A decade ago, as a student in Ghatsila, I often travelled to my college in Jamshedpur by train. At the Ghatsila station, I would see some women in white sari and blouse. They would be carrying huge plastic boxes besides handbags and a smaller cloth bag for tiffin box and water bottle. There was another thing I noticed about them. They didn’t look fit to carry the load: They looked that undernourished!
Four years ago, when I came to Pakur to work as a doctor, I understood that those women were auxiliary nurses and midwives (ANMs). They work with the Jharkhand government and are posted at primary health centres, additional primary health centres, and health sub-centres. The health and medical care system in Jharkhand depends on them. They go from village to village, one tola to another, often on foot, carrying their bags and boxes, doing ante-natal check-ups of pregnant women, immunising pregnant women and newborn babies and children, conducting deliveries, prescribing and distributing medicines to various patients, visiting homes that have reported childbirth, weighing newborn babies, working as supervisors in national programmes like the Pulse Polio, identifying patients of malaria and kala azar, identifying children suffering from AFP (acute flaccid paralysis, a consequence of contracting polio), malnourished children, organising health camps, mobilising people in villages to attend health camps, immunisation sessions, and other health-related programmes, co-ordinating with anganwadi sevikas and school teachers to distribute iron and albendazole tablets to school-going children, calculating figures and compiling reports, and doing hundred other work.
The ANMs I met in Pakur were not different from the ones I had seen in Ghatsila: Thin and sickly, as malnourished as the pregnant women they advised. The life of an ANM, I saw, was full of hardship. I found out that the big plastic box is a vaccine carrier in which the nurses carry various vaccines, stored at an appropriate temperature provided by cold, frozen ice packs.
When I heard about the new diktat of the government that all artistic portraits of Birsa Munda be shown without shackles, I wondered if it really made any difference. How will shackling or unshackling affect Birsa? There are real people who are in shackles, metaphorically speaking. Will they be unshackled?
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For instance, who will unshackle the ANMs? With the limited means the government provides, the ANMs in Jharkhand are trying to provide the public an approximation of all the facilities it has promised! Calmly, patiently, despite their own poor health, they keep the health department running, working more than, perhaps, even doctors. In addition to their professional capabilities, they have to be social enough to deal with domineering anganwadi sevikas and sahiyas — or worse, their husbands, who often claim to have political clout. They need to be fearless to face when the public gets unruly. When the work on the field is over and they have to attend evening briefings in the headquarters, these women have to be strong enough to face criticism.
A typical day of an ANM in Pakur is perhaps like this. She must be up at 4:30am or 5am. As Pakur has severe water crisis, she needs to fill up water first, from a hand pump or a municipal tap outside her house. She must then cook for herself and family, get children ready for school, and catch a local train, a Vikram or a bhutbhutiya to travel to her centre or immunisation site. Many even have to walk a good distance with all their paraphernalia — stethoscope, sphygmomanometer, weighing machine, and so on. At the site, if sevikas and sahiyas are good, ANMs can breathe; otherwise, they have to clean and ready the place and even call the beneficiaries themselves. If these weren’t enough, they are sent to faraway sites, often without a mode of transport, to fill in for absent ANMs. Their faults are enumerated and they have to endure threats that their salaries would be stopped or they would be paid only half or a third of their salary), or their jobs will be terminated. By the time they are ready to return home, probably after sunset, these women are unlikely to have even a gram of life left in them to spend time with their families, watch TV serials like other ordinary women, or just live their lives.
No wonder, the blood pressure of many ANMs hangs at 100/60 mmHg. One fainted during an evening briefing during the last Pulse Polio round. Recently, an ANM was threatened by the husband of the sahayika of an anganwadi that he would undress her in public! Though that rogue apologised, the woman knew she couldn’t press charges because that might lead to further trouble as she needs to visit that anganwadi regularly and alone.
Yet, officers of the health department are always told to remind the ANMs that every programme is being personally monitored by Someone-Big-Up-There-In-Delhi, and that if they don’t perform well they would have to face harsh consequences. Does anyone bother if the ANMs, many of them contract workers, are paid in proportion to the work they do? Why can’t those on contract be made regular and provided some job security? In Jharkhand, where more ANMs are needed, why isn’t there fresh recruitment?
Birsa Munda is being unshackled in portraits. When will these real women in real life and time be unshackled?
View From The Right: Politics of yoga