Foot soldiers of the war against the pandemic, the women workforce have been toiling hard to ensure the safety and health of people under their care
Since 2006, ASHA worker, a trained community of female health workers, has been acting as a link between the healthcare system and society at the grassroot level. Of the one million ASHA workers in the country, Kerala has 26,221.
“They worked alongside the police, health workers and volunteers to contain the spread of the pandemic and have been an integral part of Rapid Response Teams (RRT). They had to arrange for quarantine facilities, food and medicines and extend special care to the elderly, pregnant women and children. It was heartening to see how many of them went out of the way to help the people under their care,” says Seena KM, senior consultant (social development), National Health Mission.
- ASHA initiative that falls under National Health Mission was launched in the country in 2006. Tasks assigned to the workers include creating awareness about nutrition, basic sanitation and hygienic practices, pre and post-natal care, immunisation and contraception, facilitating access to health services available at villages or primary health centres, accompanying pregnant women and children if needed, providing care for ailments and first aid, palliative care and documenting births and deaths in the village among other duties.
- Malappuram district has the maximum number of ASHA workers in Kerala.
- The state has 476 Hamlet ASHA workers, who work in tribal areas. They are in the districts of Wayanad, Kannur, Idukki, Palakkad, Thrissur, Kollam, and Thiruvananthapuram.
- ASHA workers’ monthly income is ₹5,000 (honorarium), ₹2,000 (fixed incentive) and ₹1,000 (COVID-19 incentive). They are also eligible for task/activity-based incentives, which varies every month. This include maternal and child health, immunisation, family planning, adolescent health, routine activities such as meetings and health awareness sessions, leprosy eradication programme, vector-borne disease control, iodine deficiency disease control and the like.
Priya V, a 38-year-old ASHA worker in Thiruvananthapuram, recalls how they were working all through the lockdown. “We would go on foot to visit houses of the elderly to give them their supplies of medicines, food, provision kits and so on. Initially, we did face problems in some places while putting up stickers on houses in which there was a patient with COVID-19 or quarantined residents. But we persevered and received generous support from society at large.” says Priya.
Each Panchayat had its own set of challenges. Sindhu PP, an ASHA worker from Kannur, knew that migrant labourers in her ward would go hungry once the hotels were closed. So she rushed to start a community kitchen in one of the hotels and with the help of donors provided food for the migrant labourers for three months. “Since we hail from the same place as the residents, we know most of them. There is a feeling of mutual trust. Even before March, awareness sessions were conducted and we were organised into smaller teams called RRTs,” says Sindhu.
A Valsala, ASHA worker in Perinad from Kollam, asserts that awareness sessions on how to tackle the pandemic began in January when the world was awakening to the pandemic. Her journal records that it was on January 4 that a medical student from China reached her Panchayat for a wedding.
“I rushed to their house and found him wearing a mask. It was a novelty for me. He left in the second week of January and there were no untoward incidents. As the workshops progressed, we were taught about quarantine (a new word for all of us), home isolation, oxymeters etc,” says Valsala, adding, “First, we made a list of all houses with relatives staying abroad. The work was carried out meticulously in stages. So by the time there was an outbreak in March with 530 residents traced as primary contacts, we were well prepared. The area was declared a containment zone and within 21 days, we were able to declare the place COVID-free.”
ASHA workers were there to support the ill and also console those who lost a relative to the pandemic. Although the Government does not promote childbirth at home, ASHA workers have been trained to do so in case of an emergency. As in the case of Ambily Chacko from Vandipperiyar in Idukki, who attended to two childbirths, one of them in a tribal hamlet. “Keeping in with their beliefs, they never go to a hospital. So pregnant women move to a temporary shed, Valaimappura, for delivery. Since it was her fifth child, it was not tough for me,” she says. However the second delivery that she supervised was challenging. “The family was in dire straits and had no money to go to hospital. And when the woman went into labour no vehicles were available to transport her. So I had to handle the situation with assistance from other women in the neighbourhood. It was a harrowing experience because the mother was very weak and had high blood pressure,” says Ambily, 40, an ASHA worker for 13 years with 383 houses under her jurisdiction.
Ushakumari S from Kottarakkara in Kollam says that the pandemic tested their resilience and patience like never before. The 48-year-old, with eight years of experience, was in the news for taking a COVID-19 patient, Ramla Beevi, to the hospital for the second antigen test. “Since no ambulance was available, she pillion rode with me on my two-wheeler. I was in the PPE kit my son had bought for me and it was quite a sight watching people and vehicles making way for my vehicle! Many might have even thought it is a man riding the scooter,” she laughs.
Krishnakumari from Vamanapuram in Thiruvananthapuram, points out: “It was like a battle and we have succeeded to a great extent.” The 52-year-old, who has been assigned 475 houses in her ward, mentions about taking care of a pregnant woman. “As her husband had lost his job, they had no money to run daily affairs let alone go to the hospital. So, with the support of our ward member, I arranged everything for the family and extended all help before and after her delivery,” she adds.
According to Seena, over 750 ASHA workers have tested positive so far. Among them was Sheeba Kuttan and Preetha MP, both from Thrissur. While Preetha considers herself lucky as no one in her family tested positive, Sheeba’s case was not so. The 48-year-old is in tears when she recalls how nine of them at her home came down with the pandemic, including her pregnant daughter and four grandchildren. “It was a tough time and my son had to rush home from abroad. And I can’t thank enough the ASHA team and health officials for standing by me and my family,” she says.
“For us, it was a service we were rendering to society. For instance, I donned a PPE kit and cleaned and fumigated the houses of COVID-19 patients since many were scared about contracting the virus. In another case, I saw an accident in Payyannur where an injured man was lying unattended. I rushed him to hospital in the four-wheeler I was travelling in. Every ASHA worker would have hundreds of such instances to talk about,” says 42-year-old Rajana Mohan, district general secretary of the ASHA Workers Federation (CITU) in Kannur.
Priya asserts that their hard work during the pandemic has earned them a new-found respect. “It was not always like that. Moreover, I learnt that during a crisis, wealth and privilege do not matter. It is a shoulder to lean on that matters the most. And many a time, it was an ASHA worker who was there to support, console and motivate them.”
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