White Ribbon Alliance

India

More than meets the eye

The Statesman

August 1, 2016
This article was originally published in The Statesman and was written by Saket Suman

As part of her Lady Julia Grey series, Deanna Raybourn famously wrote in Dark Road to Darjeeling, “When the wind is right and the cloud is gone, you can see down this road as far as Darjeeling,” I told her. “But it is a long and difficult road, full of perils, and if a traveller on foot were to look at the length of it, his spirit would be overcome and he would sit down and refuse to go any further. You must not look to the end of the road, Portia. Look only to the step in front of you. That you can do. Just one step. And you will not make the journey alone.”

These lines would be read aloud again and again by our headmaster during my childhood in a boarding school in Darjeeling. He was a strict disciplinarian and an avid trekker who would lead a troupe of 50-60 interested students on long treks right up to the mountains and through the most remote hamlets of the hills — the small pristine villages of Chitre, Chimney, Dow Hill and Bagora, among others — literally mingling with the fog that played hide and sick with travellers.

Growing up in the hills, surrounded by birds, bees and a hundred kinds of trees in the midst of a perennial calm that then exemplified Darjeeling, I would admire the beautiful women working in the vast expanse of numerous tea gardens in the hills and the nearby Dooars. Imagine a group of young, bold and energetic middle-schoolchildren, far removed from the harsh realities of life, walking uphill from Giddhe pahar (a village in Kurseong) after an excursion to Netaji Museum (associated with memories of Subhash Chandra Bose). Suddenly, the fog clears, a green tea valley comes to light and, much like something out of a fairy tale, a beautiful girl emerges from the haze. The group is left dumbstruck, in awe of her elegance. In a calm, composed yet mischievous manner, she goes about plucking leaves and soon disappears soon among other women. It was what we now call “first crush” and for several days they would make their way to the same valley hoping to see her again but to no avail.

For numerous travellers visiting Darjeeling and the Dooars, the tea gardens have been an everlasting attraction. Hop on to a Tata Spacio from Siliguri to Kalimpong and the Dooars on one side or to Kurseong and Darjeeling on the other and you’re almost certain to encounter tea garden workers posing for photographs. But for most, they’re only an abstract ornament of our travelogues and we little consider the odds they withstand to make ends meet.

Though fortunate to have spent the dawn of my life in the hills, bound as I was within the boundaries of boarding school I remained largely unaware of the ground realities in many of these gardens. So when an invitation arrived from White Ribbon Alliance, an international NGO, to study the maternal health in one such Dooars tea garden, I jumped at it without second thought. Landing at Bagdogra I then made my way to Nagarkata, a town in Jalpaiguri district of North Bengal.

Here’s where Kurti Tea Garden village is located, with a total of 913 resident families. It has a population of 4,285, of which 2,093 are males, as per the 2011 Census. Its numbers are estimated to have risen to about 4,600 now, with 490 children up to the age of six years, which makes up 11.44 per cent of its total population. The average sex ratio here is 1,047, which is higher than West Bengal’s 950, and the child sex ratio, as per the Census, is 960 — higher than West Bengal’s of 956.

But Kurti Tea Garden village has a lower literacy rate compared to West Bengal. In 2011, it was 49.38 per cent compared to West Bengal’s 76.26 per cent, and its literacy rate stands at 58.11 per cent for men and 41.14 per cent for women. White Ribbon Alliance is working to improve maternal health in the area.

Poverty exposes its ugliest face in this village, not to forget the threat of leopards and pythons looming in the backdrop. This place witnessed a high rate of maternal deaths till a few years back but the situation is improving gradually. One major problem in the region had been home deliveries, with women reluctant to adopt institutional delivery. What White Ribbon Alliance is doing is connecting the dots and spreading awareness among people about the privileges they are entitled to.

Just three Accredited Social Health Activists look after a population of 4,600 supported by two Auxiliary Nurse Midwives. “There are just the three of us and there is quite a lot to do, but we are managing somehow. The most important challenge here was to convince women about institutional delivery because many of them were so unwilling to go to hospital for delivery,” said Bibha Lama, popularly known as Asha didi. “There is nothing in the tea gardens. There is no public transport to reach the Integrated Child Development Services Centre and we can only provide basic treatment here. The nearest hospital is 10 km away and people are so poor that they cannot afford Rs 500 for an ambulance,” she said.

There is a provision for a free ambulance for pregnant mothers but this service is only for delivery — a mother can take advantage of it only once for delivery and thrice after the child is born. “The free ambulance is for delivery only and not for treatment, but sometimes when it is serious we request the officials and they provide it, but we cannot do that always,” said Beena Eka, another Asha worker.

There is a separate hospital for tea garden workers and they are provided most of the facilities, even an ambulance to transport them free of cost to the hospital owned by the garden administration. But only a handful of them are on the regular payroll, with most working on daily wages.

These, then, are the worst affected. “They have to work daily to meet ends. If they do not work for one day, it is very possible they will have no food to eat that night. What do you think they will do? They hide their pregnancy and work for long hours even during the last month. We have also seen cases of delivery in the tea garden,” said Santu, a local health activist. Those on the payroll are entitled to one-and-a-half months’ maternity leave before and after the birth of their babies but others have to put in hours of work continuously, even in the last month of pregnancy.

