by Miriam Meijer

Child with sequelae of polioOnly today's fear surrounding HIV/AIDS can rival the feelings Americans used to experience about poliomyelitis ("polio") in the first half of the twentieth century. Known as infantile paralysis, polio was the great crippler of children. Spread in ways similar to the common cold or flu, polio was more rare when sanitation was poor. Improvements in waste disposal and the widespread use of indoor plumbing made epidemics of polio appear with regularity in the developed world, primarily in cities during the summer. After sewage was dumped away from the drinking water supply (a development that helped reduce diseases like cholera), babies were less likely to be infected with polio and gain protective immunity. Children were then exposed to the virus going to school or swimming in public pools. Accumulating polio sufferers hobbled on crutches, rolled in wheelchairs, or laid immobile in giant iron lungs.

With the victorious end of World War II, President Franklin D. Roosevelt, who was himself crippled by polio in 1921, declared a "War on Polio." The tremendous resources of postwar America were brought to bear on the hope of developing a vaccine. A vaccine for polio was theoretically feasible—in contrast to the pathogens like malaria and HIV. By the early 1960s, the Jonas Salk's killed-virus and Albert Sabin's live-virus polio vaccines were proven effective. The last case of indigenously acquired polio in the United States occurred in 1979. By 1994 the World Health Organization (WHO) certified the Region of the Americas as polio-free.

On October 29, 2000, the WHO Western Pacific Region—the second in the world—was certified polio-free by an independent panel of international public health experts. This region consists of American Samoa, Australia, Brunei Darussalam, Cambodia, China, Cook Islands, the Federated States of Micronesia, Fiji, French Polynesia, Guam, Hong Kong (China), Japan, Kiribati, the Lao People's Democratic Republic, Macao (China), Malaysia, Marshall Islands, Mongolia, Nauru, New Caledonia, New Zealand, Niue, Northern Mariana Islands, Palau, Papua New Guinea, the Philippines, Pitcairn Islands, the Republic of Korea, Samoa, Singapore, Solomon Islands, Tokelau, Tonga, Tuvalu, Vanuatu, Viet Nam, and Wallis and Futuna. The last indigenous case of polio in the Region occurred in a 15-month old girl, Mum Chanty, who was paralyzed in Cambodia in March 1997. The successful outcome of polio immunization can be proved only years later and depends on the accurate recording of statistics and a groundwork of epidemiology.

The Global Polio Eradication Initiative was launched in 1988. It is spearheaded by WHO, Rotary International (which has contributed US$378 million so far), the U.S. Centers for Disease Control and Prevention (CDC), and UNICEF. It is also supported by national governments, private foundations (such as The UN Foundation and The Bill & Melinda Gates Foundation), development banks (e.g., The World Bank), donor governments (including Australia, Belgium, Canada, Denmark, Finland, Germany, Italy, Japan, the Netherlands, Portugal, United Kingdom and United States), humanitarian organizations (such as the International Red Cross and Red Crescent movement) and corporate partners (e.g., Aventis Pasteur, De Beers).

The number of polio cases globally has dropped by over 95%, from an estimated 350,000 in 1988 to 7,094 in 1999. There have only been 1,481 confirmed cases of polio so far this year. The WHO European Region (made up of 51 countries, including the Commonwealth of Independent States) has not had any new cases of indigenous polio for almost two years. At the end of 1999, the poliovirus was circulating in only 30 countries in the world, 17 of which have had confirmed poliovirus transmission so far this year. The virus still circulates in South Asia, including Bangladesh, India, Pakistan, as well in West and Central Africa, including Angola, the Democratic Republic of the Congo (DRC), and Somalia.

"National Immunization Days" (NIDs) and intensive house-to-house mop-up campaigns are conducted to interrupt the remaining chains of poliovirus transmission. Volunteers in the developing nations play a key role in combatting polio. Once a month, for a day or a weekend, an enormous apparatus of health workers, vaccine and equipment is mobilized to deliver the oral polio vaccine to every child under age 5. More than 10 million people have participated in mass immunization campaigns in recent years. On November 5, 2000 in India—in which 50% of the world's polio cases occur—hundreds of thousands of people fanned out across the country to immunize more than 100 million children in a polio vaccination blitz.

In Africa, children are often automatically given inter-muscular anti-malarial injections at the first sign of serious fever, though the fever in a particular case may well be from polio rather than malaria. Since traumatizing a muscle when the body is trying to fight polio greatly increases the chances of it suffering paralysis, the widespread instinct to treat fevers with injections causes the paralysis rate to be unusually high in Africa.

Leaders from West and Central Africa have launched the largest public health initiative in the region's history. The countries that are synchronizing their NIDs include Benin, Burkina Faso, Cameroon, Chad, Côte d'Ivoire, Gambia, Ghana, Guinea, Guinea Bissau, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone and Togo. Over several days, health workers and hundreds of thousands of volunteers are joining forces to immunize 70 million children through the Economic Community of West African States (ECOWAS). President Olusegun Obasanjo has pledged US$15 million for the purchase of polio vaccine for NIDs in Nigeria in 2000 alone. Nigeria is the largest remaining reservoir of wild poliovirus in Africa.

