Proactive approach by district administration in Kullu demystifies vaccines in slum colonies

“Dev Bhumi” is the abode of the gods and is the most frequented tourist and pilgrim destination of India. District Kullu, nestled by the river Beas, bounded by the Pir Panjal mountain ranges, the lower Himalayas and Greater Himalayas, is blessed with the bounties of nature. The district performs well on immunization with 89% immunization coverage which is in line with the overall high immunization coverage of the state.

Migrant communities shun healthcare and immunization

What many do not know is that the bustling township of Kullu which is frequented by tourists throughout the year for its cool climate and breathtaking vistas, has a dark underbelly with slum settlements that have sprung up on the picturesque banks of the river Beas. These slums at Sarwari, Piridi and Bhuntar are small isles where migrant workers from the states of Bihar, Rajasthan and Uttar Pradesh have set up their homes as they work in the neighbouring townships. While Sarwari is the dwelling of the daily labourers from Bihar, Piridi is densely populated with residents of Uttar Pradesh who are living and working in the city’s sanitation sector. Then there are families from Rajasthan living in the Bhuntar slum who are engaged in the process of segregating garbage from the landfills etc.

Illiteracy, ignorance, lack of awareness about the importance of good health, struggle for survival and livelihood in an alien environment pose their share of challenges to the health care personnel. Those in-charge of Immunization for the district have for years battled this scourge and attempted repeated drives for awareness and behaviour change.

Perception that vaccines will make children weak have been ingrained in the mindsets of these communities, making it hard for vaccinators to penetrate through this rigid thought process. So strong is their antagonism and  mistrust that on several occasions they have let loose their pet animals and dogs to ensure that the team of ANMs, ASHAs and other health workers do not enter their residential area.  Some of the miscreants from within the community have also snatched the wallets and mobile phones of the health workers in an attempt to teach them a lesson from getting too close to them.

Valiant efforts of the district teams to include migrants into the vaccination fold

“The migrant communities are as it is cut off. They do not have much contact with locals apart from their work. When we visited them few times and won over their trust, they expressed their concerns and queries. Since we are more directly connected to the health system and are health workers, they relied on us more than they did any other government department. It was easier for us to strike a rapport and gradually get them to agree for immunization.

District Immunization Officer, Kullu, Himachal Pradesh 

Despite these turn of events, the district health teams did not give up and continued with their efforts to provide information, knowledge, tools and access to health services. With the introduction of  Mission Indradhanush and the thrust to immunize all unimmunized and partially immunized children through additional sessions in uncovered and undercovered areas,  the district immunization team’s drive became more intensified to convince these slum dwellers to also be a part of the immunization drives.

Taking a step further, the districts’ senior immunization officials visited them to understand their problems in detail and assess for themselves the barriers that were preventing them from accessing services. To mobilise these communities, the District Immunization Officer (DIO), Medical Officer, Health Officer from the Ministry of Health along with a team of doctors, ANMs and ASHAs held meetings with the leaders of the slums. They also organised one-on-one meetings with parents and family members where the importance of immunization was taken up. Group discussions were held and questions invited from the community.

Along with these official visits, the ASHAs visited each and every household and encouraged home dwellers to step forward to clarify their doubts. They made it a point to share success stories that highlighted the role of the mothers, fathers, family elders and others as they took up the immunization charter, advocating for the same and getting their families fully vaccinated. They were told about the special Mission Indradhanush sessions.  Colourful banners were put up with information in the local language. This combined with frequent visits by senior officials made a positive impression on these slum dwellers.

Gradually the attendance at the MI sessions began to improve and more and more children registered for their vaccinations leading to a marked improvement in the immunization coverage. Presently, with the continued and dedicated efforts of the DIO and his team and the frontline health workers, all the children of these slums are taking vaccines regularly. If any child misses a vaccine due to whatever reason, the parents call the ASHAs to complete the vaccination.

This is a long and eventful journey that the slum residents have made thanks to the concerted and unfailing efforts of the immunization team. As each family gets vaccinated, the data is entered in the district records. There is a sigh of relief because every life saved due to preventable conditions is an event worth celebrating.