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Title
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COMPREHENSIVE RURAL HEALTH PROJECT
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extracted text
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RF_IH_9_SUDHA
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COMPREHENSIVE RU.AL HEALTH PROJECT., JAMKM1D
TEE VILLAGE LjVEL WORKER
THE Comprehensive Rural Health Project is working in 30 villages in and
around Jamkhed. The aim of the Project is to find a method of delivery
of health care best suited to the needs and resources (financial and
man power) of the rural area.
THE rural economy is such that- it cannot support the servic >s of a physician
in every village or groups of villages, neither are qualified physicians
readily available in rural areas.' Taking this ir to account the project's
method of delivery of health care is to delegate the responsibility people
lesser trained. Delegation of every task to the humblest member of the
team capable of doing it satisfactorily is one of the ways of overcoming
the problems of’inadequate manpower and financial resources.
A Three tier system of delivery of health care has been organized. The
physician is at the head of the health team. He delegates the responsibility
of rendering primary health care to the nurse and paramedical worker
(2nd tier). The third tier in this system is the village level worker,
who is a member of the community and comes in close contact with her
peers and therefore she acts as.the liaison between the community and the
more educated nurse or paramedical worker.
THE VILLAGE LEVEL -ORKER
A cultural gap was found to exist between the city-educated nurse/paramedical
worker and the illiterate rural folk. Very often it was found that a patient
after listeming to the advice of a physician or nurse, would take and
follow the advice of the illiterate watchman .or. sweeper of the health centre,
rather than that of the physician. This is because he identifies himself
with another illiterate person and feels closer to him rather than the
educated sophisticated nurse. Taking this attitude into consideration it
ias .felt that the best way to get. into the community and teach them to
accept new methods, change attitudes was to enlist the help of women from
within the community.
It was found that a nurse staying in a village for several months, could
not convince a single woman to undergo tubectomy. On the other hand.a woman
(illiterate) from the same village, when convinced herself was able to get
75 women for tubectomy within the same period of time.
THIS experience led us to form the third tier of workers the village level
workers.
THE village community is asked to find women from their o.wn community who
would be interested in joining the health care team to help in rendering
health care. Usually women with no household responsibilities volunteer
for such work.
PREPARATION 0? THE VILLAGE LEVEL WORKER
THE women come to the health centre at Jamkhed on Saturdays and Sundays.
On these two days they are ^iven regular classeson various health topics
by the physicians, nurses and paramedical workers. The women are mostly
illiterate and therefore most of the teaching is done with help of flash
cards and charts.
The five priorities of the Project are stressed, and the village level
workers role in of them is explained. Ehch class is begun with repetition
of the previous weeks teaching and a discussion of the application of their
in the village.
THE women are also taught the use of flash cards so that they Can use
them in their promotional work.
BY this, method we .are in the process of training 8 workers and the
experience with them is so far very encouraging.
One worker has been able to convince 200 women.to take Antenatal care
and bring over 100 women for tubectomy. She is also able to follow up
patients with tuberculosis and leprosy and encourage -them to take
treatment regularly from the clinic.
§
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CAHP - Code No. 20:
PART-TIME VILLAGE LEVEL HEALTH WORKERS - "BABEFOOT
DOCTORS" - AT HEALTH UNIT,PALGHAR?
R. Jannarkar* and P.M. Shah.**
Newer techniques are being developed in all the walks of life
to improve quality of life.
'Industrial Revelation' and 'Green
Revelation' have been familiar words for sometime.
However, disease
and premature death are still prevelant in our country.
The communi
cable diseases and malnutrition in the developing countries are the
leading causes of the high mortality and morbidity rates which adver
sely affect their national economics.
These preventable diseases
beget poverty which in turn leads to poor health; ’a vicious cycle.
With the present knowledge, a number of killing communicable
diseases can be controlled or eradicated,
The management of protein
calorie malnutrition is. well documented.
The problem is how to
take this knowledge to ..a great number of suffering people in the
community where it is difficult to reach them.
It is anticipated
that due to industrial growth and increased of agricultural output,
the socio-economic conditions of a developing country would improve
and subsequently general health would improve.
slow process.
more time.
But this is a very
The developing countries can not afford to waste any
They should have results as soon as possible'which means
They have to work within all
employing the simplest possible way.
the limitations of men, money and material.
Only revolutionary
methods and approach can bring about the "Health Revelation".
Health Care in developing countries;-
The concept of revolution in health planning has been accepted
by number of developing countries.
In Sudan, Uganda, Zambia, Nigeria,
Malavi and many other countries, the health auxiliaries provide health
and medical care through clinics and hospitals.
There are places
where Medical Assistants are managing 2,00-bed hospitals and perform
major surgical operations A It is remarkable that Sudan can reach
so many people with health services, even though simple in form, due
te auxiliary and paramedical personnel particularly Medical Assistants.'
* Reader in Preventive and Social Medicine, Grant Medical College,
Bombay, Officer Incharge, Rural Health Unit, Palghar.
‘ ♦
** Professor of Paediatrics, Institute of Child Health, JJ Group of
Hospitals and Grant Medical College, Bombay. Paediatrician, Rural
Health Unit, Palghar.
* Based on the W.H.O. aided project 'Domiciliary management, of Malnu
trition' .
Chief Investigators Dr. P.M. Shah.
2
In Malavi a few professional health people provide a
high standard
of oare for a relatively few patients while Medical Assistants provide
more basic care for the rest.
The common medical needs are not so complex.
The lower level
medical worker must only be able to recognise threats to health that
are visible and easy to identify (like diarrhoea, upper respiratory
infections, malnutrition, infectious diseases and infestations) or
problems that are less threatening and more of a personal concern like
headache, constipation, earache, cuts, etc.
Auxiliary workers could
easily look after these problems while the professionals could function
as leaders, consultant? and managers,.
The Chinese claim a solution to this problem of community health,
with maximum benefits from minimum cost in their system of "Barefoot
doctors".
They have placed a priority on preventive programmes.
The key to this system of 'Barefoot doctors-'
of available manpower.
is the proper management
From the beginning of the revolution, they
rejected the traditional Doctor-patient relationship which .a poor
country cannot afford as it requires a large investment for training
facilities and hospital-based services.
As an alternative they empha
sized the provision of health care for the greatest number of people
at the least cost.
The 'Barefoot doctors' appeared at the beginning of 'Cultural
Revolution'; with rural health oriented programmes.
The local people
are trained in both modern and traditional health care methods during
slack agricultural season.
Depending on the availability of various
health personnel and acceptance by the people, the Barefoot doctors
work as links between the community and the available medical manpower.
Their duties include treatment of minor ailments, organisation of
health education programmes,
'Patriotic' health campaigns and general
sanitation work in their locality.
The work of these 'Doctors' is
Y er
supposed by all those who are engaged in the preventive programmes..
Recently, to increase manpower in this army of health, traditional
doctors, oriented in modern medical methods, have been incoporated.
These concepts are of basic importance sine# more manpower can be
trained for a given health budget.5
Medical manpower in India;-
In India the problem of medieal manpower is' grave, even though
the doctor to population ratio- is 1 to 5112.
In fact 80% of the
doctors are not available for the 81% of the population who reside in
1
villages.4 As a result there is an acute scarcity of skilled medical
men in the rural areas.
The nurse to doctor ratio is ls2 which is
3
well below the recommendation of 3:1.
Moreover, wherever a
doctor who could provide health care is available in rural
area,
he is busy providing medical relief to 100,000 population at the
Primary Health Centre and has limited time and interest in preventive
and promotional health care,
the shortage of doctors is going to
prevail for years to come as training of doctors is long and costly.
All the developing countries are experiencing this problem which
explains why the concept of bz maximum utilization of health auxili
aries is getting more and more popular.
In India various national health programmes are managed quite
successfully through health and
auxiliaries.
The National Malaria
Eradication Programme, the Leprosy Programme and the Small-pox
Eradication Programme are examples.
These auxiliaries are not sub
stitutes for the doctors; their role is supplementary.
Jili EXPERIMENT 'WITH VILLAGE-LEVEL- HEALTH WORKERS AT HEALTH UNIT,
PALGHAR:
The long-term planning for health has to be basic, comprehensive,,
preventive and promotive.
As the first step to sow the seeds of
health is in early childhood, the most vulnerable period, a W.H.O.
aided project on "Domiciliary Management of Malnutrition" and Inte
grated health care for the. children under five years was started
at, Heal th Unit, Palghar, Dist. Thana, Maharashtra, in August, 1972?
Here is an attempt to solve the local health problems in the village
The project is designed to
itself with the help of local persons.
promote the health of the children under five years of age at the
village level by continuous, co-ordinated, community care,
Under
this project part-time, village-level health workers, who are the
key persons in the project, have been appointed.
It is obvious
that the problem of health and nutrition can not be solved by medi
cal and more highly-trained para-medical personnel alone.
there is a need to «over a wider
Moreover,
rural area with limited health
personnel at a Primary Health Centre.
Hence, the part-time, village
level health workers are appointed -in this project to link the
eommunity with the existing health services.
Part-time, village-level Health Workers;
While appointing these part-time health workers an emphasis
w=s given on selecting a local, middle-aged, mother with educational
qualification up to 7th standard.
However, four out of five workers
have the educational qualifications of only the 4th
or 5th standard.
4
Care was taken to select a person with leadership qualities.
Those
women are familiar to the local people and know the regional langu
age, customs, attitudes and beliefs in
child rearing.
These women
are culturally acceptable to the community and specially to the local
women folks with whom they communicate in a better and more effective
way than the outsiders.
They have an easy access, to the kitchen
where the traditional policy of nutrition and child rearing of the
family are determined by the dominating grandmother or mother-in-
law.
The part-time health worker takes part in their 'Kitchen meet
ings' and at times participates in "gossiping".
The worker is trained
in such a way that she introduces her advice in a culturally accept
able way.
The nutrition advice is practical, scientific and feasible
for the local conditions and meagre budgets.
The whole idea of appointing these health workers is to improve
the services according to the values of society.
Health planning
must be pragmatic and take socio-economic aspects into consideration.
Five such part-time health workers have been appointed in this
project.
They are paid Rs. 60.00 per month and they work for four
hours a day.
Each worker looks after a total population of 2500 to
3000 in tow to four close-by k villages or hamlets.
On an average
these villages are- at a distance of 4 to 6 kilometers from a sub
centre,
head quarters of a nursing auxiliary, and are within 2
kilometers from the residence of the part-time workers.
.'TRAINING OF THE WORKERS 8Thexe workers were given training for three weeks, two weeks
in the class-room and clinics and one week in the field.
The training
programmes were so arranged that they had practical' experience of
taking weights, recording-them on weight charts, measuring heights
and giving health and nutrition education to the mothers and others.
They were trained in ascertaining birth dates by using local events
calender.
They were introduced to personal hygience, common communi
cable and nutritional diseases of children, immunisation, growth and
development, and familyplanning.
active participation.
Emphasis was given to learning by
Cases of common
diseases were demonstrated to
them in the clinics.
The class room training was followed by field training in the•
village of Umroli where a model programme has been going 6n for the
last one and a half year.
They were given assignments and the results
were discussed with all the participants.
5
Job description and responsibilities of the part-time Workers:-
Every child under five years of age in twenty villages/hamlets
has been covered by the five workers.
The children needing special
care and whose parents cannot come to the clinics because they are
daily wage earners are treated at home.
the clinics.
Other children are seen at
The job assignments, including
the responsibility of
the part-time health workers, are as mentioned below.
1.
Census: to enlist the population at risk as well as all the
household members by age and sex.
The housesa are given
Census figures are brought upto-date every six .
numbers.
months.
2.
Sequential weighing and selection of beneficiaries for nutri
tion programme:
Serial weighing is a practical and reliable
measure of growth in children under five years.
Birth date
is decided according to a local events calender and then the
weights are recorded periodically, according to age and nutri
tional status, (figs. 1&2) on weight charts0 printed in Mara
thi.
The Salter's weighing scale model No. 235 T with spring
and dial is being used as it is an accurate, handy and econo
mical.
Figures on the dial of the weighing scale are given
in the local language.
The workers talk to the mothers about
the weight curves oh the charts, their importance in health
and disease, and the necessity of timely regular recording of
weights.
They give advice on feeding to all the mothers at
the clinics or in the homes.
The part-time assistants are trained to determine the degree
of malnutrition with the help of the weight curves within
a fraction of a degree by means of a simple plastic folder
over-lay designed for the project (fig.III).
Accordingly,
beneficiaries are classified for nutrition supplements and/or
7
nutrition education.
3.
Listing 'Special Care' children:
In each village they maintain
a list of children who require 'Special Care'.
The list indi
cates specifically which children must be seen by the nurse
and/or the doctor when they visit the village.
The status
of these children is followed at the clinic and by home visits.
The local community is made aware of the condition of these
children.
The following are the reasons for "Special Care".
3
6
:
Those whose weight is below 60% of the reference standard;
1.
Those who have difficulties in breast feeding and are put on
2.
bottle feeding before six months;
Those who fail to gain 0.5 kg. a month in the first trimester or
3.
0.25 kg. a month during the second trimester of life,
4.
Those Pre-term or low-birth weight babies weighing less than
5.
Twin babies;
1.5 kg;
Those whose mothers have a history of death of more than two
6.
offsprings between the age of one and twelve months;
Those with severe, or acute infections like measles or whooping
7.
cough,
8.
Death of one of the parents;
9.
Those whose birth order is fourth or beyond;
10.
Sterilisation of one of the parents and
11.
Only child after a long married life.
4.
Under-Fives' Cliniess
The part-time workers conduct clinics for
•children under five years of age.
Every alternate clinic is
attended by the nursing auxiliary, while the doctor visits once
a month,
The frequency of Jihe clinics varies from thrice a week
to once a fortnight depending on the population df a village.
each clinic 15-20 scheduled children are brought.
afe places given by the local community.
In
They are held
The clinic's timings are
altered to suit the working mothers..
5.
Immunisations
They organise immunisation campaigns for the child
ren, by identifying and collecting the children due for immunisa
tions when the nurse visits their village.
They assist the nurs
ing auxiliaries in carrying out immunisations.
6.
Domiciliary visits:
They go to visit the home of defaulters
and also of the children listed as "Special Care".
each worker has to visit 7 to 8 homes per day.
On an average
While on home
■ visits they weigh the children (Fig.IV) and talk to mothers about
feeding and other health matters.
When simple drugs are prescrib
ed for a child, these workers assist by delivering the medicins,
continuing the therapy, and reporting the progress.
7.
Nutrition Education;
They advise on protective foods,- their con
sumption, preparation and cost.
They identify the dominant figure
in the family and have a dialogue on health and nutrition education.
7
8.
Health educations
They give advice on personal hygiene and talk
on growth and development, common diseases of childhood and their
prevention.
9.
Vital statistics:
They collect information on births, deaths
and migration.
10.
Deworming and special programmes:
They help in periodic deworming
of the children in the villages where there is heavy infestation.
11.
Planning of families!
They advise on family planning to the eli
gible couples and motivate them at the time when all the children
under five years in their family are progressing well on weight
charts and
12.
Referrals:
They promptly refer the sick children to the nurse or
to the doctor at the headquarters.
Community Participation:
These workers coordinate their activities in each village with the
village health committee, nursing, auxiliaries and other personnels of
the health department.
They have developed effective rapport with the
women folks and the villagers.
They bridge the 'Oultural gap' between
the modern health services and the community at large.
Organisation:
To give an idea of the role of part-ti,me health workers in the
project, the organisation of the project is depicted in a chart (Fig.V).
The project is designed to fit the existing health services and to help
in extending and strengthening the health services,
Twp to three
workers are under guidance of a nursing auxiliary and enable her tn
cover effectively a population of about 10,000.
Records:
After one year's experience in a pilot study at village Umroli,
near Palghar, a new system of records has been devised.
are minimised for nursing personnel.
The records
The same are simplified by means
of weight charts and assignment identification and planning cards.
The
workers with the help of nursing auxiliary, fill-up the built-in eva-’
luation tables.
Evaluation:
A project is divided into three main sudy groups (i) service
oriented, (ii) Research oriented, and (iii) Evaluation oriented.
The
results of evaluation of nutritional status and immunisation status
8
:
can easily be read at a glance from the tables given below (Tables
I
& II)?’? The tables are completed by the nurse midwifes.
This
data is furnished every month which provides a built-in evaluation of
the on-going programme.
It will be noticed from the above description that these health
sorkers do not treat sick but prevent sickness and promote positive
health.
There is no danger of creatings 'quacks' as they are not going
to cure diseases.
Their purpose is to extend health care and prevent
ive and promotional health.
Health Revelation:
The:
The Indian Way:
aim of the project is to create a balanced programme for the
future, both at the family and the community levels.Here lies the
difference between Indian Way of health care and the Chinese way.
At
Palghar, the mothers are oriented to help mothers: and to extend compa—
ssionate care.
India is a poor country like many other developing
countries and ban not afford the rising cos.t of therapy/ Revolutionary
and economic ways of delivering health care need to be worked
out.
The responsibility of providing health care to all, even in the remotest
villagS or hamlet must be met; in the existing conditions of limited
medical manpower and finances, the system similar to Chinese 'Barefooi
doctors', our part-time health workers, is the practical :.add necessary
approach to health care.
These 'Workers' can help to bringing about
the "Health Revolution".
The experiment with the part-time health workers is only nine months
old and it has shown promising results with reference to nutrition,
growth, morbidity and even mortality.
It has been observed that 75 to
'
80/ of the deaths in the under fives' were from the group of these
needing special care.
The workers have already gained fairly good
confidence of the community.
Itlshould be possible to extend their f
field of activites, in the future.to the pregnant and lactating mpthers.
references
1.
Bryant, John
Health and the Developing World,
First Ed. Cornell University Press,
London, 1969.
2.
Jqpna^kar, A.R. and
Surveillance to Evaluate the Changes in
Shah. P.M.
Nutritional Status of Preschool Commu
nity. with the Help of Village-Level
Workers. (under publication).
!
9
3„
Morley, D.C,
A medical service for children under
five years of age in West Afriaa.
Trans. Roy, Soc. Trop. Med. Hyg. 57,
79-94, 1963.
4.
Park, J.E.
Text book of Preventive & Social Medicine
2nd Ed. Page 22, Banarasidas Bhanot,
Jabalpur - India, 1972.
5.
Rifkin, S and Raphael,K.
’Health Strategy and Development Planning
Lessons from the peoples' Republic of
China: Reproduced by the Tropical Child
Health Unit, Institute of Child Health,
London, 1972:.
6.
Shah, P.M.
Promotion of Adequate Ggrowth and conti
nuous Health Care through Under Fives1
Clinics’, the proceedings of the work
shop on "Under Fives’ Care" held in
Hyderabad 6th & 7th October, 1972.
(Under publication).
7.
Shah P.M. and Jannarkar, Simplified Methods for a Village-Level
A.R.
Worker to Select Beneficiaries for Nutria
williams, Cioily D and
Mother and Child Health Delivery. The
Jelliffe, D.B.
services, P. 78, First ed. Oxford Uni
tional Supplements (under publication)
8-.
versity Press , L.qndon, 1972.
TABLE
-
II
EVALUATION OF IMMUNIZATIONAL
Further copies can be obtained from:
Coordinating Agency for Health Planning,
C-45, South Extension, Part II,
New Delhi-110049.
STATUS
THE
KASA
MOHN
PROTECT
Integrated Mother-Child Health-Nutrition Model
PRIMARY
Sponsors:
HEALTH
CENTRE,
Government of India,
and
KASA
Government of Maharashtra
CARE-Lhharashtra
Administered by:
CARE-Maharashtra
STANDING INSTRUCT LOTS TO THE NURSES AND PART-TIME SOCIAL WORKERS
FOR
THE TIMELY HEALTH CARE OF CHILDREN AND MOTHERS
Prepared by ;
Dr. KUSUM P. SHAH
Associate Professor of Obstetrics
and Gynaecology
J.J. Group of Hospitals &
Grant Medical College
BOMBAY.
Dr. P.M. SHAH
(Hon) PROJECT DIRECTOR (TECH)
Professor of Paediatrics
Institute of Child Health
J.J. Group of Hospitals &
Grant Medical College
BOMBAY.
_ ,4
I
it
*■ 5
_ r- .580001
I
M P 0 P, T A N T
Do's
1.
Wash your hands aft ar examining a patient
2.
In case of doubt always refer the cases to the Medical Officer
3.
Check the weight chart of the patient to find the Nutritional S ts-.tus
and Immunization S atus
4.
Make entries in the treatment sheets of the cases
5.
Always maintain a record of the cases.
Don'ts
1.
Do not treat any patient with dirty or unclean hands
2.
Do not give medicine to a patient for more than 2 days unless
prescribed by the Medical Officer.
Guidelines
Illness
for
Treatment
Symptoms
of
Simple
Hines s
Treatment.
URI (Upper respiratory tract infection)
1„ Upper respiratory
tract infections without
fever
1... No drugs to be usedo In small children nasal passage
1. Running of hose, cough
should he cleaned with moist cotton plugs, particularly
sore throat for less tha:
when there is difficulty in breathing through the nose
10 days without fever
and at night time,
2. Upper respiratory tract
infection with fever
2. Cold, cough or sore
throat over 10 days
duration associated with
a) fever less than 38.5'C
body temperature
b) fever more than 38.5'C
body temperature.
2. Treat with Sulphadiazine and Aspirin or Paracetamol
tablets, as below:
a) Sulphadiazine
Infants
1/2 tablet .
3 or 4 times a day
1-4 yrs = 1 tablet
3 or 4 times a day
Above 4 yrs = 2 tablets
3 times a day
Sulphadiazine should not be given for more than 5 days.
b) Paracetamol/Aspirin tablet along with tepid sponges
Infants = 1/4 to 1/3 tablet
1-3 yrs = 1/3 to 1/2 tablet
3-6 yrs = 1/2 to 3/4 tablet
Above 6 yrs = 1 tablet
Paracetamol or Aspirin should be given immediately.
Repeat dosage if fever does not come down within. Half-..an
hour. Do not give tablets on an empty stomach.
Also give Sulphadiazine tablet as above for five days.
Always give tablets to young children in powdered form
mixed with jaggery or honey.
REFER CASE TO MEDICAL OFFICER
a) If the respiration rate of the child is fast i.e.
above 40/minute,
b) If child looks very ill,
c) If child does not respond to treatment within 2 days.
Illness
Symptoms
Treatment
3. Fever
3. Body temperature above
38,5*0 may be associated
with cough and cold
3. Give paracetamol tablets in doses as noted in item (2)
Also give.cold sponges. For children give plenty of
fluids orally.- ■ Associated cough and cold should be
managed simultaneously.
REFER TO MEDICAL OFFICER
.
a) If the fever persists for more than 3 days,
b) If the fever is associated with chills & rigors.
Also take blood smear to confirm an attack of I&laria,
c) When child is delirious or is having convulsions.
As first-aid, give Aspirin, or Paracetamol tablet as
noted in item (2) and cold sponges. Doctor should
be consulted immediately.
4. Measles
4. High fever for about 4
days, followed by the
appearence of rash, bfey
be associated with severe
cough or diarrhoea.
4. Treatment is symptomatic. Give Paracetamol/Aspirin
tablets in doses as noted in item (2). Gough, when
severe, should be treated with cough sedative mixture
or syrup.
Treat diarrhoea if it is associated. These children
should be.given plenty of fluids - water, milk, tea
and semi-solids - a soft diet. If the parents refuse
to administer medicine before the rash subsides,
advise plenty of fluids and a frequent soft or semi
solid diet.
Also advise eye drops for sore eyes.
After the rash subsides, if the child still has fever
or cough, treat him accordingly.
REFER TO MEDICAL OFFICER
a) If severe cough persists after the rash has sub
sided,
b) If the respiratory rate is fast, i.e. more than
40/minute and Hi ere is indrawing of intercostal
and subcostal spaces,
c) If the fever continues after the rash subsides.
d) Soreness of the eyes persists for more than 3
days.
Illness
Symptoms
Treatment
5. Diarrhoea and Vomiting
5. Vomiting and/or passing
of more than 4 semisolid
stoole
5. Administer, orally, water-and Electrolytes powder; this
prevents dehydration and death.
When the child has more than 4 semisolid or watery stools
in a day, he/she should be given Water-electrolytes
formula.
Dissolve 1 packet of Electrolytes in 4 glasses of water.
In case of mild diarrhoea, give 2 to 3 glasses of Water
electrolytes. In cases of moderate to severe diarrhoea
give 4 to 6 glasses of Water-electrolytes in 24 hours
to a child of 6 months to 2 years of age. When Electro
lyte powders are not available, prepare a solution of
6 teaspoons of Sugar and 1 teaspoon of Salt in 4 glasses
of water.
If the child is on breast feeding, it should be continued.
Continue other feeding as before. In case of moderate
to severe diarrhoea, advise breast milk or cream-free
milk, banana and tea decoction.
In cases of mild diarrhoea of duration of less than 2
days, drugs need not be given. In case of moderate-to- .
severe diarrhoea, or when diarrhoea is associated with
fever, or when a mild attack d'oes not subside after 2
days, give Sulphadiazine tablets. The dosage is same as
in item No. (2). When there is associated vomiting give
Largectyl tablet (25 mg). The dosage is
Infants = 1/4 tablet
1-5 yrs = 1/3 tablet
This should be given along with jaggery or honey.
REFER TO MEDICAL OFFICER
a) If the vomiting persists even after the administration
of Largectyl tablet.
6, Conjunctivitis
6. fted eyes with-discharge
6. If there is profuse discharge from the eyes, clean them
frequently with sterile Saline water.
Administer Sulpha cetamide eye drops, 2 to 3 times a
day. For children under 2 years of age, use 10% solution.
Illness
Symptoms
Treatment
and for children above 2 years ,use 3Q% solution. If eye
drops are not available then use Penicillin dr' Terramycin
eve drops twice a day.
In eases with very sore eyes and associated fever give
bulptiadiazine or Paracetamol tablet according to the
prescribed doses (see item 2).
REFER TO MEDICAL OFFICER
a) If there is no improvement within 4 days of starting
of the treatment,
b) If the child has night blindness or other signs of
Vitamin A deficiency,
c) If it is impossible to open the eye of the patient
and see the cornea,
d) If there is corneal opacity or ulcer.
7» Otorrhoea
7. Discharge or infection
7. Clean the outer ear with dry cotton swab, 4 to 5 times
a day.
DO NOT put a stick into the ear to clean the inside of
the ear.
DO NOT put any oil or medicines into the e,ar.
Give injection of Benzathin Penicillin.
The dosage is for children
under 2 years
=
300,000 Units
2-6 years
=
600,000 Units
Above 6 years
= 1200,000 Units
every week, for 3 to 4 weeks.
Cr treat with Sulphadiazine for 7 days.
If there is only pain in ears and not ctorrhoea, then
treat for possible throat infection with Paracetamol/
Aspirin and Sulphadiazine.
Make sure that the child with discharge from ears has
been given DPT vaccine. Give a booster dose of Tetanus
Toxoid.
.
REFER TO MEDICAL OFFICER
If otorrhoea continues even after treatment
is given.
Illness
Symptoms
8. Pyroderma (Boils)
9. Round Worm
Treatment
8. Instruct the parents to bathe the child every day.
If
boils are very few, apply Gentian Violet 10$ or Sulpha
diazine or Furacine ointment, locally.
If there are many boils or there is associated fever,
then give Sulphadiazine tablets- for five days.
Boils, when associated with scratching, or when other
members of the family have itching or multiple boils or
when boils are between fingers, are symptoms of Infected
Scabies. Give the child.-. Sulphadiazine tablets along
with treatment for Scabies.
Cut the nails to minimize injury due to scratching end
secondary infection.
9. Passing of round worms
with stools.
9. Give a single dose of Piperazine tablet at bedtime. The
dose is one tablet per year of age.
The tablet should be crushed and given with honey or
jaggery in a single dose.
10. Head lice
10. Dispense DDT powder mixed with coconut oil or other oil,
and cover the head, This should be applied just before
bedtime. Wash the hair and comb the next day.
Repeat the same treatment after a week. It may be nece
ssary to treat the entire family.
11. Malnutrition.
ll.Enrole and give Nutrition Supplement, daily, to all seve
rely malnourished children weighing less than 65$ of the
reference weight. Prepare weight charts and assess the
nutritional status of these children periodically.
Advise parents on the proper and frequent feeding of the
child.
For associated Anemia give one Iron-folic acid tablet
twice a day. For associated Vit. A deficiency give
massive Vit. A (oral - 200,000 units) on alternate days
for 5 times.
Treat cough, cold and fever with Sulphadiazine or Penicillin tablets.
Illness
Symptoms
Treatment
Treat Diarrhoea with Water-electrolytes solutions.
Treat roundworm infestations with Piperazine tablets.
Treat alJ associated illness, at first contact, and if
need be, refer to the medical officer early.
REFER TO MEDICAL OFFICER
a)
b)
c)
d)
12. Severe anemia
12. Severe or moderate
pallor
12.
If associated fever is high
If associated diarrhoea is severe
If there is breathlessness
If there is swelling on legs
T’reat with Iron-folic acid tablets. Dosage
I xfant - 1/2 a tablet, twice a day for a month
C Haren - 1 tablet, twice a day for a month.
REFER TO THE MEDICAL OFFICER
1.
2.
3.
PM3:lIS:sc
If pallor does not respond to treatment, even after
15
days.
If there is severe pallor with swelling on legs
If there are a number of children m the family or
hamlet or the village who have moderate or severe
pallor.
:7:
Guidelines
for
Management
of
the
"At risk"
Children
The following should be the management of
at-risk" children under 6 years of age.
All the at-risk children should be seen by the ANMZnm or Male Multipurpose Worker.
Condition
Management
lo (a) If a child weigh 65$ (IIA grade
of malnutrition) of the refer
ence weight or leas
or (b) If a child fails to gain weight
for 3 successive months
or (c) If a child loses weight for 2
successive months-.
1. (a) Provide nutrition supplements and make arrangements so that those
are eaten by the beneficiary child
(b) Explain to the parents about malnutrition with the help of the
weight chart. Advise on what and how frequently the child should
be fed by them or mother-substitutes.
(c) Weigh these children frequently. Treat associated illnesse;
like
diarrhoea, fever and cough, worms, severe anaemia or vitamin A.
deficiency
REFER TO THE MEDICAL OFFICER
If the "at-risk" child does not improve.
2. If a child weighs. '■ less than 1.5
kg at birth
2» Advise the mother to breast feed the child every 2 or 2-g- hours.
When the weight becomes equal to grade I malnutrition drop the child
from special care list.
REFER TO THE MEDICAL OFFICER
1) If there is a lactation failure
2) If the child is not taking feeds
3) If the weight of the child does not increase.
3.
If a child has an attack of severe
diarrhoea or measles
3.
See under illness.list for management
REFER TO THE MEDICAL OFFICER
If the condition of the child does not improve within 48 hours of
starting the treatment.
PMS:NS:sc
Guidelines for Treatment of Obstetric and Gynaecological Problems
MIDWIFERY
PROBLEMS
A. Problems during First Trimester (first three months)
Pr obi ems/conditions/symptoms
Treatment/bfenagement
1.
Constipation
1.
Advise the woman to eat green leafy vegetables and to drink a
glass of water in the morning.
Nausea and vomiting
2.
Advise the woman: To eat foods which she likes; the intake
should be small but frequent; to avoid fluids in the morning;
take only solid and semi solid foods; that nausea and vomiting
will: stop.after 10 - 12 weeks of pregnancy. Give tablets
Vitamin B& (Pyridoxin or Ancoloxin) to be taken in the morning .
(if vomiting persist).
Dosage: 1 tablet for 4 to 5 days.
-■■ 2.
REFER TO MEDICAL OFFICER
■If the woman is not able to retain any fluid/food intake and
vomits more than 4-5 times a day.
3.
Retention of Urine
(bfey be due to retroverted gravid
uterus)
■3;
The ANM should Catheberize the woman.
Advise the woman to lie in knee chest position for 10-15 minutes,
3
to 4 times a day.
4.
Burning in micturition
4.
Give tablet of Sulphadiazine
Dosage: 2 tablets
3 times a day
Plenty of water must be taken.
5.»
Slight bleeding per vaginum
5..
Advise complete bed rest.
6.
Profuse bleeding per vaginum
6.
This woman is about to abort.. After the complete abortus is
expelled. Give Methergine tablets.
Dosage: 1 tablet
3 times a day for 2 or 3 days.
89:
Problems/conditions/symptoms
Tr eatment/Wiag ement
REFER TO MEDICAL OFFICER
1)
2)
3)
If the profuse bleeding does not stop
If the complete abortus is not expelled. At the PHC the uterus
should be evacuated.
If along with the bleeding vesicles are also passed.
7.
Fever
7.
Give tablet Sulphadiazine
Dosage: 2 tablets
3 times a day
plenty of water must be taken
8.
Diarrhoea (loose motions)
8.
Give Sulpha guanedine tablets.
Dosage: 2 tablets
4 times a day
Advise, plenty of fluids
REFER TO MEDICAL OFFICER
If the diarrhoea/loose motions does not stop within 3 days.
9.
Anaemia
9.
Treat with Iron tablets
Dosage: 2 tablets twice a day till required.
Advise the woman to eat green leafy vegetables.
REFER TO MEDICAL OFFICER .
1)
2)
If there is severe pallor
If the condition does not improve
B. Problems in Second Trimester (4th, 5th & 6th month)
Note: All problems under first trimester can occur in second trimester also and should be managed/treated as
specified
10. Heart 'burn
10. Advise the mother to chew Gelusil tablets
Dosage; 1 tablet
2 or 3 times a day ■
wMle condition persists.
,'10:
Problems/c onditions/sympt oms
Treatment/Management
11. Swelling of feet
11. Press over the bone with thumb. Watch for-prolonged depression.
Examine the urine for Albumin- If Albumin is present get the BP
checked at PHC. If the BP is normal advise rest and if the BP is
high advise the mother to avoid salt in foods, avoid eating pickles,
chutney and papad.
REFER TO MEDICAL OFFICER
If the’ BP is high
12. Vitamin/mineral supplementation
therapy
12. Give Vitamin/mineral tablets to all pregnant women.
a. Iron tablets
.
Dosage: 1 tablet twice a day after meals.
b. Folic acid tablet (5 mg)
Dosage: 1 tablet twice a day.
c. Calcuim Lactate tablets
Dosage: 2 tablets twice a day.
& Problems in Third Trimester (7th, 8th & 9th month)
.
.
.
Note: All problems under I & II trimester can occur in III trimester and should be managed/treated as specified.
13. Slight bleeding with uterine
contractions
13. The women might deliver prematurely.
or conduct the delivery there. *-' •
14. Bleeding P V
14. Without "doing internal examination send the patient to the PHC.
D. Predelivery
REFER TO THE MEDICAL OFFICER IF ONE OR MORE CONDITIONS OCCUR
1.
If the pregnant women has history of'
a. Abortion
b. Still births
c. Premature deliver
Send her to PHC immediately
:llr
Problems/ccnaitions/symptoms
2c
3c
4c
5,
6„
7C
8,
Treatment/lferiageiaent
d„ Caesarian section
e.
Bleeding per vaginum curing this pregnancy
fo Leaking membrane'
-If the pregnant women is over 30 years and tly.s is her first pregnancy
If this is pregnant women-s 5th or later child
If the pregnant women has multiple pregnancy (twins)
If the pregnant women has abnormal presentation of the child in the uterus
If the pregnant women has severe Anaemia
If the pregnant women has swelling in the legs, Albumin© in urine and high blood pressure
If the pregnant women has Jaundice
Preventive health care
Give the woman Tetanus toxoid
Schedule: 2 shots given at 2 months interval.
1.
Immunization during antinatal period
1.
2.
Weight
2.
Record the mothers weight on her chart
3«
Diet
3c
Advise diet as per the availability, habit and liking of the
mother.
olivery
iile conducting normal delivery carry out the following:
. Take complete aseptic precautions while conducting delivery.
Give simple enema.
. Ask the pregnant woman to pass urine frequently. This will keep the urinary bladder empty.
Give the pregnant woman fluid diet like tea, milk gruel etc.
Ask the patient not bear down till the cervix is fully dilated
Maintain flexion of the baby’s head. Press Occiput with your left hand fingers till the baby’s head comes or
of pubic symphysis.
Keep'the pad on perinium with your right hand.
Deliver the baby. Hold the baby's head end at low level. Clean the baby's air passage with Sterile gauze
piece wrapped on your little finger.
Giamp the cord. Cut the cord with scissors or blade cleaned with spirit at a distance of !§• to 2".
Do not press the uterus to deliver the placenta. Have a cord traction. Apply final pressure only when
olacenta is seperated.
Problem/conditions/synpt eras.
11„
T r ea tnent/Manag enent
If there is bleeding after delivery do bimanual massage.
Stop.
12.
G.
REFER to the medical officer if the bleeding docs not
;
If the placenta is retained, do not pull the cord, or press on the uterus.
REFER
the woman to PHG.
Post Delivery
1,
Puerperal Sepesis
Slight fever with foul smelling
discharge from vaginun
l0
Treat with Sulphadia'sine
Dosage: 2 tablets
3 tines a day for 5 days.
REFER TO MEDICAL OFFICER
If the condition does not improve.
H.
Family Planning
1.
Family Planning methods
I. G?/naecological problems
1.
All Gynaecological problems
1.
Advise the mothers to adopt a family planning methods ■
Advise mothers with 1 child to use oral pills or IUCD (loop).
Advise mothers with 2 children or more to adopt* a permanent method
tubectomy or vasectomy of her husband.
REFER TO MEDICAL OFFICER
As these require Bimanual and persepeculum examination.
"5
,PJ6:NS:sc
r'iAHA - x
COMPREHENSIVE RURAL HEALTH PROJECT,. JALKHED
STANDING ORDERS
UNDER-FIVES
I.
A. DIARRH^L
Jigns and Symptoms,
Loose bowel movements, more than three
times, with or without fever.
May be present with cold, ear
infection, etc.
Treatment.
1.
Advise plenty of fluids, sugar water with a
2.
Pectokab,
3.
4.
Sulpharaezathine.
pinch of salt.
3.
1 tsp. with every stool.
Baby aspirin for fever p.r.n.
DEHYDRATION
Causes.
Diarrhoea, vomiting or fever.
Signs and Symptoms,
ASSESSMENT OF DEHYDRATION BY FIVE CLINICAL SIGNS
Appearance
MLD
Skin
Anterior ■
•Elasticity* Fontanelle
Eyes
Mouth
Fretful
Normal or
slightly
reduced
Normal or
slightly
depressed
Normal or Dry, red
slightly
sunken
MXlDS3t.iTE Restloss
Moderately
impaired
Moderately
sunken
Sunken
SEVERE
Severely
impaired
Deeply
sunken
Deeply
Very dry
sunken,
cyanosed
’staring1
*N3te:
Semi—coma
Do not rely on skin elasticity in the presence of
malnutrition.
Treatment.
1.
Very dry
slight
cyanosis
Fluid replacement.
Fluid requirements first 24 hours:
Mild dehydration-90 cc/lb body weight.
,
Moderate dehydration-110 cc/lb body weight.
Severe dehydration-ref er immediately to Jarakhed
clinic after giving initial
100 cc. subcutaneous saline.
3.
Treat cause of dehydration.
. o
-
o
c-
-2-
II.
FEVER
Causes.
A.
UPPER RESPIRATORY INFECTION
Signs and Symptoms.
Treatment.
B.
.’ever, running nose, cough, and sometimes vomiting
1.
Baby aspirin.
2.
Sulphamezathine.
3.
Cough sedative.
4.
Plenty of fluids and normal diet.
EAR INFECTION
Signs and Symptoms.
May be as above with ear ache, ear discharge, ear
drums red and tender.
Treatment.
1.
As above,
2.
Local treatment:
a) Antibiotic eardrops.
b)
III.
pneumonia
Signs and Symptoms.
Patient looks sick, rapid respiration with alae
high fever, cough.
nasi working, chest pain,
heard
May be restless.
Hales
and poor air entry.
Treatment.
1.
Plenty of fluids.
2.
Normal diet.
3.
Aspirin.
4.
Antibiotics-Procaine Penicillin, 4 lakhs.
5.
Refer to hospital.
C> vu
P'
IV.
Hydrogen peroxide (HgOg).
MSaS L^S
Signs and Symptoms.
Cough, fever, redness of eyes, running nose,
rash appears (4th day), on face, trunk, extremities, irregular,
maculo-papular.
treatment.
1.
Plenty of fluids and food, normal diet.
2.
Aspirin.
3.
Antibiotics to prevent complications, such as
otitis, pneumonia, diarrhoea-Sulpharaezathine.
PERTUSSIS
Signs and Symptoms.
Persistent cough, often with whoop, fever,
running nose, and red eyes.
Treatment.
1.
Chloromycetin.
2.
Phenobarb.
3.
Cough sedative.
4.
Aspirin.
5.
Adequate fluids and frequent small feeds.
VI .
FE3RI L S OCX VULSI OX'S
Signs and Symptoms.
Fever due to any cause and convulsions
involving one or more extremities.
Treatment.
VII.
1 cc per year of age, I.M.
1.
Give paraldehyde,
2.
Cold sponging and aspirin.
3.
Phenobarbitone.
4.
Treat cause of fever.
5.
Refer to hospital,
ROUND WORMS
Treatmani.
For children up to 5 years, Piperazine liquid,
1 tsp. t.i.di x 2 days.
For children 5 years to 12 years, Piperazine ii
t.i.d. x 2 days.
X.
SORE EYES
Treatment.
XI.
Apply penicillin eye ointment.
TRACHOMA
Signs and Symptoms.
Small granules in eye lids (patient com
plains of sand in eyes).
Treatment.
Sulphaeetamide drops to eyes.
ADULTS
I.
FLU, UPPER RESPIRATORY INFECTION
Signs and Symptoms.
Headache, feeling weak, cough and fever,
1-4 days.
Treatment.
1.
Plenty of fluids.
2.
Normal diet.
3.
Aspirin.
4.
Inject Novalgin, 2 ec I.M., if necessary.
-Ii-
II.
PNEUMONIA
Fever, cough, chest pain, shortness of
Signs and Syrap toms.
breath, rapid breathing, alao nasi working.
Rales hoard over
one or both sides of chest.
Treatment.
1.
Inject Terramycin, 250 mgmt I.M.
2.
LAS i q.o.d. x 1 day.
3.
Aspirin ii t.i.d. x 1 day.
4.
Cough sedative i t.i.d* x 1 day.
5*
Advise hospitalisation or consultation with
6.
Plenty of fluids and normal diet.
doctors.
III.
TYPHOID
Fever, body ache, coated tongue, patient looks
Signs and Symptoms.
sick.
Cough, diarrhoea or constipation, abdominal distension.
Treatment.
IV.
1.
Chloromycetin ii tablets q.i.d.
2.
B Complex.
3.
High protein diet with plenty of fluids.
4,
Advise hospitalisation.
PEPTIC ULCER DISEASE
Signs and Symptoms.
Epigastric pain, acid eructations, pain
increases after hot food or on empty stomach.
Treatment.
V.
1.
Magnesium trisilicate ii t.i.d.
2.
Belladonna tab i t.i.d.
3.
Advise small, frequent food.
4.
Bland diet.
DIARRHOEA .IND VOMITING
Signs and Symptoms.
Loose bowel movements and abdominal pain.
Abdomen soft, generalised tenderness but no gourding.
Treatment.
VI.
1.
diarrhoea tab ii t.i.d. x 1 day.
2.
Sulphamezathine ii t.i.d. x 2 days.
3.
Plenty of fluids.
4.
Eiligan i p.r.n. for vomiting.
5.
If severe, start I.V. fluids.
ARTHRITIS
Signs and Symptoms.
Treatment.
Joint pains in one or more joints.
1.
Aspirin ii t.i.d. x 3 days.
2.
3.
Mothyl salicylate for external use.
If having extreme pain, inject Butazolidine
4.
Advise consultation with doctor.
3
cc, deep I.M.
-5-
VII.
RHEUMATIC FEVER
Signs and Symptoms-
largo joints.
Pevor, floating joint pains, mainly of
Very tender and swollen.
of previous attack often present.
Rapid pulse.
History
Ask for history suggestive of
heart disease, such as chest pain, shortness of breath, cough.
Treatment.
VIII.
1.
Aspirin ii t.i.d.
2.
Bedrest.
3.
LAS i q.oid.
1 arap I.M., if necessary.
U.
Injoct Butazolidine,
5.
Advise consultation with doctor.
BRONCHI .IL ASTHMA
Signs and Symptoms.
Repeated attacks of difficulty in breath
ing, wheezing, cough and mucoid sputum.
Prolonged expiration
with generalised rhonchi.
Acute attack treatment.'
1-
Inject Adronalino -J cc subcu
2.
Aminophylline i t.i.d.
3.
PET i h.s. q.o.d.
taneously.
Qhronie .treatment.
1.
Aminophyllino i t.i.d.
2.
PET i h.s. q.o.d.
ANTENATAL CARE
Complete obstetrical history.
Danger signs needing hospital referral:
1.
Ang&inia, hemoglobin below 9 grams.
2.
Bleeding after previous delivery or during this
3.
Any baby born dead or after difficult delivery,
4.
Swelling of hands or face.
delivery.
forceps or Caesarian.
5»
Diastolic blood pressure over 90 mm Hg.
6.
Breathlessness with heart murmur or cough or
sputum for 1 month.
I.
REGULAR ANTENATAL CARE
1.
Two doses of Tetanus Toxoid during pregnancy,
2.
Forsolate i daily.
3.
Calcium gluconato i daily.
4.
b Complex i daily.
5.
Family planning advice should be given at each ANC visit
-6II.
TOXAEMIA OF PREGNANCY
Signs and ^ymptoins.
Treatment.
1.
Any two of the following present:
1•
Albuminuria.
2.
High blood pressure, diastolic abover90 mm Hg
3.
Swelling of face or extremities.
Advise low salt diet.
2.
Diuril i on alternate days.
3.
Rest.
4.
Advise consultation with doctor.
Warn
patient about dangers of eclampsia.
III.
VOMITING OF PREGNANCY
Treatment,
1.
Diligan i p.r.n.
2.
Vitamin Bg i daily.
3.
ANC pack
If persistent and uncontrollable, consult with doctor.
IV.
ANAEMIA OF PREGNANCY
Treatment.
1.
Folic acid i b.i.d.
2.
Fersolate i t.i.d.
If hemoglobin below 9 grams, refer to hospital.
TUBERCULOSIS
Signs and Symptoms.
Fever, especially in the evening, loss
of appetite, loss of weight, cough of more than two weeks
duration, hemoptysis.
To confirm diagnosis:
1) collect
sputum for AFB x 3, 2) advise chest x-ray and screening.
Treatment.
Contacts.
1.
Streptomycin.
2.
Isozone Forte.
3.
4.
Multivitamin.
5.
Good nutrition, no diet restriction.
6.
Advise patient to cover mouth while coughing.
(a)
Treat all contacts with INH
Cough sedative.
(l) Adults-300 mgm. daily.
(2) 5-12 years-200 mgm. daily.
(3) 2-5 years-100 mgm. daily.
(4) below 2 years-50 mgm. daily.
(b)
Advise chest screening of all contacts.
-T-
LEPROSY
Signs and Symptoms.
Anaesthetic patches, thickened greater
auricular, ulna and lateral popliteal nerves.
Loss of sensa
tion in hands and feet and motor woeJcnoss of fingors.
Loss of
eye brows, thickening of skin, especially ear lobos.
Trophic
ulcers.
Tako skin clip for AFB.
Treatment;
1.
D.D.S. dosage schedules
(1) 5 mgm. twice a week x
(2)
• woeks.
10 mgm. twice a week x 4 weeks.
(3)
20 mgm. twice a week x 4 weeks.
(M 25 mgm. twice a weok x 4 weeks.
(5) 25 mgm. 4 times a week x 4 weeks.
(6) 25 mg:n. 6 times a week x 4 weeks.
(7) 50 mgm, 6 times a week x 8 weeks.
(8)
100 mgm. 6 times a week.
2.
Examine eyes for corneal ulceration and give
3.
Trophic ulcers should be taken care of with
Sulphacetamide drops.
acriflavine dressing, penicillin ointment,
magnesium sulphate soaks.
4.
Glycerin for dry nasal mucous membranes.
Treatment for Dj,a._S. reactions (in order):
(1)
-Rest, aspirin.
(2)
Chloroquine i t.i.d. x 3 days.
(3)
Lamprene i on alternate days, increasing to
i daily, if necessary.
(4)
Contacts.
Precin.
Treat all contacts of lepromatous and indeterminate
cases with D.D.y.
DRUG REACTION
Drug reaction may be mild, moderate, or severe.
I,
Mild reaction, such as urticaria and drug rash may occur immedi
ately to one week after drug has been started.
Treatment.
II.
1.
Stop the drug causing reaction,
2.
Benadryl, 50 mgm. t.i.d. or q.i.d.
Moderate reaction, occurring within few hours of intake of drug,
urticaria, vomiting, diarrhoea, dizziness, falliin blood pressure
Treatment.
1.
Inject Syncpen 1 arap I.M.
2.
Inject Adrenaline 1 cc, if necessary.
3.
-Benadryl 50 mgm. t.i.d. or q.i.d.
If hypotensive, intravenous fluids should bo
started.
III.
Severe reaction (anaphylactic shock), immediate shock-like and
frequently fatal reactions which occur within minutes of admin
istration of drugs.
Three syndromes of anaphylaxis may be
1) laryngeal edema, 2) bronchospasm, and 3) vascu
recognised:
lar collapse.
Signs and Symptoms.
Apprehension, paracsthesia, generalised
urticarigi, choking sensation, cyanosis, wheezing cough, incon
tinence, shock, fever, dilatation of pupils, loss of conscious
ness and convulsions, death may occur within 5-10 minutes.
Therefore, treatment must be started immediately and oraergancy
drugs must be «■'’•<«». 1-etble uhorw.^' injections are given,
Treatm.eji.fe-
1.
Adrenaline 1 cc .I.M. immediately,.
2.
Plaea patient in shock position.
3.
Maintain adequate airway.
4,
Inject Synopen 1 amp I.M.
5.
If patient has not responded to adrenaline,
6.
For hypotension, start intravenous fluids with
7.
02 (oxygon).
give Botnesol I.V. 2 ampules.
noradrenaline 4 mgm. in 1 litre of saline.
8.
For bronchospasm (wheezing), give aminophylline
V.
I.
slowly.
-9-
RSFERENCE TABLE
DRUG DOSAGE IN CHILDREN
0-6 mos.
over 6 inos.1 year
1-4 years
4-10 years
Baby Aspirin
■J- tab
t.i.d.
1 tab
t.i.d.
2 tabs
t.i.d.
Adult ASa
t.i.d.
Sulphamezathine
y tab
t.i.d.
1 tab
t.i.d.
1 tab
t.i.d.
1 tab
q.i.d.
Phenobarbitone
5 mgm.
t.i.d.
7y mgm.
t.i.d.
10 mgm.
t.i.d.
15 mgm.
t.i.d.
Chloromycetin
100 ragm,,
t.i.d.
200 mgm.
t.i.d.
