Project Report on rcn The Foundation for Research in Community Health 1998 Training Support For Auxiliary Nurse Midwives (ANMs) in the states of Madhya Pradesh and Maharashtra
Item
- Title
-
Project Report
on
rcn
The Foundation for Research in Community Health
1998
Training Support For Auxiliary Nurse Midwives
(ANMs) in the states of
Madhya Pradesh and Maharashtra - extracted text
-
Project Report
on
Training Support For Auxiliary Nurse Midwives
(ANMs) in the states of
Madhya Pradesh and Maharashtra
Seema Deodhar
Ganpat Pandit & Devendra Dalal
rcn
The Foundation for Research in Community Health
1998
The Foundation for Research in Community Health (FRCH) was established in 1975. It is a non-profit,
voluntary organisation which carries out research and conducts field studies primarily in rural areas to
gain a better understanding of the problems of health and health care of the majority of our people who
live in villages and slums and who do not receive any meaningful form of health care.
With its staff from various disciplines - doctors, social scientists, specialists in management,
documentation and economics - FRCH conducts grassroots field studies as well as conceptual studies and
is trying to determine the reasons for the failure in our country's health care system. It is also attempting
to evolve cost effective alternative strategies which can be utilised on a countrywide scale.
Experiments with new approaches like the training of semi-literate village women as in the Mandwa
and Parinche Project have demonstrated that the majority of our health and sickness problems can be effectively
tackled by the people themselves.
FRCH's larger aim is to create a people's health movement by demystifying medicine and increasing
public awareness.
Foundation for Research in Community Health
84 - A, R. G. Thandani Marg,
Worli Sea Face, Mumbai - 400 018
Tel : (022) 4938601
Fax : (022) 4932876, 4933187
E-mail : frchbom@bom2.vsnl.net.in
3&4 Trimiti B Apts., 85. Anand Park
Aundh, Pune - 411007
Tel : (0212) 387020
Fax : (0212) 381308
E-mail : frchpune@giaspnol.vsnl.net.in
• r
LIBRARY
ANO
•^FORMATION
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This project was carried out with the aid of a grant from The Danish International Development
Agency (DANIDA), Denmark.
Project Period : 1st October 1993 to 31st March 1998
The Project Team
Dr. Amar Jesani (October 93 to December 95)
Ms. Seema Deodhar
Mr. Ganpat Pandit
Mr. Devendra Dalal
Ms. Jayashree Puranik
Mr. Rajesh Ingle
Associated for limited duration
Ms. Vandana Kulkarni
Dr. Sushil Tickley
Ms. Sangeeta Ramble
Acknowledgements
Our Special thanks to the following :
Dr. N.H. Antia, Director, FRCH for his valuable insights and enthusing presence and his constant
support to our project.
The Danish International Development Agency (DANIDA) for financing the project.
Dr. Nergis Mistry for her guidance which helped in streamlining the project.
Prof. R.K. Mutatkar for his suggestions.
Shirish Kavadi and Dr. Sudhakar Morankar for their suggestions and comments.
Vaijayanti Aphale, Frey a Barua and Anuradha Gupte for editing the report.
All our colleagues at FRCH for administrative and other informal inputs.
The ANMs, for whom the project was meant, who responded so enthusiastically to all our issues
and without whose support the project would not have been completed.
COMPLETION REPORT
MINOR PROJECT
1.
Organisation
Please state name of organisation
Foundation for Research in
Community Health
2.
Project title
Training Support for ANMs, Madhya
Pradesh and Maharashtra
3.
Country
India
4.
Project period
1st Oct. 1993 - 31st March, 1998
Start (day/month/year)
5.
Indicators for goals
Please state the indicators as they
were given in the application form
together with the obtained goals.
Ongoing documentation,
Concurrent evaluation,
Journal and Manuals in two
language and 4 Manuals
6.
Results
4 Manuals, 37 issues of Aayushi in
Marathi and Hindi,
6 work shops
7.
Total project costs
Rs. 7.400.00
Please state costs in DKK
DKK 1.480.000
Danida’s contribution to the project
Rs. 7.400.00
Please state the size of Danida’s
contriubution in DKK
DKK 1.480.000
Other sources of financing
Nil
8.
9.
Please indicate other sources of
financing incl. the organisation who
applies and also the size of these
contributions (i DKK)
10.
Purchases in Denmark
Please state an indication for how many
DKK from Danida were used for
purchase of goods and service contri
butions in Denmark.
Nil
11.
12.
Target group and sex
How many men, women (boys/girls)
have been profiting from the project?
Were there activities that mostly favoured
the long ranging needs of women? If yes,
please describe.
Directly, 15,000 women who will be
serving 3.75 crores of women in
rural India.
Environment
No direct environmental consequences
Has the project had or is it expected
to have environmental consequences positive or negative ? If yes, please
describe.
13.
Project implementation
Feed back surveys, workshops.
Timely Funding, satisfactory
remuneration to authors ensuring timely
and quality contribution.
CONTENTS
Page No.
1.
Basic Project Data
1.1
2.
Background
1
2 - 5
Fulfilment of Objectives
6 - 49
2.1
Providing Information
6 - 24
2.2
Continuing Education of ANMs
25 - 33
2.3
Developing Training Manuals
34 - 39
3.
Activities
40 - 40
4.
Efficiency
40 - 40
5.
Sustainability
42 - 42
6.
Possible Future DANIDA Support
42 - 42
7.
Other Comments and Information
43 - 46
8.
Budget / Expenditures
47 - 49
9.
Annexures
1.
Annotated Bibliography
i. Social Inputs
ii. Technical Inputs
iii. Administrative Inputs
50 - 81
82 - 96
97 - 108
2.
ANMs requirements for information
109 - 109
3.
Participatory Training
110 - 110
4.
ANMs* Drug List
111 - 111
5.
Dr. Meera Savara’s letter
112 - 112
6.
ANM Questionnaire
113 - 113
7.
Maps of Field Area
114 - onwards
1.
Basic Project Data
Title of the Project
Training Support For ANMs in the states of
Madhya Pradesh and Maharashtra
Sector
HEALTH
Project Area
Madhya Pradesh and Maharashtra
Responsible Authority
on recipient side
Dr. N. H. ANTIA
Director, FRCH
Funded by
DANIDA
Date of agreement
1st October, 1993
Project Period
1st October 1993 to 31st March 1998
Objectives
To provide the ANMs in the states of Madhya
Pradesh and Maharashtra with training inputs so
that they can deal more confidently and
competently with the technical, administrative and
social problems in their day to day functioning.
To provide ANMs with relevant technical,
administrative and social information on a
regular basis in the form of a contact programme
in continuing education and training of ANMs.
To develop training modules for improving the
quality of basic and in-service training of ANMs
through the training teams and MPW training
institutions.
i
BACKGROUND
Introduction
- Conducting immunisation camps;
- Carrying out nutrition programmes;
During the pre-independence days, the
- Giving treatment and taking part in all activities
services of nurses, midwives and health visitors
were
only
available
at
hospitals.
related to the prevention of communicable
After
diseases programmes;
independence, the government realised that there
was a need for
- Collecting & maintaining vital statistics,
special functionaries to provide
recording births and deaths in their area;
primary health services at the grassroot levels,
- Maintaining ante-natal and postnatal records of
especially in rural India. Thus the Auxiliary Nurse
mothers, record of children below five years of
Midwife came into existence as a special
functionary to provide health services in rural areas.
age and of couples eligible for Family Planning
etc.;
An Auxiliary Nurse Midwife (ANM) can be
- Providing Primary medical care to a population
defined as someone trained in the various aspects
of about five thousand residing in villages and
of health care, whose responsibilities are defined
hamlets under the jurisdiction of the Sub-centre;
and
by the tasks to be performed rather than by
- Participating in all the Primary Health Centre
traditional professional roles (WHO, 1961). The
activities.
second five- year plan described the task of an
auxiliary worker as supplementing the contribution
The job responsibilities of ANMs affirm and
made by doctors and other highly trained personnel
imply that they are the key workers in the health
for promotive, preventive and curative health
care delivery system. A heavy responsibility thus
activities in their various branches. (GOT, 1956 : 54)
rests on them.
Functions of ANMs
Training of ANMs
The duties of ANMs are varied. The functions
ANMs are regarded as the first contact
that ANMs are expected to perform at present
between people and the public health system for
include, in order of priority
health care. Keeping in view the important role they
Implementing the Maternal and Child Health
play, a basic job-oriented training and continuing
Programme:
education are essential.
Motivating and handling Family Planning;
A wide variety of subjects are taught to
Referring cases for medical termination of
ANMs in their eighteen months of training. Within
pregnancy;
this short period, they are expected to gain primary
2
knowledge in anatomy & physiology, fundamentals
these stipulated 20 deliveries. Before 1985 the focus
of nursing, community
health, sociology,
was on midwifery training, which lasted for one
psychology, family health, health education,
year. Due to a change in the syllabus, the focus
nutrition, basic medicine & pharmacology,
on midwifery training has now been reduced,
obstetrics and child health. In some aspects, the
leaving the ANMs ill-equipped for even this
content and focus of training is not in keeping
important task.
with the job they are expected to do. For example,
forty hours of training are used up by lectures in
Various social circumstances of the ANMs,
theoretical nursing, the content of which is largely
such as solitary living at the sub-centre, irregular
related to hospital work such as admission and
hours of work and the prevalent social attitudes
discharge of patients, and care to be provided. This
towards single women, render them vulnerable to
is largely irrelevant to ANMs, who rarely encounter
sexual exploitation. Unfortunately, many ANMs are
such a situation in the field. Thus there is a
not prepared to tackle these real life difficulties
mismatch between the training content and the field
which they may have to face. It should be an integral
requirement. The practical experience includes
part of their training to make them aware of the
hospital and rural training. Even here, hospital
law and other social agencies which can help them
based training predominates over village-based
in the case of any form of sexual harrassment,
field work. During the 78 weeks of training, a
overt or covert.
trainee spends only 24 weeks in rural areas, which
amounts to only 33% of the training period.
There are few in-service education
programmes, if any, besides those that concern Family
One of the major responsibilities of ANMs
Planning. As a part of continuing education, apart
is to assess signs and symptoms of illness, make
from medical knowledge, ANMs should also be
a primary diagnosis and treat patients, or refer them
oriented to various social issues and women’s issues.
to doctors depending on the seriousness of their
Keeping in view the need for such continuing
condition. However, during their rural training, the
education, the project was conceptualised with the
diagnosis and treatment are prescribed by the Doctor/
following three specific objectives :
Intern / Compounder and the ANM only gets to hand
1. To provide ANMs in the states of Madhya Pradesh
out the medicines.
and Maharashtra with information to help them
In the course of their field placements, they
deal more confidently and competently with the
are expected to gain experience in pre-natal and post
technical, administrative and social problems in
natal examinations of twenty deliveries on their own.
their day-to-day functioning.
Looking at the complex nature of child birth, twenty
2. To provide ANMs with relevant technical,
cases hardly qualify an ANM to handle all situations
administrative and social information on a regular
which may crop up during childbirth. In practice,
basis.
considering the short period of rural posting for
3. To develop training modules for improving the
each trainee, it is difficult to get to conduct even
quality of basic and in-service training of ANMs.
3
The project has resulted in the following
publications
such as life-styles, making health the responsibility
of the people too. The quality of paper used was
1. A monthly journal ‘Aayushi’ for ANMs in Hindi
good : the imprints of the diagrams or photographs
and Marathi (36 and 38 issues, respectively)
were not see - through, thus making reading easy
and pleasant. The cover page usually depicted a
2. Basic training module for the initial training
contemporary theme in an attractive manner.
course of ANMs. (Dishd)
3. Reference Manual of 400 pages for ANMs.
4. Continuing Education and Training Modules for
The journals published by doctors provided
ANMs. The names are Dua, Madhyam and Disha
information on disease conditions and diagnostic or
surgical techniques which would have otherwise
Review
remained unknown to most people. The line diagram:IS
used to depict anatomy and physiology were
Note on Current Health Journals
satisfactory.
Before beginning the actual work on the
Though each had its strong points, the four
Aayushi journal, a rapid assessment of the then
journals had certain common weaknesses.
existing health journals was done in order to pinpoint
and incorporate their strengths. The language used
(1) All of them tended to look at health as an
in the current health journals was generally English.
individual responsibility. For example, the
Except for the medical journals, health journals in
government journal focussed on preventive aspects,
English generally combined cosmetic issues with
such as kitchen gardens, latrines, contraception,
health issues, thus serving only the urban society.
soakage pits etc.
There were four major Health Journals being
The journal produced by the Christian
published in Marathi. Two of them were published
organisation focused on dietary practices, relaxation
by doctors, one by the state government and the other
and mental and spiritual health which could be
by a Christian organisation.
achieved at the individual level.
The journal published by the state government
The two journals published by doctors looked
contained articles on preventive aspects of health
at illness or diseases through symptomology and
and articles on increasing awareness of health
advised seeking medical help as soon as possible;
workers about various disease conditions. The staff
preventive aspects were rarely discussed.
of Primary health centres usually contributed by way
of articles, poems etc. The language used was simple.
None of the above journals focused on health
The readership was high as the journals were usually
as a community responsibility as well.
read by the entire staff of the primary health centre.
(2) The journals followed a top-down approach
The journal published by the Christian
stating what needed to be done to achieve good
organisation related health to a wider perspective
health. None of them actually made readers
4
participate in any issues. If at all the readers
2) A disease or illness condition would be explained
contributed, it would be with regard to aspects
regarding the health education only.
through the socio-economic paradigm instead of
through the use of a medical model alone.
(3) Except for the government journal, the other three
journals had an urban-biased approach.
3) Having rejected the top-down approach, we would
adopt an approach where mutual sharing of
knowledge and experience was possible.
(4) All journals reflected the male viewpoint. None
of them addressed the low status of women and their
4) We would lay emphasis on women’s issues, which
heavy work load, as related to their poor health.
have a bearing on their health. The journal would
not necessarily reflect a feminist ideology, but rather
(5) The two journals published by doctors as well
a concern for involving the entire community.
as the Christian journal did address some issues
on plural systems of medicine, but none in the nature
of a debate or as information on when to seek help
5) Emphasis on home remedies and danger signals
calling for medical help would be stressed in the
journal.
from these systems. The government journal gave
information on herbal treatment but concentrated more
on the description of plants. Rarely were home
remedies given due importance.
6) A Reader-friendly approach and attractive layout:
The information provided at the grassroot level
compromises on paper quality, layout etc. and the
content is not sensitive to the interest of readers.
(6) None of them addressed health services or made
a critique of the existing system.
7) Non-target approach : It was decided that the
journal would not support the target-oriented
approach adopted by the Government and would
also criticise it. The journal would moreover,
encourage a ‘bottom-up’ participatory approach.
Approach of our Publication
After some long discussions, our group
decided upon the following approach for our
publication :
Thus, we decided to overcome all these barriers,
within the framework of FRCH’s basic philosophy.
1) Health would be addressed in the widest aspect
possible, relating it to existing socio-economic,
cultural and political factors.
5
I
PROVIDING
INFORMATION
I
I
I
OBJECTIVE 1
discussions are presented here in brief.
Title of the Journal : We wished the title
of our journal to be appropriate yet distinct. After
To provide the ANMs in the states of
Madhya Pradesh and Maharashtra with training
collecting a list of names from various sources, we
inputs so that they can deal more confidently and
decided on the name ‘Aayushi’- which literally means
‘one who provides life’.
competently with the technical, administrative and
social problems in their day to day functioning.
One of the dilemmas was whether to consider
it a journal or a monthly magazine. A journal is
We had to redefine the above objective as
defined in the dictionary as a serious magazine
usually produced by a specialist society.
the role of media lies in creating awareness. To
develop a change in confidence level requires
complex psychological tests, while measuring
A magazine is defined as a sort of book with
a paper cover and usually large pages which contains
competence requires close interaction with the target
group, both of which were not possible within the
given resources and time of this project. Hence we
have redefined our objective.
written articles, photographs and advertisements
usually on a special subject or for a certain group
of people and which is printed or sold every week
or month.
The redefined objective :
Our publication was to include two sections:
one which would provide ANMs with technical
To provide the ANMs in states of
Maharashtra and Madhya Pradesh with
information related to common disease conditions,
contraceptives, women’s and children’s health
problems and how to manage them, public health
issues, health care delivery, home remedies and so
on. This section was to be in a simple language
with illustrations and line diagrams, photographs etc.
The other section was to deal with real life case
studies of ANMs, short stories on women’s lives
and their predicament in the present society,
commentaries on social issues, communication from
ANMs and other health workers, etc.
information regarding technical, administrative
and social problems, on a regular basis.
To achieve the above - stated objective, it
was decided to publish a monthly journal of 16 pages.
ACTIVITIES CARRIED OUT
A. Production of the Journal
The project commenced in November 1993.
Before the actual work started, discussions were
carried out among the project staff, other FRCH
colleagues as well as outside experts on the various
issues of the project. The outcome of these
As our publication included features both of
a journal as well as a magazine, we decided to
6
consider it a journal for ANMs - ‘Aayushi’
it leaves an impression on the reverse of the paper.
Size of the Journal : It was decided to have
Art paper is expensive and weighs more and
the journal in A4 size, keeping in mind the following
criteria :
thus further increases the cost of transport or postage.
*
Reduction in wastage of paper
it is usually used in textbooks or journals pertaining
*
Adequate space to display matter and related
to geography, technology and science which contains
diagrams.
Maplitho paper has a closer weave and thus
tables, etc. in readable font size. The number of
pages decided were sixteen including both the manual
as well as magazine section.
Maplitho paper is available in the 56 GSM
to 140 GSM. (Grams per square meter).
It was felt that a page length of sixteen pages
Maplitho paper below 80 GSM is too thin
would be sufficient for ANMs to go through in a
month, keeping in view :
and see through : Maplitho paper of higher than 80
GSM would have been of better quality but the
weight of paper increases the cost of the postage.
It is not readily available in the market either.
* the spare time they had;
* Their reading habits - many of the ANMs are
Thus after discussion with our printer, we *
decided to use 80 GSM Maplitho paper quality on
account of its :
ft
the first educated generation of women in their family.
Thus reading habits would not be developed to a
great extent. In the context of the ANMs’ low
educational status, a mixture of technical and social
information would be appreciated.
*
Easy availability;
*
Cost-effectiveness; both in the cost of paper
as well as postage.
Our first concern was that the journal should
not be intimidating in appearance and not be too
heavily academic. In order to achieve the objective
Layout: It was decided that the journal will
have two sections : (i) Manual, (ii) Magazine, and
this called for a special layout. The magazine
section, as the name suggests was to contain stories,
poems and articles on social issues.
we took extra care to design the layout with the
help of a professional.
The cover was made simple yet attractive,
conveying a message that it was directed at rural
women and children.
The manual section was distinguished by
using natural shade paper. The manual section was
intended to be pulled out and kept together in a file
which could later be used as a reference manual.
Paper Selected : There are three main types
of paper used for such journals :
For these reasons, the manual section was punched
and perforated, facilitating its being pulled out easily
and filed. The pages in the manual section were
numbered continuously so that the index of articles
in it could provide ANMs with a guide for the use
of the manual.
1) Cream-wove 2) Art paper 3) Maplitho
Cream-wove paper has a loose weave and
therefore is used only when there is running text
matter. If photos or line-diagrams have to be printed
7
I
I
Special Diwali Issue : In Maharashtra, there
On the other hand, three columns make it
is a tradition of publishing special Diwali issues
difficult to print graphs or technical line diagrams.
of magazines. Such issues are colorful and are
Selection of Fonts, Size and leading :
Presently, there are about 100 different kinds of fonts
preserved by the family members for a long time
and read by most members of the family. We also
available on the computers for Devnagari. The fonts
kept to this tradition and published special Diwali
used were ‘Natraj’ for running text matter and
issues during the three years of the project.
‘Yogesh’ for the article titles and names of the
authors.
Layout of the Hindi Journal : Hindi
language is more long-winded, as compared to
‘Natraj’ has the following advantages over
other fonts :
Marathi. Thus, the layout had to be adjusted to fit
within the sixteen page format.
Columns : The magazine section contained
1)
Universal availability : It is available in
D.T.P. software with Devnagari Script.
2)
The style of the alphabets is simple yet
3)
attractive, thus making it pleasant to read.
It is very compact, hence a lot of space is
saved.
pages with three columns to accommodate the art
work, while the manual section contained pages
with two coloumns. Two columns were selected
for the manual section, since the text matter running
for the length of the entire page in a single column
tires the eyes, by not providing a resting space.
Specimen of Natraj’ font
Specimen of a page with 2 columns
Needed : A Give and Take
Local Health Perceptions and Practices
Miuiqi^i
Seema Deodhar
In the course of
our training project at
Parinche, our tais (local
women trainees) had the
opportunity to interact with
ch4)
SJTH
other local people and gain
an insight into their
understanding of various
diseases.
cmi4I
wh
rMMN SIR dPlA
Yogesh - The size is bigger, the font clearer, thus
it is appropriate for titles. Even when made in bold
type, it would not be overpowering for the eyes.
Specimen of a page with 3 columns
Specimen of 'Yogesh’ font
Needed : A Give and Take
Local Health Perceptions and Practices
Seema Deodhar
In the
course of our
training project at
Parinche, our tais
(local women
trainees) had the
opportunity to
interact with other
local
people
and gain an insight
into
their
understanding of
various diseases,
the indigenous
cbl<Su^l^l6l vlIXvTlxA RTR ttut, rqlell-q tJR
remedies for
these diseases,
their preferred
health
care
providers etc.
^uidld.
Font Size : ANMs are not widely exposed to any
kind of reading material as a result of their location
in remote villages. Therefore, we decided not to
make the fonts too small, which would strain their
eyes or too big, which would make the print appear
8
I
I
childish. Thus finally, a font size of 13.5 for ‘Natraj’
was selected for the text.
Moreover ISM and ALP packages have a
facility that allows them to be converted into 14
different languages.
The use of ‘Yogesh’ introduces visual
variation and was used for the main titles and subtitles.
Thus after going through the pros and cons
of various software and computers, we decided on
a 386 IBM Computer with ALP and ISM software
packages.
Leading : Auto leading has been used
throughout our publication as the leading and was
most appropriate in relation to the size of the fonts.
B. PREPARATION OF MAILING LIST
Printing : In the initial stages of the project,
we submitted laser transparencies to the printer. But
with laser transparencies, the print gets faded in
The Mailing list software package was
developed in FoxPro 2.0 under DOS.
larger print runs. As our print-run, (the number of copies
Reasons for using Foxpro as the software are :
to be published) was very large; Marathi : 14,500,
i) Provides indexes for sorting the database and keeps
the database updated at all times.
Hindi : 3500) and also because it is difficult to
preserve laser transparencies, later on we decided
to use negatives from which in turn, plates were
made for printing.
ii) Also, FoxPro under DOS does not require any high
configuration. The basic configuration required is
640KB, 4MB RAM, PC, DOS 3.0 (or above) and
Foxpro 2.0.
Binding : Staple-stitched binding was used
for the issues of the journal. This form of binding
is typical for journals with few pages and allows
Programming involves 3 basic steps from the user.
the pages to be opened without obstructing the ability
to read the text. As the manual section was perforated
1. For a new entry, the user has to select ‘ADD’
option.
and punched, it is possible to remove it easily,
without disturbing the overall binding of the journal.
2. For modification of an existing entry, the user has
to select ‘MOD’ option.
3. For deleting an old mailing address the user has to
select ‘DEL’ option.
Computer Hardware/Software : We have
used software produced by C-DAC: ALP and ISM.
While ALP was meant for inputting, ISM was used
4. ‘LIST’ allows the user to see the list of addresses
on the screen.
for converting text into the PageMaker. For the same
reason, we had to reject the Apple Mackintosh
hardware available only for Desk Top Publishing
as it does not contain a separate package for data
entry.
5. ‘VIEW’ allows the user to view a particular
address.
The p rogramming takes care of confirming
each action from the user before making any change
in the database.
Using a PC, we could load other useful
packages on the computer along with ISM and ALP
packages.
C DELIVERING THE JOURNAL TO ANMS
The first issue of the Marathi ‘Aayushi’ was
9
published in April 1994. We sent copies of
in reading them.
‘Aayushi’ to Primary Health Centres up to August
*
1994. We visited PHCs and sub-centres in
Maharashtra (near Pune) in July and August with
often read by Doctors, Male health workers,
When despatched to the PHCs the itsue is
pharmacists, who may neglect handing over this
issue to the ANMs.
the objective of finding out whether ANMs were
receiving Aayushi regularly and if not, what were
*
As told by Postal department in rural areas,
there are few permanent postal employees but usually
the reasons for non-receipt or delay.
In the course of discussions, we realised that
daily wage postmen. Therefore accountability of
work and efficiency of services are lacking.
‘Aayushi’ is read by other PHC staff and by those
ANMs who are posted at the Primary Health Centres.
So we decided to do a readership survey
to enquire whether ANMs were receiving their
However, ANMs posted at sub-centres were not
receiving the copies. So we decided to post copies
copies of ‘Aayushi’.
to all the sub-centres. We requested a list of sub
centres from the Director of Health Services,
Maharashtra. We received the list from the Director,
excepting the list of subcentres in 3 districts, namely
Methodology of selection of Sub Centres:
Except for the three districts where we did not have
sub-centre addresses from the other districts, we
randomly selected 20% of sub-centres from two
Jalna, Thane and Sholapur. We had requested DHOs
(District Health Officer) to send us the list but
we had not received the list until the end of 1996.
randomly selected talukas of the remaining districts
and posted the readership survey forms to the ANMs
Then the copies of ‘Aayushi’ were posted to PHCs
in the above districts. The return of posted copies
asking to them to mark out the issues not received
by them. We posted this survey form on a self
of Aayushi has been nil from the above districts.
addressed double pre paid post card so that the
ANMs would have to do a minimum of work. We
posted 2457 such letters and received a response
of 426 letters i.e. 17.33%.
From our field survey in other districts, we
could make out that ‘Aayushi’ copies were not read
regularly because of irregular receipt. One of the
reasons for lack of access to the journal, is that
the copies of the journal are kept at the Gram
Panchayat office as there are often no sub-centre buildings.
Our surveys have revealed that ANMs do not always
receive their copies of Aayushi for various reasons :
These 426 letters were analysed on the basis
of whether the ANMs were receiving Aayushi or
not, year wise.
N = 426
*
ANMs do not stay at sub-centres and in many
areas the sub-centre building is not within the
village, but outside it. In a few places, there are
no sub-centre buildings. Copies of Aayushi in such
places are deposited at the Gram Panchayat office
and can be picked up by anyone who is interested
Year
1994
1995
1996
10
Those
Receiving
(%)
80.05
88.96
92.00
Those
Not Receiving
(%)
19.95
11.03
8.00
Further, we analysed the issues that were
lost month wise to check on the irregularity of
the receipt of the journal. In the last 3 1/2 years
issues have been brought out regularly without a
break. Therefore we analysed the irregularity of
the journal month-wise from the readership survey.
The average irregularity over the two years
was 36.28% in 1994 and 29.87 in 1995 (decrease
of 7%). While conducting a survey of ANMs from
different region in 1996 the irregularity of receipt of
the journal has been reduced to 7.04%. Irregularities
in the receipt of the journal were due to :
iii. The ANMs are high school pass outs with an
additional 18 months of course training. Most of
them are first generation educated women in the
family and thus have generally not developed the
reading habit.
Due to the reasons stated above, data for
impact assessment can not be generalised.
Time Activity Chart
Morning
Wake up time
01. Bathing/
Getting ready
02. Sweeping, cleaning
03. Cleaning utensils
04. Bath
05. Prayers/Pooja
06. Getting the kids
ready for school
07. Cooking tiffins
lunch
08. Having break fast
09. Getting ready
to go to work
10. Reach office
* Postal services being weak in rural areas.
