Thursday, November 29, 2018

My First 100 Days: Chronicles of a Clueless Economics Student

Cearet Sood

The importance of the First 1000 Days was only a concept that I had studied in my second year of college, as a part of the Indian Economic Development module. Infant Mortality Rate, Maternal Mortality Rate were just definitions to me, meant to be reproduced in examinations. I was taught their relation to Gross Domestic Product and per capita growth. Economics, at university level in India, is taught without emotion. We learn everything as it is. As it exists, without ever questioning it.

This lack of discourse, instead of demotivating me, encouraged me to find answers for myself. Post college, I studied liberal arts. There, I had to unlearn a few things which I had been taught as an economics student. Never assume things or preexistence of knowledge and never take things as they come- always question, protest, demand, rage - do whatever it takes to initiate change. If you want to be a changemaker, you have got to start from the start. By this, I mean to say that one needs to understand and appreciate the complexities involved in fighting the existing reality and building new models which will bring about a change. Numerous inefficiencies in health, education, security, food exist but our criticism counts if we do something about it.

With this in mind, I joined The Antara Foundation with hopes and dreams of shaking things up in the public health domain. My first few weeks were spent in digesting the information about the existing health system, government schemes, and TAF’s  interventions. After that, I started making field visits to Anganwadi Centres in the sector allotted to me- Panwar. A sector is the third tier in the rural demography (District -> Block -> Sector -> Village). Panwar’s population is around 19000. I was assigned to the technology intervention; we have developed an application and provided Frontline Workers with tablets. This has been done with the intention of making the process of data collection easier.  It has made coordination between the three FLWs easier, as data flows easily among them, making possible a three-way cycle. It makes data monitoring easy for us as well, as we have proper documentation and therefore, better identification of beneficiaries. 

The 'Honey Singh pose' is a favourite among kids
I understood the economics/data collection part of it: baseline data collection (pre-intervention data), operational data (to see how the intervention is playing out). What I took time to understand are the stories behind these data points. These stories are the reason why I don’t dread waking up every day. How my health workers have reached the point they are at now, how some of them have overcome difficult personal problems, how they have managed to study so much, and how they take care of the children and other MCHN beneficiaries that come to their AWCs. They work at home, they work in their fields (literally), and they work in AWCs/SCs/PHCs/CHCs. Their ability to juggle their responsibilities and still do everything efficiently is inspiring to me. Their warmth and hospitality never fails to amaze me. I have learnt a lot from them, and I hope I continue to do so.

Smiling through the bad lighting
Another thought that came to my head was how we’ve been conditioned to focus on the end result, and never the journey that takes us to it. Here, I realized that the journey is just as important. During under-graduation, I had been trained to look at what the statistics and regression lines tell me. While, they are crucial for such interventions, I have been fortunate to learn the other part as well.

Another important part of this journey has been the result of my mild disdain for practical pursuits, which in this case would be to understand and memorize the directions to my AWCs. Sadly, my navigation skills aren’t quite up to the mark. When brainstorming about the title of this blog post, my coworker suggested Lost in Panwar, which does make a lot of sense because a minimum of 10-15 minutes of my time goes into finding the places that I’ve visited at least thrice now. This experience seems worth mentioning as nothing is more embarrassing than the fact that even your FLWs don’t trust you when it comes to finding your car. The good, and the bad, both need to be out.

Jhalawar in July (which is when I joined) is beautiful. Jhalawar, in other months is also beautiful. You just need to know where to look. The first two things I noticed here were the # of cows, and the # of flowers. Both these categories fascinated me to no end. Like a typical city person, I clicked pictures at every instance I could find in villages. They were just keepsakes- to remind me of a simpler world every time stuff gets complicated in office (Beat Plans, Open Data Kit, Sharepoint graphs.. you get the drift). Jhalawar has helped me in living more simply and slowly.

Fast forward to November: one lesson learnt is that it takes time to ‘shake up things’ (first job lessons, people). It’s been a heartwarming experience. Babies have taken selfies from my camera, ladies have offered me tea and sweets unfailingly- every time, school children have played games with me.

Mother-son duo showing the way to the AWC
For an economics student, this has been an eye-opening experience. I have learnt that we cannot understand things in silos. Everything is interconnected and interlinked. Our systems comprise of humans, after all. It is imperative to look at these systems holistically and not mechanically, as we have been used to doing. 