250 mgm.
t.i.d.
250 mgm.
q.i.d.
•Paraldehyde
1 co per year of age
Streptomycin
200 nigra,.
per day
400 mgm.
per day
i gram
per day
1 gram
per day
INH
50 mgm.
per day
50 mgm.
per day
100 mgm.
p er d ay
200 mgm.
per day
X
COHTAC
T
10
Christian Radical Cosaission World Council of Churches
Geneva 20 Switzerland
150 Route de Ferney 1211
August 1972
COMFXH
:
Ti'JXL HiXI-TE .-X.'J.’T?
Jnnkhed, In-lia
Rajnnikont S. Arole, HD
■(Address given to the CKO at its annual meeting in Juno 1972)
My wife and I wr; both concerned about dv- nodical care of the rural population
of India, and soafter graduation we both went to a hospital situated in a rural
area and worked there for about five years. To our asazesont, at c:'W end of five
years, we found that all we had done wan to trike cure of patients who came to the
doorsteps of the hospital, but we had on? little for the general, -health
of the community around us. To give you a simple example, we served a population!)
of about ICC,©CO. Thera must have been 4000 deliveries each year, but we were
taking earn of only 500 of them. Vo asked ourselves, "What happasiod to the
recoining 3700 deliveries?" Thar was nobody besides wa in the area.
Examples such as this made un realize cur need for public health training to
enable us to reach out to the community. ,Therafort, we went to Johns Hopkins
University ano took a public health course. A lot of notarial that we read
came fron the Christian Medical Coxrrii coion. The books and articles written by
zany r?there of t>io Ccrodssion helped us to formulate a programme.
1.
To sake available facilities and personnel in rural aroasj
2.
to do something about the rapid population explosion:
o
3.
to attempt to reduce the high infant mortality and continued mortality
end morbidity up to the age of five;
v.
4.
to take care of certain chronic diseases which not only contribute to
mortality but also morbidity in ths society and which, more than that,
deprive the people cf their dignity, especially those suffering from
leprosy.
Sc the goal was to develop a programme which would be fitted to the needs of
ths community but which would alco be compatible with the resources available
to the community.
The MSTHO- wo adopted was to take a specific area for our responsibility. The
selected area is within a ten mile radius o! a village called Jsmklwd in
Maharashtra State. Thia area has a.total population of 80,000 living in 55
villages. 'fe cannot take cate of the whole area right now, so vo have
this ac follows:
Phase 1.
Phase 2
Phase 3
20,000 population - in two years
40,000 population - in the next two years
80,000 population - by the ond of six years
The method will be to establish a main centre in the central area — i.e. at
Jaakhed - whera we snail have diagnostic help, facilities fur e!serya;i<:y surgery
and emergency medical care. The ihzex there will be ten subcantre® in ten
surrounding vii;agee, ths aaxiauw distance bstween the central village urs-cJ the
subcentres being tun nileo. For this rirogram o «•• will need to uae auxiliary
workers and paramedical workers: we will need the cuopalsitlon and involvement
of ths indigenous jrerx practitioners, ot'.ei’ health officials, schoolteachers and
dais (indigenous siidwivec). There will be cp-peration with other . ovemaent
progresses. An-i finally at the end of six years this will have to be a selfsupporting progm&ae. For a program's to b? self supporting, motivation will
have to be developed in the community.nd the eossunity leaders, the local state
and the central government taking responsibility for thio kind of work.
.2
360 (PH
Since the problems in rural areas relating to health are many, we set the following
priorities:
2
Qb^ectivos
1.
reduce birthrate fron 40/1000 to 30/1000
2.
reduce under-fives* mortality by 50 per cent
3.
identify and bring under regular treatment leprosy and tuberculosis
patients
4.
train indigenous workers and offield training to health workers
To achieve our objectives, the- sain activities will be
— the -jstablishsent of unrier-fiven* clinics — these clinics should
be mainly for supplementary
yrogra-^es, inaunisation,
traatnont of minor illnesses;
- family welfare program®*# cioneletlng of antenatal care, delivery
and postnatal care;
- fanily planning prograarses
devices and operations;
;«..- use of all known contraceptive
- detection of Icprosy-and tuberculosis patients and treating
thee in a wll-integrated prog'ra'wo;
- curative services in the .ain centre for obstructed labour,
acute surgical and medical eaer.g’Gncios an?. diagnosis;
- laobiln clinics;
— school health prograrm.
This, in short, is a sussaty of the project wo are try5ng to devalop,
Today I an going to share wit?; you .•■ainly th© conaunity involvsQsnt
in nerving at certain decisions in regard tc tbo programs.
While we ver- studying in the United States, so decided that we would go
to an arsa where there was no Christian witness because ve wanted to
establish a Christian witness in ah entirely non-ohriatlan area. Secondly,
we wanted &.■ area, where there was an -scute need for nediaal car© and where
was no ’.■©saibility of any future devc ley tent, not only develcynsRt in the
health field but also in other fields, co that after five y-nrs there would
be no other factors to account for the. changes that take pIac-. ’4e c'-ose.
this nr-.’a in Maharashtra, where there is no scesibility of any ".i.'or
industrial or agricultural changes planned for the next five yo^rs. Thia
area, like -aany other rural areas of India, has a very siren,.“ cs*te system.
About 50 per cent of the people are oultlv'uors or f/'raorsj 20 per <j»nt
are untouchables - th© people who are very poor end. usually landless labourers who socially have no status. The villages haves governing beard with an
elected head called Ssrpaneh. Most of the leadership comes froa the farmer caste
who are the decision—makes for the community. In addition to theoe two castes,
there are wealthy famere, school teach©-p and other educated pavemaent employees
who are the accepted leaders of .the coh •.'unity. 0ne cannot enter any community
by passing the leaders because if a l-.'-ider feels thnt .he has no* been given
due recognition, he can become hostile «nd uncooperative.
U; wera coaplatsly unaqquainted with ths cusmmity .and lenders of thia area*
Ve wrote several letters in the local langwage to the j'Olitionl leaders and
to the village lenders. In our letters we described the entire program© that
we had in aind. Wa said, "If you want us to cone into your area, there are
certain things that you should be prepared to do. We shall bo about 20 to 25
health workers coming into your area without having any-housing fsoil!ties. We
expect you to tssaka snae arrangements for aceosnodation for about 20 people,
Tou should also give u« temporary buildings for our clinloa and our diagnoetie
facilities, an! if after a six-sonth period we find that your interaot in uo
renains, you should donate us land to build peraano'-t stru-tiur s in your arsa".
Thera *•«» varied reactions to cur letters*
In one area (sy :s«w* village)
wealthy fansera who owned sugar factoriee wanted to build a r.--^Ora, well-equipped
....?
hospital to cater to their
curative a«nd'-. In another area the influential
inti, enoua practitlon-sr 'alt threatened, »o he dii »li he could to cr.-vent
dialogue with ths eoatnunliy lenders in hiss village. In « third village there
■ ir : corL-.unit.; '. ■ ■ ‘c' f r<wv onolble for health {: 1.t’-t
:.
a:’ 2 KULli&i
people, and he lanediately e w the beaefite for hie area in our propcaal.
There ms also a sinister st the etste level, u state os" 32 million people
v; o happens to come frcra thia ww. These two on ih'< nvuiy ndvantages for
their conounity and saw the political advantages for
own re-elections.
Therefore, they went into the yoarnmdty, into different villager, and got
resolutions passed by these villagers inviting ua io cone nnd start work in
thia ares.
•ib etated, we laid condition# under which we «oidd be willlag to go to
the area, and they war* willin.;: to fulfill theso conditions. They ciapti-id
out ;>n old veterinary
about 30 « 10 ft, which we need as our outpatient
depnrtsent. They p'«vs us a ntoj.v-yc place ’’or Inpetisuts and rented a place
"or us to live. It wao s v-r nipple arrang-* nont - nh electricity, no running
water and all 20 Of us having to live in a 20 x 30 ft area.
.4
4
Cur ori/inal plan wss that •..<*
' rstart at n central vilV>.;“ «ith
population of about 7,000 l an' work
». rgdiuc of about five
r
•:' .-»:•.-■/••>
11
•• .
V :r villc.
realised that we QMld not folio-:
■'•• ■
-
'. inter >:'• i in
•;■> •<
ul lion O;’.' X,-Xf', hut w<? ;oon
pl-.r, .
e ■■
’■
.
.->?• 1 ’
.1
ir.’.t villa o that
Mr
interested
that they alr ■.■’..■■y
■ tuil-l.c- for
an; > nc aacocutodation f r our nurse
They were willing to contribute acntMy Cor our cervices to t\vm. Though
this did not eooe into our oMglnnl design of work, wo h*d to Modify ti •.■■•• plan
ir • of the rapport .*sw?. relit! -nahi;- with the cosnunity.
"» are located at th; co;-: 'r of three eounteioc. If
verb in one
county,. th’ political leaders would probably feel that they could put preaeure
on un; but located as we ar-, •..• >■ n jove fre« one county to another U> avoid
iwh
■■ urea. « ■•■’>• ■' v: •. ' • ’-• • locui :
l.ov -;e
1-i /;■ t sv-.i-z if .r.
i- not
T.’
i - -■ c • • • ■• • i -a ■■it I-', six iv/Vsn. .•.'• ,cu
we build, a c ntre using tin abo 'if jab a sited; wo wor- fortunate as we wore
able
a*
< ' ■■ : \ ".
■'-,
> pr
't..?-■’.-? : ■:■ ■; .
tin
' ’" In ■ ••» m-SOf, «U: ’.•'© <i~-? comfortable.)
(? o slu:iir.l>j.. ■:CSC,J not
? •’. •••:'■ </ .’■' .■/.
.•■ ’. ■!’;ie. ,’h ■
building s<n be <U.*ttM»ti f v-iti •;• -congtructed within 15 dry? by the firm
which built it.
I wojI ■ now like to describe a typical ‘ncounter with a vi
■„■«. . <•
usually ,;■» in th» waning becau .• f.h-V. in tha tis-> '-hen the vili -.er is
relax
: n‘ we ;’C
C-.’ll :/ vi3.1
If
.•?. Vh’’
fi*-?] i-,;c;-t
a doctor
1 ft ':>.•
1/
•■’■' <;<- » till
tfioir
<?. t'e
are usually glvm »«a, and we etart our discuaaion. Ver;- often we find that
•■■.■■ iq
; Mt ■••’.??.• is :aven
.• ■■. l- lfir ■ :■■ ... -j jver, la ;>-;t
’. tilth;
■ u-uil cu-.’-ntion lo cc.i. 7 ,h- -ri- ■::;.■■■.•} i
’■> t v ■•u. " ‘-v-r & fanlne when we entered the ar;wi. ’•:« vt?e their land and discuss food for
f ;■
r.;. ”?n ua ;o into
■ tc-ric c. ■ -.Inu■■>.•.-.■;■ ",
c:u-j uith
■
■
*TOttr ob.il-!?
. v
■>: .
wo can
pet so
s;??nsy involvad vni inter a'. ?.’ in retting ;.o;a - Mik for your children.
lhat will you <;o in wl'us?* lad the vilinfers ait down together, and they
Coan sp with the idea that tb»y will brin< j-o--? t’-vi - •. fro
own hoa<?s
and xvik-a a cos’.on isunl for the chlidrm. 75 one whv ar
■•- i.- would donate
boss nancy, -n.i these who hw ■ ■: ■ aonvy would
antribufc: labour.
So rlfht then art’ I her- wo fora « cosMttee, and we suy that fror<
Church t'orld Servic • wn esm try •'•.«■’ ,;et wJv?nt dr tallit voider or goybe ns, but
this comdttee in r^sponBible for cocking the foo >. The r-aponsibllity uvans
purchaeinc fuel and utensils, aaint-inlng daily r.’cordr, an-! getting the
cliilriren together for tb.«
;i. This co^srsittoo than apr-oint:' people wh. will
collect the soney ’or the fa®l sn.i utunMlv and tr-ker. char®-- of th'i reading
prorr/uave. In thin way th'.?«o vill:r;r’ h»v-- about JOC-J children ■«hich are being
fed ov- r- day. ye giva a eMja-'L-yarntary protein diat io Hi-.-ra,
did not inpoee
.i.
f.
•?-/• :•:■ Ml 17- st.
:■
■
■■.■ ' ; ;l'vv
Vr..^;. tb.-..ir
elt n-v d,
tic
felt need was food, an! -'radnnlly ve translated that into a sup•losentary
feeding prograa .•■:■ for children un’er five.
At th™ seuae tin-, we realised i’at the Church 'i0rl3. fsrrice food say
not continue for ev--r or any , -.iftr ,"ror abroad teay stop, smd we h -ve to plan
ahead.
realized that the second ssost n-^od-id it ’-’: i-; water for i'araing
and drinking. So we put anothr-r ..'roposal tu th'? villa/»ra.
tol<! the.;,
"Tour children ar . bein-- fed by ills Method now, but thi» ir nut going to be
pi;rm.’.nxr:t. Why don’t we think of sone thing elee which .dll be nor* permanent
and lasting?" ’>> propose Sakin;: i-oils wh ch will asks psuporo into rich
aen. Ve then aek if when they tecc-®*? rich, they waul ’ sA-’jro their riches with
the others. They ay they xiil. ’ .- th-?n fora a c-K i.itt .®, and this ooAsittae
decides which farsor or fA-mers are likely to Mv • water in their fields or
w’Jilch farmers will ba wiliin-' to produce food for tfc’t children r»nd which one
ara 11 sly to be gonerous- nft-jr tJ-tsy
the weXl-’ sunk in t4;»ir land.
So the coanittee doeidM how to find a pensanent solution lor the undernourietod children iv he villa; o 'ey r.ettin/? a well sunk. Then we translate
this connunity nation into a scientific action. There »r*
anakea in that
areri u’hlch are working with borin'.’: aachinws for wat/rsupply and sinking
wells. :’o ;<ot this t-Jaa to cose «»•’. de a survey, aflM ihan out of the four
or five nar.ea t*:® eoonunity he, --usgeetod, thi» teas :iaka out two or three
n&ae* and decld«B ahich la Unlikely place where they ><hall strike water for
a well. Up to -Sate there are ton ;. Ils whore we hare struck water, and six of
thee© wells h*v- ^nnuf’i wate.*? ‘or irrigation. So after thin nonsoon we
shall have 15 acr?s of land to ;;sow rich protein food, Mow we nr -ur» that when
this experience works, there will be noro farmers who will bo interested and
will -'-k land av-ilacl- for feeding children of the entire villa e, fio again
we helped the comunity to dccido just by encouraging then and helping then
to arrive st tka decision
vented th*»s io :*ake.
*« do not always go and listen to the ..'robte-xs ot the villagers. Son<>tinea
we ait with the villa © pac-pte an-.‘ talk to thorn about our probleaw — for example,
the : -obl;>" of .-©tting to their vill- ; s because ’!? roads are so bad - vnd if
they really want us to con© to their villoma, -.hat cm they do? Already the
-■illafrc have wade a sevan rile road connectin'* t.«a ernlraj th- Mnieter has
50 ~il < '
c wills
. ' v-to ; t‘>- jcudsi ov pwitv: thi rends
is not important, but vh*t £' to o;-..ant in that to: people wanted us and the
car we could offer than .• f t they were willinj; to pay for th-> eare and
share the r,>s:-.onoibllty for it n;-. well as sako voto's
sin.
Children ara immunised at tin centre. X^sunlaatica in the villager is only
donv when the villagers fulfill certain condition© we have laid - naaoly, the
villr • ■ •■' . i- ■■') ■'- 0*11 ""t at least 80 .per -ont of th» c*ildror<, list •'• ir
naasa,
to/ then, and then ;?end us woxi to conss to inoculate then, 10w wo
arrive at ■:» villa;-;©, we got C< school teaclier or to. uarpanch to tell the
■■ 1
th* ' ■> C; .<■■:■ :>-■■■■: . i.:.'
'■■■-• Kfid
"■'■ ■:■:■;•’.to
p*S*£bl* reaction*
freo the iununlzations riven. :m m ■ally give am drug;:, such as aspirins to
the Sarranch, and to. toll.’? hi . . ■.:!■ '.hat if the sft.vl: have any reactions,
he will ,'.iv-- the» nedieinee.
In school health the school towbhoiw take a • s.jor part. They Hot the
cbildrer, tent their sight, ■ ■U h then, and help u.? cT. an/,
maMnetiona.
Vs l?av-.! with ibex dr^go for trastsmt thai soy to ro^uired.
l?i ;t>sy if- n eoeial probl -,.. ;••> hav-- tri.:-d <:■ int^.mte loprvny treatment
into
■ -i.i
- .
•: ■
i-.?’.:; n
... 11
lepn-osy patiaat** I say to Mw paddle, "I would like t® • e -thasj please take
ae to their hose." I fo t? U.dr homo; I :i»ot tn© pati«nt| I nhake hands
with hiaj and th© people will cay, ’"Doctor, plea/:*e vm h your hands." I aay, "I
will vs-h ■.' -. later." I esk ,h“- rattent, "What arc ycur relatione with these
peorla?" And the leprosy
■•..tent a»ys, "I’m finsj I*a all s’ighti I liva in
my place, and they leave tr? alone.“ Then I any to tbo p;ople, "This taan baa
leprocy; another rvtn has tubwrculosiB} but both an; caused by the aoato gerej
loth can h - curwd by very si^yl© mdicins, Why ?o ,y .u want to tr^st leproay
different fros tub>»rouloaia?* Then I ack if l‘c‘ would yl«*sse let thic «an
cou’to n© khan oth- r patients cnvr<« to ae® ttn. Mayb?; the others cow.o for coughs
or colds, but Ibis tun n ertn rti dicin" juet as th t ot’-i ;rc do.
;«? :.r ■ •; tr nit rU-v if Inrriet;.; i ■ thi- w\..
;’•<■
hwvo secswle
clinic: for
?•.!.!'"■ n«‘. ■'■'>
'■'.
ti- n'.: ’ ?<ora;‘s;
they all con;? to Hv? centre. To a>y aa^sanint the real objection was . o’, from
the eowaunity but fro our
nu: ; •■■•.
ssarv'-lv at
capacity of th? village
comunity to understand what if ;; id.
Our survey work is done by a tea , not by cm pareon alone. Usually in
thv t as +.h»r?’ is a nu^sa, an suxiliaxy nurse raiduiffi, a
cial faaily planning
worker, a basic health worker «nd n laboratory teehnlei.«n. Th-» teas goes
fror; house
house. Mobod.y -.'.news »i-o la lookin-r for a l-’psosy patch. Th© tess
surveys a family for antenatal patients, for children under
five, for pattento with a hronic cough, and for tea© with a akin lesion. So
child car*, antenatal csr»s, tr?'.'.tnwt for leprosy and tuberculosis can bo given.
The nurtifte ar-; r.upr'ltod with »i»fl® drugs ar>; enn f.ivo antibiotie injections.
Over the last 18 eontha «» now have 460 leprosy patient® under treatnsnt.
3o»« of thee* nr® very early «««»»» with only ® patch «nd/or a thickened norve
?>ev vould probably not have coac for tr at«ant until they had got deforaities.
•a have issr/resead on ".h<»s-r ■••tents the valuee- cosing for treatment regularly,
as otherwise the disease will wrsen and thay will #*et d-’forslti©*.
.6
In rural work due respect has to bo given to tho indigenous practitioner.
These indigenous practitioners are usually rebuffed by trained doctors. We are
naturally a threat to them. So we have established a rapport with the®, taken
steps to ensure.their friendship, making sure not to bypass then or belittle
then. We seek their cooperation In feeding programmes for children, treatment
of leprosy and tuberculosis. We give then drugs and so involve thorn in the
treatment of village patients. ’ e have also explained to thorn the important
role their wives can play in the cars of antental cases. Two wives of indigenous
practitioners ar. already attending the hospital for help towards giving such
services. During the school vacation we are involving the school children in
areas of nutrition, sanitation, and family planning. Wa have found that these
youth groups can play an active part, particularly in family planning.
Often wo underestimate the community, but this is a practical example of
how our trust in the community has involved thorn in h alth care programme.
/ Surrey /
7 ANT’'NATAL WOMAN
14 REOISTERitD RSVISITS
2
DELIVERIES
5 ORAL CONTR.V'EmV.WS
4
TUBSCTCHIXS
2
VASECTOMIES .
5
SEW T.B. PATISETS
50 OLD TllJiATED
800 MEN WORKING ON WL'LLS
3
5 IW LriPROST PAT1
25 TRKAT.sD OLD
10 MOBILE CLINICS
14 R ALTH TALKb
240 CHILD '.LN OTD’iR
IV". CLINIC 303 ILLNESS
30 SCHOOL CHXLDREK EXAMINED
1 MULTIPURPOSE CLINIC
908 SICK PATI ARTS SEEN
233 LAB. TESTS
60 X-RAYS SCRSSERINGS
8400 M2AL3 SERVED
136 CHILDiiSH IMMUNIZED
2
Objectives
1.
reduce birthrate froa 40/1000 to 3O/1OOO
2.
reduce unier-fivas* mortality by 50 per cent
3.
identify and bring under regular treatment leprosy and tuberculosis
patients
4.
train indigenous workers and offer field training to health workers
To achieve our objectives, the main activities will be
- the establishment of under-fives’ clinics - these clinics should
be mainly for supplementary feeding programmes, iaaunization,
treatsent of minor illnesses;
- fauily welfare programmes consisting of antenatal care, delivery
and postnatal care;
- fanily planning progrades making use of all known contraceptive
devices and operations;
- detection of leprosy and tuberculosis patients and treating
thorn in a w"ll-integrated programme;
- curative services in the jfiin centre for obstructed labour,
acute surgical and medical emergencies and diagnosis;
- mobile clinics;
- school health programme.
This, in short, is a susmazy of the project we are trying to develop.
Today I aa going to share with yep mainly the cosnaunity involvement
in arrving at certain decisions in regard to the programme.
While we wer ■ studying in the United States, ue decided that we would go
to an area where there was no Christian witness because we wanted to
establish a Christian witness in an entirely non-christian area. Secondly,
we wanted a,, area where there was an acute need for medical care and where
was no possibility of any future development, not only development in the
health field but also in other fields, so that after five ye-.vs there would
be no other factors to account for the changes that taka place. We chose
this area in Maharashtra, where there is no possibility of any major
industrial or agricultural changes planned for the next five years. This
area,'like many other rural areas of India, has a ver;/ strong caete eystea.
About 50 per cent of the people are cultivators or farmers; 20 per cent
are untouchables - the people who are vary poor and usually landless labourers who socially have no status. The villages have a governing hoard with an
elected head called Sarpanch. Meat of the leadership comes from ths farmer caste
who are the decision—makes for the community. In addition to these two castes,
there are wealthy farmers, schoolteachers and other educated government employees
who are the accepted leaders of the community. 0ne cannot enter any community
by passing the leaders because if a leader feels that he has not been given
due recognition, he can become hostile and uncooperative.
W--: wore completely unacquainted with the community and leaders of this area.
We wrote several letters in the local language to the political leaders and
to the village leaders. In our letters we described the entire programme that
we had in mind. We said, "If you want us to come into your area, there are
certain things that you should be prepared to do. We shall be about 20 to 25
health workers coming into your area without having any housing facilities. We
expect you to make some arrangements for accommodation for about 20 people*
Ton should also give us temporary buildings for our clinics and our diagnostic
facilities, and if after a six-month period we find that your interest *n ua
remains, you should donate us land to build permanent structures in your area".
There were varied roactienn to our letters. In one area (my homo village)
wealthy farmers who owned sugar factories wanted to build a modem, well-aquicped
.3
3
hospital to cater to their own curative needs. In another area the influential
indigenous practitioner felt threatened, bo he did oJJ. he could to prevent
dialogue with the community leaders in his village. In a third village there
was a community leader responsible for health planning of a district of 2 million
people, and he immediately s w the benefits for hip. area in our proposal.
There was also a minister at the state level, a stat© of 32 million poople
who happens to cose from this area. These two san the many advantages for
their community andsaw the political advantages for their own re-elections.
Therefore, they went into the community, into different villages, and got
resolutions passed by these villagers inviting ua to coran and start work in
this area.
. As stated, we laid conditions tinder which we would be willing to go to
the area, and they wers willing to fulfill these conditions. They emptied
out an old veterinary dispensary, about 30 x 10 ft, which wo used as our outpatient
department. They gave us a storage place for inpatients and rented a. place
for ua to live. It was a very simple arrangement - nib electricity, no running
water and all 20 of us having to live in a 20 x 30 ft area.
We started work in real earnest in January 1971. We formed a consultative
committee which consisted of not only members of this local village but
others fro., different area, representing different oomOnities, especially
the poor ’hax'ijan’ (untouchable) community. The first responsibility we gave
this committee was to find accommodation for us and accommodation for our health
centre. 7e then asked them to find us staff. Most of our staf*', like nurses
and puraaedicsJ. workers, had to bo brought from the city. This staff had to
be Christian because wa were there to establish a Christian witness anti at
t’w same tin give medical cam. This c'n.-U?. *ta f formed a ahelaws
where we were all like minded; al- ha* a Christian dedication because though
they vers coming to' this particular area and leaving their jobs, they were
not going to get anyextra remuneration. So mon^y wes not the thing that
was bringing them there; on the contrary, they wers j.oing- to have a lot of
inconvenience s.
Besides thi’ nucleus of Christian staff we needed other people - the
nonpro-essionals an--; the community. i;e asked out con ultativ committee to
hir
the.--: for us. Tl.i
.ad an a v-iit’??
•';?
wanted to
th : r
best for ua, for we had told th©:.; tint if within six .onths m did not
havo ■>
re-
would f ind some other plan
to work. 8©
they found good, honest, hardworking staff of another 10 to 15 people from
lo i.i -/■’ :-.u-it-y. ?’h
fo .• <>t croodd sad found building contractors
and other people to supervise and plan the buildings for the future. All this
work done by the eom>aittee was in an honorary capacity.
After that we wont around fjxn village to village, holding meetings
in each village. Our first objective was to yet an idea of the felt needs.
In certain villages they ju?t did not feel that there was? any need for
medical care and wee® quite hap y with what t bey had. But there were villages
where th- people felt that they did not have competent physicians, especially
for care of their emergency illnesses, like obstructed labour or fractures
and other medical ejMrganoias. Th y did not h.ve any diagnostic facilities.
In the north there is a hospital 50 miles away; in the south ther'? is one
130 miles away; in the a?. .1 one is 150 sileu away; and in the vest one- about
70 miles.away, ‘.-.e discussed with the members o'-' th? community our internet
to improve their health, but they felt that curative care should take precedence
over other -trogrea
that we i;>r- proposing to them. Wc told them if they
were willing to pay for these services, wo would start with these. They all
agreed to this; so from th© first day we have been eelf-aup;porting as far ae
curative work is concaned. The;; understand that they have to pay for any
curative work that they get from ue.
This ia what happened '.t the local village. As the news spread to the
nearby -.illagee, people b came aware that they could cans and negotiate
with us to go to their villages. Here again we said, "The decision to start
work in your village ar-a is entirely ip to you. These arc cur conditions; If
you want us to come to your village to start health work, you five us a place
to work, give us you/ cooperation, give ua your help in child car. and
iKaunisati.cn of children, - iv-e full cooperation to our team, and cure for our
nurse, when they stay in your villages."
.4
4
Our original plan was that we would start at a central village with
a population of about 7,000 people and work within a radius of about five
miles around thia villa,v to «akr up a popul tion of 20,000, but we soon
realised that we could not follow this plan because the first village that
was vnoat interested in us was 12 miles away. The people there were so interested.
that they already had n building for us and.had accommodation f r our nurse
They wore willing to contribute monthly for our services to them. Though
thia did not come into our original design of work, we had. to modify the plan
because of the rapport and relationship with the community.
We are located at the box-der of three counteinn. If we were in one
counts’, the political leaders would probably feel that they could put pressure
on us; but located as we are, we can move from one county to another to avoid
such pressures. Ve asked one of the local men how we could get away if we
did not get ths required cooperation within six months. He suggested that
we build a c'-ntre using tin sheets as a shed; wo ware fortunate as we wore
able to get enough money to put up a prefabricated aluminium tin structure.
(The aluminium does not get hot in the summer, and we are comfortable.)
Our main building has a JO-bed capacity and an outpatient clinic. The entire
building can be dismantled and reconstructed within 15 days by the firm.
which built it.
I would now like to describe a typical encounter with a village. We
usually go in the evening because that is the time when the villager is
relaxed, and we go and call the village leaders. The leaders feel important
that a doctor has left hie place and come all the way to their village. We
are usually given tea, and we start our discussion. Very often we find that
the uppermost thing in their mind, even when talking to a doctor, is not
health; the usual question is food. Thia was especially so because there was
a famine when we entered the area. We take their lead and discuss food for
the children. Tan we go into the topic of malnutrition, and wo come with
a proposal and say, "Your children do not have enough food. Maybe we can
get so:'.e agency involved and interested in getting some milk for your children.
What will you do in return?" And the villagers sit down together, and they
come up with the idea that they will bring some things fro- their own homes
and make a common meal for the children. Those who ar ■ able would donate
some -money, and those who havo no money would contribute labour.
So right then and there we form a committee, and we say that from
Church Korld Service wa can try and. get wheat 6r milk powder or soybeans, but
this coiaiittee is responsible for cooking the food. The responsibility means
purchasing fuel and utensils, maintaining daily record-?, and getting the
children together for the meal. This committee then appoints people who will
collect the money for the fuel and utensils and takes charge of the feeding
programme. In this way those village: have about 3000 children which are being
fed every day. Ke give a supplementary protein diet to them. We did not impose
this programme on them. Ve went and talked about their bit need, and the
felt need was food, and gradually we translated that into a supplementary
feeding programme for children under five.
At the sane time wa realised, that the Church World Service food laay
not continue for ever or any gifts from abroad may stop, and wo have to plan
ahead. V® realised rhat the second most needed item is water for farming
and drinking. So we put another proposal to the villagers. Ve told then,
"lour children are being fed by this method now, but this is not going to be
permanent. Why don’t we think of something else which will be more permanent
and lasting?" We propose making wells which will make paupers into rich
sen. ¥e then ask if when they become rich, they would share their fiches with
the others. They /ay they will. We then form a ooiMittee, and this committee
decides which farmer or farmers are likely to hav1 water in their fields or
which farmers will be willing to produce food for the children and which one
are li ely to be generous after they get the wells sunk in their land.
So the connittee decides how to find a permanent solution forthe under
nourished children in he village by getting a well sunk. Then we translate
thia eoasunity action into a scientific action. There are a encies in that
area which are working with boring machines for watersupply and sinking
wells. ¥e get this team to com and do a survey, and then out of the four
or five names the community has suggested, this team picks out two or three
1
5
naaee and decides which is thelikoly place where they shall strike water for
a well. Up to date there are ten w Ils where we have struck water, and six of
these wells have enough water for irrigation. So after this monsoon we
shall have 15 acras of land to grow rich protein food. Now we ar ■ sure that when
this experience works, there will be more farmers who will be interested and
will make land available for feeding children of the entire villa's. So again
we helped the community to decide just by encouraging them and helping them
to arrive at the decision we wanted them to make.
We do not always go and listen to the problems of the villagers. Sometimes
wo sit with the village people and talk to them about our problems - for example,
the problem of getting to their villug •« because the roads are so bad - and if
they really want us to edao to their villages, 'hat can they do? Already the
villagers have made a seven mile road connecting two centres; the minister has
had 50 miles of road paved to the villages. Making the roads or paving the roads
is not important, but what in important is that the people wanted us and the
cam we could offer them so hut they were willing to pay for the care and
share the rcsponsiblity for it as well as make roads for us.
Children are immunised at the centre. Immunisation in the villages is only
donw when the villagers fulfill certain conditions we have laid - namely, ths
village people must collect at least CO per cent of the children, list their
names, weigh/ them, and then send us won! to come to inoculate them. When we
arrive at the village, we get the school teacher or the Sarpanch to tell the
?oplo the reason for our being there and what to expect as possible reactions
from the immunizations given. We usually give some drugs such as aspirins to
the Sarpanch, and he tells his people that if they should have any reactions,
he will give them medicines.
In school health the school teachers take a major part. They list the
children, test their sight, weigh them, and help us during their examinations.
We leave with them drugs for treatment that may bo required.
Leprosy is a social problem. Wo have tried to integrate leprosy- treatment
into our daily work. When we go into a. community, we ask if there are any
leprosy patients. I say to trio people, "I would liloo to s e them; please take
me to their home." I go to their home; I meet the patient; I shake hands
with him; and the people will say, "Doctor, please wa.ih your hands." I say, "I
will wash them later." I ask the patient, "What are your relations with these
people?" And the leprosy patient says, "I’m fine; I’m all right; I live in
ray place, and they leave me alone." Then I say to the people, "This Ban has
leprosy; another man has tuberculosis; but both are caused by the seme germ;
both can be cured by very simple medicine. Why do you want to treat leprosy
different from tuberculosis?" Then I ask if they would please let this man
cometo me when other patients come to see me. Maybe the others come for coughs
or colds, but this man needs medicine just ae the others do.
Vie try to break down the barriers in this way. we do not have separate
clinics for leprosy patients. We do not go to the leprosy patients’ homes;
they all come to the centre. To my amazement the real objection was not from
the community but from our own nurses. 0n,e marvels at the capacity of the village
community to understand what is suid.
Our survey work is done by a tea-, not by one person alone. Usually in
the team there is a nurse, on auxiliary nurse midwife, a special family planning
worker, a basic health worker and a laboratory technician. Ths team goes
from house to house. Nobody knows who is looking for a leprosy patch. Tho team
geee—surveys a family for antenatal patients, for children under
five, for patients with a hronic cough, and. for tbso with a skin lesion. So
child care, antenatal care, treatment for leprosy and tuberculosis can be given.
The nurses are supplied with simple drugs an<’ can give antibiotic injections.
Over the last 18 months we now have 460 leprosy patients under treatment.
Some of these are very early cases with only a patch and/or a thickened nerve
They would probably not have come for treatment until they had got deformities
ve have impressed on these patients the value of coming for treatment regularly*
as otherwise the disease will worsen and they will get deformities.
"’
.6
6
In rural work due respect haa to ba given to the indigenous practitioner.
These indigenous practitioners are usually rebuffed by trained doctors. We are
naturally a threat to than. So we have established a rapport with them, taken
steps to ensure their friendship, making auro not to bypass them or belittle
them. We seek' their cooporation in feeding programmes for children, treatment
of leprosy and tuberculosis. We give them drugs and so involve them in the
treatment of village patients. Ve have also explained to them the important
role their wives can play in the care of antental cases. Two wives of indigenous
practitioners ar- already attending the hospital for help towards giving such
services. During the school vacation we are involving the school children in
areas of nutrition, sanitation, and family planning. We have found that these
youth groups can play an active part, particularly in family planning.
Often wo underestimate the community, but this is a practical example of
how our trust in the community has involved them in health care programme.
7 ANTENATAL WOMEN
14 REGISTERED REVISITS
2
DELIVERIES.
5 ORAL CONTRACEPTIVES
4
TUBECTOMIES
2 VASECTOMIES
5
HEW T.B. PATIENTS
30 OLD TREATED
800 MEN WORKING ON WELLS
5 NEW LEPROSY PATI.SNTS
25 TREATED OLD
10 MOBILE CLINICS
14 H :ALTH TALKS
240 CHILDREN UNDER ?IVE CLINIC FOR ILLNESS
30 SCHOOL CHILDREN EXAMINED
1 MULTIPURPOSE CLINIC
908 SICK PATIENTS SEEN
233 LAB. TESTS
60 X-RAYS SCR8SENINGS
8400 MEALS SERVED
136 CHILDREN IMMUNIZED
March 9, 1970
Dr. R.Arole
The Johns Hopkins University
School of Hygiene and Public Health
Department of International Health
International Health 2 - Pinal Presentation
COMPREHENSIVE HEAIZPH CENTER FOR RURAL INDIA
This presentation is based on Appendix given with my first
presentation and partly summarises it.
I.
Problems
1) Rapid increase in population
2) High infant mortality (200/1000) and continued high morta
lity among children under 5 yrs. (40 % of total deaths)
3) Prevalence of chronic diseases
a) Tuberculosis 15/1000
b) Leprosy
11/1000
c) Guinea worm 150/100,000
4) Lack of facilities for adequate health care
II. Goal
To develop effective medical program fitted to the needs
and resources of the area.
III. Methods
1)’Take specific area as project's responsibility.
. 2) Establish minimum facility treatment center with outreach
in the community.
3) Use auxiliary and paramedical health workers.
4) Cooperate with Dais, indigenous practitioners and other
health professionals in improving medical care.
5) Cooperate with government programs.
6) Motivate‘community to take financial responsibility
IV. Objectives'
1) Reduction in birth rate from 40/1000 to 30/1000.
2) 50$ reduction in 'hinder fives" mortality.
3) Identify and bring under regular treatment leprosy patients
.4) Train indigenous dais and offer field training to nurses,
interns and other health professionals.
V.
Time limit : 5 -6 years
VI. Population served 80,000 (equivalent to that of a community
block)
Area covered 18 miles x 18 miles
Number of villages - 56
Women in childbearing age - 14,400
Number of deliveries in a year - 3,200
Children 0-4 years of age - 12,000
Leprosy patients - 800
NOTE :
Population Projections
(Rate of Natural Increase - 2.5% )
Year
1971
1972
1973
1974
1975
Population
82,000
84,100
86,150
88,250
90,485
No. Of Births to be Prevented J
820
841
861
882
904
______
£U
Total 4308 (4300)
o C
2
Methods to Be Used to Prevent 4300 Births
Method
Sterilization
IUD
Oral Contraceptives
Percent
60 %
20 %
20 %
Total Number
2,580
860
860
I.
One sterilization prevents 1.5 births.
To prevent 2,580-births, 1,720 sterilizations are necessary.
75 % of sterilizations will be tubal ligations.
25 % of sterilizations will be vasectomy.
Tubal ligations — 1,290
Vasectomy
—
430
II.
One IUD prevents 0.5 births.
To prevent 860 births, 1,720 IUD's are needed.
Year
Tubal Ligation
1971
1972
1973
1974
1975
115
325
350
400
Vasectomy
•;-o
70
120
130
150
IUD
100
160
175
200
225
Personnel Rs. 45,000
Equipment _RsJL_45 2.000
Rs. 90,000 = 18,000/yr.
Rural health center in a central town - 10,000 pop.
This serves surrounding area of 5 mile radius (20,000 pop.)
Establish 8 mobile clinics to visit 8 villages at an average
distance of 7 miles.
Establish 8 sub-centers in the villages.
A sub-center will be run by an auxiliary nurse midwife-.
Cost for five years :
1.
2.
3.
4.
5.
Rural Health Center Activities
Under Five Clinic
Run by a nurse and an ANM
Physician to consult only
Total no. of children 4500; 4 visits/child/yr.
II.
Pre-post-natal clinic
Run by an AM; supervised by a nurse; consultant and
physician;
Total population 1800, 5 visits/mother
III. Family planning clinic
Population 5400 couples
Target 3000 couples, 3 visits/yr.
IV. General outpatient clinic
Triage by a nurse
V.
In-patient facilities
■a. Abnormal obstertr'ics
b. Sterilization (tubal ligation) pts.
c. Acute medical and surgical emergencies.
VI. Diagnostic laboratory, referrals from sub-centers.
VII. Referrals to district hospital.
I.
Two Mobile Clinics
1 .
2.
3«
Area covered - 5-9 miles from the center
Population covered - 50,000
Total no. of visits 40/year
Activities - pre - post-natal clinics
"under five" clinic
family planning
Staff - 2 nurses
4 ANI/I’s
2 field workers (F.P.) cum drivers
2 basic health workers
Physician supervision and consultation - 16 hrs/wk.
Clinic run by a nurse.
Capital cost Rs. 57,000
Receiving cost Rs. 35,OOO/yr.
Cost per visit Rs. 110.00.
Subcenter
Population covered - 6,000
No-. of villages - 5
Situated in a large central village
Activities carried on by an ANM
Supervision and Consultation by a nurse and a physician
Inservice training
Regular meeting at the center once a week
Capital cost - Rs. 4000
Receiving cost - Rs. 4500.00
Leprosy Control and Treatment
Chief social workers are responsible for the work. Pour
paramedical workers to do the work. House to house survey in a
systematic manner beginning at the center. Ultimately, four
paramedical workers to be stationed in four of the sub-centers.
Training
1. To give local Dais 6 month course in midwifery at the center.
2. .Encourage A.N.M. to help Dai in her deliveries.
3. Train local school teachers in giving vaccinations and use
them for immunization program. Especially in villages where
there is no A.N.M., train the school teachers in giving pre
liminary care.
4. Inservice training for the nurses and midwives.
5. Field training for interns.
Resources
Manpower
2 physicians; 5 nurses; 11 auxiliary nurse midwives; 5 leprosy
paramedical workers; 1 pharmacist; 1 laboratory technicians; 10
aides; 2 clerks; 1 driver cum field worker (family planning); 1
mechanic driver cum field worker; 2 basic health workers; 1 family
planning extension educator; 1 stenographer.
Financial Resources
A. For capital expenditure Rs. 520,000.
B. For recurring expenses
per year
Rs. 200,000
(Equivalent to Rs.2.50 per head)
4
Capital' Expenditure
Rs.
12000
52500
120000
142000
100000
50000
57000
Land Development
Clinic Building
Inpatient facilities
Staff Housing
Equipment
Subcenter Buildings
Mobile Clinic
515000
(Construction cost Rs. 50 per square foot and increase in cons
truction cost by 5/ per year.)
.
$ 1 = Rs. 7/50
1.
2.
3.
4.
5.
6.
Recurring Expenses
Staff Salaries
2 Mobile Units
Drugs and Supplies
Equipment Replacement
Maintenance
Educational Material Audiovisual aid
Rs.
Rs.
Rs.
Rs.
Rs.
Rs.
6.7500
45000
52500
12500
10000
12'500
Rs. 200000
2 Physicians
5 Nurses
10 Auxiliaries
2 Technicians
1 Extension Edu=cator
'4 Leprosy parame
dical workers
1 Leprosy worker
2 Clerks
1 Stenographer
2 Nurs es
4 Auxiliaries
1 Driver
1 Mechanic
2 Basic health
workers ■
2 physicians
(2r$ salary)
Maintenance of
vehicles
Supplies
Staff Salaries
2 X 800 X 12
(75 $)
3 x- 250 X 12
10 x 175 X 12
2 X 200 X 12
=
=
=
—
14400
9000
21000
4800
2400
1
X
200 X 12
=
4
1
2
1
X
X
X
X
150 X 12
200 X 12
150 X 12
250 X 12
" 7200
2400
==
3600
= __3000
67800
-
Mobile Unit
2 X 250 X 12 .
x
4
175 X 12
1 X 150 X 12...
1 X 200 x 12
=
S5
—:
Rs .
6000
8400
1800
2400
2 X 125 X 12
2 X 1(800 x 12
=
3000
4800
=
8000
=
_1222
Rs.55400
Vehicle Replacement fund'
®s*_9222
45000
A.
B.
Church
Capital Bunds
Part of recurring expenses
Government
1. Capital funds for family planning Rs.18000., surgery.
2. Capital funds for clinic Rs. 8800
5. Salaries of family..plaining staff,.Rs .;i517£ per year.'
4.' Salaries of leprosy workers Rsj 7200/year.'
5. Salary for physician Rs. 3000/yr.
5
Community
1. Building of sub-centers
Rs. 30,000,
2. Capitation fee from each household owning land
Rs.40,000/year.
D. Christian Medical Association of India
For Sterilization operations
Rs. 83450/5 years
Expected Results
A. Benefits
Money saved by preventing births (Rs.9600/per birth).
B. Reduction in mortality and morbidity among young children.
C. Reduction in disability due to leprosy.
Evaluation
1. Baseline survey done at the beginning of the project.
Comparison with current records and with final survey will
give an idea whether we achieved our goals.
2. Good record keeping will be useful to evaluate our progress.
3. Records will give an idea of: a.) activities, b) efforts.
g.
e.
no. of immunizations done, no. of visits patients made,
4. Number of persons trained.
Bibliography.
1. Bibliography with 1st presentation.
2. Annual Public Health Report, 1961, Government of Maharashtra,
1965.
3. District Census Handbook, Osmanabad. (1961)
4. Deniston et al, Evaluation of Program Efficiency, Public
Health Reports 83: 603, 1968.
5. Williams, H., Value of Community Health Centers in Preventive
and Curative Mediqine, A.J.P.H., 36:623, 194^6. Franz, Rosa, Impact of New Family Planning Approach on Rural
MCH Coverage in Developing Countries - India's Example;
A.J.P.H., 57:1 ,327, 1967.
7. Merten, W. , Pert and Planning for Health Programs, P.H.Reports
81: 449, May 1966.
8. Seminar on Health Problems of Pre-School Child, - All India
Institute of Hygience and Public Health, Calcutta, Vol.XVIII.
9. Hanlon, J.J., The Design of Public Health Programs for
Underdeveloped Countries, P.H.Reports, 69: 1 ,028, 1954.
10. Role of Immunization in Communicable Disease Program, P.H.
Papers 8, WHO, Geneva, 1961.
11. Webb, JKG. et al, Infection and Diseases in a Group of South
Indian Families, American Journal of Epidemiology, 89:375,
■ 1969.
12. Functional Analysis of Rural Health Services, Mimeograph,
International Health.
Key to PERT
18. Orientation of staff to rural
1. Rent facilities
2. Recruit candidates to send
health work
19. Survey Analysis
for training
20. Mobile clinic organized
3. Establish contact with
21 . Candidates in training
government officials
22. Apply for government grant
4. Establish rapport contact
23. Order clinic equipment
5. Plan Survey
24. Target population identified
6. Order supplies for clinic
25. Clinic supply received
and survey
26. Clinic building completed
7. Acquire land ■
27. Inpatient building started
8. Pre-test survey
■
28.
Inpatient supplies ordered
9. Obtain supplies
■ •
29. Programs launched
10. Establish rapport in
30. Inpatient supplies received
surrounding villages
11. Register and obtain license 31. Trainees ready for work.
32. 3, Subcenters established
12. Survey form printed
39- Health center completed
13. Print clinic card forms
40. Target population contacted
1.4. Recruit'staff
41. Services rendered
15. Contract for building
C.
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- £ S) Crt • s ^ /? //A/C-
G,oc>e> ?£o/=-4.£- "\/
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“■“** .
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---------- —------------ -
Uruli-Kanchan has become a legend where technology takes a different meaning: promoting prosperi
ty for the rural poor. Starting as a nature cure ashram, the Bharatiya Agro-Industries Foundation
offers many services to the farmer.
SERVING THE POOR
By Dr. M.N. Upadhyay
N THE SLEEPY little village of UruliKanchan, 35 Kms east of Poona, a special
train steamed in on the morning of 1946, carry
ing Sudhir Ghosh, a special emissary of Lord
Louis Mountbatten, Viceroy of India. Ghosh’s
mission was to bring Gandhiji along with him
to Delhi immediately for crucial talks with the
Viceroy regarding transfer of power.
The Mahatma politely informed Ghosh that
he could not leave immediately as “I am commit
ted to attend today’s evening prayer meeting
with Uruli-Kanchanites”, and added characteris
tically, “remember, unless Uruli-Kanchan is
made, Delhi cannot survive”.
This statement is considered the flash point
that gave birth to the idea of Uruli-Kanchan,
which was to emerge as one of the most specta
cular success stories among rural development
exercises in India. To quote a leading foreign
expert “Uruli-Kanchan has become a legend
where technology takes a different meaning—a
means of promoting prosperity for the poor”’
The Bharatiya Agro-Industries Foundation
was registered in 1967 as a no-profit non-Government voluntary organisation under the Bombay
Public Trust Act', 1950. Preceding this was a vow
taken by a young disciple of Gandhiji, Manibhai
Desai, that he would serve the people of UruliKanchan till the end of his life. Starting with a
modest nature cure ashram, the institution grew
up to encompass a rare combination of philo
sophy and technology, dedicated to the cause
of the poor.
The foundation seeks to work for total
I
Imprint, December 1978
integrated development of socio-economically
weaker sections by applying research and exten
sion methods in agriculture, horticulture, dairy,
husbandry, animal sciences and agro-based vocatations. Today, the Bharatiya Agro-Industries
Foundation has over a dozen activities including
a frozen semen technology for genetic upgradation of nondescript (Deshi) cows, a network of
cattle breeding centres spread over 23 districts
in Maharashtra, Gujarat, Uttar Pradesh and
Karnataka and a vaccine production unit for
foot and mouth disease.
AU this has been possible with the visionary
outlook of Manibhai Desai, who heads the
foundation and is assisted by a team of profes
sional executives, whose average age is below
30 years.
A number of international agencies have
collaborated in his unique project including
DANIDA (Danish International Development
Agency), CHF (Canadian.Hunger Foundation),
CAA (Community Aid Abroad), CRS (Catholic
Relief Services), CA (Christian Aid), CORSO,
OXFAM etc. The aid from these agencies has
been utilised primarily for importing critical
inputs for the cattle development programme
including liquid, nitrogen plants, cryogenic con
tainers and frozen semen of proven sires of
Holstein Friesian and Jersey breeds from Den
mark, Canada, USA, Australia, UK and New
Zealand.
The latest imports have been technology and
equipment for the manufacture of foot and
mouth disease vaccine.
61
•o
<b
at
DR. M.N. UPADHYA Y
- The foot and mouth disease vaccine production unit at Umli-Kanchan.
The focus of the foundation is primarily in
regard to the genetic upgradation of the indi
genous cow. The crossbred cow has been recog
nised as the most efficient animal for converting
feed into milk. Studies have revealed that while
the Deshi cow yields 600 litres of milk per lacta
tion, the crossbred cow can yield upto 2500
litres: a net addition of 1000 litres. While the
Deshi cow’s milk declines sharply at the end of
the 4th or 5th month of lactation, the crossbred
cow continues its higher yield till, the tenth
month of lactation. Moreover a crossbred cow
calves much earlier and has a longer productive
life.
Dr. Rudramurthy of the Mafatlal Centre for
Rural Development has estimated the projected
income and expenditure of a farmer cross-breed
ing one nondescript (Deshi) cow. Accordingly,
the surplus of income over expenditure of the
cross-bred progeny ranges from Rs.405 in the
first year-to Rs.4,666 in the tenth. To achieve
this objective, the Bharatiya Agro-Industries
Foundation has introduced a network of 112
cattle breeding centres in four States. Each of
these.has an area of operation extending upto a
radius of 10 to 15 kms, covering 20 to 25 villages,
700 to 1000 families and 2000 cows. Each
cattle development centre has a qualified veteri-i
nary doctor, who undergoes an intensive orien
tation programme at the foundation, which!
emphasizes his role as a social-change agent, g
before he is posted to a centre.
’
Five centres are grouped together under an
area, with an experienced veterinary doctor who
coordinates the functions of the centres. Five ■
areas and 25 centres are under the supervision
and management of a zone, headed by a zonal
officer, who is an experienced postgraduate in
veterinary sciences and animal husbandry. The
regional office of the cattle development pro
gramme has got two zones under its purview and
has a number of functionaries.
