Khandwa - the challenges of Kalwa Part I

We had a breeze of a time hiring staff in Alirajpur. After interviewing over 60 women we were able to settle on 11 who had varying degrees of experience, but almost all whom are tribal, educated, and willing to work and live in the remote areas we're targeting.

Moving east to Khandwa, we experienced challenges and road blocks I never thought we would.

Khandwa, specifically its tribal block Kalwa, became notorious last year for malnutrition deaths, making headlines around the world and causing panic within the state government (see: http://www.nytimes.com/2009/03/13/world/asia/13malnutrition.html). This is the same district where UNICEF got in trouble for using RUTF in an attempt to save lives in response to those lost (see my former posting http://malnourishedmillions.blogspot.com/2009/09/rutf-and-its-absence.html).

I expected that moving into Khandwa we would find a lot of NGO action in the Kalwa block, where over 100 malnutrition deaths occurred within a 3 month span and where they still reportedly continue. We expected to, like other districts, tap into the NGO network to help us find staff and get the lay of the land, ruling out intervening in villages which are already covered by other NGOs. I was perplexed to find that there are hardly any NGOs working on the ground in Kalwa. Jhabua, Alirajpur, and Barwani districts are just as poor as Khandwa, but have 100s of NGOs. So many that NGO in-fighting is the best gossip in town. Khandwa, where the need is arguably higher, has hardly any.
We did find old friends, Spandaan, a grassroots NGO focusing on malnutrition awareness in the area, but who only have funding for interventions in a few model villages. The Khandwa Diocesan Social Society (KDSS), run by the Catholic church is the single most active non-governmental organization in the district providing education and health services but their reach in Kalwa is limited as well. As we spoke to these NGOs and government officials we discovered the reason for so few NGOs working in the Kalwa. Its really really difficult. Difficult to staff, difficult to travel to and from, and difficult to monitor.
We interviewed some great young women who lived in Khandwa’s center, among them staff from UNICEF’s now closed program in the district and despite the warnings from our friends in Khandwa, were optimistic about staffing our program. That is until we made our first field visits and realized the distances between Khandwa’s main town and Kalwa block. While I've visited Kalwa on numerous occasions, I was almost always riding in a jeep and only paying attention to the tragic stories I heard from locals on the way out to field sites, not assessing the distances from place to place with a program in mind. The drive from Khandwa’s center, where all the staff we interviewed are based, is 2 hours by jeep to just the center of Kalwa, 4 – 5 hours to many of the remote villages. Kalwa block is forested, spread out, and mostly inaccessible by roads. There is extremely limited to no bus connectivity. Since we cannot afford to provide jeeps or motorcycles to all our staff and bus connectivity is so poor, the only feasible way to work in this area we decided, is to staff our program with women living in Kalwa block itself.

We started our search by entering the bigger towns of Kalwa and began asking local contacts at PHCs, CHCs, and church mission stations (the only non-governmental organization in the region) to refer any 12th pass women who would be interested in our position. "12th pass?" the locals laughed incredulously. "There are no women who have 12th pass here". "Ok, 10th pass". More laughs. "Basic literacy?" "Hmmm, come back in a week and we'll see if we can find anything." Quite a strong indicator development indicator for this area.

In villages where we could find a literate woman willing to consider taking on our work, we hit our next obstacle. The tribal group of Kalwa block, the Kurkos, are an extremely shy and backward tribe, whose language, culture, and traditions have a rich, but isolated history. The women in this tribe typically do not venture far from home, let alone leave their villages. Many of the locals we spoke to told us we would have a hard time finding a literate, Korku, woman willing to travel to 5 neighboring villages let alone our goal of 10.

This staffing problem isn't an obstacle we just stumbled into. The district’s Chief Medicial Officer told me that they have a large number of ASHA and ANM posts vacant in Kalwa block and have had a very difficult time filling these postings (which require a 10th pass education).

Distances, lack of education, lack of mobility, little access to health care, no NGO presence. Every reason not to work in Kalwa block. And every reason we have to try.

While we were disappointed in not being able to staff our program in one swoop as we had done in Jhabua and Alirajpur, this is to be expected in an area this difficult. We placed a bunch of feelers out throughout remote villages, with plans to follow up on potential leads within a week.