Keller in Shopian district, south Kashmir, a paradise within the larger paradise is a work zone marked by daunting challenges for Shahnaz (name changed). She is a front line worker from the local health department contributing to the district's fight against the spread of the Wuhan virus and Covid-19.
She has been assisting teams of doctors in tracing, treating, and vaccinating the local residents who live in far flung villages in Keller -- the place that cradles the Gujjar-Bakkarwal community. Snow or sun, she picks a kit packed with essentials for her duties, and heads out for a long, long day.
There are times when Shahnaz notices unwelcoming signs in the villages she visits with her team.
Recently, something unexpected happened. A village resident, opposing their entry in the village, snatched her kit. She narrates over the phone that one man took a lathi to warn her. "I broke down and called the SHO telling him about the incident," she says.
Looking back, she is able to laugh at herself, "I was crying and the Tehsildar asked me why I was crying. When I told him about what happened, he said, aap koi bachchi ho? chup karo (are you a little girl? stop crying)."
She mentions that the BLO who was accompanying her was more scared than her. But they move ahead. "It's for the protection of our people that we all are working," she adds.
She has worked "even on Sundays" during a vaccination drive focussed on residents 45 years and above -- a task undertaken by the local health department in Keller, Zainapora and other parts of Shopian. The task has transformed into a feat.
Shopian is one of the two districts in Kashmir division that have achieved 100 percent vaccination of all in the age group of 45 years and above with at least the first dose of Covid-19 inoculation. Jammu in Jammu division is the other district and was the first to reach the milestone.
Building trust for success
Keller seems to be the highlight in Shopian's success story owing to geography and landscape. A doctor tells Swarajya over the phone: "The first thing one has to understand is that the area we are talking about -- Keller -- is one of the most inaccessible areas. Snowfall and road connectivity are issues and challenges that we have faced. Education level is low. Too low. Awareness level is too low. Vaccination was for the benefit of the common people. Our aim was to reach each person eligible."
In March Keller was receiving snowfall. There were many areas that the health workers and FLWs found getting across to challenging. They would walk through snow to reach people belonging to the nomadic communities. In terror-affected areas of the district, the health department workers worked with the same dedication -- despite challenges.
Building trust was the only step for the final goal -- vaccination. To calm people's doubts about the jab, a doctor tells this author over the phone that he came up with a unique move. He took himself as an example as a candidate for vaccination and got vaccinated in the presence of around 100 people.
He points out that the rural health system is strong in Shopian. People rely on government hospitals. "We checked the people for diabetes, we checked their blood pressure prior to the vaccine. This helped people understand that we care for them. Trust developed. Once trust came in, they said 'now we are ready for the vaccine," he adds.
This led to a chain of trust and response to the vaccine. "Jab patient patient ko kheenchta hai, trust banta gaya."
"I told them that there is nothing to worry. That was a long journey. I was just a part of the system, every person played a part," he says.
Shahnaz mentions that the allocated centre was at a local school, but that didn't help. People wouldn't turn up. So, FLWs would walk long distances to reach the last person eligible for the vaccine; for spreading awareness, for tracing and treating. "Aapko pata hai field mein kya kya karna padta hai. Koi gaali deta hai. Fir bhi humnein ghar ghar ja kar vaccine ki (your know what we face on ground, we face expletives, yet we proceeded from door to door) ," she adds.
She mentions that people look at the them with a sense of distrust and doubt. "Some people tell us that we get paid for testing them."
Efforts were made to educate the village residents on the disease.
Another doctor tells Swarajya, "I was initially a Covid test in charge. People used to pelt stones at us. We did not want to involve the police or administration because that would take the feeling of distrust higher. Jo thhoda bahut hum unhe convince karte thhe, wo wo bhi na hote (the little trust we build would fizzle out if we inform the police)."
Increase in fatality rate increased the fear for the disease. This turned things around -- slightly.
Another doctor says that one strong factor that contributed to the success of the vaccination drive was that the teams were sent to cover each eligible candidate for the vaccination, "We didn't wait for people to come to the vaccination centres, we reached out to them, followed them with teams. We would divide teams accordingly. Ek hee jagah baith ke nahin hua (it didn't happen by sitting at one place)."
