What does it mean for me to be in CARE?

I have to submit this application! I simply cannot miss this wonderful opportunity”, mumbling this to myself, I started another unfinished job as my supervisor called out for me. It was another day being spent in frustration, but the difference was that I had something going on in my head! It was just about 5:30, perhaps the closing time, when I clicked on the vacancies in CARE portal and uploaded my application on the same.

Next thing I knew, I was on the train to Delhi to attend the interview in a project called Integrated Family Health Initiative (IFHI). The interview was an experience which made me smile throughout the day! One moment I was talking to a group of animated young professionals to help ‘us’ get to a conclusion during group activity, and the very next moment I was sitting in front of a desktop analyzing my feelings in different situations!

My joy knew no bounds when I heard from ‘them’. The first thing which caught my attention was the name of the organization; “CARE” it evokes a kind of warmth to hear that. For a beginner who was still not very sure of herself, it was ecstatic to hear from an organization which had a ‘big name’ (Especially when I had tried hard to do an internship during summers in CARE and had no success in that!).

I had not yet joined CARE, when I attended one of its meetings. It changed my complete outlook towards my job. I wanted to be right there, in the midst of those intelligent and passionate people working for something which made a difference to lives. I kept awake that night, waiting and wondering when I would be a part of it. My own life was in turmoil personally as well as professionally when I joined CARE. I was not sure whether the change of organization gave me that high feeling or was it something else?

By joining CARE, my college days came back to me! I would sit with awe as our Technical Director would speak. I would put up as many questions before him without even thinking for a split second (I actually bugged many people in that process; as incidentally my question would just pop up when we would be running late for Tea break!). I was like a child, who was starved of knowledge, of ideas; my job had done that to me. But here I was there, beginning to feel alive yet again!

It has been about 5 months today and I seem to have come a long way forward.  My family often tells me that I seem to be radiating positive energy lately. It is basically a game of the attitude on work; I have found so much of warmth and optimism in people here that makes me belong here; in this team and this project!  

Working on a project on Maternal and Child health was my dream since long! The issue closest to my heart is the health of women in our society especially would-be mothers. A sensitive thought as put in one of our meetings “Pregnancy itself is risk to life” clearly mentions the grave danger our women (especially in developing countries) face during child birth. One of the natural process become life threatening! Here we are trying to make a change and remove road blocks from all sides; awareness among the community members as well as quality of services in Public facilities. I always was intrigued with ‘doctor-like’ technical details of things; what better would be to heal lives? With continuous brushing up of our knowledge skills on technical side of IFHI project, today I feel empowered to speak to front line workers about some simple things which act nothing less than a doctor’s advice. Gaining and use of this knowledge on field has given me immense satisfaction of doing something worthwhile. Counseling of one mother successfully on field who was resistant to get a TT shot gave me a peaceful sleep at night!

When ‘perceived’ cold and disinterested front line workers listen to you with awe;  and start to share their experiences (apart from their usual grievances about incentives not paid) is when my heart swells up with pride and confidence. I can make them laugh too! Imagine a person like me, who used to be so very conscious of speaking in front of even two people. Today I can conduct trainings efficiently and ‘connect’ with people; my dream to teach is getting realized too! Earlier I always needed my lines ready in the form of a paper incase I go blank in front of an audience; but not anymore!

I had only read about soft skills of a manager in our HR class during college, but my job had not given me an opportunity to explore that. Here in CARE I seem to slowly understand the intricacies and challenges to work with a team; and to experience people report to you! Believe me, it gives you a high!

Most importantly I have witnessed in myself a sense of receptiveness to ambiguity of situations. I personally am a person who would be very uncomfortable in a situation which is unpredictable. Here ever since we have joined IFHI, the project seems to be evolving! It feels we are here to put our heads (and hearts) together to make something work. It gives me the feeling of being in a perfect learning organization (another concept we learned in HR class in college) which is giving me a golden opportunity to grow professionally as well as personally!   

I am an agent of CHANGE!

Born in suburb’s of Patna as eldest of her siblings; the responsibility of the whole house rested on the fragile shoulders. Her curly hairs were short because she did not have any time to care for them. The pink and blue coloured suit which she wore often was her favourite one and she made sure it was always clean.

“Sumitra, where are you? Come here and feed Manish; your little brother. Is the food ready Sumitra; why is it taking so long?” 