An advantage of frozen semen cross-breeding
[technology is that an ejaculation can be made
(into one hundred and fifty straws, while a natural
service by a bull can inseminate only one cow.
Frozen, semen can be preserved for several years
and easily transported to remote villages.
Imprint, December 1978
SERVING THE POOR
Limited Success
S ON 31 March, 1978, 1,40,000 insemina
tions were effected,'in the centres from
which over 1,00,000 deshi cows conceived. The
number of female calves, produced and recorded,
numbered 15,000. The reason for the relatively
limited number of inseminations included a
reverential attitude to the cow in our rural
society, where many consider it a sin to have the
cow impregnated by unknown foreign semen.
There are some who will not agree to the cow
being treated as a commercial proposition, much
less to its artificial insemination for the purpose
of increasing milk yield.
A
1
The selling of milk itself is frowned upon by
a few: unbecoming of the sacred relationship
they have with the cow. These reactions of a
traditional society are, however, on the decline
and there is an increasing acceptance of the
desirability of artificial insemination.
A fee of Rs.10 is charged for registration
while Rs.150/- is charged for a conception. No!
fee is charged in case the centres are adopted
and paid .for by the corporate sector or other
institutions. Frozen semen artificial insemina
.< .
MU
Picture of prosperity: crossbred cow.
Imprint, December 1978
tion is done both at the residence or farm of the
party. A record is maintained of the number of
calls made on a day and indicating the results of
the insemination. When conception does not
take place, a second, and sometimes even a third
insemination is made. If the result continues to
be negative, the cow is examined thoroughly-for
defects in its reproductory system, which are
treated.
Crossbred Cow
URING a visit to the Akluj Cattle Develop
ment Centre, which is in the sugarcane-rich
area of Sholapur District in Maharashtra, I met
Dr. Nimadge, the BAIF veterinary doctor, who
is in charge of the centre. He is provided with a
5 H.P. motorcycle fitted with carriers for a three
litre liquid nitrogen vacuum flask which holds
150 to 200 doses of frozen semen. He also has a
29 litre liquid nitrogen container for refilling
the “vacuum flask’, as the straws have to be main
tained at a temperature of minus 196° centi
grade, enabling them to be effective for a period
of fifteen to twenty years.
Maruti Ganpat Honkade of Tambve village
comes from a cobbler’s family, but has disconti-
D
nued his traditional vocation. His crossbred cow
giveshim an yield of six litres as against 2)6 litres
produced by his former dcshi cow. The deshi
cow’s milk yield declined sharply to half a litre
at the end of 5th month of lactation, while the
crossbred continues to give its yield till 10
months of lactation. He sold his milk at Rs.l .95
per litre to the milk collection centre and also
earned Rs.4/- per day as. a casual agricultural
labourer.
Laxman Ganpat Gaikwad of Bagewadi village
is a small farmer with half an acre of land. In
1972-73, he had a deshi cow, which gave him a
five litre yield for three months which gradually
declined thereafter. When this cow was artificial
ly inseminated, there was a dramatic change in
the milk yield which recorded a 12 litre output
till eight months of lactation. Gaikwad sells his
milk at Rs.2.15 per litre to a milk marketing
society and earns over Rs.700/- per month. His
monthly expenses included Rs.80/- for concen
trates, Rs.70 for dry fodder and Rs.180/- for
green fodder. This nets a surplus of about
64
Rs.480/- per month on the basis of a single cross
bred cow. Ramchandra Jagannath Ingle has a
second generation Jersey crossbred which is a
specimen of buoyant health and good looks. It
yields seven litres of milk per day netting an
income of over Rs.400/-.
Yet another success story was that off
Madhukar Balchandra Singare, who had become
owner of 18 acres of land after obtaining its
legal title from the absentee owner. In addition
to his crossbred cows, of which he was obviously
proud, he grew sugarcane and improved varieties
of cotton (H4) which brought him obvious
prosperity, not disclosed in money terms.
In the midst of these success stories, was the
case of Jhingra Sambhaji Bhong who after un
successfully trying artificial insemination, revert
ed to the service of a deshi bull, which impreg
nated it. When asked as to why she had not called
for the artificial insemination a second time, she
replied that she was unsure, of its effectiveness.
This suggests that while the BAIF is doing a
good work, it suffers from a certain weakness in
regard to follow-up action. This may be due to
Imprint, December 1978
SER VING THE POOR
a dearth of adequate staff at the cattle breeding
centre. Also, it seems that the type of compre
hensive health-cover that is necessary, is not
available from Government veterinary agencies.
However, the BAIF is planning to launch a com
prehensive programme of poly-clinics to supple
ment its efforts.
The integrated rural development programme
includes agriculture development, cattle develop
ment, education and skills-oriented training and
customs services. The BAIF is already involved
in the implementation of a highly successful
joint farming society and a lift irrigation scheme.
THE END
THE MAN BEHIND IT ALL
1^/T ANIBHAI Desai is the soft-spoken
IV1 live wire behind the BAIF. A stimu
lating conversationalist, he recalls his
early association with Gandhiji with a
touch of nostalgia and reverence and feels
happy that he has been able to keep his
promise to Bapuji to dedicate his life to
rural development.
After a brilliant academic career,
Manibhai was for some time involved in
subversive activities under the leadership
of Jayaprakash Narayan during the inde
pendence struggle. A first class graduate
in physics, Manibhai was an expert in
making bombs and blowing up bridges. He
also successfully intercepted government
telephone communications by tampering
with telephone wires. He courted arrest
and was sentenced to rigorous imprison
ment by the British.
When Gandhiji disapproved of violent
activities, Manibhai gave them up and
spent some time at the Sevagram Ashram
at Vardha. Here Gandhiji entrusted him
with sanitary arrangements at the ashram,
insisting that lavatories should be clean
enough for a Gita recitation in it, and
polished enough to reflect the image of
the person using it.
Manibhai recalls the challenges faced
by him and his colleagues during the
cholera epidemic at the ashram. Later, he
worked as an accountant and when
Gandhiji was fully satisfied with him, he
was chosen for rural development work at
Uruli-Kanchan.
A nature cure ashram was the first
activity launched by Manibhai at UruliKanchan, a place noted for its backward
ness. People were in debt and were given
Imprint, December 1978
to drunkenness. Most of them were under
the grip of a Pathan moneylender who
mercilessly harassed the villagers. Manibhai
and his associates launched a movement
to rid the village of both the moneylender
and alcohol.
There was a large plot of land near the
river just outside the village in which the
ashram cows grazed. The income from the
land was only Rs.300 a year and Manibhai
thought it would be a good idea to improve
the land and use it for cultivation. Accord
ingly he organised a joint farming and lift
irrigation society, both of which after
several major hardships are doing extreme
ly well today.
Among the problems that had to be
encountered .were the alkalinity of the
soil, government, restrictions regarding
irrigation and technical problems in the
'growing of crops, fruits and sugarcane.
A cooperative sugar factory has also
been organised in the neighbouring village
and cane supplied to it. These successes
encouraged Manibhai to launch a major
multifaceted development complex and
ushered in the Bharatiya Agro Industries
Foundation.
Apart from organising these activities
through frequent tours and contact with
field staff and beneficiaries, Manibhai has
negotiated for loans and grants from many
foreign governments and institutions
which have collaborated both technically
and financially in the work at BAIF.
A confirmed bachelor and vegetarian,
Manibhai is not dogmatic either about his
principles or views. He combines modem
sensibility and age-old wisdom in his work.
THE END
65
4,
No.
1001
Rural Dev.
Maharashtra
Agricultural Institute, Kosbad, Maharashtra
1.
Started in 1949
3.
Activities.
..
•
a.
Education; residential schools, including work
experience, including fields such as poultry
keeping, kitchen gardening, carpentry as well as
helping in agricultural work;
b.
Training: A Tribal Youth's Training Centre for
above activities.
c.
Research in problems of agricultural production
peculiar in the area.
d.
Development: Adoption of 5 villages to demonstrate
and develop the cultrivation of improved crops
etc on a continuing programme.
7.
Sponsorship & Funds.
Maharashtra.
12.
Reference: J. Sommer et al (1974)
Note:
No information available on items No. 2,
8, 9, 10 and 11..
Gokhale Education Society,
4, 5, 6,
- v
No. 1002
Comprehensive
Health
Maharashtra
Integrated Health Services Project, Miraj Medical Centre,
Miraj, Sangli district
1.
Started in
2.
Coverage. The entire Miraj Taluka (936 sq.km.)
comprising of 58 villages and a rural population of
over 2.3 million.
3.
Activities.
The Miraj Medical Centre.
By female staff
a.
Maternal care.
b.
Child care.
c,
Family Planning.
d.
Medical Care (% day daily)
e.
Health Education (% day daily)
f.
School Health
g.
Coordination of activities with Male Health
Workers.
By Indigenous 'Dais 1
a.
Hygienic deliveries.
b.
Family Planning motivation.
c.
Simple symptomatic treatment of minor ailments.
(some dais only - on villages without health
centres).
By male staff
a.
Detection of infectious diseases.
b.
Vital statistics.
c.
Smallpox, Malaria, T.B. and Leprosy work,
both detective and immunization etc.
d.
Family Planning.
e.
Environmental Sanitation
f.
Health Education.
2
NO.
4.
1002
g.
School Health.
h.
.Treatment
i.
Cholera and Typhoid Innoculation .
j.
Coordination of activities with female staff.
.of minor ailments^.
Personnel and Training.
5.
a.
Six medical officers
area.
b.
41 male and 30 female government unipurpose
health staff - six months training to convert
them.into Integrated Health Staff.
c.
173 (93% of all in area) dais - trained for
tasks as above.
d.
40 local women trained 'to be part-time health
assistants working for.the ANMs.
(3 PHCs) in project
Supervision and Records.
(a) A system of continuous
monitoring of data on all aspects has been operating;
(b) a feedback system on a quarterly basis for the
average worker and on a monthly basis for the weaker
one is proving effective.; (c) direct and constant
supervision in the form ;of/education, guidance, help
and problem-solving is used. Memos'are replaced by
problem-solving sessions with concerned workers.
6.
.
Community and other Participation.. Government and
Zilla Parishad (District Council) participation “
exists since;the project is utilizing their present
infrastructures.
7.
Sponsorship/Funds. This is a joint project of the
Government of Maharashtra, Sangli Zilla Parishad and
Miraj Medical Centre. Staff are paid by the first
two. Extra input funds are provided by the World
Council of Churches in Geneva.
3.
Evaluation.
(a) A baseline sample survey was conducted
and a mid-term evaluation in the middle of the 3rd year;
(b) data on pre-project years is also available for
comparison.
Control areas are not easily available;
(c) hope to evolve an indigenous method of evaluation
to compare the individual1 ,s performance as a unipurpose
health worker and as a multipurpose worker.
3
No. 1002
Problems.
a.
Differential salary scales in the government
structure create problems- when MPW scheme
is started.
b.
■
Loss of T.A. due to smaller area served in
MPW scheme.
c.
Lack of leave reserves in the first year.
d.
Mon-positioning of ANMs for a long time.
e.
Resistance among older staff to new system.
f.
Resistance among MOs to new pattern especially
regarding visits to SCs, to supervision of the
staff, to preventive aspects, to training staff.
g.
h.
Transfers of trained staff;
Delay in follow-up of diagnoses leading to
. low morale. ■
-i.-:
-
The campaign approach does little to -enforce
integration.,
j.
Statewise shortage of vaccines, vitamin A
syrup, iron and folic acid laboratoryMedicines invariably never reached SCs,' reason
given being that quota was too small even for
the PHC.
11.
Contact.
12
Reference. Paper presented at the National Symposium,
1976; WIO, UNICEF.
Notes
Dr Eric R. Ram, Project Director. '
Information not available- for item 10.
/O ,3_<7
MAHARASHTRA LOKAHITA SEVA MANDAL:
Maharashtra Lokahita Seva Mandal was barn in 1970. The purpose
of the Mandal is to help the poor with special emphasis on Medical Re
lief, Education and Rehabilitation. The Mandal started its active
work in 1976.
The Banbay Municipality allocated to the Mandal for the Leprosy
Control work the 'H' ward to cover a population of 2i Lakhs. Later, as
the project progressed the 'P' ward was also allocated wherein we cover
a population of 7 lakhs. Both these wards are in the northern suburbs
of the Bombay city. The incidence of leprosy in these wards is very
high.
AREAS COVERED:
'H' ward east - East Mithi River, C.S.T.Road, Santacruz Rast,
West - Western Railway line, North Vile-Parle subway, South Khar Fast
(upto Nirrnal Nagar). Population - 2.5 lakhs, 47 slums.
'P' Ward - East Kurar Village and Aarey Milk Colony, West Aksa,
Erangal, Madh Villages, Manori creek, South upto Oshiwara Bridge,North
upto Goraswadi Petrol Pump. Population 7 lakhs, 60 slums.
AIM OF THE PROJECT:
The aim of the project was to evolve a functionally feasible
’methodology for urban leprosy control in order to reduce the transmis
sion of the infection by bringing down the quantum of infectivity.
METHODOLOGY OF WORK:
SET programme (under guidance of National Leprosy Control
Progranme).
FIRST LEVEL OF WORK:
The first level of work is detection through intensive surveys.
Each ward is divided into zones to facilitate a systematic examination
of the entire population. The Mandal conducts house to house surveys
in slums, skin check-up in schools, factories and housing colonies
within the projet area by trained medical and Para-medical teams.
By
intensive surveys the new cases arising will be brought under treatment
at an early stage and the chances of these cases progressing into infe
ctious form will be minimised. The pattern of deformity in cases which
are detected early will be minimum and they will be amenable to conser
vative physiotherapy measures. The functional ability of such individ
uals will be preserved.
SECOND LEVEL OF WORK:
(continued)
100 09S •
The second level of work is propaganda and health education.These
have two fold purpose: one is to awaken public consciousness about lep
rosy. Facts about its prevelance, its nature, its spreads, its conseq
uences and its cure have to be dissemenated in order to obtain public
co-operation in combating the disease and in removing the social stigma
regarding leprosy. Health Education is providing through talks and il
lustrated lectures. The Mandal has given a course of health education
talks to the students of higher standards and to the teachers which come
under our project area. In slum areas, organised talks with the slides
are given periodically. Besides, the doctor and para-medical workers
very frequently give talks to groups whenever a slum area is visited.
Small scale exhibitions with charts, photographs and posters are often
in slum areas, schools and factories with the aim of educating people
about the facts of leprosy and lessening the prejudice against leprosy
patients. The other purpose is to instruct patients, especially those
in the incipient stage, regarding care and cure of the disease, and to
encourage the public to submit to surveys for the detection of the
disease. Talks and slide shows are also arranged for Doctors and Nurses
working in 'H' & 'P' wards.
Film shows are arranged for the public in
our project areaAs a result of all these programmes many people
erme voluntarily for examination.
2
THIRD LEVEL OF WORK:
The third level of work is treatment of detected cases. 23
dispensaries have been set up and are attended by full time doctors,
trained para-medical worker, physiotherapist and helpers, so that
the disease can be controlled in its early stages and its side
effects treated. This is followed up, especially in the case of
leprcmatous patients, by periodic visiting of the patients in their
hemes for ensuring their regular attendance at the dispensaries.
Patients are intimated previous day (evening) and on the clinic day.
In the clinic, they are examined and treated for leprosy, skin dis
eases and other minor ailments dressings done, smears and biopsies
performed.
*H' Ward - 13 clinics,
'P* ward - 10 clinics.
DETAILS OF THERAPY:
Mainstay Dapsone other drugs Rifampicin, Clofazimine, Isonex
and Thiacetazone etc.
FOURTH LEVEL OF WORK IS REHABILITATION:
This means rehabilitating the leprosy patients in their normal
heme environment in various way” through education of the younger
patients, and generally providing any profitable occupation for the
patients suitable to their socialassimilation in wider society. Fina
ncial help is given to the most needy patients through repairing hut
ments and providing ration.
Care is taken to underline the fact that project activities do
not consist only in merely giving out treatment to patients. In fact
tis is a comprehensive community health work beneficial not only to
the patients and to their families but to the community as a whole.
Though the Mandal has represented work at four levels, equal
emphasis is given to all levels of work.
PHYSIOTHERAPY SECTION:
Report upto the end of the year 1980.
The role of physiotherapy in a leprosy control programme cannot
be over emphasised. Physiotherapy is aimed at prevention of sequele,
and is a pre-requisite for rehabilitation of leprosy patients. The
Mandal has services of a full time physiotherapist for this job. Physi
otherapy services are offered at all the field clinics, and a central
unit for intensive physiotherapy is being envisaged.
Upto the month under report, out of 2910 cases registered, 241
cases has been recorded for deformity, [as per WHO classificationland
their type-wise, grade-wise distribution is as follows:-
CLASSIFICATION
Deformity
Grade:
TOTAL
L
N
N?L
I
32
28
35
95
II
40
26
36
102
III
12
5
27
44
59
98
241
TOTAL:
84
[Types of Physiotherapy services offered]
1.
Advice on care of hands and feet - all patients grade I and
above.
(continued)
•: 3 iHydrotherapy, oil application and specific exercises - all
patients grade I and above.
2.
3.
Ulcer dressings - at field clinics as required.
4.
POP splints - static and dynamic [upto the month under report,
10 such splints have Deen provided].
5.
Footwear - ordinary chappals inclduing MCR sandals - about
100 peirs, 4 spring shoes, 4 rigid moulded snoes.
6.
Referrals for reconstructive surgery - so far,
cases have
been referred for surgery, at J.J.Hosital and Sion Hospitals.
Surgery includes Tendon Transfers, and Pre and Post operative
physiotherapy are ma.iaged at the field clinics itself.
7.
Referrals for rehabilitation - deserving cases are continuously
referred to the rehabilation unit, and follow up for physiothe
rapy assessment is being carried out.
Physiotherapy also includes the provisions of artificial aids
to patients with injured and anaesthetic limbs.
HEALTH EDUCATION:
Health education is one of the major procedures in the control
programme of leprosy. It is a process by which the orthodox attitudes,
knowledge and practices can be diverted and simultaneously prevent il
lness and promote health by their own efforts.
Before the surveys are conducted in various areas, leaflets
painted in various languages are distributed to the people in that
area. This approach helps us in receiving all the co-operation we
need. The Mandal organises slide shows, film shows, group talks,
exhibitions, doctors seminars, and press conferences. The effect
of such programmes is obvious, by the number of voluntary cases
which consititute 27% of the total cases detected. The enthusi
astic co-operation of the public towards our control programme is
also evident.
Particulars of Health Education Programmes conducted by
Maharashtra Lokahita Seva Mandal are given below :-
Sr.No:
PROGRAMMES
NOS
APPROX: ATTENDANCE:
1
Slide shows
51
3,876
2
Film shows
40
59,425
3
Exhibitions
7
26,4]0
4
Doctor's Seminar
1
52 [doctors]
5
Press conferences
2
35 [reporters]
STAFF:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10,
11,
12.
13.
14.
Medical Officers ...................... 2
Field Officer ............................. 1
Non-medical &ipervisors........ 2
Para-Medical workers............... 11
Under Training P.M.W............... 2
Health Educator ......................... 1 [also trained P-M Worker]
It
II
II
J
Physiotherapist ......................... 1 [ W
i
w
*.
”
11
i
Laboratory Technician .......... 1
Untrained workers .................... 7
Drivers........................................... 2
Peen.................................................. 1
Typist........................................... .. 1
Social Worker ............................. 1
Accountant.................................... 1
(OCNHNUED)
4 :oil '■■■->
■ ■ ": .
<...........>i
’
TOTAL KNCWN CASES UPTO THE END OF THE YEAR 1980 [since beginning]
MODE OF DETECTION:
Ennumerated:
toss Survey
Examined:
%
L
114
7.1%
2,76,250
1,99,150
52%
School Survey:
57,686
49,928
17.6%
Contact Survey:
8,,416
6,180
3.2%
6,347
6,347
27.2%
3,48,697
2,61,605
100%
Voluntary cases:
TOTAL:
N-
N2L
Total
1334
83.1%
517
95:2%
83
83%
652
77.5%
2586
83.7%
157
Q.R%
26
4.8%
8
8%
128
15.2%
319
10.-3%
1605
100%
543
100%
100
100%
841
100%
3089
100%
,
9
9%
61
7.3%
184
6%
■ '
.
.
TOTAL REGISTERED CASES UPTO THE END OF THE YEAR 19801 since beginning]
MODE OF DETECTION:
L
N
N?L
Total:
Mass Survey:
110
1091
147
1348
442
19
461
School Survey:
Contact Survey:
9
74
8
91
Voluntary cases:
61
645
128
834
TOTAL:
180
2252
302
2734
TOTAL KNOWN CASES UPTO THE END OF THE YEAR 1980 -[since beginning] AGE, SEX, AND TYPE WISE DISTRIBUTION:!l7 ' -
Mode of
detection
Grand
■It>ta^
N?L
N
L
------- 1
M
Mass
Survey:
66
f'
44
School
Survey:
Contact
Survey:
Mo
Fc
Total
4
M
Mo
F
Fc
Total
Total
157
1605
'70'
55
20
12
517
2
-
14
10
26
543
114 368
550
191
225 1334
19
14
248
236
i i, -
’Ms’’
F
M
1
1
-
9
17
29
22
15
83
6
1
■i
-
8
100
Voluntary
Survey:
20
1
1
61 176
228
130
118
552
52
51
15
10
128
841
TOTAL: 112
65
2
5
184 580
821
591
594 2586
130 107
50
32
319
3089
7
d
(continued)
5 :ATTENDANCE;
No.of
Patients:
75-]00%
50-75%
25-50%
1-25%
Nil
160
146
91.2%
7
4.3%
3
2%
4
2.5%
-
286
205
71.7%
11
3.8%
16
5.6%
54
18.9%
-
Non-Leprcmatous :
1955
990
50.6%
303
15.5%
229
11.5%
296
15.2%
137
7%
Total:
2401
1341
55.9%
321
13.4%
248
18.3%
354
14.7%
137
5.7%
TYPE:
Lepranatous
N?L:
Registered cases deleted upto the end of the year 1980 [since beginning]
L - 20,
N2L - 26,
N - 287.
Total........
3 3 3.
Prevalence rate : 12/1000.
Total No.of Mult leprosy cases - male 822[45.3%] Female - 993 [54.7%]
Total No.of child leprosy cases - male 643[50.5%] Female - 631 [49.5%
% of adult leprosy cases - 58.8%
% of child leprosy cases - 41.2%
% of cases voluntarily detected - 27%
Smear taken of all new cases ( N?L & L )
Inactive cases - at the end of the year - 1980 - 4 7 8
Released from control----------------------- 2 9
Repairing of houses [leprosy patients] --------
8
Rehabilitation of the patients ---------------
12
Ration for the patients--------------------- 15
Helping school children [leprosy family] ------
4
Clinic Attendance ------------ --------------- 87.3%
6
DISPENSARIES RUN IN 1P" WARD (MALAD):
Sr.
No.
Name & address of the dispensary:
Day and
Time
Nagrik Seva Sangh,
Quari Road,Dhanjiwadi,Ma lad (E)>
MALAD (EAST)
Monday
8.30 to
11.30 A.M.
2.
Hanuman Temple, Near MalvaniChurch,Bhanda rwada,
MALAD (WEST).
3.30 P.M. to
5.00 P.M.
Monday.
(evening)
3.
Ra i pada,
MALAD (WEST)
Monday.
8.30 A.M. to
10.30 A.M.
(once in a
month)
4.
Friend's Welfare Centre,
Plot No.2, R.No.3, Collector'sCompound,Gate No.5,MALAD (W):
Tuesday
8.30 A.M. to
11.30 A.M.
5.
Manori Church Building, ManoriVia Ma lad,
BOMBAY-92*.
Wednesday
9.00 A.M. to
1.00 P.M.
Shanker Temple, Near The Nalla,
Orlem, MALAD (WEST)
Thursday
8.30 A.M. to ■
11.30 A.M.
1.
6.
7,
Dr. Jain's Clinic,
Pushpa Park,
MALAD (EAST).
8.
New Malavni Health Centre,
M.H.S. Colony, Gate No.7,
MALAD (WEST).
Friday
8.30 A.M. to
11.30 A.M.
9.
Dr. Vinod Shenoy's Clinic,
Near Shah and Sanghi Garage,
Kanchpada, (Orlem).
Saturday
8.30 A.M. to
10.30 A.M.
10.
Sayed Bakery,
Gudiapada Orlem,
Malad (west).
Saturday
10.30 A.M. to
12.00 noon.
Thursday
3.30 P.M. to
5.00 P.M.
R e n a r k 1
(evening)
DISPENSARIES RUN IN 'H' WARD
1.
Hanuman Temple,
Gaondevi,
Santacruz (East).
Monday,
8.00 A.M. to
11.00 A.M.
2.
Muslim League Office,
Ambewadi Road, Jawahar Nagar,
Khar (East).
Monday,
3.U0 P.M. to
5.00 P.M.
3.
Makin K.G. Classes,
Masjid Road, Goli bar,
Santacruz (East).
Tuesday,
8.00 A.M. to
11.00 A.M.
(Evening)
(Continued)
: 7
Sr.
No.
Name & address of the dispensary
Day and
Time
4.
Opp: Yoga As ram,
Prabhat Colony,
Santacruz (East).
Tuesday,
3.30 P.M. to
5.00 P.M.
5.
Panduran Vakil Wadi,
Vakola Masjid Road,
Santacruz (East).
Wednesday
8.00 A.M. to
10.30 A.M.
6.
Ba 1wad i,
Siddharth Nagar,
Santacruz (East).
Wednesday
10.30 A.M. to
12.00 Noon.
7.
Zopadpatti Sangh,
Hanuman Tekdi,
Santacruz (east).
Wednesday,
3.00 P.M. to
5.00 P.M.
8.
Sudha Mandi r,
Manipada,
KALINA.
Thursday,
8.00 A.M. to
11.00 A.M.
9.
Satguru Chawl Committee,
Jaihind Nagar,
Khar East.
Thursday,
3.00 P.M. to
5.00 P.M.
(Fort
nightly)
10.
Om Bharat Vyam Shala,
Jawahar Nagar,
KHAR EAST.
Thursday,
3.00 P.M. to
5.00 P.M.
(FortNightly)
11.
Congress Office,
Vakola Bridge,
Santacruz (East).
Friday,
8.00 A.M. to
11.00 A.M.
(also in the
evening)
12.
Mahila Mandal,
Shastri Nagar, Kalina,
Santacruz (east).
Saturday,
8.00 A.M. to
10.30 A.M.
13.
Mahila Mandal,
Jamiipada, Kalina,
Santacruz (East).
Saturday,
10.-30 A.M. to
12.00 noon.
R e m a r If:
(Even i ngX
WIDER HORIZONS
om
iiMT^
A Workshop on the theme,
w
“FROM APATHY TO AWARENESS^ S I
and ACTION.”
?: A '•
X - ' :
JANUARY 26th - 30th 1977
| 2 J
at the
o «
MORAL RE-ARMAMENT CENTRE| £ <
Pancheani, Maharashtra.
ff
----- COMWUK ’■--------gfH c u—
(First i iuo; )oc. Marks Aea£
BAMGAlOHB - 560 00®
engineering meet others who are having a satisfying
★
experience of working in the rural and urban areas where
development is needed. The village heads and community
leaders also need to express their deeply felt needs
In India 80% of our doctors have settled
in cities, providing medical care to only
19% of the country’s population.
to those in the health profession.
It is hoped that this workshop will attract and involve
★
Three out of four of all ill cases do not g^
any health care whatsoever.
★
Two out of three deaths are not attended
by any medical help.
Atre people in the above-mentioned fields, and that
five days spent together at the Moral Re-Armament
training centre will help motivate participants. This
could have the result of widening the base of dedicated
men and women who take responsibility of working
towards total health care in rural and urban
Fortunately in recent years, people have started
becoming aware of the real needs of the community
and of the steps required to meet this, keeping in mind
communities.
TOPICS FOR DISCUSSION :
(i)
our limited resources.
The Government, the World Health Organisation and
the World Bank are allotting more funds for new plans
for community health and integrated community
development. But in order to make any plan work people
are needed who believe in action and are ready to reset
their priorities in life.
PURPOSE OF WORKSHOP
|
Conferences of Government officials along with doctors
Review of present conditions in community health
care. Realistic approach towards community health
care.
(ii)
(iii)
Nutrition and sanitation — the community’s role.
Integrated community development — what it takes.
Role of agriculturist, architect, engineer, teacher,
social worker and doctors.
(iv)
Moral aspects of total health care — how to get along
with ones colleagues; team work, an honest and
—
unselfish approach to problems.
DATES:
Wed. Jan. 26
—
opening session at
5.00 p.m.
medical students and students of agriculture, animal
Jan. 27 -29
-—
continuing sessions.
husbandry, social science, anthropology, architecture and
Sun. Jan. 30
—
closing session
(11.00 a.m. -12.30 p.m.)
are being held gainfully in connection with community
health. But we feel the need for a workshop where the
★
engineering meet others who are having a satisfying
experience of working in the rural and urban areas where
development is needed. The village heads and community
leaders also need to express their deeply felt needs
to those in the health profession.
In India 80% of our doctors have settled
in cities, providing medical care to only
19% of the country’s population.
SPONSORS :
Dr. Rajnikant and Dr. Mabel Arole, Director and Co-Direc
tor, Comprehensive Rural Healh Project, Jamkhed.
Dr. P. M. Shah, Prof, of Paediatrics, Grant Medical
College, and J. J. group of hospitals, Bombay, (Hon.)
Project Director (Tech.) Kasa Model Integrated
Mother-Child-Health-Nutrition Project, Primary Health
Centre, Kasa.
It is hoped that this workshop will attract and involve
Three out of four of all ill cases do not gj^
any health care whatsoever.
•
Mrs. A. G. Sigamany, Principal Leelabai Thackersey
College of Nursing, Bombay.
re people in the above-mentioned fields, and that
' five days spent together at the Moral Re-Armament
Dr. Vasant Tahvalkar, Paediatric Surgeon, Jt. Sec. India^
Medical Assoc. (Bombay).
training centre will help motivate participants. This
★
Two out of three deaths are not attended
by any medical help.
Dr. A. M. Raut, Jt. Sec. National
Association.
could have the result of widening the base of dedicated
men and women who take responsibility of working
towards total health care in rural and urban
communities.
Fortunately in recent years, people have started
Dr. Satish Tibrewala, Member Editorial Board, Medico
Friend Circle Bulletin.
becoming aware of the real needs of the community
and of the steps required to meet this, keeping in mind
Dr. R. K. Anand, Assoc. Prof, of Paediatrics T. N. Medical
College and Nair Hospital.
TOPICS FOR DISCUSSION :
(i)
Review of present conditions in community health
care. Realistic approach towards community health
care.
the World Bank are allotting more funds for new plans
(ii)
Nutrition and sanitation — the community’s role.
for community health and integrated community
development. But in order to make any plan work people
Integrated community development — what it takes.
Role of agriculturist, architect, engineer, teacher,
social worker and doctors.
(iv)
Moral aspects of total health care — how to get along
with one's colleagues; team work, an honest and
_
unselfish approach to problems.
our limited resources.
The Government, the World Health Organisation and
are needed who believe in action and are ready to reset
their priorities in life.
PURPOSE OF WORKSHOP
£
Conferences of Government officials along with doctors
are being held gainfully in connection with community
medical students and students of agriculture, animal
husbandry, social science, anthropology, architecture and
CONTRIBUTIONS :
(includes registration fee, boarding and lodging).
Rs. 200/- per delegate for the entire workshop.
Rs. 60/- per student delegate for the entire
workshop.
(iii)
DATES:
Wed. Jan. 26
—
opening session at
5.00 p.m.
Jan. 27 - 29
—
continuing sessions.
Sun. Jan. 30
—
closing session
(11.00 a.m. -12.30 p.m.)
health. But we feel the need for a workshop where the
Integrated Medical
Shri Krishnadas Shah, hon. adviser to the Govt., (Rural
Devel. Dept.) Maharashtra.
Any cheques should be made in favour of
Friends of Moral Re-Armament (India).
REGISTRATION:
For further details regarding the workshop
please write to the organising secretary.
DR. R. K. ANAND
g
"
55. KAVI APARTMENTS. WORLI,
BOMBAY 400 018.
Telephones: Resi.: 377358
VENUE :
See next page
Office: 354699
(3.00 - 6.00 p.m.)
VENUE:
Asia Plateau,
PANCHGANI,
Maharashtra 412 805
Telephones : Panchgani. 75 or 98
Cables : Neworlnews Panchgani
Panchgani is 248 Km from Bombay and 100 Km from
KSpona. which is the nearest station and airport. State
transport buses and taxis leave from outside Poona
Station for Panchgani. The last bus departs at 4.30 p.m.
The State Transport buses also run direct from Bombay
to Panchgani.
Panchgani is at an altitude of 1300 metres. Bedding is
provided for delegates, but it is advisable to bring a
pullover or jacket to wear in the evening.
Excellent conference facilities are available and over
the last years hundreds have attended seminars and
conferences at this centre to discover new and unselfish
approaches to problems.
e
INDUSTRY IN THE SERVICE OF THE NATION
Three Seminars will be held at the Centre for Moral Re-Annament at Panchgani, Maharashtra, as follows:
6—12 October, 1974
3— 9 November, 1974
4—10 January, 1975
Since 1969, the facilities at the MRA Centre at Panchgani have been available for companies to send
delegations of workers, junior and senior management. These have included Bajaj Auto Ltd., Delhi Cloth and
General Mills Co. Ltd., Karamchand Thapar and Bros. Pvt. Ltd., Khatau Makanji Spinning & Weaving
Co. Ltd., Kirloskar Oil Engines Ltd., Philips India Ltd., Polydor of India Ltd., Steelsworth Pvt. Ltd.,
Tata Engineering and Locomotive Co. Ltd., and Wanson (India) Pvt. Ltd.
The daily programme will consist of two plenary sessions, informal group discussions, films and audio-visual
aid presentations and recreatioi^^Sessions will commence on the evening of the firs^^ty and conclude on the
morning of the last day.
The subjects being dealt with i^fce Seminars will include:
Industry’s fullest role in the nation
Confrontation, co-operation or chaos
Productivity and partnership in industry
Automation and humanisation
The factory and the family
The unique element of these sessions is workers and managers sharing their experiences together, studying
the art of tackling human bottlenecks at all levels of industry and learning how to find “what is right” rather
than “who is right” in every situation. The study goes beyond industrial relations techniques to the
fundamentals of changing people whose prejudices and points of view can be the nation’s most expensive
overhead. Others also attending the sessions will include professional men, teachers and students.
The Chairman of Khatau Mills sends delegations to every session. One of his factory managers says that the
whole atmosphere of the factory is very different. Disputes have been settled by men trained at Asia Plateau.
Godavali Education Centre:
rfcj. <3-" J?.S?
A home for the homeless
.\\
by Salite Wood
THE new building glints in the
sun. Soon its four wings will be
home to the laughter and longings
of 40 orphans who find their way to
the Godavali Education Centre in
Panchgani, Maharashtra.
This building stands monument to
16 years of patience, of commitment
and, above all, the astonishing faith
of the initiators, Mr and Mrs Homi
Shroff. Defying conventional retire
ment, this middle-aged Parsi couple
fepld their Bombay furniture business
to put all their savings “to the last
rupee” into a project with an aim to
“bring up orphans and destitute
children on the true pathway of life
without any distinction of caste, co
lour or creed”.
But, confesses Mr Shroff, he had
no conception of the . consequences
of this idea. “We thought in our
lifetime we would bring up eight to
10 children. We never knew we
would grow so much. God has plan
ned for a long time.” Eyes alight,
Mr Shroff’s determination belies his
thin frame.
Homi Shroff had spent 20 years in
the furniture business before he and
his wife felt a “spiritual call” to work
-■for children. Mrs Nergish Shroff had
twbrked in a school for children in
need of special care for eight years.
Armed only with this experience,
the Shroffs began to search for land
to house an orphanage. When in
1964 they purchased 70 acres of
land for the price of two, Mr Shroff
says: “That was the first green light
God gave us.”
Situated one and a half kilometres
from the Panchgani bazaar, the site
overlooks open expanses of rolling
hills that seem to unfold to the hori
zon. Mr Shroff describes the first
three years of preparing the almost
barren hillside. “There was no cot
tage, no well. We had to purchase
water at that time and carry it on
our shoulders. We planted all these
trees with our own hands.” He points
to tall trees which stand silent wit
ness to the last decade or more.
HIMMAT September 19, 1980
Gradually the first children began
to arrive. “We bring them through
the juvenile court. And we select
those who are really needy, without
any. parents. Formerly we used to
take private cases, .but seven chil
dren were taken away by blackmail.
So we have stopped that.”
He talks of the time when they
brought in three sisters whose mother
died of tetanus. Six months la'er
their father also died. Another boy,
had lost both his parents in a train
accident when the Shroffs discover
ed him. Four 21-day-old babies
came in, whose mothers had died in
childbirth. Mr Shroff explains that
when the children ask about their
backgrounds, they are told unevasively. “We inform them. It is better
to let them know the answers ra her
than wait for them to know from
outside.” The Shroffs have a sepa
rate file for each child.
Now 24 children form the Shroffs’
current “family”. “They come up
slowly. Most are underfed children.
They have had vitamin deficiencies.”
They arrive often covered with sores
and suffering from rickets.
Sixteen of these children attend lo
cal schools — studying in the Hindi,
Marathi and English medium. The
annual expenses for one child works
out at Rs 1500. Of this, roughly Rs
35 a month is covered by a govern
ment stipend. The Shroffs depend
heavily on donations from friends
and visitors, as well as the help and
backing of their 14 trustees.
The Godavali Education Centre is’
registered under ithe Public Trusts
Act with the Charity Commissioner
of Bombay. In 1976-77 the Centre
became affiliated to SOS Children’s
Villages
(Balgrams),
Maharashtra.
After World War II in 1949 Dr Her
mann Gmeiner had .established the
world-wide SOS movement for chil
dren in distress. Coinciding with the
Shroffs’ own beliefs, the SOS aims at
children being brought up in a home
ly environment, with one foster pa
rent, preferably in small groupings of
eight or 10 children so that each
CONTINUED ON PAGE 18
MMMI
Feet still dusty from the fields and forests, about 800 tribals from Dahanu marched to Bombay. (Pic: Chandu
Mhatre)
WARLIS FIGHT FOR
THEIR LAND
By Sunil Shanbag (SOL)
Pics: Bimal Maskara (SOL)
The land in the villages of Dahanu was once owned by the Warli tribals who had cleared vast tracts of
forests. Over the years, most of their lands passed into the hands of powerful landlords from Dahanu.
The landlords in their turn have used this to exploit tire tribals bo th physically and economically. But
now the Warlis have realised their rights. Once they would hide at the approach of a stranger. But
that was a long time ago.
10
Imprint, June 1980
NEW DELHI NOTINGS
The innocent air travellers will at least be spared
all the trouble of being frisked and searched!
*
*
*
N HEARING that alleged hijackers are
given tickets for the Assembly elections, a
Delhiwala says that Lalwani should take com
fort from this incident. He says Lalwani can
hope for a ticket too when favourable winds
blow later!
There is a very interesting theory about
Lalwani’s motivation for having “attempted to
murder” tire P.M. Many persons in Delhi
seriously believe tire following story. Lalwani
was a frustrated, unemployed youth who was
also chronically sick. While he was angry with
the government and its policies, he had no
reason to commit the sort of foolhardy act that
he did on April 14. He did not seem mentally
unbalanced either. The real motive, the story
goes, was to obtain good medical attention for
himself as he was suffering from jaundice,
tuberculosis and acute pericardis. If this is true
(several persons are willing to lay a wager on
tins), Lalwani must be credited grudgingly with
some ingenuity. Perverse logic, may be, but his
reasoning is original! What is more, his project
seems to have succeeded as an impressive panel
of doctors examined him and tire best of medi
cines were administered! Here is hoping some
other young man will not emulate Lalwani’s
path to getting for himself his much needed
daktari, kapda aur makan!
O
64 A SSAM dur ast” is how a citizen of Dellii
A is wont to consider the extremely explo
sive situation prevailing in Assam. Assam is
indeed dur ast for most people in India and
hence one cannot easily imagine the seriousness
of the problem there. In Delhi, however, the
civil servants who are dealing with the crisis
are able to give a balanced view of the happen
ings which make one very worried. The agitation
is now nearly nine months old arid shows no
signs of letting up. It has touched off a similar
situation in Manipur. There is no doubt that
Mrs. Gandlii has faced no internal problem of
such magnitude before. Judging by the results,
all the strategies of the centre hitherto have fail
ed. It was the carrot policy, followed by the
stick policy followed by the carrot and stick
policy, all of which were mistimed and hence
did not succeed. New Delhi’s bureaucrats say
Imprint, June 1980
that their responses were based on the apprecia
tion of tire situation from time to time and
blame tire Assam State Government and the
centre’s own monitoring agencies in tire Home
Ministry for incorrect assessments. Tire price
we are paying for tills ineptitude is Rs.25 crores
a day, not counting the human misery and the
long term damages to the fabric of the nation.
It hurts us when someone says that all this
could have been avoided if the carrot, the stick
and the carrot and stick had been tried at the
appropriate moments and the situation would
have been controlled long before it reached tire
confrontation stage. Without any doubt, the
Home Ministry is answerable for this fiasco and
perhaps Mrs. Gandlii will take time off very
soon to take a severe look at this Ministry and
infuse some dynamism and efficiency among its
cadres.
*
*
*
JT WAS ON April 4, 1980 that Mrs. Gandlii
IL observed that wasteful expenditure and
ostentation should be avoided in India and ask
ed her colleagues to set an example. She made
a pointed reference to elaborate dinners and
extravagant marriage ceremonies. Two montlis
have passed since then, but there are not even
feeble attempts to follow Mrs. Gandhi’s advice.
New Delhi’s fashionable areas and ministerial
quarters continue to be the most incorrigible
conspicuous consumption areas. For marriage
ceremonies, dinners are ordered from five star
hotels and enormous quantity of food wasted.
Power shortage does not deter our leaders from
blazing all the lights at even ordinary functions.
Why is it that our political leaders and big busi
nessmen wiio are anxious to please the P.M. do
not take the cue in a matter like austerity? One
of the ways to punish this vulgarity would have
been for theP.M. to announce that those against
whom there were complaints of such extra
vagance would not qualify for tickets to the
assembly elections. Naive as our politicians are,
it would not be surprising if some of them
arranged a multi-course dinner at a five star
hotel to announce during the after-dinner speech
that they were always wedded to simplicity
and austerity!
*
*
*
VERHEARD in a New Delhi motor car
garage: “My advice as a mechanic, sir, is
that you keep the oil and change the car!
THE END
O
9
WARLIS FIGHT FOR THEIR LAND
OPAL BODHLE’S face was set in an
expression of intense concentration as he
urged his group of fifty tribals, into the main
body of the 800-strong procession of Warlis,
towards Bombay’s Flora Fountain. He danced
around them on his wiry legs, never letting
them flag or break formation and calling the
slogans out loud. Curious office-goers stared
at the tribals, whose bare feet and clothes still
carried the reddish-brown dust of the fields
and forests of the Palghar, Dahanu and Talasari
talukas of Maharashtra’s Thane-district, 120
kms north along the coast.
The women led, with black hair neatly oiled
and rolled into buns, wearing the characteristic
half sarees with bare midriffs and faded blouses.
The men, wearing rough shorts and faded, torn
shirts, some clutching old and tattered um
brellas, followed. The rhythmic gait of the
tribals, a people accustomed to walking long
distances, belied their tiredness.
They had woken early the day before in the
cool darkness of their huts, packed a few dry
rice bhakars (a shortcrust chappati) and set out
on a trek of almost 30 kms through dark forests
and dry fields, to converge at Dahanu Road
station for the early morning train to Bombay.
The little cardboard badges they wore identified
their organisations. Most of them belonged to
the Kashtakari Sanghatana, with its symbol of a
raised clenched fist between scales. The tribals
marched, shouting slogans, demanding that the
government recognise their ownership of the
forest lands they, have been cultivating for over
nineteen years.
Gopal Bodlile, 32, comes from the village
of Shishne, which lies behind a gently rising
hill about 30 kms north-east of Dahanu. The
village consists of several clusters of huts, neatly
thatched with large leaves and evenly spread
grass, weighed down by a few dry branches,
and separated from each other by paddy fields.
G opal’s hut is one large room with a small
porch where visitors may sit on a wooden bench.
The square walls are made of dried stalks of
jowar bound together and plastered with mud.
The hut is supported by a sturdy frame of dark
teak from the forests to the east of the village.
It is dark inside and the only source of light
is the cooking fire in the corner, because the
Warlis do not build windows into their walls.
In tire coolness of this hut, Gopal lives with
his two wives and five children, ranging from
less than a year to six years. The children play
on the packed mud floor a few feet away from
G
Imprint, June 1980
Gopal’s two bulls who share the hut, chewing
contentedly, their large black eyes gleaming in
the firelight.
Gopal’s father, Ramji Devji, was the village
police patil. On a salary of Rs.10 a month, he
could barely support his large family of eight;
two wives and six children. His family owned
only a few acres of uneven grazing land.
But this was not always so. According to
Gopal and others of Shishne, all the land around
the village was owned by the Warlis who had
cleared large tracts of forests. Over the years
most of their land passed into the hands of
powerful landlords from Dahanu. The Warlis
depend entirely on their land to feed them
through the year. When the monsoons fail, they
have little to eat, and are forced to approach
the landlords for food or money.
Gopal’s father; like many others, entered
into an agreement with a landlord from Dahanu.
The major part of the produce from liis land
was sent to the landlord and he was allowed
to keep just enough rice to see his family
through the lean monsoon months. This system,
known as the khand, bound most Warlis and
more often than not backfired on them. “Even
if the crop was poor,” says Gopal, “we had to.
give the seth a fixed number of bags of rice,
though we would have nothing left for ourselves.
Apart from this, my father had to work on the
seth’s farm without being paid for it.”
Eventually Ramji Devji and the twenty other
Warlis who had pledged their lands to the same
landlord somehow saved enough money to
pay back the original loan and repossess the
lands. Gopal’s father’s share, 31 acres, would
have been sufflcient-except that, counting
Gopal’s family and that of his five brothers, a
total of 51 people depend on it for their food.
Lost Land
OT ALL the-Warlis managed to get back
even part of their lands. About twenty
years ago, several Warlis from the village of
Karanjvira, two miles south of Shishne, were
cheated out of their lands by Gulabchand, an
other
Marwari
landlord from Dahanu.
Mahemitya, sitting on his haunches and rolling
beedis from dried aptlia leaves, is now a gnarled
old man, but he remembers the incident well
enough. “One day all the villagers who had
pledged their lands to the seth were called to
his house in Dahanu. My father was one of
them. The seth told them that he was making
arrangements to transfer the lands back to them
N
SUNIL SHANBAG
and that they would have to put their thumb
impressions on the transfer papers. Our elders
were innocent. They did what they were told.
The next year, after the first rain, when they
went to work on the fields, they were stopped
by the landlord’s guard who told them that
the land no longer belonged to them. To prove
this, the landlord showed them their thumb
impressions on the transfer papers, which actual
ly said that the Warlis were willingly transferring
their lands to the landlord. “These fields,”
Mahemitya says, pointing to a vast stretch of
rich green paddy land, “were ours. Now the
seth has planted cashew because it has a much
higher market price. We get hardly enough from
our patches to last us half the year.”
In the monsoons, the food situation gets
tricky. The previous year’s rice is nearly over
and the work on the new crop is only beginning.
Every morning the tribals drink a plateful of
hot kanji, bland boiled rice swimming in water.
It has low nutritive value. “Some Warli families
are so poor that they cannot even salt their
kanji,” says Gopal. Fresh vegetables are hardly
ever seen, but the Warlis supplement their kanji
with a pickled wild berry called kakad. Green
12
and hard, kakad is marinated in salt water till
it ferments and softens. Now it exudes a sour
smell and has a strong aftertaste. A plateful of
kanji and half a dozen kakads must keep a
Warli going in the fields through the day.
Using their own bulls, or a pair hired from
titelandlord, they plough their fields and scatter
seed. If the rains are regular and adequate,
transplantation follows. Now the entire family
is at the fields, because every land counts. This
is one of the reasons why Warli culture permits
bigamy. Gopal’s father had two wives and so
does Gopal. But more than two wives is looked
down upon as an indulgence. “A Warli in
Ambessari village has four wives,” spits Gopal
contemptuously.
The children help with the loads, graze
cattle or simply play in the mud. Education
gets low priority, especially in the monsoons.
The rest of the year, when there is very little
to do, Warli children attend school, if their
village is fortunate to have one.
Gopal studied upto the fourth standard in
Shishne’s missionary school. The large tileroofed hut houses a church, with a mud statue
of St. Jacob and a wooden altar, as well as a
Imprint, June 1980
WARLIS FIGHT FOR THEIR LAND
school. Gopal remembers his teacher, Augustin
Kantela, a Warli convert, very fondly. “He
understood us well,” he says.
But Gopal’s schooling was, cut short by a
cholera epidemic that ravaged Shishne. With
no medical facilities, many Warlis succumbed.
Gopal’s father died; his two wives, and Gopal’s
elder brother followed. “In our village alone,
at least twenty people died. There was no time
to get a doctor from the town,” says Gopal,
agitated, as he remembers the helplessness and
the terror among the Warlis. ‘‘I began working
on my elder brother’s land. He was married but
had no children, and I wanted to help.”
After two years on his brother’s land, Gopal
was employed to supervise Warli labourers on
the plantation of Bapltna, a landlord from
Dahanu. He was given a hut to stay in on the
plantation and was on call 24 hours a day
because his work included any odd job either
Baphna or his family wanted done.
“The seth would not give me food. I had to
keep a stock of rice, which my family could
hardly spare, and cook it in the hut,” says
Gopal. His monthly salary was Rs.30.
It was here that Gopal first met the men the
landlords used, to physically control their Warli
labour and to carry out their threats: migrant
bhaiyaas from Uttar Pradesh, in search of jobs
and money to support their large joint families
in their home villages. They were strong and
muscular, shrewd enough to realise that being
in the landlord’s pay against the Warlis was
to their advantage. Being farmers, they under
stood the working of the plantations, and were
detatchcd enough from the local population to
carry out orders, however unjust. The bhaiyaas
did everything from beating up erring Warlis,
evicting them from their lands and guarding
the landlords’ property, to supervising tile
labour. They learnt the Warli dialect, and
Maratlii, but never mingled with tire Warlis.
Thus, ironically, the Warlis came to be control
led by the people who had the same social
and economic background as them.
The setlis often loaned the bhaiyaas capital
to set up business, usually a grocery. Harishankai
Rajnath Pande, 28 came to the area eight years
ago. Several people from his village of Ghazipur
had small shops in Dahanu. Harishankar had
little difficulty in obtaining a job as a supervisor
in a farm. He is a lean man, tall, with hostile,
blood-shot eyes, and a constant expression of
surliness and suspicion. He probably was good
at his job, because .within two years he had
saved up enough to bring his wife, his brother
Mahendra and his family to Dahanu, as well
A Warli woman shops at Harishankar Pande’s provision store at Shishne.
