As the Covid 19 cases increasing day by day and the scare of more deaths continue to haunt the city of Vizag, a large army of volunteers who act as an important interface between the community and the public health care system in Andhra Pradesh makes its way every day between 7-8 am in the morning, in their assigned wards, to perform a number of assignments during ongoing pandemic. But navigating private and public spheres in a mostly patriarchal society has made their circumstances aggravating. When Venkata Lakshmi of Mindi in Pedagantyada mandal of Visakhapatnam district mentioned to her husband about her assigned work, he did not want her to leave the house. Despite her husband’s non-cooperation, every day, Lakshmi visits around 25 households, a target which she has set for herself. “I am supposed to do this. Even if I am scared, I cannot step back,” she says. “More than myself, I am afraid of transmitting the infection to my children and my mother-in-law,” she added.
Women like Lakshmi are known as ASHA — an acronym for Accredited Social Health Activists, which also spells the Hindi word for “hope” have been deployed as India’s first line of defence to track down “imported cases” of the coronavirus. After completing the survey, Lakshmi is required to hand over the data to her supervisor at around 3 pm, which will be submitted to the nearby primary health centre (PHC). Moreover, they have been instructed to screen all households to identify any persons showing symptoms of the coronavirus infection, in the desired format provided by the state. Providing further details of her daily tasks, Lakshmi says, information related to travel history and symptomatic cases is channelled differently. “In case any person has a travel history or shows symptoms of the infection, we have to immediately report to our higher-ups, who in turn, inform at control rooms of the GVMC enable them to rush to the spot with Rapid Response Team consists of medical team to test the infected and take further necessary action.” After checking the case, the team takes the decision depending on the symptoms whether to send the patient to isolation ward or advise quarantine.
A complete focus on the pandemic means that other duties have taken a backseat as health services deemed non-emergency have been put on hold. For Annapurna Devi, who has been an ASHA worker for 6 years and currently looks after population of 2,000, this means she is unable to provide immunisation to pregnant women or birth control methods.
Bharati, another ASHA worker in neighbouring ward said, due to a swirl of rumours, triggered by social media, has made her work even more challenging. “People are fearful that contracting the virus means immediate death. I tell them, ‘look at me. I have a dupatta to cover my face. I wash my hands every half an hour. Has anything happened to me? Bharati says some of ASHA workers have even refused to work. They say ‘we have children, we have families. How can we put them at risk? Bharati says, I feel the fear is quite natural. My husband, who is very supportive of my work otherwise, keeps telling me, ‘what is the need to work so hard. What if you fall sick? So, I use fresh mask or use my dupatta. I have a bath as soon as I get back and wash my hands as often as I can, she said. But Bharati says “Sometimes, I feel proud to serve the community in this unprecedented situation, but I am still risking my life. What will I do with medical insurance cover of Rs 50 lakh for three months from central government and other is remuneration of Rs 10,000 from the state government, if I don’t stay alive and healthy?”
But overriding sentiment among these workers, however, is that the work must go on. They also battle hostility from communities which they have served for many years. These are the same communities which used to address them as ‘Akka’ (elder sister), out of reverence and recognition for the essential work they do to keep rural populations, particularly women and children, healthy and safe. Perhaps, these ASHA workers are so low in the chain of the health bureaucracy that their efforts and community-leadership neither get highlighted nor recognised. However, the ongoing crisis should open our eyes to not only re-shape and re-design our future which includes ‘nutrition for all’ and ‘healthcare for all’, but it should also do so in a humane way where the efforts of our last mile workers are recognised and appreciated both socially as well as economically. Does the government have the heart and the will to do so, at least after having used their services extensively at a time of national crisis?