Case Studies
Maternity Centre in a Hutment
MAVIM identified some staff to work in the remote hamlets in Satpura ranges. In order to lend assistance to them and also to ensure health care to the women in the villages, a maternity centre was established in a hut in Bijaripada with the help of the Department of Health.
Che Geuvara, a revolutionary, an icon of the youth throughout the world! Che joined the revolutionary forces in Cuba and then planned to carry out similar revolutionary struggles in latin american countries. By training, however, Che was a medical practitioner. He was committed to provide medical facilities to the mining workers. The realisation dawned on him while diagnosing the illnesses of the workers and treating them, that the chief cause of the illnesses of the mining workers was the situation in which they lived and the remedy lay in bringing about a change in the situation itself. Che then strived throughout his life to ensure that the miners could work in a healthy atmosphere and that they get access to health facilities. A somewhat similar situation was experienced by the functionaries of Mahila Arthik Vikas Mahamandal or MAVIM. Their attention was drawn by the plight of the tribals in the Sahyadri and Satpura ranges where the situation was grim. Leave aside access to health care, there was no trace of educational facilities as well. MAVIM was not an organisation which could be deterred by this situation. They first carried out a comprehensive study of the situation when they realized that no health facilities existed in these areas. In fact, the tribals had no awareness of health related issues whatsoever. It was at first necessary to bring about awareness of health issues. It was equally important to ensure provision of medical facilities. Thus, a maternity facilitation centre was established with the help of the primary health centre of the area. This health centre housed in a hut has brought about a revolutionary change in the health related situation. MAVIM is convinced that if the tribal women of Nandurbar district are provided proper guidance, they would be certainly be able not only to banish malnutrition from this district which has been declared as malnutrition affected, but also provide solution to many health related issues obtaining in the district. There have been many instances of deaths of pregnant women due to lack of medical facilities or due to delayed provision of facilities. The tribal groups inhabiting the hill ranges of Satpura have to face innumerable hardships as regards availability of health services. Obviously, the only solution to this is provision of adequate health services. However, as the government follows certain criteria for providing health centres, the machinery providing health services does not reach small hamlets. MAVIM, however, was determined to put an end to this situation. As a solution, some staff were identified to work in these areas. In order to lend assistance to them as also to ensure health care to the women in the villages, a maternity centre was established in a hut in the remote hamlet of Bijaripada with the help of the Department of Health. The tribal women used to deliver within their homes, a practice which carried many risks to their health and safety. Therefore, a maternity centre was established as a first step. Bijaripati is a hamlet in the Satpura ranges on the Akkalkuwa- Molgi road. It consists of six smaller hamlets. The village, with a population of around 950 people, is strewn with small huts. Endowed with nature’s beauty, the surroundings are inhabited by simple minded people who share with each other their tales of sorrows and joys. It is indeed delightful to state that the maternity centre is operationalised in this area with the guidance and help of MAVIM.
The genesis of the idea
MAVIM had organized a workshop in Nandurbar in which the representatives of the self help groups in the district were invited. Discussions were held in the workshop on health related issues. This was a topic close to the hearts of the women. As they were aware that the graph of good health of a family rises when the woman of the house herself is healthy, the thought took root that some initiative should be taken for the provision of health care within the village itself. This led to the idea that some facilities should exist in the village at least for elementary health care.
The village development council (gav vikas samiti) of Bijaripati took the initiative and the health care centre was established in April 2010.
The Health Centre
The health centre has been started in a hut like structure in Bijaripati. The place belonged to Rekha Padvi who offered it for the health centre. The structure has been partitioned into two and the inner part has arrangements for adequate light where a cot has been placed. The area for checkup has been formed by using a saree as a curtain. Expectant women are examined on the cot with a clean sheet spread out. The centre has become a point of attraction has it has been established with whatever resources were available. The establishment of such a centre by MAVIM with the co-operation of the health department in such a remote area which was devoid of access to any health facility is the first step taken in the health care revolution spearheaded by MAVIM.
The activities at the health centre
Any member of the self help group or any other woman in the village visits the centre whenever she misses her periods. The women in the self help group encourage the woman to visit the centre as considerable ignorance about these matters exists in the minds of the women in these areas. The Asha worker at the health centre examines the woman. “Bene resha padot tah dihi rohi ha ko” (display of two lines on the strip indicates that the woman is pregnant) – the woman learns about the good news at the centre itself. She is also given iron tablets at the centre. In the ensuing period, attention is paid to the woman by the workers at the centre. The medical officer at the primary health centre and the Asha worker have trained the women members of the self help group in taking care of a pregnant woman.
Pregnant women are encouraged to deliver at the health centre and are extended the necessary support. The sahyoginis provide the necessary counseling to the women for delivering at the health centre. If required, the woman is taken by an ambulance or any other vehicle to the Primary Health Centre at Urmilamal, about 8 kilometres away, so that the delivery is carried out safely.
