TRAINING PROGRAMME FOR COMMUNITY HEALTH WORKERS FOR KALYANDURGA KAMABADUR BLOCKS IN VENKATADRIPALLI FROM SEPTEMBER 3 - 29, 1984,
Item
- Title
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TRAINING PROGRAMME
FOR COMMUNITY HEALTH WORKERS
FOR KALYANDURGA KAMABADUR BLOCKS
IN VENKATADRIPALLI FROM SEPTEMBER 3 - 29, 1984, - extracted text
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TRAINING PROGRAMME
FOR COMUNITY HEALTH WORKERS
FOR KALYANDURG/KA2ABADLIR BLOCKS
IN VENKATADRIPALLI FROM SEPTEMBER 3 - 29, 1984,
6ONDUCTED BY WOMEN AND HEALTH DEPARTMENTS.
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HEALTH CARE:
In India’s rural areas Government has formed certain
ructures for peoples1 health care. In every Block for appoximately 80,000 population there is a Public Health Centre
*hich normally has two or three Doctors - one in charge of
amily Planning, one in charge of general O.P. and one in chaje of locally trained volunteers.
For every 5,000 to 8,000 population there is a Sub-Cene with two multi-purpose workers - a man and a woman* The
Bale health worker mostly looks after family planning, ante
natal care and deliveries and some minor ailments and the male
^alth worker looks after family planning work, Immunization
d some minor ailments treatment* In charge of female multirpose workers there are Health Visitors who themselves do
mily planning, ante-natal, post-natal care and deliveries,
charge of male multi-purpose workers there Health Supervirs* For every 1,000 population the Government Mbs trained .
x local person as a Community Health Volunteer and he is supsed to assist the multipurpose workers and to treat minor
.iments* Besides these workers there is a special person
uled Non-medical Assistant for follow-up of leprosy patients.
GOOD INFBR-STRUCTURE;
m—————— i ■ i ■ ■ ■ i■
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With quite a good infra—structure as cbove why then is
c necessary for RDTf a voluntary organization to train local
?alth workers in the villages ?
Contd...2/-
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The Community Health Volunteers in Government service
who are supposed to be "locally selected" have been usually
selected through some "known person or persons" in the village
such as the Surpanch or others* These influential persons may
have had some interest in putting forward a particular candi
date’s name and besides this there was no other community or
village participation in the selection of the candidate and
the candidate may not have had any special Interest in the work
besides the fact that he needed a job. The training of CHVs is
usually carried out by persons who have not made any special
study of village needs and who have very little knowledge of
h0w to conduct trainingo The follow-up of CHVs after the train
ing is not necessarily done by the same persons who are Involved
in the training and therefore there is no constant follow th
rough from selection to follow-up^n the field.
In any training programme for village health workers or
any type of local workers, if either the selection or training
or follow-up is not done properly, the whole health training
project can fail. If it happens that all the three stages are
not done properly then we cannot be surprised if the scheme be
comes a failure. It is very difficult for Government to succeed
in this type of training. Their infrastructure does not allow
them to select or train candidates successfully.
INDIVIDUAL
APPROACH:
Government trained multi-purpose workers do a satisfac
tory job but they have to serve five or more villages and their
work is so structured that importance is given mainly to family
planning and record keeping and they are not able to give atten
tion to other health work, education and medical care.
The doctors in the PHCs have little facilities and resour
ces even if they like to do a good job. And all the personnel
in the Government Health Care system from doctors down to CHVs
Contd...3/-
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have been trained mostly for an institutional or Individual
health care approach and most of them do not even realise that
Community Health Care requires a different type of approach.
WHY THE NEED FOR LOCAL HEALTH WORKERS:
In rural areas in this district 80% of the poor popula
tion are illiterate and in our target community who are mostly
Harijans and Tribals, 90 or 95 percent are llleterate. To try
and help these people who are not educated, learn something
about Primary Health Care the usual 'lecture-type1 approach of
doctors and nurses is not suitable and another method has to
be followed.
Through our organization have passed between 50 to 80
trained doctors and nurses. But we can count on one hand those
persons who were able to change their "medical college-type
approach" and adjust to a new type of community health approach.
Since women and children form the majority of the "sick"
in a village where culture does not allow male health workers
to come close to mothers and children, it is obvious that a
health worker should preferably be a woman. As we have said
above, most of the poor people are illiterate especially women.
Therefore it is not possible to select an educated woman from
the village to be trained as a health worker. Therefore if the
community has to select a woman of their choice as health worker
she will usually be illiterate.
TEACHING UNEDUCATED TO LE\EN:
*
As we know uneducated persons are not unintelligent
persons. They are also highly sharp and intelligent; only they
do not know to read, write and study and even holding a pen is
foreign to them. Uneducated people can learn - the only problem
is to remember. Educated people can take notes and study but
Contde..4/-
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un-educated persons cannot. Therefore to teach Illiterate
women the teachers have to first learn themselves. Teaching by
lectures has to be minimum and teaching by demonstrations, pic
tures, film-shows, role-plays etc. has to be maximum.
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TEACHING BY DEMONSTRATION AND THROUGH
CHARTS.
After working for many years with the health problems of
people in villages RDT felt that only by training illiterate
women could we get close to mother and childrens’ problems which
are surrounded by many beliefs and traditions.
RDT has so far trained 75 illiterate Community
r __ __4 Health
Workers in 4 blocks which is about one fourth of the number
__ .■ we
need to train for the 4 blocks i 1 which RDT is working,
if we
expect one CHW for each village
RDT’s Community Health Workers have so far proved useful
in the treatment and control.of diarrhoea, scabies, health education for nutrition and other women’s diseases, treatment of
headaches, fevers, body pains and antenatal, post-natal care and
deliveries.
Contd..5/t
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WHAT IS THE FUTURE FOR Ms:
What is the future for uneducated CKWs trained by a
Voluntary Agency ? What RDT asks people "what do you want your
CHWs to learn ?" The first answer is usually "deliveries", In
rural areas in India still more than 80% of deliveries are con
ducted by old local Dais (midwives). If the village women has
a normal delivery y/ith no untoward incident happening she is
indeed lucky. The local dais know many things which are useful
from their experience.
They also do not know many things which
are harmful because they have no means of knowing.
Now-a-days there is a feeling amongst women in the villages
that they would like to have "a more knowledgeable person" to
deliver their babies. A young AN?4 (multipurpose worker) is not
available to all and not appreciated by all since she is en out. sider, too young and often unmarried, so that many women do not
have much confidence in her. PHCs are too far away and people
- are not going to go there for normal deliveries unless there is a
problem and then it is very often too late to do anything about
it. Therefore there is a feeling in villages that there should be
somebody in the village with a better midwifery training. If the
Community Health Worker in a period of 2 to 3 years can learn to
conduct normal deliveries and recognise risk pregnancies and also
cooperate in Government family planning programmes, she could
become a useful member of the PHC field staff, if their rules
allow them to accept an uneducated person.
Is it possible to continue the post of CHW beyond the
generation of the presently trained CHWs ? If the training of
• CHWs becomes institutional it may lose its relevance in the vil
lages. It is possible that somebody in the family of the CHW or
• in the village learns from the present CHW - but these are all
only distant possibilities for the future.
Contd..ad/-
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Can government train useful CHWs ? It does not look
possible. With the present structure it is not possible to
implement the selection, training or follow-up of local health
workers.
ROLE
AS
A
WOMAN:
What is the CHW's role as a Woman ? In the villages as
of course elsewhere women's problems and health go much together.
In our training programmes a few major problems for women came to
the forefront. Almost exactly the same problems appeared in an
international health magazine as the main problems affecting women
in developing countries. These main problems brought out by women
themselves were the following:
1.
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Owls
3.
4.
5.
Child birth and
pregnancy related
problems.
Wife beating and
other similar
cruelties.
Dependency on men.
Sickness due to
STD dieaases and
lack of knowledge
about STD diseases
and
Alcoholism in the
family men.
tL": •
In RDT, Women’s
problems
did not get
ABOUT CHILD MARRIAGE
much importance until
the beginning of 1982 and then RD.T started a seperate Trust called
Womens Development Trust (V.’DT) to take up the responsibility of
Womens' programmes in villages. It soon became apparent that it
would not be good for WDT to form a seperate Staff structure with
out-side employed women but that it would be better to use the pre
sently trained Community Health Workers to be the link in the vil
lage for Women's programmes.
Contd...7/-
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In RDT’s health programme the majority of staff and
locally trained persons have been men since educated women were
not available to work in these areas. If our health programme
staff alone had to select and train Women Health Workers, they
would have found it very difficult since in these areas only
women can mix closely with other women.
INVOLVEMENT
OF
WDT:
Therefore WDT has been cooperati.ng with the health pro
gramme taking part in the selection, training and follcw-up of
Community Health Workers.
In the villages in this area women are not accustomed to
think for themselves about their family or community problems.
When WDT first approaches a village they first gather the women
and have a number of meetings to discuss how women in that par
ticular village feel about themselves and their problems.
The main problems women talk about are normally economic
dependency on men that men have the right to decide what happens
to all the income from their family labour and women don’t have
a say. Another problem they bring out is too much money spent
by men on alcohol, not enough work and not enough food for the
family.
