Indian Health Heroines Fight to Unionize

www.ozy.com [OZY]( [OZY]() Your World. Bold & Bright [Daily Dose]( Sponsored by [Boots]( The newsletter to fuel — and thrill — your mind. Read for deep dives into the unmissable ideas and topics shaping our world. Sep 19, 2022 Today The World Health Organization honored India’s million-strong, rural female health advocacy force with the[Global Health Leaders Award]( this year. Known as “accredited social health activists,” their acronym, ASHA, means hope in Hindi and many other Indian languages — appropriate because these workers often risk everything to deliver healthcare to the last mile in a vast, geographically diverse country. They’ve saved countless lives since ASHA’s 2006 inception. But today, amid widespread calls for better working conditions and decent pay, they make just 43 cents per day for COVID-19 duty, even in India’s richest state. Now they’re unionizing and fighting back. – with reporting by Sanket Jain from Maharashtra, India [Better Boots, Without The High Retail Markup]( [Bokksu]( Comfortable, versatile, & durable! [Thursday Boot]( Company has a simple philosophy: make the highest quality boots and sell them at the lowest susustainable markup possible. Try yours today with free shipping & returns. [Free Shipping & Returns]( ‘No option but to fight back’ Suraiyya Terdale sensed the danger, but she did not stop. During the peak of India’s deadliest COVID-19 wave in May 2021, when the country was reporting over [400,000 new cases]( daily, Terdale went door to door in her village of Ganeshwadi in western India’s Maharashtra state to ask people to get vaccinated.  “One man suddenly lost his calm and started abusing me,” she told OZY. She was used to people misbehaving when she arrived at their doors during the pandemic.  Yet, ASHAs — who have traditionally worked on public health campaigns, often involving women and children — had been given the responsibility of ensuring that rural Indians overcame vaccine hesitancy to receive their shots. So, she tried to explain the importance of inoculation to the increasingly hostile man.  This time, though, things were getting out of hand. “Within a minute, the man first threatened to beat me and then even brought a stick,” she recalled.  The 36-year-old knew she was at risk, so she dialed the local police and an elected village official. But they dismissed her concerns. She then called fellow ASHAs, and six of them arrived within four minutes. Seeing them, the abusive man went back inside his home.  That instinctive sense of unity and the readiness to stand by each other are now formalizing into a unique effort by the ASHAs to unionize and demand better conditions from a country that rarely acknowledges their impact.  In March 2020, as India’s health ministry [devised]( a plan to contain the pandemic, it made ASHAs in charge of contact tracing, surveying and finding suspected COVID patients, along with monitoring them and performing other tasks. The vaccine advocacy was added once shots were available last year. Yet these women were sent to the front lines without any safeguards.  “For the first few weeks, we weren’t even given masks,” said Terdale. After protesting several times, they were each given a single-layered cotton mask and a mere 200 milliliters of sanitizer. “Every day, family members asked me to quit because they were scared of catching COVID.”  She didn’t. Instead, she and many other ASHAs worked for more than 400 days without a break.  Terdale would discuss her concerns with fellow ASHA Netradipa Patil from Maharashtra’s Kolhapur district. “During COVID duty, every day I would get several calls from ASHAs of at least ten states regarding verbal, physical abuse, delayed payment and much more,” said Patil, an activist who leads a group of 3,000 ASHAs.  Patil herself was overworked and mentally tired, but she started meeting these ASHAs and eventually unionized them in the city of Kolhapur, Maharashtra. ASHAs have led previous protest campaigns demanding better working conditions, “but during COVID, things got much worse,” Patil said. “So we had no option other than to protest on a larger scale to fight back.” ‘Our strength is our union’ In Kolhapur district alone, these ASHAs have since staged over 10 protests, drawing almost all of the district’s healthcare workers. Meanwhile, their counterparts in other parts of the country were also protesting. On Aug. 7, 2020, roughly 600,000 ASHAs across India went on a [two-day]( strike demanding better wages and working conditions, and the legal status of full-time workers. ASHAs, instituted under India’s National Rural Health Mission of 2006, are formally termed volunteers, which means that the government is not required to pay them a minimum wage.  In fact, ASHAs don’t have any regular wages — they are paid different rates for each specific task, whether it’s helping with vaccinations or working on a sanitation campaign. That means a fluctuating monthly income, though in many states, the government offers a minimum stipend. Yet even with these stipends and such relatively better-paying tasks as COVID-19 relief work, ASHAs were often making less than $100 a month.  