Zofeen Ebrahim reports on the growing discontent among health workers

Her vision, blurred by the tears streaming down her face, 30-something Shazia Khalid rushed to where the shooting had taken place only to find her two colleagues, Madiha and Fehmida, lying still in a pool of blood. “I was told they had been shot, I didn’t know the poor women had died!”

Her first thought as she saw them was whether their work was worth it.

“It’s like a stamp on us, and even with a veil, the entire neighbourhood recognises us as polio workers,” says Khalid, who has been working as a volunteer administering polio drops to children under five, for the last nine years in Gulshan-i-Buneer, in Landhi.

Khalid’s 15-year-old daughter pleads with her not to step out of the house. “She tells me I would be killed if I leave home; I don’t know how to reassure her.”

Being the in charge, immediately after the shooting, she asked the other volunteers to head for their homes and to hide their medical boxes. “Word had spread that there were masked men hunting down polio workers and shooting them on sight,” Khalid states.

As the shock and outrage over the deaths of nine polio workers begins to sink in, it is replaced by anger among the workers.

“We encountered several problems in the field which we’d share with our supervisors but they never paid any heed, nor did they ever accompany us into the field, to assuage us,” Khalid says.

Further, polio workers say their superiors often preach that their mission to eradicate polio is like doing ‘jihad’. “Then why don’t they come into the field with us and support us?” asks 24-year-old Nida Mohammad, who has been working in Orangi for the past six years. “It was always a thankless and difficult job; now it has become dangerous as well.”

For Nasim Munir, one of the supervisors, the biggest worry now is finding volunteers.

“Earlier we’d manage to rope in our lady health workers; now they are so scared, it will not be easy to convince them to be part of the polio teams. Some have even said they do not care if we terminate them!” exclaims Munir, president of the Karachi chapter of the All Pakistan Lady Health Workers Association. In addition, the volunteers belonging to the communities also say that they will only work if they are guaranteed some form of security.

The same was suggested by Riaz Shah, husband of Fehmida, who was killed recently. “Till the government provides security to volunteers, they should suspend the door-to-door campaigns,”, he says.

“But it is impossible to provide a police officer with each team,” points out Munir adding: “Even the law enforcement agencies are under threat from the militants; how can they provide security to us!”

However, she suggests that if the campaign has to continue, more stationary centres need to be set up which can be provided with better security. At the same time, she emphasises, parents need to commit to polio eradication as well.

Another suggestion that has come from those in the field is that if the door-to-door vaccination has to continue, the government should employ more women into the Lady Health Worker’s programme.

“Despite their huge commitment to polio eradication programme, there has been brewing discontent among health workers for some time about low wages, extremely long hours and difficult working conditions,” says Heidi J. Larson, senior lecturer at the London School of Hygiene and Tropical Medicine, who has long been following the polio eradication efforts in Pakistan.

“It would be a good time to recognise the importance of the health workers by increasing their wages,” asserts Larson, a former head of Unicef’s Global Immunisation Communication, adding that it was important that these were not just “temporary supplements for their work on polio”, but that their “longer term role and salaries as health workers (beyond the polio programmes) are made more secure”.