CASE STUDIES IN HEALTH AND DEVELOPMENT
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- Title
- CASE STUDIES IN HEALTH AND DEVELOPMENT
- extracted text
-
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OKHLA NEIGHBOURHOOD COMPREHENSIVE HEALTH AND WELFARE PILOT PROJECT
PROJECT
•
•
1.
11.
111.
IV.
V.
VI.
Vll.
Vlll.
IX.
X.
XI.
CONTENTS
INTRODUCTION
SERVICE
_ .
DIAGRAM
BACKGROUND AND HEALTH SURVEY CONTENT
AIMS AND OBJECTIVES
PROPOSED PROGRAMME, COORDINATION
STRUCTURAL AND ADMINISTRATIVE ORGANIZATION
STAFFING PATTERN
FINANCIAL REQUIREMENTS
SUMMARY OF THE PI.AN
BACKGROUND INFORMATION PAPERS
.... Page No. 1.
ii
....
1.
ii
....
1A
ii
....
"1 1.
n
....
1-4
ii
....
4.
ii
4A
ii
....
5.
ii
....
6-9.
ii
10. .
....
ii
10A&10B.
....
Paper No. 1 - Objects of the Dr. Zakir Hussain
Memorial Welfare Society
Paper No. 2.- For Theory to practice
....
ti
11-16
....
ii
17-23
Paper No.
3 - Project Services of the Compre
hensive Rural Health Service
....
1!
24-25
Paper No.
4 - Standing Committees and Activities
of the Dr. Zakir Hussain Memorial ....
Welfare Society
11
26-27
***************
Page No. 1.
1.
INTRODUCTION
In cooperation with the Delhi Municipal Corporation the area of Delhi
South zone, between Mathura Road and Agra Canal is a composite community area
presently consisting of 12 separate villages and/or semi/rural areas. The
population of this area is estimated about 15,000 people and is culturally
composed of Muslims, Hindus- and Christains. Two percent of these people are
landowners, 38$ shopkeepers, teachers, clerks, etc., 60$, are labourers at Rs. 100$
month or less. The contracts of this marginal village ^rea and the rapidly
expanding high income housing areas, like Maharani Bagh and Friends Colony as
well as the living patterns evidence the need for developing the health, welfare
and educational facilities in the area for the development and uplifting of the
community.
11.
SERVICE AREA
For the geographic layout (See Diagram) tho diameter of the service area
is 1J mile. The radius from the Holy Family, Jamia Millia or Don Bosco is as
follows:
Mathura Road to Okhla
Holy Family Hospital to Bharat Nagar
Holy Family Hospital to Khiszorabad
Holy Family Hospital to Julliana
Holy Family Hospital to Masigarh
Holy Family Hospital to Okhla
Holy Family Hospital to Nuru Nagar
Khizzerabad to Masigarh
1 Mile
l/li "
3/h "
1/8 "
1A "
1/2 "
1
"
1 11
From Jamia Millia eastward the cultural grouping is Muslim. The remainder
of the area is Hindu with the exception of one small section of 12 to 13 homes
of Masigarh wnich arc Christain, The residents of Joga Bahai, Gafoor Nagar and
Nuru Nagar are landless unauthorized dwellers.
111.
A.
BACKGROUND AND HEALTH SURVEY CONTENT
Cultural
The 12 villages are culturally very separate due to religious and social
differences. Okhla, Batala House, Joga Bai, Gafoor Nagar, Jamia Nagar and
Nuru Nagar is primarily a Muslim Population. The remaining villages are Hindu
with the exception of Masigarh which is populated by Christian who'have lapsod ”■1
back to a'type of Hinduism. There are about 20 Christian families in the total ■
area, of these, 12 families live in a Christian settlement removed from the main
Masihgarh population and attached to the Church. Because, of the religious and
traditional caste distinction these villages and setups are all very separate and
distinct communities with no communication, awareness of community sense or concern.
B,
Family Population
2,17h
755
l?,100
5,100
398
Total families
Infants
Toddlers
School Age
Antenatals
Total Populations
C.
Estimated
15,100
Economic Population-of the above family population
Income below Rs. 100/- month - 68$
Income above Rs..100/- month - .32$
Of 32 income above Rs.100/1. Labourers
» t.'0$
2. Teaehers, Shopkeeper $ Clerks, ..
etc.
3» Farmers
ll. Landed leaders income Rs. 2,000/“ 2$
1.
2.
D,
Social Status & Condition
1. The social conditions of Rs. 100/- month and less are as follows:
Landless daily labourers meaning the wage earner and his wife together are employed
only about 50$ of the time- this means if a job is abailable there is some income
for food. If it is not available the few resources are rapidly exhausted
during the unemployment time, anxiety builds, family problems are heightened, diet
is minimal e.g. Joga Bhai resident - major diet is Chapati and Chili.
From this the health problems of marasmus, nutritional diffidences, common
sessonal infective and accident or other medical problems are neglected. This
is due to ignorance of facilities available and there are no facilities in the
area that are within their economic means. In this remaining 38$ (shopkeepers,
teachers, clerks, etc.) Who maintain a little higher social status, the following
pattern has emerged. Even though their income is Rs. 100/- month in addition
clothing and educating their children on the present wage. These families are
lucky to break even each month.. Shauld serious health family or legal problems
arise they are neglected as their economic means places these amenities at this
time for them a luxury.
2. The social background and condition of the women presents the belief
that a women very seldom and with exception accepts any kind of medical
attention or welfare assistance unless she is eriously ill or extremely depperate
jrhis emerges i n the following pattern. A medical check-up or literacy classes
are considered luxury. Health and welfare services are considered necessary but
if charges are attached to them it is received as a service beyond their means hence
they will not participate and make use of such services. Unless health service
are given at a minimal fee they are not accepted or participated in.
3. In the service area there are abslutely no social or recreational
facilities available to any of the residents.
h. 70/80$ of the women of the area are working mothers, that is, they are
occupied with other household duties such as tending to buffaloes, cutting
grass, etc. About 10$ of the women go to Okhla Industries of building sites
as daily labourers hence the social problems of children are numerous. Children
have to lead the family buffalo and because of these commitments and economic
scarcity they are unable to attend sc tool. Borne are just idle all day and
become destructive. Because of limited family guidance their most formative
years their psychological and social maturity is impaired. Due to high rent,
congested living and lack of privacy, the children are exposed and involved in
their parental social activity and family problems which they are too young to
understand, but which deeply influence them and they are unable to cope with.
This problem emerges and shows itself in the children's inability to be construct
ive or concentrate. This contibutes to school dropouts and delinquency.
E.
Facilities and Factors in Service Area
1. These villages are administratively under the Lajpatnagar Welfare
Centre wish due to overpowering population of its service area and georgaphic
distance from them leaves the residents of 12 village areas with very little
assistance.
2. Nearly within 1 mile of Holy Family Hospital are the Okhla Industries
which employa certain percentage cf the population here. It will be reasonable
and beneficial to incestigate the areas of technical training and cooperation
with Okhla Industries for future trained employees coming from the population
described. The Don Bosco Vocatonal School will also be of value here.
3. The three doctors in the villages are not qualified, they hold L.M.P.
& L.C.Ps.) and there are no other medical or welfare facilities available..
There are still quite active untrained dais who take even now 1/5 of the deliveries.
In Gafoor Nagar there has been a high incidence of neenaial death & stillbirths
with an occasional maternal death.
'•
U. In this area there are positive and negative factors which influence the
health. The positive factor is that there is a generally good water supply. The
negative factors are:
inadequate and ill ventilated houses
open drains
city dumping areas just adjacent to Okhala, Nuru Nagar & Julliana
(this has caused an enormous fly problem)
d) There are little or no facilities for animal shelter hence goats, cows,
buffaloes and chickens reside in the house.
e) Sweepers who clean the drains leaves all day to dry. As these streets
are only areas for children's play, they are daily exposed to and play
in these piles.
a)
b)
c)
Within Okhala, Khizerabad, Nurunagar and Julliana which are not traditional
Indian villages, there is very little if any community sense within them.
Consequently the existing chaupals (which in Hindu tradition have been recreati
onal and meeting places for the elders) are sitting idle 90$ of the time. It is
felt that in the villages they could be quite effective. It is felt that if the
village contribute these chaupals, they could become the proposed sub-centres.
Because they are ideally located in the centre of villages, they could be quite
effective. It is felt at this time that the cooperation from the village leaders
is excellent.
-- r
F.
Health Analysis Comparison
Village ,
------------_
Family
Julliana1 Shopkeepers Educated
t
employed
!
Cottage
Industry
I
1
!
I
I
!
1
1
Masigarh ’
Bharat
Nagar
Gagoor
Nagar
Farmer
Toddlers
,
t Infants
70-80 per cent
untrained dai
delivery infetteion Anaemia
> Weaning mal Nutri- 1 Intestinal
’ tion,
1 & other
' Deficient
' infection
' Character
1 due to
' formation 80$
' sanitation
1 primary small' pox sec. vacs.
:
1 done
' DPT and other
' immunization
1 nil
(
t
' Psychological
i
' development
( training nil
1 Pre-school pre1 preparation nil
’
1
’
1
1 Same as above
’ 90-95 per
’ cent worms
1 Same as above
' Same as
1 above
: Anaemia
1 Holy Family Hospital.1 Same as above
1 employees
i
t
shopkeepers
i
educated
i
employed Cottage
i
Industry
1 Class: IV employees
’ at Jamia Millia
i
Unemployed daily
1 labourers
’ Same as above,
1
but
1
&
1
t
?
!
1
!
1
t
1
!
1
1
i
i
i
t
i
’ Undemour1 ished due
’ to infect1 ion Intest1 ional
• infection
' due to
’ sanitation
t
t
"i-------------------,
Antenatal
t
-J________________ .j______________
1 98 per cent
’ village dai
' delivery
> indication of
' extraordinary
’ high stillbirth
’ and neonatal
' birth Few wit’ nessed maternal
' deaths
F. Health Analysis Comparison (Contd„)
Village
t
Jogabai
Family
'acute malnutri'tion due to
'family diet of
'mainly chappati
'and chili
'street children
'acute dismal'nutrition No
'schooling
Teachers of
Jamia Millia
' Generally
■' Active healthy
' children need
' for immuniza’ tion
I
!
!
!
!
t
Toddlers
?8 percent
t
Batla
House
1
'
Antenatal
' Under nourished ' Ante-natal
' due to infection' anaemia dai
' and diet high
' delivery infection
' incidence of
'
' diarrhoea,
'
' worms URI
'
!
1 Lwunization
s
t
1 98 per contained
t dai delivery
j..
>
Professors
( Intestinal infectJ High infant
1 early marriage;
Law income
• ions Emotional
* death ,
1 there fore high
labourers
’• and psychological1 Marasmus
1 incidence of
middle
1 problems
1
1 grand multiperas
’ !
class
1 Anemia Rickets
1 intestinal
1 Anaemia
few land-owners1
1 infections •
1
_______________ j---------------- -------- ;--------------------------1-
.Okhla
IV.
■ A.
Infants
'
PROJECT AIMS & OBJECTIVES
The project aims and objectives are;
1. Neighbourhood development.
2„ Total Family Care through in oegrated-health and welfare and
educational services.
B. By providing total family care as well as suitable recreational activities,
economic betterment and education to give rise to the general .development, of the
area with the purpose of evolving comi.on programmes for families. o.f whole service
I'area neighbourhood to be.
.
PROPOSED PROGRAMME
In order to achieve the aims and tbjactives of TV, we plan to coordinate the
service activities of the .following existing agencies or institutions:
1.
2.
3,
h-
5.
Jamia. .School of Social Work training. programme
..
Dr. Zakir Hussain Memorial Haifa*9 Society
;
Holy Family Hospital (as referral ' for treatment)
Holy Family Hospital Community He al th Department (to promote the health
of the area).
.
The educational and referral facilities of Don Bosco technical'training
schoolo
For information regarding the services p rovided by the above "see Structural
Service Pattern in subsequent section (Section .1, page hi).
The immediate aims of the preposed prograi mo will be to coordinate the already
functioning Health Service with the proposed Wei.. ’are Service in the following phases:
Phase 1. Actual Coordination and Community
curricular planning.
VI STRUCTURAL SERVICE ORGANIZATION
xv
Consists of:
Health Central Section
J
1. T.B. Clinic
j
2. Referral Centre for:
5
a) investigation
$
b) admission
5
c) rehabilitation
J
3. Health Unit Supervisor
5
4- Central Laboratory
Project Coordinator ---- T------------------------ ----------- staff (
Welfare
Consists of Vocational
Central
Section
Education
---------------------------5
?
s
x
j
x
x
x
x
x
(To be provided by Don
Basco School)
1, Suoervisory Unit
2. a.) Total Welfare Project
b) Childr n's Welfare
c) Women's Welfare
d) Pre School Children
Education
3. Communication Service to Sub Centre
5 identical sub
centres
Health
Maternity Child Health
and Family Planning
2. School Health
3. Communicable Disease
4. Nutritional
5. .Medical Care
6. T.B. Screening
7. Delivery coordination
8. Health Education
1.
N.B.
Welfare
1. Women’s Welfare Classes
a) Tailoring Classes
'
b) Adult Literacy Classes
c) Cooking & Nutrition Classes
. d) Child Prenatal, Postnatal Care
e) Talks, demonstrations on all above
Balwadi (Children's School)
2.
Play Centre
i
3.
Case Work and Counselling Services
4.
Don Bosco School of Vocational Training -will be used for referrals. The Don
Basco School of Vocational Training will be represented on the executive
committee. None of the existing institutions or agencies lose autonomy.
Coordinating
1 Assistant
1 Clerk Tyoist
Phase 11.
Inpiementation of the coordinated health, welfare and educational
activities for short term plan of three years.
Phase 111. Evaluation.
Progress based development.
VII STAFFING PATERN (JOB SUMMARY)
A.
Community Health
2. Public Health Nurses; Post-graduate nursing in Public Health - one in
supervisory capacity of main centre and subcentre, one for school health.
2. Doctors; MBBS with 5 months Public Health to serves main centre and two or
three sub-centres as well as schools in his area.
2. Social Workers; MSC Medical Social Work, Medical Case Work in sub-centre and
referrals and follow up in welfare program (coordinate with welfare Social Workers)
1* Nutritionist; BSC, .toplied Nutrition program and follow up to all centres and
co-ordinate with Women’s Welfare program.
1.
Lab. Technician;
3 years - Do all lab. incestigation.
6. Lady Health Visitors; 2j yrs. diploma course programme, MCH specialist, in
charge of all village families, health supervision of sub-centre and trainer of
dais.
5. Auxiliary Nurse Midwife;
deliveries in her area.
1 year auxiliary nursing in midwifery, to take all
5. Trained Dais; Local dais having completed a 3 months course of necessary
hygine.and procedures.
Village level Moti'cators; Women of local village who are accepted by peersj
somewhat capable of influencing women in their area-cum work assistant, cleaner
of subcentre_s_
2. Receptionist-cum-clerk/typist:- Sub-centre registration and record keeping and
clerical work concerned.
B.
Welfare
1. Chief Welfare Organizer; M.A. Social Work. Minimum of 3 years experience
organizing welfare activities
Administrative, supervisory, c/o central- office. Responsible for women’s
Welfare in subcentre.
1. Child Welfare Organizer; M.A. Social Work with specialisation in child
Welfare
i) supervising all children’s activities including Balwadi & Children’s
Club.
ii) takes care of all reports ■
1. Family case Worker; M.A. Social Work with specialization in Psychiatric
Social Work or Family Case Work.
i) c/o family guidance, problems - referrals from centres.
1 Office Secretary 1) Accounts
11) Charge of maintenance of records
111) Supplies.
1 Women's Welfare Worker; Higher Secondary graduate with diploma in home
Subcentre
science craft.
Page No. 6<
B, Welfare (Contd.)
"■» Pre-School Worker
: Higher Secondary graduate with diploma in nursery
"Subcentre
education.
1. Children's Club Worker; Higher Secondary graduate with training in social
Work, Honors or ordinary degree with diploma in
Social Work.
1. Full time Centre Worker (Attendant) Local Women who will be work assistant
Sub-centers
cum-cleaner,
mi, financial requirements
A. Health
Staff Salaries
Recurring expenses
Non Recurring expenses
Rs. 1,07,610.00
1,20,500.00
2b,85O.QO
Less Estimated income
2,52,990.00
1,0b, 500.00
l,b8,b9O.OO
Welfare
Dr. Zakir Hussain Memorial Welfare Society
Children's Club
Pre-School Education
Women's Welfare
32,700.00
27,550.00
bO,185.00
b9,325.00
C. Vocational Training
D. Project Coordinator and Central Overhead
10,000.00
27,000.00
Total
(l.OO-Rs. 7.50)
Rs. 3,35,250.00
bb,700.00
l,b9,760.00
HOLY FAMILY HOSPITAL COMMUNITY HEALTH DEPARTMENT.
A. Budget Portion
Health :
1« Staff Saleries
2. Doctors Rs. 625/per month)
2. Public Health Nurses (Rs. li50/-per month)i
ii
i1
2. Social Workers
(Rs. U$O/6. Lac(y Health Visitors (Rs. 350/"
)1
1. Nutritionist
(Rs, 600/11
)1
5. Auxiliary Nurse Midwives 200/"
)1
2. Village Level Motiva
>
tors
(Rs. 12$/1. Driver
(RsT 300/1
it,
’)
5. Dais (trained)
(Rs,120/11
<>
2. Receptionist-cum-clerkRs. 250/it
')
1. Lab. Technician
(Rs. 320/-
Sub Total s
2.
Rs. 15,000.00
Rs. 10,800.00
Rs. 10,800.00
Rs, 25,200.00
Rs.
7,200.00
Rs. 15,000.00
Rs.
ss-.
Rs.
Rs.
Rs.
3,000.00
3,600.00
7,200.00
6,000.00
3,8hO.OO
Rs.
1,07,6140.00
Rs.
Rs.
Rs.
Rs.
Rs.
35,000.00
6,000.00
500.00
2,500i00
30,000.00
Rs.
Rs.
Rs.
Rs.
Rs.
36,000.00
6,000.00
2,500.00
2,000.00
20,000.00
Rs.
1,20,500.00
Rs.
Rs.
Rs.
Rs.
Rs.
Rs.
Rs.
Rs.
900.00
1,200.00
600.00
800.00
300.00
500.00
250.00
20,000.00
Rs.
214,850.00
Rs.
Rs.
Rs.
Rs.
Rs.
30,000.00
16,000.00
6,000.00
2,5oo.oo
50,000.00
Rs.
1,014,500.00
Recurring
Medicine
...
Van Maintenance etc.
...
Supply
Miscellaneous
...
Referrals
...
Student Education (integration
of Public Health)
Vaccination drugs
...
Rent of centres
...
Maintenance
...
Total
3. Non Recurring
Tables (3)
Cupboards (2)
File Cabinets (2)
Examining Table (2)
Baby Scale (2)
Adult Scale (3)
B.P. Apparatus (2)
Diagonstic Set (1)
Jeep
« A..
...
...
...
...
...
•••
Total
A. ESRIMATED INCOME PORTION
OXFAM
Delhi Administration
....
Municipal Corporation
...
Land Owners
...
Holy Family Hospital Auxiliary ...
Total
** in excess of medicines and vaccines contributed by Government
*** Not available until april 70 -estimate (not firm)
N.B.
All the Nutritional Supplies are aided by C.R.S.
U.N.I.C.E.F. has promised audiovisual aids
j-Lejy?-06 aid
Grail teams are giving their service twice a week in
health teaching and demonstration.
.
B« Welfare Portion (Dr. Zakir Hussain Memorial Welfare Society)
S.NO.
1. Salaries
1)
ii)
iii)
iv)
v)
Amount
yearly
Amount
per month
Particulars
Chief Welfare Organizer
800/- fixed
Child Welfare Supervison(l)b50/- "
Family Case Worker (1)
b50/- "
Office Secretary (1)
350/- "
Typist/derk
(1)
300/"
2. Contingencies
3. Non-■recurring
Typewriter
(one)
Total Expenditure
Total Income
Total Deficit
Rs.
Rs.
Rs.
Total Income
9,600.00
5,boo.oo
5,boo.oo
b, 200.00
3,600;00
28,200.00
2,500.00
2,500.00
2,000.00
2,000.00
32,700.00
32,700.00
■ Nil
32,700.00
z
B. Welfare Portion (Children's Club)
Particulars
S.Na .
1.
2.
3.
Salaries Full time worker (1)
Contingencies
Non Recurring
Total Expenditure
Estimated income
From fees
Deficit
EXPENDITURE
Amount
Amount for 5
Amount
centres_____
per month
per year
3,600.00 18,000.00
300/-Fixed
2,500.00
500/- "
1,500/- "
7,500.00
28,000.00
Rs. 28,000.00
b5o.oo'
Rs. 27,550.00
B. Welfare portion (pre-school Education)
S.No.
Particulars
__________ EXPENDITURE_______________
Amount per
Amount per Amount for 5
month
year
centres
1. Salaries
full time worker (one)
2. Contingencies
Non-~iecurring
Total expenditure
Total Income
Total Deficit
300/- Fixed
1,200/"
3,597/"
3,600.00
Rs. bi.185.00
Rs. 1,200.00
Rs. bOjl'^pSO
18,000.00
6,000.00
17,98^.00
3. Welfare Portion ccn'cd. (.(’omen's .ci'."."o;
S P.J'D..?vR£;
S.No.
1* Salaries
i)
Fulltime worker (one)
i±)
Attendant
(one)
Amount
yearly
300.00 Fix
170.00
3,600.00
2,040.00 5/40.00 28/00.00
2» Contingencies
1,200.00
3. Non Recurring
Deficit
3,600.00
49,3'25.00
C.
__ ___
per month
Particulars
Total
amount for
6,000.00
Coordinator1s
Salaries
Coordinator's salary
Asst. Coordinator's salary
Clerk, Typist
Rs. 1,500.00 per month x 12
Rs. 450.00
11
x 12
Rs.
300.00
"
x 12
18,000.00
5,400.00
3,600.00
Rs. 27,000.00"
A.
IX. SUMMARY OF THE PLAN
OKHLA NEIGHBOURHOOD COMPREHENSIVE HEALTH AND WELFARE PILOT PROJECT
Aims and objectives
1. The primary objective as a pilot study is to show how a hospital can
leave its walls and become involved with the total approach to cunprehensive
health. By encouraging other agencies available in the area to join with us
in a community effort we hope to demonstrate what can be done to comb-'’t
social and health problems of the community. The specific objective is to
improve the health of the entire family.
Neighbourhood development through total family care by integrated he'-1th
welfare and educe,tional services.
2.
The above objective will be accomplished by:
3.
a)
Reducing the high incidence of morbidity among the vulnerable group
(infant and toddlers) and the damage and death due especially to the
diseases such as gastrointestinal diseases caused by intestinal worms,.
giardia, anceba, etc. Almost 80$ of the children are infected with one
or more intestional parasties like these. During the bi-weekly children's
clinic and school health visits, a routine examination is nm.de.■ These
children whose I© is below 10 mgs are given a routine stool examination.
Also those children who attend clinics with any gastrointestinal diseases
are investigated. Treatment and follow-up are done on these cases, i.e.
deworming process through medicine, proper and repeated health education
to the fami1 yr The general health of the children is built up by giving
iron vitamins and protein supplements. (See the Nutritional Progress
report)
Through the adults clinic other members of the Family who are
suffering from the same diseases are given a similar investigation -and
treatment. A family folder is kept for each family under our care.
These cases are followed up and strongly encouraged to come to the clinic
every week. So far the result has been good. Many factors are involved
. in the causes of gastrointestinal disease. The local water supply,
examined through a sample survey, was found to be good. However, the
drains are still open and general sanitation is poor. We are constantly
approaching the Municipal Corporation and stimulating the ”>eo^le toward
getting closed drains we hope for success soon.
b)
When anemia occurs, many factors, again, are involved. We are trying to
incestigate and treat any infections diseases within the vulnerable group
(almost 70-75$ of the children are anemic) in the first instance before
it become chronic. For this, much health education is needed. The con
cept of disease is such that not until one is chronically or seriously ill
does the patient seek help. Giving early antenatal care and building up
the mothers HB$ is another step in fighting anemia. The child who will
be born will have a good HB$ with which to start life. The Nutrition
team and the women's welfare group of Jamia -are trying to educate these
mothers on introduction of solids and other Nutritional education for the
maintenance of good health. The responsibility of parents in the upbring of their children is emphasized.
c)
Reducing nutritional deficiency disease such as marasmus and rickets.
Cases of marasmus and rickets which are diagnosed from the bi-weekly
clinics or found through home visits are referred to the nutrition clinic.
Milk, protein, cereals, etc. are given.’ If the child in the family is
seriously malnourished due to socio-ecdnomic or other family problems
the family is contacted by the social welfare team under the Dr. Zakir
Russian Memorial Welfare Society. (See Page. 12-13: Family Welfare
Programme). Education is given in every possible aspects.
d)
Protecting this vulnerable group from communicable disease esoecirlly
tuberculsois end whooping cough, (See the Immunization programme end
the T.B. programme, attached^.
e)
Enlarging the social and psychological development of these children.
This is going to be fulfiled by the Welfare Team through organization of
children's welfare, pre-school education. Women's welfare and nrrriage
counselling programmes. The objective can be achieved only if the mothers
are given and are receptive to proper education, making them aware of
their responsibility in bringing up their children. (See pages 13 to 15
Welfare Programme)
f)
Decreasing death rate and accidents due to home deliveries which are
conducted by untrained village dais and there by to improve the health
of the mother and child - most of the deliveries are conducted by those
untrained personnel even today. It is hoped to decrease the problems
by 1) decillary maternity service, 2) early antenatal attendance -at
clinics 3) conduction of home deliveries and postnatal care, 4) referral
to the hospital of all cases needing special investigation and treatment.
5) training of village dais, 6) counselling and educ-tionrl efforts of
the welfare team.
g)
Reducing the high rate of T.B. This is almost 10 in 1000 p-'”!ul"tion.
Our aim is to bring dw the high incidence of T.B, cases to lz2 or to
nothing. (See T.B. Programme). Another Public Health Problem at present
is the high level of air-population due partly to industrial development
.and chemicals used for agricultural, development. A few incidences of
lung collpase in T.B. cases were discovered. Is this collapse due to
T.B. ? a foreign body from the air? In spite of the efforts being nrde
at present, the result can be counted only after 5 to iO ye"rs.
h)
Making the villages aware of health and disease in order to make them
responsible for thei own health and feel the need and seek the avail ability of facilities in their midst. All the efforts of cyr. health
education through various combined channels are geared toward this
purpose. (See the Welfare and Health Education Programmes: pages 12 to
27)
An example of specified targets on immunization would be seen as
i)
D.
P.T.
and BCG.
First year (1970) Second year
and third year (and after)
innoculatfed 500 children (25$ of the
total pop) the percentage will be
higher, however the number will be
less.
According to our programme we are planning to give D P T to all the
children below 5 years, and BCG below 12 years in the school and clinict This
we can active within two years. After this, DPT and BCG are given once for a
life time.
Small pox
Tyahoid
Cholera
will be increased. According to the
1970 data 20$ of the total population
was innoculrted. It is hoped that in
the year 1971 we will increase innocul.'tions by 40-50$ of the
population. There after, we rre
hoping to over the wh -le p viulation
by 80$ in a mass sc"le yearly
vaccing.
