It had been decided that a rural women’s health center had to be opened on the Belati-Pathari road- The Women’s Health Association-Mangal Pratap Stree Arogya Kendra. Dr. Priya Ajay Chauhan (MD-Obstetrics and Gynaecology, Founder Director) and I (Dr. Kusum V. Moray, MD Community Medicine, Public Health Physician, and Executive Director) had to start laying down a foundation for the center. I had many inspiring stories to draw from- that of remote clinics and hospitals in Odisha, Chhattisgarh, Karnataka, and Tamil Nadu. However, my learnings in Implementation Research re-emphasized that context is key. What has worked in a different state or even in the same state in a different district was unlikely to work here in our environment. Also, the journey was not as straightforward as setting up a clinic in a city. We wanted to do more than provide curative outpatient services. Defining that ‘more’ has been at the core of our discussions since we met on that fateful train Journey in 2022. Should we have outreach clinics? What services should we provide? Will focus on preventive services be accepted by women? But, wait, how often do we, as healthcare providers ask- “What does ‘she’-the woman/patient want? How does she want the health system to be?” In research terminology, this is a key feature of ‘participatory’ research (Involving the people for whom a service is intended in the decision-making process).

We started this approach by meeting with women from the villages near the intended center. We attempted to understand their ways of living and how they spent a typical day. Here is a brief account of what we learned. Most women wake early at the crack of dawn, and after a customary bath, they clean the house and the courtyard in front of it. They decorate the entry to the house with ‘Rangoli’- a design drawn on the floor with white powder. They pray to God, light a lamp, and cook for the family. Older women are exempt from these responsibilities if they have a younger daughter or daughter-in-law to do these chores. During the day, most women walk short distances multiple times to fetch water for the house. Drinking water supply is once in 4-5 days and that is collected separately. After cooking, they wash the utensils and clothes.  Depending on the season, they have seasonal activities, for example, in summer, they make papad and fryums that are dried in the sun (to be used by deep frying for the rest of the year as an accompaniment with rice and food). Often, there are festivals, requiring additional time in the kitchen to make sweets and savories specific to those celebrations. Afternoons are usually time to lie down and rest before cooking again for the evening. Amidst this packed schedule; women say they do not find time for themselves. They say there is no time to pursue their interests and hobbies or to exercise. Also, technology and the food industry have found their way into the villages. Most women use the mobile phone and TV often during the day. While discussing the food they consume during a typical day, women chided each other for eating ‘Kurkure’ and ‘Lays’ i.e. packaged fried stuff. Many women are employed in others’ farms and engage in de-weeding, harvesting, and other agricultural labor for most of the day. A few are self-employed and take financial support from the Bachatgad to help grow their small businesses.

We wanted to conduct health education sessions on topics shortlisted for prevention among women. As a first step, we conducted a ‘prioritization exercise’, where women were asked to place Bindis on a) the topic they felt was important and (b) method to be used for communication. The women chose posters/charts over videos and laptop communication and chose heart health and bone health as their top priorities. I designed evidence-based charts on these topics and had small discussion sessions with them. This is but a small step in the journey we wish to undertake. In our journey, we want to keep this question at the center- “What does she want?.”