Mathew Abraham Puthenchirayil : Medicine to Community Health: A Journey of Discovery
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SIR RATAN TATA FELLOWSHIP IN
COMMUNITY HEALTH
Reflection and Report
By
Mathew Abraham Puthenchirayil
Mentor
Dr. Thelma Narayan,
Community Health Cell
Bangalore 560 034
June 2003- June 2004
CONTENTS
INTRODUCTION
FELLOWSHIP OBJECTIVES
Chapter 1.
COMMUNITY HEALTH FELLOWSHIP SCHEME: A Reflection
Chapter 2.
EXPEREIENCES WITH PEOPLE
•
Urban poor: slum experience
•
Rural / tribal poor:, Jharkhand, Karnataka and Arunachal Pradesh
Chapter 3.
EXPERIENCES WITH SOME CATALYSTS
•
NGOs: APSA, CRHP Jamkhed, FRCH Pune, , CHAI/CHABIJ
•
Peoples’ movements:, PHM, WSF, Plachimada
Chapter 4.
CONFERENCES AND WORKSHOPS ATTENDED
Chapter 5.
TRAINING PROGRAMME CONDUCTED
•
Community Health Orientation Program
CONCLUSION
ANNEXURES
ACKNOWLEDGEMENT
I would like to extent my heartfelt thanks to Drs. Thelma Narayan and Ravi
Narayan for their presence in my life for the past 5-6 years, especially during the period
of fellowship, as friends, philosophers and guides, in my journey from medicine to
community health. Thanks to Drs. C.M.Francis, Paresh Kumar, Mr. Rajendren and Mr.
Chander for the timely help as resource persons. Thanks to Mr. James, Mr. Joseph, Mr.
Hariprasad, Mr. Mahadevaswamy, Mr. Anil, Mr. Srinidhi, Mrs. Noreen, Mrs. Deepu
Shylaja and Mrs. Kamalamma for making my days in CHC a very pleasant experience.
Thanks for Sr. Prabha HC, Sr. Dr. Aquinas HC and the Christian Brothers for the
opportunities, the guidance and friendship they provided me during this period. Thanks
for the encouragement I received from my congregation, the Redemptorists, to peruse my
heart’s desire, especially in the last one year. Thanks to Xavier, Abraham, Naveen and
Prasanna for their wonderful companionship. Thanks to Joe and Julie for all the healing I
experienced from them in the midst of emotional drain. Thanks to Sunil who’s computer
skills saved me from lot of trouble during the write up of this reflection. Finally, a special
thanks to the many underprivileged people, who enriched me during this one year.
INTRODUCTION:
An old fashioned building with lots of doors and windows. People – poor and
helpless, going around it knocking at the different doors and windows. When it came to
one window I felt that the knock was on ME ! What is it all about? Why this knock? Who
are you? In the depth of my being I experienced this gentle inspiration; the old building is
the medical profession. We were at the heart of it. They have replaced us with money,
fame and technology. It was supposed to be a healing profession. We are looking for an
opening to get back to its’ core. Who will bring it back to its original purpose? Will you
cooperate with us?
Sounds like a dream? But it gave me lot of confidence. The confidence that, my
thought process was not completely out of touch with reality. That, I was not eccentric.
Then came the document ROME (Reorientation of Medical Education) as a confirmation.
In an era of technological advancement why should our pregnant mothers face delivery in
fear of death? Why should 20 plus young mothers die when 1000 babies are born,
especially when we are capable of doing neurosurgery to rectify the hydrocephalus of an
unborn baby in uterus? Why should millions and millions of babies die due to diarrhea
and dehydration when we are capable of assuring the survival of pre-term babies even of
30 weeks of gestational age? Why should malaria and TB continue to be the leading
cause of death when we have all the knowledge and skills to contain them? Why are the
doctors more interested in complicated procedures like corneal transplantation for a few
people, when millions of children become blind due to vitamin A deficiency which can
be prevented by a simple procedure of giving Vitamin A capsules once in 6 months?
These where the questions that stared at me towards the end of my MBBS internship in
1992.
Then came the time to go for the crucial choice of the postgraduate degree which
determined the key towards one’s life status. Some wanted to go for anesthesia because
they didn’t want to interact with the patients. Knock them off at first sight; push them off
from sight before they open their eyes. Some wanted radio diagnosis because life will be
comfortable in the AC room. Some opted for ophthalmology because one can practice
without many infrastructures. What disturbed me was not the specialty they chose
(because every specialty is good in itself), but the criteria they had in choosing these
specialties!
Twenty thousand plus medical professionals coming out every year. Why there is
so much of shortage of them in the needy areas of India? Why are they so keen on
working only in the big city hospitals? Why most of them go to the affluent countries to
serve the elite when there is so much of need in our country?
Adolescents in their late teens (17-18 years); forced into 190 plus medical
colleges due to various pressures of the family and the society. Forced to learn anatomy,
biochemistry and physiology without much orientation as to why on earth they should
study all these. A few dare to question. They are silenced. Probably these questions are
too threatening for the young lecturers who happen to end up in one of these specialties
because the competition to get into clinical specialties is too much! In their desperation,
who comes to the aid of these confused teenagers? Their equally confused seniors! They
taught us that the objective of studying the above mentioned subjects is to CLEAR the
exams so that one can have access to the stethoscope that is waiting for them in the
clinical year. Over the years these teenagers have devised clever and easy ways of
CLEARING the exams! But unfortunately even in the clinical year the story continues…
Human beings are no more persons; but a case- an organ or a system to be studied. Who
cares about the physical and emotional trauma the patient goes through – it is a wonderful
case, which every one should come and learn. When do these teenagers first hear about
some value (ethics)? The day of graduation, when they rattle through the famous
Hippocratic Oath just before they receive their degree certificates. The irony is that at the
time of taking this oath most of us had numbed our rationality with alcohol because of the
euphoria of having become DOCTORS! Why is there not even a single lecture on
medical ethics in the whole course of medical education? Why such an unjust emphasis
on skills and knowledge at the cost of attitudes? Why none of the mentors in the medical
education dare to talk to these teenagers about the goal of the medical profession – the
very reason for its existence?
This was the context in which I decided to follow my heart’s desire, instead of
floating with the current. The journey was painful, especially in the initial stages. But
providence lead me into the right persons, right books, right circumstances… who helped
me in this journey; the journey from Medicine, to Community Medicine to Community
Health. During this journey I was privileged to go through the experience of the
CHAD(Community Health and Development) model of CMC Vellore. That experience
gave me an idea about Primary Health Care (PHC) especially the 8 components being put
into practice. Another experience I cherish during this journey is my 5 years with the
Indian Redemptorists (one of the many congregations of the Catholic Church) of which I
am a member. From the Redemptorists I picked up philosophy and psychology – which
are essential to look at realities like truth & falsity, good & evil, meaning of life,
relationships, pleasant & unpleasant feelings and so on. I learned about community lifehow to live in harmony with people from various
cultures and backgrounds. How to work together even with difference of opinions and
many other essentials of community life.
The Community Health Fellowship scheme and my Regency1 complemented very
well, that it was with a great satisfaction I started off the fellowship. At the end of my
fellowship I am happy to acknowledge that this was another crucial phase in my journey.
1
A year of break the Redemptorists take during the Course in Theology, where they get
involved with the struggles of the poor and the marginalized of the society as part of their
learning experience.
COMMUNITY HEALTH FELLOWSHIP LEARNING OBJECTIVES
(Prepared on 11.7.2003)
These are the objectives developed in consultation with mentors of fellowship, at the
beginning of the Fellowship. However these objectives will continue to evolve through
out the fellowship for the year 2003-04:
1. To have a first hand experience of the struggles of the urban poor like pavement
dwellers, slum dwellers, street children, Commercial Sex Workers, etc.
2. To have a first hand experience of the struggles of the Rural Poor especially in
North India.
3. To have brief exposures to various models in Primary Health Care and
Community Health.
4. To develop long term personal relationship with individuals and groups who are
working towards a better society.
5. To broaden the understanding about larger issues that affect health, like poverty,
globalization, widening gap between rich and poor etc.
6. To broaden the understanding about the health care activities of the Christian
churches especially the Catholic Church. Their priorities, policies, strengths and
weaknesses.
7. To explore ways of improving and optimizing utilization of the available
resources of the churches, NGOs and government in bringing forth Holistic
Community Health and Development.
8. To broaden the understanding about the health related responsibilities of
Government and International agencies like WHO, UNICEF etc. Their priorities,
policies, strengths and weakness.
9. To have a deeper exposure to the various activities of CHC and to learn from its
20 years of experience in Community Health.
Chapter 1.
COMMUNITY HEALTH FELLOWSHIP SCHEME:
A Reflection
Given an opportunity I would have done my schooling, medical education – both
undergraduate and postgraduate courses in a different way. But the last one year of
community health fellowship I would do the same way. Why is it so? Is it that I did not
learn anything from my schooling and medical education? Is it that it was so traumatic? I
don’t think so. There are many reasons for the above statement that I made. But to
compress it all in one sentence, I would say that after my early childhood period of
learning (till 5 years of age), once again I got an opportunity to ‘follow my heart’s
desire’, in the last one year. What I really liked about the fellowship was this: its
sensitivity to the fellows’ interests and aptitudes, its flexibility and openness, the quality
of the mentoring and its emphasis on fostering attitudes and skills; in addition to the
constant internalization of the basic concepts in community health.
In the beginning of the fellowship when I sat with my mentor and wrote my
specific objectives for the year, it was not even in my wild dreams that I would get such
an enriching experience over this one year. Because of its semi structured nature, as I
proceeded with my fellowship many of the learning opportunities evolved..
The mentoring sessions:
In addition to the several one to one mentoring sessions and many informal peer
sessions among the fellows, over this one-year we had two major debriefing sessions.
Those sessions helped me to consolidate and internalize many of my experiences. As
Socrates, the great philosopher rightly said “an un reflected life is not worth living”, these
reflections remain at the core of the learning process we experienced last year. During the
first debriefing that was held in CHC from November 24-25, 2003, we learned a lot by
reflecting our 5-6 months experience under five major headings. Drs. Ravi Narayan,
Paresh Kumar, Thelma Narayan and C.M.Francis facilitated this process. They used five
questions to stimulate our reflection process. These were the questions: From the last few
months’ experience,
What did you learn about yourself, your strengths and weaknesses?
What did you learn about your mission?
What did you learn about the people whom you were exposed to, their strengths
and weaknesses?
What did you learn about the other catalysts who are working with the people,
their strengths and weaknesses?
What did you learn about health and community health?
The second debriefing also was in CHC, from March 11-12, 2004. During
this
debriefing which was facilitated by the same CHC team, we reflected our experiences in
line with the fellowship objectives and focused more on the knowledge, skills and
attitudes we acquired over this one year. (Refer Annexure1). During this one year I
experienced probably the best ever mentoring session I had in my life. This was an
unplanned informal 3-4 hours session, which I had with Dr. Thelma during a jeep journey
we had together from Hanur to Bangalore. She was returning to Bangalore, after visiting
me in the field as part of my fellowship placement.
The learning process:
Over centuries the Rationalists and the Empiricists kept on arguing about learning
through reasoning, and experiential learning. Some one has compared the rationalists to
spiders who sit in a corner and reflect to satisfy their need to reach truth and the
empiricists as ants who go around and keep on gathering information to satisfy their need
to achieve truth. During the past one-year, we were probably like the bees, where we not
only gathered experiences and information, but also processed it to internalize it for the
future.
Right from the beginning of the fellowship I was looking for some first hand field
experiences especially from the viewpoint of the poor and the marginalized and I feel that
I got it to my satisfaction. There are so many life stories regarding the struggles and the
successes of the ordinary people, which I am carrying with me at the end of this
fellowship. Putting it all together is beyond the scope of this write up.
Self discovery:
This fellowship also contributed to the process of my self-discovery. It helped me
to discover and sharpen many of my skills, confirm many of my thoughts regarding my
future mission and so on. It helped me to realize that my aptitude is more towards the
principles of primary health care, especially ‘community participation’ and ‘equitable
distribution’, than the 8 components of primary health care. I could also confirm my role
in the general process of community building, as a base for community health and the
specific role of a net worker in the process of working towards Holistic Community
Health and Development. Probably I can consider this fellowship as a major phase of my
gradual paradigm shift from Allopathic Medicine to Community Medicine to
Community Health.
Limitations:
None of us are unlimited beings. The fact that we are human means that we are
limited. Because of my specific priorities, I could not learn much in depth, about broader
issues related to health especially issues related to public health. I couldn’t go much into
policy issues, which affects the lives of millions of poor people in the world. Because of
my extensive travel and my direct involvement with the day to day struggles of the poor
and marginalized people in the society, I needed lot of time for myself to cope with the
emotional drain which I experienced all through this year. As a result I could not spend
much time for reading even the wonderful books and articles suggested as reading
material during the fellowship. (Refer annexure2). But I am sure that I will go through
those reading materials in the coming few years. This fellowship has given me enough
motivation to do so and I will be able to make more sense out of this one-year experience,
once I do the reading part.
Chapter 2.
EXPERIENCES WITH PEOPLE:
Section I.
URBAN POOR: Slum Experience.
Rajendranagar slum, Koramangala, Bangalore.
DATE:
July 10- November 26, 2003.
CONTEXT:
I always had in my mind the idea of working with the slum dwellers. But the first
time I thought of the possibility of living in a slum was when I read the book The City of
Joy by Dominique Lappire. When I discussed this idea with one of my companions
Bro.Xavier, he too seemed to be interested. So we decided to spend a few months in a
slum. We chose Rajendra Nagar because of CHCs involvement in it as part of an action
research and its proximity to CHC.
ABOUT THE PLACE:
It is one of the 1000 plus slums in Bangalore. It is considered as the biggest slum
in Bangalore. There are about 5000 houses with a population of about 30,000.
LEARNING EXPERIENCE:
The people are basically villagers who have migrated to the city for work. They
still preserve some of the characteristics they carried with them from their village. Some
of the issues we encountered there were: gender bias; problems related to accumulated
anger; a tremendous need for health care, shelter and also emotional health; money
lending and its consequences; injustice and corruption. We also stumbled across some
activities, which we think have the potential to bring the people together as a community
irrespective of their caste, class, gender and other differences. We prefer to call them as
community building exercises, which is essential to bring forth community health. (Refer
annexure3)
CONCLUSION:
So far I had experienced the realities of life from the viewpoint of a middle class,
traditional, catholic, Keralite, community oriented doctor. This exposure helped me to
look at realities of life a slum dweller. It has definitely made a difference in my attitudes;
many of the prejudices being shed and time will have to prove the impact it has made in
me.
----------------
Section II.
RURAL POOR: Jharkhand, Karnataka and Arunachal Pradesh.
Mahuadnar, Chechady valley, Lathehar dist., Jharkhand
Ranchi, Jharkhand
DATE:
December 8, 2003- January 10, 2004
CONTEXT:
As part of my fellowship objectives while I was looking for a brief exposure with
the struggles of the rural poor, I came across Sr. Prabha, the director of CHABI. We met
for the first time in Hyderabad during the national consultation on Universal Access to
Health Care organized by CHAI. She too was fascinated about the idea and then we
started working towards it.
ABOUT THE PLACE:
Jharkhand was formed as a separate state on August 9, 2000. Before that it was
part of Bihar. It is divided into 18 districts, with Ranchi as its headquarters. It has a
population of around 2.2 crores, with about 80 % of its population being tribals.
Jharkhand is well known for it rich mineral wealth esp. bauxite and coal. It is also known
for its vast fertile land with forests and sufficient surface and ground water. Mahuadanar
is a small township, the epicenter of about 120 tribal villages scattered around in a
beautiful valley called the Chechady valley. It is surrounded by mountains all around, is
located in the Lathehar district and is about 50 km in radius.
LEARNING EXPERIENCE:
About the people:
The people are mostly tribals who belong to various tribal groups. They belong to
the Dravidian race and are considered as the original inhabitants of India before the Arian
invasion. Hence they are called the Adivasis. They live in typical adivasi villages with
about 20-50 mud houses per village. They do mostly agriculture and use forest products
as a source of income. By nature they are gentle, timid, hardworking, very hospitable and
have a tremendous sense of belonging to their community. They consider agricultural
land as common possession and help in each other’s field in cultivation. They have a
sense of celebrating life and hence they do create opportunities of celebrations, family as
well as village, and use lot of singing and dancing where all irrespective of age and sex
participate. They don’t seem to be interested in entrepreneurship and amassing wealth for
the future. They have a way of settling disputes through village meetings with the help of
the elders. During their celebrations they use home made alcohol irrespective of age and
sex. Many of them in course of time go on to addiction and end up with problems related
to that.
Mortality and morbidity due to simple and preventable communicable diseases
are very common. The major causes of infant mortality are diarrhea- dehydration,
pneumonia, and malaria. Malaria and TB are the common causes of mortality and
morbidity among the adults. Morbidity related to antenatal and natal problems are also
common. These can be attributed to ignorance, lack of health care facilities and so on.
The exploitation:
Exploitation is very common in this area. At a macro level, the politicians use
various means to displace the adivasis from their land. One of the ways they use is by
deliberately withholding development like provision of electricity, assistance for
irrigation etc. as a result many of the youth migrate to other areas like Punjab for
agricultural labour which they could have done in their on fields. Some youth get
frustrated due to joblessness and get into destructive activities by joining the naxalites.
Those who have been working with the tribals consider it as a conspiracy between the
politicians and the multinational companies in order to take away the tribal land for
mining the mineral wealth by displacing the adivasis. For this reason the govt.
deliberately withhold health care facilities so that premature death due to preventable
diseases will gradually eliminate the adivasis. Similarly primary education is also
discouraged directly or indirectly. Even in 2004, there are many villages which are not
electrified, but there are documents in Patna (the headquarters at that time) showing that
many of these villages have been electrified even 20-25 years back. That is the level of
corruption where politicians are siphoning money in the name of developmental projects.
At a local level the PHC doctors and other govt. officials take their salary without
attending to their duties. In the cities and the township, outsiders like people from Bihar,
Bengal, Kerala etc. dominate the business world making maximum profit out of the
adivasis. One common sight in the villages is the picture of adivasi young men carrying
bundles of firewood, which they cut illegally from the forest. They sell it to the business
class in the township for merger amount. They do it for day-to-day survival without
knowing that they are being exploited. Another exploitation is the illegal trafficking of
young tribal girls in huge numbers to the cities like Mumbai and Delhi for cheap
domestic labour.
The various catalysts who make a difference:
In this context I could meet a few good people who make a difference in the lives
of these adivasis. Some of them live among the adivasis in the remote villages helping
them in primary education, primary health care, empowerment against exploitation and
so on. Some of their stories were very impressive. How they save the lives of people
coming with dehydration, pneumonia, cerebral malaria and so on. People, who are
brought in unconscious in the night, open their eyes by morning, sit up and eat by
lunchtime and go home walking with their rolled up mat in hand by evening. The
impressive fact is that this is done by ANM nurses who are the least in the medical
hierarchy. They do it out of necessity because of lack of medical professionals and
hospitals being very far from these villages. Moreover the poor adivasis cannot afford to
visit the hospitals.
CONCLUSION:
This exposure was a very enriching experience for me. As a result I could get to
know more about the strengths, weaknesses as well as the potential of the CHAI network.
It also resulted in lot of constructive discussions and exchange of ideas between us,
regarding community health, our future mission and so on. It also gave me an opportunity
to have a first hand experience of the struggles and aspirations of a group of adivasis.
During this exposure I could also spend sometime studying and documenting a local
medical insurance scheme, which had been going on for sometime. (Refer annexure 4)
---------------
Hanur, Kollegal, Chamrajnagar dist., Karnataka.
DURATION:
February 3- March 9, 2004.
CONTEXT:
The suggestion to spend some time in Hanur first came from Dr. Thelma Narayan
during one of our discussions as part of my mentering process. Later I could meet Dr.
Aquinas, the director of Holy Cross CRHP, Hanur, when she came to CHC for a meeting.
That time we worked on an exposure programe for a group of thelogy students from CRI
institute, Bangalore in her project and I was coordinating that program. During that
program while I was in Hanur for a few days, we discussed the possibility of me
spending some time in Hanur later sometime.
PLACE:
Hanur is a small township from where the holy cross CRHP reaches out to the 72
interior villages of its project area. This is a drought prone area located in one of the most
backward districts of south Karnataka- Chamrajnagar dist.
LEARNING EXPERIENCE:
The people:
The people of this part of rural Karnataka are generally poor. Their main income
was from agriculture and because of lack of rain and poor rainwater harvesting they have
been facing drought for the past few years. Hence migration to the cities for work is a
common phenomenon. As a result migrant malaria, which is brought from the cities, is
slowly emerging as a problem. This area which was once non-endemic for malaria can
become endemic due to presence of forest with the vector mosquito, once migrant
malaria sets in. caste system is so much deep rooted in the people that it keeps them
divided in working towards development. Another issue is discrimination due to gender.
Alcoholism and child labour / bonded lobour are also very much prevalent in this area.
The exploitation:
From 1980’s people started becoming aware of the need for village
development through the Local Self Governments (LSG), esp. the gram panchayats. But
their knowledge about LSG and the democratic process was quite insufficient. Hence
implementing developmental projects through LSG became a profit making business.
These projects benefited only a few individuals. The predominant caste used even the
leaders of the minority and underprivileged for their own vested interests. Only a
minority got involved in this power game. Majority remained neutral. This resulted in
formation of lot of groups and division that affected the overall development of the
village. For example, the functioning of the govt. school was not depended on the teacher
alone but on the school development committee (SDC). Lot of resources were allotted for
the SDC, but again only a few influential people got involved in it. Most of the LSG
projects were poverty alleviation programmes. Hence long-term infrastructure
development like electricity, agriculture development was not done. The involvement of
NGOs resulted in emergence of local leaders out of people’s organizations like SHGs.
For sometime they stood up for issues related to the poor and the marginalized, but in
course of time the local politicians of the LSG absorbed them too.
