Akhter Mohammad had been married for 12 years and had only two daughters, when in 2015 he was blessed with twin sons. The children’s grandmother wanted to save her grandsons from the ‘evil eye’ and kept them indoors mostly. So when health workers showed up at their door to administer polio drops to the children, they were disallowed to do so. The officials term the parents’ non-cooperation as ‘silent refusal’; they were not included as ‘refusals’ to their official record. The district health officials claim that the twins did not receive a single dose of polio vaccine.
Unfortunately, saving the children from ‘evil eye’ resulted in Habib contracting polio and being paralysed for life. At the age of two, Habibur Rehman was diagnosed with polio in November 2017. Cradling the child in her lap now, his grandmother says, “We are poor and have nothing for the treatment of my ailing grandson.”
Thirty-five-year-old Akhter Mohammad, the only bread-earner of the hand-to-mouth family, lived in a mud house surrounded by similar huts in Sohrab Goth — a slum in the east of Zhob district in Balochistan — for about a year. The majority of those residing in the katchi abadi had migrated from Loralai district as their relatives lived there.
Will Pakistan’s anti-polio drive this year clear areas like Zhob district where a case of polio has been detected?
Zhob district was declared poliovirus free four years ago, but in November 2017 the situation became challenging for health officials, when the National Institute of Health (NIH) report confirmed that Habib-ur-Rehman had contracted the disease. His stool samples were sent to the central lab for diagnostic tests, where the virus was detected.
Zhob has not only historical but geographical importance as well in Balochistan. The area falls on the international route of Afghan nomads, locally known as Kochis who pass here twice every year. The Kochis, are a high risk mobile population and are considered to be the biggest carriers of poliovirus.
Health officials quoting the NIH report, say that the virus was brought from Landhi, Karachi to Loralai and then to the slum area in Zhob. Though Habib’s family has been residing in Zhob, their relatives from Loralai brought the virus from Karachi to Loralai and then to Zhob.
This year’s first nationwide polio campaign, which began on January 21, aimed to include children who move across the Afghan-Pakistan border. The drive targets 39.2 million under-five children across the country, except for some areas badly hit by winter rains. A health official says 260,000 staffers are involved.
In 2014, a polio worker, an ambulance driver and two Levies personnel escorting them were kidnapped from the Murgha Kibzai district. They were murdered and their bodies were dumped in a desolate part of the dusty mountains of Kakkal area. The Taliban claimed responsibility for the ruthless killing of the four employees. The incident sparked fear surrounding the anti-polio drive which cast a long shadow.
Dr Mohammad Amin, officer in charge of District Polio Control Room, Zhob, terms the union council of Murgha Kibzai as the most sensitive area in the district.
Naimatullah, a resident of Murgha Kibzai union council and father of five children, says, he doesn’t allow anti-polio drops to be administered to his children because he believes that the vaccine has ‘prohibited’ ingredients which will cause infertility and that the polio campaign is a Western conspiracy. He believes the entire polio campaign to be a family planning programme aimed at sterilising children. “In my area, some religious scholars prohibit people to not get their kids vaccinated because the drops cause infertility,” he says.
In 2015, CHIP Training and Consulting under the Communication Network project — a non-governmental organisation with the help of Unicef — hired communication officers for social mobilisation in 10 high-risk union councils of the district. Their key role was to end misinformation, build trust among communities, provide a conducive environment for health workers and sensitise parents about the serious nature of the poliovirus. The officers revealed 4,000 refusals in the district. But following their mobilisation work, the number has decreased to 300-800 in the righ-risk union councils. However, according to the data provided by the Integrated Disease Information Management System, the number has now reduced to nil.
A religious scholar Maulana Maula Dad Kakar says that he gets his children regularly vaccinated against polio. “It is not a curable disease and vaccination is the only way to save children from contracting polio,” he says, adding that he prefers the injectable form instead of oral polio vaccine.
“Following [Habib’s] case the entire Zhob division has been declared as a high-risk division, with Loralai and Zhob being on the top of the list,” the health department head explains.
“In the 30 union councils, including the high-risk ones in the district, the targeted population of children under five years is 68,310, including the Afghan nomads and roaming children,” says Amin.
Although the area is cleared in terms of refusals, health officials claim that a few refusals exist in the area, the exact number of refusing parents being unclear. According to officials, recently, over 800 refusals were recorded, but all of them were covered on ‘catch-up day’.
Abdul Manan Kibzai, a resident of Tang Sar union council, has been working voluntarily with the mobile teams in the area. He says, “Kakshei, Wiyasta and Kakkal are the areas in the high risk union council Tang Sar, where a large number of parents refuse polio drops.” He adds that the people in these areas lack access to health services and existing health facilities are non-functional.
Last year, only eight cases were reported nationwide. While the Punjab government promises full elimination of the virus by end year, the anti-polio campaign in parts of the country like Balochistan has been hampered due to a number of factors. Illiteracy, repeated campaigns, poor performance of the healthcare system, medicine demands, misconceptions, lack of social mobilisation and limited resources are the main reasons behind the refusals and weaknesses during the drives.
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Published in Dawn, EOS, February 3rd, 2019