Walk With Pride – Polio Eradication Efforts
Rotary International
In 2016 I went on assignment with Rotary International to document Rotary's involvement in Polio Immunization activities in Karachi, Islamabad and Peshawar. These included Subnational Polio Immunization Day activities as coordinated by the WHO, The CDC and local Governments in Karachi and the Permanent Transit Posts in rural areas of Pakistan strategized to immunize mobile and migrant populations.
A young child is vaccinated against polio at a government hospital in Nowshera, Khyber Pakhtunkhwa (Pakistan).
Inside a women only tent at Jalozai Camp in Khyber Pakhtunkhwa where Internally Displaced Persons (IDPs) currently live after military operations in 2009 forced them out of the Federally Administered Tribal Areas (FATA). Two permanent vaccination posts serve residents here. The high risk mobile population and displaced populations are Pakistan’s largest percent children who are not reached by routine immunizations.
A female health worker advises a new mother during her first post-natal visit at a Rotary funded clinic in Nowshera, Khyber Pakhtunkhwa (Pakistan). Operated and facilitated by Rotarian Tayyuba Gul, Gul is passionate about training local women to care for women in their own villages and neighborhoods. Public mistrust and intimidation by militant groups played a part in many parents’ refusal to have their children vaccinated. To counteract the intimidation, Rotary opened eight polio resource centers to build community trust in high-risk areas. The centers, in addition to giving polio vaccinations, sponsor health camps that offer immunizations against measles and other diseases, as well as free medical examinations, medicine, and eyeglasses.
Lady Health Visitors routinely visit and average of ten households a day in Khyber Pakhtunkhwa (Pakistan). Community-based vaccinations, which involve sustained engagement and help from local, permanent vaccinators, mostly women, have reduced the number of refusals from 87,000 in March 2014 to 23,000 in March 2016 — a refusal rate of less than 1 percent.
Three school age girls at the Jalozai Camp for internally displaced persons in Nowshera. For nearly four years, from 2012 to 2015, half a million children in the Federally Administered Tribal Areas were inaccessible to vaccinators. The military action created a refugee crisis, putting tens of thousands of people in camps for the internally displaced but cleared the way for vaccinators to inoculate hundreds of previously inaccessible children.
A young girl near her shelter at the Jalozai Camp for internally displaced persons in Nowshera, Khyber Pakhtunkhwa. The military actions that drove families out of FATA were devastating circumstances but created an opportunity to reach 265,000 children.
Rotary Member, Tayyuba Gul immunizes a child during a routine home visit where she is training lady visitors in Nowshera, Khyber Pakhtunkhwa. The Community Protected Vaccination Program, supported by the government of Pakistan, has adopted a Polio Plus approach where trained health workers can provide more than just the polio vaccine. They can advise on family planning, take a child’s temperature, offer rehydration packets, and check up on pregnant mothers.
A Rotary Volunteer along with health workers work in a largely Afghan neighborhood in Nowshera, checking pinkies for the purple ink indicated that they have been immunized for polio.
A government hospital in Nowshera, Kyber Pakhtunkhwa (Pakistan), where one of 376 permanent polio vaccination post are stationed strategically to vaccinate children at birth and while traveling with families receiving other services. This child has just been circumcised.
More than 700 children are vaccinated daily at the Permanent Transit Post stationed at the busy Kohat Toll Plaza, which borders Khyber Pakhtunkhawa and the Federally Administered Tribal Areas. People traveling through here are generally under-immunized and are not caught on either side of the border during routine vaccination campaigns. Cross-border PTPs and vaccination efforts are critical to the polio program. Up to 500 vehicles are flagged down daily, where health workers negotiate refusals, vaccinate a high risk mobile population and record information about where the family is traveling to and from.
A polio health worker negotiates a refusal with a group of women from Interior Sindh at the Karachi Cantonment Railway station a strategic point for a permanent transit post where more than 53 million people who travel by rail each year in Pakistan.
Health worker training includes how to hold and handle a baby comfortably, even at busy transit points with little time to spare, this builds trust and a positive reputation with concerned parents. Pakistan and the GPEI partners had more than 200,000 trained and dedicated vaccinators fan out to Karachi, Khyber Pakhtunkhwa, and Quetta, the three core reservoirs of wild poliovirus. From Karachi in the south to Islamabad and the tribal areas in the north, Rotary has negotiated to place PTPs in high-traffic areas, including highways, toll plazas, train and bus stations, airports, markets, and even amusement parks.
Government support escorts polio health workers during home visits. These vaccinators come from the community and feel a sense of purpose and dedication with their work. They are also an example for young women who need educated, strong, brave role models who work within their faith.
A health worker seen talking to a family about immunizing a child at the Karachi Cantonment Railway Station. In total, the PTP strategy has vaccinated more than 68 million children who would otherwise be missed.
A health worker seen standing next to her police escort at the Karachi Cantonment Railway Station. Deploying female health workers is effective but delicate. In rural hard to reach areas or busy stations in core poliovirus reservoirs, comes with risks. As teams become a regular presence in these communities, they become more susceptible to attacks.
A child look up as a health worker gently marks his finger after immunizing him at the Karachi Cantonment Railway Station. Many health workers see this campaign as a call to cleanliness, a core belief in the Muslim faith. They are proud to be a part of this campaign and see it as a duty to protect the future of Pakistan, it’s children.
Two drops, every campaign, every time. “The generations will not forget us. We want them to walk with pride.” – Rotary Polio Plus Chair, Aziz Memon
