The 28th Foreign Correspondent Report

No More Dying to Give BirthMs. Swapna MAJUMDAR (India)

Whenever Champa, an auxiliary nurse midwife (ANM), has to go to Sabaka, asmall remote tribal village in Araku valley in the southern Indian state of Andhra
Pradesh, she has to start early in the morning. She will have to walk 15 kilometresup a hilly uneven track after being dropped off at the closest point accessible on a
motorable road. Then she will check on all the pregnant women in the village andconduct the blood, urine and blood pressure tests to check for any anomalies,
especially as anaemia is common among the tribal women. Also, she will counsel thewomen on the necessity to undergo such antenatal tests. Sometimes it takes a coupleof hours to explain as literacy levels here are abysmally low, and superstitions andmyths prevent the women from seeking healthcare. But Champa is determined tomake every effort to ensure no woman dies while giving life especially from causes
preventable through quality antenatal, obstetric and postnatal care in the region
where maternal and neonatal mortality is high.

Helping pregnant women across inaccessible roads“Some months ago, I received a call at 1 a.m. from the family of a pregnant woman
I was looking after when she went into labour. As she suffered from epilepsy, we had
to be really quick in getting her to a hospital. Since Sabaka is a secluded village, ourjeep had to stop at the closest point. Then we walked up to her house and carried her
down and rushed her to the government area hospital, where she had a safe delivery.
I feel really happy that we saved her life,” said Champa.

Making the Difference
But this would not have been possible had she not been registered with Asara. Itis a free healthcare programme instituted to eliminate preventable maternal andThe 28th Foreign Correspondent Reportneonatal deaths in three trial areas in Andhra Pradesh, and was started in 2011 by
Piramal Swasthya, a not-for-profit organization working to improve healthcare forthe marginalized.
At the forefront of this campaign are the ANMs who traverse forests and steep
hills, cross streams and walk several kilometers of undulating roads. In the last sixyears, the programme has reached out to over 4,900 pregnant women living in farflung hamlets in Araku. This intervention is proven to be making the difference
between life and death in the region where the maternal mortality rate in 2011 was
400 per 100,000 live births (while the national average of that time was around 215
per 100,000 live births) and the neonatal mortality was over 60 for every 1,000 live
births (while the national average of that time was around 44 per 1,000 live births).
In fact, there have been no maternal deaths reported in the last two years in
Araku’s 181 hard-to-reach hamlets where the programme has been implemented forthe last six years. Even institutional deliveries have increased in the projectintervention areas―from 18% in 2011 to 68% in 2017. The success of the programme
has led to its expansion in 2017.

Innovation Saves Women
Since a majority of the 181 hamlets chosen for the intervention in the first phasewere hard to reach, an innovative telemedicine concept was adopted. This entailed
reaching out to the women through trained paramedics to provide antenatal andpostnatal care services at their doorstep. Once registered by the ANMs, the Tele
Medicine Centre (TMC)’s jeeps are sent to pick the pregnant and lactating womenfrom the point closest to their village and bring them to the centre. Their data is
digitized and helps keep track of the health of the pregnant women and newborn
babies. It is also shared with the government’s health facilities at the time ofinstitutional delivery. If required, the women are connected to a specialist
gynaecologist based in Piramal Swasthya’s office in Hyderabad through videoconferencing for advice. Then, they are brought back to their village.
However, building trust with the women has not been easy. It took time andsingle-minded determination to change their mindsets. So, the fact that Pramilla, an
Asara ANM, is six months pregnant has not deterred her from braving the heat andThe 28th Foreign Correspondent Report

long winding road to visit Ranginigudda village to check on Laxmi. She is 28 years
old and gave birth to her second child in March this year. “I am uneducated, but I
know if it had not been for Pramilla’s help, neither my baby nor I would be alive,”stated Laxmi.
Laxmi is right in saying that she would not have been treated properly and lived
to tell the tale if Pramilla had not recognized the signs of her pre-eclampsia.