Real lives

Introduction

 

A day in the life of a Purulia health worker

© UNICEF/ 2008
Dipali counseling Anima

Jhalda, Purulia, West Bengal: Dipali Mahato’s working day begins at sun-up. Rushing through her domestic chores, she leaves for her daily rounds as an ASHA (Accredited Social Health Activist) worker, proudly carrying her IMNCI (Integrated management Neonatal and childhood illness) kit in her shoulder bag.

It is her day to visit Kotshila village in Jhalda II block of Purulia district in West Bengal. The first stop is to check up on baby Sita, the firstborn daughter of 20-year-old Anima and Gurcharan Oraon.

When Anima’s labour pains started on June 9, the family rushed her in a rickshaw to hospital after midnight. A healthy baby girl weighing 3 kg was born at 2.20 am and she was home the next day.

Dipali had visited Anima on the third day to find the infant with watering eyes and unable to suckle properly. She had instructed the mother on the right way to hold the baby while feeding her and offered a simple remedy for the watering eyes. She checked on the baby two days later and now on the seventh day she finds everything normal.

Dipali had visited Anima on the third day to find the infant with watering eyes and unable to suckle properly. She had instructed the mother on the right way to hold the baby while feeding her and offered a simple remedy for the watering eyes. She checked on the baby two days later and now on the seventh day she finds everything normal.

Dipali’s next stop is Kumarpara in Kotshila, the home of Sushila Kumar whose son, Parameswar, was born four days earlier at the hospital.

Sushila’s labour was prolonged and she had to be put on drip. “I visited the day after she came home and examined the baby. He weighed 2 kg,” Dipali says.

Baby Parameswar was asleep in a dark airless room. The family rolls bidis (local cigarette) for a living and tobacco dust hung thickly in the air. “I’ve told Sushila the baby needs fresh air, but what can she do? It’s her home,” Dipali says.

Jhalda, the most backward among the five blocks selected for the IMNCI  pilot project in Purulia, has a large scheduled caste/scheduled tribe population.

The soil is stony and arid and the little arable land that there is, yields only one crop a year. There are few job opportunities and a large section works in the bidi industry where they get just Rs.70 (USD 1.75) for 1,000 bidis rolled.

In the next lane lives 35-year-old Mandobi Kumar, whose fifth child, a daughter, was born a week earlier, weighing 2.2 kg.

Examining the baby, Dipali found the infant clearly unwell – the area around the navel was infected, her breathing was fast and laboured and she had a large sore.

Dipali’s queries drew curt responses from the family including Mandobi’s husband, Khanram Kumar, while the mother sat silently.

Their 15-year-old son was especially hostile. “We took her to hospital and got no money. Where’s the doctor? Why have you come here?” He repeated the question when Dipali handed the pink referral card to Mandobi and told her to take the child immediately to hospital.

Dipali patiently explained that incentives are given only for the first two children, but the family was not willing to listen. “I do get occasional cases where the family is hostile, especially in the Kumar community who are clannish and resistant to change,” Dipali says. “Fortunately it’s not often, and things change for the better in cases where we’re able to help a sick child.”

Block Medical Officer of Balarampur, Dr. Sardar is an enthusiastic supporter of IMNCI. “It’s a unique programme,” he says, giving the example of breastfeeding.

“Breastfeeding is instinctive, but can also be taught. Our mothers are ignorant; they need to be guided. If a child is held properly it can suckle properly.”

Dr. Kunal Majumdar of R G Kar Hospital, Kolkata, who conducts the IMNCI training, concurs. “This is also true among the urban middleclass. We say that for six months a child can survive on breast milk alone and does not need any additional food, not even water. Yet mothers come to me to say they do not have adequate milk or that the child is not suckling properly. In many cases we have shown that if the mother holds the baby properly and guides the child to find the nipple, the problem goes away automatically. We counsel them how to feed, how long to feed. This is very important because breast milk has many good qualities – it is the best defence of a child against under-nutrition, infections, and many major ailments.”

The IMNCI has been a boon, according to Dr. Majumdar. “Earlier disease management was done through isolated programmes – like the diarrhoea control programme because many children died of diarrhoea. But later we realized that children brought to hospitals suffered from more than one ailment. With the IMNCI training, the community health workers can look after the children in a systematic way. They have been taught to identify and understand the symptoms of diseases and they’re at the right place, at the right time. So, with time we hope to be able to control child mortality in a big way.”

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