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Bigger than polio

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Pakistan’s female vaccinators are doing more than helping end a disease

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Women make up two-thirds of Pakistan’s polio workforce. It’s a startling statistic for a nation that ranks 145th out of 146 countries for gender parity in economic participation and opportunity, according to a World Economic Forum gender inequality index.

The role of female vaccinators is born of necessity. Because of cultural norms, men are not allowed into many people’s homes in Pakistan. Women who provide the health care are the key link. They can build mom-to-mom relationships and provide trusted advice on not only polio but other health issues.

“Women working with women on the front line is going to be what gets us across the finish line,” says Rotary President Jennifer Jones, who met last year with polio workers in Pakistan. The country and Afghanistan are the only two where wild poliovirus is still transmitted persistently.

Female health workers can enter homes where male health workers would not be allowed.

The female vaccinators’ work is neither safe nor easy. The women in Pakistan are sworn at, shoved, beaten, and some even killed. They’re fighting misinformation. But their work is crucial — and not just for the cause of polio eradication.

“They are supporting their education, they’re supporting their household, they’re supporting their men and giving a change in Pakistan,” says Sadia Shakeel, coordinator for a Rotary-supported polio resource center in Karachi. “This is bigger than polio.”

Shakeel calls them “little entrepreneurs.” Most of the women range in age from 21-38 and have their own children, she says. Yet they wake to say prayers before dawn, feed their children breakfast, and leave to start their work to end a disease.

Employing women is one key strategy of the Global Polio Eradication Initiative. And that’s not just to deliver the vaccines at the front line; it’s also to hire women as supervisors, doctors, and decision-makers. “We cannot succeed without the women we have in the program at all levels,” says Hamid Jafari, a pediatric infectious disease doctor and director of polio eradication for the World Health Organization’s Eastern Mediterranean region.

Meet five of the women working to end polio in Pakistan

  • Tayyaba Gul: Rotary Club of Islamabad (Metropolitan)

    Tayyaba Gul joined Rotary in 2000 and has worked in public health for over two decades. She represents Rotary at Pakistan’s National Emergency Operations Centre, working with partners and the national government to help address gaps. She also runs a Rotary-supported polio resource center in Nowshera. “I work with Pashtun communities and have faced a lot of hurdles,” she says. “I feel like after spending such a long period of time here, they respect me a lot, and they listen to me. I feel proud that in such a community, my voice — a woman’s voice — is being heard.”

    Tayyaba Gul (right) of the Rotary Club of Islamabad (Metropolitan), and Parveen Ajmal, another health worker, cross the Kabul River in Nowshera to reach embankment communities.

  • Azra Fazal Pechuho: Minister of Health and Population Welfare, Sindh province

    There are about 1,500 vaccinators in Karachi, the capital of Sindh province. Many are women who did not leave their houses previously. Because they start earning money, “their voice within the household increases, their decision-making powers increase,” Azra Fazal Pechuho says. “Gender equity comes in because of the fact we have employed female workers.” But polio can’t be eradicated without these women and their ability to enter houses where men are not allowed. “They’ve been a great asset,” she says. “They are a tremendous force, and I think their work is to be acknowledged.”

    Dr. Azra Fazal Pechuho meets with RI President Jennifer Jones at the Emergency Operation Centre in Karachi in August.

  • Effat Naz: Polio supervisor, Torkham border crossing

    Vaccination teams approach people at the busiest border crossing between Pakistan and Afghanistan. It’s crucial to catch mobile populations to stop the spread of poliovirus. As a supervisor, Effat Naz is responsible for planning cold chain logistics to preserve vaccines and working with families who refuse vaccination. “Women workers find it difficult to work here,” she says. “Yet we do it because we love our country, Pakistan. We have joined the frontline force to save our country from this virus.”

    Effat Naz (right) and health workers prepare to provide polio vaccinations.

  • Soofia Yunus: Former director general of the Federal Directorate of Immunization

    Soofia Yunus is the first woman to have led Pakistan’s national immunization program since it began in 1976. “In every strategy we make and in every activity that we conduct, we ensure that females are a part of it,” she says. To help with security, the program is recruiting couples such as husbands and wives or brothers and sisters to be vaccinators together.

    Dr. Soofia Yunus speaks at a conference at the National Emergency Operations Centre in Islamabad in August.

  • Mehr: Vaccinator and water plant manager

    Mehr, who gave only one name, has worked as a vaccinator since 2012. “I am working to support my children so they can get educated,” she says. “This is what I spend my salary on. I also want to help my community.” She notes that the work has become more data-driven, and vaccinators visit homes more frequently. “People used to push us out of their homes and curse us, but now that we go regularly, our presence is normalized,” she says. “The awareness level has increased that we are doing this to help them and their children.”

    Mehr (left) meets with community health workers. “I want this disease to end,” she says.

This story will also appear in the April 2023 issue of Rotary magazine.

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