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Many village health workers were completely illiterate when they began training. When Sathe first started making rounds in Jawalke, she had never attended a day of school. Salve had completed fourth grade. Sathe was married at the age of ten; Salve at two and a half. Every worker I met was married by age 13. Many had been abandoned by their husbands. Others talked about terrible beatings; Surekha Sadafule, who is 26, recounted how her husband threw her down a well after she bore him a daughter. Her parents would not allow her to come home. "You must suffer whatever he gives you," they said. "That is Indian culture."

The health workers' first task was to transform themselves, beginning with two weeks of training on Jamkhed's campus. The Aroles' daughter Shobha, 47, a doctor who is now associate director of the program, conducted some of the training. "I would ask, ‘What's your name?' and they would say the village they come from and their caste. They had no self-identity," she says.

"They wouldn't look into your eyes or talk to you. They didn't even feel a woman has intelligence." Shobha's mother would ask the women, "Who is more intelligent—a woman or a rat?" "A rat," they would say. Shobha had the women practice saying their names in front of a mirror. She asked them, "Who is the one person who will never leave you?" Then they would walk behind a curtain to be confronted by the mirror. The training boosted their self-confidence. "Everyone can give technical knowledge," says Shobha. "What makes it successful is time spent building up their confidence." Training is an ongoing campaign: Every Tuesday many of the women return for two days to discuss problems in their villages, review what they learned the previous week, and tackle a new subject, such as heart disease. The women sleep on the floor under one enormous blanket they sewed together from small ones.

The health workers did not become village authorities instantly. It took months or years for a village to start listening, a process helped along by medical successes, such as delivering a high-caste woman's baby or curing a child's fever. The women also have backing from a mobile team—a nurse, paramedic, social worker, and sometimes a doctor—who visit each village every week in the beginning, then less and less often. The mobile team sees the hardest cases and reinforces the authority of the village health worker. Sadafule told me that she and the mobile team went to the house of a high-caste woman in her village. As the caste system requires, the woman made tea for the visitors, but not for Sadafule—an Untouchable. "The social worker put the cup in my hand," Sadafule said. She had prescribed medicine, but the high-caste woman didn't trust her, and asked the nurse the same question. The nurse confirmed the prescription and asked Sadafule to take the medicine back out of her bag and give it to the woman.

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