This week is a particularly busy time for the 250 call "agents" (as those attending calls are called), at three Sehat Tahaffuz 1166 Helpline centres in Lahore, Islamabad and Karachi.
The calls range from "why no polio worker has come to their home" to a parent calling to ask why their child isn't feeling well after being administered the drops to whether the vaccine is halal. There are other calls inquiring about routine vaccination against other childhood diseases as well that the helpline addresses.
The reason for more queries around polio is because a second polio eradication campaign, post Covid-19, is underway. It began on August 13 and August 21. It will be carried out in 130 districts across the country.
Pakistan is among the two endemic countries, with neighbouring Afghanistan being the other, where the polio virus continues to haunt its children. This year, Pakistan has so far reported 65 wild polio virus cases (Punjab 6, Sindh 21, Khyber Pakhtunkhwa 22, Balochistan 16). In 2019, the number of cases was 147, compared to 12 and eight in 2018 and 2017, respectively.
"A total of 34.4 million under-five children will be vaccinated during campaign, including 17.86m in 33 districts of Punjab, 9.26m in all 41 districts of Sindh, 4.56m in 21 districts of KP, 2.1m in 25 districts of Balochistan, and 0.67m in all 10 districts of Azad Jammu and Kashmir," says Dr Rana Muhammad Safdar, National Coordinator for Polio Eradication.
In addition, Vitamin-A supplement will be administered to around 31 million of those children under 59 months along with the polio drops. "This will further boost immunity against all infectious diseases," he adds.
Shed myths, address fears
With each agent attending, on an average, 300 calls in their eight-hour shift, they have the difficult task of shedding myths and misconceptions about the vaccine, listen to grievances and assuring callers their complaints will be addressed. In between, they have to endure abusive language and handle prank callers as well.
While a majority of the callers want to request them to send polio team to their area, agents continue to receive a vast number of calls asking if the vaccine is halal or if it will cause infertility in children.
Over the past months since Nadia Afsheen joined the helpline as an agent and is now a supervisor, she has learnt to navigate particularly sticky situations. "I read out fatwas of different religious scholars but if they still remain unconvinced I tell them if the vaccine was haram, would the government administer the drops to all those going for Haj and Umrah — the holiest of all places?" she says.
Among some fears that people have about the vaccine which these agents try to assuage are that of children becoming sterilised or their gender getting altered, says 22-year old Ayman Shahid, another agent at the helpline. "We continue to receive such calls," he says.
For Shahid, a fresh graduate from an engineering university, who joined the helpline to help the public during the Coronavirus pandemic, handling the calls and the callers has been a learning process. "I have learnt to handle some of the difficult calls with composure by putting myself in the shoes of the caller," he says.
"Some callers may irritate you, some may be downright abusive, but I have learnt to be patient," he says.
More on this: Polio in pandemic
"Even when callers are offensive, we have to keep ourselves calm and remain polite till we end the call," says Afsheen, who has wiped many a tears of her colleagues and "calmed" them down. "Sometimes, the calls can be very disturbing and take a toll on you," she says, and thus require grit and tact to handle.
There are callers who want to find out if the polio vaccine was made in India. Many believe some foreign hands are bent on sterilising Pakistani children.
Shahid may have joined the helpline to help the health sector, but today, he takes pride in being a mine of information, not only for polio but for the nine other childhood diseases that the government provides vaccination against free of cost through the Expanded Programme on Immunisation that started back in 1974.
"When we joined we were given a five-day training. But refreshers are held every week for two to four hours," Shahid informs.
"I don't think I took polio as seriously as I do now," says Afsheen and confessed that her household was among those who often sent away the polio workers if the timing did not suit them. "I now realise they are the backbone of this campaign and I salute their efforts," she adds.
1166 taking on the Covid challenge
Although this helpline was initially set up to inform and educate parents about polio and other childhood diseases, with the Covid-19 pandemic outbreak, the government decided to use it for coronavirus as well.
"From just a few hundred phone calls daily in the early days that the 55 trained agents were able to manage, the number of calls swelled to over 80,000. We had to train and hire more agents and today have 250 people handling these calls," says Huma Shaukat, project manager for the helpline. Operating in shifts, the agents begin work from 8:00 am to midnight every day, seven days a week.
Today, on average, says Shaukat, half the calls are related to polio and other vaccine-preventable diseases and the other half to Covid-19. "For the coronavirus, we have 18 doctors who handle the already screened callers suspected of having symptoms," she says.
The most common call
For polio, the most common complaint is that the vaccination team has not reached their neighbourhood, says Shaukat. "We address this immediately and send a team and then follow it up by confirming with the caller if the team had reached," she says. In fact, they actually welcome these calls as this way they are able to "vaccinate any missed children", she adds.
And when a child is suspected of having polio, often parents turn to the helpline to seek guidance. "We tell them where to go for polio tests which most people do not know or who can authenticate if the child is actually suffering from polio," says Shaukat.
There are others who call on 1166 to inquire if the helpline can assist them in finding the nearest vaccination centre.
Read further: Routine vaccination
According to Shaukat, who was there when the "concept of a helpline was being brain-stormed and just on paper", with the goal to ward off anti-vaccine propaganda by providing legitimate and reliable information on immunisation and vaccine-preventable diseases, the helpline has played a vital role in reaching out to parents who never got their children vaccinated before.
"The 1166 [helpline] has helped build the parent's trust as well as remove misconceptions," she says.
More importantly, says Dr Safdar, "the sentiments and perceptions of the people that we gauge from these calls has helped us in monitoring and steering the programme better".