She explains that the vaccine, taken in two drops of fluid, grows in the
intestine and is excreted by the body for a few weeks while immunity builds
up. She then clicks on a slide of an open sewer.
"You can see how it's rather easy for people to get fecal microbes on
their hands," O'Neal says. "In fact, even though only 93 percent of children
on average get vaccinated in a campaign, the other 7 percent get immunized
through the feces in the environment."
A groan briefly mixes with the tinkling of glassware as the Rotarians
settle in for the latest dispatch from their organization's 15-year campaign
to eradicate polio, the leading cause of childhood paralysis.
This scene at the Hotel Washington recently is not one that George F.
Babbitt, the title character of Sinclair Lewis's 1922 novel, would easily
recognize. A small-minded resident of a fictional American city, Babbitt
belonged to a Rotary-like organization called the Boosters Club. Lewis
lampooned it as little more than institutionalized selfishness, and his
unflattering picture still lingers in the American psyche.
That may be the reason so few people know that the heirs of Babbitt's
Boosters -- not only in Rotary but also in two other large clubs like it --
are now major players in the global fight against disease. They are engaged
in arduous and thankless campaigns against ailments that have largely
disappeared from the places where their members live.
Since 1988, Rotary International has
contributed $500 million and sent thousands of volunteers to work on the
polio campaign. The club is second only to the U.S. government in the amount
of money it has poured into the effort to eradicate a human disease for only
the second time in history.
In 1994, Kiwanis International adopted as its cause the elimination of
iodine deficiency, the biggest cause of preventable mental retardation in
the world. Since then, the club has provided more than $50 million to help
ensure that all salt used in food contains iodine.
Lions Clubs International, once famous for collecting and recycling used
eyeglasses, spent $148 million over the past decade on sight-preservation
projects in 79 countries. It plays an important role in a river-blindness
campaign in Africa, has trained 14,000 ophthalmic workers in India and
helped pay for 2.1 million cataract operations in 104 rural counties in
China, where last year it became the only Western "service club" allowed to
establish chapters.
The contributions of these clubs, however, go well beyond money. Over the
past decade they have essentially created a new species of nongovernmental
organization.
Unlike many medical charities in the developing world, these are not
small cadres of overworked, self-sacrificing idealists. Instead, they are
vast, permanent networks of well-connected people willing to put in small
amounts of time -- often in the form of lobbying and consciousness-raising
-- against a few targeted diseases.
"Their contribution goes way beyond pretty important. I believe that
eradication of polio would not have been feasible without the participation
of Rotary International," said R. Bruce Aylward, a Canadian physician who is
the World Health Organization's coordinator for the Global Polio Eradication
Initiative.
"Kiwanis is signed up indefinitely, not for donating money but for
raising their voice if they see any backsliding," said Frits van der Haar, a
Dutch nutritionist who heads the Network for Sustained Elimination of Iodine
Deficiency. "Outsiders like Kiwanis are the watchdogs. They see that the
work is done well and continues to get done."
In the river-blindness campaign, Merck & Co. provides the drug ivermectin
and Lions Clubs International pays to train African villagers to dispense
it. The "barefoot doctor" strategy that has evolved from the program may
become a model for other medical programs in places with few health
professionals, said Moses Katabarwa, a Ugandan epidemiologist and
anthropologist.
"The Lions, they have triggered off a process in which there is no
reverse," said Katabarwa, who recently moved to the United States to work on
river blindness with the Carter Center in Atlanta.
The three clubs came to their work independently, tracing similar paths
from their origins as social organizations for midwestern businessmen.
Rotary, the oldest, was founded in Chicago in 1905. Kiwanis (whose name
is a shortened form of an Indian phrase meaning "we trade") began in Detroit
in 1915. The first Lions Club formed in Chicago two years later.
All made charitable works in their communities part of their mission. The
Lions chose blindness prevention as a theme in 1925 when 45-year-old Helen
Keller challenged them to become "knights of the blind in this crusade
against darkness." All eventually opened clubs on other continents.
In the early 1980s, several Rotary leaders proposed beginning an
organization-wide project separate from local efforts. "This was contrary to
the beginnings of Rotary and was also contrary to the feelings of a lot of
senior Rotarians," recalled William T. Sergeant, who at age 84 heads
Rotary's polio activities. But the idea took hold.