*
Irregular visits by ANMs to their sub-centres.
Lack of initiative of PHC Staff to disseminate
the journals which were reaching them, (we usually
recovered journals from the Pharmacist’s cupboards
or from Medical Officers’ tables.)
*
A total of 37 issues and 352 articles have
been published (For Annoted bibliography, see
Annexure 1.1, page 50-81).
Many articles have covered all the three aspects
namely, technical, administrative and social problems.
Following is the percentage of articles
published under each head.
N = 352
Sr.
Themes
%
No.
No.
(*)
of articles
1
2
3
Social
Technical
Administration
303
143
103
04.30 Hrs
20 min
30 min
15 min
10 min
15 min.
04.50 Hrs
05.20 Hrs
05.35 Hrs
05.45 Hrs
06.00 Hrs
30 min.
06.30 Hrs
60 min
30 min
07.30 Hrs
08.00 Hrs
20 min.
30-60 min
08.20 Hrs
09.00 Hrs
5 Hrs
15.00 Hrs
30 min
60 min
30 min
15.30 Hrs
16.30 Hrs
17.00 Hrs
20 min
17.20 hrs
60 min
18.20 hrs
2 hrs
20.20 hrs
45 min
21.00 hrs
30 min
21.30 hrs
60 min.
6 1/2 hrs
22.30 hrs
04.30 hrs
(Going on foot)
Afternoons
11. Home visits
30 Visits daily
12. Return home
13. Having lunch
14. Rest
15. Tea/Snacks
Self/Family
86.00
40.62
29.26
Evenings
16. Washing clothes,
Utensils
* Overlapping Themes
Late evenings
17. Cooking/Kids’
studies
18. Supper/
cleaning up
19. Watching T. V./
News
20. Report writing /
planning for next day
21. Sleeping
Assessing the impact of the journal was rather
difficult as : i. ANMs could not receive the journal
regularly because of various reasons stated above.
ii. Generally, the daily work schedule of ANMs
does not leave much time for reading. The daily
work schedule of 229 ANMs from four different
regions is given below.
It is evident from the Time Activity Chart that
ANMs are very busy and have to find time to read
Total working hours
‘Aayushi’.
11
18 hrs.
I
D. ASSESSING THE IMPACT OF THE
JOURNAL :
of the total ANM population. This should be
considered as good as it is more than 2 1/2 times
of the average response received by the Times of
I
impact
India, with the additional factor that the average
I
1. Informal feedback
reader of the Times Of India is much more educated
than the average ANM, for whom responding to
Four methods were employed to assess the
a journal was itself a novel idea. ANMs responded
ANMs’ response through letters and articles;
responses of PHC and non-PHC staff.
from all the four socio-economic regions of
Maharashtra.
2. Field Survey
On enquiry many ANMs said that they were
conducted by FRCH Staff involving verbal feed
back of ANMs and PHC staff
mentally not prepared to give their opinions/
experiences in writing.
3. Formal feedback
Responses to mailed questionnaires.
ANMs Contribution
4. Workshops
in the four socio-economic regions of
Maharashtra.
Total no
of Response
Letters
Articles Poems
1002
875
82
45
It should be noted that the total number
of ANMs contacted through the above 4 methods
were 2678 and there was no overlap in the sample
covered through each method.
The articles and poems sent by ANMs were
regarding their work, problems and interesting
experiences.
Letters to FRCH from ANMs
1002
1.
ANMs from Vidarbha gave the most
enthusiastic response as many of the ANMs therein
Field work
582-
Questionnaires
384
reside at the Subcentres unlike in Western
Maharashtra where travel facilities are better.
Workshops
239
Total
2017
2.
Besides, in Western Maharashtra, ANMs
have more of other entertaining reading material
to choose from.
1. Informal Feedback :
1002 ANMs out of 11500 ANMs responded
to our publication through letters. This is 8.66%
12
ANMs LETTERS
Sr.
1.
Regions
(%)
(%)
40.47
6.51
1.14
7.5
33.71
4.57
0.8
5.46
18.97
3.08
0.4
3.42
6.74
1.02
0.3
1.37
Subscription
Enquiries
Feedback
about
Aayushi
(%)
(%)
Western
Maharashtra
ANMs
4.
Demanding
back issues of
Aayushi
Marathwada
ANMs
3.
Total No.
of letters
Vidarbha
ANMs
2.
(N = 875)
Konkan
ANMs
3.
Only 6.6% of ANMs have demanded backissues. On enquiring during field surveys/workshops
other ANMs said that though they also wanted the issues
they did not actually get down to asking for them.
A few accused us of concocting the
experiences narrated by us. For e.g.. the
experience we printed in the Diwali 94 issue,
with the title 'Question Mark" sent to us by
a Nasik based ANM. (Refer to the Annoted
Bibliography in Annexure 1.1, page no. 57)
4.
Only 24 ANMs have enquired about
subscription rates. On enquiry they felt that it was
distributed free of cost to them.
Table
Analysis of letters
5,
Only 20 ANMs out of 880 had pointed out
mistakes, or pointed out what they did not like.
The complaints in brief :
<
Jan. 95 cover depicts a wrong method of
injection administration by an ANN.
•
Another critically observing ANM pointed
out that the dose ofTB. medication was wrong.
It was actually a printing mistake and we
apologised for it.
13
Do not like
Aayushi
Appreciate Find
Aayushi
useful
2.2%
97.71%
90%
Ready
to subscribe
60%
I
I
To cite a few appreciation letters.
1.
An
20 MOs from various PHCs showed
initiative by asking that the ANMs under them
ANM from Sironcha Tahsil of
Gadchiroli district was lavish in her praises
should be put on the ‘Aayushi’ mailing list.
of ‘Aayushi’. She stated that Aayushi was
Fifteen letters from Male Health Workers
and Pharmacists and Doctors claimed that ANMs
do not read ‘Aayushi’. Rather they themselves
should be included in the Mailing List of ‘Aayushi’
as they were the neutral readers.
extremely helpful and useful in her work.
2.
ANMs of Ganeshpur PHC in Buldhana
district said that : They awaited ‘Aayushi’
eagerly It gave them useful tips which helped
them to improve their rapport with women
during home visits.
110 letters have come from Non-PHC Staff
members, all of them demanding ‘Aayushi’. One
3.
Due to transfers, ‘Aayushi ’ is not received
says an ANM from Baramati and she misses
Police Inspector from Jalgaon district specially
visited the FRCH, Pune office to ask for ‘Aayushi’
it badly.
and even paid the annual subscription for it.
4.
ANMs from Chockhard PHC in Jalagaon
district had to say in praise of Aayushi :
One post master had managed to get hold
of the Diwali 95 issue of Aayushi and he liked
it so much that he insisted on being put on the
“ANMs deal with subjects of interest to the
LETTERS OTHER THAN ANMs
Total No.
of letters
Sr.
Demanding
back issues of
Aayushi
Subscription
Enquiries
P.H.C.
demanding
Aayushi
Feedback
of
Aayushi
1.
PHC Staff
99
55.55 %
40%
41.41%
56%
2.
General
126
45.23%
57.93%
Nil
46%
Aayushi Mailing list. Though this response pleased
us, the flip side is that it deprives the ANMs from
receiving their issues regularly, when those not on
the regular Aayushi mailing list keep the ‘Aayushi’
with themselves.
ANMs 'Aayushi’ represents an ANM’.
PHC staff, excluding ANMs also have
expressed their views :
Most of them would like to receive separate
copies of Aayushi. One PHC staff member has
threatened to obtain an order from court as he felt
that distribution of Aayushi only to ANMs was
discriminatory and therefore illegal.
The response through letters proves that
Aayushi has indeed made an impact on various
categories of people.
14
I
I
2.
Field Surveys
home where they could be read at length. Though
the subcentres had their own premises the ANMs
Madhya Pradesh
did not reside in them. They resided in the main
The publication of Hindi ‘Aayushi’ was
launched in January’ 94 to help the ANMs to perform
their duties better.
town and worked at their stations for 2 to 4 hrs.
daily. A surprisingly large number were not aware
of the fact that ‘Aayushi’ is entirely devoted to
A feedback study was undertaken by FRCH
to gauge the effectiveness of the publication and
fulfilment of the intended objectives. PHCs and
ANMs and their duties and hence, had not read
subcenters in the seven districts in Madhya Pradesh
in order to distribute them to the ANMs during
were mailed sets of ‘Aayushi’ issues (Anne.8). Each
the periodic meetings of ANMs. Subsequently,
set contained seven issues of January, February and
FRCH mailed 400 copies to each DPO as decided.
March 94. At the end of this quarter it was decided
After two months, in June’94 we re-visited Shivpuri
and Guna. The findings of the visit are as under:
the issues mailed to them. The DPOs concerned
asked for 400 copies to be mailed to each of them
to visit the state of Madhya Pradesh to gauge the
performance of ‘Aayushi’ (See map Annexure 7).
Shivpuri : The DPO had received both issues.
The opinion of the ANMs was sought on
the following points :
However, only one issue had been distributed while
the May’94 issue had not been distributed as agreed.
1. Do ANMs receive ‘Aayushi’ regularly ?
2. If yes, do they read it ?
Guna : The DPO had received both the issues. None
of them were distributed as agreed through he
3. If yes, do they feel the language is easy to follow?
4. What subjects would they prefer to be incorporated
in the forthcoming issues of ‘Aayushi’ ?
promised to do so at the forthcoming meeting. As
per the advice of the Deputy Director of DANIDA,
we also mailed the issues to the DPO’s residence.
5- Suggestions were invited regarding content,
subjects desired by ANMs in forthcoming issues.
6. Probable reasons, if any, for non-receipt of
‘Aayushi’ by ANMs.
Even then, the ANMs never received the issues, as
is evident from the letters received by this institution
from private Medical Practitioners and MPWs.
Hence, FRCH obtained the list of PHCs and
subcentres for mailing the issues to them directly.
In July 1994 again, three districts from the
above 7 districts were chosen viz, Gwalior, Shivpuri
& Guna (Refer to map, annexure 7). Upon visiting
the District Project Officers (DPOs), in these
districts it was found that DPOs were unaware of
FRCH’s proposal covering Madhya Pradesh
was for a year only. Therefore though Aayushis
were posted feed back survey was not taken.
‘Aayushi’ and its objectives. Further, as a result
of visits to various PHCs and subcenters, it was
also learnt that though the PHCs had received the
issues, they were not distributed to the ANMs.
Neither were the ANMs allowed to take the issues
Maharashtra
The Marathi edition of Aayushi commenced
in Aprir94. A list of PHCs was obtained from the
Health Department, Government of Maharashtra.
15
I
I
I
It was convenient to mail the issues to the PHCs
As a result of our discussions with in-house
directly. A set of seven copies each was mailed
experts in Anthropology and Statistics, we decided
to all PHCs. But upon following up with some
on random sampling of districts as follows :
PHCs in Pune district it was found that these sets
1.
Making an alphabetical list of all the districts
in Maharashtra which were serially numbered
accordingly.
were not distributed to the ANMs. All those ANMs
whom we met suggested that ‘Aayushi’ should be
mailed to them directly at subcentres. (Mailing
A random number table was used to select
‘Aayushi’ issues to ANMs individually was not
2.
possible as a complete list of ANMs was not
available.) This suggestion was accepted and acted
serial numbers. Thus those districts represented by
the randomly selected serial numbers were chosen.
upon. All the ANMs were mailed copies addressed
to their subcentres (except those in Sholapur and
Jalgaon Districts, as the list from Director, Health
3.
An attempt was made to cover the entire
district, generally starting from a backward/tribal
area in one particular geographical direction to
Services Maharashtra did not include these two
make the survey logistically feasible.
districts). Subsequently, a list was obtained from
4.
the DHOs in these districts and they were also
mailed the copies of ‘Aayushi’. After mailing
The sole bias present was that of choosing
appropriate PHCs/SCs geographically linked to the
first PHC chosen. Therefore this does not amount
‘Aayushi’ to the ANMs from April to December’94,
a follow-up study was undertaken to gauge its
effectiveness by assessing whether ANMs read
to purposive sampling of PHCs but an ‘at random
selection’ of PHCs.
Aayushi? If yes, how regularly? Did they like it
? Was it useful to them in their work ? etc.
5.
Methodology used in selection of PHCs
and Subcentres in Maharashtra
introducing a further degree of randomness in the
selection of ANMs.
Random Selection : The phrase random sampling
of trainers and trainees appears out of context as
there are basic problems involved in performing a
random sampling of individual ANMs.
It was found that after the issues were mailed
directly to the ANMs at sub-centres the ANMs read
the issues of ‘Aayushi’ regularly. Alternatively, it
was also found that a parallel publication, ‘Aarogya
For e.g. geographical factors pose an
enormous logistical problem of tracking down
randomly selected individual ANMs even if the
sample were limited to one district of Maharashtra.
Each ANM is responsible for approximately five
villages. It is not possible to know in advance the
precise movements of randomly selected ANMs
Patrika’ published by the State Government, was
From the selected PHCs only those ANMs
present at the time of our visit were interviewed,
gathering dust in the PHCs. Given the encouraging
response from ANMs and with a view to avoiding
the fate of ‘Aarogya Patrika’, ‘Aayushi’ was mailed
directly to subcentres.
As ‘Aayushi’ is meant for the benefit of
the ANMs only, the male workers who wished to
read ‘Aayushi’ would take it home directly from
on a particular day.
16
I
I
the PHCs for reading at length.
anganwadi teachers who happened to read ‘Aayushi’
also found it very informative, useful and good
reading. In Satara, it was also found that a few
This only shows that ‘Aayushi’ was
appreciated by all those who read it and not enough
copies were being mailed. Many ANMs also
informed us that they received the issues of ‘Aayushi’
ANMs were preserving the issues, which they
received regularly. But they were exceptions. Unlike
Satara District where ‘Aayushi’ was received
regularly, other places complained of irregular
delivery.
irregularly. Quite a few sub-centres have no building
of their own. Hence, chances of ANMs receiving
‘Aayushi’ at these subcentres were remote. In such
a case, some issues were returned to FRCH,
delivered to Gram Panchayats, private medical
The ANMs in Nasik district positively
affirmed that ‘Aayushi’ as a magazine fared better
than ‘Arogya Patrika’ and ‘Centre’, two other health
practitioners or in some cases even to banks, as
was noticed by us in Pune District.
publications of the Government as Aayushi is more
informative and useful to field workers. When asked
about the content of future issues of ‘Aayushi’,
the ANMs requested that subjects like AIDS,
CANCER, FAMILY PLANNING, TB, LEPROSY,
Generally, it was found that ‘Aayushi’ was
not received by the ANMs regularly. However,
whatever issues the ANMs received were declared
by them as useful, informative and interesting.
Special efforts were made to make ‘Aayushi’ reader
friendly. The issue was divided in two parts : 1)
MALARIA etc. be included. They also wanted more
illustrations, sketches to be included in order to
make ‘Aayushi’ more useful.
Magazine and 2) Manual, to make the publication
both entertaining and informative. Stories, poems,
write-ups about womens’ lives were also included.
These also had the added advantage of ‘Aayushi’
The information and contents are read
publicly in Mahila Mandals, workshops, training
sessions etc. In fact, a large number of PHC staff,
not seeming like a text-book but making it much
especially in Maharashtra, asserted that ‘Aayushi’
more interesting reading, as vouched by the ANMs,
the MOs and other ardent readers of ‘ Aayushi’.
In some cases, especially in Pune and Nasik
Districts, the ANMs wanted the language of
‘Aayushi’ to be simplified though the ANMs from
other districts found the language to be all right.
Generally, the ANMs were busy at home and at
is used during training courses for ANMs. During
monthly meeting also Aayushi is read. The Medical
Officers and Training Officers used ‘Aayushi’ along
with the Government Training manuals but it was
‘Aayushi’ which made training ANMs easier.
In the Konkan area, we met ANMs in
Ratnagiri and Raigad districts. These ANMs perhaps
have the toughest job among all ANMs, as they
have to survive in a very hostile natural
environment, making it especially tough for home
visits. Hence these ANMs can spare very little time
for ‘Aayushi’. In spite of these difficulties, some
ANMs managed to assimilate ‘Aayushi’ and even
work, and hence could not find enough time to
fully appreciate ‘Aayushi’. But the other staff
members at the PHCs were very vocal in their
praise of ‘Aayushi’ as was seen in the districts
of Pune, Ahmednagar, Satara, Nasik, Sholapur and
Kolhapur. Social workers, teachers, post masters,
17
their other family members read and enjoyed the
not devote enough time to ‘Aayushi’ but insisted
that ‘Aayushi’ be continued. They were also vocal
magazine.
about inclusion of the problems faced by them,
in ‘Aayushi’.
‘Aayushi’ is found to be most widely read
in Maharashtra. “We eagerly await Aayushi” is what
all the ANMs declare. Here, ‘Aayushi’ is read not
only by ANMs but the entire staff including the M.O.
State
Some ANMs confessed to lending ‘Aayushi’ to
No. of PHCs
& SC visited
neighbours who found it equally interesting.
Open letters to the editor or ‘Bolake Patra’
is an opportunity for the ANMs to state their feelings
and problems. In this, the ANMs wrote back showing
their appreciation for other columns like write-ups
No. of ANMs
contacted
Maharashtra
433
551
Madhya Pradesh
Total
16
449
31
582
Refer Annexure - 9 and 10
by David Werner, songs at the last page, informative
N = 582
essays about children, women and poems. In some
No.
No. of
No.
cf ANMs
ANMs
response
do not
read
read Aayushi Aayushi
PHCs in Vidarbh ‘Aayushi’ issues were bound and
preserved. Some MOs and DHOs felt that it was
equally useful to Doctors. All of them insisted that
they be individually mailed a copy rather than
through subcentres so as not to miss any issue
of ‘Aayushi’. They had voluntarily compiled a list
with names and addresses of those wanting Aayushi.
(%)
(%)
27.19
65.69
No. of Find
Willing to
ANMs Aayushi subscribe
preserve useful
issues
after
reading
(%)
(%)
(%)
(%)
7
65.69
61.08
58.15
‘Aayushi’ has proved to be successful among
those for whom it was meant. However, we have
not managed to collect the necessary subscriptions
for its continued publication.
Majority of the ANMs were ready and
willing to pay subscription from their own pockets,
but they differed as to the amount to be paid. The
following options were suggested 1) As much as
Arogya Patrika, 2) Between Rs. 20/- to Rs. 50.
3. Formal Response Mailed Questionnaires :
Marathwada ANMs informed us that they
were willing to pay even above Rs. 50/- rather
than see it discontinued. A large number of ANMs
To gauge the impact of Aayushi,
questionnaires was prepared and field tested. (For
questionnaire refer Annexure 6)
felt that if they could spend big amounts on luxuries,
they could certainly pay between Rs. 50/- to Rs.
100/- for ‘Aayushi’. Unfortunately, in Western
Maharashtra, ‘Aayushi’ was not received as
Only 120 out of a total of 11,500 ANMs
returned the questionnaire. The questionnaire was
repeatedly printed in three consecutive issues of
‘Aayushi’ to reach all ANMs at least once. The
response to the questionnaire was 1% Dr. Meera
Savara (Annexure 5) has conducted Magazine based
enthusiastically} as elsewhere.
ANMs working in tribal or Adivasi areas
claimed that due to time constraints they could
18
*
surveys in magazines like Business India,
Gentleman, Sauvy, Debonair. These are all highly
‘Questionnaires’ were a new concept to a
lot of ANMs.
priced English language publications aimed at the
*
Some of them were scared of repercussions
involving the authorities later on.
educated middle and upper classes. The response
rate received by publishing questionnaires in this
magazine is in the range of 1% to 2 %. According
*
to Dr. Savara this response of 1 to 2 % is considered
to be acceptable, and is similar to the rate found
running to two pages was too lengthy and tedious
to be filled in.
in magazine Surveys done in the Western Countries.
After our personal interactions with them
through workshops we received 244 filled in
During our interaction with the ANMs we
Some thought
that the questionnaire
questionnaires making a total of 364. Our analysis
is based on these 364 questionnaires.
enquired why there was such a low response : The
explanation they gave was :
ANMs assessment of Aayushi (N = 364)
No.
■
Subjects
Easy to
Understand
Useful for
their work
New Information
(%)
(%)
(%)
1.
Women and Health
22.80
35.71
31.31
2.
Pediatrics
49.72
43.68
15.93
3.
National Problems
5.4
10.98
23.62
4.
Commonly occuring disorders
25.82
56.04
55.49
5.
First Aid
13.73
8.02
6.31
6.
Policy Related themes
14.01
3.02
7.41
7.
Development Project
2.47
0.05
5.49
-8. •
Drugs
69.23
50.00
60.43
* Percentages add more than 100% due to multiple response.
19
as tley will never able to implenfenTo/hlve a^ay i^XVmXrs3"'1 deVeI°Pment pr°jeCts lrrelevant
Magazine Section (N = 364)
No.
Subject
1.
Literature Appreciated
by ANMs
Social issues
2
57.69%
Women's issues
3
40%
Poem
4.
38%
Policy related
5.
7.6%
Development issues
9.89%
* Percentages add more than 100% due to multiple response.
ANMs found Aayushi useful (N = 364)
Helped in
changing perspective
Helped in
community organisation
45.85 %
*
Helped
in diagnosis
45.85 %
Helped in
referral
78.84% %
27.61%
Percentages add more than 100% due to multiple response.
On enquiry ANMs said that the perspective has changed their outlook specifically
towards women
and the community in general.
zzze; rr- ”icies
-—
Community Organisation
N = 364
Interaction with women
%
Home visits
Mahila Mandals
*
61
59
Percentages add more than 100% due to multiple response.
20
ANMs received information about Medication
(N = 364)
No.
I
Subject
New Information
1.
Herbal
58.95 %
2
Allopathic
42.35 %
3
Plural Systems of medicine
54.58 %
* Percentages add more than 100% due to multiple response.
The impact of Aayushi through field survey can be gauged by the following table
N = 364
Read Aayushi
Find Aayushi useful
Preserve issues of Aayushi
Willing to subscribe
(%)
(%)
(%)
(%)
69
92
72
92
21
4.
Workshops
All the 213 attending ANMs paid the annual
subscription of Rs. 60.00 for Aayushi on the spot.
To gauge the impact of ‘Aayushi’ on ANMs,
we decided to take workshops involving discussions.
They said that ‘Aayushi’ should continue to be
published. ‘General comments of participants in
the workshop
(Ref. Annexure 11)
The workshops had to cover altogether 1%
of the total numbers ANMs i.e. 125 out of total
11,500 ANMs. To get a complete representation
1) ANMs look forward to receiving “AAYUSHI”
each month.
of ANMs coming from different socio-economic
2) The Monthly issue of “AAYUSHI” is awaited
regions and yet do away with any bias in the sample
by their neighbours as well. The neighbours borrow
it to read and make use of it and if necessary,
inform the ANMs.
selection we decided to do stratified random
sampling. We decided to invite 40 ANMs from
each of the four socio-economic regions of
Maharashtra : Konkan, Vidarbha, Marathwada and
3) ANMs find “AAYUSHI” to be a mine of
Western Maharashtra. The four districts were
information. They get to know of matters like child
labour which they may not have heard before.
chosen on the basis of ANMs accessibility to these
districts and the infrastructure available for holding
the workshops. Though technically, the total ANMs
through this method would amount to 160, which
was more than our target of 125 ANMs, this was
necessary as it was possible that due to the nature
of their work, some of the ANMs would have to
4) ANMs feel “AAYUSHI” helps them to become
better parents. It makes them think about becoming
better/ideal parents. It informs them about incidents/
factors that influence their children and about solving
the problems of their children. They get all this and
more from “AAYUSHI”. It has taught them to think
about their children’s welfare.
drop out from the workshop at the last moment. The
ANMs from each region were selected through the
5) “AAYUSHI” gives them a new point of view.
They can view society with a clearer outlook.
method of random sampling (using Random Tables).
Four workshops were held, one in each
region, at Pune (Western Maharashtra), Gadchiroli
(Vidarbha), Raigadh (Konkan) and Latur
(Marathwada). In each region 40 ANMs were
6) ”AAYUSHI” has introduced them to a womenoriented perspective.
7) The M O and other staff members at the PHCs
and sub-centres complained about not receiving
“AAYUSHI”. They wanted to be included on the
mailing list for “AAYUSHI” alongwith the ANMs.
invited for the workshops.
The workshop was a new concept for ANMs.
The attending ANMs were apprehensive since they
were under the impression that they were to be
burdened with additional duties in the workshop.
They felt sheer relief on realising that the workshop
was not meant’ to make them implement any new
8) Exercises for reducing the waste and for
alleviating back troubles were helpful. One ANM
who suffered from lower back troubles followed
the line diagram and tried out the exercises. She
was rewarded with immediate relief. On realising
the effectiveness of the exercises, she could help
programme.
22
relieve the lower back pain of others.
requirements in producing a journal for ANMs as
revealed by this project.
9) Patients being treated at the PHCs have also
appreciated “AAYUSHI” which they chanced to read
Impact of Aayushi through workshop
while awaiting treatment. They later wanted to
N = 229
subscribe to it as they realised that “AAYUSHI”
was useful reading.
Do
Read
not Aayushi
read
(%)
(%)
10) The ANMs believe that “AAYUSHI” is their
own while “AROGYA PATRIKA” is for health
workers. The ANMs treat “AAYUSHI” exclusively
as their own journal.
6.5
11) ANMs claim that “AAYUSHI” has helped them
in improving skills relating to their profession. It
93.44
Changed Find
their
useful
perspective
(%)
(%)
100
87.33
Actually paid
Subscription
(%)
92
Language and Content
*
A sentence should not extend beyond fourteen
words to ensure simplicity.
helped them to learn whatever they missed during
their training.
* A paragraph should generally contain only 150
to 170 words.
12) “AAYUSHI” was read in public at various
forums and meetings.
* An article should not contain more than 1800 to
13) One MO in Akola Dist. has filed copies of
2000 words.
all “AAYUSHI” issues received by him. This MO
* A three column layout per page is easier on the
ensures that there is sufficient time during each
monthly meeting for the public reading of various
topics printed in “AAYUSHI”.
eye.
* The font should not be too artistic as it becomes
difficult to read.
14) As “AAYUSHI” was received in the remotest
areas as well as where no other publications were
available, “AAYUSHI” earned itself the place of
“THE FRIEND” with the ANMs.
* The language should be reader friendly. Flowery
academic language with superlatives should be
avoided.
* The dialogue form is more appealing and easier
15) “AAYUSHI” is primarily meant for ANMs but
has earned the faith of the entire community. Some
people feel that “AAYUSHI” should become a
permanent feature of public libraries. It’s readership
is no longer restricted to the ANMs only but the
entire community reads it avidly.
to understand when a concept has to be conveyed.
* The matter should be relevant to their own life
experiences.
* Stories with tragic ends are not appreciated. A
positive outlook is preferred.
Suggestions received during the workshop to
make Aayushi more effective
* The content should be straight-forward. Irony is
not appreciated as it is not easily understood.
The following are some of the important
* As far as poems are concerned they should be
23
I
I
women-oriented poems on grassroot activities.
D.
Pictures that are too abstract or symbolic
are difficult to comprehend.
E.
Human figures representeo m straight lines/
Poems focussing on personal emotions or human
relations are not understood.
* Suggestions pertaining to pictures included in
Aayushi :
A.
Line diagrams are preferred over figures.
square forms are not appreciated.
B.
Urban stereo types are not appreciated.
Conclusion
1. A journal like ‘Aayushi’ is necessary for ANMs.
2. The journal, if it is to be effective, should be
C.
based on personal interaction and rapport with
ANMs through workshops.
Figures represented in a definite background
are contextualized and hence understood
better.
