Coronavirus Outbreak: Rural Maharashtra's ASHA workers toil despite lack of safety measures, limited pay
Accredited Social Health Activist (ASHA) workers, the foot soldiers of rural healthcare in India, earn about Rs 3000 per month. Tasked with surveying households and spreading awareness about the coronavirus pandemic, these workers find themselves exposed to risk due to a lack of adequate masks and no sanitisers
Every day before she leaves, Shubhangi Kamble has to lock down her fears. But upon surveying the 204th household, her anxiety has resurfaced. “I have to be very careful when I return home, my younger daughter is all of five. What if she contracts the coronavirus?”
Shubhangi, 34, is an Accredited Social Health Activist (ASHA) worker — the foot soldiers of rural healthcare. The thaali and taali banging on 22 March, a gesture to thank those fighting the virus, as suggested by Prime Minister Narendra Modi, has not resolved her concerns. “We need masks and hand sanitisers,” she asserts.
ASHA and anganwadi workers have been assigned the task of containing the local transmission of the coronavirus. For this, they have to survey and find the suspected cases, list the people who came in contact with them, monitor them daily, inform the Supervisory Medical Officer about these cases, and create awareness about the disease among community members. They also consistently follow up with self-quarantined and isolated individuals, to check if they have developed any symptom of COVID-19.
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Of the 212 families she surveyed in the first round, five people had returned from Pune and one from Goa. Shubhangi ensured they were all quarantined as per the government guidelines. She and four other ASHA workers in the Arjunwad village of Shirol taluka in Maharashtra’s Kolhapur district have been given one single mask each as protective gear while they conduct their surveys. “Considering this, how will we escape the virus?” she asks.
As per the guidelines, ASHA workers are supposed to survey 50 houses daily. Shubhangi leaves at 8.30 in the morning and returns only by 2.30 pm. When I spoke to her on 28 March, her troubles had escalated because of an ill-planned lockdown of 21 days announced by the Central Government. “Don divsat chul band hoil (The food at home won’t last beyond two days),” she says as she breaks into tears, “The local kirana store has refused to sell grains on credit now.” To make ends meet, Shubhangi works as an agricultural labourer, but she had to pause this work in February because of poor health. Her husband Sanjay, who is in his mid-30s, works as an agricultural labourer and a cane cutter. These days, he leaves at 7 in the morning and returns only after 6 in the evening.
In a fit of anger, she says, “There’s no point of poor people living anymore.” Her frustrations stem from the "lack of concern" for ASHA workers and the 2019 August floods which ravaged her house. “Every day, my husband asks why I conduct these surveys... I tell him that I want to do social service, to make sure that the right information reaches the people. I am proud to be a health activist,” she says.
On 14, 15 and 16 March, ASHA workers distributed pamphlets about the coronavirus in Arjunwad. Over the course of her visits, she found that a lot of the older villagers don’t follow the lockdown; they frequently ask her questions about the disease. “They say they will inevitably die after four days.” If people don't pay heed to her advice about staying safe, she warns them that she will take a photograph and send it to the local police and panchayat. This has helped her to persuade people into staying at home.
It is impossible to go about this work armed with a single mask. “Somehow, I managed to procure another mask, and I wash it with Dettol each day,” she says. However, masks alone aren’t enough to ensure her safety. “The government should help us now. What is the point of being given 50 lakh rupees after we die?” she asks.
As per the National Health Systems Resource Centre (NHSRC), there are 60,794 ASHA workers working under the National Rural Health Mission (NRHM) in Maharashtra, and 9,05,047 across India. One among them is 36-year-old Deepali Rawal, who has been on pandemic duty since 17 March. She began with surveying 230 families, and as more cases were reported across the country, the list of tasks she was assigned seemed endless.
On 26 and 27 March, she surveyed 500 of the 1327 families in the Nigave Dumala village in Kolhapur’s Karvir taluka. “47 people in our village had returned from Pune and Mumbai, and two returned from Canada and Germany 45 days ago,” she says.
