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The Optimist

India health progress collage

With national gains in health, the women polo players of Manipur, India, take their shot

The rumble of hooves rises above the honking traffic of Imphal, the capital of Manipur, India. Tann Thoudam, age 18, races her pony across the field, gripping the reins in one hand and her polo mallet with the other. Making a windmill motion, she strikes the ball, thwack, passing it downfield to her teammate who then takes a shot on goal.

The riders gather to discuss the set play, knowing that in one week’s time there will be stiff competition at the fourth annual Manipur Statehood Women’s Polo Tournament. They’ll compete against some of the best women polo players from Argentina, Canada, Kenya, and the United States. The Manipuris, some of whom picked up polo as recently as just a few years ago, are a long-shot to win the tournament.

Thoudam, who played in the inaugural Manipur Statehood Women’s Polo Tournament in 2016, remembers how formidable the other teams were. “The international players were intimidatingly tall and strong,” Thoudam says in the documentary Daughters of the Polo God. “I wondered how far they would shoot the ball with their strong arms.”

Unlike the visiting players, the Manipuris, most of whom are in their 20s and 30s, were born in an era when India ranked dead last in global health. In 1990, alone, 25 percent of all deaths in the world were in India. One quarter of the world’s under-five deaths were in India. Only 50 percent of the population ever saw a vaccine. And around 10,500 people contracted polio, which in many cases led to life-long disabilities.

Since then, the Indian government has doubled-down on solving its crippling health problems in partnership with internationally-funded health organizations like Gavi, the Vaccine Alliance, the Global Polio Eradication Initiative, and The Global Fund. Polio was eradicated in 2014. Under-five mortality is down by 69 percent across the country. National immunization campaigns reach upwards of 80 percent of the population.

And India now accounts for only 20 percent of global deaths – a significant change, considering its 1.37 billion people represent 17.74 percent of the world’s population. Moving the needle in India has a tectonic impact on global health figures.

The women polo players of Manipur are living symbols of a new India where the never-thought-possible has become possible. If the nation stays on track, a baby girl born this year has better odds of living to celebrate her fifth birthday (99 percent), graduating from high school (85 percent), and becoming a professional polo player in Manipur (1 in 31,000), than of being struck by lightning (1 in 4 million), killed in a traffic accident (1 in 9,000), or contracting polio (zero chance, so long as immunization rates remain high).

But statistics don’t win polo matches. To improve their odds, the Manipuris know they must train. Thoudam kicks her pony into a gallop and strikes the ball again downfield.

 

Under 5 mortality in India

 

Vaccine intelligence network pinpoints every last “drop”

Of course there will be an emergency while Dr. Santosh Shukla is away on vacation. He’s on the island of Sri Lanka when his cell phone rings. There’s been a system alert at the state vaccine store in Madhya Pradesh, where Shukla directs the state’s immunization programs. It’s a warning that a large stockpile of DPT and DT vaccines are soon to expire. Combined, they represent the opportunity to protect 25,000 children from diphtheria, tetanus, and whooping cough.

“We’re not going to let a single drop go to waste,” Shukla says.

The next day, he’s back at his desk in the capital city of Bhopal. Using the cloud-based program eVIN (electronic vaccine intelligence network), Shukla and his team pinpoint the precise location of every soon-to-expire vaccine vial around the state. They decide to create a strike force-style vaccine campaign to put them to use.

The eVIN app was developed in 2014 by the tech company Logistimo, in partnership with the Government of India, with funding from GAVI, and technical support from the United Nations Development Program. The app was piloted in Uttar Pradesh, by the Immunization Technical Support Unit, converting that state’s vaccine management system from analog to digital. It is now used in 21 out of 36 states and union territories in India.

Shukla helped implement eVIN in Madhya Pradesh. Almost overnight, program managers could monitor in real-time every vial in the state’s 58 vaccine stores with the push of a button.

The app showed them where there were vaccine shortages and overstocks, made it easy to order transfers between distribution points, and tracked expiration dates. It even monitored the temperatures at 1,126 cold chain points across the state.

And with nationally-trained mechanics stationed in every district, a faulty refrigerator could be identified and repaired within 48 hours, saving its contents from spoilage.