3. The length of the journal should be around 12
pages, for efficacy since ANMs are short of time.
The response proves that Aayushi made an
impact. The project has achievedits objective to a
high degree.
N = 2017
Read
Aayushi
(%)
86
Preserve
Aayushi
(%)
Find
usefill
(%)
Subscribe
for Aayushi
(%)
86
72
66
□□
24
CONTINUING EDUCATION OF ANMS
OBJECTIVE 2
demonstration should be discussion based rather
than lecture based. Demonstrations would be more
appropriate if conducted in rural settings. Training
To provide ANMs with relevant technical,
administrative and social information on a regular
basis in the form of contact programme in
continuing education and training of ANMs.
of ANMs consists of specific hours of theoretical
lectures and practical experiences, which includes
hospital and rural training.
The following is a description of activities
conducted between April 94 and March 98, with
The following table gives an idea about the
proportion of time divided in imparting practical
a view to attaining the above stated objective.
as well as theoretical training to ANMs in urban
and rural settings. The percentages have been worked
out by calculating the number of hours given to
practical work and lectures. This is an outline of
the training imparted by an average ANM training
school.
Background about ANM training :
The pattern and emphasis in the training of
ANMs varies between institutions, and across the
country. The training is imparted through Government
Nursing Schools, Grant-in-Aid Schools as well as
recognised Private Organisations. There is a lack
of uniformity in the training imparted by these
different institutions. The Nursing Council, having
Time Division in ANM Training
Placement
set the syllabus, does not bother to implement it
in its true spirit. There being few checks, the training
institutes take this opportunity to turn out poorly
trained ANMs and also obtain free labour for
services in their hospitals in the bargain. Training
institutes thus have an impact of developing a
hospital oriented outlook amongst trainees. The
extent and quality of training determines the
performance of a job. In addition to the above
mentioned drawback, teachers and teaching
methods also generate the outlook that hospital
work is superior to working in the community. The
teachers in the training school themselves need
orientation for community health.
Practical
Lectures
Total
%
%
%
Rural PHC
based
25
8
33
Urban
hospital
based
50
17
67
Total
75
25
100
Out of the 25% of lecture hours, 65% is spent
on theoretical lectures which include subjects such
as anatomy and physiology, psychology, sociology,
nutrition, fundamentals of nursing, basic medicine,
microbiology, etc. Only 35% of the lectures are
related to community health, covering subjects like
communicable diseases, domiciliary midwifery,
family health, health education, nutrition education,
health problems and plans, mental health, family
The method of teaching used is class-room
lectures, with demonstrations either on dummies or
indoor patients. Classroom teaching or
25
planning, hygiene, community health and child
Inadequate Rural Component
health. The absence of sufficient bias in favour
Practical experience includes hospital and
rural training. As already mentioned, it is more
of community health thus becomes apparent.
hospital-based rather than rural-based. Out of the 78
weeks of training, a trainee spends only 24 weeks
in rural areas, where she is to work in the future.
Training Content vs Field Needs
A wide variety of subjects are taught to
ANMs in 18 months. Within this short period they
This amounts to only 33% of the total training period.
are expected to gain primary knowledge in the above
subjects. In some instances content and focus in
training is not in keeping with the job they are
expected to do. The following examples are
One of the major responsibilities of ANMs
is to assess signs and symptoms, make a primary
diagnosis and treat patients, or refer them, depending
presented by way of illustrations. The number of
on the seriousness of their condition. However,
hours for theoretical lectures of Fundamentals of
during rural training, they are expected to carry out
Nursing is forty and the content is much more
related to hospital work such as admission and
discharge of a patient, care to be provided to heart
the above functions with the help of Supervisor/
Doctor. At PHCs the diagnosis and treatment to
be prescribed is written by the Doctor/Intem/Compounder
and the ANM just hands out the medicines. As a result,
patient, etc. In practice an ANM rarely encounters
the ANM does not develop the necessary skills and
confidence to make primary diagnosis.
such a situation in the field. First Aid, according
to the standard course outline, is given only 20
hrs. of lectures inspite it being the primary and
main responsibility of ANMs. The same lack of
In the course of field placement, they are
expected to gain experience in pre-natal and post
natal examinations and conduct 20 deliveries on their
foresight is seen again in the subject matter of
microbiology. The emphasis is more on types of
microbes and classification rather than information
regarding sources where microbes are found,
conditions under which they grow and how to
own. Looking at the complex nature of childbirth,
20 cases can hardly qualify an ANM to handle
all situations which may crop up during childbirth.
Also, in practice it is difficult within the short
rural posting for each trainee to conduct as many
control them. In the subject nutrition, the course
content covers merely the fundamentals. The socio
economic linkages in nutritional status are rarely
touched upon.
as 20 deliveries. Before 1985, the focus was on
midwifery and the time allotted for it was a year.
Due to the changed syllabus and reduced period of
training, the quantum of training for midwifery has
The image of women’s role in our society,
decreased. As a result the ANMs remain ill-equipped
even for this important task.
which sees them primarily as mothers, is reflected
in the training of ANMs also. Consequently the
emphasis on care of women’s health is confined to
pre and post-natal care. Treatment of gynaecological
disorders, which are so rampant, is not taught with
the same zeal. In fact, the course content in this
important area is very limited.
Trainees are based at PHCs instead of at
Sub-centres, where they have to work in future. At
the PHC they are the junior-most persons and
therefore not obliged to take decisions. But once
they start working at the Sub-centre they often have
26
to, to an extent, take independent decisions about
Family Planning, which is almost an obsession in
the health needs of people. Yet, during their training
students receive little or no experience in assuming
responsibilities or taking decisions, as the
administration usually decides on all matters
government sponsored Primary Health Care. During
their training period also, the emphasis on family
planning has increased, generating the outlook that
family planning is their chief responsibility and other
concerning them. In addition to this, nurses are trained
functions are not very important. As part of continuing
education, apart from medical knowledge inputs,
to be submissive to doctors and accept the
hierarchical nature of the medical profession. Given
also the culturally imposed inferior status of women.
ANMs should also be oriented to various social
issues - including women’s issues - through various
methods and media.
ANMs often find themselves inadequate to take
decisions and be assertive even when a situation
demands it.
The reason for conducting a training
programme in the Nursing school was to explore
Solitary living at the Sub-centre, irregular
possible alternatives to the present system, through
hours of work and young age render them vulnerable
to sexual exploitation. Society does not look upon
favourably at a young woman going out alone or
discussing about family planning methods. During
their training ANMs are not prepared to tackle many
such practical difficulties which they may face. They
direct interaction with students and teachers.
1. From April 94 - July 94
Selection of Nursing School : The
Maharashtra Nursing Council was contacted for a
list of Training Schools in the state. The Maharashtra
Nursing Council issued a list of schools along with
their criteria for selection of ANMs. Pune has two
are not aware of the agencies/persons, besides the
PHC Medical Officer (who is often a male), to
look for help in a crisis. It should be an integral
part of their training that they are aware of the law
and other social agencies which can help them in
case of any form of sexual harassment, overt or covert.
ANM training schools but both being grant-in-aid
schools, they were rejected. The Satara Nursing
School was selected as it is a Government School.
Since there is a backlog of posts to be filled from
the backward categories, the Govt, run schools like
this one, tend to enroll students from backward
(reserved) classes. As such, the graduates of this
school stand a better chance of gaining employment
as rural ANMs than those graduating from grant
in-aid schools.
A trainee spends about 50% of the total
training in the urban hospital. In the clinical setting,
experiences are planned in relation to service needs
rather than the curriculum objectives. In many places,
trainees are made to work with hospital procedures
such as bed making, personal hygiene of patients,
post-operative care etc. As already mentioned, the
hospital authority utilises student services for
hospital work instead of employing extra nursing
staff.
A meeting was held with the teaching staff
of this school so as to discuss the best way possible
to attain the objectives mentioned earlier.
2. From July 94 - Dec. 94
There are few in-service education
programmes. If there are any, they only concern
Training of ANMs in the selected nursing
27
I
school. For this purpose, a batch of 30 students
from the first semester was made available for one
one of the students was surprised to learn that the
stomach is placed so high. Earlier she thought that
and half hours every 15 days.
it was situated around the umbilicus. Similarly,
students were surprised to know that the uterus is
During our interaction with students we
just the size of a fist. They had earlier thought of
it as being much larger in size. Comparing the size
enquired about their problems, expectations, and
aspirations. We concentrated on basic lectures rather
of a new born infant, and the uterus size, the concept
of elasticity of muscles could be explained.
than continuing education. This was carried on for
4 months. (Training Content Annexure 3)
On enquiry, the students said that when the
The students reported the problems and
difficulties faced by them with respect to the training.
above method was used it was easier to understand
the concepts. Since colloquial words were used they
Most of the students found words used in Anatomy
did not have to make efforts to learn the words and
and Physiology too difficult. The words used for
instead could concentrate on other aspects such as
function and location of the organs. They enjoyed
the session as it was participatory and informative.
organs and processes were either in English or
Sanskrit while the students preferred colloquial
names and words. As a result, they felt that they
had to sit for long hours listening to lectures which
In Nov. 94 the above mentioned batch of
students were posted for rural field work.
were not relevant.
The ANM training course is conducted in
three semesters of six months each. During the first
semester, basic lectures on Anatomy, Physiology,
Microbiology, Nutrition etc. are completed. The
second semester is devoted to gaining rural field
experience. During this semester it is almost
impossible to hold any lectures as students do not
have any regular working hours. During the final
and third semester lectures in Basic medicine and
To overcome the above difficulties, we
decided to involve students in the process so as
to increase their participation.
To make them understand different body parts
and functions the following approach was used :
*
Most of the students were from non
vegetarian homes. They were asked to name different
parts of the chicken. Students were able to identify
60% of body parts and function. There upon, it was
easy to relate this knowledge to the human body.
Pharmacology, Sociology, Midwifery, and
Communicable diseases are delivered, and the
trainees are provided with clinical experience. This
leaves them with little or no time for any additional
training. Thus the third semester students could not
be spared for additional work. We were allowed
only one session with them.
*
The remaining parts with functions were
explained with the help of diagrams from their text
book.
*
The next step was to locate these organs by
drawing imaginary lines on their body.
Third semester students had some experience
in the field and thus were aware of many issues
related to work though they faced the following
This helped them to understand location,
shape and size of the organ. To cite an example
28
I
problems :
knowledge was provided to them in isolated parts
*
No cognisance was taken of their experience
and final integration of all knowledge was not done.
and the trainers were unable to provide them with
We helped them to understand the above
practical alternatives.
process by starting with common complaints like
We discussed the problems faced by ANMs
in a group and told them to relate their experiences.
Most of the students could find alternatives to the
problems faced by them. The experience sharing
session helped them to solve problems using one
anothers’ experiences.
backache.
We first discussed the etiology of backache
and from there moved on to the Anatomy and
Physiology of related systems such as the
skeletal, muscular and reproductive systems. We
also discussed diagnostic methods and the
necessary treatment for the same. To make the
sessions participatory, the students were divided
into groups and were given books and material
to read which they had to discuss and present.
They were also asked to narrate particular cases
they had seen. This helped them to develop a
holistic outlook including the socio-cultural
aspect. For example, women suffering from
backache do so because of the nature of work
they carry out either at home or in the fields.
All jobs done by them require only forward
bending. The solution in this case was identified
as the need to perform backward bending exercises.
One student related her experience about
dealing with a case of snake bite. The person
was taken to the “Bhairoba” temple and the
Bhagat gave him a few neem leaves and two
green chilies to chew. Since he could not
perceive the bitter and hot taste, the Bhagat
predicted that he would die. Through discussion,
the group was able to relate this "‘diagnostic
practice ” to the fact that cobra poison is neuro
toxic and affects the nervous system and sense
organs including taste buds. (However, this
diagnostic practice may not work when the
person is bitten by a lethally poisonous snake
but one with haemo_toxic venom like the viper
or krait.) Therefore, the Bhagat could identify
that the person had been bitten by a cobra
(a snake with lethal poison), and would hence
die anyway. Since the Bhagat’s predictions
mostly turn out to be correct with the help of
the above mentioned diagnostic skill, people
tend to have faith in the Bhagat. Once the
ANMs were able to understand the diagnostic
process and the reason behind the faith shown
by the people in the Bhagat, they could identify
the solution for handling this problem more
effectively. The alternative suggested was to
make the patient first take anti-snake-venom
(ASV), and then seek advice from the Bhagat.
*
*
For giving them a broader dimension of
Health, they were asked to write down their concept
of a healthy village and what steps needed be taken
to achieve this ideal village. ANMs came out with
a wide spectrum of activities to be performed right
from setting up a health centre to income generation
activities. This information was then presented to
the class and the connected issues were discussed
in detail.
As mentioned earlier, we could take only
one session with the third year students and so our
training was limited.
During the third Semester they are taught
Basic Medicine and Pharmacology, while Anatomy
and Physiology is taught in the first semester.
Suggestions made by the students regarding
training :
Students were unable to integrate their knowledge
*
and treat the patients coming to them since the
improvement. The teachers should be made aware
29
Training methods at ANM schools need
of new teaching methods which are participatory
in nature.
Attitude was gauged through discussions.
Discussions were held on i) Target free approach
ii) Health in broader context iii) Community
*
The syllabus needs revision to make it more
holistic and integrated.
participation. The discussions were documented.
3. From Jan. 95 - Dec. 95.
These discussions revealed a positive outlook
on the part of the ANMs.
At the Satara Nursing School we were able
*
Out of 40 ANMs, only 3 said they did not
believe in the target free-approach.
to identify the lacunae of the existing system. We
devised an improvised package for ANMs already
posted in the field. Our attempt was to provide
*
All 40 stated that socio-economic
development is crucial for improving the health of
a village, community.
continuing education to these ANMS and to test the
improvised package, and at the same time identify
field related problems, and seek alternatives for
these.
ANMs offered the following suggestions for
improving community participation.
Every district has a District Training Team
(D.T.T) comprising of an M.O., P.H.N, Malaria
Supervisor, L.H.V. etc., The function of this team
is to provide continuing education to Govt health
- Use of traditional medicines.
- Improvement in diagnostic skills.
- Increase in ANMs knowledge/information about
staff. However, the focus of this team is to provide
laws, especially regarding women, various
training to M.Os and other higher level functionaries
rather than to ANMs. The only inputs that ANMs
receive are related to Family Planning and
Immunization target achievements.
Government schemes etc. so that they could share
the knowledge with the community and relate better
to it.
- Improvement in their skills concerning
gynecological disorders.
We contacted the Pune District Training Team
and were able to obtain a three hour slot during
Skills : They were given skills in speculum
examination and identification of minor ailments,
which 36 out of 40 ANMs were able to handle.
workshops. We conducted three hour sessions each
at 3 months interval.
The method used consisted of participatory
training as used earlier (Ref. Annex. 3 for training
contents.)
After 3 sessions, the D.T.T. was reluctant
to give any more slots as it meant keeping the same
ANMs away from their stations for a long period
which adversely affected the fulfillment of their
targets.
Evaluation : Attitudes and skills were
evaluated. Knowledge is cumulative and need based
and thus was not focussed upon by us while
evaluating. Understanding rather than memory was
emphasised.
4. Jan - 96 to April - 97
After numerous discussions amongst
30
ourselves and with PHNs and the DHO at Pune,
regions of Maharashtra with the objective of giving
we decided to take up their suggestion to contact
MOs in two PHCs and ask them for time either
the benefit of the contact training programme to
4 other regions other than Pune, and of making
during their monthly meetings, or on courier day when
our training method as relevant as possible. 240
the ANMs come to submit their reports at the PHCs.
ANMs participated in this workshop. (Geographical
details in Annexure 7). The sample covered was
PHCs selected
the same as for Aayushi impact assessment.
Two PHCs near Pune were selected so that
they could be visited frequently. We were asked by
The workshops included only ANMs and the
FRCH team, and we made it a point to exclude senior
health service officials so as to allow ANMs to
the PHCs to continue sessions after the monsoons.
Since January - March are normally busy months,
only one session could be held as the ANMs had
freely express their views. The method was
participatory with an emphasis on discussions with
to be relieved so as to reach sub-centres before
heavy rains.
the participants. Additionally, group discussions and
presentations were also arranged. Seating
arrangements were circular and first names were
Fourteen ANMs whom we contacted
regularly once a month were selected by us.
Method Used : Participatory training as used
earlier (Ref. Annex. 3 for training contents.)
used to remove any kind of hierarchical equations.
(Refer to Annexure 3 for contents covered in the
workshop.).
Evaluation using the same method as
The ANMs all enjoyed the workshops
The results are as follows :
immensely, and wanted such workshops to be held
each year, not only for themselves but for other
mentioned above.
*
10 out of 14 ANMs improved their rapport
with the women since they were able to treat their
gynecological ailments.
ANMs as well. For most, it was a rare opportunity
to learn, and a forum to discuss their problems and
views. At the end of each workshop, the ANMs
expressed that it was like “homecoming” for all of
*
Use of home remedies increased. All 14
ANMs started using home remedies.
them. They were all reluctant to leave and the parting
was very emotional for us as well as for them.
*
Out of 14, 10 felt that the target free approach
was correct. The remaining 4 were not convinced.
Workshop evaluation was carried out using
the method used earlier, and attitudes and skills were
emphasised rather than knowledge and memory.
Communication and Diagnostic skills along with
attitude and perspective were focussed upon for
effective field performance.
*
All 14 ANMs came up with different
problems and valuable suggestions regarding : 1.
Improvement in nursing training 2. Drugs to be issued
to them 3. Administration problems.
5. Sept 97 - March 98 : Workshops
We conducted
workshops in 4 different
31
From the evaluation we gathered that :
While discussing the population issue, the
relation between density of population and life
style were discussed and participants were
informed about countries with high population
densities and affluent standards of living, in
spite of having poor natural resources. These
included several examples from Europe. The
group realised that high population density need
not be accompanied by poverty.
*
Out of 240 ANMs, only 27 said they did
not believe in the target free-approach.
*
All 240 stated that to improve the health of
a village, socio-economic development is the most
important.
*
All of them expressed that they would use
plural systems of medicine for treatment.
Secondly the flaws in the existing Family
Planning Programme were discussed. The
Family Planning programme run by the Govt
uses a target oriented approach. This was
discussed in detail, and it was felt that this
is not a democratic approach. Additionally, the
devices presently used are provider controlled
rather than user friendly. The target oriented
approach results in the promotion of provider
controlled mechanisms like tubectomy and IUD,
rather than user controlled mechanisms like
natural family planning or barrier methods. The
underlying philosophy is that people are not
“equipped” to deal with their own health. This
philosophy also affects the extent of information
given to ANMs, and thus to the community as
a whole. Our discussion revealed that even the
ANMs did not know about the history of the IUD,
and the complication its use may lead to. The
gender bias in the approach is evident as women
constitute the target group for Family Planning.
Table
Number of ANMs contacted for training=357
Would like contact programme
Will not like
to attend
contact
programme
350
07
Conclusion
With respect to initial training of ANMs:
* TYaining content : The syllabus needs revision
to make it more holistic and integrated. Apart from
medicine, the training should also include subjects
like legal counselling, gender issues, community
organisation, communication skills, and govt schemes
In U.K. for example, population levels
declined only after economic development
occurred. In Cuba, which is an underdeveloped
nation, the population declined within a period
of 25 years, since population programmes
focussed upon women's education and
development.
for development. The total training period of 18
The causal relation between poverty and large
family size was discussed. Whether a large family
size results in poverty, or vice versa was the debated
question. Ofthe 240ANMs, 213 ( %)felt that poverty
is the cause of large family size.
physiology, sociology, and psychology can focus more
The exercise helped the group to
understand the population issue in it’s broad
perspective.
years rather than one and a half years, so that both
months is too short to get acquainted with the
various subjects taught. It would therefore be better
to limit the training content to fewer subjects, giving
greater inputs in areas that would equip them for
their specific roles. The subject matter of anatomy,
on areas geared to their practical work instead of
being taught as abstract theoretical subjects.
* Training duration : The duration should be two
social and technical skills may be enhanced.
32
*
TYaining arena : Rural training period should
rather than occasional : Training should be
be increased and quantum of time spent in hospitals
conducted at four monthly intervals for two or three
days, through out the service period.
should be reduced to make this programme a truly
community based programme.
* Experience sharing : The principles of Adult
* Training methods : These need improvement.
Education need to be used and participatory
The teachers should be made aware of new teaching
approaches rather than lectures must be used.
methods which are participatory in nature.
* Need based :
Training must be need based and
not scheme based.
* Evaluation : The training should be evaluated
on the basis of attitude and skills and not only
on the basis of knowledge.
The objective relating to contact programme
in continuing education and training of ANMs is
* Inclusion of other science subjects : Other
subjects offered as a part of the Higher Secondary
extremely relevant. Our project has achieved this
Course need to be included in the course so that
objective to an acceptable degree, but if accepted
at the policy-making level, it would have a wider
ANMs can pursue further studies (Degrees or
diplomas). The inclusion of mainstream subjects
and long lasting impact on the health service delivery
system.
would make it possible to consider this course
equivalent to Higher Secondary Course (Science).
□□
With respect to continuing education :
* Regular training throughout the service period
33
I
I
DEVELOPING TRAINING MANUALS
Objective 3
efficiency at present, were discussed.
To develop training modules for improving
The discussions revealed the bureaucratic
the quality of basic and in-service training of
ANMs through the training teams and MPW
approach of Directors, and target oriented pre
occupation of PHNs and DHOs. Teachers in ANM
training institutions.
training centres seemed to be focussing more on
hospital based technical skills rather than on
The training manuals were prepared :
grassroot level skills that ANMs require. The
1. To increase the professional skills of the ANMs.
discussions with MOs and ANMs were most fruitful
2. To enable the ANMs to reach out efficiently
in terms of identification of problems faced by
to a maximum number of people, with health
Steps carried out in the preparatory phase :
ANMs revealing better awareness of ground
realities. Few were however able to give suggestions
for improving the existing situation.
1. Discussions
2. Study of reports
services.
The following reports/s studies were studied
with regard to the preparation of the training manual.
The people who were approached for
consultation and discussion with regard to the training
manual were as follows :
i.
“Evaluation of ANMs function” published
by Government of India, 1989
ii.
“Evaluation of ANMs skills” by Dr.
a. Director, Health services, Maharashtra
b. ANMs - 125
Western Maharashtra
Konkan region
Vidarbha region
Marathwada region
Prakashamma, 1985. (Unpublished PhD
thesis JNU), Delhi
25
20
iii. “Women in Health Care” - by Aditi Iyer,
Amar Jessani et al, FRCH, Mumbai/Pune
1992.
70
10
The GOI publication on evaluation of ANMs
emphasised the target oriented approach, hence skill
125
c. District Public Health Nurses (PHN)
- 8
d. District Health Officers (DHOs)
5
e. Medical Officers (MOs)
10
evaluation regarding other functions of ANMs
remained overlooked. Dr Prakashamma has discussed
the unsatisfactory level of skills but has not delved
into the factors responsible for ANMs’ inability to
develop skills. The FRCH publication highlights the
socio-cultural problems faced by ANMs leading to
poor performance, but fails to look at the inherent
f. Teachers in the ANM training Centre - 12
Specifically, points relating to factors that
would contribute to improvement of work
performance of ANMs and factors hampering their
34
limitations of ANMs due to poor knowlege and
low level of skills of the ANMs.
health, by viewing the issue in a more holistic way.
4.
3. Field Work
ANMs would benefit from information
We carried out surveys and interacted with
regarding rules and regulations pertaining to their
work.
the ANMS in 15 districts of Maharashtra, and 4
districts of Madhya Pradesh.(See Annexure 7)
Taking these needs into account, the following
manuals were devised :
Based on our interaction, we could arrive
at the following inferences :
1.
Duva - For information on diagnosis of
diseases by gauging symptoms, home remedies,
the use of medicines in ANMs kits, and tips
for referral of patients.
1.
ANMs did not seem to enjoy sufficient
credibility in the area of operation. This was seen
to be related to inadequate diagnostic skills.
2.
2.
ANMs were often unable to establish rapport
with the members of the community. This was due
to poor communication skills.
Madhyam - For development of interpersonal
communication skills.
3.
Disha - On women and health, and women
health workers.
3.
4.
Drishti - Information about administrative
rules, education, savings and investment,
ANMs, being women, many women come
to them with women-specific health problems.
However, the ANMs were not able to deal with
even minor gynecological disorders.
women’s organisations, relevant to ANMs.
Writing the manuals
4.
ANMs are not aware of government rules
and regulations as prescribed by the state government
After the contents of the manual had been
determined in the above mentioned manner, we
and hence are exploited regarding simple matters
such as leave from work,travelling allowance, and
at times, even salaries.
studied the available books/ manuals for health
workers. These books/manuals can be broadly
divided in two types :
- All the above affected their performance
in turn, affecting health care delivery.
1. Books where information has been provided
descriptively.
What needs to be done :
1.
2. Books/Manuals where information has been
illustrated in the form of flow charts and tables.
2.
In order to field test both these methods of
information presentation, we conducted three
workshops with ANMs, with the help of Pune DTT,
as well as with the trainee ANMs in Satara Nursing
School.
In order to increase the credibility of the
ANMs in the community, one needs to help them
to improve their diagnostic skills.
Similarly, oral communication skills need to
be developed so as to help them establish a
better rapport with the community.
3.
ANMs would benefit from self-learning
manuals that would help them to deal with women’s
In general the the 70 ANMs that we spoke
to were of the view that it is easier to understand
35
information presented in a descriptive manner.
Information presented in a descreptive fashion is
the ability to translate the information presented, into
action, and to understand the logic seemed to be near
wholesome in terms of content, and can provide all
absent amongst the ANMs. This reflects the lacunae
the details as well as dimensions of a particular
in the training received by them. It was therefore
issue or problem. On the other hand, Tables provide
decided to present the manuals in text and table form.
information at a glance and can be consulted when
is promptly needed, such as when a patient is waiting
While studying the available health manuals,
an important drawback observed was that the contents
are not interrelated or integrated with each other.
for treatment, tables prove to be an effective mode
of obtaining information quickly. We were able
Also the complete context of any given issue is not
discussed. While carrying out a particular task or
to ascertain that, as far as flow-charts are concerned,
activity, the problems pertaining to technical, social
quick reference is essential. Hence when information
or skill-related aspects might arise. However, the
manuals only deal with the technical information. Taking
Example of Flow Chart
Has your child
passed no faeces for
more than a day?
-Yes ->
Does your child
complain of abdominal
pain?
into consideration this drawback, we have attempted
to present information in an integrated manner.
I
No
When ANMs are trained in the method of
water-purification, they are taught to measure
water capacity of a well, based on the assumption
that the well would be circular in shape. The
quantity of bleaching powder to be added will
vary according to the estimated water capacity.
In reality, water capacity estimates can go
haywire since wells are often triangular, square,
or rectangular. Additionally, bleaching powder
leads to death of fish found in wells. The
implications of such factors remain out of the
framework of the text books. Often villagers
refuse to drink water out of wells where
bleaching powder has been added due to the
smell and the feeling that the water has now
become “non-vegetarian”. Further implications
of this could be women having to fetch water
from distant wells where bleaching powder has
not been added. The final impact of this could
well mean facing the hostility of village women
instead of establishing rapport with them.
No
_____ I
J
________
Is it usual for your child
Normal bowel rhythms
to defecate only once - Yes> vary considerably. If your
every few days?
child is well and has no
dicomfort, this is no cause
I
for concern.
No
4/
Has your child had a
feverish illness OR has
he or she been vomiting?
— Yes-^-
No
L
Has your child
passed hard or pellet
like faeces?
—I
Loss of fluid as a result
of sweating or vomitting
can cause your child's
normal bowel rhythms to
be upset.
