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INDIA BEATS
Dais make a difference
MEENA MENON
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In a region where women have a low access to healthcare, a referral clinic run by dais has made a striking impact.
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Photo: Meena Menon
Vital resource: The midwives at the referral clinic.
A woman has delivered 22 times in a nearby village,” says Parma, her eyes crinkling up with laughter. Dressed in a flamboyant skirt and blouse and chunky silver jewellery, Parma, a dai or midwife, is in charge of the referral clinic for women at Khavda, a remote outpost, 71 km from Bhuj in Kutch district. “We get anything from five to 20 patients a day, sometimes from very far villages. We help in delivery and also motivate the women for family planning,” she says. Parma herself has five children and travels 21 km to work.
Raima is one of the dais who comes every day from Mota Paiyya village. “I’ve been working here for five years and I am paid Rs. 2,700 a month,” she says. The clinic is open round the clock and four dais are on call. It has eight beds and caters to a radius of 30 km. Bayyaben Desar learnt midwifery when she was very young. Like most women here, she was married at 15 and has been a dai for 40 years. It is the traditional wisdom and experience of these women that form the backbone of the clinic, affectionately called Jedle Jo Jatan (Dedicated to women friends).
Far from help
As you drive the 70-odd km from Bhuj to Khavda, the arid landscape is relieved by colourful clusters of bhungas or the pink tiled conical huts, home to the people of Banni, a region which was once a rich grassland. People here live in wandhs or little hamlets that are far apart from each other and engage in dairy farming or leather work. The population here is 85 per cent Muslim. It was in this remote place that Kutch Mahila Vikas Sanghatana (KMVS), a voluntary organisation, chose to work and over the last twelve years it has been in the process of organising women on reproductive health issues as this area has a very high fertility rate and high infant mortality.
The low access to healthcare meant that women often could not even resolve simple problems. When KMVS started working here, it found that one in 10 to 15 women had a prolapsed uterus. The whole focus was on ante-natal health and deliveries and not the overall health of women.
So in Khavda, famous for its milk sweets, KMVS pushed for a referral clinic entirely run by the local midwives or dais. The Sanghatana had a lot of dais as members and the idea to have a community-run clinic with doctors was an innovative approach to deal with the lack of primary healthcare facilities in the region. Since women could not depend on government health care or the sporadic camp approach, this new model was a sustainable way out.
Joint effort
The referral clinic started in a small way with the women being trained at Tata Memorial Hospital in Mumbai in 1999 on a range of problems from infections to cervical cancer and the ones who were motivated were then upgraded. The women were also trained in primary diagnosis and when the first ever health camp was held in Khavda that year, many gynaecological issues were brought out. The Bhojay Sarvodaya Trust, which was keen on working on women’s health, teamed up with KMVS. The severe cases would be taken to the Trust’s hospital in Bhojay village, about 150 km away. The entire effort has led to the midwives, the State and the doctors working as a team to make the primary health care system more accountable.
According to Liladharbhai Gada of the Trust, about 100 women have been trained so far from the area. The dais are proficient enough to identify patients who need a hysterectomy. The Bhojay Sarvodaya Trust conducts surgical camps four times a year and it is these women who identify and motivate patients.
When KMVS and Bhojay Sarvodaya Trust came up with this idea of setting up a clinic, the government gave them an old guest house, and some grant for setting up the place which has been fully functional since 2002. However, the doctors appointed were erratic. Mr. Gada said that KMVS and the Trust decided to get doctors from the medical colleges and now two doctors are in regular attendance. The clinic will remain a place for primary care and deliveries while complicated cases are referred to Bhuj or Bhojay. KMVS takes care of the resources, support and administration while the Trust looks after the logistics support. NRIs are among those who support this venture. The clinic has developed into a health initiative with a focus on educational aspects and now the reproductive health interventions involve young boys in the area. The issues too have extended to a wider range covering menopause and health of adolescents. An insurance scheme for women linked to the clinic is in the offing. With their colourful attire and friendly approach, Parma and her friends bring a whole new meaning to healthcare.
India Beats features stories of the unusual, the exotic and the extraordinary.
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