The Importance of Politics: Polio Staff and Lethal Violence

MALABIKA SARKER: The public health is not apolitical, cannot be. Despite the success, the polio program in many areas are disrupted because of the political instability and lethal violence. A string of deadly attacks cost many health workers life and made the job dangerous in countries like Pakistan and Nigeria. Please pause this presentation and view the video at the link provided. When you are finished, return and continue this presentation.

Pakistan’s frontline staff, Lady Health workers, are the pillars of the community-based care. The scope of services provided by Lady Health workers has grown from an initial focus on maternal child health to participation in large health campaigns like polio, newborn care, community management of tuberculosis, and health education on HIV/AIDS. Most Lady Health workers start working because of acute financial need. But even if this need passes, many keep working because they are serving the needs of the neighbors, self-actualization, and the fact that the work was not only interesting, but meaningful too. As one of the Lady Health workers shared, when I first left the house to work, I was scared and nervous.

When I kept going out, I learned how to do it. I learned how to meet people, how to talk to people, learned that they are just no trouble. Unfortunately, the majority of Lady Health workers live at a rate of income around, or in many cases well below, $2 a day per person. In the context of skyrocketing food and living costs, it’s not much. Lady Health workers repeatedly mentioned extreme difficulty in covering unforeseen expenses, such as medical treatment for a child illness or an adult’s injury which leads to catastrophic health expenditure. Most had started working as Lady Health workers because they desperately needed money. The step to work outside the home as women have social cost and was not taken lightly.

And so low pay was a very important issue to these women. In addition to it, job advancement is very difficult. Lady Health workers repeatedly talked about their desire for more education. But nearly all of them say to that, due to the limited income that had caused them to become a Lady Health worker in the first place, their plans were nearly impossible to put into practice. The narrative shared by a Lady Health worker– I became a Lady Health worker when I was very young. I had such a desire to become a doctor. I had been thinking of further study because really I want to move up. But I look and there really are not any ways for me to advance.

There’s no chance, absolutely no way. All of my dreams I have left all behind what I wanted to do. The reality reflects her narrative. No programs to learn vaccination are one that many Lady Health workers wanted– [INAUDIBLE] Certainly, none to move up in the health system. In Pakistan, most nurses are men and nearly all the positions of a community health worker in the health system are men, except for doctors. Thousands of Lady Health workers participated in a labor movement starting in 2010, occupying public spaces and shutting down roads across the country.

In late 2010, the Pakistani Supreme Court ruled that Lady Health workers were entitled to receive that legal minimum wage– about $100 a month– more than twice their previous salary. However, this increase did not quickly materialize. As a result, at least one Lady Health worker committed suicide and labor protests continued in 2011 and 2012 when pay was as much as nine months in arrears in many parts of the country. In December 2012, when anti-government forces started murdering polio workers, some Lady Health workers were told that if they did not work on polio campaigns, they would be fired.

After some very high profile strikes, the government did promise them basic benefits, like basic job security, that had thus far been denied to them. But the polio work in dangerous times continued. So considering the final strongholds of polio today are in conflict-ridden regions, which critically affect functioning health system, human resource, vaccine supply, power supply, financial resources, and surveillance activities, access to children, and the safety of workers is thus a significant challenge. [INAUDIBLE] vaccinators have been frequently targets of directed violence, spreading fear and [INAUDIBLE].. In this scenario, let’s listen to the discussion about this provocative questions.