MICHELE NORRIS, host:
From NPR News, this is ALL THINGS CONSIDERED. I'm Michele Norris.
Our series on global health takes us to Indonesia today. In 2003 polio had come so close to being eradicated worldwide that some poor countries cut back on vaccination. Then the disease made a comeback, first in Africa. Last March Indonesia had its first new case in 10 years. Now 300 Indonesian children have been paralyzed and 60,000 have been infected. In the effort to get rid of polio and other diseases, parents often present a hurdle. That's because many don't allow their children to be vaccinated. NPR's Joanne Silberner has the story of two women who are trying to get parents in Indonesia to say yes to the polio vaccine.
JOANNE SILBERNER reporting:
Banten province is a few hours' drive from modern Jakarta, and it's a world away. Here farmers use water buffalos to plow their fields. They thresh their rice by hand. Most of Indonesia's polio cases have occurred in Banten. That's why UNICEF has sent two young-looking grandmas in baby blue baseball caps and UNICEF T-shirts to supervise National Immunization Day here.
Unidentified Woman #1: (Foreign language spoken) There are children here.
SILBERNER: Jane Miansen Magoba(ph) and Ibu Seranani Nani(ph) have come to a vaccination center in Suriman(ph), a small farming village.
Unidentified Woman #2: (Foreign language spoken)
SILBERNER: The problem is immediately evident. A woman in a red dress has just fled past the bamboo huts down the hard dirt alley. Her reason? A mother standing next to the vaccination post holding her baby. The baby is carefully outfitted in a white dress with pink and white piping. Her legs hang loosely down. The mother is telling everyone around her that the vaccine gave her baby polio.
Unidentified Woman #3: (Foreign language spoken)
Unidentified Woman #4: All her neighbors asked her what happened to the child. So that's why she explained to the neighbors that the child got polio one day after receiving the vaccine. And all the neighbors were scared, including the woman in the red dress just now. They think that all the mothers and children hide in somewhere else and refused the polintists(ph) who come to their house who want to give the vaccination.
SILBERNER: The oral polio vaccine almost never causes polio. With wild polio cases in the area, these children are at a much higher risk when they don't get three or more doses of the vaccine. Ibu Nani tells the mother her baby was infected before she got her first dose.
Unidentified Woman #3: (Foreign language spoken)
SILBERNER: But the woman's not convinced. There has been no polio for 10 years. The disease and the vaccine came at about the same time.
Unidentified Woman #4: She doesn't believe her. She doesn't believe Ibu Nani.
SILBERNER: Why not?
Unidentified Woman #4: She say that's the way all health worker say, but she just believe in the fact that the child was healthy but after one day receiving the vaccine the child got paralyzed. That's the fact and she believes in the fact.
SILBERNER: After a few minutes Ibu Nani gives up trying to convince the mother. She turns around to the health official vaccinating the few babies whose mothers have brought them in. They're nowhere near their goal.
Unidentified Woman #3: Forty-seven right now, but our tally is 221.
SILBERNER: Two hundred and twenty-one children live in this village, and it's the job of Ibu Nani and Jane Magoba to see to it that all are vaccinated. The district health workers say it's time to go out into the narrow, unpaved streets, so they all go. At a little shop there are a dozen women, many with babies on their hips.
Unidentified Woman #4: The midwife says that here--for the mothers here would you like your children to be immunized, that's OK. The vaccine is safe, but there is no reaction from the mothers.
SILBERNER: Only one woman agrees to have her child vaccinated. Ibu Nani plans on coming back tomorrow. Jane Magoba has seen parents refuse the vaccine before. She went door-to-door on a polio campaign in Nigeria.
Ms. JANE MAGOBA (UNICEF Worker): Somebody pulled out a sword because I went in his house to immunize. I was scared. I didn't know what to do. I thought I should run back. I thought I should beg him, but he pretended not to know English. So I just made a sign of the cross and he smiled and said `Go away, go away, go away.'
SILBERNER: At that time religious leaders in Nigeria were telling people falsely that the polio vaccine was contaminated and would sterilize young girls. Vaccination has since resumed, but not before carriers spread polio to surrounding countries and eventually to Saudi Arabia, Yemen and on to Banten province, Indonesia.
(Soundbite of busy street)
SILBERNER: The road through Banten province runs between a river and a canal. Jane Magoba pulls out a map of the area and points to where the local cases of polio have occurred.
Ms. MAGOBA: This is a polio case. This is a polio case. This is a polio case. You can very well see that the polio cases are very close to the river.
SILBERNER: This muddy brown canal is the center of social life. Jane Magoba sees people bathing here, washing their clothes and dishes, scrubbing their vegetables and more.
Ms. MAGOBA: Look at this. She's cleaning her teeth with the same water in which the other woman is bathing also, the same water in which the other men are bathing and the same water in which some children defecate.
SILBERNER: One woman is knee-deep in the murky canal washing her clothes. Children are swimming and diving around her. Through a translator, Jane Magoba tells her that the polio virus thrives in feces and can survive in water for several weeks or more.
Ms. MAGOBA: When a child gets the polio virus, it goes through the mouth from contaminated food or water and then it goes in the body and then comes out through feces, fecal material.
SILBERNER: But the woman says she's not worried about the canal.
