Jogita didn't know he was suffering from tuberculosis and a frustrating hospital visit left him unwilling to visit another doctor. - Photo by Sarah K.

Jogita didn't know he was suffering from tuberculosis and a frustrating hospital visit left him unwilling to visit another doctor. - Photo by Sarah K.

Jogita didn’t know it, but his hacking cough, chest pain, and overwhelming exhaustion was tuberculosis. He wasn’t young – getting to the hospital, which was an hour away over barely paved roads, was difficult. He’d gone once before and the medicine the doctor had prescribed hadn’t worked. Maybe the doctor hadn’t been listening – surrounded as he was by several dozen other patients. Maybe Jogita, illiterate and not one to live life by the clock, had failed to take the medicine at the right intervals. Whatever the reason, he wasn’t going to go through all the trouble of another wasted trip. But his symptoms were still troubling him too.

Just down the street, Abha didn’t know what to do either: she was pregnant for the fourth time – this time with twins. Twins didn’t mean double the happiness, it meant double the burden. Abha and her family were terrified. “We’re poor people. What do we know to keep two babies alive?” her mother-in-law lamented. At night, lying on her bamboo mat on their hard dirt floor, Abha wondered how one could even hold two babies at the same time. They had never known anyone who’d kept twins alive through the extra care and economic investment they required.

When Rita took the position of village nurse (Asha), she was too nervous to go even a few streets away without her husband. - Photo by Sarah K.

When Rita took the position of village nurse (Asha), she was too nervous to go even a few streets away without her husband. - Photo by Sarah K.

The person who should’ve known was the village “asha” - a village nurse. An asha makes sure tuberculosis patients like Jogita take their medicine on time and finish the full six-month course. They oversee pregnant women like Abha, giving pre-natal vitamins and exams and explaining the benefits of hospital births rather than the traditional home births. Once babies are born, ashas visit to make sure the babies are being breastfed and getting their required vaccinations.

The village’s Asha was Rita – and she wouldn’t be able to tell Jogita or Abha anything useful, even had she known about their concerns. She had no idea what her job entailed, even though she had taken the job as “asha” several years ago. She was glad for the money the government offered her for the job, but no one told her what her responsibilities entailed, nor did anyone train her. As a high-caste woman, she was expected to stay indoors. Going around the village talking to people, especially anyone from a lower caste, was out of the question. So for five years, her name filled the slot on a government roster but her village remained uncared for.

One day, three Chetna staff members arrived at her door asking for the village asha. They sat down with Rita and asked about her responsibilities in her community. She nervously admitted she didn’t do anything an asha should do. Chetna, a partner project of SIM, works with government-appointed community service volunteers helping them understand their responsibilities and giving them training for how to best serve their communities. They focus mainly on village health workers like ashas and local preschool initiatives.

As she begun to understand her responsibility, Rita gathered her courage and started visiting the sick in her village. At first, she made her husband go with her anywhere further than just a few streets away. Now she goes all on her own, ignoring local convention by sitting in the houses of the lower caste to discuss illness and childrearing.

When she was told she was having twins, Abha had never known anyone to successfully keep two new babies alive. Rita helped her feel confident she could do it and gave her the skills to know how to do so. - Photo by Sarah K.

When she was told she was having twins, Abha had never known anyone to successfully keep two new babies alive. Rita helped her feel confident she could do it and gave her the skills to know how to do so. - Photo by Sarah K.

Rita began visiting Abha’s house every day shortly after they discovered they were going to have twins. She made sure Abha took her vitamins daily and was getting enough food. She listened and calmed the family’s fears. She helped them make plans for a hospital birth. She discussed the possibility of the twins being girls, which didn’t sit well with Abha’s mother-in-law. Two of the three children they already had were girls – two more would be an unwelcome burden in a society where boys earn to provide for their families but girls must be married off with expensive dowries.

When twin baby girls were born, weighing barely 2.5kgs each, the family didn’t mourn like they did when their first two girls were born. Rita had helped them see that girls were just as valuable as boys. The family couldn’t afford to keep the girls in the hospital with incubators, so she helped them find another option.

“Rita taught us how to put the babies inside our blouses to keep them warm,” Abha’s mother-in-law remembers, laughing.

Abha cradles her twin girls, one on each arm, “Rita showed us how to hold two babies at once,” she adds shyly.

Across town, Jogita has finished his second month of tuberculosis medicine. He went back to the hospital when Rita said she’d go with him and now she monitors his daily medicine intake. They’ve also discussed how to safely dispose of the mucus his cough brings up – otherwise he could infect his entire family. Two men in their village had died of tuberculosis before Rita began her work. Jogita knows he could’ve been next – he’s alive because Rita was present to teach him.

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He reflects on what he’s learned because of Rita. “If someone doesn’t tell a man – how will he know?”



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