Indonesian Children Grapple With Resurgence of Polio

GIRI JAYA, Indonesia —  Big tears stream down Siti Fauziah’s cheeks as she snuggles her doll and buries her face into her mother’s shoulder. She has lost her balance and fallen again as the 4 1/2 -year-old learns what it means to live with polio.

Siti is one of eight children in Indonesia now struggling to walk because of paralysis, victims of the country’s first polio outbreak in a decade. She and the others from a few poor mountain villages in West Java may never fully recover, leaving their parents stunned and asking why.

As Siti walks across the concrete floor of her crude cement home, her right leg drags behind her left, forcing her to limp.

“I want to go ride my bicycle,” she cries.

But when she climbs onto the tiny plastic bike with training wheels, her leg is too weak to turn the pedal. Her older sister helps push, but it doesn’t stop Siti’s tears.

“She just sits on the bike and the other kids pull her around,” said Siti’s mom, Sumarnah, speaking her native language, Bahasa Indonesia. “When she grows up, I cannot imagine what she can do with this.”

Siti lives in Giri Jaya village, high in the mountains off a crumbled road just wide enough for a small car. It’s only about 62 miles south of Jakarta, but the remote village might as well be thousands of miles from the capital for those who live there.

Rice fields dot the landscape along with cassava and banana trees. The only major traffic is from trucks at nearby bottled water companies, which have set up purification plants to tap the fresh mountain spring water.

Ironically, it’s the untreated water below that carries polio. Small ponds and reservoirs of brown water are everywhere along the road, often filled with children bathing and splashing, or women washing clothes or dishes. Many villagers have neither running water nor bathrooms, allowing sewage to seep into water flowing into the crude, outdoor wash areas.

Polio is spread through feces, contaminating water that infects people who have not been vaccinated. It usually attacks young children, targeting the nervous system, causing paralysis, muscular atrophy, deformation and sometimes death. The disease has been eradicated in much of the world, but remains endemic in Nigeria, India, Pakistan, Niger, Afghanistan and Egypt.

Polio hadn’t been seen in Indonesia, the world’s fourth most populous country, since 1995. Officials say it probably came from Saudi Arabia after a migrant worker or religious pilgrim returned home. More than 80% of Indonesia’s 210 million people have been vaccinated against polio, health officials say, but pockets without coverage remain.

Siti’s 33-year-old mother knows nothing of this. She initially thought that her daughter simply broke her leg and was shocked to learn that the water flowing into a small pond used for bathing below her house was probably to blame. She had not taken any of her four children to get vaccinations because they had always been healthy and she had heard that immunizations could cause fever or diarrhea.

Her only income comes from her husband, a tailor who works five hours away, bringing home about $21 each month when he comes to visit. The family has no phone or running water and is lucky to eat meat twice a year. Siti’s father found out about his daughter’s polio after he saw her on a TV news report at work and rushed home to be with her.

A few houses over, Yayat Nurhayati cradles Fikri, 20 months, who like many Indonesians uses only one name. The toddler’s big brown eyes are lively and he giggles while watching nearby children. But when he squirms and tries to get down, his mother pulls him back onto her lap.

Until recently, Fikri was running through the dirt yard among chickens and playing ball with the other kids. Now, when Yayat tries to stand him up, his chubby right leg buckles under the weight and hangs limp. His left arm was also affected and while he can still move it, he’s unable to raise it over his head.

“When he sees his friends playing around here, he wants to go but he cannot move,” said Yayat, 30. “I’m afraid that he cannot walk again. I’m afraid that he cannot do anything.”

She said she had never heard the word “polio” before Fikri became the first child in the outbreak. He came down with a high fever that left him sweaty and unable to move his legs. Even after learning that his condition could have been prevented with oral vaccine, Yayat remained skeptical -- Fikri’s older brother died about three years ago after getting a shot.

“I really regret that this happened to my son,” she said. “I would have liked to have had Fikri vaccinated, but I’m still afraid.”

Fikri and Siti have been vaccinated since being diagnosed with polio, and about 6,000 other children in the surrounding villages also have been immunized, the World Health Organization says. Indonesia plans to vaccinate 5.2 million children under age 5 by July.

It’s unknown whether the two children will ever have full use of their legs again, but there is still hope that the paralysis will lessen, said Arun Thapa, WHO’s regional adviser for polio in Southeast Asia, who investigated the Indonesian outbreak.

Both children have shown improvement; when they first got sick, they were unable to move their legs. But they still cry out in pain at night.

Exercise and therapy are essential to keep the muscles active, and the parents have been given vitamins to help supplement what’s missing from their diets. But the mothers worry that their children will spend the rest of their lives serving as reminders of a disease that everyone thought was gone.

“In this day and age, it’s very tragic when kids in a polio-free country have to be paralyzed because of polio,” Thapa said. “It’s terrible.”