One month into my apprenticeship

Aditi Revankar.

Frontline workers. I would say, frontline women. Women. In purple. An ASHA. In red. An AWW. In green and white. An ANM. Together, the AAA*. Three frontline women responsible for the delivery of public health services to the masses of India.

Chourai. Sausar. Bicchua. Tamia. Mokhed. One-month in, I had been to each of the blocks in which we are directly intervening. I went with the respective Program Officers (PO) in charge. Paras (the team lead), Prerna, Yogesh, Harhini, Shankar. Also, with Soumya, our nurse mentor, who travels to all blocks for capacity building. They, the skilled practitioners, me, the apprentice.

An anganwadi worker in her place of work

When I got to Chhindwara, the initial village mapping process was largely finished. We were now chasing down the last few frontline women, who hadn’t yet sent in their village maps; the ones that necessitated that we pay them a visit in person. The village maps are integral to the AAA platform, a flagship Antara Foundation intervention. The maps help the frontline workers keep track of beneficiaries (adolescent girls, pregnant and lactating women, young children), identify patterns in the way the beneficiaries are dispersed across the village, and integrate their data, among other uses.

An ASHA worker using bindis to indicate beneficiaries’ homes on the map of her village

As a fellow, I was to take charge of a sector. A sector typically comprises five-six sub-health centres, with a population of around 25,000-30,000. I was to take charge of 33 villages, to be precise, which make up Kunda sector in block Chourai, managed by Paras. Therefore, during my apprenticeship, I visited Chourai with Paras, the most.

In each of the blocks, we went in pursuit of the last few didis (an affectionate, informal word used to address an older sister, often used on field to refer to the frontline workers), in search of purple, red, and white and green. We spent most time with the frontline women. We all wore masks. We used words and spoke with our eyes.

As we drove to the Anganwadi Centre (AWC) in Sitapuri, Paras expressed his delight at finally having gotten a hold over an AWW who was proving to be particularly elusive. He spoke too soon. Where we expected to find the AWC was a building that was still under construction. Sitapuri didn’t have an AWC yet. So, we went in search of the AWW’s home. This, I was to learn, was a fairly common practice in places that didn’t have functioning AWCs. When we asked for directions, people pointed ahead, to the sky, and said wahaan (there).

Turns out, the AWW ’s house was on a small hill, overlooking green fields, with a courtyard large enough to host a panchayat meeting. Her husband ran out to greet us and said his wife was on the way. We sat down, and a very unwell looking daughter brought us cups of tea. She told us that she’d had a fever and body ache. We snuck a look at each other, reluctantly lowered our masks, no doubt both hoping that she didn’t have COVID, and gulped down the tea. The entrance to the house looked like the entrance to a temple, the daughter was a data analyst, the son was studying to get into one of the world-renowned IITs (Indian Institutes of Technology).

After a little bit of wait, just about forty-five minutes, a tall, thin lady, greeted us with a number of excuses in place of the more common, hello, and then we sat down to discuss maps. In the meantime, the other AWW, from the tola (a tola is a hamlet that is often associated with the village closest to it) joined us. So, there were two AWWs, one from Sitapuri, the other from Sitapuri Tola).

We explained how the houses were to be numbered. Paras said we’d been getting complaints that the work wasn’t being done. I think he made that up. We were the ones doing the complaining. He was pushing them to get the work done. And yet, in some time, they felt comfortable enough to tell us about payments that were delayed and talk about other impediments they faced. When they began to complain about their superiors, Paras firmly countered them with a aisa bilkul nahin hai didi (It is not like that at all, sister). He was saying, you’re not doing your work, please do your work, oh yes, tell me about your problems, I’m here to help out if I can, and yet he didn’t allow any bad-mouthing either.

Another day, an ANM met us on the road, on the way to Kachiwada. She handed us a couple of maps and complained about some frontline women. I didn’t catch much of the conversation. Paras listened, waved to her daughter who was standing across the road in her school uniform, and we were off.

At Kachiwada, we learned that the AWW had passed away in a car accident, and the ASHA hadn’t been able to convene a committee of villagers who would help her draw the map. It seemed as if she didn’t have the confidence to begin by herself, and her husband, a farmer, said, we are illiterate people. We sat down with them at their home, Google maps open, and drew the roads of their village, with them telling us, haan aise hi, yahaan road mudta hai, aur yahaan judtha hai (yes, like that, this is where the roads turns and this is where it joins).

