Manjusha.B.Dhiwar Health Situation Across Globe - An Overview (Including on the Borader Determinants
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- Manjusha.B.Dhiwar Health Situation Across Globe - An Overview (Including on the Borader Determinants
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COMMUNITY HEALTH FELLOWSHIP SCHEME
APRIL 2005 TO OCTOBER 2005.
Reported by
Miss. Manjusha.B.Dhiwar.
Submitted to
COMMUNITY HEALTH CELL
Mentor
Dr. Thelma Narayan.
Field Mentor
Dr. Rakhal Gaitonde.
ACKNOWLEDGEMENT
The experiences I got in this six month of fellowship is an eye opener to me about health. For
that I worship thanks to my god for giving me the way and I thank to my parents who
strengthened me.
I express my heartfelt thanks to Community Health Cell and Sir Ratan Tata Trust for having
given me such a good experience. It showed a path to me to study and know about health
(public and community health). It is a great motivation to me for future to work.
I am very much thankful to Dr. Ravi Narayan , Dr. Thelma Narayan and Dr. Francis to put
their great efforts and for providing me encouraging support and guidance. I don’t have words
to express my feelings.
Dr. Ravi and Thelma are the Pot maker and CHC is a wheel (through which pot is
made) when Dr. Ravi and Thelma rounds the wheel and gives shape to the raw mud it
becomes a nice pot, and when these pot is baked in fire then its procedure completes and the
pot becomes useful to fill water in. Its use is precious because it satisfies thirsty when he gets
cold water from it.
I am thankful to all CHC Staff for their direct and indirect support.
I am thankful to FRCH (Foundation for Research in Community Health) who permit me to
work and learn with them. I am also thankful to my field mentor Dr. Rakhal who was my
guide, motivator and supported me a lot. And Dr. Sarika who had help me in my studies.
I give thanks to all my senior fellows, co-fellows for sharing their experiences and given
invaluable inputs.
.
CONTENTS
A.
Orientation.
B.
Introduction
C.
Research Design
D.
Details of study
E.
Findings & Conclusion
F.
Training Report (community health workers training)
G.
Visits
H.
Activities.
A. ORIENTATION.
Report on Interns/Fellowship Orientation program.
INTRODUTION:-
15/4/05
Self-introduction, we were two myself and Madhumita.
CHC-SOCHARA overview, CHFS - objectives and overview
Expectations of participants from CHFS, Expectations from interns/ fellows.
All CHC team had introduced themselves and its objectives and their reflections
towards community health is a process of enabling people, to exercise collectively their
responsibility to their own health and to demand health as their right.
To enhance the ‘community health’ approach it is therefore necessary for ‘health action’
initiating teams to evolve a greater democratic, non-hierarchical, participatory, team building
and team empowering ethos in their own relationships as individuals and members of a team.
Community health action is closely intertwined with efforts to build an alternative socio
political economic cultural system in which health can become a reality for all people.
Afternoon session:- Introduction about Admin, Accounts and Library.
Understanding self, identity, and relationships.
Ravi asked one question to us about self-identity and then explain how we know our
self or other know us or we don’t know about others and also us or other don’t know about us.
Feedback may be positive or negative.
Discussion on reading assignment- Health for All- Now
The International conference of PHC co-sponsored by WHO &UNICEF was held in ALMA
ATA (USSR) from 6th to 12th September 1978.
The strategy of PHC, advanced by WHO & UNICEF, was declared by 134 states at ALMA
ATA in 1978 to be the means to achieve health for all by the year 2000.
Nutritional Assessment of under-6 children, for Developing an interventionVisit to TVS. Hosur.
18/4/05
We went to Hosur with Navin, Chandar and Divya. It was a field visit to observe how
nutritional assessment is done. At first we went to community center their self-help group
women’s were doing chapattis it was a SHG women’s chapatti production and sales center.
Then we went home to home to do survey and we had taken height and weight of under-6
children to analyses nutritional status of children and they awaring people how to take care of
their children which nutritional food should be given, importance of taking weight and height.
We were there till evening we covered around 85 houses/ In between we went to TVS
company for lunch their we saw that there was a separate facilities of dispensary & Pharmacy
is given to their employees.
In Hosur visit I learned that awareness of nutrition would create more effective work
Health Situation Across The Globe- An Overview (including a discussion on the
broader determinants.
19/4/05
Dr, CMF had a discussion on the determinants- Advance development and reduce
poverty by 2015 Daly’s, MDG-Millennium development goalsEradicating extreme poverty and hunger.
Achieve universal primary education. Promote gender equality and empower women. Reduce
child mortality. Improve maternal health.
Combat HIV/AIDS, malaria and other disease.
Ensure environmental sustainability.
Develop a global partnership for development.
I learned that we are good planner but not good achievers because qualitative
implementation is less.
Afternoon Session – Introduction to health and community health.
Ravi had taken this session. I like this session because the way of explaining the
subject was nice,. He had explained the difference between medicine and health. The
Promotive, Preventive, Curative, Rehabilitative how it is useful, whose role is what. Which
things to be consider necessary for keeping good health, then he had explain us about
paradigm shift on which we discussed on many factors.
Biomedical model
and
Community health
1
Medicine/Disease
Health / states of wellbeing
2
Physical/Psychological
Social, cultural, spiritual
3
Patients/beneficiaries
Participants
4
Individual
Collective
5
Providing
Enabling/Empowering
6
Intracellular
Baboolist
The Response to the Context:-JSA, Right to Healthcare’ campaign,
Janaarogya Andoloana:20/4/05
In this we learn that revolutions is necessary. People should demand
because health is a justicable right demand of comprehensive health care. Right to health
campaingn- we discussed Problems- Ignorance of health care and health facilities among
people No proper treatments, Lack of transport facilities. No proper implementation of health
scheme.
My learning was- Health education is necessary, enabling people to use their rights.
Awareness and community organization is necessary to fight for their right, to
change/provide govt., pattern or services mobile services.
Afternoon session –Alma Ata to The people’s Health Movement, People charter
for Health, Mumbai declaration
We had a discussion on Alma Ata to the people’s health movement people charter for
health, Mumbai declaration (In which we also discussed what is missing in Alma Ata)
Appropriate technology, Community participation, Primary health care, Disability, Gender
issues, globalization, war conflicts and disaster.
My learning was why health movement is necessary we should work on issue related
to Human rights, Equity reaching the unreached
Health Situation In India: - 21/4/05
We had learned that according to health situation in India there is a need to work in
community and on social health awareness in large scale for poor and marginalized people.
Afternoon session: - Health and Nutrition
In the beginning of session Padmasini asked all of us to ask question or topic about
which we want information. So we all had asked her questions-To know about balance diet /
Women diet. And Adolescent diet.