When it comes to Health scenario, there are enough PHCs (16) in the Kollegal
taluk and the govt. has upgraded them. There is at least one medical officer in each PHC.
PHCs are provided with essential drugs. There are 69 sub centers with ANMs in them.
They have an efficient reporting system. They even have mobile systems to reach the
people in the villages. There is constant pressure from the govt. on the PHC officials to
reach the health care services to the people. There are lot of reforms from the govt. in the
field of education and health. In spite of all these the people are not benefiting because
majority of them are unaware of these resources.
People’s lack of awareness about ecology has resulted in massive deforestation in
the name of development. Deforestation is done for firewood for brick making and
turmeric processing. Lack of proper rainwater harvesting and exploitation of ground
water for agriculture has forced the govt. to pass laws banning bore wells for agricultural
purpose. This has resulted in widespread joblessness, frustration, antisocial activities and
migration for quarry work. People’s main concern is survival, not progress or
development. In this context NGOs tend to make people dependent and make people
escape from their responsibility.
CONCLUSION:
Through this exposure I could get a first hand experience of the dynamics of the
functioning of a community health project. It was a good experiece to closely observe
and participate in the issues associated with the day today running of a community based
project like, the difficulties of the field staff, problems of accounts, documentation, the
thrill of setting up a new endever (center for school dropouts and bonded labour
children), the village meetings, the personal diffences of the team members and so on. It
also gave me an experience of the struggles of the rural people of a drought prone area.
During this exposure, I could also contribute to the project by helping them to setup an
information system for the project. (Refer annexure5).
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Sangram, Kurungkumey dist., Arunachal Pradesh
DURATION:
March 19- 31, 2004.
CONTEXT:
The suggestion for this exposure came from Dr. Aquinas. She had been invited by
a group of educationalists- the Christian Brothers, who had been based in Sangram for
the past few years. The purpose was to look into their newly started health project and to
give suggestions for improvement. Dr. Aquinas being a physician felt that general
medicine and community medicine would be an ideal combination for that purpose.
THE PLACE:
Arunachal Pradesh is part of the Himalayas at an average altitude of 3000 feet
above sea level. It lays on the northeastern most tip of India, cradled between Bhutan,
China and Burma. It is a hilly terrain with numerous rivers, waterfalls and thick virgin
forest. It has a population of only about 8.5 lakhs, spread over a vast area of about 84
thousand sq. km. Kurungkumey is a newly formed district with a population of about 47
thousand spread out in 300 villages in 11 circles (taluk). Sangram is one of the circles and
has 40 villages in it. Sangram is about 125 km from the nearest tar road and only way to
reach there is by difficult mud road. To cover this 125 km it takes about 7-8 hours by
jeep. There is no electricity or telephone facility in the Sangram circle.
LEARNING EXPERIENCE:
The people:
They belong to the indo-Mongoloid race and there are about 20 tribes in
Arunachal. The inhabitants of sangram belong to the nishi tribe, which is one of the
major tribes. Their language is also called nishi, which sounds like Chinese. Their staple
food is rice, daal and mustard leaves. They are generally very pleasant people, but can
become wild and aggressive when they are angry. The males including children carry
long and sharp knives hanging on their neck.
The status of the women in the society seemed to be very low. They are bought by
men in exchange of mithuns (wild cattle) as wives and are considered as possessions of
men. One man can posses more than one wife. According to those who have been there
for some time, it is not a rare sight that unwilling young girls of 8-9 years being chained
and dragged by their new owners (husbands) who could sometimes be in their 60s. It is
not uncommon for a father to barter his juvenile daughter so that he can buy for his son or
even for himself, a young bride.
They live in houses made of bamboo, which is built on wooden pillars on the hill
slope. The house is an unusually long (200 feet) single room with a hearth in the middle.
All the activities including cooking, eating, sleeping takes place around the central
hearth. They defecate in a partially enclosed area within the house and breed swine below
the toilet-cum-kitchen-cum-bedroom-cum-dining room, house. Have their babies’ bottom
licked by dogs. Eat with fingers with nails caked in mud from the fields. Eat meat of
animals found dead and rotten in jungle. They take bath very rarely.
Sickness and death are attributed to the occult and the world of spirits. It is
considered as a curse and demands costly animal sacrifices. The average human life span
is less than 30 years. The under five mortality was found to be 425(1998 survey) in
sangram. It is quite common for women to have delivered up to 10 babies but have only 4
or 5 surviving. The common causes of infant mortality are: diarrhea-dehydration,
pneumonia, measles and so on. Women deliver by themselves without being assisted by
anybody resulting in severe tear of the perineum and morbidity related to that. Suffering
associated with pregnancy and childbirth are unimaginable.
According to the DHO, Dr. Bingia Tobin, there are 3 PHCs and 3 CHCs in the
whole district. For these 6 health centers there are only 2 doctors of which one is on long
leave and 4 ANMs and 1 staff nurse. The PHC in Sangram is run by the sweeper
assistant. The pharmacist who is posted there lives in the town, which is 8 hours journey
by jeep. She is very prompt in collecting her salary at the end of the month and the DHO
himself is very much aware of these facts. But we were surprised to hear that in the
district hospital there were 18 doctors sitting without much work and drawing regular
salary.
CONCLUSION:
This exposure confirmed my thoughts that some thing has drastically gone wrong
with the medical profession of India. It was one more confirmation of my decision to
move into community health and my future mission. During that brief period the
Christian Brothers had arranged such a wonderful schedule, where we got lot of
opportunity for a wide exposure to the ground realities. In addition to the discussions
with their health team, they had organized roadside clinics, well baby competitions,
health education sessions and a 3-day training for VHWs. (Refer annexure6).
---------------------
Chapter 3.
EXPERIENCES WITH SOME CATALYSTS:
Section I.
NGOs.
Association for promoting social action. (APSA),
Annasandrapalaya, Bangalore.
DURATION:
August 26-29, 2003.
CONTEXT:
As part of my fellowship objectives I was interested to have an experience of the
life of street children. I came to know more about APSA and its involvement with the
street children during a workshop organized by them on street children.
THE ORGANIZATION:
APSA is a child centered community development organization. At the grass root level,
APSA facilitate the empowerment of the urban poor through community-based projects
to promote human and democratic rights. APSA also works at the macro level through
advocacy and policy planning initiatives. Some of their initiatives are:
Nammane; a crisis intervention center for children in acute distress. Children
rescued from difficult background like, child labour, street children, victims of violence
and abuse find residential support here.
Navajeevana Nilaya: girls at risk who have graduated from nammane live here
during their first year of employment. Here they acquire skills to live independently and
learn to get over their exploitative past. The national and Karnataka open school systems
give such children more flexible education options.
Child labour project: there are over 100 million child laborers in India. APSA
works towards preventing the children of the urban poor becoming child laborers. It also
work among urban child laborers who are in hazardous conditions towards their rescue
and long term alternatives.
Child line: APSA runs a 24-hour toll free hotline for children in distress.
Interventions range from medical help, shelter and protection from abuse.
Street community: an estimated 80 thousand street children live in Bangalore
alone. APSA reaches out to these children in over 17 street locations. Special emphasis is
placed on protecting girl children. There are short term interventions like drug
desensitization and street level education. Long-term interventions like campaign for
their basic democratic rights are also done. In addition to this APSA is also involved in
slum outreach and the disabled in Bangalore as well as in Hyderabad.
LEARNING EXPERIENCES FROM APSA:
. The street community project of APSA provided me that opportunity. APSA
works through their street educators who meet these children on a regular basis in over 17
street locations. I could spend a few days with these street kids in Jayanagar, Bangalore.
Shilpa: the first sight of her is still vivid in my eyes. Even though she was 11 year old,
she seemed to me like a 7-8year old child. She was sitting leaning on to the compound
wall of a big house with a small puppy in her hands. She was dirty, had torn shabby
clothes on her. She hadn’t eaten anything for the past 36 hours. Her friends, Raja,
Bhuvanesh and Muniappa located her first. I was moved by the way these 3 friends of her
shared the little food with her, which they had picked up from the dustbin. Solidarity in
the midst of misery! Later Ramadevi, the street educator told me that Shilpa is into
commercial sex work and is having white discharge PV for which she is refusing to go to
hospital. While walking back I could sense emotions swelling up within me along with a
few questions… Can we call an 11year old pre-pubertal girl a prostitute (CSW)? How
can she be safe from sexual abuse when she is forced to sleep in the street? Are the
conventional systems including the health system be of any help for her? She represents
the millions of children deprived of basic human rights. And she too belongs to the
human family! Manjula, Ammulu, Ellamma all of them had similar stories to tell.
-----------------
Comprehensive Rural Health Project (CRHP), Jamkhed,
Ahmednagar dist., Maharashtra, India.
DURATION:
September 16-18, 2003.
CONTEXT:
On the 6th of August 2003, I had a discussion with Dr. Mani Kaliath (consultant
for CHAI) on the possibility of being part of a CHAI study team visiting a few model
projects to learn from them. The official request came from CHAI on the 5th of
September, 2003, to be part of a 6 member team to visit 2 projects; CRHP, Jamkhed and
FRCH, Pune. Since this was very much in line with my fellowship objectives, of having a
first hand experience of a few model projects in community health, I decided to be part of
the team.
THE PROJECT:
Drs. Raj and Mebelle Arole started the project in 1970. They realized that the
usual way of providing medical care – mainly curative in an established hospital, or clinic
based on a western, medical model – was not improving the health of individuals or
communities. They wanted to try a new approach; a community based primary health
care and development approach. Their aim was to enable and empower people and
communities to take health into their own hands. From the beginning of the project, the
different village communities were involved and participated in a partnership relationship
with the project staff.
The principles of this project were; equity, integration and empowerment. This
was to improve the status of the women and the weaker sections of the society.
CRHP initially covered 8 villages. By 1980 it expanded rapidly to cover 70
villages with 10 million population. By 1985, 250 villages in karjat and Jamkhed talukas
wwre covered serving a population of 25 million. In another tribal area, a 6-hour drive
from Jamkhed, CRHP works in the Bhandardara hills with 30 villages and 50 thousand
population. This was developed by the Jamkhed villagers and is an example of an
approach focusing on health information and income generation; without having a base
hospital. In 1993 when Latur, 150 km from Jamkhed was destroyed by an earthquake, the
villagers volunteered to go and live with the victims to help them. As a result a program
was established there covering 25 thousand population in 20 villages. Since the beginning
of the project, 50 million persons in 400 villages in Ahmednagar, Beed and Osmanabad
districts have been involved in transforming their lives and communities through CRHP.
The impact of the program on the health status can be understood by looking at
the following table:
1971
1976 1986 1993
Year
Infant mortality rate
176
52
49
19
Crude birth rate
40
34
28
20
Children under five years
Immunization ( DPT, Polio)
0.5% 81% 91% 92%
Malnutrition: wt for age
40%
30% 5%
5%
Maternal services
Prenatal care
0.5% 80% 82% 96%
Deliveries by trained attendants
<0.5% 74% 83% 98%
Couples practicing family planning <1%
38% 60% 60%
Chronic diseases
Leprosy prevalence (per 1000)
2
1
0.1
TB Prevalence (per 1000)
15
11
6
Today Jamkhed project has developed into an internationally well-known training
institute and research center. They conduct short courses in community health and
development for many from all over the world.
This is the vision statement of CRHP:
“People are made in the image of God. They are endowed with talents and
abilities and have the potential for personnel growth and development. We are called to
facilitate and empower them, so that their health can be improved in a holistic and
integrated way available to all with equity and justice”
LEARNING EXPERIENCE FROM JAMKHED:
Personal discussion with Dr. Arole: September 16, 2003.
Dr Arole started of with his childhood experience of suffering and sickness in
rural Maharashtra, where he was born and brought up. His friends dying of plague and
his mother suffering from breast abscess moved him. His undergraduate training in CMC,
Vellore, good medical education and good role models. But he gradually realized that it
was all out of touch with the Indian realities and the doctors came out found themselves
misfits for the Indian scenario. The solution was not much of technological but of
immersing oneself with the people. For him medicine became more than a science, it
became an art of caring. Thus he moved from hospital, to village clinics to community
health. They realized that 60-70% of the illness was due to impure water. Hence started
working for water projects: e.g. 250 bore wells. While they were busy in the community,
they could empower the ANMs to manage most of the base hospital work. The diseases
of the poor are simple and can be dealt easily. These simple problems if not intervened
early may lead to complicated problems. According to him, it is impossible to sit in a big
hospital and do primary health care / community health. Most of the time these big
institutions are tapping all our energy. He emphasized the 3 basic principles they used –
equity, integration and empowerment. Regarding the base hospital, they could
deliberately limit it to a good secondary care center, affordable for the people with a good
referral system. In the beginning they had about 400 out patients per day, most of them
acute communicable diseases, 40% of them being children. Today it has come down to
about 75 out patients, 2% of them being children. There is also a shift from, acute
communicable, to chronic communicable to non- communicable diseases.
Meeting with VHWs: September 17, 2003. (Afternoon)
Their confidence and commitment were evident from the discussion we had with
them. These were some of the things they shared:
“ I carried a 7 month old child, 7 miles to catch a bus to base hospital in order to save it
from snake bite poisoning”
“ I conducted the delivery for a Muslim woman with TB, because nobody was willing to
help her. Today that child is a big officer and he has great respect for me”
“ When we help the blind the lame, we are doing something for god. Then they help each
other”
Among the health workers there were 3 of them who deserve special mention;
Yamunabai, Mukthabai and Moses. Yamunabai told proudly that she had conducted
about 800 deliveries so far and needed the assistance of doctors in the base hospital only
thrice. She also added that 20 years back she was an illiterate village woman who was
afraid to come out of her house. Muktabai was invited to Geneva to address WHO
delegates. She concluded her speech by showing them a lighted oil lamp in her hands;
“you are like the chandeliers of this room. You bring light to others. But the common
people cannot afford to come to you. We are like this oil lamp; we light the other lamps
too and that will bring forth health for all.”
Moses was a school drop out, after his 2nd standard. He came to Jamkhed as a
construction worker for the base hospital. Aroles’ were impressed by his commitment to
whatever work he did. After the construction work was over he was given some simple
responsibilities in the hospital. When he started showing interest in people with disability
he was send for training in artificial limb in Jaipur. Today he has rehabilitated around
6000 people, goes to the African countries to train people in low cost rehabilitation
technique and is the head of the department of the rehabilitation center of Jamkhed.
Meeting with the mobile team: September 18, 2003.
They are members of the team who can read and write. They are involved in
assisting and supervising the VHWs. They have weekly meeting with the VHWs. They
assist the VHWs by: support and reassurance at the field level. Helping them in
completing their records. Helping them in their continuing education.
These were some of their words, which reveal their attitude towards the health workers:
“ I consider VHW as my friend”
“ She may be wrong. Instead of screaming at her I do the right thing and she learns.”
“ We understand their difficulties” “ she is a volunteer. We look at her commitment and
not her weakness” “ we are a team. So we support each other.” “ We follow adult
learning technique. Every one has brain and experiences.” “ In a team relationships are
more important than supervision.”
Where did they get these values and attitudes? They did not have separate value
education. But they caught it from the Aroles; “ the way they sat with us, their
commitment, the way they corrected us, their love for the poor…. We witnessed it.”
Visit to Gotgav: September 17, 2003. (Morning)
We had meeting with the village leaders in front of yamunabai’s house. The
village sarpanch was a harijan. It was impressive to see Brahmins, Marathas, harijans and
women sitting together to share their experiences. They shared with pride how over the
years they managed to overcome the caste differences, disrespect for women,
alcoholism… and how they could work together towards the welfare of their village.
There was one shahaji patil, a landlord who decided to follow the govt. rule of
distributing excess land for the landless. When Rajiv Gandhi was the prime minister, the
Gotgav representatives were invited to share their experiences with the cabinet members.
They were proud of the fact that other villagers from all over the country are coming and
seeking guidance from them. Before the Aroles came into the picture, they too were
divided in the name of caste, class, gender and so on, which hindered their development
process.
CONCLUSION:
As an under graduate and a postgraduate student I was familiar with the concept
of health workers. I considered them as an extension of the medical system into the
community and the lowest in the medical hierarchy. I never perceived their potential or
their ability to transform society. It was an eye opener for me to see that an illiterate
woman can make the WHO delegates give her a standing ovation in Geneva; that an
illiterate woman can speak so confidently in a national consultation of experts that she
has conducted 800 deliveries and needed the help of doctors only thrice in her whole
carrier and that a school dropout after 2 yrs in school could become the head of the
department of a rehabilitation center, could rehabilitate 6000 plus people without limbs,
and could go to other countries quite often to train them in rehabilitation.
--------------
Parinche project, Foundation For Research in Community Health
(FRCH), Pune, Maharashtra.
DATE OF VISIT:
September 19-21, 2003.
CONTEXT:
Same as Jamkhed visit.
ABOUT THE PROJECT:
Dr. N.H.Antia, a plastic surgeon, established FRCH in 1975. The purpose was to
promote the concept of health care rather than mere care of illness. The emphasis is on
the problems of the underprivileged sections of our society FRCH is involved in both
conceptual research as well as field studies into the problems faced in achieving health
for all. The aim is to influence govt. policy and to sensitize the people at all levels to the
problems and the possibility of achieving good health at affordable cost. FRCH aims to
create a peoples’ health movement by demystifying medicine and increasing public
awareness on health especially at the grassroots and by strengthening our own age-old
health culture of the people. The Parinche project (named after the Parinche village which
acts as the headquarters) was initiated in 1995. The main aim of the Parinche project was
to device a training program for women that will result in overall development in these
villages. This project was expected to help promote the concept of decentralized
development under Panchayti Raj, where the village can become a self-sustaining entity
for its various social and economic requirements. It also hoped to demonstrate a new
mode of development that could be self-sustaining for use on a larger scale.
The project area covers a population of about 20 thousand in 13 gram panchayats.
One third of the area consists of mountainous terrain with altitude up to 4000 feet. The
villages in the upper regions are poorer than those in the valley. The villagers are largely
engaged in cattle rearing and agriculture. FRCH selected interested women from their
own communities in and around Parinche, and began educating these tais in various
fields. Today FRCH has about 50 functioning tais. The Parinche project is an action
research on the impact of health education and empowerment of women. Making them
think, by asking questions does this empowerment.
LEARNING EXPERIENCES FROM PARINCHE:
Nirmala tai:
She wanted to become a nurse or a teacher. But like any other village girl of her
place she too was married off soon after her 10th standard. That was the end of her
studies. When she heard of the tai training she was motivated to go for it. But her family
including her husband was not so cooperative. So in the initial stages of the training she
had to do additional work; both domestic and farm, in order to go for the training. Now
her husband helps her in the domestic and farm work when she organizes the community.
This is because he now realized that she is skilled and is capable of dealing with many
problems of the people. She investigated a hepatitis epidemic in her village, with the help
of NIV, Pune. She could identify the first case, the source of infection and could take
measures along with the villagers to control the epidemic. She could recognize her
mother in law going for a stroke quite early; take her to the PHC first, then to the district
hospital at the right time. When her mother in law was in bed for 3 months, she acted as
the nurse, occupational therapist at home. Now her mother in law is capable of walking
by herself and quite independent. She had the courage to question the PHC doctor against
irrational practices and for a proper referral letter. The tais confront; yet they gain the
confidence of those whom they confront. E.g. their husbands and the doctors. Part of her
house is a library and is open for others to gain knowledge.
Sunitha tai:
After her tai training she took initiative to be trained as an anganwadi teacher and started
an anganwadi by her own initiative. She learned cycling by her own initiative and cycles
3 km. every day to take care of 65 children in her anganwadi. In the 1st year there was no
payment from the govt. In the 2nd year when the govt. wanted to appoint somebody else
as the teacher, the people stood for her and got her appointed officially as the teacher. She
is aware of her aptitude of children and enjoys her work.
Nanda tai:
She speaks proudly of her daughter whom she could make a trained nurse.
According to the doctors her daughter is a better quality nurse and according to her
mother in law she is a better quality housewife. She attributes all this to her
empowerment through the tai training.
Kaladhari village:
This village is considered as a model village by the Maharashtra govt. and was
given award for the same. Before 1995 this too was an ordinary village with starvation
and children dying of diarrhea and dehydration. The difference started when Mr. Ankush
parkandae became the sarpanch. He is just a 10th standard person who knows only
marati. They received no special funds from the govt. but could mobilize the existing
govt. funds to the maximum. They started with a watershed program. There was
tremendous cooperation from the people because it was their felt need. With the
availability of water, their agriculture improved, infant mortality came down and they
started experiencing signs of prosperity. Then he initiated a movement to clean up the
village. People took responsibility to clean up their on streets. The teachers, the students,
the sarpanch all were involved in the process. Soakage pits and drains were made. Lots
of dustbins were placed in the village. The PHC officials were requested do chlorination
on a regular basis. The women and children were also trained in chlorination. The next
initiative was the launching of a community-based organization (CBO). Today they have
a milk-processing unit with a turn over of Rs.10 lakh per month of which Rs. 1 lakh is
profit. This profit money is used for the development of the village. Another
characteristic of this village is that there is 100% tax payment, which is also used for the
development of the village. Since electricity has not yet reached there, one can see solar
lamps and aero-generators in the village. The health status of the people improved
considerably with food, water and sanitation in place. People are also made aware of the
facilities in the PHC and they do make use of the facilities to the maximum. They make
use of the referral services to the district as well as private hospitals in the city. Those
who are poor are given assistance from the CBO for medical care. The role of FRCH in
the whole process was in identifying the potential of the sarpanch and providing
appropriate and relevant information for him at the right time, directly and indirectly.
Today kaladari village remains as an inspiration for many other villages and provides
guidance for them for self-development.
Anganwadi, Khelwadi and Eco group:
The tais work with the govt. anganwadis. They teach them songs which contains
messages for healthy life style, check their weights, look for nutritional deficiencies and
so on. This is for children < 4 years. Khelwadi is for the children in the primary school.
After school they go home and come back around 5.30 pm for an hour. The tais make
them sit in a circle and demystify science and health issues through songs, games and
demonstrations. E.g. Preparation of ORS. Eco group is for the older children. These
children some times act as pressure groups when it comes to health issues.
