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Even the smallest question should be answered

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Ms. Rina Dey, Communications Director for CORE Group Polio Project India, explains why listening to communities is key to ending polio.

Ms. Rina Dey has spent over 25 years working in health and development, including front-line efforts to eradicate polio in India and globally.

“Unless we work at the community level, we’re not getting the full story. Ensuring community participation is the only way to achieve social transformation and to ensure that all children get immunized,” she explains.

In her role as Director of Communications for the CORE Group Polio Project, Ms. Dey works tirelessly to bring community perspectives to decision-makers at the national and state levels. Ms. Dey also continues to share lessons and innovative strategies from her work in India with other parts of the world impacted by polio.

Regardless of the location, her message is the same, “We need to take the time to listen. All questions and concerns are valid when it comes to making decisions about the health of one’s family – each deserves to be heard, understood and acted upon – without this, we will not be successful in protecting children.”

India, once thought to be the most difficult place in the world to end polio, was declared wild polio-free on March 27, 2014. A large part of this huge success was the ability to work one-on-one with communities in high-risk areas.

A pivotal moment

Ms. Dey began working in polio as a front-line Health Information, Education and Communication Officer with UNICEF and WHO.

She remembers, “Early in my career, during a field visit to Meerut, Uttar Pradesh, I came with a vaccination team to a house for polio immunization. A man came to the door, armed with a sword, and shouted that he would kill his nine-month old daughter, if we tried to enter and give her polio drops. I took a step back and directed our team to leave the house. It shook me.”

After taking the time to listen to the man’s concerns, Ms. Dey learned that the man was receiving a lot of misinformation from friends as well as his workplace. Out of fear and misunderstanding, he made the most severe threat possible to try and keep the health workers away from his family – in his mind to protect them.

“After taking the time to really listen to him and his friends, we began talking. I assured him that no one would vaccinate his daughter without his permission.”

Health workers need the knowledge and skills to effectively deal with these types of situations and to ensure that communities are receiving accurate information to make choices about the health of their families.

“The key is to address their questions and to build trust. By the following day, he welcomed the vaccination of his daughter and even went on to become an influential member of the community helping to address the concerns of other families.”

Ms. Dey decided to re-shape the way frontline health workers were trained.

“We needed to equip the health worker and vaccination teams with accurate knowledge and enhanced communication skills to understand and address the concerns of the families. There were many myths and misunderstandings to dispel, so I have put a lot of thinking into developing simple and user-friendly materials and methods which are local and participatory.”

“Investing in building capacities of frontline workers works! If they are not technically sound, they won’t be able to answer people’s queries.”

Nothing for us, without us

The Moradabad district in Uttar Pradesh was once an epicenter for polio outbreaks globally. Today, a monument to the district’s success stands tall above the bustling traffic of Moradabad City.

The monument is comprised of a large mother and child sculpture surrounded by the slogan “Two drops of life“. A polio vaccine vial sits on a base with four panels describing the partnership, strategies and journey to a polio-free India.

“No one thought it could be done when we started, but people from Uttar Pradesh, Delhi and West Bengal supported the polio eradication cause with high spirit and the job was done peacefully. A sense of great pride remains in Moradabad, and the whole of India.”

“When communities are heard and feel a sense of pride in the effort, sustained change is possible. But the flip side is also true.”

Ms. Dey remembers how children would come running with excitement, waving and cheering to interact with her team.

“When we were out on visits, the children would run to greet us. They wanted to know who we were, why we were in their neighbourhood and what we were doing. We would talk with them – we knew their names and what they were studying.”

“However, after some time, I realized that the children stopped coming, and some even began hiding from us. This was heartbreaking.”

Communities were being told that the vaccines could cause infertility, and parents were telling their children to run away from immunization teams. Dey took these insights to heart. She pushed her team, government officials and partners to think differently.

“I never thought of quitting. I want to see a polio-free world in my lifetime. I love children. I am working so that they can have a healthy life.”

She decided to develop strategies that would ramp up the involvement of influential members of the community, parents, schools, local government and families to ensure that accurate information was accessible to community members.

“We worked hard, and the scenario changed. Parents deserve to have accurate information so that they can make informed decisions about their children’s health. Many of those we engaged in this project are still advocates for polio eradication and immunization today.”

Women’s contributions cannot be overlooked

“At ground level, we have lots of female health workers. In many countries a majority of frontline health workers and vaccinators are women, but at the higher levels, we find that the majority of leadership positions are held by men.”

“Women can often be sidelined in meetings. Things have improved, but we have more work to do. When women are in leadership positions, you find that other women are promoted and women’s voices from community level are more often heard.”

Ms. Dey recalls her own experience, “Once during a discussion with community leaders, I was not allowed inside one of the prestigious religious institutions. Even as a senior member of the team, I was made to wait outside for hours, while my male colleagues were permitted to speak with the officials inside.”

When asked what advice she would give to women beginning their careers in public health, Ms. Dey says, “Be a good listener. You must visit communities, spend time with them and build strategies for your work that are grounded in the realities of the people you are aiming to reach. You must make communications simple and always put appropriate ingredients into your approaches.”

“The health of our children and families is a very personal and foundational aspect of human life. Ultimately to increase vaccine acceptance, we have to relate to people on a human level first before launching into the science.”

“We’re always ready to give answers, but we also have to listen – at every level,” says Ms. Dey. “We must move away from being instructive and take the time to see people’s concerns as valid and to help people understand the science behind what we’re asking them to do.”