Friday, January 02, 2009

Rajashree Papal: Community Health Worker and Epi researcher

I have written previously about Community Health workers in Dahanu Taluka (Maharashtra) and in Harur Taluka (Tamil Nadu).

I also met community health workers in Purandhar Taluka, Pune district (Maharashtra) who were trained by the Foundation for Research in Community Health (FRCH): Pushpa, Kalpana, and Rajashree are all remarkable women, but Rajashree stood out for the epidemiological research she'd done.

Rajashree Tai (center, reading) at a meeting in Mandhar Hamlet

Rajashree is an Arogya Tai in Mandhar hamlet (served by the Parinche Primary Health Center [PHC]). Many women in her hamlet used to report feeling tired and not having a healthy appetite. Suspecting anemia, Rajashree got the PHC to check the Hemoglobin level in about 50 women from her hamlet. Mandhar is a small hamlet in a mountainous region south of Pune, where people are dependent on rains for agriculture. She compared the Hemoglobin of women here to that of women from Khengrewadi, a village with access to year-round irrigation for agriculture.

Rajashree Tai found that the prevalence of anemia in Khengrewadi was far less than that in Mandhar, where 84% of the women tested were anemic. She referred people who were severely anemic to the PHC and got them Iron Folic Acid tablets-the PHC initially denied these tablets to anemic women saying they were only meant for pregnant women. However, Rajashree managed to lobby the PHC officials to provide IFA tablets to anemic women. She also counseled others in the village to eat leafy vegetables and use iron vessels to cook food in. She was able to reduce the prevalence of anemia by 50% in her village.

Rajashree had categorized her data, allowing her to make a fairly detailed comparison of Mandhar and Khengrewadi. For instance, there were a fair number of women with Hemoglobin levels between 6.1 and 7, 7.1 and 8, 8.1 and 9 in Mandhar, but none in these categories in Khengrewadi (everyone tested in Khengrewadi had a Hemoglobin level >9.0). I'm not going to reproduce all her data here, but they showed that the odds of a woman having anemia (with Hemoglobin <9.0) in Mandhar are about 50 times that in Khengrewadi.

It is interesting that in neither village did anyone tested have a hemoglobin level >12.0, which would be normal for adult women. There could be at least two reasons for this: 1. it could have something to do with the accuracy of the test in Parinche, or 2. it could be that people in this area have a depressed level of hemoglobin in general. If the second case is true, people with a healthy diet still have a Hemoglobin level <12.0. I wonder if this might warrant a rethink about the normal range of Hemoglobin for adult women in this area based on their diet?

1 comment:

vamsi parimi said...

Hi Supriya,

After a series of chained search, I happened to finally have your contact info. I read your article on Dishaa;Dec 2008 issue. I partly agreed with you about the disparity of employment, based on orthodox education but felt you lost the essential role of trainees and CHW. They need not be accredited by any agency but the community they work for. Unless you really looked in to the issue of federal employment for CHWs trained by SATHI(once again I am not sure your representative population here with specific issue). I honestly do not believe in Govt making keen observations and decisions but would like the idea of her own community supporting CHWs. You could also have brought the issue of total illiterate community as an issue and winning your debate. I also disagree your comment on paying terms. They might be meager but they help them to sustain.

On a different note on Hemoglobin levels, I believe you cannot rule either of your theories since small communities in India share common food which might be off balanced and might carry genetic Hb anomalies because of inbreeding among close communities(I haven't come across of any because of poor health care data).

Thank you for sharing your interesting community experiences.

Vamsi Parimi