Imprint, June 1980
SUNIL SHANBAG
as set up a grocery shop along tire BombayAhmedabad highway, a mile from Shishne
village.
Harishankar stocks provisions tire Warlis
need from-day to day: cheap masalas, sold in
little packets, rice, kerosene, soap, tea dust,
talcum powder in garish tins, low grade jaggery
meant for cattle but also used to distill a strong
homemade alcoholic brew, and sticky boiled
sweets for children, stand on rows of sagging
and blackened shelves against the back wall of
the shop. The shop itself is a modified Warli
hut, the front wall broken down to make way
for two rough wooden benches and a crude
waist-high serving counter. Large, framed pic
tures of Hindu gods adorn part of the back
wall, where agarbattis burn through the day. The
left wing of the shop is partitioned into a little
room where the entire family of six lives.
High Interests
HE TRADERS’ relationship with the Warlis
has never been one of trust. Ill feelings'
are aggravated when the traders function as
money-lenders during the lean months, charging
interest rates the tribals can. barely afford.
' “We are here to make money,” says
Mahendra, one of the traders. “If a regular
customer has no money, we offer him credit. If
he has a bag of rice we buy it off him, keeping
a 20 per cent margin to cover our transport
expenses. What is wrong with that? After all,
we are here for business. We don’t go to the
V/arlis and offer them loans, they come to us.”
The Warlis complain that the traders very
often do not keep their side of the deal. Gopal
remembers Wanshi Bopin, an elderly Warli
woman from his village, who sold Harishankar
14 bags of paddy worth Rs.1,400. “For two
years he paid her in small instalments, and each
time only after abusing her,” says Gopal.
Such is the distrust between traders and
Warlis that no Warli sends his child to shop for
anything expensive like kerosene or masala, for
fear that the trader might cheat the child.
Similarly, the traders demand to see the Warlis’
money before handing over the goods.
Circumstances keep the two together. The
trader depends on the tribals’ meagre purchases
to keep the business rolling, and the tribals
need his cheap goods to survive.
The bhaiyaas on their part, have fixed a
certain inferior status on the tribals that has
strong cultural and religious overtones. For the
T
14
past four months an elderly straightbacked
man, foul-mouthed and with a tuft denoting
his brahmin caste, has been living with Hari
shankar, Rajmani Ramsahai Chaube, 52 also
from Ghazipur, performs religious services for
immigrants from liis village, in exchange for a
small fee. When Chaube speaks in his loud voice
and chaste Hindi, both Harishankar, his pupil
in the village, and Mahendra, fall silent. Though
Chaube has been in the area for only four
months, he has already assigned the Warlis a
place in the rigid hierarchy of the Hindu
shastras.
“When Ram was in exile, he travelled south
to the land of the demons living in the forests,
to destroy them. That hill there,” Chaube says,
his eyes glinting as he points to a conical,
heavily forested top, “was the home of the
demon king Khardushan. You can still see the
ruins of his fort. The forests were full of his
followers whom Ram had to fight before he
killed Khardushan himself. Ram had to kill
Khardushan because the demon was a threat to
the Hindu dharma. But tire Warlis consider the
ruins of Iris fort sacred. They claim that their.
god lived there,” he says, leaving his listeners
to draw the necessary conclusion.
Chaube tugs at his tuft and rolling it lovingly
around Jus finger continues, “Of course I cannot
be sure that the Warlis are descendents of the
demon............. so many aeons have passed since
Ramrajya. But when I observe their dirty habits,
their fondness for drink, tlieir acceptance of two
wives, tlieir uncivilized behaviour, I cannot but
come to that conclusion. Do you know,” he
blurts in excitement, “after they slut they don’t
clean themselves with water! They use leaves!
They see me going every morning with a lota
of water. . . . Can’t they follow me?” Chaube’s
eyes are wide open with indignation.
Inadequate research has been done on the
origins of the Warlis but .historians generally
agree that they are non-Aryan uplanders who
moved south from the hilly terrain of the
Vindhyas and Satpuras to the present coastal
district. They have some traits in common with
tlie Bliils, a tribe with a distinctive culture and
an Indo-European language found in South
Rajasthan and Gujarat. The Warlis probably
assimilated other southern tribes like the Kolis
and Kunbis, and imbibed th’e lower caste
Maratha language and their customs.
The Warlis always refer to themselves as
farmers. They cleared large tracts in the dense
Imprint, June 1980
WARLIS FIGHT FOR THEIR LAND
forests of the coastal district and began to culti
vate. The forest provided them with teak wood
to build huts, wild fruit and berries like bel,
tamarind and kakad when the food supply was
low, herbs and medicinal plants like the
rauwolfia serpentina (locally, sarpagandha), tlie
karanj seed and the liirda fruit. The Warlis learnt
that the corrolae of the moha flower yield
alcohol on distillation, and they used this as
the base for a strong drink. Even tiie forests,
their deep relationship with the forest never
changes.
Outsiders from the north-west began trickl
ing in: Marwari farmers from Rajasthan, like
the Baphnas who came to Dahanu 160 years
ago, or Parsis, like Firoz Vakil’s family, who
came here as early as 1900. They found the soil
virgin and rich, the rainfall adequate, the forests
packed with a fortune in timber, and the local
tribals friendly but childlike and intractable.
The new settlers were. determined to fully
exploit the rich soil, and set up trading centres
for the timber.
Dalianu was fast becoming an administrative
centre for the British, and Vasai, about 60 kms
down the coast, was a growing Portuguese base.
Commercial activity was increasing, and after
half a generation of sustained labour the out
siders had carved out farmlands for themselves
around the small coastal towns.
The Marwaris and tlie Parsis acquired land
from tlie tribals at ridiculously low prices. The
severe drought of 1899 led to a famine, and
hungry Warlis stumbled into tlie towns from the
forests, looking for food. Sometimes land was
sold for as little as a bag of rice or for Rs.5, and
sometimes at 8 annas an acre. When the money
or the bag of rice was over, the Warlis came
back to the town and sold more land. Finally,
when tlie rains came, very few had any land
worth cultivating.
The landlords found die new and vast acqui
sitions difficult to control and cultivate. The
Warlis returned, diis time to beg for some work
and the landlords hired them-provided half
the harvest was paid to die landlord. This was
the beginning of the kliand system, and the
bhaiyaa class of enforcers. Those Warlis who
could not make do with their share of die
produce, went into the forests and clandestinely
cleared little patches to grow paddy and add to
dieir source of food. Poverty and domination
forced die Warlis into a culture of fear and
silence.
Imprint, June 1980
The Priests
N THE late 1920’s, die first Catholic mission
aries arrived. They were the Franciscan
Brodiers, a sect of black-robed mendicants who
shunned die enclosed life of monasteries, and
had a tradition of preaching and converting.
They were also active educationalists and set up
their first base at Uplat, a large village 12 kms
from Talasari.
The Warlis practice a primitive type of
Hinduism and animism. The tiger, Waghoba, is
one of their important gods. Every Warli'village
is protected by Wagiioba drawn on flat wooden
boards sunk into the ground. The Franciscan
Brothers attributed die Warlis’ sickness, poverty
and helplessness, to their primitive religious
beliefs. They were partially successful in convert
ing Warlis to Christianity, because die tribals
were going through a particularly difficult phase.
Kaluram Dharma Dhangad, 32, dark and pug
nosed, belongs to Shishne’s first Christian
family. His father was a well-known bhagat,
(religious head among the Warlis). During a
prolonged illness that his religious powers did
not seem able to cure, he allowed the Franciscan
Brodiers to convert him to Christianity. “They
told him that if he sought refuge in Christianity,
the Hindu demons would stop tormenting him”,
says Kaluram with a smile that tells you he
thinks it all nonsense. “After my family, ajjout
25 other families in die village were converted
by the missionaries.”
The Franciscan Brothers set up schools, like
die one in Shisitne, to preach and to educate.
But they ran into trouble with landlords who
resented their growing influence on die Warlis.
Several times, Franciscan monks were beaten
up, and they withdrew from the area.
About 55 years ago, the Jesuits arrived,
making Talasari their base. Though they conti
nued running the schools set up earlier, diey
shifted their emphasis to developmental work.
By 1966, their development centres were scat
tered over four talukas in Thane district.
The same year, the short ebullient priest,
Father Stanislaus Miranda, a graduate in agri
culture from the Laval University of Quebec
and a veteran of Talasari for ten years, came to
Ashagadh, six kms from Dahanu and set up a
new development centre called the Shantivan
Shetkari Seva Mandal. Father Miranda initially
believed diat die solution to India’s poverty was
to grow more food. When American PL-480
I
15
SUNIL SIIANBAG
grain began pouring into India in the late ’60s.
Father Miranda used the Mandat’s allotment to
pay tire Warlis who worked on development
projects set up in close collaboration with the
local Block Development Office. On a seven acre
demonstration plot at Ashagadh, Father Miranda
taught the Warlis how to level their fields, sow
high yield paddy, construct stronger bunds and
manage their water.
Alongside, Father Miranda began helping
Warlis take up cases against landlords who had
cheated them. When some of the Warlis won,
others felt encouraged to approach Father
Miranda.
Then, two years ago, abruptly, everything
came to a half. Old projects were phased out
and no new ones begun. Governmental circles
accused the Jesuits of using PL-480 grain and
money to convert the Warlis. The priests, too,
had realised that despite their work, tire Warlis
remained in a vicious circle of. perpetual indebt
edness, either to the priests or to the money
lenders. The priests’ loans paid back the village
moneylender. To repay the priests they re
borrowed from the moneylender. The pumpsets
the priests gave them remained idle because the
tribals did not know how to maintain them.
The manner in which the mission schools
were being run also came in for criticism.
Kaluram Dhangad, from Shishne, finished high
school from Talasari and then began teaching in
the mission school in his own village. He had
plenty to grouse about the way he as a teacher
was treated and the way the school was run.
“I had about 80 students on my roll,” says
Kaluram, carefully weighing every word, “and
1 repeatedly told the Jesuits that I needed an
other teacher to help me. They refused-, saying
that they had no funds. Then, they began cheat
ing me. On the pretext that I was not attending
classes, they cut my salary. Scholarship money
meant for students never got to them. All they
received were a few note books and pencils.
Eventually, in disgust, Kaluram went to the
Jesuit headquarters at Talasari and threw down
the school register and resigned.
“Our work made the Warlis dependent on
us,” says Father Miranda. “A few could keep up
with the pace, but others were left behind. We
are ashamed of it.” At 59 he shut down his
work of 23 years and went on a year’s
sabbatical.
In 1972, when Kaluram was training to be a
16
teacher in the Gyanmata school in Talasari, he
was impressed by a young Jesuit who was the
acting principal of tire school.
“I noticed that he understood tlie Warlis
better than anybody else. Despite his liberal
behaviour there was far more discipline among
the students,” says Kaluram.
Social Work
HE JESUIT, Peter D’Mello, was a philo
sophy graduate from Bombay who was
working in Talasari as part of his training before
being ordained. When Kaluram noticed him,
Peter was going through a serious phase of
introspection. All his life he had wanted to work
with the poor, and this urge had made him join
the Jesuits when he was only sixteen. But now
he was rethinking the traditional concept of
social work.
Peter, now 32, with short greying hair and
deep-set intense eyes, says, “The boys at the
school respected me, but one of them told me
that I could never get close to them because I
did not know what their reality was.”
Peter went back to Bombay to do a course
in Personnel Management at tlie Tata Institute
of Social Science. “I was basically interested in
Trade Union work, but in 1973, Rama Garat, a
Warli I knew in Talasari, called me to Dapchari,
a village 3 kins out of Talasari. He wanted me -to
help in an agitation of Warlis displaced by the.
setting up of a government dairy farm,” says
Peter. But the protest fizzled out and the Jesuit
order expelled Peter from Talasari for his
participation.
“The priests were worried that my involve
ment with tlie Warlis was compromising them
with the police. When tlie police made enquiries
about me at the mission, they disowned any
knowledge of me,” says Peter.
In 1976, Peter was ordained in Bombay. He
immediately returned to Thane district, to live
for a year with tlie Warlis of Kosbad village,
studying their lives and understanding their
problems. In 1977, Peter, now known among the
Warlis as Pradeep, grouped with Kaluram whom
he met at Ashagadh, and Nicky Cardozo, a
priest from the Talasari development centre.
The three planned the first of several camps
called Festivals for Warli youth, at Zari village,
30 kms from Dalianu.
T
The objectives of the camp were: to help
Warlis develop a self-image, to understand and
analyse the nature of their exploitative environImprint, June 1980
WARLIS FIGHT FOR THEIR LAND
ment, and to visualise a new and equal society
and the role they must play in it.
The first camp stretched over ten days. Peter
had come equipped with a 170-page manual in
which he had devised games and situations
through which the Warlis could overcome their
deep rooted fears and inhibitions.
“By making them play-act and therefore
objectify real life, we tried to make them see
their situation with detachment, and thus under
stand them better,” says Peter. The tribals re
created the circumstances that lead them into
debt with landlords, or the Kafkaesque situation
when a Warli goes to the BDO for a loan and is
confronted by a pile of forms and applications
that he can neither read nor understand.
Through songs, symbols, posters, and self
expression sessions, the Warlis were slowly led
out of their years of silence into an awareness
of themselves and the world around them.
The effect of the camps on some of the
youth was profound. Jairam Ladkya Bhonar, 22,
from the village of Nagzari attended one of the
camps at Dongarpada village. Even though
Jairam and several others fell ill during the
camp, which closed prematurely, the experience
haunted him. “When 1 returned home, I dreamt
of the camp in my sleep and saw in it a way to
Imprint, June 1980
do something for my people,” he says. This
lithe, bearded youth broke away from his
father, a leading Communist Party of India
(Marxist) activist because he wanted Jairam to
work with the CPM instead of the ‘padres’ as he
referred to Peter and Nicky. Jairam persisted
with the camps despite threats from his former
CPM associates and warnings from his father
that he would lose his religion.
“The camp made so many things clear to
us,” he says. “Warlis always tend to blame
themselves for everything. If tire shopkeeper
cheats us we felt that maybe we heard the price
wrong in the first place and gave the shopkeeper
excess money. The seths’ power over us has
grown so strong that we live in a world created
by them for us. When we wanted some work
done at the government office and the seth gave
us a note of recommendation, the job got done
immediately. When one of us wanted to get
married, it was the seth who gave us the money.
When we had no food we went to the seth. It
became so that the village believed that if you
did not work for the seth there was something
wrong with you, and you were to be avoided.”
“I did not expect this kind of commitment
from them,” says Peter talking about Gopal,
Kaluram and the other Warli youth who attend
19
SUNIL SllANBAG
ed the camps, “Now they can conduct some
programmes in tire camp better than I can
because they understand the Warli mind so
much better.”
Nicky Cardozo, Peter’s pleasant faced, stout
companion, helped plan the first camp at Zari,
but had not yet committed himself entirely to
the new movement.
“I think I lacked the courage at the time,”
he says. “When I saw the sincerity of the youth
at the camp, it came to me as a realisation that
while I could always quit and return to security
and a hot meal, the youth had notliing to fall
back on.”
Popular Action
N JANUARY this year, the Warlis formed
their own organisation, tire Kashtakari
Sanghatana. The Sanghatana met some difficulty
in winning the confidence of the Warlis, but a
series of successful campaigns against local
traders soon gave it a popular image.
On January 10, the villagers of Shishne
marched down to Harishankar Pande’s shop and
demanded that he pay Wanshi Bopin the Rs.800
he had owed her for two years. Harishankar
paid up at once. The Warlis were overjoyed, but
Harishankar is still bitter about it. “The women
danced in front of our shops like prostitutes
and hurled abuse at us. I would have paid Wanshi
Bopin anyway. What do I want to keep her
money for?” asks Harishankar.
On March 30, the Sanghatana led a march
in Gangagaon, this time against an elderly,
grey-haired trader Laxminivas Dubey, who had
been in this area for the last 24 years. The Warlis
claimed that Dubey had cheated several of them
on wages. Dubey was out, so the tribals filed
complaints against him and Hasnath Tripathi,
a trader from an adjoining village, at the Kasa
police station.
Tire backlash, was swift and vicious. Two
days later Peter and two other Sanghatana
workers were arrested by the police on what tire
First Information Report said were charges of
dacoity, house breaking and endangering human
life. The complainants were Laxminivas Dubey
and Hasnath Tripathi. For 27 days the three
accused were lodged at Dalianu jail and refused
bail.Till todate, there has been no formal charge
sheet, but the accused still have to report to
Kasa police station every Sunday and Monday.
“Their case is still under investigation,”
PSI Gurule of Kasa police station. “We have
I
20
no enmity with these people. I told Peter tire
last time he was here that he is doing good work,
but he must use peaceful methods. There must
be no breaking of the law.”
Gurule is a dark, well-built man with a thick
moustache. He leans confidently across his desk
and says, “I shall give you proof that we are not
on tire side of the traders. You know the com
plainant in Peter’s case—Dubey? We read a
report in the newspaper that a Warli woman had
complained to some social workers that sire had
been molested by him. On our own initiative
we went to the village, and after finding reason
to believe the woman, we charged Dubey under
section 354, arrested him and produced him in
court.” Dubey’s 22 year old son Sudhakar, also
has a charge of molestation pending against
him.
“The Warlis are like poisonous snakes,” says
Dubey, who has left Gangagaon and now sells
withered and tired looking vegetables in the
village of Thakarpada. “They bite the hands that
feed them. They are drunks; brother fights
brother; son fights father. How can anyone
believe what they say?”
Local vested interests call the Sanghatana
the watchdog of missionary interests in tire area.
But the Warlis deny this charge. The presence
of Peter and Nicky as leading forces in the
organisation created much of this controversy,
especially because precisely at this time the
MP O.P. Tyagi proposed the Freedom of
Religion Bill in Parliament. Playing safe, Peter
severed all his links with tire Jesuits in Ashagadh
and Talasari. This most affected Father Miranda
who was now back at Ashagadh and eager to
help in tire new movement.
“I told Stanny (Miranda) very firmly that
he was not to come anywhere near the Sangha
tana,” says Peter, fully aware of how hurt
Father Miranda was at being kept out. “I respect
him for his dedication and years of experience,
but his presence would have complicated the
issue further. The Warli youth were very clear
about not having any of the missionaries around
the Sanghatana.”
About his own position, Peter says, “Neither
staying with the Jesuits nor opting out will
change my life. I don’t perform any religious
functions here and my commitment has been
made. If I feel that my being a Jesuit is coming
in the way of my involvement with the people.
my choice is with the people. In fact, I’m
seriously thinking of quitting the Jesuit order.”
Imprint, June 1980
WARLIS FIGHT FOR THEIR LAND
The elders in the Society of Jesus accuse
Peter and Nicky of being communists, and the
CPM accuses them of being missionaries. But
Kaluram waves aside these accusations. To him
religion does not matter. “I believed in the
Christian faith, but after working in the Sanghatana and reading the works of Karl Marx, I have
come to believe that religion has been used to
suppress these people. It is truly tile opium of
tire people,” he says.
The arrest of the three Sanghatana workers
kept tire Warlis low for a while, but their grow
ing awareness, and their successful struggle
against the traders and the landlords had given
them the confidence to tackle a far more basic
problem—one which has threatened their entire
existence. In December last year, tire Maha
rashtra Government passed an order regularising
encroachments on forest lands as of March
1978. Numerous landless tribals and backward
classes throughout Maharashtra had clandestine
ly cleared tracts in the forest to cultivate, and
over the years had been pressurising tire govern
ment to recognise their ownership of these
plots. But the new order was a severe blow to
them because it excluded hundreds who had
been forcibly evicted between 1969-72 and then
again during the emergency from the land they
had been cultivating. Among these, the only
ones with any proof that they had encroached
were those that the Forest Department had
arrested, and in the process, provided with
documentary evidence. The new order would
deprive 95 per cent of the Warlis of their lands
because they could not prove th'ey had cultivat
ed it before March 1978.
Tire Kashtakari Sanghatana joined hands
with other organisations like the Bhoomi Sena
of Palghar to press the government to move
the date back to March 1960, and arrange for a
committee of representatives of the people, the
Forest Department and tire government to
scrutinise all claims to encroached land.
Tough Fight
HE WARLIS know that the fight is not
going to be easy, for they are up against
their most powerful opponent, tire Forest
Department. Since the British took over the
forest in 1860, there has been hostility between
the Forest Department and the Warlis. The
tribals feel entitled to the produce of the forest,
while the Forest Department jealously guards it.
“The tribals are depleting the forest by fell
T
imprint, June. 1980
ing trees for firewood and smuggling out previ
ous teak and aim to sell to private contractors,”
says C.S. Katke, Range Forest Officer. “If any
more encroachments are regularised there will
be no forest left,” he says.
But the Warlis throw the same accusations
back at the Forest Department. Kaluram says,
“A Warli will never destroy a forest. He has a
deep relationship with it and knows that ulti
mately his survival depends on it. It is the
corrupt Forest Department in connivance with
greedy timber contractors who are depleting
our forests. Forest guards demand bribes from
Warlis and abuse them if they catch them felling
trees to build huts, but they always look the
other way when contractors fell them by the
dozens for money.”
The Forest Department wants to replant the
encroached areas, wherever possible, with teak
to raise the commercial value of the forest. The
current Working Plan for the Reserved Forest
of Thane states: “The capital value of the Thane
forests is Rs.697.50 per hectare, while that of
a teak plantation is Rs. 1,03 5 per hectare. There
fore tire conversion of the present mixed type
of forest into a teak forest will increase the
value of tire forest by Rs.337.50 per hectare.”
The Warlis consider this thinking warped.
“The encroached land is our only hope for
survival, but to the Forest Department tire
forest is nothing more than a way of making
more money,” says Kaluram. In April, an inci
dent involving a Warli girl and a forest guard
brought the distrust between the tribals and the
Forest Department to a new high.
Mahi Wanshe was asleep in her hut in the
village of Haladpada. Her father was working a
late night shift at the Dapchari dairy complex
a few miles away, and her mother was out help- .
ing a neighbour through a particularly difficult
delivery. The village was dark arid silent, and
inside the hut a soot blackened oil lamp cast a
feeble glow. The hut’s rough wooden door was
closed but not bolted. There was a shuffling
outside and then loud knocking. Mahi jerked
awake, and saw an unfamiliar man outside tire
door. In the dim light, she could just make out
a young face with a moustache twirled upwards.
He wore a dull coloured T-shirt and a loosely
tied lungi. Leaving the door open, he moved into
the hut and demanded some liquor. Mahi guess
ed he was one of the forest guards who often
roamed the village after dark knocking on the
villagers’ doors demanding their strong home
21
SUNIL SHANBAG
Sleeping alone in her hut, 12-year-old Mahi Wanshi was molested by a forest guard.
made liquor. But there wasn’t any in Mahi’s
hut and she told him so.
He moved closer till he could see her clearer.
Though only twelve, Mahi looks older, with an
attractive face and large, deep eyes. Impatiently
the man said, “You are young. Stop behaving
like an old woman and get me some daru.”
Mahi replied with .growing panic that she
could not get him any, and tried to run past
him out of the hut. He caught her by the
shoulders, and as she struggled, he pulled her
towards him and began running his hands all
over her body. Mahi somehow broke free and
ran into the night sobbing wildly.
When Mahi’s mother found her, outside a
neighbour’s hut, all Mahi could say, between
sobs, was, “I was scared... .1 was so scared....”
Her parents lodged a complaint at the police
station but also demanded that the forest guards
be paraded before the village where Mahi would
publicly identify the culprit. The police refused
the demand, and the case was dropped. The
molester went free.
After two months of protest in Dahanu,
Talasari, and the historic march to Bombay, the
tribals have discovered that the Forest Depart
22
ment and the government are not as easy to
fight as the traders. As a concession, the govern
ment moved the date to 1972, still depriving 30
per cent of the tribals of their land. The tribals
have refused to accept this decision and the
situation is in a deadlock.
The Warlis’ new-found confidence has also
struck fear among the landlords. “They are not
cultivating farms of plantations more than 7 kms
away from Dahanu, because of the hostility of
the tribals,” says Firoz Vakil. “When we went
to cut grass at my fields near Charoti, they said
that since they cultivated the land, the produce
from it belonged to them. We literally had to
flee that day.” He adds philosophically, “It’s
all.in the game, we have to take it as it comes.”
In the 20-odd villages where the Sanghatana
has its support, morale is high. The spirit of
the movement can be seen in the Warlis’ smiles
as they greet each other on forest rials of fields
with hand upraised, the fist clenched, and a
shout of “Zindabad”.
“There was a time when we would hide in
fear at the approach of a stranger in city
clothes,” says Gopal.
But that was a long time ago.
THE END
Imprint, June 1980
SCC medicare
for villagers
SHAHABAD, June 8
The Associated Cement Com
panies have launched schemes
that have brought
comprehen
sive health care services to the
villagers at Wadi and here.
The diagnostic and
dispensing
facilities of ACC hospitals were
thrown open weekly for the bene
fit of villagers residing within
nine km. Radlcus of the Wadi
and local works, according to
Dr. S. Subramanian. manager,
rural development, ACC, Bom
bay.
The ACC Wadi village wel
fare centre arranged a nine-day
free eye camp with free medical
aid, food
and
hospitalisation
and eminent eye • surgeons from
Gulbarga, provided free service
and conducted operations. Hun
dreds of villagers utilised this
-opportunity.
~~~raa
©
For outstanding performance? and acftivement."
tile promotion of rural and
agricultural activities
ACC BAGS
‘ASSOCHAM’
AWARD
FOR RURAL WORK
Managing director Kamaljit Singh receives the'ASSOCHAM' award
from union finance minister H M Patel at Vigyan Bhavan,
New Delhi June 27
these awards in four r^sific areas — which are con
sidered of "utmost criTcal importance to the Indian
economy." These are :
THE Associated Cement Companies Ltd, (ACC)
bagged the first national award for 1976, instituted
this year by the Associated Chambers of Commerce
and Industry of India (ASSOCHAM). The presenta
tion was made by union finance minister H M Patel
to ACC's managing director Kamaljit Singh, at the
Chambers' annual general meeting at the Vigyan
Bhavan, New Delhi Monday June 27.
(a)
Ccw-y-jar protection and service through
an appropriate distribution network;
(b~;
import
(<?)
.- -' '"i.'.m of rural and agricultural acti
vities;
(d)
Promotion of ancillary industries through
self-employed entrepreneurs in small-scale
sectors.
substitution
through
indigenous
The awards are open to all (individuals, com
panies, associations) engaged in the promotion and
development of industry, trade, commerce, and/or
any other activity conducive to the betterment of
society — and particularly to serving the interest of
the economy of India.
ACC won the award for "outstanding per
formance and achievement in promoting rural
and agricultural activities” — through its Village
Welfare Scheme (VWS) — during the last three
years. Winning the ASSOCHAM award is a doubly
significant achievement inasmuch as ACC's Village
Welfare Scheme enters its Silver Jubilee year on
October 2.
In deciding the award, these criteria will operate :
(a) exceptional service and/or outstanding
achievements in the four categories;
PURPOSE OF AWARDS
The purpose of the awards is "to recognize and
reward talent in India by honouring each year indi
viduals, organizations etc, and thus offer encourage
ment for others to improve upon their performance.
(b)
it is not incumbent to give prizes under
all the areas indicated, every year;
(c)
no one may receive an award in the same
field more than once in three years.
A QUIET TRANSFORMATION
ACC's rural development programme, implemented
through its Village Welfare Scheme, is the story
ASSOCHAM, which is the oldest apex body of
commerce and industry in the country, has instituted
2
have been set up at ®tcherial (Andhra Pradesh),
Chaibasa and Khalari (Bihar), Dwarka and Sevalia
(Gujarat), Shahabad and Wadi (Karnataka), Jamul
and Kymore (Madhya Pradesh), Chanda (Maha
rashtra) and Lakheri (Rajasthan). Each centre has
a nucleus staff comprising an agricultural supervisor,
a village level worker, and a mason-cum-mistry. All
of them technically qualified and trained in their
appropriate fields.
of a quiet transformation that is bringing new life
into 225 Indian village.
ths story of hew
private enterprise has e-,c_•j/sos” villagers to work
together to reduce poverty, dispe! ignorance, and
to improve their living conditions. It is a factual
record of a social experiment that has benefited over
three lakh people. Probably the first of its kind in
southeast Asia.
Each centre carries out its own programme based
on surveys and feasibility studies on the socio
economic development of the community. Problems
and felt needs of the villagers are studied, after which
the people are motivated towards the need for self
improvement. The VW team then works in close
coordination with villagers in the execution of a
development plan, solving problems which may crop
up and fostering pride in achievement. Follow-up
is continuous, and progress is stimulated.
Twenty-five years ago, ACC realized that every
business enterprise is affected by the way of life of
the people who live in the localities from where it
draws its labour force. It saw that it could with
advantage improve living conditions in those areas
by helping the people to raise their agricultural pro
duction, economic status, intellectual level, socio
logical strata and physical standards. It sought to
achieve these objectives by instilling in the villagers
the need for self-help and self-reliance, without
making substantial financial commitments. It en
deavoured to create awareness among the people
by encouraging them to undertake development pro
grammes with their own resources: money, materials,
and voluntary (shramdan) labour. ACC's VW staff pro
vided the technical guidance and supervision. In the
process it strived to inspires sense of dignity and pur
pose in the villagers as a whole, and to inculcate a
sense of good citizenship and responsible leadership.
Whatever the nature and scope of the project,
the VW staff must tackle first the antiquated beliefs
and prejudices spawned by a backward existence
and shackled to an inbred apathy and lethargy.
Which makes the preliminary surveys, feasibility
studies, and motivation generated among the villagers
the determining criteria of the measure of the success
for any project.
THE ASSOCHAM AWARD
It all started with a national seminar organized by
the Agricultural Finance Corporation, ASSOCHAM
VWS AT WORK
The first Village Welfare centre was opened at
Balasinor quarries near ACC's Sevalia factory in
Gujarat on October 2, 1952. Since then 11 more
(Continued on page 4)
3
THE LAST THREE YEARS
The main activities of the VWS, dur’n9
three years, are in the areas of agriculture, ani
husbandry, constructions, education, rural he.
recreation, cottage industries and cooperative socie
Agriculture : Almost 782 hectares of new la
were
reclaimed in villages through
motiva
and appropriate advisory services. Sixty-one a
and the department
of
rural
development,
ministry of agriculture, on the "Role of industrial
and commercial houses in agricultural and rural
development" at Ranchi August 21-22, 1976.
Twenty-five industrial and commercial houses, twelve
banks, seven fertilizer and pesticide firms and six
government departments participated. ACC repre
sentatives included Dr S Subramanian, officer-incharge VWS, from head office, Mr C R M Ayyar,
general manager, Khalari, Mr R A Tripathi, centre
in-charge, Khalari, and Mr M R Kaddu, agricultural
supervisor, Wadi.
Among several
papers
contributed,
14 were
selected for presentation at the seminar. One of
these on the "Role of ACC in rural development"
by Dr Subramanian. The paper outlined ACC's
integrated approach to rural development.
It was at this seminar that a decision was taken
by ASSOCHAM to institute annual awards to indus
trial and commercial houses "who have done out
standing work in agricultural and rural development."
As a follow-up, in March this year, ASSOCHAM —
through press advertisements and circular-letters
about the institution of the award — invited nomina-
Photo-montage depicting integrated rural development ac
tivities. Clockwise from top: Family welfare clinic for
planned parenthood, recreation for yuvak mandats, a farmer
with bumper maize crop, pucca concrete well, afforestation
through tree-planting, schools to promote education, smoke
less chutah for clean and hygienic cooking, teaching stitching
-a mahita mandat activity; and at centre, spinning - an
additional income
tions from industrial and commercial houses in India.
While filing our nomination, the areas of our VWS
work, and the achievements made during the last
three years with supporting documents were sent to
ASSOCHAM.
5
THE LAST THREE YEARS
The main activities of the VWS, during the last
three years, are in the areas of agriculture, animal
husbandry, constructions, education, rural health,
recreation, cottage industries and cooperative societies.
Agriculture : Almost 782 hectares of new lands
were reclaimed in villages through motivation
and appropriate advisory services. Sixty-one agri
cultural demonstrations were laid out in marginal
and small farmers' fields during kharif and rabi sea
sons for which inputs like seeds, fertilizers and pesti
cides were given free, and field days were organized
and conducted in villages to show the field perfor
mance of crops demonstrated.
As a service to farmers, 211 soil and water
samples from their fields were collected, analysed
at the nearest laboratory, and recommendations were
given. For timely plant protection measures, equip
ments were hired out on nominal charges to 545
farmers. Seven agricultural exhibitions/fairs were
organized for improved high-yielding grain, fruits,
vegetable and cash crops, and suitable incentives
were given. Sixteen gobar gas plants were installed
in villages for which technical know-how was pro
vided. Technical advisory service in cropping, cul{Continued on page 7)
>d,
14 were
ninar. One of
development"
utlined ACC's
nt.
on was taken
/ards to indusave done outdevelopment."
ASSOCHAM —
circular-letters
nvited nomina-
Photo-montage depicting integrated rural development ac
tivities. Clockwise from top: Family welfare clinic for
planned parenthood, recreation for yuvak mandats, a farmer
with bumper maize crop, pucca concrete well, afforestation
through tree-planting, schools to promote education, smoke
less chulah for clean and hygienic cooking, teaching stitching
-a mahita mandat activity; and at centre, spinning - an
additional income
lions from industrial and commercial houses in India.
While filing our nomination, the areas of our VWS
work, and the achievements made during the last
three years with supporting documents were sent to
ASSOCHAM.
5
:
Tac.u^h5i
help "for construction
of
30 primary, middl^Wnd high school buildings was
given in rural areas. Thirty-six incentive prizes to SSC
tural, manurial and plant protection were also given
to 8,449 farmers.
students to promote education were given. Adult
education classes in five villages were conducted.
Demonstrations using improved high-yielding crop
varieties were conducted at our farm and shown
to 2,711 cultivators. Seeds of these varieties, totalling
517 quintals, 929 quintals of fertilizers based on soil
test reports, and 44 quintals and 93 litres of plant
protection chemicals were supplied at cost to 11,066
farmers — either directly by us or channelized through
appropriate agencies.
Rural health: Fourteen diagnostic, five immu
nization and child welfare, six dental and eye clinics,
and seven family welfare camps were staged in rural
areas benefiting 501 villagers. Disinfection of com
munity wells using bleaching powder was carried
out in villages. Technical guidance and supervision
for 386 items like soak pits, latrines, bathrooms,
septic tanks, drains, roads etc, were provided. In
coordination with health authorities immunization
programmes were carried out for rural people, cattle
and fowls, against various diseases.
Animal husbandry:
Eight cattle shows were
organized to encourage villagers to rear better breeds
of cattle and prizes were awarded. Technical ad
visory services — pertaining to artificial insemination,
cross breeding, animal care, dairy, poultry and feed —
were given to 6,948 villagers. To improve the quality
of milch cows and buffaloes, 1,233 animals received
artificial insemination through key village centres,
and ten new breeds were introduced.
Recreation:
Eleven
mahila manda/s with a
membership of 287 were organized in villages, and
the activities of the manda/s involved stitching of
clothes, knitting, embroidery, pappad- and pickle
making, and kitchen gardening. Thirty-seven yuvak
manda/s, with a membership of 1,113, were organized
in 35 villages to promote social and cultural activities,
develop leadership qualities and involve them in the
development programmes of the villages. Suitable
competitions were organized among members of the
manda/s, and prizes were given to encourage such ac
tivities. In addition, sports clubs and libraries were
organized in villages to provide recreation facilities.
Construction: Cement was used in the plan
ning, designing, estimating and supervisory work of
1,905 improved individual and community construc
tions in rural areas — valued at Rs 93.76 lakhs.
Nearly 713.85 tonnes of ACC cement was made
available at cost to 2,500 villagers for various con
structional items. Concrete products like cattle
troughs, irrigation channels and pipes, were made
and supplied at cost to 1,217 villagers, as also 106.25
quintals of hoop iron to 733 villagers for agricultural
and poultry development.
Cottage industries: Nearly 935 villagers were
motivated and helped in self-employment in cottage
7
past is any indi<Mlon, it is evident that its
s::■.has not Been merely philanthropical—
os aven a social obligation only. Rather it has
demonstrated that an industry's approach to
community development can be an integral
part of its business activity. It is with these
thoughts in mind that ACC looks forward to
a long and fruitful partnership in India's com
munity life.
industries like basket-making, bamboo work, weaving,
rope-making, poultry, piggery, duckery, fishery, tusserrearing, blacksmithy, carpentry, pottery, shoe-making,
and in making bricks, tiles, and matches. In addition,
422 villagers were provided employment in old cement
bag repair work. Besides the centres also involved
villagers in drought-relief
measures — such
as
deepening drinking water tanks, earthen bunds,
construction of reservoirs etc.
Cooperative societies: Thirty-five
service co
operative societies organized either with our help
or by government agencies extended credit facilities
amounting to Rs 8.22 lakhs to farmers. Seven
milk cooperative societies supplied 25.09 lakh litres
of milk to the Amul milk dairy. In addition to the
above activities, the scheme also undertook mass
tree-planting programmes in villages by motivating
and giving technical guidance and supervision re
sulting in the establishment of 2,500 trees.
STUPENDOUS TASK
Rural development is a stupendous task
which needs primarily establishment of a
proper rapport between rural development
agencies and government authorities at state/
district/block/village levels, with a view to
achieving the desired goal by collective partici
pation and effective coordination as a team.
ACC
Towards this end, ACC's Village Welfare
Scheme channelizes its energies and resources,
as it enters its Silver Jubilee year. And, if the
Printed and published by Ramesh R Verma, Publicity and Public
Relations Manager, The Associated Cement Companies Ltd, 121,
Maharshi Karve Road, Bombay 400 020, at New Thacker's Fine Art
Press Private Ltd, Shakti Mills Lane, Mahalaxmi, Bombay 400 011
8
THE ASSOCIATED CEMENT COMPANIES LTD
Mn
.«?$ S. H
GRAMAYAN
RULES AND REGULATIONS
- Zo
‘GRAM AY AN’
1025 Sadashiv Peth, Pune 411 030
Rules and Regulations:
1.
Name :
The Name of the Association shall be
‘ Gramayan
2.
Registered The Registered Office of the
Office :
Association shall be at
1025, Sadashiv Peth, Pune - 411 030.
3.
Aims and Objectives of the Association :
We believe that the process of economic, social and
cultural transformation of our society has necessarily
to be started with the development of rural area with
special
emphasis on
the
economically weak and
oppressed section. We further believe that the efforts
of voluntary agencies and social workers are necessary
along with the Govt, efforts to initiate and sustain this
process and realise the objective of creating self-depen
dent, self-sustaining and modernised society. Gramayan
primarily concerns itself with such voluntary efforts.
The aims and objectives of Gramayan are as follows:
( a ) To undertake all activities which will promote
and assist voluntary individual social workers
and agencies working for rural development.
( b) To establish contacts with such
voluntary
workers and organise meetings and seminars
for exchange of ideas and experiences in rural
development.
(c) To organise technical, financial and other
assistance for the agencies and workers, work
ing for rural development.
((7) To publish, propogate and disseminate infor
mation useful for rural development.
( e ) To organise training camps of voluntary social
workers.
(/) To organise youth camps and arrange study
tours and visits to projects etc.
(g ) To organise exchanges of social workers work
ing in different organisations.
(h) To conduct development projects
in rural
areas.
(i) To organise co-ordination between rural and
urban voluntary organisations.
(/) To undertake
any other activity consistent
with the objectives mentioned above.
4.
Accounting Year :
The accounting year of the Association shall be
from 1st April to 31st March of the next year.
5.
Classes of Membership :
( A ) Founder Members—
The persons by virtue of their initial efforts
to promote Gramayan are the Founder Mem
bers of this Association.
(5) Life Members—
Any person interested
in the activities of
Gramayan can become a Life Member by
paying a minimum amount of Rs. 250/ —
without any recurring payments.
( C) Honorary Members—
Any person interested in the activities of
Gramayan can become an Honorary Member
by paying a minimum fee of Rs. 51 /-(Rupees
Fifty-one only ) and a retainer fee of Rs. 10/—
( Rupees Ten only ) per annum.
( D ) Institutional Membership—
Voluntary Agencies in rural areas can become
member of Gramayan by paying Rs. 101/—
( Rupees One Hundred and One Only ) and
a retainer fee of Rs. 15/- ( Rupees Fifteen
only ) per annum.
( E) Youth Membership—
This category shall include the persons who
are interested in rural development and who
have not completed twenty-eight years of age.
The annual membership for this class shall be
Rs. 5/- ( Rupees Five only ).
(F) Ordinary Members—
Anybody who is interested in activities of
Gramayan can become an ordinary member
by paying an annual fee of Rs. 10/— ( Rupees
Ten only ).
6.
Conditions of Membership
(a ■) An applicant for membership at classes ( B ),
(C), (D), (E ), (F) above shall be required
to apply in the prescribed form and pay the
prescribed fees along with the applications.
(B)
The Founder Members shall scrutinise the
application so received and take whatever
decision they may deem fit. The decision shall
be taken
by simple majority of Founder
Members present in a meeting specially called
for this purpose. The decision of this meeting
shall be final.
(C)
Membership - A list of Members shall be
maintained as provided under Rule 15 of the
Societies
1971
Registration ( Maharashtra ) Rule
in form of
Rules in
Schedule VI to the said
respect of such members as are
members within the meaning of Section 15 of
the Societies Registration Act, 1860.
Executive Committee
7.
I.
There shall be an Executive Committee
con
sisting of thirteen members elected as follows.
(a) Four elected by the Founder Members from
amongst themselves.
(b) Two elected by the Life Members from
amongst themselves.
( c ) Two elected by the Honorary Members from
amongst themselves.
(d) Two elected
by the Voluntary
Agencies
from amongst themselves.
( e) Two elected by the Youth Members from
amongst themselves.
(f) One elected by the Ordinary Members from
amongst themselves.
II.
To be the office bearer of any political party
at any time during the period of the tenure
of his office in this organisation shall be
considered as a disqualification to be a member
of the Executive Committee.
III.
(A) The Executive Committee shall be elected by
the members of all classes and the elections
e
shall be by Postal Ballot.
The election
procedure shall be decided by the Executive
Committee. The Executive Committee shall
appoint the Election Officer to complete the
procedure of elections and
this election
shall be comfirmed by the Annual General
Body Meeting to be held within one month.
(B) The previous Executive body will function
till the new body validly takes over. The
new elected body shall take over immediately
after the approval of the annual General
Body that meets immediately
after the
elections.
(C) The election procedure for the elections of
the Executive Committee shall be completed
after every two years in the month of
August.
(D) Those who are the valid members as on
30th of June of the year will be the voters
qualified to vote for the election of the
Executive Commitee for
the next
year.
Any valid voter can contest the election for
the membership of the Executive Committee.
( £) The Executive Committee thus elected shall
elect from among themselves :
IV.
Chairman
One
Vice Chairman
One
Secretary
One
Joint Secretary
One
Treasurer
One
Functions of the Executive Committee—
The Executive
Committee shall meet at
least once in three months.
The Executive
Committee shall be responsible for taking
proper actions for carrying out the work of
the ‘ Gramayan ’ as per the objectives.
The Executive Committee meeting may be
V.
called with eight clear days notice for the
purpose.
VI.
QuorumThe Quorum for Executive Committee meet
ing shall be 5 ( to carry on its proceedings )
and if the Quorum is not available during the
first half hour the adjourned meeting will take
place with the members present by the time
of the first half hour and will be competent
to transact all the business of that meeting.
8.
Annual General Meeting :
(A ) The Annual General Meeting of all the valid
members shall be held as far as possible in
the month of August or at any other suitable
time as may be decided upon by the Executive
Committee but not later than the end of the
October of the year.
(B) The Annual General Body Meeting may be
called with ten clear days notice for the
purpose.
(C) Quorum—
The quorum for the Annual or Specialf
o
General Body Meeting shall be fifteen and i
for the first half hour the Quorum is not
available the meeting will carry the business
with the members present by the time of the
first half hour.
This adjourned meeting shall
be competent to transact all the business of
the meeting.
(D)
Following business shall be transacted in the
Meeting—
( 1 ) To elect the President and Vice President
for the every two years from amongst
the members present and voting.
( 2 ) To consider and pass the annual report
and accounts for the accounting year and
Budget for the ensuing year.
( 3 ) To appoint auditors and fix fees of the
Auditors.
( 4 ) To consider the programme for the com
ing year.
( 5 ) To note and confirm the elections to the
Executive Committee.
( 6 ) To amend the constitution whenever
necessary by a majority of two third
members present and voting.
( 7 ) To consider any other matter with the
permission of the president.
Functions of Secretary :
9.
( 1 ) The Secretary is competent to call the meet
ing of the General Body ( Annual or Special )
or of the Executive Committee in consultation
with the President (in case of General Body )
or Chairman (in case of Executive Committee)
of the respective bodies.
(2) The Secretary shall maintain all the necessary
record and proceeding of ‘ Gramayan ’.
10.
Finance :
In addition to the collection of funds through
the usual subscription from the members, the
Association may collect finance through dona
tion, grants from individuals, organizations and
Governments. The Association may collect
Finance through organization of appropriate
social programmes for fund collection.
The
Association has a borrowing power.
Association is entitled to create, hold, purchase
transfer, mortgage property including movable
and immovable.
11.
Amendments :
Amendments, alterations, additions, modifica
tion etc. in any one or more rules can only be
made or amended as per provisions of Sec. 12
and 12-A of the S. R. Act 1860.
12.
Dissolution :
The Society will be dissolved as per Section 13
and 14 of the Societies Registration Act 1860. #
— 21
PEOPLE SCIENCE MOVEMENT
A
REPORT ON VIDNYAN
SANGHATANA "
JATRA FROM " LOK VIDNYAN
( People Science Sanghatana )
ANJALI MONTEIRO
PRESENTED BY
ULHAS GORE
It is the morning of 31 March, 1980, in Prakasha village,
Shahada taluka, Dhulia District Maharashtra. On an open ground
near the S.T. bus stand one can see a rectangle of make shift
tents. Vidnyan Jatra ’80’, 'Lok Vidnyan Chalval' (People’s
science movement) the banners outside proclaim. There are groups
of people standing around - school children, Adivasi landless
labourers, rich peasants a motley crowd - all curious to enter
and see this new kind of Jatra.
In the minds of people a jatra is something tremendously
entertaining, an escape from everyday life into a world of colour
and music where there is so much to do and see. The popularity
of the jatra Was one reason why the People's Science Movement
(PSM) decided to experiment with this form. But with a different
purpose in mind. The aim here was not to thrill, to mystify, to
provide an' escape. While entertaining people it should give them
a fresh insight into the world around them, bring science within
their reach and make them conscious of their own creative poten
tial to change thdir reality.
This jatra has been organised by PSM with the cooperation
of Shramik’Sanghatana, a mass organisation of"Adivasi landless
labourers. The.PSM wants to bring together the scientific intelligensia, dissatisfied with the existing situation on the
one hand, and the masses who want change on the other.
The Shramik Sanghatana activists also feel the need for the
kind of activity like PSM to widen people *s horizons and'help
them in their struggle
. change their lives. This’ jatra is
an initial attempt to explore this possibility. How will people
respond1to'this new experiment? To what extent will the jatra
demonstrate a new way of looking at science and at their own
day to-day lives? In the midst of.the.atmosphere of festivity,
excitement and anticipation, these questions lurk just under
the surface.
...2/-
- 2 -
A jatra on this scale involved a massive amount of prepara
tory work. For the past two months, volunteers of PSM in Bombay,
Pune and Nanded had been planning various exhibits, visiting
schools, hospitals and other institutions all over Maharashtra,
getting them interested in the idea of Vidnyan Jatra and in
lending their materials for it. In addition to this available
material, a lot of fresh material had to be prepared if each
area were to be presented interestingly and coherently for a
rural audience. Scientists, doctors, engineers, teachers, stud
ents, artists and fulltime workers of PSM spent night after
night making posters, models and writing rough commentaries to
go with the exhibits. At last, about ten days before the jatra,
most of the material was ready to be transported to Shahda.
The collection, -packing and transportation of this ^assorted
and delicate baggage was not easy. However, -slowly but surely
volunteers with the materials began trickling into the Shramik
Sanghatana office in Shahada, the only casualities being a few
damaged modela and the frayed nerves of our volunteers and S.T.
bus conductors. The Shramik Sanghatana office took on the app
earance of a bizarre
workshop. In one corner, clouds and
rainfall were being made by a group of enthusiastic volunteers,
in another the intricacies of the human skeleton were laid bare,
in the centre a jar of poisonous snakes reeking of formalin
was'being examined with great interest.
had begun.
The’ training programme
’ There were about 50 people - local adiv'asi youth and work
ers, activities of Shramik Sanghatana and PSM volunteers from
Bombay, Pune, Belgaum, Nanded and Somnath-.
'The^bulk of vo
lunteers were Adivasis, as by and large, the explanation of
- 3 -
the various exhibits would be given by them in the local dia
lect, Bhilori. The training programme started off with the
four areas for which materials, had arrived. Health, Water,
Astronomy and Natural History. Initially, wanted to train all
the volunteers in all the areas, but time was short, so after
a days general oriantation and a survey.cf of all 4- areas,
volunteers opted for the area on which they would like to
work at the jatra. There followed two days of intensive
discussions, demonstrations and experiments. The activists
of i'SH and the local volunteers threw themselves into the
task of adapting the material, attempting to start from the
existing conceptions of the local people and incorporating
these in the manner of presentation (analogies from everyday
life and a questioning of common misconceptions). It was a
period of creativity, of learning for all those involved.
For the local volunteers, an exposure to so much that was new
and interesting, a fresh look at the world around them; for
the ISM activists, an insight into what mass education involves
the need for it to be interwoven so closely with the experiences
of people.
While the training programme was going on at Shahada,
activists of Shramik Sanghatana were struggling to set up
the stall and infrastructure for the jatra. All .the
materials - bamboo, tarpaulin,.pieces of cloth and sacking,
were collected by the local volunteers from their own
villages and brought.+c. the jatra site. With great effort,
the tents were exected,. only to be blown away by the next
morning. There was much concern and discussion - should the
jatra be shifted to a less open and windy site? That would
involve getting a fresh round of permissions from v arious
local authorities, and there were only 2 days left for the
jatra to begin. Finally, it was decided to alter the layout
and to .set up the tents somewhat differently. The new
arrangement stood firm, much to our relief.
...4/-
4
But that was not- the end of our problems;. It was very
difficult to work in the heat - the temperature, was around
40 to 45.C.Summer .was the one time when agricultural labours
were relatively free. Arrangements had been made for
electricity, but more offen than not there were interruptions
in the supply which meant that many of our models could not
work. Drinking water had to be fetched from long distances.
Arrangements had to be made to feed 60 people for a week,
tables and chairs> to be borrowed. We needed a couple of
dark rooms fpr projection of slides and- some models, but it
was very difficult to construct a dark room out of tarpaulin.