We learn that those people who are poor or living in rural area the women has a
sacrificial nature food is limited they feel that they should not eat more ilt ils a cultural
sociology. Being poor it does not mean to a ill health. So basic diet is necessary for regulatory
growth, develop and fight against diseases. Mother’s ignorance leads inefficiency because
they don’t understand when to give solid to children so it is necessary to give education to
women that what ever food is available should be eat enough because you have to feed
children and yourself. it is very expensive to afford ill child than normal child. Then she told
that adolescent diet is not to go on junk food. but green vegetables, rice, all types of dal, milk,
egg, meat all should eat .
22/4/05
Today we saw a Documentary film show on CHC .In which different Doctors like Ravi,
Antiya, Benjamin, Zaffruddin, Arole shared their ideas, opinions, experiences, thoughts, and
work on community health. Which impressed me for doing efforts for community in a right
way.
Understand Primary Health Care:-
25/4/05
Concept of PH- It is a essential health care made universally accessible to individual
and families in the communities by means acceptable to their full participation and at a cost
that the community and country can afford. Gobi – Growth monitoring, Primary Health care
includes: -Promotion of proper nutrition, availability of adequate supply of safe water, basic
sanitation, immunization against major infectious disease, maternal and child care including
family welfare etc. Obstacles to PHC and comprehensive primary health. (promotive.
preventive, curative, rehabilitative) My learning is that People should encouraged to take
treatment in primary health care and that people should demand better services. Because
going to private hospitals is double burden on people’s expenditure with unnecessary
treatment
Health and Finance:Neeta had shared her study of Health finance in which she told us about types,
methods of health finance, rules and regulations, security, importance, how it is beneficiary to
whom all aspects of health finance. My learning is health finance is a good concept when it
will be beneficial to poor and marginalized community for comprehensive health.
Afternoon session:- Communicable and Non communicable Diseases
AIDS in India. Prevalence of HIV positive-0.9%, Majority of HIV infected population
in sub-Saharan Africa-29.4 million. U.N declaration of commitment on HIV/AIDS. June
2001. Information, work on Tobacco, Alcohol, Information about GFATM.
My learning is importance of HIV/AIDS facts should reach to people.
CHC Planning workshop:-
26/4/05
All CHC fellows and team were present in the workshop. All of them shared their
experiences and work. We got sum ideas of different type of social issues and work on which
all members are working with one aim comprehensive health for all. Then Thelma had told us
about NRHM. It was a very good experience to me.
Development communication: -
27/4/05
In which we learn how developmental communication is useful and what are the
problems in effective communication.
WIGO:- What is going on
WIS :- What is selected
WIMTU :- What is mean to us.
Teaching and training
The first problem what is going on. Something is always going on in every bodies mind.
Problem arises when an individual finds what is going on her mind is exactly same in others
mind. Human beings are selective in nature e.g. I select which is familiar to me.
Types of communication
One way communication (2) Two way communication (3) Direct (4) Indirect (5)
Interpersonal (6) Interpersonal (7) Verbal (8) Nonverbal.
After that Krishna told us about skills of communication (1) Listening skill is a basic
skill (2) eye contact (3) Voice also about Mass Media communication Then they showed film
show about their work using several development communication methods.
Afternoon session:- Orientation to Life skills.(Sheshadri)
After introduction they shared some incidence about violence against women. Then he
showed how to use life skill by some games. There some life skill which can be used in
communities:- Decision making and problem solving.
Critical thinking and creative thinking
Intra personal and effective communication
Self-awareness and Empathy
Coping with stress and coping with emotions.
Visit to a NGO (APSA): Association For Promoting Social Action. 28/4/05
It is a child centered community development organization. They work at the macro
levels of state and the country through Advocacy and policy planning initiative. At the grass
root level, we facilitate the empowerment of the urban poor through community based,
interconnected projects to promote human and democratic rights.
ACTIVITIES:NIMMAME, NAVJEEVAN NILAYA, SLUM OUTREACH, CHILDLINE
We had seen the shelter and training center and informal education, library,
computer hall, laboratory where these orphans, slum children’s were given education. We ask
them how they face the problems and difficulties.
It was a nice exposure to me because there are so many shelter and projects are their
but APSA is different because here all the facilities are given at one place and sustainable
efforts are made here which really make a child self independent.
Towards understanding the community. (Ms. Valli Seshan) 29/4/05
We had made discussion on how to understand community needs, requirements and
discussed many topics factual resources for solving problems, conflict management, how to
approach community voluntarily, advantages and disadvantages in communities, Ethics. In
our discussion we did not found solutions but many other ideas, thought, came out which
should be consider while working with communities.
I learned that learning something means there is a change in you. Risk taking also
means being creative.
Medical Ethics and public health:- Dr, Francis had discussed with us about :2/5/05
1) Doctor - Patients relationship:- Beneficence , Non malfeasance , Autonomy, Informed
consent, confidentiality, Patient rights, Malpractice, Negligence.
2) Medicine and Society:- Right to health, Health policy, Allocation of resources, Justice,
equity, Quality of health care, Gender, Children, Aged, Commercialization of medical
care.
3) Ethical problems at beginning and end of life.
4) Special concerns.
5) Right of the Patient:-a) Right to medical care of good quality
b) Right to self determination
c) Right to freedom of choice.
d) The unconscious patient.
e) Legally incompetent patient.
f) Right to information
g) Right to confidentiality
h) Right to health education.
i) Right to dignity.
j) Right to religious assistance.
Then Abraham gave some information about informed concent and confidentiality.
My learning is that all this information is important it should be followed and we should
aware communities and tries to promote social justice in the provision and distribution of
health care wherever possible.
Afternoon session;- Health policy public health Research and action.
I learn how health policy was been made which factors are necessary to be kept in
mind while making policy.
Visit an NGO situated in Banaswadi (BASIC NEEDS):-
3/5/05
It is a NGO working on mental health. There we met with Mr. Noyada. they share
their experiences with us how they work in the communities on mental health and they
showed us a documentary film of their work which is activated by community themselves.
Basic needs staff works voluntarily and some of them are from community and work more
efficiently, they said we follow principal of dignity and hard work
My learning is mental illness is a part of health illness and not a stigma and they
should also get health care.
Abraham showed us a film on sterilization programme It was implemented and
what are the opinions of people and the doctors. India was the first country to adopt family
planning prog. as a govt. program. For that 9 million dollar were been funded in 1952.
Then we had made discussion on the film. We came to the conclusion that these
programme was based on female sterilization, because they showed many things to avoid
pregnancy but all these products are made for women.
My learning is without consent and choice of people these programs was and is
implemented to achieve target and not health care of people. Such developmental
programme which are based on target and other interest is killing the poor and not
poverty.
HIV/AIDS in Kenneya
4/5/05
Today Sunil had shared his experiences of HIV/AIDS in Kenneya. He told us the
geographical, political, economical, cultural, social situation of the village, slums of
Kenneya. He shares the living standard of people, he said Poverty, HIV/AIDS, Slums are
big problem, in slums people are living in unhygienic condition in a very crowded area
with different addictions. Now due to some awareness and govt. has given free services to
test HIV people are responding positively. The infected people are taking care of
themselves and accepting, and declaring facts to others. There is a good change in the
thoughts of people towards HIV/AIDS.
