The challenging journey to reach Nepal's hillside communities with vaccines
How dedicated health workers and a robust cold chain keep communities protected.
Communities perched on hilltops
Doti District lies in a remote corner of far-western Nepal. Lush green meadows lie in the valleys here, beneath the hills that sweep their way through this region. As you look up from those valleys, you see communities in the distance, perched on top of the hills.
Reaching those communities with health care services isn’t straightforward. Bringing vaccines to the children and families that live in these villages and municipalities often requires steep climbs and navigating treacherous roads.
For Basanta Malla, that journey is a big part of her job. She’s a nurse at the Primary Healthcare Centre in Jorayal Rural Municipality. Basanta has been at the forefront of the efforts to expand the coverage of routine vaccinations in this region for 27 years.
A challenging journey
Every month, Basanta and her colleague, Tilak Raj Joshi, will carefully place vaccines into a carrier box in the cold room at their healthcare centre. They’re then faced with a difficult journey, often on foot.
“Some of these places can take up to three hours to walk to, one way. The roads here are not paved, and taking vehicles can be dangerous, especially during the monsoon season,” Basanta explains.
These healthcare workers often navigate landslides and flooding during the rainy season to reach the communities they serve.
“One of us usually goes ahead to check if things are okay while the other waits. They’ll then signal the other to follow if all is fine. That’s how we go on. You also have leeches to worry about among other things. We have to carry umbrellas and packs of salt in our hands to ward them off,” says Basanta.
Communicating effectively about vaccines
Despite the challenges faced on the journey, Basanta believes it’s worth it. For her, it’s rewarding to see how positive people are in the municipality of Jorayal about vaccines. She believes that’s primarily a consequence of effective communication and counseling from health workers like herself, who build trust in these services.
“We have been able to remind them of what things were like before vaccines were available - when people used to fall ill or even die of various vaccine-preventable diseases. Since vaccinations against these diseases started, we have seen a drastic reduction in mortality rates, especially that of children,” Basanta says.
A thankful community
Durga Ghartimagar is one of the mothers that is thankful for the long journeys these healthcare workers make to reach these communities. She knows firsthand what it’s like. Durga has walked over three hours to reach the vaccination clinic in the village of Upparkot, which lies in the Jorayal District.
With the midday sun beating down, Durga makes her way up the last hilly stretch that leads to the clinic. She’s carrying her 3-month-old son Rhythm in her arms.
“We were told that children were being vaccinated here today,” she says. “The last time we had come for his vaccination, the health workers had reminded us that we needed to come next time.”
For Durga, the walk might be long and tiring, but the opportunity to protect her child is invaluable. “Vaccines protect children from diseases, they build their immunity against illnesses and keep them healthy,” she reflects.
It’s a similar belief that brings mother Nitu Nepali back with her child, 1-year-old Nitika. Nitika has just received her vaccine against Japanese encephalitis, which means that she’s now completed all the vaccines that are recommended for children her age.
Nitu credits the healthcare workers and the female community health volunteers for the work they do. “They teach us about what the vaccines are, what they do, and how they will benefit the child,” she says.
A mothers’ group meeting to build trust
To help build trust in vaccines in this community, there’s a monthly mothers’ group meeting. Female Community Health Volunteers facilitate conversations, which help to educate caregivers about the various aspects of child and maternal health.
“It’s easy when everyone is there, in person, to talk about why children need to get these vaccines,” says Pashupati Joshi, who is one of the volunteers. “The women in the mothers’ group really listen to what we’re saying, with great interest, and take that to heart.”
That sentiment is echoed by another volunteer, Sharada Madai. She says that that relationship building is essential when it comes to spreading correct information and increasing awareness. Sharada will additionally make the rounds in the community, visiting families personally to ensure that they’re aware of when it’s time to get their children vaccinated. Sharada believes that the importance of vaccines has now become ingrained in the minds of caregivers.
A robust cold chain is crucial
Getting vaccines to children in these remote communities requires a strong cold chain. The cold chain refers to a series of precisely coordinated events in temperature-controlled environments to store, manage and transport the doses.
To facilitate this, UNICEF has been working closely with Nepal’s government and key partners like Gavi, to expand and strengthen the country’s cold chain capacity.
More cold rooms, refrigerators and freezers have been installed in vaccine storage facilities. And there’s been an increase in the supply of refrigerated containers and cold boxes that are used to transport the vaccines from these facilities to the communities often situated high on those hills.
Basanta Malla, the nurse we first introduced you to, admits that the process can seem long and arduous, especially given the equipment, knowledge and skills that are needed. “But I think we should count ourselves lucky that thanks to the technology, we have the ability to do all this and to serve families,” she says.
“Many of the children that I vaccinated when I first started this job have themselves become parents today. Seeing them bring their children to get vaccinated gives me a sense of great pride,” Basanta reflects.