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Chhattisgarh nurses are wading through rivers to help tribal women with prenatal care

According to state data, early referral centres have resulted in more institutional births, but terrain & lack of connectivity are biggest challenges for caregivers in Naxal-infested Abujmarh.

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Orcha/Abujmarh: Chandravali, a tribal woman from the Gond community, living in Vattekal village of Chhattisgarh’s Abujmarh region, lost her firstborn son in 2021, just five days after his birth. For days after the delivery, Chandravali had continued to bleed, too weak to even stand up.

She religiously followed the rituals prescribed by the Sirah (the local exorcist, also a quack) to propitiate the devi-devtas (gods and goddesses), but it took her almost a year to recover.

With the scars of losing her baby still fresh in her mind, she was more scared than happy when her period cycle was disrupted last year and she realised she was pregnant again.

That was when a nervous Chandravali decided to tread a hitherto alien path — medically-assisted birth, of which she had only heard in the village, but never dared to inquire about since it is frowned upon in her community. She knew resistance was inevitable, but she was ready to fight.

Chandravali is not the only woman to have suffered in silence because of the lack of proper medical care in the “Naxal-infested” area of Abujmarh, locally referred to as the “unknown hills”. The region is characterised by a rocky terrain, dotted with rivers and rivulets, and little-to-no road, transport or mobile connectivity.

Seeking medical help, however, may never have been an option were it not for counsellors and nurses who, working in tandem with the state administration, climb mountains, wade through rivers and crisscross thick forests for days, to reach the remote wilderness of Abujmarh to identify pregnant women and convince them and their families to opt for institutional deliveries.

Once convinced, pregnant women are brought to early referral centres (ERCs), set up in 2020, where they are kept under observation, given nutritious food and undergo routine check-ups by visiting doctors. Two years later, these referral centres have become popular among tribal women in Chhattisgarh, which sees 159 maternal mortalities per 100,000 births — among the highest in India, after Bihar, Assam, Rajasthan, Uttar Pradesh and Madhya Pradesh.

Pregnant women at an early referral centre in Orchha village | Praveen Jain | ThePrint
Pregnant women at an early referral centre in Orchha village | Praveen Jain | ThePrint

According to the state administration, since these referral centres were set up in Narayanpur district — which includes parts of Abujmarh — more babies are being born in hospitals than before. According to data available with the state administration, Narayanpur recorded over 755 institutional deliveries between January 2020 and December 2022, compared to just 310 between 2017 and 2019.

Orchha, an administrative block that is part of the Narayanpur district has four such centres, where approximately 120 deliveries take place on average every month when it doesn’t rain, according to data provided by district authorities. When it rains, villages in the jungles of Abujmarh — spread over 4,000 square kilometres — are cut off from the world due to flooded water bodies, slush and dense foliage, said the local administration. The region has several small villages, many of which serve as hideouts for Naxal leaders and their training camps, according to the administration

“The early referral centres have been very useful for areas where health care professionals cannot reach owing to accessibility issues, such as Abujmarh which consists of rugged tracts with dense forests, hills, rivers and streams. It has significantly reduced infant mortality rate and maternal mortality rate among primitive tribes,” Narayanpur district collector Ajeet Vasant said.

Chandravali, was seated on a charpoy covered with a mosquito net at one such early referral centre in Orchha, when ThePrint visited last week.

“With what happened to me the last time, I did not want to take a chance. I did not think I would survive. Moreover, I have seen so many women and newborns die in the village. I was very scared when I got pregnant this time,” she said.

Chandravali added: “I am glad I found the didis (Anganwadi workers) who came and got me with them here.” She eats a plate of dal-chawal (lentils-rice), with tamarind, as she talks.

To get the women to the ERC, counsellors — with help from anganwadi workers and counsellors — travel from village to village to identify those who are pregnant, explained Vasant. Since often the women don’t even know their expected delivery date, he added, a basic examination is carried out to ascertain the same, so that they can be sent to the centre two-three weeks in advance.

Also Read: Did Punjab doctor ‘deliver baby’ via video call? What panel probing pregnant woman’s death found

Rough terrain meets superstition

The road to Orchha, made of deep red laterite soil, is lined with thick forests on both sides. There is no mobile network coverage here. Surrounded by the iron ore-rich Aamdai Ghati range, the ERC here is a pale-yellow building, the walls of which are covered with handmade charts on antenatal care and names of adjoining villages with details of their distance from the centre.

The sound of giggling women float out as one approaches the building. Inside, the women are seated on charpoys, engrossed in a Malayali action film dubbed in Hindi, which they find amusing despite the fact that none of them understands Hindi. Most of the women are from the Gond community.

For most of these women, who belong to different villages in the Abujmarh region, getting to the centre was a struggle. While some of the women themselves needed convincing, others had to fight with their families to ensure they got antenatal care. But the biggest challenge in ensuring that these women had access to antenatal care was the terrain, said Madhavi Yadav, a counsellor at the ERC in Narayanpur’s Dhanora sector.

