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50 for 50: Building Healthy Communities

By Mukti Bosco and Gayathri Prashanth

This essay is a selection from the special edition of UnPoverty by Mark Lutz. The new edition has been released in celebration of Opportunity International’s 50th Anniversary, featuring new chapters from leaders throughout Opportunity’s history. To receive a copy, simply make a donation of any size to Opportunity and we’ll send it to you.

India faces intense challenges on every level.

Over the past two years, the healthcare infrastructure throughout the country has been thoroughly tested, and the effects of the COVID-19 pandemic are devastating. Every person in India has been affected by the pandemic. Every person has lost at least one beloved friend or relative to the virus. The published statistics aren’t reflecting the whole picture. As of July 2021, it’s very possible that the actual death tolls are 10 to 30 times higher than rates reported by the government and media.

But amid these challenges are rural women who want to improve the lives of their families and communities. Healing Fields Foundation, an Opportunity International partner, has the privilege of providing these women with holistic healthcare training. The mission of Healing Fields is to create an ecosystem that ensures access to affordable and quality healthcare for all, especially women from rural and resource-poor regions. Our trainees have been essential and active responders throughout the COVID-19 crisis. The change these women create in their communities is as remarkable as the changes they experience as individuals.

Take, for example, the story of Kalawati, one of our trainees.

Kalawati is a woman from a low caste, called Dalits, from Ballia. As far as the social pecking order of India goes, she and her family were at the bottom, forced to live in a hut outside the village.

Kalawati’s husband pulled a rickshaw by hand to provide for her and for their young son, carting supplies for different vendors and people in the village. He had to pay daily rent on the rickshaw, equal to about half of everything he earned that day. It was a hard life for her family, and Kalawati started looking for a way to change their circumstances.

To end the cyclical rickshaw renting and debt, she took a loan from one of Opportunity’s microcredit partners. The first loan went toward helping the family pay off their debts. With a second loan, she bought a rickshaw for her husband. His earnings soon paid back the loan on the rickshaw they would own outright.

After the successful experience with the microloans, Opportunity told Kalawati about Healing Fields, and she showed interest in becoming a Community Health Entrepreneur. Women who go through this training learn holistic healthcare principles that can be applied not just in their own houses but also in their communities by conducting health education with other women and adolescent girls in their communities. They take their knowledge and skills back to their communities, ushering in change from the ground up.

Like the vast majority of women who train to be Community Health Entrepreneurs, Kalawati wouldn’t even speak at her first training session. This silence constitutes a cultural norm, but trainings are structured in such a manner that the trainees have to participate and interact with staff and trainers. Group sessions, role play and patience on the part of the organizers place a new expectation on these women—that their voices matter. That they matter. After two months of silence, Kalawati slowly started opening up.

One day, Kalawati’s husband was waiting outside of the training center, hesitant about her new direction and the value of the training. The Healing Fields staff welcomed him. After he met the trainers and sat through one of the sessions, he gave his wholehearted approval for her to continue. He was able to understand the value of the training and wanted his wife to have the opportunity to learn. A husband, mother-in-law or son of most trainees will often want to see exactly what’s happening at the Healing Fields training center before they give their approval for their wife, daughter-in-law or mother to continue training.

In the third month of training at Healing Fields, women learn how to purify water to make it safe for drinking. The water used by many families in Ballia was not clean, which led to many stomach problems, like gastroenteritis, that plagued the people living in or near the village. The water purifying methods taught by Healing Fields are cost-effective and immediately accessible. For example, if the seeds from a moringa tree are tied in a cloth and set in the water, the seeds draw out the impurities in the water.

Kalawati put this training into action at home, hoping the idea would catch on with the families living around her, but at first, no one would believe her. The communities are remarkably hesitant to change, even when the change could provide something as important and basic as clean water. As the women are taught at Healing Fields, the first change they can make is in their own homes. 

Other families noticed that Kalawati and her son and husband were no longer getting sick as frequently. Her story was enough to convince a few families to try the new methods. The changes spread throughout her community, and illnesses among children started decreasing. Kalawati helped 100 families start using water purifying methods.

Next, she spoke with the village leader and convinced him that the platform around the water pump the families shared needed to be cemented into the ground. Due to her persistence and the support of the other mothers, the village leader had the ground around the hand pump sealed off with cement. Illness caused by water impurity continued to decline.

Kalawati learned first aid and other household sanitation staples. She brought another surprise to her neighborhood that was much stranger than the moringa seed method—she had a toilet installed outside of her house. Her neighbors were shocked. By example, she gradually introduced her neighbors to the idea of sanitation. She allowed her neighbors to use the toilet when they were sick and showed them the right way to clean it. Building personal household toilets spread through the village, a few families at a time.

She kept working to holistically improve the situation of her own family, starting with the vantage points of health and financial stability, always looking ahead to the next step. She started earning an income and taking additional loans. She bought more rickshaws and rented them out at ethical rates, allowing the renters to keep a much larger portion of their daily income than the standard rental operations. When the time was right, Kalawati sold those rickshaws to buy battery- operated ones for her husband’s use and their rental business. They were no longer dependent on loans.

