No hashtags are made on them. They don't get featured in the media. But these one million ASHA workers -- who are on the frontline of the COVID-19 battle – have been silently doing their job
The news was authentic. The phone call had informed stealthily: “Didi, someone has come from Mumbai in our neighbourhood.”
The labourers who had returned to Uttar Pradesh’s Atesua village from Mumbai should have been quarantined for 14 days, but the gram pradhan did not do so due to their sudden arrival. Kusum Singh, 48, the ASHA worker, knew that if she pointed her accusing finger directly to the pradhan, she would be vehemently opposed. She could not even reveal that the news was given to her by the neighbours of the labourers who came from outside. So, Kusum called the pradhan up and immediately came up with a false story.
“We have got a call from the health department that they (the labourers) have come from Mumbai. Now, from the details of all the online tickets, the government is aware of who has come from outside into every village,” she said.
Believing Kusum’s words, the gram pradhan had immediately sent the labourers who had arrived from Mumbai to a government school outside the village for quarantine. For the next fourteen days, she remained in touch with the people who had been quarantined to look out for the symtoms of the infection, like cold, cough or fever.
Kusum is one of the million footsoldiers of the country who, at present, will have the report of every household in the villages. They know who has symptoms of cough, cold, fever, sore throat, sugar and TB in the village, how many people have come from other states, how many people have been tested or are to be tested.
During the lockdown, the work of these ASHA (Accredited Social Health Activist) workers is totally different from their earlier activities. In the first phase of the coronavirus infection, they surveyed every household and identified sick people. In the second phase, a list of people from outside was made and the quarantined people were followed up for 14 days. After the lockdown has been extended, the work has been varied as per the requirements of different states. Somewhere, slogans are being written on the walls, and somewhere, with the help of a song sung on the beats of a dholak, villagers are being appealed to stay at home Somewhere, circles are being painted to facilitate social distancing, whereas elsewhere, these ASHAs are doing door-to-door delivery of medicines.
As per the National Rural Health Mission (NRHM) data, the total number of ASHA workers in the country, until September 2018, was about 10.3 lakh. Kusum happens to be one of them.
About 40 kms away from Lucknow district headquarters in Uttar Pradesh, ASHA worker Kusum, who is residing in the village of Atesuva in Bakshi Ka Talab block, begins her day at 5 AM. After looking after all her household responsibilities, from morning tea to cooking, Kusum goes out to the streets of the village by 9 AM.
Wearing a cream color saree with a maroon border, with a mask covering her face, Kusum stands upon the Khadanja (village brick road) instructing a family. “You must always keep your mouth and nose covered with some cloth. Do not get out of the house unless absolutely necessary. Wash your hands repeatedly with soap. Keep a distance of two to three hands from each other,” she says.
An 80-85-year-old elderly person, a 35-year-old woman and a 12-year-old boy sitting on a cot in front of that house nodded their heads in agreement. At present, ASHA workers are not entering anybody’s house. They call people outside, speak out their point and then move ahead. Under the scorching sun of April, Kusum’s face was sweating profusely, but she was engaged in her work.
No hashtags are made on them, they don’t get accolades in the media, but in this fight against the novel coronavirus, ASHA workers are waging a war afoot that is keeping millions of people safe. They form the first order of security of the Indian health system at the grassroots level … but, even today, they fail to get the status of a government servant.
When one enters the village of Atesuva, one would come across many slogans on the walls. Somewhere it is written …”Hum gaon ki Asha ne milke ye thana he, sab ghar me raho desh se corona ko bhagana he (We, the ASHAs of the village, request you all to stay at home so that we can drive corona out of the country), and somewhere …”Noon roti khayenge, ghar se bahar nahi jayenge (we may have to live on salt and bread, but we shan’t step out)”. While somewhere it is written, “Papa ghar me raho bahar corona he, sab mil kar saath rahe, nahi kisi Ko khona he (Dad, do stay in for corona lurks outside the house. Let us stay together and not lose anyone). One would find dozens of such slogans.
The coronavirus infection, which ASHAs are striving day and night against to protect the villagers from, has already infected more than 37 lakh people worldwide and claimed around 2.6 lakh lives (as on May 6, 2020). The number of patients infected with this virus in India has gone up to 49,436 (as on May 6) and 1,694 people have died so far.
After the lockdown was extended, Gaon Connection reporter spent one day with ASHA workers to understand their routine. Kusum spends the entire day, from 9 AM to 6 PM in convincing everyone to stay in the house. She returns home in the afternoon to have her lunch. In this village, apart from Kusum, there are two more ASHA workers.
On that day, Kusum went to a few houses after 9 AM and took the news of the people there. Later, with the ASHA and Asha Sangini (assistant) of the village, she took to the streets of the village in the sultry afternoon, urging people by singing songs, to frequently wash their hands and cover their face with cloth.
“Saare desh me phel rahi corona ki mahamari, gaon walo agar bachao chahte ho to mano baat mamari (If the villagers want to avoid the corona pandemic that is fast spreading all over the country, they must listen to us carefully)”. The song, written by thirty-eight-year Asha Sangini Renu Singh, who works at the Community Health Centre, Itaunja, was being sung together by ASHAs Kusum, Anisha and Uma.
The women of the houses stood by their doors, gazing at them with their noses covered with their sari’s pallu. As they were passing through the streets of the village, the villagers went out of their homes and listened to them … In the scorching heat, when everyone is inside, this small pedestrian army marches on singing, beating thali (a plate) and shouting slogans.
