By Antonia Paradela
GADAP TOWN, Pakistan, 29 October 2009 – As part of a national immunization campaign, Ruksana Bilqis has been working for the past two months as a polio community mobilizer in Gadap Town, a community of conservative Pashtu speakers from North-West Frontier Province and the tribal areas near Pakistan's border with Afghanistan.
Wearing a black veil and cloak, she moves easily in this conservative community of roughly 150,000 people. It is a poor area, with a broad river of open sewage traversing the town and flies filling the air. A few women in burqas walk the dusty streets while children play amongst the rubble.
In such an unsterile environment, the task of the vaccination team is made all the more difficult. When the chilled boxes with the oral vaccines arrive, the vaccinators must rush into the streets to give polio drops to all children under the age of five.
In this area alone, about 65,000 children need to be vaccinated, so the team goes door to door. When they encounter resistance from a child's parents, Ms. Bilqis's work begins.
Countering misconceptions
Most of the refusals are related to misconceptions that the vaccine is unsafe or is related to family planning. Ms. Bilqis, a young Punjabi woman who speaks fluent Pashtu, addresses such concerns with parents. Thus far, she has been able to persuade 129 families to allow polio vaccination for their children.
Her efforts are paying off. According to Dr. Tufail, the District Support Coordinator in Gadap Town, of the 179 children not covered in the previous campaign, 173 received the polio drops this time around with their parents' consent.
This coverage is largely due to the efforts of people like Ms. Bilqis and their tireless work with parents, schools and mosques.
Influx of the displaced
Pakistan is one of four remaining countries in the world where polio remains endemic. UNICEF and the World Health Organization are working with the government to rid the country of the disease. In recent years, cases have been concentrated in the north-west and Karachi.
A particular challenge has been the arrival in recent months of thousands of families displaced due to the ongoing conflict in north-west Pakistan.
One of the most recent polio cases was a 17-month-old child who had recently arrived with his family from the tribal area of South Waziristan, near the Afghan border. The child had never received the polio vaccine in his hometown, and the four doses he was administered in Karachi were insufficient to prevent the onset of the disease.
Another problem is that frequent bouts of diarrhoea can affect the absorption of the oral polio vaccine. In areas where there is poor water, hygiene and sanitation, children need more than 10 doses to develop immunity.
A vaccination challenge
With a population of almost 20 million, including millions of children, Karachi presents immense challenges for vaccinators.
Its densely populated communities consist of groups from across the region, each with its own native language and social customs. Conservative mores often hinder women's mobility outside of the home, and resistance to male teams entering homes – combined with a lack of female health workers – have been major barriers.
To address some of these issues, Dr. Tufail says Ms. Bilqis is recruiting the women who will be part of 45 teams working in the Pashtu-speaking areas.
"Young, educated women like Ruksana, who speak the language and know the culture, are the linchpin of efforts to eradicate polio amongst communities where women's literacy is low," said UNICEF's Programme Communications Specialist for Polio and the Expanded Programme for Immunization, Melissa Corkum.
"Working in partnership with the government and with dedicated people like her, we can hope to reach every Pakistani child under five and eradicate this potentially deadly disease," she added.
