不能没有的天使 Necessary Angels
发布: 2008-12-12 17:08 | 作者: 知音 | 来源: 大风车中英文门户网站社区
必需的天使
他们不是医生。他们不是护士。他们是从印度的贱民种姓中来的文盲妇女。然而，作为培训乡村卫生工作者，他们是拯救生命(包括他们自己)的天使。
They are not doctors. They are not nurses. They are illiterate women from India's Untouchable castes. Yet as trained village health workers, they are saving lives—including their own.
大风车带你看真实的世界
印度人种姓等级
虽然现在印度的种姓繁多，但终归有几个大的等级：
第一等级：最高贵的婆罗门：掌管精神世界的神职人员。
第二等级：刹帝利： 掌管世俗权利的国王和武士 。
第三等级：吠舍： 从事农业，牧业，手工艺，商业的公民。
以上三大种姓是印度教的高种姓，可以学习经书，获得精神上的重生，所以也叫“重生种姓”。
识别方法：这三大印度教高种姓的男性有一个明显的标志，就是佩带“圣线”，在高种姓男孩出生后要进行佩带“圣线”的仪式，“圣线”由3股拧成，婆罗门男孩佩带棉线，刹帝利男孩佩带亚麻线，而吠舍男孩佩带毛线，作为高种姓的标志，所以当你看到一个印度男人，只要看看他的手腕就知道他的种姓位置了，如果有线圈说明他出身高种姓，然后只要辨别一下线圈的质地，他所属的种姓大的等级就明了......如果没有圣线，说明他可能来自低种姓或贱民，或者是非印度教徒的信仰其他宗教的印度人......印度人服装多是短袖或把袖子挽起来，所以很一目了然的哦 ：）
接着说，在这3大高种姓之下，就是印度教低种姓，其实种姓制度并不复杂，只有一个低种姓大类，那就是奴隶种姓“首陀罗”在现在的印度他们大都从事苦力等体力劳动，比如打扫卫生，车夫，工地工人，搬重东西的脚夫.....虽然都是从事体力劳动也有区分，比如有扫低的种姓，洗衣服的种姓等，这从他们的姓名上已经标注的很清楚，而且扫地的种姓不能洗衣服，洗衣服的种姓不能打扫厕所，打扫厕所的种姓是最低贱的，所以从事最低贱的劳动.....他们是没有资格佩带圣线的，也没有资格学习经书，如果他们敢朗诵经文要被割掉舌头的，但是他们还不是印度社会中最生活最痛苦的人......
在低种姓之下还有一群被排除在种姓之外的印度人---“贱民”！
他们是最痛苦的人，从事着最肮脏低贱的工作，他们也被称为“不可触摸者”，如果哪个印度人不小心碰到了贱民会被认为受了“污染”，要请祭祀做法式来消除，贱民没有受教育的权利，不被允许学习宗教经文，不允许进入寺庙，不许进入商店等公共场合，不能在公用的饮水处喝水，不能和其他人并肩行走，甚至如果他们的影子碰到别人都是不允许的，自古贱民经常因为无意中冒犯其他人而被活活打死，烧死，无人来管，他们不被允许融入印度社会，一般都是居住在单独的偏僻村落.....是生活习惯上，贱民也有禁忌，比如印度是个喜爱佩带首饰的民族，但贱民妇女不允许佩带首饰...贱民男人下雨天不许打伞，不能穿鞋......当然印度几千万贱民也在进行抗争，历史上曾有一位贱民出身的总统，但毕竟是特例.....
