Arti Gajanan Modshe became a health worker by chance.
Growing up in a remote village in India’s Maharashtra state, her farming family was unable to support her education beyond secondary school after the untimely death of her father in 2012. “We had no money for any other career options I was thinking of,” Modshe recalls. “When I found out about the two-year Auxiliary Nurse Midwife (ANM) course at Panchgani that was affordable, my mother allowed me to go.”
Since 2010, more than 200 young women from rural villages have received ANM training at the Indian Red Cross Society’s Bel Air College of Nursing in Panchgani, Maharashtra, with support from the Johnson & Johnson Foundation that covered their tuition, housing and other expenses. The program, approved by the Indian Nursing Council, was set up to address the shortage of nurses in rural villages, and to help girls from underprivileged circumstances pursue higher education and gain employment.
Remote communities like Modshe’s face an acute shortage of health workers. As a result, many communities do not have access to essential healthcare. The ANM program focuses on the health problems prevalent in such rural areas and trains students for two years to provide services at the community level. Upon graduation, they are offered job placements in village health programs under the National Rural Health Mission.
When Modshe graduated in 2018, she was posted at a subcenter under a Primary Health Center (PHC) situated in one of the district’s remotest areas across a lake from the PHC. The region has no public transport, and many areas are only accessible by boat. Prior to Modshe’s arrival, access to healthcare was sporadic and for short periods, through a visiting nurse or doctor.
Modshe is responsible for 11 villages under the subcenter, with a population of approximately 1,000. Her day begins at the subcenter, providing basic healthcare to patients in co-ordination with the PHC medical officer. Four days of the week, she visits 40-50 homes a day, identifying and registering pregnant women and providing prenatal care, and screening for other common conditions including hypertension, diabetes and cancer and referring them to the PHC when abnormalities are noted. During her home visits she educates mothers individually and in groups on better family health including maternal and child health, family planning, nutrition, immunization, control of communicable diseases, and personal and environmental hygiene. She also administers vaccinations and delivers babies at the subcenter, and refers complicated cases to a higher-level center and provides follow-up.
Her dedication and hard work over the last three years has paid off. Today, the subcenter is the top achiever of goals and targets set under the national health programs, especially in reproductive and child health.
Building a Community’s Trust
One of the first challenges Modshe faced in the beginning was getting pregnant mothers to deliver their babies at the health center.
“The first six months people were still doing deliveries at home,” says Modshe. “They used to keep it a secret and neighbors would call and let us know. Then one day a pregnant woman went into labor at her home. To get to her quickly, I had to climb over a hill with all my equipment. She was already in labor and bleeding when I arrived, but I was able to deliver the baby safely and then get a vehicle to bring mother and baby down the hill to the health center. That day people were convinced of my skills.”
When Modshe does home visits, she sends word in advance through community health workers and people stay back from the fields to see her. “We reach out to each and every home in the village, give information about national health schemes and programs available to them,” says Modshe. “My way of interacting and my experience must have made them trust me. When a patient recovers from illness, they tell others about me.”
The groundwork of trust has been crucial during COVID-19. “People were very scared,” she says. “I visited every home in every village and explained the concept of social distancing, wearing masks, using sanitizer. We explained what symptoms to observe, and the importance of quarantining of suspected patients.”
When the first wave of the pandemic hit, Modshe proved to be a true warrior. During a routine home visit, she came across a person with COVID-19 symptoms, however, the patient supported by community leaders vehemently opposed getting tested. But Modshe stood her ground and raised the matter with the village head. The person tested positive and was immediately quarantined. That timely intervention helped stop the spread of COVID-19 in the area at that time.
Eventually more people began to test positive, she adds, and at certain points whole villages needed to be quarantined. “But we were there and didn’t make anyone feel discriminated, so they were not afraid to come forward and get tested.”
An inspiration and role model
“I never intended to come into this job, but because I did, I am changing people’s lives,” says Modshe. “Earlier there were cases of infants and mothers dying, since deliveries were happening at home—that has stopped completely. Now people know if there is a medical emergency, I will be here for them.”
Working in a remote area, often alone, can be hard, she acknowledges. Sundays are her day off, but patients still show up, and she does not turn them away. “People walk such long distance to see me, so I see them even if they come on Sunday. I am completely occupied, but I was chosen to do this, and people are benefiting because of my work. I am helping to achieve zero child and maternal mortality rate. Saving two lives is in my hands.”
The hardest part of her job, she says, is when a patient dies because of lack of immediate treatment. “I think they should give me an assistant, because it is not manageable for one person,” she says. “There should be a doctor at every subcenter, to handle critical health situations, like a heart attack. All the required infrastructure, transportation, medicines should be available even at the subcenter level.”
Modshe is incredibly proud of what she has been able to achieve with the limited resources. And she is an inspiration for other girls in her community. In the villages where she works, education after secondary school is non-existent and most people, especially girls, cannot afford to travel to other places to further their education. “But when I tell them the village I come from, they are amazed and especially girls feel inspired. They say I also want to become someone like you,” says Modshe.
Joining the ANM course completely changed her life, says Modshe. In addition to bringing healthcare to her community, she is proud to be an “earner” and support her family. “Before I always worried if any emergency occurs, no one would help us. But after I finished this course and joined work, my life just changed completely for good.”