KARACHI: Two-year-old Hazrat Bilal looks at people around him with tired eyes. His uncle, Abdul Razzaq, tries to get his attention by calling his name but Bilal looks up for a few seconds before looking away.

Presently residing in Liaquatabad’s Khamosh Colony, Bilal is one of the five children to have contracted polio recently.

This is the 14th case in Karachi and 15th across Sindh making its way among the 171 polio cases in Pakistan at present.

Know more: Sindh records year’s 15th polio case

On Wednesday afternoon, the family sat in one of the empty rooms inside their home to discuss what went wrong with Bilal. As his father, Khayal Mohammad, was busy at the roadside restaurant owned by the family, his uncle Abdul Razzaq spoke on his behalf. “He was really ill a month back,” he says as he tries to swaddle Bilal’s lower body with a wrapping sheet. “Our family doctor at the nearest Imam Zainul Abideen Hospital thought that he had got a meningitis fever as his neck arms and upper body had no movement in them. We shifted him to the National Institute of Child Health immediately soon after the doctor asked us to.”

The child had diarrhoea and fever for almost a week before being taken to the hospital, the family says. On being taken to the NICH, the doctors there asked them to wait for a ventilator to be available that alarmed the parents. “He almost made it to the ventilator but was declared ‘out of danger’ after five hours. He was admitted in the hospital for 13 days after that,” says Razzaq.

During this time, Bilal couldn’t sit properly. His arms were also paralysed for a while until he started making some improvement but he is in a much better condition now.

His mother Zakiya (last name not given), a 25-year-old woman, however, says that he still cries at night. “He wakes up in the middle of the night and cries till morning, and then there are times that he doesn’t wake up at all,” she says. Sitting in her lap, the child’s left foot is motionless until someone from the family touches it to make a point, making him wince in pain. Bilal is the youngest among Zakiya’s four children. She says, “I gave birth to him at home, back in my village in Tor Ghar tehsil of Khyber Pakhtunkhwa. There are no hospitals over there so he didn’t get immunised. It was only when I brought him to Karachi as a one-year-old that he got polio drops from a polio team that had come to our doorstep.” The mother said that was the only time the child had received the polio vaccine until he got seriously sick a month back.

The home, where12 more children apart from Bilal live, houses five families, says Razzaq. “We are very scared for them now. Their immunisation was done at a private hospital after we saw what happened to Bilal. We have never refused immunisation by the polio teams. What happened to Bilal was maybe because of the sheer laziness on our part, I think. We thought nothing would happen to him,” he adds.

The patriarch of the family, Gohar Ali Khan, moved to Karachi in the 1950s from Tor Ghar tehsil. He owns a number of restaurants in Liaquatabad, managed and supervised by his five sons. Sitting in the same room as his family, he quietly eats his lunch at the time of the interview, remarking later, “There were no immunisations during our times, and yet I survived for so long.” On hearing that, his son says that he has had a bypass surgery and is a sugar patient on medicines at the moment.

The family has been waiting for Bilal’s reports which were sent to the National Institute of Health in Islamabad for further verification, making him, what senior paediatrician Dr Ghaffar Billo calls, a “suspected polio case”.

Dr Billo says a polio case can be further verified after sending it to the Centre for Disease Control (CDC) in Atlanta, Georgia for gene identification, if the parents want to be completely sure. “But since we don’t have the basic practice of taking children for vaccinations, going for an advanced option like this becomes a luxury availed by only a few people,” he adds.

Immunisation coverage

About the current crop of cases specifically in Sindh, Dr Billo says the routine immunisation programme till the 1980s “was the best period for Pakistan as it covered 95 per cent of the children. The World Health Organisation started a national immunisation programme worldwide in 1988 but in Pakistan it kicked off in 1994. That period in between, where there was no activity with regard to polio, left the space for the virus to take its hold.”

Also, since then, he explains, “The population coverage for polio remained between 65 and 75 per cent; whereas it should be 95 per cent otherwise it won’t have the desired impact. So in a way, 35 per cent of our population has always remained uncovered with regard to polio immunisation, be it Fata, KP, Quetta or Qilla Abdullah in Balochistan.”

In Bilal’s case, he says, “One dose a year won’t make a difference, as it takes at least seven to 10 doses, with proper monthly gaps, to ensure immunity.”

Executive District Officer for Health Dr Zafar Aijaz says there are around “325 centres for polio immunisation across Karachi. And we, on our part, have been requesting the families to come to these centres to get their children immunised.”

He insists that it’s not only a job of government hospitals “but community at large to ensure there is awareness about polio”.

Like Dr Billo, Dr Aijaz also says that routine immunisation “is the main concern of our department. If routine immunisation is properly sustained and followed it will help us fight other diseases too.”

However, Dr Billo says that unless and until, “there’s proper reportage of cases and a genuine utilisation of funds we’ll be faced with same problems over and over again.”

Published in Dawn, September 25th, 2014