New Girl in the Village: My First Week on the Field

Aditi Revankar.

I moved to Chhindwara, amidst the pandemic, to begin my Fellowship. For the first two weeks, I quarantined. After that, I ventured into the field.

Chourai. Sausar. Bicchua. Tamia. At the end of my first week, I had been to four different blocks on four different days with four different field officers. Most days, we had rain. Some days shine. Always Corona. Of course, we went armed with sanitizers and masks.

The Antara Foundation (TAF) intervenes on the demand and supply side, I was told. They work with the frontline workers - who are the providers, as well as with the beneficiaries - who are expectant mothers and young children. A student of economics myself, I was only too pleased to be looking at work through the familiar demand-supply lens. It felt comfortable like a pair of cooling glasses that make it easier to see without squinting, in the harsh sunlight. I was thrilled at this simple enough, theoretically sound approach. However, I soon saw that the practice of this seemingly straightforward theory is anything but simple.

Photo: A beautifully painted Anganwadi Centre in Chourai

On my first day, we headed to a village in Chourai. In about ten minutes, the hustle-bustle of the market faded out into the green countryside. The winds came through the open window, and carried away bouts of nervousness, leaving behind sheer excitement and calm. We turned off the highway and drove through meandering village roads to reach the Anganwadi Centre (AWC). There was no one there. It was a pink building with colourful images and advisory messages painted on its outer walls. We dialled some of the numbers on the wall, painted amidst the many slogans such as jab dard shuru hoye, hospital jaana (literally means, when the pain begins, go to the hospital, meant to urge people to have institutional deliveries). Eventually, we got the message to the Anganwadi Worker (AWW) and the Accredited Social Health Activist (ASHA) [1]. They came in about 20 minutes. Drenched in the rain, one of them had had to go back to change. The AWC hadn’t been opened in a while. Because of COVID, they said. Quickly they tidied up, and we sat down together to correct the hand drawn map of their village.

A part of every one of the four days on field was spent correcting maps. In Bicchua, Yogesh (our field officer) informed the didis (an affectionate, informal word used to address an older sister, often used on field to refer to the women we work with) about the corrections that needed to be made, and said we’d be back in 30 minutes. When we came back, after an hour and a half, they had barely made any progress. When we sat with them to figure out where they were getting stuck, one of the didis said, bahut dimaag lagaana padtha hai (we have to use our brains a lot). And this was for basic counting and numbering of houses. 

From the week of conversations and observations, there are some hypotheses for why the work of front-line workers is far from perfect. There’s some chill marna (goofing off). But also, what seems like a serious skill deficit, and scope for pedagogical improvement. What seemed like very basic arithmetic to me, is a muscle that these women have seldom flexed. It is no surprise then that making a map and numbering the houses and families, requires significant effort.

At a Village Health and Nutrition Day (VHND) in Sausar, Prerna (our field officer) noticed that some vaccines weren’t being administered. When asked why, the ANM said, vaccines thi hi nahi, kya pata (the vaccines weren’t available, they didn’t know why). Some children weren’t going to be immunized on time because for some reason, the vaccines were just not in the cold storage box.

Photo: Beneficiaries entering an AWC to get their child immunised on a VHND

In one of the online induction sessions, I was asked, “Aditi, can you tell me why in some places, there are sub-centres but no ANMs?” Some homes were so far away, that ANMs didn’t want to go to those regions.

After speaking with a few community members from Tamia, I got another perspective. The conversations brought to light impediments to communities accessing healthcare services.

An old man, while talking about the history of his village, dismissed modern medicine. He alluded to the olden days when they would take herbs out of the ground and eat them when they were sick. As we sat together on a cot in his home, I saw first-hand the belief in jadibootiya (traditional herbs) and jhad phoonk (black magic). On a more personal note, when I asked him to repeat himself once, seemingly annoyed, he started mumbling to himself. I was stumped. But Harhini laughed and continued speaking. I learnt something. I was going to try to not take myself so seriously, to take rejection gracefully, and to also think about the position I’m putting another person in, when I walk into their house and ask them to speak with me.

Next, we went to the home of Kalavati Devi, a mother of seven girl children, pregnant yet again for the eighth time. One of her older daughters braided her hair, while the littlest walked around, unclothed. Three others sat around us. She said she had considered the “operation”, shorthand for sterilization in the villages, but that she didn’t have enough information. She went onto say that if she heard of an upcoming sterilization camp, she would get the operation even if her alcoholic husband didn’t agree. We later heard from the ASHA and AWW that her husband had threatened to hit or kill her if she got herself sterilised. The word for both hitting and killing is the same in Hindi (maarna).