CONCLUSION:
As someone has observed, every community has three categories of people; a few
who are motivated for the Good, a few who are motivated for exploitation and a good
majority who are passive onlookers. “It is better to light a candle rather than cursing the
darkness”. This exposure helped me to realize that by identifying those who are
motivated for the Good, by supporting them and by building their capacity in various
ways we can make a difference and they in turn will build a better society by taking with
them even the good majority of passive onlookers too.
-------------------
Catholic Health Association of India (CHAI)
DURATION:
August 5-6, 2003; September 16-21, 2003; December 8-January 10, 2004; April
5-11, 2004.
CONTEXT:
An exposure with CHAI was very much part of my fellowship objectives. The
first opportunity came when Dr. Thelma suggested to attend the national consultation on
universal access to health care organized by CHAI in Hydrabad on August 5, 2003. This
was followed by spending a day in CHAI central office on August 6, 2003, where I could
interact with various people including Dr. Mani Kaliath. Later I got an invitation to be
part of a CHAI study team, which visited Jamkhed and FRCH, Pune between September
16-21, 2003. During second half of the fellowship, I could spend more than a month, in
December and April, with CHABI, one of the regional units of CHAI. This visit was
worked out with Sr. Prabha, the director of CHABI, when I met her in Hyderabad during
the national consultation organized by CHAI.
ABOUT THE ORGANIZATION:
The origin of CHAI goes back to July 29, 1943 when 16 religious sisters
representing 8 medical institutions of the then British India gathered at St. Josephs’
hospital Guntur, Andhra Pradesh. That time there were 50 medical institutions in India.
The convener of that meeting was Sr. Mary Glowrey, an Australian sister doctor. It was
called Catholic Hospital Association (CHA) in that meeting. After independence it
became the catholic hospital association of India (CHAI). In 1993 it was renamed as
catholic health association of India.
The main thrust of CHAI is promotion of community health and community
based health care. This implies a holistic understanding of health, building
Healthy communities, enabling people esp. the poor and the marginalized to collectively
take responsibility to attain and maintain health and to demand health as a right, to ensure
the availability of health care at a reasonable cost by its members and so on..
The backbone of CHAI is the 3000 plus member organizations spread all over
India. 80% of them are in remote and isolated areas. CHAI was divided into 11 regional
units in order to cater to the varied regional needs and problems of the member
organizations. They are: Andhra Pradesh (CHAP), Karnataka (CHAKA), Tamil Nadu
(CHAT), Kerala, Orissa (OCHA), Maharashtra, Gujarat & Goa (CHAW), Madhya
Pradesh (CHAMP), West Bengal, Bihar & Jharkhand (CHABI), Rajasthan & Uttar
Pradesh (RUPCHA), And the North-East (NECHA).
Some of the activities of CHAI include: advocacy, health communication,
capacity building, research and project evaluation, promoting alternate systems of
medicine, networking and so on…
LEARNING EXPERIENCE FROM CHAI:
(Based on discussions with Drs. RN, TN, Mani Kaliath, Sr. Prabha, and a few members
of CHAI)
The real strength of the CHAI network is its 3000 plus peripheral institutions with
committed personnel having the right attitudes. Ideologically it has the potential to
contribute much to bringing forth health for all in the Indian society. But in reality it is
functioning only about 30% of its potential. Some of the issues which contributes to this
problem are:
Health care at the periphery of the church: Most of the time, for the church
authorities parish activities and education are at the center of its mission. Hence the CBCI
Health Commission, CHAI, and health are at the periphery of the church’s mission. If
health itself is in the periphery where will community health be?
Congregational structures: about 200 congregations, which are governed by
groups without much common interaction, own the 3000 plus member organizations.
Power struggle: within and among the congregations. Gender bias: sisters not
given the same power to make their own decisions.
Profit motives: profit-making institutions given preference than community
based work with the poor and marginalized. Competent sisters are often caught up in
profit making big institutions where as less competent sisters are send for communitybased work for the masses.
Competency gap: even though they have the right motivation and attitudes,
because of the lack of certain technical skills many of the sisters in the member
institutions get burnt out and become frustrated. Leadership: lack of vision, experience
and personal weaknesses of those at leadership also contribute to this.
Lack of an integrated approach: in the member institution community. E.g.
Health center sisters and the community development sisters unable to work as a team.
Irrelevant training programs: the training programs conducted by CHAI central
office away from the realities of the member institutions. Moreover the lack of
consistency among the sisters who are send for important meetings.
CHAI central office problems: the presence of 40-45 unproductive clerical staff
and program funds being diverted to maintain them.
CONCLUSION:
I know an old Catholic priest, who speaks very little. Once he told me “Mathew,
the Catholic Church is a sleeping giant. If it is woken up, it can contribute much to the
society, esp. regarding Justice and Peace.” I was always convinced about the hidden
potential of CHAI, in contributing much towards the struggle for Health for All in India.
Today after my fellowship I consider CHAI as a big village with 3000 plus households,
spread out all over India with most of the dynamics of any human community. There is
power struggle, class difference, gender bias, lack of skills, lack of clarity regarding basic
concepts in community health….., yet it has the potential to make a difference, to become
leaven in the bread (society), transforming it from within.
Section II.
PEOPLES’ MOVEMENTS.
Peoples Health Movement (PHM)
DURATION:
June 2003 – May 2004
CONTEXT:
I did not know about the existence of PHM before I started the fellowship. We
happened to be based in a room in the PHM secretariat, especially in the initial phase of
the fellowship. Today when I look back, that arrangement gave me lot of opportunity to
have exposure to many of the activities of PHM.
THE MOVEMENT:
In 1978 govt. representative from all countries assembled together in Alma Ata
and declared that they would ensure health for all by 2000 AD. This important pledge
was won after a number of struggles and was a landmark in the struggle for health. But
today most govt. health documents don’t even mention that they made such a pledge in
1978.
To protest this betrayal by governments, people’s movements across the world
decided to come together for the peoples’ health assembly at Dhaka, Bangladesh in
December 2000. There were 1500 representatives from 91 countries all over the world.
As a precursor to the assembly, in every country village level campaigns were organized
to highlight the main issues in health and to ensure that people don’t let governments
forget the promise they had made.
In India, in January 2000, 18 national networks of voluntary organizations
representing over 2000 different organizations came together to organize a large
campaign on health for all, now! By the end of year 2000, people from all parts of India
came together in 4 peoples’ health trains and assembled at Calcutta for the national health
assembly. A people’s health charter was adopted with specific demands from the govt.
Delegated from different countries that had gone through similar movements met
together in Dhaka to discuss strategies for building a global movement for health and to
finalize the international peoples health charter. Thus was born the peoples health
movement; a global coalition of peoples’ organizations working on health rights and
ensuring health for all now!
SOME SPECIFIC EXPOSURES:
National Working Group, PHM-India, Bangalore, July 26-27, 2003.(Ref. Annexure7)
National consultation on Universal Access to Health, Hydrabad, August 5, 2003.
Nationl workshop on Right to Health Care, Mumbai, September 5, 2003.
National public hearing on Right to Health Care, Mumbai, September 6, 2003.
International Health Forum, Mumbai, January, 14-15, 2004.
Meeting with ex-Health minister, Mauritius, PHM secretariat, Bangalore.
Meeting on Traditional Systems of Medicine, PHM secretariat, Bangalore.
Personal discussions with a few leaders of PHMDrs. Ravi Narayan, N.H.Antia, B.Ekbal, Saffrulla Chowdhary, Prem John,
Narendra Gupta, Abhay Shukla, Sunder Raman, Unnikrishnan.
LEARNING EXPERIENCE:
All through my postgraduate studies I had this question in my mind. For the past
many years we have enough and more knowledge and skills in the medical profession.
For e.g. we know everything about diarrhea and dehydration, we have all the skills to
prevent people getting it and dying from it. But even in this third millennium why should
it continue to be the leading cause of death among children? Why should TB and malaria
continue to be the leading cause of death among the youth? Medical profession has
become too much biomedical and profit oriented. The socio economic political and
cultural (SEPC) aspects of health are not taken into consideration. In this context health
for all is impossible through medical professionals alone. Some times they remain as the
greatest obstacle towards health for all. That is where people have to become aware that
health is their right as well as their responsibility. Medicine and health has to be
demystified. People should be able to exercise moral pressure on the authorities that
behave irresponsible. I think that is where PHM has its role to play.
---------------
World Social Forum (WSF), Mumbai
DURATION:
January 16-20, 2004.
CONTEXT:
PHM had a role to play in the WSF. The International Heath Forum (IHF) was
organized in Mumbai 2 days before the WSF, as a preparation for the WSF. Being
associated with the PHM secretariat I was very much aware of the background work that
was going on for the IHF and the WSF. I attended the WSF as part of the PHM team
from the secretariat.
THE MOVEMENT:
The WSF is not an organization or an institution but a platform of different
organizations. The India general council with about 200 organizations took up the
challenge to build a process of alliance building and to organize this event. The 4th
international gathering of the 2004 WSF, in Mumbai, is a dialogue to formulate a blue
print for building another world- a plural, just, responsible and shared world which
accords equal dignity and rights to all its people. The focus was on the impact of neoliberal globalization and its processes, which are creating a small global ‘over-class’ and
a vast increasingly vulnerable ‘under-class’ in every country. There were diverse forms
of interaction; plenary sessions, conferences, panels, round tables, seminars, workshops,
cultural events, solidarity meetings, rallies and marches. Even though the language used
in the public address system was English, there was simultaneous translation into 11
languages through the radio system.
LEARNING EXPERIENCE:
Human beings are a mystery. There are many things we have learned about
ourselves over the years. But still there are many more areas we need to discover about
us. Our experiences, aptitudes, interests, involvement and mission vary from individual to
individual. Yet sometimes we come across common interests. Those who are involved
with the struggles of the oppressed and the marginalized sometimes feel the need for
mutual support and solidarity. They also need revitalization at various levels. For me
WSF was a forum for this. I was impressed in many ways. The 1000 plus workshops and
meetings, to quench the thirst of the intellect, the variety of celebrations to quench the
emotional need, the plurality of culture and language in an atmosphere of solidarity, the
thousands of methods used to bring forth the cry for justice and peace by those who
represent the oppressed and the voiceless, all were very impressive. I felt that in my little
effort to bring forth a society of justice and peace, of care and concern, I was not alone!
---------------
Anti-Coco Cola Movement, Plachimada, Palakkad dist. , Kerala.
DURATION:
January 27- 28, 2004.
CONTEXT:
After the WSF while I was settling down in CHC, Dr. Thelma asked me whether I
am interested in joining a team from South America to visit Plachimada. Even though I
was not very keen, out of courtesy I agreed because I felt that my familiarity in the local
language (Malayalam) would be of help to the team. But eventually it turned out to be a
wonderful learning experience for me.
THE MOVEMENT:
Plachimada is a tiny village land in Moolathara village, Palakkad dist. of Kerala.
Majority of the people depend on agriculture for their livelihood. The bottling plant
started its production in 1998 on a 42-acre plot in violation of the Kerala land utilization
act, 1967. The intention of this act was to prevent the use of agricultural land for nonagricultural purpose. Though it owns 42 acres the company is remitting land tax only for
34 acres to the panchayat. The working capacity of the unit is 1.5 million liters per day
(until recently 1.2 million bottles of soft drinks were being loaded from the company
every day). By 2004 the water scarcity has struck even the company that it is able to
extract only 0.8 million liters of water per day from the bore wells.
About 370 laborers are working in the unit out of which 240 are casual temporary
workers. The local residents who are employed in the company are only about 40-50 and
are casual temporary workers. Among the temporary workers those who are
recommended by the political leaders get an amount of Rs.100/- per day, whereas others
get 60 per day for males and 50 per day for females.
Studies conducted by experts within the country as well as outside came with the
findings that its not only water depletion but also environmental pollution that is
happening in and around Plachimada. As a result agriculture, local economy, health
status and even the day-to-day life of the people are affected. Anemia, low birth weight,
hair loss, burning in eyes, vomiting, pain in the limbs, skin lesions etc. are shown to have
of high relative risk. The level of lead and cadmium in drinking water were found to be
quite high.
In this context residents of the area launched an agitation against coke on April
22, 2002, about 3 years after the company started its unit. On April 7, 2003 the local
panchayat decided to cancel the companies license. But because of the ambiguous stand
taken by the higher authorities and the state govt., the company is still functioning and
the agitation is continuing. Representatives from the different peoples’ movements from
all over the world continue to come to Plachimada to extend their support to them.
LEARNING EXPERIENCE:
Over the past few years I have been listening to the debate on the positives and
the negatives of globalization. I was not so much interested in this debate because I
thought it was just an intellectual exercise, which is of no help for the common people.
Visiting Plachimada made me interested in globalization. Listening to their stories of
physical, economic and emotional distress made a difference. When they boiled the water
in front of me to show the thick sediment, tasting that water which was like diluted acid,
seeing some of the skin lesions all made me interested in knowing more about
globalization.
Who will not get angry when one has to walk about 2-3 km. every day for water,
leaving their little babies at home, when a few months ago they had the luxury of potable
water at their door steps? Globalization is good…. But when somebody in another
continent due to extreme selfishness and greed, try to amass wealth at the cost of the
basic necessities of others who are helpless, can we still consider globalization good? The
people of Plachimada may or may not succeed, but their story will always remain as an
inspiration for the millions who are crushed by greed and selfishness.
CONCLUSION:
In addition to what I learned about the negative impact of globalization, I was
impressed by the commitment of the South American team towards social justice. It was
interesting to listen to the various stories of the struggle for social justice happening in
the other parts of the world. It also gave me my first exposure to a press conference.
(Refer annexure8).
------------
Chapter 4.
CONFERENCES AND WORKSHOPS ATTENDED
Sexual development and sexual health in teenage street and slum
children in India.
DATE AND VENUE:
July 22-25, Bangalore, India.
THE CONFERENCE:
Organized by: APSA, Bangalore, NIMHANS Bangalore and Youth incentives
Netherlands.
Participants: about 50 participants from street and slum children’s organizations.
Objectives:
•
To share the recent research findings on teenage sexuality in street and
slum children in India.
•
To discuss the preliminary ideas for interventions with as many
organizations as possible
•
To incorporate the best ideas into the program
•
The conference may help to build skills for effective intervention
•
The conference may spur the growth of a movement or network of
organizations interested in street children in south India.
•
To initiate the process of developing a very practical and user friendly
activities workbook and staff training manual, relevant to the specific life
circumstances of teenage street and slum children.
The Program:
These were the topics covered in the conference:
Day I: introduction to adolescence and sexuality.
Street boys and sexuality – a study
Street girls and sexuality – a study
This was followed by discussion
Day II: there were four parallel workshops
How to work with teenage street and slum boys and girls; attitudes and skills
How to work with teenage street and slum boys and girls; using creative methods
Sensitizing to adolescent sexuality; personal memories and attitudes
Sensitizing to adolescent sexuality; sexual rights and sexual health
Day III: there were two parallel workshops in five small subgroups.
Translation into an intervention program- developing sexuality related activities.
(The 5 themes were: intimacy, consent, STDs & HIV / AIDS, pleasure and urge,
what is good for me and how to take control over my life)
Translation into an intervention program- developing psychology related activities
(the 5 themes were: general influence of peers, substance use, loneliness, coping
with problems, future orientation)
This was followed by active presentations of the ideas and the form and content of
the workbook (intervention program)
Day IV: further discussions on the workbook and the staff-training module, which was
done in four small subgroups, followed by presentations by the subgroups.
LEARNING EXPERIENCES:
A child as soon as it is born does not walk or run. It goes through a growth
process which takes quite a lot of time. In that process it crawls, creeps and falls. The
society is very tolerant to that process and supports the child in that process. It is almost
the same when the child goes through the process of learning to speak. There is lot of
understanding and support from the society. But when it comes to the process of sexual
and emotional maturity the society seems to be very intolerant and judgmental. This
conference provided an environment where most of us could become at ease with
sexuality and discussions around it. In the context of the current HIV / AIDS pandemic it
is not only condoms but sexual and emotional maturity also is important. There was a lot
of professionalism and participation in the process of the workshop
---------------
Cochrane workshop on systematic reviews and meta-analysis
DATE AND VENUE:
August 19, 2003. NIMHANS, Bangalore.
THE WORKSHOP:
Organized by: CHC, NIMHANS and St. Johns Medical College, Bangalore.
Participants: about 30, mostly medical graduates and postgraduates.
Conducted by: Dr. Madhukar Pai, division of epidemiology, university of California,
Berkeley.
Program: after a brief self-introduction of the participants, the workshop started around
9.00 am. These were the topics dealt with:
•
•
•
•
•
•
•
•
•
•
Introduction to systematic review and meta-analysis.
How to critically read systematic reviews and meta-analysis?
Critical appraisal of a systematic review- small group session 1
How to conduct a systematic review: formulating the review question
How to conduct a systematic review: searching and including primary studies
How to conduct a systematic review: extracting data and assessing study quality
How to conduct a systematic review: analyzing the data
How to conduct a systematic review: interpreting the results and writing the report
Critical appraisal of a systematic review- small group session 2
The Cochrane collaboration and Cochrane library.
LEARNING EXPERIENCES:
Every human mind, which is active, experience a hunger, the desire to know the
truth. The mind gets satisfied only when it experiences the truth. In this era of
information explosion, we are bombarded with lot of information, much of which is far
from the truth. It is well known that all who conduct research and publish papers do not
do so out of their passion for knowing and disseminating truth. In this context it was good
to learn the technicalities of another research methodology, meta-analysis. Thanks to
Madhukar Pai.
-----------------
National Workshop on Right to Health Care.
DATE AND VENUE:
September 5, 2003., Bandra, Mumbai.
THE WORKSHOP:
Organized by: Jan Swasthya Abhiyan-PHM, India.
Participants: about 250 JSA activists from all over India.
Objectives:
• To discuss the perspective, content and the further campaign strategy regarding
the right to health care
• To share the various cases of denial of health care, which were documented from
various parts of India.
Program: the program started at 10 am. There were 4 sessions.
Session 1. Introduction of participants
Overview of the program and the issue of Right to Health Care
Session II. There were two parallel sessions on four topics.
Right to essential drugs
Right to health care in situations of conflicts and displacement.
Right to basic health services, including primary health care
Session III. This was the first post lunch session. This session included a short plenary
presentation on the following topics:
Health rights in the context of the private medical sector.
Right to mental health care
Public health sector employees and the right to health care
Children’s right to health care
This was followed by another parallel session with two topics;
Right to health care for unorganized workers and urban poor
Right to health care for HIV-AIDS affected persons
Session IV. The last session included
Sharing of cases of denial of health care documented from different parts of India.
This was done in four groups.
Presentation and discussion on JSA strategy to establish the right to health care.
The workshop ended by around 6.30 pm.
LEARNING EXPERIENCES:
Why is it that there is so much of denial of right to health care today? Some of
the reasons are these: the negative impact of the Liberalization, Privatization and
Globalization (LPG) policies; the decreasing involvement of the state regarding public
health and the proliferation of the unregulated private sector. It was interesting to know
that there are so many documents to justify this right; the UN declaration, the Alma Ata
declaration, the constitution of India (art. 47), the supreme court judgment, the NHRC
recommendation and so on. The enthusiasm of the activists from all over India was very
evident and encouraging.
-----------------
National Public Hearing on right to health care.
DATE AND VENUE:
September 6, 2003., Bandra, Mumbai.
THE CONSULTATION:
Organized by: Jan Swasthya Abhiyan-PHM, India.
Participants: about 250 JSA activists from all over India.
Objectives of the consultation:
Public hearing on the select testimonies from representatives from various states
on specific examples of denial of access to health care
Presentations by leading public health and legal experts on right to health care
Response from NHRC and health ministry officials
Program: the program started at 10 am with a welcome address from Dr. N.H. Antia.
This was followed by the inaugural address by Justice A.S. Anand, Chairperson, NHRC.
Following this, representatives from various states presented selected testimonies of cases
of denial of access to heath care. After that Prof. Satyaranjan Sathe spoke on the legal and
constitutional entitlements for the right to health care. Dr. Abhay Shukla presented the
framework and set of suggestions to establish the right to health care. The pre-lunch
session ended by the concluding remarks of Dr. Justice A.S. Anand.
Post lunch session was mostly presentations and discussions based on the
pervious days issues from parallel sessions. The consultation ended by 5.00 pm with a
group discussion on how to take the campaign and JSA forward.
LEARNING EXPERIENCES:
The three basic functions of the state are: law and order, education and health
care. Pulling out of it means the state is going against the constitution. When the state
pulls out of these responsibilities the civil society comes under the mercy of the market.
Hence the civil society need to be empowered; become watch dogs of the state and take
control over the market. Laws can prevent a bad person from doing evil but it cannot
make people do good. Legislation alone is not enough. Its implementation is also
important. For that the civil society has a major role to play. In this context, the PHM is a
ray of hope.
---------------
International Health Forum (IHF) for the defense of
People’ health
DATE AND VENUE:
January 14-15, 2004. Mumbai
THE WORKSHOP:
Organized by: peoples health movement (PHM)
Participants: about 700 participants from 50 countries, from all over the world
Objectives of the forum: to bring together individuals, groups, organizations and
movements involved in the struggle for making the voices of the unheard heard and to
attain heath for all.
To review concerns on a wide range of broader, national and global determinants
which affect health for all. (globalization, militarism, war, exclusion due to gender ethnic
minority status, disability, poverty and marginalization)
To share the experiences, alternatives and strategies evolving at local national and
global levels in meeting these challenges.
To evolve the further course of the PHM at global, national and regional levels
To mainstream health in the events of the WSF through involvement of health
activists and professionals in cross-sectoral issues.
Program:
Day I: the program started at 9.00 am. The inaugural session had the following
topics:
Overview on confronting the challenges of globalization through health work:
perspectives, struggles and strategies.
Short report on the PHM and the main challenges before it
Presentations by regions on challenges, struggles and the role of PHM(Asia,
Africa, Americas, Europe and India)
Case studies from countries
This was followed by 2 parallel plenary: Globalization, health policies and health
sector reforms
Health under war, occupation and militarization.