All these problems have brought us to the conclusion that it is
much, more feasible to organise a jatra on some school premises,
where, the infreastructural arrangements required are more
readfly available, and at a time of the year when the weather
is.more conduc ive to work.-
The jatra ground was finally ready.. There was now just
a day left for the jatra - time to transport the exhibits
from Shahada to Pnakasha. The Nehru Science Centre van
arrived from Bombay. In it were bundled all the delicate
models and specimens. The rest was sent by tractor. The
work of arranging the nine different stalls had to start
immediately - posters to be put up, models to be assembled.
The shortage of materials like bamboo, sacking and-tables forced
volunteers to use their resourcefulness to put up then stalls.
Bedsheets, blankets, whatever was available was used to cover
gaps in the tarpaul7c.nd rig up partitions.
In the midst-of all this bustle and confusion songs
were being composed, about PSM, about the Jatra. The song
written in Marathi for PSM starts something like this:
5/-
5
'There is an eclipse of the sun of knowledge,
Awaken, people, awaken, open your eyes
At last, by noon of the 31 March, the Jatra begins.
Let us make a round of the jatra, from the beginning to
the end, see and hear something of what went on in each
atall and of how people reached to what the eyes saw.
Right at the entrace to the jatra is a section of
assorted items, including some:scientific toys. The
commentator starts off with showing people a fresnel lens.
It looks like an ordinary piece ofplastic with some grooves
in it. Hold it up against someone's face and see how the
face looks magnified and distorted. People laugh at this.
Their leughter turns to amazement when they see how it can
be used to concentrats the rays of the sun at a point and
set anything on fire. Why does this happen? The volunteer
tries to explain. However, with the exception of literate man
and. children, the others don't seem to comprehend or to be
interested in the explanation. This' is' true of some of the
other things shown harethe mobius strip, the balancing clown.
The demonstrations ars^thoroughly enjoyable but it is very
difficult to get people to understand the scientific principles
underlying these; At most they can drawanalogies between what
they see and some similar application of the principle in theirdaily lives. In some case, the examples used are inappropriate,
Many of the things, like the fresnel lens, are very far removed
from their experiences. This raises the question ofhow best to
combine an enjoyable experience, a connection with daily life
and an understanding of the underlying scientific principle.
Should tnis uot.be kept more strictly in mind when selecting
items for a jatra?
' <• ■
.......... 6/-
6
People commonly believe that whatever is witnessed by
the eyes is correct, the absolute truth. In the section on
optical illusions they are shown examples of how their eyes can
deceive them. A strip which appears emphatically bigger than
another, suddenly appears smaller when positions are interchanged
Straight lines appear curved, lengths are misjudged, black and
white sport keep appearing in clear areas, a picture points at
you from all directions such coomon optical illusions startle
people. They seem to enjoy the variety of ways in which their
eyes can deceive them. Through startling demonstrations they
become conscious of the importance of scientific methods of
measurement.
The next stall is not as entartaining as the previous one,
bui/it deals with an area which is of vital importance and
interest to all kinds of people in the rural areas - the
problem of water. This area is presented so as to bring out
the social issues involved, along side with'giving the
necessary scientific information. The volunteer starts with
explaining the water cycle with the help of some posters and
a model. Then he talks about underground water. One model
which holds people’s attention demonstrates how the same
ground water feeds the wells of untouchables as well as other
castes. But misconceptions about divining water sources are
missed out. The next few posters deal with oteforestation. They
take up question like why forests .are necessaiy for rainfall.
Why does deforestation take place? Who benefits from it, both
in the. past and today".'
j?rom here we -move on to irrigation different types-of irrigation, their relative costs and benefits,
how irrigation facilities are distributed in Maharashtra,
between various crops, between various sections of the rural
population emphasizing the efficient use of water.
....7/-
7
Different types of people respond differently to this
stall. .Peasants with land show great interest in the section
on irrigation, participate in the-discussion. Landless
labourers and women are less enthused. They respond very well
and participate in the commentary on.the water cycle when
given by local activists in the local dialect. There are
probably two reasons, for this. The manner of presentation
does not pose sharply the problem of water as faced by the
landless, labourer. Secondly, the stall is bare, few posters
and fewer models. This stall would have been much more
interesting if it used forma like slideshows, drama, and more
models.
Then follows a poster exhibition on food adulteration
obtained from the Maharashtra Government. The fact that all
kinds of food can be adulterated, is a new and interestingideas
People, particularly those from the ;middle class, want
to see what they can do in their homes do detact adulteration,.
It would be helpful, one ..feels, if there' were actual demons
trations of t.his. Some posters are irrelevant, "they deal with
foods like butter and saffron which most people are not familiar
with. .
,
Why ismeasurement important? What are the different
things that cante measured and how? These questions are
dealt with in the exhibition of models of. the Nehru .Science
Centre. The models need electricity to work and most, of .the
time there is no electricity. Most of the things presented
here and the examples used are not familiar to a rural audience.
with the exception of school children, This exhibition can be
much more effective and interesting .if it were to use as- its
starting point the conceptions of measurements that- the people
have. One thing that attracts people to this section-, is that
they can handle the models.. Children, particularly, go wildwith the excitement of pressing different buttons and seeing
all..kinds,.of things happening.
...8/-
8
There are many modelsin the section on Astronomy. The
first is a model of the earth - -moon - sun system where people
are shown how day and night, seasons, the phases of the moon
and eclipess occur. Interesting discussions take place around
this models. A group of middle class women tall the volunteer
- even if what you say is true, we cannot give up the traditiona.1
practices that we observe during the sclipse.’ After this is a
section on the siler eclipse - a set ofposters dealing with the
misconceptions prevalent about the eclipse and a model which
uses the principle of the pinhole camera to explain how the
eclipse occurs and how it appeared on February 16th 1980 in
different parts of the country. Unforutnately, this model
can be demonstrated only when there is electricity. The
biggest draw in this saction is the model of Skylab. People
begin taking of the fears they felt when they knew Skylab
was going to fall, ofhow some people sold all their goats and
chickness and went on a last drinking binge. The remaining
things in this section a?e a set of slides on the solar system
and the talescope which everyone wants to handle.
The local
volunteers feel that people would have a lot of doubts and
questions about this area which, though not expressed immediately
would crop up later, for many of the ideas presented challenge
their basic conceptions of the universe.
A solar cooker cooks rice and tea is boiled served on
another cooker in the solar'energy stall. When they see»rice
and tea being made on a solar cooker, some people find it
difficult to believe that the source of power is the sun.
There must be at least electicity inside, They feel. One
question frequenetly asked - How can we use this cooker in the
mons oons? Some of the cooker models, like the one made from
an umbrella are cheap and simple, but there is one, made of
mirrors, which is relatively difficult to make and expensive.
,....9/-
9
The. adivasi landless labourers tell the voluntiers. 'This
cooker is for the landlords, Where dove have the money to make
such a big one?1 After considering people's reactions the
volunteers feel that all the cookers demonstrated should have
been made from local materials, and the costs of this, as
against other forms of energy more rigorously worked out.
How are wild animals, birds and snakes our friends? How
do tiey live, what are their habits? What is the difference
between poisonous and nonpoisonous snakes? These are the main
questions discussed in a section on "our friends". People
enjoy looking at all the specimens of animals, birds and
snakes. Given this interest, the subject could have been
presented in a more integrated manner, bringing out the
idea of an ecosystem. This stall is the scene of an unplanned
but very practical demonstration of how some snakes are non
poisonous. One of the PSM activists is bitten when she is
trying to catch an escaping snake. The snake seams to suffer
greater damage than tie lady, for it loses • —nber of its teeth
and goes into sulky retirement for the rest of the jatra.
There are 3 section in the stall on Health-the human
body, disease and a section only for women on the repreductive
system, pregnancy and childbirth'. In the first section, a
skelteon, a model of the torso and specimen of soft organs
are used by the voluentear to take people on a journey of their
bodies. Por some, it is a fascinating experience. An old
Adivasi women says ’I r«79r knew that there were slo many things
inside our bodies'. People are particulary struck by the soft
organ specimens - a lung showing a tuberculosed cavity, a
cirrhosed liver, worms clinging to the intestine. Some of them
said that after this they would stop smoking and drinking.
10/-
10
The next section on diseases has a series of posters on
TB, diarroea, scabies, malaria and leprosy. However, after
having already spent 3 hours going from stall to stall, people
are tired and not ready to assimilate new information unless
presented very strikingly. So, on the spot, the voluntears
improvise a play about a TB patient which is quite successful.
The TB patients wife is played by a Adivasi volunteer with a
flair for drama and a bxg moustache. The moustached wife keeps
people in splits of laughter, at the same time ensuring a more
objective response on their part to the drama. Enthused by the
success of theirplay, by the last day the voluntears decide to
put the same story into an action song in Bhilori and to get
the audience to sing slong toe.
Bor the women, the next section is the most interesting
part of the whole jatra. The male and female reproductive system
menstruation, conception, pregnancy, childbirth, abortion and
family planning are discussed in this section. A serious attempt
is made to look into this area from a women’s point of view, to
get women to think and talk about their own conceptions of their
body and its reproductive functions, to cbbunk certain mythss
about menstruation a pregnancy. The reactions of women are
quite intense-? Some feel that this area should not be discussed
so openly. Others, particularly "those active in mass struggles,
feel that they have gained a lot from this section.
Bor many of them, it is the first time they are able to discuss
such issues among a group of women without any sense of shame
or embarassment.
The stall dealing with superstitions and, godmen is by
for the most popular one in the jatra. It has a serie's of
posters dealing with questions of belief in God and blind
faith in godmen from a scientific, rations list point of view.
...11/-
11
However, more than the posters, it is the 'miracles’
performed by a 'godmen’ (one of our volunteers) that attr
acts people to this stall. They watch faci.nated as drops of
water drip from his hair and blood from his fingertips, as
he sets paper on fire without using matches, produces an egg
from his empty hat, all the time invoking- the gods. Some
people spontaneously give him money. However, after he is
challenged and debunked by a member of the audience(again one
of our volunteers) they demand their money back.
On the last night of the jatra, a performance the same
subject is put up. A woman is 'possessed and she is being
taken in a procession down the village street to a "guru"
who will drive away the avil Spirits. The "guru" is challenged
by a' rationalist and there is a confrontation between them.
Crowds gather around to watch this situation. They take sides,
Those who have been to the jatra and have seen the gcdran
there are quite sceptical of the powers of the guru to cure
the woman. Of all the sections in the jatra, this one seems
to have the most powerful impact, at least in terms of immediate
changes in attitudes and perceptions.
Every night, after the jatra closes, there is a programme
of science films from the ^ehru Science Centre Films on the
Universe, Astronomy, like under the sea, the history of the
rocket, are seen with rapt attention by large audiences. The
original English Commentary is replaced extempore by a live
Marathi one, by a member of the Nehru Science Centre team,
which tries to make the subject interesting and relevant
for a rural audience.
All together, about 7000 people attended the jatra. What,
were people's immediate reactions? when questioned, they would
say that it was very good, tiat they liked everything.■ Some
...12/-
12
people, particularly the women, seemed somewhat dazed by the
amount of new information they had been exposed to, and unable
to absorb it all. The thingsthey remembared and talked about
after the jatra were those which were in some way linked to
their experiences and presented in a visually striking manner
a model, .a specimen, a drama,.
Now that the jatra is over and people have gone back to '
their daily lives, the local volunteers are trying to find
out the impact of this jatra on people's perceptions. Do they
still remember and talk about the thingsthey saw? Has it in
any way changed their misconceptions? Would they like future
programmes of this type? A jatra like this can be only a
starting point, a speark that kindless interest and facili
tates and educational process, the/sti. Lags of a popular
movement.
This jatra was -PSM's first experience of mass education
on such a scale. Mistakes were made, in the presentation of
areas and selection of models, •in the actual'organisation of
the jatra. At times there was inefficiency and wastage, our
organisational weakness showed up. But all in all, it has
been a tremendous learning experience. It has brought to us
a realisation of our own potential, a realisation of the
curiosity and desire, however hesistantly ex?ressed, of common
.people to know more about the world around them and to make
sense of it.
Rural Health Research Project, Alibag
The Godrej Experience
HE modem system of medicine in India was
imported from Britain to cater to the British
troops and civilian expatriates, and to a small
favoured elite of the native population. During
the three decades after Independence the medi
cal profession, steeped in western teaching and
practice, abrogated to themselves the total res
ponsibility for the planning and operation of a
health service, which was now meant to cater
for the entire population of a predominantly
rural country whose per capita income was one
of the lowest in the world. Unable to compre
hend this entirely new problem and not being
trained in the skills of planning, organisation
and management, their reaction was to expand
the existing medical services, with slight modi
fication. The result as we see it today is a vastly
expanded service based on an increasingly sophis
ticated and personalised type of curative medi
cine suitable only for affluent western nations.
T
The differences in disease problems as well
as the social, economic and cultural differences
between India and the West, and even between
the urban and rural areas of our own country
have received scant attention. This is a major
factor affecting almost all fields of development
in this country. We have failed to appreciate
the over-riding importance of the cultural factors
in the delivery of our services and no amount
of technological excellence, even if it is appro
priate, can bridge this 'cultural gap’.
Coupled with the 'cultural and technological
gap’ is the almost total lack of involvement of
the community itself in the programmes aimed
at their health. As a result of the lack of parti
cipation, there is almost no feedback from the
field; and peripheral workers are at liberty to
work or not, since organisational supervision is at
best sporadic.
The Rural Health Research Project was begun
as an attempt to correct some of these imbalances
December 1977
and to evolve a health care model which would
be efficient, cost-effective, replicable, and elicit
the people’s participation.
The Foundation for Research in Community
Health was established because it was felt that
the present system of health care was unsuited
to the vast majority of people in this country,
especially in the rural areas. We postulated the
following hypotheses:
1.
That health can be attained only if the
people understand and participate in pro
grammes aimed at improving their health.
Health care cannot be delivered effectively by
an extraneous service if the people themselves
play a passive role.
2.
That the present health service is predomi
nantly illness-oriented, expensive, too sophisti
cated, personalised and consequently unsuited
to the needs of most of our people.
3.
That the medical profession, who have abro
gated to themselves the responsibility of health
care have failed to deliver the goods, for rea
sons of their training and orientation, which
is westernised and curative-biased.
4.
That efficient health care is neither expen
sive nor elaborate, provided it is based on pre
vention and early treatment; and axiomatically
that even simple village people can be trained
to undertake a considerable degree of health
care in their own communities. In this approach,
what is lost in depth is more than adequately
made up by width of coverage.
5.
That such village-level health-workers can
function efficiently only within an appropriate
supervisory and referral structure. In the
present system, Government-trained male and
female auxiliaries (such as Auxiliary Nurse
Midwife’s and Basic Health Worker/Multi-
11
purpose Worker’s) can be retrained not only
as multi-purpose workers, but as supervisors
for the Village Health Workers.
lage Health Worker, a village woman trained to
do health work for her village, is the functional
expression of this objective.
2.
To develop a model rural health scheme in
6.
The nutrition, sanitation, and pure drinking
water are essential components of health, as a typical underserviced area. This model should
important as curative care.
be practical, feasible, and replicable. This means
proving that an efficient and successful health
7.
The one of the most important means of service can be manned and run primarily by
para-medical and auxiliary personnel with only
improving the health status of the people is
through health education, since change of atti one or two doctors.
tudes is in the long run more effective than
3.
To evolve an efficient delivery system for
technology alone.
both preventive and curative health care, with
8.
That a health-service structure based on the particular emphasis on the preventive approach.
above hypotheses will necessitate a new type
of functionary at the apex : i.e., at the Primary
Methodology
1.
Baseline survey to gauge health problems,
Health Centre level. The present day MBBS
doctors, because of their curative-orientation attitude, services available, services required,
undertaken by the Tata Institute of Social
and inability to work with and within a health
team, cannot continue to head this new team
Sciences, Bombay.
without seriously retarding their efficiency and
confusing their orientation.
2.
Introduction of persons trained in commu
nity work to explain the programme to local peo
The project began in December, 1973, with the ple, obtain financial and popular support for the
recruitment of a senior community organiser, village health-worker, and maintain relationships
who undertook the task of interpreting to the with panchayats to ensure community participa
people our aims, gaining their confidence, and tion in the programme.
support of the panchayat samiti and zila pari3.
Establishment of primary health unit (PHU)
shad officials. One of his major goals was to
to provide both out-patient and in-patient ser
discourage conventional notions of welfare agen
cies being institutions of charity, and to promote vices.
the concept of development with participation. A
4.
Establishment of sub-centres to serve popu
few months later, a young dedicated MBBS doctor
lations of 5000-7000 manned by an Auxiliary
joined the project and helped to establish a pre
Nurse Midwife.
liminary medical service. In mid-1974, an ad
ministrative officer and a social scientist were
5.
Training and fielding of ANM to fulfil a
recruited and the project began expanding to in
multi-purpose
health
worker role, supervise
clude actual training and fielding of VHW’s, sup
ported by a re-oriented health team. After the work of VHW’s, and give technical services (e.g.,
ante-natal clinics and immunisation).
health programmes were functioning fairly effi
ciently we began a few socio-economic pro
6.
Training and fielding of VHW’s (local women
grammes, though in a limited way. We have now
reached the consolidation phase, where greater selected by the panchayats and trained by the
stress will be given to the research component project to do simple detection work, follow-up,
health education and minor ailment treatment,
of our project.
at the ratio of one worker to 1000 population. The
VHW is a part-time worker.
Objectives
1.
To enlist the involvement and participation
(Contd. on page 32.)
of the people in their own healh care. The vil
12
Voluntary Action
No.
1007
Comprehens ive
Health
Maharashtra
Rural Health Research Project, North Alibag and Uran Talukas
1......... .
Started in December 1973 in North Alibag; only
recently in Uran Taluka.
2.
Coverage.
In North Alibag Taluka, a 30,000 population
is covered; and in Uran Taluka 60,000. The. population
are mostly agriculturists, fisherfolk, and some tribals.
3.
Activities.
Initial';
a.
Concept of development .with community participation
promoted by a local community organizer.
b.
■c.
Medical services by a doctor who also trained VHWs
Baseline 'survey by Tata institute of Social Sciences,
Bombay
Ongoing;
.. - a.
■
VHFJ's home visits (3 hours/day) for’minor ailments;
check under fives -for immunization and nutritional
..statuses; check\fdr .ante-natal cases and for TB
--and Leprosy symptoms. Also impart.health education.
g
b.
ANMs~ conduct ante-natal”clinics and deliveries;
give immunizations and refers casesgneeding further
attention to PHC Unit doctor.
:
c.
PHC Unit apart from traditional.curative role,
the doctor1 is expected to. go out into community,
recognize health problems and initiate preventive
measures using team. Outpatient clinics are
conducted at remote, selected villages.
c
j?
■
fc
“
d;:
In Uran Taluka, project is taking over the
government. PHC and re-training its .staff as MPWs.
p
P
e-.
- Land reclamation for tribals,
L:
•
f.
L
Recently, a comprehensive S-E survey conducted as
requested by the two new development engineers as
a first step to initiate a number of development
projects.
2
No. 1007
Personnel & Training.
4.
5.
VHWs (part-time, 25-50 years of age; education
2-7th standard, but two are illiterate (children
maintain their records). Orientation is for
10 days, followed by regular inservice training.
So far 30 VHWs (1 per 1,000 population) have
been trained in North Alibag.
b.
ANMs - Training needed for supervisory skills.
c.
Doctors - Orientation needed to make him team
leader and preventive-minded.
Supervision & Records. .VHW is given continuous on-thejob supervision. VHWs monthly report is signed by the
doctor and a copy sent to the Panchayat.
■
Community and other Participation. VHW is chosen by
Panchayat and Project personnel together.
30 rupees
of her 50 rupees salary is paid by the Panchayat.
6.
7.
.
9.
Sponsorship/Funds.
The Foundation for Research in
. Community Health, a voluntary organization sponsors
and funds the projects. The Foundation itself is
funded by both Indian trustees and charitable
organizations abroad. Government of Maharashtra's
PHU and PHC budgets for the areas are also available.
Problems -.
.
10.
a.
a.
Villagers take time to gain confidence in VHWs.
b.
VHW .is: more curative - rather than preventive
ly .oriented (training,.needs reorientation).
c.
Her work-pattern is unsystematij because of her
previous work-style.
d.
. ANM has a tendency to look down upon the VHW.
e.
Turnover in doctors; their inability to utilize
their staff properly, and to delegate jobs to
them. They are purely curative-oriented.
f.
.. A tendency for the community to expect all
welfare measures to come from the government.
g.
Difference between their perception and the
development worker's perception of needs.
.Outlook. .. J>rbpose to start' development programmes
including health, sanitation, water supply and land
reclamation.
No. 1007
.Coritaot. Dr N.H. Antia, Trustee, The Foundation for
Research in Community Health, 84—A, Abdul Gaffar
Khan Road, Worli, Bombay.
11.
-
12.
Reference. Paper presented at the National
Symposium, 1976.
Note:
No information available for item 8.
..
■.
.
Vk
No. 1-008
:~:
Health
Maharashtra
Sone Guruji Vidya Prabodhini, Khiroda, Talgaon District.
(also called Janata Shikshan Mandal).
1.
Started in 1930
3.
Activities.
a.
Pre/basic school for children 5-7 years of age.
b.
Primary basic training college, secondary school,
panchayatiraj training centre, boarding house for
students from backward classes, arts school and
college of education.
c.
dispensary for tribals;
d.
youth club to promote CD through various acti
vities .
12.
Reference.
John Sommer et al, Rural Development at
the Grassroots, The Ford Foundation, New Delhi, Oct.
1974.
Note;
No information available on items 2, 4, 5, 6, 7, 8, 9,
10 and 11.
THE- DILEMMA OF PRIMARY HEALTH CARE
by
Dr. N.H. Antia, Director,
The Foundation for Research in Community Health,
84-AJ R.G.Thadani Marg, Sea Face Corner, Werli, Bombay-400018.
When the Shore Committee in 1946 first enunciated the concept
of Primary Health Care it was with the simple moral imperative that
the "tiller of the soil" must be the first concern of the health
system.
This in fact, is the essence of the concept of primary health
care; the basic, integral, non—negotiable health needs of the commu
nity; the foundation without which all other services are superfluous.
This concept has become diluted to mean a second rate service which
is foisted on the community while the privileged few receive their
care from sophisticated medical institutions and highly trained
personnel paid for by the nation*
It is clear that 80 percent or more of our people are beyond
the pale of even such diluted services. Why is this so? Essentially
there are two reason's behind this impasse which I shall cal " The
Dilemma of Primary Health Oare" . On the one hand, the public Health
system has expanded its net work over the last 30 years, yet like
the spiders web, it is impressive to behold but lacks substance* On
the other hand, the health services have not concerned themselves
with the peoples* welfare nor do they possess administrative,techni
cal or organizational competence. They have not only alienated them
selves from the community but from each other as shown by the
hierarchies and rivalries within themselves.
Our experience of two pilot health projects in Kulaba distt.
of Maharashtra make us despair as to whether we can even fulfil our
commitment of Health for All by 2000 AD if we proceed along the
present lines. Yet some of our experiences in the field indicate that
the problem is not insoluble. But the answer lies in a radically
different if not a diametrically opposite approach to our existing
methods of health care. The strengths and weaknesses of our people
and of the existing health system will be discussed and an alterna
tive strategy proposed.
-CO
INVOLVEMENT OF THE COMMUNITY
IN HEALTH CARE PROGRAMMES
ty
Dr. Sushila Nayar, President,
Kasturba Health Society, P^O. Sevagrant, Wardah-442 102.
dCnns
gL
Importance of community involvement
£
(-•
u °
*3
o
<
S
for the success of primary health care to
C.M.R.
I.
<;•
A:
be highlighted in presentation.
£A
project involving school
teachers in delivery' of primary health care
and in stimulating community participation
in their own health care to be discussed.
:';
-o
□
tt
o
®
A few other experiments for the
involvement. of the community interest in
their own health care also to be discussed.
co
\
.
rfcxLo. -
No 1°06
Rural Devi.
Maharashtra
zMaliwada
1.
(Deogiri), Aurangabad District, Maharashtra
Started in 1975
2.
Coverage 2,300 population
3.
Activities
7.
a.
Programmes include: community health
(preventive medicines, medical care,
re.ferral services, health education)
b.
Demonstration Home:
(community kittihen,
domestic management, :family planning,
nutrition education) ,
c.
Community Commons
animal farm)
d.
Community Education (Pre-school, infant care,
functional education, in-field training)
e.
Service Training:
trade skills)
f.
Rural Housing, village construction, community
industry, community agriculture, irrigation
(vegetable gardens,
(technical, rural management,
Sponsorship & Funds.
This is a pilot (experimental)
- project undertaken by the. Institute of Cultural
Affairs (ICA) with the support of the state govern
ment.
This is an effort of cooperation between the
ICA and the local community. .The basic, aim of this
project is to improve the. quality of rural life and
to strengthen the socio-economic condition of the
rural poor.
This experiment envisages an integrated
approach towards rural agriculture, industry,
education, health, sanitation, etc.
Mr Vinod Parekh/Mr W.J. Patterson
11.
Contact.
12.
Reference. WIO, UNICEF Note
Not e:
No information available on items 4, 5, 6, 8, 9 & 10
- !C>
No. 1005
Health
Maharashtra
x Kasturba Health Society, Sewagram, Wardha 442102
1.
Started in 1964
2.
Coverage. Wardha C.D. block
3.
Activities.
7.
.
_
a.
Kasturba Hospital, Sewagram, with 372 beds.
The OPD . is run by the Department of Social .
and Preventive Medicine (PSM) in collaboration
with those of Medicine and Paediatrics.
b.
Rural centres visited by hospital specialists,
with weekly clinics at three and fortnightly/
monthly ones at seven others.
c.
An ayurvedic OPD
functions twice weekly at
the hospital (since 1975).
d.
Yoga and Nature Cure Centre attempts to associate
Yoga with modern medicine (since 1974).
e.
Health Insurance Scheme with active involvement
of the PSM department insures families for
Rs 25 a year and also village units.
Over
14,000 are currently insured.
f.
Need-based, rural-oriented medical training.
g.
Research projects including those on improved
health delivery systems?through school teachers
and through basic health workers.
Sponsorship/Funds. The Mahatma Gandhi.National
Memorial Trust-was the forerunner of the Society.
11.
Contact. Dr Sushila Nayar, President of the Society.
12.
Reference. Annural Report 1975-76 of the Society.
Note; No information available cn items 4, 5, 6, 8, 9, and 10.
■
OA rt.
_ f|
GAON KE KARIGAR *
AUR SCIENCE
Gaon Ke Karigar
Aur
Science
Introduction.
.. .. The last few years have witnessed a significant shift in the accent and focus of plan
ning for' social and economic development in India. This shift marks the predominance of developing the rural India—its economy, industries and the life style. By
' now it is. clearly recognised that unless the rural sector is rendered economically and
. . socially a strong and viable base, developmental planning, as hitherto, attempted will
’ only be illusive.
. Hural development then is the key to the problem of India’s development. The rural
economy in India revolves round agriculture and allied agro-based industries and a large
number of. handicrafts and trades, each with a technological base perhaps as ancient as
rural India itself. Any plan of rural development cannot be blind to this technology
base requiring- some elemental innovational changes and modernisation to yield greater
.■ productivity ,and efficiency. Equally significant is the profile of the rural craftsman and
-/..artisan suffering from poverty and low levels of education and resources.
» s-Science and technology in .India, with its, impressive record of achievements and
. "'breakthroughs in' thq'past,’ has still to make .its'.'impact felt in the rural sectors. Soienti• "fig?ah’d>^ustrial Research has been largely urban-oriented. Several reasons for this
apathy cpii^d be cited, .of winch not the least -is’tKe Scientist’s attitude tdi rural -develop-;
ment,: ge/idoes not*;-se»-'in it Challenges'sufficient to 'motivate him as he perhaps
sees ■in./ddVelpping a process -or -product for "a sophisticated
industrial
application.
There-ds ajso" thi? . virtual ■ communication ga^ between him and the rural artisan or
the craftsman jWttjtr- the J devastating..: result‘-(.that nejther'-knows'the other. But _properly
viewed, tlje y^ral/^ect^^eehndlogies^/prbbjems should' be able -to generate tre
mendous chaU'e^fr1^to^h^-scj?htists7'be it in the field^of development Of appropriate
technologies ot--1®clmoli^^ tranter tor. evenT;ech'nology.. management.’. Their problems,
though perhaps simp!®/fife bettqixtdoling, ifpp'roved materials'.reduction of drudgery,
quality or products and wastage of resources, 'contain enormous scope for applied
research calling for innovation and simplification. - ,
To bridge the existing gap between ther scientists and the rural sectors, a Workshop
on “Gaon ke Karigar aur Science”, (Village Artisans and Scientists) as first of a series
of steps in this direction, is being organised at -WardKa jointly under the auspices of
the Management Development Unit, Planning Division, Council of Scientific and
Industrial Research and the Centre of Science for Villages, Wardha. The Workshop has
the following objectives;
♦
Objectives of the Workshop
1.
Serve as a first of several contacts to come, between artisans and scientists.
2.
Enable a study of the problems faced by the village artisan.
3.
Enable the Scientists to see the artisans at work in the village in a few select
ed trades.
On the basis of the above, pinpoint areas of action:—
4.
to make further in-depth study of definite problems;
a)
b)
to suggest solutions for these through
available, or
draw
c)
up
projects
for
adoption
of
technologies
already
finding technologies to solve these problems:
Participants
The participants in the Workshop would include scientists from the national labo
ratories engaged in applied research in the following areas and artisans | craftsmen
aided by some activists|promoters in these areas:—
i)
Food Processing Industries;
ii)
Rural Civil Engineering;
iii)
Carpentry & Blacksmithy;
iv)
Leather Technology;
v)
Village Pottery;
vi)
Energy;
vii)
Habitat and Environment,
Methodology:
The Methodology in the Workshop will be intense dialogues between the participants
at work sites and in the workshop rooms. Status Report in each trade highlighting the
problems and perspectives will be introduced for discussion.
The Venue
Maganwadi, WARDHA (Maharashtra).
Duration
7th to 11th September, 1978.
Workshop Directors:
Prof A Rahman,
Chief (Planning) and Head, Centre
of the Study of Science, Technology
& Development, CSIR,
NEW DELHI
Shri Devendra Kumar,
Director,
Centre of Science for Villages
Maganwadhi, WARDHA.
Workshop Coordinators:
Shri P. N. Chowdhury
Scientist & Coordinator
Management Development Unit,
Planning Division, CSIR,
NEW DELHI
Shri M. A. Sathianathan,
Centre of Science for Villages
Magan Sangrahalaya
WARDHA
Management Development Unit, Planning Division, CSIR, NEW DELHI.
The Planning Division in CSIR is engage-.' in intensive studies in the fields of Science
Policy and Science-Management to generate well-defined concepts and techniques con
sistent with socio-economic goals of R&D in India. The Management Development Unit
of the Division is devoted to instil a spirit of Scientific Management of R&D and de
velop the professional skills of R&D Managers. The programmes so far organised in
clude Orientation programmes on Science and Society (for Central Schools Organi
sation) Workshops and Training Courses in specific aspects of R&D Managemen
Administrative ' Management,
Materials Management and Financial Management.
The Unit also undertakes consultancy assignments in R&D Administration and
Management.
Centre of Science for Villages, WARDHA.
Centre of Science for Villages, Magan Sangrahalaya,
Wardha,
founded
by
Mahatma Gandhi in 1937 work for the fulfilment of the Sutra’ Science-|-Spirituality=
Sarvcdaya (Welfare of all). The Centre is involved in the constructive work of taldng
the new technology to villages. To facilitate this ambitious scheme the Centre collects
scientific and technical information and dis-seminate it to village artisans and craftsmen
after suitably processing it. The Centre also arranges the demonstration of various
experiments which have been tested and found to be fruitful. It organises Workshops
and Seminars on the subjects of vital interest to the rural development. One such
seminar was conducted on Solar Energy. A scheme to improve sanitation to do away
with manual scavenging of night soil was undertaken by the Centre at Wardha.
New)Age Printing Press, Rani Jhansi Road, New Delhi-110055.
MA&AN SANGRAH A*_AYA
A NATIONAL MUSEUM OF RURAL TECHNIQUES
Mrt Kft fZA s HTKft - ll
an historical perspective on the
OCCASION OF THE INAUGURATION OF
THE 40TH ANNIVERSARY ON 30-XII-1978
BY THE PRIME MINISTER SHRI MORARJI DESAI
Centre of Science for Villages,
Magan Sangrahalaya, Wardha, 442001
FORTY
YEARS
OF
M A G A N SANGRAHALAYA
Gandhiji, after his experience in three Continents—
Asia, Europe and Africa—came to the conclusion that it
is through low capital, labour-intensive, decentralized
industries—that we could produce a self-reliant and
regionally inter-dependent society as would bring a com
parative and peaceful world into being.
THE NUCLEUS
He did not stop
at theorising but began putting these principles to which
he was inspired by the traditions of his country and
which were endorsed by Ruskin and Tolstoy. He put
them into practice by starting the Phoenix Ashram (1904),
Tolstoy Farm (1910), Sabarmati Ashram (1915), Maganwadi (1934) and Sevagram (1936).
*
The birth of an Institution
After his departure from Sabarmati in Ahmedabad in
1930 he settled at Maganwadi in Wardha in 1930. This
Ashram he named after Maganlal Gandhi, his close associ
ate who had been his right hand in all the earlier three
Ashrams but who had suddenly died while working, at
his behest, in Bihar in 1928. This fourth institution of
Gandhiji was dedicated to the cause of rural industries.
The All India Village Industries Association was founded
by a resolution of the All India Congress Committee on
26th October 1934 with Mahatma Gandhi as its President
and J.C. Kumarappa as its organiser and Secretary. The
objectives of the A I V I A said:
“The object of the Association shall be village reorga
nisation and reconstruction, including the revival,
encouragement and improvement of village industries,
and the moral and physical advancement of the
villager of India. For the due fulfilment of its object,
the Association shall raise funds to carry on research
work, publish literature, organise propaganda, esta
blish agencies, devise measures, for the improvement
of village tools, and do everything that may be
necessary for the furtherance of its object”.
2
<T>
At Maganwadi a quandrng*-of rural crafts was desi
gned wih a gate which had a farmer and his wife as the
two pillars and the bullocks were indicated on the upper
arch. The village industries sections therein were divided
into—
(a)
food—paddy husking, cereal grinding, oil pressing
palm-gur and bee keeping,
(b)
cloth—spinning and weaving,
(c)
shelter—pottery
(d)
Other needs—soap making, paper making etc.
Along with this was a training centre called Gram
Sevak Vidyalaya where rural social workers from al lover
the country came to learn the rural techniques and
Gandhian economics.
There was a laboratory at the centre of this industry
quadrangle (called Udyog Bhawan) which tried to help
the various industry departments in their experimentations
and innovations and it used eto keep in touch with other
technical laboratories which biped in this work. Gandhij'i
had also made an advise*
committee of A I V I A which
consisted of many scientists.
The members were: Rabin-
dra Nath Tagore, Sir J.B. Bose, Sir P.C. Ray, Sir C.V.
Raman, Prof. San Higginbottom, Major-General Sir
Robert McCarrison, Dr. Purshottam Patel, Shri V. Patel
Dr. B.C. Roy, Dr. S. Subbarao, Dr. M.A. Ansari, Dr.
Rajabally Dr. Jivraj Mehta, Sir G.D. Birla, Jamal Moha
med Sahib and Shri Ramdas Pantulu, and Sri S. Pochkha-
nawalla.
40 Years Back
On the 30th December 1938, Gandhiji inaugurated the
Udyog Bhawan the museum of rural technology which
was called Magan Sangrahalaya and made the following
remarks on the occasion:
“Critics may perhaps ask how these old implements
and processes of production could usher in Swaraj?
These Village Industries already existed in India
before. Will they be able to hold their own against
1
the Western Industrial competition?
Will these indus
tries be able to attain that standard of perfection
which the Western countries have attained on account
of their latest scientific inventions and engineering 1
.feats? My reply is that these industries no doubt
existed before, but people were not aware of their
talent potentialities and awakened masses had never
utilised them as the means of gaining independence. I
admit that on account of the uniform pattern of
current economics taught to our students in the colle
ges and accepted by the public at large resuscitation.
of Khadi and Village Industries may appear to them
as reverting to medieval times.
But I wish all of you
enter this Udyog Bhawan leaving behind all these
ideas ingrained in your brains. I wish you do not
consider this Sangrahalaya as window-dressing for
toys, but a living book of self-education”.
5
e
This Sangrahalaya (Museum) stands on 2.3 acres of
land in a building of 10,000 sq. ft. floor area and has two
.wings—one of Khadi showing various raw materials,
tools and finished goods used in handspun and woven
textile and the second displays similar facts about other
village industries as were being practised in the Udyog
Bhawan.
Gandhiji visited the museum last in 1944 after his
release from the prison after the ‘Quit India movement’.
At that time he observed that the museum should not be a
static picture of the techniques which can improve the vill
age life but should be a dynamic window on evolving techni
ques in rural industrialisation and thus be ever changing all
the time.
He wanted it to be a centre of education for the
common man to impart information on new modes of pro
duction which could help the poor of the land.
6
o
Changing patterns with time
This museum was a part of the All India Village-
Industries Association in the 40’s.
When Sarva Seva
Sangh was created.as an amalgum of the Gandhian Insti
tutions, the Magan Sangrahalaya came under charge in
the 50’s. Unfortunately for some reason or the other the
museum remained inactive and closed during most part of
the 60’s. It was handed over to a successor institutioncreated by the Sarva Sewa Sangh for the purpose, and is.
being looked after in the 70’s by the Magan.Sangrahalay®
Samiti.
In a way the All India Village Industries Association-
which had emerged with the Serva Sewa Sangh, was dis
banded after its various activities were handed over to
the Khadi & Village Industries Commission, created by
an Act of the Government of India. The Gramodyog
7
Bhawan in which various village industries were situated
became part of the Central Research Laboratory of the
K.VIC and after some years, this section which was enga
ged in the productioncum-training-cum-research activi
ties became a purely experimental and research depart
ment.
The Training School for the Gram Sevak Vidyalayd
which attracted people from all the States of the country
and helped to bring out a cadre of rural social workers
with nation-wide perspective and deep commitments to
Gandhian values also came to an end as the K.VIC with
its various training programmes in the respective village
industries centres in the country expanded.
The integrated view of things which AIVIA and
the Sarva Sewa Sangh had aimed at was lost in the pro
cess. Now therefore when we observe the 40th Anniver
sary of Maganwadi and Magan Sangrahalaya we are
trying to see how we can resurrect and reconstruct the
spirit in which the Institution was conceived by the father
of the nation.
8
0
Presently the Museum attracts about 40,000 visitors
■every year. One of its attractions is the mud and bamboo
hut in which Kumarappa used to live, (next .to the
Museum,) providing inspiration and guidance for
austerity, simplicity and idealism.
The coming decade:
On 30.12.78 we enter the fifth decade of this Institu
tion.
This decade is a crucial one both from
the point of view of India as well as the world. There
has fortunately been a new awareness on the part of the
scientists, technologists, economists, sociologists and ex
perts in other disciplines all over the country towards
Gandhian values.
This is a result of the complexities and
problems born due to centralization of industries overconsumption of natural resources and imbalances created
in the ecological fields as well as of undue stresses on psy
chological, social and political systems. Magan Sangra-
halaya, therefore, stands committed to try to find out
solutions in these through its exhibits and other activities.
The following plan therefore is being pieced together for
the future.
9
More and Newer Village Industries:
The villages of India require greater and more kinds
of new occupations to keep the people occupied all the
(1)
year round and produce wealth. For tnis along with
agriculture, dairying and allied activities, the traditional
food processes and other village Industries have got to be
brought back on sound foundation. However, this alone
will not be able to bring village life to its fullness. We
will have to hunt out many new kinds of industries and
professions part-time, seasonal and whole time, which will
•arrest the erosion of talented people from villages to the
cities and give succour to those who are partly or wholly
unemployed.
The inputs of science and technology
should be invited to help in this regard and the number
of industries which had so far been included in the sche
dule of village industries should increase and multiply
with time. The museum, therefore,' would try to have
more panels to include new industries which are progressi
vely made available for being taken to the villages Tibs.
10
will. require more space than what it lias at present. It is •
therefore suggested that the building be extended vertically
by having a second storey added as was envisaged in the '
original plan and horizontally by having two verandhas
outside the two wings.
(2)
Practical Demonstration
The time has come when we ought to have, Wardha,
the place which Gandhiji had made his own, present a"
glimpse of his dreams in regard to village industries. Far
this purpose the various techniques and economic propo
sitions for improvement of the poor in the villages as
shown in the museum, ought to be available as practically
playing in the villages round about. We have, therefore .
selected 30-40 villages within the radius of 5 miles from
the town where in each of them a different kind of indus-;
try or technique could be demonstrated. For example
Paunar could be a place where self-sufficiency in Khadi’
of
handspinning
could
be
brought
about
village Warud midway betwee Paunar and
Tile
Sevagram
could be a place where sanitation programmes could be
shown in broad relief. Another village could show hand
made paper made from agricultural fibrous wastes likep'antain stems. A village will show bio-gas plants
covering the needs of large section of the community
both for fuel and manure.'The wind-mill, utilization of
of non-edible oil seeds, self-sufficiency in food oils etc.
are instances of the old and new techniques to be de
monstrated in respective villages. The people who will
come to Wardha will get information and statistics about
the industry at the Magan Sangrahalaya proper and will
be able to closely examine the practical feasibility of the
industry they are interested in by going to the proper
village where the same is being plied. The agencies which
are sponsoring the respective techniques, like the KVIC,
the various laboratories of the CSIR and other such
bodies in India and other parts of the world are expected
to come forward for giving financial assistance and tech
nical guidance to instal their technique in a particular
village. They will bear the nonrecurring expenses of
installation as well as the recurring expenses of initial
running for the first three ^rs by which time the tech
niques will form part of the village economy. This nurs
ery of new rural technologies will be run on economic
lines under the aegis of Magan Sangrahalaya and its
Centre of Science for villages.
(3)
Centre of Science for Villages :
This wing of the Magan Sangrahalaya has been crea
ted to find out from various sources where technology
takes shape in the CSIR laboratories and other scientific
and technoogical specialist bodies in the country as well as
techniques that may be available with institutions work
ing for appropriate technology for the Third World in
the affluent countries. These techniques are to be studied
from the point of view of their utility in the villages
which fall under three categories - the small (500 popula
tion) the medium (5000) and the big (15,000 to 20,000).
Experiments are to be done for the adoption of these tec
hniques for the welfare of weaker sections of the villages
by converting them into rural occupations or trades.
CSV will keep in touc’^ with the Institutions working
(T)
for the villages of the country and help them find out a
linkage with the technological world. The new industries
for the villages created by the efforts of the CSV could
form the basis of added industries under the schedule of
Khadi & Village Industries Commission and thus the
CSV could be a path-finder for bringing new trades and
occupations in our villages. It shall strive to find out eco
nomic means which will bridge the gulf between the poor
and the rich in the villages and the rural and urban eco
nomies.
A multi-disciplinary team of scientists along with an
infrastructure is to be created for CSV. It will also have
adocumentation and dissemination cell. A beginning has
been made by undertaking a set of projects concerning
transference of new techniques in each village with the
assistance of Department of Science and Technology,
14
&
t'
Government of India. Various CSIR laboratories and the
Planning wing of the CSIR is cooperating with the CSV
in what could be said as the task of laying conduits bet
ween thresholds of the laboratories and the doors of
mud-huts.
4. Training in New Techninqes :
Magan Sangrahalaya in conjunction with Sewagram
Ashram Pratisthan and Maharogi Seva Samiti of wardha
has already undertaken various training programmes for
imparting knowledge and skills in new techniques. There
has also been a workshop organised by the CSIR and
the CSV at Sevagram on ‘Gaon Ke Karigar Aur Science’,
from the 7th to 11th of September this year, where , it
was discussed that a permanent training centre be evol
ved at Sevagram which could be used by the. laboratories
of the country for imparting training in new techniques
of such rural applications to agencies which are working
in the developmental field of rural India. The facility of
training rural social workers in appropriate technology
and a continuation of the Vidyalaya activity which was
going on during Gandhiji’s' time is a felt need
15
$
Conclusion:
The next decade of the work of Magan Sangrahalaya-.
which was started by Gandhiji forty years back could flo
wer with a well integrated programme of development
of the various facets of rural life. The above plan of'
making the Magan Sangrahalaya contribute to this is ex
pected to be implemented with the help of various cons
tructive work institutions in Wardha and the educationnal, social and governmental organisations engaged in the
developmental work. In short, the decade of development
of Magan Sangrahalaya which is being inaugurated by the
Prime Minister, Shri Morarjibhai Desai on the occasion
of the 40th anniversary of the museum envisages develop
ing : (i) expansion of the museum building, (ii) extension
of its activities in the villages around to exhibit in thefield what is displayed in its windows, (iii) experimenta
tion in new industries based on new techniques evolved in
and technological laboratories, (iv) Education in new tech
niques to the voluntary bodies working in the villages.
16
CENTRE &F 5QIEJNCE FOB VILLAGES
To the Scientist of India
“I would like you to be men, who stand up before-the world
firm in your convictions. Let your zeal for the dumb millions
be not' stifled in the search for wealth. I tell you, you can
devise a far greater wireless instrument which does not
require external research but internal—and all research will
be useless. if it is not'allied to internal research—which can
link your hearts with those of the millions. Unless all the '
discoveries that you make have the welfare of the poor as.
the end in 'view, all your uforksflijps will be really no better
than Sataws workshops.”
Gandhi
13.7.27
“What have we to do if we are to settle India in this scientific
age ? First, we have to resolve to decide all social problems
■ by non-violent• means. Secondly, science should be utilised
for producing ■ instruments that would stfrve man and not
armaments that would kill, Thirdly, the prevailing sitution
alone should decide whether science should be ordered to
produce big machines or small one*. If we keep these axioms
in mind,, we can derive . immense benefit from science. Let
the growth of science be steady and unimpeded, this is my.
' desire.”
Vinoba Bliave
Printed at Maharashtra Printers, Wardin
€
STRATEGY:
In 1935, when Gandhi started the All India Village
Industries Association (AIVIA), he had invited the top scien
tist of the day to be on its Advisory . Committee, including
Dr. Jagdish Chandra Bose, Sir C. V..Raman, Ach^rya Prafulla
Chandra Ray and others. The experiments in village industries,
he got initiated, were meant not only to improve the existing
crafts in the rural dreas, but also to introduce new techniques
on the basis of the latest scientific knowledge, which would
improve rural economy. True, efforts-so far, fall far short of the
expectations of.Gandhi, of converting the rural habitat
into
an ideal setting which could afford man the fullest expre
ssion to his being in close communion with fellow human
beings pn one hand and
Mother Nature on the other. Yet as
we look to the results of rural' developmental work done by
voluntary agencies under Gandhi's inspiration for the past 50
years we find that there is great impact leading to the. forma
tion of 1500-2000 dedicated
people in small groups working
independently and are covering a large number of villages.
The field of their activities is varied eig.
Khadi and Village
industries . welfare of tribals, removal of untouchablity, basic
education, agriculture-and cow protection (Goseva), welfare
of woman and children etc. This is nd mean achivement
in a country where, the gulf dividing urban elite and the village
people is probably the widest, the communication between
the elite class and the masses is wefak; • and the understanding
of the
realities of., the villages by
the decision
makers
is poor. Through,these institutions, the application of science
and technology, has to b.e done to meet the requirements of
the poorest and to pursue the unfulfilled dream of Gandhi.
The Line of Approach:
,T
' '
The procedure to be adopted for this endeavour, will
,
have to take the experience of the
past
into consideration
and lay down the future plan of . action, in .which all the
available^ resources are utilized in such way that the lower ■.
most-will be benefited.
The following points could act as guidelines in this:
The kind of techiniques which we pick up for the
a)
villages should . be. such as to touch the life of'the poorer
'i sections of the peqple..and bring.hope.to the oppressed.
■ These techniques should increase the avenues in'
b)
' rural employment, prevent the erosion
of talents from the.
villages and enrich the life of the total community.
All institutions engaged in rural work/ along with
c)
their usual
activities, should
undertake the responsibility
of
introducing some appropriate techniques in their field. This-
activity of transfer of technology for the ,beneifit of the poor
will give' ready results, and it will also brirtg confidence in the
fulfillment of the long range,plans that are being implemented
by the institutions.
d)
.
1
In introducing new methods,
it is. necessary that
the. technological institutions and the scientists
assist the
voluntary organisations doing constructive work, adding to the
efficient functioning of the project, this will give an opportunity
for
interaction
between
the
scientists and
the
social
.
workers.
Mobilizing the Three Forces:
The . need
of
the day is-to bring about a forceful
movement by establishing co-operation between the voluntary
5
organisations, the scientific institutions'and • the industries’* for
the benefit of^the^Iess fortunate section of the society. India
possesses the ^largest group of technologically trained people
in the world.
The result of their scientific work, however,-is
unable to bring ready benefits to the large number of people
living in the villages, as it is mostly urban oriented leading
to greater economic stratification of the society;
The
‘other great force that
can faring about rural’
development is that of the industries in the country. The
industrial sector - should not only look for increasing product-
tion, but also
be responsible for the welfare of the weakest,
and removal of disparity in this land.
.
The Next Step -.
All these.three forces, the agencies doing constructive
work, the technological Institutions and the industries, require
the establishment of bilateral links and need a source from
where information abqut the applicable techniques'can be
obtained. To facilitate such co-ordination, the following are
Being undertaken by the CSV.
a)
T
Documentation and Dissemination:
To collect and disseminate all such information from
the technological institutions and other agencies in India, and
abroad which will .fit io with the objective laid down above.
b)
Demobstration and Experimentation :
Such of the experiments which have' been tested and
'■ found to be fruitful, should be demonstrated at the-centre.
6
c)
Field Application:
In this work7 -the various voluntary agencies working
in rural areas will be approached and through
them the
techniques which need to be perfected at the field level 1. e, in
’ the villages,, will be tried before making them available to the”
nation. Each
institution could choose a few techniques and
experiment them in one or more key villages so that small
> villages around, them can observe a particular technique that
are being introduced, thereby
motivate people
to apply the
i observed technique.
Co-ordination in this endeavour.
d)
The three kinds of institutions mentioned earlier could
associate
themselves in a co-ordinated
movement.
This
general plan is expected to lead to a cohesion amongst various
agencies involved in the constructive workj-'taking the new
technology to' villages. Thi^is, no doubt a very, ambitious
scheme and requires a tremendous amount of labour. But, the
optimism is that if once the people concerned, catch the idqa,
beneficial results will flow out of it itj a short period of jime
and will spur the nation towards the required direction.
The
Centre
of
Science for
villages
at
Magan
Sangrahalaya, the museum for rural industries founded by
‘Mahatma Gandhi in 1937 at Maganwadi, Wardha, will work
for the fulfilment of the Sutra (Formula) of—
,
Science + Spirituality = Sarvodaya (Welfare of all)
IMPLEMENTATION:
•
Centre of Science . for villages (CSV)
the approach
on the basis of
initiated above, which was approved-and co
signed by Acharya Vinobo Bhave,.took.its first step in 1977.
