to-side with significant poverty. Those living at the bottom (whom we spoke to) seem to believe that India was a poor country and therefore their position was not unusual. It is poor in a lot of parts but it is also very wealthy in others.

 

The really impressive part of the Polio Vaccination process is that every house with a child in it is visited and checked after vaccination day and that vaccination is not optional, such is the determination of Government to rid India of Polio. 

Here a mother is visited by Vaccinators and asked about her children

If the child is found not to be vaccinated, then it will be done immediately, the vaccine being in the cool box.

This child was found to have been vaccinated.

So the records are updated and the building is chalked up with the sign for a successful visit.

The mother and child see us off

and she gets back to her plastering with a mixture of buffalo dung and mud and straw.

The coding system used is that X means not checked because either no one is in or the child is out – the system

then requires that visits be repeated until they know what happened.

P means that the child(ren) living in this house have been vaccinated. And this door has multiple chalkings still showing on it from earlier vaccinations – the most recent previous one being in January 2013. There are scheduled to be 10 vaccinations in 2013 with every child being vaccinated every time.

Other doors have a messages on them from the local field worker.

 

This one says that it is vaccination day in a weeks time on the top two lines and then underneath it is the message showing that the house (the 73rd that day) was visited and the child(ren) inside Passed the check, the visit was carried out by Team 60 on 25-2-13.

After checking a number of houses and seeing how the process worked, it was village meeting time and villagers

arrived by every mode of transport.

The meeting was held in the playground of the local school

over whose entrance was a banner about the NID on the 24th (note the Rotary symbol bottom right) and soon the school yard was packed with people

sitting near to another banner which recorded whom (including Rotary) had funded the Polio eradication drive.

In the audience you could again see both poverty and mobile phones – here the phones being used to take photographs of me.

There followed speeches,

and garlands and small gifts being given in both directions.

We even featured in the local press.

and the meeting finished with snacks and offerings of water which came from

the local well. Although only one of our number suffered stomach problems during our time in the field, she felt really ill and so we were very careful when offered local water.

There was a Polio victim living in the village who had caught the disease 25 years ago when he was 5, the results of which meant that he had no use in his legs and his hands were deformed. He accepted without bitterness that the disease which had caused him so much suffering was now on the verge of extinction but he did comment that he had a very hard life and received virtually no support from the State.

Afterwards, the children wanted to shake hands

and to get one of the balloons from our remaining supplies.

Eventually we managed to leave and to head in the direction of Delhi (or so the driver believed) for the supposed 3 hour drive back.

 

A few hours after leaving (when we were starting to get hungry) we stopped in a town to buy some fruit in the market. The sight of people dressed in yellow getting off a bus caused quite a stir but as soon as we mentioned the words “Polio, Rotary” and made the hand gestures of using the polio dropper, people starting shaking our hands and thanking us in their own languages – we could not understand the words but the meaning was obvious. The stall holders then changed their pricing policy for the fruit we were buying and sold to us a local prices – not that charged to gullible tourists (although they probably did not get many of any nationality in that isolated town) and one man came up to me and said he was a local Rotarian and he was honoured to meet us and thanked us for what we were doing.

Such a reaction was very common throughout our time in India – one of a group reported that when her tuctuc driver realised she was a Polio volunteer, he refused to take payment for the ride.

Some eight hours later we arrived in Delhi having been lost twice and stuck in traffic for nearly an hour on the middle of a railway level crossing. Once we realised that we were not going to get to Delhi by any civilised time, we stopped at a truck drivers cafe some 50 kms from Delhi and had the most wonderfully authentic alfresco Indian dinner of whatever he

had cooking in the kitchen bar the salad

and we had a wonderful meal for 200 rupees (less than £3 each).

Well done Team Sally! – Angela Winson, Penny Underwood, Nicky Creed, Andrew Davies, Sally Hoadley from Brue Valley; Siobban McKay from Dungannon; Susannah Garton from Holmes Chapel, Sarah and Richard Hughes from Marlow Thames; and Paul and Pat Harvey.

So how was the NID for us?

We are absolutely delighted we came and thoroughly enjoyed every moment. It has been an experience never to be forgotten.

After the overnight flight, we were very tired on the first day on Delhi and therefore next time, would come out a day earlier in order to get used to the time change.

