After-dark effort to vax Adivasis

Caption Nilabai Maalu Suryavanshi a resident of Aliyabad who was due for her second dose was approached by health staff as part of the doortodoor night vaccination drive While she initially complied she refused and got up seconds before the nurse was to vaccinate her Nilabai believes that her health deteriorated after taking the first doseThis is where time stands still The village situated in the Satana tehsil previously known as Baglan of Nashik district is home to nearly 25000 residents a majority belonging to the Kokni tribe that inhabits parts of Maharashtra and Gujarat It empties out before dawn with farmers making a dash for their fields and daily wage earners cramming inside pickup trucks to travel across the border to neighbouring Gujarat 4 km awayBy 5 pm when this writer arrives in the village after a 10hour drive from Mumbai Aliyabad has only just begun to return to life Herders are heading back from the hills with their cows and goats and women are seen gathering around hand pumps steel handis in tow The scent of sweat and toil is overrun by smoke from firewood burning inside homes Cooking gas is a novelty Houses still hold together only with bricks and mud Electricity comes here as quickly as it goes And only phones with one service providerrsquos SIM can promise network Itrsquos a world wersquove long forgotten Nilabai Maalu Suryavanshi a resident of Bhimket pada in Aliyabad is due for her second COVID dose While she initially complied with health workers who visited her home during the night vaccination drive she refused to take the shot when she saw a nurse approach her with the injection Nilabai who has difficulty walking believes that her condition got worse after she took the first dose PicsPradeep DhivarUndeveloped and remote as it ismdashthe nearest city Satana which is also the subdistrict headquarter is over 40 km awaymdashthe village nestled in the Sahyadris has left health officers in a quandary since the beginning of the Coronavirus outbreak in March 2020 Aliyabad which is made up of nine gram panchayats and 27 padas completely escaped the first wave of infection with zero cases being reported The subsequent waves including the more recent and infectious Omicron third wave saw a total of just 22 cases and just one casualty that of a senior citizen Nashik district where the village is located reported an average of 318 cases per day last month Itrsquos a tiny victory for the Primary Healthcare Centre PHC staff and one would imagine a good enough reason to give themselves a pat on the back But when we visit the staff at the PHC is experiencing the very opposite of that ldquoEverybody here knows about Corona but because there were hardly any cases nobody believes it to be dangerous Itrsquos like any ordinary cold for themrdquo says Dr Manisha Rajaram Mohite medical health officer at the Aliyabad PHC ldquoWhich is why most of the locals have refused to take the vaccine They think we are injecting something that will in fact make them sickrdquoKamal Choudhary an ASHA worker in Hanumant pada who has been trying to convince villagers to get vaccinated says that she often gets booed away ldquoThey get violent and even throw stones at usrdquoThe issue came to a head in October 2020mdash10 months after the vaccination drive had kickstarted in the countrymdashwhen health officials had barely vaccinated 50 per cent of the 18322 villagers eligible for the dose ldquoWe were desperately trying to find a way to convince them to take the vaccinerdquo remembers Dr Mohite Itrsquos around this time that the Taluka Health Office in Satana which had been given the target of 95 per cent vax coverage came up with the idea of a doortodoor vaccination camp that would kick off after sundown The drive which begins daily at dusk and sometimes continues until midnight has met with successful results In the last four months health officials claim to have covered 70 per cent of the targeted population in the village The Kokni is a scheduled tribe residing in the SahyadriSatpura ranges of Maharashtramdashmostly in the Nashik Nandurbar and Dhule districts They are also distributed in the Valsad and Dang districts of Gujarat Most of the community members are agriculturists but the landless Kokni members still work as farm labour ldquoIn Aliyabad the tribals leave for work by 6 am and only return late in the evening When we first began the drive last year wersquod give them the vaccine at the PHC during the day at around 830 am Though the vaccine was free they had to take a day off from work to visit the centre They couldnrsquot afford losing the wages This deterred manyrdquo remembers Dr Mohite who has been working at the Aliyabad PHC for the last three years An early morning drive also failed The elderly population she says was most difficult to convince ldquoMost of them are uneducated and believe in superstitious practices They donrsquot even come to us to get treated for a snake bite Theyrsquod rather go to the babas and bhagatsrdquo she says ldquoWhen we told them about how the vaccine would create antibodies that would help fight COVID19 most of them didnrsquot seem to care They said their time was already up anywayrdquo Health staff from Satana city 40 km away arrive in a COVID ambulance to vaccinate tribal residents of AliyabadSuch an environment she admits wasnrsquot conducive to create awareness about a disease that had barely hit home ldquoWhen the pandemic broke out we had tried to spread awareness about using masks and sanitising regularly In fact we wouldnrsquot allow villagers to visit the PHC without masks but they simply refused to listen They couldnrsquot understand why we were making such a big deal about Coronardquo The PHC on its part was COVIDready conducting regular RTPCR and Rapid Antigen Tests at their laboratory Though cases were few and far between COVID positive patients were sent to a nearby isolation centre which again prevented suspicious locals from reporting their symptoms In order to boost the vaccination drive the PHC staff enlisted the help of local Zilla Parishad officials the sarpanchs as well as the police patils to reach out to locals ldquoWe would organise