My learning is that proper knowledge, information, good communication; hard work
is necessary to bring change in the thoughts of people.
Globalization.
5/5/05
We discussed about globalization, its meaning, history, advantages and disadvantages
from both the sides community and self. How globalization relates to health and women.
Conclusion was that it is harmful as well as helpful in some extent.
Afterward Prasanna came and he also discussed with us about globalization and how it
affects to health of the people. I understand globalization as a privatization;
commercialization, liberalization, industrialization and it will give rise to many problems.
Then Prasanna gave us information about PATENT –
Patent means a monopoly given to a people in a limited no. Of years. There is two type of
patents- (1) Product Patent (2) Process patent.
Before 1970 we had a product patent. Now govt. is changing the patent pattern and
which will affect to our whole health economy etc. we are trying to give some ideas,
thoughts, opinions to govt. about patent issue.
This was my last day after that my fellowship orientation programme was finished.
In all my sessions I had learn about health from different angles, its importance, different
perspective’s and necessities. Also our liabilities towards it. I am very thankful to all my
CHC team, which had given me a great opportunity to understand the facts of health and
aims and objectives of CHC.
B] INTRODUCTION
In my fellowship in Community Health Cell From 14 April,05 to 15 October,05 I had
done a study to know peoples perspective towards primary health care center within which I
had done some focus group discussions with different types of people and side by side I got
involve with community health workers training as a part of my fellowship to know
community health. This Training was going on in the same area where my study had taking
place in the institute called FRCH working on health about which I had mentioned further in
my reports. While doing all these process I met with a case of a domestic violence and I got a
chance to study the physical and mental health of a women living in rural area and I had a
case study. Also with in this fellowship period I got a chance to attend ‘International
Women’s Health Meeting’ held in Delhi and it was a great eye open to me. And I also got a
chance to meet some Activist like ‘Manisha Gupte’. This entire fellowship scheme has turned
my life and created a different view to see the world.
“STUDY OF PUBLIC HEALTH SYSTEM”
Date:- 3/06/05
Background:The govt. is spending huge amount of money on the public health system. There are
problems with in the system itself promoted but still utilization of the services provided is also
low. It seems that the provider’s perspectives are different for the users perspectives. This
study is as attempt to understand these different perspectives.
Introduction:- This study is done to know about Community health and to study about
The people’s perspective of about the public health system and to see whether they know
about their rights regarding health and their life in drought prone villages in Parner Block,
MH (state). In which I had selected four villages viz, Panolli, Pimpalner, Vadule,
Sangvisurya. To come up with probable ways to increase the utilization of the public health
system by the people it was necessary to know about their perspective regarding that. The
govt. is spending huge amount of money on the public health system. There are problems with
in the system itself promoted but still utilization of the services provided is also low. It seems
that the provider’s perspectives are different for the users perspectives. This study is as
attempt to understand these different perspectives. In Maharashtra , Ahmednagar district is
declare as Drought prone area and it is mostly seen in ‘Parner’ Block. While working with
women self help groups in four village aiming for the overall development I had achieved
organization, participation of village community at some extent but then I realize that some
part is missing because thought women’s status has been increased in some extent they are not
satisfied with the resources available to them because there the majority of women and
children had no access to health care they were spending lot of money on health. So I started
looking in to their health status and started thinking how to tackle with this problem.
So through the Fellowship in Community Health Cell (Bangalore) I got a wide perspective
and then After knowing health is not just the absence of disease ore stress But is directly
related to a person’s stability, normal functioning and the realization of potentials to the
fullest extent. I fixed some learning objectives to be fulfilled during my fellowship.
Learning Objectives :•
•
•
•
•
To study the peoples perspective of about the public health system in drought
prone villages in Parner Block, MH (state)
To study the perspective of those in service in the public health system.
To Study the NGO’s perspective about public health system.
To come up with probable ways to increase the accountability of the public
health system to the people.
To come up with probable ways to increase the utilization of the public health
system by the people.
So I could not satisfied all of my objectives due to time limit but I started working with the
help of Foundation Research for Community Health organization ( who was working in the
same four villages on health issue ) To study the peoples perspective of about the public
health system in drought prone villages in Parner Block, MH (state).
Maharashtra is a well qualified state in the sense the education status is quite good but still
health condition is poor in some part such as in drought prone area. So thinking that the
greatest risk for poor health and quality of life is poverty. It is obvious that poor,middle-class
and wealthy women and men live in separate worlds and their access to and control over
resources is mitigated dramatically by their socio-economic situation.
I had chosen four villages in Parner (Block ) viz, Panolli, Pimpalner, Vadule and Sangvisurya.
Where Watershed development project is also going on and through which we had achieved a
good rapport with the community so to know their perspective of about the public health
system was essential for me.
C] RESEARCH DESIGN.
Methodology:
The methodology was evolved during the fellowship period to ensure that it was
peoples perspective towards primary health care center and health as a right.
The study area:
The study was conducted in 4 villages in rural areas of the state where a woman’s are
actively engaged in self-help groups. The fellow is social worker working in rural
communities.
Methods of data collection:
Given the exploratory nature of the goals, facilitator chooses to go for (a)Focus Group
Discussion (FGDs) a method from within the domain of qualitative research methodologies.
(b) Interview guides to case study women with their experiences of primary health care
services. The interview session with women for case studies had to be completed over 2-3
sittings each lasting for about 1 to 2 hours.
Interviews were recorded manually during and immediately after interviews. The fieldwork
lasted for about four months. Case studies were conducted over 1 to 2 sittings with selective
women groups each lasting for about 1 to 2 hours on an average. No electronic recording
methods were used. Women included for case studies were identified through some
homogeneity (rich, poor, young, old women SHG groups) of methods. In that the interactions
during the FGDs women from each of the four villages played important roles. Also, the
fellow work in these villages since from 3 years allowed close interactions with the groups;
enhanced the quality of data.
Goals:
The goals of this learner were to understand people’s perspectives about Public health
care system which ultimately could be used to explore and identify appropriate areas of
enquiry into the subject matter and to contribute to improving people’s access to primary
health care services through awareness building and advocacy campaign., Some of the
specific objectives which evolved through the formative research were: (a) to know peoples
view regarding health and primary health care center. (b) To understand their expectations
about quality health care services. (c) Their knowledge about Right to health.
D] DETAILS OF STUDY
Focus group discussion: (pilot)
Date: 24/7/05.
Introduction:-Facilitator had chosen this Laximinarayan self help group for FGD as it
is a young women group with a same amount of saving. They all were from one village. Prior
permission was taken from all the participants.
Village: - Vadule.
