Laxmi Carpenter has been an Auxilliary Nurse Midwife (ANM) for close to 13 years. From 2002 to 2015, she worked in Mandsaur district in Madhya Pradesh, providing life-saving health services such as vaccination at the grassroots level. As an ANM, Laxmi had to play several roles in the rural community. ANMs are often the first point of contact for people in the village with the public health system, and one of their primary jobs is to build an interface between the district health system and people in the districts they cover.
Laxmi coordinated with the ASHAs (Accredited Social Health Activist) to maintain a list of children who are born in each village, conducted surveys to identify their ages – thereby determining which vaccinations were due for each child, administered vaccines to children, and provided childbirth, pre-natal and ante-natal care services for pregnant women in the village. She also had to make a note of drop-out kids so that she could make sure that they were vaccinated in the next session. She also had a lot of administrative duties that she conducted from the health sub-centre – coordinating with the district medical officer and the village leaders such as sarpanchs, pradhans and kotedars, and setting up saas-bahu meetings with mothers in the community to educate them about important aspects of child health such as newborn care, vaccination and nutrition.
Despite the heavy load of work, for Laxmi, the community she served, was her family. She was often treated as such. “People in the villages used to come to me for all sorts of problems, not just health issues. They thought I could solve everything,” she laughs. This trust that she built with the community was crucial since a large part of her job involved addressing any concerns or questions parents might have about vaccination. “A big part of the job was to talk to families and rid of the misconceptions and rumours about vaccination. I would often go door to door with the ASHAs to talk to parents, making them understand that they are putting their child at risk by not immunising. “Every month, we would make a routine: we’ll go to this ward this Tuesday, this other ward the next…and we would ensure that all villages would be covered over the course of the month. Plus we also had to make sure that parents whose children were away on the day we came to the village – either because they were at a relative’s or were sick – were brought to the sub-centre for their routine immunisation.”
Often her job was challenging, to say the least. “During the rains, things used to be particularly difficult. Many of the kaccha (unpaved) roads would be flooded, and we couldn’t go by car or motorbikes to our villages. I remember that we would carry one bag with needles, syringes, registers, etc. in one hand, and the vaccine carrier kit in the other – close to 20 kg in all – and walk three-four kilometres on foot, in the mud, to reach those villages.”But despite the odds, Laxmi is content that her work resulted in positive impact. “From 2002 to today, awareness has increased a lot. Previously, a lot of parents were unaware of vaccination. Now, thanks to the government’s campaigns – through TV and radio – and the work that health workers are doing, parents in even the remotest parts of the country are more informed. Today, even before we go door to door announcing dates for immunisation, parents often come to the sub-centres asking about when they can come to vaccinate their children. On campaign days, we often don’t even get time to have a quick drink of water because there are so many children to immunise.”
Rural communities have also become much more aware of personal hygiene because of the good work that health workers like Laxmi have been doing. “Earlier, the women of the village would eat or cook or play with their children in the same area where their cows were tied – we used to tell them that without good personal hygiene a lot of diseases can spread. But now, people know that the pens for animals need to be kept separate and away from the house,” says Laxmi. Women like Laxmi are the building blocks on which the success of India’s public healthcare system is built. Today, with the introduction of several new vaccines in India’s Universal Immunisation Programme, this work has become even more crucial. There’s still a long way to go to ensure that no child in India dies of vaccine-preventable diseases, but Laxmi hopes that day is not too far away in the future.
World Immunisation Week is from 24-30 April. Join the conversation by downloading our toolkit and using #AajKeHeroes #VaccinesWork #ProtectedTogether.