This 12 year old girl was ‘almost’ the mother of her 6 sisters and youngest brother. She was ‘on call’ all the time and as she herself tells us “I was the one who was consulted for any future plans for the family or even the daily menu! I used to be brilliant in studies and games as well. My father would often say that once I grew up, I would change the world!”

But the reality of life turned out to be different for her. She had just completed 8th when she was married off. Life did not become what she dreamt of.

Sumitra tells us “For my own future, none consulted me! I wanted to study more, do something for myself and my society. But my pleas did not find any place in my dad’s ears (who was otherwise the most caring person in my world!) That was the day when I sensed that my life is nothing better than that of a refugee.”

Her new home was in a remote village called ‘Kedalpura.’ Since she was the young wife, youngest of 4 ‘married’ brothers and hence was destined to be most submissive. Her submissiveness found a way into her husband’s heart who supported her when she wanted to apply as an Anganwadi worker. Sumitra says “One day at the village hand pump, I heard few women talking about some kind of work in the village itself - ‘Anganwadi worker’. I also came to know what one needed to be 8th pass for it.” It was then that Sumitra decided to approach her husband to help her fill the form for it.

It has been about 4 years since she has been working as an Anganwadi worker. Sumitra fitted into the role of teaching young kids, feeding them at the centre and distributing food materials to pregnant and lactating women perfectly. When we first met her, a lot of issues were on her mind; poor payment system, dissatisfactory government pricing of the foods to be distributed, unpaid incentives and extra work from almost all departments.

There was a lot of frustration in her; regarding her work and the system around her. Sumitra tells us “I would at times find my work to be too mechanical. Supporting my family was my initial thought about taking up the job, but then I started searching meaning in it. It was then we met people from CARE”

Operations of CARE had begun in Danapur block, one of the blocks in the Patna district in Bihar in April, 2011. The initial meeting included orientation to all the front line workers and follow up through block coordinators. The uptake of complete enumeration of families in the villages was the most difficult part. It was rigorous outreach activities that helped us make some space in minds and hearts of the workers. But then we met gems like Sumitra on the way, who were searching for a meaning in their jobs. It is true for many others out there who are self-motivated, just that little push would do! Who doesn’t need a purpose in life? Our interactions with AWWs on field soon initiated their home visits to beneficiaries’ especially pregnant women and young mothers. “We used to make visits to houses, but without any knowledge. Now we have an agenda and a clear picture as what we want mothers to know and do when we meet them” states Sumitra.

It has not been long in the project but there are many such stories which make you smile and wonder at how lives change through simple actions! It is not about how the system is working or what we are working on. It is about empowerment of people, individuals who are already in the system. It is not as much through putting in more resource we would be able to help them, but making them responsible for it. As finally Sumitra puts it “There may be a thousand problems in the job, but I find a unique happiness in looking into young healthy eyes. I feel proud and responsible for making a difference in their lives. I may not have changed the world, but I surely have contributed my bit!”

The Story of a Hospital............

Screaming, abusing and threatening the authorities a man rushes past! It was the third incident that week. It was only a day before that same intensity of screaming and shouting was followed by violent sobs. There was a loss of life! A young woman had entered the premises just around 9 at night. There was as it is few staff in the labour room then (I still don’t know if they can work out some kind of duty by round system). Her eyes looked full of grief; it was as though she would not be able to survive the pain. But she did! Her child could not-it died soon after birth. It seems that the child was in the womb for ‘too long’! It could not breathe when it came out, and no one knew what to do. Next day the story was a little different, we lost the mother itself!

Here let me take a few words to introduce myself; I am known as Referral hospital, Naubatpur, which is a block in Patna district, Bihar (It seems it is due to the fact that most of the cases are not handled here, but only referred out!). It is also sad but true that my premises are (or ‘were’ perhaps, but still there is a lot of scope of improvement) not too good, they are just ‘Ok’ types. Apart from that, the disinterested look on the face of the facility staff is what used to scare me most! They don’t seem to be dealing with human lives; all had become so very mechanical in their work.

