Tuesday 30 January 2018

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.

Fully Immunize Every Child

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.

Monday 29 January 2018

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 

Street Scene

where some people live in houses and flats

Checking railway Track

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.

Meeting local politicians

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.

Has your son 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. 

Public Toilet

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.

Polio Teddy

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 if vaccinated

Checking involves going around where the children are,

Checking in street

be it with their parents at work, 

Checking Finger

or in the street,

Into the slum

up alleyways,

Checking on Track

or on the railway track 

David Ward Checking Finger

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

Children showing finger 001

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

Marking finger

And if they are not vaccinated

Robert Vaccinating

then they are immediately given their two drops of vaccine.

Vaccine through the market

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

Vaccinated

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

Vaccinated finger

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

Dhakuria Railway Sign

Railway station

Working on the railway track was an unusual experience.

Selling on the track

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.

Living on the tracks

Railway Track Checking 2

People also live in huts adjacent to the track

Railway Track Checking 3

Working on the tracks

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

Where railway live

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

Track market

Happy

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.

House Checked Sign

“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. 

Across the River

That thoroughness was demonstrated the following day when

Hoogly Ferry

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

CheckingTwo Checkers  

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

Sunday 28 January 2018

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.

Us on Plane

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.

Delhi Smog

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

Meeting Banner

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

Team Meeting

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

Hoogly at Sunset

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

Sunday National Immunisation Day

Polio Team

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

Polio Car

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

Our area

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

Polio Poster

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.

Drains Problem

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

Street Life

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.

Local Health Centre 001

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

Local Health Centre

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

Fully Immunize Every Child

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

Health Workers

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.

Another Health Centre

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.

Health Worker vaccinating

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

Class to be vaccinatied

Occasionally we came across a class of children awaiting vaccination

Pat Vaccinating 001

and we were given the occasional opportunity

Sunday Pat vaccinating

to vaccinate

Sunday team work

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

Score Chart

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

Rotary Clinic Sign

in establishing their own specialist health facilities 

Rotary Health Centre

Rotary Clinic Sign 001

and this one was opened as an eye clinic

Inside Rotary Clinic 001

which was of particular interest to Mrs Harvey

Inside Rotary Clinic

because she recently had had Cataract Surgery on one eye.

Coconuts

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.