Despite her limp, Priya* navigates quickly and steadily through the narrow lanes and puddles of the slum. When she reaches a door, she leans against the frame and uses her cane to pound against the door shouting “Baaabi, eh baaabi!!” The people next door laugh. They tell me that everyday she wanders through the community. From her shouting, they can anticipate her arrival long before she gets there.
Priya is a community health volunteer (CHV) at Shivaji Nagar slum. I accompany the CHVs into the community to help identify people to work with for my research, but I find it fascinating to see them working daily to promote health in their communities.
On the day I followed Priya, she was going door to door to make sure the children of the community were vaccinated, especially against polio. India has very recently eradicated polio and through efforts of women like these, India stays polio free.
We would visit some homes to have the families roll their eyes. Yes, we got the vaccine like you told us to. Here is the vaccination sheet. Priya would quickly jot down the vaccination dates and carry on to the next house. Some homes, however, would shamefully admit they hadn’t gotten the vaccination yet, giving some excuse or another. Priya would admonish them to go to the health center that very afternoon to get vaccinated.
After spending so much time reading negative portrayals of public health in India, it is encouraging for me to see people doing such a good job improving the health of their communities. I regularly read about the alarmingly low amount of money spent on health in India and the alarmingly high prevalence of disease and malnutrition, especially in comparison to countries with lower average incomes.
Walking around with the CHVs presents a different story: health matters and these women are invested in it.
I accompanied another women, Ash, who was trying to find a patient who had been admitted to the hospital for severe gastrointestinal problems. We searched and searched throughout the community, with only the name of the woman and neighborhood (one in which several thousand people live) on hand. After lots of nos and perplexed looks, Ash finally came across one woman who heard the name and immediately recognized it. She led us to a very narrow lane and we came across a green painted metal house. Despite the time spent looking for the woman, the conversation was quick and then the CHVs immediately started asking the neighbors about whether they had the same disease symptoms.
Ash explained to me that they needed to search for the woman to make sure there was no disease outbreak. Polluted water or contaminated food could potentially lead to a devastating outbreak if not curbed early. They wanted to make sure that this was an isolated incident.
Many of the women have been doing this work for over twenty years. They tell me that it was very difficult before. They struggled to get people to listen to them. Now people are more aware of the importance of their advice.
Following the CHVs makes me appreciate the kind of effort it takes to address health inequalities. I often think or hear about public health on such a huge and abstract scale: numbers, percentages, growth rates, etc. But walking around with the CHVs, I can’t help but think: this is what public health looks like, real, raw and day to day