The Hidden Children Of Pakistan.
Article by Dr Meher A. Zaidi.
Why And How Children Are Missed In Immunisation And Vaccination.
Pakistan has a very large number of child population. A very large number is in the age group which can be vaccinated . The Federal Government of Pakistan provides a standard Expanded Immunization Program (EPI) under which it tries to give a broad coverage to preventable diseases like, tetanus, measles, polio, diphtheria, hepatitis B, Influenza Haemophilis B etc.
The statistical records of number of vaccinations and immunization is roughly estimated from various registries in government run hospitals and dispensaries. As the larger number of population is covered by both registered medical practitioners and unregistered quacks all over Pakistan, a considerably larger number is never, ever reportedly covered both in government programs and private campaigns. The newspaper and electronic media gives coverage to government or some organization announced program , therefore a large number of unreported or uncovered children are never reported and counted in statistical records.
The majority of Pakistan’s child population is covered by ,if covered at all, by unregistered medical practitioners or popularly known as quacks in Pakistan. They are called “Doctors” irrespective of the fact that they are not even primary school pass. A doctor friend of mine , practicing in an urban slum of Karachi, known as Shireen Jinnah Colony since last 30 years had to forcibly support and inaugurate a “Clinic”, by her own driver who collected “charity money” , some 70 ,000 Rupees and practices with daily injections and antibiotic prescriptions, copied from other doctor’s prescriptions. He is given protection from the “religious” community elders in the area and is flourishing. She can neither “dare” to report or be rude to the “competitor” .She is a very conscientious doctor and was giving preventive vaccination out of her own subsidized resources. Now she cannot guarantee a large number of children who have happily switched to the quack “doctor”. There are a large number of such quacks all over Pakistan.(The rackets of stolen and expired and ineffectively stored vaccines is another story).
The other large chunk is the population of children who are living in remote areas such as Baluchistan, interior of Sindh, mountaineous areas of the Frontier province. The Frontier province as it is due to militancy, war, and the religious teachings of the militant preachers has lost a large number of children to non-receiving portion of the immunized children. Here the early vaccines such as DPT, Polio are missed , so the later vaccines such as Measles as in MMR are definitely missed.
The third very important “Hidden” children groups are the children whose parents are very poor and are either sick, hospitalized, or are not with the child. I see a large number of such children begging for alms and food in urban “posh” shopping areas of Karachi. Such children are all over Pakistan and are neither categorized or registered or covered in any government, private, organizational capacity. These “hidden” children are neither reported nor searched for vaccination or immunization.
The fourth very important component is the “poor girl child”. She is present in villages, urban slums, employed in homes, non-traditional work force, cottage industry. She is neither given curative medical care, preventable medical care is a far out dream for her. She will fall sooner or later to the much dreaded Tuberculosis, and also Measles and Rubella as MMR vaccine which is given later in the EPI schedule (at 9 months of age ) is surely missed for her. Due to gender discrimination which is a sad and established part of the cultures of all the ethnic groups in Pakistan, the girl child is a large chunk of the “Hidden” child population.
It is clear that factors such as poverty, illiteracy, religious and social discrimination against girl child and other “poor” social groups, lack of awareness among the general population, insensitivity and lack of focus on compassionate approach to the “poor” child are all relevant factors that are creating constant hurdles in Pakistan for the achievement of a disease free state. The mere reporting of some causes or statistics to lack of achievement in measles vaccination does not give a true picture of the lack of access to preventable health services. I do hope my article opens the eyes of some researchers and policy makers in really how to approach this problem. The statistics available on Unicef and Pakistan government websites are mere “fillers” for expensively funded studies and reports. They neither give the true picture nor give any help in realistic addressing this issue.
The very idea of compassion so quickly claimed by our “religiously” oriented elite falls shamefully short of getting a poor child vaccinated and immunized against the basic diseases covered by the EPI. If each family in Pakistan takes responsibility for one family children coverage, be it from taking to the government run program, or private doctor then the massive deficiency in this program will be covered. Also the schools especially the private schools which give largest coverage to Pakistani children should encourage vaccination, organize parents awareness programs and liase with government and NGO to cover all children.