WEBVTT

00:00:00.000 --> 00:00:02.910 align:middle line:90%
[MUSIC PLAYING]

00:00:02.910 --> 00:00:07.770 align:middle line:90%


00:00:07.770 --> 00:00:10.520 align:middle line:84%
MALABIKA SARKER: The public
health is not apolitical,

00:00:10.520 --> 00:00:11.520 align:middle line:90%
cannot be.

00:00:11.520 --> 00:00:15.390 align:middle line:84%
Despite the success, the
polio program in many areas

00:00:15.390 --> 00:00:19.590 align:middle line:84%
are disrupted because of
the political instability

00:00:19.590 --> 00:00:23.000 align:middle line:90%
and lethal violence.

00:00:23.000 --> 00:00:27.220 align:middle line:84%
A string of deadly attacks
cost many health workers life

00:00:27.220 --> 00:00:29.830 align:middle line:84%
and made the job
dangerous in countries

00:00:29.830 --> 00:00:33.910 align:middle line:90%
like Pakistan and Nigeria.

00:00:33.910 --> 00:00:37.720 align:middle line:84%
Please pause this presentation
and view the video

00:00:37.720 --> 00:00:39.580 align:middle line:90%
at the link provided.

00:00:39.580 --> 00:00:43.900 align:middle line:84%
When you are finished, return
and continue this presentation.

00:00:43.900 --> 00:00:48.090 align:middle line:90%


00:00:48.090 --> 00:00:51.300 align:middle line:84%
Pakistan's frontline
staff, Lady Health workers,

00:00:51.300 --> 00:00:54.390 align:middle line:84%
are the pillars of the
community-based care.

00:00:54.390 --> 00:00:57.780 align:middle line:84%
The scope of services provided
by Lady Health workers

00:00:57.780 --> 00:01:01.710 align:middle line:84%
has grown from an initial
focus on maternal child health

00:01:01.710 --> 00:01:05.730 align:middle line:84%
to participation in large
health campaigns like polio,

00:01:05.730 --> 00:01:09.360 align:middle line:84%
newborn care, community
management of tuberculosis,

00:01:09.360 --> 00:01:12.270 align:middle line:84%
and health education
on HIV/AIDS.

00:01:12.270 --> 00:01:15.450 align:middle line:84%
Most Lady Health workers
start working because

00:01:15.450 --> 00:01:17.910 align:middle line:90%
of acute financial need.

00:01:17.910 --> 00:01:20.760 align:middle line:84%
But even if this
need passes, many

00:01:20.760 --> 00:01:23.010 align:middle line:84%
keep working because
they are serving

00:01:23.010 --> 00:01:26.940 align:middle line:84%
the needs of the neighbors,
self-actualization,

00:01:26.940 --> 00:01:29.640 align:middle line:84%
and the fact that
the work was not

00:01:29.640 --> 00:01:33.380 align:middle line:84%
only interesting,
but meaningful too.

00:01:33.380 --> 00:01:36.620 align:middle line:84%
As one of the Lady
Health workers shared,

00:01:36.620 --> 00:01:42.590 align:middle line:84%
when I first left the house to
work, I was scared and nervous.

00:01:42.590 --> 00:01:46.670 align:middle line:84%
When I kept going out,
I learned how to do it.

00:01:46.670 --> 00:01:50.360 align:middle line:84%
I learned how to meet people,
how to talk to people,

00:01:50.360 --> 00:01:54.370 align:middle line:84%
learned that they
are just no trouble.

00:01:54.370 --> 00:01:58.570 align:middle line:84%
Unfortunately, the majority
of Lady Health workers

00:01:58.570 --> 00:02:03.430 align:middle line:84%
live at a rate of income
around, or in many cases

00:02:03.430 --> 00:02:07.270 align:middle line:90%
well below, $2 a day per person.

00:02:07.270 --> 00:02:11.350 align:middle line:84%
In the context of skyrocketing
food and living costs,

00:02:11.350 --> 00:02:13.240 align:middle line:90%
it's not much.

00:02:13.240 --> 00:02:17.530 align:middle line:84%
Lady Health workers repeatedly
mentioned extreme difficulty

00:02:17.530 --> 00:02:21.550 align:middle line:84%
in covering unforeseen expenses,
such as medical treatment

00:02:21.550 --> 00:02:25.210 align:middle line:84%
for a child illness or
an adult's injury which

00:02:25.210 --> 00:02:28.840 align:middle line:84%
leads to catastrophic
health expenditure.

00:02:28.840 --> 00:02:32.770 align:middle line:84%
Most had started working
as Lady Health workers

00:02:32.770 --> 00:02:35.470 align:middle line:84%
because they desperately
needed money.

00:02:35.470 --> 00:02:40.780 align:middle line:84%
The step to work outside the
home as women have social cost

00:02:40.780 --> 00:02:43.910 align:middle line:90%
and was not taken lightly.

00:02:43.910 --> 00:02:48.910 align:middle line:84%
And so low pay was a very
important issue to these women.

00:02:48.910 --> 00:02:53.710 align:middle line:84%
In addition to it, job
advancement is very difficult.

00:02:53.710 --> 00:02:55.870 align:middle line:84%
Lady Health workers
repeatedly talked

00:02:55.870 --> 00:02:59.080 align:middle line:84%
about their desire
for more education.

00:02:59.080 --> 00:03:03.820 align:middle line:84%
But nearly all of them say to
that, due to the limited income

00:03:03.820 --> 00:03:06.880 align:middle line:84%
that had caused them
to become a Lady Health

00:03:06.880 --> 00:03:09.760 align:middle line:84%
worker in the first
place, their plans

00:03:09.760 --> 00:03:14.140 align:middle line:84%
were nearly impossible
to put into practice.

