Ashoqullah is just three years old, and his right arm and leg have been paralysed by polio. He never received a dose of the oral polio vaccine because vaccinators had not visited his village, Dama Kohistanat, in the Behsood district of Nangarhar province. Campaigns in 2015 need to reach every single child with multiple rounds of polio vaccines in Afghanistan, so that children like this one are protected against polio which is incurable, meaning that those affected are crippled for life.

Mirwais Hospital in Kandahar city is a very busy place, and Doctor Mohammad Sidiq is a very busy man. As a Senior Pediatrican and acute flaccid paralysis (AFP) focal point for the hospital, he sees many children every day. He checks to see whether they have been vaccinated and, in case of a child presenting with floppiness or weakness in their arms or legs, he informs his WHO colleague who collects a stool sample for laboratory testing. AFP surveillance is one of the core pillars of global polio eradication efforts. According to Dr. Sidiq, ‘... polio vaccination campaigns are the key solution to eradicate poliovirus from all places in the country.’

'As a pharmacist, I am often in touch with people more than a doctor is, especially with the villagers’, says Shah Mahmmod Qurishi, a pharmacist in downtown Kandahar city. When parents come to him, he asks them if the vaccination team reached their home or not. There are still some parents who do not see the need for their children to be vaccinated every round, thinking that one time is enough. So the pharmacist explains to them that all children, including new-borns, need to receive two drops, every single time the vaccinators come to call. As a volunteer working in AFP surveillance, he also refers children with weak or floppy limbs to the AFP focal point, who then informs WHO so that a stool sample can be taken to the laboratory to be tested for polio.'

Hamid Ullah works as a volunteer vaccinator within Spinboldak city in Kandahar province. On campaign days, he eagerly sets to work with his team, going house-to-house to vaccinate every child under 5 years in the area. While his team mate vaccinates children and marks their finger as evidence for the monitors that they have received the vaccine, his role is to fill in the tally sheet, to record when children weren’t able to be vaccinated in each household so that they can be reached another time, and to mark every door. The door-marking indicates how many children were vaccinated in every home, enabling the monitors to check that no child is missed.

Nargis is a 22 year old Post Campaign Monitor in Jalalabad city, Nangarhar province. She trains vaccinators on how to carry out and monitor campaigns properly. After each polio campaign, Nargis checks doors and finger markings through household visits to assess the performance of the campaigns. Post campaign assessment helps the polio programme to estimate the number of children vaccinated, and to track the number of and reason for missed children. ‘There are many problems that we have to handle through different methods and techniques in order to obtain reliable information,’ says Nargis.

At Asadabad Central Hospital in the capital of Kunar province, an Afghan mobile vaccinator marks the finger of a little girl who has been given the oral polio vaccine as part of a polio campaign. These dots of ink on the finger make it possible for monitors to check which children have received protection, and which still need the crucial dose of the vaccine that each campaign seeks to provide.

Masoom Jan is a preacher at Etifaq Mina Mosque in Paktia province of Eastern region. ‘Islam has not forbidden vaccination drives, which are to benefit members of a society and to keep them healthy and strong,’ he explains to parents. ‘One of my happiest moment in the mosque is when I inform the residents during Friday prayers that a polio vaccination campaign is about to start in the province.’

Female volunteer vaccinators
Like their male colleagues, female volunteer vaccinators leave the Team Support Centre in the mornings with a supply of vaccines, ready to go house-to-house during polio campaign days. They vaccinate all children below 5 years, ask in each household for any child with floppiness/weakness, mark fingers and doors, and record on their tally sheet. ‘As female volunteers, we are serving our community and at the same time we do have access to ladies in the houses,’ says one vaccinator. While women working during a campaign is accepted in Jalalabad, and can make it easier for vaccinators to enter a home, it can be challenging in other provinces depending on cultural norms, where it may not be acceptable for women to work outside the home.

Families have a crucial role to play in the eradication of polio. Most families are made aware of the threat of polio and the importance of vaccines by media campaigns, preachers, village elders and teachers. Mohammad Nasir is 61 years old and has three children under the age of 5, and grandchildren from his older children in Gardez City of Paktia province. He knows all about the dangers of polio, and has always vaccinated his family. ‘They are my life and my only hope for the future is to have healthy children. I cannot see innocent children being paralyzed.’

Here, three children show the dots of ink on their fingers which show that they were reached with polio vaccines during a polio vaccine on the outskirts of Kandahar city. The hard work of every single person involved in polio campaigns and the love of the parents of children like these results in their being protected against polio for life. These hard working individuals are just some of thousands going house-to-house during each and every day of campaigns to reaching children with the polio vaccine. Afghanistan and neighbouring Pakistan will be the countries to take the world over the finishing line of polio eradication - thanks to the people from all walks of life who commit their time and passion to seeing the job done.