Why can't polio be eradicated from the impoverished flood plain region of India?

From The Times of India:

KHAGARIA, India -- On the sandy banks of Kosi river in north Bihar, a quiet crowd of several hundred people is waiting in the sizzling morning sun. A speck appears in the pale blue summer sky, rapidly growing in size — its a gleaming white helicopter. Within seconds it is hovering above the opposite bank, amidst the cornfields.

The crowd is awestruck at the monstrous machine as it settles down in billowing clouds of sand. Out comes the man everybody has been waiting to see — Bill Gates. Till recently the richest man in the world, he is visiting one of the poorest areas of the country: the flood plains of Kosi in Khagaria district of Bihar.

Nearly 70% of people in Khagaria are poor even by the low official standards. The literacy rate is only 42% and for women it is a shocking 20%, lower than the state average and less than half the national average. There is no industry, there are no minerals, and as if this was not enough, Khagaria is also called the Saat Nadiyon ka Sasural (the marital home of seven rivers) because seven rivers flow through it, flooding almost the whole district every year.

One of the most wretched corners of this district is the area between two massive embankments built in the 1960s to contain the angry Kosi waters. This area, spread over several districts was a fertile plain till a few generations back. But the embankments have trapped waters, and people within, converting the plain into a treeless sandy expanse where only one crop can be grown in winter maize.

Gates is choppering into this area.

Why has he decided to visit a small hamlet of Mohraghat in Alauli block? The Bill and Melinda Gates Foundation (endowment: $35.2 billion; total grants since 1994: $22.7 billion), chaired by Bill Gates, has donated millions of dollars to agencies like the Unicef and WHO for eradication of polio. Globally, polio survives in a handful of countries, including India. And this area is one of the hotspots. In 2009, 38 cases of polio were reported from Bihar, out of which nearly a third were in this area. Gates wants to understand the difficulties faced by people in the area, and the reasons why full coverage by immunization is not happening.

According to Dr Hemant Shukla, the WHO representative in Patna, reaching out to all children is difficult because of periodic flooding. "Families shift when the flood comes, and it is difficult to cross rivers to reach all the children," he says.

So Gates takes a stroll through the Musahari tola of the village after crossing the Kosi in a boat, accompanied by a bevy of eager officials, and followed by a huge crowd of curious villagers.

He is a curious type, asking a variety of questions to get a fix on the people.

He has obviously done is homework and wants a hands on grasp. He chats will the anganwadi workers, who supervise the immunization programme. He discusses the transport of vaccines with volunteers.

He displays an inclination to reduce problems to the nuts and bolts — who keeps the records, the ANM or the ASHA, he asks trying to pin down any gaps in record keeping which would interrupt the dosage chain.

But when confronted with larger problems, he flounders. People complain of lack of basic health facilities.

The primary health centre (PHC) is more than 8 km away, and patients have to cross two rivers by boat. "If there is an emergency delivery case, we can't get attention," says Gita Devi, whose husband is a boatman.

There are only 49 auxiliary nurse and midwives under the PHC, against a sanctioned strength of 76, says Dr Ram Narayan Chaudhury, one of the doctors at the Alouli PHC. As per the district health plan for 2009-10, the block should have 51 health sub-centers but it has only 37. So, the delivery of basic health services is itself a distant dream.

Gates can only promise to take up the matter with the CM Nitish Kumar, whom he is meeting that afternoon. The villagers hope against hope. Isn't the spread of polio linked to lack of sanitation and basic health facilities? Gates acknowledges this fact but says that it is for the government to do the needful. "We are concentrating on the eradication of polio, which is achievable through vaccines," he says.

Most of the people following Gates around in the village are not aware of who he is. Some of the younger, educated persons know of him through newspapers. "We have come to see him because he is the world's richest man," says Manish Kumar, a student, who knows the polio connection. For the children, the chopper is the main attraction.

Gates himself leaves satisfied. "I can go back and tell the other donors that 'look, I have been there, the work is superb, but They need more support'."