Today was split between two sight visits where we had the chance to speak directly with some of the front line health care workers in rural India. We started out at the Jaley First Referral Unit (FRU), which is a 30 bed health care center providing labor and delivery services as well as basic diagnostics and treatments. Any case that the Jaley FRU is not equipped to handle is referred to the Darbhanga Medical College Hospital, about 40 bumpy km away. While Stephen, Anmol, Namrata, and Sharon got a break down on the labor and delivery services at Jaley; Hector, Sowmya and I had the chance to speak with 7 ASHA leaders. ASHA stands for Accredited Social Health Activist and also means Hope in Hindi. These women are community volunteers with a main functional role to counseling their community on health care matters and encouraging people to seek care at proper facilities when necessary. An individual ASHA covers a local area of about 1,000 people through home visits and weekly immunization camps and receives monetary incentives from the government when their counselling results in medical services such as antenatal care visits or institutional delivery being sought out by the villagers they cover. The ASHA uniform is a white and blue sari that is easy to spot out in the villages and the level of enthusiasm shown by the women we talked to leads me to believe they are well respected within their community. While the ASHA role is basically limited to counselling now in Bihar, these women clearly showed that the ASHAs are a crucial part of the health care system in rural India.
After thanking our Jaley hosts for dealing with our barrage of questions, we headed over to the Singhwara Primary Health Center (PHC). PHCs are the base level government health care centers staffed by doctors in rural India. This particular center is a 6 bed facility that also provides basic medical services and serves as a labor and delivery center. With fewer staff and no specialists, the PHC only takes care of very basic cases and refers more complicated issues to the DMCH. While at the PHC we had the opportunity to speak with a very experienced Auxiliary Nurse Midwife (ANM) who was kind enough to demonstrate some neonatal resuscitation techniques with a couple tools Stephen brought along. I think she had a good time working with us and several of her colleagues were peaking around the corner trying to see what was going on.
It was a long day, but we got to see first hand how health care is delivered out in the periphery. Transportation and volumes seem to be some of the most compelling system level issues that are continuous themes in our discussions and we've definitely experience both first hand now. Tomorrow we're heading to the Darbhunga Medical College Hospital to check out the higher level of care available out here.
Don't worry, we're also eating... Anmol has served as our food guide and has made sure Hector, Stephen and I are sampling a a wide variety of Indian food, though we had to switch to some Indochinese for a bit of a break tonight.
PS: Inside the fort from the steps of our temporary home at the Ganga Residence....
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