|
A unique partnership between the Pachcham Mahila Vikas Sangathan, the public healthcare sector and philanthropic trusts brings healthcare to the women of Pachcham in Kutch, Gujarat
"In the '90s, pregnancies were fraught with risks for mother and infant," recalls Fatimaben of Tuga, a small village in the Pachcham block of Kutch, Gujarat. "If there were complications, the only recourse was to carry the woman in a jholi (a makeshift stretcher) to the nearest primary health centre (PHC) at Khavda, more than 25 km away. In most cases, she or the infant would die en route. The dais (traditional birth attendants) were not trained and had no concept of hygiene. A butcher's knife would be used to cut the umbilical cord, or a dirty brick would be heated and placed on the woman's abdomen to help allay labour pains. There was no knowledge of prenatal nutrition. Intake of fruits and vegetables -- even a chilli -- was negligible. No antibiotics or vaccines were available. Infant mortality was high as no inoculations were given."
Fatimaben and Neeyamatiben, who are now active members of the Pachcham Mahila Vikas Sangathan, are explaining why the organisation took up health as the first major initiative for development.
The region has several Muslim and harijan communities, with sub-castes like Jats, Kolis and Sauda. Some of these communities are so insular that women are born and married in the same village, never venturing out of its precincts throughout their lives.
The Sangathan's initial survey of some 100 families revealed that tuberculosis, malnutrition and skin ailments posed serious problems. This is partly due to the inhospitable terrain, frequent drought and lack of clean water. Traditional divisions of labour, and traditional constraints on women affect women's health in particular. There is a strong resistance to family planning in many of the communities. There have been several instances of women who have given birth eight or 10 times; one woman has borne 22 children. Early marriage is prevalent.
Dr Neetu Aggarwal, who heads the health centre recently set up and managed by the Sangathan and the government, elaborates on these problems. "Because of the continuous cycle of pregnancy most women are very anaemic. The average haemoglobin content for the women here is 6 or 7 gm (normal values are 11-13 gm for women). There is a high rate of abortion and incidence of urinary tract infection. There are many high-risk pregnancies with high blood pressure and heart problems. Pelvic inflammatory disease and prolapsed uterus because of multiple pregnancies are also very common."
Since the region lacked government and private facilities, the Sangathan realised that it would have to evolve a new system to address women's health. Women hesitated to go to the only government community health centre (CHC) as it was in a deplorable state, with no water or proper toilet. Besides, social taboos make it difficult for women to discuss their gynaecological and obstetrical problems with outsiders. Often a woman would only say she had a headache and fever, and describe her condition in very vague terms.
As a first step, the Sangathan began requesting local health officials to send nurses out into the villages to conduct health checks and dispense some form of primary healthcare. Sangathan women also began functioning as health workers, doling out iron tablets and drugs to treat malaria, diarrhoea and dehydration and other ailments. Simple graphics were used to convey usage, as the women were not literate. Tablets for headache, for example, were stored under a graphic of a woman clutching her head.
General information was imparted through melavas (community fairs) and arogya shibirs (health camps) especially held for adolescents, in which efforts were made to demolish myths and misconceptions such as male sterilisation causing impotency.
Next, the dais were given training and their capabilities enlarged with inputs on subjects like body mapping, male/female reproduction, the menstrual cycle, nutrition during pregnancy, pre- and ante-natal care, use of safe delivery kits and immunisation. This was provided by a local gynaecologist in Bhuj. Regular training camps were held in Bhuj and women were sent to camps organised by SEWA, Jhagaria and CHETNA.
Thus a system began taking shape through partnership with the government, philanthropic organisations and other civil society organisations.
Dais were encouraged to keep records of everything. Interestingly, the government had also asked the nurses sent into villages to maintain proper records of pregnant women. When it was found that the dais noted data in a more systematic and thorough way the government authorities were receptive to the idea of partnering with the Sangathan for a proper health centre at Khavda. This was essential as, in the event of any complications, the dais had to accompany the woman all the way to Bhuj.
Since the Kutch Mahila Vikas Sangathan, the parent NGO of the Pachcham Mahila Vikas Sangathan, has the district development officer on its board, a dialogue was facilitated between health officials and the Sangathan. The expenses of procuring land and constructing a building were taken care of -- a panchayat guesthouse in Khavda was handed over to the Sangathan to be used as the health centre for women.
The centre has been functioning since February 2005 with Dr Neetu Aggarwal in charge. The costs are resonable, with a registration fee of Rs 10 and Rs 25 for any laboratory tests carried out. A normal delivery, including some medicines, costs around Rs 150.
The Sangathan collaborates with the government in its inoculation and immunisation programmes by providing vehicles for far-flung villages. Its workers also ensure that the drive is completed.
The Sangathan holds a number of health camps. Women with major gynaecological problems like prolapsed uterus are sent to Bhuj where they receive treatment or undergo free surgery by private doctors and philanthropic trusts that have partnered with the Sangathan. They are accompanied by Sangathan members who boost their confidence and provide support.
The Sangathan's latest initiative, launched in April 2006, is two holistic medical insurance schemes specifically for gynaecological and reproductive health, covering pregnancy and delivery. The first scheme requires an annual premium of Rs 350 and entails insurance cover for pregnancy effective from the third month. It includes the cost of check-ups, medicines, lab tests and delivery at the health centre. In case of an emergency and referral to a Bhuj hospital, the expenses of the ambulance are covered. The scheme also covers the cost of a Caesarean, in case it is required. The cover includes the cost of blood transfusions and any medicines required by the infant from the time it is born to three years of age for minor respiratory diseases like coughs and colds.
The second scheme with a premium of Rs 250 for women over the age of 40 covers the cost of surgery in case of prolapsed uterus. The Indo-American Foundation has helped the Sangathan draw up and formulate these policies.
One of the Sangathan's major challenges is to sensitise banking systems and financial systems in partnering development schemes for the poor.
--By Freny Manecksha
(Freny Manecksha is a journalist based in Mumbai)
InfoChange News & Features, May 2006 |