camps every single day even on weekends but got no response It was quite disappointingrdquo she shares By October 2020 the staff had barely vaccinated 10000 people Kiran Shewale taluka health supervisor at the Taluka Health Office Satana says that Aliyabad was the worst performing village in their tehsil ldquoWe knew that we had to pull up our socksrdquoNitin Prakash Sarak a local health worker checks the list of vaccinated patients due for the second doseAround this time several rural pockets in Maharashtra had already begun conducting night vaccination camps In villages in Dhule district for instance health officials with the help of local ASHA and Anganwadi workers would organise weekly night camps at makeshift centres and halls in the village premises for daily wage earners The Satana health staff decided theyrsquod also give it a shotThe COVID ambulance that middayrsquos vehicle followed from Satana reached the village around 5 pm It takes around oneandahalf hours to reach Aliyabad from the citymdashfor most part the ride is bumpy and uncomfortable with no street lights on the waymdashbut health workers have been travelling to and fro daily The staff has already vaccinated 12983 villagers in the area with at least one dose While 6250 residents are awaiting the second dose 5339 eligible locals are yet to get vaccinatedKiran Shewale taluka health supervisor at the Taluka Health Office Satana says that they had to undertake the night vaccination drive in Aliyabad as it was one of the worst performing villages in their tehsil in terms of vaccine coverageShewale who has been monitoring the drive has joined us from Satana ldquoMost of the villagers have no knowledge about vaccines They donrsquot remember when they took their last dose and whether it was Covaxin or Covishield Some donrsquot even have mobile phones and if they do they canrsquot register themselves So we have to do it for them on our phones We struggle with this too as the network is terrible in this part of Maharashtrardquo says Shewale He admits that it can get difficult for them to keep tab of eligible candidates ldquoTo circumvent this problem we started giving them a token where wersquod mention the date of the first dose the vaccine that they took and when they are due next Very often theyrsquod lose that token toordquoNow ASHA and health workers keep a list with them those who are due for the vaccine are usually approached by the team leading the night vaccination drive The first pada we visit Hanumant has seen one of the lowest turnouts in the region While 587 have taken their first dose only 266 locals have taken both shots Kamal Choudhary an ASHA worker says that she has been booed away by residents one time too many ldquoWhen they see us they shut the door Sometimes they get violent and hurl stones at us But this is our job and the government has given us a target so we have to do our bestrdquo she says She is however hopeful that theyrsquoll be able to cover more ground when some of the migrant labourers currently working in the sugarcane fields in Pune as well as UP and Bihar return to celebrate the Holi festival this monthDr Manisha Rajaram Mohite medical health officer Aliyabad PHCWhen we meet the sarpanch Kalu Somnath Choudhary he refuses to admit that villagers donrsquot take the vaccine ldquoThey donrsquot have a choice they need to take itrdquo he says ldquoIrsquoll ensure thatrdquo he assures the ASHA worker we are accompanying Later he tells this writer that villagers are wary because during the second wave when someone would show the slightest of symptoms theyrsquod be taken in an ambulance and kept in the isolation centre ldquoIt was a precautionary measure but now they are scaredrdquo In Bhimket pada which is a 10minute drive from Hanumant locals are more forthcoming An impressive 922 villagers have taken their first dose and 280 have taken both But the scepticism continues When the health workers visit the home of Nilabai Maalu Suryavanshi who is due for her second dose she complies and sits down to get the shot But as soon as the nurse approaches her with the syringe she gets up and steps away ldquoI donrsquot want itrdquo she says ldquoPlease gordquo When we ask her why she wonrsquot take the vaccine she says that she has had a problem with walking for a while and had stopped going to the fields ldquoAfter I took the first dose my condition worsened Now I need to drag myself If I take it again I wonrsquot be able to get up at allrdquo Shewale says that itrsquos hard to counter this kind of misinformation ldquoNow when people develop a slight fever they blame it on the vaccine Rumour spreads fast here They donrsquot believe in science so how are we going to tell them that they are misguidedrdquoReshma Shantaram Sable who supervises over 15 ASHA workers in the region says vaccine hesitancy is rife within the community ldquoWe may have managed to get them to take the first dose but many have refused to take the secondrdquo Sable says that several ASHA workers have been assaulted ldquoWhen they get too violent we ask the police patil to accompany us Itrsquos a risky job for the womenrdquoNitin Prakash Sarak a local health worker says they cannot use extreme measures to convince villagers to take the vaccine ldquoWhen authorities across the Gujarat border did not allow nonvaccinated labourers to travel there some of them took the vaccine There has been no outbreak here so their scepticism is justified Our job is to let them know this is safe for them and itrsquos for their own good We have to be very patientrdquo2493522Total population of Aliyabad versus the number of COVID cases reported here since 2020Why Aliyabad stayed safeAccording to Dr Manisha Rajaram Mohite medical health officer at the Aliyabad PHC the village is situated in the remotest part of the region and hence didnrsquot see cases during the first wave when the Centre had declared complete lockdown ldquoVillagers are selfsufficient and do not have to travel long distances they consume what they produce Because they eat organic healthy food they also have good immunityrdquo She says that testing continued at the PHC during the three waves and patients with symptoms were isolated