IN THE last three years, Sokina Khatun, an Auxiliary Nurse Midwife (ANM), has visited nearly all of the chars (river islets that dot the Brahmaputra) that fall under Assam’s Goalpara district. An ANM for 11 years, Sokina is now part of the Mission Indradhanush team — along with ‘extension educators’ to conduct the campaign, ASHA workers and a Boat Clinic team — tasked with ensuring immunisation at these remote outposts, many of which can only be reached by boat.
There are over 2,000 big and small chars, covering about 3.6 lakh hectares, on the Brahmaputra. While some have been inhabited for 80 to 100 years, some are temporary and disappear with the floods every 2-3 years. An estimated 30 lakh people inhabit them, with the state government saying about 80 per cent of them live below the poverty line.
At Lakhipur block in Goalpara, some 200 km from capital Guwahati, the Indradhanush team has so far achieved 98 per cent full immunisation coverage, while the district itself has achieved 107.29 per cent. At times, the coverage exceeds 100 per cent since families who had moved out, particularly because of the floods, had returned, months after the initial survey to identify children was conducted.
The floods have also meant that unlike in other states, where the Intensified Mission Indradhanush is being held between October and January, in Assam, it is being conducted between November and February.
Sokina says that since November, the team has been visiting the villages on the chars on the seventh of every month. “Many a times, we also go in the middle of the month along with doctors and other officials to ensure that no child or mother is left out,” says Sokina, who is attached with the Block Primary Health Centre (BPHC) in Lakhipur. She hails from Khormuja village, about 11 km away.
Sokina says the regular campaigns by ASHA and anganwadi workers, who have undergone communication skill training on immunisation drives, to assuage the concerns of parents have made a huge difference.
Another major impetus to the drive has been the presence of the boat clinics, a public-private partnership initiative, the first of which was launched in 2004-05. Each boat clinic has a 14-member crew — a district programme officer (DPO), two doctors, two ANMs, a pharmacist, a lab technician and three community health workers, besides three boatmen and a driver. The boat also has a portable lab and is stocked with common medicines and contraceptives. “We are not directly part of Mission Indradhanush. But we have been spreading awareness about the initiative as our boat touches one village after the other every day. Many a time, our teams also work together when we land up in the same village,” says DPO, Goalpara, Bandana Khound.
The last time Sokina visited an islet was on December 8, when she, along with local ASHA workers, Aleya Khatun and Monjura Khatun and their supervisor Samsun Nehar, were in Bamuner-Alga Part III village in Bamuner-Alga char. On the day, the team had only one pregnant woman to vaccinate — Mofida Khatun, 19, wife of Manowar Hussain. The others had already been vaccinated in November.
For Mofida, this is the first pregnancy, and although she has little idea of what immunisation means, she says she understands how important it is. “I have seen a number of children die when I was a child. I don’t remember having taken any injection or medicine when I was young. But in the last few years, I have seen medical teams coming regularly to our village. I have taken every injection and every tablet that the doctor and nurses have given me,” Mofida says.
Bamuner-Alga Part III, one of the seven villages on this char (the char keeps changing size and shape depending on the river’s course), has a population of 1,020, of whom 40 are pregnant women and 66 are children in the 0-2 age-group. The Indradhanush team has already covered 56 children and 38 pregnant women.
“While I go to different chars by the regular passenger boats that charge Rs 30 one way, we also have to walk, sometimes up to five km on sands, to reach the villages,” says Sokina.
Before the drive, she says, residents were wary of vaccination. “There was a time when people used to resist injections and come up with various excuses. About three years ago, after a three-year old girl died of diarrhoea in Bamuner-Alga, people had refused to come for immunisation. But then, with a door-to-door campaign under Mission Indradhanush, coupled with special awareness campaigns done by the boat clinic, things have become normal,” says Sokina.
In Guwahati, Mallika Medhi, Director, Family Welfare, Government of Assam, says the state has been on track with the immunisation programme. Across Assam, she says, the overall full immunisation coverage was 93.10 per cent for 2016-17. “We have already vaccinated 12,523 of the 13,382 children in the 0-2 age-group in the seven target districts in the first phase till November 2017. The targets for the second round, which began on December 7, will be easily fulfilled as motivation levels are very high, both among our workers as well as the community,” she says.