“Eliminating disparities in health care,” said Martin Luther King, “will require input from all stakeholders: health care providers, educators, community and faith leaders, policy-makers, scientists, funding agencies, corporate leaders, and everyday people. The social determinants that are at the foundation of these existing disparities necessitate system change. An amalgam of economic resources, environmental facilitation, scientific evidence, human compassion, and a healthy dose of inspiration are all essential components.”
The health inequities King talks about not only affect individuals, but also impact the overall health status of (and healthcare costs in) our nation.
In 2017, The People’s Vigilance Committee on Human Rights (PVCHR), with the support of Child Rights and You (CRY), adopted 50 villages and a couple of slums to work on the issue of child survival (maternal, neonatal health and nourishment) in the most marginalised communities in four blocks of the Varanasi district. The Right to Survival is one of the four child right categories in the United Nation Convention on the Rights of Children. Survival Rights include the child’s right to life and to fulfilling the needs of a child to lead a happy life. These include nutrition, shelter, adequate living standards, and access to health services for a healthy and happy childhood.
After entering the village, we did a baseline survey and focused on group discussion to understand the knowledge, attitude and practice (KAP) of the community. “Based on the KAP mapping, we prepared our strategies in the context of mapping stakeholders based on their interest and influence,” says Shruti Nagvanshi, Project Holder and Managing Trustee of PVCHR. She explained how the major problems identified in the baseline surveys are stereotypical thinking, superstition, and lack of trust in the government-sponsored healthcare schemes. The below-par activation of the SC (Sub Center), PHC (Primary Health Care), CHC (Community Health Care) is the main hurdle in the realisation of health services for pregnant women and their children. These communities faced apathy of the village heads and did not get access to various government schemes. Due to lack of knowledge and resources, adolescent girls use dirty cloth during periods instead of sanitary pads. There is no source to obtain information regarding the biological changes in the body. Because of this, it becomes an obligation to follow longstanding and illogical concepts.
The changes and developments in the bodies of adolescents also affect their health. Adolescents mainly suffer from anaemia and weight loss or low weight. Lack of information is the primary reason behind that. During the analysis of the sample survey conducted across 20 villages in Varanasi, we found that, due to ill-treatment and negligence in the government hospitals, 19 families out of 20 were facing a severe debt crisis.
During focused group discussions, a local resident, Kotali Nut, said, “Before that we did not have any knowledge, that children get to be immunised. We fully depend on superstition and get treatment for all kind of diseases by Ojha (a witch-doctors). They even monitor pregnant mothers. When a woman gets pregnant, they bring her to Ojha to protect the mother and child from evil and prevent stillbirth. Every month we have to pay a fee of ₹200 to Ojha as well as Daru and Murga (Alcohol and Chicken) for protection. After the delivery of the baby, Ojha performs rituals known as Gadthant to prevent neonatal and maternal death. The rituals are performed at midnight in any quadrilateral area, and the fee for the Ojha is ₹2000 to ₹5000.”
Meanwhile, PVCHR, after gaining support from the New Zealand High Commission, organised folk schools in 41 villages of the Varanasi district. In 22 Kishori Hamjholi, a group of 596 adolescent girls were informed about menstruation, personal hygiene, adolescent health, and nutrition through IC material. It also organised Kishori Swasthya and Poshan Mela, (Adolescence Health and Nutrition Fair). The fair focused on the need to eat a balanced diet. In a documentary screened at the Mela, the organisation Menstrupedia explained ‘good touch’ and ‘bad touch’, and quiz contest was also organised. The girls who gave the right answer were awarded sanitary napkins.
19-year-old Khusboo said, “I participated in the meeting with the adolescence girls and also in Mela. Instead of clothes now I am using a sanitary pad. For that, I save one rupee every day.”
Sangeeta Musahar, a student of class now XII, said, “When I did not have money, I boiled cotton cloth and dried them in the sun.”
We started a kitchen garden in 17 villages of four blocks by providing seeds and ways to utilise land near their huts to prevent malnutrition and anaemia. Veena, another local resident, informed us that “due to poverty we couldn’t afford to include vegetables in our meals. We cook vegetables when there is some special occasion or collect half-rotten vegetables that are left in the field. After starting a kitchen garden, we get fresh organic vegetables, and we include green vegetables in all meals.”
Kiran, a local resident, said, “Due to the burden of paying loan interest, my family was unable to manage the expense of two meals. In a day we hardly got one meal. In the economic crises, the vegetables planted under the kitchen garden initiative were the only source for us. Whenever we go outside for work, our children pluck tomatoes from the garden and make chutney to eat with roti and rice.”
The community kept the seed of the first crop and now will sow it for the next season.