The day ended around 7.00 pm with 7 parallel workshops: Globalization and
health policy.
Promoting synergy: towards joint antiwar action
Learning from the global tobacco control campaign
Liberation medicine
Globalization and health sector reforms
Health teams for health for all (CHWs etc.)
Traditional / alternative systems of medicine and primary health care
Day II. Had 3 plenary sessions: HIV / AIDS and resurgence of communicable
diseases- confronting the crisis
Women, population policies and violence
Health care and the marginalized
After lunch break there were 7 more parallel workshops: key issues in women’s
health
Voices of the unheard; children, adolescents and persons with disability
HIV / AIDS and the resurgence of communicable diseases
Globalization, poverty, hunger and death
New economics and its impact on medical practice in India
Social determinants of mental health and PHM
Environmental justice and peoples’ health- confronting toxics in our communities
The day ended at 7.00 pm with a closing plenary: reviving the spirit of Alma Atathe challenges before us
Towards a Mumbai declaration - an action plan building on the plenary and
workshops
LEARNING EXPERIENCES:
Since there were lots of parallel workshops, I could not attend all that I wanted to.
But it was a good experience to listen to some of the testimonies from different parts of
the world. It was interesting to see that even in the so-called developed countries there are
people who do not have access to proper health care. The solidarity of the people from
different nations, cultures and races was very impressive.
----------------
Community Health Workshop:
DATE AND VENUE:
April 14-16, 2004. Bangalore.
THE WORKSHOP:
Refer annexure9
LEARNING EXPERIENCES:
This workshop was a good way of concluding the fellowship. The four topicsRight to health care, globalization, VHWs and community health financing were areas we
were involved in during our fellowship. It helped me to deepen my understanding on
these topics. We could raise many questions and discuss it freely.
Chapter 5.
TRAINING PROGRAM CONDUCTED:
Community Health Orientation Programme
PARTICIPANTS:
2nd year theology students of CRI Brothers.
DURATION & VENUE:
October 6th to 24th, 2003. Vidyadeep College, Bangalore.
INTRODUCTION
At the request of Bro. George T.V., Dean of studies of CRI Brothers Institute,
CHC conducted a three week community health orientation programme for the 2nd year
Theology students. In discussion with Dr. Thelma I decided to take the responsibility for
co-coordinating the programme as part of the fellowship experience. My companion Br.
Xavier C.Ss.R was also involved in organizing the programme. Mr. Rajendran assisted us
in the process.
OVERVIEW OF THE PROGRAMME
The community health orientation course began on the 6th of October Monday at
9am. It started with introduction followed by an icebreaker called “toss salad”. I gave an
introduction and the purpose of the course. We had a break for half an hour and then at
10.30 I took a session on Communicable and Non communicable Disease. I began this
session with a game which brought out different kinds of diseases from the participants.
It was a very interactive session. Dr. Paresh Kumar took a session on Working with
Communities. It was very inspiring and informative. After noon we visited Snehadaan a
home for the AIDS patients run by Camilians. Fr. Mathew Perumpil the director of
Snehadaan, spoke about HIV/ AIDS, its prevention and rehabilitation. He also shared his
experiences in working with AIDS patients. It was amazing and very inspiring. After
supper we had the sharing of reflections of the day. Many expressed that their visit to
Snehadaan was a great eye opener and it changed their attitudes towards AIDS patients.
7th October Tuesday:
The day began with the session by Dr. Francis on Health situation of India.
After the tea break he took another session on Health Apostolate of the Church. He
challenged the participants by asking different questions. At the end of the session I
asked a few questions and Dr. Francis gave very inspiring answers. This was followed
by a session on Levels of prevention and Health promotion. It was very informative.
The post lunch sessions began with Dr. Shiridi Prasad. He took a session on Alternative
Systems of Medicine. He began his class by asking questions to bring out various
indigenous systems of medicine which the participants knew. Then he categorized and
explained each of the systems. This was followed by a session on Health, Community
health and Holistic health. A lot of transparencies with diagrams were used and they
brought out the essence very clearly. After supper we had the summing up of the day. In
that session many of the participants expressed that the day was hectic and no time to
reflect. So we decided to modify the daily schedule and give more time for group and
individual reflections. That night we showed them the movie Lesser Humans.
8th October Wednesday
Morning we had the prayer at 6.30 conducted by one of the six groups which we
divided for group discussions. The first session was taken by Bro. Xavier on Critical and
Creative Thinking. He began his session with a magic show and connected it to the
question how we should think critically. He asked them to decorate one person with three
news paper sheets and some broom sticks to bring out their creativity. After the tea break
we decided to give them time for group reflection. We came back for a session on
NGO’s. I started the session with an inspiring story and explained the dynamics of
NGO’s with lots of examples. After the lunch we sent them to four NGO’s, APSA, APD,
Navajeevan and Shishu Bhavan in which two were religious and the other two secular.
They went in small groups of 6 members each. After supper we had the summing up of
the day were the groups shared their reflections about the field visit.
October 9th Thursday
The day began with the morning prayer. The first two session was on Health and
Nutrition by Ms. Padmasini. She made it very simple and practical. After that Dr. Mary
Thomas took a session on Women’s Health. She brought some magazines and showed to
the participants how women are considered today and she explained how we could
empower them. The post lunch session began with Dr. Mohan Isaac on Mental health
and Family health. He explained by showing different transparencies, it was very
informative and helped the participants to understand the importance of mental health
which is one of the components of health. Evening we had a panel discussion with Ms.
Donna and Fr. Ignace C.Ss.R. Ms. Donna spoke about Equity in health especially
gender issues, she shared how women are denied of health care. She gave lot of
examples of cases from her own experiences and answered many questions of the
participants. It was amazing to see her conviction and commitment. Fr. Ignace C.Ss.R
shared about Equity in health especially poverty issues using his experiences in North
India and how he shifted from preaching to prevention of Malaria. It was thought
provoking and inspiring.
October 10th Friday
The first session was given by Dr. Rajan Patil on Environment and health. He
explained the role of environment in health. After tea we gave them time for group
reflection. Before the lunch break we had a Panel discussion with the slum youth
regarding the problems of the youth in the slum. Five of them shared about their life,
difficulties and kinds of work they do. The participants were moved by their genuine
sharing and openness. After lunch we had another panel discussion on TB., Malaria and
Alcohol. Rajendran and Chander spoke with their experience on the ill effects of Alcohol
and Tobacco and its implications on the individual and society. Evening Bro. Xavier took
a session on Interpersonal relationship and community life. He explained the different
qualities which a person need to inculcate to live a healthy community life. After dinner
we organized a Musical evening. We taught them some action songs and the participants
put up dances, skits and songs. It was like a celebration.
October 11th Saturday
Last day of the orientation programme. We started the day with Monsoon game.
The participants were divided into 5 small groups. Mr. Prahalad coordinated the game.
After the game we had the sharing of the participants about their learning experiences
from the game. They said that the game helped them to understand the dynamics of
poverty among the villagers and how the monsoon plays a important role in their lives.
After the tea break the CHC team Rajan Patil, Prahalad and Chander shared about
Globalization, Peoples Health Movement and the Charter. After that we planned for
the two weeks exposure programme.
EXPOSURE PROGRAMME
We left for Mysore on 13th morning and we reached RLHP (Rural Literacy and
Health Project) by 11.am. We decided to spend rest of the day by going around and
visiting the important tourist spots in Mysore. The next day we went to meet Fr. Chitoor.
He is staying in a village which is around 45kms away from Mysore. We had break fast
with him and then he gave a brief summary about his work and his herbal garden. He
took us around and explained about each plant and its usage. The participants were
amazed by seeing so many medicinal plants which they considered as wild plants or
weeds. After our lunch Sr. Mary brought some medicines made out of Herbs and
explained about its preparation and usage. Some of the participants bought herbal
medicine for their minor health complains. We went to see the Kabini dam which is just
5kms away from Fr. Chitoor’s place. We got back to RLHP for our night stay.
15th of October
Next day, we went to the Organization for the Development of people (ODP). It is
the Mysore Diocesan Social Service Society, a voluntary, non- profitable organization
aiming to enable community based people’s groups to become self reliant. Fr. Vincent
Fernandez the director gave a brief introduction about their work and experiences. The
participants asked many questions and his answers were genuine and inspiring. He took
us around to their various income generating projects which they have started for the poor
village girls. We visited the stationary unit were they make Note books, then to tailoring
unit were uniforms are stitched for various schools and leather bags of different kinds. In
the food processing unit they prepare some snacks based on the orders given by the
customers. We were surprised about their sale and profit margins and how the illiterate
girls were able to earn and support their families. Some of the participants bought bags to
show our support and solidarity. We got back to RLHP for lunch and at 2.30pm Mr. Joy
the director of RLHP spoke to us about their work and experiences. They are working in
the slums in Mysore, they have build up SHG’s, shelter for the street boys and girls. After
his talk we divided the participants in to four groups and sent them to different slums
were RLHP is working. After our dinner we had sharing of reflections. The participants
expressed that some of them visited developed slums which can no longer be called as
slums and others visited an underdeveloped slum. The participants appreciated the good
initiatives of RLHP.
16th of October
we went to H.D.Kote to visit the organization called Swami Vivekananda Youth
Movement. Dr. Balasubramaniam gave an introduction about the organization and its
activities. He shared the origin, principles, achievements and the challenges of the
organization. It was a good sharing. After that we went around the tribal hospital where
they follow one of their guiding principles, ‘Nothing is given free’. For any treatment and
surgery a tribal has to pay just Rs.5/- for all the expenses. We were impressed when we
went to every nook and corner of the hospital which is well equipped and totally people
oriented. After that we went to a tribal haadi for a visit and spoke with some of the
tribals. Then we got back to the hospital were Dr. Balasubramanium spoke more about
their various projects and it was an interactive, question – answer session. Evening before
reaching our place for night stay we dropped in, to watch a street play performed by the
VYM staff in one of the tribal haadis on tobacco control. It was something exciting and
new for us.
17th October
Next day, we visited the tribal school situated near the forest which follows non
conventional method of education for the tribal children keeping in mind their cultures,
customs, practices and needs. The structure of the school is something new and creative.
We had an hour of group sharing in one of the classrooms in the school. We reached
RLHP for dinner.
18th October
We went for a gathering of old aged people in a slum organized by RLHP. There
were around 300 old men and women. It was nice to see them dancing, singing, and
participating in the fancy dress and fashion show competitions. In the evening street girls
from the RLHP centre gave a cultural programme for us and the participants performed
some dances and songs for the girls. Some children shared about their experiences in the
street and how they were are rehabilitated here. It was very heart breaking and distressing
to listen to their stories.
19th to 23rd October
We left RLHP and reached Hanur which is about 40kms from Kollegal and
visited Comprehensive Rural Health Project. The holy cross sisters have taken up this
project which covers 76 villages. Sr. Aquinas is the director. We decided to leave it to
the participants to identify and choose what they would like to do in the coming 4 days.
After supper we had an open session with Sr. Aquinas. She shared about what they were
doing in the villages and what were the possible areas where the participants could
involve themselves. Fifteen of the participants opted to go and stay together in a hall
which was 2kms away from a village and wanted to work for the village in the water shed
project (lets call them group A). Five other participants decided to stay inside another
village in families and work in their fields (lets call them group B). One participant chose
to go with a staff of CRHP to identify bonded child labourers in the villages and another
went along with the mobile clinic to different villages.
Group A worked in the watershed project in few fields of the farmers in the
village on the first day. The next day they wanted to do something for the whole village.
But they experienced non- cooperation from the villagers and so they themselves repaired
the roads and cleared up the Govt. school campus in the village.
Where as group B ate what the villagers gave them and worked in their fields.
Some villagers joined them in repairing the roads. They experienced good cooperation
from the villagers. On the last day evening they gathered the whole village and organized
a cultural programme for them. There were dances, skits, jokes and they also made the
village youngsters to dance and sing in the programme.
24th morning
We had a debriefing of the four days experience in the village. The exposure
programme ended in a happy note even though some felt that expect the stay in the
village the whole programme was a waste of time. The participants agreed to submit a
final collective reflection and report before November 10th, and to have a final
presentation of about 2-3 hours to the Vidyadeep Institute and CHC consultants before
November 15th. After lunch we left for Bangalore.
OBSERVATIONS :
1. Community health orientation programme as whole is a very good module – both the
one-week orientation as well as two weeks exposure. But for whom, it is conducted
is also very important. A group that has sufficient emotional maturity, social
orientation and an inclination for poor can benefit maximum from this course.
2. There was a conflict regarding the expectations of the participants and the formatters.
Some of the participants wanted to live 3 weeks with poor people and do manual
work. Formatters wanted community health orientation programme. This conflict
became very obvious towards the 2nd week of the program.
3. The participants could be classified into 3 groups. A minority of highly motivated
and ‘other oriented’ group (about 5-6); another minority of highly motivated but more
of ‘self centered’ group (about 3-4) and a majority of a docile group which had no
stand of its own (about 10-12). The self centered group was quite influential and
could take the docile group also with them most of the time.
4. There was pressure from the participants to compromise on two basic principles
consciously chosen for this program, i.e. ‘Participatory’ approach and ‘Ballonistic’
approach.
5. When the conflict regarding expectations became quite evident, the participants were
encouraged to come together and express their feelings and thoughts freely in the
group. The dynamics of that group sharing was a very good learning experience for
us. It lasted for about one hour and we could listen to them without being defensive
or reacting, especially when the general feeling was that the program was a ‘waste of
time’ and there was no connection between the one week orientation and the exposure
program. It was painful, but our non-defensive listening attitude helped the group
itself to confront each other and over come the crisis. At the end of that group
process it became evident that the program was a ‘waste of time’ only for a minority
which expected a manual work experience. But this minority could confuse the
whole group, especially the docile group.
6. Based on the observations of the above mentioned group process, we could help the
participants to make the final week (CRHP experience) more appropriate and
relevant by incorporating their interests, needs and aptitudes. Thus they chose to
spend their last week in doing manual work, staying with the villagers. One group (5)
decided to live within the village, work with for and eat what ever the families gave
them. Another group (15) decided to stay outside the village, prepare food for
themselves and work for a watershed project in the village.
GROUP A (15)
GROUP B (5)
Experienced the positive aspect of Experienced the positive aspects of
community life only among themselves community life both among themselves
(15)
(5) as well as with the villagers.
Experienced resistance from the villagers
Experienced
villagers
cooperation
from
the
Self survival became the priority (e.g. Mission became the priority than self
food etc) than the mission
survival
Probably will become institutionalized Probably will become leaven in the
trying to transform Society from outside bread, transforming society from within
7. We perceived that there was a general feeling that group B was successful that group
A. but the final reflection at CRHP after the work experience could resolve the issue.
Even though group B apparently gave the impression of being successful, group A
too had a very rich experience. Both the groups experienced the positive aspects of
community life like mutual support, cooperation, each one as a complementary
member with various gifts and talents, meaningful prayer and recreation, respect for
each other and so on. The difference was; group B lived an intense community life in
the midst of a positive experience (Cooperation from villagers) and group A too
experienced intense community life in the midst of a negative experience (resistance
from villagers).
LIMITATIONS :
1. As far as this course is concerned we were conducting it for the 1st time.
2. Lack of availability of some of the experienced CHC consultants for some sessions of
the 1st week orientation
3. We missed the rich experience of Mr. S. D. Rajendran who has coordinated similar
courses in the past especially during the one week orientation phase. He was
coordinating another program which was going on simultaneously.
4. We missed the experience of Dr. Paresh Kumar especially regarding the field visit to
Vivekananda Youth Movement in H. D. Kote.
5. Canceling some of the already finalized sessions had brought difficulties in last
minute arrangements.
6. Lack of availability of updated phone nos. and email ids of resource persons and
groups.
7. The multiple roles we played, like developing the programme, organizing it, and
becoming resource persons for about 5-6 sessions was very stressful.
SUGGESTIONS FOR IMPROVEMENT:
1. Interacting with the participants without a preset questionnaire might help to
understand whether they are prepared for this particular course. It would also avoid
conflict of expectations.
2. If the group is not ready for this course suggest some other course which will address
their need. Another possibility would be being extremely flexible to address their felt
need and then take up community health orientation course at a later stage.
3. It would be nice to have an interaction with the formatters and the participants
together, to avoid communication gap.
4. The programme coordinator(s) becoming a participant observer through out the
program can achieve the following:
a. It will help to identify and resolve the problems among themselves that comes up
during the programme.
b. It will help to he/she to bring innovations during the programme.
c. Generate new insights for improving the programme in the future.
5. Total cost of the Programme comes about Rs.40,000. Hence the economic feasibility
of the programme should be taken into consideration in the future.
CONCLUSION:
This course, with its one-week of theory and 2 weeks of exposure seems to be a
wonderful program evolved by the many years of experience of CHC. But at the same
time it is important to conduct this course for motivated and other oriented groups for its
optimum utility. Though we experienced ‘emotional drain’ by organizing this program, it
was a wonderful learning experience for us. We acknowledge our sincere thanks to the
CHC team as a whole, for the trust and confidence they had in us even though it was
evident that we were conducting this course for the first time. (For programme schedule
and participant evaluation, refer annexure10)
CONCLUSION
CONCLUSION
There was a phase in my life where I could see only hopelessness and misery
around me. Pessimism was my predominant expression. Is the society beyond
redemption? That was the question, which resounded in my mind very often. I was
getting disillusioned by the consumerist trend, which was gradually taking over the
medical profession. But somewhere along my life I started encountering people who
instead of cursing darkness, were trying to light a lamp. Even though they were a few,
they were making a difference in the society. Coming in touch with them was a pleasant
surprise for me. It gave me enthusiasm to move out of my pessimism and to begin the
journey, which led me into the world of community Health. These people whom I
encountered helped me to make a gradual transition from the world of hospital to
community-based projects to people’s movements – the coming together of those lights
that were making a difference in the society.
This write up may not have many of the characteristics of a scientific work. It was
a deliberate choice from my part to write it this way. Probably it can be considered as an
expression of, my own transition from a purely scientific world to a human world. Earlier
I mentioned that this fellowship was a significant stage in my journey. Does it mean that I
have ended this journey? No! It will continue. We (fellows of 2004) have already started
working on ways of being in touch with each other, in order to make our contribution
towards a just society. I hope that more and more youngsters may get opportunities like
this. Our journey will continue along with the millions of the poor and the exploited as
long as there is gross injustice, exploitation and misery.
ANNEXURES
Annexure 1
Two-Day Debriefing of the fellows of 2003-2004
11th and 12th March
Community Health Cell, Bangalore
The Community Health Fellowship scheme was offered to Mr. Naveen Thomas (MSW)
Dr. Mathew Abraham (MD in community Medicine), and Dr. Abraham Thomas
(Dentist), for the year 2003 and 2004. The activities and learning experiences of the
fellows was facilitated through a discussion panel by the mentors at Community Health
Cell. Dr. Thelma Narayan, Dr. C.M. Francis, Dr. Ravi Narayan, Dr. Paresh Kumar and
Mr. S. J. Chander were the facilitators of the discussions.
The discussions were held over two days with 2 sessions a day.
The sessions were
1. Reflections on the One-Year Fellowship in line with the objectives of the
fellowship
2. The skills and the knowledge acquired over this period
3. Values and attitudes acquired and imbibed over this period
4. Reflections over the Process of learning
Session I
Facilitator: Dr. C.M. Francis
Effectiveness of the fellowship / internship scheme in line with the objectives
The session started with a 20 minutes introduction by Dr. C. M Francis highlighting the
objectives of the scheme and the importance of the learning process. This was followed
by the fellows spending 30 minutes recollecting and writing down all the learning
experiences they had in line with the objectives and also those outside the objectives.
Deepening of the understanding and praxis of community health
Cognitive Domain
-
A gradual deepening of the understanding of the difference between medicine,
community medicine and community health was possible for the fellows
A deepening of the understanding of the components and principles of primary
health was achieved
-
Understanding the dynamics of the communities was also possible through the
fellowship
Affective Domain
-
The motivation and interest to work towards community health was strengthened to a
great extent
Social Context
-
The interrelation between rural poverty and the expansions of urban slums became
evident through this experience
The dynamics of exploitation of tribal communities by people from outside was seen
and experienced
Caste, Gender and Class divides that adversely affect health and development in
various communities was understood
Session II
Facilitator: Dr. Ravi Narayan
Skills and Knowledge acquired during the Scheme
The fellows were facilitated into a process of discovering the skills and knowledge,
which they acquired or developed during the time period
Existing Skills Sharpened
New Skills Acquired
Opportunities Lost
(in acquiring certain
expected skills)
1. Reflective Action
1. Mentoring Skills
2. Reporting
2. Connectivity (Internet, Mobiles,
using Computers, Making
presentations, etc.,)
3. Using certain Epidemiological
Software (EpiInfo)
1. Organizational
Management Skills
2. Epidemiological
Skills
3. Adjusting to a wide range of
environmental condition
4. Participatory Observation
5. Networking
6. Communication
7. Coping with emotional
Stress
8. Interviewing Skills
4. Evolving Structures through
organizing programmes
5. Project Writing and Analysis
3. Public Speaking
9. Management Skills
10. Group Dynamics
11. Driving
12. Research Methodology
13. Integration, summarizing
and assimilation of
information
14. Facilitating skills and
training skills
15. Critical Evaluation
16. Conflict Management Skills
17. Public Relations
management
Session III
Facilitator: Dr. Thelma Narayan
Attitudes and values in Community Health
The fellows were provoked into thinking – Why are we doing, what we do in
Community Health?
The questions put forward for the same were…
1.
What are the values and attitudes necessary for Community Health?
2.
What are the values and attitudes that led you into community health?
3.
In your experience with the various catalysts (placement organization) what
values and attitudes did you encounter and pick up?
