Vaccines are sensitive and fragile, and hence need to be stored in proper conditions; temperatures and sequence of storage are critical elements for ensuring the potency
Deepak Pal stole a glance at the battered, metal clock. It was just past 9 am. His morning tea would have to wait. He walked up to the ice-lined refrigerator (ILR) and leaned over to read the words imprinted on the glossy flex right above it, on the wall. “O Mere Bhagwan Roj Teri Daya, Isiprakar Permanent Hame De,” he whispered in Hindi, almost in a trance, the words in Hindi mean “Seeking the kind blessings of the Almighty every day and forever”. A ray of light from a half-open window filled the room in a golden hue as he ended the cold chain prayer.
Minutes later, as he settled down to enjoy his cup of tea, Deepak, a Cold Chain Handler (CCH) at Rajpur CHC, of Barwani, a district in Madhya Pradesh, marveled at the power of the cold chain prayer. This was no ordinary chant to appease the Gods, but a powerful mnemonic to help CCHs like Deepak remember the stacking order of vaccines — starting with ‘O’ as in OPV at the bottom and ‘De’ for diluent at the top. It has become a part of Deepak’s daily routine; to review the guidelines for stacking the vaccines in the top-opening ILRs, in increasing order of temperature, from minus 20 degrees celsius to 8 degrees celsius. The prayer helped him remember this order and the right temperature, protecting the vaccines from damage. What seemed easy today was indeed a struggle a few years ago.
Vaccines are sensitive and fragile and hence need to be stored in proper conditions; temperatures and sequence of storage are critical elements for ensuring vaccines potency. Hence, vaccine storage and management has always been a critical factor for an immunisation programme’s success. Before 2014, this was proving to be a challenge, as CCHs like Deepak struggled to remember the vaccine storage guidelines. Despite several trainings to the handlers, errors continued and large volumes of vaccines were being wasted due to incorrect stacking and storing, resulting in financial loss, loss of vaccine potency, and poor immune response. In 2014, when expensive vaccines like Pentavalent, PCV, RVV, IPV were introduced in Madhya Pradesh, there was a call for urgent intervention to set things right. The solution came from Dr Santosh Shukla, the State Immunisation Officer (SEPIO), a veteran in the field of immunisation. Dr Shukla, Joint Director-cum-SEPIO, Madhya Pradesh, an officer who had worked extensively in rural and remote areas of the State, had immense knowledge and understanding of the ground realities, knew they had to quickly find a solution and think outside the box to help CCHs, supervisors, and MPW/LHVs remember the vaccine storage guidelines. Was there a way to help these target audience remember these guidelines? He found the answer in mnemonics, a learning strategy often used in classrooms from his days as a student in medical college. He codified the guidelines using mnemonics in the form of a simple prayer. For the vaccine handlers, this was a ditty they could chant every day, much like the many prayers that were a part of their lives. There was no looking back! Dr Shukla’s deep understanding of the handlers, a group of religious-minded people, had saved the day.
The results were evident from the start — the rate of vaccine wastage started dropping across the State. In a study conducted in the cold chain points of the State in 2015, it was revealed that the cold chain prayer and a mobile application for tracking vaccine storage had together saved Rs 9.72 crore worth of vaccine from wastage. This innovative practice was even appreciated by the visiting teams of the Common Review Mission from the Government of India, UNICEF, WHO and dignitaries from other Indian States. Over the years, this practice has been adopted by some other States as well.
Today, cold chain handlers like Deepak working in 1,200 cold chain points of the State start their day by chanting the cold chain prayer. It’s a part of their morning ritual. By leveraging the power of religious belief, a simple mnemonic-based prayer has become the soul of cold-chain points of the State. They say a prayer has the power to save lives. This simple chant is a living testimony to that — it may well have saved over a million lives of children in the State from vaccine-preventable diseases. By following a simple step, the providers have been able to ensure that beneficiaries get the full benefit of life-saving vaccines and protection against diseases.
Team Agenda
