As Pakistan inches closer to the eradication of polio, frontline teams have zoomed in on the last pockets of population who remain on the move, especially from areas considered hotbeds of the poliovirus.

Due to frequent movement from one place to another, such families are either vulnerable to the virus or have the potential to carry it to previously unaffected areas.

Locating, mapping and vaccination of such groups who may remain persistently unavailable due to travelling remains critical in closing the last holes for the virus to survive.

A session was held in this regard in Multan’s high risk union council of Gulshan Punj Faiz to sensitise the nomads, mostly from Sindh, about risks of polio to their children. Families from Sindh were focused because recent detection of virus in Rawalpindi was linked to Multan and Karachi.

Investigation revealed that the virus may have travelled all the way to Rawalpindi due to high population movement from multiple routes including interior Sindh.

According to the union council social profile prepared by the frontline workers including social mobilisers and Union Council Communication Officers, 38 children of Sindhi background reside in the settlement in deplorable conditions.

The shanties in the settlement are a few among thousands others in Multan housing 15,000 families from high risk groups like nomads and seasonal workers who earn their livelihood by collecting mango seeds, plastic bags and pieces of disposed of clothes.

A loud cheer from the dwellers, wearing worn-off clothes, including women, children and men welcomed the frontline health workers as they walked to the shanties. “What is polio”? asks District Health Communication Support Officer (DHCSO) Asim Bhutta from the men assembled outside a shanty.

“Polio is a disease”, replies a man in his mid-forties.

“How does it affect children?” the DHCSO asks. “It affects the body of a child”, replies an old man as he squats on a charpoy along with other members of his extended family.

“What is the best time for children to be administered polio drops?” asks the DHCSO. “Every child is required to be given drops”, says the oldest man.

“All children up to five years of age are most vulnerable to poliovirus”, the DHCSO quickly adds.

“How many polio drops every time”? He asks again.

“Two drops every child every time”, the participants reply.

Geographically linked to Lodhran, the only polio-affected district in Punjab in the current year, Multan is home to thousands of nomads, seasonal workers and devotees. It is regarded as the capital of South Punjab.

As per IDIMS data, over out of 85,000 children vaccinated at the shrine of Hazrat Bahauddin Zakariya Multani during annual Urs in November, 60 per cent of them were Sindhi.

Multan has a total number of 847,000 children under five. But in the May NID, frontline health workers registered more than 15,000 families of different backgrounds who were in addition to the original population and had settled in peri-urban settlements of the district.

A polio team deployed at the neighbouring Rahim Rar Khan revealed that thousands of families cross into Punjab and move all the way up to Multan to pay respects to sufi saints or in search of their bread and butter.

“During the harvesting season large number of nomads cross into Punjab”, says naib qasid Shahid Hussain, who has been deployed at Khan Bela, UC Liaquat Pur, Rahim Yar Khan transit point.

After the nomads have settled down in various slums or peri-urban areas, ComNet staff identify them, bring them into the notice of vaccinator so that they are given polio drops in their neighbourhoods.

“The social mobilizers and Union Council Communication Officers share details of any new settlements in their area with the vaccinator. The nomads’ data then becomes permanent part of social district profile”, the DHCSO explains adding: “joint maps are then prepared of all such nomadic localities”.

According to Emergency Operations Centre Coordinator (EOC) Dr Munir Ahmad, poor sanitary and hygienic situation in these settlements is conducive to the spread of wild polio virus.

“The immunity system in such populations is weak. Nomads have high chances of carrying poliovirus, sometimes refuse polio vaccination due to misconceptions”, says the coordinator.

After the last polio case in October 2009 in Multan, the district health department had ramped up efforts to increase coverage of routine immunization and reach out to every child in polio eradication campaigns.

According to May National Immunization Polio Control Room data, the number of children who had not received routine vaccination had dipped to 3,300. The number is marginal as compared to rest of the province where 54,000 such children were reported.

“No polio case has been reported from the district despite having huge influx of migratory population. These populations are reached through awareness sessions, out of home messaging, outdoor advertising at points of transit and vaccinated on the go as well as in host settlements. These figures prove that efforts are bearing fruit”, says Dr. Munir.

The frontline health workers play an important role in identifying such migrants. They engage them on and off campaigns to support their vaccination and overcome behavioural barriers, he adds.

“We are very sensitive about children. They can easily become either victims or virus carriers. So we keep them engaged. We cannot stumble on the last few obstacles in fight against polio”, observes the DHCSO before bidding good bye to the families living in the settlement.