Abhram Thomas- Health for All
Item
- Title
- Abhram Thomas- Health for All
- extracted text
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Community Health Fellowship Scheme
June 2003 – May 2004
Report by
Dr. Abraham Thomas
Submitted to
The Community Health Cell,
#359, Jakkasandra 1st Main,
1st Block, Koramangala,
Bangalore – 560 034
Mentor
Dr. Ravi Narayan, MD (AIIMS), DTPH (London), DIH (UK)
Community Health Advisor – Community Health Cell
&
Global Coordinator, People’s Health Movement, Bangalore
Field Mentor
Fr. John Vattamattom
CEO, Sanghamitra, Medak District, Andhra Pradesh
Fellowship Supported by :
Sir Ratan Tata Trust
Community Health Fellowship Scheme
June 2003 – May 2004
Report by
Dr. Abraham Thomas
Submitted to
The Community Health Cell,
#359, Jakkasandra 1st Main,
1st Block, Koramangala,
Bangalore – 560 034
Dr. Ravi Narayan,
MD (AIIMS), DTPH (London), DIH (UK)
Mentor
Dr. Abraham Thomas
I dedicate this report to my forefathers,
Who moulded today
To my parents who let me dream, to
My teachers who set me free, and to
The people who let me be….
Contents
Sl.
Particulars
Pages
No.
1.
The paradigm shift and the selection process
4–7
2.
Introduction to Community Health & Orientation
8 – 10
3.
Learning at the Community Health Cell
11 – 17
4.
Setting Objectives & Planning the Year of Fellowship
18 – 19
5.
The Journey with Sanghamitra
20 – 22
6.
The Land and Plenty of Talents – Tapped or
23 – 27
Untapped?
7.
Soul Searching
28 – 29
8.
The Future of the Fellowship
30 – 31
9.
ANNEXURES
32-53
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3
1. The paradigm shift and the selection process
I had made up my mind a few years ago that I would take up rural living. Life in
the city was choking me and my life as a dentist I as eager to say goodbye to.
When I worked at St. Johns Medical College and Hospital I began to like it for its
lush green campus, vast unoccupied areas, and of course, very creative students. I
was working with the Health Informatics Department as a research assistant,
generating and editing information from various online medical databases.
I
enjoyed the work and made a number of friends in that one year. I had taken the
job to support myself and to use the time to weigh various options and make
rational decisions about my future and ‘career’. My fellowship at Community
Health Cell (CHC) was serendipitous. It started me on a journey of exploration and
experimentation.
It took me another 4 months after I was first told about CHC an the unusual work
it was doing before I came to it. There I met Mr. Gopinathan for the first time. I
knew nothing about the fellowship scheme. I knew that CHC would help me find
a place where I can work and contribute my bit. I was surprised to hear that a
fellowship program exists and that is designed to help people choose a vocation in
community health and development. A few days later I attended an interview at
CHC.
It was the only interview I had attended where they asked me about my interests
and dreams, about my family, about what made my family settle down in Andhra
Pradesh and many more things seemingly irrelevant to my area of study. Before I
left, Dr. Thelma Narayan asked me to write a small essay on what had made me
approach a rural health and development program. Before day break the next day,
I had finished writing an account of the influences and inspirations that made me
choose an alternative profession to dentistry.
4
This is how the essay went…….
…Dear All at the Community Health Cell
It was really nice to have met Dr. Thelma and to have come to know a little more of the Community Health Cell.
Here, I am giving a brief account of the influences on my life that got me interested in the field of community
health and promotion of health. I come from a small town / Panchayat in Andhra Pradesh. This is my 20th year
away from home as I have been out in the boarding during school and college. Holidays and the first seven years in
Kodur have had a tremendous effect on my thinking process. Interestingly they didn’t manifest in earnest. Now, I
simply want to be involved in the process of improving the living conditions, health and the general life of many
people. In addition, I don’t see myself being able to make a profit from my work or rather prefer that monthly pay
packet. Interestingly, sometimes I dream of a community health research centre in my village.
We were a family of seven until recently when my grandmother passed away. My father grew up in Andhra
Pradesh and my mother in Kerala. My father (Dr. M.S. Thomas) is a general practitioner in our own town
(Kodur). Kodur is a gram panchayat and taluk. My father did his schooling, college and went to the university in
Andhra unlike my mother who was in Kerala in the meantime. My family migrated to Andhra in the late 30s after
my grandfather did his medicine from Stanley Medical College during his work with the leprosy mission in
Gundalpet. Later he settled down in Kodur in the late 40s before which he was working with the mission hospital
in Renigunta. The urgent need for a doctor in Kodur probably made him move to Kodur. He was a sincere and
nice person from what I have heard. He had a school constructed for the primary school, a post office for the postal
department, an office for the district education office, and a telephone exchange. I sometimes wonder how broader
his views were and how high his reach was. His sudden illness and death was quite a shock to my family because
my father was just married and had just started work at the CFC (Christian Fellowship Hospital) and three of his
sisters were still not married. My father moved back go Kodur to continue his father’s work. He worked with the
Lions Club and the Leprosy Mission until they shut doors. He helped some of the early missionary medical services
that were set up in the early seventies from Denmark, the US and Germany. During this time, he however did
have a private practice (OP) that is only a outpatient set up. His patients still get their Pentids (sarabhai
chemicals) and rarely does he prescribe higher molecules. We do not use pesticides in our garden and rarely do we
use chemical manure. Our chickens at home are healthy and resistant to disease, and one chicken is about 11 years
old and continues to lay or two at times. We are happy in our village set up. However, the scenario today is
totally contradictory; the villagers use pesticides indiscriminately; the use of chemical fertilizers over organic
manures seems to be fast gripping the farmers. The source of clean drinking water seems to be fast disappearing
5
because the ground water has been totally exhausted. Health care is a farce in the town because the doctors have
turned into agents for the specialists in neighbouring Tirupathi and Madras. What really disturbs me even more is
the lack of rains and proper Mango crops has worsened the socio-economic status of the people which has degraded
the health status over time. Ignorance and lack of basic amenities is pushing many to suicide. These ever-constant
deterioration needs to be addressed very soon. This responsibility has to be taken by someone sometime, and the
buck should stop here.
I am encouraged by the work of many around me and by my instincts to think that community health needs and the
general social needs can be met with constant effort from the part of many individuals. Moreover, with the large
knowledge back of many responsible individuals in specific communities can be tapped to identify problems,
solutions and also help formulation of policy and later monitor its implementation.
The encouragement of my parents has been very good and also been constant and ever refreshing. They supported
me in various boarding schools and university too. I have been on my own since a year and I have been St. John’s
Medical College. I came into St. John’s to actually do a study on oral microbes in November 2001 and worked
under Dr. Ragini Macaden for a period of 4 months. Later, when the project failed to kick off due to financial
problems, I spent a few months unemployed. Now, this is my 10th month of work in the Health Informatics Group
of the Division of Nutrition. Here we generate fact sheets for the London School of Hygiene and Tropical
Medicine. We research a subject and make medical literate in layman terms. I have learned the art of searching the
medical evidence validating the same. I have gained a good hold in using computers to my advantage. In fact, I
have gained a lot more than just this.
What I really want you to in earnest in your valuable advice and guidance. I would definitely need you to help me
gather a perspective and direction to my work and study. I would be benefited in many ways by working with
CHC; firstly, I would learn the ground level field work, the problems faced by every health worker on the field at
various stages.
In addition, I would learn the method of forging partnerships, networking with other
organizations having group discussions, planning etc., I hope I would be able to do an internship with CHC and be
a part of its activities.
The important feature of CHC and its new branches has given me a small idea of the broader objective of the CHC.
I would be happy to hear from you and work with you in the days to come. I would like you to know that current
job has helped me sustain myself during the last year, and I would be glad to continue this part if you have no
objection.
But if the time constraints seem pressurizing, I would stop working at the Health Informatics Group”.
6
The most interesting thing that happened to my life in that period of time, between
attending the interview and being told I was selected for the internship, was an
increase in my “Total Happiness Index”. I thought even if this internship scheme
doesn’t come through, I still know who I should be associated with in the future.
In short, it was wonderful to meet a group of highly committed people with a
great sense of creativity and communication and their selection methodology was
genuine, simple and open. I knew then that the philosophy of Gandhi still lives
and it is possible to contribute to positive changes in the field of community health
and development.
The internship programme structured for me began on 3 June 2003.
The orientation programme made helped to a large extent in my transition as a
clinical person to a community health person. Clinically one tries to see thinks in
black or white and see the disease as a separate entity and not as a part of a holistic
entity.
Paradigm Shift
Medical Model
Social Model
Individual
Community
Patient
People
Disease
Health
Providing
Enabling
Drugs Technology
Knowledge / Social Process
Professional Control
Demystification
This change of course was impending within but truly it was nurtured at the
CHC and while working with Fr. John Vattamattom.
The orientation
programme was to a large extent useful to make the fellow / interns feel at
home and also discover the areas of community health they like, or they are
more likely to enjoy.