With white-coloured dupatta wrapped around her face, Renu Singh, said in a loud voice, “Hum gaon ki Asha ne milke ye thana he, sab ghar me raho desh se corona ko bhagana he.” Everyone was repeating the slogan loudly from behind.
Some saw this from behind their doors and some sitting on a platform. In the village, the farmers, who were resting in the shade of neem trees after toiling in their fields, also listened to them intently.
ASHA workers are known in different states by different names, such as Asha Basu in Uttar Pradesh, Sahiya didi in Jharkhand and Asha in Madhya Pradesh.
Describing her daily routine, ASHA worker Rekha Jatav, 41, said: “Presently, we don’t have a single day. Our job is to go door-to-door telling people the benefits of proper hand washing, adhering to social distances and putting on masks.
Rekha is an ASHA worker from Vinapur village in Bhopal City of Madhya Pradesh. She leaves her home early in the morning because of the harsh sun during the day. She is one of the more than one million ASHA workers who form the crucial backbone of the rural health system. Like Rekha, all ASHA workers in the country are currently providing every moment’s update to the health department.
There is one ASHA worker for every thousand people. In villages with a large population, their numbers increase too. These ASHA workers are given a definite stipend in some states, while in many places they get incentive on the basis of their work. Their wages are not tantamount to their work, which they often complain about.
That afternoon, Kusum finally reached her home at about 2 PM after singing songs. Washing hands with soap at a tap outside the house, Kusum said: “This is my daily routine — leaving for my work in the morning and then coming back to eat in the afternoon and then leaving yet again in the evening.”
Apart from raising awareness about corona infection, Kusum is always ready to receive a call for delivery of pregnant women. There are no fixed hours of her work. Kusum has three daughters who handle most of the responsibility of the household while she stays out.
Whatever work Kusum has done in the morning she reports about the same over the phone, between 12 AM to 2 PM every day to ASHA Sangini. On that day, ASHA Sangini Renu Singh was with Kusum.
ASHA Sangini Renu Singh monitors 26 Asha Bahus. Renu Singh said: “Every day, we compile and send a report from these ASHAs to the block community process manager by 4 PM. This is our daily routine.”
“We have all the tasks that had been ordered to us from above. After the was lockdown extended, I felt that people should be made aware in some interesting manner. I am fond of writing so we have written a lot of slogans and even some songs,” Renu said, adding, “Only those people who are literate can read the writing on the wall. So, to make everyone understand our point, we began composing and singing our own songs. Now, many other ASHAs of the entire block are adopting it. If this lockdown extends further, then we’d even stage Nukkad Natak for raising awareness.”
Renu is adopting a number of ways for convincing people to stay in, to cover their faces with cloth, to stand at a distance from one another and to wash their hands frequently. Her sole endeavor is to keep the villages safe and secure against coronavirus, at all costs.
Dr Yogesh Singh, Superintendent, Community Health Centre, Itaunja, praised these ASHAs and said: “They have always been a strong link in the health department. At present, their responsibility has increased manifold. The good thing is that even in this environment of fear, their enthusiasm has not diminished. They are working far beyond their assigned level of duties.”
The government has announced financial security for these ‘Corona Warriors’ standing at the forefront of this battle against coronavirus. Nirmala Sitharaman, the finance minister, has announced Rs 1.70 lakh crore, including Rs 50 lakh insurance cover, from medical staff to ASHA workers and safai karamcharis who are working at such times risking their lives.
The Health Ministry has directed all states to provide financial incentives to ASHA workers for undertaking COVID-19-related activities. The ministry has also asked states to ensure that ASHA workers are supplied with adequate protective gear.
ASHA Sanginis like Renu are called differently in every state. In Jharkhand, Asha Bahu is called Sahiya Didi and ASHA Sangini as Sahiya Saathi, while in Madhya Pradesh their names are Asha and Asha Sahyogi.
“Recently, our Sahiya Didi, have been issued certain basic medicines from the hospital. Now they go door-to-door and inquire after villagers’ health and if need be, also provide them medicine,” said Sahiya Saathi Bhasha Sharma, 40, who is a resident of Jodisa village in Jamshedpur, Jharkhand. Eighteen Sahiya Didis work under her.
The National Rural Health Mission (NRHM) had created the post of ASHA worker in the year 2005 to look after rural women and children. As per the population, there are 1,000 to 2,500 ASHA workers in one district.
Asha Sahyogi (aide) Savita Sharma (42 years), who lives in Eint Khedi village of Bhopal, monitors 14 ASHAs. She informed: “At the moment, our ASHAs are drawing circles at several places to promote social distancing. They ensure that no one goes hungry. They are also writing slogans on the walls.”
Asha Bahu and Asha Sangini are the frontline soldiers of the health department who are always busy informing villagers and promoting immunisation, sanitation management, meeting with adolescent girls, caring for pregnant women, looking out for malnourished and severely malnourished children. They are used to spending days in the hospital and walking several kilometres on an empty stomach and parched throat, throughout the day.
Kusum of Atesuva village left for the Muslim settlement in her village at 4 PM after lunch, where 12 people had returned from Delhi, Mumbai and Hyderabad during the lockdown. “We will work our hardest, but not allow the corona to spread in the village,” she declared with sincere conviction.