Some thoughts and Home Again

Getting home was very easy, the planes were on time although they were slightly fuller than on the way out.

This was our sixth year participating in National Immunisation Days and our fourth year leading a team. Over this period, we have noticed a change in the role of Rotary Clubs and Rotarians during the immunisation period, namely that the process is now less dependent upon the enthusiasm and effort of Rotarians and that the Indian Government now almost totally runs immunisation. In the early days, we came across very few health workers involved in vaccination, now there are very many health workers involved and also they work out of health centres.

This is of course because the current policy of the Indian Government is to move away from the use of live polio vaccine and for all children to follow a vaccination programme from birth and during their early years.

We met many Rotary Clubs in Kolkata and all of them were very hospitable and welcoming and we thank them for that. We were very impressed with how organised they were and also how they have moved on from simply responding to Polio to running other community health projects.

Will there be another last NID we might wonder? At the time of writing, the answer is “probably yes” but there is some debate as to if it will involve Rotary or if it will be totally run by the Indian Government.

If we can, we will go. We are committed to continue the fight against Polio as long as we are able.

And if you want to watch a 20 minute presentation about Rotary and Polio, click on the above YouTube video.

Follow-Up Day in Kolkata

For us, follow up day was to be spent in and around the Dhakuria Railway Colony which is a very mixed area in the south of Kolkata 

where some people live in houses and flats

and many more live in squatter huts or alongside the railway track. Some people there are relatively wealthy and others are abjectly poor.

There is an short article in the Huffington Post about the colony here which will provide some useful background if you do not know anything about it and a Youtube video above which provides rather a long view of the area.

Kolkata has a interesting history. From the days of the East India Company through until 1911, it used to be the capital of India and hence it had a large British garrison (some of my family were born there). Roll forwards to recent times and the Communist Party of India (Marxist) were the ruling party in West Bengal.

Local politicians are very important and hence just before the start of our follow-up we met the ward councillor for the Colony and she decided to accompany us as we worked our way around the colony checking fingers and she was very effective and well known and would not accept any excuses from those whose children had not been vaccinated.

Polio is primarily spread through faecal contamination and India has been increasing the number of public and private toilets available to its population in an attempt to improve sanitary conditions. 

This public toilet was on the edge of the area we were checking (and there are some 350 others in the city) but unlike many places elsewhere in India, here it was "pay to use” and hence we did not see many people using it.

There was some, but not a lot of publicity material around telling people to get their children vaccinated. The growing role of government in the vaccination process is perhaps indicated on this poster by including a photograph on it of Mamata Banerjee who is the Chief Minister of West Bengal - a photograph we were to see on most Polio advertising.

Checking involves going around where the children are,

be it with their parents at work, 

or in the street,

up alleyways,

or on the railway track 

and looking at the little finger of their left hand for the purple mark.

Some children know what to do and you only have to waggle your little finger at them and they will respond.

And if they are not vaccinated

then they are immediately given their two drops of vaccine.

The vaccine is, as always, carried in insulated thermos boxes because it must be kept at a low temperature in order to remain effective.

We came across one child trying to wash the mark off his hand

because word had rapidly spread that if he was vaccinated by us, he might get a small present.

Working on the railway track was an unusual experience.

Many people had set up “shop” adjacent to the track and were just that extra millimetre away from the track to avoid being hit when a train went past.

People also live in huts adjacent to the track

and the track was live with trains frequently passing (slowly).

We soon learnt to get out the way and carry on checking on the other side of the track.

As is always the case, we were welcomed in a friendly way by everyone we met and this child had quickly got over being vaccinated by me.

“Houses" were marked up in chalk as usual showing that they had been checked (Team 59 checked this house on the 29th January 2018 and it passed - i.e. the children supposed to be living in it were inspected and found to be vaccinated).

It was a very interesting place to work and we found that the usual thoroughness of the Indian Vaccination process was as obvious here as it has been elsewhere - most children had the required blue finger. 

That thoroughness was demonstrated the following day when

we went on a ferry across the Hoogly River to the other side of town

  

and found Health workers working on the landing stage looking for evidence of vaccination on all children who went past.

The 2018 NID in Kolkata

From our perspective, this NID is intended to follow much the same format as earlier NIDs: we fly to Delhi for a briefing and for most of the team to assemble; we then go to Kolkata and the following day (Saturday) we take part in some Polio related activity; Sunday is the day of the NID; Monday is followup and then sometime afterwards, we return to Delhi and the UK.

Experience has taught us that going on a NID without allowing some time to get over the jet lag of India is very tiring, hence we are going out to Delhi a few days early. And this time we are making the journey even easier by going on a day-time flight rather than an overnight one.

So, as has been the case for the past few years, I start this blog entry with a badly taken selfie of us on our fairy empty Air India plane at Heathrow.

We arrived just before India Day and hence a lot of Delhi was under lock-down and as expected, the view of Delhi from our hotel room was showing the impact of the early year smog which can make living there quite unhealthy.

Over the next couple of days, most of the 100 UK Rotarians taking part in the NID arrived and we all attended the usual pre-NID briefing session which did not tell us much that we did not already know but did indicate that during the past 12 months, India had made some further progress towards replacing Live Polio Vaccine given orally with the Inert Polio Vaccine in an injectable form.

Other than the slowest imaginable drive back to the airport to get our flight to Kolkata due to India Day traffic, getting there was unremarkable and not needing comment.

Our hosts in Kolkata were many of the Kolkata Rotary Clubs (there are a lot) and Saturday was partly taken up with a briefing meeting from them

which also gave us the opportunity to demonstrate to them that we were 

serious about being actively involved in Polio vaccination - "we have not come to watch but have come to do".

For us the day finished with seeing sunset on the Hoogly River in Kolkata.

Sunday National Immunisation Day

After the usual group photograph of the team in our yellow shirts,

we divided into small teams and set off to vaccinate.

Because I was the team leader, the Rotary Clubs there wanted to spend much of the day showing us what they were doing rather than putting us to work

and the area we went to was north of the airport.

The immunisation process has changed a lot over the past few years and here I thought that there were far fewer of the posters I had grown used to seeing on display around the city.

The issue of poor sanitation and the increased risk this creates for Polio to make a come back was still evident

and the general poverty in some of the areas we went to on this day was not better or worse than we have seen before.

What has changed is that a lot of the vaccination saw took place in health centres. The establishment of these centres is central to the policy of

the Indian Government to move away from the regular use of live polio vaccine

and to incorporate it into a programme of fully vaccinating every child against a range of infant diseases.

at birth and at specific dates in their early years. There has also been a significant move towards the establishment of teams of health workers such as these who staff local health centres and deal with all aspects of children’s health.

Not all of the health centres we visited were as grand as the first one, this one above was simply a room at the side of a building.

However, within it the vaccination process took place in the usual way.

Occasionally we came across a class of children awaiting vaccination

and we were given the occasional opportunity

to vaccinate

although without the pressure of numbers of children waiting their turn which we came across in earlier years.

Although the same method of recording the numbers of children vaccinated was used as in previous years, at all of the health centres we went to, the workers said they knew exactly how many children they were expecting and where they lived.

Through the use of Founation Grants, local Rotary Clubs have been very active

in establishing their own specialist health facilities 

and this one was opened as an eye clinic

which was of particular interest to Mrs Harvey

because she recently had had Cataract Surgery on one eye.

And we finished this first day with fresh coconut juice from a coconut purchased from a road side stall, not something you can do where we live.