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2. Introduction to Community Health & Orientation
A new chapter began on the June 3 2003. I had committed myself to a six-month
program that would help me to learn about community health and development,
and to develop my skills as well as strengthen my beliefs.
There were five of us in the three-week orientation program on health and
development. The programme was designed to shake up our preconceived notions
about ‘community’, health and disease. Some of the biases each of us carried were
highlighted to let us understand the broader concepts of health. Our medicalized
views on health and treatment were challenged with examples, discussions, and
also role play. Our concern and sensitivity towards the underprivileged, sick,
exploited, and the neglected was strengthened.
We had met all the staff members of CHC by then, but not at individually. When
the staff opened up the Pandora’s box on community health through their classes,
we had the opportunity to meet them and learn about their initiatives and areas of
interest.
Some of the areas covered in the classes were as follows
-
A broader understanding of health - Community Health, Health Challenges,
understanding doctors/healers roles, Community health needs, People’s
Health Movement/ Globalization etc.
-
Communicable and Non-Communicable diseases
-
Alcoholism
-
Gender and Health,
-
Food and Nutrition
-
Traditional and Western Medicine – Philosophical paradigms
-
Working with Communities – Various approaches
-
Life skills
-
Problem Identification and Solving, Creative and Critical Thinking, Decision
Making Skills,
-
Self awareness and Empathy
-
Communication and Interpersonal Skills
8
-
Stress and Emotional Management
-
Counselling in Addiction.
After lectures one spent time in the Information Center at CHC. The Librarian, Mr.
Swami, helps fish out the most untraceable book and journal. These classes were a
much more interactive and relevant than many of my classes in university and
school.
Through the three weeks of input sessions, I perceived the differences between
primary health, community health and public health. But there was no concrete
understanding of ‘the whole picture’ yet. I knew there were components of
primary health and public health sphere that spoke of a larger picture of health,
but the community health angle was still unclear. I had not lived in one while I
worked on health and healthcare.
“Health for all by 2000” I always wondered about that. What had made them pick
this date? Was it just a round figure? Now I know the seriousness with which the
nations had come together that day, that time in Alma Ata. Most important of all,
meeting the people who were involved with that time, who must have been as old
as we are today, was very moving.
One of the most painful issues we discussed was female foeticide practice in India,
and the alarming rates of such atrocities in the parts of the country. Dr. Mira Shiva,
a senior staff of the VHAI (Voluntary Health Association of India) said that some
informal studies done by observers in New Delhi showed a male to Female
Ratio/1000 (MFR) as low as 650 for every 1000 male live births. This certainly
reflected the urban Indian’s adoption of the greed, and the obscene culture of male
glorification. Unfortunately, no one opens their eyes to their own stand against life
and the values of life. The stark contrasts between rural India and urban India was
certainly on my mind but certainly not reinforced as it is today, after a year in rural
Andhra Pradesh. In all, the state of health in India made me open my eyes wider to
the issues surrounding us.
9
The National Working Group(NWG) meeting of the Jan Swasthya Abhiyan was
the best introduction to community health and a public health perspective of the
India’s healthcare systems. Dr. Antia, plastic surgeon and community health
specialist of the Foundation for Research in Community Health was particularly
vocal about the nasty effects of the World Bank steering the course of the world’s
healthcare and health systems. Networks across India that had been contributing
to the Movement briefly talked their own activities. The Catholic Health
Association of India (CHAI), the CMAI……, the BGVS state units and the FMRAI
had very extensive and innovative programmes in that direction. The Catholic
Health Association of India (CHAI) of Tamil Nadu had collected more than five
hundred thousand signatures for the Right to Health Campaign under the slogan
“Health for All Now!)
This group planned activities for the year. At the meeting, the group paid special
attention to the Right to Healthcare Campaign and ways to work with the National
Human Rights Commission to take the campaign forward. They also discussed
and planned activities for the International Health Forum preceding the World
Social Forum in January 2004 at Mumbai. The group felt that a lot of young people
need to be infused into the movement for the growth and long-term success of the
movement.
The future of the communications between the partners was discussed in detail to
enhance the links between the various partners of JSA and the People’s Health
Movement. These experiences strengthened my own faith in movements in India
and elsewhere.
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3. Learning at the Community Health Cell
The strength of the Community Health Cell lies in its simplicity, ethical values,
and strong vision. It is indeed a great opportunity for young people like me to
interact and learn from skilled and seasoned community and public health
professionals like Dr. C. M. Francis, Dr. Ravi Narayan and Dr. Thelma Narayan.
Dr. Paresh Kumar, sociologist, was particularly insightful into community
dynamics and approaches. The Community Health Cell team consisting of Mr.
Prahalad, Mr. Rajendran, Dr. Rajan Patil and Mr. S. J. Chander were generous with
their inputs, advices, cooperation and help. Dr. C. M. Francis’s contribution to the
cause of community health that still continues to date is a testimony to those
young people pursuing a year’s internship. The library and documentation centre
is particularly extensive and exhaustive. The staff paid a lot of attention to detail.
Though there are some weaknesses in terms of computer networks and a stable
access to the Internet, the overall resources available at the centre are excellent
After classes, we visited various initiatives (by mostly NGOs) as a part of the
process of learning by doing. Among them were the initiatives with street children
by APSA (Association for the Promotion of Social Action), the Community
based Approach to Tackle Alcoholism (CHATA), an initiative of the Community
Health Cell, and World Vision initiatives to educated youth and children in slums.
We had also the chance to meet some nuns from different orders who were
working with women in slums.
APSA
APSA has been working with street children for decades and has made headway
in getting into the hearts of the children in the Jayanagar area. These children were
often from very poor households, who were either orphaned due to disease or
strife in family, or were let to fend for themselves from a very early age. Some of
them ran away from home due to petty quarrels or sustained disagreements. They
have a social network which offers support to a certain extent. They earned a
living by begging and running errands. These children earned much more than
what a coolie would earn in a whole day.
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The youngest of the kids we met during one of our visits was a 6-year-old boy. He
like many of the other children was addicted to sniffing Eras-ex. The children
never compromised on some things - food, cigarettes, beedies, alcohol, and the
eras-ex solution.
The staff members of APSA had fallen in love with these
children, and often wondered what they would do without them after a while.
Wednesdays were special to the children, as the APSA staff would come to
Jayanagar 4th Block, near the Bus Station to meet them. The children tried not to
miss this meeting and often openly said that this was the only window they have
to care and affection. APSA tried to give them legal support, counselling, and
space to settle their differences amicably.
We observed from close quarters that these children were quick learners, and
absolutely uninhibited. They had no reservations to talk about the police, violence,
sex, and drugs. The children seemed to be affected at a deeper level and were
lacking genuine love and concern, which is probably the result of an unending
saga of homelessness, abuse, harassment, hate, revenge, fights, drugs, hurt and
resentment. Their behaviour is the sum of societal neglect and gross lack of
empathy.
Today, we are at a crucial stage when we stand on many such human time bombs
such as these children who are finding their own meanings, their own paths, and
evidently their own destinies. When antisocial elements in society get their hands
on them, they would benefit from their confidence and hurt for illegal purposes
such as violence, theft, drug trafficking, and commercial sex.
APSA is trying hard to rehabilitate them and to take them off the streets after
counselling them adequately. Only a few have undergone a change of heart. As I
think of those children my heart sinks; even their basic Right to Life is under
question. Hardly any of these children see the daylight of adulthood and
responsible living. Most die young due to disease as a result of lack of care,
support systems and societal rejection. Very little is understood of the number of
street children who have come out doing well on their own, or rather nothing is
documented. Some of the boys end up working as ‘hit-men’ and local ‘goondas’.
12
It would be miraculous, if we can rehabilitate such children in a rural setting with
employment and schooling together, where their strengths are to be identified and
their skills nurtured to be able to bring “the best citizens possible” out of them.
Community Health Based Approach To Tackle Alcoholism (CHATA)
Almost over one and a half years ago, Community Health Cell had taken up a pilot
study to assess the effectiveness of a community health based approach to tackle
alcoholism. Mr. Rajendran had initiated the study and action research on the
approach with the help and support of other members of the Community Health
Cell team.
This programme primarily aims at strengthening the support mechanisms in small
communities prone to alcohol abuse and alcohol related problems. One of the
methods adopted was to build close contact with the local communities through
women’s forums. Through the forums women shared with one another, their
experiences with alcoholic husbands and children. This process moved the women
in the community to action and made them take decisive steps in convincing their
husbands and children to quit. Most often, it was the ‘method’ of using love and
concern, which yielded better results. Force and confrontation was never used in
this process. This yielded not only community participation in the programme but
also a great deal of participation in other community developmental activities such
as construction of roads, drains, and latrines. The people who underwent
detoxification treatment at the National Institute of Mental Health and Neuro
Sciences (NIMHANS) became community witnesses. Sudhamanagar Slum is a
classic example of a success story in the little effort against the dreaded epidemic
of alcoholism.
