The date is April 7, 2020. Today is a day to honor nurses and midwives and to remind world leaders of the critical role they play in keeping the world healthy. I’m taking this opportunity to honor all health workers, including nurses, auxiliary nurses and midwives (ANM), and accredited social health activists (ASHA), by sharing one of my favorite photographs.
For the past few years, I’ve been traveling throughout India photographing the Universal Immunization Programme (UIP). Throughout this trip, I’ve met and observed a number of front-line health workers at work. I’ve crossed rivers like the Brahmaputra and Narmada, climbed the Himalayas, traversed the desert, and experienced the extreme beauty of life in far-flung India by holding their hands. In the last few years, I’ve taken thousands of photographs. But this particular photograph has stayed with me to this day. This is a 3D photograph—Determination, Dedication, and Delivery—on which the entire foundation of India’s public health system is built. Allow me to tell you the exciting story behind this photo.
It was the end of August of this year. In Assam, the monsoon was in full swing. The entire state resembled a gouache painting. It was hot and humid at the same time. My first assignment took me to Dhubri. Then to Jirang, and finally to Karbi Anglong, the infamous tribal district. Many Assamese residents, including my chauffeur who drove me across the state, are sickened by the name of the last district.
For those who are unfamiliar with Karbi Anglong, it should be noted that Karbi Anglong (literally, Hills of Karbis) is Assam’s largest district and was founded in 1976. The district’s population is primarily tribal. This district’s major tribal ethnic groups are Karbis, Bodos, Kukis, Dimasas, Hmars, Garos, Rengma Nagas, Tiwas, and Man (Tai Speaking’s), who coexist with a large number of non-tribals. Assam, which has one of the highest numbers of IDPs due to ethnic conflicts, witnessed one of the most devastating ethnic clashes between Karbis and Rengma Nagas in Karbi Anglong in 2014. Nearly 3.5 lakh people from both tribal communities were displaced as a result of the internal conflict. Later, the Assam government rehabilitated them in various forest-covered hilly villages of the districts, including Siruhoti, Borpung-Tarapung, Bapuram Teron, and others. The district is made up of densely forested hills and flat plains, as well as twelve rivers and their tributaries and countless rivulets. Karbi Anglong experiences climatic variations due to topographic variation, but the hilly areas receive the most rainfall (avg. 2416 mm). As a result, except for the winter season from October to February, commuting to these hilly villages is nearly impossible the rest of the year due to these rain-fed rivers. The monsoon isolates these villages from the main market areas.
I was with the Karbi Anglong Chokihola Block Primary Health Center’s health workers (BPHC). Their destination was Bapuram Teron, a hilly village where one of the children had not received his vaccination. Ms. Sika Engti (54) was the team’s senior member and leader. Three ASHAs, the Block Programme Manager (BPM), and the Block Extension Educator (BEE) accompanied her. I was completely unaware of where we were going. It took us about four hours to walk from the BPHC to the village, mostly through muddy and slippery roads. They initially hired a single local vehicle to commute until a certain point. However, due to the excellent road conditions, it broke down after only ten minutes. To get to Bapuram Teron, we had to cross the rain-fed, terrifying Kaliyani (black water) river on foot and by melang (bamboo raft).
It was already a quarter past four when they finished their work. They would return to the BPHC, and I would be back in Guwahati the next day to catch my return flight. They were rushing because if they didn’t get to Kaliyani in time, the Melang service would be discontinued. Then, from Kaliyani, it would be another hour and a half to get to BPHC. So, on the advice of the village headman, we took a shortcut, a pathway between the hilly forest known for its wild inhabitants. It was risky, but they needed to get to Kaliyani quickly because there were three rivulets between them. The rain stopped in between. The late afternoon light was hiding and seeking in the jungle. It was magical. The path, which was usually used by the local villagers, was extremely slick. Rain aided in the growth of moss and fern throughout the forest. The chirping of birds returning to their nests provided the perfect background music.
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 looked similar to the railroad 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 it 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 timorously mesmerizing.
When I crossed two-thirds of the bridge, it started vibrating badly. I turned back and sat down on one of the wooden decks with my camera on my 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 could. 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. The reflex brought me back onto 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 on 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 away 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.
I remember Sika’s face whenever I see this image of her. Pale and sweating. I can’t bear the thought of what would happen if she slipped between the gaps. But, once again, she would lead the team to another village in this treacherous terrain. Without being afraid or asking any questions. Every day, frontline health workers around the world, like Sika and her team, take extreme risks to deliver. Their resolve is unwavering. Their commitment is unquestionable. I’ve met a number of healthcare workers over the last few years. In the states of Assam, Bihar, Himachal Pradesh, Madhya Pradesh, and Uttar Pradesh. And will most likely meet many more. I’ll never forget the love and warmth they gave me. The food they shared with me, the stories they told me, and their joys and sorrows they shared with me. But most importantly, they taught me 3D: Dedication, Determination, and Delivery.
Health workers are now at the forefront of the COVID-19 response. They are providing high-quality, respectful treatment and care, helping the community talk about fears and questions, and in some cases, collecting data for clinical studies. Simply put, there would be no response without them.
Please accept my thanks. A simple thank you is insufficient. So, here’s a small tribute. I hope people recognize your contribution to our society by accepting various risks and challenges.
Stay safe!!!
[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].