B.
Participating Agencies
1.
2.
3.
4.
C.
Holy Family Hospital
Jamia School of Social Work
Dr. Zakir Hussain Memorial Welfare Society
Don Bosco Technical Training School
Machinery for Coordination and Financial Administration
It is necessary to develop an efficient machinery for coordination and
financial administration of the proposed comprehensive health and welfare pilot
project in which many agencies will be participating. Keeping this in view' it is
is proposed to have an executive (coordination) committee consisting of the repre- "
sentatives of the participating agencies. The following will be the composition
of the committee:-
1.
2.
3.
D.
Administrator of the Holy Family Hospital (Chairman)
Two representatives each of the participating agencies
A full time coordinator (Convenor)
The functions of the Executive Committee will be as follows:
1.
2.
To consider and approve the proposals of community curricular planning.
To approve the instalments of grants-in-aid to be disbursed, on the basis
of the approved annual budget, to the participating agencies after the
funds are received from the financing agency.
3.
To approve reappropriation of the budgeted amount from one head toanother on receiving proposals in this regard from the participating
■ agencies.
4. To consider and approve peridocial reports and the pronosed annual
budgets of the participating agencies after they are consolidated by thecoordinator for the purpose.
5.
To consider and approve periodically the consolidated statement of the
accounts , for the project.-
6.
To report to the administrator of the Holy Family Hospital on duties
and functions of the coordinator and his staff.
• -
E.
By approaching the problems of out community in this manner we are endeavour
ing to demonstrate how the institutions of an area can cooperate to treat the
whole man in this environment. Joining hands will be Muslim, Hindu and
Christian elements in this effort. We will not only bring health to the .
villager or slum dweller who may not even realize he needs the assistance but
we will 'Iso attempt as part of the team effort whatever is required to help
the man whole. Not only will we work on his physical environment but will
try to develop a community awareness to his other needs be they socielgical
or educational. We hope to show in this pilot project how the mission
hospital can act as a catalyst in promoting an integrated system of com
prehensive health care in the community. We feel also that this will put
into action what so many have talked or written about as the way our work
should adjust to the realities of the localities we serve.
1 >,CK'.-ROb'tu J.jix GrtMA-lOn PAu~
Paper No. 1®
The Dr. Zakir Hussain Manorial Waif are Society has rhe following aims and Objects:
1.
To foster friend?.,., and haimonious relations among the Children, youth
and families belonging to different Communities and thus prc...ote emotion
al integration amongst them.
2.
To promote V&lfare service for the Children, the Youth and the Family
3.
To organize, for them recreational, social and cultural activities on
the local ievdu
hr To organize, guide and co-ordinate Children«s, young Men’s and Women’s
Clubs.
5.
To organise camps, tours, pionics and other joint functions for the
numbers of the affiliated clubs®
6.
To maintain one or more Model Community Certre in Delhi for the Child,
Youth and Family Welfare®
7.
To prepare and/or public he such literature specially for children, as
would be conductive to the aims and objects of the Society.
8- To provide field work placements for the students of the Jamia School of
Social Work. Hew ■ -lb: ,
9c, To do all such other acts and things are necessary of conductive to the
said objects-
The Proposed Project .For Child Welfare
The need to organise activities for children in order to keep them gainfully
busy during their leisure time and provd.de them opportunities for the healthy
development of their personalities has long since been recognised in our country.
In all big cities of India there are many child welfare agencies. In Delhi also
there are a number of agencies v <:ir.g in the field of -Ixld welfare. But right
from Nizanuddin to Okhala not a single agency can be located which runs any out of
school programme for the children- There is an urgent need for organising such
activities in this area as many slums have developed and are still developing. The
children living in slums are more prove to fall prey to bad. habits and may creats
problems by increasing the rate of jv.-nile delinquency in the area.
In view of such conditions, the Society proposed-to develop children's clubs
in these localities in which various recreational cultural and social activities
can be organised ana thus the children could be kept busy. The society also
proposed to ciganise programmes of inter-club activities for providing the children
of a.:ff erentlocalities and opportunity to rr.iz with each other- The following
are the aims and objects of child welfare programme organised by the Society.
I® To prepare children as worthy citizens of tommorro^ by prodiding them
with oppotunities to elect their own leaders, plan their own leaders, plan
thc.tr own programme organised by the Society..
2. To provide for children as many opportunities for self-expression as
possible by helping them to organise cultural and recreational programme.
Page No. 12,
3.
To bring children of all castes and creeds together on the basis of their
common interest for building up the social harmony and solidarity that our
country, needs so much today.
b. To prevent juvenile delinquency, vargrancy and other such problems in the area*
Besides organising children's club in local communities, the following activi
ties and programmes shall be undertaken by the child Welfare Section of the Society
to achieve these objectives:-
1.
To make arrangements for educational tours, summer camps and exhibitions.
2.
To make arrangements for a mobile library.
3»-
To organise recreatioml activities and sports.
h.
To organise film shows.
5.
To supply milk and other nutritional food.
6.
To provide "Health Services".
THE PROPOSED PROJECT FOR NON-STUDENTS YOUTH WELFARE
Youth has a vital place in any society and they must be given an opportunity
to make their contribution to constructive activities. Theirparticipation should
be based on personal inclination and intterest and they’should be encouraged to
become members of organisations that carry out specific programmes. The enthusiastic
participation of youth is required in programmes, and activities for promoting
physical fitness, recreation, and growth of health citizenship.
1.
Initially, it is proposed to contact youth who have organised, or have a
desire to organise themselves locally for recreational social or cultural
activities.
2.
The society shall pick up from amongst them, those who show promise of
inttiatve and drive, and to invite them to meet and share their experiences
with one another, share each other's experiences, seek and get each other's
help, formulate joint programmes and’evolve common concepts of youthwork.
The specific purpose of such courses would be:
i) To orient them in the concept, objective, function and leadership required
in the organisation of programmes for differents sections of the people
(child, youth and Women etc)
ii) To introduce them to the potentialities of wide variety of programme media
to cater to the varied interests and needs.
iii)
To bring home to them the concepts of democracy, secularism, socialism
welfare activities and of the human relationships applied to meet the day
to-day needs,.
Lectures by renowned persons, discusions and demonstrations would be the
main content of such courses.
3.
1. 3 Society shall pick up. from amongst them those who show promise of
’..d.tative and drive, and to invite them to meet and share their experiences
with one another, and discuss the problems facing them and ^heir people at
the local, state and national levels.
Page No. 13.
Follow Up:
The Society would not adequately discharge its responsibility by organising the
orientation programme alone. It will be necessary for it to keep the contact with
the volunteers alive in order to know their progress, difficulties and to determine
the efficiency of the orientation training received by them. This will be
supplemented by feed back services, the need for which may arise from time to time.
The Content of the Orientation Programme:
The orientation programmes shall be prepared according to the expressed needs of the
participants. Their content may consist some of the following:
1.
♦
Indian social, economic and cultural problems and the need for social
Welfare.
2.
Welfare State and introduction to the fields of Social Welfare.
3.
Meaning of Democracy.
4.
Secularism and Indian Constitution.
5.
National Integrals ->n and Social Conflict,
6.
Programme Media in youth Welfare.
7.
Methods of working with people.
8,
Constructive programmes as leisure time activities for Youth Welfare
Programme..
The content of the orientation programmes shall be covered through:
1.
Lectures by University teachers,
2,
Talks by others on national issues.
3.
Discussions and Seminars.
4.
Demonstration of programme Media such as group games, dramatics, arts
and crafts, adult education, vocational guidance and conselling and visit
to Welfare Agencies.
It is proposed to organise at least three such orientation programmes or one week
duration each year.
THE PROPOSED PROJECT FOR FAMILY WELFARE.
The Jamia School of Social Work is surrounded by semirural areas which are
developing as slums and lack welfare services for Women and Children, The School
has started working in these areas with a view field work experience to the trainees.
The response of the residents of these areas to the preliminary work organised by the
trainees has been v ry encouraging and the society, therefore, peoposed to establish
two or three such Centres for Farm 1y and Child Welfare.
Activities:
Initially the following activities are proposed to be taken up:
1.
Tailoring Class: From the reports of the trainees nlaced in the village
for field work it seems that most of the women folk are interested in
attending tailoring classes. In the tailoring classes it is pronosed to
teach art of stitching various types of garments within a ■•'eriod of four
to five months on rotational basis.
2,
Adult Literacy Class: 'An effort is to be made to m-^ke the ladies of the
locality literate as most of the women folk of the area are illiterate.
Page No. 14.
3.
Cooking and nutrition class: Talks shall be arranged on how to preserve
the nutritional contents while cooking vegetables along with the demonstration
of the methods by the Home Science teacher of the School
4.
Pre-natal and Post-natal Care: Talks and demonstrations shall be discussed.
Pre and Post-natal care of the expectant and nursing mothers shall be discussed
and demonstrated with the help of Health Teacher.
5.
Balwadi: Under the scheme a Balwadi is proposed to be started for the children
in the age group 2j and 6 years. This shall cater to the following needs of
the children:
Physical check-up
Supplementary nutrition
Informal education through play activity
Providing smooth transition from home to school.
(a)
(b)
(c)
(d)
6.
Play Centre: For the Children between the age-group of 6 to 11 years the centre
shall provide the following activities:
(a) Recreational and cultural activities.
(b) Work interest
(c) Referral services for children in need of special care.
■(d) Mid-day meal (if possible).
♦
7.
Case work and counselling services: The services shall be extended in due
course through the expert teachers of the school in the field of problems
ranging from marital discord, family discord, institutionalization of mentaly
handicapped child, family planning. Scholastic difficulties of children, and
referral to medical and psychiatric facilities and legal aid.
THE PROPOSED PROJECT OF A NEIGHBOURHOOD CENTRE.
The proposal to establish a neighbourhood centre is a natural out come
of the objectives envisaged in the proposed constitution of the Society. It
would facilitate an integrated approach to serve the community better as it
combines welfare services for all age groups on need base formula.
OBJECTIVES OF THE CENTRE,
The neighbourhood centre shall attempt to achieve the following objectives
1.
To organize social groups of children, youth and adults such as
friendship groups, acquintance groups, clubs, councils, committees
etc. around their leisure time interests,
2,
To foster friendly and harmonious relations among children, youth
and adults belonging to different communities.
3,
To motivate people to develop the habit of organising voluntary
association for all kinds of civic and social purposes.
4.
To help community to draw benefit from other existing Welfare agencies
and wherever necessary and wherever necessary, to seek help and
assistance of welfare organisations in strengthening the programms
of the Centre.
5.
To render case work services.
6.
To undertake surveys and research for strengthening the nolicies
and programmes of the Centre.
Page. No. 15 <
SERVICE PROGRAMME
The'proposed service programme is designed on the basis of know and
anticipated needs of the community proposed to be served by the centre. While i-t
is not possible in this preliminary planning stage to lay down priority order
of various items of activities to be taken up by the Centre, it however be stated
•that the programme for children and youth should get preference over the programmes
for adults in c rly states.
1. Children's Programme:
i) Day care Centre (age-group 3-6)
ii) Children's after School Programmes,
-
11.
Arts an^ Crafts
Dance - Drama-music,
Special events and camps,
Games, sports gymnasium,
Trips, picnics, recreational & Cultulal activities,
Children's Council, for planning of special programmes.
111. Youth Programme:
- Recreational-cultural activities
- Adult classes to help them in their educational pursuits
- Women's clubs.
- A council for Neighbourhood Planning to undertake such work which would
promote neighbourhood relations as well as civic and social facilities in
community life.
111. Case Work Services■
The Serviccs-programme will be incomplete without case work services.
Individualized help will be given to children, youth as well as adults in dealing
with their personal and social problems.
Iv. Mass-Recreatio ml and Free Play:
Besides approaching the people through various groups, mass-recreational and
free play activities will contribute to integration and development of neighbourhood
STARTING POINT.
...........................
A modest beginning has been made to achieve the ends through phasedprogramme-development. In the early stages the society has decided to organise
such activities which can be carried on with the help of the students of Jamia
School of Social Work and the traineed of Family and Child Welfare Training Centre
under the expert supervision of the teaching staff. Ths activities are so selected as
not to involve heavy expenses, Thus, financial implications in the early stage
have been kept to the minimum,
Child Welfare:
The Society organises children's club in different localities with the help
of the students and the trainees of the Jamia School of Social Work./beenit has/
decided to organise every year an inter-club competition in cultural activities_-an<i—
games for the age-group of 10-lh years on Sth February, the birthday of the late
Dr. Zakir Hussain.
Youth Welfare:
The Society is planning to organise on experimental bass an .orientation
course in constructive work for the benefit of non-student youth during the
year 1970-1971.
Page No. 16.
Family Welfare;
The Society runs two family welfare centres, one at Okhla and the other at
Noorunagar. The centres run Nursery Classes for the children of age-group 3-5
and craft classes for women.
These programmes shall further be developed after the Society is able to
raise the required funds.
Financial Requitementt ,
The Society would require considerable funds for its annual expenditure
when all its proposed programmes come' into operation. It is expected to meet
this expenditurd out of the regular folow from the reserve fund and from the
rent of the external portions cf the proposed buildings which can be let out
for a commercial purposes. The society, therefore proposes to raise funds to the
tune of rupees ten lakhs which can partly be utilized for creating the reserve
fund and partly for constructing buildings and pruchasing furniture and equipment
Page No. I?.
X. BACKGROUND INFORMATION PAPER
Paper No. 11.
FROM THEORY TO PRACTICE
Cgffipj.ehensive Rural Health Service
■
S. Kaithnthera
Hl Kendrick
K. Kukojraki
In 1968, Holy Family Hospital, situated1 in the Delhi South Zone, conducted
a survey of the hospital and its surrounding areas-. This general, 175 bed
hospital bus been in operation since 195.6'. As a result of the survey, it was found
that the most pressing need, in line witti the governments planned’medical
development, was rural preventive medicine. _It was, therefore . decided to set up*
a comprehensive rural health service based on -thd Primary, .Health Centre in pattern
and set-up, i.e. to give,total family care both at home and in,clinics in the way
of puratiye and preventrive measures.
■ This Comprehensive-Rural Health Service (CRHS). Located in the Delhi South
Zone, started functioning in 1969 in cooperation with the Delhi Municipal Corporation.
The villages in the area, nine in number, are marginal villages, combinations
of urban-rural, Muslim, Hindu and Christian populations, on the fringe of the
rapidly developing and expanding city of Delhi. The area’s population’continues
io increase every year due to migration of mostly unskilled, illiterate, daily
labourers from the nearby states of Uttar Pradesh, Rajasthan, Punjab, etc. Drought
crop failure and the promise of higher wages attract the families to this fast
growing city. With such a transient population, there are numerous problems vary
in degree from village to village. The,cost of housing is perhaps’ the highest in
the country. The city of Delhi is classified by the Government as Class "A" (an
extra allowance for housing is provided to Central Government employees). In some
. of the villages, the families live in hutments or juggies, others live in better
constructed housed. There is an upsurge of factories in the area; the Okhla Small
Industries Estate has over 85 factories employing some of their labourers from
these villages. Along with the factories come new housing developments, soon a
shopping area and the like. The villagers range from the extremely poor to the
highly educated, some being lecturers and teachers at the Jamia Millia Islamia.
PROJECT SERVICES
The goals of the CRHS are embodied in the service which have been developed
for the promotion of prevention in the village communities:
1. Health Education: Introduction of health ideas in order to develop a personal
family and communal awareness of health aspects of life. Those fundamental concepts
are integrated by way of individual counselling, demonstrations, displays, camps,
clinics, into every single aspect of this programme.
2. Maternal and child health: Maternal service is the preliminary stage of any
health service. Its purpose is to build up maternal health in order to bring
forth a healthy living child through antenatal, natal and post-natal care. The
child care, which includes infants and toddlers, concerns itself with the physical,
psychological and social and social need of the growing child* Through this,
the child is prepared for school and is followed through preliminary education.
Page No. 18,
3. Family Planning: It is hoped that through guidance and counselling a degree of
responsible pax-enihood oould bo -aohi-oved -to enable the parents tc accept the
obligations of the parental role in our society.
11. Applied nutrition: Through applied nutrition, it ishoped that acute nutritional
problems can be reduced and those suffering grom the deficiencies can be assisted to
a certain degree of normalcy. This can be achieved through the following:
a)
Feeding programmes for mothers and children (egg, milk, fortified foods)
b)
Kitchen garding to provide vegetables at minimum costs, enabling families to take
on basic nutritional values.
c)
Demonstrations of cooking methods to heighten their awareness of the value of
fends. Displays and audio-visual techniques are used to assist the educative
process. This will be done in the village as well as in theweekly clinics.
Medical aid:
This service is to establish firm foundations and reduce the
already prevalent diseases and illnesses.
6, School Health^:
This is a continuation of the maternal and child health. As the
child grows, health care and guidance are necessary for his continued physical and
psychological well-being.
7. Communicable disease assistance control; This is to be achieved through
immunization, and" vaccination with smallpoz, B»C.G., cholera and typhoid. Thl& will
be given tc all infants, toddlers and other family members. Along with this ,
communicable disease education is given on environment and higiene.
8. Basic hygiene education: This will introduce the individual and families to
the basic information of hygine an’ is given through spontaneous, group or ..
clinic talks and advice.
9. Social Family Welfare Service: Because family and individual problems are
closely related to the socio-economic, social and home circumstances, a family
fuidance and referral service is necessary to assst and fuide families to solve
their problems.
10. Nursing rural health training: Nursing students are offered rural experience
to give them an understanding of village life and the family, social economic and
personal problems of the people. There is specific training in the value of
preventive medicine which enable the student nurse to carry this into her own
community as well as into her hospital work.
11. Statistical data collation; To establish a firm basis for progressive research
in all priority and evolving problems.
STAFFING PATTERN
The team conoists of a part-time doctor and volunteer doctors, public health
nurse, four lady health visitors, nutritionist, social worker part-time lab technician
Municipal family planning worker, village motivator-cum-auxiliary, driver and fnl 1 -t-i ms
vounteers.
SPONSORING AGENCIES:
This programme is need-based as it is directly the result of a survey carried
out in the area. Maternal, child health and nutrition were given the highest
priority. The applied nutrition programme is sponsored by three agencies: UNICEF,
through poultry maintenance programme, audio
Page No. 19.
Sponsoring agencies:
(contd).
Visual equipment and feeding equipment; Government of India, which is expect
ed to donate Balahara, protein-fortified wheat; Catholic Relief Services, which
has given oil, bulgur wheat and milk powder. The Delhi Administration, through
a Public Health Grant is assisting with education and some salaries. The Communi
cable Disease Assistance Control is aided by the Municipal Corporation with
vaccination and immunization drugs, and it also cooperate with family planning
workers and sanitary inspectors for the area.
PHASE DEVELOPMENT
To' achieve these goals, there phases of operation have been designed. In
phase I, through a comprehensive health survey, the CRHS was introduced to the
villagers and non-official village leaders, those influential in the village such
as doctors dais, teachers, landowners, etc. was secured phase 11 is started as a
short term programme. It consists of (1) Maternal and child health and family
planning, (2) Applied nutrition, (3) School health, (4) Communicable disease
control.
The villages and schools have been entrusted to the four lady health
visitors. Their work in these villages is to give total family care through
home visits and clinic service referral. Family care includes all health education,
motivation and follow-up. Each lady health visitor (LHV) has, at present, about
275 families under her care. Each is responsible for about 1400 school children
as well.
I1) The early booking of cases for home delivery.
LHV visits,
This is done during the
II) Periodic check-ups which include lab. tests examination, treatment and
follow-up.
Ill) Referrals of two types will be made, one to the nutrition clinic, that is,
mothers with anaemia and/or other' nutritional deficiencies, the other will be
those cases unsuitable for home delivery to be referred to the hospital.
The Natal care is follows: For all of the booked cases home deliveries will be
arranged, These deliveries will be followed up through the postnatal care con
sisting of daily visit for 5 to 6 days_ and tenth day after delivery.
The infant care will consist of the infants attending monthly clinic and being
visited at home each month over.a period of one year. This is in order to give the
necessary immunization and follow-up their growth and development. For the infants
with nutritional problems, referrals will be made to the nutritional problems,
referrals will be made to the nutritional clinic and difficult cases to the
hospital.
The pre-school or toddler care concerns itself with the children from one year
until school age. This is through clinic attendance every three months as well
as home visits every three months. Referrals are the same as for the infant
programme.
In the home visits immediate health education is given and followed up. In the,
cl-inins there will be a set pattern of health education through use of visual aids.
The whole programme includes family care : i) family counselling to work out or
assist in marriage and fami 1y problems, (ii) employment referrals, cottate industry,
insurance and small business loans and (iii) medical aid.
Page No. 20.
The second aspect of the Phase 11 programme is applied nutrition. This is a
priority concern and is directly integrated into every level of service,
specifically in a referral clinic for nutrition. There are cooking demonstrations
of the available foods to impart knowledge of food values, vitamin, vitamin
maintenance in preparation, the "how" of increasing the nutritional content of the
family diet. Food Care will be given to nutritionally deficient mothers and
children.
Another aspect of the applied nutrition programme is kitchen gardening already
implemented and carried out by a village motivator in Joga Bhai village.
Poultry raising is to be started through UNICEF Paultry Maintenance Progranroo
(this supplements both family diet and income).
School Health Care consists of toddler follow-up, complete yearly physicals by
doctor treatment and follow-up and immunization. Classes will be held for
teachers in hygiene, home nursing and first aid. Referrals will be made from
here to the nutritional clinic or hospital, if needed.
The fourth aspect of Phase 11 is communicable Disease Control which win be
assisted by Delhi Municipal Corporation with immunization teams, sanitary
inspectors and drugs for immunization. These immunizations will be given in
clinics and home visits. Small pox, DPT and cholera are of particular concern
work is being done on the detection and referral of infections. Domicilliary
care will be given to a small number of T.B. cases. With the aid of the sanitary
inspector water will be tested and treated when necessary; insect eradication will
also be undertaken.
The CRIB programme has helped 950 families and nearly 1500 infants and toddlers.
This required an investment of Rs. 78,000/- Financial assistance was received from
the Holy Family Hospital Auxiliary and Catholic Relief Services, and the Delhi
Administration which contributed over Rs. 10,000/HEALTH ANALYSIS
Village
Family
Toddlers
Juliana
Shopkeepers
Educated
Employed
Cottage
Industry
Weaning mal
nutrition,
Deficient
Character for
mation 80/
Infants
Ante-natal
70-80 per cent
Intestinal
& other in untrained dhai
fection due delivery infe.ctto sanitat tion Anaemia
ion
Primary smallpox
Sec. Vacs.
done.
DPT and other
immunisation
nil.
Psychological
development
training -nil
Pre-school
preparation
nil.
Mxsigarh
Farmers
Same as above
90-95
percent
worms
Same as above
Page Mo. 21
Village
Family
Holy Family Hos
pital employees
shopkeepers
educated employed
Cottage industry
Gafoor
Nagar
Joga
Bhai
Class IV employees
at Jamia Milia
unemployed
daily labourers
Toddlers
Infants
Ante-nntal
Same as
above
Same as
above
Anaemia
Same as
above
Undernourished
98 per cent
due to infection village dhai
intestinal in
delivery anae
fection due to mia Indication
sanitation \
of extraordinary
high still birth
and neonatal
birth few wit
nessed maternal
deaths
98 percent un
employed daily
labourers
residing in mud
juggies
Undernour
Acute malnut
rition due to
ished due to
family diet of
infection
mainly chapatti and diet high
and chili.
incidence of
Street children diarrhoea,
acute diseases
worms URI.
due to malnutri
tion No. Schooling
Ante-natal
anaemia Dhai.
delivery
infection
Teachers of
Jamia Milia
Generally
active healthy
children. Need
for immunization
98 percent
trained dhai
delivery
Professors
Low income
labourers
middle class
Few landowners
Intestinal in
fections . ©not
ional and
psychological
problems anaemia
rickets
Immunization
High infant
death Maras
mus Intest
inal infect
ions
Early marriage;
therefore high
incidence of
grand multi
paras Anaemia
BENEFICIARIES
1.
2.
3.
4.
5.
6.
7.
8.
VILLAGE
FAMILIES
UNDER CARE
INFANTS
UNDER CARE
TODDLERS
UNDERCARE
ANTENATAL
UNDER CARE
Okhla
Batla House
Gafoor Nagar
Joga Bhai
Jamia Dairy
Bharat Nagar
Jul1i nna
Masigarh
291
4°
64
59
23
161
221
81
95
17
12
20
8
55
94
40
339
50
68
66
30
164
207
92
38
6
5
7
4
27
27
7
' Total
940
341
1016
116
Page No. 22.
PARTICIPATION
The CRHS now operates in two centres to cover all the villages. The Family Planning
Centre in Okhla was given by village resident as a base for the clinics. In
Ifcsigarh another centre, donated by the parish, is set up for d ini o.s to service
the remaining villages.
The Jamia MLllia School of Social Work initiated on March 31, 1970, the Dr. Zakir
Husain Memorial Welfare Society. The aims and objectives of this society are the'
promotion of service for the family within the community through the following five
standing committees.:
i)
Child Welfare - need for organizing children's activities in order to
keep them gainfully busy during their leisure time and to provide them
opportunities for healthy development of their personalities.
ii)
Youth Welfare a proposal to contact youth, a large segment of India's
population, through meetings and conferences, to eventually organize
Leadership'Training Courses, orienting the young toward democracy,
secularism, socialism, welfare activities and applies hum^n relations,
iii)
Fami1y Welfare - to establish suitable activities for recreation,
economic betterment and education*
iv)
Neighbourhood Centre - enabling an integrated approach to serve a
community better as it combines all the welfare services on a need
based formula.
v)
Ways and Means - finances.
This Welfare Society will work in partnership with CRHS. The aims and object
ives of both will provide one another with the vehicles necessary for increased
social welfare.
Jamia Mi 111 a Islamic has also contributed to the area through the Mukhya
sevika training project. The trainees from various states in the country
required a certain amount of field experience. Several village have been the
recipients of these projects - Mahila Mandal (home economic for women) at the
Balwadi (children's education).
Generous efforts have been made by the village women volunteers in the sewing
and cooking project. One women from the •'rillage has joined the CRHS staff as
a village level worker helping to stimulate the women to an acceptance of the
women to an acceptance of the project.
ON - GOING STUDY AND RESEARCH
During the survey, a sample study of infant and toddler deficiencies was
conducted by a pediastrician from Irwin Hospital, Based on the children's
histories, blood and stools were examined and the report indicated a high
incidence of Kwashirkor, Marasmus and Bilateral trachoma. Clinic attendance,
to date, has evidenced a very high incidence of anaemia, particularly among
the pregnant mothers and toddlers. Rickets is prevalent in the very poor.
Two research projects are being designed at present to supplement the survey
in the sense of more in-depth investigation into what responsible parenthood
real 1y is in these situations as well as an area awareness study to determine
the level of the community's response.
Page Nd. 23
EVALUATION AND rHOJECTION
Phase 111 of this programme is an overall evaluation of existing services after
one or two years based on the short team programme. Following this vri.ll be
the implementation of the long term measures based on evaluation data.
Although programmes of this type, sponsored by private voluntary organisations, are
only beginning, it is conceivable that with government consent, available finance
and resource assistance, they could be set up with a minimum of Rs, 67,000 for
adequate staff and other expenses. A programme of this sort could easily be
considered as one unit. Multiple units of four to five could be administrator
and one supervisor.