No. Of participants: 17
Situation Given: A woman whose economic condition is bad. She is having two-girl child and
expecting for third. Her husband is a drunkard does not look after home. Her in laws are old.
What should she do for her delivery?
Discussion: Woman is faulty her decision is wrong. She should have to think if her economic
condition is not good why she want one more child. She should decide and should not listen
to others and now days has changed women’s can take decision. She should speak with her
husband when he is not drunk and if he does not agree she herself should decide what is better
for her. If she is working she must dare, in spite of giving money to husband for drinking she
should save for her future requirements. Giving birth to third child she is adding her
responsibilities and expenditure due to her poor condition we don’t think she may be able to
do sex determination test. And if she delivers third girl child then he situation will become
worst. Because family people will trouble her for son. PHC will force her for family planning
operation, The third child will not get any govt. facilities, some of them started saying she
might be pressurized by her in laws for son but then she should do sonography (sex
determination). Then I asked is sex determination allowed in hospitals. Woman started no it is
ban but most of the private hospitals do but we it costly and it should be kept secrete. Primary
health care centers do not do. But every one goes to private hospital though he is rich or poor
there is no way Govt. has made rule of two children. And ANM comes and forces for family
planning operation and people want at least one son child so adjust money from anywhere but
they go for sex determination test. But how she should adjust money she should helped by
villagers e.g. In our village same type of case was happened that time our village people
helped her for vehicle and one of our Village President’s boy is a doctor in Parner. So he has
given free treatment for her labor. Otherwise she should go in PHC some said if anybody is
giving her economic support best way to go in private hospital. Because if she go to PHC
again she will have to take anybody with her then expenses increases because during labor
period the nurses and health workers do not follow their duty, the person who is with the
patient have to do the cleaning, washing of clothes, caring during whole procedure and after
that two three days. Some women said give some money to the dais then they take care.
So I asked but what about poor one of the ladies said then don’t ask no body looks
after her, if she shouts due to pain nurses scolds her. Doctor never comes to see what is going
on. I asked why that lady does not oppose or say anything to them for such behavior. Some
woman said why should se say she should listen and tolerate because it is her bad time that
will pass some woman said she have to listen because she is dominated by other women and
she is helpless. She has no self-confidence and capacity to dare anything due to responsibility
and family pressure.
I) Focus group discussion.
Date: 01/8/05.
Introduction:-Facilitator had chosen this KAMAL self help group for FGD as it is a
women group with a same amount of saving. They all were from Rich families of one village.
Prior permission was taken from all the participants.
Village: - Sangvisurya.
No. of participants: 19
Situation Given: A woman whose economic condition is bad. She is having two-girl child and
expecting for third. Her husband is a drunkard does not look after home. Her in laws are old.
What should she do for her delivery?
Discussion: What should we say for her? She has to think what will be best for her. Knowing her
economic condition we may help her giving some from our self-help group. One woman said
but where is her husband, what he is doing otherwise her parents should take her. So
facilitator explains that her parents are far away and her husband is not working. Some
woman said if she is pregnant for third time her in laws should take her responsibility and
taker her in good hospital otherwise she should abort it, immediately one woman said but
abortion is illegal and she will have to take her in laws consent for abortion. Though abortion
and sex determination is illegal but all private hospital give this services and all are doing
these things which is very costly and unaffordable for poor they should not involve in this
they should accept the govt. facilities which they will get cheaper.
Exp: - One woman said I had taken my daughter in law for abortion in private hospital at
Shirur. It took net 5000/- for 4 months pregnancy and extra medical expenses. Facilitator
asked why you abort she said we had done first sex identification test and then it was a girl
child so we done abortion. Facilitator asked don’t you think it is a illegal and unethical. Also
it affects woman health she may die. Then her daughter in law Shakuntala (she is also a group
member) started saying it us so critical and painful and I suffered much still now I am not
feeling well, but women have no right to decide about it. Once all elder members decide it
becomes difficult to oppose them and sometimes husband did not agree to take step against
them. This awkward situation puts women nowhere that time society is also with our elder’s
side. Immediately one woman said those days were different now a days women have
knowledge, economic status has increased due to our self help group also there are unlimited
resources woman with their husband’s decide what they want and what they should do. If
both are ready no other member of family will interfere in that.
Facilitator asked but where should that lady go for delivery then some women said if
she wants good facilities she should go to private hospital there are good facilities and it take
good money. Otherwise she should go in any nearer PHC. Facilitator said how is their system
some women said we don’t know we never went there we always go to private hospital who
has time to wait their for long time there is so much crowd. Some started saying that are made
for poor people then if we are self-sufficient why should we go there we had heard that there
is no one to take care of patient only nurses are doing delivery and they uses bad wards and
scolds the patient there is unhealthy environment no proper facilities, dirty surroundings, no
special rooms. In between shakuntala said their should be abortion facilities should be done
legal because any how people are doing it only the poor don’t get facilities they have to
struggle which many times cause to death of women. Some women said but many women
normally complain of lower backache and irregular bleeding after tubectomy done in govt.
hospitals. Whether these problems are related to the hurried and callous surgeries performed
on women in camps.
II) Focus group discussion.
Date: 17/8/05.
Introduction:-Facilitator had chosen this ANANDIBAI self help group for FGD as it
is a women group with a same amount of saving. They all were from Poor families of one
village. Prior permission was taken from all the participants.
Village: - Panolli.
No. of participants: 20
Situation Given: A woman whose economic condition is bad. She is having two-girl child and
expecting for third. Her husband is a drunkard does not look after home. Her in laws are old.
What should she do for her delivery?
Discussion: There is nobody to see for poor every thing we need money. If she is needy she should
do home delivery otherwise go to the nearer PHC. There she will have her labor nicely only
she has to expend 2 Rs/- for case paper and some medicine expenses. Some village people
should help her for that. Because one of our group members had gone to Parner for daughter’s
delivery it was normal and cheaper only she has to take medicine from out side. She had
registered her name to the ANM who comes to our village once in week or fifteen days. She
had her all treatment in PHC all injections and that doctor is also nice many patient goes
there. Then facilitator said that lady has heard many negative things like govt. hospitals does
not give proper services, nurses uses bad words, lack of cleanliness, limited resources,
crowded area. Immediately one woman said my sister had injured in delivery because health
worker beat her during her labor but we could not say any thing to them we were fearful that
now Nurses will scold us that patient is troubling them during labor. Due to hear of such
experience, she might be fearful to go in govt. hospital.
Then some women shouted and said if she wants such a good facilities she should
have take birth in lord family. Who will give such a comfort to poor she should understand it
is her trouble period and though the treatment given in PHC is worst she should accept it.
Because No body can object to Govt. people, patient situation is such that he can’t say
anything and relatives are unaware or they do not dare to speak. And how to say them or ask
them we are not paying to them first thing they are giving us services in free. Though we
complaint who will listen to the area and us is so crowed nobody gives information. Then one
woman said if we gave some prasad (money) to those people they take care of patients care as
well as gives correct information with services. MTP is possible in govt. hospital if tub is to
be done.
