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Champaran's community health and Sister Elise

Sister Elise is a familiar sight in the dusty lanes of Bettiah -- a district town in Bihar known for its lawlessness.

But the 55-year-old nun is unruffled about her personal safety as she goes about mobilising women on health education and empowerment. Just the other day she was visited by some local musclemen. ''They were very polite and appreciated my efforts at promoting community health. But they warned me not to teach the women about matters like panchayati raj,'' she says.

The energetic missionary has devoted a better part of her life in improving the lot of impoverished villagers in West Champaran district -- a peoples seemingly forgotten by the state government.

Supposed to have formed a part of the epic Mithala kingdom ruled by King Janak, father of Sita, Champaran hit the headlines in 1917 after M K Gandhi took up the cause of exploited peasants in the indigo plantations. The oppressed people suffered from abject poverty, illiteracy and lacked basic amenities.

Later in his autobiography My Experiments with Truth, Gandhi described his meetings with the peasants in these areas as coming ''face to face with god, ahimsa and truth.'' Today, the situation has grown worse, where all three -- god, ahimsa and truth -- seems to have forsaken them.

For Sister Elise, who heads a charitable institution set up in 1926 to promote rural development, the going is extremely tough. Nevertheless, she tries to function within her limited funds.

Two years back, Bettiah district was identified by the Delhi-based National Institute of Public Co-operation and Child Development -- an autonomous body under the department of women and child development, ministry of human resource development -- for inclusion in the integrated child development services. ''But nothing has been done so far,'' says Sister Elise.

The problem is compounded by the fact that birth registrations are not being done systematically or regularly, which makes it impossible to deduce the exact number of children in the district.

According to her, registration of births is haphazard because majority of the births in rural areas take place at home, often with the assistance of illiterate dais. ''In the villages where we work, we ensure that our health workers maintain a register. We then send the details to the block development officer of the primary health centres. After this, we have no idea what they do with the information,'' she informs.

In fact, UNICEF has come down heavily on India's poor performance in respect of birth registrations. Its report titled The progress of nations 1998, says 40 million babies go unregistered around the world every year, one-third of which are in India.

''I serve 40,000 people in five panchayats. One panchayat consists of about 25 villages,'' says Sister Elise. Her organisation, The Sacred Heart Health Centre aims to improve the health condition of women and children by reducing the mortality rate of children under five years, checking deaths due to Kala Azar, Tuberculosis, Malaria, and other communicable diseases; as well as promoting the concept of small family norms. It also works towards empowerment of women.

In Chanpatia block, consisting of 12 villages with a total population of 7,500, Sister Elise has trained eleven dais. Prabhautidevi completed the 10-day training two years ago and has since been assisting in childbirth. But she is uncertain of the exact number she has delivered so far. ''Maybe five or six,'' she says with a shrug.

For dais like her, the incentives are so little that they don't have the requisite dedication to their task. ''If a girl is born I will probably not get anything except Rs 5 for tending to the mother and child for a week,'' she says. If the newborn is a boy, some wheat or maize is also promised, but only at the time of harvesting.

Social activists claim that a sizeable number of new births go unregistered in the district. A birth certificate is not a prerequisite for admission in school. In many cases people just make affidavits giving any age of the child.

The residents of Misritola village, about three kilometres from Bettiah, claim the government has totally forgotten them. In the absence of proper roads which effectively cuts them from basic civic amenities like health and education, the villagers face problems due illiteracy and poverty. If that is not enough dirt and disease pose more threats.

Chintadevi, a mother of five children, cannot remember the last time an expectant mother delivered in hospital. ''The nearest hospital is very far away and the road is so bad. We have sent several requests to the block development officer for making a pucca road but to no avail. All births take place at home except for complicated cases which may be taken by bullock cart to the hospital,'' she says.

Urmilla, a social worker who regularly visits the village to promote health awareness among residents, says the state government has a maternity aid scheme for impoverished families called Matritwa anudan. Under the scheme, the family is given a sum of Rs 300 for the birth of the first child and Rs 500 for the second. The scheme is aimed at promoting the two-child concept, but most of the villagers have not benefited from it. ''What usually happens is that the government nurse asks for Rs 10 or 15 as the fee for filling up the form. These people have no money and so are denied the facility on the ground that they are ineligible,'' she claims.

Even with regard to new births, all details are sent to the gram sevaks. ''If we have good contacts with the gram sevak, he will help us. Otherwise they want money before they render any assistance,'' she continues. Even though the gram sevak visits the villages once a month to register all pregnant women, no follow-up is ever made.

Similarly, in nearby Baswaritola village -- primary health workers rarely make an appearance. Meena Devi, a resident, claims that health workers come once a year to teach them about family planning. It is only during this visit that they make inquiries of new births.

Several women claimed that auxiliary nursing midwives refused to come to the village to inoculate their children because they were not paid or given any other facilities by the hospital.

In such a dismal situation, Sister Elise carries on her task of rendering succour to the needy. ''We have till date formed 25 women's groups in four panchayats. Each group has an average of 15 women. These groups act as key reference groups in the villages for promotion of development action,'' she says.

Her organisation also runs a referral health centre at Banuchappar, with a staff consisting of a qualified doctor, trained nurses, one midwife, a lab technician and a part-time gynaecologist. Complicated cases are referred to the district hospital by giving the patients a health card.

''We also have a mobile clinic which goes to every panchayat once a week. An average of 450 patients are served every week by the clinic,'' adds Sister Elise. The past year has shown a marked rise in the reporting of cases. However, this increase did not depict increase of morbidity rate, but showed the prevalence rate of diseases which was never reported before.

UNI

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