A study in NIMHANS of a 20 year follow of persons treated with hospital based
care at the institute showed that only one of the 20 persons followed up continued
to live as a alcoholic, while 10 died and the others were unavailable in their earlier
places of stay. This depicts partly the ineffectiveness of hospital-based
rehabilitation or rather its failure.
13
Some of the observations one would make at this point of the study on the reasons
for the increasing trend of alcohol consumption would be
-
The increased dissatisfaction among the marginalized about their social
standing and a disgruntlement at the widening gap between the affluent and
themselves
-
Escapism from an unpleasant reality
-
The unmet need of healthcare among the marginalized which has led a number
of persons to a cycle of debt
-
An exposure to alcohol in one’s youth as a part of peer pressure and groupdecision making
-
The increased number of outlets serving alcohol and the setting up of targets
by the State Government for which the traders even serve alcohol on credit to
meet the requirement. In fact, the number of retail outlets for alcohol has had a
steep four-fold rise in the past few years
-
Lack of life skills and lack of basic self regulatory and self moderating capacity
among the people due to extreme poverty and lack of information
As a part of the fellowship, I made the most by learning from Mr. Rajendran, his
captivating style of community-based communication, his empathy, and his
dedication to the cause of those under the grip of alcoholism.
Life Skills
Community Health Cell team member, Rajendran, also imparts life skills to
adolescents in the slums. World Vision is working in the Rajendra Nagar slum area
concentrating on education and vocational training of adolescent girls.
Identification of children for the life skill education was not difficult there.
The life skills were imparted as a part of the tailoring classes the girls attended at
school. The responses to the classes were tremendous, and the outcome of the
classes was sometimes unbelievable.
14
Once, a girl asked Rajendran how it was possible to make her father stop drinking
and also stop hitting her mother. She lived in a slum and was from a family of five.
After asking a few questions, Rajendran observed that she wasn’t very affectionate
with her father though she loved him, and here was an opportunity for her to help
him out with his problem.
He asked her to change her behaviour towards him. He asked her to go to him, sit
next to him, give him a hug or hold him. He asked her to tell her father that he
ought to show his love to them. The girl did so in the following days, and there
was a miraculous outcome; the man quit his habit of drinking and promised to
stay away from the habit. Though the incident smacked of a testimony in church,
but it really did happen. It was a miracle we often forget we are capable of
performing. It seemed to me that life skill education has enormous potential to
help adolescents and young adults to face, solve and overcome hurdles in life, to
make the right decisions and to take appropriate measures in stress situations.
The Anti-Tobacco Campaign
The Community Health Cell team has been working extensively on the issue of
tobacco and poverty. Chander, who heads the initiatives along with consultations
with the other team members, has been networking with various other NGOs and
CBOs in strengthening the movement. College students are being roped in through
interactive sessions and talks on the ill effects and the social paradigm of the
problem. Anti-tobacco rallies and demonstrations have been held with the
networks. This has been an ongoing activity of Community Health Cell for many
years. Its pace and strategy have been well worked out to improve the current
trend of the movement.
Movements and Campaigns
The People’s Health Movement which took shape after the Dhaka summit of the
People’s Health Assembly in the year 2000 was of great significance to me
15
especially while considering the strength with which it dialogues with
Government at national and international levels. The National movement called
the Jan Swasthya Abhiyaan has groups in various states
Meet Sister Celina
A group of nuns located very close to the Ragigudda Slum near JP Nagar of
Bangalore introduced us to many of the families, with whom they closely worked
on economic empowerment initiatives. Some of the women of the slum agreed that
since the economic empowerment programs were linked to the education of their
children, their children’s education got a higher priority. The initiatives of the
religious nuns we were able to give us an in depth view of the economic
empowerment programs among the urban poor.
Observations
- Many young adults and old were suffering from Tuberculosis (both history
and symptoms suggested)
- Housing was poor and there was overcrowding in almost all the homes
- Many women lived on beedi-making and agarbatti-making for their
livelihood
- Women deserted by their husbands too lived in the slum while taking care of
their children and earning
- A lot of children were yet to be enrolled in schools and had not been sent to
Anganwadi centres either
- The narrowness of the streets and the lack of space brings about frustration
among children who enjoy space and freedom
- A lot of children were however yet to be enrolled in schools and had not been
sent to Anganwadi centres either
- Slum dwellers seem warm and friendly always offering a seat or something
to drink immediately afte being introduced.
- Slum dwellers are generally more resilient and strong. They have developed
mechanisms to face the everyday struggles to survive and live too
- There are issues like goondaism and exploitation that are not spoken about.
The slum dwellers remain under the grip of unscrupulous elements who
often exploit of the weakest.
16
This exposure to various urban issues put forward many questions in my mind
and had a tremendous impact on the way I speak with street children,
alcoholics, house helps, vegetable vendors, auto drivers, and rickshaw pullers.
I know now that each one has a narrative of resilience. These growing numbers
of displaced people living in cities strikes me as a spill over of rural poverty.
People in villages are proud of their own villages. They have an identity, have
an address of their own, sometimes even land of their own. Most often they
have family and friends whom they know from birth. Here in the cities, they
do not often have a sense of belonging. It takes a while before such belonging is
felt in the city. Even card-carrying city dwellers often long for home after the
fist few days in a new place.
My exposure confirmed what I had been told. Most health problems have an
underlying social context and a socio-economic link. A larger displacement of
the rural poor and an extreme growth of cities cannot be immediately
prevented. It needs careful thought and political will for this to be gradually
phased out, or even to be discouraged.
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4. Setting Objectives & Planning the Year of Fellowship
After much internal introspection I arrived at a set of objectives that I set for myself
for the one year of fellowship. I knew some would change and Dr. Ravi Narayan
helped me break up these goals into smaller tasks.
Introspection
•
To learn how Health is a part of development and to explore a vocation in
Community Health taking into consideration wholesome health
•
To be under the guidance of able and experienced hands and to share their
dreams, experiences, approaches, failures and successes
•
To build my own capacity and to change certain beliefs and assumptions
that may be harmful
•
To have a years time for soul searching on my stand in order to deepen my
own understanding of the power centres that affect health at various levels
Community Health (General Learning)
•
To integrate various aspects of Health with general sustainable
development
•
To internalise the aspects of equity, distribution of healthcare, and the
access to healthcare.
•
To understand the larger determinants of health and disease for developing
necessary safeguards
•
To understand and resist exploitative medical, pharmaceutical and other
healthcare practices which impoverish middle and low-income groups
•
To study the structure and function of the Public Health system as also of
the Private healthcare system and understand the merits and demerits of
each of them for planning an alternate system, where both coexist
(perhaps) devoid of malpractice and negligence
18
Community Health (Field Learning)
•
To develop a bond with people belonging to rural regions in India to
understand their future in terms of the current context of healthcare
•
To strive towards preserving the existing integrated systems of healthcare
•
To bring about and promote local innovations in community based health
systems and integrated development
•
To be in a community based ‘health and development’ programme for
removing biases that comes from distance learning.
•
To try various approaches to reach village communities and to first
understand their pace of life, they’re needs and aspirations, before planning
and intervention.
•
To learn how concepts of Health can be kept simple, comprehensive and
fair.
Networking
•
To share the enthusiasm and commitment with other persons and
organizations in the field of Health and Development
•
To network with them and build capacities and plan a more streamlined
and united approach for affecting greater challenges in policy that bring
equity in access and distribution
Communication
•
To understand and learn to the use of media to get across the concepts and
practices in simple and effective healthcare models
19
5. The Journey with Sanghamitra
Here is a brief account of the one year of efforts, from Sanghamitra towards
strengthening of the sub-centres in Chegunta Mandal. This is to give you a brief
idea of the activities in the project that concluded end of August. In all these
activities I have worked as a part of the team and always associated with the
planning and implementation of these programmes.
In addition to the sub-centre revitalization programme the most important of the
health initiatives taken up by Sanghamitra was the community eye health
programme. This programme was planned and proposed to the Sight Savers
International, which then came into operation in April 2004. It was indeed a good
experience.for me to have been able to help in the project planning, and
implementation. This showed me some of the most difficult areas in development
including that of Human Resources and Human relations.
Today every village in the Mandal has a village health committee, self help groups
that monitor their functioning and youth activists who report some of the gaps in
the health system and how one could change things.
1. During the project period Sanghamitra strengthened the village level
awareness on the public health system through daily village visits to meeting
with Self Help Groups and the village Janani Committees. These village
meetings contributed to increasing awareness among women about the health
facilities, the services available and also regarding the duties of the public
health personnel.
2. Most villages and hamlets in the Mandal were covered during the project
period for purpose of strengthening the people changing their perceptions of
the public health system. The Janani Committees became the main contact
points of the villages during the year for all health related activities in the 36
villages and the 8 major hamlets. The village JANANI COMMITTEES have
been imparted knowledge about the services of the public health system that
are due to the public as a state responsibility and not as a welfare measure.
20
3. The JANANI committee members today help the health workers from both the
public health department but also from NGOs and other Governmental
Societies such as Velugu and DWCRA to conduct surveys, report deaths and
report case studies of denial of healthcare in public and private healthcare
facilities.