Kalawati also introduced sanitary napkins and menstrual education to her village. Her neighbors wouldn’t buy the napkins at first, so she gave them away for free, explaining how they worked and spreading the word around the village. Soon the demand increased, and other women asked to be trained to manufacture sanitary napkins.

With capital and training made available through Opportunity, dozens of “self-help” groups emerged. These women became the needed supply chain for Kalawati and other healthcare workers who would sell these products to the women in the community when providing their services. Thousands of women are now employed in this simple income-generating enterprise.

Meanwhile, Kalawati continued her education with Healing Fields and became a Basic Care Provider. She did so well that she was encouraged to interview to become an Accredited Social Health Activist, a government position outside of Healing Fields’ structure. Many of the women who graduate from our programs go on to these positions. Kalawati interviewed with the government, took their training and earned this coveted position in the village. Today she receives an honorarium from the government for her work.

One of the skills that Kalawati learned was how to use a pulse oximeter, which proved especially important in the COVID-19 response efforts in her village. Her sister, who has serious respiratory problems, tested positive for COVID-19, and Kalawati was able to shift her to the hospital by monitoring her oxygen saturation levels and access the needed resources to help her. Most people in her village would not have even gotten tested. Her sister’s case became critical, but thanks to Kalawati’s insistence on testing and treatment, she survived and returned home from the hospital. Her confidence working with the healthcare system was invaluable for her sister and for others in her community.

Populations of every kind across India show hesitancy regarding vaccination. But Kalawati, a determined advocate of the vaccine, is persistent and patient. During the COVID-19 pandemic, her goal has been to bring in at least 100 people for vaccination weekly. When she talked with me about the vaccine hesitancy, she asked, “Madam, I hear that the other rural areas have a lot of vaccine hesitancy. Why is it that I am able to educate and bring people in for vaccination?”

I turned the question back to her, pointing to the success she has experienced in her own community, “What is it that you did? How did you mobilize them?”

Kalawati responded, “We had to spend a lot of time talking to them and tell them, ‘I got the vaccine. I had a fever for a day. And then I was fine, and I survived.’”

Built on her reputation as a health worker, Kalawati convinced the others in her community through her personal experience. We invited her to come to a few trainings on Zoom to help other Healing Fields trainees promote vaccination in their own locations. Her confidence shined as she gave hope and explanations to other trainees. She showed a complete transformation from the silent participation that characterized her interactions at Healing Fields only a few years ago.

Kalawati started in life totally marginalized, outside of the village, silent and without a future. She led her family in a new direction and changed the way people look at her, as well as at health and at education. She can travel around without her husband, and she participates in meetings with health authorities without holding back. She no longer lives in a hut outside of town but, as part of her job, has moved her family to a government-provided house in a semi-urban area.

Kalawati’s son, now 18, has passed his 10th grade exams. When he was in fifth grade, around the time Kalawati was starting her trainings with Healing Fields, he wasn’t very healthy. But Kalawati was able to apply what she learned through all her trainings to his health, education and future. Even though he’s still having some health issues, Kalawati can take him to one of the hospitals and steward his health, giving him the tools he needs.

When she’s asked by the Healing Fields staff what she wants to do next, she says, “You tell me what to do, and I’ll do anything you ask me to do. What is the next training? I definitely want to go further in this same career and keep doing better and help many more people.” Kalawati’s future includes the possibility that she may become a nurse. She continually wants to take the next step, to learn more, to give more back. Regarding the improvement of her own life, the lives of her family members and the lives in her community at large, Kalawati is unstoppable.

Kalawati is a star performer who says about her own community, “That is where I derive my strength.” It’s a remarkable comment coming from someone who was considered an outsider. What she has done defies the confines of caste and poverty. She has built up an impressive knowledge base, broadened her own skill set, and shown a fierce commitment to her family and her community. Her work as an Accredited Social Health Activist has taken her beyond the bounds of her home village. She’s very proud of this, and Healing Fields is very proud of her.

Healing Fields is already equipping women like Kalawati to change the healthcare landscape in India. Opportunity International offers a larger reach for the amazing work our organization is doing—a model built on what already works for India and for the potential “star performers” like Kalawati across the country. India’s challenges are exceeded in intensity only by the commitment of the women we train.

Opportunity recognizes that freedom from basic preventable illness is essential for sustained economic development and the end of extreme poverty. Though Healing Fields has been serving women in India for more than 20 years, they have been an Opportunity partner for only about 10 years. We envision partnerships like the one we now enjoy with Healing Fields being replicated, both in India and other hot spots of extreme poverty. Another program we are piloting in these pockets of ultra-poverty is the graduation model. As group lending was first introduced in Bangladesh, so was this program, in this case by BRAC, a large development organization. In the graduation model, people who otherwise would not qualify for a typical microfinance loan are reached with financial services. Their current degree of poverty is so severe that Opportunity’s typical lending programs would be ineffective and inappropriate.

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