On an ordinary workday, 27-year-old Pramila Bariki hikes up steep slopes, across fields, through ankle-deep rivulets, often walking up to 14 km. She gets a ride until the road is motorable, from which point she has to walk.
Her job? She doles out healthcare advice to mothers and children in the remotest tribal hamlets in the Araku valley of Andhra Pradesh.
Now heavily pregnant, Pramila has had to slow down, delegating tasks to her colleagues, Duridi Champa, Pangi Padma, Neraj Sunita and others. It’s they who now walk through forests and up mountains visiting families to identify pregnant women and conduct basic tests for diabetes and anaemia, and connect them with a primary health centre (PHC) when necessary.
Vital interventions
These young tribal women — for whom Pramila is the pioneer — are all trained auxiliary nurses, part of an experimental health project in Araku that aims to end preventable deaths during childbirth or infancy, run by Piramal Swasthya, a not-for-profit.
A tribal woman with her infant bundles coriander leaves in Devuduvalasa
The Araku valley is home to several nomadic tribes who live in small clusters of 70 to 150 homes nestled in rugged and inaccessible terrain, often undocumented in government records. Until a few years ago, these communities were unaware of government healthcare policies. The death of a child or a woman during pregnancy or childbirth was common and they were resigned to it.
Today, 38 women like Pramila, drawn from these tribes, have broken social and cultural barriers to train as nurses and reach medical care to 1,179 hamlets across the Araku, Paderu and Chintapalli mandals. Since they are from these communities, the women have been able to forge trust in their families and neighbours about formal healthcare. As a result, these remote villages have now had the first childbirth in hospital, the first delivery by trained nurse, and the first mother to not lose a child.
The nurses advise women on hygiene and nutrition, and convince them to visit the nearest health centres for further check-ups.
The valley now has telemedicine centres with a medical officer for direct evaluation or a specialist for video conferencing. Malaria, dengue, anaemia and malnutrition are common, so these interventions become vital.
A tribal boy with his pet mynah in an Araku valley village.
Common thread
Padma lives with her mother, a retired anganwadi teacher, and four brothers who are farmers. Her family doesn’t mind that she travels at odd hours or is in the company of male colleagues, which in her community was once taboo. They understand the value of her service, she says. One common thread among these young girls is that all their mothers have either worked in or taught at the village anganwadis, and they insisted that their daughters be educated.
“Initially, the people were cold and sceptical,” says Padma, “but over the past couple of years, attitudes have changed. They trust us, they have our phone numbers pasted on their walls so that they can reach out when they need to.”
Traditional to modern
Possibly the most important change these young women have brought to the valley is getting their tribes to move from traditional medicine to modern medicine. They repeatedly visited families, explained the need for better healthcare and hygiene, and taught them to eat well.
The women earn between ₹10,000 and ₹18,000 a month based on their experience. A few of them went as far as Vishakapatnam to study, but chose to return home since working in the community was important to them.
The outcome is evident in the figures. According to the 2011 census, the maternal mortality ratio in Araku valley was over 400 per 100,000 live births, more than double the national average. In the last two years, however, there have been no deaths during pregnancy or childbirth. While all these years, women gave birth in their homes, aided by the elderly in the family, or maybe a dai, the last two years have seen institutional deliveries reaching 68% of women.
The writer, a freelance journalist, is an enthusiast in all things positive.
