Chasing Polio in Pakistan: Why the (Referred to As “Lady Health Workers” in World’S Largest Public Health Initiative Pakistan), Intermediate and Zonal May Fail
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BOOK REVIEWS Chasing Polio in Pakistan: Why the (referred to as “lady health workers” in World’s Largest Public Health Initiative Pakistan), intermediate and zonal May Fail. Svea Closser, Nashville: supervisors, and drivers. Her detailed Vanderbilt University Press, 2010; 232 pp. accounts of their endeavors to find unvaccinated children and give them Elisha P. Renne doses of oral polio vaccine capture the full University of Michigan gamut of social life, with some individuals dedicated to the goals of the campaign, In Chasing Polio in Pakistan, Svea Closser while others maneuvered to minimize provides an astute analysis of the Global their efforts. These narratives, along with Polio Eradication Initiative (GPEI) in one her descriptions of the difficult ethical of three countries where wild poliovirus decisions she had to make regarding how transmission has not yet been interrupted to report missed children, provide some of (Afghanistan and Nigeria are the other the best ethnographic depictions of a two). With a background in medical public health campaign to date. anthropology and public health, Closser Closser argues that the ambivalence was well positioned to carry out this and resistance of some health workers multi-sited research, which she discusses toward the polio eradication program— in seven chapters, intersected by five short expressed by foot-dragging, data ethnographic interludes. falsification, and reliance on patron–client Through her fieldwork, which relations that undermined WHO, UNICEF, included work with a district polio and CDC personnel’s efforts—reflect eradication team in Pakistan as well as resentment toward structures of inequality interviews with WHO officials in Geneva rather than suspicions about the vaccine and CDC officers in Atlanta, Closser has itself, as was the case in Nigeria. Closser made an invaluable contribution to astutely observes that this inequality both understanding the dynamics of a global perpetuates disease transmission and health campaign. In Kaifabad, the weakens efforts to implement health and pseudonym for the district and city where disease control programs (11). She argues she served as an inadvertent health that global health leaders and major polio consultant monitoring immunization program funders, who failed to take coverage, she worked with district health political concerns and power hierarchies department officials, women vaccinators into account, have contributed to the DOI: 10.1111/maq.12045 Book Reviews situation of ongoing wild poliovirus districts to NGOs—she suggests Rotary transmission in Pakistan. The difficulties International, USAID, organizations of this situation is compounded by what associated with Saudi Arabia, or national Closser refers to as a “culture of religious groups. Such groups would have optimism,” exemplified by public the flexibility to run immunization pronouncements of GPEI officials and campaigns, working closely with local program funders, namely that polio communities leaders, while WHO eradication is “just around the corner,” personnel would continue to manage case that the technical means are there, and that surveillance (191). Although Closser is not polio eradication is simply a matter of entirely sanguine about the possibility for political will that can be easily mustered. making such changes so late in the Despite these flights of fantasy—that implementation of the GPEI, such a political action can decreed from above revised approach might have been and that the technical measures can possible if back-up plans had been overcome all obstacles, Closser, is, as she formulated earlier on in the program. puts it, “unable to abandon polio Closser also considers the policy of eradication,” both because of the dangers eradication, which has been much debated of a resurgence of polio cases and because in public health circles. From her of the extraordinary efforts that many experience in Pakistan, she concludes that involved in the Initiative have made (178). eradication is a useful public health Indeed, she argues that anthropologists strategy, particularly in areas with poor have much to contribute to such global health care services. In such cases, health programs, particularly in the programs such as the GPEI provide a planning stages when accounting for the modicum of health care. Yet, because of feasibility of political support in the face of their narrow focus on one disease and not unequal power relations should be openly on other health problems, eradication evaluated. This recommendation stems programs contribute to the very global from her belief that medical inequalities that have hampered the anthropologists who critique health program’s progress in Pakistan. (One initiatives also have a responsibility to might also argue that this single-minded engage in constructive involvement. In focus contributes to the culture of this case, she suggests that anthropologists optimism that Closser rightly criticizes.) could contribute to planning for Part of the problem with concluding the alternative, locally specific, strategies polio campaign in Pakistan has been that based on partnerships between government officials, facing many pressing international and community-based NGOs problems, did not view polio eradication that would balance program goals with as a high priority. local needs and concerns. Recent events in Pakistan—the At the book’s end, she proposes one discovery of Osama bin Laden’s possible alternative approach for ending whereabouts in Abbottabad and the wild poliovirus transmission in Pakistan sequent trial and conviction of the that would shift responsibility in problem Pakistani doctor who aided the CIA by Medical Anthropology Quarterly setting up a hepatitis B vaccination scheme there—underscores the complexity of politics and global health. In Chasing Polio, Closser makes an excellent contribution to our understanding of this complexity. The book’s content, as well as its organization and clear writing style, make it a useful addition to courses pertaining to global health and public health initiatives. .