One woman said but though she went in public or private hospital for delivery she is
delivering third child and according to govt. rule third child does not get father’s name and it
is not register in Grampanchayat and in Ration card. But women in our community have no
right to decide about children. She cannot avoid pregnancy without her husband and family’s
permission she cannot say for any contraceptives till she bears son because women’s status is
consider on that. If she does not gave at least one son the husband and his parents becomes
ready for his second marriage, still she is scolded, beaten and troubled by her in law’s or
husband. Many times it is provoked her for suicide otherwise mutual divorce.
Some women said but for delivery the Parner PHC is best the doctor is also nice they
knows everything about us they gives us card of treatment and doses mother and child care
services is given in free. That nurse comes in our village to give does and during vaccination
and Anganwadi teacher has all the record of pregnant women she gives food for them it is
insufficient if the woman is poor but at least she get some support. Then why should we
demand extra? What happens if that woman gets bad treatment she should tolerate and adjust
for getting all the treatment free?
III) Focus group discussion.
Date: 21/8/05.
Introduction:-Facilitator had chosen this NILKAMAL self help group for FGD as it
is an elder women group with a same amount of saving. They all were from Poor families of
one village. Prior permission was taken from all the participants.
Village: - Pimpalner.
No. of participants: 18
Situation Given: A woman whose economic condition is bad. She is having two-girl child and
expecting for third. Her husband is a drunkard does not look after home. Her in laws are old.
What should she do for her delivery?
Discussion: In starting discussion could not be possible women were not responding. The women
from this group are illiterate and elder. They were not at all interested in this matter. They
were saying what do it is her personal matter we cant say anything. Her family should take
her responsibility she should go to her mother’s home they will take care of her. Then
facilitator asked though she went her mother’s home the question remains the same. All
women are having this experience what is there to think so much. In our days there was home
delivery there were no special treatments given there were no facilities of doctors and
hospitals and women were having so many children’s. We do not know any medicine
everything was ok and fine with in no time. One woman said but now days are not same as
earlier there so many diseases occurred so nobody takes risk. Another said but now women
are also become weak they cannot deliver two children nicely. There are a fad of cesarean
Normal delivery has become rare still they are getting all medical facilities. One woman
started saying you tell madam how a poor can afford such high expenditure for delivery I
think that is why govt. has made a rule of two children.
Then facilitator asked what does a woman do if she doesn’t want child then one
woman said she should take pills ( Mala D ) and still she conceive then best way to abort it.
Then immediately one woman pinches her why are you saying like that. But she said what is
there in telling that every woman does Cretin if she doesn’t want child because many times
husband does not allow her to take pills or some times pills doesn’t work. Facilitator asks
were does this cretin take place then all women were stopped talking. Then one woman said
in Shirur all private hospitals does it but is costly still people does it the facilitator asked why
don’t people go for your PHC they dint understand what is PHC immediately one woman
said that nurse comes here but she always tells about family planning. So people are scared if
they go to PHC they will force us to do operation.
It is not easy to do FP operation there is one case in our area one woman she is having
four girl child her husband does not look after home he is always wander anywhere and come
to home once in three four months he does not give money to her he is drunkard drinks lots of
alcohol and beats her wife for money and goes she goes for daily wages her parents gives her
help in cash or kind. When PHC subcentre nurse comes to our area she always forces her for
family planning operation but still she cannot take decision. Then immediately some women
started saying how could she take decision First thing her parents are not taking her
responsibility she is thinking that her husband is expecting that she will bear son at least for
that he is still attached with his wife and family. One said but at least she should take some
contraceptives her health is going down day by day she is always doing abortion her parents
gives her money. Another one started saying how you are talking she has no way to do such
he husband wants son child she is helpless.
Then facilitator asked when do you go to go to govt. hospital the they said we never
goes to hospital if there is urgency then only we goes to hospital and that of private otherwise
women though very much ill does not go to doctor because she has lot of work, responsibility
there is no clinic in our village no transportation facility women are unaware of traveling and
nobody gives importance to her she herself ignores her illness. Many times she goes to
traditional healer (babas). We prefer to govt. hospital only for polio does and prenatal
treatment of pregnant woman. Some times that nurse comes and gives information and
medicine in our area.
Once there was epidemic of Hepatitis B that subcentre Nurse & Doctor Ghaimukte
were coming to our village and visited all our vasti’s and gave vaccine. But we goes very rare
one woman said once my son had gone to take dog bite injection & treatment to the subcentre
they told us to go in PHC at PALVE village where there is no transportation facilities, so he
went there but he found two time doctor was not available So he went to private hospital.
Many times for medicine we have to go for PHC because subcentre does not have sufficient
medicine.
IV)Focus group discussion.
Date: 22/07/05.
Introduction:-Facilitator had chosen this Nandini self help group for FGD as it is a
elder women group with a same amount of saving. They all were from Middleclass families
of one village. Prior permission was taken from all the participants.
Village: - Pimpalner.
No. Of participants: 14
Situation Given: A woman whose economic condition is bad. She is having two-girl child and
expecting for third. Her husband is a drunkard does not look after home. Her in laws are old.
What should she do for her delivery?
Discussion:Women asked from which village she belongs to. She is having already two girl child her
family member might be forcing her for son child. As she is poor her village people should
help her. One woman said if she is a member of any self help group, that group should help
her by giving her loan for some long period without interest on loan. Then facilitator asked
but where should she go for delivery some women said if she went in private hospital and if
she got cesarean she cannot afford the expenses one woman said she can go to Parner Primary
health center it is very cheaper and doctor is also nice. Another woman said but in Govt.
hospital it is said that people does not get proper treatment. Nurses and their assistants does
not give information completely their behavior is arrogant. One woman asked how do you
know she said once my cousin went their for delivery that time she was shouting due to pain
and that nurses we saying ‘why are you shouting so you people wants so much children and
after every one year you are here for delivery, you enjoys relations and this pain is not new to
you don’t act so much etc. So the words of nurses and their behavior are so irrigative. In
between that one women said if she want delivery free and she is poor and needy she should
listen and bear all this situation if we want something we have to listen because if she went in
PHC she will get treatment free, medicine free one woman said yes I had seen many cases of
govt. hospital people listen and accept such bad behavior because they are poor and innocent
who will listen their voices where should they complaint because it i8s the only one choice for
them. Some women if we know somebody working in PHC then we get proper treatment due
to contact with staff. One woman said she should tolerate these things as she is habitual and
secondly she is a woman she will have to tolerate.
OUT-COME: 1) Fear:People thinks that govt. officers are Superior due to ignorance and illiterate they feel
themselves unconfident. Lack of correct information, knowledge of rights they feels
unable to oppose doctors, Nurses of any abuse. PHC’s peoples attitude, behaviour
makes people less access to public hospitals. E.g. One woman went at PHC for her
tubectomy but she saw a long line and the animal behavior with the patients to achieve
family planning target, she got fear and she ran away.