WDT speaks about the importance of women coming together
to try and tackle some of these problems and when there are women
in a particular village who want to come together to try and help
their community through women’s programmes WDT helps the women
fooim an association amongst the women with their own leaders.
CHW'S
RESPONSIBILITY:
The main.responsibility for motivating women to come
together is with the CHW. To try and give a little economic
independence to women WDT puts forward the idea of a Mini Bank
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where each woman contributes a small amount monthly and when
any woman needs a small loan they take it from the Mini Bank
instead of a money lender or big farmer. If women are Interested
WDT helps them to start a small industry or an economic programme
to improve their daily income.
In association meetings and discussions problems of in
dividuals or the community are discussed and decisions taken on
what methods the community can use to solve those problems, One
such Instance may be when land-sites have been given to the
families but the local officials have not handed over the relevant
papers to them. So in a group the women get together and are able
to secure the land sites from the village officials.
What is the method RDT and WDT have for selection, training
and follow-up of CHWs ?
SELECTION::
METHOD FOR SELECTION OF COMMUNITY HEALTH WORKERS::
The number of Community Health Workers who can be satis
factorily trained at one time should normally not be more than
10 or 15; but since the area we cover is so large we often.have
to extend the number upto a maximum of 25 or 26. Therefore an
appropriate number of villages to select approximately 25 or 26
CHWs are chosen by Health and WDT teams where there is good coope
ration from the people. After a particular village has been
selected it is then seen which are the main backward communities
in that village. Generally one Community Health Worker is expected
to work for not more than approximately 500 population i.e.f upto
100 houses. If one village has a small Harijan and Tribal Comm
unity with only 15 or 20 houses then both the communities are
expected to share one Health Worker. When the villages to be
taken-up are finalised the Health and WDT staff make an appoint
ment in each village to go and conduct a meeting to discuss if
the village is interested in having a Community Health Worker.
Contd...9/-
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SELECTION
9
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MEETINGS:
In these selection-meetings the following points are
brought forward for discussion with the villagers:
1)
to explain why we propose them a locally
trained Health 'Worker instead of a quali
fied Doctor or Nurse.
2)
to explain them for how many common dis
eases and health problems a highly Quali
fied medical person is not required 'and
for which particular ailment and health
care a locally trained person can be use
ful.
3)
to explain the place and time of training
and the type of training we can give.
4)
to discuss with them which type of person
would be useful as a Health Worker.
5)
to explain the system of payment for medi
cines and the future of the Community
Health Worker.
6)
If they would like to have a Community
Health Worker to ask them to choose them
selves the person whom they would like to
send for training.
In the beginning we never say that the CHW will receive
an incentive from RDT for the work, otherwise many candidates
will come forward. If they think the work is voluntary only the
really interested ones come forward.
On an average only one or two of these type of meetings
are necessary for villagers to select a Community Health Worker,
In some cases the villagers cannot come to a decision on one per
son and a number of meetings are necessary until they are able to
unanimously agree on the choice of one woman. In a few cases it
happens that they cannot come to an agreement and then that par
ticular village is dropped and another village taken-up. It also
happens sometimes that a particular village which was dropped
because they could not come to any decision, is taken-up for a
Contd..10/—
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next training programme because by that time villagers have come
to an understanding that they went to have a Health Worker and
have agreed on the choice of one person.
PREFERABLY
MARRIED
PERSONS:
The women selected by the villagers are married because
unmarried girls go away from the villages after getting married.
They are generally between 20 to 40 and sometimes widows whom
the villagers think should be helped and who are more free to do
the work or the selected persons are women from the community on
whom every body has confidence. This selection process normally
takes between one to two months.
Very often in these selection
meetings a role-play is performed to bring-out an important
point for villagers to understand.
METHOD
OF
TRAINING:
During this one or two months selection process prepa
rations are also made by the Health and WDT staff for conducting
the training programme.
In the initial days of training a class is conducted to
find-out through the trainees the problems in the villages,'how
common, how severe and how important,they are in the minds of
the villagers. Though we conduct this class to find out what
villagers think of their problems, we already know many of the
main problems that women are going to come up with and prepa
ration of the classes is made in advance since a lot of work
has to be done in preparing classes for uneducated women.
PREPARATION
FOR
TRAINING:.
During several special meetings of WDT and Health Staff
to discuss the Training Programme subjects are allotted to in
dividuals and it is the duty of that person to research into the
causes, prevention and treatment of a particular ailment and to
Contd...11/_
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decide on the best way to
teach the subject to CHWs.
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It could be by role-play,
>•
by story telling, by demo
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nstration, by flannel cha
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rt pictures or using cha
rts, The general method
followed by each person in
charge of the class is to
.-'bW
firs^ discuss with the
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candidates what they think
about the disease and if they have any local belie-’
fs and cures for it, and
from there the trainer
PICTURES PREPARED FOR THE ANTE-NATAL
starts his/her own class.
CLASS
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For WDT subjects,
based on previous ex
perience and theory
for: womens problems
and development, the
trainer also prepares
her class with the use
of.role-plays, story
telling, flannel chart
pictures and other
charts and games.
jwil
The training sub
jects for WDT and
CHARTS BROUGHT FOR THE DELIVERY CLASS
Health are kept to a
minimum of the most important so that the CH^’s minds aue not filled
with one hundred important and less important points that they cannot
remember.
The training schedule is for one month broken into 4 separate
weeks at the request of the trainees who are all mothers, They go
home on Friday evenings and come back on Monday mornings.
Contd...12/-
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■STAFF
MEETINGS:
I
\ Ao
ONE
OF
THE
DAILY
STAFF
MEETING.
Once the training has started a meeting between WDT and
Health staff involved -in the Training Programme takes place every
morning before classes begin. At this meeting the previous day's
classes and the present day’s classes are discussed and any other
problems that come up. At this daily meeting an’Observer« is
appointed for each class which is going to be held during the day
and it is the observer’s duty to note down important points about
how the trainer conducts the class and how the trainees respond.
A class report by the trainer and an observer’s report of each
class is handed in at every daily staff meeting.
GROUP
DISCUSSIONS:
Every evening during the training days between about 6.30
and 7.30 small groups of trainees and trainers sit together and
discuss the day’s classes — if there were any points during the
day the trainees did not understand, they are clarified at these
Contd...13/-
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meetings. During
the whole training
group meetings An
the evening*’ were
found to Ue specially
useful xor review and1
disc ussion.
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GROUP DISCUSSIONS TALKING ABOUT
WOMEN'S
PRQBLD.tS
After supper film sho’^,
puppet shows and shodow si.<ws
are arranged by trainer; and
trainees on different health,
Women's and general * epics.
-RDTIi
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PHOTO SBOWING
A
PUPPET
SHOW.
For general cleaning, cooking
<
' ’
and running of the training
programme and responsibility for trainingJ arrangements, trainees
are divided into 4 groups, Each group in turn is in charge of
the different activities such as cooking , cleaning, collecting
water etc..
Contd..14/-
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Cooking of one meal 1
during the day is done I
by the Community Health
Workers as a cooking
cum-nutrition class. For
the other meals a cook was I’’
arranged otherwise the
trainees have to be too
much time in the kitchen
and not enough time in the/^,
class.
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PREPARING
A
3
MEAL
Every Friday the trainees return to their villages and
there they try to identify some of the health or womens problems
that they have learnt about in the previous week. When they
came back the following Monday the first class in the morning is
spent listening to CHWs experiences during the week-end what
their family, friends and others have to say about the training
programme and other points that they themselves bring out.
TRAINING ARRANGEMENTS:
Mothers bring their small babies to the training programme
and leave the small children behind. Generally the fathers look
after the small children at home happily for the first week*
During the second week more children return with their mothers
and during the third and fourth week there are generally as many
children as mothers in the training progransne I However, in the ■
training programme at Kalyandurg and Kambadur, we were lucky not
to have too many children since this disturbs the mothers’ con
centration in class. There were a number of 6 months to 18 months
old children and the presence of these children was very useful
Contd...15/-
15
to demonstrate to mothers the different types of food the baby
can eat after 4 or 5 months old, since in villages it is normal
not to feed babies tillythey are one year or more.
*
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7
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CH.'PS
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FROM KALYANDURG/KAMBADUR BLOCKS WITH
SOME OF THEIR CHILDREN.
One Health Guide and Women Organizer were in charge of a
group of Community Health Workers to observe personally how they
were getting on in the programme — if they were unwell, if they
were not able to understand well or if they had any problems,
These two group leaders gave a report every week on the CHWs.
Most of the last week of the training was devoted to
reviewing subjects that have been taught in the previous weeks
and preparing their work in the villages when they return. Before
- they left the training site, dates were fisted for WDT and Health
teams to come to their villages and explain to the people what
• their CHW has been taught and the work she can do and payment she
will ask.
Contd...16/-
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VILLAGE
FOLLOW-UP:
Generally when CHWs return to the village from the train
ing they feel quite nervous about the work they have to do and
qui^e often also the people make fun of them in the beginning*
They also have problems convincing the people to pay for the
medicines and treatment they are giving. So follow-up meetings
in the villages by V/DT and Health teams are found to be very
important and useful.