The status of the Operation Theatre was not much different. At most times, it was a locked quite room except for ‘Family planning operation day’ (usually a Thursday). It is on this day that one could see a huge line; you could spot women of all ages there! And if you happen to interact with them, you would come to know that perhaps they have about 4-5 children in their family already (Come to think of that; they have already overdue their share of producing babies!). The Operation Theatre was so ‘little’ clean that more than cure, people might actually end up having infections in my vicinity. And my so called “Hospital Manager” (I rather call him a blind horse) who runs my management; used to close his eyes and run after only the performance indicators! All said and done, it still remained a big zero!

The frustration which I could sense among the OPD patients was immeasurable too. They didn’t seem to get any medicines there most of the times. I even heard one of the patients say “If we have to pay here too, what is the meaning of coming to a Government facility?” Just after this the store-keeper realised that the whole new stock of medicines was consumed by termites. Imagine, at one place people don’t get medicines and at other place it rots inside my stores! What a paradoxical situation………….

It was when the situation was at its worst that few young people came into picture. They were from CARE, an organization which had started its operations in Bihar recently. The project which was named as Integrated Family Health Initiative had a huge buying. It was to help improve the health facilities; it was about me!

The whole concept of ‘problem bank’ was initiated which helped the staff to realise the problems they had and work for them collectively.

Few simple practices such as hand-washing at all ‘important steps’ was internalised. Renovation of almost all areas; OT, Labour room, New born corner and wards was another face-lift I had (Almost like a plastic surgery!). More importantly, my staff got trained. Rigorous training and handholding was needed for all here!

It just about setting some things right there. I could never imagine that a little ‘order’ in the work could help reduce the frustration level of staff so much. It was not so much change in work structure but way the work was viewed now!

I am proud to say that now no woman or child dies here; either the complications are handled well or they are referred to higher facilities on time. Neither does the ‘operations’ happen in camp mode-like a herd of cattle. Now there is a family planning corner where the counsellor talks about the “Basket of choices” to the beneficiaries ie we talk about offering eligible couples;15-49 of age (who caters to the ones who get pregnant before that, is what I still think about!) all kinds of methods of spacing and limiting. (Workers do not talk about female sterilization only, which has an incentive attached!)

I felt like an orphan since a few months back, no one would claim me! My building was in shambles and there used to be only dogs in and around my compound. I felt that perhaps the end was near when my building would be broken and a “Fancy Mall” would be made in my place. (I have heard that is what is happening to all the old buildings now)

It has been quite a journey; I am an old man now! So is the Gulmohar tree in my compound which was once very green; and in the times of spring you could not even spot a leave on it, it was so full of lovely red flowers. It got dry in between, dry and old; just as me. But you know what? I spotted a few green leaves on it the other day. My story too goes in the same fashion…………..Voila! My prayers were answered! CARE team came to my block and now, it seems CARE had adopted me! I am also in the process of repair now and whitewashed-white and red (as Hospital Code, you see!) Now as you look at me I shine like a new coin, just out of the mine!

I hold the dream of being able to provide better services to people, close to my heart. I believe I would truly be a Referral hospital (not just by name, but in practice-as Shakespeare said” What’s in a Name?”)     

A start TODAY!

Work you do does make a difference in life; and when it does to other’s life, its worth doing! Sometimes you like your work, but even better is when the work starts liking you. I am proud of myself today; but it has not been like this forever.

It seemed that my nose-ring (like a noose) kept me bound to the house, even after my husband left to work abroad. With two small kids dependent on me, it was criminal for me to sit quietly at home. I would spend most of my time in useless household work, which would still leave me with a feeling so empty and useless. I wanted to do something for my children, myself and my village.

It was then that I heard about the vacancy for the post of ASHAs in the block, and got selected and tagged as “Meera Kumari” ASHA-Parsa (where I had come as a young bride sometime back). Even after the selection it took me a long time to start my work; for once there was nothing like any training organized for us. We were left to work and learn on our own. During our monthly ASHA meets it was more or less like a political party meeting, where everyone would be there but none would or rather could hear or understand anything, leave alone clear our doubts! There were many more like me in the group who wanted to do something concrete but felt helpless due to lack of knowledge or anyone to help us.

It was 1st Wednesday of the month that we were called for a meeting at Health Sub-Centre. It was informed by ANM didi (The only one we could turn towards help, but we saw her only once a month) that it would start at about 1 pm but since it was ‘too’ far from my home; I was double-minded and reached late at the venue. There I saw a team of young people who were trying to ‘enact’ how we ‘interact’ with pregnant women and mothers during our meetings with them. I got hooked! The team was from CARE and they were actually going to train us on how to ‘talk to beneficiaries’ coming right to the village.

