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Polio: stories from West Java

© UNICEF/IDSA/037/Estey
A plaster mould is being made of 1 year-old Ramdhan's paralyzed left leg. Using the cast, a technician at the RSCM Hospital in Jakarta will make a brace to help straighten the leg and aid walking.

The under-fives of Indonesia have been immunized against polio for the third time in four months. The outbreak started in the district of Sukabumi, West Java and has spread across 10 Indonesian provinces, mainly in Java and Sumatra. It has crippled 302 children, most of whom had never received immunizations. There is no cure. While the virus continues to circulate, the only way to protect children is to keep vaccinating. The immunization campaign has cost US$39 million since the outbreak began in March, and is funded by UNICEF, The Indonesian Government and the international community. There will be another round early next year.

It’s early morning in the village of Cidahu, high in the hills of West Java and surrounded by rice paddies and banana palms. There’s a line of mothers and children outside the puskesmas, the village health centre. From a jeep parked outside, people unload colorful rubber mats, children’s toys and bags of assorted goodies. But this is no party. A closer look at the children’s legs reveals that they are wearing heavy shoes or plastic braces. Even the older children are being carried - because they can’t stand for long.

These are the first Indonesian children in a decade to have been stricken by polio. Nobody is certain exactly how the virus returned to the country, although the strain has been traced to northern Nigeria. The people unloading the jeep are doctors, physiotherapists and a prosthetics technician from hospitals in Jakarta. They are all volunteers, and have personally raised the money to pay for the children’s rehabilitation.

© UNICEF/IDSA/038/Estey
Dr Marianna and Alfien are worried about Dadaleni, 2. The left leg has been corrected but the right is curving. Alfien notices that the leg braces have hardly been used. “It is tough but without them they won’t make progress,” he says.

Dr Marianna examines the children first. She is looking for signs that their legs may be correcting, or conversely, becoming more curved. “It depends on the parents and how hard they are working with their sons and daughters. If the children do not wear the special leg braces or don’t do the right exercises, they will be badly crippled,” she says.

She’s delighted with three-year-old Meli who can bend her knees and stand on her tiptoes. “Three months ago, Meli couldn’t walk at all,” says Dr Marianna. “Her mother has been working hard with her – even playing soccer with her every day.”

Alfian makes the leg braces. He’s based at the RSCM Hospital in Jakarta, where his usual job involves creating false limbs for people who’ve been in accidents. When he meets a child with polio for the first time, he must make a plaster cast of the paralyzed limb. It is an emotionally distressing task. Today he’s making a cast for Ramdhan, a day before the toddler’s first birthday. The baby weeps and clings to his grandmother, Cia.

“The children always cry, which I find difficult,” Alfian admits. Ramdhan’s grandmother tries to comfort the child. “I had to bring him here because his mother couldn’t bear to,” she whispers.

Another ordeal awaits the children and their parents when they move into the adjoining room, where two more physiotherapists are standing by. They demonstrate to the mothers how to massage and move their children’s paralyzed limbs. The kids hate it.

“It’s difficult to treat them when they cry but we need to teach them strengthening exercises, like how to stand up from a sitting position, and get them to practice,” says Budi, one of the physiotherapists. “You develop your own strategy to cope with their distress. You have to get on with the job.



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