National Immunisation Day
Drive Against Polio Eradication

By Balaram Chaulagain

AS a part of the global effort to while out polio from the surface of the earth by 2005 AD, national drive against polio began in Nepal five years ago. Today Nepal is launching the sixth year’s 1st round anti-polio drive across the country. Last year’s a nationwide mass campaign against polio was successfully completed. Consequently this year no new case of polio has been noticed so far. The five rounds of NIDs conducted in the last five consecutive years were completely successful. The generosity of WHO, UNICEF, USAID, Rotary International, JICA & such other international agencies in providing financial and technical support for the it is highly appreciable. Besides, the sincere role played by each and every individual, political parties, social organisation media and other concerned was also unprecedented. The immunisation drive against polio has brought about positive reports by sharply reducing the paralytic polio cases in the country. This year’s anti polio campaign is scheduled to be launched in more intensified way than before. Such additional polio immunisation programme would be a booster dose to the children residing in Tarai.

Polio is a highly contagious acute viral infection which affects children under five years of age with no specific treatment but only prevention through vaccination. Primarily, polio virus affects the alimentary canal, and may be transmitted up to central nervous system through the spinal cord resulting in paralysis or causing life long deformities of the body or probably death, too. To eliminate polio, all children under the age of five should collectively receive two to three drops of oral polio vaccine (OPV) four to six weeks apart in order to be immunised from the crippling disease. The OPV can be fed to all children irrespective of their previous routine immunisation against it. Keeping interview the health hazard caused by the polio, the government under its expanded programme on immunisation (EPI) has supplied polio-vaccine along with other globally recommended vaccines freely through all the health institutions across the country. It has been estimated that routine immunisation against polio could protect only 60 to 80 per cent of children susceptible to the disease. That is why, in order, to totally eradicate polio from society, all under five children, who may harbour the viruses, must collectively receive OPV. Due to different unforeseen causes many children are yet to be immunised against polio.

The OPV induces local as well as systemic immunity against the disease. It is a component of live, attenuated, harmless and toxinless viruses prepared by highly advanced modern technology. When children are fed such vaccine viruses, they get immunity themselves. Besides, the vaccine viruses are excreted through their stool and may be disseminated in nature to kill or replace other wild disease causing polio viruses. Therefore, the importance of NID is to cultivate vaccine viruses to overcome the disease causing wild polio viruses present in nature. Poor sanitation of over crowded cities and rural slums are believed to be fertile ground for the virus’ spread. For the last five years, SAARC countries synchronised the immunisation drive simultaneously against polio to create on epidemiological block of the polio case. In this regard, Nepal tried her best to accomplish the campaign successfully. Still, it is an irony to note that the South Asian region is unlikely to eradicate polio by stipulated time frame. It is so because polio does not obey the political boundaries of any country in spreading. As per some Indian news source, India could not successfully complete the last years’ anti-polio drive as anticipated. Consequently polio cases are still reported from a few districts in the country and a large number of children are left to be immunised. As such how the WHO hopes to erase the polio from the globe by 2005 AD.

According to the official source nearly 60 per cent of the world’s polio cases reside in Indian territory alone. Hence, so long as we fail to wipe out the disease causing polio viruses from the entire surface of the earth we can’t eradicate polio. As such, priority should be accorded in the areas where paralytic polio occurs abundantly. As per WHO’s policy line a country can only be declared polio free after its three consecutive year’s zero report on polio case. Polio has been wipe out in 155 nations, including all of North & South America and Western Europe, China and Australia. It has been learnt that the disease is still endemic in 116 countries, mainly in Africa and Asia where SAARC region is believed to be a fertile ground for paralytic polio including other vaccine preventable disease like tuberculosis, tetanus and others. As in the previous years Nepal is synchronising the sixth year’s NID drive with her neighbours. According to the Department of Health Services there will be 38 thousand immunisation booths across the country where around 1,00,000 volunteers and health workers will be mobilised to accomplish the gigantic task of feeding around four million children. Since highly communicable and a dreaded small-pox has almost been eradicated from our land, polio will also be eradicated soon if all work honestly towards this global mission.

Lastly, it goes without saying that so long as poverty and ignorance, which are believed to be a major attributing factors for the prevalence of the diseases like polio and such others, will persist in the society simply official efforts do nothing. For this, a strong political commitment with full public participation is necessary. The vigour and zeal we are putting to eradicate polio should also be applied to combat other diseases like tuberculosis measles HIV/AIDS, Heptatis B, and so on. So long as all intelligentia business communities, senior citizens, journalists, government service holders as well as common people who are concerned with the well being of their children fully do not take part in this mission we can’t succeed in eradicating polio. If a single child as left out to be covered during this campaign, polio may strike again hence all efforts from all quarters of life should be applied in this regard.

HIV/AIDS Problem In Nepal

By Mahendra Chalise

THE epidemic of HIV/AIDS, which appeared for the first time in the early 1980s, remained unknown in Nepal until 1988. It was considered that the new scours of the silent killer should have nothing to do, being its origin in foreign countries, with Nepal. Even in the capital city, where majority of the people are literate and enjoy the media like Radio, TV, newspaper, no one was aware of this new epidemic that has no cure. It was only towards the beginning of the nineties that some cases of HIV/AIDS were found in Nepal. Of 24 HIV infections officially acknowledged in 1991, six were foreigners, ten Nepali women and eight Nepali men. Nine out of 100 Nepali women who were reported to have HIV positive had returned from brothels in India, while the tenth got infected after receiving blood donated by an infected relative. All the eight men who were positive had a history of promiscuous activity.

