Unseen Warriors of COVID: Forced to beg for our rights, say Hyderabad's ASHA workers

Editor’s note: As the second wave of coronavirus infections ravages parts of India, millions of front-line workers and citizens are caught up in the middle, providing their services to distressed families on one hand while trying to cope themselves on the other. This is part fourteen of a  series  profiling the stories of these people. At the peak of the COVID-19 second wave in April,  an accredited social health activist (ASHA) worker in Telangana’s Hyderabad tested positive. For weeks before she tested positive, the ASHA workers at the Urban Primary Health Centre (PHC) kept requesting their supervisor for medical-grade masks. Within a fortnight after the first case, two more ASHAs tested positive at the same PHC. The other ASHAs at the PHC, once again, raised the issue of lack of adequate protective gear: N95 masks, gloves, sanitizer, and face shields, with their supervisor. Over 15 ASHAs, both regular and contractual, work at the PHC. They received five disposable masks in the past two months. “The supervisor always gives the same response: that there is a shortage of masks,” said Saroja*(29). She claimed that another supervisor remarked that since ASHAs have been vaccinated, they will have immunity. [caption id=“attachment_9697681” align=“alignnone” width=“640”]  Fever survey in Allwyn Colony, Hyderabad. Image courtesy: @narsimha_doddi[/caption] Saroja was hired in August 2020 on a contract basis. Since then, she has received one N95 mask. She s aidthat she hasn’t ever received a PPE from the PHC, even while working near COVID-19 patients. Non-provision of protective gear has been a persistent issue across the PHCs in Hyderabad. As a result, ASHAs have resorted to wearing flimsy cloth masks, covering their faces with scarves, or approaching charities. “The quality of masks given by social workers is inconsistent, but it is better than nothing,” said Kaveri*, who has been working as an ASHA for over ten years. Kaveri has been on COVID-19 duty since March 2020. Frontline and healthcare workers in India were assigned additional duties to help the government manage the public health emergency. However, as the pandemic progressed, while the number of tasks expected of ASHAs kept increasing, the protective gear dwindled. Recently, in Telangana, ASHAs across the state got tasked with conducting door-to-door fever surveys. As part of the surveys, ASHAs, along with other healthcare workers, Anganwadi workers, and municipality staff, go 50 to 100 houses per day to identify people with COVID-19 like symptoms. Those deemed symptomatic get home isolation medicine kits, and tests are conducted too. Then, for the next few days, ASHAs check on  COVID-19 positive patients at their homes, advise them on isolation, monitor the symptoms, and trace the contacts: all sans adequate protective gear. Overworked and underpaid Kaveri starts her day around 9 am by visiting the four COVID-19 patients in her area. “Some days, they start calling from 6 am because they get anxious. Some patients call at night. I haven’t slept properly in months and work even on weekends,” said Kaveri. Post the visits, Kaveri sets out to complete the fever survey target for the day. The officials decide on the number of such surveillance rounds required in an area. In some localities, over ten rounds of fever surveys have been completed by now. [caption id=“attachment_9697701” align=“alignnone” width=“825”]  Fever survey near Shah Khamosh Darga, Hyderabad. Image courtesy: @dr_rambabu_a[/caption] Officials from the Department of Health & Family Welfare of Telangana have attributed the reduction in COVID-19 hospital admissions partly to these fever surveys ( here and  here). However, despite being tasked with such a crucial responsibility in COVID-19 management, ASHAs work with little or no equipment on most days. “I usually go around asking people how they feel and make a note of it based on whatever they say,” Kaveri said. Saroja had a similar experience. “All the hungama lasts till photos appear in the news,” Saroja says. “After the first few days, we are on our own. There is no municipal staff, no supervisor, no thermometers, no oximeters,” she claimed. These days, Saroja has about 6 to 7 hours of fieldwork and a couple of more hours of record keeping. Once they are back home, people keep calling them for clarifications. When she was hired in August 2020, officials told Saroja that being an ASHA would entail no more than three hours of work per day. At Saroja’s PHC, the ASHAs who have recovered from COVID-19 are suffering from fatigue and unable to meet the day-to-day targets. Hyderabad has over 1100 ASHA workers across 85 of its PHCs. “The city needs at least 2,000 more ASHAs to cater to the population. They hired around 800 workers during the pandemic, but that isn’t enough. The staff-shortage is impacting the health of those who have been working overtime for months,” said Vani, leader from ASHA Workers-Centre of Indian Trade