Polio boycott in Begunbari, Murshidabad

One billion is a daunting enough number. Add to that 26 million births every year, and the need for a comprehensive and organized public healthcare system becomes plain. India’s is barely comprehensive and only laughably organized. Caught in the mesh of a poorly planned infrastructure and bureaucratic inertia, the state of healthcare in India demonstrates the chaos that typifies the cleavage between the State and the individual. The higher the number, the more complicated the mathematics, the easier it becomes to make allowances for lapses. And that is the trajectory the departments of health across states have been following. That the national immunization programme has grown and managed to improve itself despite the easy habit of administrative despondency is therefore commendable.

In 2006, a global study named India the world’s lone polio exporter. The last count, taken in March this year, revealed 106 reported cases of polio. Most of them were from Bihar and Uttar Pradesh, which have now been marked as high-risk zones. (Ironically, the government has reduced the budget outlay for polio eradication to Rs 1,042 crore this year from Rs 1,094 crore in 2007.) In 2002, West Bengal itself recorded 49 cases of polio, most of them in Murshidabad.

Today, the picture is different. With help from multinational non-profit organizations like the Unicef and from local NGOs, Bengal has managed a turnaround. Its anti-polio campaign is arguably the most successful in the country so far. Detailed mobilization efforts were taken up in 2003, combining word-of-mouth awareness drives with the use of latest technology. The Geographical Information System, one such technology, locates and fills up the ‘gap areas’ in the immunization coverage base.

There has been much concern shown over the greater incidence of polio in Muslim countries or regions. The Muslim clergy has often been blamed for alleging that the polio vaccine is part of the West’s design to render children of the community infertile and to spread AIDS among the minority population. In India, religious faith and medicine have coexisted for long, the first often required to render legitimacy to the second. In Muslim-dominated Murshidabad (the worst polio-affected district in the state) for instance, health workers and volunteers engaged with moderate religious leaders and panchayat pradhans to sensitize them to the need for polio immunization and to convince them about the complete safety of the vaccine. “Miking” — the practice of travelling around villages making microphone announcements — was the preferred mode of spreading awareness among the people. Maulvis and imams who had previously denounced the immunization policy were educated about the need for immunization and contributed to the rapid fall in polio figures in West Bengal.

I was in Murshidabad last year, visiting state-sponsored health centres and hospitals in the district. The squalor and abounding misery of those places warranted my mistrust of the picture of sunny health-department competence that surveys on the success of polio eradication there indicated. I went back on Polio Day (March 30) this year, full of the cynicism that comes automatically when the government claims to be doing a good job. What I found is one among the many inside stories of the latest marketable proposition — “changing India” — a story of the inequities of opportunity that arise out of lopsided social, political and economic development. And how the government simultaneously offers and denies components of its welfare services to citizens at will.

Khilafat Mian has a daughter he cannot feed. He has another whose husband won’t accept her because she cannot bring home the subsidized rations offered by the government’s public distribution system. The old man is not alone. Begunbari, a gram panchayat that falls under Beldanga block of Murshidabad, was last issued ration cards in 1982. On Polio Day, the families of approximately 3,000 children of Begunbari boycotted the immunization programme as a mark of protest against the government’s appalling negligence in taking responsibility for them. A young man, one among the 100-odd who met in front of the booth from where health workers were to gather and despatch vials of the oral polio vaccine to sub-booths in the area, begged to be heard: “Aamar kono porichoy nei didi (I have no identity).” Some men behind him demanded to know what was to be done about registering their children in schools or signing them up for the board examinations. All these processes require proof of nationality, they shouted.

Undoubtedly, there is a theatre in all forms of active protest. It is a theatre that thrives on absolutist notions and on a somewhat inaccurate, if exaggerated, awareness of circumstances. Nevertheless, the desperation that drives men to make a political protest of a health issue that is likely to jeopardize the lives of their children is not one the State can afford to dismiss.

The men of Begunbari knew this well. Not one of them denied the importance of vaccination. Not one of them was unaware of the dangers that boycotting the immunization programme would expose their children to. When the pleas of the block division officer to allow the government to follow protocol in the issuing of ration cards was shouted down, the anger of a community of people who have been arbitrarily deprived of certain State services could hardly be contained. More obvious was the anguish that comes from being unrecognized by the State. “We will not accept the facilities provided by the state unless we are recognized as citizens,” said one man who has been unemployed since the beginning of this year.

It is an unhappy irony that we exist as much for ourselves as for the social processes that are constantly shaping our lives. Yet, for some of us, our sense of belonging to the larger construct, the State, is constantly threatened. Women doubly bear the brunt of this marginalization. By denying them their economic rights (to ration cards, in this case), the government is colluding in their exclusion from the space of marriage and family. Too many of the men present (another curious irony: the women of Begunbari were systematically kept away from the protest) complained that their sisters or daughters were being sent back from their marital homes in neighbouring villages because they did not have access to rationed rice and grains. Taking advantage of a health issue that attracts international attention, like polio-eradication does, and using it to go against the State then became an effective form of social protest.

While the complacency of the State in its dealings with the impoverished and unaccounted for is undeniable, the responsibility of citizens for the successful functioning of State processes must also be stressed. In this, the residents of Murshidabad have disappointed — boycott or not. The turnout at polio booths and sub-booths remains dismal till date. The consolation is that the cause for this now is not resistance to the polio vaccine but the smug conviction of the people that if they don’t queue up with their children for the administering of polio drops, the health workers and volunteers will go to them during the door-to-door immunization that is a follow-up to Polio Day.

Not just in Begunbari, but also in the neighbouring panchayats of Debpur and Pulinda, vaccinators sat with their thermocol boxes full of vials and waited for the sporadic arrival of a mother with her child. Jolly Datta, who has been working for the health department for 14 years, is pleased with the intensive campaigning that has helped bring down the polio count in Murshidabad dramatically. She conducts workshops at the weekly check-up sessions at ante-natal clinics and educates new mothers on the importance of immunization. “There are only stray cases of resistance now,” explains a health worker at the Debpur main booth, which had been left unattended while she visited the one family in the village that had refused to vaccinate. This was a family where two of the members had been afflicted with polio despite immunization. Hence the misconception that it was the vaccine that had caused the disease. “A few years ago, the imams would have to be coaxed into announcing that polio does not cause one to lose one’s religion. Nowadays, even that is not required,” says the worker.

The chief medical officer (health), Mangobinda Mondal believes, like most government officials, that only what is convenient to him is true. He dismisses the example of still-resistant families and concentrates instead on the statistic that every two drops of the polio vaccine cost the government Rs 850, taking freight, storage and other charges into account. He doesn’t know where the vaccines are coming from, though. He doesn’t consider it pertinent to the issue, and would rather have the media highlight the fact that by the evening of Polio Day, there was 85 per cent coverage in Murshidabad. A figure completely contrary to the scenario at the booths, and one which implies a nearly-robotic pace of door-to-door immunization post-afternoon on Polio Day. Mondal, though, would neither be discouraged from his convictions, nor stand for anyone — least of all the media — to question his claims.

At Begunbari, one man, incensed at the BDO’s bland bureaucratic promises to take up the case with the “higher authorities”, shouted, “Bachcha amader morey jak (Let our children die)!” I asked a little girl standing apart from the angry crowd why she was alone and where her mother was. “She’s gone to the neighbouring village with my brother because they won’t feed polio drops here,” she said, to my relief.