I lived in India on several occasions and used to drive by brick kilns where bricks are made in often deplorable conditions by some of the poorest populations of India. Last week I was back for a shorter visit and had the opportunity to visit a brick kiln in Haryana, India where 26 children under five years old were living with their families, including a beautiful 3 year old girl named Pooja. It was scorching hot – a dry 105 degrees, seemingly exacerbated by the heat of the kiln and the blowing ash. The community that lived there had one television and all the families had a cell phone. Yet there were no toilets for the 96 people in the community and among those we spoke with, no one had a bank account.
I was visiting this brick kiln in the state of Haryana to see unique approaches to increase routine immunization coverage (the recommended vaccines). One new approach is a program that employs immunization field volunteers to identify hard to reach households. As a prospering state, there are a large number of seasonal migrant workers who come to work during the dry season. The field volunteers had identified the brick kiln as a place where new families with young children had recently moved. Health workers visited the kiln with cold boxes to administer the scheduled vaccines. Every child we met had received their full component of recommended vaccines.
As someone whose work involves ensuring vaccines reach children in hard to reach areas, I was incredibly impressed with the people working on improving immunizations in Haryana – they were thinking outside the box to address the problems of finding the unreached and were working to get real time data to use in planning. They also were open to discussing the very real challenges they faced.
The visit was also a well needed reminder on how immunization is one component of what is needed for children to prosper. While vaccines are a critical component to children leading healthy productive lives, the trip was a well needed reminder for me on how vaccines are only one element. I saw more than a few of the young children had discolored hair and were too short for their age, a sign of long term poor nutrition. While there is no doubt that vaccines are one of the most cost-effective interventions in public health, the visit was a good reminder that great progress made in immunization also needs to be complemented with progress in other programs, like sanitation, maternal education, family planning and nutrition.