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संसारात अनेक कष्ट उपसत असताना आपल्या आरोग्याची काळजी घ्यायलाच हवी याकडे ग्रामीण महिला फारसे गांभीर्याने बघत नाहीत. सतत त्रास देणाऱ्या डोकेदुखी, हात-पाय दुखणे, कंबर, पाठ, मानदुखी, सर्दी-खोकला अशा आजारांकडे त्यांच्याकडून दुर्लक्ष केले जाते. औषधाच्या दुकानातून एखादी गोळी आणून वेळ निभावून नेली जाते आणि कामाचा गाडा ओढला जातो. अगदीच होईनासे झाले की झोपायचे पण फार काळ नाही. आजाराबाबत ग्रामीण स्त्रीची जशी उदासीनता आहे तशीच आहाराबाबतही आहे.
ग्रामीण स्त्री आहाराबाबतही उदासीन असण्यामागे बालपणी तिच्या मनावर झालेले संस्कार याला कारणीभूत आहेत. घरी होणारा स्वयंपाक, मुले-बाळे, पुरुष मंडळींना आधी दिला जातो. ताजे, गरम जेवण सर्वप्रथम पुरुषमंडळींना द्यायचे कारण त्यांना बाहेरची खूप कामे करावी लागतात, या साऱ्यातून उरले-सुरले बाईचे. मग ते ताजे नसले तरी चालेल अशी ग्रामीण स्त्रीची धारणा बनून गेली आहे. भाजी-कालवणाचा विचार तर तिच्या मनाला शिवतही नाही. यामुळेे सतत कुपोषणाच्या छायेतच तिचा वावर असतो. पोटाला पुरेसे न मिळाल्याने तिचे शरीर सतत कुरकुरत राहते. पण त्याकडेही तिच्याकडून दुर्लक्ष केले जाते.
यातच लहान वयात होणारी लग्ने, वारंवार होणारी बाळंतपणे, गरोदरपणात योग्य काळजी न घेतली जाणे, प्रसूतीनंतर आहार आणि विश्रांती याबाबत दुर्लक्ष, दैनंदिन स्वच्छतेची काळजी नसणे या साऱ्याचा दृश्य परिणाम म्हणजे ग्रामीण महिलांच्या प्रकृतीच्या सतत चालणाऱ्या तक्रारी.
याचबरोबर गावात मूलभूत सुविधांचा अभाव, दूरवरून पाणी आणावे लागणे, मिळेल तिथे रोजगाराला जाणे, जळणफाटा गोळा करणे या सगळया कष्टप्रद गोष्टी तिच्या पाचवीलाच पुजलेल्या आहेत.
हे कमी आहे म्हणून की काय गावात शौचाला दूरवर जावे लागते. शेताचा मालक शेतात येऊ देत नाही. ग्रामपंचायतीने दिलेली आडोशाची जागा वर्षानुवर्षे वापरात असल्याने अत्यंत गलिच्छ, प्रदूषित झालेली असते म्हणजे, काहींना रस्त्यावर शौचाला जावे लागते. वाहनांची, लोकांची सतत वर्दळ सुरू असल्यामुळे रात्री किंवा पहाटेच या जागेचा वापर करावा लागतो. एखादे वाहन आलेच तर घाईघाईने उठावे लागते. सतत करावी लागणारी उठबस, दिवसाउजेडी विधीसाठी जाण्याची गरज असूनही जाता न येणे, या चक्रात ही ग्रामीण महिला अडकलेली आहे. या त्रासातून बाहेर पडण्यासाठी कित्येक महिला जेवणही कमी घेतात. रात्री-बेरात्री विंचू-सापाचे भय, वाहनाच्या अपघाताची भीती तर सतत असतेच. पावसाळा, आजारपणे, बाळंतपणे या काळातली परिस्थिती तर भयावहच असते. अशा अत्यंत केविलवाण्या परिस्थितीत ही महिला जगत आली आहे.
