Unseen Warriors of COVID-19: 'Work must go on', say UP's ASHAs struggling with malfunctioning tools, public hostility

Editor's note: As the second wave of coronavirus infections ravages parts of India, millions of front-line workers and citizens are caught up in the middle, providing their services to distressed families on one hand while trying to cope themselves on the other. This is part ten of a series profiling the stories of these people.

Rajkali (39) tells her supervisor Sangini Reema — these facilitators or supervisors are called ASHA Sanginis — that her thermal scanner has malfunctioned. Also, the pulse oximeter is not showing low levels of oxygen for anyone she tests. Some educated families she visits mock her.

She says that she will only resume work once the equipment is in working order.  In this condition, they are akin to nothing more than children's toys.

On hearing Rajkali’s story, another ASHA worker, Saroj, opens up her bag and shows her malfunctioning thermal scanner. “Didi, this too doesn’t work,” she said.

ASHA workers Urmila, Rajkali and Saroj at Rasulpur village. Image procured by author

Reema instantly calls up  a senior official and lodges a complaint regarding the condition of the equipment given to the ASHA workers working under her. Although she doesn’t relay the exact content of the conversation with the senior official, a mixture of disappointment and displeasure clouds her face.

“The work has to go on,” she tells the ASHA workers. And herself.

There are four ASHA workers in Muzaffarnagar district's Rasoolpur village, which falls on Delhi-Pauri highway. The village has approximately 3,000 people. Every day, Reema, accompanied by these ASHA workers, visits the village's residents to record their temperature and oxygen levels.

The Uttar Pradesh panchayat elections, conducted during the COVID-19 pandemic, has had dire consequences for villages.

Reema with Rajkali at Rasulpur. Image procured by author

Every village has been witness to the spectre of death. The healthcare and diagnostic services exist in name only. The health center in the village is shuttered under lock and key. The entire healthcare system is dependent on the ASHA workers and the ASHA Sangini, who is in charge of four villages. The primary job of these ASHA workers is to assist pregnant women and carry out the vaccination of children.

However, amidst this crisis, the government has tasked them with carrying out door-to-door surveys in the villages. They visit every household and record residents' temperature and oxygen level, and enter the data into a register. The daily household target for each ASHA worker has been set at 50 homes.

Urmila Saini (45), an ASHA worker in Rasoolpur village, said, “We have had to face many difficulties during this period. When we visit, they are not even willing to be checked or tested. They don’t even allow us to enter, and instead tell us that everyone is alright here. Some people hide their condition. They do not wish to go to the hospital and want to be treated at home. They are afraid that if they go to hospital, their condition will get worse. I try very hard to explain the situation to people. We have only been given one thermal scanner and an oximeter, nothing else. There is a pandemic, we also have children, we deserve protective gear too.”

ASHA worker Chhaya Bhat takes the temperature of an elderly woman in in Mukarampura. Image procured by author

Under the guidance of Sangini Reema, this team of ASHA workers carries out a check-up on a family, and gives them information about COVID-19 and how to protect themselves. Of the three ASHA workers, one has a thermal scanner that doesn't work. All their oximeters show good levels. Urmila advises the family to consume a concoction of ginger, clove and black pepper.

In another village, Mukallampura, an ASHA ‘bahu’ (the residents of the village alternately call them ASHA bahu/daughter-in-law, behen/sister and worker), Chhaya Bhat tells us that by 2 pm, she has covered 25 families in her survey. She is now recording the results of the survey.

She has found four people suffering from fever in her village today. She has ordered for them to be tested further. She said, “It is a very difficult job. My husband is afraid but I am taking precautions and doing my best.” She further said that she doesn’t have a thermal scanner, but has obtained an oximeter.

The team carries out fever checks at Rasulpur village. Image procured by author

This gram panchayat has nine ASHA workers, of which two share one oximeter. Each time she enters yet another house with trepidation and talks to the family, her children come to mind. “We are the true frontline workers now. The pandemic has spread to every village. The government is saying that ASHA workers will get insurance. But what is the point of that money if we die. There is a lot of pressure to keep working. We must be given all facilities and proper medical kits.”

In Kathoda village on Meerut Expressway, ASHA worker Sunita Devi appears to be working at full speed. She is taking the temperature of Munazara in the house of Ghaffar Ahmed. She said, “Brother, I have had to buy even this mask out of my own money. A PPE kit is out of question. I have bought gloves on my own as well. We have to do this job, the surveys have to be carried out, I agree, but at the very least our safety and facilities should have been taken care of. We are human too. I am putting my life at risk for Rs 2,000. Sometimes, people get angry with us. We are working and simultaneously praying that this disease comes to an end. The situation is very tense. We try to make people understand. Women know very little about the disease. They get very anxious and panic. But they know us because we come to vaccinate their children frequently, so there is a sense of familiarity and that’s why they listen to us.”

ASHA worker Sunita Devi at Kaithora village. Image procured by author

Mahboob Alam, the former pradhan of Kathoda village, praising the ASHA workers, said he has witnessed the difficulty and risk they undertake while going door-to-door. "They counsel COVID-19 patients and raise their self-confidence, along with giving them medicines. Undoubtedly, their work in this pandemic is commendable. The government should take care of their safety and provide them with PPE kits and all necessary equipment. Their compensation should also be doubled," he said.

The remarkable contribution of ASHA workers in this COVID-19 pandemic is commendable, but the issues they face have not fully been addressed or even spoken about. Fundamentally, ASHA workers are dignified social health workers. Sangini Suman Sharma tells us that in this crisis, ASHA workers are functioning as frontline workers. The fact that their work has been seen as voluntary and not as employed work is a source of concern. They do an immense amount of work. Particularly in Uttar Pradesh, which is a large state and requires a full day of work.

Chhaya Bhat on COVID duty at Mukarampura village. Image procured by author.

Apart from the lack of masks, PPE kits, sanitisers and gloves, they face difficulties in their line of work due to the lack of awareness about the disease that people have.

Saroj, a senior ASHA worker of Rasoolpur village said that the entire burden has fallen upon them. “The senior officials demand photo updates all day long. They want an update of every step taken. But we are the ones in the field. We are the ones struggling. We are not afraid of work. We can do even more, and even better quality of work, but no one cares about our issues or the fact that our machines don’t work and we have to buy our own masks. These issues are not visible to those sitting behind desks in offices. Our voices go unheard.”

A few days ago, Chief Minister Yogi Adityanath visited Muzaffarnagar. He only spoke to one ASHA worker, that too in a very formal way.

Translated from Hindi to English by Shayma S and Sadat Hussain

Read other parts of the series here