India celebrates polio success, but sad legacy remains

by Adam Plowright

Teenage shoe-shiner Amit contracted polio as a toddler, leaving him with damaged legs and a twisted spine. He has never seen a doctor and the country's eradication of the disease came too late for him.

On Monday, India will mark three years since its last polio case, leaving it on the cusp of being declared free of the ancient scourge in what is arguably its, and one of the world's, biggest health success stories.

But the wretched sight of crippled street hawkers or beggars on trolleys, withered legs tucked underneath their bodies, will remain as a legacy of the infections that took hold during the country's time as an epicentre of the disease.

Amit, who uses only one name, was sent out to work aged nine to help clear his family's debt and has squatted on a pavement outside a busy restaurant serving south Indian food for the past five years.

He says he was about three or four when he found suddenly that he was unable to sit up straight on a family trip and he toppled off his mother's lap while travelling on a bus.

"When we reached home, I still could not sit properly. Every time I would try to sit, I would keep tipping over and that's when my mother thought I've got polio," he told AFP in between serving customers.

"My parents never took me to a doctor, they took me to a temple instead, offered prayers and sought blessings from a priest for a cure so that I could walk properly."

Care and correction

The priest's prophecy that he would be cured of his problems by the age of 20 gave false hope. The contagious virus, once it attacks the nervous system, wreaks irreversible damage.

Estimates for the number of survivors left crippled in the country vary significantly.

In the absence of any official data, most experts agree it runs into several million given the history of the disease in India which affected up to 300,000 people each year before vaccinations began in the 1970s.

Even up to the mid-1990s, when eradication efforts began gaining momentum, 50,000-150,000 new cases were occurring annually, according to estimates from the World Health Organisation.

"I am one of the happiest people that new cases are not being seen," said Mathew Varghese, one of India's leading polio surgeons who has been operating at New Delhi's St. Stephen's hospital since 1987.

"Today we don't have a single one—that is a huge achievement—but having said that there is also a backlog of cases which needs to be planned for," he said at his polio ward, one of the country's only such facilities.

"These children who are stigmatised, hobbling or crawling or with crutches in their homes and villages, need to be brought to the mainstream."

Rather than young children, many of the patients he now sees are in their teens or older, whose muscles have wasted away and joints have locked due to constant sitting.

"They'll be here for another 30 or 40 years," he said.

His operations involve inserting multiple pins into the affected legs, which are then put under gentle but constant tension to stretch out the muscles and bones until the limb is straight.

It is a long and painful process, requiring up to four months of hospitalisation and many more of physiotherapy, which St. Stephens offers for free. At the end, the fortunate are able to walk, often with the use of callipers.

But as a result of shifting priorities, "the new surgeons which are coming out have no skills in doing polio surgeries", Varghese said.

Deepak Kapur from the Rotary charity, which funded the polio vaccination programme alongside the Indian government, UN children's agency UNICEF and the Gates Foundation, estimates there are three to four million Indians left crippled by the disease.

"We would encourage people all across the country and all across the world to look after the polio survivors because it is not an easy job for them," he said. "They all need the facilities to lead a dignified life."

Prevention, not cure

For understandable reasons, the focus of India's fight against polio has so far been on ending new cases, something for years thought impossible in a vast country with poor sanitation.

While it was stamped out in Western nations more than 30 years ago, the highly contagious virus which spreads through faecal matter broke out annually in India and was carried to other countries by migrants.

But after billions of dollars and private and public investment in a vaccination programme, January 13, 2011, marked the last reported case when an 18-month-old girl in a Kolkata slum was found to be infected.

India was taken off a list compiled by the World Health Organisation (WHO) of countries where is considered endemic, leaving just Pakistan, Afghanistan and Nigeria.

Now, three years since the last infection, India will be certified by the WHO as having eradicated the disease once all records are checked around the country.

This announcement is expected some time in February or March.

For Amit though, the future holds more labour shining shoes on the tough streets of the capital.

"I had thought about studying, but my parents had to pay off debts that came from temple visits, prayers, ceremonies and various offerings for my treatment," he said.

"I don't like this work anymore. I used to like it initially, but now I don't like it so much. I want to learn how to read and write."

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