•
7
CSV puts before you the work it-has done for the past one ■ ’
'
■
year. InitialJy the centre started with the collection of relavent
information regarding the application of scientific techniques to
the rural areas, from various sources, and published it in a
'
.form of booklet. Then to post all the new techniques to those
who are interested in rural development, CSV brings out a '
bulletin called "Science for Villages".
Along with gathering and dissemination of ' information,
demonstration of the applicable
low cost
house
was
techniques'was taken up. A
constructed
at the centre, with
the
technical know-how and assistance of the* Building Research
Institute, Roorkee. This model house is
designed to suit the
•
■'
'
,
black cotton soils found in Wardha. In collaboration with
Appropriate Technological
organised a workshop
Development
Association,
■
CSV ■
collected-some .
Energy and
on Solar
■
solar heatersand fabricated 'Some cookers, which are being
tested and exhibited.
.
.
•
,
'
,
■o
CSV. took up a scheme to improv# sanitation and to
do away with manual scavan’ging of night soil,in some areas
of .Wardha,
where large ‘number
.
of. poor 'people live. The
d «'
0^5
tr « ®
scheme is to provide simple' lavatories and train masonsjn
-. §
n u*„.
. building aerobic manure tanks. The centre was instrumental in
getting Wardha selected as one of the twenty districts in India,
for a project of Integrated Rural Development. CSV emphasized
>. o
*•
rg .
<
the need for introduction of new employment avenues for the
landless and planned two schemes, (i) hand made paper units
from the fibres\of banana stems, whi.cfi go aWaste, and - (ii)
5 £
improvement of work shops of the village black smiths,-which
'
is going to - be taken up soon. In Varud village the mud walls
<?f some of the houses were coated with
gaurd them against erosion, ball
introduced,
soakpits
and
Bitumen spray to
bearing pulleys on wells were
lavatories
were
put
up
for
° ~
' 1 |
8
environmental cleanliness. A dozen villages were chosen around .
Seldoh, where late J. C.\Kumarappa had worked, for the
introduction of techniques Vvith the association' of Leprosy
Relief Institution, Dattapur.i Here intensive work is proposed
to be taken up. For-this CSV is ma'king a project report on a
prototype
st^tidn,
for
rural
techniques
and
this
will be
submitted to the Department pfr.Science and Technology,
Government of India, fpr financial assistance.
■ Links have been established with the Central Research
Laboratory of Khadi and Village Industries Commission, Whicti
is .adjacent to CSV, since the director of the centre, has been
asked to act as the Honorary Advisor of the laboratory. The
Centre has an advisory board of eminent persons viz,—
M. S. Swaniinathan, A Ramachandran, Y. Nayudamma,
D. S. Kothari,
C. Gopalan,
J. P. Naik,-
Radhakrishna,
Ramlal Parikh, C.V. S-. Ratnam. N. M. Swani, M.S. Sodha,
A. P. Verma and.V G. Bhide.
,
Courtesy—Madhaya Pradesh Sevak Sangh.
No. 1009
Health
Maharashtra
Sirur, Poona District, Maharashtra
7$ J
A-.* 6
1.
Started in 1939
2.
Coverage Nearly 37,000 pppulation (19 villages
spread over 663 sq kins)
3.
Activities
4.
Personnel & Training.
Providesccomprehensive health
care services, including referral. Undertakes
training courses for medical interns,. post-graduate
students, B.Sc Nursing, Nurse Midwives and other
special groups. -Provides MCH services, nutrition/
health education/family planning, immunisation and
.control of communicable diseases; undertakes research
and evaluation, environmental sanitation and water
supply (construction of latrines, soak-pits, etc),
and arranges health exhibitions.
11.
Contact.
-12.
Reference.
Rural Health Services and Training
Dr N.S. Deodhar, Joint Director*
Health Services
Poona
wJo, UNICEF Note
No information available on items 5, 6
8, 9 & 10.
-n
No.1010
Rural Dev.
Maharashtra
'
Uruli Devachi
1.
Started in 1973
Activities?
a)
An integrated Socio-economic and educational
programme for landless labourers including
training in? 1) human management and family
budget; 2) child care; 3) health hygiene and
cleanliness; 4) retention of literacy; 5) co
operative activities and village admin. istration; 6) trade union activities; and
; 7) leadership development. Craft training
and family planning/population education is
also given. Government of Maharashtra will
help create some projects in the vicinity
under the employment guarantee scheme.
b)
A Balwadi which, however, has to b<= fully
crystalised.
4.
Personnel & Training.
Government of Maharashtra
collaborates on technical aspects such as
training on specific subjects.
7.
Sponsorship & Funds. Asian Trade Union College
(ATUC); the International Cofederation of Free
Trade Unions (ICFTU); ILO & UNFPA are co-sponsors.
11
Contacts. Mr Virendra Kabra, Director, ICFTU,
ATUC, B—26 Green Part Extension;
Mr Ashok Tupe,
Working President Shajeevan Audhyogik Sahakari
Society Ltd. Bade Satra Nali, Hadpsar, Poona - 28.
12.
Reference?
Note;
No information available on items 2, 5, 6, 8, 9 and
10.
WHO, UNICEF
M- M-
MfiSAHOGI
SBHA
3AMITI
The J-faharcgi Geva Ganiti was established in 1936 at Dattapur
442001, District T.7ardha,
Irkamshtra
for the purpose of the treat
ment and rehabilitation of leprosy patients.
It was registered as a
Society in 1939, and as a Trust in 1950,
Objectives :
Objectives of the Sasniti as given in its Constitution are
the following ssteps to combat leprosy;
1.
To
2.
To establish and conduct clinics, hospitals, leprosia,
take all possible
agro-industrial training centres, rehabilitation colonies,
educational cen-tres, and other activities as may be found.
useful in the service of leprosy patients.
3.
To run small scale industries, cottage and village indus
tries including production and sale of khadi.
Programmes:
Lepro;y control and treatment is the main programme which
is conducted in the institution’s out-door and indoor clinics. About
1,000 out-door and 650 indoor patients are under treatment.
are from 20 villages around the institution.
They
Agriculture, livestock,
village and cottage industries, dducation and training including
family welfere programmes are organised for the patients.
Workers :
The
tary workers.
institution has 38 fulltime paid workers ard 3 volun
10 THE-INDIAN EXPRESS Thursday Nov. 16 1978
•
j!
J!
° *^n-India panel Wild spe.
Top prioiity for furm sector in onj’°^reserva^()n absence o
for backwards
economic policy proposed
rp
»j_
UJJAIN, Nov. 15
PATNA, Nov. 15 (UNI)
porters were noticeably absent fro
.WARSI NAGAR. Nov 15 (UNI)
of the stockist, be hi a farmer of farm products, specially fruits Union Minister of State for the opening day s proceedings
Union Minister of State for or a trader’’.
and xenetables. ,
..
.,
Home Dhanik Lal Mandal announ- the Janata leaders’ national can
‘•Agriculture Bhanu Pratao Singh
T
nw nf
Participating lr
-----in the discussion
Ced today that the Centre had here yesterday
To facilitate the take-over
of
OfS a* svs’en^and stocks
stocks in
in case
policy
considers).
policy at
at the
the constituted
constituted Van\ll-India'
an all-India ’*committee
committee “Vhls V*is”‘~ causing
case of
of ne€d
need,- ifc
it should
should on the economicc
'nrovidon
en.ioined upon
all stockists,
sever*1 m.mbers criticised |0 g0 lnto the question of job re- speculation about Mr. Charan Sinj
be enjoined
stockists.
•^o-Pgrmcrs
Including agricultural
producers
and Mr. Raj Na rams future pla
including
agricultural
DioducerS. the Government for its failure to servMton for backward classes.
flonrKh in’the ramm that
tba' anv
anv stock
stock above
100 quin
au»i- evolve a. viable
abre policy
” to govern
eovern Talking to reporters here Mr. with some delegates speculatng th
above 100
the
prices
of
cash
crops,
as
a
“InTnoWJU1’6 «-• tals should be kent
^h^Xon's
-ut'^rwhi^h
^erX
’
d
teen
“
ee
“
‘
SeadS*
"
’
”
five-member the BLD group migitt be tninki*
only in lic
of which farmers had been
enced
godowns.
The conditions result
tTdanai
UcenX
’^ould^however!
”&V°re^^
of licensing should, however, be made to suffer recurring losses.
Janaia MP,
They regrstted that the farmJanata
all-over t.
'T S‘mDle\
.....
... ers
?rs growing
growing' sugarcane.
sugarcane.
cotton. VAOr
-m- leaders
- thefrom
cotton.
country
and
complexion of t
failure in
To prevent distress sales bv jUte and other cash crops had to mittee
: are Mr. Diwan Mohan Lal audience
*VdienSe«at
a the camp was som
‘aDDlyine the principle of parity small farmers,
*«**^.w. cooperativ? ware- bear losses in return for increased
what different from that of t
(Rajasthan),
Mr.
R.
R.
Bhole,
Jbti determining agricultural
Drices, houses should
-ral LiiCL.--.
be established at productionparticipants at the Inaugural coi
trend continued.
they *,2®^ Judfe.
‘J?
improving the terms of
>f trade in all “vikas kendras”
where anv “*ir“ this “/ vention n-f the party held in De.favour of the rural
Uw—* and
— farmer can vdeliver l.L
sector
J— aonrehended.
his —
nroduce.
there might be
cour1, and Mr. M. N. Srl-- of agri—.• andj get paid
promptly
.bringing down the Driers
at the shart> decline in the
outnut of
« sociologist. One member There are few?» deiegates repi*
these commodities nutting severe''as>’et to be named.
cultural inputsrate of support priceenting landowning peasants.
As regards the terms of trade
should strains on the economy.
,M1• Mandal said the terms of
ib
15 ceruua
It is
certain that Mr. Chara
Later on. the farmer
-------between the rural and urban sec have the option to tak? out his
However, the running theme of reletence of the
committee were gntgh and' Mr.
“
Raj Narain wi
tors. he pointed out.
there has stock and sell it in the open mar- the
discussion was
fix ll}e oriterla for defiiiing
soci- nct turn up d ;
uie discussion
was the
wie indifter—£
been a further tilt against the ket at a higher price,
ice.’ after re- ence of the party Governments— allyV and educationally kbackward ^ays
rural sector during the past 13 oaring tfie advancs with interest both at the Centre and in States classes, ln„exam
examine
desirability
.1nne. hdeslra
?Ut:' of
°{ Considerable significance is bein
..
_
4.1,,
IvU
TPSArvaT.inn
in
inhc
and
eticro-oct.
months.
and storage charges. However, if ~ to
promises pertaining to resen anon
in jobs and suggest
The eight point new marketing the onen market prices rise above economic matters made in the steps foi then advancement.
'fcvstem recommended bv Mr. Singh th®1 “intervention” price the Gov- election manifesto.
In this con- ^ne committee would also exa-favours, among
other things. ernment
- - ' ‘ will ----whether or not adequate
have the right to text, they also referred to the mine
treating the entire country as one oroenre the stocks at the "nai-ity" infighting °***ter
leaders.
representation
was given to these
among ton leaders.
food zone and removal of restric
thpv wanted the classes in Central and State Go
Obviously.
tions on the free movement of Drice.
to elo<?> their rank vernment jobs. It might reexamine
iu arrive at ure uantv unce,
foodgrains.
-e °oveiS^
recommendations
of Kaka
1970-71 should be treated as the and take to the
5'ublic
“"a little
bit more Kaletkar commission "in the light
T”«j“affai?s tha
imoort of foodgrains and other base year. Mr. Singh sayseriously.lest
people got totally
practical
considerations which
farm products except io meet ex
He further savs that the new disillusioned and began
to look have stoo'1„ 111 the wa? °J. acce°~
treme scarcitv conditions.
marketing system will have also fOr other political
alternatives, tance of the recommendations by
PANAJI, Nov. 15
Having determined the “parity” to be protected from the vagaries Jn fact the Dr0Cess had already
Government.”
Prime Minister
Morarji Des
Price of important farm produ °f any unbalanced foreign trade, begun, some of them feared.
Mr. Mandal said with the con- declared here today that the Chik
cts. the Government should make
m another paper.
Mr
The participants were concern- stieution of the committee the magaiur election rejiUll/
result UJCS
does ni
n<
it known that it would not
inter
... .... sneaks of India's potential to be- ed about lhe lack of coordination central Government had lulfiUed make m'ita of diff’rence as i
vene in the foodgrain trade, rc C^e on’ Of.'he
-between the organisational
and the promise of
appointing three ”X“Xl proceed'agaim
Election i
save Indir
Express News Service
long as the trade operated within
governmental wings.
Some Qf commissions or committees for the Mrs. Indira
v..-----------—
Gandhi
for the enter
them favoured
an- institutional minorities.
scheduled cas-.es and gency excesses are concerned.
the parity price
which should
arrangement to bring about bet- tribes and backward classes.
He told a news conference, “if
respectively be called
“support”
ter coordination between the two.
and “intervention” prices.
The Government’s
failure to The Minister parried most of the murderer gets elected tomorro
communicate with the people on questions regarding the impact of that does not wipe out his crime.
The new marketing system enthe new job Mrs. Gandhi’s election to the Lo
various vital issues also came inthe committee on
visaces that when
the market
JAMMU, Nov. 15 <UNI)
by Sabha will “not save her” froi
for frequent criticismAnother reserva.ion scheme
--------- announced
—price fall below the
‘ support”
Seven
policemen were injured
ne party
Daixv ’s& the Bihar Government.
Jovernmer.t.
He said the proceedings launched again*
price the government will make when 20 undertrails being taken subject of attack was the
its
orga- the SUof
State
Government *was free to her, he asserted.
-----------* «™rnnwm-.
purchases directly from the far in a bus from the courts to the failure to strengthen
Asked about the infighting in h
take
its
own
decision.
mers.
nisational network.
central
jail,
attacked
them
with
own party, he agreed that Indi
When the market price exceeds handcuffs here today.
vidual party feelings continue
the “intervention”
price.
the
among the members of the const!
to
reports,
they
Government
will acquire at the According
tuent parties which merged t
which -----attacked
after the- head
"parity price all stocks.
which
— the
•— -police
------ form the Janata party, addin
are in excess of the family needs constable abused one of them.
that habits of many years tai'
time to go.
Cops attacked
with handcuffs
Loco staff stir
dislocates trains
I
SCI?8£yi
NOVEMBER 18, 1978
HIGHLIGHTS
2 Shatrughan Sinha explains how he came to be
called a “Show Off” and about his hard
climb up the success ladder as only he can
in exclusive chat with Anita Triloksinh in
“Star Forum.”
tt
; is about time all those screen “Sisters” in our
films raised their sweet voices in protest. For
no Writer or Director has yet thought of
giving the Sister a new look, A new life —
, Avaz pleads for screen "Sisters” in “About
our Stars, Studios”.
‘These days we are not making real films. A film
is a concoction of the Circus, Drama and the
• Nautanki” declares an Assistant Director in
“They also serve....”.
‘The Burning Train” unit overcomes unforseen
obstacles during filming in Delhi — Colourful
report.
‘The best thing about Sagar is his tongue” —
Exhilerating interview with the Director by <
rences within the party would 1
VIJAYAWADA, Nov, 15 Madras division, it. should be given Ironed out with the coming organ
The turning of goods and pas- up graciously to Madras division.’’ satlonal elections.
“Show me any democratic part
senger services excepting fast and the messagesaid and^ssured rh«
7^’'w’orid'wke«Ther~e’'a»_n
?a “tlon o locorun! 'hou^oT lose^'synwahy of he dUIerences.” he said.
“taff went0 » s°ick °l^ve“or’ Public and the authorities by disThe P^me MnnsterdUded a eoi
abstained from dutv from 8am locating the train services.
respondent, who tried to draw
today
“Obviously
whoever dislocates Parallel between MrSanjay Gandh
__n2ie_a<^lQn_J}y_thfi_j£H^_n^nlng ^He services will lose sympathy.” and ^lr. Kant£JDesaL^JIe^sajj
THE INDIAN EXPRESS. THURSDAY. NOVEMBER IB. It’S
9.<
The Dhulia movement
Hazards of organising the rural poor
by Renuka
But
then suddenly attacked by a group ners refused to negotiate.
here the workers were able
to
of rich peasants. Urey were ret
cued with great difficulty by
‘he sustain the battle for two and a,
labourers.
half months
with the help of,
The zila parishad officials, who other poor sections in the village/'.
were informed of the
incident, Finally, when the monsoon arri
organise agricultural labour, mostly
visited the village and tried to ved, the rich landowners accepted
Adivasis In Dhulia district, Mahapersuade, the landowners to reach defeat and agreed to negotiated;
“ashtra, is an eloquent example
a settlement. But the officials were settlement.
4 the difficulties and dangers that
rebuffed and challenged to take
However,, the more vicious am-.
come in the way of those who seek
whatever legal action they could. ong the landowners did not relish?
.to organise the rural poor.
The Shramlk Sangathan was a
the idea of having been forced to'.
continuation of the movement o'
come to negotiated settlement with*?
agricultural labour who had re*'
landless labourers started in
the
region by Am barsing Surantwanti.
mained submissive and meekly tolerated the indignities so far. la
a Bhajan singer of the area, who
was bona in the • family of a
the first week of August they again’
sharecropper.
In the beginning.
mounted an attack on the Adi
these young men were drawn to
vasi localities in Mode and Parwards the area because of the re
goda villages. The Adivasi labo
ports of the distressing conditions
urers fought, leaving wounded on
of the Adivasis and worked under
both sides. The fact that no harm?
the banner of
was done to a single landowners’*
property and that the incident
vodaya workers.
took place far away rren tl)$ lando..;jtrs- bash shows that the AdW
The task ol
vasis acted purely in self-defence i
vasis from ‘heir age old slumber
was not simple, nor was it easy
Violence initiated by th® rich i
to instil in them the confidence
has been a constant threat which
that bv organising themselves they
the Adivasis have had to face. ’
could bring about a change in their
In fact, the beginning of the ef- •
living conditions.
The fight for
fort to oiganise the rural poor in1.
e.eono/nic emancipation had to be
this region is linked with what is t
combined with the struggle
tar
known as the Patalwadi incident.1'
liberation
against
superstition,
In the 1971 famine in Mahara
taboos and
various addictions
shtra, the Adivasis of Patalwadi,.
which sapped their energy and
village went to the .biggest land
confidence.
lord of the village to ask for
The rich landlords in the area
grain. The landlord gave them 4
were quick to organise themselves
kilo each but on their way back
so that
they could
effectively
they were held by policemen ac
counter the efforts of these youth.
companied by the landlord who
A cooperative sugar factory which
accused them of having looted his
had been established on the plea
granary, when the police refused
of the development of Adivasis
to follow the landlord’s dictates
was converted into a centre for .ditions too Inconvenient withdrew. this trend, organised attacks on The labourers had no recourse but and open fire, the landlord and
hatching conspiracies against the
During the pr-’ two years, the agricultural workers in the villages to go on strike. They were able his men fired on the unarmed •
poor. It was here that a scheme Shramik Sadgaiban has
to sustain the
for. -----three Adivasis, killing one and injuring •
been of Pari. Wafdha and Mod. This ■.«
.strike
...... - —
for setting up a paramilitary or trying to insure the implementa happened when the labourers of ’ weeks even though it meant se-_ many.
ganisation. ostensibly to safe tion of the Minimum Wages Act. Pari and Wardha
for them. rrb
The.‘
took out
a rious hardships
If landlord violence is one of..
guard the crops from theft but in Though the law was passed in morcha
to /the gram panchayat Shramik Sangathan succeeded in
reality to browbeat and intimidate 1974, the
agricultural labourers office and requested the sarpanch persuading ths tehsildar to opsn the facets of the difficulties in '
the Adivasis and
to discourage, received only up to Rs 2 as daily to appoint landownars’ committee public works which could
give organising the rural poor, the1
attitude of the bureaucracy $nd
them from getting organised. was wages. The Shramik Sangathan for conducting negotiations
for some emoloyment to the workers.
the
police which in most cases is
drawn up. The Shramik Sanga Crunched struggles for recovery of payment of arrears. Getting
a But before the work could begin, a
than got hold of the written docu the arrears. A large number of negative response, the
labourers •nob of 200 to 300 landowners at under the influence of the local
Interests, poses another
ment describing the whole scheme rich landowners realising
ghero?d the gram panchayat office. tacked the Adivasi basti, wounded vested
and
destroyed seious problem.
and its exposure forced the land- gality and justification of
The leaders of the labourers were 7 or 8 of them
whatever they could. Not a single
In order to preserve the energy
earthenware was left unbroken.
for the struggle against these for
This was the beginning of
a ces the Shramik Sangathan had :
reign of terror by the rich. Even also to carry on campaigns for •
though the. activists called off the, literacy against gambling, Mutka,
strike on the. specific assurance and excessive drinking.
Their
that they would not be victimised, experience has been that libe- ,
the rich landowners went back on rated them from the menacing in
their word and attacked the wor fluences of such habits, the Adi
kers’ colony again.
vasis fight much better. A sid®.
A sadhu who had shown sym effect of these campaigns
has
pathy with the labourers and had been that they have helped to
been wounded a day earlier, was mobilise women. For Instance, it •>
stabbed on both his shoulders and was the women who played
a ..
knees.
The labourers fled the leading role in a movement for
village. The Adivasis In the near the destruction of illicit local brew
by villages were warned of dire. eries and the social boycott of
consequences If they gave shelter their owners. 1
to the Sharamik Sangathan acti
The experience of the Shramik
vists.
Sangathan
in organising
the s
The police was helpless in the rural poor underlines the impor
face of this
terror campaign. tance of a multi-pronged approach . •
Not a single case was filed aga covering economic, social and cul- Kinst the landowner as the autho tural aspects of the «life of agri- r
rities were leaving enough legal cultural labour and other rural
and technical loopholes while re poor. It also reveals the urgency
gistering the complaints.
for reorientation in the approach . *
Similar incidents occurred in of the bureaucracy if the govern-, *
village of Mode when the daily merit’s commitment to encourage "
age earners and contract labou- and support the organisation of
went on strike. The landow- the rural poor is genuine.’
'J'HE experience of the Shra
mik Sangathan, an orga
nisation set up by some com
mitted young men in 1972 to
lords to abandon their plans
to demand agreed to settle the issue
through negotiation and an agree
raise the private army.
An attempt was made during ment was arrived at in man# vil
to
the emergency to introduce
the lages. But this ran counter
same campaign through the back the interests of the. leaders of the
doors. The
landlords tried
to landowning classes who feared that
replace the local watchmen of their influence will decline if the
crop protection societies with Bal practice of negotiated settle.msut
ochi Pathans brought from Guja was accepted by individual land
rat. The Adivasis offered resistance owners.
The leaders, in order to thwart
and the Pathans finding the con-
MAh ft - 2.
COMPREHENSIVE
THE
RURAL
HEALTH
PROJECT,JAMXHED.
VILLJ.GE
LEVEL
WORKER.
The Comprehensive Rural Health Project is working in 30
villages in and around Jamkhed. The aim of the Project is to
find a method of delivery of health care best suited to the needs
and resources (financial and man power) of the rural area.
The rural economy is such that it cannot sup'port the services
of a physician in every village or groups of villages, neither
are qualified physicians readily available in rural areas.
team capable of doing it satisfactorily is one of the ways of
overcoming the problems of inadequate manpower and financial
resources,
n
Three tier system of delivery of health care has been
organized. The physician is at the head of the health team. He
delegates the responsibility of rendering primary health care to
the nurse and paramedical worker (2
tier). The third tier in
this system is the village level worker, who is a member of the
community and comes in close contact with her peers and therefore
she acts as the liaison between the community and the more
educated nurso or paramedical worker.
THE VILLAGE LJV3L WORKER.
A cultural gap was found to exist between the city-educated
nurse/pararaedical worker and the illiterate rural folk. Very
often it was found that a patient after listening to the advice
of a physician or nurse, would take and follow the advice of the
illiterate watchman or sweeper of the health centre, rather than
that of the physician. This is because he identifies himself with
another illiterate person and feels closer to him rather than the
educated sophisticated nurse. Taking this attitude into considera
tion it is was felt that the best way to get into the community
and teach them to accept new methods, change attitudes was to
enlist the help of women from within the community.
It was found that a nurso staying in a village for several
months, could not convince a single woman to undergo tubectomy.
On the other hand a woman (illiterate) from the same village,
when convinced- herself w.as able to get 75 women for tubpctomy
within the sane period of time.
SANGALOdE-560 001
trained, Delegation of every task to the humblest member of the
COMMUNITY HEALTH CELL
health care is to delegate the responsibility people lesser
47/1,(S 'irsjt 'rlo o r)S t. M arks R oad
Taking this into account the project's method of delivery of
This experience led us to form the third tier of workers the
village level workers.
The village community is asked to find -women from their own
community who would be interested in joining the health care team
to help in rendering health care. Usually women with no household
resoonsibilities volunteer for such work,
PREPAxUTIOy OF THE VILLAGE LEVEL VORKER.
The women come to the health centre at Jamkhed on Saturdays
and Sundays, On these two days they are given regular classes on
various health topics by thejphysicians, nurses and paramedical x
workers. The women are mostly illiterate and therefore most of
the teaching is done with help of flash cards and charts.
The five priorities of the Project are stressed, and the
village level workers role in of them is explained. Each class
is begun with repetition of the previous weeks teaching and a
discussion of the application of their knowledge in their work
in the village.
The women are also taught the use of flash cards so that
they can use them in their promotional work.
By this method we are in the process of training 8 workers
and the experience with them is so far very encouraging.
One worker has been able to convince 200 women to take
Antenatal care and bring over 100 women for tubectomy. She is als
able to follow up patients with tuberculosis and leprosy and
encourage them to take treatment regularly from the clinic.
£
REPORT BY THS MEDICAL OFFICER, MALLUR, ABOUT HIS RECENT STUDY TOUR AT
JAMKH3D - MAHARASHTRA
iJLT_h_ojdjctjj_t_i_o_n
COMPREHENSIVE RURAL HEALTH PROJECT:
Thia project was started about 4 years back, by Dr. & Mrs Dr Arole,
at Jamkhed which is 40 miles away from AHMADNAGAR in Maharashtra State.
Both the doctors got their degree at Christian Medical College, Vellore
After their graduation they decided to go to the village to serve in the
rural areas. Dr. Arole hails from Maharashtra stats and (Mrs) Dr Arole
from Madras. They started their health project 4 years back in the
village Jamkhed. They selected an old veterinary hospital for their
clinic and worked there for 1 year. Then both of them went to U.S.A, to
get training in COMMUNITY HEALTH, and came to India after 3 years to serve the
people of rural area.
On their way buck they made some arrangements to get financial aid
from various Christian Missionaries.
When they came back to India, some local people donated some land
about 2 miles away from the village, where the present hospital exists.
They are covering 30 villages in a radius of 20 miles comprising
40,000 population. People of these villages are very poor, backward and
uncivilized. They did not have the rains for the last 4 years. We rarely
come across green fields. All tanks and rivers are practically dry. Their
main occupation ia agriculture. Dairy farming is not at all seen in those
villages. They cultivate wheat, jowhar and dhal, and very few cultivate
rice and sugar cane.
AIMS OF THE PROJECT:
Here Dr. Arole has given top priorities for the following tasks to be
undertaken in his project.
1)
T.B, Control
2)
Leprosy control
3; Antenatal care
4)
Under Five care
5)
Family Planning
Now they are also concentrating on the following activities:
1) Supply of Safe Drinking Water by providing tube wells.
2)
Blindness control
3)
To improve agriculture
o
K
0 v
£S0
STAFF
< L ”
PATTERN
1 Director
1 Assistant Director
2 Integrated Doctors (BAMS) Residential doctors
1 Nursing Superintendent
2 Social- Workers (who are graduates)
4 trained staff nurses (who posses requisite qualifications)
7 ARM’s (who are trained in Government hospitals)
4 Leprosy Technicians
1 Laboratory Technician
1 X-ray Technician (trained at CRHB)
1 Chief Accountant
4 Clarks
1 Typist
1 Statistician
3
Ayahs
3
Ward boys
Compounding done by ANM’s alternatively
5 Drivers
1 Mechanic
1 Watchman
. •
S
H
q
v
L
2 laming in-charge
2 Village level workers
,...2
Apart from Diractors and Doctors, there are 63 para-medical workers
who are working in the project.
Vehicles:
2 land Rovers, 3 Tractors, 3 Jeeps, 1 Motor cyclo
Annual Budget = Rs.520,000
Community Out reach 10%
Kain centre OPD and in-patient 20%
Family Planning
15%
Under Five Care
13%
TB Control
18%
Leprosy Control
11%
General Public Health 5%
Administration 8%
I
J
Curative Service
Promotional, preventive and. out reach
programme
DAILY ACTIVIPES OP THS PROJECT
The Health Centre is situated, about a mile from the village proper.
Here curative and selective survices are conducted. This centre has facilities
for 30 in-patients. They have also provided quarters for the entire staff.
This health centre has a laboratory for investigations, an X-ray. Unit,
Operation theatre, wards and an office.
The daily work starts at 6.15 AM. Usually two teams go out on fields
at 6.30 A.M. and are back by 12 Noon. Each team has the following staff:
1. A staff nurse
2.
3 ANMs
3.
2 Leprosy Technicians
4.
1 Social Worker
5.
1 Driver
Sometimes a doctor accompanies the team to supervise the work.'
Usually they covei' tew or three villages in the morning. Again two teams
go Out in the evening, except on Tuesdays, Saturdays and Sundays. They cover
two or 3 villages too.
FOLLOWING WORKS ARE CARRIED OUT ON FIELDS:
1. House to House survey,by an ANM
2.
Leprosy survey by Leprosy technician
3.
Health education
social worker
4.
Antinatal clinic by staff nurse
5.
Under five clinic by ANM .
6.
Family Planning clinic by ANM
7.
Follow up cases by staff nurse
8.
Feeding programme for under five by entire staff
9.
Mobile clinic by staff and the rest of the members.
10.
Blindness survey
Every Wednesday Dr. Arole goes out on.field with the team and Mrs Dr Arole
goes out on Fridays.
. MEETING OF THE STAFF:
Every Tuesday between'4.00 PM and 6.00 PM, all members of the staff
meet and discuss their problems. In this meeting Dr. Arole speaks on
different topics on Health Education and demonstrates Flannel Graphs. Every
Saturday between 4.00 & 6.00 Pm classes are conducted for village level
workers (VLW’s)
These village level workers are usually middle aged women, who are
illiterates. There are about 21 VLW’s working in the project. Bach women is
selected from the same village. She is paid Rs.40 per month - she is trained
by Dr. Arole to work in this project. They are well trained to talk on.
health education using Flannel graphs to recognise Leprosy patients to
motivate people for family planning practice, provide post natal care and
care of under five children. VLW’s are called to the health centre on every
Saturday, and Sunday and they are trained there.
3
3
Indeed VLWs contribution amounts to quite a lot. There is a vary good
plan drawn in this project.
On Sundays elective surgery is conducted. An anaesthetist from Ahamadnagar
helps Dr and Mrs Arole in surgery. On alternative Sundays they get the
services of an ophthalmic, surgeon.
DETAILS OF THE TOP PRIORITIES
1.
Antenatal Clinic
It is conducted every day by staff nurse or AHMs and VLWs. Usually the
cases are identified by the VLWs, and they are examined by staff nurse.
Investigations like HI?®, urine, and BP are carried put at the door.. Each
case is vaccinated against tetanus. 0 e dose at 1st trimeter is given. Also
given is an A'lC pack which contains, PS, MV, BC and Calcium tablets for
a week. They also educate the people about antinatal work. Complicated cases
are adviced to goto the health centre. For such cases transport facilities .
are provided by the project at free of cost. But most of the deliveries
are conducted by an old lady of the family by crushing the cord with the help
of a stone. They never allow outsiders to conduct deliveries. They say that if
some body other than their own Tastily member conducts the delivery, it brings
evil to the family. 1^ is very difficult to change this belief of the,people.
Dr.Mrs Arole is now trying to give a sterile blade and a piece of sterile
thread to such bld ladies and motivate them to use them.
Their ultimate aim is to train the VLWs to conduct deliveries. .
If.there.is a complicated delivery, the van is sent to pick up the case
for management at the hospital. Post natal care is given by AHMs and the VLWs.
It is claimed that 60 to 70$ of the women are getting antenatal care
and in one village out of 37, 36 are under care.
There are about 800 cases registered so far from 30 villages. About 15$
of this come to the hospital for deliveries. Reasons:
a) Illiteracy
b) Economical Problem
Feas for the investigations and deliveries done at the hospital is
collected only from the people who are capable of paying.
Under five Clinic
Under five clinic is conducted daily b
1^. has three priorities
the team which goes out for field work,
a) Immunisation, b) Feeding programme, c) curative services
Immunization
Initial survey is conducted by the team and the number of children to be vaccinated
is noted, The immunization is carried out once a week. ’D3RM0GET* is used for
vaccination. Thus the jet is used for trippie antigen, BCG, tetanus toxoid and TAB.
All the vaccines are purchased.
Feeding P-yp^raeime
All thechildren below 5 years are fed with multipurpose food. At present
out of 30 villages, the children vf 23 villages are being fed.
Food from OXFOM and CASA has been acquired . Feeding is carried out by
the team with the help of local village’ people and’VLWs. Local people are contacted
and a clear instructions are given to them. They' must make all the provisions
to prepare food in the village. All the utensils needed must be provided
by them. The health centre provides them multipurpose food, jaggery and some
oil. MV., FS, Calcium and some vegetables are added on to the multipurpose food.
Dr. Arole says that for the time-being they are getting food from foreign
countries and eventually it must be self supportive, hence they have already
started cultivating wheat, dhal and pea nuts.
He said, the following formula was good for the children.
1. Wheat 50 gms, Fea nuts 25 gms, Oil 10 gms, Jaggery 10 gms,
Dhal 25 gms . . This gives half the calories required by a child i.e. 750 calories
Curative Service:
This is done fa fields and in the health centre also!
family planning programme ■
This prolamine is'conducted mainly on th® fields and health centre. Thisis done by the team on fields and doctors, in the- health centre.
The following methods are used:.-1. Spacing, 2. Vasectomy, 3> Tubectomy, 4. Oral Contrasept,ive, 5•• Condoms
6.
loop insertion.
It is claimed that out.of. the abov ? 6 methods there is good response for
.Tubectomy,oral contraceptive,. loop insertion, conde.ais in. order of choice.
Vasectomy is not done as its posses a social problem.
In Jamked village itself 78 women are using the pill. The family planning
work is being carried on very well by the village level workers. They motivate
the people and are getting a good number of cases for tubectomy.
Doctor said that in 3 villages 100 percent of people who belong to
eligible couple group are practising family planning.
TUBERCULOSIS CONTROLS PROGRAMME
Majority of the people are suffering from T.B. due to poverty. It is
often diagnosed in the OPD itself.
Again the team-plays an important role in picking up- suspected cases.of ,
TB. Theyare brought'to the health centre and the following investigations are
carried out.
a.
Screening - X-ray chest.
b.
Sputum examination
_ Blood investigations
c.
. ■
If they are positive the treatment is started..
Usually they put them on 1) Streptomycin
2) INH
3)
PAS
Usually the streptomycin is given by the. ANMs and... follow up of cases is
regularly carried out. Usually the VLWs take the drug from the health centre
once a week to the patients.
The .controls programme has 3 phases - .
1. Irradication stage
2.
Consolidation
3.
Maintainence
.stage
They are in the irradication/at the moment and they- claim to.-reach, the
maintenance phase in, the next three years.' More importance is given to the old
and children because they are prone to get the disease.
CONTROL OF HANSEN'S DISEASE •
Many people are suffering from leprosy due to poverty. They are mainly
concentrating on total integration. Hence they are admitting cases in general
ward. 0nce gain team plays on important role in picking up cases. Patients
are put on dapsone, B^, Bg, B^, MV,-Calcium at the start of treatment..
They find it very difficulty to solve the social problems. It is said that
once TB and leprosy is diagnosed and if by change the patients family comes
to know about it, the patient is made an outcast. ■' •
Dr Arole narrated a small story, A girl who got married to a rich man's
son came to the. hospital for antenatal care. Mien the doctor was examining her
he accidently noticed the patch and diagnosed leprosy after confirming his
family. So. the girl's parents were told, about the disease and treatment was ,
started without indicatingtbis to her husband. But when she went to her
husband's house to attend a function, one of her relatives identified this
patch and they took her to the leprosorium at Ahmadnagar. Th® specialist there,
5
diagnosed it. as leprosy and told this to her father in law. So they took her
home and locked her in a room. Food and water was withheld. After 6 days
some one from the girl's father in law's house went to the girl’s village
and told her parents that the girl is not to he seen in the village for the
last 6 days. So the girl's parents went to the village and brought her to
Dr Arole. She was treated for leprosy but her husband divorced her.
Incidents of this nature are quite commonj and this makes the doctor's
work more difficult The need for‘social change is obvious.
BLINDNESS CONTROL:
This work was started very recently in the month of January 1974. They
are concentrating on finding out the blind case in the project area.’The team
is trained to recognise cataracts to find out conjunctriritis and other
common ailments. They are also planning to have refractions for the school
children.
DEVELOPNEWT OF AGRICULTURE .
They are trying their best to improve the agriculture in the project
area. Special effort is being made in the waste lands that are not cultivated.
Hence 3 tractors have been purchased for this purpose. People are motivated
to use the tractors and an agreement is made that whon they get the crop
1/3 of the crop must be given to hospital as a payment for the used of thd
tractor. The share of the crop received is used, for the feeding programme.
In addition to this seeds are provided to the villagers. Advice is given
regarding deepening ofthe wells.
Also provided are sheep goats cows, and chickens on loan to improve their
economical standard.
PROVISION FOR SAFE DRINKING WATER:
This is achieved by providing tube wells. On an average they have to
go about 100*deep to get water. Hells are as deep as 250’, and water as tis
depth needs no filtsration as it is hardly contaminated.
To dig one well it costs them Rs.6,000/- and they are providing a well to
every village that belongs to the project area, particularly the wells are
dug in the Harijan area;
No. 1003
.
:
Comprehensive
Health
Maharashtra
"Comprehensive Rural Health Project, Jamkhed, District Ahmednagar
1.
Started in late 1970.
2.
Coverage 40,000 people receiving general care and care
for special target groups (50% of population) within
this community. The number of villages are 30.
3.
Activities.
4.
a.
.Supplementary nutrition - one meal daily for
deserving pre-school.
b.
Immunization of all pre-school children - 80%
coverage.
c.
Provision of simple, minor illness care.
d.
Maternal services.
e.
Family Planning services including tubectomy and
vasectomy.
f.
Control of chronic illness.
g.
Prevention of Blindness.
h)
General public health measures - safe drinking
water through tubewells, mass health education,
general agricultural development to increase
food production and thus nutrition.
Personnel & Training.
a.
VHW - intensive training in health education,
pre-school children care and maternal care.
b.
Nurse
c.
Health Centre Staff
(a) is paid an honorarium of Rs 30/- per month for parttime work (b) and (c) are paid salaries comparable to
the government scales.
VHW's job also includes collection of vital statistics,
assisting in surveys, and followup of chronically ill
patients.
6.
Community and other Participation. District level
leaders are on the Advisory Committee for the projects.
2
No. 1003
7.
Sponsorship and Funds. A local society sponsors the
'project through the governing /Advisory Committee.
It
also provides funds for the initial/capital expenditure.
Recurring expenditure is’paid' for through fees for
curative set vices.
8.
Evaluation. Monitoring of reach of activities and
periodic surveys.
9.
Problems.
a.
11.
12.
Quality of curative services provided are affected
by use of lesser trained personnel and delegation
of responsibility to them (but. outweighed by
preventive care possible) ,.
Contact.
Dr R.S. Arole, Director of the Project.
Reference..
a.
Paper presented at the National Symposium 1976
b.
"Alternative Approaches to Meeting Basic Health
Needs in Developing Countries. A joint UNICEF/
OTO study.
Note: No information available .for items 5 and 10.
-2.
COMPREHENSIVE APPROACH TO PRIMARY
HEALTH CARE IN RURAL AREAS
by
Er. R.S. Arole, Director,
Comprehensive Rural Health Project, Jamkhed, Ahmednagar.
Comprehensive Rural Health Project at
Jamkhed, Ahmednagar, was started in Jan. 1971
with the object of providing health care to
the rural people as relevant to their needs
and resources.
The objectives of the programme are: 1] to
provide primary health care; 2] To reduce
the infant mortality rate by fifty percent;
3] To provide adequate antenatal and maternal
eare; 4] to reduce the birth rate by at least
40 per 1000 to 30 per 1000; 5] to bring under
control chronic illnesses such as leprosy and
tuberculosis; and 6] to prevent blindness.
The project works in 70 villages
covering a population of approx. 80,000
people. Since this is an expanding dynamic
programme, the population served does not
remain static. The various aspects and phases
of the project involving the village health
workers (VHW), their training and functions,
the health team , the health centre, funding
of the project, evaluation will be presented
in detail.
-:2:-
The following facts seem to emerge
out of the Jamkhed experience to reach
rural masses with health care: 1] Formu
lating clear-cut objectives and developing
programmes accordingly; 2] Genuine grass
root involvement of the people specially
the weaker sections; j] Availability of
primary health worker closest to the
people at all times; 4] Team approach by
the health professionals with proper
referral system; 5] Far greater emphasis
on social responsibility of the profess
ionals to the people rather than ordinary
technical competence; 6] Willingness to
learn from illiterate poor deprived masses
and win their confidence; 7] Realization
that health is not a priority of rural
masses; 8] Health should be a part of
total development; 9] Professionals must
share knowledge with village people;
10 ] Professionals must be willing to trust
the potential of ordinary illiterate people;
11] Health care providers and recipients
of health services must be approximately
on the same socio economic level. Greater
the disparity in life styles lesser the
eommuni cat ion.
-3.
No.
t
1004
Health & Nut.
Maharashtra
Kasa Integrated Mother-Child Health-Nutrition Project
V O'achanu Taluka, District Thana
1.
Started in pecember 1974
2.
Coverage? 63,000 tribal population in 70 villages,
(10 of which all control villages).
3.
Activities; This project is a projection of the
"Domiciliary Treatment of Protein Calorie Malnutri
tion" project at Palghar, by the Institute of Child
Health, Bombay.
a)
Health Services, through home visits - preventive,
curative including referral and promotive.
b)
Nutritional assessment of under sixes and preg
nant and lactating women.
Food and vitamin supple
ments as needed.
Local foods are processed as
snacks for 2259 (24%) of the children.
c)
Immunization; Mass campaigns, plus routine pro
grammes .
d)
Surveillance for "at risk" cases?
The part-time
social workers (PTSWs identify these cases and re
fer them to supervisory staff on latter's visits.
e)
Family Planning includes sterilizations.
f)
Health & Nutrition Education;
using.the homeretained growth charts of under-sixes and records of
women.
g)
Environmental Sanitation; chlorination of drinking
water wells involving villagers in activities.
£
°
u » „
4.
Personnel & Training Normal PHC staff structure, but
some modifications in duties (more supervisory of
PTSWs) ;
7
g
Special Programme Officer (Supervisor) ;
> 5
Part-teim Social Workers (PTSWs - 28 (each covering
2,000 population) ;
Selected by the communities not highly literate,
(literacy rate in area is less than 10%) both male
and female (some non-tribal) , either residents or
from neighbouring viJfeges. These were trained for
four weeks initially (both classroom and practical
training).
o
x
$ g
:
« g
£
u
No 1004
Recently, dais in the area are being trained.
CARE has provided some staff for training, research
and supervision.
5.
Supervision & Records;
Master time-table for workers;
a system of weekly (or more frequent) supervision
all along the line.
6.
Community & Other Participation; The PTSWs are from
the community and selected by it.
7.
Sponsorship / Funds;
GOT, DSW for a year.
Later
GO Maharashtra and CARE - Maharashtra are the co
sponsors .
8.
Evaluation;
PTSWs monthly reports include status
reports on all aspects; diaries,
case study,
type of information, tabulations are done, at SCs and
PHC.
9.
Problems-' Governmental administrative procedures
leading to delays, other assignments like FP cam
paigns, non-posting of staff, dropouts among
PTSWs, poor communication network, tribal poverty
and resistance, were some of the key problems.
11.
Contact;
Dr P.M. Shah, Hony. Project Director, The
Kasa MCHN Project; Prof, of Pediatrics, Institute
of Child Health, Grant Medical College, Bombay.
12.
References
1976. -
Note:
No.information available on item 10.
Paper presented at the National Symposium,
CxlHP - Gode No. 201
PART-TIME VILLAGE LEVEL HEALTH WORKERS DOCTORS" - AT HEALTH UNIT,PALGHAR
’
A.R. Jannarkar* and P.M. Shah**
Newer techniques are being developed in all t he walks of life
to improve quality of life.
'Industrial Revolution' and 'Green
Revolution' have been familiar words for sometime.
However, disease
and premature death are still prevelant in our country.
The communi
cable diseases and malnutrition in the developing countries are the
leading causes of the high mortality and morbidity rates which adver
sely affect their national economics.
These preventable- diseases
beget poverty which in turn leads to poor health; a vicious cycle.
With the present knowledge, a number of killing communicable
diseases can be controlled or eradicated.
The management of protein
calorie malnutrition is well documented.
The problem is how to
take this knowledge to
a great number of suffering people in the
community where it is difficult to reach them.
It is anticipat-d
that due to industrial growth and increased of agricultural output,
the socio-economic conditions of a developing country would improve
and subsequently general health would improve.-
slow process.
more time.
But this is a very
The developing countries can not afford to waste any
They should have ^results as soon as possible which means
They have to work within all
employing the simplest possible way.
the limitations of men, money and material.
Only revolutionary
methods and approach can bring about the "Health Revelation".
Health Care in developing -countries:The concept of revelation in health planning has been accepted
by number of developing countries.
In Sudan, Uganda, Zambia, Nigeria,
Malavi and many other countries, the health auxiliaries provide health
and medical care thro ugh*-clinics and hospitals.
There are places
where Medical,Assistants are managing 200-bed hospitals and perform
major surgical operations.•*• It is remarkable that Sudan can reach
so many people with health services, even though-simple in form, due
ta auxiliary and paramedical personnel particularly Medical Assistants.
* Reader in Preventive and Social Medicine, Grant Medical College,
Bombay, Officer Incharge, Rural Health Unit, Palghar.
** Professor of Paediatrics, Institute of Child Health, JJ Group of
Hospitals and Grant Medical College, Bombay. Paediatrician, Rural
Health Unit, Palghar.
* Based on the W.H.O. aided project 'Domiciliary management of Malnu
trition' .
Chief Investigator: Dr. P.M. Shah.
In Malavi a few professional health people provide a
high standard
of care for a relatively few patients while Medical Assistanta provide
more basic pare for the rest.
The common medical needs are not so complex.
The lower level
medical worker must only be able to recognise threats to health that
are visible and easy to identify (like diarrhoea, upper respiratory
infections,.malnutrition, infectious diseases and infestations) or
problems that are less threatening and more of a personal concern like
headache, constipation, earache, cuts, etc.
Auxiliary workers could
easily look after these problems while the professionals could function
as leaders, consultant? and managers.
The Chinese claim a solution to this problem of community health,
with maximum benefits from minimum cost in their system of "Barefoot
doctors".
They have placed a priority on preventive programmes.
The key to this system of 'Barefoot doctors-' is the proper management
of available manpower.
From the beginning of the revolution, they
rejected the traditional Doctor-patient relationship which a poor
country cannot afford as it requires a large investment for training
facilities and hospital-based services.
As an alternative they empha
sized the provision of health care for the greatest number of people
at the least cost.
The 'Barefoot foctors' appeared at the. beginning of 'Cultural
Revolution' with rural health oriented programmes.
The local people
are trained in both modern and traditional health care methods during
slack agricultural season.
Depending on the availability of various
health personnel and acceptance by the people, the Barefoot doctors
work as links between the community and the available medical manpower.
Their duties include treatment of minor ailments, organisation of
health education programmes,
'Patriotic' health campaigns and general
sanitation work in their locality,
The work of these 'Doctors'' is
supposed by all those who are engaged in the preventive programmes.
Recently, to .increase manpower in this army of health, traditional
doctors, oriented in modern medical methods, have been incoporated.
These concepts are of basic importance since more manpower can be
trained for a given health budget.5
Medical manpower in India;-
In India the problem of mediaal manpower is grave, even though
the doctor to population ratio ■ is 1 to 5112.
In fact 80% of the
doctors are not available for the 81% of the population who reside in
villages.4 As a result there is an acute scarcity of skilled medical
men in the rural areas.
The nurse to doctor ratio is Is2 which, is
••
3
well below the recommendation of 3s1.
Moreover, wherever a
doctor who could provide health care is available in rural
area,
he is busy providing medical relief to 100,000 population at the
Primary Health Centre and has limited time and interest in preventive
and promotional health care.
The shortage of doctors is going to
prevail for years to come as training of doctors is long and costly.
All the developing countries are experiencing this problem which
explains why the concept of az- maximum utilization of- health auxili
aries is getting more and more popular.
In India various national health programmes are managed quite
successfully through health and
auxiliaries.
The National Malaria
Eradication Programme, the Leprosy Programme and the Smajl-pox
Eradication Programme are examples.
These auxiliaries are not sub
stitutes for the doctors; their role is supplementary.
AN EXPERIMENT WITH VILLAGE-LEVEL HEALTH WORKERS AT HEALTH UNIT,
PALGHAR:
The long-term planning for health has to be basic, comprehensive;,
preventive and promotive.
As the first step to sow the seeds of
health is in early childhood, the most vulnerable period, a W.H.O.
aided project on "Domiciliary Management of Malnutrition" and Inte
grated health care for the children under five years was started
at Health Unit, Palghar, List. Thana, Maharashtra, in August, 1972?
Here is an attempt to solve the. local health problems in the village
itself with the help of local persons.
The project is designed to
promote the health of the children under five years of age at the
village level by continuous, co-ordinated, community care,
Under
this project part-time, village-level health workers, who are the
key persons in the project, have been appointed.
It is obvious
that the problem of health and nutrition can not be solved by medi
cal and more.highly-trained para-medical personnel alone.. Moreover,
there is a need to ao^er a wider
rural area with limited health
personnel at a Primary Health Centre.
Hence, the part-time, village
level health workers are appointed in this project to link the
community with the existing health services.
Part-time, village-level Health Workers;
While appointing these part-time health workers an emphasis
was given on selecting a local, middle-aged, mother with educational
qualification up to 7th standard.
However, four out of five workers
have the educational qualifications of only the 4th
or 5th standard.
4
i
Care was taken to select a person with leadership qualities.
Those
women are familiar to the local people and know the regional langu
age, customs, attitudes and beliefs in
child rearing.
These women
are culturally acceptable to the community and specially to the local
women folks with whom they communicate in a better and more effective
way than the outsiders.
