Peshawar, the capital of the Pakistani province of Khyber Pakhtunkhwa, is a city of about 3 million people. This ancient city was one of the ten largest cities in the world in AD 100. It is also a strategic city in the global effort to eradicate polio because of its proximity to Afghanistan and the formerly Taliban-controlled parts of Pakistan. Monday, I checked it out.
Guided by Rotarian Nosherwan Khan and accompanied by a film crew working on a related project for Rotary International, I observed the Sub-National Immunization Day (SNID) activities in Peshawar and checked out the Permanent Transit Point at the Lady Reading Hospital.
Unlike my experiences with National Immunization Day activities in India and Ethiopia where children are invited to visit temporary or permanent immunization centers, the SNID here is run house-to-house. The army of people contacting every child in the country is a group known as the “Lady Health Workers” or LHWs. The program is run jointly by UNICEF and the World Health Organization.
The LHWs are, in my experience, young women though reportedly the government has sought more mature women. The wages of about $125 are modest even by Pakistani terms, but the LHWs take real pride in the work they do. The workers consistently report being respected members of the community because of the work they do. Relatively few women in Pakistan work outside the home, allowing these women a sense of pride.–
Following our visit to the back streets of Peshawar, we visited the regions largest hospital, the Lady Reading Hospital, a campus of buildings providing health care to millions of people around the region.
Let me just interject a personal observation. While walking the streets of a poor neighborhood in Peshawar can be discouraging–the fetid water standing in open sewers and dung cakes drying on the walls of building for fuel are clear signs of a poverty that I have not experienced–wandering the halls of the hospital here was shocking. The standard of care was so far from what we expect in the developing world–vomit and other bodily fluids left to dry on floors, overcrowding, and patients lying nearly naked on the filthy floors–left me thankful for having won the lottery of birthplace. It was relatively easy to see happy, healthy kids playing in the street and feel a sense of patience and forward progress in the presence of the polio workers. In the hospital, however, I could feel only a sense of tragedy as the mass of humanity suffered around me. I felt completely impotent.
In the hospital, we found four separate teams doing vaccinations. These teams were a bit older than the LHWs going house-to-house and included an equal number of men. The oldest was only 30 years old and almost all were still in school. The $125 per month salary seemed to be a near perfect complement to a student’s life. In fact, as I visited with one, he answered my questions assuming that I just understood that he was a student, something that only became clear when I asked him directly.
One of the polio workers introduced herself only as Nosheen. She is married, 30 years old with three children and studying to become a dental surgeon. She speaks good English and carries herself with a confidence that suggests she not only runs things but that her career plans are inevitable.
In contrast, another polio worker in the hospital introduced herself as Wakalat, which is exactly what her official identification offered as her full name. Wakalat is 22 and has a six year old son, Mohammad, and “is separated” from her husband. The deadbeat dad is gone and the little family receives no support from him. The duties of being a mother and a polio worker overwhelm Wakalat. She was the only worker I interviewed at the hospital who was not also a student.
All of the polio workers expressed pride in the work they do and excitement to see polio eradicated once and for all. Using a variety of techniques to reduce missed children and refusals, it seems likely that they will see their goal realized with suspension of transmission of wild polio virus in the current calendar year.