Health workers—who are they, and can anybody become health worker? During this World Health Workers Week (April 2 – 8, 2017), Thriveni S. Beerenahally shares some of her experiences, training wonderful women to be community health workers.
Our work in Kadugondanahalli (KG Halli), Bengaluru started in 2009 with the census of the area. KG Halli is one of the 198 administrative units in the Bengaluru Municipal Corporation area, with a population of over 50,000 living in 0.7 sq. km. of area.
Six married women joined our Urban Health Action Research Project team for data collection. They came with no prior experience, but training helped to learn about data collection. They lacked confidence, and hardly spoke with the researchers in the team.
Later, we considered enrolling them to train as health workers with the project team. The education of the six women varied from Class VI to Class XII. They could speak and write in at least one language. Training these women was challenging, due to the multiple languages (Kannada, Hindi, Tamil) they understood. But the mutual co-operation between themselves helped with cross-translation, to make sure all of them understood what was taught. Training was structured with less classroom teaching and more hands-on training in the field.
Over the years, they got trained by health professionals to become community health workers (CHWs).
As the training progressed, and home visits with the team’s doctors increased, there was a sense of satisfaction for the CHWs on learning new things about health. More than that, there was a sense of pride that they were accompanying doctors during home visits, and were respected equally by the families.
Popular training topics for the CHWs included enhancing soft skills like team building, communication skills, and how to handle challenges while working in the community. There was constant effort during training to bring in the need of the community, and how to be sympathetic and empathetic while interacting with people throughout the training session. As the months progressed, it was evident that the confidence of the women was increasing.
It was visible that they were getting empowered even to tackle their own personal issues.
As the bonding between the CHWs and research team grew, they started sharing their personal problems. That’s when I realized that these women could relate very well with issues in the community, because they came from the same socio-economic background and had similar problems. More than half of the women had the burden of managing the house and kids while their husbands were either unemployed or non-supportive
I also realized some of them were the victims of domestic abuse, and had accepted it as a norm. No word of encouragement, information about their rights and law, or support from researchers helped empower these women to fight against domestic abuse. A famous saying commonly heard in the economically backward strata in India is “Husband is god”, which the victim also believed and thought it was her fate to bear with it.
Every time they reported domestic abuse, I used to get frustrated with a sense of helplessness and failure.
However, one incident brought the CHWs together to fight domestic abuse. One lady in the team was beaten up by her husband so badly that she risked losing her vision. That moment was a tipping point for all the women. They came together and stood with her and encouraged her to report to the police, as by then, many attempts by her family had failed to stop the abuse.
That lady’s decision was so courageous, because there was a chance that her family could have disowned her. But she had the confidence to lead life without her husband’s support, which came from her training and the financial stability of her job. This helped her take that step without worrying too much about the consequences of her decision. Sadly, for months, like many Indian women do, she felt guilty of taking her husband to the police station, a stigma in society.
But constant support from the team helped her face the consequences and fight domestic abuse.
When I look back at the journey of the CHWs over the last seven years, I see remarkable change in their personalities, the way they look at the world, and their capacity to deal with personal and professional problems independently. They have a sense of responsibility for the community, and are very sympathetic towards people without judging who they are. They are the last link in the chain reaching the end-users of all health policies. More than anything else, I sense pride, confidence, motivation to bring change, and self-respect in their conduct. This change did not happen overnight. It took many years, and the road was bumpy, but the result was fruitful.
As a researcher, it was great to understand that bringing in change, especially empowering women, is a long and tedious process, and requires dedication and belief. Girls always have a list of things to do or not to do, since their childhoods. According to me, notions like girls as a kid should only play with dolls, kitchen sets, etc., are an indication that when you grow up it’s your responsibility to raise children and manage the kitchen!
When boys play with a kitchen set in Indian families, one can often hear, “You don’t have to learn cooking, and when you grow up, your wife will cook for you!” It takes lot of energy and patience to change the way women look at life, themselves, and the way the community looks at them.
Unlearning what they have heard from childhood is a difficult task.
It’s a proud moment for us to say that now, these women can “empower” other women in the community. Personal experience is always rich and enriching for researchers, and witnessing their journey was great learning for the whole team. Proper training, support, encouragement, and economic independence helped bring in change in these women’s lives. This World Health Worker’s Week, let us celebrate such inspiring people who are an integral part of the healthcare system, and whose efforts often go unnoticed and unappreciated, yet without whom, there would be a large gap between communities and the healthcare system.
(The author is the Director of Sarvagna Health Care Institute, and Adjunct Faculty at the Institute of Public Health, Bengaluru. The blog is about a project by the Institute of Public Health Bangalore in collaboration with local actors.)
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Disclaimer: This post originally appeared in the Better India on April 12, 2017.
