200 children and infants living in Puankhai village and surrounding hamlets of Tlabung subdivision were vaccinated on 13th and 14th November 2006, for the first time in their life. This village is located 45 kilometers away from Tlabung, on the Indo-Bangladesh border in Chakma tribal belt in Mizoram state. Ballazawmna, the health worker who provided this essential service to the children in the area, had to travel on foot to this remote place with support from UNICEF as part of a national campaign promoting immunization in the hard-to-reach areas of the country. While a sub-centre exists in the area, the building remained vacant for the last 10 years as no health worker was willing to be posted here. Hence immunization coverage was required to be provided urgently to these blooming youngsters to bridge the gap in their immune system.
Ballazawmna’s efforts were supported by the village council president (village head) and a local pharmacist who visited each and every household to inform the families about the immunization drive and to persuade them to attend this special immunization session that was being held at the main village road. Ballazawmna had to stay overnight in the village in order to visit the rural communities in the area before returning to his main work place at Tlabung PHC which was 15 kilometres away from the village.
At the same time, in Piperaghat, another village which was 22 Kilometers away from Tlabung, health worker Pushpa was very busy in setting up her immunisation clinic. Mothers from the village had all queued up for getting different antigens for their kids in the session that was being held after a gap of seven months. One has to walk down nine kilometers off the main road to access Piperaghat in normal circumstances, that too on a kutcha (unmetalled) road that was made very recently. Pushpa could enter this village after such a long time, thanks to the special transport and the vaccines that were made available to her as part of the week long immunisation campaigns. The village Aanganwadi had enthusiastically informed the families about this event and thus mobilised mothers to be present in the primary school of the village that day.
The situation was similar in many other areas in the 80,000 strong Chakma belt alongside the Indo-Bangladesh border. Routine immunization coverage is very low in all the Bangladesh and Myanmar border areas of Mizoram. The Chakma tribal belt is the toughest geographic area in Mizoram bordering Rangamati and Khagrachhari provinces in Chittagong Hill tracts of Bangladesh. River Karnafuli is the main source of water for all purposes for people on both sides of the border.
In India, UIP was launched in 1985 to make sure that BCG, three doses of DPT and OPV, and measles reaches all children in all areas of the country before the child completes its first birthday. UNICEF is actively supporting the GOI efforts in strengthening Routine Immunisation to avert infant/child deaths to the maximum.
However, there are many inherent problems in the Chakma belt, which makes it difficult to provide child health and development services. Apart from hilly terrain, Chakmas practice shifting cultivation called JUM which makes them inaccessible from the main land for many months. Communication is another major problem, the native Mizo health workers do not understand the Chakma language and Chakmas rarely understand Mizo language. There are only a few Chakmas who are trained to become health workers. Also, there is no access to primary schools for the Chakma children living in scattered houses.
With UNICEF support, the access and availability of the RI vaccines are successfully maintained in this area. Border Security Force officials have promised to facilitate transport, while Chakma district officials have offered to translate health messages in Chakma language for the benefit of their community. Village council heads of many villages are also roped in to remove the possible bottlenecks coming in way of holding regular immunisation sessions. Thus children in many villages and hamlets in the North Eastern states of Mizoram, Arunachal Pradesh, Tripura, Manipur, Nagaland, Sikkim and Meghalaya, were immunised for the first time in these immunisation weeks.
In 2006, GOI launched special Immunization strengthening campaigns on a monthly interval with each campaign lasting for a week. First set of such campaigns were conducted from February to May and the second series of campaigns started in October 2006 and will continue till March 2007. But reaching out to the people living in the most remote areas at least four times a year to deliver all vaccines available under Universal Immunisation Programme (UIP) is a touch task and is the key to strengthening Routine Immunisation.