Self-help : Make sure
that your child has plenty
of fluids while unwell.
Your child's bowels will
return to normal as soon
as the illness has run its
course. Consult the appro
priate chart elsewhere in
the book for advice on
treating the underlying
disorder.
Has your child had pain on
The solution to such a situation would be the
use of alternative means of water purification, for
example the use of alum or drumstick powder. Such
alternative mechanisms remain out of the framework
of the training books and schools for ANMs.
defecation in the past few
days OR have you noticed
blood on the surface of the
faeces?
36
ANMs tend to approach a problem in a
1.
Initially, we used to initiate a discussion
mechanical manner, rather than attempting to
on some topic. Everyone was expected to contribute
understand the psychology behind a particular pattern
in these discussions. The discussions were open and
of behaviour. This in turn adversely affects the human
relations aspect of the problem, which cannot be
ANMs responded without any prodding or coaxing.
overlooked. Therefore, it is necessary to orient
For example, they were asked "what kind
ANMs to approach the problems with an
of complaints do people generally turn up with.”
understanding of the perspective and socio-cultural
context.
Then these complaints were marked on the basis
of frequency and intensity. After this, it was discussed
whether they had any remedy or medication for those
ANMs complain that pregnant women are
complaints. Were they aware of Home remedies ?
not regular as far as attending monthly check
Such relevant information, as well as tips about
ups are concerned. They do not take the calcium
and iron tablets given to them. Often, women are
unable to attend because of restrictions from the
referral were given to the ANMs. This was the
manner in which we collected data during field work.
family, or because they would lose a day’s wage,
from agricultural work. With respect to
2.
Based on our interaction with ANMs we
arrived at the consensus that the manual would be
more effective in tabular form.
medication, pre-conceived notions about side
effects, and actual experience especially because
the instructions about when to take tablets are
3.
We collected home remedies from ANMs,
looked up Ayurvedic texts for remedies, and based
on relevant discussions with practising Ayurvedic
Vaids, in Pune, we selected certain remedies for
incorporating into the manual.
often vague or incomplete, lead to reluctance to
follow the medication regimen suggested. ANMs
often overlook these causal factors and blame
women for not taking care of their own health.
This affects the communication process and
rapport between the ANM and the women, since
women perceive the approach of ANMs as
"inhuman”.
4.
After the format and the content were
determined we prepared a manuscript and gave it
to two experts for testing its technical accuracy. One
of these experts was an M.D.and a practising doctor,
and the other one was a Ph.D in Pharmacy and who
has done research in Pharmaco kinetics of Ayurvedic
medicine. Their suggestions were incorporated into
the manuscript.
ANMs need to take into account, the
complete perspective, instead of having a
mechanical approach.
Manuals
5.
Then we invited suggestion from the ANMs.
This was done through the six workshops that we
conducted in four different regions of Maharashtra.
Suggestions pertained to language, illustrations and
content.
I. Duva
The important aspect in the preparing of
this manual was that it was done with the complete
participation of ANMs.
37
IL Disha (Basic Training Manual)
ANMs, and if in the discussions, it came out that
they had attempted to solve their problems through
This manual was designed to prove useful
existing methods or in an innovative manner, we
to ANMs in their routine work, helping them tackle
noted this down. The expereince sharing exercise
helped us to find feasible solutions to the problems
of the ANMs.
the difficulties they faced as women professionals
in the rural community. Similarly, it aimed to enable
ANMs to find alternative solutions for their problems
and women’s health problems.
4.
After this process was complete, we prepared
a manuscript of the manual, and gave it to experts
for suggestions. The experts comprised of a senior
In this manual, a story format has been used
taking an ANM as a central character. This was
anthropologist, two gynecologists, and an M.D.
doctor. We incorporated the suggestions of these
experts in the manuscript.
done to make it interesting and readable. Through
the central character, a representative ANM, we have
attempted to present how to tackle the problems faced
5.
Illustrations included in the manual were
selected by conducting an opinion poll among ANMs,
in which they were asked to select one out of three
by an ANM, how to deal with the difficulties
encountered while working as a woman at village
level, and how to deal with health problems of
faced, as a woman who does not belong to the
different styles of pictures. This was done to make
the manual as ‘user friendly’ as possible.
place where she works, rather than to difficulties
6.
faced as an ANM. Such difficulties can be best
handled in a story form.
This was done through the six workshops that we conducted
in four different regions of Maharashtra. Suggestions
pertained to language, illustrations and content.
women. Some of the difficulties pertain to problems
While writing this manual, various relevant
issues such as ‘interpersonal behavior, the need to
Then we invited suggestions from the ANMs.
III. Madhyam
understand others’ cultures’, the link between
political processes which impinge on health issues
positively or adversely thus affecting health
This manual was designed to improve the
communication skills of the ANMs. The manual
contains the experiences of different organisations
who have attempted to build up a rapport with the
community, based on health issues. By giving a
summary of the article at the beginning, we have
attempted to focus the subject clearly. The manual
problems, status of women and their impact on
health - have been discussed.
1.
We had discussions with 20 village women
and tried to understand their specific difficulties
regarding women’s health issues.
also explains how to initiate work in a village.
2.
We presented these difficulties to the ANMs,
and discussed how these difficulties could be
handled.
1.
We carried out discussions with ANMs in
15 districts of Maharashtra. We were able to identify
the various strategies and methods used by ANMs while
3.
working in the villages through these discussions,
which have been incorporated into the manual.
We tried to understand the problems of
38
Women and Law, Hostel accomodation for working
One ANM initiated a ‘Mahila Mandal’ or
womens group as well as a ‘Bhishi’ or rotating
fund in the village. This helped to establish
rapport with women in the community, and she
was able to carry on her tasks ably
Similarly, another ANM began to use herbal
medicines for treatment when the drug supply she
received was found to be insufficient. For this, she
had to study a few books on Herbal remedies. This
practice helped her to establish rapport with women
in the community.
women and Further Educational options for ANMs
were covered.
1.
by the ANMs during our field work.
In one case that we came across we found
that one ANM who had to spend Rs. 7500/= to
have her Travelling Allowances bill for the
amount of Rs.5000 passed. The story runs as
follows
The total area under this ANM's
jurisdiction was about 100 sq.Kms. The ANM
being under the impression that her money
would be re-embursed, continued to bear the
travelling costs for 2 Years. In the hour of need
at the festival time she tried to claim the money
due to her. She was made to pay Rs.2500 as
underhand money to grease the bureaucratic
machinery which after this, acted with unusual
speed to pay the bill. At the subsequent Audit,
this payment was objected to as being time
barred and recovered from her salary. The net
effect of this was that she lost Rs.2500 for
wanting to claim her rightful dues, as well as
We carried out discussions with a few
2.
organisations involved in the field of health
education, and incorporated their experiences in the
manual.
The expereience of a doctor working in
the slums of Pune, in the field of contraception,
provided interesting material that could be
incorporated into the manual. This doctor makes
it a practice to read a story about unequal
decision-making power to couples visiting him
for contraceptive advice. Through the story, he
conveys how women bear the brunt of taking
the complete responsibility for contraceptives,
because decision-making powers vest with the
male. Women are brainwashed into believing
that the burden of carrying out contraception
lies with them. The story tries to impart the
message that males also have equal
responsibility of contraception and should take
an equal part in the process.
IV.
We noted down the difficulties encountered
the Rs. 5000 due to her as Travelling Allowance.
2.
We gauged their level of information
(regarding administrative rules) by getting a
questionnaire filled from them. Based on this, we
charted out the manual.
3.
After the topics/issues had been pinpointed,
we researched on the relevant rules and regulations,
Drishti
and simplified language.
This manual has been prepared to explain
4.
the meaning of administrative rules and regulations
Thus, having prepared the manuscript, we
consulted the relevant authorities,(Zilla Parishad
using a simple language. Not only rules and
Adminsistrative Officer and Accounts Officer) for
regulations, but also additional topics like Saving,
obtaining their suggestions.
* 229 ANMs have shown willingness to purchase Manuals.
* Thus we can conclude that project has achieved its objectives to a high level.
39
I
Activities
ANMs in Madhya Pradesh and Maharashtra was
List major activities planned and compare
submitted in 1992.The above mentioned project was
with end of project status. Give main reasons for
sanctioned in October 1994.The Principal
Investigator of the project left FRCH unexpectedly
3.
major deviations, including such related to
performance of recipient institutions and DANIDA
in January 1996. The Project team then realised that
some aspects of the initial project proposal needed
to be revised.
1. Production of the Journal
1.
2. Preparation of the Mailing List
Magnitude of objectives stated in proposal
which included :
1. Training of ANMs
2. Production of the monthly Journal in two
3. Field Surveys done to assess impact of
journal.
4. Contact training programme of ANMs through
Nursing School.
3.
languages;
Production of four manuals.
2. Budget allocation which had not accounted
for inflation since 1992.
5. Preparation of training manuals.
The major deviations in it.
3. Personnel: In view of the objectives, the number
of personnel budgeted for, viz 1 doctor and 1 nurse,
At the Government ANM training schools
the authorities were not willing to release final year
students for training. For our purpose the first year
ANMs were completely inexperienced and totally
were found to be inadequate for the function to
be undertaken. A much larger number of staff
members of above categories would have been needed
lacking in field experience as our training impinged
for proper training of ANMs, preparing manuals, and
publishing, technical aspects of the journal.
on continuing education and not merely initial
education. Hence, since no purpose would have been
served by training the first semester students, the
Government training schools could not be
incorporated in our schedule and training was
The Journal4Aayushi’ was distributed to
15,000 ANMs in Twenty-nine districts of
Maharashtra and Seven districts of Madhya
Pradesh. Constructing the Mailing List for this
distribution itself proved to be a formidable
conducted in two PHCs.
2.
To assess the impact of journal we
conducted workshops in four different socio
enterprise. Management of the entire mailing list
for a journal of this magnitude required additional
recruitment of at least two additional personnel,
for without this, the loss during delivering of the
journals to the desired audience would have been
unacceptably large.
economic regions of Maharashtra.
4. Efficiency
Assess :
Whether plans of action were realistic and
adequately prepared.
4. Travel and training : Travel and training are
two distinctive heads which should have been
budgeted differently since there were many
FRCH‘s project proposal to DANIDA in
connection to the project “ Training support for
40
occasions where travel was under taken without
the inputs for continuing education should reflect
implicating training such as for feedback surveys
problems encounted by ANMs in the field, we held
and updating of Mailing list. Several surveys
regular meetings of ANMs working at PHCs/
needed to be conducted in Maharashtra and M.P
Subcentres. In the course of these meetings
The distances covered were often considerable. The
Participatory training was conducted.
distances covered by Jeep in a day were often over
400
kms
and
expenditure
incurred
While the Training of ANMs in Nursing
was
Schools was not achieved, extensive workshops
approximately Rs. 1500=00 per day. The budgeted
were conducted in the four different regions of
amount of one and half lacs in the project Proposal
Maharashtra which helped to improve the quality and
hence proved to be unrealistic.
relevance of the manuals. This also helped to achieve
Nevertheless, the mid course corrective
ultimate personal contact during training sessions with
measures instituted or observing the unpredicted
ANMs selected through random sampling.
difficulties when submitting the initial research
IV
proposal have proved to be effective in achieving
Assess the way in which external factors
have affected project implementation.
the major objectives. The staff as well as the
Various external forces affected the
Funding agency have shown extensive adaptability
of which latter has been greatly appreciated.
development of the Project.
Assess:
I. Contact Training Programme related issues
The quality of Project organization and
management.
1. The Government of Maharashtra objected to the
forming of groups of ANMs at Taluka level for
As mentioned previously, the management of
training purposes as it feared, that doing so would
the project was complicated by the unforseen
provide a platform for the ANMs to unionize.
resignation of the Project Officer midway in the
2. At the Government ANM training schools the
project which entailed involving changes in
authorities were not willing to release final year
personnel and budget.
students for training. For our purpose the first year
III. Assess : If any major project reformulation
ANMs were completely inexperienced and totally
took place during the implementation :
lacking in field experience as our training impinged
The major reformation of the project in the
on continuing education and not merely initial
course of its duration were : 1. The ANM training
education. Hence, since no purpose would have been
schools do not normally have continuing education
served by training the first semester students the
programmes as the employed ANMs would be
Government training schools could not be
working in the field and would have rarely the time
incorporated in our schedule.
and opportunity to avail of such programmes.
3. The District training team was unable to provide
We were compelled to conduct training with
the same ANMs consistently for contact training
student ANMs who as yet had no experience in
program as it required that the ANMs for this would
the field; in a representative ANM School. Since
have to take time off from their regular duties in
41
I
5.
the Primary Health Centres and Subcentres.
Continuous absence of such ANMs from duty would
Sustainability
Economics of the Journal
have created administrative problems.
Expenditure on any kind of publication can
be divided in the following categories :
Mailing list problems concerning the journal :
Mailing problems manifested as unexpected
1. Expenditure on salary
50%
difficulties in distribution of the journal to its vast
2. Expenses on paper
30%
readership. We were informed by the postal
department that since there are few permanent postal
3. Expenses on printing and
labour charges
20%
Thus to recover the full expenses from
subscription is difficult. FRCH is trying to generate
subscription and at the same time would reduce the
employees in rural areas as opposed to those working
on daily wages, accountability and work efficiency
are generally lacking.
Administrative Issues
quality of paper and manpower at present on the
project.
The ANM is at the lowest rung of the public
health system. In order to bring any meaningful
We have already received subscription from
people of the following categories :
changes in the system, inputs should be offered to
the administrators in the system also. To expect
ANMs to institute changes in health care delivery
system while they lack any significant say in planning
ANMs - 300
PHC Staff - 25
and management and mode of implementation is
unreasonable.
NGO - 250
Thus FRCH has decided to continue
publication of Aayushi and further promote Aayushi
for subscriptions.
FRCH will conduct workshops for ANMs
in all the 29 districts of Maharashtra. Through these
workshops, we can conduct continuing education
of ANMs as well as raise subscriptions and promote
manuals.
6. Possible Future DANIDA Support
FRCH would appreciate it if DANIDA can
support such an activity as publishing a journal in
Madhya Pradesh.
42
7. Other Comments and information
to by the ANMs in practice and the different
programmes implemented through ANMs.
During our interaction with ANMs the
following problems were brought out which make
their work less effective than desired :
3) Drug requirements & Supply : In order to enable
the ANMs to perform more effectively it is of
1) Working area of most of the ANMs was spread
paramount importance that they establish a very good
out. This results in reduction of effective working
rapport with their community. The felt need of the
hours. The average time spent by the ANMs in
community is getting their ills cured and NOT
reaching their place of duties was 2 hours (ranging
prevention. It is found that the ANM drug kit has
from a few lucky ones needing only 30 minutes to
those needing as much as 6 hrs each way.)
more preventive medicine than curative which
decreases her utility for the community. Also, drugs
have made available with the ANM at the hour of
We cite one of the examples found in the
tribal districts of Melghat and Gadhchiroli. In this
need of the intended beneficiaries (or more
specifically, all the year round) especially during
area some of the ANMs have to walk 22 Knis each
the last quarter of the financial year. (Drug list given
way. During this walk they have to climb up and down
by ANM attached, refer Annexure 4)
a few hills, cross a river where there are no bridges.
No transport is available as there are no roads. The
4) The target free approach directed by the Govt
problem becomes severe during the monsoons as these
being forest areas, the rainfall is very high.
is only on paper and NOT in practice. Moreover
tubectomy is traded in exchange for a favour like
2) Another problem is that of the population assigned
special treatment at the school, extra ration for grain
at fair priced shop, settling land disputes etc.
to each ANM.Govt Directives assign 5000 people
per ANM in plains and 3,000 people per ANM
in tribal/hilly areas. But in practice it is found that
Given this context, the ANM is a non-entity
as she can grant no favours and is thus unable to
on an average an ANM looks after anything between
7,000 to 10,000 people on the plains, and around
4,000 people in hilly/tribal areas. This obviously
is beyond the average human capacity. Disregarding
this background, ironically, the Nursing Council of
India claims that ANMs are not competent enough
meet her targets. Hence, to keep her service record
untarnished, she has to literally buy the cases. Upon
speaking to the ANMs they suggested that Family
Planning targets to be set for the village as a unit
and NOT for individual ANMs. Another cause for
worry is the recent Govt directive of making Small
savings target of Rs. 10,000 per ANM. As it is. Family
Planning targets have placed ANMs at a disadvantage
with their community, collection of money will further
create a barrier in building rapport with the community.
and hence advocates the closure of ANM schools
to be substituted with General Nursing & Midwifery
Schools. Moreover, the State Government claims that
stipulated target of the number of ANMs required
has been met, ignoring the reality.
5) To compound the problems and the difficulties
of the ANMs there is NO continuing education being
planned or implemented for them.
In actual fact, the work load and professional
responsibilities of these ANMs have increased many
fold as is evident from the average population catered
43
1
6) The ANMs are not aware of the conditions and
terms of the service. A sad example is that on the
a tiger lurking near her house in the middle of the
one hand Earned Leave is sanctioned and on the
was informed by the locals that she should be
other hand some MOs make them write that they
prepared for the tiger prowling around that area
are working of their own free will and then call
again. Being unaware of the habits of the tiger the
them to work, as a condition for sanctioning their
ANM was disbelieving. As predicted by the villagers
Earned Leave. All these difficulties result in
the tiger came there again the following night. The
adversely affecting the output, effectiveness and
ANM was scared and called out for help. A
efficiency of the ANMs.
neighbour obliged. The tiger turned and attacked the
night. Upon narrating this to the villagers the ANM
man. He was mauled to death. Had the ANM been
trained in jungle culture this probably would not
7) Tedious Record keeping is being asked to be
maintained by the ANMs, at their own expense to
have happened.
the tune of Rs. 1000 p.a. This system of Reporting
In the second instance a pair of ANMs were
takes up 20% of the working time, thereby seriously
nearly trampled to death by a herd of stampeding
bisons. It was sheer luck that they escaped by seeking
shelter in a depression in the ground in the dry water
hampering the general performance and output.
ANMs have to reside at the sub centres, and
thus land up maintaining in certain cases two
course that chanced to be in the vicinity.
establishments or even three. In some cases thier
husbands have to leave their jobs to stay with them.
Suggestions of ANMs with policy-relevance
It also some times forces them in keeping their
children at the District place for education purposes,
1.
ANMs would like government to build
hostels for their children at district places where
accomodation would be made available at a
subsidised rate.
resulting in further strain.
8) The training programme for the ANMs should
be revamped and made more in alignment with the
2.
ANMs would prefer it if govt, can provide
a fixed amount of money for TA, Medical bills. Leave
local conditions likel—
Travel Allowance etc and provide it alongwith their
salary. Their salaries and bills should be paid through
a bank.
a) ANMs stationed in tribal areas should be more
aware of problems to be faced by them while
working in the forest. To emphasise this we quote
two instances;one with extremely tragic consequences
3.
ANMs have suggested a list of drugs that
they should be supplied and quantities to be supplied
(Refer - Annexure 4)
and the other not so tragic but both emphasise
orientation of the ANMs to the local conditions.
b) Similarly, ANMs in or around Urban areas should
be more conversant with pollution and related issues
ANMs would like their training to be
improved upon.
4.
rather than snake bite remedies.
The first instance involves a tragic death of
a man by tiger mauling. In Melghat an ANM spotted
44
Some Successes of ANMs
remedies to be very effective. This also had the
1) One ANM stationed at a Sub centre in a PHC
advantage of her not having to rely on the inadequate
in Pune Disk, when she first reported for her duties,
found that there was total chaos in the place and
supply of the drugs.In spite of the hadicap she managed
to fulfill her responsibility of bettering the health of
that the system had completely broken down. She
took this opportunity as a challenge as she was
the community assigned to her.She made the community
aware of the local medicinal herbs,shrubs and home
determined to change the state of the community’s
remedies which is certainly the job entrusted to her.
health. She had to start from scratch and trust her
3) For the ANM to be able to discharge her duties
instincts to take the necessary steps. She instinctively
fully and efficiently it is necessary to create a rapport
started on the right course. She decided to make
with the community, which requires a knowledge
the women of the community her allies in this
reformation. The first step she took was to get them
of the people’s language, especially in rural areas
together by organising several activities for them
where literacy is almost non-existant. This creates
a problem for those ANMs in the border areas as
like chit funds etc, which simultaneously gave them
a little financial freedom. In our society, the money
many dialerts are spoken simaltaneously. In the
border regions of Gadhchiroli District people speak
makers are policy makers. This new found financial
a variety of dialects including Marathi, Telugu, Hindi,
freedom made the women bolder. They were eager
to get together and do something useful. The positive
results emerging from her efforts convinced her of
being on the right path and this bolstered her
Gondi and even Bengali since they reside together.
For instance, A Marathi speaking Telugu ANM was
posted in area of Gondi speaking the language of
the Madia tribe. This created a language barrier.
confidence. She decided to teach women to read and write
Moreover, some local youths harassed her. She was
and started literacy classe in the evening, daily. Soon the
considered a fair game due to her unmarried status.
Instead of getting frustrated by the situation she had
a local Marathi speaking Madia woman appointed
as her attendant with the cooperation of her MO.
ANM had made herself indispensible to the community
and developed excellent rapport with the community and
earned their respect. No festival or function,large or small
was complete without the ANM as the honoured guest.
Its practical fallout was that instead of her going on home
With the help of this new attendant who could and
did act as her interpreter she was able to discharge
her duties fairly successfully. The ANM learned
visits, it was the community that came to her to get treated.
This resulted in a wider reach and better hygiene in the
community under her charge.
Gondi from her attendant in due course and the
problem was solved.
2) Another ANM in the same area who was
physically handicapped had to travel a distance of
about 12 kms. to her workplace. This was a
superhuman effort when one considers that both her
legs are damaged permanently by polio. To overcome
4) One 42 year old ANM narrated her own
experience in an open meeting.
She came from a farmer’s family in a remote
area where there were no educational facilities. The
local school taught only upto the 4th standard. Her
family could not even afford the 4th standard
her handicap she taught herself home remedies by
attending a course on this subject. She found these
45
I
education for her and she had to leave school after
At last the examination day arrived. As
expected, she was to appear for her papers from a
rural centre. She approached the supervisior to allow
passing the 3rd standard. As per the custom of her
village she was married off quite early.
Though schooled only upto 3rd standard she was
her to copy the answers. He refused but she kept on
intelligent and dynamic. She tried and solved whatever
requesting till the fellow relented. He agreed but told
problems her village dwellers faced, be it a family problem
her that he would not shield her in the event of a visit
or a drinking water problem. Slowly she took charge of
the women of the village and their problems. As a result,
by a flying squad. Unfortunately on the 5th day she
was caught copying by a flying squad led by a lady
officer. Before she could be given any punishment she
she was later on, elected to the Gram-Panchayat.
caught the lady officer’s feet and explained to her the
The Gram-Panchayat Head, seeing her intellect
situation. The officer was so impressed that she herself
and leadership qualities, advised her to complete
wrote the girl’s paper. To disguise her hand writing
her schooling and at least get through 7th standard
she even wrote with her left hand. When the results
came, she found that she had got through her S.S.C.
so that after that she could directly appear for her
S S C. Having no time for schooling, she went to
As soon as the certificate was awarded she
submitted the same to the friendly Z P Sabhapati.
her mother’s village with her 3rd standard passing
certificate, where she bribed and cajoled to obtain a 7th
standard passing certificate with the help of her old teacher
from a neighbouring village. Now that the first obstacle
He used his influence to get her admitted into the
ANM Training School. At the ANM Training School
she was the senior most student. During the training
was cleared she had to pass her S. S. C. Examination.
she helped her batchmates with variuos problems.
If she could pass her S.S.C. then it would be
Upon completion of her ANM training she was
posted to Kolhapur Z.P.as an ANM. When she
reported for duty she was unable to obtain a place
to stay for herself, as she was mistaken for a Dalit
advantageous for the village,her family and her own
self. The Z P Sabhapati advised her to appear not
from Maharashtra where the standard is higher than
that of neighbouring Karnataka. Moreover,it was
since her surname was identical with that of Dalit
families residing in the village. Due to the strong
easier to pass by copying, if necessary where
supervision at the S.S.C. exams was more lenient,
specially in the rural centres. Accordingly, she filed
her application for S.S.C. Exams from a neighbouring
Kannada school. However, this created a problem
in that her language paper would be in Kannada
which she was not acquainted with.
casteism prevalant in the area, she had to take up
residence in the Dalit area. She took this as a blessing
and started her work as ANM in her own locality.
Subsequently she earned the respect of the
entire community who as a token of their appreciation
offered her a better choice in accomodation. But
she prefered to stay in the same accomodation among
the Dalit community from where she works for the
entire community. All her children are well educated.
One of her daughters has followed her own footsteps
and is presently undergoing ANM Training.
She started to prepare three months before the
Exams by copying verbatim from the guides and
books. She first had to locate the question then search
for the answer and then make the copy. Slowly, she
got better acquciated with the language.
46
oo
a
c
Budget Expenditure
Income Received
1st
Year
1. Grants
received
CL
era
Expenditure
3rd
Year
2nd
Year
Total
Project
Actual
Balance
Variation
TJ
E3
CX
2
21,55,460
2. Annual
Increament
21,55,460
19,63,460
19,63,460
1. Personnel
15,10,380
27,94,458 -12,84,078
2,94,519
338,697
2. Publication
40,56,000
31,32,733
+9^3^67 22.76%
22^7^79
23,02,157
3. Miscellaneous 5,16,000
13,63,837
-8,47,837
4. Capital exp.
1,02,600
5. Interest ret.
6,68,914
Total
73,83,628
= 67,15,596
Total
67,15,596
-85%
164%
Balance = 67,15,596 - 73,83,628 = -6,68,032 only
Contengency to be received from DANIDA = 6,71,559
!
!
1ST October 93 - 31ST March 98
Reasons for variation in Budget projected and actual expenditure
I.
Personnel
Expenditure incurred on salary was high due to
1.
2.
FRCH revised its Dearness Allowance grant; HRA and CCA were increased.
Annual increment to the staff.
3.
The projected salary scale listed for the position of typist/clerk is low as compared to that in exsistence.
II.
Newsletter
The expenditure incurred on publication is less than the proposed amount on account of various
reasons;
At the time of preparing the proposal, printers' quotations were invited from Pune and Mumbai
where paper/printing costs are very high. We looked further afield and found quotations stating reduced
prices in Belgaum, Karnataka.
The price incurred on the Newsletter has decreased as we were compelled to go in for a paper
of slightly lower weightage (70 GSM) as the regular paper of (80 GSM) was not available in the market.
This change has accounted for a reduction in the cost.
III.
Consultancy
The expenditure incurred on consultacy was low because many of the articles, art works and translations
were done by ER.C.H. staff.
Use of Library & Documentation facility
The expenditure incurred was above the projected budget as work on manuals required extra library
facilities to be used other than F. R.C.H. resources.
IV.
Miscelleneous
Travel and teaching, training and evaluation was considerably high then the stated project budget
proposed, but in the field, we realised that using a public transport to visit ANMs was time consuming
and not economical and amounted to low coverage of ANMs. So it was decided to hire private vehicles
to visit PHCs/Scs.
48
V.
Printing and Xerox
Mailing list was updated and computerised. Computerization of the mailing list had not been envisaged
in the project proposal. But it was included by us out of sheer practicality. Thus the actual amount spent
on printing/stationery is much higher than the original proposed amount.
To facilitate mailing the computerized addressess of each individual receipient were printed out
on to a thin wrapper encircling the issue for postal purposes. The sticking of the issue required additional
manpower hired specially for the purpose.
VI.
Postage and Telegraph
Charges rose as we started posting the newsletter to a 1000 NGOs for promotion purposes.
vn.