Much of these ills remained largely out of public and administrative knowledge but issues are gradually being addressed, thanks to several awareness programmes. Towards the end of 2015, White Ribbon Alliance organised a Public Hearing in the region, where officials from several departments as well as mothers and expectant women participated. When the achievements were being counted, an ANM worker stood up and asked why, even after so much work being done, were people still suffering and called for introspection and understanding the “real” problems. All in attendance, including the block development officer, were stunned at her outburst.

“This was a good sign for us. We saw there were so many things we did not know. We also came to know that we get a free ambulance to go to hospital — earlier the driver would ask us for chai-pani and we would give them. We need more awareness programmes like these because there is a lot of change. Now everybody wants to give birth in the hospital and not in their homes,” said Pratibha, a mother of two.

“The mobile network is also weak. Sometimes we are not even able to make a call for the ambulance in an emergency situation. What we actually need is a hospital in our village or at least a free ambulance for treatment too,” said Bibha.

Twenty-seven-year-old Sunita Mundra is expecting twins soon. She was married at the age of 23 and suffered a miscarriage in the past. Asha is particularly anxious about her. Her mother-in-law visits the Asha workers almost daily and informs them of her situation. Mundra has made up her mind to deliver in the hospital this time. “I will deliver in the hospital if everything is good but I don’t want male doctors,” she said. Other villagers also said that sometimes two or three mothers had to share the same bed and that the distance to the hospital was a lot. Mothers have to go to Sulkapara sub-centre or Malbazar Hospital, both of which are at least 10 km from the village. A hospital or a regular ambulance service, they said, would bring a sigh of relief.

The picturesque greenery of tea gardens would serve to obfuscate the depth of difficulties these women have to cope with every day. But it was actually inspiring to see the willingness of officials, unlike in most other parts of the country, to improve the situation in the region. “The biggest problem here is that most of the women work on daily wages and they are extremely poor. We have managed to tackle the problem of maternal deaths and home deliveries but there is a lot that remains to be done. Another important thing we are working on is to spread awareness among men because whenever we think of pregnancy we confine ourselves to womenfolk, but men have an equal role in it. It is my personal opinion that India is still a male-driven society and that awareness among men will make situation much better,” said Sange Pema Bhutia, block development officer, Nagarkata. “We are also targeting adolescent girls and trying to not only prevent child marriage but also to make them aware of the importance of institutional delivery. We have come across cases where mothers aren’t even aware that they are pregnant, even till five months. Later, when they are expecting babies, the condition will be much different and for the better. There has been a good impact of initiatives like the Public Hearing but much more needs to be done and on a continuous basis,” she said.

Most of the expectant mothers in the village go to Malbazar Hospital (27.4 km away) for delivery. The hospital has also undertaken a number of steps to overcome the maternal health problem and the statistics speak of the work done in this direction. There were 12 maternal deaths reported in the hospital in 2013-14, which came down to eight in 2014-15 but rose to nine in 2015-16. But there have been no deaths since April this year.

“People have started coming to the hospital for delivery now because one of the first things we ensured was that out-of-pocket expense should be zero. It is all in the government protocol. What we have actually done is try to implement that. The ambulance is another boost to the poor and it has helped a lot in decreasing maternal deaths and increasing institutional delivery,” said Masood Hassan Ali, superintendent of Malbazar Hospital. When The Statesman took up the complaints of mothers and Asha workers regarding ambulances, Ali said, “I cannot deny that there have been no births at home due to ambulances but it has certainly come down.”

Like nowhere else in the country, expecting mothers in this particular Jalpaiguri hospital are admitted with a welcome diet and get a Mother’s kit containing a glass, toothpaste, toothbrush, soap, spoon and towel. The hospital is also trying to introduce a Mothers’ hub. “We are trying to admit high-risk mothers one month prior to their expected date and keep them even 15 days after delivery,” said Ali. But would those who survive on daily wages prefer to stay in hospital for about a month and a half? “Many of them are so poor that even the two meals they get in the hospital may attract them. It is an attempt to bring high-risk mothers to the hospital and look after them,” he said.

The only other hospital where expecting mothers go is Sulkapara Block Primary Health Centre (13.1 km from the village), but efforts have reduced home deliveries to a large extent. In 2013-14, the region recorded a total of 367 home deliveries, in 2014-15 it was 332, in 2015-16 it was 150 and there were 16 and 10 home deliveries in May and June this year. In 2013-14 there were 11 maternal deaths, which fell to six in 2014-15 and three in 2015-16.

There have been no maternal deaths so far this financial year in the hospital.

Block medical officer of health Subhojit Hawla Dar told The Statesman that there were sufficient government provisions in place and with the help of awareness programmes by White Ribbon Alliance people were utilising them and that such initiatives should continue to see better results.

Like the “long and difficult road” to Darjeeling that Deanna Raybourn mentioned in her book, life in the tea gardens is “full of perils” and a lot remains to be done.

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