At 11 a.m., the sun is beating down in the densely populated urban slum tenements of Mumbra in Thane, Maharashtra. But Amrien Khan is unfazed by the heat. She walks purposefully down the narrow alleys, nodding her head as she is greeted by her neighbours. She rechecks the name displayed on the tablet in her hand and turns towards a partially constructed building.
After walking up two floors, she stops in front of a room and calls out: “Salam Alaikum! The last time I came, it was to bless your newborn. I sang and performed for donations from you. Now, I have come to remind you that your baby is due for her next dose of immunisation.” Immediately, the door opens and Khan is welcomed inside.
It is not just this door that the 30-year-old has helped to open. In a unique initiative, the transgender community has been engaged to improve routine immunisation among the children of Mumbra-Kausa. With a population of 3.68 lakh, the neighbourhood of Mumbra-Kausa, comprising predominantly migrant minority communities, is the biggest contributor to zero-dose (children who have not received a first dose of diphtheria-tetanus pertussis, or DPT1, vaccine) and under-immunised children under the purview of the Thane Municipal Corporation (TMC).
Transgender field coordinator Amrien (centre, in green) mobilising the community in Azad Nagar, Kausa.
| Photo Credit:
Swapna Majumdar
Now this is changing, thanks to Sakhee, the two-year pilot project designed and implemented by ZMQ Development, a not-for-profit, with support from GAVI, the Vaccine Alliance. Transgender persons employed and trained by ZMQ have facilitated the immunisation of 733 children identified as zero-dose or missed dose since the project began in April 2023.
Win-win for all
Just as this achievement has been life-saving for children, it has also been transformative for the transgender community. Being a part of Sakhee has boosted their confidence and provided them with a livelihood of dignity. Learning to use a mobile-based application to map and track children who have fallen off the immunisation radar has given them a new purpose in life.
For Simran, it is a chance to begin anew. Losing a leg in an accident had led to depression, an uncertain future, and financial anxiety. Although she managed to source a prosthetic limb, it was Sakhee that helped her regain confidence in her abilities. “I never got this kind of platform before to do something for the community. I’m saving lives by raising awareness through behaviour change stories on the app on each of the nine vaccines critical for children. The badge I wear around my neck has given me a new identity and respect,” she says.
Transgender field worker Megha (far right) hands over immunisation pamphlets at a local health centre in Mumbra-Kausa.
| Photo Credit:
Swapna Majumdar
For decades, the transgender community has been an integral part of the lives of the families living in Mumbra-Kausa, celebrating births, marriages and other milestones with them. ZMQ saw them as natural allies in their initiative to save lives and channelised the strength of their informant network. “As they already have access to these families, we knew they could be the bridge between them and the government health system. Since ZMQ uses technology and storytelling to share information and address hesitancy and myths about vaccines, transgender persons, with their talents in communication and performing arts, were the perfect choice for the intervention,” says Hilmi Quraishi, co-founder and chief mentor, ZMQ.
Drumming up support
In the Azad Nagar locality of Kausa, a large crowd gathers on hearing the drums typically played by transgender persons. While some men, women and children are standing on their rooftops to get a better view, others are sitting on the staircases in front of their small two-floor tenement. With a colourful tent displaying banners on immunisation and a TV monitor showing audiovisual digital stories as the backdrop, Khan leads the dancing and singing, with Tulsi, Megha, Nazo and Simran joining the performance.
All five transgender persons are part of the ZMQ field team, and come together on occasions to drum up support for the cause. Having been trained on awareness messages, they script their own stories around vaccination and sing about its benefits. Rafiya, 26, is among the crowd, transfixed by the twirling performers. Hers was one of the many cases handed over to ZMQ by the TMC after frontline health workers failed to convince the families to get their children immunised. Concerted follow-ups by the ZMQ team helped to turn around Rafiya’s case and 115 more such families over the past year.
Transgender field coordinator Tulsi (right) and team member Sana (far left) with a family in Mumbra-Kausa.
| Photo Credit:
Swapna Majumdar
The TMC acknowledges their contribution. “Migrants keep moving, so a follow-up is difficult. Many don’t listen to us,” says Dr. Nagma, second medical officer at Mumbra Primary Health Centre. “ZMQ’s involvement of the transgender community and their innovative communications have filled this gap. It has been a successful partnership for us.”
Much of the success is also due to the continuous efforts put in by ZMQ.The fieldteam makes house-to-house visits to identify and register zero-dose and low-immunised children. After entering the data on their tab, they use digital talking comics to make vaccine information interesting and encourage people to vaccinate their children. Regular follow-ups and accompanying children with their mothers to TMC immunisation camps ensures they don’t miss out.
Had it not been for their persistence, immunisation would not have been possible for many children of families living in hard-to-reach areas like Gaon Devi, a cluster of slums located on a hilly terrain alongside Mumbra bypass, or Banjara Basti, a slum that awaits paved roads. Here, the only vaccine information that most families have received is from the team. For women like Rehana and her five-month-old daughter, or Hasibul who is eight months pregnant with her third child, or Razia struggling to take care of her two young children with partially impaired vision, the team has become family. They know that even if they forget the immunisation date, the team will not.
However, it has not always been easy. Even though it is an all-woman field team, they have sometimes been rebuffed by the mothers and mothers-in-law. Field coordinators Jyoti, Nagma, Neelam, Sana and Raziya, along with their transgender community volunteers, have found ways to overcome challenges. Sometimes tapping the experience of project supervisors Shobha and Aaman has done the trick. It was Shobha’s idea to call Rafiya’s father, living in a village in U.P., and her husband working in Mumbai to convince her to immunise her two sons. In another case, having a good rapport with community health workers helped Aaman get the team to the doorstep of another family and ensure immunisation.
With nearly 100 transgender persons trained in routine immunisation messaging as part of a collaboration with Kinnar Asmita and Kinnar Maa Trust, two transgender welfare organisations in Maharashtra with over 4,000 members, the chances of enabling and ensuring immunisation among children in vulnerable communities have greatly improved.
The independent journalist writes on development and gender.