Honesty
Empowerment
Patience
Humility
Faith in People’s Abilities and
Power
Respect for the living and nonliving (Environment and Nature)
Hope (positive attitude)
Flexibility
Courage and sense of Mission
Humanness
Being non-judgmental
Integrity
Justice
Openness to Learning
Prudence
Respect for people, their culture, and
beliefs
Self-Esteem
Emotional and Sexual Maturity
Forgiveness
Accepting our human limitations
Coping with suffering
Many of these attitudes are acquired, learnt behaviors, which have come with time and
experience. Some of them were rediscovered or understood during the Fellowship as
important strengths of community health work
In some situations, it was thought that values need to be personalized. I.e. putting oneself in
the shoes of the various stakeholders involved in an issue before we take a decision.
Session IV
Facilitator: Dr. Paresh Kumar
The Process of Learning during the Fellowship
The process of learning was discussed within the following headers
1. Uncertainty of entry into the Community
2. Urgency felt during the time period due to the lack of time
3. Adaptability
4. Loss of Autonomy
Uncertainty
Since the experiences of the three fellows varied in areas such as, situation, timeframe, location, partner organization, personal objective and local needs, the
Fellowship yielded a variety of rich experiences.
There was a healthy uncertainty where the fellows could evolve and sharpen their
objectives all through the time period. The uncertainty of place, job responsibilities to
be taken up, the partner organization’s aims and work force, new culture, language
and so on were the key to the wide range of adaptations the fellows underwent.
Urgency felt during the time period due to the lack of time
In some cases there was a certain amount of urgency felt due to the lack of time
allotted to each mission, while in some of the cases there was an extension of time
allotted to the original learning experience.
Conclusion
All the Fellows found this experience beneficial and rather enriching to their lives and
beliefs which led them to take up Community Health and Development as a vocation.
Some of the existing values and skills were deepened and strengthened, some were
rediscovered, and some were put into use.
When it was raised and discussed, whether we are reinventing the wheel by making
supporting another condensed course of social work, the fellows felt that this was not
only a technical short course, but it was also a value based learning process for the
overall growth of a community health person. This course was more of getting to
know the philosophy of community health and deepening it at an experiential level.
Annexure 2
Community and Public Health Internship/Fellowship Scheme.
Reading List
A. Books and Reports
1. Compendium of Recommendations of various committees on Health and
development (1973-1975)
-Central Bureau of Helath Itelligence (1985)
2. Health Services and Medical Education-A programme for immediate action
-Group on Medaical Education and Support Manpower (Srivastaca
Report), GOI. 1974.
3. Primary Health Care: A Report of the International conference on Primary Health
Care; Alma Ata, USSR. 6-12 September 1978.
-WHO-UNICEF (1978)
4. Health for All- An Alternative Strategy
–ICSSR-ICMR (1981)
5. National Health Policy
-Ministry of Health and Family Welfare GOI (1982)
6. Investing in Health: World development Report-1993
-World Bank (1993)
7. In search of Diagnosis
-MFC (1977)
8. Health Care: Which way to go ?
-MFC
9. Under the Lens: Health and Medicine
- MFC
10. Rakku’s Story: Structures of ill-health and the Source of Change
-Zurbrigg, Sheila (1984)
11. Health and Family Planning Services in India_ An Epidemiological, SocialCultural and Political Analysis and Perspectives
-Banerji, D.
12. Poverty, Class and Health Culture in India
-Banerji, D. (1982)
13. State of India’s Health
-Mukhopadhyaya, Alok (1992)
14. My Name is Today
-Morley, David., Lovel Hermione. (1986)
Annexure III
Our Experience in a Slum
Participatory Observation and reflection
By
Mathew Abraham and Xavier
Rajendra Nagar Slum
Bangalore
th
(From July 10 to November 26th 2003)
Introduction
After making a decision to live in a slum for participatory observation, we had
four slums in our mind. W visited the four slums and then chose Rajendra Nagar slum
(opposite to the National Games Village) due to its proximity to CHC (Community
Health Cell). We tried to get a room through World Vision, which has its office and a
school in the slum, but did not succeed. Then we decided to go on our own. As we were
walking in the slum we met a lady in a cycle shop who told us that it would take at least
tow days to find a room. Then we walked further and found a common toilet. We went
inside to have a look and there we met Arumugam, the one who collects money from the
toilet users. We asked him whether we could get a room to stay. He took us around and
showed us three rooms. We chose a small room, which was simple and fitting for our
objectives and purpose.
Learning Experience from the Inconveniences
Sanitation Problem
The first day in the morning, we go up early and went for mass to Infant Jesus
Church. After the mass we were coming back to our room. On the roadside there were
children sitting and defecating. The whole place was stinking and my companion Xavier
started getting giddy. We reached a small bridge. Underneath there was an open drain
flowing and on the bridge there was garbage and human excreta. Any over stepping
would result in us stamping on the night soil! Xavier held on to me and we somehow
managed to reach our room. We took rest fro sometime and went to a hotel for breakfast.
When we tried to eat all that we had seen came to our minds and we could not eat. We
were wondering why people don’t take their children to eh common toilets. Two months
later we found the answer. We paid Rs. 1/- per person for using the toilet daily, so for a
month it was Rs.30/- per person. Most families in the slum have more than five to seven
members. If every member uses the toilet once in a day it adds up to Rs. 180/- to Rs.
210/- a month, which is quite a big amount for him or her. Hence once women use these
common toilets. This realization helped us to understand and not accuse or judge these
people.
Problem of Sleep
Being used to sleeping in our own rooms, We had to make do with a small room
where there was just enough place for town people to sleep. My leg used to touch the
wall! When Xavier turned he would touch me and I used to get up, it was the same if I
turned in my sleep as well! Both of us used to get up very often in the middle of the
night. When we were finding it difficult to sleep in our room we came to know later that
there were as many as five people staying in our room before we came. One night we
went to Raja’s(one of the youth in the slum) house to see his nephew who was sick. It
was a small hut and they had already gone to bed. We saw a saree being tied across the
room dividing it into two portions. Soon we realized that on the other side were Rajas
sister and her husband. The rest of the family slept on this side while Raja slept on the
road making this sacrifice for this sister. But there was no privacy for the couple.
Bathing Problem
Initially we were taking bath inside our room. When I took bath Xavier sat
outside the room and when he took bath I did the same. After our bath, the room would
be flooded and we would mop it before we left. This is the story of every house in the
slum because most of them don’t have separate bathrooms.
Ventilation Problem
We locked our room and went fro a two-week exposure programme near Mysore
with the CRI brothers. When we came back, we found our room full of fungus and all our
clothes we affected by it. When we asked our neighbors who they manage, they said that
they don’t go out for such a long time. They got no letter, no phone calls, rarely any and
visitors. But in spite of all this they seemed happy.
Electricity Problem
Our house owner was tapping electricity illegally without paying the bill. In the
first week of every month, the Electricity Board Officer would come and cut the
connection. For few days we had no power in our room and on top f that there were no
windows or ventilation. We managed with candles. Some of the huts in our street had no
electricity at all and used kerosene lamps in the night.
Rainwater
One night when I was out of station, my companion Xavier was sleeping. It was
the rainy season and our room started to leak in toe to three places. Since we had only a
small vessel, Xavier couldn’t do much until an idea struck him. He climbed up and tied a
plastic cover to the place where it was leaking and then continued to sleep peacefully. We
have seen people emptying water from their houses in the night during the rainy season
as the drain overflows into their very homes. The situation is very pathetic.
Some Issues that We Encountered
Gender Bias
When we first reached the slum a girl came running towards us from her house
and asked whether we would take tuition for her. We asked her name and her reply
shocked us! Her name was ‘Venda’ which means ‘I/We don’t want’ in Tamil. I had
never heard such a name before. We were disturbed and angry with her parents for giving
her such a name. We started calling her Shalini. Two months later we got a chance to
chat with her mother. We asked her why she gave such name to her daughter. Then she
shared her story with us.
This woman already had two daughters and was pregnant with the third child. All
her relatives cursed her saying she was incapable of bearing a male child. So by all means
she wanted a boy, but she delivered a girl! She was disappointed and frustrated while
many of her relatives did not even come t se the baby. Then one of her relatives told her
to give her baby such a name so that the next child would be a boy! We were able to
understand her.
Money Lenders
Shalini’s father once told us, “When I get up in the morning my head is spinning
and I am completely confused.” He is a mason and earns around Rs. 4000/- per month.
His wife does domestic work in three families and earns around Rs.1700/-, the second
daughter works in a textile company and earns around Rs. 2000/-. Thus the monthly
income of this family comes to around Rs. 8000/-. But in spite of this all the children
look malnourished. We asked them the reason and he told us that he had to pay a monthly
interest of Rs. 5000/- He had borrowed Rs. 50, 000 for his eldest daughters wedding and
had been paying the above amount as interest for the past two and a half years. This
meant that he ha already paid around 1,50,000 as interest and he was yet to return he
principle of Rs. 50,000/- Initially we were angry with the money lenders but when we
spoke to our mentors, we realized that money lending flourishes on account of the prorich banking system. Later on we met a Bank Manager in Kollegal called Mr. Vijaya
Krishnan who gave money for the poor village SHGs than for big businessmen. It helped
us realize that even in the Banking System, there are officials who are pro-poor.
Injustice and Corruption
Most of the days we had dinner from a roadside noodles shop in the slum. Meshak
comes with his son David around 7 pm and sells noodles and fried rice till 11.30 pm. One
day while we were eating, two policemen came in their official bike and stopped before
the shop, Meshak ran and gave them some money. After sometime tow men came and
ordered noodles and fried rice. When it was ready they just took the parcels away without
paying for it. Meshak told us that hey belonged to the crime branch. He also told us that
50% of his profit went to the police in this form. Every day policemen come there
between 9.15 and 9.30 pm and collect money from all the shops. We asked him what
would happen if he refuses to pay. He said that they would not allow him to keep his
shop. He also said that there is no permission to keep shops on the roadside so they have
to give something to the police.
Is this not a form of legal roudism? The policemen collect not only money but all
that is required for their family from vegetables to fruits without paying a pie. The ones
who are supposed to protect have themselves become the threat. Why are the police antipoor and using the law to crush these poor while they escort the rich?
We met some contract men who were cleaning the road. They had come from
Andhra Pradesh. The contractors bring them promising a good salary. But once they are
given jobs, they are paid only 1800/- a month and asked to sign a receipt o 2000/0 this
contractor takes Rs. 200/- from each worker and he just sits at home! He owns 106
lorries! They also said that they are throw on out of their jobs if they ask for justice. To
sustain their families they have to take up more than one work. They come back home
angry and tired. Couldn’t this explain why they try to find solace in alcohol? Why they
are rude with their spouses and children?
One day at around 6 in the morning, we saw a long queue of people standing with
cans and ration cards. Kerosene was being distributed from a tempo van. Out of curiosity
we went near them and started a conversation with them. Slowly we realized that what
was due to them was denied. They were paying Rs. 100/- for 10 litres of kerosene, but
were only being given 8 litres! And in front of them it was being sold for Rs. 15/- per litre
in black. We were angry and asked them why they don’t assert their rights. They were
indifferent. They said that these were daily happenings and asked why they should loose
even the little they were getting by doing any such thing.
According o the WHO, health is a physical, mental and social well being! Will
there be health in the midst of the day to day struggle for existence? Will there be health
in the midst of injustice?
Accumulated Anger
Raja is a 23-year-old youngster in the slum who goes for construction work. He
drinks alcohol everyday, takes 30 packets of Panparag and goes for gang fights. The rich
also use him as a pawn to settle scores. When he was 7 years old, one day he refused to
go to school because his teacher hit him the previous day. His father was drunk and hit
him badly insisting that he should go to school. When his father had finished punishing
him, his mother made him naked, prepared jaggery paste and applied it on his body, and
left him near an anthill. He cried helplessly when being bitten by ants but no one helped
him. As he was sharing this tears rolled down his eyes. At the age of eighteen, he was
arrested for attempted murder. He was beaten up by the police in the station so badly that
he could not walk properly and when they took him to the court he was asked to say that
he fell in the toilet. Two years he was in the jail and experienced a lot of torture.
Today he enjoys spending time with us in our room along with other youth. He is
no more the same Raja whom we met in the beginning. He takes only 5 packets of
Panparag and has a deep desire to quit from alcohol. W never told him change but
listened to him and maybe our non-judgmental attitude brought about this transformation
in him. Thanga, Joseph etc. are youngsters in the sum like Raja. The traumatic childhood
and other bad experiences have made them extremely angry people. They are used by the
underworld and politicians to settle scores and kill people. Sometimes we wonder
couldn’t there be an association between these ‘angry youth’ and violence like terrorism,
communal riots etc.
Emotional Health
Everyday when we opened our door, before we could enter the room children
would enter. Even changing our clothes had to be done in their midst. They use to make
us sit and fought with each other to get a place in our laps. They hugged us and told us
certain things which made us understand deeper issues. These are some of their own
words:
“I don’t like my mother or father, I like you”
Ammullu 4yrs.
“My father dips my face in the drain if I commit a mistake”
Ammullu 4yrs.
“My father beats me with his belt.”
Sangeetha 4yrs.
“ My grandfather calls me a prostitute when he is drunk.”
Nayeema 14yrs.
“I don’t want to live I want to die.”
Shabana 13 yrs.
Some call their own children –‘You Prostitute.’ We have heard it ourselves.
Initially we were angry with their parents but slowly we realized that they too are
oppressed and struggling to cope with their day to day pressures. We asked a question to
ourselves. What is the real nee? Isn’ t Love, affection, and healing of the past traumatic
experiences? Can development from outside without peoples involvement sustain?
Community building is essential for sustainable development. Unless we deal with those
issues can we think of sustainable development? Can building houses, schools, putting
pipelines, without building community help in sustainable development? Will
disciplining children from outside without addressing their emotional problems and needs
result in a better society in the future?
On of our dilemmas was whether to discipline them by giving them tuitions or to
address their emotional needs? We tried both. With the smaller children we gave a lot of
emotional support and love by playing with them and allowing them to sit in our laps.
With the teenagers we tried tuitions but slowly we realized that under the cover of
tuitions they too were coming to us to express their emotional needs and problems.
Will teaching Mathematics, Science and other subjects without addressing the
emotional issues make the children responsible citizens of tomorrow?
Will teaching philosophy and theology without addressing their emotional issues
result in better religious and priests?
Will teaching anatomy, pharmacology and surgery alone without sensitizing them
to the needs of the people result in bringing forth good doctors (healers)?
Community Building Exercises
Our entry point into the slum was through children. They did not hesitate to come
to us. We opened our door for them and spent a lot of time initially with them. They were
very possessive in the beginning. Whenever they brought some sweets for us we used to
share it with al the children present at that’s time. Initially some of them were angry but
later they started sharing with others themselves. After a few months, they suggested that
we cook and eat together. All the children came together cooked food, shared it and ate as
one family. Seeing the children cooking food the youth also wanted to do the same. We
encouraged them and all had a good meal. We felt that these were opportunities for
community building where people come together in spite of their differences.
We found some youngsters addicted to alcohol and tobacco. We wanted to do
something about it without telling them to change. So we put posters with pictures
explaining the consequences of taking alcohol and tobacco. When they saw those pictures
they were curious and asked us what they meant. We sued this opportunity to explain the
ill effects of alcohol and tobacco. When they expressed their desire to quite from these
habits, we encouraged them. On some days we had informal question-answer on AIDS,
VD, Sexuality and friendship. We taught them life skills using their own life situations
and events. We went wit them for movies and enjoyed every bit of being with them. But
the next day when we gathered in the night we helped them to look at the movie and life
in general critically.
The youth after coming back from their work were getting into gambling and
other games wasting their money. So we taught them to play chess, snake and ladder and
other games, which they could play together and enjoy.
Xavier went with a Muslim family to Mysore for a wedding. They went in a
vehicle meant for transportation of goods. They were 25 of them sitting in that small
vehicle. On the way it started to rain and all got wet since there was no cover for the
vehicle. They stayed in Mysore for tow days, enjoyed the celebrations and came back in
the same tempo. It was a wonderful experience and it brought us closer to our neighbours
and others. We had food in their houses and participated in their celebrations. They
helped us in our needs and share their problems with us.
One of the great feasts in the slum is Mother Mary’s feats. They have a flag
hoisting 9 days before the feast and on the last day i.e., the 8th of September they have a
very grand celebration. On the 7th night the slum youth brought some 50 kgs of rice and
30 kgs of onion, tomato and other vegetables. A big plastic cover was spread on the
ground and all the sacks were emptied on that. All families gathered together to cut the
vegetables. We joined them and it went up to 12.30 in the night. Another group was
decorating the statue of Mary. Children were dancing and entertaining the group. Next
day the youth distributed rice and tea for all the people in that locality. It was a great
celebration. The initiative was taken by the youth and each family had contributed around
Rs. 100/- for the expenses. We realized that these celebrations also bring divided families
together and lots of reconciliation takes place as they work together for the feast. In our
seminary when we hear loud music from the nearby slum, we shout at them without
knowing that in these celebrations there is a lot of community building and reconciliation
taking place, music being a major tool in the process.
A Ray Of Hope In The Midst Of Poverty
Muni is a 24-year-old youth in the slum. He had never been to school. He used to
help his uncle, a cobbler and thus picked up the skills of a cobbler. He saved some money
by doing construction work bought a cobblers kit and started his own shop. He shows
tremendous responsibility to life. Arjun, Rajen, Nataraj are some other youngsters in the
slum who shows responsibility towards life in the midst of misery and bad role models.
Viji is a ten-year-old girl studying in the 5th standard. After coming from school
she some time selling fruits. She also takes responsibility in disciplining her younger
siblings. She shows a kind of maturity far greater than her age. They appeared to us a ray
of hope in the midst of their difficult childhood experiences, poverty and frustration.
Need For Comfort Zones
Is it possible to have a participatory observation without getting emotionally
involved? Initially we thought that it was possible. But in the past five months there were
so many situations where we experienced tremendous emotional drain. Some of them
were due to physical inconveniences like viral fevers, allergy, diarrhea, problems of
defecation, bathing etc. first time in our life we experienced that toilets can become an
object of joy. In addition to this, when we listened to the stories of the children who have
been physically and verbally abused by their parents, hardships and the distress of some
of the youth, confusion and helplessness of the parents in coping with their day to day
living, it was not easy for us. Sometimes we just wanted to run away. In that process we
realized the importance and necessity of ‘comfort zones’ for those who got involved in
the struggles of people. Gradually over the five months, we could identify some comfort
zones, which used to help us to cope with our emotional strain. They were,
•
•
•
•
•
•
•
PHM office (fellows room with a toilet)
Reflections with our mentors
Infant Jesus Church
Some of our friends and their families
Concern and companionship of the people in the slum
The companionship between me and Xavier (Community Life)
The innocence of the slum children
Conclusion
(From working for people->living with people)
When we decided to live in the slum we never had any intention to ‘do anything.’
Nor did we have any intention to influence and change people. Our intention was to have
a direct experience of life in the slum by a participatory observation. But at the end of 5
months we realized that we and our room were becoming a hub for the people to come
together and to get transformed. Our presence in their midst started the process of
community building. When it was time for us to leave the slum they, especially the youth,
started persuading us to stay on. When we asked them the reason many of them said:
“I will tattoo your names on my upper arm to remind myself that some one loved
me very much.”
“We don’t get people like you as friends, when you say you are leaving, we are
not able to accept it.”
“We might get a lot of friends, but we will never get friends like you.”
When we asked them “there are around 25 to 30 NGOs working in this slum, why
don’t you feel the same with those NGOs as you feel with us?” they replied as
follows,
“They come and work for us. For them we are beneficiaries of their projects but
you came and lived with us. You respected us as equal human beings, participated
in our activities and became on among us.”
These five months helped us to realize the difference between the paradigm shift
Working for people
To
Working with people
To
Living with people
Probably the final step a community health activist could take is to live with them and for
them.
Annexure IV
Health Insurance Scheme ( HIS ):
Chechady Valley
A Study
( 11.12.03
11.12.03 – 30.12.03 )
by
Dr. Mathew P. Abraham, C.Ss.R – MD ( Community Medicine )
Sr. Prabha, HC – Director CHABI
Mahuadanr
10.01.04
CONTENTS
I.
Introduction
Justification and background of the study
II.
Aims & Objectives of the study
III.
Methodology
IV.
Results of the study
1. About the Project
History – Its inception & development
Terms & Conditions
2.
Membership pattern over the years
Salae
Carmel
3.
Issues that came up during the interviews / discussions
Director
Sisters of the Clinic / Hospital
Health Workers
Village Beneficiaries
4.
Stake holders suggestions
V.
I
Discussion & Recommendation
VI
Limitations
VII
Conclusion
VIII
Acknowledgement
INTRODUCTION
In this 3rd Millennium, with all the modern technology, knowledge and so many
health professionals, why should people die prematurely of malaria, diarrhoea and other
preventable diseases? This is the reality of many of the villages in Jharkhand even today!
what is wrong with the current medical profession ? Commercialization? Profit
motives? Alma Ata declaration ( 1978 ) recommended primary health care as a means to
achieve health for all. All over the world, we still have health professionals committed to
Primary Health Care. The health network of Chechady valley (Jharkhand) remains as a
beacon of hope to this commitment.
What is impressive about the Chechady valley is the marvelous work done by the
Missionaries over a century. The pioneering work of the Jesuits, the building up of tribal
communities, the establishment of strong infrastructure in the form of parishes, health
centres and schools covering about 120 villages in the Valley need to be definitely
appreciated. Another inspiring fact of the Valley is the work of the sisters of various
congregations who silently make a difference in the lives of the people. They save the
lives of thousands of people who are brought to them with very little trace of life left in
them. They are brought with cerebral malaria, tetanus, typhoid complicated abortions,
and so on. More over they make a difference in the lives of many more through health
promotion and prevention with the help of the health workers and dais.
Health Insurance Scheme ( HIS ) of Chechady : A matter of pride
Today there are many agencies who try to build up self financing schemes for
health care. They have various intentions ; some are profit oriented and some are people
oriented. About 15 years ago inspired by RAHA model, Fr. Peter Jones and Fr. Ignatius
initiated the HIS of Mahuadanr. This was done in the context of many poor people dying
without accessing even the available medical care facility due to poverty and ignorance.
