Busting myths and misconceptions about vaccination with Mission Indradhanush

“I was scared and angry. I decided not to immunize my children anymore”, as Abdul Hai Seikh was narrating his trepidation, the climatic mugginess of Dhubri at the bank of the Brahmaputra  and ‘mora’ Gadadhar was creating droplets of perspiration on his forehead. Abdul, a father of two, became firm in his resistance against vaccination after his younger child developed fever post vaccination.

Established in 1883 and known for its fascinating colonial history as well as mythology, Dhubri is a densely populated town located in the western part of Assam and is the border district of the state. A majority of its population traces its roots to the neighbouring country of Bangladesh, from where families have been migrating to Assam for livelihood for decades.

Ignorance and misinformation breeding ground for barriers to vaccination

Dhubri with its low immunization coverage of 20.1% [1] was identified as one of the 201 districts where Mission Indradhanush (MI) was implemented.  Launched in 2014, MI aimed to cover all those children under 2 years who were either unvaccinated, or partially vaccinated against the seven vaccine preventable diseases of Anthrax, Diphtheria, Haemophilus influenzae serotype B disease (Hib), Hepatitis A, Hepatitis B, Influenza (Flu) and Measles.

Because of the high rate of illiteracy, myths and religious beliefs about immunization as well as a large number of hard-to-reach areas  such as the chars [2], there were substantial number of left outs and dropouts in the district. Having received an opportunity to improve its immunization coverage, the district went out of its way to ensure it reached these segments of population through specially organised MI sessions. However, this was easier said than done and therefore Abdul’s trepidation was one such example which exemplified how illiteracy and false beliefs could create barriers to immunization, making it difficult for frontline health workers to accomplish their task.

“I was not aware that post immunization there would be fever so when my daughter Asma developed fever after taking the vaccine I was extremely concerned and panic stricken. It was then that I decided not to immunize my children further.” His decision to not vaccinate was further strengthened with the ill advice from few of his neighbours who narrated cases in the area where post vaccination, the children had developed serious complications.

Frontline health workers take up the immunization challenge on war footing

Since December 2017, Abdul’s daughter’s name was not included in the list of children due for immunization. Having noticed this, the Accredited Social Health Activists (ASHA) of the area – Renuka Bala Roy and Asma Khatoon as well as the Auxiliary Nurse Midwife (ANM), Radhamoni Pradhan, became concerned. The trio visited Abdul and tried to convince him to bring his daughter for vaccination, but were unsuccessful.

Perceiving his resistance, they conveyed the information to the Block Programme Manager, Salima Khatoon. Salima, accompanied by the ASHA supervisor, Promila Roy visited Abdul a few times but failed to convince Abdul who remained steadfast in his decision. At this juncture, Arif Ahmed, the District Community Mobiliser (DCM) joined in the discussion. Well-versed with the history, geography, culture and tradition of Dhubri, he applied his ground-level experiences and interpersonal skills to convince Abdul.

“In my experience, communication breaks barriers, if only one communicates in such a manner in which the person sitting on the other side understands the information clearly. Here, people are illiterate and if one tries to explain things too scientifically, the whole aim of communication can be jeopardised”, said Arif sharing his ground experience in Dhubri as DCM for over five years. It took him almost a day to counsel Abdul and his family. First Arif made Abdul understand that fever for a day is a usual occurrence post certain vaccines and it was a normal physiological phenomenon and in no way abnormal. He along with the team counselled the family by informing them that not receiving vaccines on time would affect his daughter‘s immunity and make her vulnerable to other diseases. Later, he convinced Abdul to bring his daughter for subsequent vaccines.

An enlightened community that sees the value of being immunized

In August 2018, Abdul brought his daughter to an MI session and she was finally given her due vaccines. A transformed Abdul who realised his folly and how he was jeopardising his children’s lives, became an active influencer in his village. While this narration was continuing, the muted light of the setting sun on the “land of rivers” lit the face of little Asma. Continuing her siesta in her mother’s lap without any scare, she is secured and immunized. According to the ASHA duo of Renuka Bala and Asma, “We have been doing our work, going house-to-house to make sure all the children in our area get vaccines. But when we were told about MI and that we needed to identify and reach the missed children, we were attentive and alert.

Arif Sir and Salima didi also went with us and guided us on how to broach this sensitive topic that may meet with several roadblocks and stubborn resistance. This gave us confidence. When we went together, the same family who did not listen to us earlier when we visited them now treated us differently and accepted our suggestion. Our perseverance, genuine concern and credible information helped in getting our message across to them. Their success was then shared at the village level encouraging many more people like Abdul to step forward and vaccinate their child.”

“Most people in my village do not know much about these injections. They hesitate and have fears and doubts in their mind leading to their saying No to vaccination. Now after my own experience and seeing the kind of support I received from the government, I am convinced these are baseless doubts. Whenever I get the opportunity, during our local meetings and religious gatherings, I now speak of the benefits of vaccines and try to convince my misinformed neighbours to immunize their children without further ado”.

Abdul Hai Seikh, resident of Dhubri town in Assam and father of two

[1] https://dhsfw.assam.gov.in/portlets/immunization

[2] Chars are floating islands which keep changing shapes depending on the push and pull of the Brahmaputra,