Unidentified Woman #4: Hopefully, this canal is safe because from ancestors there is no virus.
SILBERNER: Jane Magoba decides not to fight the ancestors, which makes it all the more important for her to convince the parents in the canal to get their children vaccinated.
Ms. MAGOBA: So we thank her very much for having listened to us, and that they should protect their children against polio.
SILBERNER: Indonesia's polio outbreak began with one boy in March of this year. Health workers quickly started immunizing but problems cropped up right away. Three children died. Indonesian newspapers and television stations blamed the vaccine. Months later an investigation proved the deaths were unrelated to the vaccine, but meanwhile worried parents have kept a million children from being immunized.
Unidentified Man #1: (Via projected acoustics) (Foreign language spoken)
SILBERNER: At a nearby village things are going a little better. A man is announcing the National Immunization Day using the loudspeaker at the local mosque. Jane Magoba and Ibu Nani find mothers and children gathered on a porch around a worker from the local health center.
Unidentified Woman #5: What is our target here?
Unidentified Woman #6: The target is 85 children.
Unidentified Woman #5: So we are expecting to immunize 80 children here.
Unidentified Woman #7: I hope you can make success here.
SILBERNER: The health center worker pulls a vaccine vial out of a large light blue cooler while Jane Magoba and Ibu Nani encourage the mothers to come forward.
Unidentified Woman #5: A baby, wow, number one.
Unidentified Woman #8: His name is Hicma(ph).
Unidentified Woman #5: Hicma?
Unidentified Woman #8: Yes.
Unidentified Woman #5: ...(Unintelligible) number one. I'm so happy that you've managed to convince the mother.
SILBERNER: The mothers hold their children's heads back so the vaccinator can squirt two clear drops of vaccine into their mouths. Each child gets shortbread cookies or chocolate wafers. One mother in line is reluctant.
Unidentified Woman #5: The mother asked the health staff to check the condition of the child first because she is sick, but Ibu Nani say that it is OK for her to receive the vaccine.
SILBERNER: Part of the confusion for the parents is that during the summer a respected group of Indonesian doctors announced that sick children shouldn't get the vaccine. But that's not right. It is safe. Ibu Nani tells the mother the polio vaccine doesn't hurt sick children but the mother still refuses.
Unidentified Man #2: Let's go, let's go, let's go.
SILBERNER: After only an hour of giving vaccine at the immunization center, no more children show up. So the vaccinating team decides to go door-to-door.
Unidentified Woman #5: Are we now going house-to-house?
SILBERNER: Brightly colored sarongs, shirts, pants and skirts flap on clotheslines near most houses. When Jane Magoba sees tiny pants and shirts, she zeroes in.
Unidentified Woman #9: (Foreign language spoken)
Ms. MAGOBA: We need to find out if there are children in this house. Our priority is to find out if they are no sleeping children that have been forgotten, if there are no children that have gone to the gardens that have not been immunized.
SILBERNER: Ibu Nani is able to convince one mother. She eases the process by cradling the baby's head.
(Soundbite of baby)
Unidentified Man #10: (Foreign language spoken)
SILBERNER: But a lot of mothers still say no.
Unidentified Woman #11: (Foreign language spoken) 50 percent.
SILBERNER: Fifty percent doesn't sound like very--yeah.
Ms. MAGOBA: Today they try to take the children out of this village so we cannot find them.
SILBERNER: The refusals are getting to Jane Magoba. Her brother in Uganda was crippled by polio when he was three. She doesn't want to see other children suffering the same fate.
Ms. MAGOBA: You go home with question marks. Is there something we failed to see? And then tomorrow when you have your a polio virus case coming up, you actually feel so guilty. I was not convincing. Maybe I could have done something. What was it that I didn't do?
SILBERNER: Vaccine campaigns anywhere against any disease depend on parents allowing their children to be vaccinated.
Ms. MAGOBA: The lessons we are witnessing here are exactly the same lessons happening elsewhere, which shows that it's very difficult to eradicate polio. But I think it will be done one day. I'm very hopeful that it will be done one day and I remain hopeful that the polio virus does not spread from Indonesia to go elsewhere.
SILBERNER: In August this year there was a vaccination day and only half the children in Banten province received the polio drops. This time, Jane Magoba and Ibu Nani's relentless door-to-door pursuit of the children pays off. In the end, 90 percent of the children in Banten get the vaccine, but unfortunately that's not good enough. The disease can still spread. New outbreaks have already occurred on the other side of the country from Banten where the tsunami hit in Aceh province. Jane Magoba's boss at UNICEF, John Budd, is worried.
Mr. JOHN BUDD (UNICEF Official): And when you get it out of this country, it won't stop at any border. It'll keep going and anywhere you find a child that hasn't been immunized, the disease has a potential to infect that child.
SILBERNER: Indonesia will hold another immunization day at the end of November using a new, more effective vaccine that requires fewer doses. The fear is if that round isn't more successful, the virus will travel to other places, Malaysia, the Philippines, Thailand, Vietnam. Ultimately a virus as infectious as polio could even spread to unvaccinated children in the US. Joanne Silberner, NPR News.
NORRIS: A timeline of the global fight against polio and photos of Indonesia's vaccination efforts are at our Web site, npr.org. And global health coverage continues tonight on television. "RX for Survival" airs on PBS stations around the country.
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