The acceptance of HIS by the people was overwhelming and it flourished with great
enthusiasm. People’s contribution was given in kind ( rice ). A year ago, the premium
was changed from kind to cash. This and some other factors weakened the scheme.
CHABI’s interaction with the health worker’s lead to the realization that a scientific
study need to be undertaken about the HIS, as early as possible.
II.
AIM :
•
To study and Document the Health Insurance Scheme ( HIS ) of the Chechady
Valley.
OBJECTIVES :
1. To study the History especially the background and the process of evolution
of the HIS from its inception till now.
2. To critically evaluate the strengths and the weaknesses of the HIS.
3. To document the experiences and opinions of the people involved in the HIS
at various levels.
III
METHODOLOGY :
•
•
•
In depth interviews
Group discussions
Studying relevant documents
Sl.
No.
Table I: In depth Interviews
Date of Name
Desigvisit
nation
01
13.12.03
Mr. Fulgence
Health
Congregation
Place
Mahuadanr
No. of
villages
covered
25
HIS
Yes /
No
Yes
worker
Carmel
Hospital
--
02
13.12.03
Sr. Philo
Nurse
(ANM)
St. Joseph of
Taubs
03
15.12.03
Sr. Sushma
Nurse
Srs.
Charity
Nazareth
04
15.12.03
Sr. Pyari Assa
Nurse
(ANM)
05
17.12.03
Sr.Rithamma
Nurse
06
18.12.03
07
08
15
Yes
19
Yes
Srs.
of Tundtoli
St.Joseph of
the Aparision
11
Yes
St.Joseph
Taubs
of Mayapur
35
Yes
Sr. Assumta Nurse
Toppo
Hand Maids Chatma
of Mary
6
No
19.12.03
Ms. Suchita Nurse
Tigga
(ANM)
Holy Cross
15
Yes
20.12.03
Fr. Ignatius
HIS
S.J
Director &
Parish Priest
09
22.12.03
Sr.
Prema Nurse
Xalxo
10
23.12.03
Sr. Rosalind
Pakripat
of Salae
of
Gothgav
Mahuadanr
--
Disciples of Dhawna
Don Bosco
Administrat CMC
or Carmel
Hospital
10
--
No
Mahuadanr
--
--
Table II : Group Discussion2
Sl.
No.
01
02
03
Date
Name of village
Clinic Area
23.12.03
29.12.03
29.12.03
Rega - Tonkatoli
Parhi - Kenatoli
-
Carmel Hospital
Carmel Hospital
Carmel Hospital
IV.
Results of the Study
1.
Terms & Conditions of the health insurance scheme ( HIS )
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
2
Participants
( Number )
Villagers ( 13 )
Villagers ( 30 )
Health Workers (14)
A minimum of 20 families are required to start the scheme in any particular
village.
Each member deposit 5 Kg. Rice or equivalent Money to the church authority.
One leader is chosen from each village for voluntary service, she or he gets
trained and receives a medical kit with emergency medicines.
Each member goes to this Health Worker ( H.W ) at the beginning of illness
for treatment. H.W keeps a register and enter the name and treatment given.
Reports are submitted to the centre during monthly meetings of all the health
workers in the centre.
When H.W. fails to manage the case, patient is referred to the dispensary or
the hospital with a letter and the scheme number. Treatment given should be
mentioned in the referral letter.
Total cost benefit for the year is Rs.750/- for each member.
To continue membership, each member should attend the monthly meeting
held in the villages by the respective staff.
Pregnant women ought to go for antenatal care at least thrice during
pregnancy to benefit from the scheme incase of complications.
Any self induced illness ( such as complications of induced abortion ) will not
benefit from the scheme.
Members are taught about the mutual benefit of the scheme and the value of
helping one another.
- Rega – Tonkatoli was chosen because out of 30 families there, 24 were part of the
HIS for
the past few years.
- Parhi Kenatoli was chosen because out of 50 families none of them were part of
the HIS.
- 14 health workers were those who came for the meeting in Carmel Hospital. The
total no.
of health workers of Carmel are 24.
11.
Members are advised to complete all vaccinations available for adults and
children
12.
If a pregnant woman is a member, her child at birth is also eligible for scheme
benefit for that year.
Members are paying about 25% of the total cost and the Jesuit Society covers the balance
amount. There are seven dispensaries in the insurance scheme area. HIS members, go to
the dispensaries for the initial treatment-referred by the health workers from the villages.
Carmel Hospital functions as a secondary care centre Hospital and the dispensaries send
timely bills to the church authority and get it paid from them. Monitoring and evaluation
is done by the community health staff.
Table – III
2.
Membership Pattern over the years
Year
Total
Members
Total
families
1996
369
1997
444
1998
473
1999
694
2000
858
2001
766
2002
707
2003
277
76
85
106
160
184
158
166
63
Graph - I
HIS - Salae Clinic
Total Members
1000
858
800
766
694
600
400
369
444
707
Line
473
277
200
0
1996 1997 1998 1999 2000 2001 2002 2003
Years
Graph - II
HIS Salae Clinic
Total families
200
184
160
150
158
166
106
100
76
85
1996
1997
Line
63
50
0
1998
1999
2000
2001
2002
2003
Year
Table - IV
HIS Mahuadanr
Year
Total
Members
Total families
1989
533
2000
1758
2001
1691
2002
1692
2003
1278
111
N.A
402
433
289
Graphs - III
HIS - Mahuadanr
Total Members
2000
1758
1691
1692
1500
1278
1000
Line
533
500
0
1989
2000
2001
2002
2003
Year
Graphs - IV
HIS Mahuadanr
Total families
500
400
433
402
300
289
200
100
111
0
1989
2001
2002
Year
2003
line
3.
Issues that came up during the interviews/Discussions: Director of HIS (Fr. Ignatius )
•
•
•
He feels that the scheme is in a declining phase and fears that it might die
out eventually
The expense every year is about Rs.5 lakhs and the income is very low (
Rs. 2 Lakhs – 1 Lakh as interest on capital and 1 lakh as collection from
people )
According to him, reasons to change from kind ( Rice ) to cash were
these:- Rice collected were of mixed variety
- In the previous years selling of this rice was easy. People
used to buy. Now people buy from market and can afford
to buy better quality rice.
- Many people in the scheme were selling their good quality
rice in the market, buying the cheapest quality from market
and was giving it for the scheme.
Sr. Nurses of the peripheral clinics:
•
Of the 8 clinics in Chechadi valley, 6 of them were very much aware of the HIS.
Two of them ( Dhawna and Chatma ) were not aware of the scheme. They too
have been going regularly for the bimonthly gathering of the nurses of the
Chechdi area. According to Dhawana & Chatma nurses these was no HIS for the
people of those areas.
•
Rest of the 6 clinics ( Mahuadanar, Pakripat, Sale, Tundtoli, Gotgav and Mayapur
) have HIS running quite active. All of them were of very high opinion about the
scheme. All of them said that this scheme is of a great help for the people
especially the poor.
•
All the 5 clinics felt that in the past 2 years the scheme is loosing popularity
among people and is slowly facing a decline. ( some even expressed the anxiety
that the scheme might die out eventually ). This was evident from the statistics of
the past years from what ever limited documents which were available ( Ref.
Table III & IV and graphs )
Some of the reasons that were mentioned for this decline were these:-
1. Lack of proper communication between the centre ( Mahuadanr ), the peripheral
units (clinics ) and people.
2. The centralized decision making without involving the peripheral units ( Sr.
Nurses ) or the people’s representatives ( VHWs / Panches )
3. Lack of sense of belongingness of the peripheral units to the scheme - Almost all
of them
felt that the HIS was a Jesuit’s scheme not the people’s scheme. “ Mahuadanr ka
scheme
he na ? “. Hence many of the sisters as well as health workers are slowly loosing
their
enthusiasm to work towards the progress of the scheme.
4. Shift of premium from kind (rice) to money ( Rs.60/- ) and again raising it to
Rupees 80/- in the immediate next year.
5. Some peripheral clinics even felt that there is too much of formalities and
difficulty to get the expenses reimbursed from the centre. ( Availability of the
Director )
6. False Propaganda against the HIS by some people with vested interests
Eg. a) The money lenders – village compounders etc.
These people propagate that: • Fathers are enjoying with the money collected from people.
• Those who are in the HIS are given second grade
medication
• They will be converted into Christianity.
•
Health Workers meeting:- HIS is a good scheme for the poor. They can access health care any time of
the year even when they do not have money with them.
For serious cases they can access to transportation ( ambulance ) too.
HIS protects the poor from exploiters like – Compounders and money
lenders
If the HIS dies, diseases ( esp. Malaria ) still continue and poor people
have to generate money by :o borrowing from money lenders
o selling animals, field or other possessions
o getting into bonded labour for 3 – 4 yrs for just Rs.1000, where
they will be given only food as wages.
HIS Motivates people to attend monthly village meetings and thus get
more informed about health and diseases.
People want to continue in the HIS, but the increase in premium to Rs.80/is affecting them, especially the big families. In spite of the increase in
premium, even now many people are motivated to continue in HIS. “ Its
difficult for us, but some how we will raise Rs.80/- per head ” was their
response.
Fr. Director meets health workers only once a year, ( during the 3 day
health convention ) but has never spoken to them about the HIS.
Meeting with Beneficiaries :-
a)
Rega Tonkatoli
-
All of them expressed that it is a very good scheme. It is of great help for
the people.
They found it difficult when the premium was shifted from kind ( rice ) to
money.
-
-
-
b)
Parhi Kenatoli:Kenatoli:-
-
In 1990 – 20 families were members of the HIS
1991 – 17 families were members of the HIS
They too feel that it’s a good scheme
During 1990, ’91 some were benefited from the HIS, but not all those who
were members. Those who were not benefited from HIS got discouraged
and dropped out. Still some wanted to join the HIS but could not because
of the ‘20 familes norm ’ in the rule.
When asked how many familes might join if the 20 family norms is
relaxed they said that 10 – 15 families might join the HIS.
-
-
4.
They were not even aware about the rise in premium from Rs.60/- to
Rs.80/-. Not even the health workers or the panch were aware of it.
According to them health is still a priority; but health is the last issue
discussed in the village as well as the parish meetings. Hence health
issues receive only little time for discussion and also by that time half of
the crowed would have dispersed. (Am Sabha )
When asked, “ if the scheme dies? ” this was their response – “ Those
who have money will go to the hospital. Poor will remain in the village
and die ”
Suggestions that came from the stake holders:-
-
-
Director meeting the above mentioned stake holders on a regular basis to
exchange ideas and suggestions
Collective decision making, by involving the peripheral clinics, health
workers, peoples representatives and Director
Flexibility in rules, terms and conditions according to the situation of the
particular villages
The HIS should be extended to more people
More awareness creation about HIS should be done through
o SHGs
o Parish Priest’s of the Chechadi Valley parishes announcing after
mass
o Gram Sabha, Catholic Sabha, Am Sabha etc.
It is not just lack of awareness : generating so much money immediately is
a problem. Hence people should be allowed to pay premium as
installments.
By reviving and propagating the founding philosophy “ I am the Caretaker
of my Brothers / Sisters too.”
Parish Priests of the peripheral clinic areas also assisting the Sisters in
motivating people to join the HIS
Some fund should be allowed to be handled at the peripheral clinics too.
Poor harijans and non catholic tribals also should be included in the
scheme.
-
Reducing expenses by avoiding Medical representatives ( Middle men ).
CHABI or some other common body acting as the agent to bring low cost
generic drugs.
Allow the scheme to die for 1 – 2 years, then people might realize its
worth and then request to restart.
-
V
DISCUSSION & RECOMMENDATIONS:-
On the whole stakeholders at all levels feel that the HIS is a very good scheme
and it is of great help for the poor. All were worried about the declining trend of
HIS especially in the past years. All of them expressed their anxiety about its
too much of centralization especially in decision making, bypassing the
stakeholders at the health centres and villages. However all of them feel that
HIS should be continued and expanded to more people. The Director seemed to
be burdened with too many responsibilities, being the Parish Priest and the rector
of the S.J. Community. HIS seemed to be very low in the Director’s priorities, as
he seemed to be struggling for enough time. Documentation at the centre seemed
to be grossly inadequate. This was true at the peripheral clinics too.
Hence we suggest the following recommendations for the revival of the HIS.
1.
Since the backbone of the HIS is the health personals at the village level (
VHW) and Health centre level ( Nurses & Doctors), it should be built
upon their strength.
2.
The HIS needed to be decentralized especially regarding
Decision making
Collection of funds at the periphery ( health centres )
In addition to the central fund, it is good to have a health centre
fund to cover some of the medical expenses at the health centre
and village level.
3. Directorship need to be taken up by somebody for whom HIS is a priority and
have enough time to work towards its progress.
4. The communitarian bond, the strong infrastructure, the wealth & resources
available in the communities of Chechady Valley has to be mobilized to its
maximum potential. This includes generation of some funds for HIS at the
local level too, through various income generation projects.
5. A system for documentation need to be developed and proper documents need
to be maintained at all levels. These documents can be used for regular
evaluation and monitoring of the HIS. This will also help others to learn from
its experiences.
VI
LIMITATIONS :1. Because it was Festival ( Christmas ) season. The availability of the Director was
limited.
2. Since this study was done over a span of just 20 days the researcher could not
organize more group meetings with the people at the village level.
3. Since there was limited knowledge of the local language, researcher could not
go for ‘ focus group discussions ‘ but had to depend on ‘ group meetings ’ with
the help of a translator.
4. Lack of availability of sufficient documents, at the centre as well as in the
peripheral clinics.
5. One of the peripheral Clinics, Cheropat was left out from the study due to lack of
time.
VII
CONCLUSION:-
The people of Chechady Valley have decided to walk on a less trodden path by
accepting HIS. They are experiencing the positive effect of that decision. At this point
of time dark clouds seems to be interfering the growth process of the HIS. When the
present health care system prefers to walk through the path of expensive medical care for
the rich minority, the great initiative taken in Chechady Valley towards a poor oriented
health insurance is a matter of pride. Inorder to sustain the process of growth of HIS a
timely intervention is obligatory. Let the poor and the abandoned receive our primary
attention.
VIII ACKNOWLEDGEMENT
We express our heartfelt gratitude to the following people for their co-operation and
support during this study.
-
Fr. Ignatius – SJ, Parish Priest, Mahuadanr
The Jesuit Community of Mahuadanr
Dr. Romeo, CMC and the Carmel Hospital team
The Carmel Sisters Community of Mahuadanr
Mr. Fulgence and the other health workers of Mahuadanr
The sisters of the health centers of Chachady Valley
The people of Rega Tonkatoli and Parhi Kenatoli
Annexure V
HOLY CROSS CRHP
Information system
for
Monitoring and Evaluation
Hanur
March 2004
Mission statement:
To empower people especially the poor and marginalized for holistic
health and through a comprehensive rural health care approach to bring
about overall development of the economically and socially most backward
villages, as health is integrally related to socio-economic well being.
Goal:
Holistic health and overall development in the project area
Objectives:
-
Health for all through primary health care approach.
Sustainable financial stability through SHG & IGPs
Self relient communities which lives in harmony and works towards equity,
justice and peace.
Principles and policies:
Empowerment, community participation, intersectoral coordination
Project area:
Area map, location, total population, No. of villages, cluster etc.
-
Organizational structure:
- Three tire structure
VHWs
- As a constant presence in the village with open senses getting to know the village
dynamics and sharing their information with CRHP in order to plan and deal with
for overall development.
- MCH care, Health education
Staff (animators)
-
As a link between VHWs (community) and CRHP verifying and documenting the
information shared by the VHW
Animating groups and organizing programmes
[ Monday morning to the field, stay back and return by Tuesday evening .
Wednesday consolidation of data – Planning.
Thursday morning to the field, stay back and return by Friday evening.
Saturday- consolidation- staff meeting.
Sunday- Holyday .
Wednesday and Saturday morning- monitoring of the staff (animators) ]
Community for Mission
- Constant vigilance on the village dynamics with the help of the data generated
from the field
- Constant brainstorming and reflection as a group, regarding the situation of the
field.
- Supervision and monitoring of the staff.
- Capacity building of the staff, VHWs and Peoples organizations according to the
need.
- Constant mentoring of the younger generation through exposure, reflection to
extent services to more people (widening the mission areas)
Activities and Personnel:
Village level activities
Economicdevelopment
- Savings
(SHGs,IGPs)
Primary Health Care
-
-
-
-
-
Health education
What, Where,
How often, How
Maternal and
Child Health
ANC, Safe
delivery, PNC,
Preparation for
marriage, Child
care, Parenting.
Child Health
Feeding,
Immunization.
Treatment of
Common
diseases and
injury
Primary care,
Referral services
Control and
prevention o
local endemic
diseases
T.B. Control
programme
-
VHW
TBAs
SHGs
&
People’s
organizati
ons
Rural
entrepreneurship
Skill training
Food and water
security
(Agriculture,wat
ershed)
Water
Social Development
-
-
Education ( Nonformal, formal)
Dealing social
evils
Bonded labour,
child labour,
Alcoholism,
Caste atrocities ,
Gender
Spiritual values
Sharing, caring,
equity,
justice,forgivene
ssetc..
Community for mission
-
Conceptualizing
- Goals/
Objectives
- Vision/ Mission
- Over all plan
Supervision and
support
Capacity
Building
Documentation
Monitoring and
evaluation
Ongoing research
Sr. Aquinas
Sr. Fidelis
Net working
Sr. Anice
community life,
problem solving,
healthy community.
Sr. Teena
Mentoring
Younger generation
Micro planning
- Documentation
system
- Monitoring and
evaluation
system
Implementation
- Daily
management
HOLY CROSS COMPREHENSIVE RURAL HEALTH PROJECT HANUR:
Monitoring tool – 1 ; Data related to DEATH.
Name of field staff:
Entry
date
Name,
Village,Cluster, Street
House No.
A S
g e
e x
Date
of
Death
Sex: 1=male, 2=female
Place of death :1=Home,2=Hospital, 3=Others
Duration of sickness: 1=1-2 days, 2=3-7days,
4=1-6months, 5=7months-1yr, 6=>1
Plac
e -D
Du
rat
ion
3=8-30days,
Cause of
Death
HOLY CROSS COMPREHENSIVE RURAL HEALTH
PROJECT HANUR:
Monitoring tool – 2 ; Data related to MORBIDITY (Diseases).
Name of the staff:
Entry
date
Name ,
Village,Cluster,
Street, House No
A S
g e
e x
Symptoms
Date
of
onset
Du
rat
ion
Sex : 1=Male, 2=Female Duration (sickness):1=1-2days,2=>2days-<2weeks,
3=>2weeks-3months,4=4-6months, 5=7-12 months, 6=>12months Treatment where:
1=VHW, 2=PHC, 3=GP,4=Hospital,5=Home Treatment period: 1=1day, 2=2-5days,
3=6-15 days,4=16-30 days, 5=>30days Expense: 1=<20Rs., 2=21-50, 3=51-100, 4=101200, 5=201-300, 6=301-500, 7=501-1000, 8=1001-5000, 9=5001-10000, 10=>10,000
Diagnosis
W
h
r
HOLY CROSS COMPREHENSIVE RURAL HEALTH PROJECT HANUR:
Monitoring tool – 3 ; Data related to MARRIAGE.
Name
of
field
Date
Name of couple
Age
Address
Date of marriage
Approximate expenditure of marriage
Debt due to marriage
Any other relevant information
Dowry
Migration due to debt: yes / no
staff
HOLY CROSS COMPREHENSIVE RURAL HEALTH PROJECT HANUR:
Monitoring tool – 4 ; Data related to VIOLENCE.
Name of field staff
Date
Name
Age
Sex
Village
Cluster
Street
House No.
Caste
Date of violence
Details of injury
Treatment details: Where ? VHW / PHC / GP / Others
Approximate expenditure
Diagnosis
Cause of violence
Any other relevant information
Admitted : Yes / No
duration of treatment
HOLY CROSS COMPREHENSIVE RURAL HEALTH PROJECT HANUR:
Monitoring tool – 5 ; Data related to ALCOHOLISM.
Name of field staff
Entry
date
Name,
Village, Cluster,
Street, House No.
A S Drin Du Wit
g e king rat hdra
e x patt ion wal
ern
Y/N
Exp
endi
ture
Problems of
drinking Y/N
M Fa So
edi mi cia
cal ly
l
Sex: 1=male, 2=female Drinking pattern: 1=occasional, 2=once a week, 3=>3days a
week, 4=daily Drinking duration: 1=<1yr, 2=1-2yrs, 3=3-5yrs, 4=6-10yrs, 5=11-20yrs,
6=>20yrs. Weekly expenditure: 1=<20Rs, 2=21-50, 3=51-100, 4=101-200, 5=201-300,
6=301-500, 7=501-700, 8=701-1000, 9=>1000
HOLY CROSS COMPREHENSIVE RURAL HEALTH PROJECT HANUR:
Monitoring tool – 6 ; Data related to SCHOOL DROPOUTS & BONDED LABOUR
Name of field staff
Ent
ry
Name &
Address
Date
Age
Details of schooling
Sex
Class
Date of
dropping
out
Reason for
dropping out
Details about work
Worki
ng
Place of
work
Type
of
work
Bonded
labour
HOLY CROSS COMPREHENSIVE RURAL HEALTH PROJECT HANUR:
Monitoring tool – 7 ; Data related to DISABILITY.
Name of field staff:
Entry
date
Name ,
Village, street,
House No.
Caste
A S Rehabilitation
g e
Ty Du A Do
e x
pe rat wa ne
ion re
Sex : 1=Male, 2=Female Dis Type :1=Visual, 2=Hearing, 3=speech, 4=Locomotor
5=Mental , 6=Burns, 7=Cleft palate-lip, 8= Cerebral palsy, 9=others
Dis duration : 1=<1 month , 2=1-6 months, 3=7-12 months, 4=1-5 yrs, 5=6-10 yrs,
6=11-20 yrs, 7=>20 yrs
HOLY CROSS COMPREHENSIVE RURAL HEALTH PROJECT HANUR:
Monitoring tool – 7 ; Data related to PREGNANCY.