EAGROUND INFORMATION PAPERS
Paner No, 3.
Page No, 24.
The Project services of the Comprehensive Rural Health Service:
1.
Health Education
Introduction of health ideas in order to develop a personal, fami1y and com
munal awareness of health aspects of life. Those fundamental concepts are inte- '
grated by way of individual counselling, demonstrations, displays, comps, clinics,
into every single aspect of this programme.
2.
Maternal and child health
Maternal service is the preliminary stage of any health service. Its purpose is
to build up maternal health in order to bring forth' a healthy living child through
antenatal, natal and post-natal care. The physical, psychological and social needs
of the grounding child. Through this, the child is prepared for school and is
followed through preliminary education. This service will be given both in the
clinics and families.
3.
FarnlY Planning
It is hoped that through guidance and counselling a degree of responsible
parenthood could be achieved to enable the parents to accept the obligations of
the parental role in our society. Referral to Government Family Planning Centres. .
4.
Applied Nutrition
Through the applied nutrition, it is hoped that acute nutritional problems
can be reduced and those suffering from the deficiencies can be assisted to a
certain degree of normalcy. This can be achieved through the following:
Feeding programmes for mothers and children (eggs, milk, protein
fortified foods).
Kitchen gardening to provide vegetables at minimum costs, enabling families
to talk on basic nutritional values.
c) Demonstrations of cooking methods to heighten their'awareness of the value
of foods. Displays and audio-visual techniques are used to assist the
educative process. This will be done in the village as well as in the
weekly clinics.
a)
b)
5.
M^cal.Aid
This service is to establish firm foundations and reduce the already prevalent
diseases and illnesses. This has been taken as one of the priorities in the short
term programme.
6.
Sghppl Health
This is continuation of the maternal and child health, as the child grows,
health care and guidance are necessary for his continued physical and psychological
wRll-bR-ing. A complete medical check up is given to each child and the treatment
■and follow up is done. The nocessary immunisation also is given.
7.
£pgMW.cab.lg_.Da,s_qage. Assistance Control.
This is to be achieved through imrmini nation and vaccination with smallpox,
B.C.G., Cholera and “typhoid, DPT. This will be given to all infants, toddlers and
other fami1y members. Along with this, communicable disease education is given on
environment and hygiene.
8.
Basic Hygiene Education..
This will introduce the individual and the families to the basic information
on hygiene and is given through spontaneous, group or clinic to like and advice.
Page. 2$,
9.
Social Family Welfare Service
Because family and individual problems are closely related to the socio-economic
and social and tome circumstances, a family guidance and referral service is necessary
to assist and guide families to solve their problems.
10.
Nursing Rural Health Training
Nursing students are offered rural experience to give them an understanding
of village life and the family, social, economic and personal problems of the
people. There is specific training in the value of preventive medicine which
enable the student nurse to carry this into her own community as well as into her
hospital work.
11.
Statistical Data Collection
To establish a firm basis four progressive research in all priority and
evolving problems.
12.
Rotating Intern ship programme
Where doctors will be offered practical training and experience in vjllage
health work.
Page No.26.
X. BACKGROUND INFORMATION PAPER
The five standing committees of the Dr. Zakir Hussain Memorial Welfare Society:
Child Welfare
1)
Need for organizing children's activities in order to keep them gainfully
busy during their leisure time and to provide them opportunities for healthy
development of their personalities.
2)
Youth Welfare
A proposal to contact youth, a large segment of India's population, through
meeting and conferences, to eventually organize Leadership Training Courses,
orienting the young toward democracy, socialism, welfare activities and applied
human relations.
3)
Family Welfare
To establish suitable activities for recreation, economic betterment and
education.
U) Neighbourhood Centre
Ehabling an integrated approach to serve a community better as it combines
all -the welfare services on a need-hased formula.
5) Ways and Means-finances
PROGRAMME OF ACTIVITIES:
1) Tailoring Class
From the report of the trainees placed in the villages for field workit seems
that most of the women folk are interested in attending tailoring class. Under the
class, it is proposed to teach art of stitph-ing various types of garments within a
period of four to five monthson rotational basis.
2) Adult Literacy Class
Talks the An eneavour is to be made to make the ladies literate of the
locality as most of the women of the village are ti terate of the locality as most of
the men.
3)
Cooking and Nutrition Class
Talks- shall be arranged on how to preserve the nutritive content while
cooking vegetables along with the demonstratio n of the Home science teacher of the
school,
ij) Child Prenatal and Post-natal Care
Talks and demonstration shall be arranged in the subject. The physical and
emotional needs of the child shall be discussed. Pre and postnatal care of the
expectant and Nursing mothers shall be discussed, and demonstrated with the help
of tbe Health Teacher.
5) Balwadi
Under the scheme a Balwadi is proposed to be started for the children in the
age group of 2j and 6 years. This shall cater to. the following needs of the
children, a) Physical check-up, b) Supplementary nutrition and milk, c) Informal
education, d) Providing smooth transition from home to school.
Page. No. 27.
6. Play Centre
For the children between the age group of 6 to 11 |rears.
The Centre shal1
provide the following activities:
a)
b)
c)
d)
Recreational and cultural Activities
Work Interest
Referral Services for children in need of special care
Mid-day meal (if possible)
7. Case Work and Counselling Services
The services shall be extended in due course through a family case worker of
the society in the field of problems ranging from martital discord, family discord,
institutionalisation of a mentally handicapped child, family planning, scholastic
difficulties of children, and referral to medical and psychiatric facilities and
legal aid.
This coordinated service will be implemented for two to three years as a short
term plan. The priority of the long term programmes will depend upon the evaluation
of the short term experiment.
NURU NAGAR SURVEY
Nuru Nagar had 245 families and a total population of 1366. There were 38 joint
families, as defined by each surveyor, and 20? single families.
The average number of members per family was 5.5. 15 fnmi1ias had only
2 members, and only 6 had more than 10 members. The following is n breakdown
according to size of families:
No, of members
No. of fl-uni 11
3
4
5
6
7
8
9
10
32
42
37
36
33
28
8
7
A breakdown according to age is given below:
'
•
'
Infants (under 1 year)
Toddlers (1 to 5)
School age ( 6 to 16 )
Antenatal
45
85
423 14 <
The incomes recorded were monthly total family incomes - i.e. the sum of
all income earned by family members. Those included'i# ■ the' definition for
semiskilled were: clerks, teachers; tailors, drivers, cooks, shopkeepers. The
19 bear walahs were also included in the semiskilled category (all but 5 earned '
Rs. 100 or below). 6? families'or 28$ had incomes of Rs. 100 or less. Of these,
52 were labourers'and 15 were semiskilled,- -99 fami11 os or 40$ of the total no.
of fnmi11es had incomes between Rs. 100 and Rs. 200. 76 families, or 30$, had
incomes above Rs. 2Q0.' Of these, 34 were labourers and 42-were semiskilled. In
this high income group, incomes.ranged up to Rs. 500 and R§. 1000.
HOME AND ENVIRONMENT'
■ \ 17.8 or 73$ of the total families had one room; 47 or 9$ had two rooms:
18 or 8$ had three rooms or more. 60$ of the total had a water source outside
the ho,use. 191'or 7^$ owned their own housing. Of the 36 families who pay rent,
15$ 9 had incomes Rs. 100 or below, and paid from Rs. 5 to Rs. 20 for rent. 16
• had incomes Rs. 11Q, to Rs. 200 and paid Rs. 30 to Rs. 50 per month. 21 had incomesabove Rs. 200 and paid from Rs. 15 to over Rs. 200 per month. 28$ of the total
fnmi11es had electricity.
Page Nu. 29.
IMMUNIZATIONS
Vaccination
all members
vaccinated
smallpox
BCG
TABC
Polio
DPT
209/85$
6”/27$
59/21$
21»/10$
26/11$
none of the
members
6/2$
11:0/57$
16o/65$
197/80$
199/91$
some of the
members
30/13$
38/16$
26/11$
21;/10$
20/8$
HEALTH
Of the family members above 5 years of age, the following ailments were
listed in five of more cases: rheumatism, having a cough for a long time, headaches
stomach pains, asthma, diarrhea, backache, menstral problems. Of those under
five years of age, most common were:sore eyes, worms, diarrhea, cold, distended
stomach, and general weakness.
i
SOCIAL PROBLEMS
11$ of the total population indicated that they worry about money.
mentioned as a common concern was the marriage of a daughter
Also
NUTRITION
26 families or 16$ of the total were begetarian; 81$ were non-vegetarian.
69 families or 28$ never drink milk; 16 or 7$ had milk for other than tea; and
65$ had it for tea. 222 or 91% never had fruit. 199 or 80% never ate eggs;
and 9% ate eggs daily. 65 or 26$ never bought meat; 23 or 9% had meat daily;
99 or hl$ had meat once a week. Below7is a breakdown of meal habits:
most families had only chapatti and tea for breakfast
13$ had only vegetable for one meal, 3$ had it for two meals
15$ had only dal for one meal
9% had vegetable or dal for one meal, 9$ had it for two mdals
12-$ had dal or vegetable or meat once a day, 12$ had it for two meals
7% of the total families had only one meal a day other than breakfast,
and had either vegetable or dal
g. 20$ had dal and vegetable once a day, 11$ had it twice a day
h. Only 2-$ had dal and vegetable and meat once a day, 2$ had it twice a day
i. 6$ are suject for one meal, 6$ ate dal and subji for one meal
a.
b.
c.
d.
e.
f.
ANNUAL REPORT FOR 1973 OF
THE COMMUNITY HEALTH DEPARTMENT
HOLY FAMILY HOSPITAL
The Pilot Project was inaugurated on February 8, 1972, as a com
prehensive programme of health, welfare and education.
The general objectives of this' programme arel
1.
2.
Neighbourhood development
Total family care through integrated health and welfare
services and educational services.
In order to develop a common programme for families of the whole
service area - our neighbourhood - recreational activities-,
economic uplift and education are steps towards total family care
and an overall social improvement.
Through the coordination of the following existing agencies and
institutions we are able to achieve the aims and objectives set
up:
1. Jamia School of Social Work training programme
2. Dr. Zakir Hussain Memorial Welfare Society
3. Holy Family Hospital (as referral centre and specialized
treatment centre)
4. Holy Family Hospital Community Health Department
5. Holy Family Hospital School of Nursing and the department
of medicine and DCH for. training
6. The educational and referral facilities of Don Bosco
Technicial Training School.
COMMUNITY KAITH CEtL^
Review of the work in 1969 - 1972
HEALTH PROGRAMME
47/1.(First l
*
In 1969 we selected an area out of the Delhi South Zone between
Mathura Road and Agra Canal, in cooperation with the Delhi Muni
cipal Corporation. The population of this area is about 20000
and its has a pj * i.ure of Christians, Moslems and Hindus.
Some 60% of the breadwinners in the families are daily labourers,
38% are shopkeepers, clerks, teachers etc. and only 2% landowners.
Out of that 60% had an .income below 100 Rs. per month, 30% had
an income between 100 - 300 Rs. per month and 2% are earning
2000rs. or more monthly. The average family .size was 5-7 family
members.
The health problems siere of quite an extensive type in this
initial stage of the project.’ Maternal deaths, malnutrition,
anaemia and worm infestations were found to be the most common
cent.
' * *'.
diseases. Almost 80% of the-families in the area have a one room
accommodation only and this causes several socio-economic
problems. We alsc found the sanitation and drainage system to
be very peer in the area.
After the initial survey of the area in which the above facts and
needs were discovered, we made a family folder for every family
including separate record cards for infants, Tcddlei-s, antenatals and adults.
In order to start the work and set the priorities we made the
following our aims:
To- reduce the high incidence of morbidity among vulner
able groups ana to reduce damage and .death caused by
gastro-intestinal diseases.
2. To reduce the number of anaemic cases. 75% of the
children were duffering from anaemia.
3. To reduce nutrition deficiencies.
4. To reduce maternal deaths.
5. Protection from communicable diseases among the
"Under fives", through immunization programmes.
6. To reduce the high rate of TB, by clinics and referrals,
TB, cases were 10/12 - 1000 in the papulation.
7. To make the villagers aware of health needs through
health education and to encourage their own initiatives
in using and developing health services provided.
1.
The goals were set for each year to achieve these aims and
evaluations.
During 1970 we made it a task to emphasize a growing link betw
een our department and the resr of the hospital. At the same
time the stress was laid on the completion of the comprehensive
health survey and on the full implementation of the nutrition'and
immunization programmes. Curative services were integrated with
the preventive sector, Our estimation was that the first two
years-would require more emphasize on medical care than in the
later stage of cur programme.
The above 1970 aims were materialized through daily medical cli?^^;
ics and nutrition clinics set up in tho tillages, as well as
•through health education, school health services and referrals
of serious cases to the hospital. It was alsc carried out
through deliveries conducted at home by our staff, being on
day or night duty.
Along with this we started to provide students of nursing a good
rural experience and health education. By periodic service
evaluation and in-service training for our team we were able to
see the positive and negative aspc-cts of our work more clearly.
During 1971 and 1972 the above programme was strengthened. More
attention was given to the integration of health and welfare
services. The total immunizations of DPT, BCG, polic, Smallpox
and cholera for children under five was set up as a definite goal
as well as to conduct a Dai training. The health education was
extended by a planned curriculum and a .cleanliness drive was
started in one of the most needy villages. Finally we also started
to prepare the village population for a future self supporting
programme. One more health centre was opened in 1972, making the
total of four centres and five welfare centres. The total number
of families under care in 1972 was 1853, members of whom came
came to ante-natal, under fives, family and nutrition clinics
according to their age^school health and home visits were continued
In 1972 we also moved into a new office, giving us more space to
work in than previously.
For 1973 we had set the Goals as follows:
1.
2,.
3.
4.
5.
£.
7.
8.
9.
Completion of the whole immunization programme
More home visits for health educational and nutritional
purposes.
Resurvey to evaluate new needs and attitudes of each
family.
More involvement of local leaders in our work.
More feferrals to other hospitals and centres
Filtre-clinic, i.e. treating routine complaints in
the clinics with standing orders.
Starting preparations for a health insurance scheme.
Strengthen the school health programme with planned
Health Education
T.B. Case finding.
RESURVEY.
The year 1973 started with a total resurvey of the whole service
area. In order tc find out new needs of the families as well as
their reactions and attitudes^effects towards our programme we
made a Comprehensive questionnaire, covering both the welfare and
the health aspects. At the same time it was a tentative prepar
ation for a self supporting scheme. I664 families were surveyed.
. .4..
TJjds however excludes the village c f Nuru Nagar, consisting of
336 families, since that village was surveyed one and a half year
ago, before opening its centre.
By asking the villagers how much they weuld be willing to contri
bute towards a health insurance scheme in 1974 we found out.their
economic ca.pacities fcr self support and their response tc bear
ing an increasing responsibility fcr health services. As the stat
istical reports cf this resurvey show, some 15-20% of the popul
ation are in favour of an insurance scheme whereas many others had
net yet made up their mind. Among these giving a definite respon
se of approval 60% are willing tc contribute 1-2 rupees per
family per month the rest mcrej asked the question whether cont
inued health services are preferred t the threat cf closing
clinics for lack cf funds, 75-80% replied that our centres and
work should go on by whatever means possible. They will pay for
the medicine. The general knowledge 'of cur work among the villagers
ers is shewn by the resurvey tc be good and there are hardly
any cases where our work has not been heard cf at all. Only 29
families in the whole service area stated complete ignorance of
our clinics.
As for the items the community expects from us, the majority
replied that medical care, nutrition and immunizations were the
most essential. Among the points tc be improved seme mentioned
more personalized relations with the staff through home visits
(a fact well known from previously), seme mentioned the need for
latrine facilities in the centres and some other families stressed
the fact that patients had to wait for quite seme time ifa the
clinics due to the cfowd(15%) /mother percentage of the populat
ion, about 4, 5%, stated economic poverty to be one of the reasons.
fcr not coming regularly to the centre, as a nominal fee is charged
there.
The structure of this resurvey differs somewhat from the initial
survey we made in 1969. The latter was aimed at finding out
concrete socio-economic-facts and figures health needs whereas
this resurvey stresses attitudes and preferences cf the Community.
Yet even from this resurvey it can be found that the general
health and welfare level has been raised considerably. The monthly
income cf the majority of labourers has increased. Approximately
10% of the families have a monthly earning of below Rs. 50%>
whereas the larger part of the population (30%) earn between
100-200 rs/- per month and 20% of the families 200 to 300 Rs. per
month and the remaining 40% between above 300 up to 800. Only two
families in the area have a monthly income of 1000 - 2000 or more.
According to the resurvey no family is entirely unemployed.
-5Thc distribution of work has not changed its pattern
nuch since 1969. The number of daily labourers, part
time workers, hookers and factory' or field labourers
form the largest professicnal group in the area. About
420 families, including sweepers, peons and servants, are
working in this sector. At the same time there is a fairly
large group of tailors, carpenters, welders, masons, black
smiths, dhobis and the like, making for a lower middle
Class, Some. 300 families can be included in this category.
The are two large scale shopkeepers in the area and 78
families having small scale shops of the juggi type. There
aye eight doctors in the community as well as 74 teachers,
Clerks and typists, an occupation sprung from the urbaniza
tion of the area, were found to be the breadwinners' in 68
families. Only 3 families were earning their livelihood
through begging. However, due to the shortage of wheat and
other grains, the women who were working in the modi mills
and other shops as daily labourers, are now sitting idle in
the home. As a whole it is clear that there is a general
trend away from the traditional agricultural work and
daily labourers' occupation ’to new means of subsisting,
found'in a city.
As for the educational level it clearly shews a growing
equality between both sexes in comparison to the previous
generation. Among the adults of the villages about 1650 in
habitants were found to be illiterate, of whom females
twice as much as the male group. Throughout the various
stages from primary school up to college twice or thrice
as many men were found to be educated as women. Only in
the field of private studies we found 10 educated women
in comparison to 3 men. Among the children of school going
age however the distribution was fairly equal, except for
colleges where the figures showed 47 male against 19 fe
male. In technical schools however the level was the same.
(4 males to 4 females) The largest bulk of students are
found from nursery classes up to the middle school in
cluded. Again the female dominance is striking when it
comes to private studies - 5 females to 2 men.
The immunization coverage, health education and curative
care have made people more aware of the values of medical
service .and right hygiene and the community is giving a
-6growing place in its time and spending capacity to health
betterment.. Also it is prepared to give support and help
in whatever way possible.. According to the survey report
these who are educated premised their parttime help, doing
for instance typing or helping in the centres, Those who
are not educated - especially women - help us in cleaning,
prepacking, etc.
THE UNDER FIVES' CLINIC
Our goal to cover the whole area with a total family care
is fully implemented. The under fives' clinic is an inte
grated clinic of medical aid, immunizations, nutrition,
family councelling, health education and all children can
attend the clinic, whether well or ill..
Through the medical check up in the centre and the resur
vey and home visits more cases of malnourishment and maras
mus in the early ages could be found. Those children have
immediately been referred to our nutritionist and we now
have a regular follow up of those cases, combined with
health education on proper diet, cleanliness etc. for the
mother.
The disease pattern has also taken a new shape. The per
centage of severe diseases has been reduced and apprexima- '
tely 55-60 % of the daily diagnosis in the centres are
confined to 3-4 common diseases, partly conditioned by the
prevailing season. General weakness, URI, fever, boils and
diarrhoea cases are very frequent. The variety of diseases
is less and the rate of morbidity has decreased considerably.
This can also be seen from less clinical visits for the same
complaint. Among toddlers and infants this decrease of re
visits is 40$ and 60$ respectively as compared to 1972,
and among adult patients the revisits have gene down slightly.
The goal to cover all the children under five by a complete
immunization programme comes close to an end. The statistics
show the following figures of coverage for 1973:
-7DPT
89%
BCG
78,2%
POLIO
91%
SMALLPOX
88%
•’MK hi M "’•J
7>i'iflL l - P- >x
ti .
tILD. p. T Likewisi the over all improvement of health can be seen in
the results of hemoglobin and stool tests. From various
group checks in the villages the average figures Were far
more satisfactory than last year.
/mother important move is that the frequency of admissions
into the hospital has been brought down due to an intensified
treatment,in the department.of patients coming after clinic
hours. Doctor and staff, being on night and day duty, are
ready to give help to patients even of a more serious kind,
like pneumonia or gastrointestinal cases. Thi.s has helped us
considerably in our efforts to reduce the current expenses
of our programme. Statistical reports show that referrals
for specialized treatment have gone down by 40% since 1972,
the referrals for admi§j34ons by 60 % since last year. Also
this effort has made it possible to refer patients needing
no emergency care, to other hospitals, like the Government
run Safdarjang Hospital or the New Delhi TB Centro in Kingsway Camp. Such outside referrals have increased by 35 %
since last year. The integration of welfare and health in
the project has been further consolidated. Referrals to the
welfare section of the project have increased by 50% since
last year.
In cne of our villages, Okhla, the Delhi Administration has
set up a dispensary, providing daily services. With this dis
pensary we cooperate in such a way that we refer adult patient
from the centre to the dispensary for dressing and treatment
whereas patients from the dispensary will come to us for
medicines and immunizations. One effect of this 'is that the
number of adult patients in our Okhla centre has decreased,
leaving more time for home visits.
-8At present the distribution of cur patients is as follows
Infants
under care
Toddlers
under care
School ago
under care
836
1907
3541
AdultS
under care
TB patients
under care
5989
29
=
Antenatals
under care
138
Nutrition:
One of the nutritional changes during 1973 is that in
November the family nutrition was stepped, due to shortage
of supplies. Instead all children under 6 years of age are
given at birth a PRC card (Patient's retained card) in
which the monthly height and weight is registered on a
Scale, Likewise hemoglobin and immunizations are marked in
this card. After the age of 3 months we provide a protein
mix for all those children (WSB + milk or CSM + milk, given
by the CRS) Through the follow up on the cards and by home
visits the progress of the child is properly surveyed. On
the card, below the normal weight sector on the scale, we .
divide the malnourishment into three degrees, cf which the
second and third degree children are constantly followed up
by home visits. It is also to be noted that a normal Hb,
weight and height lasting for some months does not necessari
ly mean that the child's malnourishment has been turned into
permanent health and resistance. Through pneumonia or intes- ■
tinal diseases many of the cards show that the child's line
on the scale can suddenly drop from normal to a lower degree.
Due to this fact a constant and individualized follop up
is important.
For the near future we foresee to introduce a new product,
called Okhla Mix, consisting of Bengal roasted gran (20%),
of wheat (60%) and jaggery (20%). This mixture has an over
all effect along with'the milk powder. We want to start this
in three phases:
-9The first phase is: we prepare, the mixture and the family
has to buy from us. The second phase: the family itself will
prepare the mixture, with our supervision.- The third phase:
the mixture has become a natural part of the daily menu for
the child.The nutritional statistics of this year show a clear trend
towards success in our fight against malnutrition. In the ini
tial stage 56 % cf the infants were suffering from a 2nd or
3rd degree malnutrition.- Only 13% were normal. At present
41% of the infants have a normal weight, height and HB and
only 23% belong to the 2nd or 3rd degree level. Among the
toddlers in the area only 22,3% had a normal weight in the
beginning phase. Now 56,5% are safely within the normal sector
whereas the 2nd and 3rd degree malnutrition still prevails
among 19% of the toddlers.
"Case study ?
Case of Chandra Wati (marasmic child): A three year old
ehild, Chandra wati, was found lying in the house during the
home visit by our LHV. The mother's name is Kisan Devi.- The
father, Chandan, is a dhobi. The parents are busy with their
daily work as dhobis. The child was born normal, weight being
7 lbs. Till one year the child was keeping normal weight.
Within a year the mother had her 6th baby and she was unable
to look after the two younger ones and her daily work. She
took the child to her village in U.P. and entrusted it to the
grandmother. The child stayed there for two years and became
severely marasmic. The eye sight was gone. The grandmother
treated the child with the help of the village priest and
mantras. She believed it is the evil eye which made the child
marasmic and the child is blind because during pregnancy the
mother must have looked at something evil or unpleasant or
she must have looked at a dead body. At last the mother went
to the village and brought the child back. When we found the
child she could not sit or stand and the weight was 7 kg. She’
could not see, not swallow anything and her body was just skin
and bones. The child was seen by the Public Health Doctor and
eye specialist. One of the health visitors goes to the family
twice a day and helps the mother to cook special diet for the
child and feed the child. Also she gives high protein mix and
Vitamin A + D. Within three months the child can now sit up
-10The weight came up to 12 kg. It can sec and recognize the
people. We had atfcut five or six such cases - all are now
doing well. (Report of the LHV)
Taking care of a premature baby at home: a challenge to mid
wifery students during their Public Health experience.
Bero delivered a premature baby girl. The weight was 3 lbs.
Having 4 boys the mother was very happy to have a girl. We made
an improvised incubator with blanket pieces and a soft pillow as
a mattress. The students visited the home 3.-4 times a day and
once a night during 4 days, (the home was near to the department)
We taught the mother the feeding of the baby with dropper, how
to give bath etc. After that we visited the child daily and
early night. After 3 months the baby's weight came up to 4 kg.
Now the baby is 6 months old, weight 14 lbs. We had four such
cases, at present having a premature baby from the village with
the weight of 2 lbs at birth. Being very active, it progresses.
HEALTH EDUCATION
Along with the clinics running, health education has been
b^oade^^ ^nd one Lady Health Visitor has been specially train
ed as a health educator to give several talks daily, before
the rush sets in in the clinics. With the help of demonstra
tion articles such as posters, flash cards and play materials
she stresses various topics, such as right diet, sanitation,
personal hygiene, cleanliness, need for immunizations, mother's
craft etc. All together 1’592 health talks were given in the
clinics and 4135 in the homes, making it a total of 110 more
health talks than last year.
Jointly with this health education is also carried out by an
annual exhibition and by 3 periodical exhibitions in the
villages, all of them dealing with the importance of right
and clean diet plus personal hygiene so as to prevent intes
tinal diseases. TB and its prevention was also one of the
topics. Those latter exhibitions were a joint cooperation
between our staff and students from the Central Health Edu
cation Bureau, New Delhi. Those students did a very valuable
work, being highly experienced in various fields of health.
Film shows featuring a three hour long movie in which family
welfare/planning topics were pointed out in between, have been
shown once a month in four localities. These were replaced in
November by daily mime shows (for six weeks) in each village
-11dealing with antenatal care, cleanliness, sanitation,
diarrhoea, worm infestations, proper diet, necessity of medi
cal check ups and introduction of solids. Puppet shows were
presented several times in each village,.and they were arranged
by Public Health Students from outside institutions.
Finally our home visits also partly belong to the field of
health education. By on-the-spot advice the effect is more
personalized. Yet it needs to be stressed that for the nutri
tional follow up of malnourished children we need more home
visiting. By instant teaching how to apply the nutrition and
how to feed the child we can assure regular mother care,.
It has been noticed that the mother of (for instance) a mara
smic child will start feeding preparations only at that time
when our. staff enters the home., for a visit. Through home
visits the links of confidence between staff and community
are strengthened.’During 1973 many visits have been performed
by a planned scheme,- The days when a centre»in-charge has no
clinic to run, she goes for home visiting in the area for
which she is responsible, This means that ghe goes out for
home visiting at least 2-3 days a week. On Fridays the whole
staff goes for home visits, including the nutritionist, health
educator and social worker. The clinics on that day are opened
for a few hours during the morning, for giving injections.