4. Though the time frame prescribed by the project to empower village Janani
Teams, Village Health Committees and the Community Advisory Boards to
take up the complete responsibility of locally monitoring the services was
realized to be quite insufficient considering the slower pace of village life and
the village reactivity to programmatic implementation of the project.
5. The project holder, Sanghamitra, facilitated people to make complaints
regarding the poor services in the Public Health system in the area. These
efforts initially brought about criticism from the Government Staff, but over
time all the staff members realized that the project intervention was intended
to bring back transparency in the services of the Public Health System. Today,
many of the staff members continue to collaborate with the project holder and
the Janani Team Members in activities that improve the health conditions of
the people.
6. The health committees in some of the villages brought to the notice of
Sanghamitra cases of denial of healthcare in many different places.
Integration - A vision with Fr. John
Integration has been Fr. John's dream from the time he was working with the
Catholic Health Association of India (CHAI) as the director. As the founder and
secretary of the organization Sanghamitra Fr. John is hopeful that the objectives
with which they setup Sanghamitra would be realized some day. Fr. John always
says that the deeper meaning of integration must be understood by the people, the
leaders and the administration. So, he always begins with the staff of Sanghamitra
lays emphasis on their role of integrating the health sector, the developmental
21
sector, the agricultural sector, the forest and environmental sectors, the education
sectors and the administrative structure. He believes that true development would
take place only when there is unison among these sectors.
During this one year...
The sub centre revitalization programme
I was closely associated with the village library project a population of
20000.
The community eye health programme covering a population of over two
hundred thousand
Identification of children who are in the risk of being trafficked
Working and interviewing Street sex workers
NB: Programme reports set as annexure
22
6. The Land and Plenty of Talents
Tapped or Untapped?
The Mandal of Chegunta is known for its diverse population and peaceful coexistence
- different castes, religions, sects and economic strata, alike. This coexistence had
contributed to the growth and development of the society in diverse ways.
Chegunta and its neighbouring mandals flourished once with weavers, artisans,
basket makers, shoemakers, dressmakers, potters and acrobats. The strength of these
art forms came from generations of dedication, steadfast local improvisations and a
constant demand for the various products. The market and demand for these products
and art forms had existed locally for many hundred years but unfortunately died a
sudden death. The sudden changes in the open markets, mass industrial production,
and lack of preparedness among artisans and neglect of such small industries
impoverished the artists and lead a number of them to migration and suicide. Some of
the well to do persons took to other lucrative professions. Today some of these
professions lack the critical mass to voice their concerns about their difficult lives and
dying professions. These people are also best at their own trade and profession. They
are less inclined to other forms of livelihood opportunities and this warrants
intervention from many quarters including those of Governmental agencies, NGOs,
local bodies, women's collectives and surely that of the communities in which they
live.
The Last Man Standing
The Weaver Community engaged in the making of cloth, sarees, dress material, dying
and embroidery have only one person in the whole of three blocks (as far as the
knowledge of the people of the community *(Padma Shali) continuing the profession
of their ancestors. Shri. Bala Narasaiah is the last man standing, and does the long
learnt art in pride. He does not produce many items but takes care that he does not
stop spinning wheel. His wife is a proud and worried woman, who describes the pace
of his work as "sacred". She again lightly puts it as "Nela oka pogu" (one yarn a
month).
23
The Sanghamitra team that visited elderly man were touched by his sincerity,
humbleness and simplicity, not to forget his hospitality. He said, he could teach this
profession to patient, and eager youth who could carry on this profession. He said that
women could well carry out this profession forward if they were given the necessary
training and support. Shri. Bala Narasiah is the last man standing against the
onslaught of the effects of industrialization, neo-liberal economic policies and
globalisation.
Wooden Wonders
What was passed on from the fathers and forefathers of Mr. Md Sarvar Hussain today
still holds hope and livelihood for the 20 families of Chettlathimmaipally. Wooden
handicrafts - such as Units for garlands and wooden ornaments, Door knobs,
Koolattam sticks, Dolls, and other small artistic carved wooden implements. The art
from must have originated from the Mughal time and has a history of more that 150
years in this region. This art from provides a round the year employment and has an
excellent export possibility in the years to come. Today, it is limited to Hyderabad but
if explored, this art from can build into a very good small scale industry and the
results for the communities needs no mention. Mr. Md Sarvar Hussain, and Mr. Md
Kausar Hussain of Chettalthimmaipally have a lot of promise in store and we could
well take them to higher strides through integration and support.
Bangles of Pearls
Chandampet has been long known for making bangles with pearl and precious stone
inlay work. Today, as many as One thousand of such artisans have migrated from
Chandampet for better prospects to other areas thus leaving the local economy in
shambles. The support system in the local economy was devastated a few years ago
when the market economy came into full thrust and industrial production of less
exotic and cheap bangles were produced on a mass scale in various parts of the
country. The local traders did not have the necessary inputs on aggressive marketing
and were suffocated with the breakdown of their market.
24
Today, there is hope again with women involved in DWCRA SHG groups taking the
lead in reviving the production lines of the profession. We hope that their effort have a
long way to go and lots to promise the local economy and the pride of the people of
Chandampet.
Potters with Empty Coffers
The potters the region have another miserable story to tell.... There are many potters
and the new age pottery has not left them with much. The changes in the wants of the
people and the changes in the lifestyle of the people has left them with little. The main
employment generating source was earthen roof material. The roofs of concrete, which
do not conform to the climatic conditions and health of the people, have decreased the
demand for earthen roof material to an all time low, to almost nothing. Brick houses
and concrete jungles in the area have not only affected the growth of the industry but
also changed the economic support systems of the people of the area. Lack of
knowledge and stagnation among the potters and other social factors has brought
them to this pitiable situation.
Prospects for them seem bright when we see the brighter sideTile making units, brick making units and other small handicraft from making units of
clay and mud can change the bleak future of the community....
Baskets of hopelessness
Basket making tribes in the area are underpaid and have been at the mercy of bargains
and daily troubles. The skill passed on to them from generations is still being utilized
to the maximum today... We need to bring hope to these people through a well
thought strategy that would bring sustained equality in pay and earning.
Improvement of skill through skill development classes and training programmes can
bring much entry into the markets of cities and local minds.
25
Women neglected, society demolished
Women In the area have taken to beedi making putting their mental, social, physical,
and spiritual health on a thin line ... We need to bring back the life of the people and
identify with them closely, as close as to the heart. The changes in the economic
patters, markets and the new age needs kept in mind we need to change things
positively and for good. Women need to be not just empowered economically but also
given their due in society through out programmes....
We need to bring back the glory of the skill in the area and involve the women in this
effort to the maximum...
Schools of Weaving, Units for Bricks, Units for Wooden implements and basket
making industries have lots to promise,., Aggressive marketing and education of local
consumers of self sustainability of economies is the need of the HOUR.
26
B. Kondapur Village, Chegunta Mandal, Medak District
The Janani Team
Bonal S/C
1.
Sarpanch, Chairperson
Sri. Karingula Mallawa
2.
ANM, Convenor
Smt. M. Sarala Kumari
3.
Ward Member
Smt. Paleti Laxmi
4.
Anganwadi Worker
Smt. R. Napurnima
5.
Self Help Group Members
Smt. Srkali Mangamma
Smt. Chanda Mangamma
6.
Mother’s Committee President
Smt. Boya Padma
7.
Youth Activist Preferably Adolescent
Rangammapari Swapna
Action Plan area of ANM including all the Hamlets and Tandas
1.
B. Kondapur
2.
Bondal
3.
Pulimadu
4.
Kistapur (t)
ANM Signature
Sarpanch, B.Kondapur
PHC Medical Officer
Mandal Development Officer
27
7. Soul Searching
There is a lot of truth out there; we just need to realize them…. Live them
and see what we need in our lives, take them and carry them for others to
see. Truth is what will change hearts, not intellectual exercises –
I made this up.
There is a philosophy of Disease, the realization of `Self’ during illnesses, the
knowledge of civilizations, the philosophy of simple and holistic health, the humility of
healers, simplicity of their thought, the need for sacrifices in life, the acceptance of
natural death, and the simplicity of healing, which are the utmost lessons of health in
the Indian context.
We have a rich culture that has a beautiful methodology of dealing with sickness and
the soul way of dealing with losses, disease or disability. For example, we need to
appreciate the concept of community based healing of the mental illnesses in many
parts of the country. Though we are on a warpath trying to ape the western hospital
based care, we need to keep the ever more simple and effective approaches of healthcare
in the reach of all people. All!
In September 2003 I began my journey with rural India's health, where fresh air, simple
living, nutritious and fresh food, and love were in abundance. I surely did not look for
what they did not have. `People - sure did not have my `know it all attitude'.
These were some of the most intriguing times of my life, when I was left to
myself in a relatively underdeveloped region in terms of investments and
industry and left to feel with the people what their everyday lives had to
offer, the processes in place, the systems which were either or not in place,
and to see the patterns of livelihood opportunities and future trends that
were to come.
