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" On the face of it, Noorjehan, a mother in her mid-fifties, is like any other woman of her community in India’s northern state of Uttar Pradesh. "

A community health worker administers the polio vaccine to a boy.

On the face of it, Noorjehan, a mother in her mid-fifties, is like any other woman of her community in India’s northern state of Uttar Pradesh.

She has four children, two of whom work in Saudi Arabia, sending back enough money to ensure their mother, who lives in the state’s eastern district of Basti, has a comfortable life in what is largely an under-developed area. But what distinguishes her is her mission: to help eradicate polio from her community.

A personal mission to eradicate polio

Wealthy enough to buy additional property or other assets, Noorjehan spends her resources rather unusually – on raising money to help increase awareness about polio. She travels across villages in a hired jeep educating people about the immunisation plus programme and in not being literate herself, pays a young man to help her complete paperwork related to polio.

Her lined face breaks into a proud smile when she says, “I have freed 14 immunisation-resistant villages in this district. Everyone in the area knows me. I love my work.”  Noorjehan is one of UNICEF’s 3,000 community mobilisers working to free the state of Uttar Pradesh from polio. She is also one of the many thousands who are making a crucial contribution to improving the state’s public-health profile. In 2003, Uttar Pradesh accounted for more than 88 per cent of the world’s current polio cases. UNICEF, along with government authorities and partners such as Rotary and CORE, is leading a large-scale strategic intervention mobilising communities and families to increase immunisation coverage.

The result of one such elaborate intervention is that clusters resistant to immunisation have been identified and progressively addressed with specific messages. Around 452 blocks (sub-district administrative areas) of UP have a social mobilisation coordinator (SMC), and each block has a block mobilisation co-ordinator (BMC) with several community mobilisers (CMC) under him or her. Together, they are bringing about a quiet revolution to help turn around the fate of one of India’s poorest and most densely populated areas.

A quiet revolution

The three-tiered set-up of the SMC, BMC and the CMC do receive financial compensation for their work. But for most, the work is more like a calling. The mobilisers educate communities on nearly everything, ranging from reproductive health, child immunisation and demonstrations on Oral Re-hydration Salts to the critical importance of polio immunisation. Although awareness activities carry on around the year, they reach a crescendo just before the stipulated national immunisation days, when polio booths are set up across the state and house-to-house immunisation takes place.

The mobilisers concentrate on techniques proven to work most effectively. Intensive one-to-one sessions are combined with saas-bahu sammelans (mother-in-law, daughter-in-law meetings), rallies, slogans and health melas (or fairs). The mobilisers are chosen with care so that each is familiar with virtually every family in his or her area.

Mohammed Tyeb is an imam (or cleric) in Jogapur village in the state’s Basti district. This community mobiliser is a respected man in the area, with five children of his own. “At first, there were a lot of resistant homes in the village. Now there is not a single one,” he says proudly.

So how does he motivate people of his community, which is particularly resistant to immunisation, who fear it would lead to impotency and infertility? “We remind people about the smallpox virus and the kind of suspiciousness it had been met with initially – but also how effective immunisation against it has been,” says Tyeb. Others like him repeat this argument and it helps strike a chord, particularly amongst members of the older generation who remember the time when smallpox was rampant.

“We have to approach people with what they understand. Just telling them about immunisation in the abstract does not help,” says Onkar Nath Upadhyaya, a social mobiliser responsible for supervising seven other mobilisers who work under him. All day he roams the rutted, pot-holed roads of villages, talking, convincing and cajoling. As we walk with him, Mr Upadhyaya points to the work going on in his area. There are wall writings everywhere, rallies with several hundred children were held one day before booth day. A fellow community member is appreciative of the work UNICEF does, despite the fact that his one-year-old niece has been diagnosed with polio. The untiring mobiliser is proud of his record. His area is virtually free of resistance.

Persisting in the face of resistance

Other community mobilisers have virtually moved in with resistant families to help break their reluctance. Faced with hostility from the khatiks, or gypsies, in his area, Ram Naresh Singh actually lived with them for 15 days at a time, talking to them and convincing them to bring their children to the booth on pulse polio day. “I ate with them and drank with them. It helped. There is no resistance left in this area,” he says. But others have a tougher time. Kamaluddin is the block mobilisation coordinator of Semariyan, an area known locally to be a hotspot for polio.

He has to deal with daily rejection by people who throw him out of their house or bang their doors shut on him. But the young man carries on almost unaffected. “I do think I have been successful in the face of such resistance. We know exactly which house in the area has refused the drops, and we will redouble our efforts to break this resistance.”

This relentless dedication is producing results. There are thousands of community mobilisers working to inspire awareness and sustain demand for immunisation to help lead to the eradication of polio in villages throughout India. They know that if Uttar Pradesh does not increase routine immunisation coverage and eradicate polio, India cannot eradicate polio. For as long as polio exists in India, it continues to pose a threat to the world at large.

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