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A Vaccinator’s Resolve to Protect Every Single Child from Vaccine-Preventable Diseases

By: A. Sami Malik

Nankana Sahib, Punjab, Pakistan – March 2015: “I have been vaccinating children for the last 25 years,” says Farrukh Hussain the 43-year-old vaccinator who works at the Basic Health Unit, Budha village in Nankana district. “I have five children of my own, three girls and two boys, and I have vaccinated all of them myself. Vaccination is the first line of defence against vaccine-preventable diseases and every time I vaccinate a child it feels as if I have saved a life.”

Farrukh’s profession as a vaccinator is also his passion. He has dedicated his life to vaccinating children and works with energy and passion. His sole objective is to protect every single child from vaccine-preventable diseases. With a vaccine carrier placed behind his motorbike, he reaches out to communities living in the remotest areas of the Nankana Sahib district. 

© UNICEF/Pakistan/2015/Asad Zaidi
Farrukh Hussain (43), vaccinator at the BHU Budha, giving the second dose of Pneumococcal vaccine to ten-week old Abdur Rehman while his mother Sumaiya Idrees holds the child. 

Nankana is a city and capital of Nankana Sahib District in Punjab province. Being the birth place of the first Guru and founder of the Sikh religion, Guru Nanak, it is a popular pilgrimage site for Sikhs from all over the world. Thousands of pilgrims, mostly from the neighbouring India, visit Nankana Sahib to pay their respect and attend various festivals held during the year. The district has a population of around 1600,000 of which nearly 58,000 are live births. The district health authorities work vigorously to vaccinate them against vaccine-preventable diseases. 

After completing his intermediate certificate in 1989 from a school in Lahore, the provincial capital of Punjab, Farrukh returned to his native village in Nankana district. He enrolled in a three-month training course for vaccinators conducted at the Tehsil (administrative area) Headquarter Hospital Nankana and upon successful completion, started his practical life as a vaccinator. After working as a vaccinator for quarter of a century, Farrukh today enjoys the reputation of a highly conscientious and hardworking professional. 

© UNICEF/Pakistan/2015/Asad Zaidi
With a vaccine carrier and related equipment placed on his motorbike, Farrukh reaches the remotest areas of Nankana Sahib District to vaccinate children against vaccine-preventable diseases.

Recalling early days as a vaccinator, Farrukh says, “My hands would shake and my heartbeat "It is like saving children and their parents from a lot of pain and worries later on.”increased every time I injected a child. It felt as if I was hurting them. But soon I realised how important it is to vaccinate children during the early years of their lives. It is like saving children and their parents from a lot of pain and worries later on.”

The process of immunizing a child against vaccine-preventable diseases begins immediately after birth and will go on till the child is two years old. During this time, a child is vaccinated against Tuberculosis, Influenza Whooping Cough, Tetanus, Hepatitis B, Diphtheria, Measles, Polio and Pneumonia. The role of a vaccinator in protecting children against vaccine preventable diseases is extremely important as vaccines are temperature sensitive and need to be stored and administered with extreme care. 

In 2012, the Government of Pakistan added Pneumococcal vaccine for prevention against Pneumonia to the group of antigens given to children within the first two years of their lives and became the first country in South Asia to introduce this particular vaccine. Gavi, the Vaccine Alliance, which brings together public and private sectors with the shared goal of creating equal access to vaccines for children living in underdeveloped countries, provides the Pneumococcal vaccine and financial support while UNICEF and WHO provide technical support to health authorities in Pakistan. 

After the decision to add Pneumococcal vaccine to the routine immunization regime, vaccinators working in the public health system were given a two-day training on management and administering of the vaccine. Farrukh received this training at the District Headquarter Hospital, Nankana Sahib. “Our entire vaccination team was trained on handling and injecting Pneumococcal vaccine,” says Farrukh. “The group included Vaccinators, Lady Health Workers/Visitors (LHW/LHV), Sanitary Inspectors and the Community Disease Control Supervisors. We were given practical demonstration on how to manage the temperature of the vaccine and how to inject the child’s left leg. We were given easy to understand literature in local language and were initially made to practice on rubber models.”

© UNICEF/Pakistan/2015/Asad Zaidi
Farrukh Hussain prepares to vaccinate children against vaccine-preventable diseases during one of his visits to the community. 

The addition of Pneumococcal vaccine to routine immunization has drastically reduced the cases of pneumonia amongst children. In rural communities of Punjab, the household is usually large and each family has on an average four to five children with not much age difference between their births. Hygiene level is not ideal and children roam around in open areas which make them susceptible to community-acquired pneumonia. Earlier, a large number of children would get pneumonia, especially in winter season. Since the addition of Pneumococcal vaccine to routine immunization regime, the number of cases has gone down and if a child catches pneumonia despite being vaccinated, it can be easily controlled with medication and the recovery is quick.   

By and large, communities living in Nankana Sahib have a proactive attitude towards getting their children vaccinated. Farrukh explains, “A complete course of Pneumococcal vaccination comprises three shots/injections given when the child is six, ten and fourteen weeks old. Mothers have the ‘yellow card’ on which we make an entry whenever a child is vaccinated. In case our visit to the community is delayed for a day or two, they either bring the child to the BHU or call us on the phone to ask about the team’s visit to their village.”

The challenge Farrukh faces in vaccinating children is in the far flung remote areas which are not covered by the Lady Health Worker (LHW). Each LHW is assigned a certain area which generally has around 200 to 250 households. In their catchment areas, the LHWs support the vaccination activities by mobilizing the target children for vaccination on the day when the vaccinator is supposed to visit the community. In the ‘uncovered’ area which does not come under the LHW the vaccinator has to go on his own and vaccinate children.
Farrukh explains, “Reaching communities in the uncovered remote areas is a challenge. Sometimes women in those areas prefer a female vaccinator but when I tell them that vaccination is a facility provided by the government free of charge which would otherwise cost them thousands of rupees, they understand.”

“Pakistan is the world’s sixth largest population with the biggest birth cohort,” says Dr. Saadia Farrukh, UNICEF Health Specialist EPI. “Each year, more than 350,000 children do not live to celebrate their fifth birthday; one of the major causes of these deaths is vaccine-preventable diseases“Each year, more than 350,000 children do not live to celebrate their fifth birthday; one of the major causes of these deaths is vaccine-preventable diseases.", 18 per cent attributed to pneumonia. In 2012, with the financial support of Gavi, Pakistan introduced PCV-10, realizing that this is an opportunity for strengthening routine immunization thereby leading to reduction in the disease burden due to Pneumonia in children under five years of age.” 

It is the dedication and resolve of health providers such as vaccinator Farrukh Hussain that makes a difference in protecting children and women against vaccine-preventable diseases. Vaccination is the most equitable and cost effective health intervention and healthy children grow up to be healthy adults and become productive members of a society. Timely vaccination protects children from disease and help them grow to their full potential – one of their basic rights.




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