31/7/2013 – After a six hour night train journey from Hyderabad, followed by a bumpy car ride deep into the forest of Khammam district, we emerge through the trees to arrive at a clearing I’m told is Ramavaram Village, a settlement inhabited by 26 families.
I’m here with colleagues from ActionAid India and our partner organisation ASDS to see our work with tribal communities in the southern state of Andhra Pradesh. The project, funded by the European Commission’s Humanitarian Aid and Civil Protection department (ECHO), aims to provide basic healthcare, clean drinking water and livelihood support to people in 83 settlements who have been displaced by the conflict situation in the neighbouring state of Chhattisgarh.
Walking around the settlement, I’m struck by the lack of services catering to the families who live here, many of whom have small children. My colleagues tell me that most of the settlements don’t have a local primary healthcare clinic (often the nearest one is more than 10km away), or access to clean drinking water. As a marginalised section of the population as a result of being displaced, they’re also often denied the entitlements that would enable them to make a living, or buy food supplies at subsidised prices through government food security schemes.
I’m introduced to two volunteers with the project, 19 year old Pojamma Dirudu, and Adi Lakshmi, aged 27. Pojamma is what’s known as an ICYF – an Infant and Young Child Feeding volunteer – responsible for linking with pregnant women in the community to promote good health and hygiene practices during and post-pregnancy. Adi, a qualified nurse, is an Immunization Volunteer who has previously worked with the tribal communities as a Nutrition Rehabilitation Coordinator, helping identify and refer for treatment children suffering from malnutrition.
“My role is preventative rather than curative,” Adi explains. “This project focuses on children under two years old – I have to identify them in the settlements and explain to their parents the outcomes of not being immunised against diseases like diphtheria, tetanus, polio, Hepatitis B and measles.”
She enjoys her work, but highlights the low level of education about healthcare amongst the community as a key obstacle. “The main challenge is motivating community members – people are ignorant about these issues.”
Both women are from the tribal communities, which, they explain, helps community members to accept them.
“When the mobile health camp comes to the settlement I ensure that the pregnant women see the doctor and get the three injections they should receive during their pregnancy”, says Pojamma. “I assist with antenatal check-ups and encourage women to have an institutional delivery (giving birth in a hospital as opposed to their settlement). The women listen to my advice because I am from the community.”
As well as talking to and interacting with community members, the women carry picture cards which demonstrate how to breastfeed, the importance of hand washing to ensure good hygiene, and other beneficial practices.
“It helps to have the picture cards I carry around, as most of the women cannot read,” explains Pojamma.
The project is making positive strides towards ensuring the most vulnerable – particularly pregnant women, babies and young children – are able to access basic healthcare. But it’s clear that, in order to ensure such services are available in the long term, the government must ensure healthcare facilities for these vulnerable populations.
That’s why ActionAid and our partners make a conscious effort to listen to the people we work with, understand what it is they need to improve their basic conditions, and work with them to lobby relevant local authorities.
“I take feedback from the community and inform the Cluster Coordinator (a person hired as part of the project to coordinate activities across a cluster of villages) who can then feedback any demands from the community to the (ActionAid) partner organisation,” Pojamma says.
Airlie Taylor, Programme Funding Officer, ActionAid