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Can Pakistan be Polio free?

By Dr Ilmana Fasih Published: July 31, 2019 here: Express Tribune Blogs

A Pakistani health worker administers polio vaccine drops to school children. PHOTO: GETTY

People who know me well know that I often compulsively compare and contrast India and Pakistan by virtue of not just their close proximity, but because I consider both countries as my home.

When the World Health Organisation (WHO) declared India polio free on March 27, 2014, after it had not had a single case since 2009, I was filled with great pride. Knowing that Indiais densely populated, afflicted with poverty and has poor access to healthcare for millions, polio eradication was indeed something to celebrate. But as in every such situation, I naturally wanted to know how long it would take Pakistan to reach this milestone.

As India has put an end to the polio epidemic, its neighbour Pakistan remains one of the three countries in the world that are still trying to eradicate the disease. I thought to myself, four times larger in size than Pakistan and more populated, so if India could do it, why can’t Pakistan?

With fingers crossed, I have kept my eyes on the numbers ever since. Polio cases dropped in Pakistan from over 300 in 2014 to 54 in 2015. This gave me hope. In 2016, polio cases further went down to 20 and then to eight in 2017.

It must be said here that it is remarkable how the entire world of healthcare had come together, spending $16 billion in the global polio drive over the last 31 years, to eradicate a disease that has in the past left many children disabled for life.

So I was certain in my heart of my hearts that Pakistan would get there.

But it was not meant to be and there are a confluence of factors that have prevented polio eradication from becoming a reality in Pakistan.

Amidst the politicisation of polio vaccines, not just polio workers, but the police officials accompanying them continued to be gunned down. Yet this still has not deterred the brave health workers from taking risks, high up in the mountains in Khyber Pakhtunkhwa (K-P) or in the ghettos in Karachi, from ensuring that children are given proper and timely access to vaccines.

Early this year, rumours made rounds on social media that children were dying as a result of polio vaccines, thus creating a panic among the thousands of households whose children had been administered these vaccines. In retaliation, health centres were set on fire. It was also reported that a man had divorced his wife after he found out that she ensured their family was administered polio vaccines.

A video also surfaced on social media recently, where children were made to pretend to be dead by a man who wished to prove how dangerous polio vaccines are. Given the spread of such misinformation in the digital age, the proliferation and rise of such videos is deeply concerning and could prove to be a serious roadblock.

If all this wasn’t bad enough, just a couple of weeks ago we heard news of fake polio markersbeing sold in Pakistan, which parents were using to mark their children’s finger to make it seem like they have already been given those ‘dangerous’ two drops. This only further compounds the already arduous job of Pakistan’s polio workers.

What also damages the effectiveness of Pakistan’s polio drive is when polio workers are unable to reach certain localities. It has been reported that 37,678 children missed a recent special immunisation drive which was conducted in Bannu, Lakki Marwat and North Waziristan. While many children could not be given polio drops because their parents refused, 11,853 children could not be reached altogether. An inability to get access to these children will only further complicate an already difficult task.

I have never, and will probably never be able to understand the reasons as to why parents choose to ensure that their children are not given polio drops. Why can’t these people understand how detrimental this kind of rumour mongering can be?

The push-back against polio vaccines stems largely from a whole host of myths which have been floating around for years. From people claiming that the drops are being used to sterilise Muslims, to the campaign being part of a ‘western agenda’, to stories that children have died because of polio drops. The only valid criticism I have come across is the one pertaining to the Shakil Afridi case because it did indeed damage the trust of the communities to a great extent. However, very few know that he was part of the hepatitis vaccine campaign, not the polio vaccine.

The New York Times

✔@nytimes

Polio vaccination teams are frequently targeted in Pakistan. Islamist militants and hard-line clerics say the vaccination drive is a foreign plot to sterilize Muslim children and a cover for western spies. https://nyti.ms/2XDqREm

Polio Vaccinator Is Shot and Killed in Pakistan

The woman was part of a vaccination campaign. Another worker in her team was injured. A total of three polio workers have been killed this week as unfounded rumors against vaccines spread.

nytimes.com

In contrast to 12 cases in 2018, there have been 47 reported cases of polio in 2019 so far. It is likely that this number will have gone up by the end of the year.