2) Son Preference:
A very strong gender bias is entrenched in the cultural heritage of Indian society. It is
a society that idolizes sons. With in the family it is the women who perpetuate the
preference of male child though there may also be valid economic reasons for this.
Sons are considered ritually and economically desirable. They are desirable not only to
light the funeral pyres of their parents, but also to ensure continuation of the lineage ad
family name. The status of women is enhanced when she becomes the mother of a son
and this cultural and economic preference is seen to have serious implications not only
for the status but also for the survival of females. Foetal sex examination with a view
to aborting the female foetus continues in spite of the laws against such as (Prenatal
diagnostic techniques Act 1994) by expending much more money in private hospitals
which further leads them indebtedness.
3) Forceful family Planning Operations:
The issue of targets has completely distorted the entire delivery of health care services
in rural areas. Health workers lose the trust and confidence of the common people
because of their persistent nagging about family planning. The end results are poor
access to health care for most needy people and a population growth that eludes any
control..
4) Satisfied with free services:Govt. services are free and therefore people have no right to expect good quality
services. So what ever we get should be accepted otherwise we must have money.
Rich people can afford so they can demand how can a poor.
5) Acceptance of two child norm:People had to accept two child norm the reason behind it is not a women’s health but
govt. has made restrictions, a third child would not get name on ration card, the family
will not get concessions for any govt services and hence we have to accept it.
6) Feeling that abortion is illegal.:Due to lack of awareness and information women feels that abortion is illegal and this
facility can not be available in nearest PHC so they go in private hospitals and those
who cannot afford the expenses tries different local medicines which affects them
physically or mentally. Only because women are kept ignorant of the facts do they
allow themselves to stay untreated and humiliated.
7) Status of Women:Women’s health care continues to be a neglected area except during pregnancy or for
Abortion women hardly access the health care service. To gauge the socio-economic
and cultural independency especially relating to homely matters, women were asked
there decision which is also rare, it was found that those living in the nuclear families
could decide on relatively more no. of issues that in joint families where either fatherin-law or mother-in-law headed the household and ran it according to there whims.
8) Right to Health:People are not aware of the rights due to the culture of silence regarding health
problems and lack of autonomy in decisions making.
9) Quality of Services:In study it has been seen that quality of services is worse according to peoples
perspective. The environment is very crowded and dirty there are no proper facilities,
no medicines available, behavior of the health workers during labor is bad, going PHC
is time consuming though it is free if we want good services we have to pay money
separate to health worker. Most of the people prefers private hospitals very poor and
needy people goes to public hospitals.
10) Less access to health care:The study also shows that generally rural people, especially the working class, have
low access to healthcare, whether to private or public health care services. The reasons
behind that are numerous. It is found that primary health care centers were placed at
the extreme end of the Taluka (tehsil) people, of course, do not know these
administrative distribution and with common sense of logic they go to the nearest
primary health care center where they are send back.
11) Empowerment:Reality is that women not only from a major section of the society but also hold
greater responsibilities than men towards many facets of life .Therefore, it is the
women who matters because if one women is empowered through education. Health
and information then whole family benefits and these benefits are spread over the
whole society automatically. The empowerment and autonomy of women and the
improvement of their political, social, economical and health status is a highly
important end in itself.
E) FINDINGS:1) It brought out violence perpetrated by nurses and the health workers during labor,
violation of medical ethics by medical professionals while dealing with women abortion
care needs, private medical professionals indulgence in illegal abortion practice.
2) It also brought to light that money and connection in govt. hospitals provides good care and
facilities.
3) Ignorance, fear makes people unhealthy to demand their rights.
4) Patient, being poor in pain, trauma and fear, are already in a disadvantaged position can
hardly question to health workers for their mischief.
5) Women normally complain of lower backache and irregular bleeding after tubectomy done
in govt. hospitals. Whether these problems are related to the hurried and callous surgeries
performed on women in camps.
6) Women’s utilization of health services both public and private is quite low only for
delivery and sterilization.
7) Women have to suffer the consequences in silence, more so because the family would
doubt the women’s monogamity.
8) Use of facilities, especially among young women is rapidly increasing first for sex
determination and second for delivery complications like cesarean delivery.
9) The felt needs of the people for maternity and other emergency care remains unattended
due to their over emphasis on family planning programmed.
10) Men more easily manifest their problems through alcoholism, drugs etc but women’s
problems are neglected, to be suffered in silence and isolation.
CONCLUSION: Helping the people so that they can help themselves.
All human beings are entitled to a healthy and productive life in harmony with nature.
They have the right to an adequate food, clothing, housing, water and sanitation, adequate
standard of living for themselves and their families and for long and healthy life their should
be equal distribution of knowledge and access to resources needed for a decent standard of
living.
The gender difference in health between men and women are of a greater imp because
the health vulnerabilities of women are more pronounced.
The low level of health service utilization and the poor quality of health care received during
pregnancy are also responsible for both high levels of neonatal and maternal mortalities. So
there is a need of support, sectarianism, reservations, or feminists clubs and movements of
women rights can liberate and make women healthy, educated, informed, trained and
gainfully employed and have a say in population decision. For which we have to cultivate
health awareness, education, lifestyle that is promotive of health and participating action in a
social responsibility for health. Build people to demand health rights acceleration of antipoverty prog. Through organizing, training, educating people for the implantation of PHC and
other referral services and make them accountable to Village Panchayats. Campaign for active
women candidates for joining the Panchayat and support them during election. Enhancing
awareness among Panchayat members about the available services at the PHC’ and
subcentres.
In short the following are the main overall learnings:
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I appreciated the complexity of health and the intimate connections with various
aspects of life.
I appreciated that the people have different points of view from the 'experts' and this is
based on their real life experience.
I felt the need for concerted work with the people as the only way towards health for
all.
I realised the importance of understanding the peoples perspectives while working
with them.
F) Training Report from 12th May, to 30th August, 2005.
Introduction;I am doing my internship /fellowship under Foundation for Research in Community
Health Institute, PUNE in which they had implemented a project of voluntary health workers
in 30000-population which covered 6 villages area approximate for three years period.
Community health workers come two days in a week for training. From the project the VHW
receives a stipend of around Rs- 40/- per week to cover their weekly travel. The training held
in a centre place which is Ralegansiddhi at Tal-Parner & Dist-Ahmednagar, Maharashtra.
Most of the teaching is based on a discussion of actual cases. The roles of sanitation,
water supply, nutrition, health & hygiene people, and social issues are discussed. The major
tool of training is verbal communication. In which dialogue and discussion are the main
means of teaching than practical demonstration. Messages are repeated at all levels, by
trainers. Constant sharing of experiences and appreciation of successful efforts reinforce high
motivation. These VHW’s are encouraged for home remedies and minimum use of simple
drugs. The focus is more on preventive and promotive measures.
