To the Mountain Top: Health workers brave challenging terrain to deliver vaccines

In the eastern mountains of Northeast India, where the sun rises early, Dematso Khamblai’s day of delivering vaccines starts well before dawn. He is a member of the area’s Alternative Vaccine Delivery System.

At 3:30 a.m., Dematso leaves his home and heads to the local health centre. There, he stocks up on vaccines, packing them into a grey insulated carrier. By 4:30 a.m., he is on the road, bumping along for as far as a motorbike.

When the roads end, he begins his trek over hills, through valleys and across rickety suspended bridges. His mission: to deliver vaccines to villages hidden away in the mountains of this north-east corner of India.

“The mountains are steep, and we have to be very careful while hiking,” Dematso said. “It becomes dangerous during the monsoon season as rains make the trek slippery. There are also frequent landslides during the monsoon season, which make the trek tough.”

Northeast India, known for its natural beauty and rugged terrain, poses a challenge for health workers striving to ensure that all children receive necessary vaccinations. High mountains, deep gorges, and dense forests, combined with unpredictable weather conditions, make the journey to reach vulnerable communities perilous.

The vaccinators who brave the journey need skills, courage, and patience to transport and maintain vaccines at the right temperatures across these winding and treacherous trails.

Dematso is a member of the area’s alternative vaccine delivery system, which consists of a corps of health workers who bring vaccines to one of the most remote rural regions in the world. Most of the villages that depend on Dematso’s team for immunization, cannot be accessed by road, often having to cross turbulent rivers on suspended wooden bridges.

“Earlier there was no health facility available here,” said Kheti Meyor, a Gaon Burha (elder). “But now Dematso Khamblai and his team members visit us periodically to immunize the children.”

Sushma Meyor credits Dematso and his team with helping her make sure that her eight-month-old son is vaccinated.

“They come to us and explain everything to us,” she said. “They also tell us about the date of next vaccine. We don’t have to worry at all. The team arrives here at the scheduled time and immunizations are done.”

Long distances without roads is not the only challenge to immunizing children in this region. The remote location means that few children are born in health-care facilities and few families record the birth of the children, said Dr. S. Nayil, a district health officer specializing in reproductive and child health. In addition, limited internet connection makes record-keeping difficult, and lack of accessibility and awareness of vaccines makes micro-planning difficult.

As a result, the alternative vaccine delivery team and health workers are also required to register births in the villages they cover. With this information, district health officials are able to track children’s immunization histories and plan vaccination outreach on a micro level. The alternative vaccine delivery team now informs parents and caregivers directly of upcoming vaccination opportunities. The result has been universal vaccination coverage for children in the district, Dr. Nayil said.

During the height of the COVID-19 pandemic, the alternative vaccine delivery (AVD) teams were under extreme stress. Instead of 7 or 8 days in a month of trekking through the remote region, the teams were on foot for at least 20 days a month.

In addition, populations are scattered throughout the steep terrain.

“There are some villages in the region that require a trek of seven to eight hours to reach one village,” Dr. Nayil said. “The AVD teams are quite motivated, and it is because of their motivation that we have been able to succeed so far.”

Despite the hours of trekking and the dangers of monsoons and landslides, Dematso said he has discovered a sense of purpose in the job.

“Earlier, the duty seemed like instructions to be followed,” he said. “But now I feel it as my responsibility.”

As the sun sets over the mountains, these health workers return to their homes, exhausted but satisfied with the knowledge that they have made a difference in their communities. Their work may be difficult, but it is also fulfilling and rewarding.

Thanks to their efforts, more children in Northeast India are receiving the vaccines they need to stay healthy and thrive.

Pic © UNICEF/UN0732860/Bannerjee VII Photo
The article was originally published in THE STATE OF THE WORLD’S CHILDREN 2023 REPORT