Office Rent/Repairs and Maintainance and Sundry Expenses
The expenditure includes repairs and maintainance as well. It was realized in the 2nd year when
appropriate storage and working space was found that rental charges would include maintainance of office
equipment as well as premises. The wear and tear of computers, printers, xerox machines were considerable
as should be expected in the context of publishing a regular journal.
49
Annexure 1
'Aayushi’ - Social Inputs
MONTH
APRIL
1994
MAY
1994
FOCUS
1. Editorial The title’s meaning; explanation of the Layout’s logic,
into a magazine section + Manual; need to establish
a dialogue with the readership, to ensure the journal's
quality.
2. Article
Dr. Ambedkar’s Views on Family Planning :
The article reviews Dr. Ambedkar’s strict advocacy
of enforced Family Planning to control population and
poverty-related problems. The article however, speaks
about how large families are needed to compensate
for child deaths, a frequent phenomenon among the poor.
3. Story
Mulgi (Girl) About a 16 year old girl who wants
to complete her education, rather than be married off
young. The girl's aunt tells her that the changes prevalent
today were due to the struggle of Phule, Agarkar, Karve
and other social reformers. The story endorses that
Gender inequality is a social, not biological issue.
4. Poem
(by Asavari Kakde) about a woman's quiet self-assurance
and strength in being able to express herself when needed.
5. Report
On the opening of the Feminist Health Centre at Saswad.
The report describes the Centre's focus on treating health
problems holistically, taking into account the need to open
up the underlying mental problems of women patients, and
not just function as a medicine distribution centre.
6. Poem
Translation of Shehnaz Sheikh’s well-known poem originally
written in Hindi. A mildly satirical poem about a woman's
letter to her husband in Dubai asking for his permission for
every petty issue in her life. Makes a firm political statement.
7. Editorial Focus on May 1st as International Workers’ Day
and International Nurses’ Day. The editorial makes
a plea for the labour conditions of working womens'
contending with unequal payment, lack of maternity leave,
creches or even toilets. Women's double workloadprofessionally and domestically and its social, rather than
biological expectation, is questioned. The dedication of pioneers
like Florence Nightingale is admired, while endorsing that
individual Nurses' work constraints and family pressures may
make such dedication difficult. The editorial urges nurses to
come together and share their problems with their colleagues,
leading to the formation of an organisation based on shared
interests, helping them fight their own battles.
50
MONTH
JUNE
1994
FOCUS
8. Article
Describes a woman as an 'Ashtabhuja Devi’ an eight-armed
Goddess, holding household implements. The conditions of
women's double load; and work devoid of appreciation; the
lack of rest or 'leave' or salary', the low self-esteem of being
a housewife and the feeling of 'doing nothing'. Details of juggling
housework and professional life are discussed.
9. Book
Review
of Mi Nursabai (I am a Nurse by Medha Kirane) Discusses
the book's focus of looking upon the hospital system's view
of nurses as parasites.
10. Biography
Case Study of an ANM. The job taken up to assist the woman
in her domestic tragedy, leads to the ANM’s self-development
and public regard in the village. Yet, acknowledges that ANMs
feel less respected than their male counterparts.
11. Interview
With Anuradha Athavale, the Leader of the Nurse's Union
in Pune. Reflections on how the Union was started, the
difficulties faced. Now, 20,000 nurses are enrolled and the
Union runs various schemes, including creches.
12. Poem
Based on the children’s Nursery Rhyme- 'Sang Sang Bholanath’,
talking about gender inequality between a little girl and her
pampered brother.
13. Article
Gives a positive, constructive alternative of natural
family planning as against artificial methods of birth control,
emphasising on the empowerment of women by a new approach
to body and sexuality. An account of a programme with women,
aimed at family planning by the "mucus method"
14. Editorial
On International Environment Day June 5th The
Relationship between health and environment is studied,
raising questions of mankind's survival of all round
pollution.
15. Biography
of Dr. Vandana Shiva, the well-known physicist and ecofeminist, whose major work is in the field od environment
and bio-diversity. She comments on how seed keeping and
biodiversity, traditionally part of a woman's preserve are now
corporate or nationalised ventures, involving commercial
forestry and hybrid seeds, which have ironically reduced bio
diversity.
16. Article
On the redundancy of traditional forms of extortionate marriage,
like the 'Pakdaowa system in Bihar, where a man js kidnapped
by a bride's family and married off at gunpoint The article
questions the basis of such a marriage.
51
> 1
MONTH
JULY
FOCUS
17. Story
Initial story of a serialised story: Radha ki Kahani (Radha's
Story)
18. Biography
An ANM recounts some remarkable experiences gained
while working among the Dhangar tribals (Shepherd)5, tressing
the immense goodwill gained, due to kind and appropriate
medical intervention,
19. Article
Natural Family Planning (Continued from previous month) An
explanatory article with illustrations, aiding women to
understand their menstrual cycle through three signs vaginal
mucus, cervical position and vaginal temperature, in order to
use this knowledge to control and make decisions about
conception and understanding their own bodies.
20. Editorial
Based on a poem by Bertolt Brecht, questioning the
basis of poverty. Is poverty on account of being illiterate,
superstitious, lazy, excessive population, lack of agricultural
land or industries? Or is it due to economic disparity, where
a few people exploit others in all ways, economic, political,
cultural, social? The editorial exhorts people to reduce this
disparity first, rather than going in for intensive forms of
development like the Green Revolution.
21. Report
On Medha Patkar and her vision of Development.
22. Story
Further serialisation of Radha ki Kahani.
1994
23. Book Review of the book (Adolescent Children: Their Problems and
How to communicate with them, by Lata Katgane)
AUGUST
24. Biography
Of Dr. Kanna Madhavi, the first Adivasi (Tribal) doctor. The
struggles of the man to gain a good education, without parental
support or understanding. The doctor's wish to retain the human
touch and his wish to work in Government PHCs in the rural
and tribal areas.
25. Article
A short piece looking at menstruation from the point of view
of understanding the female body and its working, instead of
negating and repressing it as a taboo subject.
26. Editorial
On India's 47th Independence Day Analyses the term
"We have freedom". "We" connotes males, not females,
as after 47 years of Independence, India has not seen
much change in woman's status, with the perpetuation
52
MONTH
FOCUS
of female foeticide, dowry deaths etc; though Nehru had stressed
women's education, gender, class and caste inequalities still
exist, making it impossible to claim that we are free.
SEPT.
27. Article
On why Religious functions are always related to Women,
particularly fasts and ceremonies or sacrifices. The context
of these rituals in the current climate of social change would
need to be reassessed.
28. Biography
An ANM's account of her experience in saving a newborn
baby left for dead and abandoned by its superstitious father,
who believed it to be an avenging ghost. The ANM's role
in mobilising the police and getting the baby to hospital, was
crucial.
29. Poem
on Mother, where the daughter - narrator addresses her
mother’s tendency of covering up her frustrations and
disappointments, without letting them taint others, while yet
spreading her love and giving her children the chance to dream
and grow.
30. Article
An insightful article, approaching the issue of female sexuality
and its negation in society, beginning with an acquaintance of
the female external sexual organs. Attempts to break the
conventional misconceptions and negative perceptions accorded
to female sexuality.
31. Editorial
Commemorates Teachers’ Day (September 5th) and
raises the issue of how teachers should be instrumental
in changing the Public perception of women, looked upon as
sex objects (in the light of the recent Jalgaon and Sawantwadi
sex scandals). ANMs too have a clear didactic role in society.
32. Story
First Sati - Based on the Roopkanwar story and the evil
arguments determining a young widow's being burnt.
33. Biography
On transfers, hanging like a Damocles' sword over most
ANMs' heads, since their marriages, husband's careers and
children's education are all compromised in the context of
transfers. The situation perpetuates, as ANMs say nothing
against it.
34. Story
Continued serialisation of Radha ki Kahani.
35. Article
On the Population and Development Conference. Questions
whether it is third world over-population or first world over
consumption that leads to environmental damage. The context
1994
53
MONTH
FOCUS
of more children where there is high infant and child mortality.
The injustice of contraception being seen as exclusively
a woman’s responsibility though women are fertile for only
a short period every month, as against man's constant fertility.
A discussion of the Government's Family Planning policies
and current Cafeteria approach' ensues. A plea for Development
and education as the best Family Planning method is made.
OCT.
36. Article
A detailed understanding of the monthly cycle, explaining the
internal sexual organs, and the various processes, involved
in the transmission of the ovum from the ovaries to the uterus.
Combats the misconceptions which are based on ignorance,
regarding this knowledge.
37. Article
Gives preventive measures at home and community levels, to
control mosquitoes and prevent the onset of malaria. An account
of the work done by the Malaria Eradication Programme, and
makes suggestions for its better implementation.
38. Editorial
Discusses the Bhopal issue. (The anniversary of the
Bhopal Gas disaster falls in December but the December
issue would be a part of the Diwali special). The
editorial discusses industrialists and exploitation. The
difficulties of getting compensation for the sufferers in
occupational health hazard cases is brought out.
39. Story
About the ironies of the son-syndrome in old age. Society
encourages women to neglect their daughters, even though
it is often the daughters rather than the sons, who may guard
their parents in their old age.
40. Article
An obstacle in women's development is that very few
women are part of the decision making process. Though
34% of the workers are women, only 5% are at the decision
making level. At UNESCO, too there are 175 people, of whom
only 3.5% are women. This disparity, caused by women's
prioritising of family considerations over career goals is a
development issue, women are, largely, less concerned with
ruthless exploitation.
41. Story
Continued serialisation of Radha ki Kahani.
42. Article
Discusses the concept of" Anaemia' and brings out the possible
causes for decrease in the percentage of essential components
of blood.
1994
54
MONTH
FOCUS
DIWALI
ISSUE NovemberDecember 1994.
43. Theme
I
Violence is considered as a major mental health problem
not normally considered an important matter. This issue
is concerned with women, health and violence, (by Manisha
Varma, originally written in Hindi)
44. Poem
(by Manisha Varma, originally written in Hindi) about
a girl foetus, telling her mother not to go in for an
abortion.
45. Editorial
Talks about society celebrating Diwali as a family occasion.
Until family violence is resolved, there is no genuine
togetherness or feeling of celebration. The editorial advises
ANMs to deal not only with the physical ailments, but
also with the mental traumas of their patients.
46. Story
Ratna (by D. S. Salgaonkar, A police Inspector, based on
an actual case study.) A story about the all-round inhuman
treatment. Meted out to a young woman Ratna, who is treated
cruelly by her in-laws and attacked murderously by her own
father and brother, in order to get rid of the burden of her
responsibility. Rescued by the PI from drowning in a river,
she is then placed in a remand home.
47. Article
On family Violence (by Asha Mundle). The reasons
behind family violence are delineated: lack of democracy in
the household; irrelevance of children's opinions, patriarchal
dominance being taken for granted; acceptance of physical
abuse.
48. Article
What Sita did not say. About the injustice of Lord
Ram’s Ayodhya where all except Sita can expect to
receive justice; as shown in the Agnipariksha or test
by fire.
49. Article
My Experiences with Adivasi (Tribal) Women (by
Anutai Limaye, a renowned social worker) About the
anti-alcohol movement initiated by tribal women, compelled
by their economy to brew alcohol and tortured by drunken
husbands' violence, which is explored. When told to stop
brewing rice beer, which sold at Rs.2/- per glass, a tribal
woman asked for alternative occupation. The social worker
arranged for an alternative occupation, which the tribal woman
readily took up.
50. Article
by Abhay . The poem rhetorically describes a rape victim
as resembling not a woman, but a skeleton; if she dies, her
55
MONTH
FOCUS
honour is preserved; if she lives, she is considered a fallen
woman. The double standards are castigated.
51. Article
On Violence ( by Manisha Gupte, Director of MASUM)
discusses the genesis of violence springing from the interaction
of patriarchy and social politics. The woman's loss of identity
after marriage into a different village and the culture of silence
that endorses silent acceptance as the hallmark of a 'good'
woman are some of the issues raised, as creating the basis
for socially sanctioned violence against women.
52. Story
Twentieth Century Shylock (by Dr. Satish Kulkarni) About
a tribal girl's self-assertion in getting her own way by outwittingand subverting her father's subservience to an extortionate
moneylender by agreeing to marry the latter-day Shylock
and immediately eloping with her real lover. By subverting
a marriage made on false premises, the tribal girl asserts her
moral and sexual freedom of action.
53. Article
Are Women their Own Worst Enemies ? (by Vidya
Kulkarni) A scathing look at patriarchy where a woman's
goodness' is dependent on a man-centred perspective. Women
in a family are required to talk against each other in order
to maintain the primacy of the man; life degenerates into a
perpetual conflict of arguments and interests.
54. Book
Review
Aparajita s Expiration (ed. Vidya Bal) reviewed by
Mandakini Bharadwaj - The book details women struggling
against adverse circumstances.
55. Story
Can you Believe That It’s True ? ( by Kusum Nargolkar),
About an Adivasi tribe, where the common ailments that people
suffer from are believed to be the result of witchcraft. Based
on a true story.
56. Biography
Rakhma (by Varsha Gajendragadakar). A biography
of Rakhmabai, the first practising Indian Woman doctor
(in the last decades of the nineteenth century), a signal
individual in the history of women's education in India.
57. Story
Still no Justice (by Viji Sriniwasan). Based on a true
incident, this story examines the dowry death of Sasibala and
her mother's courageous struggle for justice.
58. Article
Bitter Truth (by Rohini Chitale) Based on the author's
own aunt’s life. An unconventional look al a woman’s suffering
56
MONTH
FOCUS
in an unconsummated marriage to a socially successful- though
adulterous-man. The question of the wife's sexual needs
remaining unsatisfied is raised.
59. Poem
(by Abhay) About a woman who is pushed and pulled
metaphorically, to fit the 'Procrustean bed' of marriage, if she
does not at first fit into its framework.
60. Article
On Physical Illness, Disability and violence A TB sufferer
is thrown out of her marital home.
61. Article
Old Age and Violence; The article examines 3 case studies
of widows in an old age home, where each old woman is
cheated and cruelly spurned (one widow's fingers were cut
off, on her refusing to sign over her property) by her own
children.
62. Story
Questionmark (by Shaku Markad) Details an ANMs'
experience in a hospital, which raises the issue of marital
rape (of a woman who has just given birth, by her husband,
an engineer). This contentious issue is discussed.
63. Article
Problems of Abandoned Women (by Nisha Shivurkar).
This article looks at the economic, social, sexual problems
of abandoned women and is written by a lawyer- activist
specialising in women's issues.
64. Article
Family Violence and Methods to Stop It (by Vandana
Kulkarni). This article takes 3 case studies; 1) Kiranjit
Ahluwalia, a Sikh woman in the UK who murdered her
husband after suffering 10 years' mental torture. She is acquitted.
2) Sudha Goel, a 9-months' pregnant woman burnt for dowry
in Delhi. The husband and mother-in-law are sentenced to 14
years' R.I., but not jailed as the file is lost before it reaches
the relevant police station, Ashok Jain, a journalist sees the
husband and tracks him down, discovering that he has remarried
and has, a new child. The culprits have got away scot free
due to loopholes in law -enforcement. Neither of these case
studies depicts a positive resolution. This problem,as may
be seen in the case study of.
3) Flavia Agnes: About a woman's physical abuse at the hands
of her violent husband. She comes out of her trauma, becomes
a lawyer and is a prominent activist for women's rights.
65. Article
On the New Women’s Policy of Maharashtra (by
Advocate Vivek Dhamankar). Discusses Sharad Pawar's Poliicy
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and the relevance of this policy to Violence Eradication looking
at various schemes:
1) Gender sensitisation for police;
2) Special cadre of people, who would look into
violence from all angles;
3) Demographic surveys to determine types of people
more susceptible to violence.
4) Special courts established to hear family violence
cases, to hasten justice.
5) Legal issues that need to be examined and establishing a
legal committee to examine the loopholes in the laws for
women. Other points that should be disseminated are discussed,
such as:
* A woman cannot be thrown out of her maternal or
marital house.
* A norm to protect economically backward woman
to gain a share of their property has to be worked
out.
* A Committee should monitor the portrayal of woman
in advertisements and films, to prevent women's denigration.
2/3 majority of a censor board's consensus should be mandatory
before clearing any published material.
66. Poem
(by Sarveshwar Saxena) about a woman refusing to stay with
her husband if he is not brave enough to fight corruption.
67. Article
On Child Abuse: Destroys several myths. Shows that
relatives and neighbours are the most likely child abusers in
actual fact. Children should be protected from victim-blaming.
Cases should be filed as soon as possible, the medical
examination should be performed by a senior doctor and the
report preserved, as also a copy of the FIR, A list of Women’s
support Organisations in the 4 Regions of India is appended.
68. Article
An Activist song about the lit lamp of politics becoming
a rampaging fire. The poem exhorts its listeners to extinguish
this fire, by getting together to fight it.
69. Article
Deals with the physical, mental and emotional aspects of violence,
and examines in detail its causes, nature and impact on the victim.
Gives tips on handling a victim of violence, especially immediately
after the experience.
70. Article
Brings out the resignation with which women tolerate violence,
and expresses the need to rise out of their passivity and act
against such violence.
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Jan. 95
FOCUS
71. Article
Explains the phenomenon of wife-beating, in a recurrent cycle
of three stages - pent up tension, explosion and reconciliation,
emphasising that there generally is no end to this vicious cycle,
unless bold action is taken.
72. Article
Welcomes the Government act to ban Amniocentesis, for the purpose
of sex determination, voicing the violence perpetuated on the female
gender through such tests.
73. Article
Discusses the sexual exploitation of young girls, especially
at an incestuous level in a patriarchal society, through various
illustrations. Reflects on the possible solutions to this problem,
emphasising on trustful, intimate relationship between mother
and daughter as an important necessity in this regard.
74. Article
Reflects on the issue of Child Abuse in its physical, social
and psychological aspects, concentrating on sex abuse and its
impact on children.
75. Study
Questions the validity of reasons given for victims of burnsespecially in case of women. Studies the correlation between
social situation and the number of women succumbing to death
by burning in a study conducted in Sassoon Hospital, Pune.
76. Article
A short feature containing the kinds of action to be taken in
case of a situation concerning women facing marital problems
or actual violence.
77. Article
Discusses the solution to marital and familiar discord in the
light of various kinds of counselling techniques, pointing the
importance of a technique which is gender conscious and
empowers women to be able decision makers.
78. Editorial
Focuses on the work of Savitribai Phule - the pioneer
of women's education in India, on the occasion of
her birth anniversary; also talks about Leprosy Day and
the condition of lepers in India.
79. Article
A productive look at the lifelong work of Savitribai
Phule, who worked increasingly for social reform
through women's education.
80. Article
Discusses the social stigma attached to Leprosy and
leprosy patients. Points out the importance of rooting
out misconceptions, biases and ignorance in society
in order to eradicate the disease and socially rehabilitate
victims.
81. Short story
An account of the struggle of a woman, tortured by
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her husband, and deserted by her lover after more than
ten years of living together. The woman desperately
strives to atleast get maintenance for her children.
Feb. 95
82. Article
A review of three plays by prominent playwrights in
Marathi, reflecting upon the negative attitudes of the family
and society towards leprosy patients, as well as the ray of
hope offered by people with progressive and sensitive ideas.
83. Article
The article discusses the etiology, symptoms, diagnosis and
cure of leprosy in a lucid language, emphasising the preventive
aspect. A reflection on the nature of leprosy as a social disease,
resultant of poverty - symptomatic of inequalities between the
first and the third world.
84. Article
An informational guide to nutrient values of food articles
commonly consumed by people, with an emphasis on lowcost diet components with high nutritive value. Includes tips
on increasing nutrient value of foods.
85. Article
Describes the nature of anaemia, taking into consideration, that
women are especially prone to it. Gives a list of methods,
medical and home based, to deal with the disease.
86. Article
Enquiries into the causes of concentration of trained medical
professionals in urban areas, in spite of dire need for them
in rural areas. Discusses the commercialisation and urban bias
of the medical profession.
87. Editorial
The urgent need for health issues to concern themselves
with fundamental factors like poverty, environmental
hygiene, and appropriate services, rather than short term
and superficial ways of combating individual diseases.
88. Story
The story of a determined woman who, after an
unsuccessful marriage, brings up her siblings with grit.
Dispels the misconceptions of "unlucky" daughters in
law.
89. Article
An introduction to the ideology and working methods
of an organisation - "Stree Aadhaar Kendra." recounting
some case histories of women, who have availed of
the organisation's help.
90. Article
Describes the inception of a non-formal education project for
tribal children, in Thane district of Maharashtra.
91. Article
On the occasion of Ms. Sujata Manohar, being appointed
a judge in the Supreme Court. Points this out as an encouraging
trend, which will be motivating for women to come out and
be bold, as well as lead to more sensitivity in administration
of justice.
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March 95
FOCUS
92. Letters
ot ANMs and health officials to Aayushi, voicing out
the importance of Aayushi's contribution in reflecting
the views of ANMs as well as providing knowledge
of relevant subjects.
93. Article
Gives a historical and critical perspective of family planning
methods, followed in India since independence. Envisages the
broad principles for an alternative, humane and more
decentralised system of family planning.
94. Article
A brief overview of the clinical aspects of Tuberculosis
(including symptoms, diagnosis and cure), with information
about government measures against the disease. Also discusses
difficulties of a social and medical nature, involved in the
control of Tuberculosis.
95. Article
Critically examines how Allopathy, as a medicine system, is
limited (due to a curative approach) in working towards a
holistic, integrated system of health. Briefly discusses alternative
health systems, and the possibility of combinatory usage of
two or more systems, in leading to holistic health.
96. Editorial
A special issue on Women and Health", it solicits sensitivity
on part of ANMs towards women in rural areas with physical
or emotional health problems.
97. Story
Based on an original story by Ravindranath Tagore. Depicts
the plight of a mute girl who is close to nature and animals,
being confined to a city life, because of marriage. Deals with
the pain of the inability to communicate or express, leading
to loneliness.
98. Poem
Expresses the frustration of a rural female labourer who can't
spend her own money freely, because of other pressing needs
in the family.
99. Portrait
of Bangladeshi rebel writer, Taslima Nasreen: her rebellion
as a woman in an orthodox Muslim Community.
100. Story
Discusses the issue of gender-discrimination and how
women are forced to beget male children; the social stigma
and emotional stress suffered by women without male offspring.
101. Poem
Expresses the daily grind and exhaustion in the life of a poor
rural woman, striving to make both ends meet. Invites women
to come together so that life is made easier to bear.
102. Article
A diagrammatical illustration of various social and cultural
aspects of the vicious cycle in which women are caught up,
which contribute to their poor health status.
103. Article
Discusses a variety of social factors, rooted in gender
discrimination, which are causative for malnutrition in women
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and children.
April 95
104. Article
Brings out the correlation between inadequate and subnormal
public sanitation facilities and the spread of contagious diseases
in urban as well as rural areas. Articulates the need to improve
upon the former in order to control these diseases.
105. Article
Discusses in detail the health hazards faced by women related
to their work - within home and outside, especially in rural
areas. Considers the sexual violence faced by women at work,
as well as the emotional stress involved in a monotonous,
exhausting work schedule.
106. Article
An account of the population conference held in Cairo in 1994,
revealing how the concern for womens' health is only a
superficial priority on the international as well as the Indian
agenda.
107. Article
Examines the causes for non-accessibility of health facilities
for rural women, encompassing women's status, their
powerlessness and non-awareness and unavailability of medical
services as the main factors. Perceives the role of the ANM,
as a vital alternative in rural areas.
108. Editorial
Discusses the illicit trade in human organs as well as
blood, which goes on unchecked. Talks about the 'human organ
transplant Act and asks people to be cautious and conscious
while dealing with medical professionals.
109. Story
The story of a young widow, who rejects the offer of marriage
from a man - because she feels it to a generated out of pity
and expectation of appreciation from society. She prefers suicide
as a way out of her life of loneliness.
110. Experiences
An ANM recollects some of her unusual cases and experiences
while on duty.
111. Article
Gives information about laws pertaining to women's justice
viz, dowry, rape laws and family laws. Emphasises the need
for individuals and society to ensure that these laws are
implemented appropriately.
112. Letters
Two letters from Aayushi readers, commenting on the relevance
of the publication of such a magazine.
113. Poem
Reflects the exhausting, energy-sapping life of women, forced
to work in inhuman condition, without respite.
114. Article
Discusses the etiology and nature of 'pain', pointing out its
role in enabling knowledge of deep-seated health problems.
Warns against detrimental use of pain-killers, which do not
handle the problem, but only lessen the symptoms. Also deals
with the issue of mental and emotional pain.
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May 95
115. Editorial
On completion of one year of Aayushi's existence. Discusses
the difficulties faced by ANMs in conducting home visits, at
odd hours during emergencies, as well as meeting family
planning targets.
116. Autobiographical
Notes
An octegenarian ANM, who still actively pursues her
profession recalls her life as a nurse and her experiences.
117. Poem
About the working woman, who manages both fronts efficiently,
but who is looked upon as a 'slave', her needs sacrificed for
those of the family.
118. Memoirs
An ex-nurse (who is in the teaching profession) reflects
upon her experiences as a nurse. Certain incidents have
served to sharpen her sensitivity, making her think
keenly about the role of nurses in helping patients.
119. Article
Reviews the portrayal of nurses in contemporary Marathi plays
and their image in society. Connects how the image of a nurse
in society - as an immoral woman, corresponds to that depicted
in plays.
120. Box
Enumerates the duties of a nurse, hundred years ago.
in a British Hospital, as well as the various conditions
attached to the job, in those times, including pay raise,
saving etc.
121. Article
A descriptive analysis of a survey study of 'ANM' conducted
by FRCH, in order to understand the difficulties faced by them,
as a result of social victimisation pertaining to gender and
caste, and the negative perceptions of co-workers, rural
population and their own families. Explains the role of the
centralised medical system in contributing to the problems faced
by the ANM. Contains suggestions from the ANMs to eliminate
these difficulties.
122. Article
A narration of experiences of sexual violence (rape)
encountered by the ANMs, while working, and how they have
been combated. A reflection on how no protection is provided
against such incidences.
123. Article
Describes the general negligence shown in the health planning
policies, towards women health and their problems, specifically
showing how government rules and policies affect the female
nurses working in rural areas. Voices the need for nurses to
unite and work for their rights.
124. Article
An account of a health training project in Andhra pradesh,
which aims to empower women, and women health workers,
to understand and deal with their health problems, taking into
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consideration social, economic and political situations which
cause these problems.
June 95
125. Editorial
Deals with the various personal and professional problems
faced by ANMs and stresses the need for ANMs to come
together and fight against injustice meted out to them by society,
126. Report
of a movement of women from a Himalayan village, who
organised to bring about the opening of forest areas around
their village, as community resource to meet their fuel and
fodder needs.
127. Opinions
A letter from a iregular contributor to 'Aayushi' expressing
that the magazine fulfils the role of provoking its> readers
to think about the myriad problems in society.
128. Article
Second part of the series dealing with women's legal rights.
Deals with Muslim Family laws, Registered marriage Act and
family courts in this part.
129. Book
Review
A Marathi translation of Dr. Park's book "Essentials of
community Health Nursing" has been reviewed as an extremely
useful book for field workers and nurses.
130. Experiences
An ANM relates an incident where an educated woman
lands up in an emergency situation due to a folk remedy
used to relieve her of stomach pains. The ANM reflects on
why education, meant to equip people to think and not blindly
follow superstition does not help us to do so.
131. Box
Informs about the detoxification centre at Gadchiroli, run by
SEARCH. The centre has just compete one year of operation
successfully. ... - -
132. Poem
Parallels drawn between the chores of women and the larger
systems of injustice and exploitation in the life of women.
133. Article
Gives the results of a study conducted to determine the
knowledge of the ANM regarding the medicines commonly
distributed by them. The survey suggests that it is vital to
provide increased knowledge to the ANMs in this regard.
