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Assam: Through ‘baator naats’ and on boats, ensuring no one misses Covid shot

Street plays, vaccine boats and sustained awareness drives — how this Project is taking the Covid vaccine to remote Assam areas, including sandbars along the Brahmaputra.

Updated: November 19, 2022 16:53 IST

The village drunk staggers down the road, throws his arms open and declares: “I get all the immunity I need from my alcohol, I don’t need any vaccine to protect me”. The woman next to him wails in frustration. Fed up of her husband’s antics, she proceeds to give him a comical push.

As the scene unfolds, the midday traffic at Kopati bazaar — a bustling market in a village in Assam’s Darrang district — comes to a standstill. Shoppers put down their shopping bags, motorcycles halt, and a small crowd gathers to watch. Some smile, others whip out their phones to record the spectacle. “I have heard that people die within two years of the shot,” the drunk shouts at no one in particular. “I am in no mood to die, I don’t need a vaccine”.

In the following 10 minutes of the street play, or baator naat, performed by Antaranga Gusti, a local Assamese theatre group, some serious myth-busting is underway: Covid vaccines don’t have damaging side-effects, vaccines are safe for pregnant/lactating women, vaccines will protect you, and vaccines definitely won’t kill you.

With these interventions by three health workers, the drunk gradually comes on board. “I am on my way to get the vaccine, are you?” he tells the crowd as the play wraps up.

Pankaj Saharia, the director of the drama, who also plays the village drunk, says the point was to use a “simple story that everyone could relate to”. “Vaccine hesitancy in remote rural areas is real. There can be 100 ads in the newspaper, or announcements on the radio, but nothing is as intimate as a play in action,” he says.

Plays like Saharia’s are among the many innovative measures being implemented as part of the Momentum Routine Immunization Transformation and Equity Covid-19 Vaccination Project. Supported by USAID and implemented through John Snow India Pvt. Ltd (JSI), the initiative aims at boosting the government’s efforts in vaccinating marginalised communities living in remote areas across 18 states. In Assam, the project has been implemented in at least 25 districts.

The Project is working in close collaboration with state/district authorities and complementing state’s efforts in expanding COVID-19 vaccination to all in Assam to ensure no one is left behind.

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Local collaborations and government support have facilitated and elevated the Project’s scope of work so everyone even in the most remote corners of Assam can avail the benefits of the COVID-19 vaccine.

While nationwide vaccine deployment efforts have been on in earnest for the past two years, the uptake of the precautionary dose has been slow. Take for example, 60-year-old Noni Devi in Kopati bazaar. The retired school teacher got her first two doses on time, but has put off the third for months now. “We rarely hear of Covid cases these days…so the vaccine is not on anyone’s priority list,” she says, “But this play served as a good reminder why we should.” Near her, Saumeshwari Saikia, another senior citizen who is yet to take the third dose, nods in agreement.

Supported by USAID, the Project is being implemented by John Snow India Pvt Ltd in collaboration with the Centre, and works with local NGOs to increase vaccination coverage, particularly for vulnerable and marginalised populations, in 18 states across India.

It is people like Devi and Saikia that Project Momentum is targeting. “This is the knowledge gap we want to bridge. Last mile vaccine delivery is our aim,” an official associated with the Project says.

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And in Assam, the Project’s work is supported by LEHS|WISH (Wadhwani Initiative for Sustainable Healthcare) , HelpaAge India and TCI Foundation.

On a boat, to the char

In the street play, the drunk points out that the vaccine “gave him a fever”. “Who will run my house if I am laid up in bed?” he asks.

The dialogue finds an echo a hundred-odd kilometres away in 48-year-old Majibur, a resident of a char, or a sandbar along the Brahmaputra. The fever he got from the first shot restricted him to bed for two days. “For char-dwelling, daily wage earners like me, that is a huge loss,” he says.

Vaccine outreach drive in the Char area. (Express photo: Tora Agarwala)

Though conditions have marginally improved, the chars-chaporis, or shifting riverine islands of the Brahmaputra, have been marred by lack of development, illiteracy, poverty and high birth rates. It is routine for these islands to sink every monsoon, only to emerge in another place when the waters abate.

“It is a tough life,” says Rahman, who now lives in a char in Sonitpur district’s Bihaguri block. His earlier home, in another char, was swallowed up by the river.

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Standing in queue at a Project vaccine outreach programme at his char, he recalls how he had to spend his own money, travel by boat to a government vaccination camp last year for the shot.

While he is still deciding whether to take the third dose, Rahman says he appreciates that the health workers have come right to their doorstep this time, courtesy a “vaccine drive by boat” organised by the Project. “They have explained why it’s important to take the booster dose — Covid has not gone away. I suppose missing a day’s wage is the sacrifice I will have to make,” he says.

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For the health workers, navigating into such remote areas is no mean feat. “The main problem in a char area is the accessibility — there is no easy way to get to a char,” says a community health worker engaged in the area. “Going to a char means hiring a boat, walking for miles in the sand,” he says, adding: “While the government arranges boats wherever possible, the area is so widespread that some parts are inevitably skipped.”

The Project’s “Vaccine Boats” — currently deployed in five districts of the state — go a long way.

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Biman Sharma, the additional chief medical and health officer of Sonitpur district, says the Project has helped the government navigate two challenges. “One is accessibility, And the other is resistance,” says Sharma.

Vaccine on wheels

In Sonitpur district’s Nunijharni, Gangamani Hazoary, who is part of the village women’s association, remembers how they had to physically chase some people to take the shot. “I have always been enthusiastic about the vaccine but there are some people who are convinced that the vaccine will kill them. When you see your neighbours and friends resisting so firmly, you begin to have doubts too,” she says.

Pregnant women, too, fear that vaccines will harm the unborn child. “The only way to deal with such cases is to reach out to them and raise awareness. We tell them things like, see, we have taken it too, as have our old parents and we are all just fine,” says a young health worker in Nunijharni.

As part of the Project, a “Vaccine Express” was also recently inaugurated in 10 districts to get the shot to “hard-to-reach” areas that may have been left out in previous drives.

“These are far-flung areas where nurses find it very hard to go for a number of reasons, including lack of public transport to the village, or a communication gap,” says the worker.

Based on data from the government, the workers identify such villages that have slipped through the cracks, and deploy the Project’s mobile van. “A week before we send the car, we do a mobilisation programme in the village to raise awareness,” he says.

In a village in Darrang district’s Kharupetia, where the Vaccine Express visits on a November afternoon, 76-year-old Nazim Ali says that such measures are ultimately effective, despite hesitancy. “When health workers come right up to our homes and explain why we should take it, even the most reluctant people end up changing their minds,” he says.

Disclaimer: MOMENTUM Routine Immunization Transformation and Equity Project, supported by USAID is implemented in India by John Snow India Pvt Ltd in close collaboration with the Government of India to strengthen their outreach and delivery efforts with communities for vaccination; and through partnerships with local NGOs to increase demand, distribution and uptake of COVID-19 vaccination, particularly for vulnerable and marginalized populations across selected 18 states of India. (Visit: https://usaidmomentum.org/)

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