印度的种姓不仅是等级的标志，它影响到印度教徒生活的方方面面，比如种姓内部婚配，一般人们只会在同种姓中寻找配偶，一些严格的教徒甚至在必须要求对方是相同亚种姓，印度男人可以娶比自己低一个种姓的女人为妻（称为顺婚，是男性特权），而女人却不能嫁给比自己低种姓的男人（这是逆婚），这种情况将有有辱家族门风的大事，此女将被开除出自己的种姓，她的孩子也将会沦为贱民，为人欺辱。
除了内部婚配，印度教徒还必须从事自己种姓所规定的职业，而不能自由求职，不能从事比自己种姓低，或者高的职业，也许你会说这职业和种姓有什么关系，谁能看出来呢？其实不然，在印度教内部有些严格的规定，比如一个人经营一个小工艺品店铺，那他十有8，9是吠舍种姓，种姓和姓名也有直接关系，如果这个人的姓氏是“古普塔”那他200%是吠舍，如果一个人是寺庙的祭祀，那绝对是婆罗门跑不了！当然也有家庭破败的婆罗门从事低等的工作比如厨师，因为婆罗门做的饭菜所有种姓都可以吃，而低种姓做的饭，高种姓是绝对不能吃的，也有发迹的低种姓受了教育踏上仕途的，但毕竟是极少数。
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56岁的沙维是一位体型纤瘦、沉默寡言、略显严肃的女性；戴着金属框飞行员眼镜，黑色长发中夹杂着灰白。平日她分别在早上9点与晚上6点出门，走访贾瓦克村的街头巷尾。这个村庄在印度的马哈拉什特拉邦中部，约有240户人家。沙维随身带着血压计、听诊器、婴儿磅秤和一本薄薄的日志。经常陪同她走访的芭贝‧萨雷是一位热情开朗、身材丰腴、总爱咧嘴微笑的47岁妇人。
她们负责维持贾瓦克村民的健康。她们要接生并探望新生儿、照料孕妇和老年人，还为村民量血压、探视病愈的痲疯病患。
这天是个晴朗的1月早晨，她们要探访的第一位病人叫拉妮‧卡雷。她目前的住处是用泥土混合牛粪盖成，屋顶是茅草铺的。
卡雷怀有身孕。假如她是贾瓦克村民，沙维早就会常来探视她，并送她到医院照超音波；然而她的村庄却在一小时的路程外，她是为了待产才回娘家。
这是卡雷的第二胎。直到十天前来到贾瓦克后，她才开始接受产前照护。沙维曾为她做检查，并建议她照超音波，可是卡雷没有接受。而今，再过几天，也许几小时，她就要临盆了。沙维帮她量了血压、检查指甲和眼睛看是否有贫血迹象，并触摸她的双腿，看看有没有水肿。她带卡雷进入屋里，让她躺在草席上进行骨盆腔检查，接着又低头靠在卡雷的肚子上，聆听胎儿的心跳声。
不过卡雷的肚子太紧绷了，难以察觉任何动静。萨雷满脸担忧，她认为婴儿的胎位不正，「不过胎儿有时候会移动，」她说。她告诉卡雷：「我们过一、两个小时再回来。如果胎位还是不正常，我们就带你去医院。如果你开始分娩，就叫人来找我们。」沙维请卡雷的一位姨妈倒茶给卡雷喝。「不会有事的。」她安慰她们。
下一站是玛妮莎‧马内的家。这位母亲有一个三个月大、先天颚裂的男婴。萨雷和沙维看着宝宝吃奶，然后把他放进一个吊网中秤重：大约四公斤。太轻了。「你必须补充营养，」沙维说。她和萨雷教导马内如何用油、高粱和蔬菜煮粥，指出宝宝在成长曲线上所处的位置，并跟她讨论疫苗接种的事。在照料过马内患有高血压的婆婆后，萨雷来到一所幼儿园。有位政府人员预定在这里为村民施打疫苗；消息一传开，幼儿园很快就变成了临时诊所，怀孕及刚生产完的女性都来了，而较年长的妇女也前来量血压。
因为沙维和萨雷，贾瓦克村和别处大不相同。沙维从1984年起就开始在村中访诊；据她本人所言，她总共接生了551个婴儿，而且从没有婴儿或产妇死在她手中。「我开始访诊时，村里的孩子都长了疥疮，而且到处脏乱不堪，」她说。过去常有小孩夭折，也有孕妇在生产时或产后死亡。恶劣的卫生条件常导致疟疾和腹泻等疾病，幼童都没有接种疫苗，而且痲疯和结核病也十分普遍。
我问沙维现在贾瓦克村民有什么健康问题。「高血压和糖尿病，」她说——两者都是在富裕国家才有的病。在印度乡村的大部分地区，只有幸运儿才有这些毛病…。
They are not doctors. They are not nurses. They are illiterate women from India's Untouchable castes. Yet as trained village health workers, they are delivering babies, curing disease, and saving lives—including their own.
By Tina Rosenberg
Photograph by Lynn Johnson
When Sarubai Salve walks through her village, she gathers a crowd. Salve is 56, a slim, reserved, somewhat stern woman with wire-rimmed aviator glasses and long black hair streaked with gray. On most days she sets off twice, at nine in the morning and six at night, through the streets of Jawalke, a village of about 240 families in the central part of India's Maharashtra state. She carries a blood-pressure cuff, a stethoscope, a baby scale, and a thin logbook. She is often accompanied by Babai Sathe, an exuberant woman of 47, a bit zaftig, with a toothy smile.
The two of them are responsible for keeping Jawalke healthy. They deliver babies and then visit them. They see pregnant women and old people. They take blood pressure and check on villagers cured of leprosy.
Today, a sunny morning in January, the first patient they see is Rani Kale. The house where Kale is staying is made of mud, dirt, and cow dung with a thatched roof. A cat perches on one slope. In the yard, bricks are stacked up, clothes are slung over a line, and small fire pits hold twigs for cooking sorghum flatbread. A brown cow lies contentedly in the shade.
Kale is pregnant. If she were a resident of Jawalke, she would have been seen by Salve many times and sent to the hospital for a sonogram. But she is from a village an hour away. She has come to her mother's house to give birth.