134. Editorial
Deals with the issue of malnutrition in Tribal population
and locates its sources in the Governmental policies of denying
tribals, access to land, water and forest resources, and
dispossession. Questions the validity of welfare schemes and
projects when fundamental rights are denied.
135. Story
The autobiographical reflections of a woman, representative
of many women's lives today, where in spite of having tired
ol a life of drudgery, she continues to maintain the status quo.
July 95
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out of reluctance to acknowledge boredom.
136. Article
Points out how the first world countries, inspite of
causing tremendous environmental degradation, deteriorating
the lives of people in the third world, through their commercial
ventures, call out "danger" in the name of increasing population
and try to suppress population growth in Third World Countries.
Seeks to explode the myth about population being a cause
for Third world problems.
137. Reflections
How women are discriminated against in all spheres of life,
and the conditioning that makes them accept it as a natural
thing in a patriarchal society. Expresses the need for women
to recognise and question this.
138. Poem
Lop-sided policies in the name of development have caused
environmental degradation. In spite of vested interests of the
rich and the powerful, the poor come together and resolve
to save the forests and the earth.
139. Article
Appeal from the editor to the readers to respond by writing
their views about the magazine, its content, what needs to be
added etc.
140. Article
Analyses the unequal distribution of resources between the
First World and the Third World as a prime cause of scarcity
and poverty. Points out the flaws in the Indian population control
policies and gives a comprehensive method to bring about
awareness through women oriented policies, to enable
conscious family planning.
141. Article
Considers the extremely negative impact of the target-oriented
family planning programmes on the attitudes and behaviours
of the health workers, and consequently on their relationship
with the rural population.
142. Article
A reflective article on how the choice vis-a-vis family planning
does not really rest with women, but is imposed by other
social factors. Narratives of women from different strata of
society.
143. Article
Questions the violence committed against women in the form
of uninformed and forced usage of contraceptive devices which are primarily targeted at women. Traces the connection
between the fallacious notions of population explosion, and
the vested interests of the First World Countries.
144. Article
Gives a historical development of the Intra - Uterine device
as a contraceptive through the years.
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August, 95
145. Editorial
Draws attention to the problem of droughts, its consequences.
Discusses how urbanisation has increased the tendency to
droughts, while its victims are the rural poor.
146. Story
The guilt of a man who is party to a wedding in which
fraud is performed. The man impersonates the bridegroom,
who is an old, ugly man and ruins the future of a young, hopeful
bride.
147. Article
Explains how women have been uninvolved in fiscal matters
like investments, large purchases, traditionally. Points out the
importance of women equipping themselves to deal with these
issues, with changing times.
148. Poem
Envisages the woman, dignified and creative, in a world
fashioned by herself, conducive to her growth and development.
149. Article
Investigates the impact of a liberalised and profit-oriented
medicine industry on the price structure and production of
medicines in India. Points out the governmental responsibility
in the control of production and distribution of unessential
irrational and hazardous drugs.
150. Editorial
On the occasion of Teacher's Day, 5th Sept, it looks
at the ANM as a teacher, striving to bring about changes
in social practices and habits of the people so as to bring
about an environment of health.
Sept. 95
151. Autobiographical
Note
The despair of a young tribal girl, who educated herself
against all odds, yet is unemployed. Wonders if there are any
reservations for scheduled tribes which she can avail of.
152. Experiences
Of a worker in Health agency about a training programme
conducted in a tribal area. Reflects on the differences in the
efforts taken by trainers, and the inconveniences troubles
encountered by the trainees in order to attend the programme.
153. Article
Discusses the way in which willingly or unwillingly, children
may suffer at the hands of parents and calls for more sensitivity
from parents in dealing with children.
154. Autobiographical
Note
A labourer, suffers in silence the beatings at the hands of her
husband like a "good wife". But when she gets pregnant, she
retaliates in order to protect the child in her womb. The husband
repents and turns to the 'man' from the 'devil' he had become.
155. Poem
Using metaphorical images, deals with the power relationships
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between a man and a woman, which is what any relationship
ultimately boils down to.
156. Article
A narration of a woman's experience of childbirth as a positive
and fulfilling process, attempting to break the conventional
myths, negative attitudes and psychological stress surrounding
pregnancy and child birth.
157. Article
Explains the various kinds of impurities found in water, and
emphasises the need of access to potable and clean water
in order to enhance public health.
158. Article
Articulates the need to view menstrual pains (Dysmenorrhoea)
with a social perspective, taking into consideration the
con-elation between mental pressure, poverty and related factors
and menstrual pain.
159. Editorial
The issue deals with the theme "factors affecting and diseases
of the Reproductive system". Explains how these problems
remain untreated in women, in spite of easy diagnosis and
inexpensive treatment, because of the taboo in our culture against
speaking about such issues. Emphasises the need for ANMs
to get information about these diseases and help woman deal
with them.
160. Poem
Brings out three mythological women in Indian culture, who
by their example have set the rigid patterns for women’s ideals
in a patriarchal society.
161. Story
An imaginary future situation, in which statistics decide whether
children can be born or not, and foetuses are indoctrinated
with the propagandist ideology of the ruling class. A couple
attempts to break free of such all pervasive control, and ensure
that their child is born 'free'
162. Poem
There is always hope enough to keep on trying, without
despair, and living life fully.
163. Article
Prostitutes are held responsible for the spread of AIDS,
but the dangers and risks faced by them of contracting the
disease themselves, are ignored. Society is unconcerned about
their health and social problems which need to be attacked
as seriously as the issue of AIDS.
164. Article
Reflects upon how all the decisions concerning family planning
- right from whether to have a child, to what contraceptives
should be used, are taken by the husband, with the wife only
a passive, subjugated receiver of the decisions. Compares this
to a game of cards, where the woman always loses, because
she is always given poor cards.
Diwali ’95
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165. Poem
looks at current events of violence like rape and murder,
and reflects that this kind of evil can't exist in a woman,
who has a natural method of purifying herself every month,
through her menstrual cycle.
166. Poem
How a women is transformed into a stunted 'bonsai', as her
thoughts and actions are structured within the conventional
frame work, cutting her wings.
167. Folk tale
A folk tale of a woman, close to nature, who understands
the language of birds and animals. A misunderstanding with
her family leads to a later reconciliation. Brings out the
importance of proximity to nature for human fulfillment.
168. Poem
Dignity, freedom, equality are not to be conferred on women
but they naturally belong to each human being, and have to
be sought individually.
169. Poem
Exhorting people to encourage the development of women out
of the structured framework and injustice in which they live.
170. Poem
A hopeful song, calling out for women to unite, in order
to attain the dignity with which they deserve to live.
171. Article
Describes the history of gynaecology as a series of assaults
on the female body and mind. Looks at the contemporary
practices in the field, medication and family planning as a
continuing assault of a similar nature. Brings out the need to
investigate an alternative.
172. Article
Describes the conceptions of the Bhil and Pawra tribals
regarding the male and female reproductive systems,
menstruation, fertilization and foetal growth - a knowledge
system totally independent of modern anatomical and
physiological findings.
173. Article
An overview of the AIDS and its impact on affected patients
and their families. The need to change social attitudes in order
to control the onset and spread of the disease, as well as
to secure humane treatment for the afflicted people.
174. Article
Perceives malnutrition as causative of various illnesses seen
in females. Correlates poverty and other social factors, including
gender discrimination, as reasons for malnutrition in Third
World Countries, emphasising the need to make women aware
regarding their nutrition intake and health.
175. Article
Talks about the mental harmony between partners as a
prerequisite for making the marital relationship - at sexual
and other levels, a mutually fulfilling experience.
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176. Article
In view of the general negligence shown towards female health,
the article defines the role of the ANM in establishing a rapport
with rural women and empowering them to deal with their
own health. Perceives the need to train ANM in this direction.
177. Article
Points out the need to improve the status of women and family
health, through the narration of the learning experiences gained
in a project for Dai-training.
178. Article
The results of a study based in a slum, studying the correlation
between women's work and their reproductive health. Infers
that, inspite of increased income, lacks of adequate medical
services, occupationally related illnesses, and non-awareness
regarding their rights - women register a low index of health.
179. Article
A brief survey of laws pertaining to women's health, their
loopholes and lack of awareness regarding them. Reiterates
the need for women to unite and bring about proper
implementation of these laws.
180. Article
An illustratory features on how negligence and lack of time
in a hospital can lead to the parameters of sterlisation and
hygiene being disregarded.
181. Editorial
Discusses the questionnaire meant for the ANMs so that they
can give their opinions/feedbacks about Aayushi to the magazine
team. Also refers to responses of readers, which express the
relevance the control of Aayushi.
182. Article
A thought-provoking case of an innocent boy, sexually abused
by men, who tranforms from a homosexual to a 'eunuch' in
the span of a few years. Shows concern for such a deterioration
in a person's life, while society looks by, uninterested.
183. Article
Gives an overview of Vinoba Bhave's thoughts on education,
woman's role as a wife, gender equality and potential
professions for women. In a lucid manner, it presents the
progressive ideas of a great educational and social reformer
of 20th Century.
184. Poem
Muses about the future of young girl. Whatever she may choose,
hopes that she learns to know herself, her strength, her dreams,
and love her "being"
185. Article
A feature on urinary-tract infections, discussing in detail its
causes, diagnosis, remedies and means of preventing the
recurrence of these infections..
186. Article
A narration of an experience of severe urinary tract infection,
which can go unnoticed due to lacks of information and
awareness. Reflection on the need for women to be positively
Dec. 95
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aware of their own bodies without embarrassment.
187. Article
Discussing the natural and industrial causes for pollution of
water, and gives homebased as well as large-scale methods
for purification of water.
188. Editorial
Reflects upon the glorification of childbearing by society,
leading to contempt for childless women. The issue, being
a special one on infertility, the editorial discusses medical
intervention for infertility as well as adoption as an alternative.
189. Story
Based on a Hindi story by Mannu Bhandari. The story is
about how people tend to compartmentalise lives, thus leading
to feelings of distrust and insecurity, even in intimate
relationships.
190. Article
The first part of a compilation of experiences of women
who have chosen adoption as an alternative after undergoing
intensive medical treatment for conception, includes views of
adoption officials.
191. Box
The technical and legal problems arising during the adoption
process, when the wife has maintained
her ----maiden
— —
name.
192. Poem
Addressed to women, living in poverty, facing numerous
difficulties and still giving of themselves selflessly, to everyone.
193. Article
A narration of the emotional frustration and self-doubt
experienced as a result of an inability to conceive a child.
Expresses how social perceptions and conventions contribute
to this feeling.
194. Article
Discusses the pros and cons of involving more trained nurses,
in primary health care system, in the United State's medical
system.
195. Article
The review of a book, which discusses sensitively the social,
emotional, clinical and cultural factors related to the menstrual
phenomenon and the female reproductive system. The book
helps to build up a more positive attitude towards menstruation
and sexuality (Eka Shapachi Janmakatha - The birth of curse.
By Aruna Deshpande)
196. Editorial
Discusses how increasing urbanisation and development
leading to environmental degradation, has resulted in the spread
of disease causing bacteria prevalent in animals to the human
species. Also explains how unclean surroundings and reduced
human resistance, leads to the spread of epidemics.
197. Story
A young, adolescent girl's feeling of guilt, shame because
Jan. 96
Feb. 96
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of conditioning as a "woman" by her mother and society.
How this negative attitude slowly changes after understanding
a different perspective.
198. Article
Second part of compilation of experiences of women with
adopted children, and adoption officials.
199. Poem
Expressing how conditioning of a woman as a secondary
being is destructive for the dignity of woman.
200. Article
Analyses the functioning of the Tuberculosis Control
Programmes of the government, based on a research study by
the FRCH. Reflects on inadequacy of services, work pressure
on workers and target-based indicators as major factors leading
to non-efficiency and low success in the programme.
201. Article
A detailed article, discussing the various aspects of adoption
in view of the contemporary social situation. Perceives adoption
as a creative, positive process of dealing with the problems
of childlessness and destitute children.
202. Editorial
Talks about "Panchayati Raj", its meaning, the avenues
open to women due to 33% reservations. Also discusses, what
role an ANM has, as a people's representative with health
knowledge.
203. Letter
written by Savitribai Phule to Jyotiba Phule, originally
in Modi script. One letter describes how Savitribai
explains to her brother the nobility of Mahatma Phule's
work. The other describes an incident where she saves
a couple - a brahmin man and an untouchable girl from
the wrath of the community.
204. Report
The rationale for holding the International Women's
Conference at Beijing and a brief reporting about it.
205. Article
An account of various local women's agitations against liquor
problems, continuing in the antagonistic environment, where
vested interests of bar owners, alcoholics and govt, officials
perpetuate the vice.
206. Poem
A satirical poem on how the dowry system is perpetuated
openly inspite of the legal ban on it.
207. Article
Brings out the way in which pharmaceuticals use deceptive
and underhand techniques to increase sales and profit, citing
examples of commonly used medicines for common illnesses.
Stresses the importance of home-remedies.
March 96
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April 96
208. Editorial
Focuses on the World Health Day, 7th April. Brings out the
importance of promotive health as against the curative aspect.
Points out the disparity in govt, expenditure in rural and urban
areas, and stresses the need for people's participation.
209. Story
Story of a lone old woman in a deserted village on the front.
Describes her fear, loneliness and sense of hopelessness while
trying to combat the knowledge that she has been left alone.
210. Article
Discusses the issue of Child prostitution, pointing out the factors
responsible for its perpetuation - namely, poverty, an apathetic
society, increasing demand in the form of foreign "tourists"
and unscrupulous people in the business. Also views this issue
and its pertinence to the spread of AIDS.
211. Article
Reflects upon the all pervading discrimination between men
and women in society giving illustrations. Emphasises the need
to be aware of this difference being an artificial construct,
rather than a natural one, leading to an unjust social system.
212. Poem
Exorts women to continue on the path towards freedom,
inspite of being discouraged, exhausted.
213. Article
An international perspective on the progress of thought and
practice pertaining to health issues. Explores the connection
between social justice, standard of living and health problems,
putting the former as prerequisites for health achievement.
Brings out the need of a comprehensive health information
dissemination strategy, and relevant health policy.
214. Article
The article discusses the idea of a conducive environment in
a holistic manner and relates it to 'Health for AH'. Gives details
of the findings of World Commission on Environment and
development, and suggests accordingly the necessary action
that can be taken at a global level.
215. Article
An exploration of principles which can enhance community
based health information dissemination. Emphasises the need
to use an integrated, multidisciplinary, participatory approach
in this regard.
216. Article
(A continuation of an earlier series) Explains how 'tonics'
to cure weakness, and 'capsules' are used by medicine
manufacturers, as devices to increase profits because of myths
and misconceptions prevalent in people.
217. Editorial
Relates an experience where ANMs and MPWs of two
districts were asked to work without given targets and the
positive results of this experiment.
May, 96
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218. Story
The underlying affection that prevails in a family inspite
of overt fights and quarrels.
219. Article
The findings of a European study about work done by
women in pregnancy and post-partum period at home, and its
negative effects - both physical and emotional.
220. Article
The problems faced by the ANMs in the fulfillment of the
monthly targets for the six national programmes, and the factors
underlying this - namely negative social perceptions, familial
pressure, emotional and sexual harassment, transferable jobs
etc.
221. Article
Clears up misconceptions regarding the intake of injections,
saline solutions etc. Explains how they are abused by medical
practitioners, to deceive people and brings out the danger of
resorting unnecessarily to these methods.
222. Editorial
It being the monsoon period, the editorial discusses water borne
diseases like diarrhoea. The issue is a special issue on
respiratory diseases, hence it also discuses pneumonia,
misconceptions about it and need for awareness.
223. Story
The story of a doctor who helps a poverty-stricken woman,
forced into sexual exploitation for monetary needs. The doctor
falsely "marries" the woman, so as to ensure the abortion of
an unwanted child. Reflects on the pitiful situation of women
forced to sell their body to support their family.
224. Article
Discusses how women unwillingly or for individual gains
contribute to strengthen the patriarchal social system. Stresses
the need to be aware of this conditioning and break free from
it in order to restore the balance of equality.
225. Article
Case studies of women who have emerged out of unsuccessful
marriages as a result of divorce, desertion or voluntary. Points
out the role of society and its members in giving justice to
women.
226. Poem
A poem reflecting the doubt inherent in a woman, with allencompassing love for her lover, about whether the love is
to be fruitful or not.
226 (A). Article
A thought - provoking feature in the form of a dialogue between
an ANM and rural women, which brings out the social
perceptions, inadequacy of infrastructure and medical services,
as factors preventing access of medical service to people.
This is followed by questions intended to facilitate the reader's
thinking in this regard.
June, 96
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July, 96
227. Editorial
On the occasion of the World Population day, it discusses
the myth that population is the cause of poverty, the unjust
attitude of the government's family planning policy and draws
attention to traditional methods of family planning.
228. Story
The plight of a woman who has been driven out of her in
laws' house, because she only bigots daughters. Her sisterin-law accepts her and shows her a hopeful future by showing
her ways to be independent.
229. Poem
The determination of a woman to bloom, to be herself, in
spite of odds, and self doubt.
230. Editorial
In view of Independence Day, discusses the need for rural
development and women's development programmes to be
implemented appropriately.
231. Story
The story of a police official who marries a girl living
in a colony of lepers, distilling illicit liquor. The young
couple, living in the colony, work towards the development
of the slum colony.
232. Article
The first part of a series on "Feminism", defining its concept,
ideology, which aims to bring about equality and justice for
women in a patriarchal society.
233. Poem
Deals with the dual exploitation of a woman labourer at the
hands of the "Mukadam" as well as her husband.
234. Article
The article explains elaborately the nature, causes and necessary
cure for malaria, at an individual as well as public health
level. Discusses the results of a study of workers in public
sanitation, working to prevent malaria, focussing on the health
hazards faced by them, and gives suggestions to improve their
condition.
235. Editorial
Reflects upon the inception, implementation and impact of the
Aayushi project, with the magazine itself, talking in first
person, as a woman.
236. Story
A sensible and mature mother helps her daughter realise
that she has been responsible for perpetuating a feeling of
inferiority in her brother’s wife, who is childless, by not inviting
her to the baby's christening.
237. Article
Second part of the series, explaining "Feminism"; this article
discusses its origin, various aspects from a historical point
of view as well as contemporary issues and relevance in modern
times.
August 96
Sept. 96
74
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238. Poem
Diwali Issue, 96
239. Editorial
A poem reflecting on the "inner call" for awakening within
women, using the metaphorical images of 'dawn', sun and the
crowing cock.
Increasing employment of women in the industrial sector
has had various repercussions. Discusses whether this has
proved detrimental or has positive effects on the status of
women.
240. Story
The story of a young mute girl from a rural family, who runs
away to the city with a lover, only to be deserted by him.
Finally she is forced into prostitution by circumstances, which,
accompanied with poverty and exploitation leads to her death.
241. Article
Contests the assumption that prostitutes or women who sell
liquor are "immoral”. Two case studies of women forced to
take up liquor selling and their efforts to get out of the
business.
242. Article
Reviews an article in an old womens' magazine, "Prachi
Prabha (1909) on Hysteria. Attempts to give a comparative
perspective on perceptions about hysteria then and now.
243. Article
Deals with rural women, and the impact of their work on
their health. Problems related to pregnancy and reproductive
organs are emphasised, because of their relation to hard manual
labour.
244. Story
A woman leaves her unfaithful husband, only to encounter
undesirable sexual interest, at her work place. Emerges as
a wiser and more mature woman.
245. Article
The findings of a research study based on the 1991 census,
analysing the contribution (overt and hidden) of rural women
in the work, its increase over time, and its repercussions of
women's health.
246. Poem
Depicts the condition of a female labourer, labouring to support
her family, for meagre wages.
247. Poem
Talks about the neglected female labourer whose work and
existence is considered invisible, inspite of her immense
contribution to the family and economy.
248. Poem
A poem in native dialect, reflecting the agonies of the women,
leading an exhausting life, with no rewards.
249. Article
Analyses the adverse effects of women's employment in an
industrial society (as well as rural areas) - on women's health.
Brings out the correlation between employment, marginalised
status and poor health.
75
MONTH
FOCUS
250. Article
An account of the results of a public interest litigation case
related to the rights of workers in mines and asbestos industrywhich focuses on the health aspect as a primary issue in
securing rights in the work environment for the workers in
any industry.
251. Article
Discusses the exploitation and victimisation faced by working
women in a primarily patriarchal society, in the form of negative
social perceptions, work stress, gender discrimination and
violence at work etc. Urges working women to come together
for a constructive alternative.
252. Article
Deals with the health problems commonly found in women
involved in strenrious household chores - focussing on the
preventive aspect through proper precautions.
253. Article
A comparative evaluation of the achievements pertaining to
women’s development, and the darker side of development,
since independence, in social, economic, educational legal,
technological spheres.
254. Article
A story, depicting the vicious cycle of gender discrimination,
ignorance, suppression, poverty and illhealth in which many
women are perpetually caught in.
255. Article
Brings out to the fore the problem of sexual violence in the
work environment. Defines the nature of sexual violence, at
an individual and -organisational level.
256. Article
A profile of female ragprikers, describing their health problems,
social problems, expressing the need to organise this workforce
. for better rights and working conditions.
257. Article
Examines the work environment and health related problems
of women in the Electronics industry, and stresses the
importance of consciously striving towards better working
conditions for them.
258. Article
Discusses the economic and health problems of female Bidi
workers, which continue in spite of governmental intervention,
in the form of legal procedures and schemes, due to non-access
to them and no information about the same. Explains how
unionisation has been incapable of solving these difficulties.
259. Article
A profile of the domestic workers, discussing the nature of
their work, especially as an unorganised sector. Examines the
economic, health and sexual problems related to this. Brings
out suggestions for rendering this sector more independent.
260. Article
A portrayal of the life of prostitutes who are a marginalised
section of society, voicing their opinions and feelings about
the negative social attitudes that they confront, especially
76
MONTH
FOCUS
pertaining to the accusation regarding the spread of AIDS.
Dec. 96
261. Editorial
On occasion of the World AIDS day. Enumerates the various
campaigns undertaken to spread AIDS awareness. It looks at
AIDS as a problem aggravated by urbanisation and lop-sided
development, as well as ignorance about sexuality.
262. Story
The issue of environmental degradation, water pollution,
and harm to the living organism; brought about by self-centred
human greed, dealt in the form of a fairy tale.
263. Article
The third part of the series of articles on ’’Feminism” discussing
the manufeslation of gender discrimination in a capitalistic
and industrial, modern society, perpetuating the condition of
patriachy.
264. Letter
A doctor writes about the attitudes of ANMs, who inspite
of being in better positions than rural women retain their
traditional, stereotypical female psyche, also exploiting other
women at times. Encourages Aayushi in its endeavour.
265. Poem
Using metaphorical images of 'sunbeams' for the fragile and
momentary existence of women, the poem seeks to find a
way out of darkness for women.
266. Editorial
Introduces the beginning of subscriptions of the issue, beyond
the circle of ANMs. Also announces the commencing of a
number of series on Anatomy-physiology, health and diseases,
feminism, in the forthcoming issues.
267. Story
The portrait of a village woman migrated to an urban area
who provides support, emotional and otherwise, to all hopefuls
coming to the city in search of employment
268. Article
First of the series on 'Women and environment'. Describes
the concept of mother forests (Matruvan) which is an ancient
tradition in India in which a certain area of forests is under
the control of the community women. Environment nurturing
and regenerating activities were carried out women. Reflects
how loss of status for woman has also resulted in less proximity
to nature and environmental degradation.
269. Article
About the activity of a woman's organisation, which works
with slum women. A discussion facilitated by the activist,
triggered by the suicide attempt of a housewife, who is troubled
by the family situation, leads to whether alternatives can be
worked out for change in situations.
270. Poem
Inspite of the firm hold of tradition of women, which moulds
them in accordance with the wishes and needs of a patriarchal
Jan. 97
77
FOCUS
MONTH
society, it embodies the belief, that
crumble to give a new culture.
these foundations will
271. Article
A thought provoking feature on the exploitative nature of the
lop-sided, capitalist developmental approach-bringing out its
negative impact on the people. Attempts to outline a paradigm
of a people-centred plan for development.
272. Article
Brings out the importance of dissemination of adequate and
relevant information pertaining to diseases and health, discusses
the nature of information, recipients of information and how
it should be imparted.
273. Editorial
Informs about WHO's announcement of 1997 as "year for control
of Contagaous diseases. "Comments on the high occurrence
of contagious diseases in India, especially in rural areas because
of inefficient services, poverty and ignorance. The need to
improve quality of life at all levels - social, cultural, economic
and political.
274. Story
A middle aged woman mistakes a man to be her son in law
and asks him to take a parcel for her daughter, who is dead.
The psychological situation of a woman who has undergone
emotional stress.
275. Poem
It asks the mother of a daughter to be happy for begetting
a daughter, who is as dead. The psychological situation of
a woman who has undergone emotional stress.
276. Article
A discussion of changing one's situation between an activist
and a group of women, where she offers to the women, the
perspective of 'historical materialism' as a way to perceive
and change the situation.
277. Editorial
On the occasion of women's day. While celebrations go on,
the struggles for women's rights to be implemented as in the
constitution, also continues. Economic independence and
political participation are perceived as the cornerstones for
women's progress.
278. Story
A mythological story of the daughter of the Sun, who refuses
to marry an arrogant and powerful suitor, and conducts a contest
among the Gods, to select a husband. Reflects a breaking away
of tradition and subjugation.
279. Article
Retraces the history and the landmarks of the women's struggle
to get their rights, since 1857, explaining why the Sth March
is followed as Women's Day.
Feb. 97
March 97
78
MONTH
FOCUS
280. Article
The results of a study to gauge the impact of information
dissemination about the IRDP project of central govt. Analysis
use of information by beneficiary, and also the basic
shortcomings of any project which causes poor to suffer, while
well to do people benefit from the schemes.
281. Article
Gives information about the 'hiefer project' which provides
families below poverty line with animals, which provide
nourishment for children. Training in the care of the animal
is undertaken. Its relevance to environmental regeneration is
discussed.
282. Poem
An introspective wondering at the nature of one's existence
and the nature of self-hood.
283. Editorial
On the occasion of World Health Day - 7th April. Voices
concern about the impact of increasing pollution and
environment degradation on Health.
284. Story
Of two middle aged women's conversation about death. Puts
up a case for the right to die voluntarily.
285. Poem
How the woman cheerfully bears all the pains and conditions
within her life, while tending to her family.
286. Article
(Women and Environment) : Talks of women as protectors
of biodiversity, in the role of nurturers and conservers of deep
ecological knowledge bases. The change brought about by the
capitalist model of development - where subordination of
women leads to a loss of environmental balance.
287. Article
about a woman who can make women 'pregnant' with her
blessings, even inducing false symptoms of pregnancy in these
women. The author cautions against superstitious beliefs in
such cases.
288. Poem
Wonders whether women, as generators of life have been
themselves responsible for the inhuman existence they live,
by not rebelling against it.
288 (A). Article
(A continuation of earlier feature). Deals with the causes leading
upto Anaemia, emphasising on home-based, low-cost preventive
methods to deal with it. Also gives information on clinical
cure for Anaemia and tips to be followed during Blood
Transfusion.
289. Editorial
(12th May) 'Nurses Day' is celebrated by nurses in hospitals.
Compares the difference in the working patterns of urban nurses
and ANMs, who are not united and have various problems
to face on field. Invites ANMs to respond with their needs
April 97
May 97
79
MONTH
FOCUS
and problems to Aayushi.
290. Story
A story from Vedic mythology, about a sensitive responsible
queen of a cruel king, unconcerned about the welfare of his
subjects. While trying to change the king's attitude, she saw
to it that poverty was eradicated and education spread in the
state, thus taking the role of a 'good wife' who ensured that
right action was taken.
