Caption: CHO Nehal Khalko (left) and RHO Asunta Toppo in front of Ayushman Arogya Mandir. The duo’s dedication and hard work have made this sub-health centre popular among locals
Even today, many parts of our vast country are awaiting progress and development. Some of these areas are remote and poverty-stricken, thereby lacking basic facilities in both education and healthcare. The inhabitants of such regions cannot afford treatment in private facilities. Under the circumstances, their only option and ray of hope is the public health system. The silver lining for such people are those health workers who carry out their duties with utmost sincerity, and the satisfaction and happiness they derive from doing so.
People look up to such health workers for their commitment to their role in the public health system. Here, we record our interactions with women health workers who, despite the odds, have done excellent work and have saved many lives. The joy and contentment from their work motivate these women to keep going.
Caption: When we went to meet Sanjeevani, a child who was saved by Asunta Toppo, we found his mother Vimla Rathia working in a paddy field nearby
One such lifesaver is Asunta Toppo, a Rural Health Coordinator (RHO) at Ayushman Arogya Mandir. This government sub-health centre is in Miriguda village of Dharamjaigarh block, Raigarh district, Chhattisgarh.
When we reached the sub-health centre, a meeting of the Mitanin didis (ASHA workers) was in progress. Community Health Officer (CHO) Neha Khalkho and Asunta Toppo were present at the meeting.
After the meeting, CHO Khalkho and RHO Toppo told us in detail about the people of the area and the patients coming to them for treatment. In the words of the CHO, “This is a backward area largely inhabited by Adivasis. Transportation is a big problem here. The people of Miriguda, Nakna, Bhanwarkhol and Simipali Khurj depend on this sub-health centre. These four villages have a population of about 4,000. Most of them are from the Rathia (Kanwar) tribe. There are about 20 houses of Oraon Adivasis. There are more than 25 houses of the Particularly Vulnerable Tribal Group (PVTG) Baiga Adivasis, and there are also three Birhor families, another PVTG. There are also a few people of Satnami and Basond communities. Apart from farming, the livelihoods of these people depend on the forest.”
“Get cases of malaria, dengue and diarrhoea while cases of non-communicable diseases range from diabetes to hypertension. They also treat people for common cold and fever”. She added, “We do not conduct blood tests, but we make Rapid Diagnostic (RD) kit slides. We run tests for haemoglobin, malaria, HIV, sickle cell and so on.”
Next, we asked Khalkho and Toppo about the kind of patients who come to them for treatment. The CHO explained that among communicable diseases, they “get cases of malaria, dengue and diarrhoea while cases of non-communicable diseases range from diabetes to hypertension. They also treat people for common cold and fever”. She added, “We do not conduct blood tests, but we make Rapid Diagnostic (RD) kit slides. We run tests for haemoglobin, malaria, HIV, sickle cell and so on.”
“But more than anything, people of the region come to this sub-health centre for childbirth.”
But more than anything, people of the region come to this sub-health centre for childbirth. According to the CHO, on an average, this unit handles more than 10 deliveries a month. At the time of our visit, a total of 65 babies had been delivered at the centre since January 2024. “We keep doing regular check-ups of pregnant women. All normal deliveries are conducted here. If the case is complicated or high-risk, we refer it to the Primary Health Centre in Dharamjaigarh or the District Hospital in Raigarh,” Khalkho added.
This sub-health centre used to see a higher number of births, but the opening of another such centre nearby has eased the pressure to a certain extent. Khalkho has been working here for four years while Toppo has given 19 years of her life to this health unit. She has overseen the delivery of nearly 3,000 babies.
“People come here knowing that they are safe in Asunta Didi’s hands,” says CHO Khalkho.
“I started in 2005. Now I am a resident of this village. Transportation was a bigger issue then. I would sometimes walk 15 to 20 km to visit my patients in their villages,” she recalled. Cases of vomiting, diarrhoea and seasonal diseases were more common in those days. Deaths due to blood pressure issues and blood sugar irregularities have also reduced, added Asunta Didi.
In 19 years, the trusted and respected Asunta Didi has seen many changes, big and small, in the area. “I started in 2005. Now I am a resident of this village. Transportation was a bigger issue then. I would sometimes walk 15 to 20 km to visit my patients in their villages,” she recalled. Cases of vomiting, diarrhoea and seasonal diseases were more common in those days. Deaths due to blood pressure issues and blood sugar irregularities have also reduced, added Asunta Didi.
With a relatively higher degree of awareness among people, cases of malaria, too, have reduced over the years. This change hasn’t come overnight. Repeated efforts such as health surveys, various kinds of vaccines, distribution of medicated mosquito nets and awareness campaigns on diseases spread my mosquitoes, snakes and insects such as bedbugs have brought about a positive shift.
“Earlier, hygiene-related issues were more common. The current situation is slightly better. There was a time when members of marginalised communities such as Birhors avoided visiting hospitals. They chose to deliver babies outside the village and cut the umbilical cord with a stone. Thankfully, things are now changing.”
