“Asha means hope”, says the twenty nine year old SarodhanMalsom, describing her work as the Accredited Social Health Activist ( ASHA) in remote Dhanchora village ofAmbassablock of Dhalaidistrict where more than fifty eight people have died due to the recent outbreak of Malaria. Sarodhangoes around walking from home to home every day looking for malaria patients. At the same time she advises people to keep their surroundings clean, fight the outbreak and get them tested in case of any suspicion for the disease. She collects blood, tests the infection immediately in the diagnostic kits provided by the district health authorities and finally prescribes medicines for emergency cases.
Dhanchoravillage had five deaths in the last month due to malaria. During her daily rounds Sarodan finds a patient too sick with the most severe strains of the parasite in his blood. She arranges to shift him to the public health camp organized by the hospital. To others who also had tested positive for mild strains she provides the first dose of the medicine before facilitating their visit the nearby health camp for chloroquin and primaquinoral tablets.
“She is our hope”, “I had been detected with both the strains of the deadly disease but she gave me another life”, says frail JugunReang a forty- year old just recovered from the epidemic that hit Dhalai district a month ago.
Sarodhan is a mother of two and has attended her children also suffering from malaria before going around villages attending to patients. She is a trained ASHAworking with the district hospital for the last seven years. With the yearly outbreak of malaria in the state she doubles up as a help for the multi-purpose workers (MPWs) who attend to health issues in the remote villages.
Sarodhan like many other Reang, Tripura and Malsom tribe girls happen to be now running the health services in remote tribal villages of Tripura. The communities considered primitive people group (PPG), remain excluded and backward living in extreme poverty and deprivation.
Just like SarodhanUmmariumReang has also been on an emergency call to the ASHA health center attending to people queued to get their blood tested. She tests patients for malarial parasite through a diagnostic kit provided by the district hospital. A prick in the middle finger of the patient takes out a few drops of bloodthat she puts in the kit diligently, adding a testing medicine and then within seconds the results are out. Two of the patients were detected positive for malaria infected with the deadly parasites(Plasmodium falciparum and plasmodium vivax)whereas three others were mildly infected with just one strain of the parasite. The tested slides are then kept carefully tied with a band to be handed over to the district health officials. Each slide will fetch her fifteen rupees whereas if it is a malarial positive slide it would provide her rupees ninety. Till now she has been able to collect more than seventy slides some positive and some negative. “But I will get reimbursed only next year in February” we usually get paid during the end of the financial year.” NyantaraDebram a mother of three has been an ASHA worker for the last nine years. Her two sons were born at home and she was almost dying during her child births. But it was her own personal experiences that motivated her to be a health activist. “The hospitals are so far off. We are paid only rupees six hundred as incentives if we are able to get the two ante-natal check-ups for the mothers and ensure child births and immunization for the babies in hospitals”, explains Nyantara.
With almost no public transport facilities available in remote villages it is nearly impossible to complete institutionalized child birth process in these villages. Many of the ASHA workers just exist on papers as many of them cannot complete their tasks.SanaliReang is just twenty year old from the Reang community said to be one of the most primitive tribes of Tripura. She could not finish her sixth grade only because there were no schools in the proximity of her village near Gandhachara block. She joined as an ASHA worker after one of the girls left feeling demotivated. “Actually she could not complete even one cycle of institutionalized deliveries. Also it takes so much time for the reimbursements that we end up paying from our own pockets”, she adds.
TharanaReang was born two years back in the middle of the night at home. “We could not arrange for conveyance. Usually we hire auto rickshaw that comes to take the pregnant women to hospital. They charge about five hundred rupees. It is too much. The villagers cannot afford. Even though allowances for the pregnant women cover the cost but it actually takes long before the reimbursement, says ShayamReang, Sanali’s husband.
Still, it’s sheer motivation that keeps the Asha workers going.”At a time when the public health services are almost on collapse in the state, the voluntary services by these village women serve as the only support system”, accepts ChandrakantaMalsom, the project officer of World Vision, the NGO working for the uplift of the tribalsin the remote hilly region of the state. The organization is supplying insecticideimpregnated mosquito nets to families to fight malaria. It is the ASHA workers who facilitate distribution and use of the nets in the villages that is now turned to be the epicenter for Malaria.
Vector borne diseases are very common in the land locked state Tripura sharing the major border with Bangladesh. The terrain being hilly and far- fetched makes it all the more unreachable for many. In addition low literacy rate and severely malnourished families make the districts extremely backward and under developed. The onus is on the ASHA workers who despite the hardships of living in disease prone areas facilitate the health services.
PhulaitiReang another Asha lady from the Reang communitycould not even motivate people of Dharampara in Khowai district home to the Tripuris, Malsom and Reangtribals, to go to the nearby public health center. “Children did test positive for malaria. I did almost beg to the villagers but initially most of the people of my community do not understand the gravity of the situation. This is the time for jhum (shifting) cultivation and people almost live for months in the fields. They would not want to leave work and go for treatment. They live in the makeshift huts in the field very susceptible to mosquito bites”, Phulaiti explains.
“That is the reason people depend more on quacks and perform their traditional pujas than visit the far off hospitals”, adds Dr. Anup Das of the Ganganagar Health Center. “It is difficult to mobilize patients in the hospital and so we have to depend on local ASHA workers”. But KroinuMog, another ASHA worker adds, “If the ASHA workers can reach the remotest of the villages why can’t others?”