I General Information:
Name…………………………………………………….Age
Residence: Project area/outside
Husband Name…………………………………..
Village……………………………………… ……Cluster
Street…………………………………………….. House No.
Previous pregnancy details
No. of pregnancies
No of abortions
No of stillbirths
No of live births
No. of children alive
boys
girls
II ANC details: (Quality of ANC:)
Registration of pregnancy. Y/N
No. of checkups
Place of registration .PHC /.G.P /.Hospital /.CRHP /.VHN
Details
IFA
TT1 TT2 Booster received
IFA
consum
ed
Abdo
B.P. Weight men
Urine
albumin
Y/N
Number
×
×
×
Place
×
III Complications:
Any complications during pregnancy
Y/N
1.APH 2. Abnormal presentation 3. IUGR 4. Multiple pregnancy 5. Hydramnios
6. Severe Aneamia 7. PIH 8. Heart disease 9. Diabetes Mellitus
Urine
sugar
Any complications during delivery Y/N
1. PPH 2. Infection 3. Others
IV Outcome of Pregnancy:
Date of delivery
Place of delivery 1. Home 2.PHC 3. Hospital 4.Subcentre 5.GP 6. Dispensary
Outcome
1.Normal
2. Pre term 3. instrumental delivery 4. Still birth 5. Caesarian
Person conducted delivery
1. Trained Dai 2. Untrained Dai 3. VHW 4. VHN 5. Doctor
Sex of Baby M/F
Birth wt.
kg
Family Planning Y/N
If yes 1. Permanent 2. Temporary
Name of the field staff:
Date of data collection:
Annexure VI
Annexure VII
MINUTES OF THE NWG JSA MEETING
HELD ON 26TH AND 27TH OF JULY 2003
AT INDIAN SOCIAL INSTUTE, , BANGALORE.
MEMBERS PRESENT
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
Dr. N.H.Antia - Chairperson, JSA; Foundation for Research in Community
Health.
Dr. B.Ekbal – Convenor, JSA; Kerala Sahitya Sahitya Parishad / Vice
Chancellor, Kerala University.
Dr. Ravi Narayan – Coordinator, International Secretariat, PHM; Community
Health Cell (CHC).
Dr. Zafarullah Chowdhury – PHM Steering Committee;
Gonoshasthaya
Kendra, Bangladesh.
Dr. K.Balasubramaniam – PHM, Steering Committee, Health Action
International – Asia Pacific Region, Sri Lanka.
Dr. Mira Shiva - NWG Member and International PHM Link group;
Voluntary Health Association of India.
Dr. Prem John – PHM Steering Committee; (ACHAN) Asian Community
Health Action Network.
Dr.T.Sundararaman – Joint Convener; All India Peoples Science Network
(AIPSN) / Bharat Gyan Vigyan Samiti (BGVS), Director State Health
Resource centre, Chattisgarh .
Dr. Abhay Shukla, Joint Convener; National Secretariat; Jan Arogya Abhiyan,
Maharashtra, CEHAT.
Dr. Amit Sengupta – Joint Convener; Delhi Science forum (DSF) / AIPSN.
Mr. Amitava Guha – Joint Convener; Federation of Medical Representatives
Association of India (FMRAI), Calcutta West Bengal.
Dr. Thelma Narayan –Joint Convener; Society for Committee Awareness
Research and Action (SOCHARA) / Jan Arogya Andolana-Karnataka (JAAK).
Dr. P.V. Unnikrishnan – PHM / International Peoples Health Council (IPHC).
Dr Joe Varghese – NWG member; Christian Medical Association of India,
Delhi.
Sr.Fatima – NWG Member; Catholic Health Association of India,
Secunderabad.
Mr. Geo Jose- NWG Member; National Alliance of Peoples Movements
(NAPM); Kerala.
Dr. Narendra Gupta – NWG Member; Rajasthan, PRAYAS, (Chittorgarh).
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.
52.
53.
Sr. Concelia – JSA – Utter Pradesh; RUPCHA.
Mr. Prashant Kumar - NWG Member, Coordinator JSA-Delhi.
Ms. Jaya Velankar – NWG Member Maharashtra; WSF Committee member.
Sr. Gracy –CHAT, Tamilnadu.
Dr. Balaji Sampath, JSA – Tamil Nadu; Association for India’s Development
(AID); Tamilnadu Science Forum (TNSF); Arogya Iyakkam.
Fr. John Vattamattom – Andhra Pradesh, Sanghamitra, MEDAK District.
Ms. Ruth Manorama – NAWO, JSA- National Coordination Committee;
Women’s Voice.
Dr. H.Sudarshan – Chairperson, Jan Arogya Andolana, Karnataka; VGKK/
Lokayukta.
Ms. K.K. Sumithra – NFIW (Karnataka Unit) National Coordination
Committee NCC
Ms. Vinutha – NFIW- (Karnataka Unit).
Mr. Mashood – AID –Bangalore – Karnataka.
Mr. Kutti Balaji – AID, Tamilnadu.
Dr. Hari John, Special Invitee, Chennai, Tamilnadu.
Mr. E. Basavaraju , State Coordinator JAA-K;
Bharat Gyan Vigyan
Samithi.
Mr. Harirammurthy, JAA_K; Foundation for Revitalisation of Local Health
Traditions.
Ms. Aruna, Joint Womens Programme, JAA-K / NCC.
Mr. Prahlad – State Coordinator – JAA-K; CHC.
Ms. Amrutha – JAA-K; Mahila Samakhya, Karnataka.
Mr. Tomy Joseph - JAA-K ; CHAKA.
Mr. Prasanna Saligrama – Communication Officer, International PHM
Secretariat.
Dr. Paresh Kumar – CHC/ JAA-K (Incharge organizational arrangements for
this NWG Meeting).
Mr.S.J.Chander – CHC / JAA-K Bangalore Urban District Unit.
Mr.S.D.Rajendran – CHC.
Dr.Rajan Patil – CHC.
Dr.Rakhal Gaitonde –Christian Medical College, Vellore.
Dr. R. Balasubramaniam – Jan Arogya Andolana, Karnataka (from
Vivekananda Foundation H.D.Kote Taluk, Mysore District).
Mrs. K.Balasubramaniam – Special Invitee Sri Lanka.
Dr. Mathew Abraham – Fellow CHC (Volunteer rapporteur).
Dr. Abraham Thomas – Intern, CHC (Volunteer rapporteur).
Mr. Xavier- CHC, trainee (Volunteer).
Ms. Geeta Menon, Observer, Jagruti Bangalore.
Ms. Veena Mathrani, Observer, Bangalore
Ms. Edwina Pereira, Observer, INSA-India, Bangalore.
Ms. Agatha, Observer, INSA – India, Bangalore.
Ms. Beena Vasantharam, Student Observer, CHC
Mr.V.Ramani, Observer, Siddha Research Hospital, Swagangai District,
Tamilnadu.
54.
Mr.Bidhaan, Green peace India, Bangalore
Introduction:
The two day deliberations started with a welcome note by Dr.Thelma Narayan, and
followed by various persons sharing their work on ground.
These were the agenda for the 2 days of NWG meeting
1. Various JSA activities and individual experiences
2. Right to health care
3. Hunger watch
4. Organisation
5. Website
6. PHM – Global and JSA interface
7. WSF Mumbai and International Forum in defence of Health
M/s. Amrutha shared on the JAA Karnataka,
Dr. Abhay Shukla on Maharashtra JSA activities.
Mr. Prashanth on JSA Delhi
Sr. Concelia on JSA-UP
Dr.Narendra Gupta on JSA, Rajasthan
Sr. Gracy on JSA Tamil Nadu
Dr.Ekbal on JSA Kerala
Dr.Joe Varghese on CMAI
Mr.Geo Jose on NAPM.
These sharings along with some of the personal sharings by Mrs. Ruth Manorama, Dr.
Antia, all created an environment of solidarity and concern for each other in the NWG.
After this the group took each agenda for further discussions.
I. RIGHT TO HEALTH CARE CAMPAIGN
1. Right to health care campaign
Is part of right to health, which includes broader
Issues like water, nutrition, poverty etc but for the sake of advocacy we are
focusing on right to ‘ Health Care’.
The major issues are
1. Do we have an uncritical attitude towards technological medicine?
2. Right to health care in the context of globalization
3. Public interest litigation on violation of right to health care, at national level.
Since NHRC cannot have an official public hearing, the possibility of a National
public consultation on right to health care was explored. It was decided to have this
consultation on September 6th in Mumbai.
The detailed plan for this consultation was worked out in the NWG meeting
3 sessions :
1st session –
•
•
Public health in general
Legal issues in public health
2nd session –
•
Testimonies on violation of right to health care
- individuals
- institutions
3rd session –
•
NHRC’s response
Some of the ideas / questions came up are the following –
•
•
•
The objective of the September 6th consultation should be to highlight
‘structural’ failures not to victimize individual doctors.
This consultation should not contribute to the World Bank agenda of
privatization of health care by blaming the public health sector for its failures.
Hence we should also highlight areas where the public system has succeeded.
If possible bring out a few ‘mess-ups’ in the private sector too.
Should we address issues like
♦ Corruption
•
•
•
•
♦ Health system seen as a milk cow by the politicians (transfers,
promotions bribes etc)
♦ The inability of health department to use the allotted funds fully.
♦ Private sector getting involved in preventive and promotive care
The format for the case studies with covering letter has been sent to
various organizations.
The question of how the case studies are going to be presented in the
public consultation was also raised.
It was decided to have one-day training programme on September 5th in
association with consultation of September 6th for JSA members all over
India.
The participants for the September 5th and 6th programme
Western India – Utter Pradesh -5
80-100
Rajasthan – 20
CMAI – 10
Madhya Pradesh – 20
CHAI – 10
Chathisgrah – 10
AIDWA – 10
Karnataka – 10
NFIW – 10
Andhra – 10
FMRAI – 20
Kerala – 5
NAPM – 20
Tamil Nadu –5
VHAI – 8
Remaining states – 5 each
•
The group responsible for this programme
?
2.
Advisory group for JSA :
Mr.Abhay Shukla brought up the possibility of having an advisory group for
JSA, for the on going campaign. Some of the names came up were these :
• Mr.John Rakes
• Mr.Collin Gonsalves
• Ms.Ritu Priya
• Mr.Amarjith Sinha
These people are already working towards health for all and can become a
potential group that can contribute much for JSA agenda. The possibility of
inviting them for the September 6th meeting was also explored.
3. Technical Resource group : (TRG)
In the context of denyal of Health care, we should know,what ‘denyal’ means.
Hence the necessity of a TRG.
-
What should be the function of TRG?
TRG should compile documents and help others to make clear the following
things.
• What are the services available in the primary health centre and the higher
referral centres.
• What are the responsibilities of the staff in these centres?
• What are the standard treatment guide lines?
•
•
•
•
•
•
The persons suggested as the members of TRG are the following.
Dr.Thelma Narayan
Mr.Abhay Shukla
Dr.Meera Shiva
Mr.Sunder Rajan
Mr.Narendra Gupta and
Ms.Vandana
-
It was suggested to base this group in CHC , Bangalore because of its experience
with government sector and its strength in documentation. Central government
and NHRC documents also need to be collected. Amit Sen Gupta agreed to send
some documents to TRG. Ms.Vandana might need some junior person to
help her to send the documents to CHC.
- Convenor of the TRG
? Sunder Raman
When it comes to denyal of health services, not only the quantity but also quality of
health care should be taken into consideration.
4. Report on “State of health care in India” :
The possibility of bringing this report
declaration (HFA 2000) was discussed.
on the 25th anniversary of Alma Ata
- Who is bringing it out ?
Dr.Abhay Sukla
- When ?
By end of September 2003
- Formal release of the report will be done in WSF
As a run up to this formal release, releasing in all state capitals on December 10th
2003 (PHA anniversary)
- It was also suggested to bring out a popular version of the report (cartoon form)
5. Right to health care’ in election Manifesto of the political parties.
The possibility of organizing a one day convention for all major political party
representatives, before the election was explored. This is to make use of the preelection availability of the politicians and to sensitize them to the right to health care
agenda and if possible to push it into their election manifesto. It should be more
than just a critique of the existing health system. It should also propose alternate
models, the ‘people centered’ model of health care. The importance of focussing on
MLAs and the Gram Panchayat representatives were also discussed.
The possibility of a follow up of this convention focussing on health ministry was
also explored. The tentative date of this convention was fixed up in March 2004.
II. HUNGER WATCH:
This is a response to the starvation deaths happening in many states. Discussion was
initiated on the 2 day meeting in Bhopal to be held on August 16th and 17th. There
will be participants form 6-8 states. There is very good response form various
NGOs especially the ‘Right to food group’. JSA members are also welcome for the
hunger watch meeting. Certain methodological issues like epidemiological issues,
necessity of differentiating acute and chronic malnutrition; malnutrition and
starvation deaths will be dealt by Dr.Rajan and Dr.Rakhal.
Issues on Anemia; measles/diarrheal deaths due to malnutrition; the quality of ICDS,
midday meal programme are also important and need to be addressed. Broader
issues related to starvation like, land ownership displacement of tribals etc are also
important.
III.
ORGAINSATION
The challenge highlighted was, how to keep JSA alive in the midst of the plurality of
the groups involved in it?
All groups are doing something on health, but some of them are not only purely
‘health groups’, but non-health groups also.
Some of the suggestions came up for the strengthening of the ‘organisation’ of the
JSA were these :
-
-
A Brochure for JSA –
The conversion of the people’s health charter into a simple and attractive
brochure.
Development of a ‘common minimum programme’ which will be of interest for
the member organisations.
A team to visit the organisations on a personal basis and on a regular basis.
-
Using the word ‘ facilitation’ rather than coordination, when it comes to PHM
activities and PHM is not trying to Co-ordinate but facilitate the process.
The 5 PHA booklets jointly published by the 18 organisations strengthened
PHM (JSA).
-
Why not more jointly published booklets? The option a 6th booklet on “Right to
health care” was also considered.
IV.
WEBSITE :
What is the objective of the Website ?
•
Information exchange among the leaders of the PHM, so that they can take it to
the grass roots.
Mr. Prasanna, the Communication Officer of the PHM Secretariat is incharge of the
PHM Website. Mr. Prasanna will take responsibility for the JSA Website too, till
somebody else takes it over.
Mr. Prasanna will take initiative to start an ‘e’ group for JSA. This e-group will
have two components.
1. For information exchange.
2. For decision making.
Mr.Prasanna agreed to do a demonstration of the Website during lunch break and
also to circulate the format for e-group.
• It was agreed by the group to give a gentle nudge to each other, so that more and
more information will be given to Mr. Prasanna from local, regional and state
level.
•
VI. PHM GLOBAL AND JSA :
•
•
Dr. Ravi Narayan (RN)gave an overview of the PHM Global Network and high
lighted the importance of JSA considering itself as part of this larger network.
He suggested the need to mention along with JSA, PHM-India in parenthesis,
especially when it comes to communications to PHM of other countries.
RN mentioned briefly about how PHA, got transformed into PHM, about the
founding 8 (F8), steering group (F13) and the 92 member countries in 13
regions.
In the PHM Website, to facilitate relevant discussions there are two types of
circles.
1. Country/state level circles (regional circles)
2. Issue / event based circles.
(e.g WHO circle; poverty circle; war conflict, disaster
circle.)
One can be part of regional circles or issue based circles depending upon each
one’s interest.
• PHM Secretariat – the idea is not to have a coordinating point but to have a
contact point. Decision making is through the steering ‘e’ group. There are 3
staff in Secretariat(Dr. RN, Mr.Prasanna and Mr.Srinidhi)
•
All the members of PHM are considered as Technical full time persons contributing
to PHM in their own capacity.
The Website of PHM is Phmovement.org.
•
After the presentation of RN, there was a suggestion that it would be good for
JSA to be in touch with PHM Secretariat. For eg. during the NWG meetings one
session can be kept for the PHM secretariat. JSA should start thinking how can
it contribute to the PHM secretariat. But PHM secretariat should take initiative
for this.
VII W.S.F Mumbai (JAN 16-21,2004) and international forum in
defense of health (Jan 14-16, 2004)
Mr.Amit Sen Gupta coordinated the discussion of WSF. (For details refer the hand out).
This is the first time WSF is conducted outside Brazil. Around 60,000-70,000 people are
expected. The participants might exceed beyond that.
The main discussion was about the international forum for defence of health (Jan 14-15).
Focus will be on 5 issues related to health
• Globalization and health
• Militarism and health
• Patriarchy and health
• Exclusivism and health
• Health and the marginlized
Afternoons there will be 4 panel discussions running parallel. The themes has to be
decided. These will be approximately 500-600 people for the forum of which about 250
will be from India.
Last date of initial registration will be on September 15th.
The topics should promote plurality.
It should not only highlight the badness of the system but also should provide hope by
highlighting the good that people are already doing
• The possibility of pushing for a panel in WSF on health was also
discussed.
• Receive suggestions by August 30th
• Finalize the topics by 10th December
• Teams to work on it has to be finalized. It is better to have one
representative from each region.
• Regarding finances, it was decided that each JSA unit in India will
contribute at least Rs.5,000/- to WSF, Mumbai.
Annexure 8
“Withdraw the support to Coke”
International Public Health Team that visited Plachimada appeals to the Kerala
Chief Minister.
The Team denounces Coca Cola
Following the World Social Forum in Mumbai, a group of health activists
representing the People’s Health Movement of the Americas is visiting the state of
Kerala with the explicit goal of expressing solidarity with the community of
Plachimada in their struggle against Coca Cola.
The team consists of Edgar Isch, former Minister of the Environment of Ecuador,
Dr. Arturo Quizhpe Peralta, Professor of Pediatrics at the University of Cuenca,
Ecuador, Julio Monsalvo, a public health doctor from Argentina, and Jeff Conant, a
U.S. health communications specialist. Together they represent the Americas branch
of the People’s Health Movement (PHM), a coalition of health activists and grass
root health workers representing more then 100 countries.
The team was drawn to Plachimada by news reports, substantiated by BBC radio and
the Kerala Pollution Control Board, that Coca Cola is responsible for dumping high
levels of lead and cadmium in the local environment. Both substances are known to
cause cancer, neurological disorders, and developmental disabilities.
Edgar Isch, former environment minister of Ecuador said, “What we witnessed in
Plachimada worries us deeply. The poor health of the inhabitants appears closely
linked with the existence of the Coca Cola plant. We exhort the government of
Kerala and of India to take urgent measures to resolve the crisis. No community’s
water source should be robbed and polluted like this by any multinational giant.”
Dr. Artro Quizhpe Peralta, a child health specialist, added, “In these situations the
first victims are the mothers, who suffer deterioration of their physical and mental
health, transporting water from more than 2 or 3 kilometers away. This has direct
consequences on the care and development of their children. The children are the
silent and innocent victims of this human tragedy, deprived of a healthy environment
by a private corporation that destroys any notion of sustainability in the region.”
“As members of the People’s Health Movement, “ Dr. Quizhpe Peralta said, “we
will support the assembly of a team to monitor the health of the people of
Plachimada and to denounce the corresponding abuse of human rights at the
upcoming World Health Assembly in Geneva.”
Julio Monsalvo of Argentina noted that “the story of the Coca Cola plant is a
startling demonstration that a private company can set up shop with the stated goal
of increasing employment-but with the immediate result of destruction of life,
beginning with the water. My question is ‘is this progress?’ As a visitor, I have
tremendous admiration for the community’s struggle, and level of consciousness, in
particular among the women.”
The team stated that they would take up the issue in their respective countries. In
support of the overall movement against corporate globalization in North America
and Latin America, as well as India, the team has urged the Chief Minister of Kerala,
Mr. A.K.Antony, to immediately withdraw all support to the Coca Cola plant and to
“make Kerala free from Coke and Pepsi.”
Peoples Health Charter, the guiding spirit of the People’s Health Movement says:
“Hold transnational and national corporations, public institutions and the military
accountable for their destructive and hazardous activities that impact on the
environment and people’s health.” The Charter is the largest consensus document on
health in the world.
The team will hold a press conference at Press club Ernakulam on 28 January at 11
a.m.
Signed by
Dr. Arturo Quiizphe
Coordinator, PHM, Ecuador
Co-Coordinator: International People’s Health Council, Latin America
For further media enquiries: +91 (0) 9845091319 (Dr. Unnikrishnan PV)
Participants in the People’s Health Movement team visiting Plachimada,
Kerala.
1. Dr. Arturo Quizhpe, pediatrician and former dean of the Faculty of Medical
Sciences, University of Cuenca, Ecuador. He is the Latin America
coordinator of the People’s Health Movement. He has worked in several
research projects in nutrition and child development.
2. Edgar Isch Lopez a former Minister of the environment of Ecuador, the
country with the largest biodiversity in the world. Edgar is outspoken on the
issue of aerial fumigations in Plan Colombia, which he sees as a form of
chemical warfare. Ecuador is also the site of the first international lawsuit
against a United States oil company, the trial of Chevron/Texaco.
3. Julio Monsalvo, from Argentina, is with the International People’s Health
Council and People’s Health Movement. For the last 29 years he has worked
with indigenous and rural communities in the north of Argentina. He lectures
widely on ecosystem health.
4. Jeff Conant is an environment health educator, journalist, translator and antiwar campaigner representing the United States People’s Health Movement.
He works with the Hesperian Foundation, publisher of the well known book
where there is no Doctor, as well undertaking many independent projects
such as the Boycott Bush campaign and doing popular education to raise
awareness about corporate crime and war profiteering.
5. Mathew P. Abraham is a community doctor from Bangalore, and a volunteer
with the People’s Health Movement, also based in Bangalore
Annexure IX
REPORT OF THE COMMUNITY HEALTH WORKSHOP
Date:
Venue:
Background:
Objectives of the workshop:
List of Participants:
DAY – I: Wednesday – 14-04-04.