मुळात स्वच्छतेच्या सवयी नसणे, घरा-घराभोवती घाणीचे साम्राज्य, गावात स्वच्छतेचा अभाव, पिण्याचे अशुद्ध पाणी, डास, माश्या, वास यांचा सतत होणारा मारा, यातून साथीचे आजार पसरतात, पोटाचे विकार उद्भवतात, शक्य होईल तितके दिवस अंगावर काढले जातात. अगदी असह्य होईल तेव्हा डॉक्टरकडे धाव घेतली जाते. औषध-पाण्याचा खर्च तर होतोच शिवाय रोजगार बुडतो, औषधाच्या खर्चासाठी कुणापुढे तरी हात पसरावा लागतो, घरातले किडूकमिडूक गहाण टाकायची पाळी येते. या साऱ्या गोष्टी आपल्या ग्रामीण महिलांच्या नित्य परिचयाच्या झाल्या आहेत.
हे कमी आहे म्हणून की काय गावात शासकीय आरोग्य सुविधांचा सदैव असणारा अभाव, तालुका-जिल्ह्याच्या ठिकाणाच्या शासकीय आरोग्य-सुविधांबाबत असलेले गैरसमज यातून खाजगी डॉक्टरकडे धाव घेण्याचे प्रमाण अधिक आहे. असेही काहीसे संभ्रमात टाकणारे चित्र दिसते.
हे दृश्य राज्यातल्या संपूर्ण ग्रामीण भागाचे. हीच परिस्थिती `स्वयम् शिक्षण प्रयोग' ही स्वयंसेवी संस्था काम करत असलेल्या भागातही होती. मराठवाड्यातील उस्मानाबाद आणि लातूर हे दोन जिल्हे संस्थेच्या कार्यक्षेत्राचे प्रारंभीचे जिल्हे. संस्था या जिल्ह्यात काम करायला आली ते १९९३ च्या भूकंपानंतर. घरांच्या दुरुस्ती आणि मजबुतीकरणाच्या कामात महिलांच्या सहभागाची गरज लक्षात घेऊन संस्थेने एक कार्यक्रम हाती घेतला. गावांमध्ये महिला मंडळामार्फत महिला `संवाद सहायक' नियुक्त करून घरांच्या दुरुस्ती-मजबुतीकरणाचे काम हाती घेतले गेले. या कार्यक्रमातून गावपातळीवरच्या महिला, महिलामंडळे सक्रिय झाली. तोपर्यंत या भागातल्या महिला अशा कामांसाठी कधी बाहेर पडलेल्या नव्हत्या. या प्रक्रियेत घरबांधणीच्या अवघड तंत्राबरोबरच अधिकाऱ्यांशी संपर्क साधणे, लाभार्थींना माहिती देणे, ग्रामपंचायत, तलाठी, इंजिनिअर, गवंडी यांच्याबरोबर संवाद साधणे, अहवाल सादर करणे, घराच्या रचनेविषयी महिलांना माहिती देणे अशी विविध कामे या महिला प्रतिनिधींनी अत्यंत यशस्वीपणे पार पाडली.
या पाठोपाठच महिलांचे बचत गट उभारले जाऊ लागले, आर्थिक समस्या दूर व्हायला हळूहळू का होईना मदत होऊ लागली. गावातील विविध कार्यक्रमांमध्ये त्या सहभागी होऊ लागल्या. छोटे-छोटे व्यवसाय उभारले जाऊ लागले. व्यवसायांना अधिक अर्थसाह्य मिळावे यासाठी स्वयम् शिक्षण प्रयोग या संस्थेच्या माध्यमातून महिलांचे तालुका महासंघ उभारले गेले. संस्थेचे कार्यक्षेत्र सोलापूर, बीड, नांदेड या जिल्ह्यांमध्येही वाढले. महासंघाचे अर्थसाह्य प्रामुख्याने व्यवसायासाठीच दिले जाते.
