In a remote Indian village, Ranjana Dwivedi goes door to door to educate people about the coronavirus. Once she almost fell into a river on her rounds.
In the halls of power in Iceland, Dr. Alma D. Möller leads the nation's response to the pandemic.
In a mobile testing center in California, Sheeba Shafaq works 12-hour shifts as she also seeks to become certified to practice medicine in the U.S. after fleeing Afghanistan, where the doctor's life was in danger because of her role as an advocate for women.
Here are portraits of these three members of the army of health care advocates around the world. NPR interviewed them as part of a project on how women — who are said to bear a heavier burden at times of crisis because of their many caregiving responsibilities — are playing a key role in the global effort to control the pandemic.
The Chief Of Health Stays Calm In A Storm
It was one of those September days in Reykjavik when you just don't know. The sky was mostly gray and yet the sun shone through. It might start to rain or clear up completely. But it made for a nice view from Dr. Alma D. Möller's glass-encased office. Not that she had time to enjoy it.
At 3 p.m., she breezed into her office, smiling, in a dark pinstriped suit. She looked like a bank executive, but in fact is Iceland's director of health. Earlier in her career, she was the first female doctor aboard search and rescue helicopters. She'd be lowered from the copter by a wire. That didn't as much prepare her for her current job, she said, as show the world she's not afraid of challenges and hard work.
And the past few months have been hard work, leading a team of around a dozen experts, mostly men, in the fight against COVID-19. Iceland had gone through two waves, mostly without significant restrictions on daily life. By the day of the interview, the number of daily infections was down to the single digits, even none on some days.
"I started following what was happening in mid-January. And it was clear right away that this was a serious disease. Dead people on the streets of Wuhan, Chinese authorities scrambling to build hospitals for thousands. On Jan. 27, I wrote a memo with the chief epidemiologist, detailing our worries. We knew this would reach us, but we didn't anticipate how rapidly the numbers would rise once it did. I sat home, on my couch, going through the data and my daughter snapped a picture of me. I think it shows a lot." She pulls out her phone and finds the picture. It shows Möller focused, not smiling, looking at a stack of papers. Serious stuff. Möller, who is 59 years old, has two children.
"I told people we would get pushed through a meat grinder. It didn't turn out quite that bad, thank goodness." Möller leaned back in her chair and sighed. Today was amazingly different from six months ago. She'd spent parts of the day in a budget meeting that only had a little to do with COVID-19. But she did note that there were six new cases the day of the interview — higher than recent daily counts. A number of them were linked to Reykjavik's largest university, where her daughter is studying law. She said she simply reminded her daughter to be careful. The next day, more infections were diagnosed, and a third wave officially began.
Möller believes planning and preparing for a pandemic, starting in mid-January, had made the biggest difference. But she pointed out that Iceland is a small island with one major gateway. Contact tracing is much easier than elsewhere.
And her role? Well, she said, she's used to hard work and long hours, taking charge and managing teams. And the team was key. Besides, she added with a wry smile, Icelanders really do well in crisis, with volcanic eruptions, earthquakes and crazy weather being frequent.
I told people we would get pushed through a meat grinder. It didn't turn out quite that bad, thank goodness.
Being a woman leading a pandemic team was never an issue, she said — and in fact was an asset. "Women think differently than men. I think every team needs people of both genders." She corrects herself: "Of all genders. We need different points of view, different people, on every team."
Once her day is done, she likes to go home to her family and dog. Perhaps slip into the hot tub. Read a book. Watch some TV. And sleep. Women around the world are caregivers, she said, but during stressful times like these they must remember to take care of themselves.
Photos by Sigga Ella. Text by Ingólfur Bjarni Sigfússon
A Doctor Fled For Her Life From Afghanistan — And Is Now On The Front Lines Of COVID-19
It turns out growing up in a war zone in Kabul, Afghanistan, prepares you to be on the frontlines of a pandemic in Sacramento, Calif., said 29-year-old Sheeba Shafaq.
"I don't panic as much as my co-workers," she said at a mobile testing site where she is the supervisor, promoted last month to lead a team of health care workers and medical student volunteers.
"It just gives you the mindset that, 'I can get through this. There are no bombs that are going to drop on me.' "
Shafaq knows what it is like to live in a country where bombs are dropping. Trained as a doctor in Afghanistan, she was forced to flee her country and her medical career after the Taliban threatened her life over her work as an advocate for Afghan women. She was granted political asylum in 2019.
In quiet moments, she checks her social media feed for news from home, a country that is also dealing with the COVID-19 pandemic and political turmoil as the Taliban gain power again.
Shafaq comes from a medical family; her father is a surgeon and her brothers are doctors. "My dad is super-liberal, supportive, "she said. When she was growing up, he encouraged all of his children to study medicine, she recalled, telling them: "I don't care if you're my daughter or my son, that's what we do."
The pandemic has changed her life again. In March, Shafaq joined the mobile testing team, excited to be contributing in the medical field again.
"I'm back and it feels good," she said of the 12-hour shifts swabbing patients.
"It was hard when we started," she recalled. More than 200 people would show up every day and test kits were in short supply.
"One day, we had 34 positives," she said. This summer the spike in cases – and deaths — alarmed her.
But the distress has faded. "As long as you do something on a daily routine," she said, "it just gets you used to it."
She's not yet licensed to practice medicine in the U.S., which is a costly process that can take years. But she's working on it. The first step was winning a scholarship for graduate school, where she was certified as a medical assistant. Her work at a COVID-19 testing site counts as experience.
