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By Freny Manecksha
Nine months ago, in one of India's least-developed districts, Malika was born, premature and underweight, with pneumonia, umbilical sepsis and hypothermia. This is the story of how she survived, thanks to the efforts of village health worker Gandhara Bhagde
At nine months, Malika weighs 9 kg and is, by all accounts, a happy, healthy baby. It’s difficult to believe that she was born premature, with a birth weight of just 1.1 kg, or that she had a problem with feeding and that in the weeks after her birth suffered from hypothermia, umbilical sepsis, pneumonia and bacterial skin infection.
Amazingly, this “miracle” baby’s survival saga took place not in any neo-natal care unit of a high-tech hospital but in the village of Taylornagar, Tuljapur taluka, Osmanabad district -- one of the most underdeveloped regions in India. Equally remarkable, she was monitored and her illnesses promptly diagnosed and treated by a village woman who has studied only up to Class II. Through her zeal to learn and her dedication, Arogyadut Gandhara Bhagde has vindicated the trust placed in her and the efficacy of the Ankur project carried out in some 11 villages in Osmanabad district.
Modelled on the highly acclaimed SEARCH (Society for Education, Action Research in Community Health), developed by Drs Rani and Abhay Bang, this home-based neo-natal care project involves the training of arogyaduts (village health workers) to monitor high-risk infants through 14 home visits over 28 days (See On the road with village health workers). They are trained to diagnose the three main risks -- sepsis, hypothermia and pneumonia -- by using a simple checklist. All arogyaduts are provided with a kit of necessary medicines and simple equipment like a warm bag to combat hypothermia and suction tubes to help resuscitate an infant at birth.
Bhagde’s name was suggested for training by the women of the self-help group she belongs to. Though keen, Bhagde lacked confidence. Says Meghna Kulkarni of Sahayog Nirmitee, the civil society organisation that has taken up the Ankur project in Osmanabad district: “We realise that in villages it is difficult to get someone who has been educated. For the selection of arogyaduts who are not very conversant in reading and writing we carry out a memory test. We see if they are able to complete the procedure in a checklist. While we can improve someone’s communication skills we need to know if the person chosen has a close rapport with the community. Bhagde scored because she had taken the initiative in shramdan (voluntary labour) for the community.”
Bhagde says: “Under Babita Patil, the neo-natal care supervisor, I began learning how to use a pen to sign my name. When I first held a pen after 20 years the letters came all crooked, but I persevered and practised for more than six months.”
Among the criteria to be certified as an arogyadut is the administering of at least 20 injections. Bhagde practised first on a doll and then later on patients, under supervision. But since she was still short of the target she asked Babita Patil to take her to other villages -- Yeoti, Khanapur and Chavanwadi -- to get the necessary experience.
According to Patil, Bhagde made up for her lack of education with a zeal for practical training. She diagnosed the first pneumonia case in the village involving a three-year-old boy, by noting that his chest was in-drawn and by taking his pulse. Her prompt treatment meant there was no need for the child to be taken to hospital. In another case she used a mucus-extractor to help resuscitate an infant born to a young girl after prolonged labour. A private doctor had been called in, and when the baby did not cry at birth and seemed unconscious the doctor himself asked Bhagde for help.
These experiences helped Bhagde gain confidence. So when baby Malika was born pre-term at six months to Zarina Yunnus Mujawar, who had gone to her mother’s place for the delivery, Bhagde was prepared to take up the challenge. She realised the very young mother had problems with nursing and the child was not feeding well so she helped her ‘express’ the milk and then feed the child.
On the sixth day there was a major crisis: the baby vomited, developed fever and fell unconscious. Bhagde diagnosed umbilical sepsis and began treatment with a gentamycin injection even as the worried family waited for a bus to take them to the nearest primary health centre (PHC) in Kadgaon. But staff at the PMC refused to treat the infant and told the family they must take her to Sholapur hospital where there was a neo-natal unit. They also chided the family for allowing an arogyadut to give the baby an injection.
As the family did not have the money to go to Sholapur, they resigned themselves to their fate. But, as they waited at a relative’s place, the baby’s condition began improving. She regained consciousness and started breast-feeding. Overjoyed they brought her back to the village where Bhagde continued to treat and monitor her progress closely for 10 days.
Though poor and forced to work in the fields, Bhagde remained close at hand in case there was another crisis. Her selfless dedication, and that of the dai who helped deliver the baby, pulled the child through other ailments like a touch of pneumonia and bacterial skin infection.
Since the baby was born in the winter, they suggested to the mother that a small hollow be fashioned in the ground of the mud hut and a bathroom be improvised so that the infant would not have to be bathed outside in the cold. They taught the mother how to warm a cloth before wrapping the baby in it, to lessen the chances of hypothermia. These simple, cost-effective methods proved as effective as any treatment given at a big hospital.
Today, Malika and her mother have returned to their own home in another village. But a grateful grandmother still pulls out a photograph of them to show everyone she comes across.
(Freny Manecksha is an independent writer based in Mumbai)
InfoChange News & Features, July 2005
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