This will be Kale's second baby. She has had no prenatal care until ten days ago, when she first arrived in Jawalke. Salve examined her and advised her to get a sonogram. But Kale never did, and now birth is days, or perhaps hours, away. Salve checks Kale's blood pressure, examines her nails and eyes for signs of anemia, and feels her legs for water retention. She takes Kale inside the hut and lays her on a mat for a pelvic exam. She puts her head on Kale's belly, listening to the heartbeat.
But Kale's belly is so tight that it is hard to detect anything. Sathe looks worried; she believes the baby is out of position. "But sometimes they move," she says. She tells Kale, "We'll come back in an hour or two. If the position is still not normal, we'll take you to the hospital. If you begin labor, just send someone for us." Salve asks one of Kale's aunts to give her tea. "Everything will be fine," she says reassuringly.
Next stop is the home of Manisha Mane, mother of a three-month-old boy with a cleft palate. Sathe and Salve watch the baby suckle, and then put him in a sling and weigh him: nine pounds. Not enough. "You have to supplement," says Salve. They tell Mane how to make a porridge of sorghum, oil, and vegetables. They show her where the baby falls on a growth chart and talk about vaccinations. After tending to Mane's mother-in-law, who suffers from hypertension, Sathe stops at a kindergarten where a government worker is scheduled to give vaccines. When word gets out, the kindergarten quickly becomes a makeshift clinic. Pregnant women and mothers of newborns stop in, and older women come in for blood-pressure checks.
Jawalke is a very different place because of Salve and Sathe. Salve has been doing rounds in Jawalke since 1984. By her own count, she has delivered 551 babies and says she's never lost a single infant or mother. "When I started, the children all had scabies and there was filth everywhere," she says. Small kids used to die. Pregnant women died during and after delivery. Poor sanitation led to malaria and diarrheal diseases. Children went unvaccinated. Leprosy and tuberculosis were common.
I ask Salve about Jawalke's health problems today. "Hypertension and diabetes," she says— rich-country illnesses. In most of rural India, only the fortunate suffer from such diseases.
The shortage of doctors in poor countries is widely lamented, especially in English-speaking countries such as Ghana, Malawi, and India, where doctors often leave for high-paying jobs abroad. They are pushed to leave by abysmal conditions—major hospitals may have only a handful of doctors and a dozen nurses to care for hundreds. Patients die unnecessarily. Pay is terrible and often months late. But doctors and nurses are also pulled to places like the United States, Canada, Britain, and Australia. These countries don't have doctors willing to work in rural areas or enough nurses at all. They fill the gap with health professionals from poor countries.
The result is that Africa and to a lesser extent India now effectively subsidize medicine in the U.S. and Britain. Ghana, Malawi, and Zimbabwe are among 16 African nations with more doctors practicing outside their countries than in them. In recent years the number of nurses leaving Malawi for jobs has outstripped the number graduating from nursing school. The medical brain drain is a problem being discussed by the G8 forum of the world's richest countries, the WHO, and Harvard University, among others.
But enticing doctors and nurses to stay home may not be the answer to the health care crisis in poor countries. I asked Nils Daulaire, the head of a U.S.-based group called the Global Health Council, what can be done about the fact that there are only, for example, roughly three doctors for every 150,000 people in Malawi.
"Can we get it down to two? Or one?" he said. Daulaire was only half joking. Doctors, he says, are not the solution for the world's poorest people. Even if they do not emigrate, doctors stay in the cities. In Malawi half of the country's doctors work in just one of four hospitals in major cities, although Malawi is about 85 percent rural. With a handful of exceptions, doctors in poor countries become doctors for the same reason most people all over the world do: to make a good living. If Malawi or India does succeed in recruiting a doctor for a health post in the countryside, chances are that a patient looking for him there will not find him. He will be in the capital, treating patients who can pay.
Even doctors who do treat villagers, moreover, rarely spend time teaching them about nutrition, breast-feeding, hygiene, and using home remedies such as oral rehydration solutions. They don't help villages acquire clean water and sanitation systems or improve their farming practices—ways to eliminate the root causes of disease. They don't work to dispel myths that keep people sick. They don't combat the discrimination against women and low-caste people that is toxic to good health. Doctors also present a powerful institutional lobby that can block the real solution for places like Jawalke: training villagers like Sarubai Salve and Babai Sathe to do all these things.
"Doctors promote medical care because that's where the money is," says Raj Arole. "We promote health." The distinction is crucial to Arole, 75, a doctor himself, and the founder, along with his wife, Mabelle (who died in 1999), of the program, known as Jamkhed, that trained Salve and Sathe. The Aroles graduated top in their class from one of India's most prestigious medical schools, Christian Medical College in Vellore, Tamil Nadu. "They were trying to impose an education that would make you a good doctor in France or Germany," says Arole. But the Aroles had a different goal: to promote health among the poorest of the poor. They worked at a mission hospital, then did their residencies and studied public health in the United States.