During the month following the training WDT and Health
teams visit the villages where the CHWs have been trained and
spend one or two hours discussing with the men and women what
they feel about the CHWs and in particular what problems they
may be facing.
In these special meetings we have to explain that in the
beginning CHWs know very small things and people should not
expect them to give injections or big treatment. We a^so have
to explain how much the CHW is charging and why it is necessary
for people to pay. Generally after these meetings the CHW finds
work more easy in her village.
Every month on a particular day CHWs gather in a central
place along with health and WDT staff to review their past months
work. Sometimes a particular subject is reviewed or a new sub
ject is introduced. The CHWs have a weekly report which is
printed in health symbols and they tick the number of each particular health symbol they have treated that week, This report
for the month is given in at every monthly meeting.
After the intial one month’s training a refresher training
of 3 days every 4 months is held when old subjects are reviewed
and if necessary new subjects introduced. At the end of the year
a longer refresher training is carried out lasting about 10 days.
Every month the CHWs are visited twice on thrice by health
and WDT staff who guide and assist 'them in their work andmSifficulties.
Contd..17/r
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government
COOPERATION:
We are very much interested during the training and follow
up to involve the government health staff as much as possible in
the training and in the field follow-up. We inform the PHC staff
the name and villages where we have CHWs and they in turn ask
their multipurpose workers to contract the CHW and see how far
she can help Government staff and programmes.
FINANC LAL
ASSISTANCE:
For the last few years the main agency helping us to train
and follow up CHWs has been Action Aid, London with its field
Office in Bangalore. The Action Aid staff from Bangalore have
always been very positive in helping to train these health workers.
We are very much grateful for their support in this programme.
In the last year UNICEF has also come forward to participate and
help RDT in these training programmes and villages health work.
We hope that one day CHWs will be useful enough to be inde
pendently supported by their village or taken on by the government
as part of their field staff. We feel that their contribution to
rural Primary Health Care can be very high.
The following report is a resume of the training programme
conducted at Venkatadripalli Training Centre between the 3rd
September and 29th September, 1984 for 26 CHW trainees from
Kambadur and Kalyandurg Blocks. For each week of the training the
important points have been brought out and some examples narrated
of typical staff meetings, classes, observers’ reports, evening
group discussions, meal times and night entertatnment.
(
FOURTH
WEEK
M 0 R N I N’ G
ARRIVAL
9«00 to 10«00 am
STAFF MEETING
STAFF MEETING
OF
2«OO to 3«OO pm
STAFF MEETING -
C H Ua
FAMILY PLANNING (SOCIAL
ANO HEALTH VIEW).
INDUCED ABORTIONS.
GROUP ACTION
Miss, Dceno Kumari
- Hrs. Lalitho
10.00 to 11.15 am
11.30 to 1.15 pm
3.30 to 4.30 pm
4.45 to 5.30 pm
REVIEW - DIARRHOEA
FEVER, MANAGEMENT,
SORE EYES - REVIEW
APPROACH TO
DEVELOPMENT.
WDT
— Mrs. Usha
IDENTIFICATION
OF LEPROSY
— NMA, Beluguppa
CHILD MOTHER RELA
TIONSHIP.
IMMUNIZATION 1
TETANUS - REVIEW
MEASLES f.. MUMPS
REVIEW
- Mrs. Lalitha
— Hr. Dasarath
REVIEW NUTRITION
PAYMENTS &. PLANNING OF CHWs' WORK IN THE
VILLAGE (KITS, CONTRIBUTIONS, CHARTS ANO
HOJ TO FILL-IN. REFERRAL DAYS.
FILLING OF YELLOW CARDS.
- CR. Sudheer
REFERRALS a
CONTRIBUTIONS
— B.C. Narasimhulu
Rao
NORMAL PREGNANCIES
a RISK PREGNANCIES
- Mrs. Rani &.
Deena Kumari
EAR DISCHARGE
STAFF MEETING
5.00 to 6.00 pw
HEALTH
CHWs WCRK, PAYMENT,
DISCUSSION ON REVIEW OF
'YELLOW CARDS; HEALTH
EDUCATION INDIVIDUAL
o
VO
1 GROUP DISCUSSION.o
- Dr. Janardhana
STAFF MEETING
3.00 to 5.00 pm
- C.C. Thippanna, HO
Uravakonda
SHOWING ANO
IDENTIFICATION
OF TABLETS
FILLING OF YELLOW CARDS
5.30 x
O.00 pm
GROUP
DISCUSSION
GROUP
DISCUSSION
B. Thippeswamy
GROUP
DISCUSSION
FARE-WELL
1_
SYLLABUS FOR C.H.Ws TRAINING PROCS1AMME
KALYANDRUG & KAMBADUR BLOCKS.
^SEPTEMBER 3 TO SEPTEMBER 2STH
FIRST WEEK:
MORNING
Sept.
3rd
Mon.
9. to
10.00 a.m.
4th
Tues.
Staff
meeting
Sth
Wed.
Staff
meeting
Sth
Thur.
Staff
meeting
7th
Fri.
Staff
meeting
3th.
Sat.
Staff
meeting
2 to
3.15 p.m.
3.15 to
4.30 p.m.
4.45 to
5.30 p.m.
I
5.30 to
6.00 to
6.00 p.m.
7-00 p.m.
Introduc
Groupwise
Groupwise
Gardening and
Allotment
tion by
dis
represen
Arrival of CHWs
making into
of
pairs.
cussions
tions.
groups. By
duties.
Mrs. Rani
'10.00 to
11.45 to
3.30 to
4.45 to
6.00 to
6.30 to
11.00 am_____
_ p.m.
1.15
4.30 p.m.
6,00 p.m.______
6.30
pm
7.00 p.m.
Finding out heal- Analysing the SKIM games
WDT problems obthg & social pro
Puppet
show
priorities.
(Memory)
jectives of women
Group
blems. Mr. Samuel Mr.Samuel &
“
TRADITIONAL
games.)
associations.
discussion
& Mrs. Lalitha
Mrs. Lalitha
BELIEFS".
Mrs. Usha
Mrs. Rani______
Management
WDT social
WDT
Class on
Oral Rehydra
& Economical
Education
Group
Film show on
DIARRHOEA
tion Therepy
aspects.
villagers
discussion
DIARRHOEA.
C.R. Sudheer
Mrs Lalitha
talk._________
WDT Leadership
Health Sore
V/DT
Drinking
Health
(to help gain
Eyes.
Slides on Sore
Group
Ear dischar habits Mrs.
confidence)
eyes &
B.C.NarasimAnantamma.
discussion
Mrs. Tresa.
____ hulu_____ ge .Chinnappa Mr. Sirrappa,____
Drunkenness.
llealth Scabies
Health mana
!
V/DT
Lesson on PUPPET
&' personal Hyg
gement of
Film show on
Group
Associations
Show
iene .
Fever.
SCABIES &
discussion
Mr. Rani.
Mr.Thi ppcswamy
Mr. V.V. Ramana
B.C. NarasiFEVER.
mulu.
Wdt Women's
Othef
problems &
Mumps and
CHW
*s
experience
child marri
injuries
Group
Measles
in
their
Literacy
ages
super
C.R. Sudheer.
K
discussion
B.Thippe
villages
from
stitions.
Swamy.
URAVAKONDA.
Mrs. Rani.
★ ★ ★ ★
(
/
I
TRAINING PR0GRA14ME
sb
FIRST WEEK:
WL
' *-fl
*:•»
1
> '♦< ' *
ri' r-.M ;»
■9
VENKATADRIPALLE TRAINING CENTRE
I.
Participants:
1.
a.
Community Health Work Trainees:
From Kalyandruq Block:
1.
2.
3.
4.
5.
6.
b.
7.
8.
9.
10.
11.
Bheemakka
Anjinamma
Marekka
Gowramma
SanJakka
Vannuramma
■ 12.
Govindamma
Fhilomina
Onhuramma
Onnurakka
Chowdamma
Obulamma
8.
9.
10.
11.
12.
13.
14.
Thippamma
Kullayamma
Vannuramma
Devalamma
Yellakka
Marekka
Laxmamma
From Kambadur Block:
1.
2.
3.
4.
5.
6.
7.
Thimakka
Laxmamma
Hanumakka
Obulamma
Gan gamma
Neelamma
Kollamma
Contd...
’ I
2.
Community Health Guides:
i
____
Li!
rW- T ■ ' n
CHWs and Health Staff
1.
2.
3.
4.
5.
6.
3.
Niyaz
Siva^wa
Hussain Peera
7.
8.
9.
10.
11.
12.
Ravindranath
Santhamma - ANM
Mary Francis - ANM
Nazeer
Govt. N.M.A.
P. Venkatesulu
5.
6.
7.
8.
B. Thippeswamy
Dasarath
Thippanna
Chinnappa
Health Organisers:
1.
2.
3.
4.
