Monday, 24 February 2014

Polio Vaccination Day Follow Up

Follow Up Day

Although every attempt is made to ensure that all 172 million eligible children are vaccinated in one day, there are inevitably some who manage to escape. The purpose of "follow up” is to check that children have been vaccinated i.e. to look for the magic purple mark on their little finger. Last year we took part in follow up in the countryside and there every house was visited and the results of the visit chalked on to the door. If the house failed because the children were not present, then it would be revisited every day that week until the children were found and ticked off (or vaccinated and then ticked off).

Delhi seems to carry out follow up a different way. We were dispatched to an area of north west Delhi and dropped off at a large Health Centre

Health Workers Briefing













where we were attached to two health workers.

City Street













With them we walked down an ordinary street and then dived

Into Alleyway









down a side alleyway.

Street Life 001













into a maze of passages

Street Life









where people carried on their normal lives and jobs,

Ground Floor













and lived in rooms at ground floor level,

Searching Upstairs













first floor level 

Delhi Camp Street Scene 001













and even higher.

Pooing in the street













Sanitary facilities were completely lacking and of course this is why the possible return of Polio is such a threat

Lead health worker













The Health Workers had a large ledger which contained details of all children known to live in this maze and when they had been vaccinated. This was duly marked off with the details of the children we found.

Checking the register









It was a slow a painstaking job.

Children found upstairs













Any child found who had not been vaccinated was brought out

Vaccinating in Village drop going in










was vaccinated

Mark Child









and then marked.

About to be vaccinated










Again, we were warmly welcomed by everyone we met.

Having done the checking (we found around 30 taking our total for this campaign to 650)

Local Health Centre 001









we then regrouped at the local health centre which was very different to the one we had started out at in order 

Inside Health Centre









to count up totals and ensure that everyones figures agreed.

Giving out food 001













This health centre also seemed to act as a food centre for those in desperate need of something for themselves and their families. Here, beans and a sago like food are being quietly given to a mother who appeared with her three children.

St Stephen’s Hospital

St Stephen s Sign









St Stephen’s Hospital in Delhi specialises in Polio rehabilitation surgery

St Stephens Hospital Rotary Polio Sign









and all of the costs of this surgery are paid for by Rotary Foundation. Anyone who has had Polio and now suffers from a polio related joint problem can be operated on free of charge. They are also

St Stephens Hospital Polio Ward 2









allowed to bring one relative with them whilst they are in hospital

St Stephens Hospital Polio Ward 3









and this relative is accommodated and fed free of charge. The hospital estimated that an operation cost between £200 and £2000 but the average cost was now rising because the medical issues they saw were getting more serious - they have dealt with all of the simple ones.

Polio Callipers













The effectiveness of this process is demonstrated by the picture above. This 19 year old girl had never walked. She was showing us how she puts on her post operation leg strengthening calliper. Her mother said to us “she will be taking her first ever step next week, once she can walk she will be able to get married”.

Fellow Rotarians - this is why we should all contribute to Rotary Foundation.

We were delighted to have been able to take part in this year’s campaign and are determined to come back again next year. Although India has now been declared Polio Free,

Delhi Camp Polio Sign










because Polio is sill prevalent in two bordering countries (Afghanistan and Pakistan), they will be carrying on the vaccination programme for the foreseeable future. 

Sunday, 23 February 2014

Polio Vaccination Day

This year we have chosen to take part in the Delhi vaccination programme. Usually three options are offered: a rural; a city; and somewhere in Delhi. We chose to vaccinate in Delhi this year because last time we did a rural site (the same one is on offer this year) and we have already been to the city offering (Ghaziabad). Delhi is large enough to absorb any number of vaccinators and there are numerous booths set up everywhere in the city.

The arrangement is that we stand in the hotel foyer and representatives of local Rotary Clubs arrive and take a few off us to wherever they are vaccinating. We are collected by President Arvind Gupta of the Delhi Vivek Rotary Club and taken off by him to the eastern part of Delhi

Delhi Camp Rotary Sign









where his club has built a vaccination booth on a street near to a village

Delhi Camp Street Stall Start









which is sandwiched between a Private School on one side and The Railway Officers Club on the other. The school is a large, modern, clean institution providing education to the wealthy of the area, the Officers Club is a large social club in a large green park behind a high wall. 