वेगवेगळया कार्यक्रमाच्या निमित्ताने बैठका, मेळावे यांच्या माध्यमातून महिला वारंवार एकत्र यायला लागल्या. विविध उपक्रमांची माहिती घेऊ लागल्या. गटाची बैठक, गटाचे नेतृत्व, गट कसा चालवायचा, रेकॉर्ड कसे ठेवायचे, व्यवसाय कोणते करता येतील, ग्रामसभा म्हणजे काय, शाळा-अंगणवाडी-पाणी अशा विविध मुद्द्यांवर चर्चा होत होती. हे घडत असतानाच महिलांच्या आरोग्याच्या तक्रारी वारंवार समोर येत होत्या. महिला व्यवसायासाठी महासंघाचे अर्थसाह्य द्यायच्या, त्याच्या परतफेडीचा नियमित आढावा घेतला जात होता. महासंघ व बचतगट अत्यंत चांगल्या पद्धतीने चालत होते. परतफेडही व्यवस्थित होत होती. हे सर्व सुरळीत चालत असतानाच काही महिला महासंघाचे अर्थसहाय्य परत करायला असमर्थ ठरत असल्याचे आढळले. त्याची पाहणी करण्यात आली. तेव्हा महासंघाच्या अर्थसहाय्यातील बरीचशी रक्कम त्यांच्याकडून आरोग्यावर खर्च झालेली होती, जवळपास ७० टक्के रक्कम त्यासाठी वापरली गेली होती, यामुळे नियमित परतफेडीत अडथळे येत होते अशी तथ्ये समोर येत गेली. याचबरोबर बचत गटांचे अर्थसहाय्य कोणत्या कारणासाठी अधिक घेतले जात आहे याचाही अभ्यास करण्यात आला. त्यावेळी बचतगटांचे बहुसंख्य अर्थसाह्य आरोग्यासाठी घेतले गेले होते. यातूनच महिलांचे आरोग्याचे काय प्रश्न आहेत, काय अडचणी आहेत, हे जाणून घेण्याची गरज भासू लागली.
महिलांच्या विविध बैठकांमधून माहिती काढली गेली. तेव्हा घरात दिवसभर काबाडकष्ट करणारी, कुटुंबाची काळजी वाहणारी, घरातल्या प्रत्येकाला पोटभर खायला मिळावे यासाठी धडपडणारी, कुटुंबातील आर्थिक समस्या दूर करण्यासाठी बचतगटाचा आधार घेणारी, ही महिला स्वत:च्या आरोग्याबाबत किती निष्काळजी आहे हे दृष्टोत्पत्तीस आले.
संसाराचा कणा असणाऱ्या बाईला स्वत:च्या आरोग्याबाबत काळजी घ्यायची सवय लागावी, स्वच्छतेच्या सवयी जोपासल्या जात. संपूर्ण कुटुंबाचे आरोग्य सुरक्षित राखता यावे, गाव पातळीवर आरोग्याच्या सुविधा उपलब्ध व्हाव्यात हा दृष्टिकोन डोळयांसमोर ठेवून २००० पासून संस्थेच्या कार्यक्षेत्रातील ग्रामीण भागात आरोग्यविषयक कार्यक्रम हाती घेण्यात आला.
प्राथमिक आरोग्य केंद्राची पाहणी झाली. `एक बाई शिकली तर तिचे सारे कुटुंब सुधारते' हे जितके खरे आहे तितकेच एका बाईने आरोग्याची काळजी घेतली, स्वच्छतेच्या सवयी लावून धेतल्या तर सारे कुटुंब आरोग्यदायी बनते हेही खरेच आहे, पण ही संकल्पना प्रत्येकीच्या मनात रुजवणे गरजेचे होते. याबाबत काही गोष्टी महिलांशी चर्चा करून ठरवण्यात आल्या.
महिला कोणत्या आजारासाठी कोठे जातात, कोणते उपचार घेतात, ह्यात काय अडचणी येतात हे जाणून घेण्यात आले.
गावपातळीपासून जिल्हा पातळीपर्यंत आलेल्या आरोग्यसुविधा यंत्रणा महिलांना माहीत आहेत का? त्याचा वापर होतो का? तिथे काही अडचणी आहेत का याचा शोध घेण्यासाठी प्राथमिक आरोग्य केंद्रांचा सर्व्हे करण्यात आला.
बचत गटाच्या दोन महिला आपल्या गावाजवळच्या प्राथमिक केंद्रावर दोन दिवस संपूर्ण पाहणी करतील. त्यानंतर एक दिवस ए.एन.एम. (अछच - र्आीुळश्रळरीू र्छीीीश चळवुळषश) बरोबर गावात जाऊन माहिती घेतील असे ठरले.
त्यानुसार लातूर जिल्ह्यात २६ आणि उस्मानाबाद जिल्ह्यातल्या २६ गावातल्या महिलांनी ही पाहणी केली.त्यावेळी-
* आरोग्य केंद्रे लांब आहेत.
* केंद्रापर्यंत जाण्यासाठी सोय नाही.