As people were not informed and aware of the nature and characteristic of the infection of viruses and its implication, the above cases were found accidentally. There was a lack of surveillance due to lack of knowledge, information as well as the prerequisite. Till then even the government did not seem to have been much concerned about it, neither had it set up any agency to work seriously in this direction until 1994 when AIDS prevention and Control Project was formed.

In the following year, it was officially declared that 207 persons were found with HIV positive, 31 of them having AIDS and 15 dead. The figures are on the rise. As of October 30, 2001, it was officially declared that 2097 had HIV positive, with 533 of them having AIDS and 149 dead. Given that there are only about a few hundred reported infections in Nepal, there might be a notion among people that there is no need to be much concerned about it. Moreover, it should not be taken for granted the official figures were realistic because they are just the tip of an epidemiological iceberg. The unofficial figures are estimated to be at thousands, which might rise higher in the coming years if nothing drastic to prevent the spread of the infection is undertaken.

Indian Impact

Nepal is a landlocked country with India on three sides. People freely move to and from India through the open border. Now that the epidemic is spreading at an alarming rate in India, even ahead of the African countries, Nepal cannot remain unaffected from the transmission of the viruses from India. In this sense, India is the source of origin of HIV/AIDS epidemics in Nepal. Hundreds of thousands Nepalese migrate to India for employment. Religious pilgrimage and cultural exchanges are the other reasons of visits and contacts.

There are three modes of transmission of HIV viruses: sexual intercourse, blood transfusion and childbirth from infected parents. Transmission through sexual intercourse is estimated to account for about 80 per cent all over the world. It could go even higher in Nepal because of the stark poverty prevailing all over the country where people have no alternative means of recreation and entertainment except getting indulged in sexual activities. It is in this category that most of the risk groups fall, which is responsible for the spread of the epidemic. These are sex workers, migrant labourers, traders and travellers.

Some 5000 Nepalese girls are trafficked and sold in India every year. Of the sex workers in the Indian city of Bombay, where over 10 thousands brothels are in operation, 40 per cent are Nepalese. In spite of continued attempt to check the trafficking in women, the flesh trade has not abated. Besides Bombay, the girls are sold in other large Indian cities like Calcutta, Delhi, Lucknow, Baranasi, and Gorakhpur.

The traffickers use various devises and pretensions to seduce the simple village girls who are tempted to luxurious life and dream of holding lucrative jobs in big cities and even becoming cine artistes. Tired of the discriminatory treatment given by the parents and burdened under the incessant workload of farm and household together with the hardship of poverty, the uneducated girls are easily persuaded by the pimps.

Some agents assure the girls of marrying them to rich Indians, while some marry them in Nepal before leaving for India. But when they get landed in Bombay, the girls find themselves sold to brothels where they are tortured into submission and locked into the room, poorly fed and forced to serve 20-30 customers every day. And gradually, they get used to the trade.

Once they are accustomed in the sex trade they feel comfortable and enjoy life with more income, a part of which is taken away by their families back home to lessen the hardship of poverty and enhance their prestige in their village by paying off their debts, replacing the thatched roofs by the corrugated sheet and uplift their living standards. This practice limited to a particular areas like Sindhupalchok, Dhading, Nuwakot and Kavrepalanchok districts. This has encouraged the people in the neighbourhood to send their girls to Bombay for the ‘trade’. The families without girl wish to have the births of girl child.

In Bombay 47 per cent of the prostitutes are reported to have been infected with HIV positive. This shows that a large number of Nepalese sex workers have contracted the disease. As soon as they are found to have been infected with HIV/AIDS, they are instantly forced to go back to Nepal and many a time they are left helpless at the Nepal-India border. If they go back home they are generally not accepted in the family. In such a situation they have no other option left with them than going to some other towns and start the sex trade so that they can make a living to survive before disease topples then down to a deplorable death. Similarly, any number of these girls, who get married, brings about the same disastrous impact on the spouses and their kids.

Uphill Battle

Besides, the battle against AIDS even for the purpose of preventing the infection further seem to be immensely difficult and problematic because of peculiar characteristic of the epidemic. To put it briefly, the infection of AIDS has no symptom of its own; it is rather the symptom of known and usual diseases or mixture of diseases associated with no cure possibility. Besides, there is most likelihood to confuse and mislead the victims when they usually look healthy and normal enjoying life like others for quite some time. The antibodies tests, in case some one is suspected, is quite expensive and such test units are few in number making it beyond the reach of the people in a situation when such tests are required. This may lead to the transmission of the virus from person to person unknowingly.

All the factors put together naturally fans the fire of the epidemic even to a more dangerously extensive extent. If the government does not become firmly committed to controlling it, and INGOs and NGOs do not come out with necessary resources and dedication in concerted manner, the number of the victims can exceed hundreds of thousands in the coming years.