Kechri village, Block Todabhim, District Karauli, Rajasthan
Meena Kumari Jataw, an auxiliary nurse midwife (ANM) workingfor the last 11 years at a sub center in Rajasthan’s Machri village, is witnessing the perils of the pandemic on the bodies and minds of people every day. Surrounded by the Aravalli mountain range, this agrarian village makes for a very picturesque setting. But these days, like so much of the world, this village, too, is surrounded by the constant fear of being engulfed by the coronavirus disease. The state of Rajasthan has one of the highest numbers of COVID-19 cases in the country.Situated on the eastern part of this state, ANM Meena’s sub-center caters to seven neighboring villages and more than 1,200 households, with the nearest referral facility 12 kilometers away.
The new normal for Meena, along with the accredited social health activist (ASHA) and the Anganwadi (village courtyard shelter) worker, is to go door-to-door in the community, spreading awareness about the disease, checking for the health of the residents, especially those with travel history, and explaining the preventive measures to the villagers. “During the home visits, I inform the residents about frequent and proper hand washing, importance of maintaining social distance, counseling them to stay home and only if really urgent, to step out wearing a cloth mask,”says the ANM.
With pregnant women unable to come to the health center amid travel restrictions,and the regular maternal child health and nutrition days,or the monthly antenatal checkups under Pradhan Mantri Surakshit Matritva (a government initiative to provide assured, comprehensive and quality antenatal care, free of cost, universally to all pregnant women on the 9th of every month) called off at the moment, ANMs like Meena are putting their home visits to additional use-providing antenatal care for the pregnant women in the comfort of their own homes.
“While visiting homes of pregnant women, I counsel them, try and identify if any of them have risk factors,and provide them with sufficient quantities of folic acid, iron and calcium. I assure every pregnant woman of my full assistance, and encourage them to contact me for any pregnancy related issues. For new mothers, I tell them about the benefits of exclusive breastfeeding and advise them to take safety precautions during the lockdown.”
All the ANMs in Karuali district, including Meena, have previously been trained under Jhpiego’s Born Healthy program, which aims to transform antenatal care in Rajasthan in partnership with the state government and with support from the Children’s Investment Fund Foundation.With the rapidly spreading pandemic, Jhpiego conducted special trainings for health workers to give them a good understanding of COVID-19, its signs and symptoms, modes of transmission and precautionary measures. Very importantly, the training also helped participants like Meena understand howto prepare their facilities for COVID-19 positive cases, provide specific care to pregnant and breastfeeding women during the pandemic, understand triaging of patients and learn steps to prevent infections. This has equipped Meena to do her job well.
“After receiving the Jhpiego training, I am confident of actions to be taken in case any pregnant woman is suspected or found COVID-19 positive. I also learned about how to continue to provide antenatal care to women, even to those who might be affected by COVID-19,” says the ANM.
Since her training, Meena has had several opportunities to put her learnings to practice. Soon after the country wide lock down was announced, a 5-month pregnant woman had returned from Bhilwara, the epicenter of COVID-19 in Rajasthan at that time. When Meena met the woman, she was nervous and complained of pain in her abdomen and feet. Without the knowledge, Meena would have worried, but the training helped her chart out the next steps. She immediately informed the Medical Officer of the nearest community health center (CHC) at Todabhimand arranged for an ambulance to send the pregnant woman there while maintaining proper quarantine measures.
At the CHC, all the laboratory investigations were conducted to ensure the mother-to-be’s safety, also measuring her hemoglobin, blood sugar, among other tests. She received sufficient nutritional supplements like calcium and iron so she would not have to return to the facility during the lock down. The pregnant woman’s pain was diagnosed as spasmodic, and after keeping her under observation for a few hours, she was discharged and brought back home.What relieved this mother-to-be most was that she had the support and care in case of an emergency, even during the lockdown.
Further, Meena’s home visits and counseling on nutrition helped her take better care of herself than she did earlier.
Machri has been seeing many migrant laborers returning to the village from high-risk areas which have seen many COVID-19 cases. Vijay Sain, a brick mason returned from Gurugram in Haryana to his home and wife Chandani, who was in her final weeks of pregnancy. ANM Meena had been following up and monitoring Chandani through her pregnancy. Being anemic, Chandani had earlier received four doses of iron sucrose at the health facility. With her husband having returned from a high-risk area, Meena counseled him to self-isolate and instructed Chandani to follow safety measures, from washing hands properly to wearing a mask.
As this was her first pregnancy, Chandani was highly anxious about her safety and that of her unborn baby, complaining at times of abdominal pain. Meena calmed the mother-to-be, explaining the difference between false and true labor pains and advised Chandani to immediately contact her in case the pains increase in frequency and intensity.
Within a few days, Jataw got the call from Chandani. With her estimated date of delivery nearly there, Jataw sprung to action. Chandani was taken to the nearest CHCat Todabhim, and further transferred to the district hospital at Dausa as she needed a c-section due to breech position of the baby. The baby was delivered safely,and mom and baby were able to return home after following all precautionary protocols at the hospital.
Chandani is extremely thankful to ANM Meena, who helped her navigate those tense weeks and stood by her as a strong support.She says, “ANM didi(sister) is known for her goodness throughout the village. She is like my elder sister. She regularly examined me at home and helped me through my pregnancy. I thank her for helping me in my time of need.”
ANM Meena understands the importance of her role well, and concludes, “Making people aware of the risks of being exposed to the infected people, staying home to stay safeand maintaining social distance are the best waysto protect againstCOVID-19. Being part of the community, it is easier for me to make the community members understand the public health concerns. Along with this, the care of pregnant women is also my priority. Going door-to-door and providing adequate quantity of iron and calcium to them, thus ensuring that their health indicators are maintained even during this pandemic is a big responsibility on my shoulder. … As part of the public health system, it is my utmost priority to serve them. “