Empathy, joy, gratitude is what my FLWs and the community has taught me. I can only hope I can offer something as precious back. Then, I’ll have fulfilled my hopes of attempting to make a change.

MCHN: Maternal and Child Healthcare, and Nutrition
FLWs: Frontline Workers
AWC: Anganwadi Villages
SC: Sub Centres
PHC: Primary Health Centre
CHC: Community Health Centre

Cearet Sood is a fellow with the Antara Foundation

Tuesday, November 27, 2018

Questions I wish to answer

Prerna Gopal

As women, we are always expected to be careful of our surroundings, of who we talk to, and even how we conduct ourselves. Our path is often blocked by the constant fear of finding ourselves in situations that lead to trouble. Thus, things that come easily to the other half of society often elude our grasp, making it all the more difficult to survive in a man’s world. Being raised in a liberal family that sees no difference between men and women, makes me question the marginalization of women, every day.

I came across a situation during my field visit to a sector called Manoharthana in Jhalawar, Rajasthan. An inebriated man walked into a sub-centre, that was being run by an Auxiliary Nurse Midwife (ANM) and also had a few male patients present. He threatened all those who sat in the clinic and forced them to tend to his self-induced problem. Eventually, the other male patients managed to pacify this nuisance of a man and handled the situation as they felt necessary. It may seem like a fairly inconsequential event to many. However, the anger and dismay I felt at that moment were stronger than others could potentially fathom. I was told that such incidents were routine and all health workers have to deal with them, particularly female health workers. 

During another such visit to the Harigarh Primary Health Centre (PHC), I was involved in an interesting conversation with the ANM present there. Apparently, there was a sterilization camp being organized at the PHC a few days later. Many questions popped into my head when I heard of this event which prompted me to ask about her experience while trying to promote vasectomies and other forms of sterilization.

“Aadmiyon se baat nahi karte hum. Kya pata woh humme kya samjhe aur humein kya mushkile hon”
(“We do not talk to men. They might misunderstand us and we might land into trouble with them”)

Primary Health Centre, Harigarh (Picture: Rithika Sangameshwaran)
Her answer made me wonder what the female front-line workers (FLWs) feel every time they go for health visits around the village advocating for important public health issues like contraception, reproductive health, and maternal health. How comfortable are these women talking about such things in public? Especially when they stand the risk of being stigmatized and labelled uncultured for merely uttering these terms. Perhaps this might be just the smallest of their worries. They might even be subject to physical harassment or worse.

A study conducted in Udaipur, Rajasthan looking at the performance of ASHAs identified multiple socio-cultural challenges1. These include lack of support from family members, economic struggles, lack of adequate remuneration, and caste/religion-based discrimination. This study reiterates the importance of societal structures and systems in the functioning of health departments and workers. Particularly with regards to female FLWs including ANMs, Anganwadi Workers (AWW), and Accredited Social Health Activists (ASHAs) who work within a social system that forever burdens women with problems that are essentially not even theirs to start with. It feels no remorse while burying them deeper and deeper, into a dark chasm. Yet, the general consensus is that health workers are lazy, uninterested, and even incompetent. But is that really true?

Even though there might be exceptions to this, I feel we must introspect and ask ourselves how often we pause and think about the consequences of our ignorance. In other words, what are the implications of our ineptitude to alleviate these women from their worries? These women yearn for a world where the combination of their chromosomes does not predetermine their chances at a safe future or their competency. We can only achieve this if we start looking at health in tandem with other wider social and economic determinants and gauge their impact on the functioning of health service delivery.

By writing this article, I do not intend to justify or even excuse the work done by these health workers. I merely wish to find out what role do young individuals like myself play in addressing these inequalities? How do we bring about a social movement where one’s health is prioritized over everything else? How do we build institutions and systems that are strong enough to stand the test of time and eliminate all forms of malady? Perhaps, these are the questions I would be trying to answer during my year-long fellowship with the hope that maybe one day we can build a safe haven for every woman, man, and child. 

(1) Reetu Sharma, Premila Webster & Sanghita Bhattacharyya (2014) Factors affecting the performance of community health workers in India: a multi-stakeholder perspective, Global Health Action, 7:1, 25352, DOI: 10.3402/gha.v7.25352

Prerna Gopal is a fellow with the Antara Foundation

My First 100 Days: Chronicles of a Clueless Economics Student

Cearet Sood The importance of the First 1000 Days was only a concept that I had studied in my second year of college, as a part of the I...