With every case of polio paralysis, the virus spreads to 200 more children in the neighbourhood. As a result, the virus has been found in multiple sewage samples in Karachi, Sindh, Balochistan, K-P and Punjab. Not just limited to Pakistan and Afghanistan, the same strain of polio virus has even been detected in sewage samples in Iran and in the Xinjiang province in China.

It seems that the polio virus is here to stay in Pakistan for much longer than we would want it to.

All the kids afflicted with polio paralysis, if they survive, will grow up to be adults on crutches and in wheelchairs. Many of them may not even be able to afford crutches and will be dragging their stick-thin, polio-afflicted limbs along the ground. Will they be living in abject poverty, dependent on their family, or will they resort to begging on the streets?

What about those hundreds of children who will be affected in the years to come?

As a Pakistani, as a doctor and as a mother, I am pleading with all the parents: please let those two drops help save your children’s future.

ilmana.fasih

Dr Ilmana Fasih

An Indian gynaecologist, married to a Pakistani, Ilmana is a health activist, and m-Health entrepreneur, who writes on social and health issues as a passion. She dreams of a world without borders and wars.

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Health, M-Health, Pakistan, Politics, Social Issues, Uncategorized

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MYTHS AND FACTS ON SEXUAL ABUSE

Believe that Knowledge is Empowerment.

TABEER and ZMQ , we believe in dealing with the issues at their source and attempting to ‘nip it in the bud’ before it gets too late.

As part of our vision to see a safe world for all and the mission is to spread awareness about various health related issues.

With the ‘EmpowerSHE’ initiative– a collaboration between TABEER and ZMQ .Inc , we believe in ‘dreaming’ of a safe world for our young girls and kids.

Our mission: Unveiling the veil of ignorance.”
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On the occasion of the 100th Anniversary of the International Women‘s Day 2011 we begin with the awareness against the Sexual Abuse..

There are many myths about sexual abuse and the perpetrators take advantage of these myths in pursuing their beastly acts. Many of these myths and realities one may not find documented in the literature but one learns through a number of years of experience in the field.( Though most of the facts presented are evidence based).

And here they are:

MYTH: Is due to inappropriate dressing/flirting/ seductive talking/going out with friends/drinking/smoking/drugs are the main cause of sexual abuse among adolescents.

FACT: Sexual abuse can NEVER EVER be justified. No matter what. PERIOD.

MYTH: Good and protective parenting can protect the children from abuse.

FACT: Every parent is a well meaning parent and wants to shelter his/her kid to the maximum But the perpetrators are excellent manipulators and make the parents believe that the kids are safe in their care. The only near ‘sure’ way to protect the child from abuse after he/she has attained reasonable understanding is to empower them with the knowledge about Sexual abuse and that they should not be afraid to speak up if anything happens or was about to happen.
They should be told to realise the difference between the ‘good touch’ and the ‘bad touch’ and should believe in themselves even if they get bad vibes from the closest of relatives or acquaintances.
They should be taught how to remove themselves from the vulnerable situation and to contact parents or whoever they trust the most, as soon as possible

For the parents: They should calmly listen to their children’s complaints and believe in them. The guilt of not being an effective parent often leads them to deny if such a thing to ever happens.

MYTH: Most abusers are strangers:

FACT: On the contrary most abusers are people who the parents or they know and trust. It is important to teach your child of the difference between an acceptable and an unacceptable touch be it anyone unknown or known. In simple words to specify the ‘unacceptable bad touch zone is anything that would be covered by a bathing suit and face.
The kids should be told to report if they get any weird vibes from anyone known or unknown and be it touch, talk , look or even the body language of the person. And for the parents they should listen to the child and believe the child. The perpetrator could very well be an uncle, cousin, friend or even a first of kin (hard to digest but it is a FACT). But, children need to know that we can’t always trust people that we think we can. They need to know how grown-ups can manipulate children.

MYTH: Sexual abuse is limited to intercourse.

FACT: No, even fondling, touching, rubbing, French kissing, mouth kissing, lewd talk, pornography exposure, exhibitionism , or voyeurism are all acts of sexual abuse and can be extremely damaging to the psyche of the person going through it.

MYTH: Children or girls make up stories of make belief about sexual abuse:

FACT: True, kids of certain age do indulge in make belief. But the research has proven that children DONOT ever make up stories about sexual abuse. They should be believed in whatever they are complaining about. Many times young kids say about the abuse but then retract. This is mainly either due to the fear from the perpetrators or fear of losing the loved or due to the sudden panicky reactions they receive from their parents or loved ones.

