Visiting the Communities, Part 4: Vikas Mitra Training Session, Anganwadi Visit, and Focus Group Discussion – Blog Post #7

Continuing to post all my blogs 🙂

Saturday, July 2nd

Even though I wanted to stay for a few more weeks in Purnea to do field work, it all ends tomorrow. I feel like the research came off more as a school assignment than a partnership, which I don’t blame Pathfinder for because community-based participatory research is new territory for me and I could have communicated my project better. It was a struggle between trying to really invest as much time as I could in the communities and not interfering in Pathfinder’s work too much, given that there 1-year implementation project has several mini-deadlines and that they have really done a lot to make my trip successful. They were able to accommodate me for two-weeks in the field in Purnea, and I am really thankful for that. I will be returning to Patna tomorrow, where I still have a lot left to do. I’ll be able to go back to Pathfinder’s Bihar office, ask Arun Sir any remaining questions, and tie up any loose ends. But this is what I’ve been up to during my second week in the communities:

Wednesday & Thursday – Vikas Mitra Training Session: I was able to observe how Pathfinder trains Vikas Mitras. The 2-day training session was very similar to the 3-day Life Education Session for the unmarried adolescents. It was similar in terms of the content they had to learn regarding SRH/HTSP, given that female Vikas Mitras will assist ASHAs in doing home visits and group discussions with women on these topics, while the male Vikas Mitras will do a group discussion with the men in the communities. In addition to the hard facts, they were taught how to establish rapport with and gain the trust of the community members, how to use their booklets to do a home visit/group discussion (there was a demonstration and practice round, but only three Vikas Mitras were able to practice), and how to chart responses. I was able to interview Pathfinder’s District Coordinator and the Vikas Mitras as well.

Friday – Visit to the Anganwadi Center and Discussion with Community Women: Friday was VHSND day, or “Village Health, Sanitation, and Nutrition Day.” Once a month, the ASHAs and AWWs (Anganwadi Workers) are supposed to mobilize women and children in their community (but it is open to all community members) to come to the Anganwadi Center to receive basic health information and services (e.g. checkups, immunizations). As a premed student, I was really excited to learn about community-level health and to speak with community healthcare workers. I was able to meet with an ASHA facilitator (the head of the ASHAs for her community), an ANM (Auxiliary Nurse Midwife), and Sevika, and ask them questions about their roles and responsibilities. I believe that ANMs are involved mostly with deliveries, but based on the interview, they work with everything health-related. The ANM told me that any health-related information she receives, she passes on to the community. I heard once again that although ANMs receive a salary, ASHAs do not. Instead, they work off of incentives. Incentives are basically small sums of money that they are rewarded for completing responsibilities such as helping a woman deliver, giving a woman or child the proper immunizations, or correctly identifying a leprosy patient. Furthermore, I was told that at the Anganwadi Center, pregnant women and children are provided a ration or nutrition plate, seeing that it contains lentils, chickpeas, spinach/green leaves, and sugar. I also learned for the first time about Sevikas, another community healthcare worker. She told me that she primarily works with children from only a few months to 6 years of age and any health-related children’s programs. She provides children in the community with basic education (e.g. hygiene, how to sit) and also monitors their growth, providing the necessary information to parents. She also assists the ANM and ASHA. Moreover, I was able to observe an antenatal checkup, seeing how immunizations are given and how hemoglobin is checked in the Anganwadi Center. There was more sanitation than I expected, but still not enough. However, the village that we had come to did not really have any Mahadalits, so I could not really learn more about their community or ask any questions about early marriage specifically with regards to their beliefs. Following the visit, we conducted home visits in a Mahadalit habitation. Prabha led the way to one girl’s house, where she introduced herself, us, and the ASHA facilitator that had come with us. She asked her to come out of her house and talk to us because we had some questions for her. However, it was really difficult for Prabha to motivate her and her mother-in-law to speak with us because they did not seem to trust us. Eventually, however, the women were ready to speak with us and after gathering a few other women from the community, we all gathered at the local temple or “mandir” on a cot. Based on Prabha’s and my questions, the responses regarding contraceptive use and beliefs regarding early marriage were very similar in comparison to the other home visits I had made. Most of the women agreed that it is better to marry later, and that even though they were married early and uneducated, they will not do that to their children. What was most interesting was that there was an elderly man in the mandir who had kindly moved so that we could use the space for the discussion. However, he was listening to the whole conversation and agreed that what Prabha was talking about was really important and the women needed to hear it. For me, this was unexpected given that I thought there would be a clash between the beliefs of the elderly and young regarding early marriage.

The remaining part of my second week in the communities is described in my next post!