No child left behind: The struggle of polio workers in Balochistan

Polio workers in Balochistan struggle to reach thousands without access to life-saving vaccine

As is typical for Pashtun women, Arifa’s face is covered by a loose white scarf when I meet her. But with direct eye contact, she projects an air of self-confidence that no scarf can hide. Arifa is a 29-year-old polio worker in Pashtunabad, a highly-conservative neighbourhood in Balochistan’s provincial capital, Quetta. She is part of a very important cause — the eradication of the crippling poliovirus from areas like Pahstunabad, home to roughly 10,000 families.

This year, three cases of poliovirus have been confirmed in Balochistan: one each from Quetta, Qila Abdullah and Loralai. The Quetta case was detected in the Pashtunabad neighbourhood. Pakistan accounted for 95% of the world’s poliovirus cases this year. According to the Balochistan Emergency Operation Centre (BEOC), 24 cases of poliovirus have been detected nationwide, of which 10 cases were recorded in Khyber-Pakhtunkhwa, seven in Federally Administered Tribal Areas, four in Sindh and three in Balochistan.



As many as 51 union councils in five districts of Balochistan have so far been declared at high risk for contracting poliovirus. According to Unicef Polio Team Lead Dr Jawahir Habib, at least 21,000 children are missed in every campaign in Balochistan. These children form an unvaccinated pool that represents not only a danger to themselves but magnifies the risk of infection to others.

The BEOC says that the province’s highest risk union councils lie in Quetta, Pishin, Qila Abadullah, Zhob and Mastung. According to their reports, the environmental samples taken in Quetta and Qila Abdullah in May tested positive for poliovirus and set off alarm bells. “The failure to eradicate poliovirus is a source of great embarrassment for Pakistan in the world,” states a government official who wished to remain anonymous. A mass immunisation campaign, the Sub-National Immunisation Days campaign, kicked off on May 28 and targets eight districts — Quetta, Pishin, Qila Abdullah, Zhob, Jaffarabad, Lasebala, Nasirabad and Sherani — with a target population of more than 1.2 million children.

Arifa is one of many Union Council Communication Support Officers working to reach those 21,000 unvaccinated children. In attaining this position, she has defied many cultural norms and stereotypes. Her job entails monitoring the anti-polio drive, training women vaccinators and persuading parents who refuse anti-polio drops for their children on religious or other grounds. “There have been about 800 refusals to date,” she says. “We try very hard to revisit these parents and change their minds.”



The refusals are not the hardest part of the job, however. On the day I met Arifa, four police officials were shot dead in Pashtunabad. On November 26 last year, four women vaccinators in Quetta were brutally killed. For Arifa, however, such threats make her conviction in the work she is doing stronger. “Why should I be fearful? Whom should I fear?” she asks. “To tell you the truth, I have no fear at all. People need to understand that we have to win this war against polio. We need to protect future generations from the risk of life-long disability.”

Arifa has been working to help eradicate the poliovirus for four years now. When asked what bothers her most about working in the field, she admits to being hurt sometimes by the stereotypes people have and the negative attitude towards working women. “People think that because I dare to leave the house and work like a man does, I must not be of good character,” she says. “They seem to believe this particularly of women involved in the anti-polio drive.”

A mass immunisation campaign kicked off in Balochistan on May 28 with a target population of more than 1.2 million children. PHOTO: REUTERS

Arifa and her sister are the sole breadwinners in their family. The neighbourhood near Pashtunabad where they live is made up of mostly single-storey mud houses. Her family comprises an older sister, a differently-abled brother and a widowed mother. “My mother is proud of me and of the work I do. That makes me happy,” she says, when asked whether she faces opposition at home. “My female cousins also praise my work.” Such support,however, stops at the door to her home. In the field, she says she has been followed and verbally harassed. “I get catcalls from men on the streets but I really don’t care. I know I’m on the right path.”

When dealing with parents reluctant to allow their children to be vaccinated, Arifa faces resistance of a different nature. She reports that some parents are suspicious of the anti-polio drops, fearing they are part of a conspiracy to control the world’s Muslim population by suppressing fertility. “Parents say, ‘How come every other medicine is expensive but anti-polio drops are free and get delivered to our home?’” she says. “I’ve heard statements regarding refusals, coverage and lack of availability of anti-polio teams that are completely false.” This is a very serious issue, she says, one that exposes the weak foundations of the vaccination campaign. According to Arifa and other vaccinators in Quetta, the timely payment of wages has also negatively affected the quality of the campaign. “Payment, security and performance are the main challenges the vaccinators face today,” she says. “The wage of a vaccinator is a mere Rs700 to Rs800 (approximately US$7) per day. It is difficult to live on such a small sum,” she says.

Arifa is one of many Union Council Communication Support Officers working to reach 21,000 unvaccinated children in the province. PHOTO COURTESY: SHEZAD BALOCH

Officials say it has not been easy to employ female vaccinators like Arifa largely due to a cultural barrier, as women here do not work in an environment where they must go door-to-door in a neighbourhood. Thus, a Community Health Volunteer (CHV) programme has been launched in Balochistan in order to ensure that no child is left without the vaccine. Officials say the mapping, tracing and coverage of unvaccinated children is a top priority and the deployment of nearly 600 female CHVs in 23 high-risk union councils in the province is part of that effort. “The government and partner agencies are putting their best efforts into ensuring that every child in Balochistan is vaccinated against polio,” says BEOC coordinator Syed Saif Ur Rehman. But with families shutting their doors on polio workers, it will be long before we see a polio-free Balochistan.

Shezad Baloch is a Quetta-based freelance journalist.

He tweets @Shezadbaloch

Published in The Express Tribune, Sunday Magazine, June 21^st, 2015.