Lady health workers: The unsung heroes of Pakistan’s healthcare system

In November 2022, a truck conveying police faculty was designated in a self destruction assault in Quetta, Balochistan, killing four individuals and injuring another 27. Police officers were the victims, who were on their way to protect polio workers.

Over the course of the past few years, numerous attacks have been directed at polio teams, the majority of which are female health workers (LHWs). Media reports claim that over a hundred individuals associated with vaccination campaigns have been killed since 2012. There are no official records on the number of health workers killed by terrorist attacks.

Dr. Ala Awan, WHO Regional Director for the Eastern Mediterranean, urged the Pakistani government to provide polio vaccination teams with safety measures in August 2012.

Although polio teams were instructed to be accompanied by armed police escorts, numerous teams were still attacked, resulting in the deaths of both polio workers and police personnel.

The polio infection
“Polio, or poliomyelitis, is a debilitating and dangerous infection brought about by the polio infection. According to the Centers for Disease Control and Prevention (CDC), “the virus spreads from person to person and has the potential to infect a person’s spinal cord, resulting in paralysis.”

All polio cases in Pakistan have been reported from seven Southern KP districts since January 2021. Pakistan recorded 20 polio cases in 2022. Due to the tireless efforts of LHWs, the number of cases has significantly decreased from last year. Until Spring this year, no new cases had been accounted for. On the other hand, on March 15, a brand-new case of polio in a three-year-old boy was reported from Bannu district, one of KP’s seven polio-endemic districts.

Despite the fact that the number of cases has decreased, the fight against polio remains challenging for the nation.

Stories from the field In addition to the deadly terrorist attacks, LHWs face a variety of obstacles and challenges in the field, the most significant of which is opposition from families to the vaccination of their children. The immunization teams face danger from this resistance at times.

“Our groups and associates have been gone after while doing hands on work, some of them have been harmed and others have lost their lives,” said SA*, a LHW who works in Sindh (SA’s name has been kept on demand — most LHWs, terrified of kickback, don’t wish to be named).

Because they are on the front lines distributing vaccines to the general public, a lot of LHWs are susceptible to health issues. They were not provided with protective gear even as they dealt with one of the deadliest pandemics we have ever seen.

More details: Undervaluing the LINCHPINS According to Uzma*, a Sindh-based LHW, “We are the first to be affected by any disease, virus, or illness as we are sent to vaccinate people.” Even though we aren’t infected, we can carry the virus and be the source of transmission to our families. We were terrified that our families would become infected during the pandemic, which made it extremely stressful for us.

LHWs frequently face harassment in the field, including sexual harassment, in addition to these issues. They frequently lack support.

They are concerned that confiding in their families would result in restrictions being imposed on them because no one in their department takes any action in response to complaints of harassment. The LHWs turn to one another, try to support one another, and deal as best they can during these times.

In the field, LHWs encounter numerous issues on a daily basis. Although some of these are less severe than targeted attacks, their effects are long-lasting. SA* stated, “We have to continue working even though it sometimes becomes difficult to continue working in the circumstances.”

We work on a variety of campaigns, one of which is family planning. We go to women’s homes to discuss family planning, but their families, particularly their husbands and mothers-in-law, don’t want us to talk to the women. When men open the door and discover our presence, they frequently yell at us and even physically abuse us.

She recalled, “once I went to a house and the man who opened the door was not wearing a shirt.” He started making obscene gestures and making innuendos when I told him who I was and why I was there. I left as quickly as I could because I was very stressed.

Other LHWs likewise had comparable accounts of how men attempted to irritate them and, in certain cases, attempted to draw them into the house. These LHWs have devised a plan to ensure their own safety because they frequently conduct these home visits alone.

Safia*, a LHW who works in Karachi’s suburbs, stated, “We try to keep in touch with each other via phones, informing each other where we are.” It is the main thing we can do … it causes us to feel more secure.”

Similar issues confront LHWs working in other metropolitan areas. We face provocation day to day,” said Saima*, a LHW who works in Hyderabad. ” When we go to homes to talk about family planning, there are times when we can’t talk to the younger women. Our intentions are questioned and sometimes we are prevented from meeting their daughters-in-law. They sometimes say that we try to make women sterile. The matriarch always watches over the younger women whenever they are allowed to speak with us.