291. Article
Deals with the hazardous and unhealthy occupations and
industries in which child labour is prevalent. Discusses factors
which can permanently damage children's health, sometimes
even turning fatal. The need to be sensitive to rights of such
exploited children.
292. Article
(Women and environment) Role of women at the dawn of
civilization, where 'woman' was at the centre of community
existence, cultural continuity being maintained through her. A
change in mode of existence and production gave way to
patriarchy relegating women to the background.
293. Poem
A poem in traditional metre and style about the cultural
perception, that however loved a daughter may be, she is never
one's own, but belongs to 'someone else'
294. Article
Looks at malnutrition from an integrated viewpoint, emphasising
on balanced diets and healthy habits, as against consumption
of "packaged" vitamins, proteins and other ingredients sold
under the name of "medicines."
295. Editorial
On the occasion of Sth June, environment day, it discusses
severe environmental degradation in urban as well as rural
areas. Reflects over the change in perspective while looking
at environment and related problems. Suggests simple ways
to contribute to clean surrounding.
296. Story
The story of a mythical figure Savitri, who with her
commitment and dedication brought her husband from the
clutches of death. Appeals to women, as daughters of Savitri,
to use their strength to change adverse conditions in life.
297. Memoirs
A husband regretfully relates the last days of his wife who
died of stomach cancer.
298. Comment
Comments on the possible causes in the family and society,
which led a young engineering student to commit suicide,
due to coercion from anti-social elements. Stresses the need
for responsible citizens to act upon social issues constructively.
299. Article
(Women and Environment) : Deals with the issue of women
and population control, since population is regarded as a major
June 97
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factor for environmental degradation. Discusses how women
have always been targets and not decisionmakers in the process
of family planning, and voices the importance for women to
choose and decide on such matters.
300. Poem
Using traditional metre and style, the poem exalts the power
of women to withstand opposition of any kind and resist
injustice.
301. Article
Aims at provoking readers to approach health from an
environmental and community based viewpoint. Facilitates a
questioning which can yield an area specific analysis of health
situation for the ANMs.
302. Editorial
Explains how 'population explosion’ is a bogey raised by rich,
developed countries, who want to exploit limited earth
resources for meeting their standards of living. Looks at socio
economic inequality as the real problem as against population
explosion and violation of human rights in the name of
population control.
303. Editorial
On occasion of the 50th Indian Independence Day reflects on
whether real development has been achieved for the masses
of the country. Holds politicians responsible for defective,
lopsided planning. Considers need for decentralisation of
power, through schemes like Panchayati Raj as essential for
development.
303 (A). Article
An understanding of Hysterectomy, the various diseases and
reasons leading upto it. Answers various questions about the
removal of uterus, its consequences and the dangers during
the process.
July 97
August 97
81
Aayushi
Technical Inputs
FOCUS
MONTH
APRIL
1994
MAY
1994
JUNE
1994
1. Article
Explains the concept of "medicine" as an active chemical, to
be taken in the body in order to better health. Emphasises
the importance of understanding the function of medicines,
dosage, forms of dosage and the dangers in administration of
medicines.
2. Article
An informative feature concerning 'FEVER' - its various types,
accompanied with a chart, illustrating how fever can be only
a symptom of various illnesses as well as a flow chart which
contains questions for accurate diagnosis of fever and related
illnesses. Includes information about the various remedies
involved.
3. Article
Describes two commonly found illnesses in children - measles
and chicken pox, along with their causes, symptoms, diagnosis
and cure, dealing also with the ppreventive aspect. Contains
a table illustrating the differences between the two diseases.
4. Article
Discusses heatstroke, and heat rash - two afflictions which
are common in summer, focussing on the causes and their impact
on the body - giving preventive measures for them.
5. Article
Contains practical tips concerning the care of the new - born
infant, in many aspects - chiefly pertaining to health. Enumerates
symptoms which are dangerous and recommends immediate
medical help.
6. Article
Gives a positive, constructive alternative of natural family
planning as against artificial methods of birth control,
emphasising on the empowerment of women by a new approach
to body and sexuality. An account of a programme with women,
aimed at family planning by the "mucus method" Union runs
various schemes, including creches.
7. Article
Initial story of a serialised story: Radha ki Kahani (Radha's
Story)
8. Article
Natural Family Planning (Continued from previous month) An
explanatory article with illustrations, aiding women to
understand their menstrual cycle through three sign vaginal
mucus, cervical position and vaginal temperature, in order-to
use this knowledge to control and make decisions about
conception and understanding their own bodies.
9. Article
Discusses 'WATER' and the various ways in which it can be
polluted. Gives homebased methods to purify water. Enumerates
water borne diseases, and explains importance of pure water
82
MONTH
FOCUS
in preventing them.
JULY
1994
AUGUST
10. Article
A feature on the nature of jaundice (Hepatitis A-B), its causes,
and method of diagnosis and cure. Explains in detail the care
to be taken during illness, as well as ways to prevent the
onset of the disease.
11. Article
Deals with the problem of Infantile Colic, emphasising that
it is a natural condition. Discusses how the condition can be
diagnosed, abetted and cured by medicines and home based
remedies.
12. Article
Further serialisation of Radha ki Kahani.
13. Article
A detailed understanding of diarrhoea in infants and young
children covering the aspects of its causes, its symptoms, diet
and care to be followed during the disease, the various
medicinal remedies etc. Includes a lot of diagrams to illustrate
the concepts explained.
14. Article
A short piece looking at menstruation from the point of view
of understanding the female body and its working, instead of
negating and repressing it as a taboo subject.
15. Article
Explains the concept of vaccine, which is an important method
of immunisation, giving various ways in which vaccines can
be made, in order to control the onset of specific diseases.
16. Article
Contains information about diphtheria, mainly concentrating on
its diagnosis through symptoms. Tabulated information about
comparative symptoms of other related diseases, as well as
an understanding of remedial and preventive measures.
17. Article
Deals with 'MALARIA' especially with reference to its
etiology. Explains the cycle of the plasmodium vivex, in the
human being and the agent. Also contains the symptoms and
various remedial measures for the disease.
18. Article
An insightful article, approaching the issue of female sexuality
and its negation in society, beginning with an acquaintance of
the female external sexual organs. Attempts to break the
conventional misconceptions and negative perceptions accorded
to female sexuality.
19. Article
The article discusses the etiology, symptoms, diagnosis and
cure of Typhoid and Paratyphoid, also explaining preventive
1994
SEPT
1994
83
I
MONTH
FOCUS
measures to prevent its onset.
20. Article
Gives a lucid explanation of the hormonal secretions during
the monthly cycle, its impact on the vaginal mucus, release
of ovum etc. Also explains how psychological and physical
environment may affect the menstrual cycle.
21. Article
Enumerates the list of food ingredients to form a nutritious
diet for a pregnant woman. Explains the various kinds of
physical discomfort experienced by pregnant women, advising
appropriate care.
22. Article
Discusses the concept of 'Anaemia' and brings out the possible
causes for decrease in the percentage of essential components
of blood.
23. Article
Introduces the concept of Bacterial-Resistance, which has led
to newer strains of micro-organisms resistant to existing
medicines, thus nullifying their impact in destroying germs.
Emphasis the need to improve on the body’s immune system,
instead of increasing dependence on medicines.
DIWALI ISSUE
1994
24. Article
Deals with the physical, mental and emotional aspects of violence,
and examines in detail its causes, nature and impact on the victim.
Gives tips on handling a victim of violence, especially immediately
after the experience.
25. Article
Brings out the resignation with which women tolerate violence,
and expresses the need to rise out of their passivity and act
against such violence.
26. Article
Discusses the sexual exploitation of young girls, especially
at an incestual level in a patriarchal society, through various
illustrations. Reflects on the possible solutions to this problem,
emphasising on trustful, intimate relationship between mother
and daughter as an important necessity in this regard.
27. Article
Reflects on the issue of Child Abuse in its physical, social
and psychological aspects, concentrating on sex abuse and its
impact on children.
28. Article
Questions the validity of reasons given for victims of burnsespecially in case of women. Studies the correlation between
social situation and the number of women succumbing to death
by burning in a study conducted in Sassoon Hospital, Pune.
29. Article
Discusses the social stigma attached to Leprosy and
leprosy patients. Points out the importance of rooting
Jan. 95
84
MONTH
FOCUS
out misconceptions, biases and ignorance in society
in order to eradicate the disease and socially rehabilitate
victims.
30. Article
The article discusses the etiology, symptoms, diagnosis and
cure of leprosy in a lucid language, emphasising the preventive
aspect. A reflection on the nature of leprosy as a social disease,
resultant of poverty - symptomatic of inequalities between the
first and the third world.
31. Article
An informational guide to nutrient values of food articles
commonly consumed by people, with an emphasis on lowcost diet components with high nutritive value. Includes tips
on increasing nutrient value of foods.
32. Article
Describes the nature of anaemia, taking into consideration, that
women are especially prone to it. Gives a list of methods,
medical and home based, to deal with the disease.
33. Article
A brief overview of the clinical aspects of Tuberculosis
(including symptoms, diagnosis and cure), with information
about government measures against the disease. Also discusses
difficulties of a social and medical nature, involved in the
control of Tuberculosis.
34. Article
Critically examines how Allopathy, as a medicine system, is
limited (due to a curative approach) in working towards a
holistic, integrated system of health. Briefly discusses alternative
health systems, and the possibility of combinatory usage of
two or more systems, in leading to holistic health.
35. Editorial
A special issue on "Women and Health", it solicits sensitivity
on part of ANMs towards women in rural areas with physical
or emotional health problems.
36. Article
A diagrammatical illustration of various social and cultural
aspects of the vicious cycle in which women are caught up,
which contribute to their poor health status.
37. Article
Discusses a variety of social factors, rooted in gender
discrimination, which are causative for malnutrition in women
and children.
38. Article
Explores the real functioning of national programmes for women
welfare. Brings out the fallaciousness and danger of targetoriented family-planning methods, used by the government,
which victimise women at all levels.
39. Article
Discusses in detail the health hazards faced by women related
Feb. 95
Mar. 95
85
MONTH
FOCUS
to their work - within home and outside, especially in rural
areas. Considers the sexual violence faced by women at work,
as well as the emotional stress involved in a monotonous,
exhausting work schedule.
40. Article
Examines the causes for non-accessibility of health facilities
for rural women, encompassing women’s status, their
powerlessness and non-awareness and unavailability of medical
services as the main factors. Perceives the role of the ANM,
as a vital alternative in rural areas.
41. Article
Discusses the etiology and nature of pain’, pointing out its
role in enabling knowledge of deep-seated health problems.
Warns against detrimental use of painkillers, which do not
handle the problem, but only lessen the symptoms. Also deals
with the issue of mental and emotional pain.
42. Article
An informative article on the kinds of pains, infants suffer
from, including how they can be diagnosed and remedied, at
home. Explains the causes of infants crying and helps to interpret
this expression of pain.
43. Article
Presents the alternative science of acupressure, as a means
of eliminating bodily pain, as against resorting to pain killers.
Describes in detail, the various pressure points of the body,
to deal with commonly experienced body-aches.
44. Article
Provides information about the nature and function of allopathic
pain killers, together with their harmful effects in general and
when consumed in excess.
45. Article
A feature on the continued usage of 'Analgin', in the country
despite the ban on it since 1980.
46. Article
A descriptive analysis of a survey study of'ANM’ conducted
by FRCH, in order to understand the difficulties faced by them,
as a result of social victimisation pertaining to gender and
caste, and the negative perceptions of co-workers, rural
population and their own families. Explains the role of the
Apr. 95
May 95.
centralised medical system in contributing to the problems faced
by the ANM. Contains suggestions from the ANMs to eliminate
these difficulties.
47. Article
Enumerates the various sources of possible illnesses, which
may be contracted by the health workers, during the course
of their work, and contact with patients. Gives measures to
prevent the same.
86
MONTH
FOCUS
48. Article
A narration of experiences of sexual violence (rape)
encountered by the ANMs, while working, and how they have
been combated. A reflection on how no protection is provided
against such incidences.
49. Article
Describes the general negligence shown in the health planning
policies, towards women health and their problems, specifically
showing how government rules and policies affect the female
nurses working in rural areas. Voices the need for nurses to
unite and work for their rights.
50. Book
Review
A Marathi translation of Dr. Park’s book "Essentials of
community Health Nursing" has been reviewed as an extremely
useful book for field workers and nurses.
51. Experiences
An ANM relates an incident where an educated woman
lands up in an emergency situation due to a folk remedy
used to relieve her of stomach pains. The ANM reflects on
why education, meant to equip people to think and not blindly
follow superstition does not help us to do so.
52. Article
Discusses the problems of back pain, and pain in the waist,
giving simple exercises to combat these pains and tips regarding
how these exercises are to be performed.
53. Article
Gives the results of a study conducted to determine the
knowledge of the ANM regarding the medicines commonly
distributed by them. The survey suggests that it is vital to
provide increased knowledge to the ANMs in this regard.
54. Article
An information-oriented article on occupationally related
illnesses, the various chemical and other substances causative
of such illnesses and the need to take measures for their control.
55. Article
Points out how the first world countries, inspite of
causing tremendous environmental degradation, deteriorating
the lives of people in the third world, through their commercial
ventures, call out "danger" in the name of increasing population
and try to suppress population growth in Third World Countries.
Seeks to explode the myth about population being a cause
for Third world problems.
56. Article
Questions the violence committed against women in the form
of uninformed and forced usage of contraceptive devices which are primarily targeted at women. Traces the connection
between the fallacious notions of population explosion, and
the vested interests of the First World Countries.
June 95
July 95
87
MONTH
FOCUS
57. Article
Gives a historical development of the Intra - Uterine device
as a contraceptive through the years.
58. Article
Deals with the problems of worms in children, explaining their
causes and symptoms. Gives the solution for the control of
these illnesses at a preventive and curative level.
59. Article
Provides information about the various kinds of diseases
contracted by human beings, through contact with animals, and
gives tips to prevent the same.
60. Article
Explains the causes for vomiting in infants, especially when
it occurs as symptomatic of more serious illnesses.
61. Article
A short piece on various kinds of bodily aches, their possible
causes and remedies to ameliorate the pain, focussing on a
holistic method of proper diet, exercise and rest.
62. Article
A narration of a woman's experience of childbirth as a positive
and fulfilling process, attempting to break the conventional
myths, negative attitudes and psychological stress surrounding
pregnancy and child birth.
63. Article
Explains the various kinds of impurities found in water, and
emphasises the need of access to potable and clean water
in order to enhance public health.
64. Article
Articulates the need to view menstrual pains (Dysmenorrhoea)
with a social perspective, taking into consideration the
correlation between mental pressure, poverty and related factors
and menstrual pain.
Aug. 95
Sept. 95
Diwali Issue 95
65. Article
Describes the history of gynaecology as a series of assaults
on the female body and mind. Looks at the contemporary
practices in the field, medication and family planning as a
continuing assault of a similar nature. Brings out the need to
investigate an alternative.
66. Article
The hazardous impact of pollutants in rural and urban areas,
which deteriorate the functioning of the reproductive system.
67. Article
Describes the conceptions of the Bhil and Pawra tribals
regarding the male and female reproductive systems,
menstruation, fertilization and foetal growth - a knowledge
system totally independent of modern anatomical and
physiological findings.
68. Article
An overview of the AIDS and its impact on affected patients
88
MONTH
FOCUS
June 96
88. Editorial
It being the monsoon period, the editorial discusses water borne
diseases like diarrhoea. The issue is a special issue on
respiratory diseases, hence it also discusses pneumonia,
misconceptions about it and need for awareness.
89. Article
A thought - provoking feature in the form of a dialogue between
an ANM and rural women, which brings out the social
perceptions, inadequacy of infrastructure and medical services,
as factors preventing access of medical service to people.
This is followed by questions intended to facilitate the reader's
thinking in this regard.
90. Article
A detailed article dealing with the causes and types of cough
and cold (Bronchitis, Sinus pain etc.), along with their
symptoms. Gives remedies- clinical as well as home-based,
in order to cure them; also mentions preventive measures for
the same.
91. Article
Discusses elaborately the nature of diarrhoea, dysentery and
loose motions, explaining their various causes, especially with
reference to children. Illustrates symptoms and cure through
a lucid chart and gives medical and home-based remedies (ORS
formula), for the illnesses.
July 96
Describes the correlation between the irrigation system and
health in its positive as well as negative aspects-specifically
explaining the spread of communicable diseases through water
irrigation channels, and stagnant water areas.
Aug. 96
92. Article
The article explains elaborately the nature, causes and necessary
cure for malaria, at an individual as well as public health
level. Discusses the results of a study of workers in public
sanitation, working to prevent malaria, focussing on the health
hazards faced by them, and gives suggestions to improve their
condition.
93. Article
Consists of information about fractures at various locations
in the body, ways to identify fractures, their symptoms and
tips on first-aid to be given in order to minimise the damage
caused.
Sept. 96
Diwali Issue 96
94. Article
Reviews an article in an old womens' magazine, "Prachi
Prabha (1909) on Hysteria. Attempts to give a comparative
perspective on perceptions about hysteria then and now.
91
MONTH
FOCUS
95. Article
Deals with rural women, and the impact of their work
on their health. Problems related to pregnancy and reproductive
organs are emphasised, because of their relation to hard manual
labour.
96. Article
The findings of a research study based on the 1991 census,
analysing the contribution (overt and hidden) of rural women
in the work, its increase over time, and its repercussions of
women's health.
97. Article
Analyses the adverse effects of women's employment in an
industrial society (as well as rural areas) - on women's health.
Brings out the correlation between employment, marginalised
status and poor health.
98. Article
Explores the issue of occupational health in the context of
women, explaining the various aspects of health hazards. Gives
suggestions in order to change the work situation as well as
direct research towards more fruitful study in the area of
women's occupational health.
99. Article
An account of the results of a public interest litigation case
related to the rights of workers in mines and asbestos industrywhich focuses on the health aspect as a primary issue in
securing rights in the work environment for the workers in
any industry.
100. Article
Discusses the exploitation and victimisation faced by working
women in a primarily patriarchal society, in the form of negative
social perceptions, work stress, gender discrimination and
violence at work etc. Urges working women to come together
for a constructive alternative.
101. Article
Deals with the health problems commonly found in women
involved in strenrious household chores - focussing on the
preventive aspect through proper precautions.
102. Article
A story, depicting the vicious cycle of gender discrimination,
ignorance, suppression, poverty and illhealth in which many
women are perpetually caught in.
103. Article
A profile of female ragprikers, describing their health problems,
social problems, expressing the need to organise this workforce
for better rights and working conditions.
104. Article
Examines the work environment and health related problems
of women in the Electronics industry, and stresses the
importance of consciously striving towards better working
conditions for them.
105. Article
Discusses the economic and health problems of female Bidi
workers, which continue in spite of governmental intervention,
92
MONTH
FOCUS
and their families. The need to change social attitudes in order
to control the onset and spread of the disease, as well as
to secure humane treatment for the afflicted people.
69. Article
Perceives malnutrition as causative of various illnesses seen
in females. Correlates poverty and other social factors, including
gender discrimination, as reasons for malnutrition in Third
World Countries, emphasising the need to make women aware
regarding their nutrition intake and health.
70. Article
In view of the general negligence shown towards female health,
the article defines the role of the ANM in establishing a rapport
with rural women and empowering them to deal with their
own health. Perceives the need to train ANM in this direction.
71. Article
An Ayurvedic way of understanding excessive vaginal discharge
and home-remedies to deal with the problem.
72. Article
A thought - provoking article on tribal and urban perceptions
of sexuality, reflecting whether the urban view seems more
narrow minded, hypocritical and limited, as a consequence
of distancing from nature.
73. Article
Points out the need to improve the status of women and family
health, through the narration of the learning experiences gained
in a project for Dai-training.
74. Article
A short feature on the potential contraceptive function of certain
traditionally used natural substances - which need to be
investigated and further studied.
74. Article
The results of a study based in a slum, studying the correlation
between women's work and their reproductive health. Infers
that, inspite of increased income, lacks of adequate medical
services, occupationally related illnesses, and non-awareness
regarding their rights - women register a low index of health.
76. Article
Gives an idea as to the nature of reproductive tract infection
as well as tips to prevent the same.
77. Article
A brief survey of laws pertaining to women's health, their
loopholes and lack of awareness regarding them. Reiterates
the need for women to unite and bring about proper
implementation of these laws.
78. Article
An illustratory features on how negligence and lack of time
in a hospital can lead to the parameters of sterilisation and
hygiene being disregarded.
Dec. 95
79. Reader's
opinions
Appreciate the work of 'Aayushi' while commenting on
89
MONTH
FOCUS
the need for information about medicines, their dosage,
side effects etc. for the use of ANMs.
80. Article
A feature on urinary-tract infections, discussing in detail its
causes, diagnosis, remedies and means of preventing the
recurrence of these infections.
81. Article
A description of Kegel exercises', and how to perform them.
They tone the pelvic - floor muscles.
82. Article
A narration of an experience of severe urinary tract infection,
which can go unnoticed due to lacks of information and
awareness. Reflection on the need for women to be positively
aware of their own bodies - without embarrassment.
82. Article
Discusses the natural and industrial causes for pollution of
water, and gives homebased as well as large-scale methods
for purification of water.
83. Article
An article describing possible causes of sterility and medical
techniques to investigate the same. Tries to remove
misconceptions regarding sterility and introduces the concepts
adoption.
84. Article
A clinical understanding of Tuberculosis of the reproductive
organs, its symptoms, and its impact on the functioning of the
reproductive organs and fertility.
85. Article
Analyses the functioning of the Tuberculosis Control
Programmes of the government, based on a research study by
the FRCH. Reflects on inadequacy of services, work pressure
on workers and target-based indicators as major factors leading
to non-efficiency and low success in the programme.
86. Article
An international perspective on the progress of thought and
practice pertaining to health issues. Explores the connection
between social justice, standard of living and health problems,
putting the former as prerequisites for health achievement.
Brings out the need of a comprehensive health information
dissemination strategy, and relevant health policy.
87. Article
The findings of a European study about work done by
women in pregnancy and postpartum period at home, and its
negative effects - both physical and emotional.
Jan. 96
Feb. 96
Mar. 96
Apr. 96
May 96
90
MONTH
FOCUS
in the form of legal procedures and schemes, due to non-access
to them and no information about the same. Explains how
unionisation has been incapable of solving these difficulties.
106. Article
A profile of the domestic workers, discussing the nature of
their work, especially as an unorganised sector. Examines the
economic, health and sexual problems related to this. Brings
out suggestions for rendering this sector more independent.
107. Article
A portrayal of the life of prostitutes who are a marginalised
section of society, voicing their opinions and feelings about
the negative social attitudes that they confront, especially
pertaining to the accusation regarding the spread of AIDS.
108. Story
The issue of environmental degradation, water pollution, and
harm to the living organism; brought about by self-centred human
greed, dealt in the form of a fairy tale.
109. Article
Explains the types of hemorrhage, their various causes, and
the first aid to be delivered in case of such bleeding. Deals
in details about the various locations which actual hemorrhage
may occur.
110. Article
Explains in detail the concept of 'cells', and the cellular
organisation of all living objects. Emphasises on unicellular
of microorganism which are responsible for diseases, their
effect on the cells in the human body as well as the immune
system of the body.
111. Article
Categorises various types of illhealth and deals in detail with
physical illhealth, and its various aspects, especially
communicable diseases.
112. Editorial
Informs about WHO’s announcement of 1997 as "year for
control of Contagious diseases. "Comments on the high
occurrence of contagious diseases in India, especially in rural
areas because of inefficient services,
113. Article
A description of the constituent structure of cells, tissues
explaining various kinds of tissues and their roles in bodily
functioning.
114. Article
An informative article describing various kinds of
microorganisms, that are harmful to the bodily functioning.
Explains the connection between a healthy immune system,
vaccination and reduced possibility of onset of communicable
diseases.
Dec. 96
Jan. 97
Feb. 97
93
MONTH
FOCUS
Mar. 97
115. Article
A detailed piece dealing with the constituent structure of human
blood, how it is produced, and its functions. Also discusses
anaemia, its diagnosis and various causes. Introduces the
concept of immune system of body, for which white blood
corpuscles are important.
116. Article
Questions the validity of the Governmental regulations regarding
distribution of iron and calcium pills, holding that the approved
quantify is far less than the required amount. Also brings out
the need to subsidise these dosages and not restrict there
consumption to pregnant and lactating women.
117. Article
(Women and Environment) : Talks of women as protectors
of biodiversity, in the role of nurturers and conservers of deep
ecological knowledge bases. The change brought about by the
capitalist model of development - where subordination of
women leads to a loss of environmental balance.
118. Article
about a woman who can make women 'pregnant’ with her
blessings, even inducing false symptoms of pregnancy in these
women. The author cautions against superstitious beliefs in
such cases.
119. Article
Explains the various processes of the human body, which serve
to destroy harmful organisms and combat bodily ailments,
together constituting the immune system.
120. Article
(A continuation of earlier feature). Deals with the causes leading
upto Anaemia, emphasising on home-based, low-cost preventive
methods to deal with it. Also gives information on clinical
cure for Anaemia and tips to be followed during Blood
Transfusion.
121. Article
A feature on Jaundice, pertaining to newborn infants and
children, describing its causes, symptoms and cure.
122. Article
A detailed and informative article, in a question-answer form,
covering doubts pertaining to the causes and nature of an
enlarged prostate glands, its symptoms and the various aspects
of surgery related to it.
123. Article
Looks at malnutrition from an integrated viewpoint, emphasising
on balanced diets and healthy habits, as against consumption
of packaged vitamins, proteins and other ingredients sold
under the name of "medicines."
124. Article
An understanding of lymphatic fluid, its function and its specific
role in the immune system of the body. Describes the process
April 97
May 97
94
MONTH
FOCUS
whereby the lymph system combats external organisms.
125. Article
(Continuation of earlier feature) Deals in detail with various
aspects involved in the removal of prostate glands - including
post-surgery problems, care to be taken during the period, as
well as information relating to the actual surgery and anaesthetic
etc.
126. Article
Contains brief tips about collecting samples of urine and blood
of patients for investigation.
127. Article
(Women and Environment) : Deals with the issue of women
and population control, since population is regarded as a major
factor for environmental degradation. Discusses how women
have always been targeted and not decision makers in the
process of family planning, and voices the importance for
women to choose and decide on such matters.
128. Article
Explains the various physical irregularities occurring in new
born children, as normal adjustmental problems in the infant
body, advising to be cautions and conscious while dealing
with them.
129. Article
Aims at provoking readers to approach health from an
environmental and community based viewpoint. Facilitates a
questioning which can yield an area specific analysis of health
situation for the ANMs.
130. Article
Explains in details, the concept of Cataract, it causes and
symptoms, concentrating mainly on the surgery related to
removal of cataract. Clears doubts regarding the same giving
post-surgery care tips.
131. Article
A brief article discussing the problem of Glaucoma and its
causes.
132. Editorial
Explains how 'population explosion’ is a bogie raised by rich,
developed countries, who want to exploit limited earth
resources for meeting their standards of living. Looks at socio
economic inequality as the real problem as against population
explosion and violation of human rights in the name of
population control.
133. Article
Takes up the problem of anal fissure and its related problems
(perianal abscess, fistual-in-ano), discussing the causes, the
symptoms and the surgical operations related to it.
134. Article
Discusses the problem of Piles, with reference to the surgery
in order to ameliorate the problem.
June 97
July 97
95
MONTH
FOCUS
135. Article
A detailed discussion about the inflammation of tonsils, its
causes, reasons for removing them emphasising on the surgical
part giving dangers involved in the process and care to be
taken before and after the surgery.
