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Real lives

On polio’s last frontier in Pakistan

© UNICEF/2003/Hajaj
Healthworker Falaknaz, 19, is a vaccinator for the polio eradication programme in Pakistan.

Mardan, 16 October 2003 - “Come on, it’s not far now,” laughed 19 year-old Falaknaz. We followed her cautiously up the treacherous, muddy path leading to her village, on Pakistan’s North West Frontier province. Behind us, the green mountains of the Afghan border lay shadowed by the burning heat of late afternoon.

A group of local children flocked towards us, wide-eyed with curiosity, pointing and laughing as we slipped and struggled towards them. Maybe we seemed more like a circus act, come to entertain them, than a group of polio immunization monitors from the faraway cities of Peshawar, Islamabad and New York, come to check on the progress of the polio eradication campaign in this far corner of Pakistan.

Our guide, Falaknaz, is barely more than a child herself, but she is entrusted with a serious responsibility. As a vaccinator for the polio eradication programme in Pakistan, she has been on her feet since 6a.m., trekking exhausting, unforgiving routes without rest. On her shoulder, she carries a vaccination box marked with a sketch of mother and child, the symbol of Pakistan’s immunization programme. Inside this box are precious vials of oral polio vaccine – two drops for each of the 225 children she will immunize today.

A tremendous challenge

Being a polio vaccinator in the North West Frontier province is a tremendous challenge. Because this province is now one of the five chief reservoirs of the polio virus in the world, polio immunization campaigns are held up to eight times every year here, each one spanning three days. For every round, Falaknaz and her fellow vaccinators will walk many arduous miles, knock on more than 100 doors, answer dozens of questions and may even confront hostile behaviour. No matter what Falaknaz faces in her work, she must be patient, diplomatic and above all, persistent. On her shoulders lies the trust of a community and the global eradication of a disease.

Polio may be a distant nightmare in the developed world, but in Falaknaz’s district - Mardan, in North West Frontier Province - a child was crippled with polio only last February. The incident has sent a thrill of fear throughout the community. During this immunization round, Falaknaz is particularly determined to make sure that every single child in her village gets the polio drops.

“I want to keep this disease away from my community, from my friends and family,” she says. This means going house-to-house in the blistering heat, and delivering the polio vaccine to every child under five years old.

© UNICEF/2003/Hajaj
Falaknaz explains the importance of immunization to a Pakistani family.

Eradicating polio

Without people like Falaknaz, polio would still be crippling 350,000 children a year.  Because of her, and millions of other dedicated health workers, polio has been driven back to only seven countries. So far in 2003, only 406 cases have been recorded, 96 per cent of them in three countries – Nigeria, India and Pakistan.

The Global Polio Eradication Initiative, a partnership dedicated to creating a polio-free world, anticipates that by 2005 polio transmission will have stopped forever. But today, Pakistan is still on the frontline of the fight against the disease, and Falaknaz and her fellow vaccinators have a lot of work to do. It’s a responsibility she welcomes.

“When I come to the door, most of the mothers welcome me, because they know me,” she says. “I tell them the vaccine is good for their children, and they let me give them the drops. In six weeks time, I will go back again, to give the children even more protection. This way we will drive it out of our village, out of our district and out of Pakistan.”

But it’s not always easy to find every child. “Mothers are busy and children want to play outside, so many of them are out when we come,” says Falaknaz. “Or maybe a mother doesn’t want to wake up her baby, if it is sleeping and fretful. Some parents listen to folktales about the vaccine being bad for children, and they become too frightened to bring their children to the door.”

To help Falaknaz keep a record of children she missed, the District Health Team gives her a tally sheet on which she keeps a careful note of every absent child. During immunization rounds, she will also leave a chalk marking on every house she visits, to record the number of children who received the vaccine and the children who will need to be “caught-up” later.

Now, at the end of a long day, she is going back to find every one of those “catch-up” children, to make sure that they too get their vital polio drops. As we near the top of the hill, I ask her why she does this work with such dedication.

“I am proud to help my community,” she answers, a smile breaking across her shy face. “And I will be proud when this disease has gone, because then people will see what women can achieve for their communities. If I can be respected for being a health worker and helping my neighbours, maybe other girls in my village will believe they can do the same."




17 May 2004: Watch video on women vaccinators in Pakistan.  Footage courtesy of the CARE film, "The Last Child"

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