By Dr. Pravin H Khobragade
All the children of Dawa Ningzata village of East Garo hills district of Meghalaya were either never vaccinated or in various stages of partial vaccination when Monika Marak, ANM reached there after a hiatus of four years. Though the village is just five kilometers from sub-centre, reaching it takes three hours by foot – crossing hills and a river and trekking through a jungle that is inhabited by wild elephants.
This time however, Mr. Rohman Sangma, District Health Education Officer and Ms. Jamila Marak Public Health Nurse accompanied her Along with her husband. Reaching the unreached or poorly reached is the core strategy of a weeklong Immunization drive in Meghalaya state. Unknown of this special team effort, Mr. Malakar, State Cold Chain Officer along with UNICEF staff member (Dr. Pravin Khobragade) reached Dawa Ningzata as a part of their monitoring of immunization activities in hard to reach habitations.
“We all are scared to come here crossing jungles – there are poisonous snakes and leeches” explained Mr. Rohman Sangma. As the houses in the village are scattered, vaccinating beneficiaries at one spot (as happens in the plain areas of the country) is difficult and the team is compelled to move from one cluster of houses to another.
Monika Marak instantly communicates with families and there is a sparkle in her eyes as she acknowledges the growth in children whom she had seen four years ago. Many families were eagerly waiting for her and expressed concern that they cannot bring their children and pregnant women for vaccination to the sub-centre as they too have to trek the risky route. “We need to vaccinate each and every child who is, as you know, have missed some doses. Also the pregnant women need to be given Tetanus Toxoid injection. Similar is the situation for many other villages of our state” says Mr. Malakar, State Cold Chain Officer.
When the team reached the house of Hebina Marak, it seemed that the family was eagerly waiting for Monika Marak. Monika had named their first son as ‘Twelse’, a four year old healthy child during her last visit when she had administered BCG and OPV to the child. Now they had a beautiful daughter of five months and they waited for Monika to name the child. Without any ceremony, Monika instantly names the child as ‘Neharika’ and administers BCG, first dose of DPT and OPV. She also vaccinates Twelse with DT 1, measles vaccine and OPV as he had missed the schedule since four years.
At another house, Morjina T Sangma a 25 years old pregnant woman beamed happily on seeing Monika Marak. Morjina is pregnant for the fifth time and has a 3 years old daughter – Marcina – who has never being vaccinated. Morjina’s three children died of acute respiratory infections when they were in their neonatal periodNot to loose any opportunity, Monika conducted an antenatal checkup, gave iron and folic acid tablets and administered tetanus injection. Marcina is administered measles vaccine, DT1, OPV and Vitamin A. Mr. Teres, husband of Morjina, on seeing the response of immunization team then went on a mobilization spree and mobilized many children to their house for vaccination.
These initiatives from the ground level workers who build a team within themselves to reach the unreached communities led to decrease of never vaccinated children from 61% to 21% in the district of East Garo Hills of Meghalaya. Pregnant women not received TT2 or B has decreased from 75% to 57%. The DPT 1 coverage has increased from 36% pre- immunization weeks to 82% at the end of two rounds of immunization weeks. During the first round of immunization week 1,432 children were administered measles vaccine, which would have taken 10 months for the district to vaccinate in normal course.
Mr. Malakar while guiding the return of the team cleared bushes and was unfortunately wounded on left foot by a thorn from a plant. On reaching the district headquarter, Mr. Malakar while dressing his left foot, smiles seeing the results of East Garo Hills and points out to the immunization monitoring chart below. “In the past, more than 50% of successive cohorts remained unprotected against measles infection; also 50% of pregnant women remained inadequately protected against tetanus infection - leaving a large unvaccinated cohort. This has led to already 1, 283 reported cases of measles in the state with 50 deaths this year. The immunization drive was a timely intervention to reach our children in hard to reach areas.”.
The state during successive rounds of immunization week reached to more than 8 percent children being vaccinated against BCG and DPT 1 and more than 5 % children vaccinated with measles vaccine in both the rounds in comparison to the annual target. Reaching to more than 2 % of the annual target in a week’s time is sign of reaching to the unreached.