The RHO who delivers

He calls her ‘ma’, but Sanjeevani is not Asunta’s son.

Asunta Toppo is a rural health organiser (RHO). She has been working in the health sub-centre at Miriguda in Dharamjaigarh block for almost two decades. A few years ago, she had to take charge of a high-risk child birth. The mother’s blood pressure was very high and haemoglobin was low, less than seven grams. “By the time she came to our health sub-centre, labour pains had already started. Before we could even put her on the table, the child was born,” recalls Asunta.

The condition of the baby after delivery at the health sub-centre, locally known as Upswasthya Kendra, was not good. “Here we did not have facilities of oxygen and the mother’s condition was equally precarious,” recalls Asunta. There was a lot of bleeding and the RHO was unsure about whether to take care of the mother or the child.

“First we took them to Dharamjaigarh. There was a doctor, I would not like to name her. She expressed her displeasure and asked us why we had brought the mother and child in such a serious and critical condition,” she recalls. But Asunta fought with the doctor. “I told her, if you are not able to do it, then leave it. Please help me a little. She got angry.”

Asunta picked up the child and insisted on an ambulance. Meanwhile the doctor did relent and administered an injection. Asunta says the mitanin (accredited social health activist) accompanying her was of great help as she struggled to keep the child alive by giving him mouth-to-mouth resuscitation.

The state health helpline number 108 finally responded, an ambulance arrived and a doctor took charge of the mother. They left for Raigarh Medical College, a bigger and better-equipped hospital in Raigarh city of Chhattisgarh. “I lifted the child in my lap,” adds the RHO, and she continued giving mouth-to-mouth resuscitation. When Asunta handed over the newborn to the doctors there she was told he would not survive. “The paediatric doctor said there was no hope,” she recalls.

But Asunta had not travelled 80 kilometres with the baby for nothing, and so she pushed the doctors to do their bit. “Both mother and baby were saved. This gave me great satisfaction.” Asunta ends her narration with a long sigh and adds, “it’s been five years now, and he is fine and fit.”

The little boy lives in Miriguda village with his family who are farmers. “I have named him ‘Sanjeevani’! Since I got the Sanjeevani service [ambulance] for the first time!” Asunta adds, who is often called 'sister' (nurse) by locals.

RHO Asunta Toppo is from the Oraon community and takes care of over 4,000 people – Rathia, Baiga and Birhor Adivasis – here in Dharamjaigarh block (earlier known as Udaipur) of Chhattisgarh. Most depend on farming small parcels of land and collecting non timber forest produce – firewood, mahua, char and tendu leaves – from nearby forests.

They live in the villages of Miriguda, Nakana, Bhawnrkhol and Semipali Khurd and depend on the health centre at Miriguda where Asunta works.

“I am here since 2005,” says Asunta who has become a resident in the area. “I witnessed many changes. Earlier communication was very difficult and I would walk 15-20 kilometres to reach different villages in a day.”

In 2015, when vehicles could not ply the roads, a pregnant woman from Pathridandgaon came down with eclampsia. “We tied her in a cot and brought her here with difficulty. The child was born here,” she tells us.

The RHO recalls how she felt the constant danger of wild animals as she walked through the forests. Looking back, she adds, “diarrhea and seasonal illnesses were more then. Now it has reduced, as has hypertension and diabetes, with regular check-ups and medication.”

India has a high incidence of malaria and Chhattisgarh has the third highest number of malaria cases – 17,765 recorded this year till July (2024), says this data issued by the National Centre for Vector-borne Disease Control. It’s down from 31,706 in 2023. Asunta says that awareness campaigns, regular surveys, and medicated mosquito nets have all helped to bring it down.

Later we go along with Asunta to Sanjeevani’s home where he is busy playing with friends. Seeing Sister Asunta, Sanjeevani’s mother Vimla stops her work in the paddy field and comes to chat with us.

“Sister Asunta’s trust brings many people here,” says Neha Khalko, Community Health Officer (CHO) of the area. “Since she [Asunta] has been here, 3,000 deliveries have taken place in the Miriguda Health subcentre in Dharamjaigarh block.

“Earlier Birhor [Adivasi] people would not come to the hospital. They would deliver outside the village. Their children's umbilical cord would be cut with a stone,” says Asunta.

Asunta recalls a Birhor (Particularly Vulnerable Tribal Group) mother who was having her seventh child when her entire uterus also came out. The RHO had to work quickly to push it back in.

But change has come with regular village health sanitation and nutrition day, antenatal tests and more supported by non-governmental organisations working in the field of health, who train mitanins.

When this writer reached the health sub centre in Miriguda, a meeting of mitanins (accredited social health activists) was going on. It was July, and it had rained recently and the health centre was surrounded by green fields of paddy.

A doctor was training the mitanins on how to screen for high-risk births. “Now we are referring the complicated and high-risk cases to the civil hospital at Dharamjaigarh and tracking these pregnancies. Although we don’t have all the facilities in our sub-centre, we are trying our best to systematise it,” says Neha Khalko, CHO, Miriguda.

Technology is helping no doubt. But it is the face and work of RHOs like Asunta who inspire confidence and trust in the locals. It is they who make government health services accessible to all.

An earlier version of this story appeared on the website of the Azim Premji Foundation.