At the suggestion of Albert Sabin, inventor of the oral polio vaccine,
Rotary chose as its goal universal immunization of children against polio
and several other infectious diseases. In 1986, it decided to support the
effort through 2005, the club's centennial year. It did not envisage
eradicating polio.
A two-year campaign brought in more than twice as much money as expected
-- $247 million, not $120 million. Partly on the strength of that support,
the World Health Organization in 1988 announced its intent to rid the world
of polio. A WHO-led effort had previously eradicated smallpox in a campaign
lasting from 1966 to 1980.
"A lot of people have very ambitious ideas, but almost nobody has the
funding to kick-start a global initiative," Aylward said. "Rotary was the
Gates Foundation of 1988."
But eradication has proved more difficult than anyone anticipated. The
target date was originally 2000; it is now 2005. The extra time required
more money. Earlier this year, Rotary completed a second fundraising
campaign, which raised $111 million -- again more than the target, which was
$80 million. The club's contributions, including interest, now total more
than $500 million.
Lions Clubs International, the world's largest service club, decided to
reorient much of its sight-saving efforts after it held a symposium with
experts in blindness prevention in Singapore in 1989.
"We were astounded to hear that blindness was increasing, particularly in
the developing world," said Brian Stevenson, a provincial judge in Alberta
who had just finished a term as Lions president. "They told us there were 40
million blind people in the world, and 32 million of the cases were or had
been treatable. So it gave us a lot of focus."
Lions set a goal of $130 million but raised $147 million for its
SightFirst program. The organization has funded more than 550 grants in 78
countries targeting the main causes of blindness.
Kiwanis's entry into the global health arena was due in part to the
example of the two other clubs.
In 1991, William Foege, former head of the Centers for Disease Control
and Prevention, asked the Kiwanis president, a physician named Wil Blechman,
what the club was doing for the world's children. Foege cited Rotary's polio
work and Lions' just-created SightFirst. While Kiwanis had urged local clubs
to have a charitable activity aimed at children younger than 5, there was no
organization-wide project.
"I will bring this to the attention of our board, because I don't know at
the moment," Blechman recalled answering sheepishly.
The board discussed the idea and ultimately surveyed its membership,
which favored a global project 2 to 1. UNICEF suggested a focus on iodine
deficiency.
Iodine is an essential part of thyroid hormone, which in turn is
essential to brain development. In places where diets contain insufficient
iodine, generally because the soil contains little and there is no seafood,
the intelligence of the entire population is shifted downward. In 1990, only
20 percent of the world's households consumed salt treated with enough
iodine to prevent deficiency.
UNICEF estimated the problem could be eliminated worldwide in five years
for $50 million to $75 million. Kiwanis took the challenge because it was
important, concrete and "something we thought we could handle," Blechman
said.
The organization pledged to raise $75 million and has already contributed
$57 million. The money pays for iodization equipment for salt manufacturers
and campaigns on the importance of iodized salt.
Occasionally, members of service clubs do the work themselves. Thousands
of Rotarians, both local and foreign volunteers, have participated in
national immunization days when vaccine is given to millions of children
over a few days.
Dave Groner, a 60-year-old funeral director in Dowagiac, Mich., has led
four groups of Rotarians to India and one to Nigeria. Next month, he will
take 14 people, 10 of them nurses, to Niger. They will all pay their own way
-- about $3,000 each. "We've never been asked to not work or to get lost,"
he said.
Occasionally, club members play a role nobody else can. Angola has a
single Rotary Club, 32 people who meet in the capital, Luanda. They are led
by Sylvia Nagy, who with her husband owns a foundry. In 1997, a 25-year
civil war, which ended last year with the death of rebel leader Jonas
Savimbi, was underway. There had not been a vaccination campaign in the
rebel-held half of the country in years.
Nagy, along with representatives of WHO and UNICEF, negotiated a truce so
immunization days could be held in June that year. Rotary rented planes,
boats and four-wheel-drive vehicles to deliver vaccine, and disbursed $4
million to far-flung vaccinators. About 2.5 million children were
vaccinated.
On Sept. 2, Angola marked its second year
without a single case of polio.