The DPT vaccines in question will expire in 30 days. An army of vaccine workers load their mobile coolers and set out by foot, bike, scooter, motorickshaw, even boat to deliver the vaccines to schools where children are waiting.

A few months later, Shukla is at his office when he gets another urgent phone call. It’s a representative from the ministry of health in Indonesia. Their analog-based vaccine management system is a mess. They want to learn more about this app known as eVIN.

 

India's polio vaccine coverage

 

Frontline health workers extend the “cold chain”

Kicking off her sandals, Abaron Bibi wades into the slow-moving water of the Brahmaputra River, a major waterway bisecting the Indian state of Assam. The river splits into a series of braids, creating an aquatic labyrinth with an archipelago of islands that are home to some of India’s most remote communities. These villages cannot be reached by road or bridge. The only way is to ford the river.

As Bibi walks into the water, she pulls a raft made of bound reeds. It holds a precious cargo: a blue cooler stocked with 100 doses of the measles-rubella vaccine.

The vaccine has led to a 51 percent reduction in measles deaths, thanks to an increase in immunization rates from 56 to 88 percent. Bibi is an “accredited social health activist,” one of the one million frontline health workers who do the jobs of connecting their home communities with local and regional health clinics. Today, Bibi ushers two auxiliary nurse midwives, and their vaccine coolers, to her village of West Mora-Godadhar Char.

At the river’s deepest, Bibi sinks up to her neck, her sodden clothes pulling her down as she struggles to keep her footing. Reaching the far shore, Bibi climbs out of the river, puts on her sandals and continues leading the team down the footpath to her village. The local elementary school has gathered the children for vaccination day.

“This is my village,” Bibi says. “If I refuse to do it, who else will?”

Once the cooler is open, the cold chain will be snapped. They must work quickly. The vaccines have traveled thousands of miles to reach Assam, stored along the way at a constant temperature of between 35.6 - 46.4 degrees Fahrenheit (2 - 8 degrees Celsius).

With the outside temperature hovering above 100 degrees Fahrenheit (37 degrees Celsius), it won’t take long for the vaccines to spoil. Bibi’s effort (along with the hundreds of other health workers making up the immunization pipeline) will have been for naught.

 

coverage of 8 essential vaccines in India

 

It’s game day and the Manipuri ladies are scheduled to play against the team from Kenya. The ball will drop at 5:00 PM at the Mapal Kangjeipung Polo Ground, the world’s oldest polo field. The international players say traveling to Manipur is their sport’s version of a journey to Mecca.

The Manipuris, though, have a different pilgrimage in mind. In preparation for the game, they visit a hilltop temple for the god of polo, Lord Marjing. According to Meiti mythology, Lord Marjing rode a winged pony named Samadon Ayangba in a polo match between the gods and humans. Legend has it another god clipped Samadon Ayangba’s wings out of jealousy, castigating the pony down to earth where it became the ancestor of the Manipuri ponies roaming free through the fields, streets, and markets.

The women climb a stairway cluttered with Pegasus-like figurines. At the top, they kneel before the statue of a winged polo horse and light candles, bowing low as a priest wafts ceremonial smoke over them.

Now with their ponies saddled, the Manipuris enter the arena where players from the opposing teams mingle in their brightly colored polo shirts. The grandstand is packed with cheering fans – the tournament has been advertised on billboards across the city – and the Manipuris are a crowd favorite. The women of the U.S. polo team, who mentored the Manipuris back in 2016, form an especially boisterous cheering section.

The Manipuris make one last ceremonial bow to the ground, touching their hands to the turf and back to their heads. They then step into their stirrups, rising five feet off the ground.

A referee throws the ball into play and a scrum forms of red (Manipur) and black (Kenya) polo shirts. Eventually, Thoudam emerges with the ball, kicking her horse into a gallop. A Kenyan player is closing in fast. She sees a teammate open downfield. Raising her polo mallet to the sky, she swings it with all her strength.

Thwack.

About the Author

Ryan Bell
Ryan Bell is a journalist whose pieces have appeared in publications such as National Geographic and NPR.

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