Training to these community health workers are given by Doctors, Shayogini Tai’s
(Senior Tai’s working experience of 10 years in their own village.) two days in every week
which is Tuesday and Wednesday.
Training started with a prayer song after that exercise and again one song about
women empowerment. After that revision of last week’s topics then discussions on any
experiences, questions and then the groups separate into two groups and then the main topic
get starts.
I had involved in the training as a learner so I had also learned all the topics, which
the health workers had taught and explain it to self help groups individually and through Tai’s
in some extent and done some community participative work in four villages which is my
fellowship field area.
Report No – 1
Topic :- Infertility
Date :- 17/05/05.
In last week Tai’s (VWH’s) were asked to prepare some messages regarding the
clarification hepatitis B ( about its misunderstandings ). They were given mike to speak the
message it was a trial so that they feel confident while they are addressing the village people.
It was felt that Tais were still not very perfect about the messages therefore it was explained
again today. After the group separated in two groups previous topic was resumed. Today they
had started discussing about Infertility. Trainer asked what do you think about infertility. One
of the tai said if a woman did not conceive people starts blaming her the reasons behind it
may be anything. All suggest her for medical checkup go for some spiritual things. Nobody
advises to husband anything and men’s did not become ready to have health checkup.
Tai asked when could you call someone impotent. Who is responsible for that because most
of the time it is the women who are held responsible? If a woman has only girl child then also
she is held responsible. Some tai explained that both of them should be explained the cause
and both of them should go for check-up and treatment if required.
Definition of infertility was explained by showing the posters. Tai’s said that general
belief is if someone cut the hair of a woman it could lead to infertility. Tais were given roleplay where infertility issue was taken up along with the reaction of various family members.
The issue related to the spiritual Baba’s who treat infertility. Most of them believe that trust in
god helps psychologically to conceive as in most of the cases baba’s act as the mediator for
conception.
Next day while discussing on fertility the question of Adoption was taken in which
tais discussed on the issues, beliefs related to adoption in their area. Trainers explain this issue
with the help of posters tais wanted to know about single parents especially with respect to
women and what are the legal requirements. In their discussion some tai explained that one
should take care of the children as their own child. She further explained that there is some
difference like how we expect our own child to be a doctor or so can we expect the same from
adopted child. This sentence and the inference were quite strange. Tais replied that no, it is
completely depends on the capacity of the child. The discussion further came that Adoptions
should be from adoptions centers rather than from a relative because of caste identification,
for child benefits, child gets proper behavior due to unawareness about his background. Then
trainers explained the legal procedure of adoption in the last session.
Report :- 2
Topic: - Infertility (Adoption)
Date :- 17/05/05.
Today after song and exercise the session started with different feedback. Panolli tai’s
specially Taratai and Mangal tai talked about their vasti meeting. Vasti people were happy to
know about FRCH training and hospital. Then Ralegan tai’s said that they had designed to
announce the hepatitis B information on mike but we were not able to this in last week. Other
tai’s said we gave this information in our workplace and in SHG meeting.
After the group separation Ralegan tai was saying that there is a malnourished patient
found in Ralegan that you know, we had went to see that child but mother of that child is not
reciprocating as she is not ready to accept anybody’s interference in her matter. Tai’s still
asked her to give soup of dal and rice but mother said that such thing doesn’t help, as the child
cannot digest the food. Tai feels that child should give only milk and tonic to complement the
food.
Today the remaining part of law of Adoption is taught. Tai asked how panchayat can
adopt such children is it a sustainable process. For how long the village will contribute for
such family and will this solve the problem in the long run. It can be sustainable if could
provide employment or provide labor to the family.
Second day session continues with adoption topic and moved towards violence against
women and alcoholism how in majority cases it has affected the women. Tai’s felt that in such
circumstances they don’t have much choice to access. Many women cannot talk openly in the
village. Such issues should be taken in Gramsabha (women gramsabha), but we don’t know
about Gramsabha when and for what purpose it is arranged many times it is only on paper.
Trainer asked do you know about women reservation in election. Responses of tai• Reservation of women is necessary without compulsion women will not get chance to
participate.
• Women should consider for all the seats including reservation.
• But the women who becomes should be well educated.
• Not only responsibility but also powers should be given to women sarpanch.
Then at the end of the session Tai’s were told to collect the information of panchayats
but some of the tai said we cannot do all of a sudden.
At the end of the session holiday on next week (24/25/05/05) was declared.
Report No – 3
Topic:-Infertility
Date:- 31/05/05.
After one week gap tai’s were happy to come together. Revision was taken as to see
how much tai ‘s remember after having holiday. Then the trainers came again on the
remaining topic of infertility. While talking on social factor Tai’s discussed on Rohini tai’s
brother’s example (Alcohol and tobacco consumption could also lead to infertility.)
•
•
•
•
•
•
Social reasons of InfertilityAccording to tai’s discussion beliefs like it is due to not worshiping or curse of
the traditional family god.
If any funeral is taking place and that time any married women who has not yet
conceive cross the dead body then she becomes infertile.
A woman who is infertile is said as Vanzh and the reason of her vanzhness is that
god has cursed her by birth.
Remedies for infertility:The married women who are not conceiving should make fast and worship to
Mavalai or Sattubai and arrange meals for the seven married women.
A woman can became pregnant if she please god with fast and touches any
woman who had small kids in temple.
There are some spiritual Baba’s whom treat but the rules of such treatment is
compulsory to be followed then only it works. E.g. there is one woman in Gujarat
who treats the woman. She only touches the woman ask some rules to follow and
the woman get pregnant But 9 months she should not go to doctor for any illness.
Then trainer explain the tai’s the reasons and treatments of infertility. Some
new inventions were also discussed. Many questions raised regarding conception,
hysterectomy, cesarean where and how it happens and what exactly do in tubectomy.
Trainers explain all the things deeply. Some tai asked how TB is related to infertility, how if
a man is injured (due to accident) it can also lead to infertility. Trainer taught them all the
things regarding infertility and the possible measures, which can bring fertility.
In second days training trainer asked tai’s do you want any other information other
than medical from us then some tai said now every where there is election atmosphere so we
want to know about details of panchayatiraj. Remaining second half session I was not able
to attend due to some urgent work.
Report No – 4
Topic:-Pregnancy
Date :- 7/06/05.
Today’s session started with the topic of pregnancy, in beginning some tai’s were
feeling very shy to speak on pregnancy. Some tai’s shared experience how everyone ask
woman about conception after few months of marriage. Then trainer taught how pregnancy
occurs and how to identify that the woman is pregnant. Their was long discussion on
symptoms of pregnancy in which tai’s asked why women are facing so much of vomiting
problem in pregnancy she cannot have proper food and which may further leads to anemia.
Trainer asked what do you do to stop this problem. Some tai said there is no medicine on it, it
happens to everybody so no one take it seriously.
