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Persuading the polio refusers

© UNICEF/PAKA/01P/Unknown
A child receving polio drops

By: Mary de Sousa

Lahore, November 5: For three or four days this month when Tehseen Akhtar takes to the tiny streets of her crowded neighbourhood in Lahore she will scan every small child she meets carefully. She will be looking for a little black indelible ink mark on the index finger of their left hand.

“That’s the sign that the child has been vaccinated against polio,” she says. “If I don’t see it and the child turns out to be the right age I administer the drops right there in the street.”

Mother and grandmother Tehseen Akhtar has been a Lady Health Worker for many years and began polio vaccinations in June 1999. She is known and trusted by everyone in her ‘patch’ of 123 households in this congested maze of streets that feels like a village but is just 20 minutes from the smart shopping malls of Lahore’s centre.

Despite Tehseen’s vigilance and status one family continues to refuse to have their two small children vaccinated. They come originally from the conservative North West Frontier Province and she has been trying to persuade them since they moved in over two years ago.

From November 14 to 16 Tehseen will once more be pounding the streets for National Immunisation Day when she will vaccinate 5-700 children under five a day. This year so far five full house to house NIDs have been carried out and two supplementary immunisations (SNIDS).

© UNICEF/PAKA/12P/Unknown
Polio vaccinators work in pairs. One administers the drops while the other registers and marks the child's finger

“No matter how many thousands of excuses they give me I will keep trying,” says Tehseen Akhtar, a polio vaccinator. “It is my duty to stop this disease and one day I will vaccinate their children.”

Pakistan is one of only four countries left in the world where the polio virus is endemic (the others are Nigeria, India and Afghanistan) and is close to eradicating the disease. In 2005 there were only 28 polio cases compared to 53 in 2004 and to date in 2006, 29 cases of wild poliovirus have been reported from 15 districts. Punjab has had just two cases.

Because of the persistent nature of the virus a handful of refusers, or even a single one, can leave the whole community open to risk. With 14% of Pakistan’s polio cases coming from refusal families, un-immunised children are a major concern.

 There are a variety of reasons for refusal. "Mostly they have heard the rumour that the vaccine will affect fertility," says Tehseen, “or that because it is free it is old medicine that the government is trying to get rid of.” Tehseen has the perfect solution for dealing with the first rumour. “I bring my daughters and their children with me on immunisation days and that way they can see it has not affected them at all,” she says.

To combat the spread of misinformation at a community level, UNICEF works closely to engage religious and community leaders as well as influential figures from the health sector to fill the knowledge gap.

Lahore has an added problem - vaccination fatigue. “People who have seen the vaccinators several times stop thinking of it as vital and don’t want to keep being bothered in their homes. They become indifferent and don’t make an effort if their child is out playing or sleeping’ says Tehseen.

As far as the recalcitrant family is concerned Tehseen in undeterred and plans another visit in a matter of days. “No matter how many thousands of excuses they give me I will keep trying,” she says. “It is my duty to stop this disease and one day I will vaccinate their children.”



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