Solidarity and protest: How an ASHA worker in Kolhapur addresses villagers' mental health concerns, fights for better wages

·9 min read

This story is part of a series on the everyday heroes of rural Maharashtra.

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When Sabina Shaikh* met Netradipa Patil after two months, she was angry. Sabina had a lot of questions. Before asking any, she hugged Netradipa and collapsed. Netradipa isn't new to this. "It gets overwhelming for her," she tells me. After five minutes, she wakes up and asks, "Tum kaha thi didi? (Where were you, sister?)" and breaks into tears. Netradipa serves her a glass of water and consoles her.

Sabina hugs her again and says, "Thank you, didi. Tumne mujhe marne se bachaya (You saved my life)." Right after, she faints yet again.

When Netradipa witnessed this for the first time, she thought it was a type of syncope. "We consulted multiple doctors, did multiple medical tests in the Kolhapur city, and the reports were fine," she says. Netradipa first met Sabina in 2018 while surveying Maharashtra's Kolhapur district. As an Accredited Social Health Activist (ASHA worker), she was tasked to survey the community and list patients diagnosed with cancer. "As I was surveying, there was an unbearable stench at least till 100 metres outside this haunted house," recalls Netradipa. "Everything seemed bizarre and strange." The rodents had turned over the soil in the narrow lane leading up to Sabina's house.

ASHA worker Bharti Kamble noting down the details of a quarantined villager who reverse migrated recently.
ASHA worker Bharti Kamble noting down the details of a quarantined villager who reverse migrated recently.

ASHA worker Bharti Kamble noting down the details of a quarantined villager who reverse migrated recently.

Somehow Netradipa made her way and pushed the door to investigate further. "Sabina was lying unconscious on the floor. That stench could have made anyone unconscious," she adds. Netradipa dialled multiple doctors before one of them agreed to diagnose. Sabina was first given intravenous drips of electrolytes at home. "None of the neighbours were even ready to give us cotton for first aid," she remembers. Drips weren't helpful. For the next four days, she started convincing Sabina to seek treatment. Netradipa was often warned of the consequences of 'trying to help Sabina.' "No one wanted to even talk about how important it was to save someone's life because of rampant communal bigotry," she remembers.

However, convincing Sabina wasn't enough as the local government doctor declined even a primary diagnosis. "The doctor bluntly said, 'I don't know' and suggested dialling 108 (for an ambulance) immediately and visit the district hospital."

Netradipa, 47, fought with the doctor and asked him to at least check the basic health parameters. "Only after signing an undertaking did the doctor agree. But he wasn't helpful." She then took her to Kolhapur several times. "Sabina was diagnosed with severe depression. However, none of the health department members took this seriously and didn't even offer basic help," she says.

This time, she faced stiff resistance from her community members to not help further. "I didn't need to think twice before ignoring this advice," she says proudly and began counselling Sabina. "The first thing I did was build her self-confidence." Every day, she began spending a few hours with Sabina. "Her cousins denied any help, and people were planning to send her to an ashram. They kept repeating that Sabina won't survive over a week."

After spending several hours with Sabina, she found, "Sabina's husband left her because she couldn't conceive a child." Within 15 months, Sabina lost all her relatives to different illnesses. "Kaun he mera, main zinda rehke kya karu? (Who can I call mine now? What should I do by staying alive?)" she kept repeating. For two years, Netradipa crowdfunded and raised Rs 15,000 and started a tiffin service for Sabina. "Sometimes, even I would prepare the food for her."

The mental toll was severe as she couldn't even walk and speak correctly. "This treatment was a mix of physiotherapy and counselling," says Netradipa. However, it did come with consequences. "When none helped, Netradipa cleaned the space without adequate protective gear.

A protesting ASHA worker with a placard that reads,
A protesting ASHA worker with a placard that reads,

A protesting ASHA worker with a placard that reads, "ASHA workers are fighting COVID, and their life's value is only Rs 33."

"During that time, I just wanted to save Sabina. I learned an important thing that it's equally important to take good care of yourself, too, while helping others." Another ASHA worker, Maya Patil from Kolhapur consistently helped Netradipa.

Netradipa caught an infection and for three months was suffering from coughing and was also given multiple antibiotics. Finally, 15 months later, Sabina started walking correctly. "Today, she can look after herself and is in a much better condition," says Netradipa with a wide grin. She delays visiting Sabina, who is in her late 40s, to avoid the risk of COVID-19 as Netradipa works as an ASHA worker.

In these 15 months, Netradipa sensed yet again 'the apathy and the society's negligence towards women from marginalised communities.' "Didi nahi aati toh main nahi hoti aaj (I wouldn't have been alive had Netradipa didi not come forward)," said Sabina.

***

As a leader of over 3,000 ASHA workers from Maharashtra's Kolhapur district, Netradipa has written over 100 letters from the local civic bodies to India's health ministry. "I have recorded this in two big files," she says. "None elicited a response, but we aren't going to stop fighting. These letters show how horrible our working conditions are."

