Afghanistan cap­i­tal for po­lio

Many fam­i­lies re­ject vac­cine, want food in­stead.

The Times-Tribune - - OBITUARIES / WORLD - BY FAHIM ABED

At just 2 years old, Mad­ina had been vac­ci­nated seven times. It was not enough: When she fell ill this fall, a trip to the doc­tor in Kan­da­har City con­firmed that she was among the lat­est Afghan tod­dlers to con­tract po­lio.

Al­most 1 mil­lion chil­dren in Kan­da­har prov­ince alone, like Mad­ina, need at least one dose of oral vac­cine a month to head off the dis­ease, health work­ers say. But many of them also live in the most vi­o­lent and so­cially dis­rupted parts of south­ern Afghanistan, where the Tal­iban con­trol large ar­eas and do not want gov­ern­ment health work­ers go­ing door to door.

These re­al­i­ties make a sus­tained vac­ci­na­tion cam­paign bru­tally dif­fi­cult for health work­ers here. And Afghanistan, one of three coun­tries where po­lio is still en­demic, is los­ing ground. Of­fi­cials have reg­is­tered 19 cases of po­lio this year, up from 13 each of the pre­vi­ous two years, ac­cord­ing to World Health Or­ga­ni­za­tion fig­ures.

In Au­gust, I fol­lowed a po­lio vac­ci­na­tion crew in Kan­da­har and saw how, even in ar­eas where health work­ers have been able to func­tion, many things stand in their way: se­cu­rity fears and drought, deep poverty and sti­fling tra­di­tion, wide­spread il­lit­er­acy and su­per­sti­tion.

Still, start­ing just af­ter dawn each day, the vac­ci­na­tion teams are at it, hop­ing to reach just a few more chil­dren.

Mawlawi Ab­dul Rashid of Kan­da­har City, a re­li­gious scholar and mem­ber of one team, said most of the res­i­dents were poor and des­per­ately wor­ried about what their chil­dren would have to eat each night. Drought adds to the daily bur­den, with fam­i­lies in many neigh­bor­hoods hav­ing to buy water from tankers af­ter wells dry up.

Given that, Rashid said, “They don’t care about po­lio vac­cine as much.”

Mo­ham­mad Shah, 38, said that as a vac­cine cam­paigner in the city he had been vis­it­ing more than 100 houses a day in tem­per­a­tures reach­ing 100 de­grees Fahrenheit. He said some fam­i­lies asked for food and other ne­ces­si­ties in­stead of the vac­cine — a need that Shah, a fa­ther of five, said he un­der­stood.

“They keep ask­ing us to bring them wheat, soup and other staples,” he said.

De­spite ef­forts to have re­li­gious schol­ars ex­press sup­port for the vac­cine, Shah said mis­trust about it still ex­isted. Many worry about whether strict in­ter­pre­ta­tions of Islam al­low the vac­cine. Some ques­tion its con­tents and be­lieve con­spir­acy the­o­ries that Western­ers have ma­nip­u­lated it to cause in­fer­til­ity.

Ab­dul Razaq, 65, who was ad­min­is­ter­ing the vac­cine in the Loya Weyala area of Kan­da­har City, which is dom­i­nated by peo­ple dis­placed by fight­ing, said around 10 of the 200 fam­i­lies there re­fused it.

“It’s very dif­fi­cult to con­vince those fam­i­lies who re­ject the vac­cine,” he said. “But we try our best.”

Most fam­i­lies here hold tra­di­tional views wary of let­ting out­side men en­ter a home if no male fam­ily mem­bers are present. For that rea­son, the health work­ers try to have at least one woman on each vac­ci­na­tion team. But there are not enough fe­male work­ers, and all-male teams are fre­quently turned away.

Po­lio was erad­i­cated be­fore 2000 in Western coun­tries, but it is still a crit­i­cal is­sue for Afghanistan, said Desta­gir Nazari, of the Health Min­istry. “The world is try­ing to erad­i­cate the virus com­pletely,” he said. “It is an in­ter­na­tional re­spon­si­bil­ity for Afghanistan to erad­i­cate it, and we try our best to do so.”

Across Afghanistan, more than 10 mil­lion chil­dren re­quire po­lio vac­cine. The United States, Canada and Ja­pan are among the largest donors for the vac­ci­na­tion drive.

The vac­ci­na­tors’ days are long. They start early in the morn­ing, gather­ing in health fa­cil­i­ties of each neigh­bor­hood of Kan­da­har City to col­lect the vac­cine and vi­ta­min E tablets, which they carry in plas­tic cool­ers.

Teams then head out in rented taxis or on mo­tor­cy­cles, armed with lists of fam­i­lies in their ar­eas that have chil­dren younger than 5.

FAHIM ABED VIA THE NEW YORK TIMES

A med­i­cal worker ad­min­is­ters po­lio vac­cines in the Kan­da­har prov­ince of Afghanistan.

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