WOMEN AT THE FRONT: In this series, we turn the spotlight on the women on the front lines; the thousands of health workers and hospital supervisors who are the first point of contact for pregnant women, new mothers and children served by ARMMAN’s programs. From emergency deliveries and tedious travel to family resistance and trouble with the authorities – they have seen, and survived it all with a smile on their face and an unwavering determination to keep going against all odds. It’s time we hear their voices and listen to their stories.
Narmada Hirkuda: The “Mini-Doctor” of Vadoli Village
Every single day, Narmada Hirkuda wakes up at the crack of dawn and sets about her daily chores. She cleans the house, cooks for her family and wraps up her work by 9 am. Once her husband leaves for his job at the municipality and her two teenage children are off to school, she gets ready for the long day ahead of her. By 10 am, she is out of the house with her medical kit and on her way to one of the four villages under her purview, often using two to three different modes of transport and walking over 6 to 7 km through hilly terrain to reach her destination. It’s a tough journey, but Narmada rarely complains. “I feel like I’m doing seva (service) for the women I work with.”
38-year old Narmada is one of 63 health workers trained and supported as part of ARMMAN’s Arogya Sakhi program in Palghar. They provide home- based preventive care, perform diagnostic tests, screen for high-risk factors and ensure early referral during pregnancy till the child is one-year old. Narmada has been an ASHA (Accredited Social Health Worker) for the past 13 years, but since the start of ARMMAN’s Arogya Sakhi program in 2017, she feels a change in herself and her role as a health worker. “Earlier if there was a problem, I couldn’t even identify it, much less do anything about it. I would just ask the women to go to the Primary Health Centre,” she says. “Now, with the help of the Arogya Sakhi kit, I can do tests for blood pressure, hemoglobin etc, which helps me identify the possible problem and enables me to counsel the woman in the appropriate manner.”
Narmada’s diagnostic skills and ability to think on her feet have proved beneficial more than once. When Darshana’s weight spiked suddenly from 48kg to 51kg between the fifth and sixth month of her pregnancy, Narmada used the foetal doppler, a hand-held ultrasound device used to detect fetal heartbeat, to confirm the presence of twins via the identification of two separate heartbeats in the womb. When Darshana went into labour soon after completing her ninth month, Narmada tried to rush her to the hospital in a private vehicle, but rerouted the vehicle to the nearest Sub-Centre when Darshana’s condition started deteriorating due to excessive bleeding. Darshana delivered twin girls weighing 1.7 kg and 1.4 kg at the Sub-Centre, following which Narmada immediately pushed for a transfer to the Jawhar Government Hospital, where the babies were kept in the Special Newborn Care Unit for some time. After two months of consistent care and regular visits by Narmada, the babies now weigh a healthy 2.8 kg and 3 kg.
In another instance, Narmada accompanied a four-month pregnant Kalpana to the cottage hospital when she complained of severe weakness and her hemoglobin was found to be less than 9 grams per deciliter, well below the standard range of 12 to 15.5 grams per deciliter for women. Since it was a busy day at the hospital, and Kalpana was too weak to wait in the queue, Narmada requested the doctor to see her on a priority basis. She also spoke to the doctor on behalf of Kalpana and clearly detailed her complaints. Because she was aware of the case, Narmada helped the doctor understand Kalpana’s history in a short duration of time, leading him to prescribe two Iron Folic tablets per day to Kalpana. Narmada further handheld Kalpana to ensure that she takes her tablets daily and consumes the right food. “I felt very happy that Kalpana’s hemoglobin level had gone up to 13.5 when I measured it last,” she says. “I felt like my seva was successful.”
Narmada says that the trust and respect of the villagers makes her feel like a “mini-doctor.” But the title comes with its own set of challenges, including the issue of transportation. Although Narmada easily walks 6-7 km on average everyday, sometimes she has to request her husband for help when she isn’t feeling too well. Prakash Hirkude is happy to ferry her on his bike. “She is my pride,” he says of his wife. “I am constantly amazed at her capacity to help others so selflessly. I feel very proud when she does her work with a lot of feeling.”
Narmada considers her family, especially her husband, her biggest support. She recounts an incident when she refused to attend an important training session organised by the government because her son was only nine months at the time. Prakash took two days off from work to take care of the house and baby, and insisted she attend the training since it was crucial to “gain knowledge and keep learning.”
Apart from the constant encouragement of her husband, Narmada is motivated by a deeply personal factor – the death of her eldest daughter. Last year, Narmada’s 18-year old daughter developed a cyst, which could not be diagnosed and treated in time despite several trips to various hospitals, including Nashik Civil Hospital. Her daughter’s untimely passing caused Narmada deep pain, but also sparked the realisation that those less aware than herself face such troubling situations all the time. Since then, she has dedicated her time to ‘seva’ to ensure that no parent has to live through the trauma experienced by her husband and herself.