The briefing on arrival was short and thorough and the information we received in our briefing packs was useful. Indian shirt sizes (we all ordered and purchased special yellow Polio t-shirts in advance) are on the small size so it may be advisable to order one size larger than you are. Also it is reported that they shrink when washed.

The hotel in Delhi was quite comfortable and acceptable other than that the price of food and drink in the hotel was very expensive and if you have the energy, it is worth going into town. The charge for WIFI at the hotel is extortionate.

The hotel we stayed in at Bareilly was acceptable for a short stay, the food was reasonable and the hotel had free WIFI. In general, free WIFI is not readily available in India.

We had no trouble in getting our clothes washed at hotels although some of the group reported getting theirs returned close to check-out time.

Indian hotels seem not to do packed lunches or breakfasts very well (we base this comment on four packed meals) and so we were grateful for the various bars and snacks we brought with us from the UK to cover just such an eventuality.

We took old trainers with us to wear out in the villages, the plan being to throw them away if they got too muddy and mucky. In the event, the ground was relatively dry.

We were glad we chose a rural location as against a town because it would appear that we got more “hands on time” than some of those who chose Delhi or Lucknow. The downside to this was that we had a lot of coach travel – what we saw and experienced was very interesting but the travel was tiring.

The journeys we undertook were not for the travel sick not for the travel nervous. Most of the roads were very bumpy and Indian driving is an experience you will never forget (or probably ever get over). After a while we got used to the constant “Marigold Moments” – if this does not mean anything to you, read the Darjeeling blog entry which follows.

The villages we were taken to for the NID gave us an experience we will never forget. The welcome and hospitality offered by someone who had nothing was astonishing. The first booth we went to had started work at 8 am so by the time we arrived (11.30) most of the children had been vaccinated. There were plenty of children at the next booths however.

Feedback meetings with various layers of Indian officialdom are part of the package and provided some useful information.

The follow-up day was interesting in that we saw how it worked but we had no hands on experience. The village we went to was even more of an eye opener than the previous day.

We might not take pencils and pens next time but concentrate upon balloons, whistles and balls etc. Toothbrushes were not much use in the villages because toothpaste is not readily available. We gave all of our left-over gifts to the local coordinators for them to use during the next campaign.

 

We had no trouble in finding supplies of bottled water – most of it looked reliable, a couple of bottles we wondered about. Hence we were grateful for the spare bottles we kept in our bags for just such an eventuality.

None of our internal scheduled flights departed at the time on the ticket – they were all rescheduled, some earlier some later. Checked luggage weight limits of 20kg for internal flights were strictly observed and some bags mysteriously gained weight which a few rupees removed. No weight limit seemed to apply to hand luggage. The time it took to get through the airport (security etc) varied from 1 hour to 2½ hours, Delhi being the worst. Allowing ample time is essential.

The food we were offered whilst out in the field was superb and we enjoyed eating it very much. Whenever possible, we restricted ourselves to freshly cooked food and avoided salads (you do not know the quality of the water used to rinse it). Bananas were ok, we avoided grapes, apples etc. Politeness did mean that on occasions we had to take a risk.

Access to toilets was sometimes problematical and we had to ask on a number of occasions for a “rest break”. Toilet paper is not the norm outside of hotels and therefore we took our own.

We did not suffer from any stomach problems during our time here, perhaps because we were very careful to only drink bottled water or tea, we avoided salads and fruit, we used hand wipes and hand disinfectant etc. We did not take malaria tablets (on advice we were told it was not needed) but some of the group did.

We were able to recharge our array of electronics using European two pin converters although next time we will purchase a three round pin Indian converter (from Amazon) because some of the sockets we found were difficult to use.

We were welcomed by all of the Rotary groups we met and it was very nice to be able to participate in the international fellowship which all Rotarians believe is such an important part of Rotary life. We took a few club banners and a couple of books about our home town with us as gifts for the clubs we visited.

Tipping is a constant thing in India and applies to everyone who gives you a service not matter how routine. There are plenty of others who try to do something for you which you did not ask for or may not even want in order to extract a tip (refuse to tip). Hence keeping a supply of small notes (10s, 20s, 50s) is essential. No one likes to be given old or torn notes.

