My team recently completed two weeks of field work in two districts of Assam. UNICEF has partnered with the Government of India to initialize an accreditation process of all maternal and child community health centres (Anganwadi Centres, or AWCs) in Assam, and it was our job to use the accreditation checklist to cross-verify information and collect data for our project. Ultimately, our findings will be used to refine the accreditation tool (checklist) and process. Our work involved observing activity at the AWCs, checking records and registers, interviewing the primary health worker, supervisor, village mothers and community members. Our first district, Dibrugrarh, is in Upper Assam and located 440 km from our base city of Guwahati. We spent a total of ten days in this lush, remote region known for its tea gardens. The eight days of field work in Dibrugarh were bookended by travel days to allow us to fly to/from Guwahati, as UNICEF security restrictions forbid our train travel, and by road it would have taken upwards of ten hours each way. During this time, my team of four broke into teams of two, with at minimum one translator per team. We alternated visiting 2 and 3 AWCs per day, allowing us collectively to visit and gather data from 40 AWCs in 8 projects. After completing our field work in Dibrugarh, we returned to Guwahati and traveled over 200 km daily to the district of Morigaon, for five additional days of field work in this Lower Assam district where accreditation of AWCs has not been initialized (our “control” district). Remarkably, we were able to visit 40 AWCs in Morigaon as well, splitting into individual teams and each visiting 2 centres/day, with the assistance of a translator for each of us. In addition to conducting interviews and small group meetings at each centres, we organized focus group discussions of about 50 supervisors and 5 higher officials in each district on the final day of our data collection.
So much happened on our field visits. We met an elephant on the road on the 4th of July, I watched a boy climb a 20 foot fruit tree to retrieve berries presented to me as a gift, and an Anganwadi Centre management committee member insisted that I had the nicest nose she had ever seen (yes, all of these things actually happened!) In Dibrugarh we were particularly impressed with the warmth and hospitality of each centre. At nearly every AWC, we were offered drinking water, tea and biscuits and very often were presented with the traditional gamosa, a hand-woven red and white ceremonial shawl given to esteemed guests. Each village has a distinct pattern reflected in the embroidery of the shawl. The centres are small, similar to a one-room schoolhouse, sometimes with an interior partition used for storage or where a coal stove could go. The extent of hospitality was particularly impressive given that each centre has a miniscule budget with which to operate; nearly all funds allocated by the government are intended for supplementary nutrition or take home rations for the children and families that come to attend preschool or for immunizations, counseling and health check-ups.
On our fourth day in Dibrugarh, Thahira and I visited a centre called Thanachuk, which quickly became my favorite visit. Located in a very rural area about 2 hours drive from Dibrugarh, this centre is surrounded by tea gardens and accessible only by a dirt path. We arrived around 9AM in a heavy rainstorm, but were greeted at our car by the health worker, community members and preschool children. This entourage of around 30 people held umbrellas over our heads and presented us with flowers that the mothers had picked and the children had assembled. After we settled into the centre, we were offered even more gifts, in the form of freshly steeped Assam tea, fruit, local pastries and the ceremonial shawl. The worker expressed her delight at having visitors come from so far, and explained that many of the community members had never met a white person prior to my visit. (We tried our best to convince her the truth: that it was she who was doing us a favor by allowing us to visit and collect data for our study.)
In many areas like this, the level of community participation is remarkable, a testament to the investment and genuine concern they have in caring for their children and young mothers. In several centres, community members had come together to build the center a walkway, kitchen, boundary fencing and even a toilet; many also performed building maintenance and would regularly assist the worker by bringing clean water to the AWC every day. Each centre in Assam is meant to have a volunteer management committee, and it was always clear when this group was active.
Days in the field were at once exhilarating and exhausting. Most mornings we left at 6AM and returned between 6 and 8PM, traveling by car long distances through heavy rain and muddy, unpaved roads to meet with eager participants. While I did my best to treat everyone with equal interest and energy, my inner battery usually ran low by mid-afternoon, and we didn’t usually break for lunch until 3 or 4PM. It was disheartening at times to meet with young mothers who had not been adequately counseled on breastfeeding and monitoring their child’s growth status, and to visit centres in Morigaon which had lost all health records and preschool supplies in the recent flooding. On the other hand, I visited several centres that were clean, bright and full of life, where the health worker was doing an excellent job at monitoring child growth, counseling parents, providing regular immunizations and supplementary rations. In a discussion with one centre’s very active management committee, I was pleased to hear them ask for advice on what more they could do to improve the centre and continue to invest in the children of their village.
Our favorite meal was in the village of Thaiphucket, located near a sprawling Buddhist Monastery. After completing our field work that Saturday, we had our 5PM “lunch” at a family dhaba which served us fresh-caught fish, locally grown vegetables and other traditional fare flavored with ginger and cardamom, instead of the more common masala spice.
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