October 17, 2014
The Polio and Jalsa Viruses in Pakistan
Not only have the polio and jalsa viruses paralyzed Pakistan, there are no credible plans to control them.
Pakistan has this curious penchant to get chalked up in the various lists of infamy. The Global Polio Eradication Initiative was started in 1988 and was based on vaccination and surveillance. Progress was tracked through surveillance of cases of acute flaccid paralysis with testing of stool samples and sewage for the polio virus in the area of the acute case. The results have been dramatic. In 1988 polio was endemic in 125 countries and paralyzed 350,000 children every year. By 2011 the number of polio cases had been reduced to 650. By 2012 only three countries remained where the polio virus had not been interrupted: Afghanistan, Nigeria and Pakistan. And Pakistan is the only country showing an increase in the number of detected cases.
The polio virus is transmitted through fecal-hand-oral contamination. It can result in weakness of the leg muscles or quadriplegia, respiratory failure and death. There are no effective treatments for the paralysis caused by polio, so the mainstay is immunization. The protection from immunization with the injectable and the oral polio vaccines is around 90%.
Pakistan had almost eradicated the polio virus in 2012 but the fake CIA hepatitis immunization program to gain information about Osama bin Laden brought efforts to a screeching halt. The Taliban banned all immunizations as they felt that immunization programs were being used for spying. Some radicals also believe that immunization programs will be used as a cover for sterilization of Muslim children. Since 2012 at least 40 health workers have been killed because of their participation in immunization programs.
The highest incidence of polio was in Taliban-controlled areas in North and South Waziristan. With Operation Zarb-e-Azb there have been fears that polio would spread across Pakistan with the exodus of IDPs. But we can use this as an opportunity to immunize; about 100,000 IDP children had been immunized by June 2014; the aim is to vaccinate 200,000 children.
But the bad news has not stopped. In September 2014 the polio virus was detected in the sewage of some major cities: Lahore, Rawalpindi, Karachi, Hyderabad, Quetta and Jacobabad. Very surprisingly Islamabad and Peshawar sewage samples tested negative for the polio virus.
Instead of spending from the public treasury to protect, actually over-protect, the prime minister, the president, the cabinet, parliamentarians as well as children of former prime ministers, we need to provide fool-proof security to immunization health workers. Bullet-proof vests, traveling with a cordon of soldiers and security of their homes are a compelling need. And if nothing else matters, perhaps we should be ashamed that India has eradicated polio; and most certainly, if India can, so can we.
A massive health education program needs to be initiated as well as infomercials repeated over all television stations, highlighting the importance of hygiene, immunization and population control. Unlike India and Bangladesh, Pakistan has no population-control programs in place and a good amount of its misery is the population rapidly outstripping its already meager resources.
Dharnas (sit-ins) are more difficult to continue and make a success of, compared to jalsas (large public gatherings). Tired of the stalemate with his D-Chowk dharna, Imran Khan figured he’d branch out into the jalsa business. Karachi was treated to a mammoth jalsa, as were Lahore and Mianwali. Noticing his dharna had gotten a bit old, Tahirul Qadri has planned a jalsa. And like the polio virus the jalsa virus is spreading. Bilawal Bhutto has taken some intensive Urdu lessons so he can scream at the Karachi PPP jalsa soon. Bilawal still needs to work on his genders, something his mother also struggled with. And the MQM need never worry; they have the corner on the market on jalsas. It never fails to amaze me that people from all walks of life sit for hours listening to alternately roaring and hissing Altaf Hussain, manic or somnolent, singing, reprimanding, praising or blackmailing a sea of his supporters.
As though high unemployment, hunger and disease were not enough to paralyze Pakistan, Eid brings five days of leave from work. Political leaders call for Day of Sorrow or Day of Fury type strikes for a minimum of two days and Pakistan seems to be a nation on a perpetual vacation.
I was in Karachi when Benazir Bhutto was killed. The city’s paralysis defied the mind. Many citizens get groceries on a daily basis and they suddenly faced hunger for days. The Islamabad dharnas have paralyzed governmental functioning and Pakistan is losing billions of rupees in numerous ways. The jalsas in various cities compromise the functioning of an already oppressed population even more. Opposition parties always do what they do best: oppose. The responsibility for government lies with the party in power. And the onus of resolution for the sake of the nation also lies with the ruling party.
Prime ministers and presidents sometimes begin to live in a severe and serious state of disconnect with the people. It appears that the Sharifs are deaf and blind, evidenced by the statements of the brothers as well as the tweets of Maryam Nawaz. For her to tweet that security has been ordered to beat citizens who shout “go Nawaz go”is as ridiculous as Queen Marie Antoinette allegedly saying “let them eat cake” when she was told that the French people did not even have bread to eat.
Enough is really enough. The Sharifs should try to resolve this, not just for the sake of Pakistan or the PMLN but primarily for themselves. An interim government, a thorough and rapid election investigation as well as mid-term elections are compelling needs. The backlash against VIP culture and the steadily rising frustration and fury of the people might be a trailer for bloody civil disorder. We must avoid that at all costs. Even the cost of the crown.
(Dr Mahjabeen Islam is an addiction and family medicine specialist. She can be reached at mahjabeen.islam@gmail.com)