136. Article
(Continuation of earlier article). Discusses diagnosis and
surgical operations related to Glaucoma, types of glaucoma,
and care to be taken in the surgical process.
137. Article
A reprint of the tips for collecting samples of urine and blood
for investigation.
138. Article
Enumerates the various uses of Paracetamol as a multi purpose
drug, warning against its side effects especially with reference
to children. Advises appropriate dosages for children for
various problems.
139. Article
Answer basic questions about the nature of Hernia, its causes,
symptoms and methods to ameliorate it. Explains in detail the
various aspects of the surgical process, pre and post surgical
care etc.
140. Article
An informative feature on the nature, causes and symptoms
of Appendicitis, with information about tests for diagnosis,
and surgical procedures for removing the Appendix, with the
dangers involved in the process.
141. Article
Explains Curating" as a surgical operation intended to diagnose
certain diseases related to the female reproductive system, as
well as to remedy some of them. Also includes the process
of surgery and potential dangers.
142. Article
An understanding of Hysterectomy, the various diseases and
reasons leading upto it. Answers various questions about the
removal of uterus, its consequences and the dangers during
the process.
143. Article
Aims at giving readers appropriate information and empower
them to understand the process of surgical operation and
Anaesthetisation in general. Considers the various aspects
relevant in such a situation, and facilitates people to be more
conscious as patients.
August 97
96
MONTH
FOCUS
her mother’s courageous struggle for justice.
19. Article
On the New Women’s Policy of Maharashtra (by
Advocate Vivek Dhamankar). Discusses Sharad Pawar's Policy
and the relevance of this policy to Violence Eradication looking
at various schemes:
1) Gender sensitisation for police;
2) Special cadre of people, who would look into
violence from all angles;
3) Demographic surveys to determine types of people
more susceptible to violence.
4) Special courts established to hear family violence
cases, to hasten justice.
5) Legal issues that need to be examined and establishing a
legal committee to examine the loopholes in the laws for
women. Other points that should be disseminated are discussed,
such as:
* A woman cannot be thrown out of her maternal or
marital house.
* A norm to protect economically backward woman
to gain a share of their property has to be worked
out.
* A Committee should monitor the portrayal of woman
in advertisements and films, to prevent women's denigration.
2/3 majority of a censor board's consensus should be mandatory
before clearing any published material.
20. Article
Explains the phenomenon of wife-beating, in a recurrent cycle
of three stages - pent up tension, explosion and reconciliation,
emphasising that there generally is no end to this vicious cycle,
unless bold action is taken.
21. Article
Welcomes the Government act to ban Amniocentesis, for the purpose
of sex determination, voicing the violence perpetuated on the female
gender through such tests.
22. Article
Questions the validity of reasons given for victims of burnsespecially in case of women. Studies the correlation between
social situation and the number of women succumbing to death
by burning in a study conducted in Sassoon Hospital, Pune.
23. Article
A representative account of a dowry-death, explaining the
intricacies of the legal system and the need to resort to it
in case of suspicions deaths.
24. Article
Explains the importance of First Information Report (F.I.R.)
at a legal level, in order to protect and aid women suffering
from violence.
99
MONTH
FOCUS
Jan. 95
Feb. 95
25. Article
An introduction to the ideology and working methods of an
organisation - Stree Aadhaar Kendra." recounting some case
histories of women, who have availed of the organisation's
help.
26. Article
Describes the inception of a non-formal education project for
tribal children, in Thane district of Maharashtra.
27. Letters
of ANMs and health officials to Aayushi, voicing out the
importance of Aayushi’s contribution in reflecting the views
of ANMs as well as providing knowledge of relevant subjects.
28. Article
Gives a historical and critical perspective of family planning
methods, followed in India since independence. Envisages the
broad principles for an alternative, humane and more
decentralised system of family planning.
29. Article
Critically examines how Allopathy, as a medicine system, is
limited (due to a curative approach) in working towards a
holistic, integrated system of health. Briefly discusses alternative
health systems, and the possibility of combinatory usage of
two or more systems, in leading to holistic health.
30. Article
Explores the real functioning of national programmes for women
welfare. Brings out the fallaciousness and danger of targetoriented family-planning methods, used by the government,
which victimise women at all levels.
31. Article
Examines the causes for non-accessibility of health facilities
for rural women, encompassing women's status, their
powerlessness and non-awareness and unavailability of medical
services as the main factors. Perceives the role of the ANM,
as a vital alternative in rural areas.
32. Experiences
An ANM recollects some of her unusual cases and experiences
while on duty.
33. Article
Gives information about laws pertaining to women's justice
viz, dowry, rape laws and family laws. Emphasises the need
for individuals and society to ensure that these laws are
implemented appropriately.
34. Article
A feature on the continued usage of 'Analgin', in the country
despite the ban on it since 1980.
35. Editorial
On completion of one year of Aayushi’s existence. Discusses
the difficulties faced by ANMs in conducting home visits, at
Mar. 95
April 95
May 95
100
Aayushi - Administrative Inputs
MONTH
FOCUS
APRIL
1994
MAY
1994
JUNE
1994
JULY
1. Book Review
of Mi Nursabai (I am a Nurse by Medha Kirane) Discusses
the book's focus of looking upon the hospital system's view
of nurses as parasites.
2. Biography
Case Study of an ANM. The job taken up to assist the woman
in her domestic tragedy, leads to the ANM's self-development
and public regard in the village. Yet, acknowledges that ANMs
feel less respected than their male counterparts.
3. Interview
With Anuradha Athavale, the Leader of the Nurse’s Union
in Pune. Reflections on how the Union was started, the
difficulties faced. Now, 20,000 nurses are enrolled and the
Union runs various schemes, including creches.
4. Story
Initial story of a serialised story: Radha ki Kahani (Radha’s
Story)
5. Biography
An ANM recounts some remarkable experiences gained
while working among the Dhangar tribals (Shepherd)5 tressing
the immense goodwill gained, due to kind and appropriate
medical intervention,
6. Story
Further serialisation of Radha ki Kahani.
7. Article
A detailed understanding of diarrhoea in infants and young
children covering the aspects of its causes, its symptoms, diet
and care to be followed during the disease, the various
medicinal remedies etc. Includes a lot of diagrams to illustrate
the concepts explained.
8. Article
Explains the concept of vaccine, which is an important method
ot immunisation, giving various ways in which vaccines can
be made, in order to control the onset of specific diseases.
9. Biography
An ANM's account of her experience in saving a newborn
baby left for dead and abandoned by its superstitious father,
who believed it to be an avenging ghost. The ANM’s role
in mobilising the police and getting the baby to hospital, was
crucial.
10. Article
Deals with 'MALARIA' especially with reference to itsetiology. Explains the cycle of the plasmodium vivex, in the
human being and the agent. Also contains the symptoms and
various remedial measures for the disease.
1994
AUGUST
1994
97
MONTH
SEPT
1994
OCT.
1994
FOCUS
11. Biography
On transfers, hanging like a Damocles' sword over most
ANMs heads, since their marriages, husband's careers and
children s education are all compromised in the context of
transfer. The situation perpetuates as ANMs say nothing against
it.
12. Story
Continued serialisation of Radha ki Kahani.
13. Article
On the Population and Development Conference Questions
whether it is third world overpopulation or first world over
consumption that leads to environmental damage. The context
of more children where there is high infant and child mortality.
The injustice of contraception being seen as exclusively
a woman's responsibility though women are fertile for only
a short period every month, as against man's constant fertility.
A discussion of the Government's Family Planning policies
and current Cafeteria approach' ensues. A plea for Development
and education as the best Family Planning method is made.
14. Article
Gives preventive measures at home and community levels, to
control mosquitoes and prevent the onset of malaria. An account
of the work done by the Malaria Eradication Programme, and
makes suggestions for its better implementation.
15. Editorial
Discusses the Bhopal issue. (The anniversary of the
Bhopal Gas disaster falls in December but the December
issue would be a part of the Diwali special). The
editorial discusses industrialists and exploitation. The
difficulties of getting compensation for the sufferers in
occupational health hazard cases is brought out.
16. Article
An obstacle in women’s development is that very few
women are part of the decision making process. Though
34% of the workers are women, only 5% are at the decision
making level. At UNESCO, too there are 175 people, of whom
only 3.5% are women. This disparity, caused by women's
prioritising of family considerations over career goals is a
development issue, women are, largely, less concerned with
ruthless exploitation.
17. Story
Continued serialisation of Radha ki Kahani.
Diwali Issue 94
Nov-Dec. 18. Story
Still no Justice ( by Viji Sriniwasan). Based on a true
incident, this story examines the dowry death of Sasibala and
98
MONTH
FOCUS
of the Reproductive system". Explains how these problems
remain untreated in women, in spite of easy diagnosis and
inexpensive treatment, because of the taboo in our culture against
speaking about such issues. Emphasises the need for ANMs
to get information about these diseases and help woman deal
with them.
54. Article
Points out the need to improve the status of women and family
health, through the narration of the learning experiences gained
in a project for Dai-training.
55. Article
A brief survey of laws pertaining to women’s health, their
loopholes and lack of awareness regarding them. Reiterates
the need for women to unite and bring about proper
implementation of these laws.
56. Reader’s
opinions
Appreciate the work of 'Aayushi' while commenting on
the need for information about medicines, their dosage,
side effects etc. for the use of ANMs.
Jan. 96
57. Box
The technical and legal problems arising during the adoption
process, when the wife has maintained her maiden name.
58. Article
Discusses the pros and cons of involving more trained nurses,
in primary health care system, in the United State's medical
system.
59. Editorial
Discusses how increasing urbanisation and development leading
to environmental degradation, has resulted in the spread of
disease causing bacteria prevalent in animals to the human
species. Also explains how unclean surroundings and reduced
human resistance, leads to the spread of epidemics.
60. Article
Second part of compilation of experiences of women with
adopted children, and adoption officials.
61. Article
A short piece mentioning the basic features of the Hindu
Adoption and Maintenance Act.
62. Editorial
Talks about "Panchayati Raj", its meaning, the avenues
open to women due to 33% reservations. Also discusses, what
role an ANM has, as a people's representative with health
knowledge.
63. Report
The rationale for holding the International Women's Conference
at Beijing and a brief reporting about it.
64. Article
An account of various local women's agitations against liquor
Feb. 96
Mar. 96
l03
Tm-’IO
> 1
MONTH
FOCUS
problems, continuing in the antagonistic environment, where
vested interests of bar owners, alcoholics and govt, officials
perpetuate the vice.
65. Article
The article discusses the poor functioning of primary health
centres in the rural areas and suggests a pattern for making
it more efficient through people's participation, decentralisation,
training, non-target based indicators and transparency.
66. Article
An in-depth discussion of the concept of decentralisation as
a policy - at the economic, political and administrative levels.
Reflects on the distortion of this idea by political parties and
government. Emphasises the need to rethinks decentralisation
as a series of processes arising at grass-root level, proceeding
upwards.
67. Article
Brings out the way in which pharmaceuticals use deceptive
and underhand techniques to increase sales and profit, citing
examples of commonly used medicines for common illnesses.
Stresses the importance of home-remedies.
68. Editorial
Fucuses on the World Health Day, 7th April. Brings out the
importance of promotive health as against the curative aspect.
Points out the disparity in govt, expenditure in rural and urban
areas, and stresses the need for people's participation.
69. Article
Discusses the issue of Child prostitution, pointing out the factors
responsible for its perpetuation - namely, poverty, an apathetic
society, increasing demand in the form of foreign "tourists"
and unscrupulous people in the business. Also views this issue
and its pertinence to the spread of AIDS.
70. Article
The article discusses the idea of a conducive environment in
a holistic manner and relates it to 'Health for AH'. Gives details
of the findings of World Commission on Environment and
development, and suggests accordingly the necessary action
that can be taken at a global level.
71. Article
An exploration of principles which can enhance community
based health information dissemination. Emphasises the need
to use an integrated, multidisciplinary, participatory approach
in this regard.
72. Article
(A continuation of an earlier series) Explains how Tonics’
to cure weakness, and 'capsules' are used by medicine
manufacturers, as devices to increase profits because of myths
and misconceptions prevalent in people.
73. Editorial
Relates an experience where ANMs and MPWs of two
April 96
May, 96
104
MONTH
FOCUS
odd hours during emergencies, as well as meeting family
planning targets.
36. Autobiographical
Notes
An octogenarian ANM, who still actively pursues her profession
recalls her life as a nurse and her experiences.
37. Box
Enumerates the duties of a nurse, hundred years ago,
in a British Hospital, as well as the various conditions
attached to the job, in those times, including pay raise,
saving etc.
38. Article
A descriptive analysis of a survey study of'ANM' conducted
by FRCH, in order to understand the difficulties faced by them,
as a result of social victimisation pertaining to gender and
caste, and the negative perceptions of co-workers, rural
population and then own families. Explains the role of the
centralised medical system in contributing to the problems faced
by the ANM. Contains suggestions from the ANMs to eliminate
these difficulties.
39. Article
A narration of experiences of sexual violence (rape)
encountered by the ANMs, while working, and how they have
been combatted. A reflection on how no protection is provided
against such incidences.
40. Article
Describes the general negligence shown in the health planning
policies, towards women health and their problems, specifically
showing how government rules and policies affect the female
nurses working in rural areas. Voices the need for nurses to
unite and work for their rights.
41. Editorial
Deals with the various personal and professional problems
faced by ANMs and stresses the need for ANMs to come
together and fight against injustice meted out to them by society,
42. Report
of a movement of women from a Himalayan village, who
organised to bring about the opening of forest areas around
their village, as community resource to meet their fuel and
fodder needs.
43. Article
Second part of the series dealing with women's legal rights.
Deals with Muslim Family laws, Registered marriage Act and
family courts in this part.
44. Article
Gives the results of a study conducted to determine the
knowledge of the ANM regarding the medicines commonly
distributed by them. The survey suggests that it is vital to
provide increased knowledge to the ANMs in this regard.
June, 95
101
MONTH
FOCUS
July 95
45. Editorial
Deals with the issue of malnutrition in Tribal population
and locates its sources in the Governmental policies of denying
tribals, access to land, water and forest resources, and
dispossession. Questions the validity of welfare schemes and
projects when fundamental rights are denied.
46. Article
Points out how the first world countries, inspite of
causing tremendous environmental degradation, deteriorating
the lives of people in the third world, through their commercial
ventures, call out "danger" in the name of increasing population
and try to suppress population growth in Third World Countries.
Seeks to explode the myth about population being a cause
for Third world problems.
47. Poem
Lopsided policies in the name of development have caused
environmental degradation. In spite of vested interests of the
rich and the powerful, the poor come together and resolve
to save the forests and the earth.
48. Article
Considers the extremely negative impact of the target-oriented
family planning programmes on the attitudes and behaviours
of the health workers, and consequently on their relationship
with the rural population.
49. Article
Questions the violence committed against women in the form
of uninformed and forced usage of contraceptive devices which are primarily targeted at women. Traces the connection
between the fallacious notions of population explosion, and
the vested interests of the First World Countries.
50. Editorial
Draws attention to the problem of droughts, its consequences.
Discusses how urbanisation has increased the tendency to
droughts, while its victims are the rural poor.
51. Article
Investigates the impact of a liberalised and profit-oriented
medicine industry on the price structure and production of
medicines in India. Points out the governmental responsibility
in the control of production and distribution of unessential
irrational and hazardous drugs.
52. Experiences
Of a worker in Health agency about a training programme
conducted in a tribal area. Reflects on the differences in the
efforts taken by trainers, and the inconveniences troubles
encountered by the trainees in order to attend the programme.
53. Editorial
The issue deals with the theme "factors affecting, and diseases
August, 95
Sept. 95
Diwali ’95
102
MONTH
FOCUS
districts were asked to work without given targets and the
positive results of this experiment.
74. Article
An ANM writes about her experiences during training as and
ANM in Pune, and during training in a rural area. She perceives
the rural training to be more flexible, group oriented, learner
centered, practical and nontarget based.
75. Article
Studies the structure and the content of the training programme
of the ANMs, from the point of view of contemporary health
needs and the health situation in rural areas. Voices the need
to remove disparities between training and reality in order
to enhance its effectively.
76. Article
Reflects on the marginalised status of women in the health
machinery as a whole, and the further pressure put on them
through target-based indicators. Exhorts ANMs to come forward
in order to combat this situation.
77. Article
The problems faced by the ANMs in the fulfillment of the
monthly targets fortthe six national programmes, and the factors
underlying this - namely negative social perceptions, familial
pressure, emotional and sexual harassment, transferable jobs
etc.
78. Article
Clears up misconceptions regarding the intake of injections,
saline solutions etc. Explains how they are abused by medical
practitioners, to deceive people and brings out the danger of
resorting unnecessarily to these methods.
79. Editorial
On the occasion of the World Population day, it discusses
the myth that population is the cause of poverty, the unjust
attitude of the government's family planning policy and draws
attention to traditional methods of family planning.
80. Letter
A letter from an ANM expressing discrimination in
responsibilities of an MPW and ANM, the difficulties an ANM
faces in her work, especially in completing family planning
targets.
81. Editorial
In view of Independence Day, discusses the need for rural
development and women's development programmes to be
implemented appropriately.
82. Article
The article explains elaborately the nature, causes and necessary
cure for malaria, at an individual as well as public health
level. Discusses the results of a study of workers in public
sanitation, working to prevent malaria, focussing on the health
June 96
July, 96
Aug. 96
105
MONTH
FOCUS
hazards faced by them, and gives suggestions to improve their
condition.
Sept. 96
——
Diwali Issue, 96 (Nov. & Dec.)
83. Editorial
Increasing employment of women in the industrial sector
has had various repercussions. Discusses whether this has
proved detrimental or has positive effects on the status of
women.
84. Article
The findings of a research study based on the 1991 census,
analysing the contribution (overt and hidden) of rural women
in the work, its increase over time, and its repercussions of
women's health.
85. Article
An account of the results of a public interest litigation care
related to the rights of workers in mines and asbestos industrywhich focuses on the health aspect as a primary issue in
securing rights in the work environment for the workers in
any industry.
86. Article
Discusses the exploitation and victimisation faced by working
women in a primarily patriarchal society, in the form of negative
social perceptions, work stress, gender discrimination and
violence at work etc. Urges working women to come together
for a constructive alternative.
87. Article
Gives information about the various kinds of leaves from work,
legally available to workers, and the rules pertaining to them.
Explains in detail the non-implementation of maternity leave
and grants available to working women.
88. Article
A model form for ANMs to send to the district Zilla Parishad
authority, to facilitate the procedure for availing of the Provident
fund scheme.
89. Article
Brings out to the fore the problem of sexual violence in the
work environment. Defines the nature of sexual violence, at
an individual and organisational level.
90. Article
A thought provoking feature on-the exploitative nature of the
lopsided, capitalist developmental approach-bringing out its
negative impact on the people. Attempts to outline a paradigm
of a people-centred plan for development.
91. Article
Brings out the importance of dissemination of adequate and
relevant information pertaining to diseases and health, discusses
Dec. 96.
Jan. 97
106
MONTH
FOCUS
the nature of information, recipients of information and how
it should be imparted.
Feb. 97
92. Editorial
Informs about WHO's announcement of 1997 as "year for control
of Contagious diseases. "Comments on the high occurrence
of contagious diseases in India, especially in rural areas because
of inefficient services, poverty and ignorance. The need to
improve quality of life at all levels - social, cultural, economic
and political.
93. Article
A revised version of the feedback questionnaire for the ANMs
aimed to receive information on reader opinion vis-a-vis
relevance of content and methodology, as given in Aayushi,
to actual field experience.
94. Article
The results of a study to gauge the impact of information
dissemination about the IRDP project of central govt. Analysis
use of information by beneficiary, and also the basic
shortcomings of any project which causes poor to suffer, while
well to do people benefit from the schemes.
95. Article
Gives information about the 'hiefer project’ which provides
families below poverty line with animals, which provide
nourishment for children. Training in the care of the animal
is undertaken. Its relevance to environmental regeneration is
discussed.
96. Article
Questions the validity of the Governmental regulations regarding
distribution of iron and calcium pills, holding that the approved
quantify is far less than the required amount. Also brings out
the need to subsidise these dosages and not restrict there
consumption to pregnant and lactating women.
97. Editorial
On the occasion of World Health Day - 7th April. Voices
concern about the impact of increasing pollution and
environment degradation on Health.
98. Article
Deals with the hazardous and unhealthy occupations and
industries in which child labour is prevalent. Discusses factors
which can permanently damage children's health, sometimes
even turning fatal. The need to be sensitive to rights of such
exploited children.
99. Article
Aims at provoking readers to approach health from an
environmental and community based viewpoint. Facilitates a
Mar. 97
Apr. 97
May 97
June 97
107
MONTH
FOCUS
questioning which can yield an area specific analysis of health
situation for the ANMs.
July 97
100. Article
Intents to empower people as conscious consumers of health
services and products, rather than mute recipients of the same.
Warns against inappropriate and unnecessary consumption of
medicinal products.
101. Editorial
On occasion of the 50th Indian Independence Day reflects on
whether real development has been achieved for the masses
of the country. Holds politicians responsible for defective,
lopsided planning. Considers need for decentralisation of
power, through schemes like Panchayati Raj as essential for
development.
102. Article
Enumerates the various uses of Paracetamol as a multi purpose
drug, warning against its side effects especially with reference
to children. Advises appropriate dosages for children for
various problems.
103. Article
Explains "Curating" as a surgical operation intended to diagnose
certain diseases related to the female reproductive system, as
well as to remedy some of them. Also includes the process
of surgery and potential dangers.
Aug. 97
r
108
Annexure 2
ANMs would like information on following topics :
*
Home Visits,
*
Target free approach / Family Planning,
*
Gynaecological disorders,
*
Immunisation,
*
Legal aspects,
*
Community Organisation,
*
Maternal and Child health,
*
Drugs and Herbal Medicine
109
Annexure 3
I. Participatory Training taken in Nursing Schools
1.
Anatomy and physiology of various systems.
2.
Why do people behave as they behave
3.
Menstrual Cycle
4.
Family Planning
II. Participatory Training Taken through D.T.T.
1.
Women and Health
2.
Reproductive tract infections, causes and management
3.
Family Planning
III. Participatory Training Taken at Primary Health Centres
1.
Symptoms based diagnostic technique and treatments
2.
Women's Health
3.
Reproductive Tract conditions and treatment
4.
Family Planning
5.
Gender Sensitivity
6.
Community Participation
IV. Participatory Training at Workshops
1.
Community Participation and Organisation
2.
Communication
3.
Women's Health
4.
Gender Sensitivity
5.
Reproductive tract condition and management
110
Annexure 4
Drug List (from discussion with 240 ANMs)
ANMs Kit
What ANMs feel they need to have
Yearly
Yearly
1.
Fersolate (big)
26,000
30,000
2.
Fersolate (small)
24,000
26,000
3.
Oral Rehydration Solution
3,600
5,000
4.
Chloroquine
3,600
5,000
5.
Furazolidone
1,000
12,000
6.
Co-trimaxazole
2,400
2,400
7.
Mebendazole
2,400
2,400
8.
Vit A Solution
1,200 ml.
1,200 ml.
9.
Paracetamol
1,000
12,000
10.
Gelusil
2,400
4,000
11.
B. Complex
12,000
12,000
12.
Methargin
Nil
100
13.
Aspirin
2,400
1,000
111
Annexure 5
Dr. Meera Savara
Date : 20th March '98
B-10 Sun - N - Sea
25 JP RD, Vesave
Andheri (W)
Mumbai 400061
Ms. Seema Deodhar
FRCH
Pune
Dear Ms. Deodhar,
Ref : Response rates using Magazines Surveys in India
This is in response to your query regarding response rates I have received using surveys published
in Magazines.
On the past 5 years, I have conducted magazine based surveys in the magazines. Debonair, Saavy,
Business India, Gentleman. These are all highly priced English language publications aimed at the educated,
middle and upper class.
The response rate I have received by publishing questionnaires in these magazines is in the range
of 1% - 2%. This is considered to be an acceptable level, which has been found in magazine surveys
done in the Western Countries.
I hope this answers your query and best wishes for your work. If I can be of further assistance,
please do contact me.
Thanking you,
Sincerely yours
(Meera Savara)
112
Annexure 6
ANM QUESTIONNAIRE
Q.l.
a) Which information
from the manual was difficult to understand?
b) Which information was easy to understand?
Q.2.
Which information from the manual proved useful in your work?
Q.3
Which information from the manual was new to you?
Q.4.
Which information from the manual was not to your requirement?
Q.5.
Which of the following information would you like to know in detail (please tick appropiately)?
i. First Aid ii. Home visits iii. Home remedies iv. Family Planning v. Targets vi. Drugs vii. Others
Q.6.
Some of the articles in the manual carry boxes containing information on home remedies or
Ayurvedic medicines. Which of these remedies have you tried out?
Q.7.
a) Have you read the Ayushi issues dealing with accupressre and pelvic muscle floor exercises?
b) Has this information been of any use to you?
Q.8.
What information helped you in the diagnosis of diseases and from where did you get it?
Q.9.
How much time (in percentage) do you devote for each of the following tasks?
i. Home visits ii. Family Planning iii. M.C.H. iv. Immunisation v. T.B. Control vi. Leprosy Control
vii. Prevention of blindness viii. Public Hygiene ix. Eradication of Malaria x. Record and Register
maintenance
Q.10. a) Which officer should be ideally responsible for laying down targets for family planning?
b) Would you like to define the targets yourself?
c) On what basis would you fix the targets?
Q.ll
a) Which new medicines were introduced to you through Aayushi?
b) What information about medicines have you gained from other magazines?
Q.12
Which of the following medicine should be provided to the ANMs (please tick appropiate)?
i. Paracetamol ii. Mebendazole iii. Aspirin iv. Fersolete v. Co-trimexazole vi. Dettol vii. C.P.M.
viii. Chloroquine ix. Primaquine x. Oral pills xi. Others (specify)
Q.13
Why do devloped countries like America have a low birth rate,low population, and less incidence
of infectious diseases?
Q.14
a) Give the titles of those poems, stories or articles from Aayushi which you have enjoyed most?
b) Which of the articles on women have you liked most?
113
ANNHXURE
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Annexure 8
Districts covered by Aayushi
(Madhya Pradesh)
Sr. No.
Name of District
1.
Bhind
2.
Guna
3.
Gwalior
4.
Moren a
5.
Sagar
6.
Shivpuri
7.
Tikamgarh
113
Annexure 9
Field Work Details (Maharashtra)
Sr. No.
Name of Districts
1.
No. of PHCs
and SCs visited
No. of ANMs
contacted
Aurangabad
06
12
2.
Akola
37
72
3.
Amravati
50
35
4.
Ahmednagar
42
35
5.
Seed
08
15
6.
Dhule
41
41
7.
Jalgaon
40
45
8.
Kolhapur
29
27
9.
Nagpur
17
19
10.
Nasik
40
60
11.
Pune
40
60
12.
Rai gad
28
40
13.
Ratnagiri
07
09
14.
Solapur
27
31
15.
Sat ara
21
30
Total
433
551
12f)
Annexure 10
Field Work Details (Madhya Pradesh)
Sr. No.
Name of Districts
1.
No. of PHCs
and SCs visited
No. of ANMs
contacted
Bhind
02
06
2.
Guna
04
12
3.
Gwalior
05
07
4.
Shivpuri
05
06
5.
Morena
02
03
Total
18
31
1^1
Annexure 11
Details of Work Shops
(Maharashtra)
Sr. No.
Name of Districts
1.
Amravati
01
41
2.
Gadchiroli
01
55
3.
Kolhapur
01
39
4.
Latur
01
41
5.
Pune
01
31
6.
Raigad'
01
32
Total
06
239
No. of Workshops
No. of ANMs
attended
- Media
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