My tribute on World Health Day 2020

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Today is April 7, 2020. Today is the day to celebrate the work of nurses and midwives and remind world leaders of the critical role they play in keeping the world healthy. I am taking this opportunity to pay my tribute to all the health workers including Nurses, Auxillary Nurses & Midwives (ANM) and Accredited Social Health Activists (ASHA) by sharing one of my captured photographs, which is my personal favorite.

For the last couple of years, I am traveling across India as a commissioned health science photographer to capture the Universal Immunisation Programme (UIP). During this journey, I have encountered several frontline health workers and witnessed their works in the field. By holding their hands, I have crossed rivers like Brahmaputra and Narmada, climbed the Himalayas, experienced the extreme beauties of life in far-flung India. I have captured a few thousands of photographs in these two years. But this particular photograph remains close to my heart, till date. This is a photograph of about 3D – Determination, Dedication, and Delivery, based on which the entire foundation of the public health system of India is alive. Let me tell you the exciting story behind this photograph.

It was the end of August 2018. Monsoon was in its full swing in Assam. The whole state was looking like a gouache painting. It was simultaneously hot and humid. My first assignment was in Dhubri. And then in Jirang and finally to the infamous tribal district, Karbi Anglong. The name of the last district is good enough to create stomachache to many residents of Assam, including my chauffeur who drove me across the state.

For those who are not aware of Karbi Anglong, for them, it should be mentioned that Karbi Anglong (literally means Hills of Karbis) is the largest district of Assam and born in 1976. The population of the district is predominantly tribal. The major tribal ethnic groups of this district are Karbis, Bodos, Kukis, Dimasas, Hmars, Garos, Rengma Nagas, Tiwas, Man (Tai Speaking’s) live together in this region along with a large number of non-tribals. Known for one of the highest numbers of Internally Displaced Persons (IDP) due to ethnic conflicts, Assam witnessed one of the devastating ethnic clashes between Karbis and Rengma Nagas at Karbi Anglong in 2014. The clash internally displaced nearly 3.5 lakhs people from both the tribal communities. Later on, the Government of Assam rehabilitated them in the different forest-covered hilly villages of the districts including Siruhoti, Borpung-Tarapung, Bapuram Teron, etc. The district is covered with both dense tropical forest-covered hills and flat plains along with twelve rivers and their tributaries and innumerable rivulets. Due to variation in the topography, Karbi Anglong experiences climatic variations in different parts, but the hilly parts receive maximum rainfall (avg. 2416 mm). Hence, except for the winter season from October to February, the rest of the year commuting to these hilly villages is nearly impossible because of these rain-fed rivers. Monsoon completely cuts off these villages from the main market areas.

I was accompanying the health workers of Chokihola Block Primary Health Center (BPHC), Karbi Anglong. Their destination was Bapuram Teron, a hilly village, where one particular child left out of vaccination. The ANM, Ms. Sika Engti (54) was the senior-most and was leading the team. She was accompanied by three ASHAs, the Block Programme Manager (BPM), and the Block Extension Educator (BEE). I was completely unaware of our final destination. It took us about four hours to reach the village from the BPHC mostly by foot through the muddy and slippery roads. Initially, they hired one local vehicle to commute until a certain point. But it broke down just after ten minutes, because of the terrific road condition. To reach Bapuram Teron, we crossed the rain-fed, fearsome Kaliyani (black water) river by a Melang (bamboo raft), and numerous rivulets by foot.

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The axel broke within ten minutes after the journey started.
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Melang (bamboo raft), the only mode of transportation between these villages and the main market.
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One of the several rivulets that they crossed by foot to reach the villages and also during return.

When they finished their job, it was already quarter past four. They would return to the BPHC and I would be back in Guwahati, to catch my return flight the very next day. They were in a rush because if it became too late to reach Kaliyani, the Melang service won’t be available anymore. And then from Kaliyani, it would take another one and a half hours to reach BPHC. So, taking advice from the village headman, they took a shortcut, a pathway between the hilly forest known for its wild inhabitants. It was risky but they were in a rush because in between there were three rivulets before Kaliyani. The rain stopped in between. The soft light in the late afternoon was playing hide and seek in the jungle. It was magical. The path, that is usually using by the native villagers, was extremely slippery. Rain helped to grow moss and fern all over the forest. The chirping of the birds returning to homes was a perfect background score.

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Call off the day at Bapuram Teron.

And then suddenly, around 5.40 PM, we all stopped in front of an abandoned wooden bridge. About 15 feet long. About 30 feet above a rain-fed tributary of Kaliyani. Was it a bridge? I don’t know. It was looking similar to the railway track. Probably built many years ago to commute. This bridge was unknown to these health workers. They are not familiar with this route. The condition of the bridge was scary. The wooden decks were extremely slippery. The gaps between the decks were about three to four feet. A slight disbalance would end-up straight in the flowing Kaliyani. Understanding the condition of the bridge, we decided to cross the bridge one after another, not to put any extra load on the bridge. Mr. Satyajit Bay, the BEE, took the first step. It was taking about 5-6 minutes to cross the bridge carefully. Eventually, I also started to cross the bridge, keeping my balance. I could see and hear the current of deadly black water flowing below my feet. The sound of the flowing river was timourously mesmerizing.

When I crossed two-third of the bridge, it started vibrating badly. I turned back and sat down on one of the wooden deck with my camera on the lap. Switched on. The senior ANM, Sika Engti, was following me. She started to follow me even before I reached the end. She was almost in the middle of the bridge. And was trying to cross hastily, as fast as she can. Probably the sound of the flowing river impacted her, psychologically. I pressed the shutter, keeping the camera on my lap. One – two – three. And she slipped with her rubber slippers. The reflex brought me back on my foot. Keeping my balance, half running and half walking, I rushed to her. For that moment I forgot that Kaliyoni was waiting for me beneath my feet. I extended my hand. She obliged me. By that time she was back to her feet. We both crossed the bridge, slowly and safely. Sika was carrying a red towel on her left shoulder throughout the journey. She was perspiring profusely. She wiped the sweat. And smiled back. We finally reached the BPHC at around 7.30 in the evening. It was a full moon.

And I safely returned to Guwahati by road at 5.30 in the morning.

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One-two-three. And the slip. Image © Dr Kaushik Ghosh, GIS ARPS

Whenever I am seeing this image of Sika, I remember her face. Pale and perspiring. I don’t want to imagine what happened if she slipped between the gap. But again she would lead the team to reach another village in this extremely difficult terrain. Without any fear, without asking any question. Like Sika and her team, these frontline health workers all across the globe are taking extreme risks, every day, to deliver. Their determination is rock solid. Their dedication is unquestionable. In these two years, I met several health workers. In Assam, Bihar, Himachal, Madhya Pradesh, Uttar Pradesh. And probably will meet many more. I shall never forget the love and warmth I received from them. The food they shared with me, the stories they shared with me, their ecstasies and agonies that they shared with me. But above all, they taught me about 3D – Dedication, Determination, and Delivery.

Today, health workers are at the forefront of COVID-19 response – providing high quality, respectful treatment, and care, leading community dialogue to address fears and questions and, in some instances, collecting data for clinical studies. Quite simply, without them, there would be no response.

Take my bow. A thank you is not enough. Hence, this little tribute. Hope people will understand your contribution to our society by accepting all kinds of risks and challenges.

Stay safe!!!

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[This post would not finish without acknowledging my travel partner during the Assam journey, Abhijit Biswas from UNICEF. Without his immense support and network, this assignment won’t be accomplished. And my heartfelt thanks to all those organisations who gave me the opportunity to meet these amazing souls].

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