The statistics shew that the increase of visits to the families
have been very high compared to 1972.,Last year we made’1427
visits whereas this year the figures show 2902 family visits.
It is also to be noted that the home visits connected with
post natal care have gone up by more than 1000 (120 visits made
in 1972, 1328 visits in 1973). The reason is that we now have
4-6 weeks post natal care of the mothers and babies, the first
15 days of which we make daily visits to the home.
ANTENATAL AND HOME DELIVERY^
In every village centre we have once a week an antenatal
clinic. At present we have 138 patients attending those clinics,
the progressive total of the year bding 3791 .
Those who
are attending the antenatal clinic are booked for home delivery
These deliveries are. conducted at the patien's home by a Mid
wifery student, trained dai and supervised by one of the LHV
staff. Emergencies or abnormal cases are referred to the Holy
..12..
Family Hospital. In the clinics^tho Hb, urine and antenatal
check ups are made cnee a month. However the patients are encour
aged to attend the clinic every week sc- that we can give the
necessary health education as well as the weekly supply < f iron.,
vitamins and nutrition. In this way we cun assure that the ifiedioines are regularly taken ana we also encourage the mother concerning
preparations fcr heme confinement and nether craft. All the staff
are expected to learn epistemy and switchering to avoid unnecess
ary referrals and to meet the situation without a doctor. Since
there is only one doctor working with us and two different clinics
are held simultaneously an two different villages ( under fives
clinic in one village, antenatal in the an other clinic we manage
the antenatal clinics without a do ctor. Abnormal cases or any
ether complications arising, the patient is called to our central
office where one of the senior OB & GYN comes every Saturday to
see the referral cases.
SCHOOL HEALTH
In 4 primary schools and 5 balwadis the total number of children
consists of 1178. At present we are able to de physical check
ups of all the Children once a year with referrals and follow up
of all the special cases. A routine Hb. and stool test is done
once a year. Two afternoons and one morning the doctor and a
team consisting of laboratory technician, LHV and student go out
to the village schools. One of our 1973 goals was to introduce
a health education programme in schools and to get moire cooper- •
ation from the teachers. The LHV who is in charge of the school
health programme visits the schools daily and gives health talks
on personal hygiene, hind washing, TB, smallpox etc. These talks
last at least fcr 15 - 20 minutes in each class. The LHV displays
various health posters in the -classrc; ms. Also there are periodical
cal film shows, exhibitions etc. (arranged by the students coming
to work with us as a part of their training in different health
fields) Smallpox ana cholera immunizations are given every year
to the students and teachers before the hot season starts.
Likewise BCG is given whenever it is available. During 1973
students from the CHEB have done a special programme on TB cchtrol
in cne of the schools. BCG VACCINATIONS WERE GIVen to all the
stuaents aged 5-12 in that school. A health drama on TB and its
preventatien was acted out by primary class students and an
exhibition was held in the school on TB control, In 1974 we are
planning to give strength tc these health educational programmes.
It is cur hope that the education department of the Delhi Munici
pal Corporation will give us the necessary permission to make
health education a part of the curriculum and subject to evalu-
..13
ation and grade. We are really happy to- see that acme of the
schools authorities who were not cooperating in the beginning
have new given their full support to carry cut the school health
pregramme,
TB. PROGRAMME
At present we have 29 patients coming to our clinics (twice weekly
in the department). During, the years 1970 - 1973 inclusive the
total number of TB patients has been 112, of which 25 have been
definitely cured, 15 ruled out as not suffering f/om TB after
detailed investigations, and 3 patients referred to ether hospitals
for hospitaliiation. Also 18 patients have left the area and
continue new their treatment elsewhere. Six patients have died
and 16 have discontinued the treatment after one year t»eatment.
Repeated home visits and persuaticn have failed to bring them
back to treatment.
Cases finding; fcr those with a cough for more than 2 months or
other symptoms* throe- sputum examinations are dene and if the
sputum is negative while <.cubts prevails, X-ray is done. All
suspected cases are sent for consultation to a specialist
(Dr. Pamra, New Delhi TB Centre), before starting the treatment,
and according to his auvice, measures are taken. All the
patients and their reports are checked by Dr. Pamra every three
menths. Twice a we k in the afternoon, at 2.30 P.M. tc 4 P.M.,' we
have the TB clinic in .cur-department- where patients come tc get
the treatment and their medicines. A close follow up of all the
TB patients is done by home visits. This is meant to give a
continuous treatment for at least 2 years and to avoid crop out.
Periodical health talks are given in the clinics sc as to waf$
against irregular treatment. Our aim and hope is that every
family will be able to detect the early signs and symptoms of
and report it to us. This type of case finding is every
family's responsibility. The cases arc delected during homo visits
and clinic. The families <f the suspected cases are also investi
gated and treated. The children are given BCG. Adults are
given Mx-test and sputur.:,.;- test.
The programme is aided by the New Delhi TB Centre and considered
as part of their TB Control Programme.. BCG is given to all the
children under five and tc school children whenever BCG vaccine is
available. We still have to make lets cf effort for case finding
ana irregular treatments.
^J'F EDUCATION
Most cf the LHV's are studying or attending night classes for
their B.A. or M.A. as a preparation for their higher education
in different health fields. One cf the staff will be finishing
her PHN from Calcutta this year. Two . ther LHS':s who finished
their academic B.A. are planning to go for a Health Education
Course or for M.A. Sociology;Career lacdor is encouraged very
much among the staff.
Senior LHV's are working as medical assistants when necessary and
some cf them help with the' over all planning in the department,
though all are encouraged.
The village motivators and young girls from the village who can
read and write are given the training in first aid and home nurs
ing, Yet inspite cf the illiteracy cf some of the village women
they de net lack intelligence. Some of them do the dressing in
the clinics or take the temperature and the like. Also we have
started ^Literacy -classes for-these women, malting them able to
read and write the Hindi alphabet. Our next step for those
women is tc teach themcertain health talks combined with demons
trations. If this is successfull-our aim-is tc use them as village
health educators.
The ycung girls--from the villages are trained in first aid, heme
nursing.etc. also in giving immunizations. Some cf them also get
practice for clerical work,, sterilizing the articles, giving
health talks etc. Our aim is to make them fully prepared to
carry out the work with,-m'inirium supervision. This.-can certainly
-reduce the number cf staf^ .in clinics, and pave the way for
new activities.
The clerical staff is encouraged tc learn typing and driving, so
as to meet all needs of a village development work.
Finally five dais have been given training and final certificate.
They new work as full members cf our staff. They are able to
conduct all the' home deliveries. However the midwifery students,
being in training, also have tc take many delivery case in the
villages. The dai call us from where ever we are so as to enable
the student to come on the spot instantly.
It also ought to bo mentioned that we have biweekly meetings for
the benefit of self evaluation and close follow up of our work.
Our staff is further professionally trained through lectures and
readings about all aspects cf Public Health. At least every
second Tuesday afternoon is reserved for such activities.
..15..
Classes have been given .healing with interpersonal relations and
psychological self evaluation. Role plays have been performed
shewing certain typical working situations and reactions. The
LEV'S also attend classes on pharmacy in order tc keep uj. to
date their knowledge.
Voluntary services have been given by some people living nearly .
the hospital. In particular for compiling and counting connected
with the resurvey, these services have been of value.
FILTER CLIE1IC
This was introduced in the beginning of 1973* A booklet is
printed which has the standing orders for most of the seasonal and
common diseases* It was approved by the Medical director, Chief
of Medicine and Paediatrics of the HFH. In every clinic, especia^
lly in the under fives, the doctor ana the LEV together examin
the patients. The LEV screen all the patients. Those cases
being serious,, doubtful or complicated are referred tc the doctor
immediately. In the initial phase the doctor had to spend a lot
of time teaching ana checking the LEV. Ecwover it was worth
trying. Now both the LEV and the .doctor have enough time tc-give
individual attention and health education.
SOCIAL SERVICE
We have, a full time trained social worker in our team. There are
many families in the area having several social problems which
the social worker can solve or relieve, especially this area,
being on the fringcof a fast moving city and its new way of life,
frictions between old and new patterns and values are mere frequ
ent than in an entirely rural area. Our social worker also has
tc deal with many moral problems- especially among the school
going, and young people, cue tc lack of privacy at home. Our
social worker also helps to find out the family the means of
meeting expenses for hospitalization or specialized treatment.
Every year one cr two students from the Delhi School of Social
Work are sent to our team to get their field practice in,, social
w.jrk and these students are taken care of and initiated into the
programme by our social worker.
. .16
Case of deafness; During my home visit I experienced an in
teresting meeting with an old Baba, named Firoz Ahmed, aged
55 years old. One day when I was going for home visits Old Baba
was sitting and warming himself near the fire. I greeted him
and asked "how are you"? (in Hindi) He did not give me any answer
but he locked at me and smiled. I smiled back. Then he went in
side the house and brought a rubber tube, gave me one end and
kept the other end in his ears. Then I understood that he is
deaf. I greeted him again and talked through the rubber tube.
He looked very anaemic. So I asked him to come to the Okhla
Centre to see the doctor but he said that he was not sick. Then
I explained that he looks anaemic and this may make him sick
later. When he camo to the Centre we took his Hb and found it to
be 5,2 gr. We gave him a course of iron injection. The stool
test was normal. Now even his wife comes with him regularly to
the Centre, to get the iron therapy. All the conversation is
carried out through the rubber tube. Now his Hb la 11,2 gr. and
we are all happy, (extr. from Mrs. U. Kapur, LHV, staff meeting
SPECIAL STUDENTS PROGR/.FJ-.ES
report)
Every year different training schools send their students for
field work to cur team and villages. In 1973 we had two students
from the Delhi Scheel of Social Work who are in their final year
of M.A. social work. In addition to this we had 9 Public Health
Nursing students from Lady Reading Health School for their one
month rural health experience. In November 12 health education
students from the CHEB came for 6 weeks field practice.
Furthermore we had 2 master students fpcom the College of Nursing,
as well as continuous groups of nursing students from Hcly
Family Hospital.. From the New Delhi TB Centre health visitors
came to get experience in TB cases. Needless tc say it is hard
w.rk for cur staff to take care of all those students and yet
be fully involved in the daily work. However we take it as a
challenge and a valuable, experience for the staff.
ACTIVITIES BY THE STUDENTS
The social work students had taken as their responsibility to
help some families in the JogaLai village with their sccio-moral
problems. They arranged film shows every week. They also worked
in one of the primary schools in close cooperation with the
teachers tc detect seme of the causes for school drop outs
and tc give special attention tc the physically handicapped and
weak students.
The public health nursing students took as their special progra
mme tc give first aid classes to the hospital employees, working
..17..
in the kitchen, maintenance and house keeping sectr ns, They
also helped us in the resurvey. They arranged role plays for the
■staff, sc as to help us consider the patient as a person, not
a case cr a number. It was very inspiring. Th<sc students also
gave a helping hand in cur daily clinical work. -
The health education students concentrated on personal and environ
mental hygiene, TB control, BCG immunizations and prevention tf
intestinal diseases. They formed four groups, working in 3 vill
ages and one school. The also arranged puppet shews, film shows,
exhibitions, group meetings and encouraged a lot of village
participation in all those activities.
Our midwifery students took as their challenge to take care of
a premature baby at home, in an improvised incubater. The baby
was only 31bs. but within 4 months the baby increased to 4 kg.
The students taught the mother in all possible ways hew to give
a good and regular care tc the baby.
INTERNAL COOPERATION
Our staff continues to help in other areas of the hospital as
this engenders comprehensive thinking rather than departmental
ization. Our family welfare .counsellor sees patients in-the
Out patients department,(antenatal and postnatal) three after
noons a week. One of- our Public Health Nurses in the school of
nursing, available for counselling and facilitating. Literacy
classes have been given to the hospital maintenance employees.
One LHV and one R N R M conducted first' aid classes to the empl
oyees of ..the maintenance, Kitchen and heuskeeping departments.
After examination the certificate and a first.aid-box is given to
the successful candidate. The department head of Community
Health is also teaching Community Health to the Nursing students
and Ward Sisters.
There is a very close cooperation between our department and the
pharmacy, OPD, Laboratory, X-ray and Nursing Service departments
and we are very grateful to all the senior doctors for their
special attention to cur patients, eg. OB GYN, Pediatrics, Eye
specialist, Surgery and Medicine specialists, and all the other
departments.
18..
THE TEAL.
Wc have 4 Lady health Visitors as Centre incharge in 4 health
centres ( One in each centre) and one LHV as in charge of school
health. One experience PHN and one LHV and a male Social Worker
in family Counselling team and'a health team with a doctor,
trained social worker, PHN supervision, one LHV as pharma,isit,
one LBV as Vaccinator for all immunization and injections,
one LHV as Health Educator, One LHV as nutritionist and one as
relief/village motivators aids and driver as clerical staff, to do
miner treatment and dressing, help with the nutrition demonstrat
ion, cleaning and setting up the clinic etc. The team m. ves
from clinic tc clinic on Monday to Saturday, Once a week the
whole team goes for home,, visit with centre in charges, for
uiffeyent follow-ups. The same Staff, takes turns to stay back in
the central office for night class for home deleveres.
A SHORT SUMMARY
This year is the und cf our first five year plan and the end of
a team programme started three years ago. So far we have achiev
ed the full cooperation and involvement ■ f the villagers, Our
four buildings for the village clinics are given by the people
and for any health educational initiative we have the entire
support of the community. In spite of the fact that the villag
ers can give little financial ar material help they do give
a lot cf personal and moral support and encouragement.
Prom the ever all evaluation it is found that the morbidity has
decreased considerably (see the statistical report in the last
page,) and that repeated visits with the same disease are less
frequent than before. When we made the first survey in 1969
tHat in every family some one or the ether was suffering from
a disease and that this fact urged us tc curative care of already
existing diseases before any preventive -action could be taken.
Thus the priority during these first 3 years was given to full
medical care whatever the c<.st may be. Gradually the morbidity
rote came down and with it the current expenses (a&most 50%).
At the same time the villagers grew mere aware of the value of
health services. By the end of the three years period the
preventive and curative aspect cf medical care was 'integrated
in such a way that it now has become a natural part cf the
villagers' needs.
The next five years we plan to be the first phase . f a self
supporting programme, nt present the whole project is being
materialized through the help of funding agencies. Whatever
contributions we received from the community itself ' • .
.1
19
(nominal fees charged in'clinics) we are investing in a self
supporting programme, Therefore it is hoped that in the next
five years the funding agencies will be able to. meet half of
the current expenses, for instance the payment of salaries,
whereas the ether half will be 'contributed by the community (for
medicine/part of referrals etc.) This scheme devised is possible
if some of the following aspects are taken into consideration:
decrease of morbidity
peopled co operation and Co ntributions
the awareness ■ f health value and regular care especially
for the child.
K :The community feels the need and is prepared to give so.. .
as to receive.
d) Heme Nursing
a)
b)
c)
The third five year plan would then bo the 2nd phase of a self
supporting project, in which for instance only 25% of the
expenses continue to be net by funding agencies, while the last
phase aims at full self-support. Anc-thet* satisfactory trend
connected, with this gradual transformation is that the fast grow
ing neaif®^ city offers more jobs and more views of a better income
to the villagers. Added to this economic uplift of the community
there are possibilities of enlarging and diversifying various
production centres (cottage industries) within the villages.
We are also planning to have a self supporting nuhhiticn programme
as soon as the feed crisis is over.
In the beginning of our programme we were using only the HFH as
the referral hospital.. The expenses were met completely by
OXFAM. However the referrals also had to be included in our
striving towards self support. We gradually prepared the people
to use other existing Govt., hospitals in Delhi, except for
emergencies. However we also tried tc improvise the treatment
of serie us patients in the home or department itself, taking care
of premature babies, giving IV fluids to dehydrated children,
typhoid cases etc. This also reduced the’referral costs. The
villagers were encouraged to bring the patient us early as possi
ble so that further complications would not arise and the need
for admission would not occur. Thus the expenses came down from
Rs. 4000/- t. almost 300-400- Rs. per month as far.as goes referr
als and hospital admissions. By giving training tc the women
in the village tn heme nursing ban reduce the admission of the
patients tc the hospital.
>.20./.
In view cf the ab<.ve facts wo ask every funding agency to be
patient with us in cur efforts towards a self supporting project.
F^lly it should be noted that the real credit for all. these
achievements goes to our Lady Health Visiters and their team,
having given their time, energies, talents and enthusiasm for
the benefit of the community, and a special thanks tc devoted
voluntary■workers and students.
We and the people in village thank all the funding agenc;ie.<te:
■ Zenthftlstelle ,
Delhi Administration,
Delhi Municipal Corporation,
New Delhi TB Centre,
OXFAM,
Cathelic Relief Services,
Caritas,
Holy Family Hospital Lady's Auxiliary
UNICEF,
All the referral hospitals and participating
agencies.
With°uti.- their help and cooperation we cannot carry cut.
or continue this work.
..21..
GOALS FOR 1974
I,
Home nursing and first aid courses to all the village ladies
in small groups of 8 - 10 in order to make each home a domicilliary care unit and each mother a nurse, These courses
given daily will be covering the whole area and done by our
staff according tc a planned curriculum, Having the classes
in the homes it gives a direct effect and after some time the
village mother will be able to trace and detect common
diseases herself, be it in her . wn family or among neighbours.
As-the majority cf diseases at this stage of the project arc
cf a ncn-camplex nature it has become easier for the mother
herself to take .both curative and preventive actions with the
aid cf the drugs we provide. The trend so far has been tc
refer the patient from the centre t< the hospital. The 19f4
plan aim at referring tho patient from the home to the
-aentre, assuming that our clinics will •continue tc have a good
medical equipment. Gradually there can be developed a cadre
cf village health workers through this scheme and the awaren
ess of the coEununity will be further awakened
2.
Continue the sane service in the target area (with medificat.,.icns)
3+
Jinre home visits and heme care* combined with -cocking and
cleaning dejacnstrations at home.
Village level motivators and aids appointed as assistants tc
centr-e—in—chai'so.
(riftor nnoeesstrry training}
5*
More emphasize on filtre clinics
6<
Health educat io-n programme for trained dais and aids to make
them health educators.
7.
Completion of unfinished 1973 goals, especially immunizations
8.
Prepare the dais and. aides to identify malnutrition,.anaemia
and other miner diseases, and TB case finding.
9.
Get the approval cf the Delhi Municipal Corporation, Education
dept., to- introduce into, the current school health programme
acurriculum for health education, if possible subject tc
evaluation and grade.
Peri'dical meetings of the school teachers and the school
he -1th team
Maintain 100% immunization coverage f under fives', including
typhe id.
10.
11.
..22
12,
Mere c•rdination with the welfare agency and help to initiate
more pre auction centres.
13.
.arrange infernal village committees.
14,
Involve youth clubs in various project, such as health
education, (puppet shews, health aramas, entertaining
programme)
■
15,
Continue anu strengthen night classes for men ( if we find a
suitable place)
16,
Build up more team spirit and increase the interpersonal relat
ion by giving the staff in-service education,
17* arrange periodical seminars and discussions with in the
department tc. improve the professional knowledge of the
staff
1&* Encourage the staff for higher education,
19* Arrange more health educational activities in the area in
which people's participation will further grew,
2Q* Improve integration of Public. Health in the nursing curriculum
21, Survey now villages, ic. Tambu Nagar and Khizzerabad or
sunlight Col' ny.
22, Once or twice a week a mobile medical service and immunization
in these villages.
23• Health Insurance scheme (if people are ready for it)
24. Encourage the community to support cur work,
25. Mere home visits and heme care
2i • Involvement with,-4’ioce.ee and ether institutions tc help
and S^ngtheO the Community Health programmes.
Expanation of abbrevations:
LHV ’» Lady Health Visitor
P.H. = Public Health
WSB = wheat and soya beans
CSB = corn and soya beans
CHS = Catholic Relief Services
REPORT OF F^ILY WELFARE COUNSELLING
Wo have just crossed the second mile stone in the Family Welfare
Counselling programme ana an overall dent appears to be signifi
cant,- The area covered being neither purely rural nor 'u^ban,
a mixture of Vrban and rural problems, customs and culture had
to be taken into consideration. Even the womenfolks are not as
simple and amenable to reasoning as the rural women generally
are, nor are they sophisticated and understanding as the urban
women. While there are now no religious objections as such to
family planning as at the beginning, there was always the weight
of customs,.and tradition, apathy and inertia, probably due to
povertyj low income ana illiteracy. In the absence or lack of
provision f< r basic needs, which affect the physical, psycholog
ical, mental, Social and cultural and intellectual development f
the adults, their irpi'ifference to acceptance cf family planning
as a way of life is easily discernable. Boys getting married as
early as at the age of 16 - 18, which is a common practice in the
Villages especially amongst the very poor, is an impediment tc
birth control. The excuse f< r such practice is to prevent boys
running after girls.
A heart to heart eiscussi-.. n on the pros and cons as t< how
family welfare planning is going to benefit the family and the
future generation, falls cn deaf cars merely due tc the non
Co-operation of the husbands and sometimes the methers-in-law.
Generally the men wcula have anything done on their wives rather
than themselves and yet there were- cases where men refused permi
ssion for tubectomy as they feared that the women w<uld run
after ether men, as there is no- fear of getting pregnant. The
following incident will illustrate their prejudice against
sterilisation, a woman was admitted to the Holy Family Hospital
for leuccrrhcea and she had electric and she had electric
cauterisation. The rumour spread in the village that she had
tubectomy got acne. The infuriated liusband almost turned her
cut, but for the timely intervention by one of our Social
Workers, who explained the whole process and thus pacified him.
On the ether hand there are women who want mere children as a
public evidence cf their fertility mainly because cf the sland
erous utterances cf their neighbours, that some women are having
fewer children than they or that they are capable of producing
only girls after girls. Sustained and continued education over
a long period of time, using various media se^ms tc be the
-2-
answor to iverccae their ±re Judices and suspicions, an- nuke
then change their attitudes. In this c.ntoxt, a novel methodj
ie, Kime shews have again been used in.our area more extensively
and intensively than last year, to emphasise the need for good
and regular habits f-.r healthful living to improve the total
health and welfare, including family planning. The regular film
shows also have been Continued. Family Welfare Counselling as
has already been reported, covers every aspect of the total family
health care. Since family planning is recognised as an intrinsic
part of health care, cur comprehensive health and welfare
programme, which includes, health education, immunisation, nutri
tional supplements etc., provides an ideal environment for family
welfare counselling and many women seem t: have learnt the value
of such ^r.gramme for their benefit. To cite an instance of
their awareness of feed hygiene, a woman's statement, while coun
selling .on prevention of diarrhoea(as her baby had diarrhoea)
and how flies carry infections, is quoted "I have learnt all
abeyt the dangers of fly nuisance from the centre and am practi
cing what I have learnt. Come and see my house how clean it is
and hew I keep the- feed covered".
It is also, encouraging that those who have' been motivated for
the use of 'contraceptives comb inc re willingly without any reser
vation and ask for replenishment of their stock, whereas at the
beginning they were shy and waited to be called and given. The
cafeteria approach is being encouraged where camples can choose
the method suitable to them either for spacing or when they are
not willing for sterilisation. Request for abortion is on the
increase. That high level incentives helped in promoting a
large number of persons especially ft&m the lower income strata
for sterilisation is evident from the fact that we were able to
persuade 10 cases to get sterilisad last year at the sterilisat
ion camp, when the monetary incentive was Rs. 60/- whereas only
3 took advantage of the camp this year as only the regular
amount of Rs. 28/- was offered. The excuse of those motivated
for sterilisation was that they would wait until they can get
Rs. 60/-. However against 21 sterilisation cases during 23rd
October 1971 to December 1972 ( ie. one year, 2 months and a
week) we have had 30 cases in 1973, directly referred by us to
the New Delhi Family Planning association. This figure includes
8 cases motivated at the ’O.P.D. clinics. But the above figure
does not include all those who vieire motivated for sterilisation
and took consent forms signed by both husband- and wife as they
did not report back nor responded to correspondence. Such cases
pertain to these contacted in the O.P.D. There were also cases
referred to the Family Welfare Counsellor by the gynaecologists
-3-
either from the O.P.D. or maternity wards and who were in turn
referred fir sterilisation, abortion etc., but there was no
response from them either.
The extention educator, who was appointed in July 1973 has
succeeded in establishing 5 depots for distribution of Nircdh
in cur area for these who do net attend cur Health Centres. Out
of the 5 Voluntary depot holders, three are private medical
practicncrs and two are general merchants. All cf them live
in the villages, The distribution of Nirodh seems to be satis
factory in these depots,
The extention Educator had a few meetings with the village leaders
to enlist their co-operation. He has been instrumental in getting
work for a few young men as unskilled labourers in the nearby
factories and the emoluments amount to Rs. 84/- per mensem.
Apart from contacting the men,in the evenings regarding family
planning, he assists the other two Social Workers of the community
health department in their work if and when necessary, especially
in the field activities.
In cur report forwarded on 25.5.1973., it was pointed out that
we had taken over Masihgarh with.57 target couples to be wholly
responsible for Family Planning Programme, but only 18 were
traceable. But after the survey we have got on record 73 target
couples listed'as under, and the follow-up work r.n these cases
are done by the vSxtensicn Educator.
. .
Sterilisation
Using Nirodh
(Vasectomy
(Tubuctcmy
Net using any method
Total
..
..
..
..
47
6
2
18
=Z3==
It will be noticed that the pap smear item has been omitted
from Table No. I, as the programme has been discontinued, being
a research project.
The number of clinics has gone down from 10 to 7 as the adult
clinics in two centres have been amalgamated with childrens'
clinics and there is an ante-natal clinic fortnightly only.
The overall attendance in the clinics have also shown a con
siderable decline, which in turn has affected the councelling
attendance, resulting in a fairly low number. However a
significant fact is that revisits in 1973 have increased
proportionately, which shews that in spite of the decline in
general attendance, family councelling has evoked a very good
response among the acierage, eg. the Nircdh users in 1973 are
929 revisits against 106 first visits. This is evident from
Table No. II attached herewith. It is a known fact that it
is easy at first to motivate a few people while sustained
efforts are needed to motivate the hard core of the population.
Thus the achievements in the subsequent years will not be the
same as in the first or second year.
.In 1972, 1228, i.e. 61,4% of the 2000 eligible couples in our
rural area, was covered. This year out of the remaining 772
couples, 144 have adopted family planning methods, i.e. roughly
18,65 % of the remaining population. Thus it is clear that the
overall performance is reasonably satisfactory.
In order to promote family welfare planning and to create a
better awareness for acceptance, it is envisaged to arrange
regular puppet shows on family planning, through the Directorate
of Field Publicity, Ministry of Information and Broadcasting,
and the Directorate of Family Planning, Delhi Administration.
A library with family planning bocks, leaflets, pamphlets etc. ,
will also be started in a small scale. This library will be
in each centre under the supervision of the Extension Educator,
in the spare time hours of the beneficiaries,.
OKHLA COMPREHENSIVE HEALTH AND WELFARE I'ROJECT
The Department of Community
Health, Hcly Family Hospital
New Delhi
Report for the Year 1973.
Particulars of the Care
I.