They have an easy access to the kitchen
where the traditional policy of nutrition and child rearing of the
family are determined by the dominating grandmother or mother-inlaw.
The part-time health worker takes part in their 'Kitchen meet
ings’ and at times participates in "gossiping".
The worker is trained
in such a way that she introduces her advice in a culturally accept
able way.
The nutrition advice is practical, scientific and feasible
for the local conditions and meagre budgets.
The whole idea of appointing these health workers is to improve
the services according to the values of society.
Health planning
must be pragmatic and take socio-economic aspects into consideration.
Five such part-time health workers have been appointed in this
project.
They are paid Rs. 60.00 per month and they work for four
hours a day.
Each worker looks after a total pcpulation of 2500 to
3000 in tow to four close-by k villages or hamlets.
On an average
these villages are at a distance of 4 to 6 kilometers from a sub
centre,
head quarters of a nursing auxiliary, and are within 2
kilometers from the residence of the part-time workers.
TRAINING OF THE WORKERS
These workers were given training for three weeks, two weeks
in the class-room and clinics and one week in the field.
The training
programmes were so arranged that they had practical experience of
taking weights, recording them on weight charts, measuring heights
and giving health and nutrition education to the mothers and others.
They were trained in ascertaining birth dates by using leeal events
calender.
They were introduced to personal hygience, common communi
cable and nutritional diseases of children, immunisation, growth and
development, and family planning.
active participation.
Emphasis was given to learning by.
Cases of common
diseases were demonstrated to
them in the clinics.
The class room training was followed by field training in the
village of Umroli where a model programme has been going bn for the
last one and a half year.
They were given assignments and the results
were discussed with all the participants.
5
Job description and, responsibilities of the part-time Workers
Every child under five years of age in twenty villages/hamlets
has been covered by the five workers.
The children needing special
care and whose parents cannot come to the clinics because they are
daily wage earners are treated at home.
the clinics.
Other children are seen at
The job assignments, including
the responsibility of
the part-time health workers, are as mentioned below.
1.
Census: to enlist the population at risk as well as all the
household members by age and sex.
numbers.
The housesx are given
Census figures are brought upto-date every six ...
months.
2.
Sequential weighing and selection of beneficiaries for nutri
tion programme:
Serial weighing is a practical and reliable
measure of growth in children under five years.
Birth date
is decided according to a local events calender and then the
weights are recorded periodically, according to age and nutri
tional status, (figs. 1&2) on weight charts0 printed in Mara
thi.
The Salter's weighing scale model No. 235 T with spring
and dial is being used as it is an accurate, handy and econo
mical.
Figures on the dial of the weighing scale are given
in the local language.
The workers talk to the mothers about
the weight curves oh the charts, their importance in health
and disease, and the necessity of timely regular recording of
weights.
They give advice oh feeding to all the mothers at
the clinics or in the homes.
The part-time assistants are trained to.determine the degree
of malnutrition with the help of the weight curves within
a fraction of a degree by means of a simple plastic folder
over-lay designed for the project (fig.III).
Accordingly,
beneficiaries are classified for nutrition supplements and/or
nutrition education.
3.
v
Listing 'Special Care' children:
In each village they maintain
a list of children who require 'Special Care'.
The list indi
cates specifically which children must be seen by the nurse
and/or the doctor when they visit the village.
The status
of these children is followed at the clinic and by home visits.
The local community is made aware of the condition of these
children. The following are the reasons for "Special Care".3
6
1.
2.
Those whose weight is below 60% of the reference standard;
Those who have difficulties in breast feeding and are put on
bottle feeding before six months;
3.
Those who fail to gain 0.5 kg. a month in the first trimester or
0.25 kg. a month during the second trimester of life,
4.
Those Pre-term or low-birth weight babies weighing less than
1.5 kg;
5.
Twin babies;
6.
Those whose mothers have a history of death of more than two
offsprings between the age of one and twelve months;
7.
Those with severe or acute infectiona like measles or whooping
cough,
8.
Death of one of the parents;
9.
Those whose birth order is fourth or beyond;
10.
Sterilisation of one of the parents and
11.
Only child.after a long married life.
4.
Under-Fives' Clinics!
The part-time workers conduct clinics for
children under five years of age.
Every alternate clinic is
attended by the nursing auxiliary, while the doctor visits once
a month,
The frequency of the clinics varies from thrice a week
to once a fortnight depending on the population df a village.
each clinic 15-20 scheduled children are brought.
a£ places given by the local community.
In
They are held
The clinic’s timings are
altered to suit the working mothers.
5.
Immunisation:
They organise immunisation campaigns for the child
ren, by identifying and collecting the children due for immunisa
tions when the nurse visits their village.
They assist the nurs
ing auxiliaries in carrying out immunisations.
6.
Domiciliary visits:
They go to visit the home of defaulters
and also of the children listed as "Special Care".
each worker has to visit 7 to'8 homes per day.
On an average
While, on home
visits they weigh the children (Fig.IV) and talk to mothers about
feeding and other health matters.
When simple drugs are prescrib
ed for a child, these workers assist by delivering the medicine,
continuing the therapy, and reporting the progress.
7.
Nutrition Education;
They advise on protective foods,- their con
sumption, preparation and cost.
They identify the dominant'figure
in the family and have a dialogue on health and nutrition education.
7
6.
Health education:
They give advice on personal hygiene and talk
on growth and development, common diseases of childhood and their
prevention.
9.
Vital statistics:
They collect information on births, deaths
and migration.
10.
They help in periodic deworming
Deworming and special programmes:
of the children in the villages where there is heavy infestation.
11.
Planning of families:
They advise on family planning to the eli
gible couples and motivate them at the time when all the children
under five years in their family are progressing well on weight
charts and
12.
Referrals:
They promptly refer the sick children to the nurse or
to the doctor at the headquarters.
Community Participation;
These workers coordinate their activities in each village with the
village health committee, nursing auxiliaries and other perscsmels of
the health department.
They have developed effective rapport with the
women folks and the villagers.
They bridge the 'Cultural gap1 between
the modern health services and the community at large.
Organisation:
To give an idea of the role of part-time health workers in the
project, the organisation of the project is depicted in a chart (Fig,V).
The project is designed to fit the existing health services and to help
in extending and strengthening the health services,. Twq to three
workers are under guidance of a nursing auxiliary and enable her to
cover effectively a population of about 10,000.
Records:
After one year's experience in a pilot study at village Umroli,
near Palghar, a pew system of records has been devised.
are minimised for nursing personnel.
The records
The same are simplified by means
of weight charts and assignment identification and planning cards.
The
workers with the help of nursing auxiliary, fill-up the built-in eva->
luation tables,
Evaluation:
A project is divided into three main sudy groups (i) service
oriented, (ii) Research oriented, and (iii) Evaluation oriented.
The
results of evaluation of nutritional status and immunisation status
8
can easily be read at a glance from the tables given below (Tables
I & II)?’? The tables are completed by the nurse midwifes.
This
data is furnished every month which provides a built-in evaluation of
the on-going programme.
It will be noticed from the above description that these health
sorkers do not treat sick but prevent sickness and promote positive
health.
There is no danger of creatings 'quacks1 as they are not going
to cure diseases.
Their purpose is to extend health care and prevent
ive and promotional health.
Health Revelation*
The Indian Way; •
The: aim of the project ±s to create abalanced programme for.the
future, both at the family and the community levels.® Here lies the
difference ^between Indian Way of health care and the Chinese way.
At
Palghar, the mothers are oriented to help mothers and to extend compa—
ssionate care.
India is a poor country like many other developing
countries and can not afford the rising cost of therapy/ Revolutionary
and economic ways of delivering health care need to be worked
out.
The responsibility of providing health care to all, even in the remotest
villagS or hamlet must be met; in the existing conditions of limited
medical manpower and finances, the system similar to Chinese .'Barefoot
doctors', our part-time health workers, is the practical ..arid necessary
approach to health care.
These 'Workers' can help to bringing about
the "Health Revolution".
The experiment with the part-time health workers is only nine months
old and it has shown promising results with reference to nutrition,
growth, morbidity and even mortality.
It has been observed that 75 to
80% of the deaths in the under fives' were from the group of these
The workers have already gained fairly good
needing special care.
confidence of the community.
It'.should be possible to extend their f
field of activites, in the future to the pregnant and lactating mpthers.
REFERENCES
1.
Bryant, John
Health and the Developing World,
First Ed. Cornell University Press,
London, 1969.
2.
Jtyma^kar, A.R. and
Surveillance to Evaluate the Changes in
Shah, P.M.
Nutritional Status of Preschool Commu
nity with the Help of Village-Level
Workers, (under publication).
:
9
3.
Morley,
1.0,
:
A medical service for children under
five years of age in West Africa.
Trans. Roy, Soc. Trop. Med. Hyg. 57,
79-94, 1963. '
4.
Park, J.: .
Text book of Preventive & Social Medicine
2nd Ed. Page 22, Banarasidas Bhanot,
Jabalpur - India, 1972.
5.
Rifkin,
and Raphael,K.
'Health Strategy and Development Planning
Lessons from the peoples' Republic of
China; Reproduced by the Tropliical Child
Health Unit, Institute of Child Health,
London, 1972.
6.
Promotion of Adequate Ggrowth and conti
Shah, P.M .
nuous Health Care through Under Fives*
Clinics, the proceedings of the work
shop on "Under Fives' Care" held in
Hyderabad 6th & 7th October, 1972.
(Under publication).
7.
Shah P.M. and Jannarkar, Simplified Methods for a Village-Level
A.R.
'
Worker to Ssle'ct Beneficiaries for Nutri-
tional' Supplements (under publication)
8.
Williams, daily D and
Mother and Child Health Delivery. The
B.
Jelliffe, D.
services, P. 78, First ed. Oxford Uni
versity Press , London, 1972.
TABLE
-
II
EVALUATION OF IMMUNIZATIONAL
Village
Further copies can be obtained from:
Coordinating Agency for Health Planning,
C-45, South Extension, Part'll,
New Delhi.-110049.
STATUS
Month:
Mm
>ns for Special Care
Masons for Special Care
Reasons for Special ^reF
KASA MODEL INTEGRATED
MOTHER-CHILD HEALTH NUTRITION
(MCHN) PROJECT
Primary Health Centre KASA, Taluka Dahanu,
Dist. THANA
Centre/Village
Child's Name
Boy/Girl
Mother's Name
Index No.
Father's Name
. Date of First Examination
Date of Birth
Address
Brothers/Sisters
Date of Birth
-
Boy/Girl
Remarks
— ■ ....... *
Observations in Pregnancy
63
62
61
60
59
58
57
56
55
54
53
52
51
M 50
** 49
48
46
45
44
43
42
41
40
39 :
38
37
36
—35 «
Months
Stage of
Pregnancy
of Head
Blood
pressure
Oedema
Expected Date of Delivery
Expected Date of Delivery
Reason of Special Care
FT j I
I
Primy
I { |
I
!
I
r
T
63
62
61
60
59
58
57
56
56
54
53
52
51
00 50
■“ 49
48
47
46
45
r —(—p--
I
1
I
I
I
<
J
J
f.
I
i;
1
43
42
40
39
38
37
36
1
2
3
4
5
6
7
3
I
2 1 2 3 a
Haemo-
Months
Stage of
Pregnancy
Position
of Head
Blood
pressure
Oedema
1
2
3
4
5
6
7
8
)
1 2 1 2 3 4
Haemo.
Urine .
Albumin
Antititanus
Vaccine
Note j
Albumin
Antititanus
Vaccine
Note
Post-natal Observation
Data
Second Para.
Reason of Special Care
Mother
Breast feeding
Post-natal Observation
Child
Note
Weight
Note
Date
Mother
Breast-feeding
Child
Note
Weight
Note
Date
Mother
Breast-feeding
Child
Note
Weight
Note
' .
./C;. -J/;;. ' ...\
Case study
Community participation and nutrition
The Kasa project in India
P. M. Shah
Professor of Paediatrics
Institute of Child Health, Bombay
Approximately half of the deaths in India among children
under six years of age are directly due to severe malnutrition and
fetal malnutrition.
To improve the nutrition level and health of women and
children in rural communities, with special care for those identified
as “at risk”, the Kasa project north of Bombay has bridged the
wide gap between the community and the existing health delivery
system through the use of link workers from the local villages and
community participation. Health, nutrition, immunization, family
planning, and nutrition education services are provided at the
door-steps of all under-sixes and married women. The project
operates out of a government Primary Health Centre with the
objective of studying the feasibility of duplicating such a service
delivery system throughout the country.
The organization of the Kasa project is discussed in this paper,
with special emphasis on the nutrition aspect.
Considering the present trends in the development of medical
services and the present rate of economic growth, it is doubtful
whether at the end of this century the developing countries will
be in a position to provide health care to all their people, inclu
ding those in the most remote villages. Two thirds of the deaths
Carnets de 1'cnfancc, Vol. No. 35
P. M. Shah
in these countries are not attended to by any medical personnel,
and more than half of the world’s people have no access to medi
cal care. For those who are within reach of the medical care
system, the contact may have no significant influence on their lives
or health.1
The difficulties in delivering health services
There is a limited number of medical professionals, and in
India, 80% of them have settled in cities to give medical care to
only 19% of the country’s population. Some 81% of India's
population receives medical care through government-run Primary
Health Centres (phc’s) where two doctors, and at times only one,
look after the health of about 80 000 people in over one .hundred
villages, and where each auxiliary nurse midwife covers 10 000 in
habitants in ten to twelve villages.
Moreover, in India the average distance between the villages
and the health centre is 9 km. 87% of the people attending the
phc’s are from villages within a radius of 6.4 km.2
Approxi
mately 50% of the women are economically active.3 In villages
around Palghar,’ one’ of the project areas, about 60% of the
mothers were daily wage earners and many others were heavily
occupied in household chores. The majority of the children under
six years of age who had the highest morbidity and mortality
rates could not be carried to the nearby health centre by the
working parents without a loss in daily wages.4
Generally, most of those who need health services are neither
identified by health personnel nor do they voluntarily utilize the
available services. The utilization rate of health services is poor
in many developing countries. Long distances, difficult terrain,
1 Bryant. John. Health and the developing world, Cornell University Press,
London, 1969.
2 sea/24/14, who searo, New Delhi, 24 June 1975.
3 Demographic yearbook 1971, UN, New York'.
4 Shah, P. M. and Junnarkar, A. R., Village assistants, sea/ff 13/12,
who searo, New Delhi, 2S February 1974.
Community participation and nutrition
— the Kasa project in India
poor transportation, poverty, working mothers, heavy household
chores, low health consciousness, doctors’ and at times nurses’
inclination towards private practice, cultural differences between
those who administer medicine and its beneficiaries, the paucity
of medical and paramedical personnel and their vague job assign
ments, faulty planning and organization of medical care often
resulting from an attempted duplication of what is happening in
developed countries, are some of the factors that have contributed
to the under-utilization of available health services.
The community has a customary way of handling illness.
First the advice of various people who are socio-culturally accept
able is sought, i.e., the family, the neighbour, the priest, the
practitioner of indigenous medicine, the quack “doctor”, and
sometimes a “witchdoctor". Only in the event of an unsuccessful
outcome from their attempts is the government health service, if
available, approached.
Moreover, the medical needs are not complex, as they involve
recognizing threats to health which are visible and constantly
reoccurring, such as diarrhoea, upper respiratory infections, mal
nutrition, infectious diseases and infestations. Many of these ill
nesses are preventable. The management and prevention of many
of them do not call for the services of a doctor or a nurse. The
involvement of workers from the local community can be of
considerable help in bridging the cultural as well as the manpower
gap between the health services and the community.
Origin of the Kasa project
In the aim of developing an economical system of delivering
integrated health and nutrition services to young children and
mothers throughout rural India, the Kasa Mother-Child HealthNutrition Project (sponsored by the government of India, that of
Maharashtra, and CARE-Maharashtra) was initiated on 2 Decem
ber 1974, in the entire area of the Kasa phc. 'To a considerable
extent, this model project is an extension of the programmes
worked out by the Maharashtra government project on domi
ciliary treatment of protein-caloric malnutrition at Palghar, aided
by the who. The Palghar project has operated in a small area of
23 villages with a population of 23 916, since 1972. It was the
accomplishments of this project5 which stimulated the sponsors
of the Kasa project to study the feasibility from the point of view
of management and finance of duplicating the programmes in the
wider area of a phc, and to establish a model to demonstrate an
integrated services delivery system.
The project’s setting
The Kasa phc covers all the villages in the Saiwan tribal
development block, and all but nine in the Kasa block. There are
70 villages which have been stratified at the Kasa phc according
to the percentage of severe malnutrition cases among children
under six years of age, divided into five groups of 14 villages each,
from which ten basic control and five intensive study villages have
been selected. The nine villages of the Kasa block which are
otherwise in another phc have been selected as additional control
villages.
The population of the 79 villages was 74 605 on
14 January 1975, of which 56 364 lived in the 60 programme
villages.
Kasa village lies 126.5 km north of Bombay. The furthest
village is 40 km from the phc and 12 km from a health sub
centre. Per capita income in the project area has been estimated
to be as low as Rs. 0.72 or us S 0.08 per day. The literacy rates
for male and female are expected not to exceed 20% and 10%
respectively. 88% of the population is tribal, and socio-culturally
and economically underprivileged. The area is hilly and covered
with forests. A typical tribal village consists of a number of
hamlets—six on the average—and some villages spread out over
5 to 6 km from one end to the other.
5 Shah, P. M. and Junnarkar, A.R., Domiciliary treatment of protein-calorie
malnutrition : first year progress report, Institute of Child Health, Bom
bay, 1973.
Shah, P.M. and Junnarkar, A. R., Domiciliary treatment of protein-calorie
malnutrition : second year progress report, Institute of Child Health,
Bombay, 1974.
Community participation and nutrition
— the kasa project in India
All the villages have drinking water wells, except for some
hamlets where the inhabitants have to draw from rivulets or walk
2 km to fetch water. The nearest telephone and telegraph com
munication is 25 km away.
Except for a few houses in ten
villages, there is no electricity.
Converting the existing staff into multi-purpose health
workers
The normal staff structure of a phc has been maintained at Kasa.
As a matter of fact, for a period of 13 months there was only
one of two medical officers on location. The eight auxiliary
nurse midwives (two at headquarters and six in sub-centres) and
four smallpox vaccinators all reside in different villages, except
for two. Both of these categories of personnel have been conver
ted into multi-purpose health workers. The job assignments and
areas of service were discussed in a joint meeting and the auxilia
ry nurse midwives agreed to look after 6500 to 7000 inhabitants
each in around seven villages, and the multi-purpose male health
workers to cover some 3000 inhabitants in three to four remote
villages, at times at a distance of 15km in a hill or forest area.
The job of sanitary inspector was converted into that of
programme coordinator, who, with the nurse midwife, supervises
the auxiliary nurse midwives and the male health workers.
Community part-time social workers
To bridge the gap between the auxiliary nurse midwife or
male health worker and the community, 28 part-time social wor
kers (ptsw’s) were recruited from the local villages. The auxiliary
nurse midwives and health workers form a cadre of immediate
supervisors for the ptsw’s, who cover about 2000 inhabitants each
—on an average two villages—and work four to five hours a day.
They receive an honorarium of Rs. 80 or us 8 9.20 per month.
They provide health and nutrition care to all under-sixes and
married women, and identify “at risk” children and pregnant
women. These are then attended to by the auxiliary nurse midwi
ves and male health workers, while the medical officers concentrate
on those referred for immediate care.
Additional input in terms of manpower is the programme
officer. Each team member was consulted on the job description,
and points for training and supervision were identified.
Selection of the PTSW’s
At the onset of the project the programme was explained to
the local communities. The attempt to involve a school teacher,
a traditional midwife and the village head's wife as link workers
was unsuccessful for the Palghar project, and hence in the Kasa
project the communities were asked to suggest candidates from
the villages. The 60 programme villages are divided into 28 zones,
and each zone has a population of approximately 2000, scattered
between one to three villages. The assistant block development
officer and local leaders helped in the final selection of the ptsw
for each zone. Emphasis was placed on selecting local middleaged mothers with educational qualifications amounting to
around seven years of schooling, and having leadership qualities
and a desire to serve their community. The educational qualifica
tions and age specifications were lowered for a persons who was
dynamic and enthusiastic and demonstrated leadership ability.
In the Kasa project area, where the literacy rate for women
is less than 10%, those who are literate received their schooling
during the last decade, and hence it was difficult to find workers
of middle age. The mean age of the workers is therefore 22 years,
with seven years of schooling on an average, ranging from a mini
mum of four to a maximum of ten years. It was difficult to find
female workers for all areas.
In February 1976, 52% of the
workers were tribal males, 24% non-tribal females and 24% tribal
females. All but five of the 28 ptsw’s are residents in the zones
they serve, the five non-residents coming from adjacent villages.
The average number of months of employment is 12 after
16 months of operation. The drop-out rate has been heavy.
Following the 1975 Kharif harvest, nine resigned, though some
Community participation and nutrition
— the Kasa project in India
ptsw’s who resigned later rejoined.
The turnover of male wor
kers is greater than that of female. Many ptsw’s who had comple
ted eleven years of schooling left when they obtained more
remunerative jobs. On the other hand, it was a dedicated worker
with a higher educational level who achieved the most in the
delivery of various services. Ten of the ptsw’s have been with
the project since the beginning of the pre-implementation stage in
December 1974.
Four weeks of training
The initial training lasted four weeks, with classroom-cumpractical demonstrations and exercises for two weeks, and the
remaining period spent in the field. The training included child
growth and development, nutritional disorders, common child
hood diseases, infectious diseases and immunizations, medical
problems of pregnancy, delivery and post-partum. The training
programmes were arranged to provide practical experience in
taking and charting weights, identifying kwashiorkor, severe
anaemia, gross vitamin A deficiency, and assessing the grade of
malnutrition. The ptsw’s were trained in ascertaining the cor
rect age by- using a local-events calendar especially prepared for
the region.0 The training consisted of very simple explanations
in the local dialect, and covered the jobs assigned to the wor
kers. In order not to disturb their family life, the trainees retur
ned home every night.
At times some workers attended the
training course along with infants. The trainees’ travel expenses
were reimbursed, and they were given daily allowances. The
training programme was conducted by the programme officer, a
medical officer, the nurse midwife, the sanitary inspector, and an
auxiliary nurse midwife.
Experience showed that these workers have a limited reten
tion capacity, and hence the training period should be short.
However, it should be supplemented with built-in ongoing
training.
6 Shah, P. M., Early detection and prevention ofprotein-calorie malnutrition,
Popular Prakashan, Bombay, 1974.
P. M. Shah
Assignments of the part-time social workers
1.
2.
3.
4.
5.
6.
7.
They conduct a census during the first month after training,
which is kept up-to-date and verified quarterly.
They undertake a monthly sequential weighing of children and
the recording of their weights on charts.
They visit all married women every month, filling in their
cards so that early pregnancies can be detected and care
provided during the antenatal period and labour. Within
a fortnight of a missed period, if the woman desires to
terminate her pregnancy, she is referred to the medical officer
for menstrual regulation.
They independently conduct “clinics" for under-sixes and
pregnant women; this activity is supervised by the auxiliary
nurse midwives according to a time-table.
They identify children and mothers who are “at risk" and in
need of special care, on the basis of criteria listed below, and
show them to the auxiliary nurse midwife and medical officer
at the time of their visits.
They visit each child and woman at least once a month; child
ren and women needing special care are visited every week
or fortnight.
They treat minor common illnesses after one year’s job expe
rience, according to a manual of “Standing Instructions”’
which is prepared in local dialect and describes the symptoms
of common diseases and their management.
They are
equipped with electrolyte powders, massive vitamin A
tablets, iron-folic acid tablets, piperazine, aspirine and sulphadiazine.
They refer acutely ill children, mothers and
even other adults to the auxiliary nurse midwife or doctor
for examination and treatment, and then continue the imple
mentation of the prescribed treatment for malaria, tubercu
losis and leprosy patients.
7 Shah, P. M. and Shah, Kusum P., Standing instructions to the nurses and
part-time social workers for the timely health care of children and mothers,
the Kasa Integrated Mother-Child Health-Nutrition Project, Primary
Health Centre, Kasa, 1976 (mimeographed text).
Community participation and nutrition
—the Kasa project in India
8.
They distribute nutrition supplements to children and mothers
according to guidelines; they solicit the help of older village
women or men for daily distribution of supplements to all
beneficiaries, once they arc collected together in a group, to
ensure the on-the-spot consumption of the supplements by
the designated beneficiaries.
9.
They administer a massive oral dose of 200 000 international
units of vitamin A every six months to the specified children
in the one to six years of age group, and treat the diagnosed
cases of hypo-vitaminosis A as instructed.
10. They help in immunization programmes by collecting children
and women for vaccination when auxiliary nurse midwives
or immunization teams visit the village.
11. They chlorinate the drinking water wells in their service area
every month.
12. They give nutrition and health education in homes and in
“clinics”, to individuals or groups.
13. They collect vital statistics and maintain simplified records.
These include weight charts and women’s cards in duplicate.
The original copies are kept by the married women and
mothers. The weight chart reinforces the education on good
health and nutrition.
14. They motivate parents to plan their families.
15. They assist auxiliary nurse midwives in examining the haemo
globin and urine of pregnant women.
The performance of the ptsw’s depends upon the quality of
their training and supervision. It takes two to three months for
them to develop perfection in the methodologies.
A typical day’s work for a PTSW
The ptsw leaves her home at 10:00 in the morning and visits
the hamlets of a village as per her time-table, which is prepared
in advance for one year and revised every two months, if neces
sary. She carries a shoulder bag which accommodates the dupli
cate weight charts and cards of the under-sixes and women of the
P. M. Shah
hamlets she is to visit that day, a weighing scale, a small spring
balance, an adult portable scale once a month if there is a preg
nant woman, the lists of “at risk” children and pregnant women,
index cards and medicines. She collects the children and mothers
in someone’s home or beneath a tree.
She weighs all the children; identifies the grade of nutrition
by slipping the weight chart into a plastic overlay stencil which
has multiple lines on it to indicate the various grades; decides
whether nutrition supplements are needed; enquires about illness,
particularly in “at risk” children and women; administers
medicines; talks to mothers about feeding, hygiene and child care.
She enquires about the menstrual history of the women and enters
it on their card, records abortions, still-births and the state of
pregnancy. She visits homes to see those who have not attended
the “clinic”.
One day a week she distributes nutrition supplements in all
the hamlets of a village, and examines the children and women in
only one hamlet. She meets with local leaders, and casually with
traditional, mid wives and practitioners, but does not interfere with
their management. If there is any serious case or acute illness
she reports it to the auxiliary nurse midwife or doctor. She
maintains a diary on the day’s work and keeps records of the
nutrition supplements and drugs.
The auxiliary nurse midwife or male health worker visit the
ptsw’s area twice a week and guides and supervises her work.
They both go to the homes of “at risk” cases who have not
reported to the “clinic”.
A doctor visits the ptsw’s village once in five weeks, unless
there is an emergency.
Surveillance of children “at risk”
For an indefinite period of the future the health services of
most developing countries will not be able to meet either the
“real” or the “felt” needs of rural communities, since the resour
ces will continue to be in short supply. Therefore priorities must
Community participation and nutrition
— the Kasa project in India
be set in relation to national epidemiological profiles so that
available resources are used with maximum efficiency.89 Among
the primary objectives of the health services is the reduction of
the death rate and of illnesses that lead to crippling consequences.
Half of the deaths in children under six years of age in the rural
project area of Palghar were directly due to severe malnutrition
and fetal malnutrition. However, 75.5% of the children of this
age group who died had associated severe malnutrition.
At the Palghar project 84% of the under-sixes who died
showed one or more of the “at risk” indicators listed below.
After a grass-roots level health care system was organized, it was
possible for ptsw's to identify as “at risk”, in advance of their
deaths, approximately 76% of the under-fives who died?
The persons listed as “at risk” form the principal target
group for most project programmes. A child under six years of
age is listed as “at risk” if he has any one of the following'
indications :
•
o
•
•
•
weighs 65% of the Harvard standard or less
fails to gain weight for three successive months
loses weight during two successive months
weight less than 1.5 kg at birth
has an illness such as measles or acute gastroenteritis.
At the Palghar project, two thirds of the “at risk” underfives have been so classified because of severe malnutrition. The
“at risk” under-fives represented 2.1% of the total population,
and yet the deaths among this group represented 21.5% of the
total deaths, indicating the magnitude of the reducible mortalities
if special care is directed towards the “at risk” segment of the
population.10
8 Shah, P.M. and Junnarkar, A. R., Weightage of the various “at risk"
factors and practicability of management, paper presented at the Inter
national Working Conference on “at risk” factors and health of
young children, Cairo, June 23-28, 1975 (in press).
9 Ibid.
Shah, P. M., Junnarkar, A. R., Khare, R. D. and Dhole, V. S., Com
munity-wide surveillance of ‘at risk’ under-fives in need of special care,
Jour. Trap. Ped. and Em. Child Health, no. 21, 1976 (in press).
10 Ibid.
P. M. Shah
In the Kasa project, 25.5% of the under-six children were
“at risk" in May 1976. On an average there were 86 “at risk"
children, distributed between two villages or 12 hamlets, under
the care of one ptsw.
Extending the “at risk” concept to women
So that perinatal deaths and the incidence of babies born
underweight can be reduced, the “at risk" concept has been ex
tended to pregnant women. They are classified as “at risk" if
one or more of the following factors apply11 :
o
•
weighs 38 kg or less before pregnancy; or weighs 42 kg
or less at the 34th week of pregnancy
is less than 145 cm in height
•
is severely pale
e
has a child from a previous delivery who weighed less
than 2 kg.
•
had swollen legs while pregnant or having swollen legs
at time of examination
•
has high blood pressure
•
below 18 or above 30 years old and primaepara
•
is 35 years old or above at the time of pregnancy
•
has a history of abortion or still-birth during a previous
pregnancy
•
during a previous pregnancy, lost her child within one
month
•
is carrying her fifth or later child
•
has a history of bleeding during pregnancy
doubt about her having twins
11
•
had a previous caesarian delivery
•
has jaundice.
Shah, Junnarkar, Khare and Dhole, op. cit.
Community participation and nutrition
— the Kasa project in India
Employment for “at risk” families
o
The supervisory staff must see “at risk” children and women
while visiting villages or hamlets, advise ptsw’s on their manage
ment, and refer or show these cases to the medical officers. Fam
ilies are graded as “at risk” when there is more than one
child suffering from severe malnutrition.12 The parents of these
families are recommended for jobs to the local block development
officer. Under the Government Employment Guarantee Scheme,
.they receive preferential treatment, and those who wished to
work have not been disappointed.
The proper use of an “at risk” system depends upon a con
stant up-to-date flow of information not only on nutritional
status, but also on acute episodes of diarrhoea, measles, and birth
of underweight babies, as well as on emergencies and labour.
There are 17 villages which are very remote, a five-to six-hour
walk from the phc. Homing pigeons stationed in remote villages
can bring a message to Kasa within half an hour.
Identifying food beneficiaries
A system for the effective surveillance of all under-sixes and
married women, especially pregnant women and lactating mothers,
has thus been established for the entire project population, no
matter how remote the village.
Weight standards have been established for the inclusion of
under-sixes and women as nutrition programme beneficiaries.
Under-sixes weighing 65% of the Harvard standard or below,
receive food supplements until such time as they have reached a
weight equal to or above 65% of the standard, and maintain that
weight for six weeks. Food beneficiary lists are up-dated monthly
by the ptsw’s.
12 Ibid.
Kharc. R. D., Shah, P. M. and Junnarkar, A. R., Insight into the etioecologica I factors of kwashiorkor in a community, hid. Ped., no. 13,
1976, pp. 405-407.
P. M. Shah
The 65% mark was established for economic reasons. It
had been observed at the Palghar project that the number of chil
dren in the bracket of 66 to 70%of this standard was greater than
all those whose weights were in the 65% bracket or below.13
This was confirmed at the Kasa project.
Therefore, to include
the children in the 66 to 70% bracket would be to double the
cost of nutrition supplementation, an important consideration
in the implementation of a large-scale progamme.
Women who weigh 42 kg or less at the 34th week of preg
nancy14 also receive supplements during the remaining weeks of
pregnancy and continuing through the first four weeks of nursing.
Distributing supplementary foods
Roasted Bengal grams and ground-nuts purchased in Bombay
are used as supplements to provide 361 calories and 17.9 g of
protein to the needy child and 541 calories and 26.8 g of protein
to a pregnant or nursing woman. Severely malnourished children
in the age group of 9 to 15 months are given the same items mixed
with jaggery, a coarse brown sugar, in powdered form, supplying
291 calories and 11.3 g of protein.
All pregnant women receive
an iron-folic acid tablet three times a day during their last three
months of pregnancy.
Ground-nuts and grams are highly acceptable to benefici
aries, and are supplied everyday of the year. The ground-nuts
are roasted at Kasa. Daily rations of supplements are packed
at the project office in polyethylene bags during monsoon and in
locally prepared paper bags in other seasons. The minimum shelf
life of supplements in polyethylene bags is approximately eight
weeks. As ground-nuts and grams are snack items, they are
eaten as supplements and not as the substitute for a meal.
13 Shah, P. M. and Junnarkar, A. R,, Domiciliary treatment : second year
progress report, op. cit.
14 Shah, Kusum P. and Shah, P. M., Relationship of weight during preg
nancy and low birth weight, Ind. Ped., no. 9, 1952, pp. 526-531.
Shah, Kusum P., Selection of pregnant mothers as beneficiaries for nu
trition supplements, Jour. Obst. and Gynaec. India, No. 25, 1975
pp. 371-373.
’
’
Community participation and nutrition
— the Kasa project in India
In May 1976, 2259 children, or 23.8% of the child popula
tion, were receiving nutrition supplements. During the year
from May 1975 to May 1976, the nutritional status of 11.3% of
the severely and moderately malnourished children, weighing less
than 70% of the reference, improved.
The community was approached for a daily contribution of
milk for several severely malnourished infants under nine months
of age whose mothers had lactation failure. Three infants are
receiving 250 ml of milk per day provided by the community.
During the monsoon, when it is difficult to walk on the
muddy roads and rivulets are in spate, 85% of the food deliveries
were made to the beneficiaries in the “inaccessible zones” of the
project. In the summer, deliveries of nutrition supplements in
creased to 98.9% in all the zones covered by the ptsw's. With
such a high level of distribution, a new problem has arisen, that
of storage facilities. A solution to the problem is being sought
by building traditional rat-resistant storage containers with the
assistance of the local community.
Immunization programmes
The immunization campaign was intentionally begun nine
months after the implementation of the nutrition and health
programmes, so as to have better rapport with the community.
The mass campaigns were organized during November and Dec
ember 1975 (13 days) and February 1976 (12 days), in which the
district BCG team and the phc staff members participated (the
sanitary inspector, four smallpox vaccinators, seven auxiliary nurse
midwives and 28 ptsw’s). The community was informed and
educated beforehand. In May 1976 a ten-day campaign was
carried out by the local phc staff to reach the defaulters.
Ongoing immunization programmes for smallpox and dpt have
been continued by the auxiliary nurse midwives and male health
workers.
The children’s immunizational status for smallpox and bcg
vaccines increased from 52.3% and 0.2% to 94.2% and 54%
P. M. Shah
respectively during the year from June 1975 to May 1976. Only
2.1% and 1.4% of the eligible children were immunized with
1 and II doses respectively of dpt vaccine in June 1975. At the
end of one year, the rate had shot up to 81.8% and 57%.
These achievements were very remarkable in view of the
terrain of the project area, the sizable tribal population (88%),
and the scale of the operation (9560 under-sixes).
The good
results of the immunization programmes depict clearly the extent
of the rapport the ptsw’s have developed with the villagers.
Three monthly campaigns for defaultersand ongoing programmes
by the auxiliary nurse midwives and male health workers, with
the assistance of the ptsw’s, will cover the remaining population.
One BCG mass campaign is also to be organized to reach
defaulters.
Family planning
An analysis of households with children suffering from
kwashiorkor in the tribal villages at Palghar revealed that children
up to the age of 14 formed 60.8% and the under-fives 32.7% of
the population.15 The planning of families particularly through
spacing is of utmost importance in preventing severe malnutrition.
It was decided that family planning programmes would be
taken up in the second year of the project, after a rapport had
been developed with the communities. During the year from
April 1974 to March 1975, only 45 vasectomies had been perfor
med at the Kasa phc. During the year from April 1975 to March
1976, the figure increased to 750 vasectomies and 27 tubectomies.
As a matter of fact, the family planning programmes were inten
sified only after November 1975, and there was only one medical
officer at the phc. The performance exceeded by 19% the revised
target set for the phc by the government. It was the first time
tubectomies were performed in the Kasa phc area.
Vital support for the campaign came from government and
local bodies such as the administrative body at the block level
15 Kharc, Shah and Junnarkar, op. cit.
Community participation and nutrition
— the Kasa project in India
(Panchayat Samiti) and the Forest Workers’ Society, which pro
vided generous cash incentives.
All the staff members of the
strived to reach the target. The family plan
ning programme will continue to be a regular phc activity.
phc and the ptsw’s
Health and nutrition education
The primary educational tool is the home-retained record
card of the under-sixes and women. Healthy normal children, or
those who were malnourished and are now improved, serve as
models for demonstration. Most of the working mothers of
“at risk” under-sixes leave their small children in the care of
older ones of six to eight years of age.
These young mother
substitutes feed the smaller children only twice a day. The ptsw’s
attempt to discuss with them the amount and frequency of the
feedings to be given to the young children. The advice as to
feeding depends upon the availability of food at home. During
the two months of summer, some of the families live only on
tuber roots or gruel prepared from wheat or millet, and the ptsw’s
suggest that the small infant’s intake be supplemented with these
items. Person-to-person or small group talks are part of the
educational activities.
Community involvement
Medical programmes in developing countries have been struc
tured with little regard to active participation of the community.
The services offered by the state are often accepted passively as
aid or charity. Few measures have been taken to inculcate com
munity responsibility for maximum utilization and development
of the health facilities, an essential component of total community
development. Health workers should have a good understanding
of total community development programmes and be able to
stimulate an attitude of “self-help" and positive action among
the population, which is most often willing and able to contri
bute, even though poor.
P. M. Shah
Participation in nutrition programme
With these objectives in view, the ptsw’s, who have been
recommended by their communities, have been involved in stimu
lating more “self-help” in terms of community participation in
the programmes. They meet with the villagers and their leaders
and inform them of the nutritional and immunizational status of
their children, and list the names of those who are “at risk” and
require special care. The social problems encountered while
running these programmes are discussed and many times solutions
have been suggested by the villagers themselves. A fairly good
rapport has been developed with all the villagers.
The villagers provide “clinic” sites on the verandas of their
huts or houses. They assist in collecting the children and women.
In approximately one third of the villages, someone from the
hamlet collects the beneficiaries and has them eat their nutrition
supplement in front of her or him. When told of the problem
of feeding small infants whose mothers had lactation failure, the
community provided milk for 13 children in the Palghar project
and three in the Kasa.
Road construction and active support of immunization campaigns
There have been instances at the Kasa and Palghar projects
when villagers have constructed roads to facilitate communication
with the phc. During mass immunization campaigns, the block
administration (Panchayat Samiti) sanctioned Rs. 2500 (us S 290)
for the project, and the Forest Workers’ Society and villagers
made arrangements to meet the local needs of the teams, serving
tea, breakfast, lunch and dinner for 36 persons for a total of 25
days. The village leaders educated the population on immuniza
tions and collected children for the shots.
Financial contributions
The Palghar project, after its four years of existence, is now
being financed entirely by the local village level administrative
body (Gram Panchayat) and block level (Panchayat Samiti) and
Community participation and nutrition
— the Kasa project in India
district level people’s administration (Zilla Barishad). These are
contributing 20, 30 and 50% respectively for the salaries of eight
ptsw’s and the district administration will provide the necessary
nutrition supplements. The local health unit staff will manage,
guide and supervise the programmes. At present the operational
research team has withdrawn completely, and will carry out a
survey after two years.
This financial contribution from the local community will
generate the active involvement of the villagers, which should lead
to a better performance on the part of the ptsw’s and to a greater
awareness that everyone in the village indirectly contributes to
wards her or his remuneration. The field of community partici
pation could be widened to include improvement of the water
supply, environmental sanitation, communication and obtaining
of grains and funds for nutrition supplements for the children and
mothers. The community’s organized participation can be of
assistance in establishing cottage industries, which could eventu
ally help to raise its income.
Collaboration with traditional health practitioners
A meaningful collaboration with the 140 traditional mid
wives (Dais) and 278 traditional practitioners (Bhagats) of the
area is still to be organized. However the ptsw’s and supervisors
have maintained good relations with this community health per
sonnel.
Some conditions for success
In bringing health and nutrition services to the most needy
villagers, the first step is to identify them. This the ptsw’s can
do after a short training period. In the long run, the educational
level of the link worker may not be so important as a willingness
to learn, initiative, and the stamina to cover the required dista
nces. Once a pattern for the delivery of health and nutrition
services has been established, the turnover among the ptsw’s is
of less importance, because of the trust already established
between the villagers and the phc staff. When the community
has an understanding of the programmes, it is easier for the rep
lacement worker to function well from the start.
A critical analysis of the accomplishments and deficiencies
of the Kasa project, which is in operation in the context of a
government phc, reveals that the planning, coordination, sup
ervision and other components of management are the sine qua
non for the successful implementation and duplication of such
programmes elsewhere.
y—jCSMZxJ " j
C^ixc-
So.
>4P5M
y
*'"p* -
1 ^TGv^
T
TRAINING A
HEALTH WORKER AT VACHAN
Introduction:
In the context of Primary Health Care approach,
a VHW is seen as
- MOTIVATOR
— EDUCATOR
- SERVICE PROVIDER
for all the activities under its perview viz,
antenatal care (registration,
Post-natal
care
provision of iron supplement!
(same as ANC plus advice
on
breast
feeding):
immunisation (motivate follow up)
growth
monitoring
(weighing and
diarrheal diseases control
educating
mothers)
(ORT) and so on.
At VACHAN a different view is taken;
particularly in the light of
the lack of availability of cui auive services.
A HW is
- a provider of primary level CURATIVE HEALTH care service.
— a provider of REFERRAL acvice'for serious ailments.
- an EDUCATOR as a part of his role as a healer.
— a MOTIVATOR for health measures hitherto not taken by
community : ORT/ disinfection of wells.
the
SELECTION OF HEALTH WORKER
Objective
To locate a person who is
- ACCEPTABLE to all sections of the community.
an
enable
him/her
TO
LEARN the necessary diagnostic skilist Normal in VACHAN
is
- having
EDUCATIONAL BACKGROUND to
fifth to ninth standard educated boy/girl).
- placed
by
one
at a DISTANCE which can be
comfortably
traversed
a moderately ill person or a pregnant woman say
about
kilometer.
- Nomination
by
the
community
usually
in
a
community
TRAINING OF HEALTH WORKER
Having
knowledge and skills to tackle health problems
that
- are not life threatening
- do not require complex decisions to diagnose
- are amenable to simple treatment
- do not involve use of antibiotics or medicines that may
have serious side/toxic effects.
Problems include
viral infection like cold influenza, mumps, chicken pox,
uncomplicated measles, viral diarrheas with mild or
moderate dehydration.
other infections like uncomplicated amebic, bacterial
dysentry with mild dehydration amenable to 48 hours of
treatment, giardiasis fungal ingection of skins like ring
worm.
- infestations like scabies,
lice and worms.
- wounds with no sign of spread of infection and of injury
to important structures like bones, arteries, nerves.
allergic
as thaiua.
conditions
like
rashes,
colds,
uncomplicated
symptomatic treatment for short period for headaches and
joint pains, hyperacidity, dry coughs.
Training includes:
- Anatomy and Physiology particularly their applied aspects.
- Concepts in Pathology e.g.
. immunity, antibodies and vaccines,
healing. • -•
inflammation
...
and
- Concepts in Microbiology
. Different types of micro-organisms viz, viruses
bacteria, fungi and unicellular organism like ameba
- Types of bacteria
.
Based on staining. methods
- Concepts in Pharmacology
.
Drugs Action
.
Side and Toxic effects
.
Essential Drugs
.
Rational Drug use
.
Misuse of drugs incl. injections,
tonics.
- Concepts in Nutrition:
.
Components of our food &. their
functions:
Carbohydrates, fats, proteins, vitamins, minerals
.
Their sources
.
Nutritional deficiencies,
symptoms and signs,
treatment,
prevention
- Concepts in Diagnostics
.
Problem solving Approach to medical/health problems
.
History, Examination and Investigation
.
Clinical Examination: What to look for: Anemia,
nutritional deficiency
,
. Use of Diagnostic chart &. Table : Fever & Diarrhea in
adults.
c SeA Tajole. I c.y'J C-hcuX
oA *
- Child Health;
.
Weight Monitroing
.
Nurtitional advice - weaning foods
.
Immunisation
.
Common diseases/ problems
$
Seurce-'.
Having
knowledge and skills to tackle health problems
that
- are not immediately life threatening
- do not require complex decisions for diagnosis
- are amenable to simple treatment/ first aid measures.
- may involve use of antibiotics or medicines that have no
toxic effects if used with caution.
Problems Include
Bacterial infections like tonsilitis,
middle ear
infection, pneumonias, bacillary dysentery, urinary tract
infections,
infections following delivery, vaginal
infections,
- wounds with signs of spread of infection
- bronchitis following filarial infection,
- bleeding after delivery
- referral advice for ailments like sudden severe pain in
abdomen, problems involving the central nervous system or
the circulatory system, problems of children that cannot
be tackled by them,
- Symptomatic relief for vomiting,
abdomen
motion sickness,
pain in
Training includes j.
- Pharmocology of anti-biotics
- Diagnostics involving clinical training in a hospital set
up.
TABLE—I
CLASSIFICATION OF AILMENTS FOR
Group of ailments
1.
PARAMEDICAL TRAINING PROGRAMME
Diagnostic
Treatment
Sa'ety
Prevalence
Feasibility
Feasibility
Factor
Factor
tttt
”7
rrrt
tin
Minor ailments
Ailments
Common cold, minor cuts,
headaches, constipation,
fungal infection,
scabies
etc.
2.
Major ailfttents
ttt
nt
ttt
ttt
Diarrhoea, dysentery,URTI,
malaria, otitis media,
vaginitis, hyperacidity
hepatitis, etc.
3.
Serious ailments
ft
rt
t
t
Pneumonia, typhoid, fever
Acute abdomen, meningi
tis, Diptheria, tetanus etc.
4
tt
Important chronic condi
ft
tions that need early
Tuberculosis,
filariasis
ieprosy,
cancer, etc.
detection and health
education.
5.
Acute emergencies that
t
need first-aid and referral
f
t
Snake bites, Burns, Severe
dehydration; major
dents specially
, brain,
chest
acci
involving
aodomen
and haemorrhages etc.
Note:
1)
The examples under 'ailments' heading a.e not a compete list but only a few cases for
illustration.
2)
The difference betwen category 3 and category 5 Is that in category 3
( serious ailments )
there is little scope for first aid while in the later first aid can often save the patients.
3)
The diagnosis of, say snakebite, is easy but that of its effects is difficult and hence the
overall diagnostic feasibility is poor.
4)
Category 1 can be safety attended [by the paramdicals, while category 2 should be attended
with caution watching for indications for referral. Category 3 should be immediately referred
to medical experts. Category 4 needs, high suspicion index for early detection, supervision ■
over the treatment and health education and category 5 assisted with first aid before sending
for expert care.
5
FEVER DIAGNOSTIC CHART (for persons above six years)
1 INFORMATION ABOUT
OTHER COMPLAINTS
C
c
c
C
R
C
R
R
R
R
C
C
C
R
C
R
High
Irregular
C
-OUS
R
c
• TREAT
A : ALWAYS, C: COMMONLY,
R : RARELY, L : LATE
" TREAT W>TH CAimpN
~ REFEF- TO HOSPITAL
OTHER SPECIAL FEATURES
R
Eyes congested, Stuffy nose, Contagious
DIAGNOSIS
Common cold ■
C
R
Malaise, Prostration
Flu*
R
c
R
Redness on throat / tonsills. Dysphasia
Pharyngitis; Tonsillitis
R
C
Dry cough initially, Followed by productive cough
Bronchits"
C
c
R
Acute onset. Dyspnoea. Prostration
Pneumonia
lR
A
C
A
A
C
C
R
R
R
C
A
R
C
R
1
1
C
R
C
R
R
C
Chronic condition. Anorexia, Productive cough
Tuberculosis “*
C
R
R
R
C
Check site of infection, Lymphadenitis
Infection / Abcess "
C
R
C
R
Prostrations, Relative Bradycardia
Enteric Fever *”
R
R
C
R
Hypochondriac tenderness, Yellow sclera
Hepatitis / Jaundice "
R
C
Faer with chills, daily or alternate day
Malaria"
C
C
R
Neck rigidity. Change in behaviour
Meningitis'** -
C
R
Joint swellnes, Valvular heartdiseas
Rheumatic Fever■"
Lymdhadenitis, Send night blood smear
Filanaais. FirsfPhase "
Burning / ferqueney / turbidity of urine
Urinry tract infection "
A
R
A
C
C
R
C
C
A
C
R
R
A
C
A
R
C
C
R
C
R
R
R
C
R
C
C
C
G 1
1
■ 1 Lc 1
R i
c I ci
1
R
A
1
R
R
A
L
J
S
f
5
o
-J
R
C
Character
|conlinu-l
Bodyache
Headache
1
V om illinn»
I
1
A
Abdominal
A
INausea
c 1
(Chest Pain
C
1
L
Couah
Rhroai Pain
L
How Much
UIBdlUlop
1
FEVER
1
1 R
R
R
C
A
c
C
R
i
Hot environment. Acute onset
Heat stroke "
Delivery in last two weeks
Purpereat sepsis •"
|
FEVER : DIAGNOSIS (abGve six years)
ASK
THROAT PAIN
'I
THROAT CONGESTION? |
SWOLLEN TONSILLS?
DELIVERY in
LAST TWO WEEKS
PHARYNGHIS
TONSILLITIS **
ASK/CHECK
COUGH?
ACUTE ONSET
ASK/ CHECK
TACHYPNOEA?
HEST PAIN?
NO | ASK/CHECK
PNEUMONIA*** j
DRY COUGH
NO
CHECK
YELLOW SCLERA
JAUNDICE/HEPAT1TI
Refer To Hospital /
. Doctor***
Send To Hospital
11 Docs Not Respond
To treatment In 3|Days
NQ. I ASK/ CHECK
Special Invcstigalon
POSITIVE FINDING "1
IN X RAY CHEST I
INFECTION/PUS
THROBBING PAIN
ANYWHERE?
I and/or SPUTUM EXAM
i
POSITIVE?
ASK/ CHECK
NO
N0
Y
E
S
NECK RIGIDITY/
CHANGE IN
BEHAVIOUR?
