Through the depths of water and the toughest terrains
Eradicating Maternal and Neonatal Tetanus (MNT) in remote areas of Khyber Pakhtunkhwa
Haripur District, Khyber Pakhtunkhwa: The day begins early in Bharu Kot, a small island in the Haripur district, Khyber Pakhtunkhwa province of Pakistan. As the first rays of dawn touch the sea, fishermen are already busy on the water, taking advantage of the cooler temperature and calmer conditions.
Fishermen, labourers, nomads, and seasonal migrants make up the population of a vibrant community that lives on Bharu Kot. Their stories are woven together by shared circumstances. Together, they create a cultural mosaic characterized by continuous movement and adaptation.
Their way of life requires a high degree of adaptability and a profound connection to the environment, with each day shaped by both opportunities and challenges.
Stories of human resilience and adaptability are common here, reflecting the daily lives of ordinary people confronting extraordinary challenges.
One significant challenge faced by the people of Bharu Kot, is the lack of healthcare facilities, adding a layer of vulnerability for the community in such a remote setting.
Babra (36) lives with her husband and their seven children in Bharu Kot. Currently pregnant, she faces high risks associated with Maternal and Neonatal Tetanus (MNT) due to unsanitary birth practices and inadequate health services.
Having lost a baby already because of difficulties in accessing vaccinations and iron supplements, Babra is determined to change her story this time. Now in her second trimester, she feels healthier and more secure, thanks to the care provided by visiting healthcare professionals.
“Last year, I suffered a miscarriage, but this time, a healthcare worker has helped me with vaccinations and also provided iron tablets.” says Babra, on the day she is receiving the Maternal and Neonatal Tetanus (MNT) vaccination from a Lady Healthcare Worker (LHW).”
MNT is a fatal disease affecting women and their babies in countries where women often give birth at home and in unsanitary conditions. However, it is largely preventable through simple measures such as clean birthing delivery environments, including proper umbilical cord care, and life-saving vaccinations.
While tetanus cannot be eradicated due to widespread bacteria, the Maternal and Neonatal Tetanus Elimination (MNTE) initiative, was launched by the Government of Pakistan in collaboration with UNICEF in 2022.
Globally, this initiative was launched jointly by UNICEF, WHO and UNFPA in 1999, revitalizing the goal of MNTE as a public health problem. The objective was to reduce neonatal tetanus cases by less than one per 1000 births, in every district of the country.
Nazma Shaheen, a healthcare professional in the Haripur district, talks about the challenges and successes of the campaign. "At the beginning, it was difficult to persuade women in my area about the importance of vaccination," she explains.
Despite facing refusals based on religious beliefs, vaccine fatigue, reluctance, and restricted access due to recent floods and security concerns, the efforts have been fruitful: “I persevered and succeeded in vaccinating many women in the community. It is gratifying to offer safe, effective, and often hard-to-access vaccines to women and children.” says Nazma. With support from The Church of Jesus Christ of Latter-day Saints and Kiwanis International, over three million women across Khyber Pakhtunkhwa, including 700 in the Haripur district, have been reached.
“Our day starts before dawn with orientation and briefings to understand each village's specific vaccination needs and obstacles," Nazma explains, highlighting the dedication of her team of female health workers. “Armed with tally sheets, vaccines, and supplies, we tackle the challenges head-on."
Nazma remains optimistic that ongoing awareness raising about hygienic birth practices and better access to vaccines will significantly reduce the incidence of MNT in Pakistan, one of the 12 countries where the disease persists.
“As a female health worker, I often navigated unsafe routes to reach various communities. Despite these obstacles, we were always warmly welcomed, and families showed a readiness to be vaccinated. These interactions have helped us build meaningful relationships, bridging gaps across our diverse communities.”
As the community of Bharu Kot continues to adapt to its changing environment and challenges, Babra's journey underscores the importance of the healthcare initiatives that are transforming lives on the island. Through the dedicated efforts of healthcare workers and the support of global partnerships, there is renewed optimism for a healthier future for these remote communities.