4e
P> Narasimhulu
U. Nagabushanam
N. Sreenivasulu
B. Sirrappa
B. C. Narasimhulu
V. Venkatramana
C. IR.. Sudheer
From Anantapur Health Office:
Sister
P.C. Chowdappa
Dr. Janardhan Rao
Contd...
Deena
Z. Samuel
duction game that brings a good atmosphere among the trainees
and the trainers. In this game each person is given a small
toy which has a pair. The object of the game is for each
; < person to find his/her partner and spend 10 or 15 mts. in
trying to findout who is the other person, their village,
their family and other details. After this is over the
partners get up two by two and each one introduces the other.
In the beginning there is some shyness but afterwards the CHW
enjoys very much and participate very well. After this the
QHWs and the trainees break up into groups and each group dis
cusses what they feel about the training and what they felt
about the selection, what people wanted them to learn and
any doubts and questions they have.
Syllabus for the first week:
II.
agig
x .■
>
.
‘A’
9
According to the pro
blems brought out by
the Community Health
Worker Trainees the
first week’s syllabus
was finalised. The
main classes during the
first week were.
Health Subjects:
Diarrhoea, Sore, eyes,
ear-discharge, scabies,
and personal hygiene.
Management of fever,
injuries, mumps and
measles and learning
about puppets.
A
r w
-;’\W
t?
MAKING PUPPETS
During the first week in WDT they concentrated on bringing out
women problems dividing them into social and economic aspects, dis
cussing about leadership and drinking problems, formation of associa
tions and literacy. The following are the list of problems brougtM
out by the CHWs.
Contd...
c 1
f
•J <
5.
»
W.D.T.
( -
toCHWs AND W.D.T. STAFF
1.
2.
3.
4.
Mrs. Lalitha
Rani Thomas
Usha Mutholy
Annapurna.
P.C.
P.C.
5o
6.
7.
Teresa
Anantahamma
Satyavathi
INTRODUCTION:
Women from scheduled and backward communities- in our villages
are not accustomed to speak up in front of others, and therefoere
to make the atmosphere more friendly, we normally have an intro—
Ki
PAIR
WISE INTRODUCTION CLA5
DISEASES AMD PROBLEMS BROUGHT OUT BY C.H.W.s
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
Scabies
Discharge
(white)
Diarrhoea
Red discharge
Ear discharge
10
10
19 •
20.
10
9
9
21.
22.
23.
Drunkeness
Housing and
land problems
Cough & Mumps
Worms
Measles
Sore eyes
Urinary Tract
infections
Mutka
Oppression by
Rich farmers
Disunity between
groups
Vitamin B defi
ciency
Risk deliveries
Abortions
9
9
8
8
8
8
7
24.
25.
26.
27.
28.
29.
30.
7
7
6
6
6
6
Fevers
Diarrhoea &
vomitings
Abdominal pains
Piles
Post operative
problems(F.P.)
White discharge
Wounds in men
5
5
5
T.B.
Asthma
Breast Abscess
Encephalitis
Maternal deaths
5
5
4
4
4
3
3
31.
Heat boils
3
32.
Irreguler periods
3
33
34.
35.
Chicken pox
Leprosy
Neonatel congeni
tal defects.
Cancer
2
2
2
2
36.
V
s
rj i
t!
J . . • MW
CLASSIFICATION OF DISEASES AND PROBLEMS
Contd
6
5
The numbers indicate out TEN hew
important and se
rious the problem
is to villagers
TEN being of highest
importance and/or
seriousness.
I
When the CHW trainees
were asked what did b
they think were good
qualities of leader,
they answered that
they should have
patience, mix well
with others and have
a good manner in
jag
behaving.
TALKING ABOUT LEADERSHIP
MINI BANKS;
I
The Mini Bank functioning was also explained by playing a role-play
showing a family where the husband drinks and wanders here and
there.
The wife works and manages to save some money.
This is
Since the wife lost her money
when there was a big festival she went to a big farmer to borrow
She did not succeed and so she mortgaged her ear-rings as
money.
taken away by the husband to drink.
she was cheated by the big farmer.
The usefulness of the
Mini-Bank kept by the
association was thus
emphasised explaining
that if each member
contributes some
amount in the begin
ning and then monthly
Sgifi
.■
women can itake some
loans from the Mini
Bank instead of go
ing to big farmer.
Contde..•
a
|
a
i
r
I
For each class there was always an observer and his/her duty
was to bringout the important points of the class such &s the
following:
le
OBSERVERS REPORT:
Date:
Time:
7-9-1984
Day: Friday
3-10 to 4.30 pm.
First week
Subject: Associations and Mini Banks
Class incharge: Rani Thomas
Observer: B. Thippeswamy
I
Class content:
The class started with a role play showing h&w an associa
tion is started in the village in the beginning, The role
play shows how the villagers think, for example, in the
village so many women feel dependent and they are afraid to come
out to join in any development in the village. With the help
of woman organiser they started a Woman Association and this
helps people to come forward boldly and independently. The
role play explains - what is an Association. It is a group
of people sitting together to discuss their problems. Empha
sis was put on the group and not on the individual. Rani
also used somepictures and discussed - what is an Association.
Already there are Associations in some villages and CHWs
Laxmakka# Yellakka/ Thiplibai, Philomena and Marekka answered
well about the Association* The necessity for leadership in
the associations was explained and the responsibilities of
President, Secretary and ward-members of the association.
Contd
•i
The class was interesting.
All the CHWs participated well
though there was some disturbance in the middle of the class.
The teaching was done well but some reviewing is needed for
some CHWs.
2.
Class Report ;7DT:
Date:
Time:
3.9.1984.
3.30 pm
Subject: Literacy
Class incharge: Rani Thomas
Observer: Raveendra Nath
Day: Saturday
First Week
I explained in the class the importance of education now-adays. If at least they have some literacy their own work will
be made easier, they can understand some signs and letters
wnich will make easier their medicines distribution. They also
would be able to calculate how many tablets they have used
and how many cases they have seen.
After this discussion the CHWs wanted to write their names,
village names and some signs.
I started the class by asking some women to come and try to
write their names on the black-board and nearly 17 women came
forward.
To explain the importance of education I made the role-play
showing one CHW who wanted to come for the training programme
and because she could not read the name (sign) on the bus, she
sat in a different bus and arrived in another place and so she
arrived late for the training.
The CHW said that she would like to learn some letters so
that she can read the names of medicines and places, In another role-play to show the usefulness of letters and signs,
I told a story how a CHW gave wrong medicine to a patient
Contd.,.
because she could not read the signs and letters. The patient
had lots of trouble and got angry. Like this the CHW understooc
how careful she should be in giving medicines and she should
learn# to read and write the names and signs. Previously they
did not feel literacy was important for them but during this
class they felt that knowing some alphabets and letters will
be useful in their work specially because they have to give
medicines and they have to travel up and down.
3.
OBSERVERS REPORT ON INTRODUCTION CLASS AND GROUP DISCUSSIONS
By Lalitha and Sister:
Introduction class:
Class prepared by: Rani &
Sudheer
Observerls
Report.
Plus Points:
The method of introduction was good to break the ice. People
enjoyed talking to each other and when Thippeswamy forgot to
tell, the name of his partner in the introduction one CrT4 re
marked “if an educated person forgets then what about us ?••
All the CHWs participated well.
Minus Poin ts:
4
xhe class did not start properly. The women could have been
arranged in one round instead of line by line so that all could
see and hear properly. Introduction was not properly prepared
since Rani and Sudhir did not think of introduction as a class
cind did not give it much attention. Even the groupwise dis
cussions were not planned properly - how many persons, how many
groups etc. was not planned. We should have thought before
hand what were the points to be discussed, if the groups are
small then the women discuss more easily than groups which
are in big numbers. It was noticed during the introduction
that some women organisers and Health Guides were discussing
nicely with their partners whereas others were asking a few
questions and the-vi keeping quiet.
j
Contd...
^7/
Xs.
I
4.
GROUPWISE DISCUSSIONS - POINTS:
Points that caine out from the group discussions on the first
day ; CriWs wondered without education how can they can learn.
They also br&ught out the point that after they were selected
in the village already people were calling them for conducting
deliveries when they had no training.
In Siripi village one
CHW was expecting that she should do
only this work and she should not go for labour.
Some women
had problems with husbands and mothers-in-law who did not want
them to come for training and some of the CHWs expressed pro
blems with some old dais in the village who were feeling jealous
of them.
In the health problems which were brought out by the women
diarrhoeais normally very high on the list df priorities,
since more of the deaths in children upto one year old are
from dehydration caused by diarrhoea.
5.
OBSERVATION REPORT ABOUT DIARRHOEA - BY THIPPESWAMY AND
ANANTHAT4MA:
Subject:
Diarrhoea by Sudhir.
Sudhir started the class by asking the CHWs what they think
about diarrhoea, what happens when their children have diarrhoea,
what types of diarrhoea they have noticed, etc.
The CHWs could
bring out all the types of diarrhoea, watery diarrhoea, blood
and mucus motions, undigested food, etc. and they said mostly
children suffer from worst diarrhoea.
