Heroes without fame

Vaccinators save lives in Karachi’s islands

Aadarsh Laghari
Vaccinators sitting in a boat which will take them to island settlements around Karachi
30 April 2019

Karachi, Pakistan - 30 April 2019: Vaccinating children living on the many islands scattered around the port city of Karachi is no easy job.

Farzana Shakeel, 42, is one of many vaccinators in Pakistan who have dedicated their lives to saving younger lives, despite the challenges.

A mother of three, Farzana has become an experienced vaccinator, but her journey was eventful. She tells stories of being shouted at and pelted with stones in communities where people were unwilling to let her immunise their children. Some families would slam their doors in her face, some women would hurl abuses and some men and even children would threaten her.

“These are my own people, so this kind of experience only made me stronger,” she says with a vivid laugh, unseen but heard through her face veil.

Farzana, an experienced vaccinator, has been shouted at and pelted with stones in communities where people were unwilling to let her immunise their children.

One-third of children 12-23-months miss out on basic vaccines

In Pakistan, nearly one-third of children age 12-23-months miss out on the basic vaccines they need to stay alive and healthy. In the province of Sindh, where Karachi is located, the situation is worse: more than half of the children in this age-group are not fully immunised. 

At the Basic Health Unit in Younusabad, a neighbourhood of coastal Kamari Town in Karachi, Farzana and her colleague Arshad Muhammad, 45, are the only vaccinators.

Farzana, who previously worked as a polio vaccinator, has been working on routine immunisation for almost four years now and says she has seen progress.

“Parents become less aggressive once I have interacted with them for several months,” she says. “But there are always new parents who are unwelcoming, reminding me of how I used to struggle when I first started.”

“I have been working in the area for ten years, but I am still an outsider here,” her colleague Arshad says. “Happily, Farzana is always a few steps ahead. She knows how to change the mind of the families who don’t want their children to be vaccinated at first. She is a source of inspiration to me.”

Farzana vaccinates a child
Farzana, 42, vaccinates a child at the health centre in the Shamspir village, an island near the coastal town of Kemari in Karachi, Pakistan.

Farzana has talent, and also a secret weapon: she belongs to the indigenous fisherfolk community living in Kemari Town, which makes it easier for her to interact with the population.

A conservative cultural group, the fisherfolk speak their own dialect of the province’s Sindhi language and have their own lifestyle and culture.

“To this day, many people in my community think that vaccines are a conspiracy to prevent them from having more children, or to harm them in some way,” explains Farzana.

Every day, Farzana and Arshad head out on a boat to places like Shamspir – a tiny island off the coast of Karachi which is home to over 5,000 residents, including Farzana’s in-laws. The boat, a public skiff usually too overloaded for its size, precariously leaning as it yaws, carries people from a jetty to the various islands without much safety.

"To this day, many people in my community think that vaccines are a conspiracy to prevent them from having more children, or to harm them in some way"

Farzana, Vaccinator

“This is the way everyone commutes around,” Farzana explains as she steps onto the boat to join the women on one side, as they are expected to sit separately from men.

“Every week, we vaccinate seven to eight children on this island alone, but there are still around 30 per cent children in need of vaccination here.”

Nearly all of the island’s children receive their first and last vaccines from Farzana or Arshad. But many parents only have their baby receive the first vaccination when it is born, and then ignore follow-up visits to complete the vaccination course.

“There is no single front,” Farzana explains as she prepares a shot of the pentavalent vaccine. “I started this job to support my family, but both my parents and in-laws warned me that they would not support me if the community stood against me,” she says.

“We must convince these parents how important it is to complete the vaccination schedule,” says Arshad as he enters a newly vaccinated child’s name in his register.

Farzana and Arshad vaccinate a child
Farzana (in a pink veil) helps Arshad vaccinate a child at the health centre in Shamspir village in the costal outskirts of Karachi, Pakistan.

Changing attitudes

For the two vaccinators, the job neither begins nor ends with the vials of the life-saving medicines. They also need to change attitudes in the communities before they can use a needle.

For instance, to overcome people’s reluctance to have their children vaccinated, Farzana and Arshad involved village elders, religious leaders and community influencers while mobilising mothers and other women.

It turned out to be a huge success.

 “Over a year ago, there were 180-200 children in Shamspir who had not received any vaccine after possibly receiving the first shot right after birth,” says Arshad. “We worked very hard. Within ten months, each of these children had received all the immunisation shots they needed against preventable diseases,” he adds.

The immunisation coverage rate for the village now stands at more than 90 per cent.

“For us, every week is Immunisation Week,” Farzana quips as she and Arshad hop on the boat back to the city.

“On some days we have less energy and courage to complete our work,” Arshad tells on the ride back. “But we remind ourselves of all the lives we are saving, and the energy comes back.”

Farzana and Arshad are two of the many vaccinators helping Pakistan’s Expanded Programme on Immunisation (EPI) reach every child in the country. UNICEF and other partners support the Government of Pakistan’s work to save children from vaccine preventable diseases, especially in the most marginalized communities.

Arshad and Farzana interact with parents during their vaccination visit
Arshad, 45, a routine immunisation vaccinator, wearing a blue cap, accompanied by colleague Farzana (pink scarf), 42, answer a parent couple's vaccine questions during their visit to the Shamspir village, an island off the cost of Karachi, Pakistan.