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On the road with village health workers

By Freny Manecksha

Ankur, a home-based neo-natal care programme based on the acclaimed SEARCH model, is operative in 11 villages of Osmanabad district in Maharashtra. The programme is making a tangible difference to the health of infants and mothers. Freny Manecksha goes on night calls through the twisting lanes of Chauhanwadi with two village health workers

 As young Meenakshi Kannade and Babita Patil walk along the narrow twisting lanes of Chauhanwadi village in Tuljapur tehsil, they are greeted with entreaties to step into homes. The women return the greetings but keep walking. As arogyadut and neo-natal care supervisor (NCS) respectively of the Ankur project, they have a busy day ahead of them. Many babies to visit, monitor and, perhaps, treat.

A little infant, just three days old, sits on the lap of his anxious mother who fears he has a fever. "His skin seems warm," says the mother. But Meenakshi allays her fears. She pops out a thermometer and sticks it under the baby's arm. Minutes later she studies it and announces that there is no fever. She pulls out a checklist and makes notes.

Meenakshi then takes out a watch and counts the number of breaths per minute of the infant. This will alert her to any signs of a respiratory problem. She adds the date to the checklist.

Then she pulls out a small bag attached to weighing scales, weighs the baby and notes the weight. Next she examines the infant closely and tells his mother she will be giving him an injection. The mother is nervous. But Babita smilingly tells her that Meenakshi has such a light touch that her baby will, in all probability, not feel a thing. And she is right. The infant doesn't even flinch when the needle goes in.

The women explain that it's a vitamin K injection to ward off the possibility of sepsis and blood coagulation.

The medical examination over it's time to offer some practical advice. Use a soft clean cotton cloth to cover the baby. Keep him in a cool, well-ventilated place, and breastfeed him on demand. Then they are off.

Ankur, a home-based neo-natal care programme, is undertaken in collaboration with Dr Abhay and Rani Bang's world-acclaimed SEARCH (Society for Education, Action, Research in Community Health) project that has dramatically reduced infant mortality rates in Maharashtra 's Gadchiroli district. SEARCH's field programme is being replicated in 11 villages of Tuljapur tehsil, Osmanabad district, through the non-governmental organisation Sahyog Nirmitee.

Explains Megna Kulkarni, project coordinator at Sahyog: "We believe that empowerment of women is the only genuine way for rural development, and Ankur is one of the projects meant to address maternal and child health issues. Under SEARCH's guidance, for the past two years, we have conducted eight training programmes under which village women are chosen as arogyaduts."

An arogyadut is instructed on how to make ante- and post-natal care visits to closely monitor the progress of children under her care.

Babita of Nandusi village, who was doing a nursing course in Solapur, was chosen as neo-natal care supervisor over the arogyaduts. There is also Arun Dalvi, a statistician, whose job it will be to produce the statistics and keep the records.

Shalan Chauhan, who is training to become an arogyadut, proudly lists all that she has learnt so far -- after the delivery explain to the woman how the placenta can be quickly expelled if she suckles the baby. This is contrary to the traditional belief in these villages that an infant must not be fed for three days after it is born.

A baby is weighed at birth, and other parameters taken into consideration to determine whether he/she falls into the high-risk category. Accordingly, a schedule for post-natal visits is drawn up. While an arogyadut must make eight post-natal visits in 28 days for a normal baby, a high-risk infant must be visited 14 times within the same period.

Dr Bang's fieldwork and experience has helped categorise the three main risks infants face during their first 28 days -- sepsis, hypothermia and pneumonia.

With the help of a checklist, arogyaduts and NCS keep a close watch for these conditions and have been provided with the necessary equipment to deal with them. For example, they carry a warm bag to manage hypothermia, and antibiotics to ward off sepsis or pneumonia. There is, of course, a referral system too.

While dais (local midwives) and doctors attend to the mother during birth, the arogyadut is at hand to provide ready assistance to the infant in the event of asphyxia. Meenakshi displays the ambu-bag and other equipment she has been given to resuscitate a baby. The results have been dramatic. Many infants that would previously have been pronounced stillborn by dais, nurses at a primary health centres (PHC) and even doctors are now given a miraculous new lease of life.

I visit one such home. Following a difficult birth, the baby's first howls were greeted with joy after more than half-an-hour of intensive effort on Meenakshi's part. The baby's grandmother thanks Meenakshi profusely, even though it's now been a week since the baby was born.

This close bonding enables an arogyadut to dispense advice and perhaps even bring about a change in traditional customs and practices. In the same house I am visiting, the mother shows us her neck and shoulders that are covered with grey patches. Slowly she reveals how her in-laws, who live in a small town, smeared her with ash because they were convinced that the spirit of an ancestor would inhabit the body of the child she was carrying. Meenakshi and Babita try to convince her it is nothing but superstition. Did she not give birth to a healthy baby thanks to modern medicine?

As we leave an elderly woman calls out to the young women: "Hey, can you check me up too? I too need some medical aid."

Meenakshi, who has been given some rudimentary medicines to dispense for minor health problems, readily agrees. As a participant in the circle of birth and life she is only too happy to help build up a rapport with the community.

(Freny Manecksha is an independent writer based in Mumbai)

InfoChange News & Features, October 2004