Her role in the mobile clinic is another kind of education — a sobering look at her new country.
"To be honest, the homeless community is more shocking than the COVID," she said. "We literally go everywhere, under bridges and in the forests, to places that people do not have access to health care. They move from one night to the other."
"It's surprising here how low you can fall in this country," said Shafaq about a patient population with needs beyond COVID-19 testing. "Most of them need help with wound care. We give them some supplies if we think they can help themselves."
After seven months on the job, she said the days have fallen into a familiar routine. "I get up when it's so dark," she said. She's pared down her gear: medical scrubs, medical ID and a wallet. Personal protective equipment, or PPE, is packed in the trunk of her car. The evening protocol includes stripping down in the garage and a dash to shower and disinfect. "I have every kind of cleaning spray, wipes and everything," she said, mindful of protecting her roommates.
I don't panic as much as my co-workers.
In the past few weeks, the pace has changed. The lines waiting to be tested are much shorter, sometimes fewer than 50 per day. "Now that we have the test kits, people are not coming out," said Shafaq — even as California officials see a "concerning" uptick in COVID-19 cases. Shafaq is puzzled by the trend.
"Maybe, I don't know, maybe they got used to the COVID," she said.
COVID-19 has jump-started Shafaq's path back to medicine, sometimes a lonely journey without her family, whom she hasn't seen for five years. She was a trailblazer back home, a female doctor in a country where gender segregation often means women are shortchanged when it comes to careers in – and access to — health care and face other obstacles. "When I was a kid," she said, "I had a bicycle until someone told me that if they see me riding my bicycle again, they will kill me."
Now, she aims to become an American doctor. "To be honest, it's so peaceful in my head here. Even with all the hardships."
Photos by Jade Sacker. Text by Deborah Amos
Falling Into A River Won't Stop This Community Health Worker
On a sunny morning in mid-September, Ranjana Dwivedi sat at a table strewn with medicines — sachets of oral rehydration salts, iron tablets, painkillers. She was checking to make sure none of them had expired. Later, dressed in a bright purple sari — her uniform — she would go door to door in her village distributing some of those medicines. It's part of her job as a community health worker in the village of Gurguda in central India. (The community health workers are literate but don't have a medical degree and get regular training by the government and nongovernmental groups on subjects like vaccination, maternal care and nutrition.)
And when a pregnant woman in Gurguda goes into labor in the middle of the night, Dwivedi is probably the first person the family calls. For most people in the village, the 42-year-old is their only link to the public health system.
They know her as "Asha didi." Asha is an acronym for ASHA, Accredited Social Health Activist, a program run by India's Ministry of Health and Family Welfare, and Dwivedi's job title. The term asha also means "hope" in many Indian languages. Didiis Hindi for sister, which is an apt name as well. Dwivedi's job includes advising new mothers about breastfeeding, administering vaccines to babies and sharing information about common illnesses such as malaria and dengue.
This summer, Dwivedi found herself on the front lines of the coronavirus pandemic. In addition to her regular duties, she handed out masks to villagers, instructed them to social distance and told them to call her immediately if they felt sick.
Initially, COVID-19 cases were concentrated in India's cities, but the virus has been spreading in smaller towns and villages. India is now seeing more new cases every day than any other country, with about 70,000 new infections daily.
For the past few months, Dwivedi has been interacting with dozens of people each day, some of whom might be infected. Even though she wears a mask and uses sanitizer regularly, she's nervous.
"I go straight into the shower when I get back home," Dwivedi says.
But she's used to working in a dangerous environment. Her village is in a hilly, remote part of central India, surrounded by thick forests where wild animals and armed robbers roam. Twice, she's fallen into a river while trying to cross in a boat to reach her patients.
The physical demands of her job aren't the only challenges. During her early days as an ASHA worker, when she went on immunization drives, women would run away and hide from her. They feared the vaccines would harm their children.
Something similar happened during the pandemic, too.
"People would say there's no such thing as corona," Dwivedi says.
But Dwivedi explained to them how the virus works. With the help of her 21-year-old son, she drew posters featuring COVID-19 do's and don'ts. Usually mild-mannered and sweet, Dwivedi says she has to sometimes be stern with people — mostly men — who tend to joke about the virus or shrug off her instructions about masks.
"The extra responsibility of maintaining sanitation during the pandemic falls on women," says Dwivedi. "They are the ones cleaning the groceries or making sure the kids wash their hands when they come from outside."
Dwivedi has been an ASHA worker for nearly a decade. Women trust her, she says. One even named her daughter after her. The sight of a baby or a smile on a new mother's face compensates for all the stress of her job, Dwivedi says.
As for monetary compensation from the government, Dwivedi says she receives little. These days her monthly income comes to about $60, which includes an extra $16 for COVID-19 duties. Across India, ASHA workers have gone on strike in recent months, demanding a hike in wages given the health risks they undertake.
Dwivedi expresses solidarity with the protesters, but says she hasn't taken part in the strikes.
"What if someone needs me here while I'm gone?" she says.
Photos by Rishikesh Dwivedi. Text by Sushmita Pathak
Nominate A Woman
We'd like to tell more stories about women's lives in the pandemic.
Is there a woman in your community who has overcome great challenges in their personal lives? Or is helping others with their challenges? Send an email togoatsandsoda@npr.orgwith your nomination, with "Women's Stories" in the subject line. We may feature them in a future story on NPR.org.
Copyright 2021 NPR. To see more, visit https://www.npr.org. 9(MDEwMTk5OTQ0MDEzNDkxMDYyMDQ2MjdiMw004))