By Dr. Sonu Goel and by Dr. Khobragade
Damong was returning with his family from Nepal to East Sikkim district after visiting his parents in that country. Though he had crossed the borders innumerable times in the past 10 years, this time – it was completely different. Security forces detained the family, suspecting them of being from a rebel group. Damong’s pleas went unheeded for the lack of proof of residential identity. Luckily, Damong’s wife Perme was carrying the vaccination card of their second child - a 2 month old who was administered BCG, DPT 1 and OPV 1 on 2nd February 2006 in Rhenock area of SIkkim during the immunization week. The vaccination card was a savior and the family returned to their village safely. On his return, the very next day Damong visited Rhenock Primary Health Centre and narrated the incident. He also enquired about any vaccinations due to their first child a 2 year old daughter.
Sikkim state – “the adobe of Gods”, is a land of breath taking natural beauty. Situated in the eastern end of the Himalayas flanked by Bhutan, Nepal and Tibet. , the population of Sikkim is 0.5 million in hilly terrain and the state has introduced Hepatitis B vaccine in its routine immunization programme demonstrating increased commitment for fighting against vaccine preventable diseases.
The District Level Rapid Household Survey of 2002 – 04 shows that 91.4 % are vaccinated with BCG in the state, but only 50.2 % children are fully vaccinated. The poor coverage led to an initiative to cover the backlog of never vaccinated and partially vaccinated children in the state in three rounds – each round to last a week with a gap of one month in between them. The primary cause for dropouts was found to be that the immunization card was not issued to families at the start of the schedule, but families were issued cards when the child completed DPT booster vaccination. This led to a lack of recorded information with the families on the vaccination status of their children, further resulting in increase in dropouts. On request from the Indian Government, UNICEF stepped in the state in January 2006 and started catalyzing qualitative changes in the programme. Notable among them was the issuance of immunization cards to the families on the administration of any first vaccine. The incident faced by Damong’s family is an off shoot of this and evidence that qualitative improvements are already on the way.
Other recent significant improvements in the immunization programme are maintenance of counterfoils of immunization cards, having a constant dialogue with families that arrive at the session sites, explaining the necessity of vaccination and emphasizing the date of the next due vaccination. Also the practice of keeping vaccine vials in ice packs at the session site is fast disappearing for good.
UNICEF continues to provide knowledge, technical and pragmatic support to the state for developing its annual plan of action on immunization and refining micro plans.