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The Messengers of Change
" Over a period of two years, health workers like Archana Jade(L) and Hulsi Kadiyari (R) have helped bring the diarrheal death rate down to zero in Bijapur "

BASTAR, India, 12 October, 2012 - Archana Jade and Hulsi Kadiyari may appear shy and reticent during the first interaction but their will and grit shine through as they talk about riding motorcycles through dirt tracks in villages for mobilizing communities to create awareness about Diarrhea prevention.

They had worked tirelessly in the Bastar region when it had witnessed a dangerous outbreak of a Diarrhea epidemic that claimed over forty five lives.

In 2005, when civil strife in the Chhattisgarh region intensified, Archana and her family left their village Basaguda to settle in Bijapur town. When the UNICEF launched a prevention campaign to combat diarrhea, Archana saw it as an opportunity to go back to help her villagers understand the importance of safe practices and personal hygiene to prevent diarrheal deaths.

“Since I belonged to Basaguda, I knew the area and the language well. Due to the bitter memories, the villagers were distrustful of everyone. To even collect people together to talk to them as a community was a difficult task”, says Archana. Due to the work of health workers like Archana, Bijapur has not registered a single diarrhea-related death over the last two years.

Taking the Message to the Masses

In the monsoon season of 2010, there were 11 deaths reported within a span of just four days from a single settlement of Chinagulur in Bijapur district. The need of the hour was not just relief and curative efforts to save lives but also to spread the message of prevention.

Hulsi Kadiyari was among the first set of community workers to reach these diarrhea-afflicted villages. In 2010, the atmosphere of mutual suspicion and distrust in the severely strife-affected areas of Basaguda, Lingagiri and Rajpettah meant that health workers worked in fear and found it difficult to traverse the inhospitable terrain.

Hulsi learnt to ride the motorbike so as to be able to function independently in the remote areas of Bijapur district. “No health official was able to venture to these villages in a long time. The villagers were in dire need of medicines and medical intervention”, recalls Hulsi. She says that initially the villagers were taken aback by the novelty of a woman on a motorcycle. Once she started speaking to them in their language Gondi, it became easier to convince them about diarrhea prevention.

Acute Diarrheal Disease (ADD) is the second leading cause of death in children under five years old. Despite being easy to prevent and cure, a large number of children fall victim to the disease every year.

Diarrhea usually lasts several days, leaving the body without necessary water or salts required, often leading to death due to severe dehydration. Through 2010, health workers and volunteers like Hulsi struggled to make the tribal communities understand that the outbreak was not the result of an angry Gods but the result of unhygienic practices like drinking unclean running water and inadequate personal cleanliness.

UNICEF worked in collaboration with ECHO (Narayanpur district in 2012), the government machinery and non-governmental organisations to set up Diarrhea Treatment Centres and established treatment protocols.

Creating a Successful ADD Prevention Model

The lessons learnt during 2010 helped build capabilities to ensure pre-monsoon preparedness against diarrhea with a trained set of foot soldiers, implementing the training on the ground in districts like Bijapur and Dantewada. While the government provided the materials, the implementing agencies mobilised volunteers to impart the necessary information to the population.

Buckets, mops, soaps and ORS packets became the main weapons for sweeping in a change in behavioural patterns. “Initially when we tried to distribute these items to the villagers, they would misunderstand us and then were scared of us. They thought we were out to harm them. It took a lot of time and effort to make them understand, “says Kalpana, who worked with Archana in Basaguda and Pamed in 2011.

Their modus operandi was simple. The teams that travelled in groups to villages would gather the womenfolk together and talk to them in the language they preferred. For instance, while Archana was fluent in the Gondi language widely spoken in the region, Kalpana handled all the queries from Telugu-speaking tribal women.

They worked at familiarising the villagers with the use of ORS, soap, chlorine tablets for treating water and the need to maintain hygiene. Once the initial reticence of the villagers to accept the workers wore out, Kalpana says they were very curious to know how to deal with situations if there was no soap or chlorine available. The preparedness campaign in the pre-monsoon months across Bijapur was so successful that no lives were lost due to Diarrhea in 2011.

Though Kalpana, Archana and Hulsi have now moved on to work in other districts of Chhattisgarh, their pride in making Bijapur free of diarrhea deaths reflect through while they talk about the campaign. “I am so happy to look back at what we achieved there. If I get a chance to go there again, I would love to return”, says a beaming Kalpana. “I feel so proud that no one died. Language is the biggest barrier in these regions. Our biggest success was we were one of them, they related better to us”, elaborates Archana.

The district administration credits the army of volunteers that camped and worked in the remote regions of Bijapur in tandem with the department of health for bringing about the near-miraculous turnaround within a year.

So far in 2012 too, there are no diarrhea deaths reported. The district administration ensured that sufficient medicines were available to the villagers and immediate relief provided to families which reported diarrhea cases. Around ten to fourteen medical camps conducted in the interior areas also helped spread awareness and access to medical aid. “We now have a system in place. The formula of what to do – like a disaster management plan is now in place”, says Rajat Kumar, the District Collector of Bijapur. “UNICEF has been a motivator, instigator and a mobiliser that helped us flush out these areas of diarrhea deaths”, he adds.

The Tripartite Model of Service Delivery

Around one fifth to one sevenths of the district, in the district administration’s estimates has now been covered by the diarrhea prevention- ADD campaign. The biggest benefit that the district administration receives from the participation of an independent agency is the ease of access and the ability to mobilise work in areas where the access to their personnel is largely limited.

“The credit goes to the volunteer cadres – young boys and girls who reached out to the most inaccessible and excluded areas of Bijapur district and showcased successfully the ability to deliver critical services and behavioural change interventions, thus containing diarrheal disease and deaths.

More importantly, the coordinated efforts of the district administration, UNICEF and community youth were crucial in bringing meaningful changes in the lives of people and promoting equity.”, says Shaheen Nilofer, State Representative, UNICEF.

Non-governmental agencies like Saathi and the Rama Krishna Mission Ashram in Narayanpur district help in ensuring that essential health and nutrition services like the A-HOPE programme and diarrhoeal prevention campaign are accessible to remote villages in strife-affected areas of Chhattisgarh like Abujmarh with support from UNICEF-ECHO collaboration.

In a scenario where government agencies find it difficult to maintain a constant presence in these areas, non-governmental agencies are the only channels to ensure delivery of essential services like education and healthcare. NGO workers often belong to the communities they serve in, making it easier for them to earn the confidence and trust of villagers.

Their impartiality helps in ensuring that essential services like health and education are not obstructed in the crossfire between security forces and naxalites active in this region. The presence of these implementing agencies in areas of conflict is slowly bringing about a silent transformation in the health management and service delivery areas across Chhattisgarh.

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