Not so green

At first, it looks like any other code sheet card as the young girl ticks off  the numbered boxes. But a closer look reveals that questions organised in the boxes are a feedback on the state of women’s healthcare in tea gardens of the area. For example, No 30 indicates: Hospital closed during working hours; No 34: Pregnant woman referred to another hospital due to lack of services; No 62: Patient did not receive 3 check-ups during pregnancy, and so on.

Under the health facilities to be rightfully available for women under Janani Surakha Yojana (JSY), a safe motherhood intervention of  the National Rural Health Mission (NRHM), these are serious deficiencies that can affect a woman’s reproductive health.

Sunita Tanti (name changed), the young para-legal volunteer who showed her feedback sheet to her mentor, works as a ‘Community Mobiliser’ with ‘Pajhra’, an NGO that works  among the  Adivasi community in Assam’s tea gardens, mainly in the Sonitpur district on the north bank of the Brahmaputra river. Pajhra in Adivasi language means ‘spring of life’.

Stephen Ekka, founder-director of Pajhra, emphasises how important it is to concentrate on women’s health among his community. Officials at the NRHM say that the high Maternal Mortality Rate (MMR) in Assam (328 deaths per one lakh deliveries, the highest in the country) is mainly due to poor healthcare facilities among the tea garden population. Sonitpur district has the highest maternal and infant mortality rate in the country.

Anaemia among the women is rampant. According to the National Family Health Survey-4 (NFHS-4), 46 per cent of girls and women between ages 15 and 49 in Assam are anaemic. Other health related issues like hookworm, hyper tension etc. also bog down the women in tea gardens, says Lakshmi Goswami, gynaecologist and obstetrician, who has long experience of working among Adivasi women in the Sonitpur district.

Yet, these women work side by side with their male counterparts, devoting as many hours. Says Rameswari Tanti of Tinkharia T. E. located about 40 km from Tezpur, Sonitpur district’s headquarter, “We start work at 8.30 am and work till 4.30 pm with an hour’s break for lunch, all through the year. Sunday is an off day.” However, they say, they don’t have time to go to the ‘line’ (where their  houses are located) to have lunch and so bring something to eat.

The biggest problem they face, however, is lack of proper toilet; this becomes particularly difficult during their menstrual period. Though under the Swasth Bharat Abhiyan, some gardens have built toilets, they are not sufficient in number or remain half constructed, says Ekka. Recently when a survey was done in four gardens, they found that there were no sanitary napkins available, or affordable at the price. The women in Tinkharia admitted that they often went through the eight hour work schedule without changing their clothes-strips. No wonder that urinary tract infection is common among them, health workers say.

The wages for women labourers, however, are at par with male workers (at Rs 137 per day, ration extra), unlike in many other sectors. Their nimble fingers are invaluable for picking up the three leaves and a bud from the tea bushes. But, Ekka points out, “As they get paid leave for 84 days during pre and post natal period, they tend to work almost to the last of the trimester so that they can have more free time after childbirth. There are cases when a woman goes straight from the field to the hospital for delivery.” Though, by tacit understanding,  these women are to be given lighter workload during last months of pregnancy, it doesn’t happen this way most of the time, another  tea worker, Savitri Tanti, said.

On top of this, facilities they are supposed to enjoy under JSY are often missing. Lack of awareness and a certain acceptance of the circumstances make them more vulnerable.

To fill up this lacunae Pajhra, in collaboration with Nazdeek, a Delhi-based NGO providing legal help to empower marginalised communities, hit upon the idea of training  a group of 40 community mobilisers from among the community to check and monitor if the women were receiving what they are entitled to  under NRHM. The volunteers are given mobile phones so that they can text-message  their reports to the person monitoring at Pajhra.

In this, the code-sheet programming developed by New York- based International Centre for Advocates Against Discrimination (ICAAD) for Pajhra has been an extremely helpful tool. Each numbered box codifies a deficiency and the community mobiliser ticks accordingly which are then compiled according to the codes. The information is also fed to the website ‘Endmmnow.org’( ‘End Maternal Mortality Now’ and the areas where deficiency  occurs is mapped. Every three months a meeting is held at a grievance cell formed for the purpose  where the block programme manager and the block community  manager of NHM are present who are then given the feedback so that action can be taken.

Says Arpana Choudhury, justice programme associate, Nazdeek- Assam, “Working with these women has given me new insight- that women in the backwater still suffer despite the many facilities  introduced under NRHM. The loopholes in service provision have to be tackled at the grassroots. We also try to instill in the women a sense of confidence that there are people looking into their problems and they should cooperate giving information.”

Since 2014, the programme has been working in 10 gardens in the Balipara and Dhekiajuli area. Follow-ups are also done to see if things have improved after the reporting. For example, after reports were filed that the ultra-sound machine  at the Dhekiajuli Civil Hospital was not working, it was repaired. Now the pregnant women do not have to travel to Tezpur Medical College hospital at Tumuki quite far away, or pay private diagnostic centres a minimum of Rs 600 for the test.

The workers at Pajhra also hold meetings on the ‘lines’ to make the women about their healthcare. “We tell them ‘Save the children’; and take care of your health. Tell us your problems,” Choudhury says.

However, there is also a problem of retaining interest among community mobilisers. Of  the original 40 trained only 17 have remained now. “Not all of them can sustain the interest,” Ekka admits,” There could be personal problems or lack of time. Now we are looking at it from a different angle.”

As a first step they have tied up with All Adivasi Women’s Association of Assam (AAWAA) which works with the women of the community in nine districts of Assam. The members of the committee would now recommend names for the training as they are more familiar with the strengths and weaknesses of the local bodies. In another step, among the community mobiliers there are also men now. “We feel it’s important to sensitise men and make them a part of women’s healthcare  in the community,” says Ekka.

   (Pix by author)