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Turning The Table

“दबाव बहुत है। हम तो कोशिश कर रहे हैं।”, Nagma said. Nagma is a middle-aged health worker in the primary health centre (PHC) of Nichli Badi. She has been overseeing the PHC functions in absence of a doctor for the past one and a half month. A soft-spoken woman, she was reticent to share her opinions of healthcare system which directly affects community and the way she works with community.

The mumbo-jumbo about finding a common thread for communication with a person is apparent only when one talks to a stranger—not in a mutually beneficial conversation, but with a purpose to know about their life. My intention on this visit to Badi was to initiate an understanding of semi-structured interview as a participatory rural appraisal tool.

Stepping-off my high horse, I realised the language we communicated in—both vernacular as well as that of healthcare—were different and the onus to adjust lay only with me. The clichés of life started focusing in foreground as its strangeness magnified.

Once the barriers were bulldozed to flatten a comfortable ground for conversation, she started un-spooling the reel that was to serve the purpose of my visit. The PHC has been upgraded by Rajasthan government for more than an year now, but the development has been limited to paper. There has been no infrastructural progress, rather the only doctor of the two stipulated positions has also been transferred. The water has to carried from a nearby hand-pump since there is no budget for a water connection. The health workers have to run clinic themselves. The budget is not enough to cover the running costs; even office stationary has to bought personally. The only upshot is regular supply of drugs under the government’s free drug scheme. Moral responsibility for community’s health pushes the auxiliary staff to keep the centre running day after another.

At such basic levels, even the misogyny of government policy is evident. In a classic top-down approach, staff is under a constant pressure to fulfill sterilization targets throughout the year. For instance, last year, female sterilization targets were completed two-third while there was not even a single male sterilization. The targets have been further increased without taking into consideration the experiences of field workers and demographic details of community like parity and number of single woman. The disconnect between health of community, healthcare policy, and its practice is deeply unsettling.

It is easy to argue over a cup of steaming coffee. But, how does it feel to spill that coffee in one’s lap? Similarly, it is easy to generalize from a privileged position where high-quality healthcare access is always only a short walk away.  But, what is it to trust one’s life in the hands of such a system?

(Names have been changed to protect identity)

Tushar Garg

2015 fellow, placed with Innovators In Health in rural Bihar as part of his fellowship. Working on TB and Maternal and Neonatal Health in areas of community mobilization, capacity & institution building and research.

3 thoughts on “Turning The Table

  1. Its obviously great. But I will be keen to hear you voicing the way the experience makes you feel, along with what you think about it. There is time though. All the best for the beginning

  2. Commenting too late … nonetheless. The point you raised is valid ofcourse. But then where does one draw the line between quality and need to have some process started cause the wait may harm too. Like you mentioned customizing the findings on pointers like single woman which needs a level of sophistication which in turn needs investing and time. Does one stop in the interim?

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