The experience alongside Sanghamitra work in the area was particularly
enriching because the organization is young with its set of teething
28
problems, and with its own philosophy that's evolving with in-depth
involvement in communities. One of the many things I learnt to be patient while
looking at bringing about changes in systems. Patience is a virtue that has to be
picked up whenever possible and this would be particularly useful to those
working with the public health system, because of the intrinsic slow speeds with
which things take their course. But, there is of course the need for a systematic
involvement of communities in taking up health and development at all levels
beginning from the villages up to the district and state than leaving anything to
chance.
-
As children we did know that we could change situations since we used pencils
and erasers… but as we grow old we begin to believe that we cannot change things
because we use indelible ink and we just feel suffocated without finding solutions.
-
I made it up.
29
These fellows and interns can be placed in areas of interest such as public health
economics, public health planning, financing, globalization and public health,
disaster management, etc., or rather new areas such as public health and media,
animation, communication strategies, creative writing, text book writing for school
children. The spirit of CHC linking between activism and policy advocacy should
be strength. CHC expands operations to other states or regions through these
linkages
30
The fellowship programme should be dynamic and accommodating to the interests of
the individuals, which it does today. The programme is certainly aimed at bringing a
dialogue between various players in this fast changing world for healthy futures in
order to safeguard the interests of people who otherwise become spectators of
destructive changes. Public health in India is still in the process of searching for the
right answers to many complex situations. Community based health programmes that
are self sustainable with equal participation of the State needs to be brought about
with ardent efforts of young individuals who dedicate their lives to bring about the
much needed changes. It is important to keep in mind the time it took for many
organizations to build their capacities to the extent they have come, which would
remind future generations that one needs to live not just for today or a lifetime, but for
the future of the world surrounding generations.
This association through my internship with Community Health Cell has made a
tremendous impact on my life. I thank each one my guides and team members of
CHC, Sanghamitra, and all those who were associated with me for giving me the
insights I have today and I believe we would work together in this journey together.
I thank each one of you for being a part of my life. I thank Matthew Abraham
especially ' having been an excellent support during this year as a colleague and
friend.
31
ANNEXURES
Sanghamitra – Sight Savers International
Comprehensive Eye Care Services (CES) Project, Medak District
A brief account of Project Implementation
The project was initiated with the selection and training of 12 Eye Health Workers, one
supervisor and the Coordinator of the project at ICARE, LVPEI, Hyderabad. The three
week long training programme was carefully crafted to cater to the need of the
CEHWs and supervisor staff members. One supervisor joined the team on 12 May
2004 (He is trained in community eye care and community based rehabilitation at
ICARE LEPEI and was involved for six years with various initiatives in community
eye care and community based rehabilitation programmes of LVPEI in conjunction
with SSI).
The Project Team
Project Director
:
Fr. John Vattamattom, SVD
Dr. Abraham Thomas
:
Chief Project Coordinator
D. V. Ramana
:
Project Supervisor
K. Muthyalu
:
Project Supervisor
Community Health Workers
Pulaboina Devanand
Rukhsana Sultana
Pembarthi Laxman
Koppunnuri Veerapa
Kondal Reddy
Kolupula Anasuya
Kondal Goud
G. Srikanth
K. Radhakrishnan
Gatu Vinodha
M. Ramesh
Shabana
32
The Next Step after the Training
After the training programme, Sanghamitra conducted a Door-to-Door ‘mock baseline
survey’ on Eye Health for three days in the neighbouring villages of its operational
area. This was done primarily to evaluate the CEHW’s performance at field level and
to ensure efficacy of the actual baseline survey.
During this period, Sanghamitra arranged few training sessions with “Velugu”
Resource Persons, “Local Doctors” and other in-house staff members regarding the
local terrain, habits, diseases and socio-economic and sociological aspects of the area.
This helped the CEHWs to understand the spirit of Sanghamitra and to know the
other activities, with which Sanghamitra is actively involved. This also helped in
bringing about integration of various activities of the organization.
The baseline survey on eye health began immediately after the return of the staff from
their training at LVPEI.
For undertaking the survey Sanghamitra prepared the following materials:
•
Baseline survey forms with translation (to Telugu) (provided by SSI)
•
Consolidation forms and lists (provided by SSI)
•
Area revenue details
•
Population and other details from previous surveys of the Velugu Project
(APRP)
•
PHC and Sub-Centre details
•
Route maps
•
Lists of primary and secondary schools
•
Lists of Auxiliary Nurses and Anganawadi teachers
•
Details available with Sanghamitra about differently able children.
33
Physical Performance
I. Resource Built
Total number of review meetings
8
Total number of Awareness campaigns conducted at village level along 10
with the baseline door-to-door survey
Digital video recording of the survey and educational programmes on 1
eye health
Meetings with Velugu Project personnel [Govt. of Andhra Pradesh, 2
Society for Elimination of Rural Poverty (SERP)]
Orientation of CEHWs to tapping local resources in project area
3
II. Eye Care Activity
Summary of Door-to-Door Survey
Total number of villages covered
33
Total number of Households surveyed
Adults
Details
Male
6228
Children
Female
Male
Total
Female
Male
Female
Grand
Total
Total population
11947
12040
5365
5222
17312
17262
34574
2332
3235
224
269
2556
3504
6060
34
21
3
1
37
22
59
covered
Total number of curable
cases
Total number of
incurable cases
34
TO DATE THE COMPREHENSIVE EYE CARE SERVICES PROGRAMME
HAS ACHIEVED THE FOLLOWING:
•
•
•
•
33 villages and 18 hamlets have been covered through door-to-door
survey
a total revenue population of forty-six thousand (approximately) has
been cove3red during this period. A total of 6928 households and a
population of 35,547 participated in the survey.
59 incurable cases of blindness were identified so far (these cases
need screening and further evaluation before Community Based
Rehabilitation Programme (CBR) is begun
a large number of cases of Vitamin A deficiency were also identified.
Many other eye-related diseases were seen and have been recorded for
interventions at various stages.
(NB: The reasons for a difference between the revenue population and the
actual covered population were found to be the following:
1. Migration to other places in search of work as a result of continuous
drought conditions for the last 7 years.
2. Owing to people engaging in daily labour, and
3. Summer vacation]
The Baseline Survey – How we went about
The team of CEHWs were detailed for conducting the baseline survey in
groups of 4-8 members. They have been covering an average of 25 households
per day per person initially owing to lack of experience in conducting the
survey and the learning involved. This has now been improved and it is
targeted to touch 50 plus houses per day per CEHW. The lack of cycles and
motorbikes was supplemented by using auto-rickshaws and other means of
transport.
35
Activities planned for July
1. Conducting awareness programmes about the project and an Eye Health
in the context of the baseline survey findings.
2. Planning meetings with ICDS / Anganwadi teachers regarding
immunization programme linkages and IEC activities on eye health.
3. conducting training programmes on eye health for Anganwadi teachers
and ANMs.
4. Conducting community based education programmes on eye health for
Self Help Groups (formed by Sanghamitra and Government agencies).
5.
6.
7.
8.
Village Panchayatiraj members, and Primary School Teachers.
Identification of resources and resource mobilization for screening
programmes
Conducting community screening programmes.
Initiation of referral services to LVPEI through planning and MoUs (an
introductory letter to the Director of LVPEI in this regard expected).
Launching of the CES Project at block level.
Concurrently, the baseline survey will continue in Toopran and Ramayampet
Mandals.
36
37
38
Dear Mr. Vasanthram,
Here is a break up of the expenses Meghamala would incur in the next three
years. The monthly expenses could be increased if the need be, but otherwise, I
don’t want it to be that she gets used to a lot of money she wasn’t all these
days.
Thank you,
Abraham.
Sl.
Expenditure
Amount
Refundable
Yearly Total
No.
1.
College fees annually
2350.00
1800.00
550.00
2.
Hotel admission fee annually and
2750.00
1300.00
1450.00
deposit
3.
Monthly Hostel fees and Mess Bill
1150.00
Nil
13,800.00
4.
Monthly Personal expenses
400.00
Saving for
4800.00
the month
5.
Monthly expenses on stationery and
250.00
NA
3000.00
purchases for material in labs and
college
6.
Coordination expenses for Sanghamitra
1800.00
1800.00
annually
7.
Clothes
1000.00
Total support required
Total scholarship received annually
23,700.00
3100.00
39
The Science Channel
A process in progress
It takes many decades to launch satellites and longer to make them useful to common
people. As a part of the same effort, ISRO plans to launch a Science Channel that
would be accessible across the country.
To bring about participation and uniformity of character in the vision of the Channel,
DECU (Development Education and Communications Unit) of the Indian Space
Research Organization has initiated a contact programme all over the country. DECU
had brainstorming sessions in various cities across the country with think tanks,
scientists, students, farmers, union leaders, filmmakers, writers and people from the
mass media. These sessions were held in Mumbai, Bangalore, Kolkotta, Gauhati, Delhi
and Ahmedabad with the help of Ms. Chondita Mukherjee, a renowned docu-film
maker and thinker. Various student-volunteers, professors, and representatives of
Non-governmental Organizations helped in the success of the extensive and detailed
consultations.
