Mundie Majhi and Masku Majhi have 4 daughters, living in Sungher Gram Panchayat of Kashipur Block. Mundie’s village lies at the hill top where one can only reach by walking from the nearest road 2-3kms away. Mundie Majhi who was pregnant few months back lost her child in the hospital. When Mundie was 5 months pregnant Masku left for Kerela to earn some money for his family. In their small village of 9 households, most men have been going to Kerela as daily wage labourers to earn. When Mundie went into labour during her 7th month, there was no young male members in the village who could go fetch the ASHA worker at night. One of the old men in the village went to call the ASHA worker by foot but she did not come. The old villager went to summon her again in the morning when she promised to come but then did not reach the village on time.
Mundie gave birth to her child around midnight at home all by herself and her daughters but was unable to birth her placenta. It was during the same month Gram panchayat facilitators (GPF) were doing home visits of pregnant women and GPF Umadevi Naik visited Mundie early morning and rushed her to the hospital. By the time they managed to get an Auto and reach the hospital it was noon and Mundie had been waiting with her child attached to the umbilical chord for the past 10 hours and had lost quite a lot of blood.
“We use to do more of upland land agriculture before but now many of have sold of our cows. Now only 2 houses have any animals. Around 8-9 years back lot of people died due to stomach ache and Jhada (diarrhea) and some of us sold cows for immediate need of money… Since we don’t have animals men cannot plough so we go to Kerela to earn some income.”
Mundie was treated in the hospital and stayed there for a few days but lost her baby. Umadevi Nayak recollects, “It was by luck that I decided to visit Mundie’s village that day first thing in the morning but it took me a lot of time to get transport as lot of our time was also wasted in waiting for the ASHA worker who never turned up. Moreover, we had to pay around Rs.1500 to the auto.” The villagers were very unhappy with the ASHA worker and also insisted that they should be given health services as they need it on a regular basis and sometimes very urgently.
The old man who had gone to summon the ASHA worker was very upset that he was old and did not have the strength to help the daughter of his village the way younger men could have. He said, “There is a local healer in a village 3 kms away but in cases like these healers and elders like us also do not know what should be done.”
Masku who was home now explained why most men in the village migrate for work, “Earlier around 10 years back we were around 4 houses in the village and now there are 9 houses. We use to do more of upland land agriculture before but now many of us have sold of our cows. Now only 2 houses have any animals. Around 8-9 years back lot of people died due to stomach ache and Jhada (diarrhoea) and some of us sold cows for immediate need of money and some like us have sold for our son’s and daughters marriage. Since we don’t have animals men cannot plough so we go to Kerela to earn some income. The women still do some upland agriculture using hand implements and collect forest foods” It is also interesting to note that the fallow cycle of the village for hill agriculture has also reduced from 8 years to 3 years. Mundie pointed out,”..because we cannot keep going very far alone to do agriculture with children at home, we do it more on the land closer to us and there are more people to feed than before so we go back to the same patch of land again sooner.”
One can imagine that Mundie would have been taken to the hospital if there were more younger able men in the village who could have helped with getting transport, and if the ASHA worker was regular to the village and informed Mundie about her delivery date and actually taken to the hospital when she was called in. The possibility of her having enough food in the house is also grim due to the loss of animals needed to plough the field which affects her health. An early referral to the Maa gruha might have helped but then there were not many people to take care of her 4 daughters when her husband is away and rest of the women also leave early to collect food and to the field. It is important to reflect what purpose would our home visits and nutrition counseling help in this case and what kind of nutrition intervention would it require. Connecting and strengthening health system is crucial in cases where physical accessibility is a major concern in the villages.
Local economy forces could potentially worsen the health conditions of the women in the village increasing the workload of women when they are pregnant with inadequate social support and support from the health system.