Small beginnings There is a mood of hope in the north Indian village of Hasanpur. lt stems from what the people of the community have already achieved for themselves, instead of waiting for the authorities to do it Hasanpur is a small village about 30 miles from New Delhi , close to the Haryana State border. With its 110 houses and 900 residents, it is typical of villages in thi s part of north India. Most of the small brick houses..have identical, solid wooden door frames , the usual complement of cattle lazing in the · tree-shaded courtyards and a primary school with eager children merrily chanting the time-honoured arithmetic tables. It was .one of those humid , sweltering days in August when nothing seems to move. The village was almost deserted , but for a group of old men enjoying a quiet smoke on the hookah. The younger men and women were out in the fields, attending to the many tasks that are so much a part of a farmer's life. There was one young farmer , however, who was not in his fields. He had stayed at home and was engaged in activities far removed from farming. At this moment, he was putting medicine into the eyes of a loudly protesting infant. " It's easier to plough a field" , Charan Singh said with a satisfied smile, as the child settled back comfortably in his mother's ar"ms. When the mother got up to leave, Charan Singh reminded her that the treatment had to continue and she must return the next day . Charan Singh is Hasanpur's own Community Health Volunteer (cHv), selected by the vi llage just over two years ago as part of the Indian Government's scheme to provide one CHY for every 1,000 population by 1983. A three- month training course followed during which he was introduced to promotive and preventive health care, and the treat- ment of minor ailments and injuries. He A labour of love. Community health worker Charan Singh attends to a sick child (left) , and another child is treated at the doorstep (above). ( Photos WHO/A.S. Kochar) by Jitendra Tuli learnt how to render first aid, take a blood sample and prepare a slide for malaria detection . He also learnt how to chlorinate a well, and he picked up some elements of health ed ucation. For Charan Singh- and for the 145,139 other CHvs now working in vi l- lages across the country- this task is a labour of love. He receives no salary, only a modest stipend of Rs. 50 (about 6 US dollars) per month, "but I get many times that amount in the regard of my fellow villagers and the satisfaction that I am doing something to make things a little easier for those around me". . The pride of place in Charan Singh's modest main room is occupied by a small, red-topped table, on which he keeps the medicines and rolls of ban- dages he needs every day, a copy of the health volunteer's manual and a register to record his work. In a corner of the room is a large tin trunk containing his stock of medical supplies. A small child outside coughs, and Charan Singh is asked if he has been a ttended to. The child received a dose of cough syrup a few hours ago , he replies, and opens his register which records the name of the child , the date and the treatment given. On an average, Charan Singh sees at his home between five and eight persons every day . He is able to take care of a few more on hi s rounds. As he is himself quick and eager to point out, he is not a doctor. " All that I do is to give medicine for minor a ilments. If there is no relief, I refer the patients to the Primary Health Centre (PHC) at Ujwa, a few miles from here." He recalls that the patients referred by him so far included several persons requiring stitches and plaster casts for injuries sustained in the field, and four needing appendix operations. Referring to his stock of medicines, Charan Singh says that- considering the nature of work of most of the village people and the frequency of injuries- he should have a bigger stock of bandages and antiseptics. He has reported to the village council that he runs short of ban- dages and medicines for cuts and bruises, as well as syrups for coughs and colds before the six-weekly replenishment falls due. De-worming tablets , on the other hand, last a long time because there is not much demand. Having been a CHV for some time , the young farmer says that he will continue offering what service he can as long as the community wants him. Dr B. N. Mittal , Medical Officer-in-charge of the Rural Health Training Centre, Najaf- garh, explains : " That is the way the scheme operates. Charan Singh and oth- ers like him do not report to us . In fact we have no jurisdiction, as such, over them. It is for the community to select them, and to avail itself of their services. If, for some reason the community feels that the CHV is not delivering the goods, it can de-recognise him and, once this is done, all facilities provided to him as a CHV 7
Above : While their children are kept amused in a nursery, the mothers receive information on nutrition. Left: The village elders too are eager to learn how the community can impro ve its own health. ( Photos WHO/A.S. Kocharand WHO ) will automatically be withdrawn. Even though such instances are rare, they have taken place. The reason they are not fre- quent is that normally people selected by the community live up to the trust placed in them." In the case of Charan Singh, he is al- ready a member of the local panchayat (village council), the vice-president of the school society, and a secretary of the youth club. After taking over as the CHV, he says, his status in the community has gone up still further. How has the scheme benefited the community? According to the wizened old " Baba"- "grandfather" to the entire village, who claims to be 80 but could be more- Charan Singh in his CHV role is a real asset to the village. " People do not have to travel to the PHC to seek relief for minor cuts and bruises, aches and pains", Baba says. " Since Charan Singh is our man , it is easier for us, including our womenfolk, to go to him without any hesitation. Ever since he started working, you do not find as many chil- dren as before with running noses ." With the community's involvement in their own health, there has been another noticeable change in attitude . One of his patients, Ajit, who had recently been treated successfully for malaria, said: "Earlier, when health officials used to come here and urge us to do this or that, the advice was forgotten as soon as the visitors went away. Now, with Charan Singh, we are able to do much more col- lectively." Pointing to a freshly filled-up area, he said that till a year ago it used to be a stagnant pool of water, ideal for mosquito breeding. At Charan Singh's suggestion, the villagers got together and filled it up. Now there are plans to con- struct soakage pits for every house to replace the open drains in the village . It will be some time before proper ex- creta disposal facilities become available, or the dream of a piped water supply is realised, but the village people are al- ready talking about these needs. Charan Singh has told them that more than half their health problems could be solved if they had easy access to potable water. As it is , the village has only two wells with an acceptable quality of water. For irri- gation , the village relies almost wholly on seasonal rain . Taking their cue from Charan Singh, some community social workers have started knitting and sewing classes for women . A few houses down the road from Charan Singh's, a voluntary organ- ization is running a nursery, which takes care of over 50 children . While the chil- dren are kept busy with their crayons and other educational aids, their mothers are given information on nutrition and immunization . Within the compound of the building which houses the nursery, Charan Singh draws attention to the model of a dry latrine, which the people are encouraged to study and construct in their homes . These are small beginnings of things yet to come. But there is a mood of hope in Hasanpur ; it stems from what the peo- ple of the community have already achieved by taking the initiative to do something for themselves, rather than waiting for the authorities to do it for them. • 9