Overcoming hurdles to give immunisation a shot in Assam’s riverine islands

Old Batuli (Assam), Sep. 24 (PTI): No motorable roads, no electricity and two hours away by boat… But health workers say these are not the most difficult challenges they face while carrying out the immunisation drive in Old Batuli, surrounded by the swirling waters of the Brahmaputra.
The more arduous task is battling illiteracy, the stigma surrounding vaccination and the apathy of villagers.
A dedicated team of health workers toils tirelessly to make 100 per cent immunisation on the riverine islands, known as saporis or chars locally, a reality.
For Rijumani Deka, for instance, an auxilliary nurse and midwife, the day begins at dawn in Sonitpur district s Tezpur town. She collects two cold boxes containing vaccinations for 14 diseases such as diptheria, tuberculosis, tetanus and, hepatitis B from the primary health centre and reaches Jahazpur Ghat.
At 9 am sharp, the team leaves for one of the 28 islands in the district in a boat, dubbed the boat clinic. “People are still a little resistant to immunisation. The mothers, due to unfamiliarity with injections, feel their child is in a lot of pain from the vaccine. The bleeding afterwards also scares them,” said Deka.
They vaccinate over 200 children every month in the district but the drive comes with its own set of challenges, she said. According to Mousumi Duora, Sonitpur District Programme Officer, Boat Clinic, the biggest obstacle the medical teams face is the high number of child births at home.
“About 75-80 per cent of children are born at home as the mothers are unable to reach hospitals on time. Thus, vaccines like oral polio vaccine and BCG (for tuberculosis) which need to be administered within half an hour of birth cannot be provided,” she said.
The migratory nature of the population on the saporis, where about 15,000 people live, is another challenge. The villagers, mostly Muslims, who are dependent on agriculture and fishing, leave the island and shift to either the mainland or to another island every year.
The health team maintains a record of each child; if they are found on another island, their address is updated. The records inform them about the vaccines administered.
Immunisation rates are rising in the villages, but there is still some resistance, said community worker Mofiddul Islam. Besides the stigma, there is also the belief that one vaccine does not make a difference. The life of the child is left to fate in many cases.
“The villagers say that they’ve heard of people dying due to vaccination in other villages. They also are wary of the fever that children get after vaccination, as it means the mother will have to sit at home with the kid and lose out on a day’s work in the fields,” Islam said.
He makes repeated visits to their homes, cajoling and patiently making them understand the benefits of vaccinating their child.
Now an ASHA (accredited social health activist), Murtiza said she was against vaccination due to the rumours surrounding it and also because it would have meant missing out on work if her baby got fever.
However, she was convinced to change her mind and now helps health workers dispel misgivings and encourage parents to get their children immunised.
The work of Murtiza Khatun and the health workers seems to be bearing fruit. The wall of resistance is slowly whittling away, said Duora, who had helped set up the Sonitpur boat clinic in 2009. The health team visits every village in the district once in 30-40 days and the boat clinic functions for 18 days every month.
The boat clinics — a unique initiative in public private partnership mode by the Assam government to reach those living in the remote islands the 13 districts of the state function — even during the annual floods.
Overcoming parental resistance is not the only hurdle. Duora said fewer children turn up for immunisation during floods.
For a couple of months in a year, medical teams have to make do without doctors, as doctors deployed for compulsory rural training resign to appear for their masters.
According to National Family Health Survey 4, 2015-16, full immunisation coverage is at 47 per cent in the state. In Sonitpur, it is even lower with health workers estimating that immunisation covers only 20-30 per cent of the people.