It has been 4 months now after that first meeting and I have grown into a confident woman from that demure bride who could never even think about talking to her village people about ‘Family Planning’. Initially I had a lot of problems too. My work area included two extremes; one Musahar community (low castes) and Bhumihaar (upper caste) which made it very peculiar for me to work there. Although I didn’t believe much in caste system, the acceptance among the people there for me was very low. I decided to take up the challenge and started identifying the children who needed me the most.

As per growth monitoring charts, we decided to adopt few houses for ongoing counseling sessions. My visits to Musahar community were more than others since I realized that they needed my counseling more. This is where I met Laxmi and her 9 month old Rajesh. Rajesh when weighed came in ‘red line’. It was explained by the AWW that if he was not taken care of, he would be dangerously malnourished. This child as complained by his mother would not take anything other than her own milk. After getting the same reply from her in two visits; I asked her to bring whatever food was available at home. Reluctantly she brought out some cooked rice. I asked her to mix a little salt in it and started feeding the child. Lo and behold, the child started eating. Laxmi was ashamed of her laziness to feed her own child. Today the child is eating all kinds of vegetables, pulses and cereals and recovering well (as per last month’s weighing, he has come into yellow line category) and Laxmi is thankful to me.

Ravish, 2 month old was a feeble child who would never stop crying. The child caught my attention when his mother Archana had refused to get him immunized through ANM in-spite of repeated efforts. They were far too rich for that! I gathered all my courage to go to their house which was famous for its harsh language. After the initial hesitation, I was at ease with myself and started enquiring about breastfeeding practices from the mother. It was surprisingly scary that the child had been fed on bottle since the start. “We can afford bottle milk, that’s why we are feeding it!” is what I heard from the Mother-in-law, Sharda Devi. No wonder the child fell ill every 15 days and would never stop crying. Through the picture pamphlets I explained to the mother some ‘easy way’ of breastfeeding the child (I sensed the unwillingness to breastfeed was a reason here). Few signs of proper latching and suckling during breastfeeding were also taught to Archana. The whole concept of breastfeeding was changed from ‘free diet’ to ‘healthy diet’ for the richer class. This simple change in conversation style brought about a behaviour change and helped a mother to breastfeed her child again.

Today I feel the caste doesn’t define anyone’s development, only knowledge does! The continuous weekly follow up by CARE team has made us so efficient that we speak about anything related to mother and child confidently. Our visits to the field have made us gain respect in the communities. On one of the field visits when I heard “Apni ke hamni ke zindagi ke asal main Asha ho gayal baani” (you have actually become ASHA of our lives) from one of the villagers, my heart swelled with pride. I realize that there is still a very long way to go, but here I have made a start!     

A start TODAY!

Work you do does make a difference in life; and when it does to other’s life, its worth doing! Sometimes you like your work, but even better is when the work starts liking you. I am proud of myself today; but it has not been like this forever.

It seemed that my nose-ring (like a noose) kept me bound to the house, even after my husband left to work abroad. With two small kids dependent on me, it was criminal for me to sit quietly at home. I would spend most of my time in useless household work, which would still leave me with a feeling so empty and useless. I wanted to do something for my children, myself and my village.

It was then that I heard about the vacancy for the post of ASHAs in the block, and got selected and tagged as “Meera Kumari” ASHA-Parsa (where I had come as a young bride sometime back). Even after the selection it took me a long time to start my work; for once there was nothing like any training organized for us. We were left to work and learn on our own. During our monthly ASHA meets it was more or less like a political party meeting, where everyone would be there but none would or rather could hear or understand anything, leave alone clear our doubts! There were many more like me in the group who wanted to do something concrete but felt helpless due to lack of knowledge or anyone to help us.

It was 1st Wednesday of the month that we were called for a meeting at Health Sub-Centre. It was informed by ANM didi (The only one we could turn towards help, but we saw her only once a month) that it would start at about 1 pm but since it was ‘too’ far from my home; I was double-minded and reached late at the venue. There I saw a team of young people who were trying to ‘enact’ how we ‘interact’ with pregnant women and mothers during our meetings with them. I got hooked! The team was from CARE and they were actually going to train us on how to ‘talk to beneficiaries’ coming right to the village.

