All work, less pay push ASHAs in Kashmir into protest mode

The grassroots health workers do not get their meagre honorarium on time, while incentives for some services they render remain unpaidFahim Mattoo and Sadaf ShabirGanderbal, Jammu and Kashmir: Nine months ago, Shaheena Wani (29) from Chountpati Waliwar in Lar tehsil of Ganderbal district joined duty as an Accredited Social Health Activist (ASHA) in her locality. She chose this as her first job to serve the community and to help her family. However, to date, she has only received her first month’s honorarium (assured initiative) of Rs 2,000."I did not even get money for my uniform. I bought it myself and it cost me Rs 1,700. So far, my colleague and I have made 400 ABHA [Ayushman Bharat Health Account] cards, but we have not received a single penny," Wani tells 101Reporters. She was supposed to get Rs 10 for every card made.Administering vital vaccinations, guiding maternal and child health initiatives, and providing essential nutrition counselling are some of the key work areas of ASHAs in the rural landscape of Jammu and Kashmir. They work mostly three days a week, unless there is an emergency. Despite their valuable contributions, these grassroots health workers grapple with the weight of financial insecurity as their meagre incentives fluctuate with the number of patients they attend to and the services they offer. Apart from their honorariums, ASHAs get incentives for running government initiatives. Under the Janani Suraksha Yojana, they provide guidance to expectant mothers on antenatal care, birth preparedness and how to recognise danger signs during pregnancy. Following childbirth, they extend postnatal care for 42 days and initiate a two-year-long baby immunisation programme. “Despite our efforts, we are provided only Rs 600 per patient for this extensive service. Moreover, we often encounter significant delays in receiving these payments. It mostly takes five to six months to obtain what we rightfully deserve," Rubeena Showkat, an ASHA with 16 years of service in Chountpati Waliwar, tells 101Reporters.   The National Female Health Workers (NFPHW), the backbone of Immunisation Day in Chountpati Waliwar, demonstrating unwavering commitment to community health, ensuring every child receives vital vaccinations with care and expertise (Photo - Fahim Mattoo, 101Reporters)The ASHAs conduct non-communicable disease screenings for individuals aged 15 and above. “These screenings encompass full body assessments, diabetes tests, blood pressure checks and weight monitoring. They are conducted every Saturday at our centre. We are also tasked with maintaining the Comprehensive Basic Assessment of Care records of it, both online and offline. For these efforts, we are supposed to receive Rs 1,000, but payments are consistently delayed,” she explains.Similarly, the incentive of Rs 250 per child for initial immunisations has been delayed. “We have expressed our concerns through protests, and assurances were given to resolve the issue. Regrettably, upon checking the data, we discovered that not even 40% of the promised compensation had been provided.”Articulating their concerns and advocating for a prompt enforcement of the Minimum Wages Act, 1948, ASHAs from several regions of Kashmir gathered at the Press Enclave in Srinagar and held a large-scale protest on September 17. In a stern declaration, the ASHAs made it unequivocally clear that they would go on strike if their demands were not swiftly met.They say instead of honorarium, they are requesting the government to provide them with a monthly salary of Rs 5,000. Even the sought amount is insufficient, considering the nature of their work in remote areas.Meanwhile, Lar Block Medical Officer Dr Ishtiyak Naik tells 101Reporters that the policies made at the Central level are implemented for all ASHAs, and the government is actively addressing the issues at the Central level.While claiming that the monthly honorariums are paid on time, Dr Naik admits that other incentives are currently pending. "When the budget allocations come in, the pending payments will be cleared," he says. About the delay in providing uniforms to ASHAs, he says funds are released once in a year for the purpose and that ASHAs would receive their uniforms at that time.  Rubeena, the steadfast Asha worker from Chountpati Waliwar, extending a helping hand to the National Female Health Workers (Photo - Fahim Mattoo, 101Reporters)Dispelling myths at a difficult jobChountpati Waliwar comes under Chunt Waliwar village, which is home to 901 families. According to the 2011 Census, Chunt Waliwar has a total population of 5,950, comprising 3,003 males and 2,947 females.The village's literacy rate is lower (48.24%) than that of Jammu and Kashmir’s overall literacy rate (67.16%). The male literacy rate stands at 58.20%, while the female literacy rate is 38.31%. Furthermore, Scheduled Tribes account for a majority (45.01%) of its population.  For ASHAs, going door-to-door motivating people about immunisation is an incredibly challenging task. Sometimes, people refuse to come out of their homes, and at times, they hesitate to give Aadhaar cards for generating ABHA IDs, fearing misuse.