* केंद्रावर आरोग्य कर्मचारी नाहीत.
* केंद्रावर आरोग्य अधिकारी नियमित उपस्थित राहत नाहीत.
* केंद्रावर औषधाचा साठा नाही.
* उपचार व्यवस्थित केले जात नाहीत.
* उपचारासाठी आवश्यक असलेली यंत्रसामग्री नाही.
* यंत्रसामग्री नादुरुस्त असते.
* केंद्रावर रुग्णाला, त्याच्या बरोबरीच्या नातेवाइकांना आवश्यक सुविधा नाहीत.
* आरोग्य केंद्राभोवती घाणीचे साम्राज्य
यासारख्या अनेक गोष्टी समोर आल्या. हे प्रश्न कसे सोडवता येतील या दिशेने विचार सुरू झाला. गावकरी प्राथमिक आरोग्य केंद्राचा वापर कसा करतील, यासाठी काय करावे लागेल याचा विचार करण्यात आला. यासाठी पाचोड, पुणे, जामखेड येथील संस्थांना भेटी देण्यात आल्या. या अभ्यास सहलीत बचतगट, महासंघाच्या प्रतिनिधी सहभागी झाल्या होत्या.
यानंतर एक कृती कार्यक्रम तयार झाला. यात बचतगटाच्या महिला सहभागी झाल्या. यातून-
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* आरोग्य समितीच्या महिलांना जिल्हा आरोग्य विभागातर्फे ओळखपत्रे दिली गेली.
* ओळखपत्राच्या साहाय्याने गाव ते जिल्ह्यापर्यंतच्या आरोग्य-सुविधा यंत्रणेवर देखरेख होऊ लागली.
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* गावपातळीवर महिलांसाठी आरोग्याच्या संदर्भात जाणीव जागृतीचे कार्यक्रम होऊ लागले.
* प्राथमिक आरोग्य केंद्र, आरोग्य समिती, बचत गटांच्या महिला यांचे नातेसंबंध दृढ होऊ लागले.
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आजीबाईच्या बटव्याचे पुनरुज्जीवन
आरोग्याच्या संदर्भात विविध माहिती महिलांना दिली जात होती. पण त्याचबरोबर जे पारंपरिक उपचार आहेत त्या `आजीबाईच्या बटव्या'चे पुनरुज्जीवन करण्यात आले.
घरगुती उपचार कोणत्या आजारावर होऊ शकतात याबाबत मार्गदर्शन करण्यात आले. प्रत्येकीने आपल्या घरी ही घरगुती औषधे ठेवावीत ही सवय लावण्यात आली. परसबागेत औषधी वनस्पती लावल्या गेल्या.
घरगुती उपचारांची पुस्तिका
किरकोळ आजारांसाठी खेडेगावात जे उपचार केले जातात त्याची माहिती गोळा केली गेली. अनुभवी, बुजुर्ग अशा दीडशे लोकांशी चर्चा करून साठ प्रकारच्या आजारांवर औषधांची माहिती पुस्तिकेत समाविष्ट करण्यात आली.
कर्करोग तपासणी उपचार
कर्करोगासारख्या आजाराबाबत महिला जागरूक झाल्या. महिलांमध्ये आढळून येणाऱ्या गर्भाशय, स्तनाच्या कर्करोगांची तपासणी करणे, पुढील उपचार करवून घेणे, गरज असेल तर गटातून अर्थसहाय्य देणे या गोष्टी महिला आता करू लागल्या आहेत.
विविध आजारात शासकीय यंत्रणेला मदत
टीबीचा सर्व्हे, मलेरिया, हत्तीरोग, चिकन गुनिया यासारख्या आजारांच्या निर्मूलनात महिला सहभागी झाल्या. रक्तांचे नमुने घेणे, औषधांचे वाटप करणे, स्वच्छतेची माहिती देणे यासारख्या गोष्टी महिलांनी केल्या.
या साऱ्यांमधून खूप चांगले काही घडले -
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* बालके, गरोदर माता व किशोरींना आवश्यक असलेल्या लसी दिल्या जात आहेत.
* सर्वांनाच सकस आहार कसा मिळेल यासाठी प्रयत्न होतोय. त्यातूनच परसबागेमध्ये पालेभाज्यांची लागवड होत आहे.
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* गरोदर मातांची नियमित तपासणी होते.
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