Villagers normallv give
their own ’Kashayam1 and they give normal diet with butter milk
and rice and some CHV/s said they will give hot rice with chillies
and some give curd and puffed rice. To demonstrate how flies
will cause diarrhoea, Sudhir kept rice in one plate and in another
he put some sand and said it is kakka.
Some flies were sitting
i
on the kakka and then they went to sit on the rice.
Contde.e
Like this
he tried to demonstrate how germs ars passed by lies.’
He also explained other causes of diarrhoea, stagnant water, drink
ing contaminated water, eating sweets and other foods which have
been left uncovered. He also advised to keep cut short as dirt
can hide underneath long rails.
Another main cause of diarrhoea is measles, and Sudhir explained
about the importance of treating diarrhoea after measles. He
advised to give rice and butter milk and not so good to give
chillies at the time of diarrhoea. Sudhir also explained how deaths
of children are not due to diarrhoea but are due to dehydration
which is loss of water in the body.
PREPARATION OF O.R.
E
'/WfaW.fc.-.S. .St* 'IvUm
I“
-
He explained to the
how when we have
diarrhoea all the w
' - /
ter goes out of the
body and when this
happens we can noti
loss of skin elasti
child very cranky atin small babies the
fontenelle will be
depressed. The skir
and mouth will be d>
The eyes sunken. The
MAKING REHYDRATION
DRINK.
may be fever, pain 1>
the hands and legs. To show this dehydration Sudhir used small dolle
and some charts. He also showed them how to prepare re-hydration
drink with borewell water, jaggery, salt and soda. 2 CK.Vs had
diarrhoea and he asked them to prepare rehydration drink and take it.
Sudhir explained about the dosage and administration. For adults
after each motion two glasses, for children after each motion one
glass and for children below one year they should be given by tea
spoon every 15 minutes. Sudhir also explained about the importance
of diet during diarrhoea and after diarrkoe,o.
Contd...
-
I
•. and also how good diet help to prevent diarrhoea,
During
diarrhoea it is important to eat as soon as possible because
diarrhoea causes weakness and
and on top of that if we
do not eat we become more
weak.
As soon as possi
ble children should
start eating rice with
butter milk# banana
and the small babies
should start taking
breast mi Ilf •
Sudhir
covered all the essen
>i
tial points in the class
and also used interesting
charts# demonstration and
afterwards he explained
through a song.
In the
PRACTISING MAKING
O.R.T. BY CY4S
evening in the group dis
cussions we came to know that all the CrEVs understood the class well
and also they could understand how to prepare rehydration drink.
GROUP DISCUSSIONS:
6.
Every evening after 6 pm. there were group discussions with
the CHWs and trainees.
Sudhir and B.C. Narasimhulu wrote
about, the importance of group discussions.
"In this CHWs train
ing programme we found that group discussions in the evening
were very important not only for CFTNs but also staff.
The reasons are:1.
More cooperation and close contact with staff and CHV/s.
2.
In the group discussions we can do revision about the day's
3.
4.
classes.
Everybody gets a chance to express their ideas and doubts.
Staff can come to know
more closely and give concentration
to slow persons.
Contd...•
I
<
So
Go
7.
We can know the personal problems of CHWs.
In the groups the CHWs also try to learn to write their
names.
In the groups the staff who will be doing the follow up in
the fiel& were attached to the group where their CHWs were,
so that they can develop® closer contacts.
Every week the different groups give a report about their
CHWs. For e.g. in B. Thippeswamy's group there vrere 4 staff mem
bers and 6 CHWs and they give a report individually about each
CHW as follows:
CHW - Zui j anamma
Village - Dodagatta
“Anjanamma is 35 years old. she is having 6 children 4 girs
and 2 boys. She is healthy and has no sickness. She has understood
everything in this week's programme and she is able to remember also.
She says that she understands everything about diarrhoea, scabies, heac
lice, ear discharge women problems and sore eyes. She mixes well
with others and she is participating well in the group discussions.
She doesnot have any children with her1*.
Like this they give report on each CHW.
<5 tA r
1Uj72
O
S E 1 • 0 fl D
L E F. «•:
1 0 R N I N G
2.00 pm
to
3.30 pn
3.45 pm
to
U.O.T.
CHILD HAfJ/'GEMEnT
6.00 pm
•1 ——
.
I
I
, 30 em
ASLES
STAfi
I
!
NUR
VlT/tir
UEEK-END Dff’ERIENCES IN
THE FAMILY 1 VILLAGE
OF C H Us
11.45 to 12.15 pm
MALNUTRITION
uamy
— Z. Samuel
i a
FICIE-
NUTRITION S.
VITAMIN DEFICIE
NCY.
I
— Z. Samuel
HEALTH
TETANUS 1 MOTHER
& CHILD
Jeena
J
- U. Nagabhuahana
3.30 to 4,30 pm
4.45 to 6.00 pm
CHILD 1 MOTHER
imUNIDATION
CARE, RELATION
- R. Dasarath
SHIP.
- Mrs. Lalitha
UOT. CRITICAL
ANALYSIS OF
RELATIONSHIP
OF ASSOCIATION
MEMOERS.
6.00 to 6.30 pm
6.30 to 7,00 pm
GROUP
DISCUSSION
MALNUTRITION
REVIEW OF
MALNUTRITION
GROUP
DISCUSSION
UDT. DEVELOP
MENT THROUGH
GROUP ACTION
GROUP
DISCUSSION
- Mrs. Usha
SMOKELESS
CHGCLA i
DEMONSTRATION
— PC Choudappa
- Team - MOT
FILM SHLU ON
FILM SHOW ON
VITAMIN DEFICIE
NCY.
SECOND
WEEK:
In the second week we reviewed mumps and measles, took
classes on immunization and spent one full day for nutrition
and mal-nutrition. The other health classes were S.T. diseases
and Tetanus. WDT had classes on mother and child care, analysis
of association-member relationship and group action. The following
are a sample of some of the classes during the second week:
1. OBSERVERS REPORT:
Date:13-9-1984
Subject:
Day:
Thursday
Mother and Child Programmes:
Class in-charge: Mrs. Lalitha
Observers: Sudhir & Annapurna.
This class started by 3.30 PM. Lalitha started the class by
showing some pictures of a child crying, playing, dancing, blind
child, etc. with pictures of mother and father. However the pic
tures were very small and everybody could not see properly. Lalitha
asked them some questions about how they feel parents should take
care of the children in the family, what are their responsibilities
as mother and father. Vie could observe that only the CHWs in the
front row were replying.
After that Lalitha told a story of a small child who had to
do the family cooking even though she was small and could not do
it properly. So one day when she was cooking a lizard fell in the
food and the Child's mother got very angry and beat the child.
Lalitha told this story in order to show how it is the mother’s
mistake in making the small child cook. The CHWs were very inte
rested in the story and wanted to know what was the end of the story.
Lalitha was explaining how mothers and fathers have to teach
children in a proper way, not just expecting them to do the j0b and
shouting when they are not able to do it. Normally in our target
Contd...
V •
community families, it is not common for parents to discuss with
the children their problems and their future at any time. Lalitha
tried to show how being close to the children may help them develop
better. In this class also Lalitha discussed about the education
r
programme of RDT and what its aims were, to help the poor also to
become literate* They discussed the problems of bonded labour and
how this prevents children going to school. They also discussed
about the school/nutrition programme, from where do the funds come,
from where does money come for the Nutrition programme, from where
does the money come for education programme. She explained from
where the funds come and about sponsorship programme. In this
class all CHWs were understanding and gave good answers. They have
understood RDT’s programmes and where the money comes. Like this
they cleared their doubts.
2) CLASS
DATE:
REPORT
BY
Z. SAMUEL.
13-9-1984.
SUBJECT:
MAL-NUTRITICN.
Teaching aids used;
D
Chart showing Marasmus and Kwashiorkar.
2)
A model village was prepared snowing that a few rich
people holding more land and many poor families holding
a little land.
The rich people's land was fertile whereas the land
held by poor people was unfertile and barren.
The poor families were large and had more children.
The toddy shop in the village was mainly used only by
poor people.
The Government ration shop exhibited a board saying
"NO STOCK" while the rich could get rice, dhall etc., at
boosted rates.
The crop in rich man’s land was fresh and green.
The crop in poor man’s land was wiithered.
Contd...
I
3)
2 children were presented to the class.
One child from Yerragudi (Thippeswamy - 3 Years) was
malnourished.
One child from Upponka of same age was healthy.
^<77
-ST
A ’ MODEL OF
A VILLAGE SHOEING
RICH & POOR
Method of approach:-
The two children, healthy and malnourished were shown to
all students and asked them if they can find any difference.
The CHWs said that one is sick and the other is healthy.
What is meant by that sickness and what is it due to ?
Some said it is due to fever, some said that it is due
to unclean upkeep,. some said that it is due to diarrhoefi
some said that it is due to general weakness.
One Kernan said that the weakness is due to lackcpfood.
Then in the presence of whole class the mother was enquired.
She said that she had five children. 3 of them have died
after becoming weak just like the present one.
The husband is sick with T<B.
t
Contd...
Mother is not able to go for work because of the sick
child. z
Even she goes for cooly* She is not getting full wages
because she is not able to work full day because of the
siok child.