As part of Village Health Sanitation and Nutrition Day (VHSND), the RHO goes to villages on Tuesdays and Fridays to check on people. Apart from this, her other responsibility is conducting antenatal profile tests (ANCs).
“Our Mitanin didis are getting trained by the Foundation. They also sent doctors for ANC check-ups and shared information on high-risk screening.”
She mentioned the support that the sub-health centre receives from the Azim Premji Foundation for work related to maternal health. “Our Mitanin didis are getting trained by the Foundation. They also sent doctors for ANC check-ups and shared information on high-risk screening.”
Capacity-building of Anganwadi workers or AWWs is another area in which the Foundation is supporting work related to healthcare. A number of areas have been identified for the capacity development of AWWs in Dharamjaigarh: for example, their role in VHSND, skill improvement in growth monitoring of children and interpersonal communication skills for group or individual counselling.
Asunta Didi’s vast experience as a health worker is filled with challenges and successes. We asked her to share one incident that tested her skills and resilience while also giving her immense satisfaction.
Sanjeevani and his mother Vimla Rathia with Rural Health Coordinator Asunta Toppo, who is also known as Asunta Didi
Asunta Toppo with Sanjeevani, a child whose life she saved in 2018. She named the boy after the ambulance service that transported his bleeding mother and him to the government hospital in Raigarh
“It was 1 May 2018,” she began to narrate. “Here, at the sub-centre, we were dealing with a pregnant woman whose blood pressure (BP) was unusually high and haemoglobin frightfully low – less than seven. She was in labour when she was brought to us, and she gave birth even before we could lay her on the table,” the RHO added.
The next few hours were fraught with tension and uncertainties as Asunta Didi struggled to save both the mother and the child. The mother bled profusely while her newborn faced breathing issues. In the absence of an oxygen cylinder, Asunta resorted to mouth-to-mouth breathing to keep the child alive. At the same time, she managed to stabilise the mother’s condition and control the bleeding. “After this, I tried to call for help through Sanjeevani Seva 108 (ambulance). Once they arrived, their doctor took care of the mother. And I took the child in my lap as we left for Raigarh Medical College.”
All the way to the hospital, which was about 70-80 km away, Asunta Didi kept blowing oxygen into the baby’s mouth. The doctor at the hospital was initially unsure of whether the child could be saved.
“But I was adamant… If he had to die, the child would not have reached the hospital. Finally, both mother and child survived the ordeal. This is one case that still fills me with satisfaction,” Asunta Didi said.
How is the child now, we asked.
“He is here in Miriguda village,” Asunta Didi said. “I have named him Sanjeevani Rathiya. It was the first time that I had called for help from the 108 Sanjeevani service, so I named the child Sanjeevani.”
Do Sanjeevani’s parents remember that eventful day?
“They do,” she replied. “That boy calls me Maa,” she said with pride. “The child specialist had given up on his chances of survival. His family was in despair. But I was determined that nothing would happen to the child, because we had taken him all the way from Miriguda to Raigarh for treatment. It’s been more than five years now, and he is fine.”
When we asked her why she thought she could save the child and how she managed to take him from here to Raigarh, her answer was: “From here, we first took him to Dharamjaigarh. There was a lady doctor whose name I would not like to mention. She expressed her displeasure and questioned why we took the mother and child to the hospital in that condition. But I wanted to save both the mother and the child, so I argued with the doctor… I requested her, ‘Please give me an ambulance.’ After this, the maid administered an injection to the child and gave him some medicine. Then, I took him to Raigarh Medical College while giving mouth-to-mouth resuscitation.” Asunta became very emotional while recounting this.
We asked if we could meet Sanjeevani and his mother. Asunta readily agreed. We went to their house and found out that the family had gone to thresh paddy. We went to the field. The mother was busy planting paddy saplings while Sanjeevani was playing with some friends. On seeing Asunta Didi, Sanjeevani’s mother Vimala came to greet us. Sanjeevani joined us soon after. We decided to capture the moment in a photograph.
Childbirth and complications go hand in hand in Asunta’s field of work. She narrated another incident where a Birhor woman was pregnant with her seventh child. At the time of giving birth, her uterus almost came out of the body. “We managed to save her by putting the uterus back. We wanted to refer her case to the hospital, but she didn’t want to go there. She even had another child after that,” Asunta said.
In 2019, Asunta managed to save another pregnant woman who had eclampsia. Eclampsia leads to a spike in the BP and albumen in the urine of a pregnant woman. Due to low haemoglobin, the body is also likely to go into shock, which can trigger seizures. Asunta Didi’s quick thinking behind transferring the patient to the Community Health Centre (CHC) helped avert a disastrous end to this story.
The villagers’ trust in Asunta has built over the years. In 2015, when a poor woman from Patharidand village was in no condition to travel due to eclampsia, Asunta Didi and her colleagues tied her to a cot and ferried her to the sub-health centre for delivery.
Asunta Toppo and health workers like her are a ray of hope for thousands of people who rely on the state and governments for healthcare. This is why we need to recognise and appreciate their selfless and tireless service and dedication.
