Arif T. Syam, Contributor, Jakarta
A lot of stories can be told about Rotary's fight against polio in Indonesia, which kicked off as far back as 1986. Now, exactly two decades later, the results are close to expectations.
Rotary International's fight against polio began in February 1985 when this non-profit organization announced the commencement of PolioPlus, a campaign to eradicate polio the world over. The target was that by 2005, the year marking the centenary celebration of Rotary's establishment, polio would have been eradicated worldwide.
In Indonesia, Rotary carried out this program in cooperation with the country's Ministry of Health. Under this program, it was compulsory for children under one year old to be immunized. At that time, Rotary District-3400 Indonesia, led by Abidin Kartasoebrata, worked hard to find US$6 million to finance this program for a period of five years. (See interview with Abidin Kartasoebrata).
Despite a lot of difficulties, the money was raised with the help of Rotary in the Netherlands, and the program was implemented between 1987 and 1992.
Since then, slowly but surely, the number of polio cases in Indonesia continued to decline. In 1990, the country reached the free-from-polio level covering over 80 percent of the children that this program had targeted. (Universal Childhood Immunization/UCI).
Following this success, when the routine immunization program ended in 1992, the Indonesian government decided to continue with the polio immunization program and intensify it by providing polio vaccines to cover children aged five years old and below.
Called Pekan Imunisasi Nasional (PIN), the National Immunization Program, which began in 1995, vaccinates children against polio every September and October.
This program has received strong support from other international institutions, local non-governmental organizations, the government and the public at large.
Acting Polio Partners, those supporting this program, include United Nations agencies like WHO and UNICEF and family welfare centers in neighborhood communities. Even religious organizations such as Fatayat NU (the women's branch of Nahdlatul Ulama), Aisyiah Muhammadyah (the women's branch of Muhammadyah) enthusiastically support this program.
""It is really good news that the wives of government officials from the regency to ministerial levels have enthusiastically campaigned for this program,"" Past District Governor Ritje Rihatinah, Rotary District 3400 Indonesia National Polio Plus Committee Chairperson commented.
Outbreak
As a result of this intensive campaign against polio, for almost a decade Indonesia was close to having zero polio cases. Unfortunately, in March 2005, a child in Sukabumi, West Java, was diagnosed with polio. This news stunned all members of Rotary International and the Indonesian Ministry of Health.
""Where did the polio virus come from? We'd been fighting it for almost a decade,"" PDG Ritje said, recalling her panic upon receiving a report on the case.
After careful investigation, it was discovered that the virus came from Nigeria. An Indonesian migrant worker returning from the Middle East to Sukabumi had been infected with the virus.
Dr. Julitasari, an expert adviser at the Directorate General of Contagious Disease Control and Environmental Health, said,present we can detect where a polio virus come from because each polio virus has its own identity. That's how we knew the polio virus in Sukabumi came from Nigeria.
""The disease must have been transmitted through several carriers. A Nigerian citizen went to Yemen and transmitted the disease to someone else who later went to Saudi Arabia, where the Indonesian migrant worker from Sukabumi eventually got it. The virus may have been transported through water. This virus came from an adult. An adult cannot develop polio after being infected with the polio virus but he can act as a carrier,"" Julita said.
Julitasari said that many people used rivers in their daily routines, such to wash clothes, plates and cutlery and to bathe. So, Julitasari went on to say, ""The outbreak in Sukabumi occurred through water.""
The Ministry of Health and Rotary Indonesia as well as the other polio partners immediately implemented the Outbreak Response Immunization (ORI) by checking the children living around the place where the outbreak occurred. ""When one child gets polio, 200 children in his surroundings may also get it but have no symptoms,"" Julitasari said.
The Ministry of Health later decided that PIN should be accelerated in its implementation and carried out a polio mop-up campaign in three provinces (West Java, Banten and Jakarta) in May and June 2005.
""In the first round, the result was quite satisfactory,"" said Dr. Jane Soepardi, head of Subdirectorate of Immunization, Directorate General of Contagious Disease Control and Environmental Health.
""About 6.4 million children were inoculated in this first round. However, in the second round only 5.7 million children were, which was a big decline.""
The decline was attributable to the death of several children who had apparently fallen ill after being vaccinated against polio. Negative media coverage also discouraged parents from taking their children to PIN stations.
As a result, polio spread to 10 provinces. The Ministry of Health and Polio Partners then decided to carry out the next PIN in three rounds in 2005, namely in August, covering 22,262,572 children aged under five or 95 percent of the target, September with 23,025,187 under fives or 97.5 percent of the target and November with 23,206,882 under fives or 98.2 percent of the target. As for the fourth round, held in February 2006, it covered 23,204,331 under fives or 98.5 percent of the target and the fifth round covered 23,661,212 under fives or 99.8 percent of the target.
Can't stop
""We have actually been trying very hard to make this program a success,"" said Past President Betty W. Muliadinata of Rotary Jakarta Metropolitan.
At that time, Betty said, with the help of our partners, door-to-door campaigns were conducted to look for children who had yet to be immunized. ""We even used a megaphone during these campaigns,"" Betty said.
With polio spreading to several provinces in 2005, Indonesia lost its free-from-polio status. ""We were actually sad because in 2005 it was the global target of Rotary International to eradicate polio once and for all,"" Betty noted.
However, she added, we realized the fight against polio should not stop.fight must continue until no more children are threatened with polio,"" she stressed.
Ritje concurred, saying that the fight against polio should never stop. ""This is in line with Rotary's motto of `Serve Above Self'. We must not stop assisting people who need to be helped. Neither must we too easily feel satisfied about what we have done!"" Ritje stressed.
As a whole, since 1986, Rotary International has extended to the Indonesian government, through WHO, a total of about US$13 million. The funds have been spent on polio vaccines, equipment for the storage of vaccines, mobilization, information campaigns and other activities related to polio eradication.
Julitasari, agreeing with Ritje and Betty, said,short, as long as there is still a country infected by polio, we must remain vigilant.""
In Indonesia, data collected by the Directorate General of Contagious Disease Control and Environmental Health up to February 2006 reveals there had been only two polio cases. The last case was detected in Southeast Aceh. Obviously, this is a sharp decline from the 303 polio cases detected all over Indonesia in 2005.
Meanwhile, Jane added that there was misinformation about cases detected in Lampung. ""Four children died. But, laboratory results showed that three of them did not die of a polio virus but due to acute flaccid paralysis (AFP), while the laboratory result of the other child is yet to come through as testing for the polio virus takes 28 days.""
And now, amid this ongoing fight against polio, the international community has given Indonesia recognition for its efforts. At the 59th World Health Assembly meeting in Geneva in May, where health ministers from all over the world got together, the Indonesian Minister of Health earned the highest appreciation for the successful eradication of polio in Indonesia.
Indonesia continues to strive to regain its free-from-polio status.
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