The power of listening in public health

“Common people were apprehensive about vaccines. More than the disease. Which is obvious for something new that has direct implications for their life. The same happened in cases of hospitalisation during first and second waves. In my 17 years of experience, I faced this apprehension among parents too. To vaccinate their children. But me and my team overcome the refusals. For both children and adult vaccination. How? Just by listening to them. People must have questions. About vaccines. Especially in the age of social media. Fake news spreads faster than wind. So, we must answer their queries to combat the myths. We must devote time to listen to their worries and answer them. To convey we are here for you, anytime, if something goes wrong. No one wants to die. No one experienced this pandemic in their lifetime. Not even us. You know, injecting a vaccine is matter of a second. But we must win the heart of a person to build the confidence before we penetrate the syringe in the body. It’s his or her life, after all. For me, that’s vaccination. To win the heart. Gaining the confidence.”

When the ANM of Shipra subcenter, Nilima Parmer, was replying to my questions, I remembered Baba. His thoughts and beliefs about public health and preventive medicine. The hidden layers of social medicine behind the prevention. About listening to the stories of patients, which we technically call the history of the patient. Where both the clue for the diagnosis and ways of prevention are embedded. For Baba, medicine is impossible to teach without bedside and public health without the field.

About one and a half decade later, Dr. Raj Shankar Ghosh echoed Baba’s voice. While preparing me for the field. About the art of listening the stories from the field. By the frontline workers, cold chain handlers, vaccine van drivers, medical officers, immunization officials. To capture the three-dimensional essence of public health in a two-dimensional photograph. As because it is public’s health, one must understand the public. Understanding their health will follow automatically. Raj Shankar Da taught me, vaccine doesn’t save life, vaccination does. I perceived if vaccine is the science, then vaccination is the art. Without the art, science is non-existent.

Yesterday afternoon, Nilima Didi revised me to those lessons of public health one more time. I understood why the state health officials kept praising her. Why inhabitants of the bank of Shipra river only listening to her words. From vaccination to antenatal checkup to tuberculosis program to family planning. Why parents of physically and mentally retarded children also want to vaccinate their kids only by the ANM extraordinaire. I am the witness. The power of frontline workers.

I was about to leave the subcenter. An old lady came to me. An ASHA, draped in a purple-coloured saree. The uniform. “I have a few words to tell you.” I bend down to listen to her words. She was sobbing. “I lost everything in my life. Nilima gave me this job. She taught me everything. She gave me another life. For Shipra, she is Bahu, Beti and Bua. For me, she is my mother. Though she is younger than me.” I was looking at her face. Her eyes. Tears everywhere. Even among the eyes of people surrounding us. I felt a sudden ball-like discomfort in my throat.

I strolled back to my car. Head down, eyes on the ground. Trying hard to hold back my emotions. Nilima Didi was walking beside me. Before boarding the car, with folded hand I bow down in front of the extraordinary woman and said, “Merry Christmas in advance, Didi.” She smiled and replied, “May Jesus be with you.”

I started my journey back to Indore. Carrying the lesson of life. Taught by Baba, Raj Shankar Da and Nilima Didi. “Listen to the public. Allow them to question. Communicate in their language to answer their queries. The solutions are often hidden in their stories. In the stories from the field.”

[In the image: Nilima Didi was teaching me her methodology to corroborate the data from other public health programmes that she used for the covid vaccination drive, especially for women and specially abled].

Indore, Madhya Pradesh

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