Baby being given oral vaccination drops.

Gauri Shankar is startled by a vaccination, but his mother recognizes the lifesaving benefits. Photo: PATH/Gabe Bienczycki.

Bringing together children, vaccines, and a health worker

Travel in the forested hills of Madhya Pradesh is not easy for Asha Thakur, an auxiliary nurse midwife in charge of immunizing the children of eight villages in the central Indian state. A good road is one that isn’t flooded and has stretches of pavement to break up the bone-jarring potholes. Like most people in her community, the 38-year-old doesn’t own a car and must walk or get rides.

So how does Asha get vaccines to all the children in her area who need them, when they need them, safely? Until recently, with great difficulty.

Until PATH arrived in 2009, only 36 percent of children in Madhya Pradesh were fully immunized. The rest were vulnerable to conditions ranging from measles to respiratory infections. Challenging terrain, a shortage of trained health care workers and volunteer educators, and weak vaccine-management systems made it difficult to improve immunization rates—and Asha’s job harder.

Getting children to immunization day is as important as getting vaccines there.

PATH began work after we helped to dramatically improve immunization rates in the neighboring state of Andhra Pradesh. We’re strengthening every step along the immunization chain, from increasing the number of trained staff to improving vaccine storage and distribution. We’re also helping to raise awareness among parents and communities, because getting children to immunization day is as important as getting vaccines there.

Removing obstacles

It’s the third Friday of the month. That means Asha is going to the village of Baitaganj. It takes her an hour to get there by foot, but it used to take twice that long. Until recently, she first had to travel to the community health center to pick up the vaccines. By the time she reached the village, she had only a few hours to immunize the babies and no time for health education. Now, a courier system ensures that the vaccines are at the village when she arrives.

Surendra Kumar Hardah is in charge of the vaccine cold storage room at the  primary health center, where he monitors and distributes vaccines and keeps meticulous handwritten records of temperature readings and how many vaccines are distributed and where. “The idea is to maintain an adequate supply and a safe temperature from the divisional level all the way to the beneficiaries,” he says.

Community volunteers are also paving the way for Asha. While she walks past swollen ponds and trees with platter-sized leaves, they are going door to door in the village—armed with up-to-date records that show which children are due for vaccinations—to remind mothers to come to immunization day. By the time Asha arrives at the session site, the courtyard is filled with the sweet voices of small children.

Gaining acceptance

Asha Thakur

“There is no resistance to immunization anymore,” says Asha Thakur. Photo: PATH/Gabe Bienczycki.

That so many mothers are here with their children is a sign of change.

“There was mistrust in the past,” Asha says. Villagers were unsure if vaccines worked and afraid of their side effects. Crying babies and occasional fevers didn’t help. To overcome suspicions, Asha visited families and explained the benefits of immunization. PATH staff and training have supported her.

“There is no resistance to immunization anymore,” Asha says with a wide smile.

Since PATH began working in this part of Madhya Pradesh, immunization days have become more regular and parents more committed. The project is well on its way to achieving its goal of 70 percent coverage.

Five-month-old Gauri Shankar has come to immunization day before. He is a big boy—exclusively breastfed, his mother Raj Kumari says—with a goofy smile. His eyes open wide with surprise as Asha squeezes oral polio drops into his mouth, but he wails at the pinch of the shot that will protect him from diphtheria, tetanus, and pertussis.

While Raj Kumari rocks the boy, Asha explains that Gauri Shankar may get a fever from the vaccine. She gives Raj Kumari a packet of acetaminophen to mix with her breast milk.

Raj Kumari seems unworried. “We’ve learned about the importance of vaccinations and how it protects our children,” she says. “All my children are healthy.”