Never they had full meal, always one mudda is shared by
sick husband, herself and sick child*
As a result of all this situation the child has not
enough to eat and thus became malnourished*
Now you please alllof you (CH'Ws) tell me why this child
has become sick like this ?
Some said that mother did not take care.
Some said that when there is nothing to eat what care
can mother take*
Why there is nothing to eat ?
She said that, there is no land can’t go to labour be,cause
of sick child, husband cannot work due to illness, cannot
beg. So how can she get food. So now we got some causes
for not having enough food* i*e., No land to cultivate*
Further cannot work because of illness. Mother cannot go
for work because of child’s sickness. Now tell me some
more causes or think of some more causes why the poor man
does not have enough food.
REASONS
FOR
MAL-NUTRITION:
Some women said —
The wages given by rich farmer is not sufficient, however
the same is cooked into 3 or 4 Muddas and eaten by 7 or 8
people insufficient for all of us and worst suffer is the
youngest child.
Even when 2 or 3 members earn in a family, half of it is
taken away by husband for drinking. So here again the
members in the family have to eat only a little food.
The fair Price shop, When we have money, there will not
be stock in the store, When there is stock in the store
we don’t have money, That is how the store is not very
useful for poor men. So again we don’t get food supplies
regularly and we suffer and have less food. So now you
have said many causes for getting less food and the worst
sufferers in the family are children and as a result of
less food the child is becoming weak, malnourished*
Now here I want to tell you one thin|j<
Contd*••
•v • ‘
• •
•! :
J
The present mal-nourished child whom we have seen now,
is in a very bad condition. But, to come to this stage,
the child should have been weak like this, for the past
one year and more.
THE
CHILDHEN
SUFFER
MORE:
Many of our children ace less than normal. If we can
find out their malnourishment in the early stages (1+$) and
if we give them special food we can prevent those cases from
becoming like the present one.
For childsen upto 2 years there are some recipes like
smashed foods, semisolid foods etc.,
1.
Kichidy - Rice and Greendal and some greens; It should
be well cooked and smashed - If it is for 6 months baby,
the preparation should be liquid liUe.
2.
Ragi Kanji with a little jaggery semi solid.
3.
Well boiled rice with dhall soup, and smashed.
4.
Wheat sojl to make upma with greens in it and smashed.
All these varities were discussed and 4 women were alloted
these 4 recipes to prepare.
They were asked give their observations on the aids used o
IV/O rich families are theie*
They have good housesw
They,enough grass for their fattie.
They have less children.
They have lots of land with two wells and with good crop.
Their land is fertile
There are 21 huts in a small piece of land which is not
fertile.
Every family has more childsen.
The crops in their land are withered.
There is one toddy shop and many of the poor people are
in this toddy shop.
Contd...
I
• •
• •
There is one fair price shop with "NO STOCK”
boardy
Where does this situation lead to ?
The <poor are becoming poorer and rich are becoming richer.
As a result of poverty, there is not enough food, and there is
malnourishment in the family members and the worst sufferer is
the last child or children under 5 years.
3) CLASS
REPORT BY
Z. SAMIEL
DATE; 14-9-1984.
SUBJECT:
Nutrition and Vitamin difficlency diseases.
Teaching aids used;
Food materials like, proteins, Carbohydrates, Vegetable^,
Greens etc., were collected in bottles.
Two children were brought they were suffering from night
blindness and bitof spots.
Method of teaching;
»
£n the last hour, we suddenly felt that the whole class
can be presented in some sort of role play demonstration and
drama.
A well built man appeared on the scene exhibiting all his
museles and said that, this growth was due to eating protein
foods. His role was to present Protein foods. So, he carried
along with him, toys of chicken, fish, goat, bull, egg, green
dhall, Bengal gram, redgram, groundnut and all other lentils,
and explained that they were all necessary to build body.
Another man appeared representing carbohydrates, He was
doing hard work and said that he was able to do hard work because
he was eating carbohydrates. He has shown them Ragi - rice Wheat — Jonna — Sojji — Oil — GroGndnuts etc.,
Contd...
•
♦
• •
. f
I
cwt .
*
Another man
appeared representing
protecting foods. He
had all greens, vege
tables and fruits and
explained that by eat
ing all this he was
obtaining necessary
Vitamin and thus pro
tecting himself from
diseases.
Then I explained
that these 3 types of
food can not be taken
SPEAKING ABOUT DIFFERENT FOODS IN A
by 3 different people.
ROLE-PLAY
All the 3 types should
be eaten by every person in required quantities to keep up good
health. Suppose a person is taking more of Proteins, and less of
staples he may not have enough energy. Similarly, if he is not
taking vegetables and greens, he may be exposed to all diseases.
When I was tell^in^this, a person appeared with protein foods,
starchy foods and vegetables, fruits greefc etc., all around his
body. I removed starchy foods from his body, then he has shown
signs of exahustion. I removed Proteins from his body, and he was
shaky./
I asked CH’Us what they could understand by this.
They came out with answers that all types of foods should be
taken and if one is missing, it can he easily observed in the body.
I wanted to bring out. another point on eating habits. If
one is eating the same type of food, there will not be required
growth in the body. A child with rice, chillies and salt was pre
sented to them® He said that he was taking rice and chutney every
day and he was under developed.
Contd...
• •
Then I wanted to bring out the necessi£y of special diet
for children of 6 months and upto 2 years.
years* Jhie was presented
by a small drama.
WEANING
f00DS:
Two mothers with two qhildren of same pge ( 6 months )
were neighbours, one mother fed the phild w|.|h poridge in addition
to mothers milk. Therewas good growth! At 9 months he could
sit, <at a 1 year he could toddle and at 2 years he was healthy.
The other mother could not give any additional jood to her
child except her own breast milk. So, there'was stumped growth
and the child was under developed.
;
■ •..
I
*
Vitamin defficiency diseases. I askqp them what are
vitamins. They said that they are mostly greens, vegetables ,&
fruits. Then I explained that vitamin is a substance avl^lable
plenty in greens, vegetables and fruits.
What are its functions ?
They prevent diseases,
Then I asked them if they know of night blindness. They
know. This night blindness i& due to vitamin ’A* - difficiency.
I presented before them 2 children one with nigh1 bl^pdness and
another with bitot spots. They got this disease because of
Vitamin ’A’’- difficiency. How can this be pured ?
By giving plenty of vegetables and greens.
Vitamin ’A1 :is plenty available in drum stick leaves,
druio sticks, carrot, papaya; so, vitamin 'A* can be
made good by giving the above foods*
Vitamins can also be given in the form of medicine*
If a child is having, night blindness 3 full course of
treatment is to be given#
They were shown A & p capsules ( 6000
)
They have to give 6 capsules a day i.et, 2 in
morning
2 in the afternoon and 2 in the evening. Like this for 3
days if there is no improvement, give 4 gap of a week and
repeat again.
1
•
...
It is better to give vitamins to the body in the form of
food than by medicines*
The time was over and the class was postponed till further
time *
Contd..*
J
• •
i
4)
CLASS REPORT BY
USHA MUTHOLY:
DATE: 14-9-1984.
SUBJECT:
Qjass analysis of relationship between association
members.
Main idea of this class is to make then: to think criti
cally or reflect their relationship ip Association.
1.
Association is running mechapically:How ?
I pinned the pictures of President Secretary, Women Organizer,
Ward leaders and the association rnenibers by getting the answers
from them on a board, like this:
PRESIDE^
WOMEN ORGANIZER
WARD
SECRETARY
PEADEftS
Then I explained to them the relationship between each member.
Suppose when a decision is taken only among the President, Secretary
and Ward leaders what will be the People’s reaction ?
With this idea we did a Role Play,
The Role-Play members are:
<
1.
2.
3.
4.
5.
6.
President
Secretary
Ward Leader
Women Organizer
People from one ward
People from another
Ward.
Usha Mutholy
Lalltha Damodar
Rani Thomas
Annapurna
Ananth
Suseela
Sathya
Contd...
i
The Role Play is like this:
■
1
'■
i
When the President of a Men Associatiop asks the President
of a Women association to lend him some money to get tpe house
plots to th'e women, the President, Secretary and the Ward leaders
without consulting the people .concerned lent
to the Mai e
President. When the Women Organizer pomes an<d ask? for accounts
of the Mini Bank money the people concerned are ignorant. With
this they all have a big quarrel and separate from the association.
After the Role Play I initiated the discussionstREASONS FOR SUCCESSFUL
assoclAiions
1.
2.
3.
. 4.
5o
6.
Unity
Responsibility
To get experience for the
new members ( Replaced new
members for old members)
Participation
Equality
Cooperation
REASONS FOR UNDEVELOPED
ASSOClATXCn?
1»
2.
3.
Ouapspls
No unity
No Cooperation
4.
5.
Leadership
Power
6. No responsibility
7.
Interference of Men
All these above points are elicitated f^onj the CHW's. Then
the next point brought out by thep was women problems. Of course
the previous day they brought out some of their own problems and
discussed to solve the problem* Some women explained they had
solved their problems.
1.
2.
3.
4.
5.
6.
7.
8.
9.