Location of Sunday Vaccination






The village is the doglegged shape of housing roughly in the middle of the image above and is squeezed into the small space between them.

Delhi Camp Summoning Children









The theory is that children will come to the booth to be vaccinated, either on their own or with their parents. To turn the theory into reality, we have to go around the camp making sure that they are aware that there is a booth just outside and tempting them to come with the offer of a small toy.

How does one describe the village? It is almost impossible to convey what being inside the village is like. It has been built on a very small bit of land and is 

Delhi Camp Street Scene 006









cramped, noisy, dirty, occasionally smelly,

Delhi Camp Street Scene 005













and is a very very densely populated chunk of land

Delhi Camp Street Scene 007









with more people than you can imagine living close together

Delhi Camp Street Life 004









and carrying on their everyday life on the streets.

Delhi Camp Street Life 001













Everyone is very curious about us and crowds around us. That we are a curiosity is the reason we are there. All of the statistics show that when western rotarians dress sedately in bright yellow and red are present at a vaccination booth, the rate of vaccination increases considerably because children and their parents come to see what we look like.

We feel very safe in the camp and universally, everyone is welcoming and smiling. It is very common for people (who have nothing) to come up to you and offer you a drink or something to eat which they have just cooked. This of course presents a difficulty because hygiene is not what either we or our internals are used to. Water in a cup is a definite risk because usually it is pumped up from just below the ground and is likely to be contaminated (from a western health perspective). Food is less of a risk but there still is one. Our approach is to take water but not drink it, to drink cola if it is looks like it is in a clean new plastic cup and to eat a small amount of food. Last year we booth survived unscathed, this year I came down with a bad case of “Delhi Belly” and having a broad spectrum antibiotic in your travel pack is a good idea.

The vaccination process is very simple and very rapid.

Delhi Camp Polio Vial









The vaccine is contained in a small vial which contains enough for about 20 children. 

Polio keeping cold










This year we are vaccinating with the Bivalent Vaccine (there used to be three strains of polio but one has been eliminated) and now the bivalent is more effective than the trivalent.

Delhi Camp Vaccine Store









The vials are kept in either a large ice filled cool box (if you are in a booth) or a small “round the neck” cool box if you are mobile in a camp because the vaccine rapidly deteriorates if its temperature rises above -20C.

Delhi Camp Vaccine Monitor Mark









The vials have a temperature sensitive tell tale marker on them which permanently changes colour if its temperature rises above the minimum safe level.

The theory is that the children line up in an orderly fashion,

Delhi Camp Vaccinating 002









willingly open their mouths, receive their two drops of vaccine,


Delhi Camp Finger Marking



have the little finger of their left hand marked (hence purple pinkie)

Delhi Camp I want my ball









collect their toy

Delhi Camp Rotary Masks










or mask or whatever

Polio Score Chart













a tick goes onto the recording sheet

Delhi Camp Children Waiting













and the next child takes their place. This is repeated until all 172 million have been vaccinated.

Prising jaw open










In reality, some children are less than willing to approach this strange looking person and hence their mouth has to be prised open. Children crowd around the vaccinators and often try to come back again and again for vaccination so that they can collect as many toys as possible.

Delhi Camp Vaccinating Teamwork










Teamwork is often required.

Delhi Camp Baby Vaccinated









Many mothers prefer to approach a female vaccinator

Delhi Camp Paul Vaccinating













and men a male vaccinator.

When the queue disappeared, we then went out on the prowl looking for children in the camp who had not been vaccinated.

Delhi Camp Child brought by siblings










As we walked around the camp (followed by crowds of excited children), we looked at the fingers of any eligible looking child we met or if we could not see them, we wiggled our little fingers at them.

Paul giving vaccine










If it was not marked, they were vaccinated on the spot.

Being vaccinated or not is not negotiable - all children who look under five are vaccinated. Parental permission is not sought and in reality,

Village Women child being vaccinised










parents were very eager for their child to be vaccinated. The Indian Government has done a very good job of educating everyone about the need for and advantages of vaccination


Delhi Camp Team










By the end of a very exhausting morning, we had vaccinated 620 children - the club target was 500 so we felt very pleased with ourselves. That we were so successful is down to the Vivek Rotary Club and their extraordinarily dynamic Club President.