ASHA in the Pandemic- A Spotlight on the Unseen COVID Warriors
We’ve clapped for our doctors and nurses, generally agreeing that they are the saviours who got us through 2020. However, this myopic vision of who we consider as frontline health workers, ignores the ASHA workers who have played a significant role in preventing the spread of COVID-19 across rural India in 2020. In conversation with Jyosna, an ASHA (Accredited Social Health Activist), we explore how her life was transformed by COVID-19.
When news of COVID-19 struck the primary healthcare centre in Patalganga (a village in Raigad district, Maharashtra), Jyosna experienced real fear of her job for the first time in eight years. As an ASHA supervisor, she oversees the women community volunteers in her village who provide primary health services (ranging from providing maternal healthcare to young mothers and infants, to caring for the needs of TB patients) to isolated populations in rural Maharashtra.
With the onset of the lockdown in March 2020, the responsibilities of the ASHA workers grew double-fold. This was especially true for the ASHAs in Jyosna’s village, who had to monitor the inflow of migrant labourers and put their lives at risk every day to ensure that the rate of infection did not spread faster in their district. While there were only 12 positive cases reported in the village, Jyosna believes that it could have been much higher had it not been for the tireless efforts put in by her community of volunteers, all of whom are over-worked, underpaid and even initially mistreated by their own neighbours.
Day in the life of an ASHA during COVID-19
ASHA workers attending a meeting at a PHC in Maharashtra at the start of their day. Image source: The Quint
There were a number of factors which made the start of the lockdown some of the toughest few months of Jyosna’s life. She says, “I was afraid to step out every single day, knowing that if I came into contact with someone with even mild symptoms during my survey rounds, I was not only putting myself at risk, but also exposing my family and others in my community to the virus. Imagine having to do this in the peak of the summer!”
When asked about essential rest and recovery time during a pandemic, Jyosna laughs. “An ASHA is never off-duty, our service to the community is 24x7.” A typical day in her life looked like this- Overseeing PPE distribution at the health centre in the mornings, followed by conducting survey rounds. In between this, she’d have to attend to emergency calls from villagers, as well as frequent trips to the isolated Adivasi hamlet to cater to this vulnerable population’s health needs. “Since I am a supervisor, I also have to oversee hospitalisation of patients showing COVID-19 symptoms. This meant that I’d often get home very late in the evenings. Even then, I got to spend very little time with my young son through those initial months, out of fear that he’d catch the virus from me.”
Fighting COVID-19… And many other odds
Fear was a common emotion experienced by the ASHAs in Jyosna’s village while responding to the pandemic and there is plenty of reason for that. Various reports of opposition against ASHAs emerged across the country, with some of them even being met with physical violence for carrying out their responsibilities towards their communities. In Jyosna’s village, the ASHAs were also stigmatised initially- “People began avoiding us and refused to cooperate when we’d go to conduct surveys. Once a man even tore apart my forms because he didn’t want others to know that there was a COVID patient in his house. When this happened to a few other ASHAs, we decided to discuss with the Gram Panchayat to find a solution. We were advised to report to them if any such cases of violence or non-cooperation occurred immediately.”
Many ASHAs however, face opposition at a dual level, even from within their families which got amplified through the lockdown. It’s common for many young women to be discouraged from becoming an ASHA since they paid through performance-based incentives (number of deliveries, trainings attended) rather than a fixed monthly salary. As Jyosna wryly puts it, “Everyone knows going into this job that the income will remain low. In fact, one of the biggest fears we have at the moment is that the fixed raise in our wages announced at the start of the lockdown last year, will be discontinued once COVID-19 is no longer a threat.”
Seva over self-interest
How then have these healthcare workers managed to stay motivated in such an environment? As a leader, Jyosna had to make peace with her own fears when she was required to constantly encourage others to remain fearless despite all the opposition they faced. For her, there was no question of giving up this voluntary position since the entire healthcare system in the region was dependent on the backs of the ASHAs.
Duty to the community or seva, is something that Jyosna takes very seriously and this attitude has paid off. Her greatest joy and pride over the last year has been the transformation of attitudes towards healthcare workers. She says, “Their opinions have changed. Now, there are even times when they call us themselves and self-report if they are showing any virus symptoms. They are openly grateful that we’ve been able to prevent the spread of infection in our district.”
We leave you with this poignant comment made by Jyosna about why ASHAs need to be more widely recognised by both formal and informal channels across the country:
“An ASHA… is the face of the healthcare system to the population. Where I come from, if a patient is facing any difficulty, they will first contact an ASHA, then we advise them on whether they should consult a doctor. In the last year, she has saved many lives but still has very little support from higher authorities. If this doesn’t change, it will be extremely difficult to stay motivated in the future.”