What the Doorway Is For

I have been an ASHA worker in this block for six years, and I want to describe what the job actually is, because most people who use the phrase "community health worker" are picturing something cleaner than what it is. I track pregnancies. I do home visits, postnatal checkups, immunization follow ups, and I am the person who notices, usually before anyone else does, when a child isn't gaining weight the way it should. I am paid an incentive, not a salary, which is its own separate injustice, but that isn't the one I'm here to talk about today.

Here is the one I'm here to talk about. In eleven of the households I'm assigned to, I am not allowed past the doorway. I do the checkup from the threshold. I ask the mother to bring the infant to me rather than going in, because going in was made clear to me, early on and without much subtlety, as something they did not want. Nobody uses the old words for it anymore. Nobody says untouchable. They say things like "she prefers it this way" about a woman who has never once said that to me, or they simply arrange the furniture so that there's a natural stopping point, a step I'm meant to understand I don't cross.

A survey done a couple of years back, across several states, found that nearly half of Dalit ASHA workers get asked about their caste directly during their very first visit to a household, before anything else. Before the health questions. I believe that number. I was asked mine in my second week on the job, by a woman holding a baby I was there to weigh.

I want to be precise about what this costs, because vague language about "dignity" lets people nod sympathetically and move on without doing anything. It costs accuracy. A checkup done from a doorway, at a distance, in bad light, is not the same checkup as one done properly, hands on, close up. I have missed things I would not have missed if I'd been allowed inside. I am not going to pretend otherwise to make this story sound cleaner than it is. Somewhere in this block there is a case of jaundice I caught two days later than I should have, because I was assessing an infant's skin tone from four feet away through a doorway, and that delay is not an abstraction. It is a specific, measurable cost, and it was not my failure. It was the doorway's.

I raised this at a union meeting once. I was told, kindly, that this is a personal issue between me and a few families, not something the union takes up collectively, because there hasn't been a major case, nothing that made the news. I want to write that sentence again so it's clear how it sounds from where I'm standing. There hasn't been a major case. As if forty children a year, checked from four feet through a doorway, isn't itself the case. As if it needs to escalate into something with a headline before it counts as real.

So here is what I am asking for, and I am done phrasing it as a request. I want caste-based restriction of a health worker's access to a patient logged as what it is, a barrier to care, in the same category as a broken road or a missing vaccine fridge, tracked at the block level, reported up, with numbers attached to it the way every other obstacle in this job gets numbers attached to it. I want the union to treat this as a labor condition, not a hurt feeling. And I want it understood, plainly, that every checkup I do from a doorway is a checkup done worse than it should be, and that the gap between those two checkups belongs to the households that built the doorway, not to me.

I'll keep doing the job either way. I've done it for six years from the threshold and I can keep doing it from there if that's what it takes. But I am not going to keep calling it fine.