Dr Haneefa Cherukara and his team of health workers get off the jeep at Medappara village in Malappuram and start walking down a narrow mud path. It’s 10 am and the path is desolate. Spotting a scooter, junior public nurse Sajina B A flags it down. She introduces the rider as Arayal Ayoob and tells Dr Cherukara that Ayoob’s children are among those yet to be vaccinated. Dr Cherukara tells a diffident Ayoob that they are headed for his house. Ayoob tries to dissuade him, but fails.
At Ayoob’s house in Arayal, women peer over window curtains as Dr Cherukara talks to the men about the recent diphtheria deaths in Malappuram district. He says the victims were below the age of 12 and had not been immunised. He tells them there is a special immunisation drive in the district now and Ayoob should get his children, both under 10, there.
Ayoob turns to his father Sakkaria for consent. Sakkaria dismisses the idea right away. “I didn’t vaccinate my children; they are still alive. Do you have any guarantee that the injection will not cause any side effects?”
Dr Cherukara explains in detail how the vaccination is safe. The family doesn’t look convinced, but the doctor has to move on.
Last month came news that diptheria, a disease that begins as a sore throat and fever, but can damage the kidneys, nervous system and heart, had returned to Malappuram after a year’s lull. One of the major reasons was the reluctance of some Muslim families to get their children vaccinated. Malappuram district has the second largest Muslim population in the country.
Once a major cause of illness and death among children, diphtheria, which spreads through coughing or sneezing, can be controlled through vaccination. India witnessed 4,071 cases of diphtheria and 104 deaths in 2014. Delhi had the highest number of cases, 1,418, as well as deaths, 60. But Kerala’s two deaths and five cases have raised an alarm because it’s particularly worrying for a state whose health indices have been on a par with developed nations. In response to the spurt in cases, the state health department is organising a week-long immunisation drive in Malappuram. Dr Cherukara is here to convince parents to send their children for it.
A survey last month showed that more than 46,300 children in the district below the age of seven had not been immunised. Of them, 6,643 children had not got any vaccine since birth. The area under the Community Health Centre (CHC) at Valavannur had the largest number of children (1,004) who had not be vaccinated, while 3,867 had only been partially immunised.
Dr Cherukara is the lone paediatrician at the Valavannur CHC, which caters to people in eight village panchayats.
On Wednesday, Dr Cherukara and his team are covering regions under the health department’s sub-centre at Alloor, which has 859 children in 0-7 age group. Of them, 49 have never been vaccinated, while 198 have got some of their shots.
As he walks to a house next to Ayoob’s, Dr Cherukara says it is unfortunate that the region has recorded a vaccination rate of less than 80 per cent. Even Islamic countries such as Saudi Arabia, Oman and Turkey have coverage of above 96 per cent, he points out.
Chalambattil Samad, the doctor’s next stop, says he hasn’t heard of the diphtheria deaths. Father of two children, Samad shows the health card of his younger one, now 3. The doctor looks at the card and tells him his son hasn’t been vaccinated after the first dose that was given soon after his birth.
The 36-year-old automobile businessman, who owns a large house and a luxury car, is worried about the “side effects”. “I have heard that the vaccine can lead to deformities. It can also endanger the life of children.”
The doctor asks Samad to trust him. “I assure you there won’t be any side effects. All these are rumours. Bring the boy to the camp by noon.”
The team boards the jeep and moves to the next house, where they meet a three-year-old girl who has taken only the initial dose. Her mother Sharafuneesa refuses to bring her daughter to the camp. “My husband won’t let me bring her. Let the disease come, I will treat my child then.”
After failing to convince her, the team gives up. “Despite the recent deaths, many parents are not bothered about vaccinating their children,” says M P Muraleedharan, a health supervisor.
By noon, the team has covered six houses. Two hours later, they are at the special vaccination camp, set up in Randal village.
Soon, there are half a dozen children below the age of 7 in the camp. While examining the children before clearing them for vaccination, Dr Cherukara says that even if younger members in families agree for the vaccination, the elders stop them. Talking of families where the men work in the Gulf, he says orthodox grandparents often make decisions for their daughters-in-law.
Local Sunni leader and secretary of 11 ‘mahallu committees’, Noushad Ali, claims “an American agenda” behind the new cases. At the same time, he adds, “I am not personally against vaccination. But if I opt for vaccination, my family members will attack me. I can ward off health workers seeking to give vaccines to my children, but it will be hard to explain my action to family members.”
Usainkutty, general secretary of the local masjid at Kalpakanchery, says his religion is not against vaccination, but that a section of people strongly believes that everything is decided by god. “Even after being vaccinated, children die of diseases. Hence, everything rests with god (they believe),” he says.