MYTH: Sexual abuse is always violent.

FACT: Sexual abuse is a violent crime. But it is not always that it requires the use of force or threatening or weapons. If the perpetrator is a known person, manipulation and seduction could be the modes used for submission of the victim. The child or any person for that matter may be lured with treats or rewards for by complying to the demand. And many a times in dysfunctional families, sexual abuse may be the only form of touch and love that the child gets.
Incest( sexual abuse by close relatives) can involve the subtle seduction of a child, through what amounts to brainwashing.
Some perpetrators get the sexual gratification by passing inappropriate sexual comments or exhibitionism or making the victim view pornography.

MYTHS: Children can stop abuse by just saying no or telling another adults

FACT: They do often pick a child or a person who appears more vulnerable. This child is less likely to be assertive and more easily deceived. Often the abuse escalates over a period of time. The perpetrator tricks the child. The perpetrator also may threaten the child with physical harm, family abandonment, abuse of a sibling or belief that they are bad and he/she would not be touching them unless they had not asked for it. Teach children to say no and keep telling unless the adult listens.
Perpetrators are powerful and they generally do not take a NO easily unless it is a firm and a repeated no.
Don’t be angry at the child for not having said NO. Focus anger at the perpetrator, not the victim. Sometimes the child tells a parent and is not believed, or the parent confronts the abuser and believes the abuser when told “the child is lying, it was nothing, I won’t do it again.”
Parents should always take action to remove the child from the abuser.

MYTH: You can spot an abuser by how he or she looks. They may look bizarre or mean.

FACT: Unfortunately, there is no tell-tale mark of abusers. they come from all professions and have a vast array of different appearances. They could be a friend, uncle, neighbour, relative, religious preacher, even a teacher, and even a sibling or a parent. (A fact very hard to digest but is very true).
That’s why it’s important that children and teens know that it’s not just strangers that may hurt . At times the children, young girls or even anyone can get ‘weird vibes’ about a person and feel uncomfortable. One should believe one’s inner judgement and remove oneself from such situation or people.

MYTH : Incest( especially the sexual abuse by the parent) occurs when he is not satisfied by his wife?

FACT: Incest –Oh dear it is very hard to even think about it what to talk of discussing it. Incest is a universal taboo, but it exists in nearly all societies. And it is very much existent in our society too.
The most commonly reported by the survivors is the Father-daughter and has nothing to do with his sexual life. It is more of an issue of power as the perpetrators have a history of psychological problems and emotional deprivation. Often the mother is aware but feels powerless and at times colludes for reasons for family or personal reasons–fear of being abandoned by the husband or for daughter’s reputation.
Abuse between siblings should also not be overlooked.

MYTH: Only men are abusers and only women are the victims:

FACT: True, in 90% of cases the perpetrators are men and the victim a woman, but that isn’t always. Young chubby boys are a target of the abusers and especially in closed societies where the access to any form of interaction with the women is limited. The perpetrators may not necessarily be gay.
Women too can be perpetrators though such number is very tiny.

MYTH: It could never happen to me.

FACT: Oh yes it very well could. I could be a man, a woman, a child, of any sexual orientation, young, middle aged, old, a disabled, poor, rich, outgoing, reserved, a hijabi, a moderate.
This is a protective shield we all wear out of fear and denial.
But the fact is anyone including you and me can be assaulted or abused , no matter what. And if some one out there is really out to get you, they can. And it doesn’t matter if the perpetrator is a stranger or a known.
There are no 100% guarantees.
The best is to reduce minimise the risk levels by safe habits example– not allowing anyone you feel awkward with to be alone with you, never let any one known or unknown inside the house if you are alone and uncomfortable with ( especially young girls), Not leaving your young kids, infants and toddlers out of your sight in the care of others especially when they are alone with no other adults around, keeping your doors properly locked, not going out alone at night.

But MOST IMPORTANT OF ALL: trust your gut and stay away from those who make you feel awkward, creepy or unsafe with. USE YOUR HEAD and KEEP YOUR EARS OPEN TO YOUR INNER VOICE.

The world is certainly beautiful, but it is evil too.

Kindly click this link to play a Quiz online to check your understanding of facts on Sexual Abuse:

http://www.metrac.org/game.html

The Quiz was developed for METRAC http://www.metrac.org/ by ZMQ.Inc http://www.zmqsoft.com/