00:03:14.140 --> 00:03:18.250 align:middle line:84%
The narrative shared by
a Lady Health worker--

00:03:18.250 --> 00:03:22.450 align:middle line:84%
I became a Lady Health
worker when I was very young.

00:03:22.450 --> 00:03:26.320 align:middle line:84%
I had such a desire
to become a doctor.

00:03:26.320 --> 00:03:28.780 align:middle line:84%
I had been thinking
of further study

00:03:28.780 --> 00:03:32.060 align:middle line:84%
because really I
want to move up.

00:03:32.060 --> 00:03:38.710 align:middle line:84%
But I look and there really are
not any ways for me to advance.

00:03:38.710 --> 00:03:43.300 align:middle line:84%
There's no chance,
absolutely no way.

00:03:43.300 --> 00:03:49.170 align:middle line:84%
All of my dreams I have left
all behind what I wanted to do.

00:03:49.170 --> 00:03:52.950 align:middle line:84%
The reality reflects
her narrative.

00:03:52.950 --> 00:03:57.270 align:middle line:84%
No programs to learn vaccination
are one that many Lady Health

00:03:57.270 --> 00:03:58.360 align:middle line:90%
workers wanted--

00:03:58.360 --> 00:04:00.570 align:middle line:90%
[INAUDIBLE]

00:04:00.570 --> 00:04:03.960 align:middle line:84%
Certainly, none to move
up in the health system.

00:04:03.960 --> 00:04:07.800 align:middle line:84%
In Pakistan, most nurses
are men and nearly

00:04:07.800 --> 00:04:11.280 align:middle line:84%
all the positions of a community
health worker in the health

00:04:11.280 --> 00:04:16.320 align:middle line:84%
system are men,
except for doctors.

00:04:16.320 --> 00:04:19.620 align:middle line:84%
Thousands of Lady Health
workers participated in a labor

00:04:19.620 --> 00:04:25.120 align:middle line:84%
movement starting in 2010,
occupying public spaces

00:04:25.120 --> 00:04:29.140 align:middle line:84%
and shutting down roads
across the country.

00:04:29.140 --> 00:04:33.370 align:middle line:84%
In late 2010, the
Pakistani Supreme Court

00:04:33.370 --> 00:04:35.800 align:middle line:84%
ruled that Lady
Health workers were

00:04:35.800 --> 00:04:40.480 align:middle line:84%
entitled to receive that
legal minimum wage--

00:04:40.480 --> 00:04:42.550 align:middle line:90%
about $100 a month--

00:04:42.550 --> 00:04:46.090 align:middle line:84%
more than twice their
previous salary.

00:04:46.090 --> 00:04:50.650 align:middle line:84%
However, this increase did
not quickly materialize.

00:04:50.650 --> 00:04:55.300 align:middle line:84%
As a result, at least one Lady
Health worker committed suicide

00:04:55.300 --> 00:05:01.060 align:middle line:84%
and labor protests
continued in 2011 and 2012

00:05:01.060 --> 00:05:05.320 align:middle line:84%
when pay was as much as
nine months in arrears

00:05:05.320 --> 00:05:08.370 align:middle line:90%
in many parts of the country.

00:05:08.370 --> 00:05:12.000 align:middle line:84%
In December 2012, when
anti-government forces

00:05:12.000 --> 00:05:16.590 align:middle line:84%
started murdering polio workers,
some Lady Health workers

00:05:16.590 --> 00:05:20.520 align:middle line:84%
were told that if they did
not work on polio campaigns,

00:05:20.520 --> 00:05:22.320 align:middle line:90%
they would be fired.

00:05:22.320 --> 00:05:25.260 align:middle line:84%
After some very high
profile strikes,

00:05:25.260 --> 00:05:28.260 align:middle line:84%
the government did promise
them basic benefits,

00:05:28.260 --> 00:05:30.840 align:middle line:84%
like basic job
security, that had

00:05:30.840 --> 00:05:33.280 align:middle line:90%
thus far been denied to them.

00:05:33.280 --> 00:05:37.880 align:middle line:84%
But the polio work in
dangerous times continued.

00:05:37.880 --> 00:05:42.210 align:middle line:84%
So considering the final
strongholds of polio today

00:05:42.210 --> 00:05:45.990 align:middle line:84%
are in conflict-ridden regions,
which critically affect

00:05:45.990 --> 00:05:51.000 align:middle line:84%
functioning health system, human
resource, vaccine supply, power

00:05:51.000 --> 00:05:55.890 align:middle line:84%
supply, financial resources,
and surveillance activities,

00:05:55.890 --> 00:05:59.160 align:middle line:84%
access to children, and
the safety of workers

00:05:59.160 --> 00:06:02.210 align:middle line:90%
is thus a significant challenge.

00:06:02.210 --> 00:06:06.060 align:middle line:84%
[INAUDIBLE] vaccinators
have been frequently

00:06:06.060 --> 00:06:11.040 align:middle line:84%
targets of directed violence,
spreading fear and [INAUDIBLE]..

00:06:11.040 --> 00:06:15.330 align:middle line:84%
In this scenario, let's
listen to the discussion

00:06:15.330 --> 00:06:17.280 align:middle line:84%
about this
provocative questions.

00:06:17.280 --> 00:06:21.780 align:middle line:90%


00:06:21.780 --> 00:06:24.830 align:middle line:90%
[MUSIC PLAYING]

00:06:24.830 --> 00:06:29.000 align:middle line:90%