Without wheelchairs, crutches, and prostheses, mobility-impaired people in developing nations have to crawl, scoot on leather or bamboo mats, or remain bedridden in parental homes. They have a terrible time staying clean in the unpaved or muddy streets. Everyone has difficulty interacting normally with individuals who are obliged to crawl on the ground. One would rather completely avoid having to think about what it might mean to live with such a severe disability and thus prefer to ignore a disabled person as much as possible. Others, fearing that the disabled person's hands, legs and clothes are dirty from contact with the ground, do not want to have any contact.

Unthinking or uneducated people even "blame the victim" by viewing the disabled as "cursed" (the disability being a "punishment" or having some other supernatural cause) and/or "ruined" (i.e. incapable of much but begging on street corners). Treated as social outcasts, disabled people can suffer detrimental psychological effects. Many are so self-conscious and lacking in self-esteem that they live more or less on the fringe of society and associate only with other disabled persons. Internalized oppression is a process whereby disabled people are made to believe what is said about them is true (i.e. terms like "invalid" which is Latin for "worthless," phrases like "twisted mind in a twisted body," and stereotypes). They are "pushed" to agree to or accept the invalidating feelings. Thus a disabled person will believe that he/she is "sick" or at least, "inferior," has forfeited his/her right to a full life, cannot make decisions for him/herself, is the victim of a malevolent fate rather than a malevolent social system, is a burden on society and that his/her needs are met only by the kindness of people, based on their compassion and not their respect.

Recognizing the power that words have, people with disabilities have created a new language that portrays disabled persons in a positive manner. The new lexicon on disability suggests replacing "the handicapped" with "persons with disabilities/disabled people;" "physical handicap/cripple" with "persons with physical disabilities;" "deaf and dumb/deaf mute" with "the deaf;" "retarded" with "persons with mental handicap;" "mad/mental" with "persons with mental illness;" "epileptics" with "persons with epilepsy;" and "person suffering from a…" with "person with a…" The terms "impairment," "disability" and "handicap" are not interchangeable! The United Nations' World Program of Action defines "impairment" as any loss of psychological, physiological or anatomical structure or function. "Disability" refers to any restriction (resulting from an impairment) of ability to perform an activity considered to be within the norm for human beings, and "handicap" means a disadvantage that limits or prevents the fulfillment of typical social roles.

Handicap is the function of the relationship between disabled persons and their environment. Since polio is holed up tenaciously in places that are at war or without governments, the Democratic Republic of Congo (DRC, formerly Zaire), a huge inaccessible part of Central Africa, is one of the primary remaining bastions of polio. In the absence of the vaccine dose, which costs approximately US$0.03, the next best thing is a high-quality hinged brace, costing roughly US$150 (well-made braces can last 10 years or more), because orthopedic braces help level the playing field for individuals disabled by polio. Early last year, some diasbled Congolese in the cities of Kinshasa and Lubumbashi founded the Association Congolaise pour l'Assistance Orthopédique aux Jeunes Handicapés (ACAOJH) or "The Congolese Association for Orthopedic Assistance to Young People with Physical Disabilities." Visit their web site, which is supported by the International Polio Victims Response Committee (IPVRC), a U.S.-registered not-for-profit charity (the tax deductibility of donations is probable, but cannot be guaranteed until IPVRC's tax-exemption application is formally approved by the IRS), to view photographic evidence that a brace is not just a "drop in the bucket!"

Eradication of this crippling disease by 2005 would conclude the second deliberate destruction of a virus by humans (the first was smallpox). To achieve worldwide eradication of polio, access to all children must be secured (including those in conflict-affected regions), a US$450 million funding gap must be closed, and political commitment in both endemic and polio-free countries must be maintained. Hopefully the number of countries in which polio is still circulating will drop to 20 by the end of 2000. However, polio-free regions must maintain certification-standard surveillance and achieve safe containment of laboratory stocks of the wild poliovirus to prevent inadvertent release. Medical experts, meanwhile, recommend vaccination because travelers can re-introduce the disease.

B i b l i o g r a p h y

D'Aubin, April. "The Power of the Pen: Empowering Words," Conquest: Newsmagazine of the Disabled Peoples' International (Sept. 1989): 4. (DPI North American/Caribbean Region, P.O. Box 220, Liguanea, Kingston 6, Jamaica).

Hassan, Javad. "Disabled People and Attitudinal Barriers," Vox Nostra, International Newsletter of Disabled Peoples' International 2 (1990). (101-7 Evergreen, Winnipeg, MB R3L 2T3, Canada).

Polio Information Center Online (PICO)

Rice, Barbara. "Child with sequelae of polio" (1999) photograph, courtesy of the Centers for Disease Control and Prevention (CDC), Source Library PHIL ID#984. ber2@cdc.gov

"Story of Polio," Public Broadcasting Service (PBS)

Werner, David. Disabled Village Children (available from The Hesperian Foundation, P.O. Box 1692, Palo Alto, California, 94302).

World Health Organization Press Releases (October 29, 2000).

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