Farhat Sultana, a wellbeing specialist and individual from the All Woman Wellbeing Laborers Program Association regretted that LHWs needed to confront pressures at work as well as in their own homes. ” They face such countless things from family and parents in law, who have no clue about the difficulties LHWs face like badgering, lewd behavior, and different dangers.”

Another LHW who works in Karachi’s suburbs, Farah*, elaborated on the threats she has received while conducting door-to-door polio campaigns.

“A man opened the door when I went to a house once. Farah* stated, “He asked me to come in while his children were asleep and he would wake them.” I refused and requested that his wife accompany me. He became enraged and began to abuse me. It was clear that there were no women or children in the house, and I was afraid that this man would hurt me. I pivoted and left rapidly, while he continued manhandling and compromising me.”

Overworked and underappreciated: A lot of LHWs talked about job insecurity, long hours, and not getting paid for overtime. They may be required to work on holidays, failing which they may receive show-cause notices.

Safia* provided the following explanation: “We are sometimes asked to stay late to complete a report or are called in to work on Sundays and other public holidays.” We are not compensated in any way, shape, or form for this. We worked during the Coronavirus pandemic and worked during decisions — which isn’t essential for the LHWs’ expected set of responsibilities, yet we need to. We got a recompense to perform Coronavirus responsibility yet nothing for political decision obligation.”

Healthcare workers, particularly female health workers, are a crucial link in a nation lacking public healthcare for the masses. LHWs are the only health facility that thousands of people across the nation, particularly in rural areas, have access to.

“We are not just health professionals. When people come to us with issues like sexual harassment, domestic violence, and other issues, we often also serve as counselors, therapists, and even social workers for many of them. We try to assist them as best we can, “said Saima*, a Karachi-based LHW.

LHWs’ psychological well-being is permanently affected by such incidents, but they persist and continue to work. In addition to administering vaccines, providing family planning services, giving birth, and providing counseling, lady health workers are also performing these tasks on their own. Uzma, a member of the All Lady Health Workers Programme Union, stated, “We are just pushed into the field without little training or proper equipment. We don’t have any health insurance or any protection despite the hazards of our job.”

“We were provided with a risk allowance during the Covid-19 pandemic, but we were not provided with masks, hand sanitizers, or personal protective equipment (PPE) to shield us from the virus when we visited homes. The campaign ended the allowance, which was very helpful because our income is so low. Since this job is dangerous not only for the LHWs but also for our families, we should receive regular raises.

The All Lady Health Workers Programme Union organized nationwide protests in 2022 that lasted more than a month. When the authorities retaliated against the protesters seated outside the Karachi Press Club (KPC), the situation escalated. The police used water cannons and batons to charge LHWs; Several of them were detained.

In 2022, a sit-in by female health workers outside the Karachi Press Club. — Photo courtesy of the author “Our union has been working hard for the rights of LHWs, and as you saw, we were brutalized in Karachi when we were protesting in front of Karachi Press Club,” Noor Fatima, an LHW who is also a member of the union, said. In addition to being beaten and dragged, our members’ clothes were ripped and water cannons were fired at us. Numerous individuals sustained injuries and were taken into custody. We were merely requesting our rights.

Bushra Arain, president of the All Lady Health Workers Programme Union, was also abused in Karachi earlier in February 2023. Her spirit was not diminished much by it.

Arain stated to, “We will continue to fight for our rights — we are an important part of the healthcare system in Pakistan.” LHWs give the truly necessary clinical consideration that individuals need particularly in country regions and in low-pay regions however what do they receive consequently? They play an important but underrated role. We just request what is our right.”

Dealing with the floods
The new floods didn’t segregate. They caused obliteration across Pakistan, remembering for towns, towns and in the homes of numerous LHWs. The LHWs continued to work despite being affected and despite working in unsafe conditions.

Our LHWs have also been affected by the floods. Despite the fact that many of them lost their homes, they continued to assist others. Many just had pain relievers which they gave to individuals

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