1
1
Progressive Total
of the Year
,
,
,
Corresponding
progr. total of
the previous year
COVERAGE
a) Families
[
b) Adults
’
c) School Age children.
d) Toddlers
1
e) Infant s
,
f) TB patients
1
g) Ante-natals
,
2182
5989
3541
1907
336
29
138
II. DELIVERIES CONDUCTED ,
a) hone
J 1
203
179
24
b) hospital
•->
III .CLINICAL VISITS
.New Sick- [Revisits
, ness
a) Adults
,J
b) School Age children1
c) Toddlers
,!
d) Infants
1'
e) Ante-natals
,
f) TB patients
1’
IV.
well babies
J
V.
HOME VISITS
a) Family
'
■ J
b) Ante-natals
c) post-natals
d) TB cases
e) Family Counselling
2621
•
13*5
5850
'
I
2019
359
16
;
855
668
1736
702
3791
1217
,
1875
!
,
'
J
2563
3
1788
342
'
;
44
136
?
205
179
'
26
,New Sick-[ Revisits
( ness
,
' 5701
4386
: 6235
4545
' 2108
3580
1 1222
1 2484
382
' 24
33542
8133
i
'
!
2902
129
1328
'
,
1'
64
790
i
1627
120
-2-
Particulars of
unc5 care
'
>
Progressive total
of the year
, Corresp. progr.
, total of the pre, . vicus ye?:
1
VI.• HEALTH EDUCATION
a) lectures
1) in the clinics
») at the home
3) in the schools
4) in the welfare
centres
£.) Demonstrations
1) in the- clinics
2) at the hone
3) in the schools
4) in the welfare
centres
c) Audio-visual aids
i) Treatments
1) at home
2) in the schools
,
'
,
1
,
,
1
,
'
,
1
'
,
1
,
1
1592
4135
154
75
J
:
3592
1381
'
'
159
123
36 .
117
1456
:
95i
'
1106
VII. REFERRALS
!
a) Holy Family Hosp.
1) major laboratory
examinations
2) miner lab. exan.
3) X-rays
4) specialists' care
5) .admissions
6) physiotherapy
•b) TB clinics/hcsp.
c) other hospitals
d) welfare dept..- of
the project
e ) other welfare
agencies
1
,
,
'
,
'
,
1
,
1
.
,
'
'
VIII. IMMUNIZATIONS
'
a) T.A.B
b) Cholera
c) D.P.T.
d) B.C.G
'
,
'
;
42*
2049
J
1300
688
'
;
'
,
-673
1768
2097
541
2064
1540
a 3-02
e). Smallpox
f) Polio
. .
269
5506
84
412
105
8
132
56
66
3363
'!
345
;
J
736
316
1
106
31
1
-3-
Particulars of
the care
' Progressive total ' , Corresp. progr*
' of the year
, total of the pre, vious year
1
IX. NUTRITION
:
a) ■distribution
1) antenatals & post- 1
natals
2) children below 6 yr?
3) families
;
:
4) school children
96 250
4698
2628?
9519
54900
'
!
87572
3832
'
!
24394
6050
'
J
52063 '
1233
*
846
X.
SCHOOL HEALTH
a)
:
School children
under care
physical examinatir A
follow ups
laboratory tests
•
'
others (X-ray)
196--
:
2045
:
2250
736
Councelled at first
visit
Councelled upon
' .. 1309
revisit
'First
'visit
I
distribution
nirodh/jelly
'180
foam tablets
■8 ■
oral contraceptives '1
>2
diaphragm
I.U.C.D
1
tubectony
'13
vasectomy
'17
pap smear test.
;
1211
5)
TB cases
b)
c)
d)
e)
XI. FAMILY PLANNING/
COUNSELLING
a)
b)
c)
1)
2)
3)
46
5)
6)
7)
d)
1670
1276
1177
289
'
2
2
10^8
Revisit
'
'
1
953
10
6
'
12
•
1
-3-
Particulars of
the care
' Progressive total i Corresp. progr.
' of the year
, total of the pre, vious year
IX. NUTRITION
•
a) distribution
1) antenatals & post- '
natals
1
2) children below 6 yr?
3) families
4) school children
•
5) TB cases
X.
SCHOOL HEALTH
a)
School children
under care
physical exasinatic A
follow ups
t
laboratory tests
others (X-ray)
b)
c)
d)
e)
b)
c)
1)
2)
3)
49
5)
6)
7)
d)
'
I
87572
3832
26287
9519
54900
846
'
!
24394
6050
J
!
52063
1233
196s-
1670
1177
289
2
2
• 1276
2045
J
2250
736
Councelled at first
visit
Councelled upon
' .. 1309
revisit
'First
'visit
distribution
nirodh/jelly
'180
foam tablets
'8
oral contraceptives '1
diaphragm
'2
I.U.C.D
'
tubectomy
'13
vasectomy
'17
pap smear test
:,
1211
XI. FAMILY PLANNING/
COUNCELLING
a)
96 250
4698
>
1038
Revisit
1
1
953
10
6
'
12
'
1
'
We de not have language teaching in the sylla
are developing good habits.
bus of our balwadies but on the demand of the parents, the teachers now start
ed giving seme instruction about language such as Hindi, Urdu and English.
The children were also given some training in counting numbers.
also engaged in various indoor and outdoor games.
picnics periodically.
They were
They were taken out for
The children who have crossed the age of 6 years were
referred to the schools available in the neighbourhood for primary education.
The number of such children who were admited to other schools during the year
was h7.
Craft Classes:
The number of trainees attending the craft classes in the welfare
centres is given in the Appendix 2.
After one year of copducting the craft
classes in five welfare centres it was felt that some follow up studies of
It was found that majority of women who have
these women should be made.
learned the craft are doing their tailoring jobs in their homes and save some
money they were giving to the tailors for stitching the clothes.
About $0
women of these neighbourhood are working with various business concerns in
the neighbourhood or outside.
some jobs.
Many others who had training are looking for
It was the felt need of the women in the neighbourhood that some
programme should be started to provide job opportunities to them.
Looking
into this demand, the craft class for women in Okhla centre was stopped from
1st April, 1973 and this centre was converted into full fledged Production
Unit.
The trainees of this centre were transferred to other welfare Centres
mainly to Ncoru Nagar and Jogabai.
Fabric Painting Classes:
A special 11 days fabric painting classes were organised in the four
welfare centres in the month of March.
help of Narula Paints.
These classes were organised with the
78 women participated in these classes.
tion was conducted after these classes.
An examina
The result of the examination was
declared in the month of July and it was found that all the women who appeared
in the examination have passed.
These women were given certificates.
Literacy Classes For Adult Women:
The response of the women in the community towards the literacy classes
was not very encouraging.
There are many reasons for the decrease in the
..3..
number cf women attending the literacy classes.
Most important factor is
that those women actually ceme to the welfare centres for attending the craft
classes and they are not interested in the literacy.
On the ether hand some
knowledge of the measure and simple arithmetic is required for teaching the
craft of tailoring and embroidery.
It was felt in the month of June that a
new scheme cf functional literacy may be started in these welfare centres and
the Governing Boqy of the society has set up a committee to finalise the syl
labus but sc- far the syllabus of the scheme could not be finalised.
Apart
from this literacy classes some cf the girls of the community are coming to
the welfare centres'for free coaching which help them in their regular school
,
education.
Extension Lectures:
Some of the topics, of these, extension lectures which are the regular
feature of our welfare centres are: common diseases in the neighbourhood such
as cholera, typhoid, malaria, small pox etc.; first aid training, pre-natal
and post-natal care, drinking water, good habits; rules of hygiene; family
planning etc..
These lectures were mainly organised ty the Community Health
Department of the Holy Family Hospital.
In the month of August, Mobile Grail
Team approached the society for seme demonstrations and extension lectures.
The team has organised 9 extension lectures in Nooru Nagar and Bharat Nagar
welfare centres.
The topics covered ty the Grail Team were on Home Economics,
Cooking and Child Care.
The society is thankful to the community health
department of the Holy Family Hospital and Mobile Grail Team for their co
operation in organising these extension lectures and demonstrations.
The num
ber of women in these extension lectures ranges from 20 to 60 in each centre.
Social and Cultural Activities for Women:
The girls and women of the craft classes, Condensed Course and other
women welfare programmes in all the five welfare centres were taken out for
outings and picnics to the various places.
A weekly social get-tegethor of
the women in the craft class has become a regular feature.
Periodically the
Parent's Meetings of the children of the Balwadies and the trainees of the
craft classes were organised in all the centres to acquaint them about what
their wards are doing in the centres. Special variety programmes were or
ganised in these occassions.
Some of the major activities of the centre
..14..
under Social and Recreational Programmes include: a visit to zco, a visit
tc Asia 72, a visit to National Museum, celebration of various National days
such as Republic and Independence days, Celebrations of local festivals like
Basant-celebration, celebration of Id etc.
Healthy Baby Contest:
The Healthy Baby contest was organised on 11th September, 1973 in the
Masigarh welfare centre.
About 57 children participated in this contest.
These children were in the age group of 3 to 6 years.
paise per child was collected.
An entiy fees of 25
A team of Doctors, public health nurses and
social workers examined these children.- and awarded the grades.
The prizes
were given to the children who were declared 1st, 2nd and 3rd.
Sweets were
distributed tc all the children of the community.
A small get together of
the women of the community was also organised to explain them the importance
of child care in daily life.
II.
CHILD WELFARE. ACTIVITIES:
The children's clubs which were started in April 1972 for the children
in the age group 7 to lb years continued its activities of indoor and outdoor
games, recreational and cultural activities with the help of part time child
welfare workers till 33 th April, 1973.
In the month of May these clubs were
stopped as it was decided that the full time Child and Youth Welfare Workers
were tc be appointed for the evening activities of the welfare centres.
Five
Child and Youth Welfare Workers were appointed in the month of May 1973 and
after an orientation programme of one week, they were sent to the various
welfare centres tc run the Children as well as the Youth Clubs.
Masigarh and
Bharat Nagar clubs started functioning in the month of June while the other
two clubs of Nooru Nagar and Jogabai started functioning in the month of July.
The club in Okhla centre was started in the month of September as we could
not get any accommodation earlier for organising the activities of the
Children's and Youth Clubs.
The number of children attending the various
clubs is given in the Appendix 3.
Inter dub Competition:
To sustain the interest of the members of the club, the annual Inter
dub Ccnpetiticn was held on 7th February, 1973.
250 children from various
clubs and other welfare institutions of the city participated in this annual
function.
The students of Jamia School of Social Work participated in these
comp etitions as a part of their field work training.
The function was orga
nised in collaboration with the Jamia School of Social Work and its National
Service Scheme Unit on the birth anniversary of Dr.Zakir Husain.
Shri.Kri-
shan Swaroup, the Executive Counsellor, Incharge of Social welfare, Delhi
administration
distributed the prizes to the winners.
Children's Film Shows;
Five children's films were screened for the members of children's
club.
Apart from these films the members of the club were shown many other
The children have shown lot of interest in these films
films on Television.
and other programmes on T.V.
Inter Club Activities:
The inter club activities in various indoor games such as chess,
carromboard, Chinese checker were periodically organised among the ®®nbers
of five children's club.
painting.
A competition was also organised in drawing and
The group discussion and essay competition was organised in the
month of November.
The prizes were distributed to the winners of the various
competition.
Picnic and Outings;
Three picnics were organised for the members of children's club in the
month of February, August and December.
Apart from these picnics the chil
dren were also taken out to the Dolls Museum, Bal-Bhawan, Zoo and a Circus
during the year.
Children's Library:
The children's library which was started in the year 1972 continued.
This year some weekly, fortnightly and monthly magzines for the children
were also purchased and distributed among the children for reading.
Efforts
will however, be made to secure more books and magzines from various sources.
Children's Camp;
A Holiday cum Social Service Camp was organised in Ghitorni village
of Mehrauli block of Delhi during Dusshera holidays in the month of October
1973.
This camp was of 7 days duration.
participated in this camp.
society.
33 children of the neighbourhood
This camp has become a regular feature of the
The camp was organised in collaboration with the Jamia School of
Social Wcrk served as camp counsellors.
The staff of the camp consisted of
four trained social workers, one incharge of administration, one Audio-visual
aid Operator and various experts in sports and games, dramatics, songs
and
music, craft etc..
The children also participated in cock-outs, sight seeings
picnic, film; shows
and games competition organised during the carrp period.
Applied Nutrition Programme:
About 800 children of the Service Area under the age of 5 years were
getting milk-bread through our welfare centres under the scheme of Delhi ad
ministration.
III.
YOUTH WELFARE PROGRAMME:
With the appointment of five child and youth welfare workers in the
month of May 1973, the Youth Club started functioning in the month of June.
The youth in the age group of 16 to 35 years were approached to become the
members of these clubs.
These youth clubs are mainly organised for providing
the recreational, social, cultural, and educational activities for the youth
of the Area.
Through these youth clubs the society aim to orient the youth
of the Neighbourhood in the concept, objective, function and leadership re
quired in the organisation of various programmes for the different section
of the people living in this Neighbourhood.
The strength of the various
youth clubs is shewn in the Appendix U.
Inter Club Activities:
Various inter club activities were organised in indoor and out-door
games among the members of the youth clubs periodically.
An inter club
Volley Ball competition was organised in the month of November.
The members
of the Youth dub participated in the mime shows organised by Community
Health Department of Holy Family Hosnital and helped them in organising and
maintaining discipline.
A few cultural programmes were also organised in
these clubs.
Literacy Class for Men:
In Ncorunagar welfare centre, a literacy class for men was started
in the month of November.
Under this programme the illiterate men who are
working in various positions in the neighbourhood or cutside are given in
structions in Urdu language by a part time teacher employed for this purpose.
The strength in this literacy class at present is 18.
With the starting of
this class more and more youth clubs are demanding such literacy classes in
various languages such as Hindi, Urdu and English.
We hope to start mere
such classes in the next year.
Television Programme:
The members of the children and the youth clubs participate on various
alloted days in different television programmes including film shows.
The
televisicn set was given by All India Radio to the society for this purpose.
IV.
NEIGHBOURHOOD CENTRES PROGRAMMES:
The society has planned to establish a neighbourhood centre for or
ganising common programmes for the residents of Okhla Neighbourhood.
As we
did not have the required funds and building for the purpose, much has not
been done in this regard.
A few experimental projects however could be
started either in some welfare centres or in other rented building for the
purpose.
The following are some of the programmes.
Condensed Course of Education for Adult Women:
Out of the 28 women and girls who were enfolled for this course, 3
had left due to personal and family problems.
for Part-I examination of Higher Secondary.
The remaining girls appeared
Out of which 11 passed in all
the four subjects and the rest 11* were promoted to the next class with per
mission to reappear in one or two subjects in which they had failed.
In the
month of July the classes for the 2nd year of Higher Secondary started.
Two
more part time teachers were appointed to teach History and Drawing in the
month of July.
.Ill the lh girls who had failed in one or two subjects of
Part-I appeared for the supplementary examination held in the month of
September.
At present there are 18 girls in this class who will appear in
their final examination in the month of April 197b.
Sccio-Economic Programmes:
Two socio-economic programmes were started this year to supplement
the family income of the poor and needy people of the Okhla Neighbourhood.
These two programmes are:
(a) Training-cum-Production Unit - Doll Making
(b) Training-cum-Production Unit - Tailoring and Embroidery
Training-cum-Production Unit - Doll Making was started on 7th February
1973 in the Julliana village of Okhla Neighbourhood.
A local craftsman who
..8..
was doing this business of his cwn was identified and employed as the in
structor in this Production Unit.
When we took over the business of that
craftsman the number of workers was only 5. Now the number of workers who
come to the unit daily is increased to 25.
In addition to that about 10
women and children take work to their homes on piece-rate basis.
The monthly
wages of these workers vary from Rs.60/= to Rs.l|00/= per month.
At present
the unit is producing about 900 dolls in a month.
There is still scope of
increasing the strength cf the workers and thus increasing the production of
dolls.
Training is the integral part of this unit.
The women are firstly
trained for few months and during this period of training they are paid at
least Rs.2/= per day.
dually increased.
As the worker shows improvement, the wages are gra
So far we have exported dolls worth about Rs.30,000/= to
various countries such as Holland, Switzerland and Belgium.
In addition we
have also sold dolls in local market as well as in various sales and exhibi
tions organised in Delhi.
A grant of Rs.35,000/= was received from Caritas-India through the
Coordination Committee of the Project to initiate the work in the production
unit in the month cf February 1973-
’We expect that it will take another two
years to run this unit on self-sufficient basis.
Training-cum-Production Unit - Tailoring and Embroidery was started
on an experimental basis during the year 1972 in Okhla Welfare Centre together
with the tailoring and embroidery classes.
Later in April 1973 the tailoring
and embroidery classes in this centre were stopped and the unit was changed
into a full fledged production unit.
At present about 15 needy women are
working in this production unit as and when required.
The production work
of the orders from the Holy Family Hospital and from business concerns ex
porting various garments are undertake.
We hope that the unit will be getting
some orders in the coming future when the samples sent abroad are approved.
The unit at present do not have sufficient staff, equipment furniture
and money for the purchase of raw material and distributing wages to the
workers.
Efforts are being made to secure funds from governmental and non
governmental organisations.
With these funds available we hope that more
than 25 women will be provided employment in this unit who will be earning
..9.
from Rs.60/= to Rs.200/= per month.
Kinder Garten School;
On the consistent demand of the parents with a monthly income of more
than Rs. 330/=, the society has started a Kinder Garten school for the children
of these parents.
dren.
Two teachers were appointed to give instructions to 23 chit
The parents helped the Society to raise funds for this programme.
The
School-was started in the month of July, 1973Fund Raising Campaign:
The society has published a 3 years Progress Report in the form of a
Souvenir and through advertisements in this Souvenir collected Rs.2,59O/=.
Apart from this donation of Rs.3jO63.5O was collected from other sources.
During the year 1973, Rs.8,539.50 were collected through the fees.
the Society has collected a total amount of Rs.15,280/=.
This way,
We hope that this
fund raising campaign will continue .and show more progress in the year 197b.
Staff Development:
Apart from the regular meetings of the centre incharges and weekly
supervisory staff meetings a one week orientation programme was organised for
newly appointed child and youth welfare workers.
Two combined meetings of the
Okhla Pilot Project were also convened for seeking better coordination in the
two components of the Project.
1
Attendance in the^Wirfery Class-s
Appendix - 1
■..
Centre
Jan.
Feb.
Okhla
81
81
83
83
85
86
80
70
Jogabai
48
48
48
48
52
55
51
Nooru Nagar
40
45
48
42
27
25
25
Masigarh
35
37
39
37
35
30
25
23
Bharat Nagar_____
LI
49
52
53
54
35
33
36
Total
251
260
270
263
253
231
214
221 ..
August
Sr~b ;Ur
December
Noy•ember
Octob er
69 '
71
49
49
5P
46
46
40
32
37
25
24
24
25
36
29
29 _________ 00 ___
233
217
204
77
75
49
43
179
Attendance in the Craft Classes
Appendix - 2
1
'
1
I
1
Jan.
Okhla
50
50
50
Jogabai
27
25
22
March
Anril
39
Mav
39
June
39
July
55
August
Sentember October November
-
-
48
40
26
-
-
54
December
29
Noorunagar
25
30
35
25
23
33
29
33
27
22
17
10
Masigarh
40
38
36
33
33
52
39
37
42
35
28
26
Bharat Nagar_____
30
30
27
31
27
27
31
29
36
29
20______ 14
153
126
91
Total
z1
Feb.
Centre__________
172
173
170
128
122
151
154
153
79
-
n
5
(>
tfj
£H
VOLUNTARY HEALTH ASSOCIATION OF INDIA
C-45, SOUTH EXTENSION
Phone : 616308, 78433
PART-H, NEW DELHI-1 1 0049
Telegrams : 'VOLHEALTH New Delhi-49'
COMMUNITY HEALTH CELL
^/MFTrsti-lQo. )^;. Marks .load
VHAI-1006
EAAlGALOaE-66v001
Community Health Case Study
One person's experience in trying to do village health
work.
1967. I was working in/100 lied hospital which was never full. There
were other hospitals in the same city, 2uring the year, a
doctor friend lent me a book to read called Medical Care in
Developing Countries. I started village clinics within a few
months of reading this book. We had no idea of community health
care. The clinics succeeded in some villages but not in others.
We found it difficult to collect enough in fees to cover our
petrol, and staff costs. We had no special funds for this and
there were more pressing problems in the hospital.
1968 Transferred and working in another hospital, I wanted to do
village health work, but
* the administrator said it was an unwise thing to start,
as income could not be obtained to make it financially
safe.
* the nursing superintendent did not want her nurses living
in the villages where we could not guarantee their safety.
*, the medical superintendent wanted the available housing
for doctors, meaning doctors working in the hospital.
* I did not know where to get the money from.
* I did not know how to do village health work, except
clinios.
1969.Despite heavy hospital duties, I was getting tired of signing
death certificates t despite good curative work by experienced
doctors, many died of preventable diseases such as anaemia,
tetanus etc.
When another doctor was absent, I ran the well baby clinic for a
few weeks. It was not popular, and service given was slow. It
was held once a week on Wednesday afternoons.
At this time the nursing superintendent wanted a public health
nurse to improve the examination results of her nurses in that
subject. The Public Health Nurse came.
In the same month, a sample of the Morley Road to Health card
was sent to the hospital from a donor agency. With the help of
the hospital printer, we got this printed, in the local language.
The public health nurse and I started a daily 'mother and child
clinir' with the approval of the Managing Committee.
We obtained some vaccines from Kasauli by purchase, and some free
from Government. Nursing Superintendent supplied nursing students
to work in the clinic.
We had to work on the medical records to allow patients to get their
records without waiting 1 hour or more.
2
1970
The clinic was very popular, and we recorded 10,000 patient
visits in the first year.
We started running similar clinics in the City nearby, financed
out of our morning clinic.
The nurses could now pass their examinations in public health,
though we visited no villages.
People from nearby towns wanted to open similar clinics in their
town. The hospital.morning clinic was now busy enough to affo:rid
a paediatrician to run it.
I then started to plan a larger programme.
During that year, Dr. Sundaram then Director of CAHP visited and
' gave us encouragement to plan big, saying that there would be
‘plenty of funds for community health.
■1971
1972.
"All this year, we waited for our money and then our vehicle to
come. The grant application took 3 months full time work to get
ready. ; There was delay in getting the donor agency's representative
to visit. He had some, objections. Approval took 3 months but then .
there was a postal strike in the U.K. before we knew the result.
There was also a delay of 9 months because the local bank did not
notify us that our funds for starting staff housing had arrived.
Then we had to buy the vehicle, after the money actually arrived.
The hospital old vehicles were not able to be used with regularity
for village work, in case they were needed to attend Board meetings,
so we had to wait for our own community health vehicle. We had just
got started when war broke out, and the Army moved in and the town
was evacuated.
After the war it.took several months to get back to normal. Troops
were camped in the .fields for many months after the war.
We expanded our mother and child clinics.
During this year a new medical superintendent came and he felt
that we should have a village programme rather than clinics.
1973
I left, the area during thip year, and a paediatrician took over.
He worked hard for 2 years, and improved immunizations and illness
care. He had not had any previous orientation to village health
and we did not think to send him anywhere for orientation first.
One of the hospitals own trained nurses was sent away for 1 years.
public- health training. This was the first such nurse from the
hospital who was agreeable to specialising' in public health. she
was bonded to return to the hospital, ^he proved very helpful
; when the other public- health nurse left in 197,6.
1975
By this time the paediatrician was losing interest, preparatory to
entering private practice in the District.
In -fact project income from clinics fell, and there were other
difficulties.
An ..experienced .public health trained doctor joined, and she was
able io^start caring for one village, and trained 3 village level
workers.
.-e
j 3 :
She,decided to leaye, due to the fact that she.did not want to shift
to a branch rural;hospital 25 miles away, as requested by the
Medical Superintendent
1976
Difficulties .
.
•
:
•
/
Fees charged at the clinics were now high. Petrol prices had
risen greatly in 197- •■, so distant clinics had.to be stopped.
Land reform had been oily partial, -so that Harijans were poor,
and toddler malnutrition among, the Harijans was common,, still.
Costs. At the most, the programme was costing Rs. 109-, 990 per year,
and was employing about 12 full time workers.
The hospital has benefited to the tune of Rs. 5lakhs of buildings
obtained from another donor agency for very good qualityaaff
housing.
Benefits.
. The; underfive clinic idea for sick and veil babies has lasted for
■ 7 years,’ and survived several paediatricians who had. not met such
an idea before. But future paediatricians could possibly revert to
not using growth charts. In fact; hospital clinic charges are high,
and those who need growth charts cannot afford hospital clinic
charges.
,
One cannot help thinking that although thousands of children have
benefited somewhat through this programme, it is difficult to
measure this benefit, because clinic patients come from all over
the place, and one cannot easily measure the target population.
Nurses during their training have benefited.
Three doctors who have entered private practice i i the last 5 years
after working at this hospital; have introduced many of the ideas
they saw used in the programme,
Staff working in the project have found the clinics stimulating and
satisfying.
.The hospital became even better known.in surrounding towns.
Discussion..
.
. ■
I. Thoughtful concerned people who circulated books (1967) new
ideas (1969) and a hopeful forward look (1970) played, an important
role through doing seemly unimportant little things.
|- I,
. ■ .-•• ■. ■: • ■ -tor
r ••• •. ' ’
s-.l!,.
Do we always share our bes,t ideas? . ■ .r
:-4 : :
■
2(a) There were many ups arid downs. Considerable delays and unforseen circumstances occurred - mail strike, war, inefficient
banking service.
(b) Determination and persistence over the ups and downs period was
therefore necessary to achieve good results.
(c)
Many things had to coincide at the same place and time.
* staff full time for this work 1969-1970
* funds or hope of funds 1970
* good records
1969-1970
* vaccines
1969
5.
There were very severe pressures from the hospital on its community
health project. This project was expected to
* house all its own staff
* provide its own vehicles
* find its own income
The institution's survival always took precedence over the project's
survival. .
On the other hand the hospital provided some advantages * abundant supply of nurses trained or being trained
but hospital was unwilling to let them work in villages.
* hospital had excellent reputation in the area making village
, contacts easy.
* hospital back-up services were reliable for
- book keeping
- pharmacy
- vehicle maintenance.
Question:Was the hospitalmore a help than a hindrance in this
situation? What other solutions could have been
considered?
6.
Notice the constraints or boundary conditions that determined
the shape of this project:
* Doctor had nocommunity health orientation
* Finance was a problefn (1968): and in 1.976 was still a main
problem (high fees).
* Unwillingness of trained doctors to serve in rural areas
(1976) was also a problem
:
’
* Security for female staff in rural areas was a major factor
in planning from 1968 on.
:
1976
'
j
3
:
She decided to leave, due.to the fact that she did .not want to shift
to a branch rural hospital 25 miles away, as requested by the
Medical Superintendent
.
Difficulties.
Fees charged at the clinics were now high. Petrol prices had
risen greatly in 197% so distant .clinics had to be stopped.
Land reform had been oily partial, so that Harijans were poor,
and toddler malnutrition amorig the Harijans was common,, still.
Costs. At the most, the programme was costing Rs. 109, 390 per year,
and was employing about 12 full time workers.
