Every day since April, GS Lethika has been waking up early to poke around her neighbours’ houses. She visits around 30 houses each day, collects water samples from their wells, and checks that no stagnant water is lying around. It takes her about a week to do the rounds of every house in her allotted ward in Manickal, a relatively prosperous village 40 km from Thiruvananthapuram in Kerala, by which time she is ready to revisit the first lot to make sure they have made the appropriate changes.

She is not a great fan of the rains.

“At other times of the year, I work only two or three days a week,” she said, as she took us along part of her route. “I might have to visit one mother and see that she is having proper food and is going to a doctor. That takes only one day. But at this time, I have to work every day to make sure people are following the rules.”

Lethika is a government worker, an Accredited Social Health Activist. Her post as an ASHA volunteer was created with the National Rural Health Mission by the first United Progressive Alliance government in 2005. She lives in Manickal and has been working for six years with several other ASHA volunteers to monitor the health conditions in the village. They earn Rs 212 per day for their efforts.


Photo credit: Harsha Vadlamani


The initial rains are traditionally welcomed by farmers in Kerala as a life-giving force that marks a new paddy sowing season. But as crop patterns change, with paddy fields giving way to rubber plantations, there has been a rise in the prevalence of mosquitoes. Consequently, the rains have instead become foretellers of death.
India records the highest incidence of malaria in the world, with an estimated 24 million cases per year, according to the World Health Organisation. Cases of dengue have also been rising. Until October last year, the country recorded 55,063 cases of dengue, up from 12,561 two years before.

“What do the poor spend on?” asked N Jagajeevan, a health inspector at the Manickal village panchayat who describes himself as an activist first. “Education, treatment and marriages. If you want to empower the poor, the first step is to get rid of communicable diseases. It’s not just about health, but about how much money they will save.”

Jagajeevan has been involved with several social reform movements in Kerala over the years, including the Kudumbashree movement of which Lethika and all her fellow ASHA workers are members. It focuses on equipping women with the capital and skills to earn money for themselves.

While at other times of the year Lethika and her fellow ASHA workers might work on natal or palliative care, their goal since April has been to ensure that mosquitoes have no place to breed.

Mosquitoes, said Lethika, only need to find one spot of stagnant water to become dangerous, which is why vigilance is essential. Every rubber tree in the vicinity had its sap-collecting cups tipped to the side to prevent water from collecting. This vigilance has drastically reduced mosquito-related deaths, Manickal residents said. There were no dengue cases in their ward last year after similar preparations, and none yet this year. No official figures were immediately available.

If people do not cooperate with them, Manickal’s gram panchayat is planning to issue a notice saying that anyone who creates “positive conditions” for mosquito breeding will be fined.

The ASHA workers are also trained to test chemicals in water samples they collect every two weeks from all houses in their unit. Under the NRHM, each ward gets two testing cases filled with numbered chemical bottles to help them test the levels of chlorine, iron, coli and fluoride.

Lethika tips samples from bottles from each house into two-inch-tall stoppered flasks and then proceeds to perform a complicated dance of dipping two spoons of Bottle One into this and four spoons of Bottle 5 as the water changes colour in reaction to the chemicals. If she cannot determine a result herself, she sends it to the lab for further testing. If the water is impure, she inspects the supply and tries to see how it could be purified.

Lethika bundled us ahead to another ward to a meeting of women reporting to the junior health inspector, Rajakumar, about their field experiences.

Shyamala, a community development supervisor, sang a short song traditionally sung while sowing paddy. The song praises paddy, the food-giver, and says that sowing becomes easy while singing this song. Outside the makeshift meeting hall, there were only rows upon rows of rubber trees with slits down their sides to allow sap to run into waiting cups.



Read Mridula Chari's previous dispatches here.