After, we went to the ASHA's home in the second village and asked the AWW to come there. While we waited in the ASHA's living room, which had a motorcycle parked inside it, right next to a cot, she told us that their map had “failed”. In a couple of minutes, the AWW came and she seemed to know what to do. She complained that the ASHA hadn’t worked with her on the map, despite her efforts. Chai was made and handed around as we all - including the ASHAs husband and another man - discussed that the map wasn’t doomed and could be salvaged. Once it was clear what was to be done, we left, with them giving us their word that they would now get it done.

On the way back, Paras told me that, earlier, the ANM had complained about this AA pair who didn’t get along. And so, he had called the AWW to the ASHA's house. Ghar pe saath chai peethe (they would drink tea together at home), that would ease tensions, he had hoped. I was in awe, of his chai diplomacy. He picked up on information from a very brief conversation and managed to use it in a very real way, to get people together; a prerequisite to getting work done. 

Harvest festival, Pola, in Bicchua block

It dawned on me that working on the field is so much. So much more than just executing a task. It is about reading the situation, staying on your feet, actually on your tippy-toes, noticing and leveraging subtle cues. And those cues are words said and unsaid, gestures made and not, invitations extended and not, chai had-together and not. There is no formula for getting it right. If you mess up, there is sometimes no way to set it right with those same people. But if you get it right, it is possible to achieve outcomes beyond what you’d ever even thought possible, really a testament that magic happens when people come together.

On drives to and from the field, we have some time. It still feels unreal sometimes. Instead of the cacophony of vehicles honking and phones ringing, I now hear the wind. Once, Paras spoke with me about “the corruption of time” and the lack of accountability for work. Even though the work isn’t done properly, the signatures are in place, looking all authoritative, at each level of the system. In a situation when intrinsic motivation and skill levels aren’t really all that high, the absence of a real supervisor who holds people accountable to their work, and trains them appropriately, leads to significant “corruption of time”. 

In Bicchua with Soumya, at a VHND*, I saw a baby move inside its mother’s stomach for the first time, as she taught the women the different grips for an ante-natal check-up. Little alien, I thought. She taught them how to locate the head of the foetus, and how to search for its heart beat. The frontline women were excited to try themselves. They checked the blood pressure, blood sugar, measured the height and weight of beneficiaries. I saw a little baby boy grunting, his chest sinking into his ribs with each breath he took, a sign of pneumonia. I realized I had learnt this too.

In a corner, one of the AWWs answered a test we had given her to assess improvement in technical knowledge. The didis most often hadn’t even read the most basic information in the MCP* card which they held in their hands every time they entered beneficiary details. Later, in the car, Soumya showed me an excel with test scores of various AAAs. It had their overall scores along with scores on particular subjects like immunization, home based neonatal care, etc. Particular workers were being identified basis their score and given targeted training on subjects that they were weak in. I was fascinated to see a data driven approach being implemented.

Where we work. Outside an anganwadi centre in Tamia block

I attended my first triple-A meeting initiation with Harhini in Tamia. During a triple-A meeting, the triple-As review their work from the past month, plan for the next, and then end with a short peer-learning session. We initiate the first meeting, so they get an idea of how to conduct one themselves. Amidst winding green hills, sporadic settlements, and a veil of fog that engulfed us, I watched Harhini greet the women like they were old friends meeting after a long time at the AWC. They talked about the last time they’d met, when the didis had treated Harhini to some yummy food. Her infectious happy laughter close at hand, she has a way with the community. Easy-breezy-light-happy-confident.

During the meeting, we caught lies. Often, the didis would tell lies that were so easy to catch, that it was obvious they weren’t well thought out. It felt less like an intention to deceive and probably more the fear of being reprimanded, or the human instinct to hide our mistakes. Some of them have excuses for everything and start with “nahin…” (no). Others say “haan” (yes) for everything. From what I’ve seen in my time here, both mean trouble!