The hospital has benefited to the tune of Rs. 5lakhs.of buildings'
obtained from another donor agency for very good qualitysaff
housing.
Benefits.
The. underfive clinic idea for sick and well babies, has lasted for
7 -years, and survived several-paediatricians who had-not-met such
an idea before. But future paediatricians could possibly-revert to
not using growth charts. In fact hospital clinic charges are high,
and those who need' growth charts cannot afford hospital clinic
charges.
One cannot help thinking that although thousands of children have
benefited sornewhat through this programme, it. is difficult to
measure this benefit, because clinic patients come from all over
the place, and one cannot easily measure the target population.
Nurses during their training have benefited.
Three doctors who have entered private practice i i the last 5 years
after working at this hospital, have introduced many of the ideas
they saw used in the programme,
Staff working.in the project have found the clinics stimulating and
satisfying'.
The hospital became:even better known.in surrounding towns.
Discussion...
1. Thoughtful concerned people who circulated books (1967) new
ideas (1969) and a hopeful forward look (1970) played an important
role through doing seemly unimportant little'things.
•' •
,
j
• ■ »
?. .*
. ■ ' ri •) I I' ( ■
'‘‘‘ \
Do we always share our best ideas?
■.
i am
7
:j
ij
’
: 4 :
2(a) There were many ups and downs. Considerable delays and unforseen circumstances occurred - mail strike, .war, inefficient
banking service.
(b) Determination and persistence over the ups and downs period was
therefore necessary to achieve good results.
(c) Many things had to coincide at the same place and time.
* staff full time for this work 1969-1970
* funds or hope of funds 1970
* good records
1969-1970
* vaccines
1969
5,
There were very severe pressures from the hospital on its community
health project. This project was expected to
•* house all its own staff
* provide its own vehicles
* find its own income
The institution's survival always took precedence over the project's
survival .
;
On the other hand the hospital provided some advantages - ■
* abundant supply of nurses trained or being trained
but hospital was unwilling to let them work in villages.
* hospital had excellent reputation in the area making village
contacts easy.
* hospital back-up services were reliable for
- book keeping
- pharmacy
- vehicle maintenance.
Question:Was the hospitalmore a help than a hindrance in this
situation? What other solutions could have been
considered?
6.
Notice the constraints or boundary conditions that determined
the shape of this project:
* Doctor had nocommunity health orientation
* Finance was a problem (1968) and in 1976 was still a main
problem (high,fees).
* Unwillingness of trained, doctors, to serve in rural areas
(1976) was also a problem
* Security for female staff,in rural areas was a major factor
in planning from 1968 on.
: 5 :
7.
Can you think how to develop a community health programme
more rapidly?
8.
How was the problem of security for female staff in rural
areas eventually solved, What are the chances that this
problem was permanently solved if the public health doctor
in charge of the project has left in 1976.
9.
How can the leadership of a hospital be involved in its health
project to prevent project and institution being seen as rivals
to each other?
••
C
0
H
T
A
C
T
10
Christian Medical Commission World Council of Churches 150 Route de Ferney 1211
Geneva 20 Switzerland
August 1972
COXPREB liSIVK RU':..'..L HEALTH PROJECT
Jnnkhod, India
Rajanikant S. Arole, ND
(Address given to the CM6 at its annual meeting in June 1972)
My wife and I were both concerned about the medical 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 amazement, at the end of five
years, we found that all we had done was to take care of patients who came to the
doorsteps of the hospital, but we had done little .or the general health
of the coamr.ity around us. To give you a simple example, wo served a poyulatioon
of about 100,900. There- must have been 4000 deliveries each year, hut we were
taking care of only JOO of them. Ke asked ourselves, "Khat happened to the
remaining 3700 deliveries?" Ther ■ was nobody besides us in the area.
Examples such as this made us realise on:* need for public health training to
enable us to reach out to the community. Therefor?, we went to Johns Hopkins
University and took a public health course. A lot of material that we read
came from the Christian Medical Commission. The books and articles written hy
many members of this Commission helped us to formulate a programme.
Since the problems in rural areas relating to health ax’e many, we set the following
priorities:
1.
To make available facilities and personnel in rural areas;
2.
to do something about the rapid population explosion;
<9
j tc
3.
to attempt to reduce.the high infant mortality and continued mortality
and morbidity up to the age of five;
4.
to take care of certain chronic diseases which not only contribute to
mortality but also morbidity in the society and which, more than that,
deprive the people of their dignity, especially those suffering from
leprosy.
O
o
x « ®
b
;.l io
i
7; ;
£ 0S
g. £
« s
So the goal was to devolop a programme which would be fitted to the needs of o ’
the community but which would also be compatible with the resources available
C.
to the community.
5
The M3TE0D wo adopted was to take a specific area for our responsibility. The
cel'-cted area is within a ten mile radius of a village called Jankhed in
Maharashtra State. This area has a total population of 80,000 living in 55
villages. We cannot take cate of ths whole area right now, so we have PHASED
this as follows:
Phase 1
Phaeo 2
Phase 3
20,000 population - in two years
40,000 population - in the next two years
80,000 population - by the end of six years
The method will be to establish a main centre in tho central area - i.e. at
Jttkhed - where we shall have diagnostic help, facilities for emergency surgery
ana emergency medical care. The thrsx there will be ten suboontree in ten
surrounding villageo, tho maximum distance between the central village and the
sutaentres being ten miles. For thia ..rogratac© w> will need to use auxiliary
workers and paramedical workers; we will need the coopeafion and involvement
of the indigenous pxrx practitioners, other health officials, schoolteachers and
dais (indifrenous -aidwives). There will be cooperation with other govemient
progratees. And finally at the end of six years this will have to be a selfsupporting programme. For a programme to be self supporting, motivation will
have to be developed in the community nd the community loaders, the local state
and the central government taking responsibility for this kind of work.
.2
Cap-y
C
0
If
T
A
C
T
10
Christian Medical Commission World Council of Churches 150 Route de Ferney 1211
Geneva 20 Switzerland
August 1972
COMPREH 'NSIVE RUSAL HEALTH PROJECT
Jamkhed, India
Rajanikant S. Arole, ND
(Address given to the CMC at its annual meeting in June 1972)
My wife and I were both concerned about the medical 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 amazement, at the end of five
years, we found that all we had done was to take care of patients who came to the
doorsteps of the hospital, but we had done little for the general health
of the community around us. To give you a simple example, we served a populatioon
of about 100,000. There must have been 4000 deliveries each year, but we were
taking care of only 300 of them. We asked ourselves, "What happened to the
remaining 3700 deliveries?" There was nobody besides us in the area.
Examples such as this made us realize our need for public health training to
enable us to reach out to the community. Therefore, we went to Johns Hopkins
University and took a public health course. A lot of material that we read
came from the Christian Medical Commission. The books and articles written hy
many members of this Commission helped us to formulate a programme.
Since the problems in rural areas relating to health are many, we set the following
priorities:
1.
To make available facilities and personnel in rural areas;
2.
to do something about the rapid population explosion;
3.
to attempt to reduce the high infant mortality and continued mortality
and morbidity up to the age of five;
4.
to take care of certain chronic diseases which not only contribute to
mortality but also morbidity in the society and which, more than that,
deprive the people of their dignity, especially those suffering from
leprosy.
So the goal was to develop a programme which would be fitted to the needs of
the community but which would also be compatible with the resources available
to the community.
The METHOD we adopted was to take a specific area for our responsibility. The
selected area is within a ten mile radius of a village called Jamkhed in
Maharashtra State. This area has a total population of 80,000 living in 55
villages. We cannot take cate of the whole area right now, so we have PHASED
this as 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 end of six years
The method will be to establish a main centre in the central area - i.e. at
Jamkhed - where we shall have diagnostic help, facilities for emergency surgery
and emergency medical care. The ttarer there will be ten subcentres in ten
surrounding villages, the maximum distance between the central village and the
subcentres being ten wiles. For this programme w will need to use auxiliary
workers and paramedical workers; we will need the coopeation and involvement
of the indigenous xuera practitioners, other health officials, schoolteachers and
dais (indigenous midwives). There will be cooperation with other government
programmes. And finally at the end of six years this will have to be a selfsupporting programme. For a programme to be self supporting, motivation will
have to be developed in the community nd the community leaders, the local state
Vid the central government taking responsibility for this kind, of work.
.2
2
Objectives
1.
birthrate fro? 46/1000 to pC/lOOO
2.
reduce under-fives’ mortality by 50 per cent
J.
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 ■>stablishment of under-fives’ clinics - these clinics should
be mainly for supplementary feeding programmes, immunization,
treatment of minor illnesses;
- family .welfare programmes consistirg of antenatal care, delivery
and postnatal cars;
- family planning-programmes making- use of all known contraceptive
devices and operations;
- detection of leprosy and tuberculosis patients and. treating
them in a w<ll-integrated programme;
— curative services in the ?ialn centre for obstructed labour,
acute surgical and medical emergencies and diagnosis;
- mobile clinics;
— school health programme.
This, in short, is a summary of the project we are trying to develop.
Today I am going to share with you .mainly the.community involvement
in arrving at certain decisions in regard to the-programme.
While we were studying in the United States, we 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 an area where there was an acute need for medical ear® 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 yesrs there would
be no other factors to account for the changes that take 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 very strong caste system.
About 50 per cent of the people are cultivators or farmers; 20 per cent
arc untouchables - the people who are very poor end usually Icndloes labourers who socially have no status. The villages have a governing board with an
elected head called Sarpanch. Most of the leadership comes from the farmer caste
who are the decision—-nsak.es 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 lender feels that he has not been given
due recognition, he can become hostile and uncooperative.
We were completely unacquainted with the community and leaders of this area.
We wrote several letters in the local language to the political loaders and
tc the village leaders. In our letters we described the entire programme that
we had in mind. We said, "If you want us to cone into your area, there are
certain things that you should be prepared tc do. We shall be about 20 to 25
health workers coming into your area without having any housing facilities. Me
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 in us
remains, you should, donate us land to build permanent structures in your area".
There were varied reactions to our letters. In one aroa (ray home village)
wealthy farmers who owned sugar factories wanted to build a modem, well-equipped
....5
3
hospital to cater to their own curative needs. In another area the influential
indigenous practitioner felt threatened, so he did all he could to prevent
dialogue with the comunity 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 a w the benefits for his area in our proposal.
There was also a minister at the state level, a state of 32 million people
who happens to come from this area. These two saw 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 us to come and start work in
this area.
As stated, we laid conditions under which we would be willing to go to
the area, and they wero willing to fulfill these conditions. They emptied
out an old veterinary dispensary, about 30 x 10 ft, which we used as our outpatient
department. They gave us a storage place for inpatients and rented a place
for us to live. It was a very simple arrangement - nB 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 from different area, representing different communities, especially
the poor ’harijan’ (untouchable) community. The first responsibility we gave
this committee was to find accommodation for us and accommodation for our health
centre. We then asked them to find us staff. Most of our staff, like nurses
and paramedical workers, had to be brought from the city. This staff had to
be Christian because we were there to establish a Christian witness and at
the san-? tim.- give medical care. This Christian, staff formed a nucleus
where we were all like minded; all had a Christian dedication because though
they were coining to this particular area and leaving their jobs, they were
not going to get any extra remuneration. So money was not the thing that
was bringing them there; on the contrary, they were going to have a lot of
inconveniences.
Besides this nucleus of Christian staff we needed other people - the
nonprofessionals and the community, He asked out consultative committee to
hire these for us. This bad an advantge as they wanted to do th dr
best for us, for we had told them that if within six months we did not
have a good response .rom them, we would find some other place to work. So
they found good, honest, hardworking staff of another 10 to 15 people from
the local community. They also went around and found building contractors
and other people to supervise and plan the buildings for the future. All this
work done by the committee was in an honorary capacity.
After that we wont around from village to village, holding meetings
in sack village. Our first objective was to get an idea of the felt needs.
In certain villages they just did not feel that there was any need for
medical care and were quite happy with what they had. But there wero villages
where th.- people felt that they did not have competent physicians, especially
for care of their emergency illnesses, like obstructed labour or fractures
end other medical emergencies. They did not have any diagnostic facilities.
In the north there is a hospital 50 miles away; in the south there is one
130 miles away; in the east one is 150 miles away; and in the west one about
70 miles.away. V.'e discussed with the members of the community our interest
to improve their health, but they felt that curative care should take precedence
over other programmes that we were proposing to them. Ve told then if they
were willing to pay for these services, we would start with these. They all
agreed ’.0 this; so from the first day we have been self-supporting as far as ■
curative work is conce ned. They understand that they have to pay for any
curative work that they get from us.
This is what happened •’.t the local village. As the news spread to the
nearby villages, people became aware that they could ccraa 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 up to you. These are our conditions; If
you want us to come to your village to start health work, you give us a place
to ,.ork, give us your cooperation, give us your help in child car .- and
immunisation of children, give full cooperation to our team, and care for our
nurses when they stay in your villages,'1
4
Our original plan was that wo would start at a central village with
a population of about 7,000 people and work within a radius of about fiva
miles around this village to make up a population of 20,000, but we scon
realised that we could not follow this plan because the first village that
was most interested in us was 12 miles away. The people there were so interested
that they already had a building for us and had accommodation f r our nurse
They were willing to contribute monthly for our services to them. Though
this 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 border of three countries. If we were in one
county,'. 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. We asked one of the local men how we could get away if we
did not get the required cooperation within six months. He suggested that
we build a centre using tin sheets as a shed; we were fortunate as we were
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 30-bed capacity and an outpatient clinic.. The entire
building can be dismantled and reconstructed within 15 days by the firn
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 his 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. This was especially so because there was
a famine when we entered the area. We take their lead and discuss food for
the children. Ten we go into the topic of malnutrition, and we come with
a proposal and say, "Your children do not have enough food. Maybe we can
get some 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' from their own homes
and sake a common meal for the children. Those who are able would donate
some money, and those who have no money would contribute labour.
So right then and there we form a committee, and we say tliat from
Church World Service we can try and. get wheat 6r milk powder or soybeans, but
this committee is responsible for cooking the food. The responsibility means
purchasing fuel and utensils, maintaining daily records, 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 these villages? have about 3000 children which are being
fed every day. We give a supplementary protein diet to them. We did not impose
this programme on them. We went and talked about their felt need, and the
felt need was food, and gradually we translated that into a supplementary
feeding programme for children under five.
At the same time we realised that the Church World Service food may
not continue for ever or any gifts from abroad may atop, and we have to plan
ahead. We realized that the second most needed item is water for farming
and drinking. So we put another proposal to the villagers. We told then,
nYour 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?" Ue propose making wells which xri.ll make paupers into rich
men. We then ask if when thoy become rich, they would shs-re their fishes with
the others. They say they will. We then form a committee, and this committee
decides which farmer or farmers are likely to have water in their fields or
which farmers will be willing to produce food for the children and which one
are likely to be generous after they get the wells sunk in their land.
So the committee decides how to find a permanent solution for the under
nourished children in he village by getting a well sunk. Then we translate
this community action into a scientific action. There are agencies in that
area which are working with boring machines for watersupply and sinking
wells. We get this team to come and do a survey, and then out of the four
or five names the community has suggested, this team picks out two or three
.5
names and decides which is thelikely place where they shall strike water for
a well. Bp 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 acres of land to gi-ow rich protein food. Now we are sure that when
this experience works, there will be more farmers who will be interested and
will sake land available for feeding children of the entire village. 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
we sit with the village people and talk to them about our problems - for example,
the problem of getting to their villages because the roads are so bad - and if
they really want us to come to theii* villages, what can they do? Already the
villagers have made a seven utile 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 io important is that the people wanted us and the
care we could offer them so :hat they were willing to pay for the care and
share the responsiblity 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, the
village people must collect at least 80 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
people the reason for our being there and what to expect as possible reactions
from the immunisations 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 tho 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 be required.
Leprosy is a social problem. We 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 the people, "I would like to s e them; please take
se to their home.” I go to their home; I meet the patient; I shake hands
with him; and the people will say, "Doctor, please wash 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
my place, and they leave me alone." Then I say to the people, "This man lias
leprosy; another man lias tuberculosis; but both are caused by the same 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 thin man
comoto me when other patients come to see me. Maybe the others come for coughs
or colds, but this man needs medicine just as the others do.
We 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’ homos;
they all como to the centre. To ay amazement the real objection was not from
the community but from our own nurses. One marvels at the capacity of the village
community to understand what is said.
Our survey work is done by a tea, not by one person alone. Usually in
the team there is a nurse, an auxiliary nurse midwife, a special family planning
worker, a basic health worker and a laboratory technician. The team goes
from house to house. Nobody knows who is looking for a leprosy patch. The team
geea-£®«~s-he»ee surveys a family for antenatal patients, for children under
five, for patients with a chronic cough, and for tbse with a skin lesion. So
child care,-antenatal care, treatment for leprosy and tuberculosis can bs given. •
The nurses are supplied with simple drugs and 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.
We have impressed on these patients the value of coming for treatment regularly,
as otherwise the disease will worsen and they will get deformities.
In rural work due respect has to be given to the indigenous practitioner.
These indigenous practitioners are usually rebuffed by trained doctors. We are
naturally a throat to them. So we have established a rapport with them, taken
steps to ensure their friendship, making sure not to bypass them or belittle
them. We seek their cooperation in feeding programmes for children, treatment
of leprosy and tuberculosis. We give them drugs and so involve them in the
treatment of village patients. We have also explained to them the important
role their wives can play in the care of antental cases. Two wives of indigenous
practitioners are 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 we underestimate the community, but this is a practical example of
how our trust in the community has involved them in health care programme.
Zjaiggga_/
7 ANTENATAL WOMEN
14 REGISTERED REVISITS
2 DELIVERIES
5 ORAL CONTRACEPTIVES
4
TUBECTOMIES
2 VASECTOMIES
5
NEW T.B. PATIENTS
30 OLD TREATED
800 MEN WORKING CM WELLS
5 NEW LEPROSY PATIENTS
25 TREATED OLD
10 MOBILE CLINICS
14 HEALTH TALKS
240 CHILDREN UNDER ?IVE CLINIC POP. ILLNESS
30 SCHOOL CHILDREN EXAMINED
1 MULTIPURPOSE CLINIC
908 SICK PATIENTS SEEN
233 LAB. TESTS
60 X-RAYS SCREEENINGS
8400 MEALS SERVED
136 CHILDREN IMMUNIZED
(cofy)
SERVICE RESPONSIBILITY OF A DEPARTI-ENT OF COMl'lUNITY MEDICINE
THROUGH A HEALTH CO-OPERATIVE
____ *MAJ GEN B MAHADEVAN PVSM AVSM MBBS DPH., DTK & H.,FRIPHH.,FCCP.,f!'.PHA
■'BHRbwCTION
A good and well informed faculty with modern concepts of medical
education, has a capacity for extensive research in the organisation and
Hal i-inq-ry of health services through experiment, models and pilot projects.
Medical educators in general, and faculty staff of departments of Community
Medicine in particular, must assume their share of responsibility for meeting
the quantitative as well as qualitative needs of the people and must be
concerned not only with the basic mission of the University or Government
which’ is learning, but also actively help the people of a locality or region
in organising and running their own Primary Health Care Services.
For establishing an effective and viable Primary Health Care •
system, the cooperation of the local community must be ensured. In fact,
the people should be adequately motivated, involved in decision making and
actively participate in health programmes, so that ultimately it becomes
their own ’’peoples programme". Local resources such as co-operatives,
agriculture, manpower, buildings and most important of all local leadership,
should be used to solve and finance the local health programmes. It is detfirrlle- that the Primary Health Care system should be a self-sufficient
fiscal entity. Community priorities are more • likely to be met if the people
themselves raise and spend the resources required. A "total health" approach
is essential. Promotional, Preventive and Curative care need to be completely
integrated.
THE ! CONVENTIONAL APPROACH
Health faciliti ns in rural areas in the country were provided
through Primary Health Centres started as part of a national rural
development scheme called ’Community Programmes’ in 1952, with a very
modest staff in each centre to form the nucleus of integrated health
services and cater to the need of about 60,000 population in a Block. .
There are now over 5,200 Primary Health Centres, each Centre serving a
population cf 80,000 to 120,000. The annual expend-iture of medicine
permitted for each Centre ranges from Rs. 4,000/- to Rs. 6,000/- and this
had to take care of .such a large pqpiilati on. The scheme was extended to
involve Msdical Colleges in rural health work and through deliberations of
many committees, the status of health contres wore improved both qualitatively
and quantitatively, An integrated approach of providing 'health services to
the rural people, with the provision of two doctors to every Primary Health
Centre and a basic health worker with an auxiliary nurse midwife (ANM) to
every 10,000 population, was attempted.
A. Pilot Mobil .r-cum-Training-cum-Services Hospital Scheme was
introduced in some Medical Colleges with a view to involving medical
and nursing students in rural community medicine. Tho intontian was to
establish ultimately one mobilo hospital per medical college- More Medical
Colleges were established with tho sole purpose of providing rural
health services. Specialist Camps wore organised for- cataract operations,
vasectomy and tuboctomy. Although the Government’s
*Professor and Hoad of the Dopt. of Community'Medicine,
St.John’s Medical College, Bangalore 560-034.2
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idea is to train doctors for rural areas, those doctors arc not
attracted to such areas. The migration- of Indian doctors to the more
developed countries-continuesi^Even passing of a Parliament Act
which onpcwrs—government to oblige .doctors-and -engineers—below age
of 30'to work for a. period of 4 years»dn jcuxal-arSaSi remains-, unsolved—■
as we ■-are-Tanablfii-to provided-reasonable living conditions for them
in villages.
Sone Medical Colleges like Vellore Christian Medical College
incorporated in their teaching programme, tho rural dimension in a
significant way. The organisers of the Community Health Centre, have
found that it costs about Rs.8.50 per pe.son per year, which includes
prev ntive, pronotivc- and curative services* The Administration is
not very happy about this project due. to the high recurring costs.
The Kerala Government with Government of India initial
one time grants, has established Health Co-operatives in 11 districts.
Doctors are encouraged to seek self-employment in those Co-operatives.
Doctors and paramedical staff take shares in those co-operativos, a
certain fee is levied on servi' s, and medicines are also paid for.
One is locking forward anxiously to the success of the scheme. The ^j.^
initial reaction of the people has been good.
Voluntary agencies have established a largo number of
hospitals in urban areas'. However, funds are not available to these
hospitals for any significant rural health work, although .an: increasing nunbsr of dispensaciec are being opened in rural section
of ths country.
A BEV ST/ j!GY
From the facts and figures just given, it is clear that
Government in spite of its herculean efforts has-not been able to.
serioisly tackle the problem and with the scarce allotment's made
for the health scrvic s, no tangible improvement is possible in
the netr future. No voluntary agency can hope to embark on a scheme
where even the government has failed but is in a better position to
try out new methods through pilot projOctsi
When planning rural health services, one has to consider
two components, r_anely the delivery of package of rural health
services in villages and the formation of personnel who-will deliver
the same. At the same tine, there is an inescapable need for
complementary services which will develop the village economy and
education of the rural people. M^ny rural health schemes taken
up enthusiastically at the beginning flounder for lack of popular
support that has to ba expressed, by financial contributions. This
is the crux .of the natter, Any -health delivery scheme should be
a self-sufficient fiscal entity. This nay be a limiting factor
•
but the only sound way Of attempting to solve rural health problens,
is to start it in places wore conditions are favourable .for the
introduction of self-supporting schemes.
Funds for rural hral th schemes nay be raised through many
ways:
(a) Tagging health t rvices to co-operatives.
To start health co-operatives by themselves is
difficult, as health holds a low priority in the felt needs of
the people and nay not "get the .v- piired support in the initial
stages. The procedure of tagging on health services to existing
co-operatives has nany advantages — good leadership, a ready made
3
__
'■
’
v
‘
,
frame work of connunity administration for-’ introductiom.of .effective
health services and;community involvement, as ohannels of communication
'-with the people have already been estahJi.shed^ffd—operative Dairying
and ’Marketing-Ce-eperati-ves-of’different c.ommod-i t.i
ike grains,
cereals, cottage industrial products-etc., lend themselves admirably —
to this type of health services.
1)
-•
(b) Running health services with assistanccL from factory
administration where labourers are from villages nearly.
/•
'J.
}
.1
■»
A minimal deduction at the source of salary and a contribution
from the factory man-.gement will help to build up the required
funds and formation of a health co-operative. Geographical location
of industries and rural labour in close proximity are limiting factors
but is worthy of trial, in special areas.
’jj
(c) Assistance from Panchayat
Places where Panchayats and the people are interested
in health services and are willing to contribute to the same,may
■J
• venture on this method but unless sufficient funds are forthcoming
-.regularly and pe -sistently, the scheme will collapse.
■J
:.;l
(d) Starting with services and evolving a cooperative at
a later , stage.
A devoted team of health workers can establish themselves
in a village and build up the required clientele and popular opinion.
-The people can then be induced to form a cooperative and directly
employ the doctor and essential para-medical staff. Until such time,
a central agency or’other, funding agency may have to meet the
expenses. This - can- be-attempioa ov-an wi i-hniit fnmirg a roeparat.ive
in areas of affluence, where people are willing to pay for the health
services and employ thio doctor and other staff through collection of
revenue for the purpose.
THE HAELUR KILK CO-OPERATIVE (M/I.C.)’
Mallur is a village in’ Kolar' Di st of Karnataka, situated
55 miles from the city of Bangalore. The Mallur Milk Co-operative
(MMC) was an established concern with a sound and progressive
leadership and had been functioning for many<years. In addition to
production and'sale of milk, it provided otherbenefits like
provision of fodder and cattle foods, tiactor facilities and
looms at low rates of interest.
Besides the people of Mallur, tvo other villages, Muthur
and Kachahalli were members of the Co-cp.ei-vtive-.~and the total
population covered was about 5,000. These villages had a oilk farm
cooperative besides cooperative dairying. The economic position
was satisfactory, and, therefore, all conditions were favourable
for the introduction of other self-supporting schemes.
The inspiration for establishment of a Comprehensive Health
Care Programme for-the Co-opcrativo Members and their families of
these villages, came from Sr Anne Cummins of Coordinating Agency
for Health planning (CAHP) and Fr Jonas of the Catholic Bishops
Conference of India (CBCl). With these pioneers, the Dean and the
Department of Community Medicine of St John's Medical College,
representatives of the Karnataka Government and Bangalore Government
Dairy with leaders of the Mallur Milk Co-operative,worked out
a scheme for tagging on a health servic ■ to the existing MMC.
:4: ■ '
---------
The main objectives of the Mallur Health Project were:
•'
a) to study and devise methods by which the financial
base needed..f or: effecrtiv£...hx^JHdr*3ervrees-. could
emerge1- f-ron- the people themselvs in a self-sustaining
■ nanner;
b)
to help in theestablishment of rural health centres with
the staff and rendering of effective health scrvic ;s to
.a wide circle of needy people without distinction of
race, caste or croud;
c)
to study the required strategy and Methodology
for the effective rendering of primary health care in
rural areas by trying to determine the priority areas
in health caro and devising the structure found suitable
to village conditions;
d)
to help in those developmental activities which
are very necessary to ensure effective rendering of
health services in rural areas; and
e)
to. train intern doctors, nurses and other medical and
para medical staff for tho purpose of rendering
assistance in rural areas.
The St John's Medical College and its Department of
Community Medicine,• were to be mainly concerned in
acting as a catalytic agency, in the formation of a
self-sustaining rural community h-.-alth scheme,
fulfilling the above objectives.