Community Health Cell too took part in the initial consultations, and later in the
planning and facilitation of the two-day workshop at Bangalore. It took the lead in
planning and formulating the framework of the content on health content on the
proposed Science Channel. Dr. Sanjay Biswas, Professor of Mechanical Engineering at
the Indian Institute of Science (IISc) was the key organizer of the initial brainstorming
and planning of'the workshop. He also led the team in the final 2-day workshop held
at ‘Ashirwad’, on St. Marks Road in Bangalore.
A survey was done in Andhra Pradesh prior to the consultations at Bangalore to bring out information
on TV viewing among the southerners (Telugus, Kannadigas, Konkanis, Tamilians, Malayalies and
other linguistic minorities). CHC took the lead in doing the survey on rural Tv viewing. This was crucial
in giving shape to inputs for the health content on the channel.
The survey was conducted in Koduru, a block division in Cuddapah District of
Andhra Pradesh; here a lot of issues related to TV viewing were brought to light.
40
Aims of the Survey
-
To elicit the TV viewing patterns among rural populations.
-
To evaluate the needs of TV viewers of rural areas & to elicit their understanding
and its applications in their lives
-
To evaluate their likes and dislikes about TV programs
-
The role of TV in their lives today
And to understand
-
The language preferences among various age groups
-
The popular time slots for TV viewing and preferences among various age groups
-
Their preferences and formats of TV programs
-
How a Science Channel could help their communities?
-
To evaluate the popularity ratings among rural TV viewers
The survey brought out facts about the necessity for an accessible, interesting and
imaginative science channel that can bridge the rural urban divide on access to
information and technology. The additional advantage of using the science channel to
have interactive classrooms, was observed to be a useful proposition in the context of
poor education quality among rural schools, both public and private schools.
Health Deliberations for The Science Channel
The two-day consultations were formulated to accommodate discussions on broad
topics such as water, communication, management of the channel, and lastly
communication technology. The proposed health component of the science channel
was discussed with a panel of doctors, social workers, health personnel and free
thinkers on the subject. Two areas of health that are often neglected - women's health
and mental health were deliberated upon owing to availability of resource persons
who happened to be specialists in women's health and mental health, respectively. The
broad outlines with which the discussions started were based on the earlier survey.
-
The channel should be socially relevant
-
The inputs should be interesting, & technically and scientifically sound
-
Something that came out of the survey was to keep the channel more focussed on
the promotive aspects of health than on the curative.
I think the Science Channel is ISROs (Indian Space Research Organization's) most
innovative brainchild in its efforts to make "Science for Everyone ".
41
Annexure 1 (The Minutes of the Deliberations)
Report on the Deliberations of the Health Group for the Science Channel
The composition of the health discussion group
1. Dr. Uma Sri, health communicator and specialist trainer in health communication
1. (Village school exercises and interactive learning through visuals), Worked with
and organization called THREAD in Orissa
2. Elizabeth Vallikad, Former professor at the KIDVAI Institute Of Oncology,
Bangalore. Currently head of the Department of Gynaecology at St. Johns Medical
College, Bangalore
3. Dr. Srinivasa Murthy, Professor and Head of Psychiatry, NIMHANS (National
Institute Of Mental Health And Neuro-Sciences), Bangalore Specializes in
behavioral psychiatry and life skill education to children and adults
4. Dr. Sanjeev Jain, Professor of Psychiatry, NIMHAMS
5. Dr. Rajan Patil, Community Health Cell (Homeopathic Doctor, Epidemiologist,
Specialist in Vector borne diseases such as Malaria, Kala Azar and Dengue)
6. Vajranna, (A village health activist)
7. Sachin D’souza (Intern, St. Johns Medical College and Hospital, founder of the
Forum 19. (1). (a) which deals with various Current Issues, Health Issues, Rights
issues and Awareness among various student groups across Bangalore.
8. Suvarna Deshpande, Video Production Unit (DECU)
9. Michael John, Film Maker, worked as a film maker with CHAD, Vellore on
Leprosy and health related issues
10. Prof. Dr. Vidhyanand, Professor, Indian Institute of Science
11. Nirupama Sharma (Health Consultant), and
12. Dr. Abraham Thomas, Dentist, Fellow at the Community Health Cell, Bangalore.
The discussions were documented by a number of Students from Srishti School of Art
ad Design
1. Nithya Rao
2. Shamin D’Souza,
3. Seema,
4. Ekta,
5. Natasha, and
6. Thomas.
(Students of Communication and Design)
42
In addition, this group of students helped not only with the documentation of the
discussions but also by contributing innovative ideas and methods for the
presentation of the various TV programmes on health. Their inputs are very valuable,
and their doubts on health issues lent 'great strength' to the discussions.
Dr. Abraham Thomas, Focal Person for the Health discussions, moderated the various
discussions. He is a Ratan Tata Fellow for Community Health, at Community Health
Cell, Bangalore.
Minutes of the First Day Consultations
The initial discussions were aimed at identification of areas of health that require
immediate attention and address. Various persons at the group discussions introduced
themselves to each other and made themselves comfortable in the discussion group.
Prof. Dr. Vijayanand of the Indian Institute of Science suggested a documentary series
with the use of the Normal Functions of the Body since basic physiological functions
are interesting and is very important to know. During the later part of the discussions
on women’s health we found that this programme could be incorporated in education
on the biological development of the foetus, genetic influences, and growth and
development.
Dr. Srinivasa Murthy suggested that community health should be an important part of
the channel and be dealt with at three different levels
1. Grass Roots (the people of India)
a. Rural
b. Urban
2. Non- Professional, (for the health workers at Village Level, Block
Level, at Panchayat level and Anganwadi workers level)
3. Professional, (for doctors, nurses, technicians, druggists, etc.)
He also said that Mental Health was a very important subject for the channel and the
professionals and the government have neglected mental health and the issues around
it - eg. Dependence, Schizophrenia, geriatric mental health, myths and misconceptions
on mental health, etc.
43
Dr. Elizabeth Vallikad suggested 'women's health as a pressing issue that has to be
addressed with urgency through immediate action and constant intervention. She
gave startling statistics of the incidence of female genital tract cancers (cervical cancer)
and the high prevalence of this condition among Indian women; the commonest
causes of death due to this cancer are late detection and neglect.
The necessity for science, scientific understanding of health and effective health at the
grass root level was identified as an important step in the situation in India. Suggested
by Dr. Sanjeev Jain, this concept was agreed upon by the participants.
Dr. Srinivasa Murthy also suggested that the channel should be working towards
broadcasting (telecasting??)
- Three important areas
1. General information on health issues (health being a integral part of life focusing on primary education, primary health, clean water, good housing,
nutritious food - not drugs and treatment)
2. Controversial health issues through discussion and researched material, and
3. Specific validated health information
He also stressed the need to study areas of traditional medicine such as Unani,
Ayurveda, Homeopathy, and other Holistic Medical practices in India and to use the
channel to bring about the best of these areas and eliminate malpractices and
misconceptions. Dr. Rajan Patil, who is a graduate of homeopathy, suggested the
necessity to research various areas of holistic medicine and bring out the best the
various fields can offer.
Dr. Elizabeth Vallikad added, "There is a great deal of unlearning that we must
undergo to accept and to be open to the knowledge and methods of traditional
medicine. Eg, traditionally postmenopausal women supplemented calcium to diet and
avoided osteoporosis, instead it is compensated with so many drugs and supplements
today that are not only expensive but unnecessary".
To address the general myths about health and healthy living many participants of the
discussions thought the channel needs. The concept of buying health through
44
medicines was an important misconception identified even in the survey done in
Koduru, Andhra Pradesh as a part of the run up to the workshop.
Dr. Sanjeev Jain suggested that there is a need to understand the anthropological
aspects of belief systems and addressing them on those platforms, an important step
towards effectively dealing with the mindset of the people.
The issues of gender and gender inequality in health access have been proven through
PHC and hospital records in the past. Dr. Vallikad suggested it was important to bring
about social equality of health.
She emphasized on the alarming rates of female foeticide and infanticide among the
richest states in India (Punjab "754 females per 1000 males") as well as an alarming
decrease in the female ratio in Kerala, which is traditionally a female friendly state.
This suggests the negative use of high-end diagnostics (usually ultrasound machines)
meant to be used in foetal monitoring.
Dr. Vallikad said, "The regulation of these diagnostic centers as well as
implementation of laws stringently needs publicity and popular support through
channels such as these". Making doctors responsible and aware of the consequences
also needs special attention she said. At the policy level, attention must be paid on
such criminal practices and their social implications and should be a salient feature of
the health component of the channel.
Another major topic raised by Dr. Sanjeev Jain was the tendency of the Indian Medical
Education to cater only to the deeper pockets, making health inaccessible to lower
economic groups. The corporatization of health services and the corporate model of
health care were discussed along with the influence of the global economy on our
traditional and neo-healthcare systems. The transparency of these decisions and
changes, and what they mean to the health of the common man was considered to be
an important issue that needs to be researched and broadcast on the channel.
