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Azerbaijan: Immunizing hard-to-reach

by John Wendle

Driving southwest out of Guba past the village of Amsar, the road begins to rise. The road passes through villages of Nugadi One and Nugadi Two where young men sit and watch cars pass. The road continues to rise off of Azerbaijan’s coastal plain, past the mountain valley village of Gamgam and through Tengalti. These villages lie in the foothills of the Greater Caucasus in the Guba District in northern Azerbaijan.

Cresting the road as it rises between two steep hills, an ideal mountain valley opens up of vibrating green hillsides laced with weaving simple fences, flocks of sheep and bunches of orchards. The peaks of the High Caucasus can be seen rising up through a dip between two green hills in the distance. White with snow, the mountains they lie flat against the sky, massive and inert.

Winding down into the valley, a boy in a red sweater passes by on a horse, dragging behind it an A-shaped wood frame stacked high with hay. Though only an hour’s drive by local taxi from Guba, the valley seems to be a world away, and in most ways it is.

However, the village of Sabatli lies even further on. Switch-backing up the southern edge of the valley, another crest is reached and the road descends into yet another crease in the northeastern flank of the Caucasus.

The Velvele River glitters at the bottom of the next-removed valley in the morning sunlight. It is this mountain stream that defines Sabatli as a remote village. The Velvele lies braided across a wide bed of gray river stone. The main channel runs deep and fast in a dirty torrent, splashing dramatically against boulders.

The Velvele at this point is crossed only by a plank bridge reinforced with red-painted steel tubes. The bridge is wide and sturdy enough for only one local car but not sturdy enough to support a local 4WD vehicle or ambulance.

In spring the river swells with the melt water of the surrounding mountains making the ford impassable and the bridge crossing a tricky and wet undertaking.

Fording the river, the UNICEF vehicle plunges up to its axels in water and slips and grinds over submerged rocks. A group of small children watch as it pulls itself out onto the Sabatli side, river water streaming off it.

Up the bank and a two minute drive down Sabatli’s main road past ducks and gates painted with red diamonds set on blue, the small blue and white Sabatli Medical Clinic comes into view.

The clinic, set back on a patch of sheep-cropped green grass, is run by Dr. Arif Askerov, who has worked at the clinic for nearly forty years since 1968.

Dr. Askerov, a gentle man with white hair, presents a list of those vaccinated through the UNICEF-supported measles and rubella vaccination campaign. Showing the hand-written list, Dr. Askerov says that 292 children between the ages of 7-23 should be vaccinated in Sabatli, through nationwide immunization campaign, taking place from Feb. 27-March 12, 2006.

The day before, the last day of February, around 72 young people between the ages of 18-23, had come into the clinic to be vaccinated. This number would have been higher for those vaccinated outside the secondary school, but, according to Dr. Askerov, "around 20-21 young people will not get vaccinated in the village."

The doctor explained that some of the young men from Sabatli are serving in the military and that some girls have gotten married and left the village. The discrepancy arises from the fact that the list of those to be vaccinated was drawn up in November 2005.

While the young men doing their military service will get vaccinated through the same campaign at their barracks, the girls who have gotten married and left the village may be left off of vaccination lists since it is their responsibility to register with the health center to receive the vaccination in their new village.

Aside from this small problem, the campaign in Sabatli seemed to be running smoothly. Dr. Askerov said that "we had another vaccination campaign here some years ago, but we are very excited about this one."

The doctor, standing in his 1950’s-era examining room, with its glass cabinets and white, steel-framed beds wearing his Soviet-style lab coat and tall white hat, said that "the big difference between the first campaign and the present one is that the people of Sabatli are more active and willing to participate in the vaccination campaign." He added that there was a high level of awareness of the benefits of the vaccinations and of the campaign itself at the village level.

The only real resistance the clinic encountered in its efforts was from two families in the village.

"One family has just one son, so they are naturally protective of him. Also, he has asthma, and so they are even more careful," Dr. Askerov said. However, after going to the houses of both families and explaining that there was no risk and great benefits associated with the vaccinations, the families consented to have their boys vaccinated.

Even in the sun of the mountain valley, Dr. Askerov put on his great coat to lead the way down Sabatli’s main road from the clinic to the Elman Mamadov Secondary School.

With a UNICEF poster stuck to the front door and another inside the entrance announcing the vaccinations, the children were almost in a festive mood.

Shoving, pushing and shouting, children from 23-year-old mathematics teachers Sadraddin Agayarov’s class stood lined-up outside the director’s office where the vaccinations were being carried out.

Agayarov, himself an IDP who grew up in Sumgayit, said that both he and the children heard about the vaccination campaign on TV and that Dr. Askerov and his staff had also been to the school.

Most of Agayarov’s students said they had heard about the vaccinations on TV, although, as in most other rural areas in Azerbaijan, there are frequent power outages in the village. Most of the work done to educate the young people was made by Dr. Askerov and the people working at the clinic.

"In spite of the fact that there is a problem with electricity in the village, we at the clinic have made an effort to educate the children," Dr. Askerov said.

Although Dr. Askerov’s staff introduced the vaccination, the children at Mamadov Secondary School still had questions.

Agayarov’ who has been living in Sabatli for only six months after finishing his military service and university, said that the children did not fully understand.

"My students wanted to know what the vaccinations were for," said Agayarov’. "My students wanted to know why only children were getting the injections."

Agayarov’ told his class that the government and an international organization required it. He added that "it is normal for children to be afraid of such things and to have a lot of questions."

After Agayarov’s class had finished getting their vaccinations, a group of 10th and 11th grade students lined up to get their injections of the measles and rubella vaccine. A group of friends; Jamilya, Aytin, Yegana, Nailya and Gulnar, standing at the back of the line, are all between 15-16 years old.

Though at first shy and frequently covering their mouths to giggle, when the girls were asked what their first reaction was when they heard they were going to be vaccinated for measles and rubella, the became serious.

Jamilya, a 15-year-old whose favorite class is Azeri literature, said that her mother is a nurse. She said that her mother explained to her what vaccinations do and that they are good for her health.

"For us, it’s no big deal," said Jamilya.

Aytin, with her arm looped through Jamilya’s, chimed in, saying that "we’ve had a lot of vaccinations growing up."

Jamilya, picking up where she left off said, "It’s simple, we just need to get the vaccination."

Coming out of the room after getting her injection, Aytin’s only comment was, "It hurt."



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