When doctors and health care workers around Pakistan, and indeed around the world, faced an unseen adversary in the form of Covid-19 over the summer, a group of resolute women in the outbacks of Khyber Pakhtunkhwa doggedly followed their own fight, the one involving narratives.
One such woman is Zohra Zeenat, a health worker in the mountainous Shangla district of KP.
Zeenat’s role as a polio worker got much harder over the long months of Covid-19, when the populations here reacted to the pandemic with either terror or conspiracy theories. And here in the isolated villages spread across the Shangla mountains, the view of the pandemic was tainted by what they think of the polio vaccine, an effort by the West to take fertility from them.
People call us’ polio women ‘in our conservative culture, a role that is considered humiliating,” shared Zeenat, who was appointed as a health worker in 2018. “Even though we represent them, we do not get any respect from them.
During the Covid-19 pandemic, their position as front-line health workers did not receive the respect it deserved for Zeenat, who is one of 327 women health workers in Shangla district. Working in a difficult area with a hostile terrain, she did not just go about performing her duties in remote mountainous villages that included recognising people who had returned from abroad with potential coronavirus
“Come snow or sunshine, I perform my duties during harsh weather conditions for the sake of mother and child health care and to ensure polio vaccination,” Zeenat said. This is the fact that, often for months, she and other health staff sometimes do not get paid on time. “We get our salaries for a month, sometimes for two, after a break of six to seven months.”
Healthcare at your doorstep
The Lady Health Workers Program (LHWP) in Pakistan was founded in 1993 and involves district-based cadres of lady health workers (LHWs) trained to provide unique, basic primary health care and preventive services.
Their practise aims to build an atmosphere of well-being in isolated rural communities where they work with limited assistance even in urban environments, increases patient engagement with health care services and provides for prompt treatment, prevention and even disease screening. Women from local communities who have been professionally trained for at least eight years receive six months of instruction to provide health services on the doorsteps of communities. For a population of about 1,000 individuals, or about 200 households, each LHW is accountable.
Promoting maternal care, iron and folate use in labour, urgent infant care, umbilical cord care and the encouragement of breastfeeding are part of the training framework for the LHWs course.
As elsewhere in BS-5 and their superiors in BS-7, government-appointed LHWs in Shangla are working. They retire without a pension on the same salary scale. In general, in Khyber Pakhtunkhwa, there are 15,397 female health workers providing primary health care for women and girls.
A pandemic of troubles
Of the many problems faced by LHWs during the pandemic, the non-availability of drugs was the one that influenced their job most. Fatima, a health worker from Shangla’s Damorai district, said her catchment area consisted of villages and houses that were remote and difficult to access. In the absence of sufficient transport or commutable routes, she had to travel long distances for hours. She said the LHWs remained committed to their jobs because women and children were dependent on them with insufficient healthcare facilities, particularly during the long periods of lockdowns.
“In addition to women’s antenatal care and immunisation, we provide community women with medicines, but during the pandemic we have not been given medicines by the [health] department for the last several months,” she said, “even though it is the first thing female patients are asking for in the field.”
Fatima said that coping with coronavirus conspiracies was a huge problem for them and such myths often impacted the actions of people in their households.
Similar obstacles from her group were faced by Kalsoom Bibi, an LHW from the remote Chidam region of Tehsil Chaksar in Shangla, where people opposed polio and regular immunisation. To make matters worse, she said because individuals failed to take care and they had no personal protective equipment (PPE) available, the LHWs themselves were exposed to the virus. “Despite repeated requests to our supervisors to provide us with safety kits, masks and sanitisers during the Covid-19 door-to-door visits, we didn’t get any.”
The most gruelling part of Kulsoom’s work is to frequently visit as many as 123 homes, with a population of 980 people, spread over vast distances, especially when she has not been paid for months now.