Maya’s Fight Against Untouchability

Maya Garg, an Accredited Social Health Activist (ASHA), is the first point of contact with the health system for many of the residents of Dwari, a village in Madhya Pradesh, India.

Dwari is a small village in Madhya Pradesh, India. The village is plagued by a social epidemic called untouchability in which so called religious high castes are not allowed to touch or share food or water with those from lower castes. Untouchability is an ancient practice that remains prevalent in many parts of India. If someone from a high caste happens to touch or share food or water with someone from a lower caste, the person from the high caste is supposed to purify him or herself by taking a holy bath.

Maya Garg is an Accredited Social Health Activist (ASHA) in Dwari. An accredited Social Health Activists is a woman who is trained as a community health worker. These women form the first point of contact with the health system for many rural dwellers. They carry drug kits to help meet the basic healthcare demands of very low income and vulnerable sections of the population, specifically women and children. Accredited Social Health Activists receive performance based incentives to promote vaccination and to refer patients to higher levels of care. They escort patients to government health facilities for reproductive and child health services and other healthcare programs. They also generate awareness about construction of household toilets.

A focus group with beneficiaries in Dwari helped us to understand the role that an Accredited Social Health Activist (ASHA) plays in the village.

I met Maya at a focus group discussion that we conducted as a part of an ongoing project in Madhya Pradesh. Maya belongs to one of the so called higher castes. She has been fighting the plague of untouchability since she started working in the health system. Due to her proactive replies, I felt we should visit the subcenter where she works. I was also informed by the nurses in the subcenter that Maya is an exceptional performer. Maya graciously agreed to host us.

Maya has been working in Dwari for nine years. Dwari is everything I have read about rural India. The village has untouchability, superstitions, migration to cities for employment, lack of sanitation, thatched roof homes called kuccha houses, and, above all, open defecation.

We talked to a group of women in the village. They described feeling free to talk to Maya about their health related problems. If Maya does not have an answer to a health questions, she ensures that the woman is referred to a higher level of care. Maya operates out of a small center called Aarogya Kendra, right in the middle of the village.

Maya talks with members of the ACCESS Health team about some of the challenges she faces in her job.

Maya’s biggest fight in her work is the fight against untouchability. In a village where most people consider people of low caste to be untouchable, women still cover their heads in front of men, and most do not endorse modern medical practices, this brave woman personally ensures that each and every child is immunized and treated for diarrhea and infectious diseases. While many will not even touch those of low caste, Maya holds each baby in her arms as the baby is immunized. Maya also sees to it that every pregnant woman understands her right to give birth in a facility and exercises that right. Although she herself is of a high caste, Maya meets with every pregnant woman and reminds them about their prenatal and antenatal checkups because she wants every child to grow up healthy. The mothers in Dwari call her the second mother of their children. Many Accredited Social Health Activists refuse to fulfill their responsibilities. Maya is not like them.

Yet, Maya feels unappreciated. As we walked out of the village, she grew teary. We were the first people to visit her and to recognize her hard work. Accredited Social Health Activists like Maya play a vital role in the health system in India. These women are sometimes the sole connection between a healthy delivery in a government facility and an unaware pregnant woman. Studies have shown that the number of institutional deliveries has increased manifold in India in recent years, owing in large part to these frontline health workers. And many Accredited Social Health Activists like Maya are fighting and winning battles to improve health that do not show up in any official statistics. We must think beyond financial incentives for ways to recognize, encourage, and support health workers like Maya so they can continue to perform their vital roles with enthusiasm and zeal.