Unions (CITU) Hyderabad chapter. ASHAs say that they don’t know if and when the government will remove these additional tasks from their duties. “I don’t know what my job is anymore. All I know is that I can be re-assigned for any work,” said Saroja. Last year, she was sent to the Greater Hyderabad Municipal Corporation (GHMC) elections while being on COVID19 duty. ASHAs are primarily employed for around 60-70 tasks, including ante-natal, postnatal work, following up on the newborns in the locality, helping the elderly with blood pressure and diabetes, screening diseases, creating awareness about reproductive health, registering people for contraceptive devices insertion, etc. Recently, Kaveri had to rush to a hospital accompanying a woman in labour. She returned from the hospital way past 2 am, but had to start working at 9 am the next day. “I don’t want to evade work during a situation like COVID-19. However, getting the same payment as before despite so much additional work is extremely unfair,” said Kaveri. [caption id=“attachment_9697711” align=“alignnone” width=“640”]  GHMC Corporator inspecting fever survey in Seethaphalmandi, Hyderabad. Image courtesy: @hema_samala[/caption] Telangana has an incentive-based remuneration system for ASHA workers. Most get around Rs 7,500 a month. In March, the Chief Minister of Telangana K Chandrashekar Rao  announced that the 11th Pay Revision Commission (PRC) would apply to the state’s contract and outsourced employees too. ASHAs say they are yet to hear about the details of the pay revision. “The ASHA workers CITU union, however, are demanding a pay scale of Rs. 21,000. That’s a reasonable amount for a person and their family to be able to have a dignified life in a city,” said Vani from CITU. There are irregularities in the existing compensation too, Vani added. While Kaveri, a regular ASHA worker, got paid on time, Saroja hasn’t received her salary since March. The pay could also get docked if ASHAs don’t meet a target their supervisor sets. Saroja joined as a contract worker in August 2020 when her husband’s earnings fell. The initial contract was for six months, but the workers were told it would be like a regular ASHA job. “In February, my supervisor told me that the contract has ended and I can stop coming to work. For the next month-and-half, we kept protesting, requesting, submitting memorandums,” said Saroja. In March-end, the ASHAs were asked to join work again. Most of them took up the offer; some opted out due to the uncertainty. Since then, several of them haven’t received paychecks. They can’t figure out why. “I don’t have a contract document this time. But the supervisor says my name shows in their app, so I must have been made a regular worker,” said Saroja, one of the many workers uncertain of their employment status. A nationwide ASHA worker protest was held on 24 May about the issues being faced by the workers across the country. Over 350 ASHA workers from Hyderabad participated in the protest at their respective PHCs. Now, some of the temporarily hired ASHAs allege that supervisors are threatening to sack them for being ’troublemakers.’ [caption id=“attachment_9697721” align=“alignnone” width=“640”]  An ASHA worker and an ANM conducting a fever survey. Image courtesy: @dr_rambabu_a[/caption] The District Medical And Health Officer of Hyderabad is yet to respond to the requests for an interview. The story will be updated if and when a response is received. Living in constant fear Back home, as soon as Saroja enters the house, her four-year-old son runs to her. He has still not gotten used to her daily routine of keeping the ASHA saree out of his reach and taking a shower before picking him up. In the initial days, the COVID-19 training she attended kept her anxious about the risks of the disease, how it spreads, and the preventive measures. Now, the stories of other ASHA workers unsettle her. “I remember being told to soak the clothes in hot water at the end of each day and to dispose of the mask with bleaching powder solution,” said Saroja. She cannot even wash the saree every day as she was given only one. “Social distancing is not even imaginable. Even if our family sits at the corners of the biggest room in the one-bedroom house, we will still not be six feet apart,” Kaveri said. At times, their neighbours create a fuss about ASHAs using the shared spaces, which leads to owners questioning the choice of employment. “I have not paid rent in two months, so I can’t fight back,” said Saroja. Periodically, ASHAs have been touted heroes and showered with praise by officials and political representatives alike. Nevertheless, it has rarely translated to providing a better working environment for the ASHAs. “Every time there is a lockdown, the public rests, and we go on double duty. Yet, we do not get the respect we deserve, dignity, safety, or even money. If we are warriors, why are we being forced to beg for our rights?” Kaveri asked. Ayesha Minhaz is an independent journalist writing from Andhra Pradesh and Telangana