Madhavi Yadav, the counsellor at ERC in Dhanora sector | Praveen Jain | ThePrint
Madhavi Yadav, the counsellor at ERC in Dhanora sector | Praveen Jain | ThePrint

The only way in and out of most settlements in Abujmarh is through rough paths, some of which can be traversed using motorcycles or powerful utility vehicles, while the remaining settlements can only be accessed on foot, she said. Several villages are located deep within forests, across hills and streams. To reach these villages one has to walk a distance of 70-90 kilometres.

“Terrain is a very challenging part. There is a village that we have been trying to get to for the past three years, since we would have to cross three mountains and two rivers to get there. Then there is a long walk of over 40 kilometres,” said Yadav.

Promod Potai, who works with the NGO Saathi, to help the government run these centres, said, “This is Abujmarh, a place where the terrain is very difficult and so, to have institutional deliveries at this place is extremely challenging. There are no roads and all villages are cut off. We have a motorbike ambulance, which goes inside the forest to get the pregnant women, but in many cases, there are places where even a bike cannot go, since there are rivers one needs to cross on the way.”

A motorbike ambulance parked at an early referral centre in Orchha | Praveen Jain | ThePrint
A motorbike ambulance parked at an early referral centre in Orchha | Praveen Jain | ThePrint

To add to the already complex situation, malaria accounts for a major part of comorbidities in the district, said the administration, leading to high levels of anaemia in women and other complications during pregnancies and deliveries.

Many pregnant women here do not remember their last menstrual period (LMP), causing errors in estimating the date of delivery, said an official in the district administration.

Often the tribal women do not reveal pregnancies to counsellors because of superstitions, causing further challenges in providing antenatal care. “They have their set notions about hospitals, doctors and medicine. They believe that if the woman goes to the hospital, it may anger their deities and lead to an abortion or the mother’s death,” said Yadav.

Yadav’s words are backed by the experience of Desri, a resident of Kunjekal village. “My family was scared. They thought that the machines (ultrasound) might kill the baby. Or maybe the doctor will do an operation and cut my body. But the sisters who came to counsel us helped convince my family,” Desri told ThePrint at the Orchha ERC.

When Desri was having her first child in 2021, she did not go to the hospital at the insistence of her in-laws “I was in labour for days and I thought I would die. I did not want to go through that again and convinced my husband (to let me come to the ERC) after doctors convinced me that I would be taken care of.” This is her second pregnancy.

To convince the families of expecting mothers, counsellors often have to seek the assistance of the Siraha, since most of the tribals go to them for treatment.

“We have to take these people, including the elderly on board. We ask them to help us convince families. Sometimes they help, sometimes they don’t. We try to educate families about the complications of childbirth and how it can get fatal for both the mother and the baby,” Yadav told ThePrint.

Counsellors. she said, explained to the families that deliveries must take place in a hygienic environment under the watch of a trained medical team. “We tell them about complications which may occur during birth. We also give them live examples of women who have suffered from their neighbourhood, so they are able to relate to what we tell them and understand better,” added Yadav.

The counsellors also educate families about how before the delivery, a woman will be provided with the required nutrition and care at the centre.

‘Would have been working if we were at home’

For the tribal women at the ERC in Orchha, the centre is also a place to make new friends, besides receiving proper healthcare during their pregnancies. It is also a much-needed break from household chores.

“If we were at home, we would have been doing so much work. From cleaning to cooking and other things. Here, we talk, watch films, eat together, sleep and also go for walks. It is very good,” said Lakhmi, a resident of Edalnar village, in the area.

During their stay at the ERC, the women’s vitals are checked every day and a detailed checkup is carried out once a week by a doctor who comes from the adjoining hospital, just 500 metres from the centre.

Pregnant women at the early referral centre in Orchha | Praveen Jain | ThePrint
Pregnant women at the early referral centre in Orchha | Praveen Jain | ThePrint

“We come here for regular check-ups. We check their vitals and all required tests for antenatal care are done. For other tests including sonography, we arrange an ambulance and take them to the district hospital,” said Dr Ashok Kumar. Deliveries — other than referrals to the district hospital owing to complications — are done under staff supervision at the ERC.

One of the women at the centre, Sukhdai — a resident of Rohtad village 17 kms from Orccha — is expecting her first child. With her delivery date just a week away, she is happy she will be returning home soon, but sad that she will be leaving behind all her friends at the ERC.

“I will be home soon, with my child. But I will miss them all,” she said, speaking in Gondi. She holds the hand of the woman who sleeps on the bed next to her at the ERC, as she spoke.

(Edited by Amrtansh Arora)

Also Read: Adivasi identity, ST status, politics — what’s fuelling anti-Christian attacks in Chhattisgarh


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