The hamlet of Majavad Khera in Gogunda block of Udaipur district is a very remote settlement of a tribal community. Making health care accessible in such a remote place can be quite a challenge.
In these difficult conditions, Pemli Bai, a young woman from within this community, has become a source of readily available help as she is linked to a very well-functioning clinic, called AMRIT, run by a voluntary organization Basic Healthcare Services (BSH). As the on-the-spot representative of the clinic in her community, Pemli performs several useful services. Village women know that they can approach her to obtain ORS packet, contraceptives, a common medicine for reducing fever, or even a pregnancy test. However what they value even more is that she can be the contact person in an emergency situation like a woman whom Pemli helped to rush to the Amrit clinic at night by calling in an ambulance service provided by the clinic. Another recent life-saving act she remembers from recent days is that of helping a woman affected very badly by TB to obtain the help of the clinic in time.
Pemli not only educates women on nutrition, health and contraception, she also visits homes to know about any serious health problems. Due to some prevailing misconceptions and fears, even a seriously ill patient sometimes does not come forward for treatment of serious diseases like TB, and Pemli does her best to ensure that they go for treatment, sometimes playing a life-saving role. Also in diseases like TB where longer term regular medication is crucial for recovery, the role of community-based SK is very important.
Being a part of the village community, she is in a good position culturally and socially to remove misconceptions and facilitate timely treatment. She has a health kit including educational literature on health and nutrition. She also weighs children and monitors the malnutrition or under nutrition situation. She helps to maintain and update a family register at the village or hamlet level.
A conversation with Pemli and neighboring women revealed the closeness of their relations and ease of communication. Pemli appeared to be full of confidence regarding her responsibilities and willing to discuss these in a very articulate way.
Just as we came out of the courtyard to leave, she pointed out a boy with a growth on his head which needed treatment but his parents were delaying this. This immediately led to a discussion at the end of which it was decided by the family that the boy will be taken very soon to the clinic.
Community-based women health workers linked to AMRIT clinics set up in South Rajasthan by BHS are appropriately called Swasthya Kiran or SK (translated as Health Ray) as they bring a ray of hope in remote villages.
I next went to Salumbur district to attend a training session of these SKs. This was a training regarding how high risk pregnancies can be identified and the risks involved can be reduced. One of the most important roles of SKs is to reduce maternity risks and for this they are in touch anyway with pregnant women to ensure that they go for regular check-ups. In the case of a high-risk pregnancy, however, the role and involvement of SK increases further and at the training they learnt and discussed various aspects of responding to difficult situations. This discussion and learning here can one day prove to be of life-saving importance in any of the villages from where these SKs come.
Interactions with this wider group revealed them to be alert and thoughtful regarding health and social issues. Laali of Budhel village, for example, is very articulate about policy steps which can be taken to help villagers in difficult times. Several SKs said that they will be happy to be part of even wider social reform efforts so that consumption of liquor and other intoxicants in their villages can be reduced.
Improving nutrition situation is an important part of the agenda of BHS, and for this initiatives like promoting kitchen gardens are also taken up and SKs can be very helpful in this.
The BHS rural health initiative also has other community health workers, but SKs have been found to be particularly important in these efforts. One of them said that she helped arrange safe child birth for a woman who lacked aadhar card or other documents and hence was finding it difficult to get institutional care, while another said that as she was aware of the precarious economic condition of a woman as she is from the same community, she helped to arrange the waiving of all health expenditure in her case.
These SKs have proved with their contributions that the role of such community based and well-trained women health workers can be very important particularly in more remote villages. If the funds availability improves to make available increased remuneration for them, this will be an encouragement to improve their contribution further.
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The writer is Honorary Convener, Campaign to Save Earth Now. His recent books include Man over Machine, A Day in 2071, When the Two Streams Met, and Planet in Peril
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