MENINGITIS
ENCEPHALITIS
BLOOD EXAMINATION
PULMONARY
EOS1NOPHISIA
Refer if no response to dee <
deworming, within one
week
tA.SK/ CHECK
NO
RHEUAMATIC
JOINT SWELLINGS 7
NO
ASK/ CHECK
| FEVER WITH CHILLS
LYMPHADENITIS
YES
NO
NO
BURNING MICTUR1
TURBIDITY
FREQUENCY
CONTINUOUS FEVER/”] |
RELATIVE
'
BRADYCARDIA?
ASK/
CHECK
EN1ERIC
FEVER ***
F1LARIASIS'*
FIRST PHASE !’
Sum Treatment And Ruf ci
URINARY TRACI
INFECTION **
NO
Refer IfNoRclif'Wilh
Chloroquine In 2,Days
ANY OTHER DISEASE*
VACHAN
(Voluntary Association for Community Health And Nurture)
'Vasundhara Bunglow'
Nasik-Pune Road
Shivaji Nagar
Nasik-422006
Phone : 63952
Telex : 752-236 PCO IN
Fax
: 0253-77213
Soc-Regn. No. Bom. 540/86/GBBSD
April 19.,
*
Pub. Trust Reg. No. F/11721 (Bom.)
*
FCRA Reg. No. 083780382
1995
Dear friend.
What
are
Village
Health
Workers ?
Are
they
community
health
educators? Assistants to other Health Professionals in villages ?
or
acting as ’doctors’, diagnosing and treating some common ailments ?
These were
questions raised when we trained
and
supervised our
villages
based
Health Workers (HWs) in Igatpuri
Taluka
of
District
Nasik,
Maharastra.
We
based our training on ’the
Training
Manual
'Bharatvaidyak’.
We
are
happy that we have been able to do the study of
the
HWs’
activities
and
their effects in the villages where they
work
since
between
1989
and
1992.
Center
for
Development
Research
and
Documentation, Pune, an institution recognised for studying, changes in
villages by development institutions, decided to carry out this study.
We feel humbly that we were not able to trace such studies
in other
activities of training and the effect over the HWs’. We are also aware
that Ouf study is probably, the first of its kind and therefore
has
some
imperfections. However, all of us are very happy that we
tried
to find out honestly as to what the HWs’ have achieved.
So,
please let us know as to how you feel about the study
and
its
^^.observations.
We
would be very happy to get your comments
nay,
even your criticism - about the methodology of
Thanking you,
the study also.
in anticipation.
(Dr.Dhruv Mankad.)
DIRECTOR, VACHAN
NASIK.
(Dr.Sham Ashtekar.)
BHARATVAIDYAK SANSTHA.
DINDORI, NASIK.
The Gram Gourav Pratishthan, Shetkarinagar-Khalad
Taluka : Pnrandhar, District : Pune
Maharashtra State (India)
PREAMBLE
The Gram Gourav Pratishthan, Naigaon, Taluka Purandhar,
District Pune, has been working in the field of Rural
Development since last 7-8 years. A number of persons from
various walks of life have been visiting the work done by the
Gram Gourav Pratishthan and have expressed deep satisfaction
about the new approach put forth by the Gram Gourav Prati
shthan, in Soil-Water-Manpower management and socio-economic
development, particularly in drought-prone area of Purandhar
Taluka. The work done by the Gram Gourav Pratishtham is
unique in the sense that without any publicity or show it has
been working for the rural upliftment through a small group of
devoted personnel. The work done so far may no: be a dazzling
performance; but it is a grass-root work for the people in the
drought-prone area. The people had practically lost hopes of
their betterment. But now they can face natural calamities. The
people who visit the works of Gram Gourav Pratishthan arc
naturally curious to know how this transformation has been
brought about. The same has been explained in this note.
Substantial areas of our country periodically experience drought
leading to considerable loss of agricultural production and live
stock wealth, besides causing untold misery to the people inhabitingthese areas. In Maharashtra State, 7,000 villages in -87 Talukas
or block’s in 12 districts have been identified as drought prone by
a Fact Finding Committee appointed by the State Government in
the_year 1973 and Purandhar block of Pune District is one of
them.
'
Large sums heve been spent by the Government for providing
relief after occurrence of. droughts. Such expenditure has not
helped to the required extent to solve the basic problem of increa
sing the productivity of these areas and thereby reducing the
1-
severity of the impact of droughts on the human and cattle
population. To develop these areas and thereby reduce the
impact of the droughts is a challenging task.
Though the average rainfall of the Maharashtra state is 1070
mm, its pattern is not uniform, the average rainfall in the drought
prone areas varies from 250 mm to 500 mm. Besides being in
adequate it is very erratic, untimely and not assured every year.
This area generally experiences drought once in three years and
severe drought and acute scarcity once in ten years.
It is, therefore, not possible for people of this area, particularly
for marginal and small farmers, to sustain on the rainfed agricul
ture. This has forced ajarge number of them to migrate to cities
like Pune and Bombay, where conditions of life in the slums are
hardly any better; or to become agricultural labourers or share
croppers on the farms of rich farmers, in areas where there is assured
water. There arc about_ ten_ thqusand_.pc.oplc. -from Purandhar
block alone working in various textile mills in Bombay.
These people are living-in the Saitan Chowki area of Bombay.
They live in filthy, cramped quarters popularly known as ‘gala’.
Each gala is approximately 12’ ? 15' (with a makeshift mezzanine
floor ) and around 30-40 people live in it in shifts of eight hours.
In a gala each person is provided space measuring 2’::5’'2’to
spread his mat and sleep.
ORIGIN OF GRAM GOURAV PRATISHTHAN
In Maharashtra 33 per cent of the total cultivable land is affeued by drought. The population of le affected villages is about
r50 lakhs, alrnast-LGrd of the total nonulatinn of the Statc. Only
Ulper cent of the land is irrigated and only 15 per cent of the
population is covered by iL Thus sectoral planning at the
national level has resulted in socio-economic imbalances and
patches of prosperity. It, therefore, poses a basic question of
planning for the remaining 85 per cent of the population and their
88 per cent of dry land.
There was a severe drought and scarcity in 1971-72 in Purandhar
block. There was no drinking water and fodder in a cumber of
villages. The affected farmers not only sold their cattle at throw
away prices but also gifted them to those who could look after
them, instead of witnessing their slow death due to starvation and
thirst. They also started migrating to nearby towns and cities.
2
Shri V. B. Salunke, an engineer and the Managing Director of
Accurate Engineering Company had an occasion to travel in the
drought prone areas in Purandhar Taluka in the year 1972. The
severity of drought, and the plight of the people moved him. He
decided to fight famine and thought of finding out permanent
measures to face recurring droughts.
Ir 1972-73 Shri Salunke approached the Collector of Pune for
starting productive works in the scarcity area and helped the
Government organisation in preparation of plansand estimates of
percolation tanksTosting Rs. 5 lakhs in about two weeks. One
such percolaticn tank was constructed near the village Naigaon.
Shri Salunke selected Naigaon for further experiments in rural
development and started working earnestly' on "soil and waler
conservation nicasuies.
In 1974, Mr. Salunke established a charitable trust called ‘Gram
Gourav Pratishthan’ at Naigaon village in Purandhar taluka in
Pune district, with the following aims and objectives :
I.
2.
To provide initially relief to the farmers of the Purandhar
taluka by improving their economic conditions and to remove
the cause of recurring droughts.
To create facilities to raise their social and economic condi
tions to attain welfare of the people in this Taluka.
To conduct research studies in socio-economic conditions, .
so that the urban interests will be linked with the process of
creating integrated rural development.
4.
To do all such lawful things as arc conducive or incidental to
the attainment of all the above aims and objectives.
He selected this village for two reasons: Firstly, it falls in the
area which is worst afflicted during the droughts. Secondly, the
trust could get 16 hectares of land on lease to carry out experimeinE'orr7iTs7deas' of lighting the drought. The people of Naigaon
gavclfftlfc 1 nisi on a“IOlfjTeaSc H5~hectares of barren vacant
land belonging to the village temple.
The intention behind carrying out the experiment was to find
out a permanent solution to overcome the recurring drought. It
was important to understand what risks were involved in the new
approach before asking the villagers, whose existence was too
precarious, to take any themselves.
The invetigations revealed that the precipitation received during
thesouth-west monsoon(between June: nad September) in Naigaon
usually fluctuated between 2_50 mm and 500 mm. The prccip.tation received from north-cast monsoon (October-Novembe r)
comes in heavy concentrated dosages. Most of it runs off in
seasonal streams and rivers, in the absence of any water conserve
atioh work to retain it.
Experiment at Naigaon
The 16-hectare land is situated on micro-watershed. During the
heavy rains a precipitation from about 200 acres run off from
this watershed. To impound this water a percolation tank of the
capacity of a million cubic feet of water_was_ constructed within
this land. While this was being constructed the fields were contour
bunded, levelled, stones removed, ploughed and an open well dug
at the base, on the downstream ol the tank. A~pu~mp of 7.5 H. Pwas installed at the well to lift the waler up to a height of 40 ft,
(say about 13m). The rising main of R. C. C. pipes about 300
metres was laid under ground by digging trenches to the distribu
tion chambers.
§
i
r
For five long years from 1974 onwards Mr. Salunkc and his wife
Kalpana carried out experiments in water and soil conservation;
designing of low-capital-cost community minor irrigation for eight
ffionths in a year (i. e. Litt Irrigation Schemes); possibilities of
regenerating-scarce water by bui' ling small check bunds on nullas
'below the main percolation tank, the theory that water in the
tank above or used on the fields at higher elevations would perco
late Into the ground and raise the water table in lands'—at 1 owcr
elevations; irrigation techniques and management; different crop
ping patterns, to see which would yield the optimum income a nd
foodfuse of improved varieties of seeds; use of fertilizers and in
secticides to" improve agricultural production;-------------Out of the 16 hectares of land 9.60 hectares were brought under
protective irrigation, 2.40 hectares under afforestation and the
remaining 4 hectares came under the percolation tank, well, field
blinds,_tract andlnfrastructures.
When the above experiments were being carried out by the Trust
on the barren land, the farmers of Naigaon village showed little
interest. They were not only sceptical but were sure, that it was a
4
futile exercise. But soon the experiment proved a succcs.s When.
the villagers saw that_200 quintals of food grains were produced
on 24 acres of land under experiment, whereas 40 acres of their
own hardly produced ten quintals, they flocked arppnd Mr.
Salunkc, requesting him to start similar schemes for them.
Besides producing record food grains, the farm has generated
full time employment for fifteen people and supports fifteen animals.
4000 trees onthc rocky rimland and 2000 fruit trees along field
bunds arc thriving. In addition, a three-quarter acre rias been
brought under Thomson Seedless grape vine. Some decades ago
Purandhar Taliika was famous for horticulture. Today there arconly a dozen of orchards that produce guavas and custered apples-
The one million eft. of water stored in a small percolation tank
at Naigaon has proved quite sufficient to irrigate 2.43 hectares
in kharif, 8.20 hectares in Rabi and 0.5 hectares in the summer.
or about 11.00 hectares in all.
The trust has been .supported, besides Mr. Salunke's industry.
by individual philanthropists, other industries in Pune and Bombay
and has received some donations from Novib, Netherlands: Church's
Auxiliary for Social Action and Peoples Action for Developments
( .Maharashtra ), all supporting voluntary rural development
schemes.
Paui Panchayat ( Water Council)
jn 1980 Mr. Salunkc decided that lime had come to more for
ward for economic transformation of the villages. He first
started with Naigaon by seeking the involvement of the poor
farmers in establishing a series of community minor lift irrigation
schemes, building upon the experience he had acquired with the
experimental farm.The various experiments carried out at the experimental farm
have conclusively proved that, with proper methods of waiter conservation and careful distribution, half an acre of irrigated land
would reasonably sustain one person. Thus, a family womld have
a maximum of 21 acres of irrigated land. Here came Me of the
kty'ingredients in the rural transformation; the allocation of water
noFin"proportion with land holdings but in proportion with the
number of people in a family^unit. This revolutionary concept is
the kev to altering the ‘‘refraction effect” of technological inputs.
Had Naigaon followed the usual tradtional practice of alloca- ting water in proportion with kind holdings? the result is easy to
predict. Those with more land would have benefited more. Since
water in a drought prone area is the key to a more productive
agriculture, this advantage would have been multiplied down the
line in terms of the ability to use other technological inputs to
increase produetvity. Hence, the usual pattern would have soon
emerged in Naigaon, as it has in so many other well intentioned
rural development schemes throughout the country.
With irrigation, small farms intensively cultivated, would
achieve higher levels of productivity than larger farms less intensi
vely cultivated. Therefore, the overall agricultural production in
the village economy would increase more through the strategy of
allocating water to a large number of small farmers rather than to
a small number of large farmers.
Another kev chment in the_plan_was its financing. When the
lift irrigation programme started in_Naigaon, a formula called
20/40'40'wasToIIowcd, that i<, the beneficiaries put in 20 per cent
of the capital cost, the Government another 40 per cent as subsidy
and the Trust the remaining 40 per cent. (Interest free loan, to be
repaid in five years.) The Government gave subsidy from a pro
gramme called Minor irrigation extension programme 2 to 4
hectares, which was later withdrawn in. April 19S1.
This was another revolutionary approach of the scheme. When
the Government sets up irrigation system, the beneficiaries do not
contribute anything towards the capital cost. They pay water
charges and in most cases, the water is misused and benefits reach
only to a select few.
It has been noticed from the expenditure incurred by the Govcrnnient cn major and medium irrigation projects that, it has 'spent
on each beneficiary family anything from Rs, 8,COO to 16,000. On
thc_othcr hand, the Government spends anything up to Rs. 30,000
on an individual in Bombay in order to 'provide civic facilities .
Whereas, to provide community lift irrigation facility to an indivi
dual family it costs only Rs. 6,000 per hectare. In view of this the
Government was requested to contribute 80 per cent of the capital
cost as subsidy to such schemes. The 20 per cent contribution by
the beneficiaries remained unchanged. But the proposal though
accepted on paper, has not borne any fruits, on account of impra
cticable procedural requirements.
From the socio-economic consideration, the modalities of Pani
Panchayat for sharing water, the scarcest resource in a drought
prone area and the main input for increasing the agricultural
production are, therefore, as follows.
1.
2.
t.
4.
5.
6.
7.
Only group schemes are undertaken and not schemes for in
dividuals. This fosters community spirit.
The sharing of water is on the basis of the number of mem
bers in the family and not in proportion with land holdings.
Half an acre per capita, maximum of 2'/. acres. The land in
excess of 2'/. acres is to remain under rain-fed condition. The
principle of equity is thus incorporated and imbalance is
avoided.
The rights of water do not go to the land, but to the indivi
dual beneficiaries for increasing their own agricultural income.
If the land is sold, the rights of water revert to the Trust.
Beneficiaries share 20 per cent of the cost of the lift irrigation
project, according to their share. Peoples' active participation
and stakes arc thus ensured. The balance of the SO per cent
will be given by the Trust, as an interest free loan to be repaid
in five years, from the donations received. After the scheme
becomes products e, the Government will be requested to
reimburse the 80 per cent or part thereof, which may or may
not be accepted.
The beneficiaries <x the project themselves arc to administer,
and operate all its aspects. The leadership, capability and
skills of the rural people arc thus recognised and enhanced.
Crop such as sugarcane requiring more frequent watering and
consequently more quantity of water is not to be grown. This
will enable to bring mote area of seasonal crops under prote
ctive irrigation. Thereby more number of people will benefit
than otherwise.
• • ■.
The landless can also 'share water, so that they gain full
employment in the village itself' by becoming sharecroppers
to farmers having more land. This will check their migration
to cities.
IMPLEMENTATION OF LIFT IRRIGATION SCHEMES
Initially the farmers were required to be motivated to accept the
norms of Pani Panchayat, because of the revolutionary ideas of
sharing water on per capita basis, i. e., ‘.^Pcrc per person with a
ceiling limit of 2'/- acres and contribution of 20 per cent of the
capita) cost. These concepts were new to them. But, after a couple
of schemes for the motivated groups were completed, the sceptical
attitude of the people of Naigaon was sooif dispelled 'and more
and more groups of people came forward. Today there are eight
scheme-, operative in Naigaon (SeeAnnexurel)'.
"Farmers of the surrounding villages soon came to know of the
most enviable transformation that was taking place in Naigaon.
They started visiting Gram Gourav Pratishthan and the completed
schemes at Naigaon. Some of them started asking enthusiastically
if such a scheme w ould be taken up for them also. By now all
those who came to Gram Gourav Pratishthan had come to know
of the norms of the Pratishthan. and therefore no more explaining
of the norms or motivating them was required.
Today there are 36 schemes in hand for which Government
subsidy was received. Out of these, 25 are operative ( Jan., 83), 11
schemes tlfougli_almos£compicted have not been commissioned for
want of electric power connection. Two schemes arc in various
stages of completion. Even if th~ev"are complefed they would not be
cdmmjssioncd as getting power connection would be a problem.
12 fresh schemes arc taken in hand for which the Government
subsidy is not available. Out of these, three arc operational. The
remaining arc under various stages of completion and are going
to meet the same fate as mentioned earlier in regards to power
connection.
The details of the various schemes arc enclosed. (Aiv'c.xure 2).
SOCIO-ECONOMIC CHANGES
In each village dry land cultivators are in majority. On an
average they constitute 90%.per cent of the village population. A
community lift irrigation scheme is beyond the means of a dry
land farmer. As mentioned earlier, in the schemes of Pani Panehayat a beneficiary has to contribute 20 per cent of the capital cost
of a project. He docs not have the means to raise this amount.
Therefore most of them take a share of water much less than
they arc entitled to.
Many of the beneficiaries have raised their contribution of 20
per cent with great sacrifice. They had to part with whatever little
valuable things they possessed. Some sold their cattle, some their
sheep and goats, some utensils of the house and in a couple of
cases they even sold a very meagre quantity of gold from the
’• Mangalsutra " (a necklace worn by the married woman whiosc
husband is alive.), the only valuable possessed by the family.
It is just not possible for a family to subsist only on dry luind
agriculture. Many from Purandhar block had therefore to migrate
to cities like Bombay and Pune. The Shepherd community leads a
nomadic life, returning to their fields only during the monsoon to
produce whatever little grain they could. This has been the pattern
of life of the dry land farmers for generations.
These circumstances are both a curse and a blessing. A curse
because of the hard conditions of life which the lack of vvatxcr
imposes, but a blessing in that most of the families have sotme
land. In other words, the critical constraint in this drought pTmr
area is not land but waler.
The beneficiaries of the schemes comprise of al! classes high amd
low. It has brought in a social change. They no more think in
terms of individual gains but consider community or collcctiwr
gains. There is an accommodating spirit in them. Some anti-sociui'
activities in which sonic people indulged have come to an end, authey have no idle time, because irrigation has given them full time.
occupation.
The beneficiary shepherds are no more leading a nomadic life.
They have permanently settled on their lands. Those having them
fields at distant places from their village arc now living in theii’
fields by constructing thatched huts, so that they can spend more.
time on agricultural work. This has forced the children to foot the.
distance to conic to the village school,.besides giving a helping hand)
to their parents in their spare time.
A couple of groups have even solved their drinking water
problem, through the lift irrigation system. This has saved the
wamenfolk a lot of time and labour, which they can now devote
to work on the ftciddr.
In one case (Babawadi) they have even gone in for community
horticulture. In that scheme, one of the beneficiary has leased for
Rs. 3,000,'- his two acrcs~oi‘~Iand to the group for grape orchards.
The produce will be equitably shared by each individual of .the
group.
8
These are some of the social transformations.
Economic achievementsarc equally striking. An acre of land
which hardly produced 50 kg of grains is now producing 400 kg to
500 kg of food grains.
Prior to the commencement of the Lift Irrigation Scheines.it
appeared that the people had lost all the hopes about improve
ments in their conditions and a feeling of helplessness had preva
iled. But since the commencement of the schemes people have
regained self-confidence. With assured supply of carefully rationed
water, though only for eight months, the farmers have been able
to raise fine crops of onions, cotton, vegetables, cereals and even
fruit like grapes. This not only made a better life possible, but
brought it within their reach.
As a sequel to'the transformation, inanv farmers who had
migrated to Bombay returned to Purandhar imd.arc.back on their
farms. It may still be a trickje, but a process of' reverse ' migra
tion has started/ If Fam Panchayat schemes are set up w ith, the
support of the Government, the trickle can become a flood. The
slum and pavement-dwellers who now defile the atmosphere in
Bombay would once agaifFbecomc productive citizens.
Water, which is a critical input in increasing the agricultural
production, is a scarce resource in a drought prone area. The avai
lable quantum of water can be optimised to benefit a large number
ol farmers, provided the principles of Pani Panchayat are followed.
Crop planning assumes great importance in economic uplift of
the ]x>or farmers in a drought prone arc . The farmer has to
strike a balance between cash crops and other crops. When it
comes to cash crops, there is a tendency amongst the farmers to
go in for sugarcane, when some source of assured water is avai
lable. But they fail to appreciate that comparatively it requires
more water, generates less employment, derives less income and
benefits less number of farmers. This may be seen from the
enclosed sketches. (Annexurc 3/1 to 3/4).
To give a general idea of the economic transformation that has
taken place among the farmers, whose lift irrigation schemes are
functional, we have chosen two schemes, namely, Pilanwadi.which
has a perennial source of water and Babawadi at village Pisarvc,
which rets water only for eight months in a year. Their economic
statistics arc given in Annexurc 4 & 5. Il may thus be noticed
10
from these details that there is a great hope of fulfilling the aspira
tions of poor farmers through the schemes of Pani Panchayat.
M\X’AGEM£SJ OF THE SCHEMES
It is comparatively easy to start a communtiv minor lift irrucation scheme. But it is very difficult to manage it after complcijctn.
There are a number of minor irrigation co-operative societies
operative in Maharashtra. But unfortunately many ot them ha.fr
come to standstill, mainly because of their mismanagement.
The Trust has already taken over an obsolete scheme at Ake»a
in Sangola tehsil of Solapur district, in which theCentral Bank teas
already sunk more than Rs. 40 lakhs. The project has been tname
functional by the trust and is also being managed under ns
auspices. Similar requests have started coming in from some other
obsolete co-operative society’s lift irrigation schemes.
When Government subsidy under the defunct “Minor IrrigatingExtention Programme 2-4 hectare" was granted, it was not laud
down that each of these schemes should form a co-operatrwe
society. But now the Government insists on forming a co-opera
tive society in case a subsidy from 1RDP is to be availed. However,
not much of subsidy from IRDPcan be obtained as each block r>r
taluka has been doled Rs. 6 lakhs to meet the requirement for us
comprehensive development, which includes, beside minor irriga
tion schemes, dairy, afforestation; cottage industry, poultry, etc.
Pani Panchayat would like to administer these schemes itself.
Isccausc the experience of theco-opcrativc societyis unsatisfactory.
The wealthier and more important or influential members of tixt
group get appointed to the key posts. The consequence is the usncal
“refraction effect” of magnifying.economic and social disparities.
To provide management. structure for each of these schemes,. a
managed or a group leader is elected by the beneficiaries of each
scheme?-A suitable‘Patkari'or a water distribut o r t rained_fordiie
duties is appointed by Pani Panchayat. He is usually from a
neighbouring village, not directly-involved in the sefneme itself.
This person is paid a modest stipend of 200 rupees a month cad
iissures~day-To<lay fair allocation of water to all iTs beneficiariges.
In these bodies all the families participating in a particular schescne
take part equally. Every bundav group leaders participate in rdie
meeting of Pani Panchayat.
members once a fortnight.
They in turn hold meetings of its
LAND-WATER-MANPOWER MANAGEMENT TRAINING
CENTRE :
In order to ensure that the schemes of Pani Panchayat do not
meet the fate of some of the co-opcrative lift irrigation societies,
it has been decided to create a cadre of well trained extension
workers front rural dropouts aged 15 to 20. It is intended to admit
30 students each year for a course of two years and they will be
absorbed in the expanding programme of Pani Panchayat. The
syllabus will include the following :
1)
Use of modern science and technology to increase maxi mum
agricultural production with minimum water.
2)
Water and soil conservation.
3)
Agro-engincering.
•4) Lift irrigation schemes.
5) Water distribution.
t>) Crop planning.
7)
Crop diseases.
8)
Use of fertilisers and insecticides.
9)
Marketing of agricultural produce.
10)
Storage.
11)
Prevention of diseases among human beings and animals.
12)
Horticulture.
13)
Afforestation.
14)
Maintenance of pumps and motors.
15)
Keeping of accounts.
The Training centre besides training the extension workers willalso run periodical short courses for the group leaders in manage
ment of the scheme and for the beneficiary farmers in all aspects
of agricultural practices.
The establishment of the training centre is going to cost about
Rs. 19 lakhs. It will be a residential centre.
LIMITATION
A voluntary agency working for the rural development,however
dedicated it may be, cannot achieve much, unless it has got the
backing of the Government. Unfortunately the Pani Panchayat
lacks it. The efforts of Pani Panchayat in getting the '^community
in in o r 1 ift irrigation scheme" cstabl ishedhas been quite frustracmg
and enervating, Some of the limitations fromjvhich_the_DC.~»gramme of Pani Panchayat suffers arc as under :
I
The Government subsidy is available to marginal farmers
( less than 2 hectares ) and small farmers (less than 4 hectares L
A farmer in most parts of Maharashtra is a genuine small holder,
but the land records ( form 7/12 ) prepared long ago do not reflect
the actual present position. Many a time the lands are in cue
name of the eldest member in the family, whereas in actual practice
the lands have been divided amongst sons and grandsons.
The procedure laid down for updating the revenue records is so
cumbersome and vexing that most of the poor farmers are perplexed
to tread on that path. Therels, therefore, need to evolve a simpile
and quick procedure in this'respect.
2.
In case digging of an open well or a bore well on Govern
ment TancTis'mvolvcd, permission of the Revenue department is
required. Similarly, for use of'cxplosivcs to dig an open we:E.
licence of the Home branch of the collector’s office is requires.
without which the explosives cannot be procured. It is frustrating
to obtain them. It takes months and months to complete these
formalities and correspondingly the project is delayed.
3.
For lifting water from reservoirs, the permission of the Irriga
tion department is required. Normally permissions to lift water is
granted according to the total area under command of the project.
lifting of .water to the extent of 1% from the Reservoir, 5%
between dam and pick up weir and 5% from the command area.
In the case of M. I. Schemes the Irrigation Department expects
that there should be no water left in the reservoirs at the end mf
March. But in actual practice there is abundance of water left, ns
possibly, it is not used to its limit. Under such circumstances,
there is need to relax the rule. , Even When legitimate permission!
is obtained, inordinate delays take place.
4.
It is equally difficult to get electric power connection to tiur
completed lift irrigation schemes. The M. S. E. B. applies a yirai.
stick of revenue return for each scheme. That is, it must get a
return of 20% on the capital investment. Otherwise it docs nent
sanction a power connection. To improve the plight of the
marginal and small farmers, this rule will also have to be relaxed .
Even where the condition has been met, it takes considerable time
to get a power connection. There is a requirement not only to make
a special allotment of funds for the provision of power connections
to the schemes of Pani Panchayat, but also to provide them within
three months from the date of application.
5.
In the new 20-point production oriented programme annou
nced by the Prime Minister, top priority has not only been given
for increasing irrigation of dry land agriculture, but it has also
been mentioned that it would be carried out on the principles of
Pani Panchayat. It was also mentioned by the Government that
additional funds are being allotted to IRDP so that the states
which are effectively implementing the schemes should not be
starved of funds. This being so, there is no reason why the bene
ficiaries availing lift irrigation schemes through Pani Panchayat
should not get subsidy. To bring early relief to poor dry land
farmers, the Government should make a separate allocation to
the schemes undertaken on the principles of Pani Panchayat.
EXTENSION SERVICES
The agricultural production cannot be increased by provision
of water alone, unless inputs such as seeds, fertilizer and insecti
cides are used. Small farmers usually do not use fertilizers in
correct quantum. They hardly use any insecticides, mainly becauseof financial inability. In order to make him use these ingredients^
it was felt essential to start an extension service, which will provide
him the above three ingredients at a comparatively cheaper rate
and close to his farm. Three such shops have been opened. The
response from the beneficiaries to avail this service has been very
encouraging.
Most of the farmers have expressed a desire to open a co-opera
tive bank of Pani Panchayat, in which they could deposit their
money and in return could avail the benefit of extension services.
They feel that otherwise the money earmarked for the inputs would
be spent on other items of low priority The proposal of formation
of a bank is being examined.
FUTURE PLANS
Pani Panchayat aims at employment of 25,000 people who
arc struggling below the poverty line, in a period of ten years, in
I’ur.indhar taluka. It has a proposal to cover all the hundred
v illages of the taluka by undertaking 600 community minor lift
rngation schemes, which will bring under piotective-irrigation~a
id mass of 25000 acres at an outlay of Rs. 10 crores. This target
ii.:s been set on the basis ol the results of the study of the ongoing
-chemos of Pani Panchayat. It is, therefore, not an unreahstic
proposal.
Once the problem of the basic ingredient, that is, water is solved
and the agricultural production of the beneficiaries is increased,
other ancillary projects of rural development would be undertaken.
There will be dairy, social forestry, horticulture, animal hus
bandry, health, adult education, marketing, etc.
When all the 50 projects taken in hand become productive.
marketing of the produce on collective basis would be undertaker..
It is proposed to sell the agricultural produce directly to large
consumers such as canteens of industries in Pune.
As mentioned earlier, it is proposed to open a eo-operarve bank
:or the beneficiaries so that all the extension services would cater
only for seeds, fertilisers and insecticides. Later, when the exte
nsion services provision becomes sclf-sutlicient its scope will be
enlarged into departmental stores, which will cater for all the
need- of the farmers.
DEMANDS OF PANI PANCHAYAT
I.
Acceptance
Government.
of
the
principles
of
Pani Panchayat by the
The Government should accept in principle their moral respo
nsibility of making available irrigation facility of half an acre an
per capita basis, to the maximum of two and half acres per family
in consonance with the Government’s family planning programme.
This can be achieved by having community minor lift irrigation
schemes on a large scale. Where the farmers avail of community
minor lift irrigation schemes on the principles of Pani Paachayat,
Government should provide 80 per cent of the capital outlay as a
subsidy and the balance of the 20 per cent should come from the
beneficiaries; crops requiring water more frequently such as sugar
cane should be prohibited, water rights shall be to the individual
family and not to the land brought under irrigation to avoid
speculation.
2.
Provision of electric power connection
It is not possible to start agricultural production on the comple
ted schemes, unless electric power connection is provided within a
reasonable time. The Maharashtra State Electricity Board should,
therefore, provide such connections within three months from the
date of application. The formula of revenue return should not be
made applicable to community schemes. It is estimated that the
Electricity Board will have to meet, on an average, approximately
20 per cent of the capital cost of a scheme. The Government
should, therefore, make a separate provision for the schemes of
Pani Panchayat or for any other voluntary agency engaged in a
similar programme.
3.
Grant of 80 per cent subsidy
Keeping in view the future plans of Pant Panchayat. the Govern
ment should sanction Rs. 50 lakhs (80 per cent) for 50 lift irriga
tion schemes each year. It is even accepted that the Government
may carry out a comparative study of the programme of Pani
Panchayat and then take a decision on the continuation of the
aforesaid subsidy.
4.
Flow irrigation tanks vis a v.s lift irrigation scheme
The western part of Purandhar block gets a good rainfall,
whereas the eastern part receives hardly 375 mm, as the area
comes under rain shadow. In case a study of the rainfall and run off
in the Purandhar block is carried out, it will r veal that there is still
considerable scope to store water. Taking into consideration
the large magnitude of future community lift irrigation schemes,
the maximum number of water storage tanks should be constructed
by the Government'. It should, therefore, reconsider its policy of
having flow irrigation watertanks. The flow irrigation schemes may
also be run on the basis of’/» acre per capita for social equity.
In Purandhar block average run-off from rain water is 820 lakhs
CuM. Out of this, it is possible to utilise about 520 lakhs of CuM
water for Lift Irrigation schemes, on equitable share basis. The
rest can be made available by flow canal.
The condition of allowing to lift only one per cent of stored
water directly from the irrigation tank may be relaxed and if the
records show that the balance of water at the end of March is
16
,a ticient to grant permissions to the extent of more than 1%.
such permissions may be granted.
According to the estimates of the Government about 500 lakhs
o' CuM of water is available under ground. Taking into considei. on the availability of water underground and the run off, a
master plan for all available supplies should be made. The
Government should, therefore, direct the Irrigation Department
io revise the Master Plans. The planning for the best utilisation
of water wealth, during the next ten years, capital investment and
gestation period, should be determined after taking into conside
ration the experience of the people.
5
Re-charging of water tanks
There is an estimated run off of about 5000 lakhs of CuM of
water'from Nira river, which is yet to be harnessed. At present
this quantity is drained to the sea. For the utilisation of this water
Government has set up ‘Nira Watershed Development Board’.
The board has planned on paper to make available 1500 lakhs of
CuM of water for irrigating 1 1.800 hectares of the block, through
traditional flow canal system. The project is going to cost approx
imately Rs. 12 crores. This is not going to solve the problem of
even ten per cent of the people of Purandhar block. On the cont
ra'?. it will widen the disparities amongst the farmers. Instead of
concentration of irrigation in a small patch. Government should
consider diversion of this water into the neighbouring vallies.
The conservation of water in projects of small magnitudes will
benefit an area of 30.000 hectares on the basis of 20 hectares per
1 lakh CuM.
6.
Re-orientation of power supply
At present 9 MW of electricity is being produced at Veer Dam
and it is even possible to increase this capacity. By using this
electricity, if 1000 lakhs of CuM of water is lifted to a maximum
height of 100 metres to re-charge the various water storage tanks,
by linking them, it will irrigate 20,000 hectares for eight months.
II ten per cent of this area, i. e., 200 hectares are brought under
horticulture, it will aid in minimising if net eiadicating the drought
conditions.
In case the above proposal is accepted by the Government, the
beneficiary farmers are even prepared to bear ?O
17
capital cost, that the Government wW*d incur to lift run oil water,
as a • Development cess
And when the scheme is completed
they are also prepared to defray the expenses that will be required
to operate and maintain it, along with the electricity bills, under
the guidance of Pani Panchayat.
Impact of the demands
In brief the benefits that would accrue from the above mentioned
demands would be as follows.
I.
In case 2000 lakhs of CuM of water is made available during
the next 15 years in Purandhar block, 1250 CuM water per capita
can be made available
X2X
7.
Annexure 1
2. The total outlay at the current market rate would be Rs. 40
crores. That means a capital investment of Rs. 2500 per capita
for a population of 1,60,000. It is much less than the amount
spent by Government per capita in providing flow irrigation
system through big and medium dams and in which there is no
contribution of the beneficiaries.
3.
Today per capita income from agricultural production it
Rs. 400 per year, which will go up to Rs 12,000 and it will not only
provide full time employment to all on their own fields, but also
meet requirement of their needs.
4.
This wili bring an end to drought relief. Government doles
and bring the poor farmer above the poverty line.
Before we connect the river Ganga to the river Cauvcri, let us
first connect the river Nira to the river Karha, both in Purandhar
block and bring an end to the poverty of this block.
Conclusion
Pani Panchayat is not just for irrigation and equitable distribu
tion of water. It is a philosophy that can bring about a complete
socio-economic change among the poor farmers. It has a treme
ndous potential for rural reconstruction and can prevent the
migration of young men and women from rural areas to urban
centres.
18
M
SEARCH
Society For Education, Action &
Research in Community Health
Shodh - Gram, P.O. & Dist. - GADCHIROLI (Maharashtra) 442605 INDIA,
E-mail: search@satyam.netin
Birth of a dream
’ 2411' March 2004
Date :
A group of nearly thirty persons, as diverse as Satish Kumar, a
Gandhian environmentalist from UK, Prof. Samadhong Rimpoche, the
Prime Minister, Government of Tibet in exile, Shri Sidhdharaj Dhadhdha,
Prof Thakurdas Bang, Shri. Amamath bhai -senior Gandhians, Shri
Rajendra Singh - welknown water activist, Prof. Sanjay MG of National
Alliance of People’s Movements and many of us spent the last three days of
the year 2003 together in the Dandakaranya forest at Shodhagram,
Gadchiroli (Maharashtra).
The group grappled with the difficult issue of exploring the links
between Gandhi, Environment and Health, and also witnessed a concrete
action- inauguration of a new training center at Shodhagram. The training
center, named Arogya-Swarajya Sadhana Kendra (
"ht’WT
),
aims to enable individuals, voluntary groups and communities towards
‘Arogya- Swarajya’.
We are very pleased to send with this letter the report of the
deliberations in the meeting. The future activities of the training center will
need your involvement and inputs.
Satish Kumar has suggested that this training center be called Arogya
Vidyapeeth- (Health University). We certainly dream that it will become a
living university without walls, where individuals live and learn to work on
themselves and with communities to build Arogya-Swarajya.
With love and friendship
Abhay and Rani Bang.
Attachment:
- An year-end at Shodhagram.
An year end at Shodhgram
Report of the meet on
Gandhi, Environment and Health
and
Birth of a new training center at Shodhgram, Gadchiroli.
Introduction
On 29lh to 31st December 2003, coinciding with the inauguration of the new training
center, ‘Arogya Swarajya Sadhana Kendra’( SIR'M ),Sarva Seva
Sangh and SEARCH called a meeting of senior Gandhians, social activists,
environmentalists and the professionals from diverse fields such as health, science,
music, philosophy and journalism to explore the links between Gandhi, Environment and
Health. The venue was Shodhgram, the head quarter of SEARCH in the Gadchiroli
district of Maharashtra.
Answers were sought to four questions, though the only end product actively sought was
an increase in our understanding in four areas, namely, Green politics, the environment
and spirituality, healthy individuals in healthy community, and a new training center at
Shodhgram.
A list of the participants is attached.
A Buddhist Interpretation of Gandhi
Prof. Samadhong Rimpoche disagreed with Gandhi’s deism but accepted his concept
of truth. Satya is the uniting thread and society should be built on the base of
Satya^Ahimsa and honest democracy. In order to proclaim truth, one must overcome the
sense of helplessness and the desire to compromise. Social change cannot be quantified
but people must change themselves for society. If society changes in ways one does not
agree with, one can STEP OUT, one can express dissent accepting the hardships arising
out of this dissent. Gandhi rejected modem society, modem science and technology. He
believed science to be egotistical. We must proceed in the belief that nothing good can
come of science.
Green Thinking
Satish Kumar outlined the course of the Green movements in the West, concentrating
on three areas. Green politics, set off by Rachel Carson’s “Silent Spring” and developed
into the Green party in Germany (Die Gruenen) is now quite influential in German
politics and has spilled over to many European countries and to America, formally or
otherwise. The aspect of Green spirituality is detailed later. The aspect of Green living
centers on voluntary simplicity and “downsizing” (simplifying) of lifestyles.
Complementary medicine, importance given to handicrafts, insistence on the use of local
and organic products, are all aspects of the increasingly popular Green living.
Satish Kumar pointed out that Green politics has really taken root only in countries
where proportional representation is practiced (Germany, France, Italy), and has
remained diffuse elsewhere (UK, USA). He also mentioned people, their books and ideas
that had influenced the Green movements. A short and partial list could be—Rachel
Carson and “Silent Spring”, D & D Meadows and “Limits to Growth”, E. Goldsmith and
“Blueprint for Survival”, James Lovelock and GAIA, Fritjhof Capra, Brian Goodwin,
Stephan Harding, Theodore Roszak, Gregory Bateson, Margaret Mead, Ivan Ilych, Lester
Brown and eco-economics, Rupert Sheldrake etc.
Here and Now
After the exposition of Green ideas by Satish Kumar, considerable discussion took
place about the present environmental situation, especially in India, and it’s causes,
though in a rather selective fashion. In outline, these inputs can be summarized thus—
Rajendra Singh told that the New Water Policy of the Government of India
termed water as an “Asset” (Sampatti) and not as a Resource (Samsadhan). He and
others had objected to this strenuously, but to no effect. The Sampatti reference paves the
way for selling rights to the utilization of water under BOOT (Build, Own, Operate and
Transfer—one well-known objection to this tells how the ‘transfer’ can be delayed,
leading to BOO!) contracts. The Contracts go mainly to a handful of multi-national
corporations (MNCs hereafter), called the World Water Mafia by Rajendra Singh. He
also observed that the Indian people do not see water as Sampatti, but as a Samsadhan to
be shared and used conservatively. The number of ‘Bepani’ (no water source) villages is
increasing and the groundwater level is sinking rapidly. The river-linking project was
mentioned and Rajendra Singh underlined its futility by citing examples of similar failed
projects undertaken by the government in the past.
Meghana Gadgil described the erosion of sovereignty taking place all over the Third
World (Some suggested using the word ‘South’ instead of ‘Third World’). Huge
surpluses of petro-dollars generated in the ‘70s got to the World Bank (WB) and loaned
thence to the South countries. This investment, these loans, came with the condition that
they be used for ‘infrastructure development’ and not for social programs. The loans were
hard to repay and piled up exponentially. The International Monetary Fund (IMF)
stepped in with ‘structural adjustments’, otherwise describable as re-loaning with added
conditions. Other loans followed suit, enforcing further ‘development’ and further
‘austerity measures’ for social use of resources. The situation today is that even if wiser
governments are elected, they will have no freedom beyond that dictated by the bankers.
Thus the ‘sovereignty’ of the South governments is nominal—can one say, ‘illusory’?
Discussions on this centered around whether this is a new phenomenon or old, the
extent to which officials of the bankers, the MNCs and the South governments form a
single group and if and how this could be countered.
Rahul Goswami saw the situation from three angles, each offering opportunities for
counteraction. On the Production side, the MNCs are trying to eliminate all competition.
The designs of the MNCs could be foiled by propagating the use of local produce —
Swadeshi. The People side has seen the disappearance of trade unions, but the NGOs
could generate anti-globalization attitudes. Perspectives could be modified by better
handling of the new and desensitized media through a better understanding of the profile
of the new media persons.
AROGYA-SWARAJYA
The aspect of healthy individuals in a healthy community was discussed by Abhay
Bang before the main meeting began and also during the tour of Shodhgram. He
described the concept of Aarogya Swarajya on the background of an increasingly
expensive nature of curative medicine. He reported on heart disease and other illnesses
and the feeling of alienation that results from the present erroneous lifestyle. The solution
lay in a) developing models of health care which empower individuals and communities
to become more autonomous. about their health care needs, (One such model of
community health care has been developed by SEARCH ) and b) eliminating the lifestyle
and thus the mismatch between the individual and the community. It is not merely
replacing curative medicine, but the adoption of a holistic, connected lifestyle. Here, the
path to health leads inescapably into spirituality.
Green Spirituality
Green spirituality was examined in various aspects. Satish Kumar told how Gandhi
and Vinoba had united the world (Samsara), religion (Dharma) and spirituality
(Adhyatma) in a seamless whole. They spoke of using spirituality to change oneself, so
that the world appears in a new light. When Krishna gave Arjuna a glimpse of
“vishvaroop” Arjuna too became “vishvaroop”. If one does this, ‘khud’ becomes ‘khuda’
and atma becomes paramatma. It was through this unity being propagated that Gandhi
and Vinoba made revolutionaries of ordinary Indians and also made spirituality into an
instrument of revolution.
The relation between Man and Nature came in for examination in this light. The
concept of all belonging to all was enunciated. Instead of the Cartesian “I am”, it should
be “I am, because You are”, and this ‘you’ must be everything in nature, be it a tree or a
river or a mountain. This leads to the ideas of Nature’s rights, like the right of a river to
flow undammed. Like ‘belonging’ the concept of trusteeship was also discussed. That a
trustee is supposed to conserve and improve upon what is entrusted to him, is the starting
point. The question of whether this will lead to cessation of some currently enjoyed rights
came up, since sudden cessation of rights leads to conflict. Whether capitalism is going
into a trusteeship mode was also discussed. With ownership diffused over numerous
shareholders and actual management in the hands of professionals who were not owners,
is capitalism a de facto trusteeship? Satish Kumar said that the concept of trusteeship
comes out of bio-centric or earth-centric thinking instead of the current anthropocentric
thinking. But to fully achieve this, we must cease to think of actions aimed at the survival
of the planet, but value nature in itself. This is the concept of Deep Ecology, or Green
Spirituality.
The discussion about this went into many by-ways. One exploration was why the
unity achieved by Gandhi and Vinoba was lost and how it could be regained. It was
pointed out that many good workers today tended to become mathadhipatis so that they
could not unite with other like-minded people. Satish Kumar suggested abandoning ego
(ahambhav) by such people. He also said that if others did not acknowledge their
‘adhipatya it would collapse of its own accord.
Science
Another line considered was the damage done by science to the concept of spirituality.
Descartes with his body-mind dichotomy, Newton with his insistence on quantification
and Darwin with his survival of the fittest were considered to be the most damaging of
scientists. However, it was pointed out that science itself had abandoned the Cartesian
dichotomy and that Darwin never said “survival of the fittest,’ nor meant it. Satish Kumar
said that we were sitting on a branch that was being sawed through by science for the last
300 odd years. It was pointed out that we should look at the hand that wielded the saw.
Satish Kumar said that capitalism led to individualism (Vyaktivad) and the answer was in
holistic and postmodern science as also in Reverential Ecology. It was pointed out that
science never gave values and also that it never claimed to. Satish Kumar said that
traditions should be verifiable. Science must not be allowed to become a superstition or a
God. Without spirituality, science can be enslaved and misused. Without science, religion
and spirituality could become hidebound (roodhivadi). Science today is paid for by the
present commercialized paradigm. Scientists like Lovelock, working independently, are
rare. The question shifted to how much science should be used.
Abhay Bang said that the problem with today’s Gandhism was not too much science,
but too little science, which was surprising considering how scientific in thought and
action Gandhi himself was. Gandhi often used the term Satyagrahi scientist to describe
how his disciples should be. The adoption of scientific temper and scientific point of
view got support, but there were reservations about its methods. Abhay Bang said that, on
the contrary the scientific methods had to be adopted too. Satish Kumar spoke of
Reverential Ecology, but doubts were expressed whether reverence could coexist with
science. It was observed that Movements had not been studied as experiments. Sanjay
MG observed that this was probably because it could challenge some of our superstitions.
This was strongly disagreed with. Abhay Bang remarked on the lack of improvement in
the spinning wheel charakha after the Ambar model as an evidence of how little research
went into our movements or work for an alternative society. On this Sidhdharaj
Dhadhdha opined that the Ambar had distorted Gandhi’s charakha by being made into
factory equipment.
Strategies for today
The discussions began on a theoretical note and slowly moved towards likely courses
of action. Thakurdas Bang said that the new commercialized attitudes could be fought
through “note and vote” strategy. The products of the MNCs could be boycotted and
better people could be voted in. Satish Kumar mentioned a book by Bodri Llare called
‘Consumer Society’, which detailed how we were subjected to identifying with a virtual
reality, peopled by simulacra.
Rahul Goswami said that the media were no more a pillar of respectable society but
simply a tool of post-industrial capitalism. He described how MNCs had corporate
communications experts who dealt with the media and how these two groups coordinated
their activities like a ‘jugalbandi’. He advised getting to know the newer set of media
persons in profile and to think of strategies to use in getting them to be useful to us. Shri
John suggested starting our own electronic media. Kumar Prashant advised against
running after the media and suggested that we should do things which make the media
run after us. Satish Kumar said that we should reduce the stress on the purity in the same
way that we accept the impurity of our body. He said that this would make it easier to get
the media on our side. He suggested that our own media should have beauty in simplicity.
Abhay Bang said that with improved communications the world has become small. In
this context, the idea of ‘gram’ or village needed reassessment. He also said that
knowledge and information was the new power and that we should think of using them
for our ends. There was some discussion about whether knowledge and information as
power was a new phenomenon or old.
Prerana Rane described how corporations trained their own people using the group
dynamics concept and the human engineering approach to the question of human
resource development. She mentioned two books, ‘Built to Last’ and ‘Good to Better’,
which discussed how to do this in a durable way. A clear focus, continuous reality checks
and a constant revision of goals were the key. A continuous and dispassionate analysis of
ourselves and of our external circumstances was necessary.
She pointed out that Abhay Bang’s book about his heart attack had become very
popular and that this interest in personal health could be used as one track, with ideas
about holistic living forming the second. Enlisting the help of various groups like those
who had taken voluntary retirement, the senior citizens etc was also discussed. Prerana
Rane said that knowledge, skills, evaluating the strengths of our team of workers and
leadership training are four areas on which the new training center can concentrate.
Countering the misinformation and disinformation about Gandhi was also proposed as a
collateral aim for the new training center at Shodhagram.
Aarogya Vidyapeeth
Satish Kumar suggested that the various Training Centers coming up all over India
should combine in a network for greater efficacy. He suggested that this training center
at Shodhagram could be seen as a Health University ( Arogya Vidyapeeth). He also
suggested the creation of a directory of people working in various fields and various
geographical locations.
The last session concentrated on the use to which the new training center should be
put. Abhay Bang spoke about the outputs expected, the inputs needed, and the human
engineering that should go into it.
Bhajans
A notable feature of the meeting was the start of each session. Kalyani Deshmukh
enthralled the participants by exceptionally beautiful renderings of Bhajans at the start of
each session. The selection was eclectic, covering Meera, Tulsi, Kabir, Tukaram ad other
Indian Saint-Poets. These melodious beginnings helped set the mood for all the working
sessions. Kalyani also participated actively in the sessions proper, thus ensuring that her
next Bhajan would be in the apt mood.
Report by
Nanda Khare and Vidyagouri Khare.
List of the participants.
Shodhagram- 29-31st December’ 03.
1
2
3
4
5
6
7
■ 8
9
10
11
12
13
14
15
16
Mr.Satish kumar
Editor, Resurgence
U.K.
Prof. S. Rinpoche
Prime Minister
Cabinet of the Government
of Tibet in exile, Dharmashala.
Amamath Bhai
President
Sarva Seva Sangh
Shri Sidharaj Dhhadhdha
Jaipur
Shri Thakurdas Bang
Sevagram.
Shri Rajendra Singh
Tanin Bharat Sangh
Alwar
Mr. Sanjay M.G.
National Alliance
of People’s Movements,
Mumbai.
Shri M.B.Nisal
Secretary, Sevagram
Ashram Prastisthan
Smt Nalinee Nisal
Nagpur
Shri Kumar Prashant
Mumbai
Shri Avinash Kakde
Rashtriya Yuva Sangh
Shri Atmaram Saraogi
Kolkota
Shri S.S.Pandharipande
Nagpur
Smt D.S.Pandharipande
Nagpur.
Dr. Prerana Rane
Mumbai
Mr. Rahul Goswami
Journalist,
Singapore
17
18
19
20
21
22
23
24
25
Ms.Vibha Gupta
Center for Science of Villages
Wardha.
Meghana Gadgil
California, USA.
Dr.Kalyani Deshmukh
Musician
Nagpur.
Dr Avinash Saoji
Amravati.
Dr. John
India Peace Centre,
Nagpur.
Shri Nanda Khare
Editor
Nagpur.
Dr.Vidyagouri Khare,
Nagpur.
Dr.Abhay Bang
SEARCH
Gadchiroli.
Dr. Rani Bang
SEARCH
Gadchiroli.
RF_IH_9_SUDHA.pdf