With some sensitivity, we were able to take photographs whenever we wanted to although some people expected a tip.

We were not troubled by many of those living on the streets nor subjected to any hostility. Our group followed the advice of not giving on the streets but donating to charitable groups we met if they wanted.

Has Rotary made a difference in India?

Absolutely and categorically Yes – this is the view of everyone we met from people in the villages through to Chief Medical Officers. Every person we met expressed tremendous gratitude to Rotarians across the world for their commitment to the Polio campaign and we felt proud to be part of that commitment.

Would it have been better to have donated the money we spent on going to India to the cause rather than travel there and take part? The view of everyone we met (and our view) is No.

The fact that we were in India

• increased the take-up of vaccine at booths .
• increased the numbers attending briefing meetings.
• provided moral and practical support to a group of field workers who have been battling Polio for many years and are now feeling a little tired
• enabled the people of India (at all levels) to share their delight at almost beating this disease with others
• enabled us to talk with authority about how Rotary funds have been used to save lives in India

We would come again given the opportunity, it was an eye-opening experience and a privilege to be part of Rotary’s Polio Team.

Thank-you to all of the Indian Rotarians we met, in particular Shyamji Sharma. A very special thank-you to Mike and Bernice Yates without whom we would not have been able to go. And a thank-you to the Badaun team and all of the fellow Rotarians we met during the February 2013 NID.

National Immunisation Day Sunday 24th February 2013

Today is the day of the NID and we all assembled in our full working clothes to receive a briefing from Shyamji Sharma

and then to leave the hotel by 8 am for what turned out for us, to be a long drive into the depths of Uttar Pradesh.

Bareilly is not the most developed of towns but

as we drove further into the countryside, we could see that is was becoming even less developed – it was a bit like

travelling back in time but coming across the occasional reminders of the 21st century such as people squatting by the side of the road making fuel bricks out of dung and mud at the same time as talking on their mobile phone!

Fuel pats made from buffalo dung, mud and chaff are a very common fuel in the area. The mixture is also used as a kind of adobe.

The dung pats are mixed and shaped and then piled up to dry in the sun.

Houses varied in structure from Brick built boxes (there are a lot of Brick kilns in the area)

through to very basic huts. It was not unusual to see road side stalls selling the basic materials for hut construction.

Whilst there are quite a lot of tractors around, we did not see many on the fields, their most common use was for pulling a trailer loaded with people.

Animals working in the fields were quite common such as these two oxen pulling a plough which will (in this case) create a single furrow as it goes along. 

We stopped some distance south of Badaun and the group were split into three teams to go to different villages (Rijola (Usawan), Basoma (Ujnani), Sateti (Bilsi)) in the area.

The team I was in (four people) continued on for a further 30 kms turning down progressively smaller and smaller and bumpier and bumpier roads which eventually turned into a dust track and we entered the village of Raja Rijola.

According to the 2011 Indian Census, the village has 818 households and a population of just over 5300, 56% of whom are male.

The village is typical of those in this area with some

brick / concrete built houses (this one was originally the house of the person who owned the land upon which the village has developed) and some which consisted of nothing more than  mud walls with a wood and twig roof.

The village streets were brick paving in some places and earth tracks in others.

 

Open drains were common and in earlier years, these would have been the means by which the Polio virus would have spread. The village elders were well aware of the need to improve village hygiene and in our discussions with them, they indicated that this was their next priority.

There is a large lake in the village and close to this, a twice

weekly market is held – the vegetables on offer looked far fresher than those we saw at home in our local supermarkets since they were grown and picked in the fields around the village.

This is a small village with about 600 children aged under 5 in the area. There were five Polio Booths in the village open at different times and we were to visit three of them.

Our arrival at the first booth created some excitement

and above the booth (which was simply a table in the

street) there was a large yellow and red poster (the same colours as our uniforms) advertising that a vaccination would take place on the 24th.

The polio vaccine is stored in a cool box and a vial is only

taken out when it is to be used. In the summer months when the temperature is at least 40c, it can degrade very rapidly and the technique then is to hold the vial in a cold handkerchief which has also been kept in the cool box.

The vial has a metal cap on it, this is cut off and then a rubber nipple attached which you have to squeeze to get only two drops out. One vial did about 20 children in our unskilled hands, no doubt more for those adept at ensuring that only two drops are dispensed per child.

