An accredited social health activist (ASHA) in her remote, often flood-ravaged village in Odisha, Pankajani not only saves lives on a daily basis but goes way beyond her call of duty to be available to her wards at all times spreading awareness, dispensing advice and curing ills. Her dedication is plainly visible as she recalls painful memories of last year’s floods in Odisha and the steps she took to ensure that the situation in her village remained under control.
Lean, tall and with a quiet demeanour, 40-year-old Pankajani Behra looks like any other ordinary woman in the village of Bhanjachura, in Odisha’s flood-ravaged, coastal district of Balasore. But she’s actually quite special. For very often this lady in blue – she is usually dressed immaculately in a sky blue sari – is the only source of hope in times of illness or any other medical emergency for the people of Bhanjachura. “She is like an angel for me. And why just me, for most of us here. I am here, alive and talking to you, only because of her. My baby is healthy today all thanks to her,” says Tikki Donphat, a young mother.
Behra is an accredited social health activist (ASHA) of the government’s flagship programme, the National Rural Health Mission (NRHM). Her official duties include spreading awareness about good health practices, immunisation campaigns and assisting the anganwadi worker or Auxillary Nurse Midwives (ANM) in ensuring that a pregnant woman in the village, and later her child, is well taken care of, before and after delivery.
Behra’s work, however, is hardly restricted to any rule book.
For the village people, I am the most visible and first point of contact for any health related issue. So no matter what the ailment, be it a headache, fever or stomach flu, besides pregnancy related issues, I get calls for help at all times.
And she’s ever ready to swing into action. Like in the case of the eight-months-pregnant Donphat, who went into labour suddenly and started bleeding. It was in the middle of the night and Behra was called immediately. As she rushed to help her, she called for the Janani Vahini, a government ambulance, which eventually transported Donphat to the district hospital, 10 kilometres away. Behra stayed with her for two days and later returned with the baby in tow, amid relieved smiles of the family.
She recalls another time when her timely intervention saved a village elder. “A few days back, I got a call from a village elder who said that he has been having constant headaches and wanted me to take him to the hospital. When I took him there, it turned out that he has a tumour. Thankfully the treatment has begun now,” she says.
Behra takes her work seriously. Armed with basic first aid knowledge and a kit that includes Oral Rehydration Therapy (ORS) sachets, iron and folic acid tablets, chloroquine, Disposable Delivery Kits (DDK) and condoms, she walks the narrow lanes of Bhanjachura daily, visiting households and interacting with the women and others. She says,
Sometimes there is a lot of work. But when you realise that you are better equipped to tackle a health condition than any other villager, you cannot turn down a call. After all, I took up the work of an ASHA six years back for this very reason.
Although each delivery that Behra assists in not easy, seeing that she has to make proper arrangements from her remote village, her real test came when Odisha was ravaged by floods last year. Nearly 2,600 villages were submerged and lakhs of people affected. And Balasore, a coastal district, in which Bhanjachura lies, was one of the worst-affected. She recalls, “It was in October, right after the floods. I had gone out for a few days on work and when I returned, I got a phone call as soon as I stepped off the bus. It was a frantic call from someone in the village — 13 children had fallen ill and the parents didn’t know what to do.”
When she reached the village, Behra understood that she was looking at the beginnings of what would soon become an epidemic. “I mobilised some people to help me provide ORS to the ill children and then started making arrangements for a vehicle to take them to the Remuna Community Health Centre (CHC). However, when I called the medical officer at the CHC, he told me that it was full. So I decided to take them to the district hospital.”
But that was not all. With water borne ailments spreading rapidly, others in the village started falling ill, too. “It was a terrible situation. There was no one else I could turn to for help and people were looking at me for guidance. I remember ferrying nearly 50 elders and more children to the hospital, all the time making phone calls and giving them ORS for rehydration. I don’t think I slept at all for three days, and just stayed with the patients,” she says.
For her commendable efforts in saving the lives of her village folk, Behra was given state recognition in the form of an award. But she says she would do it anyway. In fact, she doesn’t really go looking for credit or monetary compensation for all the hard work she puts in. “During those days I spent more than Rs 1,000 in vehicle charges and phone calls. For a person like me, that is a large amount. But I have not been reimbursed yet,” says she.
Incidentally, ASHAs get a performance-linked incentive. For each delivery she assists in, Behra gets Rs 350. Over the last six year she has assisted in 150 deliveries. So it’s not the money but the commitment that keeps them going. “You need commitment to do a job like this. I am married with children of my own, so I have a full fledged house and family to look after. But even then, this entire village is like my family and I am at their disposal when they need me,” she says.
While the NRHM guidelines state that a village of 1,000 population should have one ASHA, until last year Behra had the responsibility of catering to the entire population of two villages. It was only after the induction of another ASHA in the nearby village that her work has eased a little.
For the overall scenario of healthcare to improve even further, she believes that health infrastructure needs to be developed considerably, especially considering that the state has a maternal mortality of 258 (for every 100,000 live births), well above the national average of 212.
We need more ambulances. The Janani Shishu Suraksha Karyakram (JSSK) scheme promises free transportation to ferry a pregnant woman to the hospital, but there are times when we call the Janani vehicle and have to wait for a long time, because it is busy elsewhere in the block. Once, one woman gave birth at home during such a wait, thankfully everything was normal, but otherwise it would have been very dangerous situation.
But despite the challenges, the hard work and the odd hours she sometimes has to keep, Behra is happy. She pauses and then comments, “I like my job. Not only does it give me the financial independence and the ability to run my household, it also gives me immense satisfaction. There’s nothing like being able to bring hope to a helpless person’s life.”