When we looked at their registers, we noticed that some pregnant women had been registered as late as in their eighth month. Many in their fifth, sixth, seventh. The ASHA worker gets an incentive for each pregnant woman she registers early, within 84 days; it is in her interest to ensure early registration. And so, we asked, aisa kyun didi? (Why did this happen, sister?) They volunteered some reasons. Some women didn’t get themselves registered early because they believed that if they did, they might have a miscarriage. Some others didn’t because they migrated to other villages, for a couple of months, to work. When that happened, pregnancies were registered late, and vaccinations were delayed. 

A river makes its way, over a motorable road that leads to a village in Tamia block. Water finding the path of least resistance doesn’t always help ambulances reach pregnant women in time.

On our way back, Harhini and I spoke about the day. We discussed migrants, and I said, if they’re invisible and not recognized by the village they travel to, then they miss out. To which she said, but we are migrants too, the difference is that we exhibit health-seeking behaviors whereas they just don’t.

The day I went to Izzatpur with Shankar for an AAA initiation, he said, you’ve seen two before, right? You do a part of today’s initiation. I was terrified. He said he would help me out. He asked me to begin. And I did, and he did the rest. I was an active facilitator for the first time. I was saying things I hadn’t even thought about. Unconsciously, I had learnt things passively. I learnt more from observing his style. He had a way of ensuring that everyone was listening and participating. When people were quiet, he said in jest, mujhe kyun lag raha hai ki me koi mahatma ban gaya hoon aur sabh bas meri baath sun rahe hain? (Why does it feel like I have become some saint that everyone just listens to?) Everyone laughed. 

Facilitating a AAA orientation with Shankar in Mokhed block

Sometimes, when we went in search of the frontline women, we were told that they’d gone off to work in the fields. On our way back, we saw a group of women heading to the fields, dressed in saris (traditional Indian attire worn by women), sickles in their hands. Maybe one of these women was an ASHA or AWW. I imagined a woman, a register in one hand talking about high “riks” pregnant women, holding a sickle in the other. At the AWC, we always saw them in their uniforms, immaculately dressed, all wearing ear rings, bangles, and most often other markers of marriage hood. But seeing these women on the way to the fields, reminded me of something I’d thought when we visited some of their homes for work. I was reminded that they were much more than the AAA. They were women, wives, mothers, village women who worked very hard in the fields. They were the people who did all the work during the many many festivals celebrated in the villages.

A few days later, Shankar told me that the didis we’d met at Izzatpur had asked why I hadn’t come too. It made me smile a wide smile. I was starting to feel a kind of kinship with the didis. Most often, in just the second meeting. There was the meeting-of-smiling-eyes, a giggle, happiness that comes from recognizing someone familiar, and the feeling that we had known each other a long time. They would say, jaise aapne samjhaya tha, waise hi kiya (we did the work exactly like you’d explained). We all wore masks. We used words and spoke with our eyes.

Less than a month into the fellowship, Paras asked me to go to the field myself to get maps corrected. Aap kar loge (you’ll do it), he said. The villages that remained either had problematic AAAs or were very far. I encountered both, sometimes on the same day.

This was around the time the floods had hit Madhya Pradesh. Homes had been destroyed, lives had been lost, bridges had collapsed. Trees lay uprooted on the banks of rivers. Yet, nature deceptively, shined in all its glory like a child who smiles innocently after having poured her milk right out, from the balcony, onto someone’s head. The fields had been bathed clean, some crops survived the showers and many perished, washing away a source of livelihood of more than a few people. Buffaloes lazed in little rain puddles amidst green grass. Colourful blankets adorned roofs, spread across to be dried, grain lay on the ground just outside homes. I listened to ‘teri baari’ on my phone, and I thought yes, meri baari hai! Mostly, I felt nervous.

At Barelinaganpur, the ANM and I recognized each other from another day on the field. She had earlier complained about having too much work, to which Soumya had said, don’t we all. When I asked about the map, she said ask the other AWW - Barelinaganpur had two AWWs. She isn’t even here. I can’t work with her, main tang aa gayi hoon (I am tired of it). She exchanged a look with the AWW who was there and giggled. Apparently, she hadn’t come when the ANM had called her to make the map earlier, and her husband was a journalist who created issues if they said anything to his wife. She wasn’t there, even though it was a VHND.