Drinking controlled
Matka (Cotton Market, Gambling) controlled
Got the bore-well repaired
Got the bore-well sanctioned
Got the house plots
Got the supply of electricity for flour mill.
Taking the serious patient to the hospital
Stopped the child marriage
Contribution ’given by women to washing platforms.
Contd...
• •
10.
5) CLASS
DATE:
REPORT
Brought back all the slabs which are stolen. So,
with the help of their good associations, people
have progressed. If they have good relationship
and good qualities as we said in the beginning
there is a scope for associations to develop. Other
wise the association will not work properly and that
will be a failure.
BY
U. NAGABHUSHANAM
14-9-1984
SUBJECT:
• •
DAY;
FRIDAY
Tetanus and Rabies
This class started with a role-play. After finishing the
role play we asked them what they understood from this role-play.
The CHWs said that one person has got tetanus which was due to
putting cow-dung on the wound, and also if we keep the wound dirty
we may get tetanus. These two causes we had broughtout in the
role-play and both these causes the CHWs could recognise.
We said that tetanus may be due to dog-bite, applying of
cow-dung on a wound, injuries, especially from some instruments
which are in the fields, cutting the umbilical cord with umM1<eai
cord with unsterile instruments, handling the mother with unclean
hands during labour, etc.,
We told the signs and symptoms of Tetanus which are
1) headache and fever 2) difficulty to swallow, 3) difficulty
to close the mouth, 4) muscle stiffness, 5) fits which may
come due to high fever. If we find a case like this we should
search for a wound in the body. If we find one we should clean,
apply some ointment and bandage it and should report to the
hospital immediately.
Prevention of Tetanus:
How can we prevent Tetanus ?
Pregnant mothers can take T.T. injections twice or thrice towards
the end of pregnancy. If you get any deep wound specially if
there is cow dung around the place you should go to the hospital
for a tetanus injection. Small babies can be given injections
against tetanus.
About Rabies we also started the class with a role-play.
After the role-play we asked the CHWs *
at is that ? '. They
Contd...
• •
said that this was the symptom of dog-bite. The patient will
cry, saliva will come from the mouth, he will talk without know
ing. He will refuse to take water. He baila told that immediately
after therq is a dog-bite we should clean it with running water
from the bore-well and should not cover it with any thing.
Immediately we have to take the person to Kalyandurg or Anantapur
for Rabies injections otherwise the person will die. We should
not leave the dog. We have to observe it for one week. If it
dies within that time it will be having rabies. People having
dog bite fan die within 10 days. They can also die after one
year. So, when people die after 6 months they think it is not dog
bite cause but that only will be the reason.
6)
SECOND
BY:
WEEK
GROUP
DISCUSSIONS:
V.V. RAMANA
DATE: 15-9-1984
Our group told all the diseases that week such as rabies,
fever, headlice, injuries, diarrhoea, ear-discharge, mumps and
measles and about associations in WDT class. All the CHWs told
some examples and all CHWs could explain about the cause of malr nutrition. Two CHWs Laxmamma and Yellakka had forgotten some
points. So, we reviewed again in the meeting. They could ex
plain about nutritions foods, body building foods, energy foods
and protecting foods.
V
About immunization they knew that DPT should be given in
the 3rd, 4th and 5th months. They said that the Vaccine should
be kept in an ice bo«; otherwise it is not good.
They also spoke about Vitamin 'A* drops which should be
given after one year for 9 doses till the age of 5 years. They
said that is is useful to prevent night blindness. They knew
that drumstick leaves, papaya and other green leaves are good
foo preventing Vitamin 'A* deficiency. About rabies and tetanus
they understood very well the points covered in the class.
7?/
xV
XK >
third
u E E K
HOR.’JinG
ARRIVAL OF C H Wa
2.00 to 3.00 pm
4.00 to 5.00 pa
STAFF HEFTING
5.00 to 6.Q0 pa
WEEK-END REVIEW
NOTRITION
“ Z. Samuel
9.00 to 10.00 an
STAFF REETTNG
GAMES
NORMAL PREGNANCY AND DELIVERY, POSTNATAL PROBLEMS.
RISK PREGNANCIES, SPONTANEOUS ADORTICNS,
-
STAFF MEETING
SMOKELESS
CHOOLA
UNICEF SOAK
PIT.
~ PC Chowdeppa
WOT
- Rachel, Santhamma £, Mary Francis
STAFF MEETING
Night — after Supper
ronnATict. or rw-r - AtiTEtiATAL ca.ie a check up.
Kechel, Santhanra L nary Francis
STAFF MEETING
6.00 to 7.00 pra
Dr. Dhagirathi
VENEREAL DISEASES AND OTHER DISCHARGES
- Miss. Deena Kuraari
SHADOW SHCU AND DELIVERY
COMPLICATED DELIVERIES.
THIRD WEEK:
The third week of the training programme was devoted mostly to
ante-natal care, deliveries, risk pregnancies, post natal care
’and S.T* diseases.
kechel who is a Government Health Visitor and the wife of Sirappa,
Rani Thomas, Dr. Bhagyarathi and Deena participated in the classes
on ante-inatal care, deliveries and post natal care.
On the first day Rachel an
Rani started the class by
asking the CHWs what they
feel about conception and
delivery. To explain con
ception Rachel used a
chart which the CHWs found
very interesting. The
CHWs wanted to show how
-they themselves do a de
livery in the village. So
three of them got up and
prepared a role-play to
show it to all the others
Bxplaining about conception
and for us. The role-play
It showed how rough villagers are in dealing
wa
with the pregnant mothess
specially at labour time.
They showed how if the
placenta does not come
out they will take the
mother and push her sto
mach against the wall.
1
Rachel and Rani discus
sed with the women about
diet during pregnancy*
During this class it
came out how many superCHWs DOING A RQEE-PLAY ABOUT A DELIVERY
Contd.•..
A '■
stitions and beliefs there are against so many foods during pregnancy
and most these are good foods like ground nuts, papaya, eggs, banana,
etc. We explained by telling that foods do not cause any disease if
they are good but if the Groundnuts are spoilt or the papaysa is too
raw or the eggs are not good then may be some disease will come.
Otherwise they can be taken safely by the mother.
Rachel and Rani explained about taking Iron and Folic acid during
pregnancy. They are not having faith in Iron and FFolic acid tablets and so they throw in one corner what the ANM gives, So we explained how Iron gives good blood end that after so many pregnancies
the women become pale and anaemic and so from the first pregnancy
if they take Iron and Folic acid tablets they will keep more healthy.
Rachel and Rani asked the CHWs if they had seen any deaths of mothers
and children from Tetanus. The CHWs told of many cases but they could
not distinguish between Tetanus and Tcxemia which also causes fits.
They explained the difference is Toxemia fits occur before delivery
or during delivery and there will be lots of swelling on the body
whereas Tetanus occurs for the mother or child after delivery.
RISK PREGNANCIES:
In the afternoon, Rachel and Rani explained about the risk pregnan
cies that it may not be possible to follow up all pregnant women
but some women need special care and these are called risk pregnan
cies, such as the first delivery, multipara deliveries, young girls,
pregnant mothers with bleeding or selling and mothers who have had
previous difficult deliveries or who are very anaemic. Rachel and
Rani explained that these type of pregnant mothers should have contact with the doctor or nurse during pregnancy.
On the next day with the aid of a dummy pelvis Rachel and Rani
showed a real delivery. The Chtls were very interested in this and
asked many questions, like whether the cord should be cut after thd
placenta has come out or before; what they should do if the placenta
does not come out; how they should convince the mothers about these
Contd
things/ etc* Often in some communities they will have a particu
lar woman who keeps a special sickle and only with that they should
cut the cord* They are not much happy to change these ideas. Even
to sterilise the sickle by passing through fire they do not feel so
happy.
On the next day Dr* Bhagirathi from Guntakal came and spoke about
ante-natal care and deliveries also showing a delivery with a dummy
pelvis* Dr. Bhagirathi explained many of her experiences with village
women and the CHWs found it very interesting explaining their experien
ces also.
S.T. DISEASES:
CLASS BY
DEENA
'village women and men have a lot of problems with S.T* diseases
because they do not like to come forward with them. They alsb do not
know the consequences of having one of these diseases on the health
of mother and father and children*
Eor these classes Deena had prepared some flash chart stories, The
first story was told about a young man who was a bachelor® and now
and then when he visited the tow he used to go to some woman. From
one of these women he contacted syphilis but since the ulcers went
away after a few days he did not bother about it. After some time
his parents arranged his marriage. But to their disappointment his
wife never gave birth to live child* Either it was premature or still
_irth. This happened for some time until somebody advised them to go
to a doctor. The doctor examined the blood and found both husband
and wife having syphilis which was the cause of alllher still births
and abortions. The couple toofa treatment and the mothers next pregHKnn nancy was a safe one and the child was born normally.
Contda.o•«
I
i
r
li
Deena explained in the
class the cause and
consequences of Goniorrhoea and syphilis*
The CHWs few that
some of these diseases
existed but they did
not }mow properly the
cause of them and the
1
A
Ok
terrible consequence
a? V v
of family life. in
the class Deena tried
to explain them that they
-rss-er
can be useful in explain
EXPLAINING /ABOUT ST PROBLEMS
ing the mothers the cause
and consequence of these
d&seases and also to try to bring forward couples for treatment.