Some children were willing and had done it before and approached the vaccinator with their mouth already open. Others were less willing and some firmness was needed, and some were asleep and were protected without even knowing it. The youngest child I vaccinated was 28 days old and this was his first vaccination – a privilege for Rotary to be able to do this.

Once vaccinated, the nail and skin just

below the nail of the little finger of their left hand is marked with a special pen (hence the phrase “Purple Pinkie”) to indicate that they have been vaccinated.

They then get given a present – balloons were very popular, pens and pencils less so although these were often taken by the parent. Also some children were given a mouse face mask or a small ball or a whistle (all with the Rotary emblem on them) from supplies held by the Indian vaccinators.

As each child is vaccinated, the next box on the score chart is marked. They do not note names and addresses or any identifying data, the focus is on a quick vaccination of everybody in the queue. They also check any child standing near the booth in case they are there out of curiosity but not yet vaccinated – they are promptly taken forward and dealt with.

Some children over the age of five tried to get vaccinated because they wanted the present and certainly there were some suspiciously old looking children presented by one of the workers who was then keen to ensure the child got a present – this is India so it was not for us to argue.

When they could not find any more children to be vaccinated, we moved on to the next booth which was in a school about 500 metres away.

On the way there we had to ask to go to the toilet and were taken to a nearby house with good facilities.

At the second booth the children were already assembled

outside

and inside one of the classrooms

It then turned into a production line for the (by then)

experienced team and quickly, all those waiting were protected.

Many children are brought by their big sister or big brother

who themselves may not be many years older than 5.

Some children had kohl drawn around their eyes, this was to indicate that they had been found to be anaemic and therefore were receiving special health treatment as well.

The school was very basic – it had 200 children up to age 12 enrolled with three teachers. Each classroom was totally bare apart from a chalk board and a few mats on the floor. From what we gathered, they were taught in Hindi but also taught the English alphabet and a few words in English but not taught English per-se. They also learnt some Maths and Social Sciences.

After tea, water, and biscuits we were taken to another house for the toilet again (perhaps they now realised such necessities were essential for us) together with some delicious freshly cooked snacks and biscuits by our host's wife – thank-you Dr Kumar.

It was amusing how many people came to the door of the room we were in to look at us and also when we left the house, there were at least 50 people sitting down in the street awaiting our reappearance.

Then it was off to our third booth to continue the process.

Whilst quite a number of women would come into the booth, a number would not enter but this did not stop them ensuring that their children were vaccinated nor peering through an adjacent window and recording the event for themselves.

Feedback and group congratulation is an important part of the process and our schedule included a series of meetings scheduled for the end of the day, gradually moving up the Polio hierarchy in the area.

Firstly we met the village “Mayor” informally with some of the villagers

and then we went to a formal meeting in the hall which was also attended by all of the polio workers and as many villagers as could be got into the hall.

 All parties gave their impressions of the

day. We told them that we were very impressed with their achievement and proud to have been able to come to their village. We also thanked them for the welcome they had given us and their hospitality (which was tremendous and genuine).

Then it was garland time during which I was presented with four garlands and I presented some to the Indian team.

Having made our leave (being escorted out of the village by everyone living there with constant hand shaking , clapping and goodbyes being cried out), we went to the nearby Primary Health Centre and repeated the process

 

with workers and managers from a wider area who were collating figures and considering the successes and difficulties of the day.

Then we went to the office of the Chief Medical Officer (CMO) for the District where we found that the other two Rotary teams were waiting for us and we discussed the success of the day with the CMO.

This sign outside of his office with the Rotary emblem on it expresses a determination to eradicate Polio.

We were told that during the day our team had vaccinated over 370 children and that they estimated that the presence of our three teams had increased the total number vaccinated that day in this area by over 500 because people came to see who we were.

Eventually we got back to our hotel just as a major thunderstorm started for a very late evening meal – very tired but elated at what we had achieved and very thoughtful about what we had seen.

We have no doubts at all that India has made great progress in eliminating Polio (and at a great financial cost) and that this results from considerable hard work by millions of people.

We also have no doubt that the contribution that Rotary has made is enormous and the respect and thanks giving to us as visiting Rotarians was truly humbling.