The programme started at 9.30 am with a game to break the ice. Mr. Naveen Thomas
initiated a process of the participants getting to know each other. This was followed by a
brief interactive session on the expectations of the participants about the workshop. The
following were some of the expectations, which came up through that session.
•
•
•
•
•
•
•
•
•
•
To learn what the younger generation thinks of community health.
To get some of the perspectives from the field
To get to know how to train community health workers.
To learn more about community health
To share some of the community health experiences from the field
To learn more about community health systems and public health issues.
To search for new avenues in community health action.
To have a better understanding of the four topics of the workshop; right to
healthcare, globalization, community health workers and community health
financing.
To analyze the future, plan and strategize
To enjoy this workshop as a ‘recharger’ through interaction with other catalysts.
In addition to these expectations, the group also brought out some key values,
which are necessary for the effective practice of community health. Some of those
values were;
Humility
Courage
Determination
Commitment
Honesty
Integrity
Equity
Team building around issues
Genuineness
Responsibility
Simplicity
Openness
Empowerment
Love……..
This was followed by a brief discussion to finalize the programme schedule
prepared earlier.
•
•
•
•
•
•
•
•
•
•
•
•
•
•
The background of the workshop; how it emerged, its objectives, were brought out
beautifully through a panel discussion. Dr. Sunil Kaul acted as the ‘devil’s advocate’ by
questioning Dr. Ravi Narayan on various issues. These were some of the issues, which
came out through the panel discussion.
• This workshop is for the advantage of those who are undergoing the fellowship /
internship scheme. Senior community health practitioners who are interested in
the younger generation and community health fellows are brought together in
order to learn from each other.
• Community health workers are not dead horses. The idea is not to look at CHW
in isolation or as The Horse, but as one of the horses. When CHW and
community health financing is seen in the context of primary health care as a
whole, then both are effective.
• This workshop will also try to link up between four issues; two community level
issues (micro level)
1. Community health workers
2. Community health financing
Two global level issues (macro level)
1. Right to health
2. Globalization
• Other areas of concern for this workshop will be to look at the Social,
economic, political and cultural dimensions of community health, which is
usually overlooked in the traditional system of training of health professionals.
• This workshop will also try to help the participants to strike a balance between
two major schools of thinking in community health; the cynical inactivity of
the ‘revolutionaries’ and the unbound optimism of the ‘field activists’.
• Regarding the outcome of the workshop, the focus will be more on the process.
Fellows will have opportunities to debate, discuss and question many of the
key issues in community health. This workshop might also come out with a
document, which may be circulated, in a larger group.
PANEL ONE: GLOBALIZATION AND RIGHT TO HEALTH CARE.
Panelists: Dr. Narendra Gupta and Dr. Thelma Narayan.
Dr. Gupta brought out issues related to right to health care through his brief
presentation. According to the constitutional rights (art. 21) and Bhore committee
report, right to health involves at least 6 areas. These are: RIGHT TO
1. Adequate and balanced FOOD
2. Adequate and safe WATER
3. Safe HOUSING
4. Safe WORKING CONDITIONS
5. Healthy LIFE STYLE
6. HEALTH CARE
There can be no health unless those bare necessities are met. According to
Alma Ata declaration, these rights were the responsibilities of the govt. but in
reality in our country, India, even today a huge chunk of people have no access
to these basic rights. Majority of our workforce work in areas like fields,
factories, construction sites etc. where there are no safe working conditions.
When it comes to unhealthy lifestyle, the pressure of media and corporates are
too much. (E.g. Tobacco and alcohol abuse; stress related diseases;
indiscriminate and unsafe sexual activity….)
Even though these rights are the responsibility of the govt. many times they
fail to do it. This is because of corruption as well as the pressure of external
forces (corporate) on the govt. due to corporate globalization. (E.g. 35 rivers in
India bought by Multinational companies without any consultation with the
local people. USA refusing to sign the pollution control document.)
Dr. Gupta also explained how his organization ‘PRAYAS’ is actively
involved in the struggles of the people of Rajasthan for these rights. PRAYAS
helps the people to demand and fight for their rights. This is done by the
formation of ‘cadre of people’ who works with these 6 human rights issues, in
association with the youth, adolescents, women and children. Regarding the
right to health care, PRAYAS works with the people to strengthen the govt.
primary health care system. Some of the major experiments are the right to
FOOD campaign and the right to INFORMATION campaign. They organized
various public hearings for this cause.
India has surplus food grains, enough to feed all Indians even if there is 3yrs
of drought. Food grains are getting rotten in the PDS go downs. There also a
great need to develop infrastructure. Then why should there be unemployment?
Why starvation? There is tremendous possibility of ‘food for work’
programmes. PRAYAS organizes public hearings and campaigns to build
pressure on the govt. politicians try to downplay these campaigns. But today
PRAYAS has become successful enough to the extent of even govt. officials
requesting them to organize campaigns on certain issues. According to Dr.
Gupta, even in the govt. system there are the exploiters and the exploited. (E.g.
ANMs, Medical Officers, etc.) PRAYAS has succeeded in mobilizing these
exploited people to build pressure against the exploiters in the system.
Dr. Gupta also explained the 7-step process they follow in building up the
‘cadre of people’. These steps are:
1. Informal interaction with the villagers.
2. Identifying a health contact’ group in the village.
3. A 3-day residential training program for 12 people from the village.
(This is a problem-based learning using modules and AV methods. They
are made to think by asking questions.)
4. Health mapping (PRA techniques are used. Villagers are made aware of
the
Total burden of the disease in the village and
The total burden of the expenses for these diseases.
5. Formation of women’s groups (SHGs etc.)
6. Formation of adolescent groups.
7. Formation of ‘village health committees’ and village health charter’.
(By this time PRAYAS has enough data to discuss in the committee.) Once the village
health charter is made, official approval of the gram sabha is got for the same.
Dr. Gupta’s presentation was followed by a brief presentation by Dr. Thelma Narayan
on the impact of globalization on the health of people.
• The poor are not a minority. They are present as big numbers in both developed and
underdeveloped countries.
• Globalization is the process of lifting barriers to flow of goods, services, capital,
knowledge, people…..
• The positive aspect of globalization includes; the growth in communication
systems, sharing of values, solidarity and so on.
• The negatives of globalization includes; corporate capitalism’, where global
resources including essential commodities like drugs, food, water etc. are
controlled. Those who are benefited by this process are only a few wealthy, but the
majority are affected negatively. There is an increase in global and national wealth;
but the gap between the rich and the poor are widening. More over the increase in
wealth is more of virtual (speculative capital) than real.
• The impact of corporate capitalism are many; some of them are:
Inequity
•
•
•
Increasing unemployment
Brain drain
Environmental pollution
Wars and conflicts
Loss of livelihood
Health problems…….
There is an increase in the quantity of
Weapons of mass destruction (WMD) and
Weapons of individual destruction ( WID) like tobacco, alcohol etc.
Not all private sectors are bad. But there are corporate sectors whose only value is
to accumulate wealth and more wealth even at the cost of basic human rights. These
corporate private sectors are very powerful, above govt. and dictate norms to them.
Hence majority of people are loosing control over the basic necessities of survival
and determinants of health.
Our struggle is against this exploitation at a global level. Situation has come to the
stage where we will have to join hands with govt. to stop the domination of these
corporates.
After the break, there were 2 group discussions.
1. Group discussion among the fellows:
So many questions and clarifications were raised by the fellows regarding
globalization and its negative impact.
(Details of questions can be obtained from Dr. Silviya)
2. Group discussion among the mentors:
(Details from TN)
After the group discussion, there was a sharing by Fr. Eddie Premdas about the
involvement of their organization in north Karnataka.
• Eddie gave an idea about the social context in which the people of that area are
struggling to cope with.
• He also shared about how being a religious; he was inspired by his brief experience
with CHC. After his CHC experience he went on to do MSW in TISS and started
working with the people of north Karnataka, where he went for his project as an
MSW student.
• Their focus is on the dalits of that area especially the women. According to him
dalit women are victims of a double oppression. They use the SANGHARH method
(which he picked up from NBA and Baba Amte), to make the existing govt. system
work. He explained how he experienced the collective strength of women, where
they came together to deal with issues like wife beating, caste violence, corruption
in PHCs, PDS etc. and so on. His sharing was also very inspiring.
Since it was already around 6 pm., the experience sharing by fellows was postponed to
the next day.
After supper the fellows had a very long informal chat with Dr. Narendra Gupta and Dr.
Ullhas Jajoo. The senior community health practitioners shared many of their personal
struggles as well as their achievements and dilemmas. It was a very inspiring and
informative session. The fellows could go into deeper and personal questions related to
community health practice. The session went into late night, till the last person fell asleep
on the ISI lawn.
DAY TWO: 15.04.04 (Thursday)
The day started of with Dr. Ravi Narayan clarifying many of the questions raised by
the fellows about globalization on the previous day. The senior community health
practitioners were happy that the young generation is raising many relevant questions. Dr.
RN expressed his anxiety about the ‘market fundamentalism which is becoming a major
problem today. Over the years there is a gradual shift in who regulates the market. The
taking over of the market by the World Bank and the WTO, has brought in a situation
where even the elected govt.’s are becoming helpless since the 80’s. He concluded by
saying that there is phenomenal evidence based on solid research, which brings out these
facts. He urged the fellows to read more about this area and suggested lot of literature on
globalization. Some of those books are:
1. Poverty, Class and Culture by D. Bannerjee
2. Socio, Cultural and Political Analysis of Health Policy in the 80’s by D.
Banerjee
3. Dying for Growth by Jim Kim et al
4. Globalization and its Discontents by Joseph
5. Pathologies of Power
6. Economy of Permanence
7. Hidden Connections by Fritz O’Capra
8. Social Science and Medicine by D. Banerjee and Rajni Kothari
PANEL TWO: COMMUNITY HEALTH WORKERS:
Panelists: Dr. Sunil Kaul and Dr. Ravi Narayan.
Dr. Sunil Kaul presented his experiences with CHW in Rajasthan and Assam.
According to him, the experiments of PRAYAS may not work in northeast. Each area
needs to have its on unique approach. He explained how the youth of northeast are taking
control of justice issues of their area through the ‘students unions’. He also explained
about the selection process they use for CHWs and the training programs they have for
them. They use a training manual of around 400 pages, for the above purpose. Women
come with their children for training. They have a combination of classroom training and
fieldwork. Once they start practicing as CHWs they can go back to the manual if necessary.
He also mentioned about his ‘hidden agenda’ of working towards PEACE in the northeast
through the CHWs. This was followed by Dr. RNs session on CHWs. He brought out the
effectiveness of health workers based on the available evidence from the various
experiments done in India and other parts of the world. In India from 1964 onwards the
village health workers (VHW) had been tried as one of the approaches to health care. These
were the conclusions by those experiments:
• Women were found to be more effective than men.
• Volunteerism worked better.
• Social control over the CHWs worked better than professional control.
• Sky is the limit for the empowerment of CHWs. (some of them could do even
surgery)
• The best training for CHW is problem based training; learning by doing.
• One method of training cannot be generalized for all the places.
The major threat to CHW was from the medical profession; the mind set which goes
against demystification of health care. He also spoke about the difficulties faced when the
CHW concept was taken to be up scaled at a larger level. This was illustrated through the
Jan Swasthya Rakshak scheme of Madhya Pradesh, where 55,000 CHWs were selected and
trained for this purpose.4
This session was followed by a group discussion among the fellows regarding CHWs.
Here also lots of questions were raised, especially regarding the feasibility of up scaling
this concept. Responding to some of those questions, the panelists explained how the ‘bare
foot’ doctor project worked in china.
• They had a strong political will
• They went to the villages and asked the people; whom do you go to when you have
trouble? That person was chosen irrespective of class, educational status, age, sex
etc. medicine was demystified to them and they became very effective health
workers.
Wherever the VHW became the part of a PROCESS, where the community played the
role of a partner they succeeded. But when CHW becomes an extension of somebody’s
project, they became a failure.
After lunch break, Dr. Unnikrishnan, gave an interesting presentation on the impact of
war and conflicts on the health of people. He brought out the horror of the situation in Iraq
and Palestine due to the war.
PANEL THREE: COMMUNITY HEALTH FINANCING:
Panelists: Dr. Ulhas Jajoo
Dr. Ulhas presented the origin, philosophy and the process of the community healthfinancing project associated with MGIMS, Wardha (Maharashtra). He brought out the
positive as well as the negative experiences associated with it. This was followed by a
brief presentation by representatives from VGKK (Karnataka) and ACCORD, Gudalur
(Tamil Nadu). The presentation as well as the group discussion followed were very brief
due to lack of time.
After supper the fellows had an informal get-together. This was an opportunity for the
fellows to get to know each other more. They also shared about their learning experiences
of the past two days and discussed about innovative ways of presenting them before the
participants the next day.
DAY THREE: FRIDAY, 16.04.04.
The fellows presented their learning experiences of the past 2 days using a skit
followed by each person sharing their experiences. On the whole the fellows felt that those
2 days were very much useful. The last year’s fellows felt that this workshop was a good
way of finishing the fellowship program. The new fellows felt that it was a good way to
start the fellowship. Last year’s fellows also shared their experiences from the field and
how they benefited from the semi structured, person oriented mentoring, approach of the
fellowship scheme. The fellows also discussed the possibility of being in touch with each
other and associating with each other during the practice of community health in the future.
Compiled by Mathew Abraham and Anant Bhan
Annexure X
COMMUNITY HEALTH AWARENESS COURSE VIDYA DEEP
INSTITUTE, CRI BROTHERS BANGALORE (Modified Schedule)
DATE: OCT 6TH – OCT 11th
TIME: FROM 9am to 4.15 pm.
OCTOBER 6TH 2003, MONDAY.
TIME
9 - 10am
10.30 – 11.30am
11.45 – 12.45am
2.30 pm.
9pm – 10pm
TIME
9 - 10am
RESOURCE
PERSON
TOPIC
Introduction and overview of the course
Bro. Mathew
Diseases: Communicable and Non communicable
(prevention and management)
Working with communities: approaches and challenges.
Problems and needs assessment of communities.
Field visit
SNEHADAAN (HIV / AIDS)
Group Reflection*
Bro. Mathew
OCTOBER 7TH 2003, TUESDAY.
TOPIC
11.45 – 12.45pm
Health situation of India, govt. health services, referral
levels and National health programmes,
Health, healing, wholeness and health apostolate of the
church.
Levels of prevention and health promotion.
2.30pm – 4pm
Alternative systems of medicine.
6pm –7pm.
Health, community health and holistic health
10.30 – 11.30am
Dr. Paresh Kumar
Bro. Mathew
RESOURCE
PERSONS
Dr. Francis
Dr. Francis
Bro. Mathew
Dr. Shiridi Prasad
Bro. Mathew
Summing up of the day / video
9pm - 10pm
TIME
9 - 10am
10.30 – 11.30am
11.45 – 12.45am
2pm
9pm – 10pm
OCTOBER 8TH 2002, WEDNESDAY
TOPIC
Critical Thinking and creative thinking
Time for personal / group reflections*
NGOs / private (General Practitioners, polyclinic,
corporate hospitals)
Field visit
Summing up of the day
RESOURCE
PERSONS
Bro. Xavier
Bro. Mathew
Dr. Thelma
Bro. Mathew
OCTOBER 9TH 2002, THURSDAY
TIME
TOPIC
RESOURCE
PERSON
9 - 10am
Health and Nutrition
Ms. Padmasini
10.30 – 11.30am
Health and Nutrition
Ms. Padmasini
11.45 – 12.45pm
Women health – a gender perspective.
Dr. Mary Thomas
2.30pm – 4pm
Mental health and family health.
Dr. Mohan Isaac
6pm – 7pm
Panel discussion : Equity in health (Poverty, Gender
9pm – 10pm
issues…etc.)
Summing up of the day
TIME
OCTOBER 10TH 2002, FRIDAY
TOPIC
9 - 10am
Environment and health (CHESS)
10.30 – 11.30am
Time for personal / group reflections*
11.45 – 12.45am
Panel discussion – problems of the slum youth*
230pm – 4pm
Panel discussion – TB, Malaria, Alcohol,
Tobacco and CHC field programmes.
6.pm – 7pm.
Interpersonal relationship and community life
9pm – 10pm.
Summing up of the day
Mrs. Donna
Fr. Ignace
RESOURCE
PERSON
Dr. Rajan,
Dr. Rajen,
Mr. Rajendren
Mr. Chander
Bro. Xavier
OCTOBER 11TH 2002, SATURDAY
TIME
9am - 11.30am
11.45 – 12.45m
TOPIC
Monsoon game
(Including tea break)
Peoples health movement and the charter.
RESOURCE
PERSON
CHC team
FIELD EXPOSURE: FROM 13TH TO 27TH OF OCTOBER
Modified Schedule
13th Monday
14th Tuesday
Mysore visit*
to
Herbal Medicine project ( Fr. Joseph Chittoor)
15th Wednesday am ODP- Mysore diocese
15th Wednesday pm RLHP – Slum visit
16th Thursday
Vivekanandha Youth Movement (VYM)
Hospital
th
17 Friday
VYM – tribal school
th
18 Saturday
RlHP – Old age programme
th
19 Sunday
Travel to Holy Cross CRHP- Planning
th
Holy Cross Comprehensive Rural Health Programme.
20 Monday am.
To 23 Thursday pm -Village experience
24th Friday am.
Debriefing (HCCRHP)
24th Friday Pm.
Back to Bangalore
13th November
Thursday am.
Final Debriefing CHC consultants and CRI staffs.
EVALUATION OF THE PARTICIPANTS ON THE 1ST WEEK OF THE COMMUNITY
HEALTH ORIENTATION PROGRAMME – CRI BROTHERS.
(Out of the 24 only 14 responded)
TOPIC
Diseases: communicable
and non communicable
Working with
communities
Health, situation of India
Health, apostolate of
church
Levels of prevention
Alternative systems of
VERY
POOR
POOR
7%
(1)
OK
GOOD
28%
(4)
42%
(6)
50%
(7)
42%
(6)
28%
(4)
35%
57%
(8)
42%
(6)
35%
(5)
50%
(7)
35%
(5)
57%
VERY
GOOD
7%
(1)
7%
(1)
7%
(1)
21%
(3)
14%
medicine.
Health, community health
and holistic health.
Critical and creative
thinking.
NGO’s \ private sector.
Health and Nutrition.
Women’s health
Mental health
7%
(1)
14%
(2)
Environment and health
Interpersonal relationship
People’s health movement
Monsoon game.
Panel discussions
Equity in health
Problems of slum youth
Alcohol and tobacco.
Field visits
Snehadaan
APD, APSA, Navajeeven
and Shishu Bhavan
7%
(1)
(5)
35%
(5)
28%
(4)
57%
(8)
14%
(2)
28%
(4)
42%
(6)
14%
(2)
21%
(3)
42%
(6)
35%
(5)
(8)
50%
(7)
57%
(8)
21%
(3)
57%
(8)
28%
(4)
42%
(6)
57%
(8)
50%
(7)
14%
(2)
21%
(3)
(2)
14%
(2)
21%
(3)
14%
(2)
28%
(4)
42%
(6)
7%
(1)
14%
(2)
21%
(3)
7%
(1)
35%
(5)
35%
(5)
7%
(1)
35%
(5)
35%
(5)
42%
(6)
50%
(7)
28%
(4)
50%
(7)
7%
(1)
42%
(6)
50%
(7)
50%
(7)
50%
(7)
EVALUATION OF THE PARTICIPANTS ON THE 2 WEEKS COKMMUNITY
HEALTH EXPOSURE PROGRAMME – CRI BROTHERS.
(Out of the 23 only 18 responded)
EXPOSURE
Herbal medicine Fr. Chittor
ODP- Mysore
WASTE
OF TIME
11%
(2)
11%
(2)
Swami Vivekananda Youth
Movement (SVYM)
a. Sharing by Dr. Bala
B. Hospital visit
c. Tribal village visit
d. Tribal school visit
e. Village street play
RLHP
a. slum visit
b. sharing by Mr. Joy
c. Programme for the aged
Holy Cross CRHP
11%
(2)
22%
(4)
16%
(3)
11%
(2)
22%
(4)
27%
(5)
22%
(4)
33%
(6)
5%
(1)
a. village experience
NO SO
USEFUL
22%
(4)
11%
(2)
5%
(1)
22%
(4)
27%
(5)
27%
(5)
11%
(2)
22%
(4)
16%
(3)
DON’T
KNOW
22%
(4)
11%
(2)
5%
(1)
16%
(3)
11%
(2)
16%
(3)
11%
(2)
22%
(4)
22%
(4)
5%
(1)
5%
(1)
11%
(2)
16%
(3)
16%
(3)
11%
(2)
5%
(1)
11%
(2)
5%
(1)
5%
(1)
b. stay in the village
c. work experience
Group reflections
16%
(3)
Community life experience
Exposure Programme as a whole
16%
(3)
USEFUL VERY
USEFUL
61%
5%
(11)
(1)
33%
11%
(6)
(2)
33%
44%
(6)
(8)
55%
16%
(10)
(3)
44%
(8)
33%
(6)
55%
16%
(10)
(3)
33%
11%(2)
(6)
38%
11%
(7)
(2)
55%
16%
(10)
(3)
44%
(8)
22%
16%
(4)
(3)
66%
11%
(12)
(2)
38%
55%
(7)
(10)
27%
66%
(5)
(12)
44%
55%
(8)
(10)
55%
5%
(10)
(1)
16%
50%
(3)
(9)
44%
22%
(8)
(4)
SOME COMMENTS OF THE PARTICIPANTS
1. First week of orientation
Very long sessions
Too theoretical
No time for personal reflection.
Not so interesting or helpful
Sessions crossing time limit
2. Two weeks of exposure
Not relevant for theologate level
Objectives and the purpose was not clear
Planning of the programme was poor
Exposure not well organized
Visiting NGOs was not necessary
Well organized
Useful and interesting
Sharing and group discussions were
meaningful
We were treated as matured persons
Cultural evening/ prayers were very good.
Field visit was excellent
Lot of freedom given
Needed more time in the village
Position: 1052 (5 views)