The necessity to integrate traditional approaches to health and health care and the
medical sciences was another area of the discussion that was greatly emphasized.
45
The entry of health insurance and the corporate influence on policy of funding public
health care systems was an important aspect of our health discussions. Dr. Sanjeev Jain
and the students of the Srishti School Of Art And Design suggested these issues be
discussed in open forums on TV for participation, for allowing feedback or criticism.
(Eg. Big Fight).
Dr. Elizabeth Vallikad recommended that the influences of the environment on health
be an essential focus of the channel because of the advent of the new age diseases
which often find no causative agent behind the disease. To sum this up the areas such
as
1. New age diseases (SARS, HIV, EBOLA, Viral Gastroenteritis)
2. Ecological medicine, and
3. Investigative medicine
Dr. Sanjeev Jain and Dr. Elizabeth Vallikad recommended these steps to keep pace
with the various aspects of the diseases and their control.
The students from the Srishti School of Art suggested consumer Rights and the
necessity to educate the public via discussion forums on TV and Design and was
backed by Dr. Srinivasa Murthy.
Dr. Sanjeev Jain suggested that the evolution of health care practices in India from the
traditional practices to the current day practices need to be studied and documented.
In addition, the evolution of the National Institutes such as CMC-Vellore, AIIMS-New
Delhi, JIPMER- Pondicherry, St. Johns Medical College-Bangalore, CMC-Ludhiana,
JJ Hospital-Bombay, and many others need to be understood and documented via the
Channel.
Many rural health centers and rural models of development and health should also be
documented. The Jamked example of integrated development and empowerment can
be an example of community participation.
46
Dr. Vallikad wanted the art of medicine to come out from the shadow of the science of
medicine for the greater interest of bringing back the largely lost glory. Geriatrics, a
neglected subject in our~ country, is another important subject that requires the
attention of both the people and the policy makers because the large middle aged
population of our country would constitute a large chunk (1/5~ ~f the population) in
20 years. Therefore, education regarding care of the old need to be addressed through
the channel.
Dr. Vallikad suggested that Road traffic accidents, health hazards of various kinds
(Industrial, Agricultural, etc.), are important issues to be addressed openly instead of
cautioning through warnings.
Drunken driving, for example, is a very common practice in India, whereas in Europe
or the US, enforcement is an effective deterrent.
Medical Ethics - regarding the current practice of medicine, the unethical prescription
of drugs by doctors was seen as very critical problem. In contrast, practicing medicine
by the oath one takes, and the need to be highlighting this with real life stories was
suggested by Dr. Thomas and Dr. D’souza.
Dr. Rajan Patil suggested that communicable diseases have remained important
healthcare issue draining our economy, and how they are sidelined. Educating people
through the health component of the channel would be a novel way of reaching those
who actually know very little about many diseases including Malaria, Kala Azar,
Filariasis, TB, Typhoid, etc.
He suggested that programmes on the causes of disease, prevention, and their cures
could be very informative and useful.
Eg: the fact that common malaria (malarial parasite) carrying mosquitoes breed in
stagnant water over the sunshades, old buckets, and utensils lying outside. This can be
avoided avoiding stagnant water and designing sunshades without a collection
compartment (making it flat).
47
The issue of immunization, its common misconceptions, and realities could be
incorporated into the popular scheme of soaps or family dramas, which would catch
the attention of the public.
Dr. Abraham Thomas added that International issues on health and the and the
changing rationale of treatment and drugs should be another focus. Debates on
populist as well as controversial pro-rich policies, the issue of "Health For All" (and
when the dream would be realized) and many other issues of international issues open
to debate can be a part of the health component of the channel. In addition, policy
level changes as a response to global pressures can be made debatable and open to the
knowledge and approval of the public via this channel.
At the end of the first day of discus5ions, the team decided to have two areas of health
for detailed discussions, so as to give shape to these areas from the stage that they are
left at, at a later stage/ date.
We therefore decided that the issues of mental health and women and child health
could be a major focus with the presence of eminent specialists from the field of
Psychiatry and Gynecology. The fact that these areas need comprehensive and
reinforced approaches to tackle such issues were discussed and agreed upon during
the discussions. These areas, according to Dr. Sanjeev Jain, have been neglected and
misunderstood by the general public all over the country for decades.
The women’s health issue was initially discussed based on the different presentation
formats we thought would be most important for airing the channel.
Filmmaker's opinion: Dr. Michael (SRISHTI) was of the opinion that we cannot make
programmes overnight, because we do not have the resources or the material to
formulate the content in excessive detail. He saw the need for a more comprehensive
framework of the two topics being discussed and elaborated upon, which would then
be valuable to decision-makers to take up issues and further make them into films or
documentaries, or animations, or debates and discussions. He said, that the immediate
need is to work out a blueprint of the two issues identified that would actually form
the guidelines for the health component of the channel.
48
This wonderful suggestion from Michael helped us focus on women’s physical and
mental health with a focus on the issues as well as guidelines.
Dr. Uma Sri was keen that health problems of women be a part of a family drama or
based in homes to help people identify with issues as well as retain the knowledge
imparted to them. She said that various aspects of women’s health could be
incorporated at many stages and situations. The need to catch the attention and
interest of women across the country was necessarily emphasized. She said, "Diseases
of various kinds, illnesses and issues such as death can be depicted in family dramas".
Dr. Vallikad emphasized the necessity of bringing awareness about women and
Women's Rights to all sections of society, and every woman. Encouraging sensitivity
to everyday discrimination against women and inculcating a sense of equality among
men and women should be a major focus of health and development. Many students
from the Srishti school of Art and Design opined that gender issues should be debated
and also discussed in open forums to learn people's perspectives.
The group suggested that The Woman's Life be divided into the following stages:
1. Preconception (normal biology of the reproductive system, the sequential
changes, the question of contraception, sexually transmitted diseases, and a
whole lot of healthy practices with a great deal of emphasis on the age related
issues of health of a woman and the best age for pregnancy)
2. Conception The biological aspect of conception, fertilization and further
development,
The question of finding the right time and planning a pregnancy,
making most of the preparations for the new life
The truth that the birth of a girl is determined by the male and not the
female
3. Pregnancy
The pressing issues of nutrition, immunization, monitoring, other
related issues
49
Foeticide and the issues of illegal sex determination · Legal issues and
accountability
Ethical issues
Social Issues and the long-term implications on Society and Human
Value Systems
4. Birth
Biology of birth, normal delivery, emergencies and complications)
The issue of birth in the context of family and friends and debatable issues of
various groups of people across the country and abroad.
The girl child's life and her health could be best dealt by presenting it stages.
The stages are
a. Neonatal Period
b. Infancy
c. Preschool (years of immunization)
5. Childhood
Diarrhoeal diseases
Mental health
Child Abuse
Discrimination and Rights Issues
6. School Age
The difference of how the male child's life is better planned than the
girl's life
Growth and development and the understanding of one's own
sexuality
Abuse issues
Development of breasts and the biological reasons and changes
50
7. Menarche
8. Graduation and further development
Being ready for marriage and issues of health and development that influence
the development and growth of humans.
9. The role as an adult, single woman and health issues of the single woman
10. As a mother and a companion
11. As a mother of growing children and their problems. Etc.
(The students of Srishti thought of this concept together with Dr. Vallikad
and Dr. Uma Sri)
The programmes made in this sequential order can actually bring about
interest in the understanding of the health among women and men about
individual and group issues.
Dr. Vallikad was specifically suggested that the sociological part of gradual changes in
a girl's life, which is brought about by the influence of elders in families, should be
recorded. The fact that the girl child often finds her perplexed to recognize herself an
untouchable during her menstrual periods (still practiced in many part of the country
and rural areas).
Reason: The very issue of accepting that is required to withstand pain and that pain
is normal should be eliminated from everyone's mind, including the Woman's
mind. This is proven by the fact that women come with advanced problems as a result
of self-neglect during the initial symptoms, whether it is dental pain, abdominal pain,
cancerous growth, or abnormal discharge from the reproductive tract. Giving the girl
child the knowledge, and people, the understanding of biological changes, health
and disease, and their purpose and nature, can break this kind of conditioning.
On the second day, we had consultations with the two eminent staff members of the
51
National Institute of Mental Health and Neurosciences, (NIMHANS), Dr. Sanjeev Jain
and Dr. Srinivasa Murthy.
Mental Health Discussions and Conclusions
At about 9:15 on the 5~ July, the health group met up in the NIMHANS premises in
the Psychiatry Department. Dr. Sanjeev Jain had prepared for the consultations the
previous day some of his views on mental health and the current mental health
practices in India. He also was keen on the sociological and religious aspect of mental
health and its relevance to our country in helping to shape and build support systems
for the mentally ill.
He shared with us many basic needs in approaching the aspect of mental health in the
context of the health component of the channel.
