Polio immunization in Tajikistan: Reaching out to those who are hardest to reach
by Olga Grebennikova
After an hour’s journey from Dushanbe through beautifully tended gardens and fields we arrive in Gissar district centre. Dropping in at the district Immunization Centre we pick up the Director and deputy chief doctor pediatrician and travel to those villages where “hardest to reach” people are living.
We are heading for the villages of Sokhtmonchien and Afgonobad. They are located only a few kilometers from the district centre, and therefore they cannot be called “remote and isolated”. But when we arrive in the villages, we feel like we’ve gone back to the last century.
Here, behind the high wattle and daub walls, life continues like one or two centuries ago. Of course, every house has a television and satellite dishes adorn several roofs, but these are the only signs of the 21st century.
We are in settlements that are home to one of the most important target groups for the polio vaccination campaign - the Roma. Here they are also called Lyuli. These people are travelers, and almost all families are constantly on the move. Despite this, there are usually lots of children in the families, though this does not stop the families from roaming around the country. One of the results of this lifestyle is that some of the children have never been given any vaccination.
Another reason for it is that the Roma usually feel themselves marginalized and usually prefer not to show up in the officially established vaccination points. That is why both Tajik Government, WHO and UNICEF decided to reach them at home.
“We’ve been working here every day since the beginning of the campaign,” says Salim Mirkhoev, Director of the district Immunization Centre. “The campaign has been carried out in a vaccination point set up in a local school and some families brought their children themselves for the immunization . But we decided to come to these villages for home vaccination, because again yesterday new people turned up in the village, and the day before as well. We have already immunized 39 extra children, but it looks like we’ll have to keep going.”
Nasiba is 24 years old – she has three children who are all in our target group. The oldest is 5, the second 3 and she is carrying the third in her arms – her younger son who is just 8 months old. “When I planned to come yesterday,” says the shawl-wrapped illiterate woman, “it was late, and our house is very far away. That’s why I stayed in the centre of the village with relatives in order to get the vaccinations. I was told that it is a very contagious illness, and I don’t want my children to get sick,” she says. The young woman can’t read, but nevertheless we gave her UNICEF booklets with reminders about the second and third rounds of vaccinations.
“Even if one non-immunized child is left in the village, it would be like a bomb for all the children in the village and the area, because everyone should be vaccinated without exception. We are all responsible for them,” says Umeda Sadykova, Health and Nutrition Programme Assistant for UNICEF.
In Gissar district there are slightly more than 38 thousand children under 6 years of age, and more than 90 per cent of them have already been vaccinated. The population of Tajikistan on the main is disciplined, and trusts doctors and the mass media.
“The problem is just in those communities where even residents don’t know how many families are away from the village at any time, and when they are coming back,” says Salim Mirzoev.
Ilkhom will soon be 5 and he bursts into tears at the sight of strangers, but the doctor tenderly strokes his head, soothing him with words, and the astonished boy swallows the vaccine, not even noticing the taste. He had been on the pastures with his father, says his mother, and he just got back this morning. It’s good that you came today.
Khidoyat is 35 years old, she has three young children and none of them has been vaccinated of any diseases so far. “We have just got back from Rudaki,” she says. “My children don’t know what vaccines are.”
It’s remarkable that almost all the adults who we have talked to know about vaccinations and are very well disposed to them, despite the fact that such communities usually value their closeness and lack of trust in outsiders.
But seeing, or rather feeling, the warm relationship from our side they repay in kind. They pose with pleasure in front of cameras and even ask to be photographed. They follow us around the village, smiling at us and trying to grab our attention.
“God bless you and your initiative,” says a very elderly woman, when we say goodbye to a family after a doctor immunises two boys who had been kept in bed after circumcision. “You came to our house to save our children from this terrible disease. We will never forget it,” she says, raising her arms to the heavens.
How many surprising discoveries can be made in a day! It is necessary to take a step back from one’s prejudices and to try to understand another world, another culture, and other values.
Vaccination is ongoing in Tajikistan…