It was estimated that a monthly budget of Rs.2,500-3,000 wouldbe. required for running the Health Cooperative and financial support"
was forthcoming by a joint contribution of 3 paise per litre from
the MMC and Bangalore Dairy, in a phased formula as shown in
Table I below. Ultimately tho MMC was to completely finance the
scheme.
TABLE I (Contributions to tho Health Co-operative)
Contributions/litre
Year
Milk Co-operative
1st
2nd
3rd
1 P
2 p
3 p
Bangalore Dairy
. 2 p
1 P
nil
' This budget was adequate to support a health programme,
organised by a.Medical Officer, Nurse, Compounder and an Ayah. The
staff were appointed by the Health Co-operative Committee.
The Health Co-operative Committee included the following members;
Chairman, MMC
Secretary, MMC
Lean, St John's Medical College, Bangalore
Head of the Dept of Community Medicine, St John's Medical
College, Bangalore
..5
Director/General Manager, Bangalore Dairy
Representative of State Health Service
-Medi cal Off i
tAall ur-fiep.lth Ikrnperrativa ^Secretary)
The composition ensured integrated planning between the'KMC and Health
Co-operative.
The Health Co-operative got off to a good start by being
inaugurated tn 19 March 1973 by the Minister of Animal Husbandry.
Dr VK Rajkumar a Senior House Officer in St Martha's Hospital,
joined ns Resident Medical Officer in charge of the Co-operative.
This Medical Officer by dedicated work and self-sacrifices, made the
Mallur .Health Cc-operativo a successful enterprise.
The Health Co-operative- in November 1973 was joined by
another dedicated- work.^r-^-Maria,. .an.Ztazlian.JP.ublic jlealth Nurse. She
with her companion. Cathy, a Volunteer from- Canada, looked after the
Maternal and- Ohil-d Healtli.dfork,-...
•'EB BREAK THROUGH' IN THE ECONOMICS OF THE H'JALTIi CO-OPERATIVE
Within five months of. 'starting the project (August 1973)
the cost of fodhr went up and milk production of the Milk Co-operative
foil as sone members began to sell out 6n higher rates. The MMC took
a decision, much to the discomfiture of the Government Dairy
Authorities, to sell directly to private parties in Bangalore, who
offered better prices. The Govt Dairy therefore stopped its contribution
of 2 paise per litre as health subsidy, and the Health Co-operative
was in a critical situation. It is at this stage a momentous decision
was taken by the responsible village leaders who were more than
convinced of the positive role of the Health Centro and its staff
in improving the health status of the people in Mallur and other
villages. The Milk Co-operative was doing well and decided to
contribute 5 paise per litre for health and took over financial
’responsibility for running the Health Centre. This financial strategy
on the part of village leaders resulted in the Project becoming
a viable unit. The Milk Co-operative has borne-the entii-o' recurring
costs of the health project ever since, and the tabl-3 below gives the
Incotne/Expenditure position for the period July 74 to June 75.
TABLE II (Recurring Costs)
(Year - July 74 to Juno 75)
Total Milk Production
Income estimated at
5-paise/li-tra.•_ . ... ...
Actual ' income . received-.. ...
from MMC
- --
Rs.31,394,.90
...
.
-Rs. 33,100-00
Total expenditure for
the year
Rs.33,790.74
6,27,898 litres
Although the Mallur Health Project is mainly financed by tha-Mallur
Milk Co-operative, it also receives help and technical direction
from St John's Medical College and the Government Health Service.
These inputs are shown in Table III,
;
.6
TABLE III (Shows the various inputs)
Source
Capital
Recurring.
1. Mallur Milk
Co-operative
Buildings,
Furniture,
Refrigerator,
Health Education
Material
Salaries
Rents/clectricity
Drugs
General stores
Patrol
2. St John’s
Medical College
- Physicians and
Midwifery Kit
Minor Surgical
Equipment
Lab Equipment
Moto? cycle (on
loan through
UNICEF)
Interns services
Specialist services
Reni for interns
quarters
3. Government
Health
Services
Nil
Vacciios,
Vit
Iron, Folic
Aci’-l supplementary
EF Devices
Surveillance of
communicable
diseases■(through
JHC Sidlaghatta)
lealth Education
Tilns (through
Ecalth Education
Department of DHS)
SERVICES RENDERED THROUGH COMMU-JTT PARTICIPATION
The St John's Medical College, adopted this Health
Co-operative as a rural training centre for Interns. Visits by
specialists of o ther departments including specialist camps were
organised. At present, 4 interns arc attached at any one time
for whom residential accommodation has been provided by the MMC
on a rental basis. The interns conduct base line demographic surveys,
immunization and school health programmes, special health projects
and mass health education programmes.
The Health Co-operative Committee moots by turns, at
Mallur and St John's Medical College, to discuss progress and
plan for the future.
The Health Team comprising of Dr Rajkunar, Miss Maria
and Interns under the technical supervision of Dot o< Comrranity
Medicine has made good contact with the villagers and a
comprehensive health care programme has been introduced. The
community of Mallur and other member villages actively participate
in all programme. They have no unreasonable expectations or
demands, as the health project is their own programme brought about
through their own contributions. This is a basic difference between
Health Centres organised through Co-operatives and Governmental
Agencies. The leaders are actively .involved in the pl ‘inning
:7 s
..and organisation as the Chairman, MMC is the Chaiman of the
Health Co-operative'Connittoo and the Secretary fflC its nenbori
Paramedical workers arc drawn from the village 6do_unity and
trained for Community Heal±h_ti£irk»-Tha..I0ittig-PFtrnors Association
actively assists in '.'any of the health pfogriaaos. They help
interns in their surveys, programnesof immunisations and environmental
sanitation including chlorination of wells and.construction of
sanitary latrines. They also organise the physical arrangements
lor th. Mass Health Education Programmes. The Mahila Mandal
under the dynamic guidance of Mrs Rajkunar, runs a nursery school
and acts as a forum where health education, applied nutrition
progranEiesand. nothorcraft are taught to the womenfolk of the villages.
The H'-alth Team and interns organise the following
services with ccnnunity participation.
PdISONtL SERVICES
1. Curative clinic (daily outpatients)
2. Maternity and child health services:
i. antorrtal care;
ii. midwifery (domiciliary)
iii. postnatal care
iv. undor-5 clinics(doniciliary)
5. School health services for village schools
4- Immunization prog ramies for smallpox, triple antia-en.
tetanus toxoid, BCG, typhoid and
■ —>
5- TB and Lon-n-j, . —
^non, treatment and
follow up
6. Motivation for family planning
7. Specialist camps at Mallur (periodical visits
by St Martha's Hospital specialists)
8. Hospital referrals
9. Family record maintenance
COMMUNITY SERVICES
1. Protection of well water supplies by chlorination
2. Popularisation and construction of sanitary latrines
and soakago pits and other advise on environmental
sanitation
3. Collection of health data through periodical surveys
4. Coordination and cooperation with government
health p rsonnol in National H altji programme activities
5. Health Education at personal, group and. village levels
6. Nutrition education and nutrition supplementation
programmes.
Members of the Milk Cooperative and their families are
entitled to all the above mentioned services free of cost. Nori-members
coning fron other surrounding villages pay for drugs/dressings
and minor surgery. AH preventive and pronotivo work are ..given
free to all categories. Table IV below shows the percentage of
member and non-Liember families in each village.
TABLE IV
(Percentage of member and non-raenber families in each
village)
Families
Village
Member
Non-nonbcr
Mallur
188
202
390
Muth'ur
63
124
187
Kachahalli
30
21
5i -
Bhaterenahalli
17
' 14
31
Harrulunagonahalli
6
18
24
304
379.
683
45.^
55.5^
To tai
•CUNclUSIQM
Our experience ove» the last two and half years have
shown that:
i)
ii)
iii)
A health function can be grafted cn to an economic
cooperative
A sound cooperative such as Ifi-IC can support ouhstantiaJ
the recurring costs of a health programme
Tagging on of a health function to a co-operative,
benefits not only the members and their families
. but also the ncn-nenbors who get indirect benefits
of professional services, preventive and promotivo
programmes.
Ths Department of Community Medicine and its staff, was
mainly concerned in acting as a catalytic agent, in thp formation
of a self-sustaining rural community health scheme. An experiment
was embarked upon and tho Mallur project is this experiment. A
Total Health Care Programme can be effectively delivered through
a Cooperative in rural areas. The Mallur Milk Co-operative is
even contemplating construction of a 15 bedded hospital at Mallur,
with the help of Governmo.it and its own funds.
Further, the Health Centre with its work.ng philosophy-,
has indirectly helped the Department of Community Medic.in^ to
conceptualise a primary health car-';
rightful role in a
future physicians, so that they pla;
contemporary society.
Thp Health Team and interns have played an important role
in tho development of the village ||
in general a*14 h,-alth aspects
m
in particular,
particular. attempts
Attempts are
arc being made to increase th- membership
of tne milk cooperative by purchase of ngr ■ cows ano incr asing
enrolment.- Oth--r economic activities such as development o
village/cottagu industries and handicrafts and ensuring sal
of products, are contemplated. W are fully aware that m the
planning of such self-supporting programmes, the Health Team
.9
H w_-| „ «up;>ortod by o:.hor 'iei.bors ’'*’<■» "411 attend to
Success or failure would depend on tackling the financial side
efficiently.
The Quality of pronotive and curative sci’viecs
would have to be improved. Simpler skills, cheaper drugs and
intermediate technology have to be introduced to suit xtiral
conditions. A drive to inprove the education of tho people
including health education, is to be attempted through use of
Village Level Workers. Their training programme is being
organised. Whether there has bean an improvement in the morbidity
and mortality statistics at Mallur, subsequent to the introduction
of these co-opoxstives in comparison with other areas in the
vicinity, needs study and this has been taken up as a health project.
The question of introducing such self-sustaining
Co-operative Schemes to other areas around Bangalore is under
active consideration. These are challenges that have to be met
in rural India and we hope that with the cooperation and
participation that is readily forthcoming from the simple rural
folk, our economic and health projects will meet with success.
.'xCK?I0T-jL3DGBJ-Il!iWT
I wish to thank the "Ad-hoc Committee" of the
Jlew Doi
C.
B.C.T.
Centrx^for in the conplation of this paper, I have
drawn literally on their report '"Acroncy for Community Health
Assistance in .Rural Areas (ACH.1R1) ".
I also would, like to thank the staff of my
department and Dr Rajkunnr of the Mallur Health Centre,
for their help.
///////////
F
KG
<So Py
€5^Cc4y-5
- -------------------
sP A H
October 1974 pp|15
son
help for the family doctor BY urmila devgom
IF it weren’t for Medex - a new program representing a significant break
with traditional methods of providing health care services - the small town
of Davenport in the Pacific Coast State of Washington would probably have
lost its last doctor.
Located in a prosperous wheat farming area, Davenport (population
1»363) once boasted three physicians to serve the town and its surrounding
area. Than one of the doctors leftj soon another decided to do the sane. As
a result, Dr. Marshall Thompson faced the prospect of handling alone a
practice he estimates was close to 3,000 patients. "The task was monumental,"
he recalls. "If I didn’t get help, I pabanned to leave." As it was, he had
little time to spend with his wife and five children or to keep up with
new developments in the field of medicine - and almost none for relaxation
or recreation. H^s plight was a familiar ono to rural doctors throughout the
United States: There just aren't enough doctors to go around.
Yet today Dr. Thompson is still in Davenport. His practice is thriving,
hie patients happy. The answer ia Medcx (from the French medicin extension
or extension of the physician). "MEDEA,'’ says Dr. Thompson, "has been a
lifesaver i’or me".
What Medox accomplished was to give, bin an extra paix* of hands—and
highly qualified ones at that. They belong to Ron Graves, 29, an ex-U.S..
Navy hospital corpsmrxn who had six years of medical experience during his
service career. Ron is one of some 30,000 medically trained personnel
discharged annually from the American armed services. About 6,000 of them
have provided what is called primary medical care and have often served as
the only medical man abroad, a ship or at an isolated station. Highly skilled,
they have had from three to 20 years of valuable experience and may have
received upto 2,000 hours of formal medical training in such fields as
medicine, surgery, pharmacology or orthopedics. Yet when they returned to
civilian life they were rarely able to use this specialized knowledge. Until
recently, the only civilian medical job open to them, says the pr sident of
the American Medical Association, has been that of hospital orderly.
This paradox in American medicine—a shortage of family doctors
on the one hand and an untapped pool of highly skilled medical corpsmen on
the other - is what gave birth to Bedox, the brainchild of Dr.Richard A.
Smith, an innovative young black physician who is associate professor of health
services at the University of Washington in Seattle and director of the
Medex program. Medex draws on the skills of the ex-medical corpsman, teaming
him with a general practitioner and making him what Smith calls "the first
totally new health professional in family medicine in this century".
Smith, who holds both doctor of medicine and master of public hoalth
degrees, was senior Peace Corpos physician in Nigeria and served later in
Peace Corps headquarters in Washington, D.C., and in the office of the
2
C O M M U N IT Y HEALTH CELL
47/1, (F irs t F loor) 3 - M arks Road
A UNIQUE PROG.'UM DRAT.: OU THE SKILLS OP
W.D10 ., corpse and ti.u’g Kir v.ith
THOSE OF GRN RAL PRACTITIONERS TO PROVIDB
1OHMUNITY H 1\LTH C’P. I IB MANY PARTS OP
RUR -L AMERICA.
2
U.S. Surgeon General. When he went to Washington State in 1968 he learned there wan
not only a severe manpower shortage in the medical profession but a constantly
declining physician-patient ratio in rural areas. In addition, the age of
general practitioners in rural areas was steadily Increasing. Something had to be
done, Smith felt, to increase the capacit of doctors already in rural areas
and also to make small town general practice more attractive to new physicians.
In the Seattle area, he noted, there was one doctor for about 500 patients; in some
rural areas the ratio was one doctor to 5,000 patients! We found doctors who were
working 14 to 16 hours a day, he said. Some hadn’t had a vacation in seven years.
Enlisting the cooperation of a group of general practitioners who volunteered
to participate in the program, Medes was launched in mid-1969 as a demonstration
project sponsored by tho Washington State Medical Association and the School of
Medicine of the University of Washington, Funding was provided by the Federal
Governnent. Interested medical corpsmen were contacted at military installations
and, after careful screening, 15 were selected to begin a three month intensive
training program at the university. This academic phase emphasized areas like
pediatrics and geriatrics, in which the corpsmen had had the least experience,
and stressed the psychological adap-.ation from military to civilian medicine.
Meanwhile the Medex met the participating physicians and,with their
families, visited them in the communities where they practiced. The physicians agreed
to train the Medex in their offices during a 12 month preceptorship of following
the ac demic training and then to hire them if the team arrangement worked out.
Great care was taken in matching Medex and preceptor for, as Dr. Smith noted, "the
Medex is an extexision of the physician, not a substitute." It was essential
that the two work well together.
Medex (the term applies both to the program and to the new professionals)
take patients’ histories, do delegated parts of physical examinations, stuture
minor lacerations, apply and remove casts and assist physicians in surgery, all
under the supervision and responsibility of their physicians. Statistics from
eight doctors indicate they handled 25,000 more patient visits in the first
year as the result of their Medex. One rural physician saw 65 per cent
more patients during his first year with a Medex than he had the previous year
when he was alone.
So successful has the project been that it is continuing in the State of
Washington - and several other states have started similar Medex programme.
Medex is an excellent program, says Dr. Thomspson. It provides relief
for a lot of overworked physicians. It is a plan that works. It established a
goal and got the job done.
Fr Dr. Thompson, Son Graves provides a much needed addition to the
health care team. Graves screens patients, takes histories, conducts physical
examinations. "He knows when something is wrong, says Thompson, even though he may
not know exactly what it is - and this is important.
The two men share night and week end duty. Thompson estimates that
each typically works a 65 hour week. People have a great deal of confidence
in Ron’s judgment, Thompson says, and I have a great deal of confidence in his
judgment. Patients -now that if the feels more advanced care is needed, he willcall
me. He never ceases to amaze me. Sometimes the practice of medicine is intuitive.
......... 3
(5
3
He’s beginning to develop this sense. It’s part of the art. They can’t teach
it to you in medical school. Some of the art of medicine, I think is lost
in our technological society. You’are treating people - not diseases but
people with diseases, Hon pots on very well with people; I hwe yet to meet
anyone who did’t like bin.
Hon and Lynda Graves, both fro:., snail towns in Iowa, feel at home
in Davenport. The are active in their church, have bought a house and look
forward to raising their three small children in Davenport. Peopla have gone
out their way being friendly to us, says Linda.
Medes offered Hon the career he wanted but hardly Hared hope for. In
fact, he almost did’t aply when h® first hoard about the project because
it just sounded too good to be true. Now, he admits, I could’t be any happier.
He likes the wide range of experiences Medex offers and the opportunity for
further training. He baa alrady taken courses in cardiology, electrocardiogram
interpretation, pharmcology and drug interaction. He sees over JOO patients
a month, scheduler, appointments at the clinic every half hour (Dr. Thompson’s
are every 15 minutes). It takes me more time to evaluate a case, he says,
and then I like to let people talk. Ip you listen long enough the. tell you
what they really came for. It isn’t always what they said at first.
Bon has the knack of putting people at ease. He is especially good
with the young and the old. “Being lonely is probably the worst disease older
people have," he observes. “They want to talk. I have the time to listen. They
need to know someone cares. He visits the local nursing home about four
times a week, making a point of spending time with each patient.
The people who go to the Davenport Clinic are delighted with Medex.
“It’s a wonderful program," says Connie Walker, mother of three, who travels
45 miles to the clinic. Graves has taken care of her baby since the child
was two months old. He is very careful, very thorough and efficient, Mrs. Walker
says. "He explains things so well that you know exactly what to do when
.take
you’re at horns. He juet doesn’t£chances."
Another Graves enthusiast is Debra Dortch who lives 40 miles away.
"My little girls just love him," she says. "Ke’e really got a way with kids.
We wouldn’t travel 40 miles for nothing, would we?
A medical assistant at the clinic adds: He is certainly an asset
not onxy to the clinic but to tho town. He and Dr.Thompson have a fabulous
relationship.
What do tho professionals think of Medex? Dr. Walter Bornemeier,
former president of the American Medier-1 Association, raises a question that
occurs to many. "Are these men competent?" he asks. "Well, one of then found
a hairline fracture in a patient which both tho doctor and a hospital radiologist
and missed. That is one example of competence".
Medex founder Dr. Smith, who has traveled widely in Africa, the Hear
East, Asia, Latin America and Europe, believes tho basic elements of the
Medex program provide a technological tool that can be used to train individuals
with or without previous medical experience. That is part of our objective,
he says, to adapt the concept’s techniqe of training and deployment of health
personnel to the existing needs and available resources in any geographic
ar a. I do not think I would be exaggerating if I said this approach can be
applied in most of the 45 countries that I have visited or worked in.".
S/O<sly"^
PROPOSAL FOR ANANDGRAM - 'THE JOY VILLAGE'
A Cultural Village Complex for Itinerant
Performing Artists and Traditional Craftsmen
A.
A Statement on Alternative Reserttlement
B.
Background
C.
The Cooperative
D.
Anandgram
E.
Budget
F.
Appendix
Bhule Bisre Kalakar Sahakari Samiti
C/0
Rajeev Sethi
Flat 4, Shankar Market
New Delhi 110001 India
tel. 45107
April 10, 1978
, oraLTH CELL
COMMONl- wlafk5Aoad
A7/1, (Hrst Hoor -> Q
5
dELHI - 2
RESETTLEMENT : OUR ALTERNATIVE
A statement from the people of Shadipur Depot Jhuggi Colony,
New Delhi, May 1976
We are, all of us - traditional puppeteers, singers, bhopas
balladeers, jhoola-wallahs, animal trainers, jugglers, circus
artists (nuts), toy-makers, wood-carvers, peep-show wallahs,
street entertainers, etc.
Nowhere else in the country is there to be found such a close
and compact community of professional performers and craftsmen;
nowhere in the country would such a community be as extensive
or contain quite such a variety of skills.
We are mostly itinerant but we need a base which we can call
our home.
We began to migrate to this city 20 years ago; and 10 years ago
we came together as a community in an area of 3 acres in Shadipur
Depot. We are now about 150 families. This has become our home;
and it has developed in such a way that strangers to the city, and
indeed, many city-dwellers themselves, would not have believed
possible.
We have preserved our rural life-style intact even as we respect
and observe the civic laws of the city.
Indeed, we have become an integral part of the city's varied
culture. Anyone who needed our skills knew at once where and how
to contact us. Traditional artists who visited this city were able
to located us with ease. We can honestly say that we feel our commun
ity has benefited the larger community of the capital.
We have entertained foreign dignitaries as we have the man in the
street. We have given their children toys to
play with. Our
decorative crafts have reached the homes not only of Delhi's citizens
but of the world.
We feel that our community of 150 families represents a major crafts
industry of the capital.
We find we are now being moved to resettlement colonies such as
Sultanpuri and are scattered far away from one another. This spells
the break-up of our community and our way of. life.
- 2 How can we organize in the future as we have so far ? How will those
people who draw on our professional skills find us when they need us ?
For sometime now we have been thinking among ourselves about a small
but permanent theatre where we would have regular showings of our
puppetry and other performing arts both for the citizens of Delhi and
for those visiting from abroad.
Side by side with this, we feel we should benefit from having a salesoutlet that we could manage ourselves without intervention or
financial under-cutting by middlemen.
We feel it may benefit the Government to build a Cutlure and
Tourist Centre and yet with very little outlay; for where else
would it find such skilled and centralized human resources ?
Maybe you, the Government can help us to organize ourselves as
responsible citizens with land to live and work on. The question
of resettlement itself would be not problem for us; but please
let this not interfere with our aspirations !.
We, the undersigned, are willing to surrender the land-allotments
given to us as separate members in favour of an area where we can
live and work side by side.
Signed by 138
Heads of families
May 1976
ANANDGRAM - ‘THE JOY VILLAGE1.
A Cultural Village Complex for Itinerant performing Artists
and Traditional Craftsmen.
B.
Background.
Less than a decade ago, residents and visitors who cared to walk
the streets of an Indian city could easily find a peep-show wallah
gladly showing all comers his picture scroll of "twelve-maund washer
woman", or chance upon a magician holding audiences spell-bound with
his clever showmanship and street ‘hypnosis'. The passerby could
also witness an animal trainer convince his monkey to take a bridg,
watch his dog leap through a wheel of fire, or see the 'bhalluwallah'
asking his bear to ride an onlooker's bicycle.
A family of acrobats whose children would put a professional gymnast
to shame could be found looming over the heads of a standing crowd
gathered for a'Tamasha'. One could easily locate jugglers performing
in an open square or a puppeteer performing his traditional ballad
plays with hilarious comic interludes. A'behrupia,' the street
impersonator, would arrive in a market square and create a sponta
neous crowd of laughing shoppers.
Street urchins would shout and run in delight as the familiar sound
of drumming announcing these wandering performers was heard approach
ing the neighborhood. The more well-to-do will remember how the
puppet-show wallah always turned up to erect his little stage
in time for the children's birthday party.
Nowadays, we see fewer and fewer of these 'pilgrims of joy'.
Decades ago they left their villages to come to the cities in search
of new patrons. Now they have started to leave again: "Life is not
what it used to be
Too many rules and regulations. "
One of the definitions of beggary in the Bombay Prevention of Beggary
Act of 1959, which is still in force in Delhi, is "Soliciting or
receiving alms in public places - under any pretence such as singing,
dancing, forture-telling, performing or offering any other article
for sale."
No one has cared to allot special places around Delhi, in parks,
open grounds or mohallas, for instance, where these professional
street artists can earn their daily bread with dignity.
Today, puppeteers and ballad singers wait in abject lines outside
development agencies for contracts to do message-loaded 'folk dramas'.
Others have deserted the street and the courtyards altogether, preferring
4
to be called "stage artists", because prestigious academics have
made them self-conscious about their ‘art1. Too many have been
forced to compromise traditional expression with the vulgar require
ments of the drunken rich at weddings and qawwali evenings
straight out of Bombay films.
Most continue to joint the wretched stream of the unemployed.
It is not that these performers
have lost either a sense of
discernment or their native skills. It is a question of survival for the performers themselves and their timeless craft.
The result is confusion, lack of direction, and a debilitating
sense that their skills are no longer of use. Perhaps, too, those
who are concerned to see the city grow have not yet gauged the
potential of such communities.
The wandering performing artists of this country must number in
thousands, There has never been any census and nor have they been
identified as a special group. Most of them have never benefitted
from any development programme of the Government or other agencies
for professionals. They remain scattered and forgotten, wandering
from place to place and living wherever they can pitch up a ragged
ten and put three stones to mark their hearth.
C.
The Cooperative Society of Neglected and Forgott en Artists.
One hundred and fifty families of Delhi street performers had
somehow managed to survive as a village community unitl their
Shadipur Depot Jhuggi Colony was bulldozed. Many have returned
to Shadipur to camp in makeshift tents or on the open ground, but
there is a constant threat of harrassment from the police and others
without a vision. Under the current resettlement schemes of the
Emergency resettlement, they will be evicted yet again and dispersed
to far-flung colonies unless another alternative is found.
Resettlement itself is not under question, but how to make it work
better, both for the Government and the people, is the main purpose
behind this proposal.
In June 1977, to unite against impending dispersion and for recog
nition as traditional performers and craftsmen, the squatters of
Shadipur Depot and elsewhere - the puppeteers, singers, magicians,
acrobats, jugglers, musicians, toy and instrument makers, etc. banded together to form India's first "Cooperative Soceity of
Neglected and Forgotten Artists", the Bhoole Bisre Kalakar Sehakari
Samiti.
5
The Cooperative is being registered as an Industrial Cooperation
under the Cooperative Registration Act of India. The members are
required to pay Rs. 50/- as
share capital and Rs. 10/- as member entrance
fee. Only traditional performing artists and craftsmen can become
members of the group. The members are selected by a Selection Committee
composed of the performers themselves. The office holders are elected
by members. There are no outside patrons of Board of Directors. Those
professionals interested in helping the Cooperative are called Friends,
and receive Rs. 1/- honorarium. The Cooperative, however, can hire the
services of any outside person according to the wishes of the Managing
and General body.
The Cooperative today has about 60 members who have been selected
and another 30 associate members who have paid their share capital.
There are many more who have filled their forms and are collecting
money to become members.
The members have already earned more than four times their share capital.
What the Cooperative has done so far :
Tune 1977
After holding several meetings with Government officials, media
people, etc. for almost six months, the group finally decided to form
themselves into an Industrial Cooperative. All other forms of Cooperatives
could not cover the professional aims of our proposed members.
A unique function was held on the lawns of Smt. Kamala Devi Chattopadhyay's
residence in the presence of about thirty guests and 150 performing artists.
July 1977
26 puppet shows sponsored by the Sangeet Natak Academy were distributed
for Rs. 75/- each. The shows were performed j.n Public Hospitals, schools,
and houses for handicapped and the aged. At the hospitals the members
were also helped to get their medical examinations.
The Cooperative provided transport fees to groups who went for subsequent
check-ups.
