“Equity implies that every man, woman and child, no matter where he or she lives, has the right to enjoy good health and deserves to have access to health services. Equity means to seek out those who are poor, forgotten, marginalized, wherever they are… CRHP has made sure that the infrastructure and facilities created to serve these groups are not snatched away from them.” (Arole, Mabel & Arole, Rajanikant. Jamkhed: A Comprehensive Rural Health Project. Pune: 1994.)
This past week, the other interns and I have been learning more about CRHP and its work through daily classes and village visits with members of the mobile health team and village health workers. My favorite parts of the classes have involved the village health workers sharing their stories with us. This week we had the amazing opportunity to hear from Lalanbai, Sarubai, Asha, and Ratna. I will include their stories and the work that they do in my next few posts. These amazing, empowered women are the reason that I initially chose to return to CRHP for the summer, and I am so excited to share with you how they have taken control of their own fate to become amazing leaders that have drastically improved both social equity and health quality in their communities.
Aside from the village health workers’ stories, we have also discussed many important topics including drought. Jamkhed has been in a drought for the past four years, and even though it is monsoon season, there is very little rainfall here. The other interns and I travelled to see a nearby waterfall that appears massive and magnificent in the past pictures that we have seen, but sadly the water source has completely dried up and the waterfall has been reduced to nothing. In speaking with the director of CRHP during dinners, we have found that interns and students used to take trips to a nearby lake, but the lake has since also lost all of its water. CRHP is currently paying for large water trucks to bring in water to fill the wells, so that the people on CRHP’s campus have enough water to live off of.
In our training courses we have learned how the drought is affecting the community. Many people who live in this area make their living off of farming, but due to lack of rainwater, crops have become difficult to grow. Maharashtra has become known as the state in India with the highest rates of farmer suicide. The farmers often feel shame and humiliation that they can’t continue their work and provide for their families and feel that they no longer have reason to live.
CRHP has an agriculturally based rehabilitation farm that is used as a home and source of income/work for people that are outcast from their communities due to heavy stigmas largely from AIDS, TB, and leprosy. However, all seven of the 70 foot deep wells and the pond on the farm are currently dry. The animals (cattle, goats, and chickens) were recently sent away to an area where the government provides food and care for them due to the fact that there is no food or grass for them at the farm. They are hoping that the animals will be able to return after the end of monsoon season. Many of the crops and resources that were once used, are now unable to grown. Tamarind is one of the few plants that they can still successfully grow. They continue to seek new methods of rainwater collection, fertilization, and crop growth to sustain the farm. While we were at the farm, we had the opportunity to hear the story of one of the amazing people that is working to improve mental health and remove disease stigma in the Jamkhed area. She has played a huge role in improving both healthcare and social equity of those who suffer from health stigmas and mental health problems.
Ratna is a village health worker and the manager of the agriculturally based rehabilitation farm at CRHP. She was raised with four sisters and two brothers in a family that faced much poverty near Jamkhed. Her sisters were all forced to leave school before fifth grade to focus on domestic work and marriage, and when her time came to do the same, she told her teacher that she was no longer able to attend school with tear-filled eyes. Her father wanted his sons to be educated but did not want to waste the time or money on sending his daughters to school. Her teacher called her father that night and explained that she would pay for Ratna to continue her schooling in exchange for Ratna helping her with housework. Because of this, Ratna was able to continue her schooling until she was in tenth grade, before her father finally drew the line and said it was time for her to marry.
Many men made marriage offers to Ratna, but when they discovered that she had no dowry for marriage, they withdrew their offers. Shockingly, one man from Mumbai said that he would marry her without any dowry, but due to the fact that she was fifteen, without a dowry and below the legal age of marriage, they struggled to find a way to legalize the marriage but were eventually able to. Ratna and her husband lived happily married in Mumbai initially, but her husband soon began to experience spells of illness.
While Ratna returned to her village to give birth to her first son, her husband went to a doctor in Mumbai who informed him that he was HIV positive and that he needed to test his wife and child for HIV as well. Ratna returned to Mumbai and was devastated to find out that she and her son also were HIV positive. When her neighbors and community members found her upset returning from the hospital, they asked what was wrong and comforted her saying that they would do everything they could to be of service to her family when she explained the situation. However, later that day, the community signed a paper out casting her from the area due to their HIV diagnosis. Ratna and her husband returned to her village near Jamkhed, but shortly later, the village began questioning them and forced them to leave. The family then moved to a farm where they began to starve and go hungry due to lack of income, and her husband became extremely ill.
They travelled to a doctor in Jamkhed, but he refused to treat them and shut them out saying that if other people discovered that he had treated an HIV patient, they would shun him and boycott his business. Two months later, her husband died from his sickness. Her mother-in-law refused to take her in and cut all ties with her, but Ratna’s biological mother invited her into her home. However, when the women of the village told Ratna’s mother that HIV was contagious and that her and her child would spread their disease to the rest of the family, her mother also cut communication and forced her to leave the house. Ratna became desperate for jobs and homes for her and her son to go to. Every place that she worked, people always discovered her HIV status and made her leave. One government job that accepted her work initially would not permit her to bring her eleven-month-old child to work, and she had no other option but to leave her son at home while working to earn any income that she could to prevent their starvation. However, when she came home one day, she found her son lying dead.
Ratna felt that she no longer had any reason to live and attempted suicide with a poison she made. Her neighbor found her and took her to the hospital where she could not be effectively treated due to lack of money. A village health worker from CRHP later came to visit her and applied various creams and medicines to help with her burns and ulcers from the poisonous liquid she drank. The village health worker continually cared for her, and Ratna lied about her illness in an attempt to prevent the kind woman from also rejecting her. However, eventually Ratna told her of her HIV status, and the village health worker explained that she already knew about Ratna’s disease and that the doctors at CRHP would care for her for free if she let them.
At the hospital, she was effectively treated and offered a job to take care of Jayesh’s children and stay in his home with his family. The community was shocked that CRHP’s social worker would let an HIV patient care for his family. Later, Ratna moved to work at the rehabilitation farm with other stigmatized leprosy and tuberculosis patients. However, when the other farm workers discovered she had HIV, they began refusing to work with her.
Dr. Raj, one of CRHP’s founders, heard of this problem from Jayesh. He went to the farm and had a huge feast for the workers and, in front of them all, asked Ratna to share food on his plate. The other farmers were astonished and exclaimed that a doctor should not share a plate with an HIV positive person. Dr. Raj used this opportunity to explain to the farmers the transmission of HIV as well as Ratna’s story. This greatly helped break down the stigma that Ratna faced with the other TB and leprosy patients, and over time, she was elected manager of the farm. Ratna became empowered and also was trained to become a village health worker to help break down disease stigmas and improve both mental and physical health in her village. She has saved hundreds of lives through her leadership in health and counseling and is continuing to make huge impacts in the lives of the communities she works in. Often, the CRHP social workers will send their patients with the most challenging mental health cases to her, because her counseling is the most effective. She helps people learn to love life again. Ratna has received many prestigious awards in India including the Woman of Excellence award in Maharashtra. She has travelled all over India telling of her story and work with CRHP to audiences of doctors and public health professionals and has been invited to speak in countries all over the world, including the United States and Nigeria. Unfortunately, she has only been able to accept Switzerland’s invitation due to visa and passport restrictions. A movie was also made about her and her story. Ratna went from being rejected from every community that she lived in to being invited to communities worldwide to speak and tell her story.
Learn more about CRHP at: jamkhed.org