Published: December 2008

Community Health

Her fingers gnarled by leprosy suffered as a teenager, Sakubai Gite examines a two-year-old girl she delivered and still cares for.

Necessary Angels

They are not doctors. They are not nurses. They are illiterate women from India's Untouchable castes. Yet as trained village health workers, they are delivering babies, curing disease, and saving lives—including their own.

By Tina Rosenberg
Photograph by Lynn Johnson

When Sarubai Salve walks through her village, she gathers a crowd. Salve is 56, a slim, reserved, somewhat stern woman with wire-rimmed aviator glasses and long black hair streaked with gray. On most days she sets off twice, at nine in the morning and six at night, through the streets of Jawalke, a village of about 240 families in the central part of India's Maharashtra state. She carries a blood-pressure cuff, a stethoscope, a baby scale, and a thin logbook. She is often accompanied by Babai Sathe, an exuberant woman of 47, a bit zaftig, with a toothy smile.

The two of them are responsible for keeping Jawalke healthy. They deliver babies and then visit them. They see pregnant women and old people. They take blood pressure and check on villagers cured of leprosy.

Today, a sunny morning in January, the first patient they see is Rani Kale. The house where Kale is staying is made of mud, dirt, and cow dung with a thatched roof. A cat perches on one slope. In the yard, bricks are stacked up, clothes are slung over a line, and small fire pits hold twigs for cooking sorghum flatbread. A brown cow lies contentedly in the shade.

Kale is pregnant. If she were a resident of Jawalke, she would have been seen by Salve many times and sent to the hospital for a sonogram. But she is from a village an hour away. She has come to her mother's house to give birth.

This will be Kale's second baby. She has had no prenatal care until ten days ago, when she first arrived in Jawalke. Salve examined her and advised her to get a sonogram. But Kale never did, and now birth is days, or perhaps hours, away. Salve checks Kale's blood pressure, examines her nails and eyes for signs of anemia, and feels her legs for water retention. She takes Kale inside the hut and lays her on a mat for a pelvic exam. She puts her head on Kale's belly, listening to the heartbeat.

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