It has been 4 months now after that first meeting and I have grown into a confident woman from that demure bride who could never even think about talking to her village people about ‘Family Planning’. Initially I had a lot of problems too. My work area included two extremes; one Musahar community (low castes) and Bhumihaar (upper caste) which made it very peculiar for me to work there. Although I didn’t believe much in caste system, the acceptance among the people there for me was very low. I decided to take up the challenge and started identifying the children who needed me the most.

As per growth monitoring charts, we decided to adopt few houses for ongoing counseling sessions. My visits to Musahar community were more than others since I realized that they needed my counseling more. This is where I met Laxmi and her 9 month old Rajesh. Rajesh when weighed came in ‘red line’. It was explained by the AWW that if he was not taken care of, he would be dangerously malnourished. This child as complained by his mother would not take anything other than her own milk. After getting the same reply from her in two visits; I asked her to bring whatever food was available at home. Reluctantly she brought out some cooked rice. I asked her to mix a little salt in it and started feeding the child. Lo and behold, the child started eating. Laxmi was ashamed of her laziness to feed her own child. Today the child is eating all kinds of vegetables, pulses and cereals and recovering well (as per last month’s weighing, he has come into yellow line category) and Laxmi is thankful to me.

Ravish, 2 month old was a feeble child who would never stop crying. The child caught my attention when his mother Archana had refused to get him immunized through ANM in-spite of repeated efforts. They were far too rich for that! I gathered all my courage to go to their house which was famous for its harsh language. After the initial hesitation, I was at ease with myself and started enquiring about breastfeeding practices from the mother. It was surprisingly scary that the child had been fed on bottle since the start. “We can afford bottle milk, that’s why we are feeding it!” is what I heard from the Mother-in-law, Sharda Devi. No wonder the child fell ill every 15 days and would never stop crying. Through the picture pamphlets I explained to the mother some ‘easy way’ of breastfeeding the child (I sensed the unwillingness to breastfeed was a reason here). Few signs of proper latching and suckling during breastfeeding were also taught to Archana. The whole concept of breastfeeding was changed from ‘free diet’ to ‘healthy diet’ for the richer class. This simple change in conversation style brought about a behaviour change and helped a mother to breastfeed her child again.

Today I feel the caste doesn’t define anyone’s development, only knowledge does! The continuous weekly follow up by CARE team has made us so efficient that we speak about anything related to mother and child confidently. Our visits to the field have made us gain respect in the communities. On one of the field visits when I heard “Apni ke hamni ke zindagi ke asal main Asha ho gayal baani” (you have actually become ASHA of our lives) from one of the villagers, my heart swelled with pride. I realize that there is still a very long way to go, but here I have made a start!     

I am NOT going to DIE!

“Sarita, Sarita……….You are going to be OK!” I hear faint voices and think perhaps I am NOT going to be OK after all. (This is what happens in movies too, I guess when someone is going to die, and the doctor says “You are going to be Ok”). I can feel someone dabbing at the end of my yellow sari and continuously caressing my brown curly hair, but the sensation is soon getting numb.

With darkness gathering around me, I think back as what I have been through in the past couple of hours (days or perhaps months or years!)

With the start of my puberty, my parents were fanatic to get me married (I simply couldn’t understand the reason back then!) The first DECENT boy they came across was to be my future husband. He lived in Tilhavan, a village situated in Naubatpur block of Patna district in Bihar. It was not even connected by a road! I could only sit and wonder as how life would be for me from now on?

It was one morning that I woke up feeling very sick and weak! Soon after that I started vomiting (and the most silly and surprising thing was that everyone around me starting congratulating me!! Is that how we deal with a patient here? I was to still find out!) The truth dawned on me soon after and I became the would-be Mother! But the fact was to be kept it a secret for some time (Though I heard my mother-in-law whispering the secret to the lady next door, who is the known radio of the village!) The days were nothing different for me even after (Except for the added burden of morning sickness, flushes, pains and headaches!). For a girl who was only 15 then, it was difficult to understand what it is about to be a mother was!

That morning I was putting out the clothes to dry, when a lady walked up to me. She introduced herself as Rashmi, an ASHA, a volunteer health worker of the village and asked if there was a woman pregnant in the house? (So the radio had worked as I expected!)