Sub District Hospital in Keller would see 5-10 people be present for the immunisation drive, he adds. One team would venture out to a village in Keller block, one would remain at the hospital.
The Extra Mile
Health care workers and front line workers have travelled the extra mile, literally, in order to vaccinate people, counsel them on the need for vaccination, to trace and track the contacts of people found positive and to collect correct data from terror-affected and far flung areas.
Vaccination for people in the age group 18 years and above hasn't begun and many residents in the age group 45 years and above have received only the first dose, yet the enthusiasm for the awaited first dose in the former and for the second dose in the latter is high. The hard work from FLWs is paying off.
A health worker told Swarajya over the phone that there is a "considerable drop" in positive cases and the situation is improving. Health workers point that the adherence for masks has improved and along with decreasing hesitancy for vaccination, it is expected to give good results.
Tight Clockwork, Blending Of Administration And Strengths
Like any district that puts up a tough fight towards containing the spreading virus or increasing infections or reducing vaccine hesitancy, Shopian achieved the feat of vaccinating people in the 45 years and above bracket by merging administrative effort.
Strengths were combined to help the weight bearers of action on ground -- the FLws -- ASHA and Aganwadi workers -- overturn every step and every effort needed towards people's response and results. For this, the entire administration backed the health department.
On ground, BLOs, along with Aganwadi and ASHA workers went door-to-door to ascertain the number of residents in the 45 years and above age bracket. People were counselled, just as they are and were for awareness, precaution from and treatment of Covid.
Tehsildars and SDMs formed the outer rung of the administrative work for the vaccination process and undertook the task of monitoring the progress on the village level.
In case of a decline in the vaccination rate and response in an area, the health department would focus on it with the help from the administration. The police department pitched in to help the health department where needed.
SDM Mushtaq Ahmad Lone told Swarajya that it was a team effort, where they mobilised people, motivated them by taking the help of religious institutions and civil society. "Vaccine available raha. Hum logon ne mobilise kiya under the dynamic leadership of the deputy commissioner. Hamari jo revenue machinery hai. We mobilised it all and focussed on vaccination."
Machinery and vaccine availability were used for achieving the target. The target age group of 45 years and above has 78,769 people, SDM Mushtaq Ahmad Lone says. The population of Shopian is around 2.7 lakh (currently). He points out that the drive was successful owing to vaccine availability -- the credit for which goes to the efforts of Lt Governor Manoj Sinha.
He adds, "We closely monitored, ki agar kaheen par numbers kam aa raha hain, vaccination kam ho gayee hai, next day we will focus on that village, that area, that pocket. To jahan kaheen bhi humein laga ki kaheen zaroorat hai mobilisation ki, announcemnts karai masjid se, humnein Auqaf Committees ko mobilise kiya, civil society ko mobilise kiya, usmein unhone role kiya aur logon ne cooperate kiya." (Every patch registering low response for the vaccination would lead to a follow up with the help pf announcements from local mosques, Auqaf Committees were mobilised for awareness).
An interesting aspect that comes to light in the use of administrative strengths and penetration is the using of the strength and presence of BLOs. BLOs in the current scenarios comprise mainly teachers -- employees from the education department.
The BLOs played an important role in stages or patches where the drive wasn't picking up or dipping. BLOs would go for door-to-door survey along with Anganwadi workers and ASHA workers. Patwaris, lambardars, chowkidars were also roped into the field machinery. People unvaccinated were motivated and brought to centres.
People residing in the far flung area, mostly in Keller, were vaccinated at centres that were put up in close vicinities for their convenience.
Centres have been designated for the much awaited vaccinated drive of the target group of 18 years and above and preparations are in progress.
A doctor explains how the sampling work is done: tracing primary contacts of people who test positive for Covid -- from family members to employees to relatives to neighbours. A list is made. Doctors and paramedics form a team, health workers at the local CHC/PHC are contacted, directions are given on activating ASHA workers.
The sampling work is undertaken and steered by doctors (male and female) in villages. "The way the health department is working, the situation will improve even further owing to the hard work going towards controlling Covid."