I called her husband. He said he was out and that she didn’t have a phone. I insisted that he send the message to her and ask her to come to the AWC with the map and her register. In ten minutes she came. Without her register. Then she went back to get it. I explained the process of numbering the houses on the map to her. She nodded, and even repeated it correctly. And then when I asked her again, she answered wrong, and we were back to square one. The ANM giggled as she administered injections to little baby’s butts.

I requested that the ANM sit with the AWW and get the map done, it was her responsibility too after all. She now complained as she poked butts and administered oral vaccines. I am too busy, I have no time, she said, I can’t do it, I can’t work with her. I left saying if you don’t, your village won’t have a map, so please set a time together and do it. For a couple of days, she didn’t answer my calls. And then finally she did, after I’d called her from three different phones. The map was ready she said. I went and collected it, and it was actually almost correct now.

En route one of the remotest villages, near Pench National Park, in Chourai block

After Barelinaganpur, I set off for Saddakpani. We drove through golden seas of bajra and maize, and then tall forest trees. No one told me that the village I was headed to was just outside Pench National Park. We saw water inlets, the water the colour of green olives, canopies of trees leaning in from both banks, leaning into an embrace. In a couple of places, the road was barely above the water. I saw firsthand why cars wouldn’t reach women in labour in these places when it rained. It reminded me of a graphic from the time of Krishna’s birth in the Mahabharatha. I got there and checked eight maps. I returned two, thanked the didi, and left. As we drove through the mythical forest, I crossed my feet, opened my lunch box, and ate what I felt was a well-deserved meal.

On my way to the office, I often stopped at the Women and Child Development (WCD) Department Office a.k.a. the office of the Child Development Project Officer (CDPO), in Chourai, to check if any maps had been left there for me. This is where the CDPO and Lady Supervisors (LS), women who supervise the work of the AWWs, sit. The CDPO runs the Integrated Child Development Services scheme - a social welfare scheme launched to tackle health problems and malnutrition in children under the age of six years and their mothers - of the WCD Department launched by the Government of India. It is a room of confident women who get work done. They speak loudly, with authority, and the vibe is very much ‘I mean business’. I call it the office of boss ladies. Smiling knowingly, because they knew I would be thrilled, they would hand over maps, and we would rejoice. One of them would make space for me to sit next to her each time I went. When I would say namaste as I left, they would reply, NAMASTE, in unison. I felt like a regular.

 A AAA meeting in Chourai block

I was now doing work that I had only seen others do. Each time I got back a map, corrected according to what we’d discussed, it felt like an accomplishment. I celebrated each small win. And some team members joined me, obliging the new addition to their team. The AAA started saying to me, aur aana madam (come here more), or when are you coming to our place next, or aaj madam humse milne aayin hain (she has come to meet us today).

Even though we do similar activities on the field, each day, till that particular stage of the intervention is completed, each day is different. It is good fun to hear their stories, many different, but some so similar, it makes me wonder if they all have a collective work consciousness. It is refreshing to meet new people, see smiling faces, some grumpy too. It is liberating, a constant reminder that no matter how much you see, there is more to the world, much more than our little words that we often find ourselves lost in.

At the end of that week, I got invited to Seema didi’s home for dinner. Seema didi sends me lunch every day. She picked me up on her scooter and took me home. Didi, her sister and I talked and looked at photos of Seema didi’s wedding. Her daughter, Aarohi - the name means badthe kram mein, or ascending, and this reminded me of how we explained that the house numbers on the village maps have to be ascending - danced and ran around the house. And Seema didi cooked us the yummiest dinner. That was my first meal with a family in Chhindwara.

One month-in, I had made my first few friends here.

Note: Names of villages have been fictionalized in the interest of the people I write about. 

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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*AAA: Each ANM is responsible on average for about five-six villages. On average, every village has one AWW and one ASHA.

*VHND: VHND is an abbreviation for Village Health and Nutrition Day which is held once a month in the villages. On this day, pregnant women are registered and checked, and children are vaccinated. It is a platform for first-contact primary healthcare.

*MCP: Mother and Child Protection Card. Information on registration and immunization is recorded in this booklet. It also contains valuable information related to Maternal and Child Healthcare and Nutrition.