Even before COVID-19 duty, ASHA workers were overworked and underpaid, and the fallouts of these are visible. "When I started working as an ASHA in 2009, I merely got Rs 300 monthly." But, till June this year, it increased only to Rs 4,000. Appointed under India's National Rural Health Mission of 2004, ASHAs constitute women healthcare workers from the same village who work for 1,000 residents.

"The government mentions that ASHAs' working hours stretch only to four hours a day. Show me one ASHA who's worked below eight hours a day in these COVI-19 times," she asks. "It takes at least 30 minutes to survey one house. How are we supposed to survey 250 households quickly if we are to work for four hours?"

In March 2020, India's Ministry of Health and Family Welfare came up with a model plan of micro containment to contain COVID-19's local transmission. ASHA workers, who aren't recognised as full-time workers, are tasked to survey the community, find suspect COVID-19 cases, ensure they get medical facilities, contact trace, create awareness, and much more. "For doing all this, the government announced Rs 33 per day. So now, an ASHA's life is just worth Rs 33?" she implores. "This bare minimum amount hasn't been paid for over 14 months now," she says.

"We haven't even received proper N95 masks, sanitisers, gloves, or PPE kits. How can we battle COVID-19 without proper equipment?"

In August 2020, over 6,00,000 ASHA workers went on a two-day strike demanding their legal status as full-time workers, better working conditions, salary increment, among others. "The government didn't even take note of our demands." This was followed by multiple strikes at local levels across India. On 24 May this year, ASHA workers went on a day-long strike. Netradipa, who has been taking note of this, realised 'nothing will work till they are unionised.'

On 15 June 2021, over 70,000 ASHA workers across Maharashtra went on an indefinite strike. After nine days, the government approved some of their demands. It increased their monthly pay by Rs 1,500 and COVID-19 duty pay by a mere Rs 500 monthly, starting 1 July. "When ASHAs stopped working for nine days, the government realised how important our work is," she says. This wasn't easy, though. "During the protests, several ASHAs got calls from the village panchayat asking to join the duty or resign," says Mandakini Kodak, another ASHA worker and leader from Kolhapur's Ajra taluka.

Both Mandakini and Netradipa received several calls from ASHAs talking of 'mental stress and exploitation from the villagers.' There have been multiple instances in the Kolhapur district where the panchayat members have forced ASHA workers to do much more work for free. "Whenever there are instances of community members abusing the ASHAs, I immediately take it up with authorities," she says. This involves multiple visits to police stations, zilla parishad, and civic bodies.

She also talks of the insurance of Rs 50 lakh, which the government announced in March 2020. "None of us know the company, and if the government has paid the premiums. If something happens to us tomorrow, how do we even claim this insurance," she asks angrily. Her concerns regarding this stem from recent experiences where 'ASHAs couldn't even find a bed in the public hospitals and had to seek loans to clear the bills of private hospitals.'

For a decade now, Netradipa has been a part of hundreds of protests pressing the demands of ASHAs. "For this, I've been to Delhi at least 15 times," she says. "Instead of any person speaking for ASHAs, why can't we voice our own concerns," was a question that always concerned her. She then became a member of the Centre of Indian Trade Unions (CITU) €" a national level trade union in 2011, and began fighting for ASHAs.

To unite and make ASHA workers aware of their rights, Netradipa began taking meetings every week in Kolhapur district's 12 talukas. "Unionising everyone was important; otherwise, we couldn't have come this far." Even while protesting, one of the recurring slogans ASHAs use is, "Hamari taakat, hamari union (Our union is our strength)."

ASHA workers helped save countless lives in the villages across India. Ever since the outbreak of COVID-19, several of them are also busting COVID-19 myths and misinformation on WhatsApp. "I made a hyper-local WhatsApp group of 200 plus community members," she says. Netradipa often talks to at least three COVID-19 doctors before sending out a message on the group, busting fake news. "Fake news is another pandemic which we ASHAs are battling," she says.

"I've asked all the ASHAs in Kolhapur to form WhatsApp groups in their areas and start circulating scientifically correct information." Her reason for doing this is to avoid a rise in the COVID-19 cases as Kolhapur has reported over 1,78,000 cases till 12 July. "Every piece of misinformation can lead to a higher fatality rate, a rapid rise in cases, and this multiplies ASHAs' workload."

In the second wave, her area reported 12 cases and no deaths, she says. This is astonishing because Shirol taluka remains one of the worst affected in the Kolhapur district.

"The government doesn't know what kind of work we ASHAs do. ASHAs reach remote villages where you can't even find a mobile network," she says proudly.

Netradipa's work is far from over. "Your work should bring a smile on the face of the oppressed and the marginalised. If that doesn't happen, you need to reflect who is benefitting from your work."

*Name changed to protect identity

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