Drowning in polio
Pakistan says it is ready to face an Ebola outbreak should it occur here. The deadly virus has claimed thousands of lives in Africa. Meanwhile, Pakistan has had more than 160 cases of polio thus far this season and remains one of the three countries alongside Afghanistan and Nigeria that continues to struggle with the epidemic. The entire world has managed to control the disease, while the epidemic seems to be exacerbating here. The need to devise a new strategy is apparent. It is a positive development that the national manager of the Expanded Programme on Immunisation has recognised this need. However, there is a sense of urgency here as the history of implementing the polio campaign is not favourable; Pakistan began the campaign in 1974 but began eradication in 1993. Today, additional factors have complicated eradication in Pakistan. The first factor is terrorism and the threat to polio workers, who risk their lives for a few hundred rupees to go door to door and immunise children. Then, there is the unwillingness on the part of parents to allow their children to be vaccinated due to mythical beliefs that the vaccine causes impotence. Third, there is the shameful lack of hygiene across the country and the lack of hygiene awareness amongst our population. Poliovirus has been found in our sewages which is relevant because the virus spreads through faecal-oral routes or through contaminated food and water. And now, we are also dealing with decreased morale as officials are fearful to venture into ‘no-go’ areas in cities such as Karachi because of security threats. Globally, since 1988, there has been a 99 per cent reduction in cases. However, Pakistan might soon offset that statistic. The number of cases of the virus rose by 37 per cent in 2011 even though, according to Amnesty International, Pakistan had vaccinated 83 per cent of children in 1991. It is welcome that there is aid coming from international organisations, such as the Bill and Melinda Gates Foundation, to help mitigate polio in Pakistan. However, these resources must be used with utmost strategic planning, for which outside help should be sought as we have suffered the disease for too long.
IDPs’ protest
If there is one group of people who are entirely justified in protesting about anything they might choose to protest about, it is the internally displaced persons (IDPs) from North Waziristan Agency. There is no universally agreed figure as to how many there are, but about a million would not seem to be far off the mark — and this is also the figure given by the government. For many they have, quite literally, lost everything. Their homes, their livestock and their crops that were standing when they left, in many cases all gone. Pictures of the shops and market places in the centre of towns in the Agency show wholesale devastation. Once thriving communities blasted to rubble. They have lost their dignity as well, going from self-reliance to beggary in a matter of days as they were forced to move out by the ongoing Zarb-e-Azb operation. Hundreds of thousands live in makeshift camps in and around Bannu, and on September 18 their frustrations came to a head in the form of a confrontation with the police on the Bannu-DI Khan road. The complaints of the protesters were many but boiled down to a sense of having been abandoned and ignored by both the provincial and federal governments, despite the obvious and undeniable sacrifices they had made in the service of the state. They were also protesting against the prolonged power cuts in Bannu that is adding to their misery, and claimed that Wapda officials were deaf to their pleas. Some of the demonstrators agreed with the claims by the army that large areas of the Agency had been cleared of militants but there appeared to be no move to get the IDPs repatriated. The threat they made was to take their protest to the Parliament House in Islamabad and there stage a sit-in, presumably jockeying for space with the several thousand already camped there. There was brawling between the police and demonstrators and live rounds were fired into the air. The North Waziristan IDPs have much to justifiably complain about, and they deserve not only to be heard but also relieved of the burden of injustice that the state has heaped upon them.
A dangerous illness
There is rising concern about the increased incidence of cases of illness usually leading to death caused by the Naegleria Fowleri (NF) amoeba. This is a protozoic that lives in fresh water and if it gets into the human body, usually via contaminated drinking water, it attacks the nervous system and quickly causes paralysis and death. The survival rate globally is about one per cent, which makes it considerably more deadly in terms of mortality rates than the Ebola virus currently rampaging across the countries of West Africa. The amoeba lives in poorly chlorinated potable water and therein lies the source of current concerns. It is often wrongly diagnosed as meningitis in its early stages and by the time it can be diagnosed it is usually too late for the patient, and many diagnoses are made post-mortem. It has a relatively low incidence in Pakistan with the majority of reported cases being from Karachi. Ten people have died in Karachi since May 2014. There are a handful of cases nationally most years but now a spike has appeared, and it is difficult not to associate this with deficiencies in the chlorination of potable water in the city. There were 3,141 water samples taken in different parts of the city of which 561 were shown to be chlorine-deficient, or around 16 per cent of the total, a worryingly high figure. Chlorine is the globally used deterrent for NF. Some 30 per cent of the water in the city is inadequately chlorinated. It is true as pointed out by a chief chemist of the Karachi Water and Sewerage Board, that too much chlorine in the water is itself harmful, but this fails to address the point. The potable water system in the city is ancient, badly maintained and underfunded. Contamination with sewage is not unknown. Until the matter is resolved the residents of Karachi need to ensure that their drinking water is from a clean source and preferably boiled for a minimum of one minute. Prevention is better than cure — especially when there is no cure.
Published in The Express Tribune, September 22nd, 2014