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Meet Mejim Dususow, an ASHA

Surviving at the Margins of India's
Health System
Mejim Dususow has 20 years experience being a dai and an ASHA. She is paid
Rs 600 per birth, and runs a small shop to help with household expenses.

Mejim Sidisow. Credit: Author provided

 Julee Jerang and Nandini Velho

HEALTH WOMEN 09/MAY/2019

Almost a million ASHAs (accredited social health activists) work

across India and are part of one of the largest public healthcare
programmes of the world. Launched in 2005, the ASHA programme
is meant to strengthen delivery of government healthcare services in
rural areas and foster community engagement and ownership of the
health programme.

However, a new review finds that many studies from other parts of
India have short-term engagements that focus on outcomes that “do
not reflect the everyday operating reality of the large-scale routine
programme”.

Mejim Dususow has 20 years of experience being a dai and an

ASHA in Arunachal Pradesh, and through her we hope to understand
the reality of working as a health worker in a place where little
information exists. In her early days as a dai, she assisted her mother
with delivering babies. It was a woman doctor from Nagaland (who
now resides in Arunachal Pradesh) who helped her get a break as an
ASHA.

Mejim now lives in Kola camp village, on one side of the Kameng
river that forms the boundary of Pakke Tiger Reserve in West
Kameng. She collects data on pregnancies and frequently visits
expecting pregnant women around the reserve. She has helped
deliver 720 babies thus far.
When people inquire about how deliveries happen in the community
at the community health centre at Bhalukpong, the district medical
officer attributes their success to his team of ASHAs. When we
visited the centre, we met a doctor who had joined in 2018 and was
on his first medical posting. “I salute them, in every delivery that
happens here they have a hand,” Dr Ningcho said.

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Also read: In Assam, the Healthcare Apparatus for Women

Needs a Complete Overhaul

Mejim is popular around Pakke. The more people know of her work,
the more they call her. She often has to arrange her own
transportation when dealing with their needs and is on call 24×7. Her
midnight calls to drivers are usually pleas of insistence: “Chalo chalo
bhai, ye aurat taklif me hai, usko ponchadoh (Come on brother, this
lady is under great stress, take us).” She now gets calls for help from
the bordering areas of Assam as well.

Life as an ASHA isn’t easy. She gets paid Rs 600 per delivery and
handles about three to four deliveries every month. She also runs a
small shop to help pay for household expenses. Her husband is a
peon in the forest department and pays for most of their household
expenses.

She says it is a noble job, especially for those who are educated and
urges the ASHAs that have gone through the formal schooling
system to hang in there, often because they can apply for higher
positions such as nurses and midwives in the health department.
She also faces emotional trauma as a community health worker. For
those who know her, it is obvious. In one instance, she had to handle
a complicated delivery case all by herself, and despite her best
efforts, the woman delivered in one of the villages she covers instead
of at a better equipped centre. There were no gloves available and all
she could use to receive the child into the world were her bare hands.
Unfortunately, the umbilical cord was wrapped tightly around the
child’s neck.

“I still remember that infant and that I didn’t have gloves that day, so
I now feel dirty eating with my hands,” Mejim said.

Also read: Lack of Basic Facilities, Underpaid and Overworked

Workers Plague Rajasthan’s Anganwadis

There was another ‘please come, call the doctor’ at her shop recently.
A pregnant woman was waiting next to a hut at a railway track in
Assam for the ambulance to arrive. By the time Mejim got there, the
woman’s contractions had begun, so Mejim set out to deliver the
baby in the hut itself. When the ambulance finally arrived, they took
the woman, now unconscious, and her baby to the community health
centre at Bhalukpong.

The doctor was able to revive the woman and congratulated Mejim
for saving the baby. But he was also curious: how did Mejim, who
often describes herself as “uneducated”, remove the coiled umbilical
cord from around the baby’s neck? It turned out Mejim learned how
at her neighbour’s house when she was 16.

She is matter-of-fact when she says she learned this and many other
things from her “uneducated mother”. Time will tell how Mejim’s
tacit knowledge, which survives on the margins of our healthcare
system, will live and be passed on.
Julee Jerang and Nandini Velho are part of a larger research
programme on tribal health determinants around tiger reserves
funded by the Wellcome Trust/DBT India Alliance.

Note: This article was updated on May 10, 2019 at 9:37 am to

correct a mistake. Mejim’s last name is Dususow, not Sidisow, as was
originally stated.

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