Next day, I was taken by the Rashmi to meet a “lady in white” who was known as the ANM didi in the health system. Manisha didi gave me a shot of Tetanus Toxoid (TT) and 100 pills to eat. These small red looking pills were to increase my blood, as I was told that I looked pale. (Let the mother-in-law stop sucking some, everything would be alright) She told me that if I delivered in a government hospital, I would obtain Rs1400/- after my delivery.

In the mean time I could feel him grow within me! He seemed to take away all the nutrition from me. Most days I would feel sapped of energy and dizzy. (If you are wondering how I already know my baby is a “HE”, it was what my mother-in-law constantly told me - rather threatened me – ‘it better be a he’).

Unexpectedly the pain started one late evening for me. The vessel out of which I was serving food to my husband fell on the ground, with a loud noise!

Since there was no vehicle in the vicinity, I had to be brought to the hospital on a cot (The news of getting money after delivery was enough to persuade my mother-in-law for an institutional delivery, otherwise as she says “All of my children are healthy and born at HOME”).

I cannot exactly call THAT a Hospital! There was none around except for a sleepy lady who cursed me for having labour pains at that hour! As soon as I was shifted on the cold steel table I started shivering badly (I felt it to be more than shivers, as though my whole body was being shaken under a spell) I was told that my blood pressure was far too high and none could handle it there. The moment the lady saw this, she asked my husband to take me to a HIGHER hospital some 40 kms away for an operation! An ambulance was arranged to take me away (Not without asking to pay for it!) It was very difficult to think to go that far by someone as poor as us. So we landed in a private clinic behind the hospital instead (to cut me open!). The nurse at this clinic took my blood from the finger and shook her head. She told my husband that I had far “too less blood” and they did not have any facility to “transfer blood” during operation. For the second time in a night, I was let down by another hospital!

Next moment I was fighting between life and death in an ambulance! (We had to finally call an ambulance to take me to the next far off hospital). It was a huge question whether I would survive to reach the hospital or not? I guess even after reaching there, would I come under the knife of a doctor? (or would there be any doctor at this hour for that matter?)

With so many questions running in mind, none of my family members believed I would survive, but I did! Yes, it was impossible, but I did make it, perhaps to write a new story.

Soon after my baby was 6 months old, some people (city folks) knocked at my doorstep. They introduced themselves from CARE. They told me that CARE was an NGO and that it had started its work recently in my village. The two-way work that they talked about, on field as well as the hospital, is what impressed me. You require two hands to clap, true isn’t it? During talks with them, the story about my child-birth came up. They talked about birth-preparedness (I still didn’t understand what that EXACTLY meant) and many more things. This visit was soon followed up by Madhuri, an Anganwadi worker,who teaches young children and provides us with some supplementary food (I did not even know she lived in my village!). My child was weighed and registered for Anganwadi services. I was asked to attend the Village Health, Sanitation and Nutrition Days (VHSND) at the Anganwadi centre once a month and was also advised about various things to follow for keeping a young child healthy and happy. In one of my visits to Anganwadi centre, I met some people, who were from CARE too. They also insisted us (young mothers like me) to visit the Anganwadi regularly and learn all the good ‘new’ things. It felt nice to have someone actually talk about you and your child’s well being. I felt there was so much more that I could have done for my baby during my pregnancy had I known about this platform earlier (or perhaps had CARE come to me earlier!)

I am a would-be mother again now, but there is a difference! I am not that naïve girl anymore, but an empowered woman. I now know that I need to save for my baby, keep contacts of the vehicle owner in my area for transport and most importantly identify the facility where complications that can arise during delivery (I know them well enough to teach people too!) can be handled well. I learnt all this in a VHSND session on birth-preparedness (I later came to know that CARE had trained the AWW for such things). I have also been talking about birth-preparedness to my sister who stays in Rohtas, another district of Bihar. I even told her, “Wish CARE would work there too, they really ‘CARE’ for you!” I have also got myself checked for ‘no danger signs’ by the ANM, and am taking all the services due for a pregnant woman; but I still know that its not ‘fool-proof’ for no complications. 

So, this time I am ready, I can take the bull by its horns. All thanks to our health system staff and CARE team who made a difference in my life and probably are going to make changes into many more lives through the life of this project.