After protests took place in the nation’s capital of New Delhi, the city’s police [registered]( cases against several dozen ASHAs for “violating social distancing norms” by gathering together. “In Kolhapur too, several cases were registered against ASHAs, but our union ensured the government took back these cases,” said Terdale.  On June 15, 2021, around [70,000]( ASHAs across Maharashtra — India’s wealthiest state — went on an indefinite strike. This was called off after nine days when the government partially agreed to their demands and promised to increase the pay by $19 monthly, up from between $44 and $64 a month, said Patil. That raise will include an increased allowance for COVID-19 tasks, which, as this article went to press, still paid around $13 a month, or 43 cents a day.  ASHAs begin every protest with the slogan: “Our strength is our union.” It truly is, said Terdale.  “Even if the pay hasn’t increased much, we at least have a primary support group,” she said. “Tomorrow, if something happens to me, I know my union will fight, and this gives me a sense of safety.” Slashing India’s infant mortality rate To understand just how critical ASHAs are to India’s public health infrastructure, look no further than the country’s infant mortality rate, which stood at [54]( per 1,000 live births in 2006, the year the ASHA program was launched. By 2020, ASHAs had helped slash infant mortality in half. That was no small feat, especially because in 2020 India had only [810 public district hospitals]( serving its [833-million](-strong rural population.  In Maharashtra’s Mugali village of 3,000 people, 47-year-old ASHA Surekha Arabole has helped prevent infant mortality since 2009. Such achievement has required quick thinking, networking and — as with Terdale — a high risk of facing abuse.  In 2020, Arabole found a migrant worker’s two-week-old baby weighed just 2.5 kilograms (5.5 pounds). And three days later, its meager weight had declined by almost a kilogram.  The infant lay in a tent made of tarpaulin sheets, dehydrated and unconscious. Quickly, Arabole took a photograph of the baby and sent it to Laxmi Narute, an auxiliary nurse midwife. Based on Narute’s instructions, she called an ambulance and the infant’s parents, who were chopping sugarcane in a field two miles away.  However, the parents weren’t willing to go to a hospital. “Why are you interfering? Who will pay for our work loss if we go to the hospital?” Arabole recalled them asking. They then began abusing her in the vernacular Marathi language. Arabole called the elected local representative, who convinced the parents to go to the hospital. Arabole then followed up with doctors at the hospital to make sure she could assist the baby when it returned to the village. After the infant was out of danger, she started administering vaccines to the child.  In its first year, a child in India is supposed to receive 19 doses of different vaccines. An ASHA who administers all of them — and thereby significantly increases the child’s chances of surviving infancy — gets paid a lump sum of [$1.25](. Arabole feels demotivated by poor pay and a lack of recognition, which means that she needs to also work as a farmer to make ends meet. WATCH ANNA MALAIKA TUBBS on [The Carlos Watson Show](! ‘Hope for everyday people’ To be sure, ASHAs like Patil are proud that the WHO has recognized their work. But what of their own country? “Nothing has changed for us,” Patil said.  Apart from public health emergencies like COVID-19, ASHAs are tasked with more than 70 other chores, ranging from counseling on family planning and immunization to maintaining health records and providing contraceptives and medicines for common ailments.  Madhuri Panhalkar, a doctor who works as a community health officer in rural Maharashtra, said: “Without ASHAs, it would be impossible to work in the villages. They know the medical history of every member in the village, which helps us offer the right treatment at the right time.”  Since 2010, Terdale has overseen about 300 successful childbirths in her village. Yet, for ensuring a safe pregnancy, childbirth, and providing prenatal care, she is paid just $6 per child.  “We represent hope for everyday people who can’t access healthcare. So how can we let them down?” Terdale asked. What about the hopes of ASHAs?  Said Terdale, “For us, the only way to keep our hopes intact is through unionizing.” Community Corner During COVID, healthcare workers have played an important role in saving countless lives worldwide. Write to us with stories from where you live. [SHARE YOUR STORIES]( ABOUT OZY OZY is a diverse, global and forward-looking media and entertainment company focused on “the New and the Next.” OZY creates space for fresh perspectives, and offers new takes on everything from news and culture to technology, business, learning and entertainment. [www.ozy.com]( / #OZY Curiosity. Enthusiasm. Action. That’s OZY! 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