Like many other ASHA workers, Deepali wasn't given a mask or sanitizer when the survey work began on 17 March in the village. “We received masks two days ago (25 March),” she says. Apart from the lack of equipment, Deepali and her fellow workers have to battle patriarchy and the carelessness of people. Convincing their own families about the need to do this work is a hurdle, too. “I have to fight with my family members to go out and do this work. They are scared for me,” she says.
Surveying in Nigave Dumala has been far from easy. “People make fun of us when we ask them questions about their health. They should co-operate and take this pandemic seriously,” she says. She faces a lot of problems from men, especially. “Whenever there is a gathering of even three men, they make fun of us and don’t listen to what we say.” During such times, she calls up the village police and panchayat members, and then proceeds with her work.
The 21-day lockdown has heavily impacted farmers, agricultural labourers, and other workers across the country. A common refrain she has heard is the demand for free medicines. The price for a single hospital visit can amount to Rs 500, these labourers and farmers lamented. The Community Health Centres (CHCs) in Nigave Dumala are running out of medicines for fever, cough and common cold. On the subject of logistics, she says, "A disaster has come upon the nation, and we expect nothing from the government. All we want is for them to arrange for basic medicines (at the CHCs) at the earliest.”
A doctor from one of the talukas in Kolhapur said on the condition of anonymity, “We lack necessary masks and sanitisers. They should have been made available.” In his department, each doctor was just given just one mask.
“When this disease was first reported in China, the government was aware about it and they should have acted on it back then. The World Health Organization (WHO) made several recommendations and even issued guidelines, but it seems like the government didn’t take them seriously. If those measures would have been taken, the government wouldn’t have had to lockdown the country,” the doctor added.
Recently, a person from the Vadgaon town of Hatkanangale taluka in Maharashtra’s Kolhapur district tested positive for coronavirus. “From then on, many people began spreading the rumour that multiple villagers had come into contact with the individual,” Deepali said. Thus far, such rumours have been false. Deepali is often spoken to with impoliteness by community members who are offended when she asks whether they have interacted with the individual who tested positive, even shunning her.
What does Deepali get in return for her labour? A fixed ‘honorarium’ of Rs 2000 each month; with money from other tasks, this amount is raised to roughly Rs 3000 - 4000. ASHA workers haven’t yet been notified about being paid a fee for the pandemic surveying.
Many of them are of the opinion that people aren't taking the pandemic seriously. Twenty-seven-year-old Swapnali Chougule, who became an ASHA worker in 2016, sounds frustrated. “People don’t co-operate at all [in Juni Dhamani, her village in the Miraj taluka in Sangli district]. What should we do in such circumstances? A person who came from Vijaywada refused to get himself stamped. Eventually, after multiple visits (over a week), we had to get the sarpanch of the village to intervene,” she says. Another hurdle is the fact that villagers are not observing the rules of the lockdown.
Swapnali has spent the last 12 days spreading awareness and noting down the names of people who have returned from cities. “We don’t have masks. I use either a big napkin or a stole. The government should have thought about giving ASHA workers hand sanitisers and masks,” she says.
The sole ASHA worker in her village, she has surveyed 235 households in Juni Dhamani from 18 March onward. “People think they won't contract the coronavirus. They tell me 'I haven’t contracted it, so why are you asking us for details?'” Incidentally, Sangli district has reported 25 cases so far.
As of 1 April, India reported 1637 positive cases, and Maharashtra, 320, with 12 deaths. Swati Siddh, 34, has been an ASHA worker for a decade now. She has only just received a mask, and there are no sanitisers available at the chemist in her village Khochi, in Kolhapur’s Hatkanangle taluka. Her precautionary measures are limited to washing hands with soap, wherever possible.
Swati's monthly honorarium averages between Rs 2500 - 3000. She senses fear among the people of her village, of the disease itself and those who have returned from cities. “A lot of villagers look at people coming from cities with suspicion. These are our people... It’s our duty to help them,” she says.
ASHA workers like her are looking to the government with hope. "What will the government do if we contract coronavirus?” she asks.
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