Recognizing Dr. Roma Solomon’s 24 years with the CORE Group Partners Project India secretariat

CORE Group Partners Project (CGPP) wants to recognize Dr. Roma Solomon, who worked for 24 years on our project, leading the India secretariat from its inception in 1999. Roma retired last week.

A medical doctor by profession, Roma became the executive director for the project after serving with South India AIDS Action program, Rotary’s PolioPlus program, and Christian Children’s Fund. Joining CGPP brought her hope in solving one of the biggest issues she saw in polio work at the time. “We quickly realized that a large part of the problem lay in surveillance,” she explained. “There was a fear [from community health workers] that reporting a case would lead to action being taken against you on the grounds that you weren’t doing your job properly.” Roma said that when the government started going door-to-door to survey for polio, suspicions began to increase from the communities. “People would ask, ‘Why all this just for polio when we need so much more and you neglect us?’ They thought it was covert sterilization and they resisted.”

This wasn’t the only resistance Roma, her team, and community workers faced. She has stories of vaccinator teams getting hot water thrown at them by community members, among other horrible treatment. But Roma found a way to listen beyond the violence. “The community was not prepared for such an ambitious and intensive health program where global standards of data collection, reporting, and accountability had to be followed. A very coercive family planning program in the 1970s made people suspicious of this program in 1999 when vaccinators landed on their doorsteps without previous warning. The suspicion and resistance were heightened when all sorts of rumors connected to the vaccine surfaced, starting with impotency, HIV/AIDS, etc. Then 9/11 happened and people thought that a certain community was being targeted due to its links with the al-Qaeda. Entire villages used to get emptied the day before the immunization campaign round, at times due to a fatwa—a formal ruling or interpretation on a point of Islamic law—circulated by an imam. To nullify that fatwa, our field staff had to set out at night to look for the perpetrator. Poor service delivery from the health and other departments also prompted such violent reactions. For example, if the government frontline workers did not provide good healthcare, or streetlights or roads were not looked after, people were angry and reacted by refusing the vaccine,” she said.

As for her and her team, she said she was intentional about keeping morale high. “The initial phase was very difficult because there were polio cases coming up everywhere and refusals were spreading. It was akin to a war, and our motto was to fight to the finish. And that’s what we did. All team members had access to me personally and communication channels were open all the time, whether it was a personal problem, especially for women, or a program-related one, no matter how small it was,” she said.

“My attitude from the beginning was to leave my ego behind when I went to work. Also, I never gave a chance to anyone to complain that I was rude to them or fought with them, no matter the provocation. Of course, my biggest support came from Ellyn Ogden. She repeatedly told the partners that I represented her in India and whatever I said came from her!” Roma said. USAID’s Worldwide Polio Eradication Coordinator Ellyn Ogden was there when CGPP started, and she and Roma have worked together since 1999.

As Roma has watched the world become more gender-aware, she said there’s still a long way to go. “The mindset at the field level hasn’t changed much. Women need to empower themselves and not wait for the men to change since they are encultured to be patriarchal. Education, negotiation skills, and diplomacy are all steps towards equality. At the same time, I believe that there should always be respect for each other, no matter what the gender is. I have seen women, once empowered, turn even more gender-insensitive and militant. I have seen women being nurturers, more sensitive but practical, having better problem-solving skills, and these need to be used as their strengths, not as conflict points against males,” she said.

One positive change she has seen is in who brings children for vaccinations. “More and more fathers are turning up, rather than mothers. In patriarchal settings like ours, baby care is taken as a mother’s job, but she needs her husband’s permission for vaccination. So, this is seen as a sort of role reversal,” she said.

Another major positive was the way that polio work brought a certain sense of unity among all development partners. “The virus brought us together with one single purpose,” she said, “to work together to protect our children from it. We were forced to look at the disease from a human angle and from the parents’ point of view.” CGPP India served as a liaison between the government and civil society. “Unless we involve people for whom this program is intended, it will not work. It is a people’s program.”

And when Roma says people, she doesn’t mean just one group of people. When the project was experiencing resistance from Muslim communities in Western Uttar Pradesh, Roma approached the Shahi Imam (the imam of one of the largest mosques in India) to discuss the reluctance of community members to get vaccinated. She presented him with facts and figures about the dangers of polio, its transmission risks, and the need for prevention. She shared that this work was the work of protecting children. This led to support from the Shahi Imam alongside other influential religious leaders.

Her beliefs about equality spans religion, gender, and economic status. “It’s too easy to think that we’re the educated elite and the community is uneducated, stupid, and without wisdom. I believe that every woman who matures to become a mother gains a certain kind of wisdom: no mother wants to see her child sick. Mothers are not stupid to deny interventions that would benefit their children. Their being illiterate or lacking knowledge should not be equated with stupidity. It is our failure if we cannot convince her or understand the reason behind her refusal,” Roma said. “Refusals need time to change toward acceptance.”

One of her most memorable moments in over two decades of work speaks to this. “On one of my field visits, the community mobilizer led me to what we called a refusal household. I saw a woman my age washing clothes in the open veranda. As soon as she saw me, she ran inside and picked up a little girl and asked me to leave. I sat down beside her and started a conversation with her, trying to find out the reason why she did not want her grandchild to get vaccinated. To my surprise she started crying and told me that she had just lost a grandson because he was given some injection by a local ‘doctor’ for ‘fever’ and she didn’t want to lose this child too. The community mobilizer and I spent the next half hour with her, explaining how the polio vaccine works and how it would protect this child and not harm her. She agreed to not only vaccinate the little one but also spread the word among her friends and neighbors,” Roma said.

Not too long ago, India had been one of the most stubborn places worldwide to eradicate polio. In a truly remarkable accomplishment, India completed 2012 without a single case of wild poliovirus. The country was certified polio-free in March 2014.

Sustaining community participation for polio vaccination after achieving polio-free status is an immense challenge. Today, in Uttar Pradesh, Haryana, and Assam, CGPP vigilantly addresses pockets of low immunization coverage by reaching significant populations of migrants and underserved communities with effective communication interventions for polio campaigns and routine immunization sessions. The secretariat is responsible for many innovations including reaching out to barbershops and building indigenous communications tools. Over time, CGPP India became a knowledge hub for other CGPP secretariats getting started.

Still, the work of polio eradication continues. Roma said that she is both fulfilled and unfulfilled in seeing how far this work has come. “We have missed many deadlines,” she said. “The world needs to work harder and faster before the virus re-emerges in polio-free areas. It can spread like wildfire and would wipe off billions of dollars and years of hard work. Somehow, I feel that the world is not very aware of the progress made and the efforts that have gone into the program so far. This war needs to be won as soon as possible,” she said.

As far as leaving a legacy, Roma said she hopes that she, along with her team, have been able to do justice to the communities they’ve worked with. “For me personally, compassion, empathy, and social justice means a lot and I have tried to work keeping all three in mind. As a team, we have been successful in transforming a generation of young women from volunteers to professionals who have the confidence and ability to move to higher positions,” she said. (A recent study was completed on CGPP India’s community mobilization coordinators and the transformative changes among them. The secretariat is currently working on publishing those results in an academic journal.)

For others working toward vaccination uptake in their regions, Roma suggests three things:
1.   Keep yourself aware and pay attention to technical updates on vaccine-preventable diseases,

2.  Do not provide freebies to promote vaccination (because “parents must realize their responsibility in keeping their child healthy and disease-free”), and

3. Work with children, parents, and all community members on infection control guidelines.