Concepts of Publicness, Impulsivity and Reputation In a Rural Setting

Interviewing a woman surrounded by neighbors and children.

When I set out for work today, my course of action, interactions and the way I tracked time was very different from when I set out for work in Bihar, a few weeks ago. Today, I gave instructions on how to get here by plugging the address into Google Maps.

When our team was set out in Saharsa, we would begin our expedition by getting into the car with our driver (Sanjay Ji-an ever colourful character with opinions and sarcastic commentary about everything and anything). Earlier one morning, we had identified a block to visit. And armed with only that bit of information, we had set off to find the village. 

When we were vaguely nearby, our driver would halt the car, beckon with his hand or yell “AYE” to summon a man from quite far away, who would then take the trouble to walk all the way over to ponder directions with us and point us in the right direction.

We asked strangers for directions, sattu stall for recommendations, and even inquired where I could buy an adapter. Throughout the trip, I would accidentally engage Siri on my phone. Siri would then respond with an “I’m sorry, Siri is not available at the moment” reply due to my spotty internet connection – just enough times to remind me of how often I used Yelp, Uber and Craigslist to get by(back home), and how I had to now craft my searches carefully and sift through volumes of information to get any answers. In contrast, the human network in villages possess easily accessible information about the surrounding areas and inhabitants.

When it comes to maternal and child healthcare, fluency in knowledge of this intricate network is an essential characteristic utilized by the ASHA. When I shadowed an ASHA, going about her duties, I noticed that she didn’t bother with the ‘due list’ and instead, used her knowledge of women in the village to infer who could possibly be pregnant by recalling the recently married, or whose husband was recently back from working outstation. There are negative impacts of the network as well. Supposedly, if a beneficiary is in the ASHA’s bad books, as a consequence she might just be in the ANM’s bad books as well, as they sometimes have a symbiotic and mutually beneficial relationship.

Similarly, if a woman wants to contact an ASHA for health advice, she just sends word through nearby youngsters, calls her on the phone or drops in at her house- no prior notice needed. When a woman goes into labor, the ASHA drops whatever she is doing and accompanies her to the hospital, in the aspirations of the money she receives for the JSY scheme. There is a familiarity factor that is an undeniable advantage and unparalleled to the care that is entirely institutional where all advisory faces are new and transient.

When it comes to research methods,  we sometimes simply showed up at a village following discretion, asked around for women who were pregnant or have recently had children. We were then immediately taken to see them. Each person we bumped into along the way was familiar with the details of other’s family. Even a sensitive topic, such as a mother who had lost a child or one who has had complications at the time of her delivery, is not unknown information. Often during the interviewing process, neighbors chime in and help beneficiaries recall stories, dates and specifics of the topic being discussed.

Information is shared on two extremes- either it is extremely personal and not shared with anyone. For example, many mothers delay sharing that the news of their pregnancy with anyone (sometimes not even with their husbands) until they are absolutely sure they are pregnant, so as not to tempt fate and induce any bad luck. In some cases, they delay it to the extent till the pregnancy is visibly obvious and impossible to hide, or otherwise the entire village knows every detail.

Women also have a very few sources of information regarding sex education, childbirth and healthcare. For many women the only source of advice comes from other women in the family who themselves have incomplete information or perpetuate beliefs that are medically proven to have a negative impact upon the health of the child- for example the practice of bathing the child with soap and water immediately after childbirth which can be a possible cause of hypothermia. The vernix that coats the skin of the baby also forms a physical barrier that protects it from infections, and which is lost upon bathing. The ASHA has been appointed as a source of information, however her advice is diluted and often overruled by traditions and elders of the household. Husbands that worked out of station, often had more exposure and a better knowledge of birth control methods, family planning and maternal care.

When families need to rush to the hospital, a rickshaw is sent on the spot- sometimes the driver is pre-identified and known to the patient, but other times someone is sent to run to the nearest main road and enlist the help of anyone present. This way of life impacts how birth preparedness is viewed- it is seen as simply not required, as people do not view planning as useful or necessary.

In some ways, this word of mouth dependence can also be a setback. When talking to an ambulance driver, he professed his objection in taking dais along because he can’t tell an experienced dai- who is an asset, apart from an inexperienced dai- who is a liability. On the other hand, he could immediately recognize the ASHA because of her distinctive, government assigned sari with its standard print, colour and fabric. Meanwhile, there is no incentive for a dai to brand or distinguish herself as she is seasoned and firmly established within her space, the village.

Can we find out at what point the effects of impulsiveness, reputation and curiosity can be harnessed and channeled into something good? Understand at what point they act as a hindrance? Can information be tailored and distributed in a manner that more naturally aligns itself to the nature of thinking in a rural setting?

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