Vaccine Hesitancy at a Tea Garden Immunization Camp
You are a Health Care student helping at a village immunization camp in a tea garden area. A 28-year-old mother, Mina, has brought her 9-month-old baby for a measles-rubella vaccine. She refuses at the last minute because a neighbour told her the injection causes fever and 'weak legs' and that the government is secretly sterilising girls. Her husband is away; her mother-in-law is with her and agrees with the neighbour. The baby is due for measles-rubella and has missed the 6-month vitamin A dose. The camp has 30 more children waiting, and the vaccinator is busy. Mina is polite but firm and starts to walk away. There is no separate counselling room, and Mina's mother-in-law is holding the baby's immunization card.
1. What communication approach should you use in the next two minutes? Give specific phrases and explain why each works.
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Start with an open question, not a lecture: 'May I ask what you heard about this injection?' This shows respect and gives Mina a chance to say the real fear. Acknowledge it: 'It is right to ask questions; many mothers worry about fever.' Ask permission: 'May I share what we know and then you decide?' Use simple language and show the vaccine and diluent. Address the fever: 'Mild fever can happen and we can give syrup; serious reactions are rare.' Address the sterilisation rumour directly but calmly: 'This vaccine protects against measles and rubella; it does not affect fertility.' Include the mother-in-law by asking her opinion and acknowledging her experience. Do not argue, do not say 'you are wrong', and do not use fear. This approach lowers defensiveness and keeps the conversation open.
2. What facts would you give about measles-rubella vaccine and vitamin A, and what would you avoid saying?
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Facts: measles-rubella vaccine protects against measles, which can cause pneumonia, diarrhoea, and brain infection, and rubella, which can cause birth defects in a future pregnancy. It is given at 9 months and again at 16-24 months. Mild fever or a small rash may occur and can be managed with paracetamol syrup as advised. Vitamin A is given orally at 6 months and then every six months; it prevents night blindness and reduces deaths from measles. Avoid saying 'there is no risk at all', 'you must do it', 'you are wrong', or 'the neighbour is stupid'. Do not promise that there will be no fever. Do not repeat the sterilisation rumour in a way that makes it sound possible; state clearly that the vaccine contains no sterilising agent. Avoid jargon such as 'immunogenicity'.
3. If Mina still refuses, what should you do next and why?
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Do not coerce or block her. Offer the vitamin A dose, which is due and is given orally, if she accepts it. Document the refusal, the reason, and the advice given. Ask the ASHA or ANM to follow up at home and invite Mina to the next session. Give her a contact number and tell her she can come back at any time. Explain the danger signs of measles (high fever, rash, cough, red eyes, breathing difficulty) so she knows when to seek care. This preserves trust, keeps the baby on the health system's radar, and leaves the door open for later acceptance. Coercion or public shaming would likely harden the refusal and discourage future visits.