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Mumbai: The agenda for World Health Awareness Day, or World Health Day 2019, is "universal health coverage", which aims to make health services affordable and accessible to all. In India, the government, as part of its initiative – "Indradhanush Mission", has significantly increased immunization coverage in states and districts, making vital vaccines available to pregnant women and children across the country. Community health workers are the real strength to effectively achieve this goal. They are the unsung heroes of health care in India, making vaccination possible even in the most remote parts of the country.
The measles and rubella campaign of the Ministry of Health and Family is underway in Assam, where the vaccine is administered to all children aged 9 months to 15 years. An injection of this vaccine prevents the two diseases, measles and rubella, thanks to the efforts of teams of health personnel, composed mainly of women.
Popularly known as the gateway to western Assam, the historic city of Dhubri is often referred to as the "land of rivers". Reaching these communities living in protected areas for vaccination is extremely difficult, but that does not deter ASHA's dedicated health workers here. Virtually no roads exist in these areas and even boats are not available. The only way to cross waterbodies and wetlands is to walk on foot or with makeshift rafts and bridges made of jute, bamboo and banana. Teams cross rough terrain, carefully transporting separate blue box vaccine containers, which ensure safe storage of vaccines.
ASHA Abaron Bibi, is the only person who makes the ASHA team cross the wetlands, alone in extremely hot and humid conditions in Golakganj, Assam. (Photo: MoHFW)
The ASHA team, made up of workers like Manibala Roy and Abaron Bibi, is expectoriously dedicated to the cause of vaccination and to improving the quality of life of the inhabitants of their region. Abaron Bibi manually transports the ASHA team from a makeshift raft across wetlands, whenever the ASHA team travels to Golakganj. Abaron is the only person who can do it and she is as sincere and hardworking as one can expect from a community health worker. "It's my village and I'm ASHA. If I refuse, then who else will do it? Replied the shy widow and mother of five children.
ASHA workers continue to isolated areas without pausing, browsing the water mbades and shifting the weight of "blue boxes", vaccine carriers from one shoulder to the other. another in Dhubri, in Assam. (Photo: MoHFW)
The team of Licensed Practical Nurses (LPNs), village health workers in India and ASHA in this region is a shining example of how women's empowerment can translate into better care for all. the base in India. They reach even the most remote areas of Assam, carry out vaccination campaigns, mobilize communities and save millions of lives from premature death.
Another heroic story is that of the fiery duo of Malana, Kullu district, Himachal Pradesh. The huge mountains of the region are not up to the determination of ANM Meena Kumari and ASHA Nirma Devi. Located at 2652 meters altitude, Malana is an ancient village nestled in the heart of verdant forests and snow-capped mountains of the Parvati Valley. With a total population of only 1935 and 220 households, Malana is isolated from the rest of the world. For immunization officials in Kullu District, Malana remained outside the scope of the vaccination because no one was willing to go there.
In April 2015, Meena Kumari joined ANM at the Pini sub-center. Undeterred by the geographical tenacity of Malana, she is committed to the mission of immunizing the children of Malana. Since there was no alternative vaccine distribution (AVD), Meena had to carry vaccine carriers from the Jari CHC cold chain, 40 kilometers from Malana alone. Take literally the road less traveled, partly by public transport and partly on foot. Meena has never failed to conduct a session in Malana, even in the winter, when the region received the heaviest snowfall.
Today, Meena is no longer an outsider or untouchable for the Malanis. They thank Meena and Nirma for the health services they provide, including immunization. (Photo: MoHFW)
Fortunately, during the same period of April 2015, Nirma Devi joined the ASHA Worker position. Nirma is the first Malani to accept working as ASHA for her village. Nirma's participation helped to remove another difficult obstacle, the Malanis language called Kanashi. Malanis do not speak or understand any other language and the rest of Himachal does not understand Kanashi. She received curses and threats for bringing Meena, a stranger, to Malana. According to the villagers, Nirma violated the order of the guardian deity of Malana, which was a bad omen and made everyone suffer. Initially, they did not allow Meena or even Nirma to touch their children.
Malana mothers are happy to attend each immunization session and there are no more unvaccinated children in Malana today. (Photo: MoHFW)
It took almost a year in Nirma to convince the council and the villagers that Meena was there to ensure the health of women and children. Nirma organized a meeting of elderly women in the village and advocated for the benefits of vaccines and the positive effects of vaccination on children's health. With Meena, she met with the village council several times and urged the Malanis to trust the government's vaccines, baduring them that their children will not suffer any damage after the vaccination.
With Nirma's support, Meena vaccinated the 170 mothers for antenatal care and then continued to immunize their children. Today, Meena is no longer an outsider or untouchable for the Malanis. Malani mothers are now grateful to Nirma and are also taking care of Meena by offering her food while she is at work. Thanks to their efforts and determination, there are no more unvaccinated children in Malana today.
The role of VADs is critical in the chain of the public health system in India, especially with regard to immunization programs. They ensure that vaccines and logistics are delivered to the site in time for the immunization session days. The AVD provider is often a local person, who usually participates in the part-time immunization campaign.
Motorcycles are the only option in these remote areas of Barwani and Alirajpur because of poor roads and lack of roads. (Photo: MoHFW)
Barwani and Alirajpur districts in Madhya Pradesh state have a team of specialized DSA service providers known as "men in pink". These men work tirelessly to support vaccination by tackling some of India's most difficult and remote terrain. The pink shirts are their official dress code and, like real symbols of hope, they go through Falias and tola, local words for small dwellings or hamlets.
Gagaprasad Saste, a young man from Badwani, is one of the driving forces of the village VEDs in the Semlet sub-center in Barwani. He has been working as a DAV in this district for 3 years. He works as kufli seller in these areas and is therefore familiar with every nook and cranny of the area. Gangaprasad is also famous in this region for his singing talent. He even recorded a few albums of traditional Nimari songs from Barwani. Gangaprasad initially hesitated to be part of the health system.
The success of VADs rests on the reliable shoulders of health workers such as Gagaprasad Saste. The AVD system has also generated employment opportunities for young unemployed people in rural areas, who often volunteer. (Photo: MoHFW)
But later, after some exchanges with the supervisor, Jitendra Dudwe, he is interested and agrees to take up his duties. "Having learned a lot from Dudwe, sir, I now know all the vaccines and I can even converse with the mothers and inform them about the benefits of vaccination," says Gangaprasad. Gangaprasad is now pbadionate about raising awareness about vaccination with altruism, adding to its popularity at the block and district level.
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