india

Updated: Dec 14, 2018 16:34 IST

When 26-year-old Shehnaz, an accredited social health activist (ASHA) in Pinangwan in Puhana tehsil of Mewat, knocked from door to door, asking residents to let her vaccinate their children last year, she was greeted with nothing but closed doors.

“We don’t need any injections, most people would say without even opening their doors. Please leave now, they would scream from inside,” Shehnaz recalled, adding that most people feared that their children would develop rashes or get a fever if they get vaccinated. “You are from the government, why should we believe you, they would say,” she said.

According to the National Family Health Survey 4 of 2015-16, the rate of immunisation in Mewat is a dismal 13%. So when the Haryana government launched the Measles-Rubella (MR) vaccination campaign on April 25 this year, a special focus was laid on the region.

And after sustained efforts, the health department met with a unique success this year.

The campaign, which aimed to cover approximately 74 lakh children in the state —both previously vaccinated and unvaccinated— between the ages of nine months and 15 years, ran for eight weeks and by the time it came to an end, 99.01% of the state target was achieved.

However, health workers maintained, a lot had to be done to achieve the target — especially changing people’s attitudes and mindsets towards vaccinations.

Around March 2017, rumours that the government’s immunisation campaigns are a conspiracy to make children sterile spread like wildlife in the region dominated by the Muslim Meo community. A few weeks later, a doctored video, purportedly showing a child with signs of breathlessness after being injected at a government school, did the rounds on WhatsApp. The video had originated from Karnataka and Tamil Nadu, where the government had just begun its MR campaign. Although no such campaign was planned for months in Mewat, the damage was already done.

“The locals started believing that vaccination is both dangerous and futile. Fearing that the vaccines were meant to sterilise children, parents would turn us away from their houses. The children would run away and hide whenever they saw health workers approaching. Some even asked us to give it in writing that getting vaccinated would guarantee lifetime protection against diseases,” said Dr Manpreet Singh Tewatia, medical officer at the primary health centre at Pinangwan in Punhana tehsil that has a population of approximately 1,25,000 people, as per the 2011 census.

According to official records, the immunisation rate in the area was a mere 20% in June 2017.

In Pinangwan and the villages around, the rumours spread mostly through word of mouth. “Not a lot of people have access to the internet here. People went outside of the village, heard the rumours, saw videos and came back with gossip. And when a rumour spreads here, it is very difficult to erase it. You see, people aren’t very educated here,” said Khursheed Ahmed, an elder of Ter village in the district and grandfather to 10 children.

He said he too had doubts about vaccination till the health workers reached out to him. Ter, according to health officials, had one of the highest rates of vaccine refusal in the district.

Over the next few weeks, attendance in many schools in the area – where the vaccination drives were planned – fell to as low as 20%. For many weeks thereafter, the government school in Ter, which has a strength of about 500 students, saw only half of the students turning up, said Duli Chand, the head teacher. “Parents of the students in my school would stand guard outside till classes got over to keep a check on them,” Chand recalled.

According to health workers, the rumours also hindered other health campaigns such as polio, tuberculosis and school nutrition programmes in the region. “For weeks, children started refusing iron and folic supplements in schools. No child turned up for their routine immunisation for at least the next three months,” said Tewatia.

Dispelling the rumours required involvement of the community – mostly of the village elders and teachers of religion.

The gritty health workers held multiple meetings with village sarpanchs and religious heads to explain why vaccines are important over a long period of time. “We presented them with facts and logical arguments, and in the process, gained their trust,” said Tewatia.

Ahmed and his fellow elders, over the course of the last one year, went to schools and madrassas in Pinangwan to encourage parents to send their children to schools and get vaccinated. They were initially received with scepticism and refusal. “Some families in Akbarpur even said that only an announcement from the village mosque would convince them that the rumours were false,” said Ahmed.

But soon, as a couple of madrassas and schools started opening their door to health workers, and the others followed suit.

“We told the teachers why not get it done with as it is only for our benefit,” said Ahmed, adding that everything in these villages runs on trust. The madrassa in Ter has since started announcing schedules for immunisation campaigns from their community loudspeaker.

As of today, 22 of 50 government schools in Pinangwan have an immunisation coverage of more than 90%. The overall immunisation rate in the PHC, Pinangwan, in November 2018, was 58% — a jump of about 38% from January last year.

Ahmed recalled that during his conversations with the villagers, he came to realise that the disbelief in government campaigns stemmed from two larger issues — locals’ distrust in the government in the state and poor health services in the district.

Medical services in the district have been in a shambles for the longest time. According to multiple health department officials, there is no gynaecologist in the whole of Mewat currently. The Primary Healthcare Centre in Pinangwan has no lab technician, no pharmacist and no gynaecologist despite the five to six deliveries that take place on an average day. The lack of facilities led to a mistrust in the public health system.

However, Shehnaz said the situation has now improved to a large extent. She said it is a lot easier to go to schools and administer vaccines now and the children don’t run away. In fact, she said, more children have now started turning up for routine immunisations than they used to last year.

“Earlier, I would stand outside doors for 15-20 minutes, asking families to come for their children’s routine immunisations but no one would answer. Now, if I knock on 13 doors, at least 10 of them turn up later in the day,” she said, adding that she tells everyone not to believe rumours as they are always untrue.

VK Bansal, director, mother and child health, in the National Health Mission, said the improved coverage was a result of micro planning in Mewat. “We had involved local leaders in the campaign and frequently held seminars with them explaining the importance of vaccination. We also increased the number of ANMs in the district to ensure wide coverage. There was no fixed deadline for the campaign as we wanted the health workers to bond with the locals first,” he said.