by Shiban Ganju
Early in the morning, my cell phone rang. I looked at the screen. It was a call from India; Anoop was on the other end. “This training will not do well. The women don’t seem enthusiastic.” He was in Uttar Pradesh, in a small village – Mijwan, the birth place of progressive poet, Kaifi Azmi. I did not believe Anoop, his assessment must be wrong. The women of Mijwan must have changed in the past eighty years since Kaifi, the son of this soil had exhorted women to walk in stride with men:
Emerge out of ancient bondage, break the idol of tradition
The weakness of pleasure, this mirage of fragility
Nor merely the thorns on the path, you have to trample on flowers too
But over many centuries, history has traveled by Mijwan without affecting it. Four capitals of ancient India, Kannauj, Kausambi, Magadha, and Ujjaini prospered within three hundred miles. Culture flourished only two hundred miles away in the city of Lucknow, just over a century back. Buddha walked on this land. Mughal emperors galloped across it. Mijwan has been a neighbor to riches, decadence, knowledge and enlightenment but has stayed frozen in poverty and ignorance.
When Kaifi Azmi was born, Mijwan was off the map. His tireless work christened it with a zip code and it got a post office; it acquired a tarmac road and a train station nearby. By the time he passed away and shortly after that, a girls’ primary school, an associate degree college, a computer training center and an embroidery school came up. Mijwan now attracts students from nearby towns.
Five hundred and fifty people live here. The local NGO, Mijwan Welfare Society, picks up their shredded ambitions and stitches them with a thread of zeal and hard work. India has 600, 000 such villages, home to over sixty percent of its population. Thousands of voluntary organizations – probably the largest number in the world – toil in these villages to usher development. They dangle the yarn of future possibility as their flag. ‘Save a Mother’ is one such small organization.
Anoop, a master trainer, was in Mijwan to expand the work of ‘Save a Mother’- a health literacy program to decrease maternal and infant mortality. He has a gift of simplifying complex health information; expressing in plain language comes to him with ease. He has lectured on health matters for many years to rural folks, who have either not gone to school or dropped out early. Just two months back, he even overcame the language barrier and trained forty nine women as health activists in the state of Karnataka in south India. He spoke in Hindi and an interpreter translated it into the local language, Kananda. He conveyed the message and in spite of the language barrier he succeeded. This morning, it was a discouraging call from usually upbeat Anoop, whose forte is to impart training.
Anoop said, “We can work around language but how do we overcome attitude? Some have their faces covered, others don’t seem interested.” He paused, “But we have two more days.”
The trainers were in Mijwan after having conducted scores of training sessions and having honed their training skills. Save a Mother (SAM) started over two years back in Sultanpur district of Uttar Pradesh, where more mothers die during child birth than most regions of the world. Measured as maternal deaths per 100, 000 live child births, maternal mortality rate in Sultanpur stands as 500 according to published data. Our own estimate places this number even higher, probably closer to 600. Our foray into maternal mortality reduction is an entry strategy to find health care solutions for the poor. Our hypothesis is that the path to health as a human right begins with human responsibility and the first step in this journey is health literacy.
SAM started in one district and now has expanded to five districts in two different states. We train health activists, mostly women in basics of health care; the initial training lasts three days and refresher training lasts one day. Every month, SAM conducts about three initial training sessions and about eight refresher courses. It trained over 1000 women in 2009.
Participatory approach is the method in all sessions; the trainers encourage participants to share their experiences, ground realities and their knowledge. Group discussions, role play, case studies, flip book and group work are the tools of training, which covers topics like communication, leadership, sanitation, personal hygiene, nutrition, immunization, pregnancy, antenatal care, post-natal care, dangerous signs in pregnancy, preparation for safe delivery, contraception and family planning methods.
These trained activists meet weekly with the women in their villages and share their leaned knowledge. They also discuss health issues, once a month, at the village cluster association, where trainers also conduct refresher training and collect data. They follow each pregnant woman in their village and ensure that she gets proper antenatal care, adequate nutrition and immunization. The activists facilitate her registration with an institution for safe delivery and postnatal care. With an ambitious target of one trained activist in each village, SAM activists are active in 600 villages now and will be present in about 2000 villages by the end of 2010.
The scope of the program is expanding to include eye care, sanitation, adolescent health and TB eradication. SAM has also started training activists in the management of primary health clinics and linked them with other public health programs. SAM hopes to include even more areas of health care in future and to develop “plug and play” modules in health care delivery for the poor, which any other organization can use. Maternal mortality reduction is just one such module, which SAM offers to any organization, which wants to expand into health care.
Our operational model follows four principles: simplicity, sustainability, scalability with speed. To maintain sustainability and keep operational cost down, SAM works only with volunteers except the field staff who are salaried; it shares resources with other organizations, outsources non-core activities and utilizes all the benefits that government offers. We study our impact in the field and modify our approach to improve.SAM devotes all its resources to training activists in the field. Anoop, who has a master’s degree in development studies and is pursuing a PhD, is the project manager and master trainer.
Understanding his dissatisfaction with the first day of training, I reminded him Kaifi Azmi had said that change is slow and you should be prepared to concede that it may not even happen in your life time; keep striving with a conviction that change will come, perhaps after you are gone.
I suggested, “Let Preeti lead the training tomorrow?” Preeti is our female trainer, an ex school teacher, who still carries that demeanor. She had excelled in Karnataka just a few weeks back, when Anoop could not break any ice. The second day of SAM training dwells on female reproductive health, which either provokes animated talk or hushed silence. The second day was a make or break day, and we took the risk .
Anoop sounded discouraged. “Five women dropped out. We had twenty six women yesterday but only twenty one showed up today. But Preeti did well and some shy women opened up on reproductive health and asked some questions.”
The dwindling number and lack of participation was not a good sign. I thought we will have to go back and redesign our methods – one size does not fit all. If the adult training failed, I envisioned some hope for the third day: we had planned a session on adolescent health for the local school girls. That would be our only redeeming consolation.
Training for school girls went well. Girls threw questions at the trainers with alacrity, which put Preeti and Anoop in good mood. But the pending final session for adults still hung heavy on them. They were concerned about the final day.
I did not hear from Anoop till the next morning, then he called, “We did it. Today, thirty one women showed up. The word has spread that the training is useful. The women were vocal and guess what – they even lifted their veils.”
The women in training willingly participated in SAM’s closing ritual of expressing ‘equality’ — they shook each others’ hands and even that of the male master trainer – Anoop.
Kaifi Azmi had said:
“History has not known your worth thus far
You have burning embers too, not merely tears
You are reality too, not a mere amusing anecdote
Your personality is something too, not just your youth
You have to change the title of your history
Get up my love; you have to walk with me”
We persevere with the conviction that, with one step at a time, these women will thrive, and hope it is in our life time. ‘Save a Mother’ has lit one small lamp in one more village and facilitated the first step from darkness to light. The veils had lifted.