AS snowflakes began to fall and the icy chill of winter blew over her small village, community health worker (CHW) Bibi Marjana, accompanied by her mother and father-in-law, wrapped her veil around the face and covered her body in an effort to fight the severe cold.

Despite the harsh weather, they marched onwards, in the hope of protecting children of their community from the crippling polio virus.

The 26-year-old Marjana, a mother of five, has been associated with the Polio Eradication Initiative (PEI) for the last three years. She works in Pishin — one of the high-risk polio districts in Balochistan.

Her husband is a hotel employee. Her mother-in-law Noor Nama also started working with the PEI three months ago to support her family.

They both work in Barshore Tehsil of a sprawling Pishin district where the population is scattered across a large, almost inaccessible area.

There are villages which even people travelling on cars or motorcycles find it difficult to reach. The health workers have to walk two to five kilometres to go from one house to another in some of the villages.

“The weather was severe, but it couldn’t shake our will and passion. We were determined to reach every child and so we did,” said Marjana.

“My target is to vaccinate 84 children. The figure is lower than other CHWs’ targets, but my area is very challenging.

“I have to climb mountains to vaccinate under-five children. Travelling through these areas during times of snowfall is difficult and causes delays in achieving the target.

“Sometimes we are stuck in between. But we try to perform our duty with zeal and honesty,” said Marjana, determination writ large on her face.

The experience of Noor Nama, the 54-year-old mother-in-law of Marjana, is no different. She, too, negotiates treacherous terrain to perform her duty.

“My daughter-in-law is working for a noble cause. I joined her to play my part for the well-being of my community.

“I am able to support my family as well. It’s very difficult to find women in our area who perform such hard tasks, going door to door for vaccinating children. But luckily my husband Hidaytullah is very supportive. He accompanies us during the campaign. 

“We are all working to save our children from life-long disability,” said Noor Nama, with pride.

Lurking danger

Pishin is a high-risk district. Although the province hasn’t had a polio case for almost two years, the threat is always present that poliovirus is ready to strike somewhere because of an extensive population movement to and from the district, from other provinces and parts of Afghanistan.

“It’s all because of our community health workers that the district has no polio case. The women are local, from the same community and have easy access to houses.

The ratio of female-male ratio is 70-30 percent in Pishin district. The percentage is even lower in rural areas and Barshore is one such Tehsil,“ said Kaleemullah, district communications officer in Pishin.

These women are working to bring about a behavioural change as they not only administer polio drops, but also give awareness to villagers about immunisation.

“Last but not the least, they are breadwinners, too. It’s very difficult to have women as CHWs in our district. We campaigned hard to persuade many families to let their females join the PEI programme.

“We now have 50 female frontline CHWs, out of 96, in Barshore alone,” said Mubeen, the communication officer in Pishin. “Marjana, her mother-in-law and father-in-law sometimes hitch a ride on a tractor to vaccinate children.

“They have to walk mile upon mile to reach a single child at the top of a mountain. If one house is on the mountain, another is beside a stream gone dry. But they work with dedication and honesty to administer polio drops to every child,” Mubeen added.

Community-based volunteers (CBVs) in Balochistan have been a pivotal link to strengthening disease surveillance and awareness, increasing vaccine coverage, and providing basic health information to improve health outcomes in hard-to-reach areas.

Syed Zahid Shah, who works at an emergency operation centre, applauding the efforts of women workers, said: “There are almost 4,000 CBV staff working in different districts of Balochistan. The women working on the frontline as community health workers in the province are the true heroes of the PEI programme as they bear every hardship, whether cultural, social, security or environmental.”

They should be respected and given a befitting recognition as they go the extra mile for saving the future of Pakistan, Zahid Shah observed.

Published in Dawn, April 10th, 2023