As I move past the “nothing-makes-sense” phase of culture shock, my discomfort has begun to subside and awe and gratitude have set in. I am in love with my life here. I don’t feel it every moment (when hurdling through potholes in a tin can on wheels), but humming underneath everything is a frequency of wonder. When I take the time to really think about it, this is the work I have dreamed of.
This week, I was able to accompany an Accredited Social Health Activist (ASHA) Sahayogini on her home visits to check on newborns and their mothers. As a part of the National Rural Health Mission, ASHA workers are meant to serve as the first contact for any health-related problems in rural areas that are not easily accessible. They are charged with creating awareness, reproductive counseling, health care mobilization, developing a village health plan, treatment of minor ailments, and recording health statistics such as birth, infant mortality, and immunizations. Because rural areas suffer from a lack of proper healthcare facilities and skilled health professionals, a well-trained ASHA worker can be the difference between life and death for rural women and children. Though I had read about these women in my preliminary research about child nutrition and the Indian health care system, I could not have anticipated how fully integrated the ASHA worker is within the community. I was moved by the ease with which she entered each home and the way that the mothers so fully entrusted her with their newborn babies.
I wanted to understand how child and maternal health care worked in this village before beginning my own nutrition baseline survey, so I asked this ASHA worker if I could accompany her on her rounds, to which she graciously agreed. I trailed behind her as she strode purposefully around the narrow, packed dirt paths between colorful pucca and cement houses. First, we stopped at her own house, which was situated amongst the others. She picked up a small package and we set out. Women greeted her with easy familiarity and welcomed her into their homes, and she knew the name and birthday of each baby by memory. Without ceasing her rapid conversation, she pulled out the contents of her package—which turned out to be a sling scale—and skillfully weighed each child. She asked the mothers about their health and the health of the baby. All five of the newborns were gaining weight on schedule.
As I marveled about this health care system on the bus ride back home, I thought about how tirelessly women show up for one another and support each other’s health. How women have been doing this since the beginning of time, but finally are being given the training and investment to increase their power. However, the ASHA worker had mentioned that her compensation was very, very low. She makes about 1,000 rupees, the equivalent of about 15 USD per month. It is easy to sing the praises of such programs and schemes which empower women as vehicles of health system delivery, but unless they are compensated properly, the system is taking advantage of their time and labor. ASHA workers across the country have mobilized to protest the perception of their role as “voluntary” workers taking place in Maharashtra, Uttrakhand and Telangana in the past few years, demanding better wages and recognition as the “backbone” of rural healthcare.