Search gives all interns the chance to do a three-day village stay to get to know the local realities better, so last week Juliane (an intern from Germany), Sulabha (a woman from Mumbai who’s working here as a psychologist) and I set off for Porla. After a short bus ride (on buses that look 60+ years old, you wonder how they’re still moving), we hopped off at the Porla stop and looked for the house of Aruna tai, a community health worker who’s been trained by Search. (Tai means sister and it’s how you address an older woman here.) When I say “looked for”, I mean that literally- there are no street names or addresses so we just wandered around asking for her! The awesome thing about these small villages is that this method actually works 🙂
There was a small school near the bus stop and when we arrived the kids were at recess. When they saw Juliane and I, they swarmed from all corners of the field to look at these strange folks. This reaction continued as we wandered down the little roads to Aruna tai’s house. It’s a really strange feeling to be watched by every single person you pass by! There’s a lot in their glances, and I wonder what people are thinking as these people with such different lives and opportunities briefly cross their path.
These different realities became apparent after a few days at Aruna tai’s house. Even though she’s probably among the more well-off people in Porla, she and her daughter still do so much work to just accomplish daily tasks. Bathing requires lugging the water up from the well near her house, and hot water gathering wood and heating the water over a fire. She has a little gas stove but since their standard meal of rice, dal (lentils) and maybe rotis (bread) and vegetables requires multiple pots, some cooking also must be done over a fire.
There’s no “instant food”—of bread or cereal out of a package, of a microwaveable dinner, or even take out from a roadside stall because that would be too expensive—each and every meal, every single day, has to be made by hand from scratch. This is the reality for so many people but it was particularly apparent here as guests in Aruna tai’s house. Though we were only there for a few days, you could see how the effort involved in each step brings you really “close” to your food, and more thankful when it finally gets into your mouth.
That feeling of closeness was tangible in many glimpses of life: most of the walking paths look out over the vibrant green rice fields that are the source of many people’s livelihood. And you couldn’t walk anywhere without passing cows, which are not merely property / assets; they’re beings whose little barns / shelters are right next to the house, so at Aruna tai’s home we would wake up and fall asleep to the windchime-like sound of the bells around their neck as they shook their heads.
As a community health worker (CHW) for 18 years, Aruna tai has been trained by Search to conduct visits to pregnant women and their newborns. Like the CHWs in Malawi, she checks for danger signs and educates mothers about proper nutrition, breastfeeding and other topics like how to prevent infections. In fact, Search’s success with these CHWs was one factor that convinced the government of Malawi to train their CHWs in newborn care. One important difference, though, is that the Search CHWs are trained not only to recognize signs of newborn infection but to treat sick newborns with injectable antibiotics. Many professional associations (e.g. medical regulatory boards) don’t feel it’s safe for CHWs to be giving injections; after all, many CHWs have only 10 or 12 years of education, so how can they have the capacity to reliably give injections properly and in the right circumstances? These are valid questions that any CHW program needs to address. But what Search showed was that with the proper training and support, CHWs can safely and correctly administer injections of antibiotics; and since infections are a main cause of newborn death, the newborn mortality rate in Search’s 40 intervention villages dropped by a large amount within a few years. (Click here to read the article.) Being able to treat infections and provide care right in the home becomes even more important here in rural India, where only about 25% of women give birth in a hospital/clinic compared to about 75% in Malawi. But the Search CHWs get a lot more attention and supervision than a typical government health worker, so the real question is whether this approach would work on a larger scale. Search is working with the Indian government to train one group of government-sponsored CHWs in this method, so it will be interesting to see the results as that gets rolled out.
Anyway, back to the village- we got to come along with Aruna tai as she visited newborn babies and their mothers! Our first visit has really stuck in my mind. At first glance it could seem like a sorry scene: the young mother laid out a mat on her earth floor while her mother-in-law watched the older child play in the dirt. But as Aruna tai began her visit, a different scene emerged. It was clear that she felt comfortable in her tasks as she weighed the baby, asked the mother questions and recorded responses neatly in her record book. And her confidence was echoed in the state of this newborn. The baby was a healthy 3.5 kg, her mother calm and knowledgeable about some of the important do’s and don’ts during this critical stage. And until the health system improves enough that this woman can deliver in a clean, well-functioning facility with adequate supplies and care from a doctor and nurse—until these changes come to Porla, this mother is getting good quality care right in her home from a woman who speaks her language, literally and culturally. Seeing a success story like this was incredibly uplifting, in a field where we’re constantly reminded of the many problems and gaps.
There were some less positive stories that were reminders of the continued need for change. We visited a mother with twins, one girl and one boy. When we entered, the boy was under a baby-sized mosquito net on the bed while the girl was on the floor being swarmed by flies. But it wasn’t just in terms of comfort that the care differed: at birth, the boy had been a bit smaller in weight, and after a few weeks the mother was having trouble producing enough milk. Ideally she should have been eating and resting more, which would probably help the milk problem. But instead the family, in consultation with the CHW, agreed that to compensate for the weight difference and account for the limited breastmilk, the boy should receive breastmilk while the girl should be bottle-fed! Now at three months, the girl weighed almost a kilogram less than the boy—and low weight can mean the difference between life and death if the baby can’t keep warm or fight off infection. Everyone involved in the decision knew that breastmilk was better… and decided to reserve it for the male child. When Sulabha, who could follow the conversation in Marathi, heard this story unfolding, she interjected and explained the need for more food and rest so there’d be enough milk for both babies. The mother seemed to be receptive: it’s not that she didn’t care about the girl child, but when faced with a seeming shortage of milk, the family had prioritized the child who’d eventually grow up to be a bread-winner.
Our second night in Porla was a festival called Ko Jagiri, which I think literally translates to “staying up all night”. The festival coincides with the full moon, and you boil milk outside under its rays which is supposed to keep you strong and healthy for the next year. So with the cows looking on from their shelter, the milk was boiled down for hours and hours, and infused with cardamom, cashews, coconut and sugar—producing a thick creamy drink that was absolutely heavenly! The best part was how we were drinking this: Aruna tai’s relatives next door had also helped with the preparation, and the 10 of us sat outside under a blanket of stars sipping the hot drink from little mugs… that feeling of simple closeness was one I’ll cherish for a long time.