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Fighting Together to Defeat A Common Enemy

 

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It took three years, a brave mother, a determined Community Mobilization Coordinator, a conscious imam, a pro-active gram pradhan and a concerned doctor to get Naeema’s third child, Zaid vaccinated.

Religious leaders, Health Workers and Community Leaders are collectively fighting resistance to vaccination to help children get better star to their lives in Pakbara village of Moradabad in Uttar Pradesh.

Text: Neha Khator
Photo Credit: UNICEF India/2014/Sumit Dayal

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House No. 238 in Pakbara village -Moradabad district- in the northern Indian State of Uttar Pradesh was for years an impenetrable citadel. Its peach-coloured walls and the only small entrance guarded fiercely by 60-year-old Azgari Begum. No one stepped in or out without the watchful eyes of Azgari Begum trailing. But there was one thing that even those old, trained eyes refused to see.

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Inside the fort lived Naeema Farukh, her daughter in law, a troubled mother of two ill children. Sameer, her first baby, was barely a day old when he contracted jaundice. A month later, he came down with pneumonia. When Saba, Naeema’s second child, was three months old, she too suffered a severe intestinal infection. “I was always irritated, crying and staying awake even at night, caring for two sick kids and managing household chores. Me and my kids were suffering but no one in the family seemed to understand,” says Naeema.

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“Both my kids have never fully recovered and are still very weak, which has affected their physical and mental health.” Sameer and Saba had never been vaccinated, refused even the polio drops. “My mother-in-law was against vaccination as she believed it to be the work of evil. She would say vaccines make kids impotent. ‘It is haram (forbidden) in Islam,’” explains Naeema.

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Rumours and suspicion against vaccination ran deep among the 70 per cent Muslim community in Pakbara village. Lack of awareness, unavailability of human resources, misconception and myths related to after-effects of Diphtheria, Polio Tetanus vaccines like fever and swollen thigh further strengthened the belief in the community that “vaccines were harmful for their kids”.

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But three years back, the Uttar Pradesh Government in partnership with UNICEF and the World Health Organization renewed its focus on Routine Immunization in high risk areas like Pakbara village in Moradabad district. High risk areas, mostly Muslim-dominated, poor and marginalized areas that resist vaccination were targeted.
“An estimated 10,000 children die in Uttar Pradesh each year due to diseases like measles that can otherwise be prevented by vaccines,” says Asif Husain, District Underserved Coordinator, UNICEF Field Office Moradabad.

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Utilizing its extensive network of Community Mobilization Coordinators (CMCs), UNICEF has built on the successes and lessons learned of its polio eradication campaign to increase acceptance of immunization among the community. Each CMC is allotted 500 homes. Every five days a week, a CMC goes door-to-door conducting awareness sessions and surveys to track the situation of families, children, newborns, pregnant mothers and assess their immunization needs.

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The databank is then shared with frontline health workers like Auxiliary Nurse Midwifes (ANMs) for vaccine procurement and ASHAs (An Accredited social health activists (ASHAs) and Anganwadi workers to spread awareness on institutional deliveries and breastfeeding. On immunization days, the CMC again goes door-to-door bringing kids to the vaccination centres.

“It’s not about going there and giving them information. It’s about building relationships with parents, gaining their trust and addressing their concerns,” points out Shama, one of the 14 CMCs working in Pakbara village alone. “The ANMs would administer the vaccine and often forget telling the mother about the fever, which is the biggest reason why 90 per cent kids dropout after second dose of vaccine. We follow-up with parents, comforting them and see how the kid is coping,” she adds.
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But changing attitudes in a closed-knit community needs more than just door-to-door counselling. Pakbara has 23 mosques and seven madrassas. Aided with quotes from the Quran (religious book) that promote child health, safety, hygiene and value of life, CMCs began mobilizing religious heads like imams.

“Imam sahibs would conduct vaccination announcements from mosque microphones and talk about immunization in their sermons on special prayer days like Eid. When religious leaders speak, people in the village sit up and notice,” states Husain.

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Besides imams, Hajis (people who return from religious pilgrimage to holy city of Mecca), gram Pradhan (village elders), local doctors and other community influencers were also approached and inducted, handed the responsibility of breaking the resistance to vaccination.
“After a CMC visit,” says Mohammed Haroon Saifi, Gram Pradhan, Pakbara, “villagers would come to me to ask whether the CMC had gave them the correct information. I would tell them that vaccination is important for their kids to grow healthy and develop their immune system.”
“In some cases, I would fasten the ration card process or any repair work of a villager if he agreed to vaccinate his kids. And happily, many did,” he smiles.

Finally, it took three years, a brave mother, a determined CMC, a conscious imam, a pro-active gram pradhan, a concerned doctor and faith in science to get Naeema’s third child vaccinated.
“I was at home when Shama came with the doctor madam (vaccinator). I didn’t want my mother-in-law to send them away and was determined to get my kid vaccinated. I told my sister-in-law to take Zaid to the doctor madam while I dealt with my mother-in-law, my husband and his brothers. Everyone shouted and made faces but I didn’t care,” recalls Naeema.
It was a big risk that she took but one she feels has paid off. “My Zaid is healthier than his siblings,” says Naeema, hugging him closer to her chest.

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Across India, Routine Immunization programme is catering to 27 million infants, saving four lakh children’s lives each year. In March 2013, there were 215 families in Pakbara alone which were refusing immunization. This year in March, the figure has come down to 65. From 25.87 per cent full immunization in January 2013, the figure in March 2014 was 93.11 per cent. 

“Since every fifth child in India is born in UP, any progress in this state creates a huge impact,” says Nizamuddin Ahmed, Communication for Development Officer, UNICEF. “About 5,000 community mobilizers – mostly female – are working tirelessly to reach 1.6 million children every month in high risk areas of Uttar Pradesh, bringing a positive change in the lives of women and children,” he explains.
But the battle is only half won, admits Ahmed. Out of 27 million children born annually in India, 7.2 million still remain unvaccinated. Nearly 47 per cent of the global child deaths from measles still occur in India.

 

 
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