[Despite efforts to have religious scholars express support for the vaccine, Mr. Shah said mistrust about it still existed. Many worry about whether strict interpretations of Islam allow the vaccine. Some question its contents and believe conspiracy theories that Westerners have manipulated it to cause infertility.]
By
Fahim Abed
 |
|
A
health care worker giving a dose of vaccine in Kandahar, Afghanistan, in
August.
Credit
Jawed Tanveer/Agence France-Presse — Getty Images
|
KANDAHAR,
Afghanistan — At just 2
years old, Madina had been vaccinated seven times. It was not enough: When she
fell ill this fall, a trip to the doctor in Kandahar City confirmed that she
was among the latest Afghan toddlers to contract polio.
Almost a million children in Kandahar
Province alone, like Madina, need at least one dose of oral vaccine a month to
head off the disease, health workers say. But many of them also live in the
most violent and socially disrupted parts of southern Afghanistan, where the
Taliban control large areas and do not want government health workers going
door to door.
These realities make a sustained vaccination
campaign brutally difficult for health workers here. And Afghanistan, one of three
countries where polio is still endemic, is losing ground. Officials have
registered 19 cases of polio so far this year, up from 13 each of the previous
two years, according to World Health Organization figures.
In August, I followed a polio vaccination
crew in Kandahar and saw how, even in areas where health workers have been able
to function, many things stand in their way: security fears and drought, deep
poverty and stifling tradition, widespread illiteracy and superstition.
Still, starting just after dawn each day, the
vaccination teams are at it, hoping to reach just a few more children.
Mawlawi Abdul Rashid of Kandahar City, a
religious scholar and member of one team, said most of the residents were poor
and desperately worried about what their children would have to eat each night.
Drought adds to the daily burden, with families in many neighborhoods having to
buy water from tankers after wells dry up.
Given that, Mr. Rashid said, “They don’t care
about polio vaccine as much.”
Mohammad Shah, 38, said that as a vaccine
campaigner in the city he had been visiting more than 100 houses a day in
temperatures reaching 100 degrees Fahrenheit. He said some families asked for
food and other necessities instead of the vaccine — a need that Mr. Shah, a
father of five, said he understood.
“They keep asking us to bring them wheat,
soup and other staples,” he said.
Despite efforts to have religious scholars
express support for the vaccine, Mr. Shah said mistrust about it still existed.
Many worry about whether strict interpretations of Islam allow the vaccine.
Some question its contents and believe conspiracy theories that Westerners have
manipulated it to cause infertility.
Abdul Razaq, 65, who was administering the
vaccine in the Loya Weyala area of Kandahar City, which is dominated by people
displaced by fighting, said around 10 of the 200 families there refused it.
“It’s very difficult to convince those
families who reject the vaccine,” he said. “But we try our best.”
Most families here hold traditional views
wary of letting outside men enter a home if no male family members are present.
For that reason, the health workers try to have at least one woman on each
vaccination team. But there are not enough female workers, and all-male teams
are frequently turned away.
Polio was eradicated before 2000 in Western
countries, but it is still a critical issue for Afghanistan, said Destagir
Nazari, of the Ministry of Health. “The world is trying to eradicate the virus
completely,” he said. “It is an international responsibility for Afghanistan to
eradicate it, and we try our best to do so.”
Across Afghanistan, more than 10 million
children require polio vaccine. The United States, Canada and Japan are among
the largest donors for the vaccination drive.
The vaccinators’ days are long. They start
early in the morning, gathering in health facilities of each neighborhood of
Kandahar City to collect the vaccine and vitamin E tablets, which they carry in
plastic coolers.
Teams then head out in rented taxis or on
motorcycles, armed with lists of families in their areas that have children
younger than 5. They go door to door, circling back after a break for lunch and
prayer to the houses where children weren’t home in the morning.
At one house, a woman insisted that she
didn’t want her 3-year-old daughter, Mursal, to be vaccinated. She wouldn’t
give a reason, but the workers suspected she was worried for religious reasons.
Each member of the three-person team tried to
persuade her, even reading from a book of religious declarations that allowed
the vaccine.
The last member of the team to try, Mr.
Razaq, was blunt: If you keep rejecting the vaccine, he asked, will you be able
to take care of your daughter when she contracts polio? He pleaded, insisting
that he was religious, too, but still made sure all his young children were
vaccinated. At last, he got through, and Mursal received her dose for the
month.
Sometimes religious scholars, like Mr.
Rashid, accompany the teams and help reassure families. “According to Islam,
health is very important, and we can use anything to ensure our health,” he
said. “We convinced 70 families this month who were rejecting polio vaccine.”
Other times, balloons work.
That was enough at one house: A woman there
said no to the vaccine, but the boy with her wanted a balloon — so he got both
it and his dose.
But bigger fears at work here than children’s
distaste for medicine. Many families know the Taliban are suspicious of the
government vaccination drive, and worry that they will become targets if they
are seen allowing the health workers into their homes.
Zabihullah Mujahid, the Taliban spokesman,
said that the insurgents were not against the vaccine and that they supported
administering it in areas under their control. But they will not allow
government teams to go door to door in their areas, saying they believe the
workers sometimes act as spies.
The Taliban usually insist on distributing
the vaccine centrally from mosques. But health workers say only a
house-by-house approach can come close to ensuring enough doses are distributed
each month.
Mr. Shah, who has been administering vaccine
for 12 years, said that as hard as this year had been, it was getting better,
at least in his area: Last year 25 families there rejected the vaccine. This
year, that dropped to eight.
“When I see a polio victim, I feel very sorry
for him and I understand that’s why my job is so important,” Mr. Shah said.
Officials, though, lament that progress is so
halting despite all their efforts.
Abdul Qayoom Pokhla, head of Kandahar
Province’s public health department, said that even without the stress of war,
eradicating polio there would take at least one or two years. “We need a secure
environment to implement the polio vaccine campaign,” he said.
Mujib Mashal contributed reporting from
Kabul.
