One of the most intriguing aspects I observed from my very first days in the fellowship was how deeply culture shapes everyday life in the Kumaon region. It is not just present in festivals or rituals: it quietly governs food, health practices, caregiving, and even decisions around childbirth.
During my initial field visits, I found myself closely observing the field workers; how they interacted with mothers and their families, how they navigated sensitive conversations, and how, in between, they gently tried to guide them towards medically recommended practices. What stood out to me was not just what they said, but how they said it with patience, empathy, and persistence.
Convincing families to move away from long-held customs is no easy task. These practices are not just habits; they are deeply rooted in identity, trust, and generational wisdom. Asking someone to question them often feels like asking them to question their own upbringing.
As I spent more time in the field, one question stayed with me:
What about the field workers themselves?
Most of them belong to the same communities they serve. They have grown up with the same beliefs, followed the same customs, and internalised the same ideas about health, food, and caregiving. So what changes when they step into their roles as health workers? Do their perceptions shift? Do they unlearn what they once believed? And if they do, how difficult is that process?
In conversations with field workers, I began to understand that their work is not just about changing community behaviour – it is also about confronting and reshaping their own beliefs.
For instance, a common belief in the region is that if a breastfeeding mother consumes green leafy vegetables, it causes the baby’s stool to turn green, which is seen as unhealthy. As a result, many families restrict new mothers from eating such foods. Similarly, foods like eggs, papaya, and dates are often avoided during pregnancy because they are considered “hot” foods.
These dietary restrictions pose a significant challenge. Field workers repeatedly emphasised how difficult it is to convince families to ensure a balanced diet for mothers. Many households continue to rely on simple meals like potato, tomato, and onion, while avoiding more nutritious options due to preconceived notions.
Another deeply ingrained practice is the discarding of colostrum – the first yellow milk produced after childbirth, which is extremely rich in nutrients. Tanuja, a field worker, shared that she herself once believed that colostrum should be thrown away. It was only after her training that she understood its importance. Today, she actively counsels mothers and families to ensure that newborns receive it.
This transition from belief to awareness, and from awareness to advocacy is not simple. It requires field workers to challenge not just others, but also themselves.
There are several other practices that field workers navigate daily. In some households, newborns are not exposed to sunlight or taken outside the room until the naming ceremony, which takes place around eleven days after birth. In others, newborns are given ghutti -a traditional liquid soon after birth, despite medical advice against it.
Another challenge arises when mothers resume work within two to three weeks of delivery, often in forests or agricultural fields. In such cases, cow’s milk is sometimes introduced early, replacing breastmilk. This goes against the recommendation of exclusive breastfeeding for the first six months.
Field workers find themselves constantly negotiating between respect for tradition and the urgency of medical advice. There are moments of resistance, hesitation, and even refusal. But there are also moments of change.
Kabita, another field worker, shared how, when she first began working in her area, institutional deliveries were rare. Most births took place at home. Over the past three years, however, she has seen a gradual increase in families opting for health facilities. She attributes this shift to continuous counselling, awareness efforts, and building trust within the community.
What often goes unnoticed is the emotional and intellectual labour that goes into this work. Field workers are not just disseminating information : they are building relationships, answering questions, addressing fears, and slowly reshaping mindsets.
Their role demands patience. It demands persistence. And most importantly, it demands empathy.
They understand that change cannot be forced. It must be negotiated, explained, and sometimes demonstrated over time.
Reflecting on these experiences, I realised that the work of field workers exists in a delicate space between tradition and transformation.
They are insiders and change-makers at the same time.
They carry within them the same conditioning as the communities they serve, yet they also carry new knowledge that challenges that conditioning. Their journey is not just about improving maternal and child health outcomes, it is also about navigating their own evolving identities.
In many ways, their stories are not just about health systems or interventions. They are about unlearning, relearning, and the quiet courage it takes to stand at the intersection of belief and science.
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