August 1977
The National Institute of Design contracted the Cooperative to perform
in the Theme Pavilion of the Agri-Expo. A repertory of twelve types of
shows was prepared and members earned from Rs. 50/- to Rs. 150/each depending upon the programme required by the client.
contd................ 6
6
January 1978
In the fall of 1977, the Guardian newspaper of U.K. wrote a one-page
article on the functions of the Cooperative. As a result, the BBC
sent a film production team from its World About Us series to film
a 50 minute colour documentary on the social history of the group,
and the formation and activities of theCooperative. The film is
to be released in May 1978, and the Cooperative will receive a free
print. Each member of the Cooperative earned Rs. 75/- from the film,
and about Rs. 10,000/- was distributed to other performing artists
from outside. Delhi.
The Cooperative participated in the PATA Conference by staging a most1
unusual fair for the Taj Group of Hotels, . The show was held at the
construction site of their forthcoming hotel in New Delhi. Every
member, including associate members, received Rs. 125/- from the show.
About 30 non-member performing artists from, outside the Cooperative
were also employed.
May ~ December 1978
A book on the tales of wandering performing artists and traditional
craftsmen is being prepared for publication,
A format for puppet-training workshops is being prepared for educa
tional institutions and development agencies.
The main task for the Cooperative is to start building Anandgram,
the cultural village complex described in this pronosaT.
D.
ANANDGRAM - " THE JOY VILLAGE " .
Recently, it has been a felt need that Tourism should also emerge
out of its 'Five Star' we stern-oriented culture. Tourism itself is
changing its valpc-patterns and shows an inclination to step out of
highways, cabaret lounges and plush bars frequented largely by the
local nouveau riche.
The New Tourist is here for more than a comfortable visual experience.
He wants, however idealistically, to get into the 'soul' of the place:
"The Real India". Too many already have been tempted to drive Cadillac®
into thS village to catch a glimpse of "the vanishing past". Others
have virtually converted villages into show-laces for tourist where
the villagers themselves can be hired to demonstrate 'culture'.
Needlees to say, this is as damaging as it is unrealistic.
Yet the need for a 'rural experience' cannot be overlooked. We need
to create an ethnic environment where professional showmanship is a
way of life.
7
Anandgram, which is to be the pioneering project of the Bhoole Bisre
Kalakar Cooperative will be a Cultural village complex to permanently
house the families of the members,. To be situated on ten acres of
land in convenient relationship to the city, Anandgram will include
a complex of indigenous style habitat for 150 families, several
courtyard theatres, a fok arts museum with special emphasis on
puppetry and theatre crafts, and common facilities for handicrafts
such as woodcarving, embroidery, pottery, straw-work, and the
construction of toys and musical instruments. The Cooperative will
promote these and other traditional skills through training courses
and experimental workshops for popular performing arts. It will also
maintain a hostel for itinerant folk artists that visit the capital
from different regions of India. The complex will house a research
component for indigenous cosmetics and homemade medical remedies.
The complex will consist of market squares with craft shops and
retail and wholesale outlets along with several street stalls for
ethnic foods and spices. There will also be other community facilities
to make the village more self-sufficient and self-sustaining.
The visitor to Anandgram, whether a tourist or a resident, will
gain an immediate experience of the craft process. In addition,
the complex would provide a ground for popular media that could
actively feed the entertainment and information industries. Their
skills already reach about 30,000 people a day, in and around Delhi.
Offering a continuing carnival of ethnic jhullas and other amusement
circuses and a variety of lesser known performances, Anandgram will
be an effective catalyst for the permanent reintegration of India's
traditional popular folk performing artists and the urban community.
The most important factor to keep in mind at present is the urgency
with which the project must proceed before the scattered and
individual families begin to send down roots wherever they have
been displaced to, and before they leave their Delhi base. At the
moment, the people are ready to build. One hardly experiences
such initiative for self-help housing.
E.
BUDGET.
The project will be implemented in three stages :
A.
B.
C.
Phase One - Preparation of a Comprehensive Scheme and Site.
Phase Two - Workshop for Review and Presentation of Scheme.
Phase Three - Construction of Village Complex.
8
This proposal requests initial funding for pPhases One and Two.
Phase One will cover expenses incurred in locating a suitable
building site and developing the comprehensive building plan.
Phase Two, to begin after the completion of the comprehensive
plan, is a special workshop on indigenous building techniques and
human settlements to be held in Delhi . Professionals such as
Dr. Hassan Fathy will be invited to analyse and review the work
done. The workshop may be coordinated with organizations such
as the National Institute of Design Ahmedabad and the All India
Handicarafts Board. The purpose of the workshop will also be to
prepare a multimedia portfolio for the presentation of the plan to
prospective funding organizations and other interested people.
Cost estimates for Phase Three, the construction of the complex
itself, '-will be determined after completion of Phases One and Two.
9
Phase One - Location of a Suitable Building Site and Preparation of
Comprehensive Building Scheme.
Duration : 3 months.
1.
Salaries for Design Team - Architect, Civil Engineer,
Design Consultant, Draftsmen, Graphic Designer,
Master Masons, Theatre Expert, Crafts Consultant, Copy
Writer, Secretary, Accounts Officer, Community
Representatives, Project Coordinators :
rs.
43,000
(The above does not include Govt. Rep. Delhi
Administration ^ourism, Education, Culture,
University etc.)
1,500
2.
Rental for Office/Shed :
3.
Office Facilities and Supplies :
1,200
Telephone, Postage, Telegrams :
3,000
4.
5.
Model, Blueprints, Drawing Equipment for
Exhibit of Plan :
5,000
6.
Display for Exhibit of Plan :
3,000
7.
Transportation :
6,000
8.
Miscellaneous and 10% Contingency :
Subtotal
7,300
Rs.
70,000
Rs.
80,000
Phase Two - Workshop and Presentation.
Duration : 15 days, New Delhi.
1.
Travel Grants and Per Diems for Dr. Hassan
Fathy, two other international experts, &
15 professionals from India :
2.
Rental of Workshop Premises :
5,000
3.
Honorariums to Performing Artists and
Professionals to be included in the
Presentation (about 80 people) :
15,000
4.
Mobile Stage Sets, Theatrical Props,
Costumes, etc.
15,000
5.
Telephone, Postage, Telegrams, Stationery
1,500
6.
Transportation :
2,500
7.
Miscellaneous and 10% contingency :
__11_'000_
Subtotal
Rs.
130,000
GRAND TOTAL
Rs.
200,000
SUNANDA
1.
Background Information :
1. Door No- I M. No.
2.
..................
Strect/Ward
MOBILE MEDICAL
UNIT COROMANDEL
K G F 563118
6
3.
Hamlet
....... ........
4.
Panchayat
z„. ...........
5,
Taluk
;........
Serial No. of the Family
7- Name of the head of the family
Religion / Caste
a] Type of house :
Pucca [ ] Kutcha [ ] Hut [
d] Owned ( ) Rented ( )
10 b] Electrified : Yes [ ] No [ ]
Baseline
II
III
.............
■ Male
Adult : -j
f Female
]
[ Male
Children : -j
f Female
...............
.
.................... ■
-
.
Total :
II. Environmental Sanitation .A. Water Supply:
Source
Type
Within the House ( ]
Outside the House [ ]
Tap ( ) Protected Well [
Pond ( ) Stream [ ]
Others :Condition of source.
[
]
B:
Specify.
III. Services in regard to Environmental Sanitation
rendered during various visits,
A,
Water Supply
C.
Latrine:
Latrine in the house Yes ( ) No. ( )
If Yes, type
Flush [ J Service ( )
Pit ( ) open air [ ] Others ( )
Whether in use : Yes ( ) No ( )
Space available for construction :
Yes f j No .[ ]
Willingness to construct : [ j Yes/No (
]
IV
Family Members :
......
Sullage Disposal
Soakage pit ( ) Drain ( ) '
Kitchen garden t ] Stagnation I
Others [ ] No arrangements [ ]
Refuse disposal:
)
Burning [ ] Manure pit [ j
No arrangements ( )
Others ( ) Specify
Sullage disposal
Latrine ;
Refuse disposal
]
............
In, III on the front page, enter the services rendered foi^^e house,
from time to time, under appropri^^ headings.
couples
__________
elig ib le
Mo- th and date
of visits
1
Family Planr.ing
services rendered
arranged/accepted
'SI. N o. o f
Family Planning
Educational activities
carried out
SI, No.
Month and date
of visits
eligible
couples
of
In IV, on the next page, in the column 2 enter nil the members of the
I as the husband (head of family/ the >,
fe and
unmarried Children. Add other relatives vk_
,
.X, residing in the household.
who are permanently
Col. ,3:- Enter relationship of each member to
*- S.
° No. 1, (eg.) W/o 1, M/o 1, B/o 1, S/o 1 etc.
Coi. 7::
State the level of education completed (eg.)
M.A.,B.Fd.,
,
,
. 1st
... year Arts, 9th std. and so on.
Col. 8ti
Occupation F for farmer, W for weaver, SK for keeper T for teachers, L for casual labour such as cooly, carpenter, mason etc., g.s. for govt, servant.
Co). 10
1 [a] If small pox marks are present put down P.
"
"■ vaccination
If
‘
scars are seen, put S 1 or S 2 S3 S 4 according to number of scars found
Col. 16 - If Vit.
‘A’ deficiency is seen.
put A. If B deficiencyz B. Protein calorie malnutrition - PCM, E washiorkar - K, Marasmus - M, Anaemia - An
In col,
1, 21,
.'ention where treatment is being given - C-..
Government- ,
(Govt.), or
-■ Project (Fjt)
, j.,
In VI, below the date and mor-th of each visit note the services rendered for each member of the family, using the following abbreviations for the several
services
F (fever) B (blood smear) D (drugs given for fever) F. P. (Family Planning) D. ?. T., T. □., B. C. G., etc. for the various immunisations, V. S. for birth &
death recording, E. I. epidemic intelligence, A. N. C. & P. N. C. (antenatal & post natal care) N. for nutrition services, Tt for Tb for treatment of Tuberculosis; Tt
for Lep. for, treatment of Leprosy, Tt for MA., for, treatment of Minor Ailments.
Months and dates of visit
F. P. Services rendered/
arranged/accepted
F. P. educational
activities carried out
1
I
■ j
1
In, III on the front page, enter the services rendered foi^Fe house, from time to time, under appropri^^ headings.
In IV, on the next page, in the column 2 enter all the members of the family unit starting with S. No. 1 as the husband (head of family,) then, the wife and
unmarried Children. Add other relatives who are permanently residing in the household.
Col. 3:- Enter relationship of each member to S. No. 1, (eg.) W/o 1, M/o 1, B/o 1, S/o 1 etc.
Col. 7:- State the level of education completed (eg.) M.A.,B.Ed., 1st year Arts, 9th std. and so on.
Col. 8:- Occupation F for farmer, W for weaver, SK for keeper T for teachers, L for casual labour sueh as cooly, carpenter, mason etc., g.s. for govt, servant.
Col. 10 [a] If small pox marks are present put down P. If vaccination scars are seen, put S 1 or S 2 S3 S 4 according to number of scars found
Col. 16:- If Vit.
‘A’ deficiency is seen.
put A. If B deficiency B. Protein calorie malnutrition - PCM, Kwashlorkar - K, Marasmus - M, Anaemia - An
In col, 21, Mention where treatment is being given - Government (Govt.) or Project (Pjt)
3.
In VI, below the date and month of each visit note the services rendered for each member of the family, using the following abbreviations for the several
services
F (fever) B (blood smear) D (drugs given for fever) F. P. (Family Planning) D. P. T., T. D., B. C. G., etc. for the various immunisations, V. S. for birth &
death recording, E. I. epidemic intelligence, A. N. C. & P. N. C. (antenatal & post natal care) N. for nutrition services. Tt for Tb for treatment of Tuberculasis; Tt
for Lep. for, treatment of Leprosy, Tt for MA., for, treatment of Minor Ailments.
Months and dates of visit
1.
2.
Family Planning
services rendered
. arranged/acceptcd
Month and date l
of visits
couples
Family Planning
Educational activities
carried out
elig ib le
1
'
SI. N o. o f
eligible
couples
Month and date
of visits
Si. No. o f
■
F. P. educational
activities carried out
F. P. Services rendered/
arranged/accepted
SUNANDA
1.
Background Information :
2.
Street/Ward
......
......
3.
Hamlet
4.
Panchayat
5.
Taluk
II. Environmental Sanitation
A. Water Supply :
Source
Type
Within the House [ ]
Outside the House f ]
Tap ( ) Protected Well [
Pond ( ) Stream [ ]
Others
[
]
B:
]
Specify.
Services in regard to Environmental Sanitation
rendered during various visits,
A,
Water Supply
UNIT COROMANDEL
K G F 563118
Baseline
11.
Family Members:
, Male
Adult :
II
. .............
[ Male
Children : -{
Female
......... .
• Total :
.........................................
c.
Latrine;
Latrine in the house Yes ( ) No. ( )
If Yes, type
Flush [ ] Service ( )
Pit ( ) open air [ ] Others ( )
Whether in use : Yes ( ) No ( )
Space available for construction :
Yis f ] No [ ]
Willingness to construct : [ j Yes/No (
Condition of source.
III.
MEDICAL
Serial No. of the Family
Name of the head of the family
.........
....i...
8. Religion / Caste
9. a] Type of house :
Pucca [ ] Kutcha [ ] Hut [ ]
d] Owned ( ) Rented ( )
io b] Electrified : Yes [ ] No [ ]
No- / M No*
■
MOBILE
6
7.
............................. ............
............. .
Sullage Disposal
Soakage pit ( ) Drain ( )
Kitchen garden I ] Stagnation I
Others [ ] No arrangements [ ]
Refuse disposal :
)
Burning [ ] Manure pit [ j
No arrangements ( )
Others ( ) Specify
Sullage disposal
Latrine ;
Refuse disposal
III
IV
Family Planning
services rendered
arrangcd/acceptcd
Mo th and date
of visits
1
i
couples
Family Planning
Educational activities
carried out
elig ib le
i
:
'SI. N o. o f
of
SI, No.
Month and date
of visits
eligible
couples
In, III on the front page, enter the services rendered, for
house, from time to time, under anpropria^^ieadings.
•
In IV, on the next page, in the column 2 enter all the members of the family unit starting with S. Vo. 1 as the husband (head of family) than,' the wife and
unmarried Children. Add other relatives who are permanently residing in the household.
Col.
Enter relationship of each member to S. No. 1, (eg.) W/o 1, M/o 1, B/o 1, S/o 1 etc.
Col. '
State the level of education completed (eg.) M.A.,B.Ed., 1st year Arts, 9th std. and so on.
Col. 8;
i
...... ... mason etc.,, g.s.
„
Occupation F for farmer, W for weaver, SK for keeper'T for teachers, L for casual labour such as cooly,
carpenter,
for govt, servant.
Col. 10
! [a] If small pox marks are present put. down P. If vaccination scars arc
4 according to number of scars found
Col. 16:- If Vit.
‘A’ deficiency is seen.
put A. If B deficiencyz B. Protein calorie malnutrition - PCM, Kwashiorkar - K, Marasmus - M, Anaemia - An
In go],I,
21, Mention where treatment is being given
2
Government
(Govt.) or Project (Pjt)
3. Ini VI, below the date and month of each visit note the services .rendered for
. . each member of the family, using the following abbreviations for the several
?!
I.
2. P.
?. T., T. i.)., B. C. G., etc. for the various immunisations, V. S. for birth &
services:. F (fever) B (blood smear) D (drugs given for fever) iF.. P. (Family Planning)
D.
death recording, E. I. epidemic intelligence, A. ? '
“ H
"
'
. . & post■ natal
__._icare)
----- . m
P. '
C. (antenatal
N. r_.
for nutrition services. Tt for Tb for treatment of Tuberculasis; Tt
for Lep. for, treatment of Leprosy, Tt for MA.
treatment of Minor Ailments
Months and dates of visit
F. P. educational
activities carried out
1 F. P. Services rendered/
arranged/accepted
!
In, III on the front page, eater the services rendered f^^Lhe house, from time to time, under approp^^e headings.
In IV, on the next page, in the column 2 enter all the members of the family unit starting with S.. No. 1 as the husband (head of family J then, the wife and
unmarried Children. Add otner relatives who are permanently residing in the household.
Col. 3:- Enter relationship of each member to S. No. 1, (eg.) W/o 1, M/o 1, B/o 1, S/o 1 etc.
Col. 7:- State the level of education completed (e-g.) M.A.,B.Ed., 1st year Arts, 9th std. and so on.
Col. 8:- Occupation F for farmer, W for weaver, SK for keeper T for teachers, L for casual labour such as cooly, carpenter, mason etc., g.s. for govt, servant.
Col. 10 [a] If small pox marks, are present put down P. If vaccination scars are seen, put S 1 or S 2 S3 S4 according to number of scars found
Col. 16:- If Vit.
CA’ deficiency is seen,
put A. If B deficiency B. Protein calorie malnutrition - PCM, Kwashiorkar - K., Marasmus - M, Anaemia - An
In col, 21, Mention where treatment is being given - Government (Govt.) or Project (Pjt)
3.
In VI, below the date and month of each visit note the services rendered for each member of the family, using the following abbreviations for the several
services
F (fever) B (blood smear) D (drugs given for fever) F. P. (Family Planning) D. P» T., T. D., B. C. G., etc. for the various immunisations, V. S. for birth &
death recording, E. I. epidemic intelligence, A. N. C. & P. N. C. (antenatal & post natal care) N. for nutrition services. Tt for Tb for treatment of Tuberculosis; Tt
for Lep. for, treatment of Leprosy, Tt for MA., for, treatment of Minor Ailments
Months and dates of visit
1.
2.
SUNANDA - COROMONDAL - KGF
118
INDIA
” I bring you nows of great joy,
a joy to be shaded, by the whole people."
- Luke: 2/10
About one hundred, kms East of Bangalore, the capital of Karnataka in
South India, we have Kolar Gold Fields, a golden place with the
deepest pit in the world; golden with the sincere hearts of simple
folks; golden with a rich harvest of huts and hovels, labour and
poverty; a place where Christ the Liberator would easily have been
born. Well in such a golden place, in 1970, at Coromondal was
'SUNANDA' born.
SUNANDA
( merits )
THE BRINGER OF JOY
The joy of truth
The joy of justice
The joy of peace
The joy of love
The joy of liberation of the whole man.
This is the mission.:of Jesus Christ;., This sis the objective of
Sunanda: to continue the mission of Jesus Christ.
SIMPLE BEGINING;
Sunanda was actually nameless for five years, though her institutes
of Commerce (Shorthand and Type-writing) and Tailoring worked under
the name of ’SARAL NIKETAN ' meaning 'HOME”OF SIMPLICITY' .
Another strange thing about Sunanda is that she started b.ir work with
School teachers and with, young men, and women who had no •.■pecial
qualification o¥ Social work- except the conviction of tne
necessity to transform the Society with dedicated work.
TRAINING;..
•
- ‘ ■
In 1976, Sunanda started training her members by Short courses in
India and other countries, through schola^shipAfrom DBF, COADY,
CAFOD, SEARSOLIN and CISRS and through Sunanda Funds.
To-day, she has forty in her team; twenty three men and, seventeen
women. Another five are undergoing training in Community Develop
ment and Organisation at Madurai and Bombay.
SUNANDA DAY:
'
J
' ’
Jesus Christ, the Supreme Liberator and Victor, is ter model and
■fittingly-enough the Easter Day, the day of final t ciumph of Jesus
Christ over death and; the. dark’forces of. this worl1/ was chosem
early in-1.931,' as - the;Sunanda Day, for Sunanda too ’is trying i “to
overcome the'dark forces of this world, and. bring 'she joy. of
a^^yai'ion.-tokfehe >peppXiaft , .
.
rJ;’- SUNANDAS^H; 0 1'970-1971 )(!J
sw • ; ‘J.‘\cw
•’
-rt . ,i
;’rr" *• '£ •'
’.?<<■' ■ v--
i
■
>;.... ' <
This'. 'ip the. 'Temporary Relief Home'1 'for 'children f ribm- broken -'home's,
complete orthans, and a ’feirwho' a'rt~ieaiiy,,iri■ grbat'n'e^'d of ‘help'rt •
... .They- are U:.at tW moment; O ' tChey ’ l'i'yeJ wi''th:d;'hduse-‘fabthe’r.';- :They---';study
in different'. Schools arid live? in. r'ente.dJi'hb&1sh; ■■'‘They-' ate^settl-M
when th'ey are of age-. OURS is/'supporting them partly and some iWeil-wishers are" of help.
' ~ ; '.
INSTITUTE OF COMMERCE;' ( 1'972-1973 )l '
II.
J ■
"
n’- ■
-
-■
•
•
."
vA?
.Jrt ..rt
TheEe.<anexal^t;.:2Qft' students ./bqthrtqr
Type-writing and Shorthajihv
it
...xi j. ij.nj, > >_a xjri .vi
i;-; ■
is {rgcoghi^edl by.-jthe -Statue ,Qqverpmpnta|. It is, self supporting, it was
helped by IC-^i.S : qqd CARIES INDIA.-in the..initial, stages. /.We have’ a
’ • libai^yaatta^eylxtQ;t^^s.^^.i;;iftu^e.;^lq^;jis be,coxing a Circulating
-library,-..
a. y . t- /.
y...-,■;//
' ?'/
"''/ <V"n“°"
^S
III.
TIT^E OF, TAILORW:^f1^7>^97>^Np-- .-•
.-y- f)' r?;-/.y ri-.t3ri.
We hre' having-ery?;iihfomiai trairiirig: for the-poor .children'^nd^QUth.
Ry^injyb^ca^ie '.partly a -production, centre which provides
-job- ■full. time, or part time'depehding^on the:-aniouht of' orders'iSre^get.
Just like th< above Institute of Commerce it was aided by Caritas. -India and.10SSS at the initial stages. Every effort is being made
to make this Institute self supporting.'-
"
’
■
-
•
'
jV- The. special features of the above .3 .institutions are that, we meet.
[
every student arid guide him in his probTdms- among these -students was
started the YOUTH ORGANISATION-.which has contact with many Youth
Groups in the Mining area and in the' Rural areas. Leadership'training
is given to these, young men. Sports and games are conducted- Career
guidance -.is also - given.
SUNANDA SATOTG.'.'SCHEME;-. ( 1981),,
.
.
h
’ L" "'/'"
Which at rthe jiiorHent is. being •;re^prganised^ was-also., started .among the
above students;• Today classes are being conducted to .different groups
regarding the•necessity of Wise- spendirig and planned Saving and it
stands operf for;ai!l ih the'Mihirig-farid-Rural areas. ,
, ...
IVOOF - ■ FH?: (197? ) '
/ '
' ,. '
'
/
'' ''
• ■e-’’
■■
„.(7- p.
■
, .... . .................. _.<c
Thisris sponsorship programme- which helps about- 380 families in.
different areasL Thotl-^i it id y<vy helpful to these particular
families, it ma'rd's it difficult to organise the whole community since
very-few only are’^in this programme. So- we have- started substiuting
widows, Widowers and haridicapped; We hope that it. becomes a Community
oriented programme.
V.
HE?LTH AND NUTRITION; ( 197^ ).
Along with curative Health programme, much stress is given to prevent ?.--.
health programme. Regular education and demonstration classes are
given and Health Camps are being conducted with- the help of. the .
Government Primary Health Centre and.a local Doctor from the. Mining--
Sospital; We work hand in hand with the PHO’ far-programmes like
Immunization, pre-natal and Post-natal care etc. Our team works in
about 22 villages teaching them the value of Herbal Medicines and is
training one or two persons from each village for further continuity
of this programme..Glasses are being conducted in the sheds put up
by CIDA. In 1978 Caritas India helped us with an Ambulance and initial
expenses. From March 1980 Christian Aid has given us fUll support and
encouragement for its extensive services.
It was ..CRS that helped us for the MCH programme from 1975. Then CASA
entered our villages in March 1979 to decrease the infant mortality
with the co-operation of the community. Caritas Neerlandica sends
Milk powder which together with- CASA helps the growth of children.
Occasionally we recieve mdi.ici.ries from DBF and CMMB. We have registered
our Health work with CHA - New Delhi.
VI.
NON- FORMAL EDUCATION; ( 1979 )
This is being conducted in bO centres both in rural and Mining areas.
There is much concentration on Social Awareness and Social Action.
The Animators are being trained regularly. 10 more centres h-0 kms
away from our village will be started on the 1 st of May 1981.
A cultural .group is under formation which goes round for street plays
depicting the present situation of the village and of the countrythus paving the way for Group Action. This is supported by CEBEMO
through AICUF. Our hope is to cover the whole Taluk within 5 years.
VII.COMMUNITY ORGANISATION; ( 1980 )
This team which was supported by CISRS for its training, straightaway
contacted the communities starting from one. village to the othbrwas able to form Panchayats (local Governing body) approved by the
Government. A few Panchayats, together, have formed one Association
called ROSI (Responsible Organisation for Slum Improvement). Through
this registered ROSI, people have succeeded in approaching and
obtaining from the Municipal and Government authorities their rights
regarding water, light etc., ROSI hopes to gather a number of villages
under her wing to get her fair share of rights and human.dignity.
VIII.SUNANDA SCHOLARSHIP SCHEME; ( 198O )
With the'help of Caritas Neerlandica, Sunanda was able to help 30 young
men and women to get themselves trained in job-oriented courses. It
hopes- to build up a revolving fund by 198? with the repayment of loan
either partly or fully from the- beneficiaries.
IX.
SUNANDA MYTHRI SAGAR; ( 1980 .) •
As- years -went by Sunanda felt that she needs a centre to gather her
members for evaluation orientation^ planning and evaluation regarding
her objective, retreats, seminars for herself as well as for other
■groups and to have it'as a home of Friendship and Fellowship. So She
'i to "
has provided a temporary shed in .one portion of the property belonging
to the Resource Fain and an named it •MYTHRI SAGAR' meaning 'AN OCCEAn
OF FREII'JDSHIP1. We have all our quarterly meetings, camps, orientations
K ct v
and "treats for different. groups. We do hope that this place will be
a centre to experience God's love and Communion among his people.
X.
AGRICULTURE: ( 1980 )
Our working in so many villages brought home to us very clearly the
need to organise the farmers# Sunanda's long' felt need was to build
up a Resource Fund for its future - placing both these thing together
we purchased some land along with a house, with the help of Caritas
Neerlandica in 1979« The three staff we have at the moment are for th .
Resource farm as well as for the organising £0 of farmers.!
Relationship with the farmers is being built up. We have not had any
rain for the past 2 years. Our District is declared as drought area.
So no work has been started yet. Here again we have sought expert
g
guidance from ICAR through our Government Agriculture office and- OXFA.I.
XI.' WOMEN1S ORGANISATION: ( 1981 )
Because of our Health Programme, Non-formal. Education, Youth Organisation
and Community Organisation the need to form an Association of Women took
birth, h- Groups have been formed. There are plans to start co-operative
Home Craft,^eibove all to make them aware of the oppressive structures
and traditions of Society regarding women and to encourage them to unite
and initiate them to action.
In the near future YMCA, will join hands with Sunanda in its continuou
and constant- effort to build a just Society.
Sunanda.is.grateful to all her benefactors-including those whose names
are not mentioned and ever remembers them as she proclaims the Good
News of Liberation especially among the Poor and Oppressed.
" Bring us out of the prison of- Self and Security Lord
that we may go forth to proclaim the Good News. "
Date: 16-^-1981.
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