DHALAI: Sarodhan Malsom, 29, a mother of two from Dhanchora, a small village in Ambassa block of Dhalai district in Tripura, is very proud of her vocation. She is the village Accredited Social Health Activists (ASHA). “ASHA means hope. And that is what I bring to the lives of so many in my community,” she says. Ummarium Reang, Nyantara Debram, Sanali Reang and Phulaiti Reang share Sarodhan’s enthusiasm and passion to make a difference. But oftentimes, when the challenges become tougher than usual, this optimistic attitude takes a beating. Every year, with the onset of the rains, the land-locked northeastern state that shares its border with Bangladesh, faces high risk of malaria outbreak. It’s been no different this time. Central to effective crisis management are ASHAs like Sarodhan who travel to far-flung areas to conduct tests and subsequently transfer the serious cases to the nearest hospitals.

Ever since malaria has wreaked havoc in Dhalai, where more than 58 people have reportedly died due to the outbreak, Sarodhan’s daily routine has been punishing. After completing her household chores she walks to every home in the village checking on families. She talks to the women about keeping their surroundings clean and urges them to immediately send word to her if anyone shows symptoms of the vector borne disease. On her rounds, Sarodhan collects blood samples and tests them for infection using the diagnostic kits that have been provided by the district health authorities. To those who test positive for mild strains this efficient health worker administers the first dose of medicine before facilitating their visit to the nearby health camp for chloroquine and primaquine oral tablets. Patients with severe strains are quickly shifted to a hospital.

As an ASHA, Sarodhan has been providing health services in the village for seven years now and she doubles up as help for the multi-purpose workers (MPWs) during times of malaria outbreak. Frail Jugun Reang, 40, owes her life to Sarodhan. As she recovers from a particularly bad case of malaria, she expresses her gratitude, “It is due to her vigilant outlook that I am alive today. I had been detected with both strains of the deadly disease - Plasmodium falciparum and Plasmodium vivax - a few days back. She came to my rescue and ensured that I got the right treatment.”

Like Sarodhan, Ummarium Reang, 30, has been on emergency duty since June 2014. There are times when she has to rush to the ASHA centre, a small pucca structure located two kilometres away from her home, to attend to the people queuing up to get their blood tests done. The procedure she follows is straightforward. Pricking the middle finger of the patient she draws a few drops of blood that she tests using a machine that comes with the diagnostic kits. The results are instantaneous and enable her to take a call on whether to give the patient medicine or arrange for him/her to be sent to the hospital. Ummarium keeps all the test slides carefully as they have to be handed over to the district health officials. She gets Rs 15 for every slide sent and Rs 90 for those that test positive for malaria. This season she has made around 70 slides – positive as well as negative. “Though I am trained to promote institutional deliveries, every year I chip in as health support staff to combat malaria. ASHAs have been trained to test blood and report to the hospital. But in this terrain it is so difficult to ensure that people get to a hospital as most of them are located very far off. Of course, for all this additional work I will get paid only by February 2015, as we usually get our dues at the end of a financial year,” she shares.

Whether they are on malaria watch or simply doing their regular duties, the challenges that the ASHAs face are multiple and, sometimes, seem insurmountable. Sanali Reang, 20, belongs to the Reang community, a primitive tribe in Tripura. She has studied till Class Six because there were no schools in the vicinity of her village Dharampura. Sanali became an ASHA after her predecessor got disheartened and gave up. “She was unable to complete even one cycle of institutional deliveries due to the problems that arise out of gaps in health service delivery. Moreover, it takes so much time to get reimbursements that we end up paying from our own pockets. Only the most committed can stick on,” observes the young health worker, who has encountered her share of difficulties since she took over.

Like when little Tharana Reang was born at home in the middle of the night two years back. “I can clearly recall that night. Despite our best efforts, we were not able to arrange for conveyance to shift her mother to the hospital. Usually, we hire an auto rickshaw for Rs 500 to transfer a pregnant woman to a health facility. The fare is too much but the allowance given for a pregnant woman can cover the cost. What lands us in a soup is the late reimbursement of payments,” rues Shayam Reang, Sanali’s husband, who supports her ASHA duties, day or night.

Clearly, it’s sheer motivation that keeps an ASHA going. Nyantara Debram, a mother of three, has been an ASHA for the last nine years. Her two sons were born at home and she almost lost her life during child birth. Her own traumatic experience spurs her to be there for other expectant women. “Even today, rural women are forced to deliver babies at home as the hospitals are located far from villages. As an ASHA I always strive to get an institutional delivery done but the difficulties are far more than the incentives. We are just paid Rs 600 if we are able to get done the requisite two ante-natal check-ups for the mothers and ensure child birth and immunisation in hospitals,” reveals Nyantara.

“At a time when public health services are almost in a state of collapse in Tripura, the voluntary services delivered by these multi-tasking women serve as the only health care support for thousands,” admits Chandrakanta Malsom, Project Officer of World Vision, a non government organisation working for the uplift of the tribals in the state. World Vision has been supplying insecticide impregnated mosquito nets in the affected areas and ASHA workers are facilitating the distribution.

Factors such as under-development, a poor literacy rate and severe malnourishment prevalent in the region make people vulnerable to diseases and pose hurdles in enabling the ASHAs to do their work properly. States Phulaiti Reang, an ASHA from Dharampara village in Khowai district, “For me to make sure that people visit their public health centre when they fall ill is not easy. When the malaria alert was sounded I went door to door asking families to get their children tested but they refused to pay cognisance. This is the time for jhum (shifting) cultivation and everyone has been busy. Even those who fall ill are unwilling to undergo treatment.”

Agrees Dr Anup Das of the Ganganagar Health Centre, “Owing to widespread poverty and illiteracy, the locals tend to trust quacks or resort to religious ‘pujas’. The hospitals are just too far away. We depend on ASHAs to mobilise people to come to a proper health facility. But nothing is really being done to make their work simpler.”

A strong sense of commitment drives an ASHA to forge on despite the challenges. But isn’t it time we stop taking this industrious workforce for granted?

(Women's Feature Service)