-------- - ' Generally only the husband comes forward for the treatment which is of no
use because the disease still continues in the wife and will be once
again passed to the husband. Among the CHWs themselves there were
two cases of chronic abortions which appear to be of some S.T.Disease.
k mJ
E
v ;:i
A
»■
FOURTH WEEKj
•
The fourth and last week was spent mainly reviewing previous classes.
The new classes were family planning, approach to development and
• identification of leprosy. We also showed the CHWs how to £111 In
, the symbols on their report card. We
We showed
showed and
the tab
and explained
explained all
all the
lets and medicines they have to use and the quantities they have to
give for adults and children.
OBSERVERS REPORT;
Subject : Fgmily planning
Date: 20-9-1984
Class teacher - Deena
Observer - c.C. Thippanna
The class started by Deena telling a story using a flannel board,
She told a story of a mother who was very healthy and after fourth
and fifth deliveries she: started to become sick, she asked the CHWs
what do they feel about :family pzlanning. Some of the CHWs started
telling how many deliberies
-- 1 their parents used to have - 10, 12 and
-13 and also told “we are having so r
ma-ny children and we are alright.
Why do you say that we will become sick?'1
----- 1 T.ien Deena showed the example of one CHW who had two
children,
two children, who
who were
were looking so well and the
mother was thin and the children were also thin.
They were telling that in the old days there
were no medical facl'‘■’’ties, no transport and out of 10 deliveries
only 5 may survive. The
rather and mother were happy to have
more children because they may xgi
support them in their old age. If there are more children they can,
earn more money for the family. But the
disadvantages were also therec
zIf there are more children there is less food,
less education^ many
sicknesses and no proper shelter for the children.
in a big family.
■
They discussed different family planning methods, Tubectomy,
Vasectomy, loop, laproscopy and tablets, CrTWs told their own
treatments for family planning and abortions if they do not want to
keep the baby and this is what they told:
W'
■W •
Raw Papaya, Milk of Jilledu plant.
Jaggery made out of palm juice, etc.
Contd
Id j i
■
t
But the CHWs did not tell clearly. They wanted to keep it a secret.
The villagers Eire thinking that if they have more children they can
send some for bonded labour and get sotae money for one child. For
Vasectomy they feel that the man becomes weak and they have lots of
ideas about post tubectomy problems of not being able to do work# etc.
DEMONSTRATION;
To show CHWs what happens for Vasectomy and Tubectomy we had a demonstra
tion kit from the PHC and we were able to show exactly what happens
inside the body. Very often what happens# when a man or woman goes
for operation# thev will already be having some discharge or some
other problem and this becomes worst if the doctor does not examine
properly and suggests loop or operation. Afterwards when they have
several problems they will blame it on the familv planning method.
At this point the explanation was not clear and CHWs were not understandino. Deena explained about the problems which can come for girls
. who are married too young# when the body has not matured• Unless
* they spece the children there are great dangers of cancer# bleeding
and other problems#
About induced abortions it was shown with the demonstration kit how
illegal abortions in the villages cause death to the mother. It was
explained also how upto a certain period it is safe to do abortions
and afterwards it is dangerous. A CHW can help women by keeping
their secret confident and trying to get them a medical abortion in
the hospital.
Deena explained that until a couple has two or three children
passed the age of 5# who are healthy# they can use temporary methods
and if they are sure that their children are alright they can get
operated. In a more better off family having two to three children
they could go for operation without using temporary method first.
Contd.•••
OBSERVERS REPORT:
Date:
By Sudhir and Rani
21.9.1984
Day:
Tuesday
Subject - Management of fever and sore eyes review.
Class teacher - B. Narasimhulu
B.C. did not start the class by teaching. Instead he asked questions
and got the answers from the CHWs. The CHWs explained all 4 essential
points. They told fever is not a disease it is a symptom for other di —
seases. They explained how to find our if anybody is having fever.
They said we should give rehydration fluids
He showed them Dispirin
tablets/ explained the cost and how the 3HW and her family members also
should pay for the treatment. He explained the dosage of Dispirin for
dultS/ children and babie
Marekka rrom Khairevu said
that in her village there
is an Anganvadi worker who
gives medicines free/ so
they won't pay her. So
B.C. told her if they do
not want to pay let them
take the medicine from
the Government worker.
But she should charge.
§1
DRINKING r-DRE FLUIDS WHEN THERE IS FEVER.
After that B.C. did a role pluy with Kullayamma how to find out if
,there is temperature. In the role play Kullayamma was able to ‘show
removing children's clothes who had fever, giving sponge bath/ giving
more water to drink and referring the child if fever was very high.
villages people do not believe, they should give cold sponge for
fever. They think it will give cold.
Contd....
B.C. tried to show them by talcing hot water in a bucket and saying
"now how shall we make the hot water cold? Should we add more hot
water or cold water ?” He explained also the dosage for Analgin/
and how to give it for adults, children and babies, In the villages
almost cent percent people have body pains.
B.C. also reviewed about
Sore eyes. Again he did
not explain. He only
asked questions if they
e 4
r J
have understood. The CHWs
9
were able to tell that the
disease comes more in the
children. It spreads by
close contact. We should
clean the eyes with salt
water. First we should
.11
clean the hands. In a
glass of water we should
put a pinch of salt. We
SORE - EYES CLASS DEMONSTRATION
SHOULD TAKE 3 or 4 small
cloth pieces, soak in the
watei’ and clean the eyes using a different piece of cloth for each e^..
Then they can put eye ointment. B.C. explained to put the ointment :r.
the eyes. He also explained that the CHW should move closely with the
villagers otherwise she cannot work well. He said that since this
disease is seasonal the CHW can arrange meetings and with the help
of Health Guide or Health Organiser she can explain to women the c^use
end iureatment of eye sore. The CHWs understood the class very we 1.1
and they themselves were giving answers.
PAYMENT FOR MEDICINES:
During this training programme we told the CHWs that they have to
collect full cost of the medicines. In the previous training jxogranme
we had not asked for full cost and only asked to pay a percentage.
Afterwards it is very difficult to increase the cost. So in this pro
gramme we asked them to collect full cost from the beginning iuid upto
the tine of writing this report the CHWs are collecting, some of
them cent percent and some of them 80 to 90 percent.
Contd.....
In the heglnntrij
I
S6
there is some fifficulty to pursuade people to pay the full cost but
afterwards once the people get used to the idea there is no pronlem.
On the contrary to increase from 50 per cent to cent percent is very
difficult.
FINANCE:
In this training programme V/DT and health worked very well together.
They shared the responsibilities and duties. The Health Organiser
Sirappa was given charge of fin^ances since he has a reputation of
being $ery thrifty. But unfortunately on the second or third day
his whole purse with all the money was stolen. Everybody felt very
bad because they d id not want to think one among them had stolen
the money.
4
But in the programme there was one cut-sider who had benn specially
called to make some drawings and charts. He was sitting in the next
room where the money was stolen and it was noticed by some Health
Guides and Health Organisers that he was frequently buying things
and using money and when they asked him if he is in need of any money
as an advance for his work he said “No”.
Everybody suspected him and they approached him and said uwe are think
ing somebody has stolen the money and kept it in your bag”. Please
have a look1. Like this they discovered the full amount less 50 or
100 rupees in the bag of this person. After that Sirappa was happy
again.
ROLE
v
PLAYS:
In this training programme also we tried to improve our role-plays.
It was noticed that the role-plays were just like telling a story
fcbout the disease without emphasizing on a few points that are
essential for the CHWs to learn through the role-play. Therefore
before making a role-play we sat down to discuss what are the aims
we want to teach through the role-play. Supposing we are teaching
aboutdiarrhoea, we may want the CHWs especially to rember about
Contd...•
*
........... .
.
“
O.R.T. and this is the point we emphasize in the role-play repeating ±t
many times.
After deciding what are the aims of the role-play we dis-
cuss who should be the members and what should the story be and we
discuss the story among us making sure that we go on repeating the
important points. When the role-play is over, if it has done pro1 perly the CHWs should immediately be able to tell what is the impor-
\tant thing to remember about diarrhoea.
<
This takes some time to
practice before we can make up the role plays quickly*
We also no
tice that we cannot just invite any body to take part in the role-play
each one should know the subject well.
.■f‘W'jp* KV
CHWs from the other blocks
Same to to the Training pro
gramme and they were very
useful and important to
speak to the trainees
.‘about their experiences when
vthey first started work
after their training.
PEDDAKKA CHW FROM URAVAKONDA
GIVING HER EXPERIENCES
%
w
Contd
iiiiii
5S
__ Jg
I
yj »<'.'4’
!
I
i
■
I’V J
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GIVING A?JAY THE KITS ON THE LAST DAY
f1
This training programme is just the beginning for CHWs - to be
really useful in the villages and to have confidence in them
selves/ it takes a number of years, and lots of follow-through
and refresher trainings.
I
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10572.pdf
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