Precautions and care during pregnancy
The visiting women are given necessary instructions and guidance for taking care of their health at the centre. On some occasions about a year back, women who were delivering for the seventh or eighth time have also been admitted at the centre. All women are now advised about keeping safe distance between two children. Contraceptives such as Mala N, Copper T etc. are also used which was not happening about earlier in the village. The centre also dispenses medicines for patients of sickle cell and T.B. The centre has succeeded in at least creating the mindset of visiting the centre whenever one falls ill.
The centre has contributed to a great extent in reducing the extent of malnutrition and infant mortality. Deliveries were carried out at home in all cases in the village in the past. However, since April 2010, all deliveries have taken place at the government/official centres. Deliveries under the guidance of experts and right care taken during the period of pregnancy have also resulted in bringing down the level of malnutrition and infant mortality. In order to reduce these, discussions were held and plans were drawn out in co-ordination with the health department, which resulted in the establishment of the centre.
Up to date records
Details of expectant mothers are recorded in an updated register of records. Hundred per cent attendance of expectant mothers is ensured at the health check-up camps. The delivery is carried out at the maternity centre. Mothers are also guided about getting the children vaccinated at regular intervals. Adolescent girls are counseled. All these activities are recorded in the register maintained.
Use of available resources
Availability of resources is always a problem in remote areas. However, use of whatever resources are available for getting the work executed has become an usual practice in these areas. The scales from the anganwadi are used to record the increase in weight of pregnant women every month. Their height is recorded by drawing lines or writing figures on mud walls. Medicines are changed only as per the advice of the health worker. Initially, the health workers had a slightly negative outlook towards the health centre. The reason for this was the feeling that they would be left with no work if the self-help group and the health centre carry out all their functions. However, on noticing the fact that hundred per cent deliveries in the village were carried out in the health centre and that the level of malnutrition was declining, this negative feeling was converted into a positive approach. It dawned on them that the health centre would only be helpful in carrying forward their work.
Use of gardens in the backyards
In Bijaripoti village the importance of growing vegetables in the backyards was explained with a view to reducing malnutrition levels and ensuring availability of nutrients to expectant mothers. The practice of having vegetables such as drumsticks, curry leaves, palak (spinach), methi (fenugreek) etc. as a part of daily meals started getting established. A positive change in the level of nutrition was brought about from the use of vegetables available in one’s own place.
An attitudinal change
One of the women residents of the village stated that the use of cow dung as manure in the past ensured that the crops in the field were immune to disease as a result of which people were also free from disease. The use of all types of fertilisers at present and the practice of eating out of the house has resulted in the prevalence of diseases which necessitates recourse to medicines. The health centre proves to be useful in this regard. A medicine box was requisitioned, at the time of establishing the health centre, from the District Health Centre for preserving some of the elementary medicines required. Follow up is on for getting this box. As the health centre refers the women to the government primary health centre, there is a rise in the demand for the services of the primary health centre. The health centre has been instrumental in driving away the inhibitions about the primary health centre in the minds of the tribal women. These are some salient features of the centre.
Adoption of a girl
A couple in the village, where the wife was suffering from psychological disorder, had a girl child. Upbringing of the child had become a serious issue in view of the state of the mother. One of the members of the self help group adopted the girl. The girl is now three years old and she has been named Kajal Pratapsingh Padvi and enrolled in the anganwadi. The attitudinal change brought about by MAVIM is an answer to the mentality obtained in urban centres about having a male child to take forward the lineage.
Democratic practice
A meeting was held initially to decide the name to be given to the self help group. It was decided to choose from lots. Names such as Indira, Savitribai, Monika, Tejaswini, Ranikajal were suggested in the lots. The slip containing the name Ranikajal was chosen which became the name of the self help group.
Such varied measures are being used to change the attitudes in the village, to plan for reducing the levels of malnutrition and infant mortality etc. through the health centre. A positive response is expected from other official machinery for strengthening this centre in tribal areas.
Health centres have been operationalized in various villages in Nandurbar district to ensure that child deliveries are carried out safely, the health of women is taken care of and the level of malnutrition is reduced. Efforts are on to get the Dr. Anandibai Joshi award to the villages which do excellent work at the taluka level.
Villages in the project
Dhadgaon taluka: Son Budruk, Talai, Mandvi, Khuntamoudi, Chounwade, Dhanaje, Khardi, Chulwad, Achpa, Sukhani. Taloda Taluka : Navagaon, Shelvai, Malda, Lobhani, Chhote Dhanpur, Amoni, Nuben Rozwa, Talwe, Rajvihir, Nalgavhan, Ratanpada, Mendwal, Ganjali. Akkalkuwa Taluka: Bijaripati, Khatkunwa, Umarkunwa, Bhabalpur, Jambhlipani, Amli, Kauligawhan, Bramhangaon. Nandurbar Taluka : Wavad, Karli. Shahada Taluka: Bamkheda, Adgaon, Ambapur, Mandane, Chandsaili, Mohida, Kakarda.