“I vividly recall an incident during the peak of the COVID-19 pandemic when we tirelessly went from door to door for vaccination. Some people would even attack us, and tragically, a woman with pre-existing health issues passed away after receiving the vaccine. Her family unjustly blamed me, alleging that the vaccine was the cause of her death,” Showkat says.“There was a prevailing myth at that time that we were injecting viruses through vaccines. Once I encountered a man who sternly warned me that if I ever visited his home, he would harm me with his axe. Despite enduring such challenges, the government has not paid adequate attention to our plight," laments Showkat, while collecting forms from the mothers of newborn babies at her centre.Recalling an incident when a woman in the seventh month of her pregnancy had to be hospitalised late in the evening due to bleeding, Wani says, “We quickly shifted her to the first sub-district hospital in Lar and then to LD Hospital in Srinagar. After she gave birth to a baby girl, I returned home at 2 am in the ambulance, and the driver dropped me midway. I had to call my husband, who then borrowed a motorcycle to pick me up. 'For just Rs 2000, you go through so much struggle. Even a labourer earns more than you,’ my husband used to tell me.”Wani is the designated ASHA of Parveena (20), who is three months pregnant. During her routine check-up, she warmly expresses: "It is Shaheena di who has been guiding me about antenatal care. These ASHAs are incredibly helpful. They dedicate their time to visit our homes and impart crucial knowledge about antenatal care and immunisation, ensuring the well-being of both mother and  child."Sabreen, a dedicated NFPHW, stands at the forefront during Immunisation Day in Chountpati Waliwar (Photo - Fahim Mattoo, 101Reporters)Capacity building effortsLast year, a two-day capacity-building workshop was organised at Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Soura, with an aim to minimise unnecessary interventions during childbirth, lowering caesarean rate, and reducing the workload for doctors. A new cadre of nurse practitioners and midwives was established to provide comprehensive assistance to women during pregnancy, childbirth and postpartum stages.Supported by the Government of India, the initiative was a collaborative effort between the Jammu and Kashmir National Health Mission, Postgraduate Institute of Medical Education and Research, Chandigarh, and United Nations Population Fund, New Delhi. "For getting trained as an ASHA for midwifery, all that is required is class 10 pass or seven years of experience in the field. However, the selection for the training lies with the higher authorities. Unfortunately, in Kashmir, no one from our region was chosen for this valuable training opportunity," Showkat notes, adding that her days of training had been in the range of five to 10 days. She suggests that training should continue in the village afterwards to facilitate continued learning.  In this regard,  Dr Naik explains that they conduct workshops periodically and are actively working on providing adequate training to all ASHAs.Meanwhile, Wani says ASHAs have repeatedly requested the Union Territory administration to provide them with tablets for official work since their phones struggle with the heavy online workload. “Our honorariums and incentives are not sufficient to purchase a smartphone,” she says.Highlighting the importance of door-to-door awareness campaigns, Sabreena Gul (32), a female multipurpose health worker at Chountpati Waliwar, says the unique local language complicates communication, making ASHAs indispensable for effective outreach. Despite their efforts, ASHAs still face challenges in mobilising the community. "Today is the immunisation day, and people were informed yesterday to bring their children for immunisation. It is already noon, and no one has turned up yet," Gul says disappointingly. Cover Photo - With determination Shaheen and Rubeena work in harmony with NFPHWs, making Immunisation Day in Chountpati Waliwar a resounding success (Photo - Fahim Mattoo, 101Reporters)

Shaken, not stirred: Trans people battle discrimination to rise above natural disasters

Fahim Mattoo & Sadaf ShabirSocial taboo prevents them easy access to relief aid in times of floods and earthquakes, but the close-knit community tries to tide over bad times by helping each otherSrinagar, Jammu and Kashmir: “I feel abandoned by the government. It has been two months since my house was damaged in an earthquake, but I have not received any sort of relief. I go to the district office every day, but always come back empty-handed. Now, I stay with the members of my community. The cost of house repair is so high that it is beyond my means.”A transgender person hailing from north Kashmir, Simran Lone (30) left home 17 years ago in search of a sense of belonging. Success meant having a place that can be called home, and to make that a reality, Lone strived like never before. Performing at weddings and stashing away every penny earned had been top on the agenda until that day in 2020 when Lone finally managed to buy a three-room house worth Rs 10 lakh at Habba Kadal in downtown Srinagar. However, the sense of joy and pride did not last long as the massive earthquake hit the region on March 21 this year. Now, only a major repair can remedy the cracks on the walls and ceiling. “I called a carpenter to assess the damage, and he gave me an estimate of Rs 1.50 lakh! I was shocked to no end,” Lone exclaimed. Forget accessing financial and material aid in the event of natural disasters, even getting credit for repair works is a mammoth task for the transgender community members. This fact is accentuated by their limited exposure to government schemes and employment opportunities.Like Lone, Zoya Khan (27) from Srinagar knows first-hand the difficulties of navigating through a disaster. During the 2014 floods, Khan was unable to access relief aid due to the unique gender identity. For almost 15 days, the ground floor of Khan's home was under water. To survive, relying on the community members was the only option, besides one's own resourcefulness.