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WORLD HEALTH DAY-PAKISTAN: Anti-Polio Drive Hits Resistance

Zofeen Ebrahim

KARACHI, Apr 6 2007 (IPS) - ”After climbing up several flights of stairs, sometimes seven or even more, our teams may be told brusquely, that the child is asleep and they should come later,” says Seemi Fatema, one many health workers in this city charged with administering polio vaccine drops to under-five children.

Fatema, who has been with the anti-polio campaign since 1995 and monitors the house-to-house drive, often has to be physically present to support her team in convincing parents to get their children immunised. It is this indifferent attitude of ”difficult” parents, she says, that is holding up eradication.

Gulshan town, where she works, is one of 18 administrative units into which Karachi is divided and has a target population of 1.6 million under-fives. The target population in the whole of Karachi is 2.24 million children.

Manning each four-day polio campaign in Karachi are 5,053 teams, out of which 411 teams are combing Gulshan alone. Each worker is paid a meagre Rs 150 (2.5 US dollars) per day. “And this amount was raised from Rs 100 (1.60 dollars) only this January,” says Syed Zohair Hasnain, 18, who has been with the campaign for the past three years.

The door-to-door drive to administer oral polio vaccine to children is part of the health ministry’s Expanded Programme on Immunisation (EPI). Pakistan’s Polio Eradication Initiative (PEI) was launched in 1994 in collaboration with the Global Polio Eradication Initiative (GPI) begun six years earlier to that.

Employing a battalion of 60,000 field workers across Pakistan and targeting 6.5 million children, coverage remains unsatisfactory. Pakistan still remains in a list of four countries still battling the crippling paediatric disease, along with Afghanistan, India and Nigeria.

For workers like Hasnain and Fatema, each four-day campaign may extend to a total of six days. ”We have to go back to those homes where children were missed. It is all the more gruelling because the town has over 4,000 high-rises (four floors and above). “I’d say almost half of the high-rises in Karachi are located in Gulshan town,” says Dr Shabbir Ahmed, district support officer, employed by the United Nations Children’s Fund (UNICEF).

Climbing up steep stairs is not the only worry. “Porters may refuse to let us inside a building. Getting inside individual homes is another task. Many homemakers refuse to let us in saying their men are not around,” says Fatema.

Sometimes teams wait for over an hour before they are let in as many homemakers go back to bed after their husbands leave for work and do not want to be disturbed or wake up their children. ”At times, we are told there are no under-five children in the house, although we can see children’s clothes on the washing line.”

For these reasons the teams have requested the government to reschedule the campaigns in such a manner as to cover the weekends and also change visit timings to afternoons and evenings. “Weekends would mean men would also be around and in the afternoons children would be home from schools,” said a worker. ”Many parents send children, even as young as between 18 months, to playgroups in the forenoons,” she explained.

Superstitions and customs abound. Some people will not allow strangers to cast eyes on a newborn until after it is 40 days old, following ancient ‘evil eye’ beliefs.

A majority of the workers are males which makes it difficult for the teams to enter a home. Some are not very well educated and lack interpersonal skills. ”Unfortunately, these factors contribute to outright refusals,” explains Fatema.

In March, during the latest round of National Immunisation Days (NIDs), the area recorded 3,000 refusals. “We were refused for various reasons. While some are missed due to pure negligence of parents, increasingly the negative propaganda against the polio vaccine is hampering our efforts. Most refusals are on religious grounds with some people believing that the vaccine is made from pig fat. Others fear it causes infertility. Or that it comes from the United States which is considered an enemy country,” said UNICEF’s Ahmed.

Of late, some religious newspapers, published in the Urdu language, have begun campaigning against the polio drive as also some of the 100-odd madrassas (Islamic seminaries) in the area, said Ahmed. ”But the government remains indifferent.”

”Antagonism against our campaign has valid reasons. For one thing the frequency has increased (this April will see the 68th round of NIDs). Because we are offering it free and making house calls, people wonder why we are so desperate when health is low on the government’s priorities. They doubt the efficacy of the drops since we are making rounds every month now,” says Mehmood Akhtar, a supervisor in the health department who feels routine immunisation has suffered because of polio campaign.

“For years, much effort and resources have gone into eradicating just polio. If we had put half that energy towards strengthening routine immunisation, we would have covered several childhood diseases including polio,” says Akhtar. ”At the moment, routine immunisation coverage remains a low 70 percent.”