Report by Badal Tah; Rayagada: Though for a bad reason Rayagada has been in the limelight for few days, there is also a positive side to it. Take the news of youths carrying & traversing through extremely muddy, undulated hilly terrain & then finally torrential Nagavali or Kalyani rivers to reach to the hospital at Kalyan Singhpur. Most of the time the pregnant lady in question is carried by a stretcher provided by the govt health department. And she is also accompanied by the local ASHA to the PHC or CHC or to the district headquarters hospital as a referral point.
“Generally poor tribals were avoiding the allopathic hospitals earlier. They did believe in their traditional healing systems and several deaths got un-noticed. The child births were usually conducted by the untrained dais in the village and the pregnant women hardly went to the local hospital for delivery purpose. I am a tribal and have three grown-up children. Like many pregnant women of the village of my time, my wife never went for an institutional delivery. I still remember a few mother and child deaths due to extreme labour pain and complicacies. But now the situation has changed. The presence of health delivery system in the form of Anganwadi Worker and ASHA at our doorstep has created a new hope among the tribal women. As both of them are from the community and readily available and accessible to the community, there are several mutual consultations. Village women also consult the local ANM whenever she is available, though her presence and visits are not frequent. The belief in the hospital health system is strengthened. Villagers are depending on the local hospital when they are sick”, said Sri Akshey Pidisika, a local tribal youth leader from Padeikani village in Kalyan Singhpur.
According to a study conducted by Centre for Health and Social Justice (CHSJ) in collaboration with the National Alliance for Maternal Health and Human Rights (NAMHHR),“ In this district, 38% of deliveries still take place in the home and these remain out of the purview of maternal health schemes. In Tribal communities, domiciliary deliveries are still common. The exploration of traditional practices of women during pregnancy and delivery shows that in this community, pregnancy and childbirth is treated as part of a natural process, not requiring much external intervention. Traditional practices are primarily geared towards protecting the mother and child, through conducting pujas or through restricting diet. Women go through childbirth in the familiar surroundings of their own home and family, continuing to work until the time of delivery, which is an important economic consideration for them. There is awareness of complications in pregnancy, and the necessity to take the woman to the health facility in such situations. This suggests that there is a well established traditional practice of birthing in the community which also recognizes the need for health system interventions. However, there has been no effort to build on this traditional understanding by the health system. For instance, traditional health providers who are important stakeholders have not been integrated into the health system.”
Despite the immense difficulties that women face like barriers of distance, language, alienating environment in the hospital, out of pocket expenses, however, they do access health facilities. So, the single minded focus on institutionalizing deliveries seems misdirected in such a situation where a complex web of barriers, makes access to health care facilities so difficult.
Most of the villages in Niyamagiri hills, the abode of Dangaria Kandhas, a Primarily Vulnerable Tribal Group(PVTG), are still inaccessible by road in spite of district administration’s sheer effort to facilitate connectivity. Members of this PVTG, earlier called as primitive tribe, had lot of blind beliefs. There were instances of abandoning the whole village if there were a few deaths within a particular time limit, even if it was a simple gastroenteritis disease. Generally they treat the patients with home remedies, through faith healers and even at times through quacks. When the disease becomes acute and the patient is on the verge of death, they leave him/her to the providence.
“But things are changing now. Dangarias are invited to attend republic and independence days in the district headquarter. Their visits to district cultural extravaganza CHAITI and Car Festival are also facilitated by the district administration. This has led to a cultural synthesis. With various other exposures, they have started to believe in the local hospital. And this is exactly the reason why more and more pregnant women are arriving at the local PHC for delivering their babies. The process is late, but it has yielded result. Infant Mortality Rate(IMR) and Maternal Mortality Rate(MMR) have drastically come down. Maa Gruha-Maternity Waiting Home is playing a vital role and that needs to be strengthened”, said Sri Purandar Bantha, a local Social Worker serving these PVTG members.
“Inaccessibility is a reality in this area. Though govt services are not foolproof or comprehensive, still one must take advantage of available infrastructures and human resources provided by the state like hospital, maa gruha, ASHA, AWW, ambulances, stretchers, temporary health centres, free medicines, mobile clinics, etc. Acquiring good health is equally the responsibility of a responsible citizen alongwith the state. There is also a need for providing support to deliveries occurring in the home, trust-building measures between the community and health system, efforts to cater to the specific cultural needs of tribal women and to preserve beneficial parts of traditional practices”, said Sri Ajay Rath, Convenor of Rayagada Nagarika Mancha.