“I have experienced prejudice and marginalisation my entire life, but a disaster makes it even more challenging to meet food, housing and medical needs. In times of crisis, we must strive to create a more inclusive society that considers the concerns of marginalised people.” Khan said even distribution of food packets during floods reeked of discrimination. “Those packets were meant for anyone in need, but we were marginalised to such an extent that we were prevented from utilising the resource. No one should be left behind in times of crisis,” pleaded the trans person, who is determined to build a better future by dancing at weddings.(Above) A 2014 file photo of rescued persons from flood-ravaged Jammu & Kashmir being airlifted to safety by Indian Air Force; (below) An aerial view of flood affected regions of Jammu & Kashmir (Photos - Wikimedia Commons)The feeling of being left behind during the COVID-19 crisis is still fresh in the mind of Khushi Mir (26). “The pandemic period has been extremely tough on me. As a trans person, I already face a lot of discrimination and challenges in my daily life. With the lockdown imposed, I was unable to work as a singer or dancer, which were my usual sources of income. So, I had no choice but to work as a labourer,” Mir said, recounting how the harsh work environment caused sunburn.However, finding strength from that bitter experience, Mir created a volunteer group and raised money through crowdfunding to help the needy transgender persons. In fact, the idea to launch the group came about after a friend made a desperate plea for food during the pandemic. “We were a group of five trying our best to reach as many transgender people as possible. We had a list of 400 with us, and were slowly providing food kits to all of them in those tough times."Dr Aijaz Ahmad Bund, an LGBTQIA rights activist and author of Hijras of Kashmir: A Marginalized Form of Personhood, identified rejection by families, discrimination, and inability to reconcile with their religion and sexuality/gender identity as the biggest challenges before the LGBTQIA Muslim community. For transgender persons, there are additional challenges such as shelter, livelihood, health, and accessing socio-religious spaces in times of disaster. “Inclusion of individuals from this cross-section of society in policy-making related to disaster management is crucial in creating a gender-sensitive framework,” he suggested.Asked how the government planned to meet the needs of the transgender community, Kulbhushan Kumar, Director of Finance, Department of Disaster Management, Relief, Rehabilitation and Reconstruction, told 101Reporters that the disaster management guidelines were the same for all individuals. “If transgender people become victims or face discrimination during a disaster, they should directly contact the deputy commissioner for assistance. While documentation may take time, it is essential that we prioritise accountability and justice for all members of the society," he said..Much like disasters, environmental degradation and pollution have a significant impact on the physical and mental health of transgender persons. Access to clean water and air is a significant challenge, especially for individuals who already face social exclusion. Disasters can also disrupt hormone therapy and allied medical treatments.The impact of climate change on the global economy can also have a disproportionate effect on transgender people. For example, they are more likely to work in low paid, precarious jobs that are vulnerable to disruptions in supply chains or other economic consequences of climate change. As for Lone, Khan and Mir, their monthly income fluctuates around Rs 5,000-10,000.  According to a recent report by the Human Rights Campaign Foundation, transgender individuals are more likely to experience poverty, violence and discrimination than the general population. They may be denied education, healthcare and employment opportunities, and forced to live in isolation or engage in risky activities to survive.  Dr Aijaz said the transgender community of Kashmir is a small and close-knit group that provides emotional and psychological support to each other. However, in times of disasters, they have to rely on external support. And this is where the problem lies. As Kulbhushan Kumar aptly pointed out, disasters do not discriminate and neither should our response. Edited by Rekha PulinnoliCover photo - A transgender person hailing from north Kashmir, Simran Lone had saved every penny towards buying a home in Srinagar, but itwas damaged in the tremors of March this year (Photo sourced by Fahim Mattoo and Sadaf Shabir, 101Reporters)