by Alka Gadgil
An hour’s journey from maximum city Mumbai, in a nondescript pocket of Thane district in Maharashtra, a quiet transformation is underway, powered by a few committed and ingenious women who have successfully managed to pull down several social and psychological barriers erected by the local community, to ensure a healthy future for their little ones.
Lead by the dynamic Chaya Khobragade, 35, the Auxiliary Nurse Midwife (ANM) posted at Nandikinara, lower middle class neighborhood in Bhiwandi, the health workers of the local health-post have, slowly but steadily, brought about a positive behavioral change when it comes to safeguarding the health of the infants in the area, by joining hands with faith leaders and concerned citizens.
The trio of Khobragade; Medha Chavan, the ASHA (Accredited Social Health Activist); and Tehrin Ansari, the Community Health Volunteer (CHV), has been working hard for over a decade now to put in place a well-accepted, well-run immunisation programme, mandated under Mission Indradhanush. Launched by the Government of India in 2014, this scheme seeks to achieve 90 per cent full immunization coverage across the country, with a focus on the high risk and underserved communities. Vaccination against eight life-threatening diseases, including diphtheria, tuberculosis and hepatitis, among others, is provided through the dedicated efforts of the grassroots health workers.
At present the mission is in its third phase – the first phase was rolled out in 2015 and the second in 2020 – with a special push for vaccination in the high-focus districts. Of the 216 districts identified for this targetted intervention across India, 12 are in Maharashtra: Ahmednagar, Aurangabad, Beed, Dhule, Hingoli, Jalgaon, Nanded, Nasik, Palgarh, Parbhani, Solapur and Thane.
In 2010, when after completing her nurses training, Khobragade was posted as the ANM at Nandikinara Health Post, little did she know that she was up against the herculean task of convincing mothers to get their babies vaccinated. “When I started out, there was bitter opposition to immunization – nearly 50 per cent of the children were not vaccinated and families were not even willing to talk to me. A polio vaccination drive was scheduled in 15 days and I was really nervous because I knew not many would turn up for it. When I spoke to some senior colleagues, they told me that they too had faced a tough time connecting with the community initially. I knew I had to do something to gain the trust of the women,” reveals Khobragade.
She decided to reach out to Ansari, the CHV, to get a deeper insight into the mindset of young mothers there, and also brainstorm on ways to get them to open up about their apprehensions regarding immunization. “Tehrin knew the community well and was the best person to consult on the way forward. The two of us decided to speak to families one-on-one,” shares the ANM. In this endeavor, Chavan, whose responsibilities as the ASHA include offering support for maternal care and immunization, also joined hands.
“In the early days no one was even willing to give us a patient hearing. It was extremely frustrating, but we decided to take a different approach. We started talking to them, woman-to-woman, about everyday life and the difficulties we face as women and mothers. I gave them whatever they needed – medicines, free sanitary pads… It took us a while but we gained their trust enough for them to tell us why they were so against vaccination,” narrates Khobragade.
So, what were families so afraid of? “The reasons parents gave us for rejecting vaccination were strange. For instance, one widespread misconception was that polio vaccine will result in infertility! Dispelling their unreasonable fears has been a long and tough journey and we have been grateful for all the help we could get. Like the many times when Khala Mausi came to our assistance,” says Khobragade.
Khala Mausi, 67, is a respected elder in Nadikinara, and after speaking to the health workers at length about the importance of vaccination, she decided to champion their cause. “Whenever the need arises Khala counsels parents on our behalf. She chats directly with parents and grandparents explaining to them why the rumors around the ‘damaging’ effects of the medicine are totally baseless. Coming from her, naturally, the message is definitely more palatable,” feels Khobragade.
When it comes to effecting long term behavioral change, patience and courage serve a health worker in good stead. Chavhan recalls an ugly incident: “Once I went to visit a family to inform them about an immunization camp. The child’s grandmother became agitated and threatened me saying: ‘I will shred your sari to pieces if you come again!’ I neither lost my cool nor was I deterred. I told her that not getting her grandson vaccinated was not a wise decision, that it could lead to very serious health problems in the future. Of course, at that time they refused to entertain me, but it so happened that in a few days the boy fell seriously ill. He was taken to a private doctor for treatment, who inquired whether the child had been fully vaccinated. When he was told that wasn’t the case, he simply sent them to the vaccination center. That was the turning point; the grandmother no longer prevented the parents from bringing the child to us.”
Adds Khobragade, “Over the last few years there have been several occasions where our intentions regarding vaccination drives have been questioned. This particularly happens when vaccination results in fever. I remember this one instance where a child’s fever continued for several days after vaccination. Her parents were distraught and they abused us and questioned the immunization service. When faced with such sensitive situations, we now turn to local faith leaders, the maulanas, for help. Their word boosts public confidence in vaccine campaigns.”
Mission Indradanush supports roping in faith leaders for community mobilization and advocacy. Indeed, their involvement in vaccine campaigns in India has been beneficial in countering misinformation regarding infectious diseases as well in facilitating vaccine acceptance. The Bhiwandi Municipal Corporation sought the backing of Muslim faith leaders and held many meetings with them to inform and answer their question regarding vaccination. The maulanas readily agreed to help, and so these days wherever and whenever doubts are raised, they readily rise to the occasion.
Owing to the relentless efforts of the all-women band of health workers, parents in the bastis around Nadikinara have voluntarily started getting their children fully vaccinated. “When we had started out a decade back, of the 655 children that needed vaccination then, families of over 300 children had turned us away. Nowadays parents come asking for the time and venue of the camp,” reveals Khobragade. In fact, riding on the hard work of health workers on the ground, Bhiwandi Municipal Corporation has improved its immunization coverage to 87 percent among the Muslim population, where five years ago it was 44 per cent.
Chhaya Khobragade
“Along with love, good nutrition and care, the mother and child need timely vaccination to enjoy good health – and we have left no stone unturned to make this into a lived reality for the majority of children being born in Nadikinara,” she signs off.