Guidelines:
1. One has to regard the existing discourse of mental health (the social, religious
and medical belief systems) with that of practice and practicality. He said that
there should be a dialogue between the beliefs and truths.
2. Increase the common knowledge of the general population on mental illnesses
and normal deviation.
He was keen that the biological aspect of the working of the brain needs to be
recorded and shown in order to improve awareness on the brain functions as - a very
simple but still so complex system that controls many functions. This, he said, could be
done interestingly, by comparing the human brain with that of the fly, or the worm or
even that of other mammals.
At the same time he was keen on stressing on the fact that early detection of mental
illnesses can be key to a cure. He also emphasized that the cure is available on an
outpatient basis and that often drugs and therapy can help normal living among
mentally ill. These, he suggested can be done by changing the general medias (movie)
perception on mental illnesses, and therefore the general belief of the general
population.
52
He posed the question "Why is Mental Health Care a Neglected field"?
Clinical issues
Controversial issues, and
People's awareness
The fact that medical science says it can treat schizophrenia 100% with drugs and
therapy is debatable. The drug policy is such that schizophrenic patients do not avail
of free medicines is another area that needs to be discussed according to Dr. Sanjeev
Jain.
--This could be an issue for discussion, and the question of irrationality of policy
should be rectified with debate and dialogue.
Geriatric mental health is another area Dr. Sanjeev Jain believes needed immediate
focus as most old people are kept at home and treated with total ignorance of the
condition. The issue that most of our country has no treatment facilities for
Alzheimer's is another issue he wanted to expose this via the channel. Comparatively,
India was behind many Southeast Asian countries with a lower GDP in the mental
health care facilities for Alzheimer's.
The two-day meet concluded with the presentations of the summary of the discussions
and an overall perspective of the doctors, intellectuals, students, freethinkers, media
persons, and others.
53
RGF Village Libraries
Second Quarterly Report (January to March 2004)
PROCESS INDICATORS
Cluster Code
Library Code
Name and address of the Library
Project No. 6/2003-1300/VL SANGHAMITRA
Village Libraries
5
1
2
3
4
RGF Rural
Library,
Chandalpet,
Chandalpet
village,
Chegunta
Mandal,
Medak District
Mujammil Md.
02.10.03
RGF Rural
Library,
Peddashivunoor,
Peddashivunoor
village, Chegunta
Mandal,
Medak District
T. Yadagiri
03.10.03
RGF Rural
Library,
Reddipally,
Reddipally
village,
Chegunta
Mandal,
Medak District
R. Sudhakar
07.10.03
RGF Rural
Library,
Gollapally,
Gollapally
village,
Chegunta
Manda,
Medak District.
D.R.Sunanda
08.10.03
33
33
40
Encouragement
259
--
30
30
35
Encouragement
255
--
32
32
40
Encouragement
249
--
259
General
Knowledge,
books on
religions, novels,
competition
magazines,
weeklies, fiction,
B.Ed. Resource
materials
255
General
Knowledge,
books on
religions, novels,
competition
magazines,
weeklies, fiction,
B.Ed. Resource
materials
249
General
Knowledge,
books on
religions,
novels,
competition
magazines,
weeklies, fiction,
B.Ed. Resource
materials
Names of News papers / magazines /
reaching the library
Eenadu
Eenadu
Are the newspapers / magazines reaching
the library
Average daily readership for newspapers /
magazines
Male
Female
Children
Yes
40
10
03
Name of the Librarian
Date of Establishment
Total Number of Paying Members
Male
Female
Total number of readers
Steps taken to increase Membership
Number of Books Received from RGF till date
Number of books received fromother sources
during the quarter
Total Number of books in the Library
Type of books preferred
Number of Library Committee Meeting held
6
7
8
9
10
RGF Rural
Library,
Upperpally,
Upperpally
village, Chegunta
Mandal, Medak
District.
RGF Rural Library,
B. Kondapur,
B. Kondapur
village, Chegunta
Mandal, Medak
District.
RGF Rural Library,
Vallabhapuram,
Vallabapuram
village, Chegunta
Manda, Medak
District
RGF Rural
Library,
Wadiaram,
Wadiaram
Village,Chegunta
Mandal,
Medak District.
Mallesh
09.10.03
RGF Rural
Library,
Karnalpally,
Karnalpally
Village,
Chegunta
Mandal,
Medak District.
V. Mahipal Reddy
12.10.03
B. Ravi Kumar
10.10.03
R. Swapna
22.10.03
B. Vanaja
22.10.03
D. Krishna
23.10.03
30
30
25
Encouragement
256
--
31
31
25
Encouragement
249
--
50
50
30
Encouragement
295
--
50
50
15
Encouragement
288
--
40
40
15
Encouragement
282
--
30
30
13
Encouragement
247
--
58
58
30
Encouragement
254
--
249
General
Knowledge,
books on
religions, novels,
competition
magazines,
weeklies, fiction,
B.Ed. Resource
materials
295
General
Knowledge,
books on
religions, novels,
competition
magazines,
weeklies, fiction,
B.Ed. Resource
materials
288
General
Knowledge,
books on
religions, novels,
competition
magazines,
weeklies, fiction,
B.Ed. Resource
materials
282
General
Knowledge, books
on religions,
novels, competition
magazines,
weeklies, fiction,
B.Ed. Resource
materials
247
General
Knowledge, books
on religions,
novels, competition
magazines,
weeklies, fiction,
B.Ed. Resource
materials
254
General
Knowledge,
books on
religions, novels,
competition
magazines,
weeklies, fiction,
B.Ed. Resource
materials
Eenadu
256
General
Knowledge,
books on
religions,
novels,
competition
magazines,
weeklies,
fiction, B.Ed.
Resource
materials
Eenadu
Eenadu
Eenadu
Eenadu
Eenadu
Eenadu
Yes
Yes
Yes
Yes
Eenadu
Vaartha
Andhra Jyothi
Deccan Chronicle
Magz.: Swathi
Yes
Yes
Yes
Yes
Yes
35
10
03
40
10
03
25
06
03
25
05
03
30
15
03
30
10
03
20
15
03
13
05
03
30
10
03
RGF Rural
Library,
Bhimroopally,
Bhimproopally
village, Chegunta
Mandal, Medak
District
37
Any Important decisions taken by the library
committees
Membership fee as decided by the Library
Committee monthly
Annual
Any other
Timings of the Library as decided by the
Library Committee
Steps taken to mobilize resources to collect
donations in cash / in any other form
Amount of Fee / fine / donation collected in
the quarter
Amount in Bank / PO till date
Additional activities being undertaken in the
library
Any other information / problem that you
wish to share?
--
--
--
--
--
--
--
--
--
--
Monthly
Minimum Rs. 5/-
Monthly
Minimum Rs. 5/-
Monthly
Minimum Rs.
5/-
Monthly
Minimum Rs.
5/-
Monthly
Minimum Rs. 5/-
Monthly
Minimum Rs. 5/-
Monthly
Minimum Rs. 5/-
Monthly Minimum
Rs. 5/-
Monthly Minimum
Rs. 5/-
Monthly
Minimum Rs.
5/-
0700 – 0900 hrs
1700 – 1900 hrs
Personal
interaction
--
0800 – 1000 hrs
1800 – 2000 hrs
Personal
interaction
--
0700 – 0900 hrs
1700 – 1900 hrs
Personal
interaction
--
0700 – 0900
hrs
Personal
interaction
--
0700 – 0900 hrs
1800 – 2000 hrs
Personal
interaction
--
0630 – 0830 hrs
1700 – 1900 hrs
Personal
interaction
--
0700 – 0900 hrs
1800 – 2000 hrs
Personal
interaction
--
0700 – 0900 hrs
1700 – 1900 hrs
Personal
interaction
--
0700 – 0900 hrs
Personal
interaction
--
0630 – 0830 hrs
1700 – 1900 hrs
Personal
interaction
--
Rs. 500.00
--
Rs. 350.00
--
Rs.100.00
--
Rs.480.00
--
Rs. 360.00
--
Rs. 800.00
--
Rs. 750.00
--
Rs.757.00
--
Rs. 325.00
--
Rs. 380.00
--
--
--
--
--
--
--
--
--
--
--
Notes:
1.
2.
3.
4.
5.
6.
7.
8.
Despite repeated efforts, the members of the libraries are not paying their membership dues regularly.
The members are more interested in reading Newspapers than books.
Educated women and girls have stopped using the libraries in all villages, perhaps because of the societal restrictions.
School going children have not been utilizing the facilities in the last two months on account of their annual examinations.
The library in Reddipally is not doing well, as far as payment of membership fee is concerned, though the readership is comparatively higher.
The librarian of Bhimraopally, B.Mallesh, has left the services owing to personal reasons. The Library Committee is now on the look out for a replacement.
The Gollapally Library has been shifted to a panchayat – owned building in the village from a private owned building. However, the condition of the panchayat building is
poor.
The members of the Vallabhapuram library are planning to raise a sum of Rs. 2500.00 as donation for the library.
38
Position: 2234 (3 views)