Recently Pakistan’s tribal areas made the headlines again. This time the issue is health care access, or refusal thereof to be more specific. According to a report parents of 24,000 children in northern Pakistan refused to allow workers to administer polio vaccines. This is blamed mainly on the fatwas (religious edicts) issued by the local clerics claiming that the vaccines are designed to ‘sterilise’ Muslim male children.
This drama reached its crescendo when a senior health official who had been instrumental in rallying support for the polio drive was recently killed. All this comes at the heels of a fatwa by a local cleric who declared war on the United Nations, the World Health Organisation and the NGOs aiding and abetting these ‘foreign organisations’. The Northern Areas of Pakistan have witnessed many political upheavals, especially in the days of the British Raj, but they have seen few sincere outsiders who understood their problems and culture. From a public health perspective some parallels can be drawn between the attitudes of the tribal people in Pakistan and African Americans in the US against organised medicine. The Tuskegee Syphilis Study continues to fuel African American distrust to this day. It took only a few hundred study-subjects in the Tuskegee Syphilis Study to lose the African American community’s trust in medical establishment. In the case of Northern Pakistan, it was the loss of more than a dozen lives in Bajaur Agency, among other incidents, that alienated the people.
However, there is one stark difference between the two communities. Whereas the collective American conscience seems to sag under the burden of heavy guilt when it comes to African Americans, it is quite the reverse in the Pakistani case.
The media has been quick to malign the tribal community in general. The ignorance and biases of tribal people undoubtedly played a part in all this. However, to see this refusal as a war of religion, as some are trying to do, seems a little bit of a stretch. Local attitudes have been shaped by recent events like bombings, especially the one that resulted in the killing of innocent civilians and children when the US forces were on the hunt for Ayman Al Zawahiri. Similarly, one of the clerics who most vociferously denounced the vaccinations had recently lost his brother during an attack on a madrassa by the Pakistani army.
But all is not lost in this struggle. For one thing, the proportion of kids that have not been vaccinated is small. According to a government report more than 5.7 million kids were vaccinated in January and another 3 million are due very soon. The area affected by polio, part of the North-West Frontier Province of Pakistan, is also the area where vaccination refusal rate is the highest. It is small enough to make covering it a feasible project administratively and logistically for public health officials. Also, leaders from major religious political parties in Pakistan have endorsed the vaccinations. Moreover, general public opinion about the vaccines is favourable even in the tribal areas, as evidenced by the overall success rate of the number of kids already vaccinated.
Despite all this, public health workers in the tribal areas face an uphill battle. Squeezed between tribal misgivings, Western biases and the recent loss of their colleagues to terrorism, they still need to get the job done. Public health officials have to expand their role from simple vaccines pushers to community builders. It will take patience on the part of the WHO, courage and dedication by the public health personnel and, above all, acceptance from the local tribal leaders to make any headway on this issue. The challenge is unique but not insurmountable.
This article was also published at The Daily Times website.
Posted on March 11, 2007 by Site Staff
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