BY TERESA REHMAN
It was raining heavily that night. ASHA worker Punam Rajput of Line No 1 at Balipara Tea Estate in Sonitpur district, Assam was eight months pregnant then. However, she had no respite from her duties. There was an emergency and a pregnant woman about to give birth developed complications. She had to take the patient from the Balipara PHC to the nearest Civil Hospital in the district headquarters, Tezpur. The patient had developed high blood pressure and was in a serious condition.
Seeing the patient’s condition, the doctors and the nurses accused Punam of being irresponsible. “I was monitoring her health regularly. She had suddenly developed hypertension, I could do nothing about it. I felt so sad because nobody bothered about my condition. I was in an advanced stage of pregnancy myself and I was feeling very uneasy,” she says.
The hospital refused to keep the patient and referred her to Guwahati, which was the nearest city. The patient’s family was very poor and could not afford to take her to Guwahati. They bought her home. The lady delivered a baby girl at home and died thereafter. “The baby girl is grown up now. Whenever, I see the girl, I remember the hapless lady. I had never felt so helpless before. I wish I could have done something to save her life. Whenever I think of that night, my heart becomes heavy,” says Punam.
Catering to 106 households and 1322 population, ASHA worker Punam has only one daughter aged 7 years. “I have been trying for a second child but I have not been able to take care of my own health. I had a miscarriage three times. I have to run whenever there is an emergency call and through bumpy roads. This led to my miscarriage. It’s an irony that I take care of every mother’s health in my jurisdiction but there is nobody to take care of me,” she rues.
Punam, however, has ‘asha’ or hope. She hopes that one day her remuneration will improve and she will be able to provide good food and education to her daughter. “We are getting only INR 1000 per month which is meagre compared to the work that we do. If we got a decent sum, we would have been able to strive to do better as our family’s needs would have been taken care of,” she says.
But Punam is not complaining. She loves her job and the respect she gets from the people in the community. “When I am in my uniform, I am in a different world. I feel so good,” she says. Though the financial returns have been minimal, she feels that she is successful as she has been able to change and save many lives. She has been able to convince many women to go for tubectomy. But it’s still a tough to convince the men to go for vasectomy. “Some of them say that they will not be able to do their puja or that they will lose their virility. They push their wives instead to take birth control measures,” she says.
Mina Thakur, 31 is a ASHA worker in an area called Chah line in Bamgaon Tea Estate in Assam’s Sonitpur district. She studied upto class eight. She became an ASHA worker in 2007. Earlier, she was a busy homemaker to her three sons and her husband who runs a hair cutting saloon. “After my second son, my mother-in-law insisted on having a daughter to add lustre to the family. But the third child was also a boy. And then, I decided to go for a tubectomy and limit my family,” she says.
Mina feels that she has a responsibility towards her society. “I must practice what I preach. I can’t go on telling people to have a small family if I don’t have one of my own. I go and tell newly-wed couples not to have more than two children. I tell them that they will be able to provide a sound education and life to their children only if they are a small family,” she says.
Mina and Punam represent the tea tribe community of Assam. This a heterogenous community of indenture labourers, mostly Adivasis, brought from different parts of central-eastern India to work in the tea gardens of Assam. For long, the tea tribe community has been neglected in terms of education and healthcare facilities.
A pathbreaking moment came in 2006 when tea gardens and the National Health Mission began a public private partnership to augment the industry’s healthcare infrastructure. The Assam government, through the NHM, decided to provide a single tea garden with up to Rs 15 lakh a year, which would be spent on providing basic healthcare to both workers and non-workers. ASHAs play a major role in the implementation of all MCH related schemes of NHM, as they are the ones who directly communicate with the community which they belong to.
Assam is known for its tea and produces 51 percent of India’s tea. An ethno-linguistic minority, the population of the community is primarily rural in nature and estimated to be near 5 million (50 lakhs) or 16% of Assam’s total population as of 2011. The state also accounts for the highest number of maternal deaths in India. “Of the approximately 400 deaths for every 100,000 live births, 77 percent are in the tea gardens. The women in the tea estates of Assam are being denied basic healthcare and nutrition. In such a situation, the role of an ASHA worker is extremely important,” says an official of the state health department.
Himani Deka, ASHA supervisor of Balipara sub-centre claims that her team has been successful in motivating the men in the only tea estate under their jurisdiction – Noorbarie Tea Garden near Tezpur in Sonitpur district in Assam. “My ASHA workers have devised an ingenious technique. We approach the incharge of the labourers also known as the Bora Babu or Mohori. We tried to convince them first. Once they were convinced, our major bottleneck was dealt with. They now encourage their male employees to take a day’s leave and get a vasectomy done. Otherwise, it is as usual difficult to convince the men to take up the responsibility of birth control.” In fact, from 2015-17, Deka’s team has been able to conduct 15 vasectomies, 40 tubectomies and 10 Copper T.
ASHA workers in the tea estates of Assam have to grapple with a lot of problems. The women workers in the tea gardens get just one month’s maternity leave which is highly insufficient. Anaemia continues to be a major health problem for women in the tea gardens. The ASHA workers alongwith their supervisors form a formidable team as they try to convince the impoverished tea workers on the benefits of family planning and contraceptive methods.