When we asked her if she knows that she is a High Risk Pregnant (HRP) woman, she said she did not. She also said that she didn’t receive food packets on time. The ASHA and AWW however, denied the charge. She’s lying, they announced. When we asked them if they were giving her contraceptives, they said yes, then they said no, then they said yes. From a conversation with one beneficiary and the front-line workers, it was impossible to discern the truth. On the drive back, we discussed the importance of triangulation of information.

An important determinant of whether pregnant women access the healthcare system is the fact that most often their husbands and mothers-in-law are the decision makers. And some of them resist institutional deliveries and prefer, the once traditional, home deliveries.

Further, being regions with significant tribal populations, who have their own belief systems and traditions, administering services according to the 1000-day construct [2] is no easy feat. It is fairly common for young unmarried couples to elope and come back only when the woman is around six months pregnant. As a result, the women miss out on most of the crucial, timely anti-natal care. Sometimes, they even get pregnant to be able to marry each other. Particularly a problem because young pregnant women often have HRPs.

Only when I was out there, seeing all this happen, did I understand what Antara actually does. The aim is not to re-invent the wheel but to ensure that systems and processes that have already been established are running, and smoothly. I see value in that. In creating parallel structures, we would be creating another phantom that would exist only on paper. Another cumbersome register added to the stack of registers that frontline workers are all so accustomed to. Another register that they would fill in with their tiny pencils in one hand, eraser in the other, sharpener in their little bag of supplies that they carry around. 

Yet, sometimes, I wondered if we were doing enough. At the VHND in Sausar, we saw a young, very pregnant girl. She sounded like a child. The ANM made it a point to make her stand in front of us to emphasise that she was an HRP woman because she was very short. I estimated that she was around 17 years old. She’d missed her anti-natal check-ups because she had gone off to her mother’s place. There was a problem with her Aadhar card, she didn’t have a bank account, she was so young. She was being berated for so many things. Things that are all, probably, out of her control. The ANM told her not to go home so much and, to instead, tell her husband her problems. That was the last straw. She teared up. All we said was, eat well, stay happy, oh and do you know you’re an HRP?

I wondered where our hearts were, why we weren’t doing more. Why couldn’t we end child marriage?

One of my major motivations for working with TAF was my belief that I would be part of an organization that empowers women. After my first week on the field, my understanding is a little more nuanced. There are so many women like Kalavati Devi and this young girl who have no autonomy over their bodies. Ensuring that they go through pregnancy safely, a pregnancy that may often not even be their decision, is a significant actionable step. For evils like child marriage, early and multiple pregnancies, and rape to completely go away, will take time. Sad though it is, that is the truth. But in the meantime, we do what we can. We act.

Why isn’t the vaccine being administered? Why hasn’t the food packet reached Kalavati? Why are so many babies being born at home? Why were so many premature? Do people have access to contraceptives? We ask why. And we push people to do.

When I worked from the office, I reviewed digital maps and updated the tracker. When I went to the field, I saw how they were corrected before they were digitized and printed. We looked at beneficiary lists, checked how many were HRPs, how many children had died. We also spoke with beneficiaries. I had come to Antara seeking to understand ground realities. Seeing the whole cycle made the theory of change come alive. That was truly special.

The first time I went to Tamia, I was in awe when I saw Harhini (our field officer) get out of the car at each AWC or home, umbrella in hand, in the rain. Come rain, shine, or Corona, work went on. And then, I realized, that I am going to be doing that too. That feeling was out of this world.

 Photo: Validating hand-drawn village maps in Chourai block

In the first week, tears rained down. It’s part of the process you see. The rain gave me company. And then, in the second week, the rain came, and with it, pleasant memories of home. The rains stayed long enough to make me feel safe. I spotted the Indian Roller, a bird I’d seen on holidays with my parents, and yet again, I met someone familiar. I began making my phetta hua (whipped) coffee. I watched my favourite show, in bed, with a bag of peanuts. And all of a sudden, in tiny pencils, in talk of surveys and registers, nakshas (maps) and stunning forests, and a resolve to learn counting in Hindi, I am finding comfort. 

Aditi Revankar is a fellow with The Antara Foundation.

Disclaimer: The article has been written in personal capacity, and the views and opinions expressed are those of the author

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Notes:

[1] The AWW is in charge of the AWC and works to meet the health and nutrition needs of women and children in the village. The ASHA is the community mobiliser, and acts as a link between the community and the public health system. Both these women are usually from the community.

[2] The 1,000 day construct is a concept in Maternal and Child Healthcare and Nutrition (MCHN) that emphasises the first 1,000 days of a child's life from the moment they are conceived until they have reached 2 years of age (24 months). This is a time when their brain, body and immune system grows and develops significantly.