ASHA and Aganwadi Workers -- The Backbone Against Odds
There are challenges FLWs have faced on a daily basis. People from the pastoral nomad communities would run away towards heights and we would have to go after them. "Pandrah pandrah bees bees kilometer ja kar humein unhein aware karna padta thha. They had to be convinced. First for testing. Then for vaccination. Mard crocodile ban jayenge. Auratein infertile ho jaengi. They believe in treating themselves with natural means. Aise logon ko convince karna to go for a jab, wo bahut mushqil thha."
The struggle to find and collect details and number of people unvaccinated would become daunting. Residents would try to misguide the visiting ASHA workers and Aganwadi workers.
"People would tell them hamara ho gaya hai (vaccination has been done). However, actually they were still without the jab. The FLWs would request them to produce certificates. Residents would tell them they don't have android phones to download the certificates."
At times, residents would raise doubts on doctors. In what sense? They would mean to say that doctors and health workers, who are in close contact with the Covid positive people, don't turn positive and are in turn compelling village residents to get the jab. Further suggesting that the probability of village residents becoming positive is low and they are being pursued for vaccination when they shouldn't be.
"They would tell us that we (the doctors and health workers) are around Covid positive patients all the time. To aap kyon nahin positive ho jaate ho (how come doctors and health workers don't get infected and become Covid positive," the doctor adds.
At the same time there were others who themselves walked down to vaccination centres and expressed willingness to get the jab.
Data collection is an important facet of the implementation of the vaccine drive on ground. ASHA workers and Aganwadi workers would become the pivot of the exercise -- related to data and the process of vaccination.
As locals themselves, they are familiar with the village and residents. They would accompany doctors to villages and help put data and information down for the remaining stages of the process in case of unvaccinated people.
"We would rely on the data provided by the ASHA workers and Aganwadi workers. In addition to this data, doctors would collect data from PHCs. All data would be compiled in an integrated manner. Final results would be extracted from there," a doctor says.
Door to door counselling helped developed trust in the village residents. "Unko convince karna bahut zyada mushqil ho jata hai. It was a difficult task.
The Dousing Of Fear
A health worker Swarajya spoke to over the phone said that around March, apple growers get busy in the care of trees and the process that involves the use of "dawaa" (against pests, assumingly) for the apple trees.
The apple growers, especially the heads of family, would naturally want to spend more and more time at the orchards for the care of the apple trees. Those infected by the virus among them were worried that their absence from orchards owing to illness would be detrimental to the produce.
FLWs put in extra hard work to cajole and counsel many residents to not wander in orchards amid rising infections and point out that at times residents had to be pulled out of apple orchards where they would hide in the fear of being found positive, or to avoid FLWs.
A doctor at the district headquarters told Swarajya over the phone that the teams faced a lot of hurdles in the beginning of the vaccination drive. He says, "Pehla masla thha ki loag saamne nahin aa rahe the. They had doubts about the vaccination and vaccine. FLWs especially those who were unmarried had a perception that it will pose problems to their sexual life in the coming years. Female health workers ke zehen mein aa gaya thha ki unki fertility rate down ho jayegi, aise hee males mein."
He adds that another challenge to the vaccination drive was hesitation for the vaccine in the target age bracket in the far flung areas, especially in Keller.
There were days and times when people would not turn up for vaccination at centres. There were times, a doctor mentions, when only 10 people in the expected 100 as target group in an area of 500 residents, would turn up. "We did not give up. We would keep another slot and date open for it. Aganwadi aur ASHA workers ne apni jaan laga dee hai ismein. Wo repeatedly jaate thhe, data collect karte thhe..."
'Never a shortage of anything'
Collating positives will help in the vaccination for the younger group.
A doctor mentions that they are unlikely to face the same hurdles for the other target group -- 18 years above -- when the drive for this group starts.
A major reason is that the younger lot has witnessed the drive and results of the vaccination for the older group. "Positive examples, whether from within the region, in Srinagar and other parts of the country, are finding mention and making presence in the residents through news and mass communication. Hurdle from the 10 per cent could come, but it is all manageable," a doctor adds.
Another doctor points at a lesser spoken about factor: He says, "There was never a shortage for us. From PPE kits to testing kits to vaccines."
He adds, "Everything was provided to us. Main nahin janta ki yeh kahan se aate hain, (where these came from is not known to me), but we were never short of them".
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