We identify according to the behavior of women as she always feels like vomiting that she
is unable to eat, but still she feels to eat some different things (e.g lemon ).Pregnant women
stomach becomes big day by day. One tai share that one woman she was feeling like
pregnant, she had always vomiting, all things had happened to her like a pregnant woman her
stomach became big but after checkup it is found that she is not pregnant. There was no child
in her womb. Trainer explained what might be the reasons behind it. What happens when the
pregnancy took place and grows in the tubes how it is dangerous to the woman’s life?
Tai’s wanted to know about loop (IUD) because most of the women face lot of
problems due to IUD that’s the reason most of the women opt for tubectomy. Tai’s wanted to
know about natural birth control mechanism. Trainer had explained and gave all detail
information.
Second day discussion was done about all the care to be taken in 9 months of
Pregnancy.
• They are taught how to check urine to about pregnancy.
• How to find out the delivery date of the patient.
• Which are the doses and injections and what time it is to be given to pregnant women.
• Which nutritious food should be given and the importance of iron tablets.
Trainer asked when did you take T.T. injection tai’s answered if someone gets
injury with any iron rod, or if any wound is septic. Most of the women don’t take this
injection except during pregnancy. Three doses are given and it is referred to govt. hospitals.
Phc nurse has record of pregnant women she gives us iron tablets and told when to come in
Phc for injection.
Aganwadi sevika gives food to the pregnant women compulsory. But many of them
does not get because at that time every one goes for work in field. Poor people need this
facilities but they cannot stay home for the little food which cnnot satisfy the pregnant women
one time. In this situation women due to pressure of work and limited food leads to anemia.
Then to examine Anemia Thalapi mirror exercise was done. Trainer showed the line
diagram from the book ‘Every Women’ in which nine stages of pregnant women was shown.
We explained and taught about how to take pulse and how to measure blood pressure.
Report No –5
Topic:- Pregnancy (Continuation)
Date :- 7/06/05.
Training started with the revision. Tai’s reflected on the fact that pregnancy is usually
becomes difficult as one feels nauseate at first few months. Tai’s discused on various
condition of first few month like nausea, liking for certain food and sensitivity towards
certain smell. Tai’s opininon was that one should eat food in small quantities but frequently
irrespective of continuous vomiting during pregnancy to avoid anemia. But some tai gave
opinion of taking rest. But some tai said that full rest should not be encouraged as it increases
other complications in natural delivery. A cesarean took place when woman takes lot of bed
rest.
Tai’s wanted to know how the pregnancy take place in fallopian tube, clarification on
the pregnancy known as ‘Draksha grabha’ it is a condition where a grapes kind of pattern is
form in the uterus. It is like a pregnant woman. Tai’s said the woman who are taking
treatment from Baba (spiritual leaders) usually as the woman to belive in things like-
Do not go to doctor for any reason of ill health.
Even if periods does not stop woman will be pregnant.
Woman should keep secrete about her menstruation.
Trainers explained tai’s about natural abortion how it happens how to identify , If you see
danger symptoms the patient immediately send to doctor other wise patien may die, what care
should be taken if any patients is getting natural abortion.
In the last session deformalities in baby was discussed. Trainer explains many things
to tai’s like constant pain, backache during and after pregnancy. Danger signs and symptoms
of pregnancy and delivery were discussed in the session. (e.g about white and red discharge.)
Report No - 6
Topic – Dilevery. Date:-
21/06/05.
Today it was decided to show video on normal and cesarean delivery. So Tai’s were
happy and excited to know the facts. The procedire of sex selective abortion was explaimed
by trainer. Tai’s wanted to know how to find out the sex of fetus through injection .Trainer
explain the method and informed that before usage of sonoghraphy this method of sex
detection was very common but it is not in use. Responses of tai’s after vedioshow :Tai’s were frightened and became serious how difficult is the delivery and cesarean
procedure. All had experienced but they had not affected or thought of such things. They said
normal delivery is better. Doctors should not suggest for cesarean without any emergency.
Overall development of child is depends on the psychological condition of mother. The good /
bad environment of family and social treatment given to women matters on its child’s
development e.g Abhimanyu in Mahabharata. Tai’s wanted to know whether really a music,
reading of good novels affect the baby. Some discussion : -Sexual relations should be avoided last three months of pregnancy.
-The sexual intercourse during last three months leads to a sticky stuff on the child..
-Earlier women were given massage for natural delivery.
-To makeup natural tear during delivery people used mixture of turmeric and oil.
-There are many problems arises due to episiotomies.
-Some tai’s said it is expensive to go for putting and removing the stitches during
delivery.
-Tai’s had some questions like, whether medicines for abortion affect the child,
consumption of certain food affect the color.
Then tai’s started discussion home remedies for spontaneous unwanted pregnancy
suggest consuming soup of methi seeds, consumption unprepared papaya, and some roots
which are hot in nature. Trainer explained heavy dose of medicine for unwanted pregnancy
leads to abnormality. Some Tai talked about their vast experience in dealing with complicated
deliveries. Remaining time of training was given to tai’s for practicing the B.P. Apparatus.
Second day training started with songs and exercise. Tais were asked to write the
procedure of taking B.P. Today one tai has brought the sample of urine of a pregnant woman
and one tai gave sample on non-pregnant woman therefore all the had experimented the
procedure testing of urine. All tai’s saw the strip test and physical touching the same helps in
reinforcing the same.
Last month tai’s were asked to monitor their discharge to explain them about safe days
cycle, few tai’s had examined some tai’s did not remember some were confused. Tai’s wanted
to know when can a couple resumes the normal sexual life after delivery.
Suman tai had bought her daughter (who was pregnant) she had voluntarily ready to
examine herself. Tai’s were taught how to examine the growth of child by touching the
stomach. It was a good exposure to Tai’s. Trainer had explained each and every aspect of the
report she has also bought her medical report all tai’s went through it.
Then in the last session there was a discussion where doctor declared cesarean case but
the woman went back home and had normal delivery.
Report No-7
Topic:-Pregnancy
Date :- 05/07/05.
Last month Tai’s were given self-examination based homework. So after separation of
two groups they were asked to tell about that, Many Tai’s were not able to do it. Homework
subject was to do self-examination about discharge. But Tai’s said that they are not
comfortable doing it. Due to big family and limited place.
Experience: - Only one of the Tai said she is keeping the record she explained about the
consistency of the discharge it is like milk or may be like curd she was not sure. All the tai’s
agreed that white discharge is common and there was a consensus that first four five days
after menstruation nothing cannot recognized but later a sticky thing could be seen in the
middle phase the discharge is like a mirror.
Then trainer explained about the fertility period. Sahyogini Tai explained the same by
giving the example of cow. If a woman keeps a close monitoring she could avoid pregnancy.
But this natural process is not recommended in certain situations like immediately after taking
the copper T as there may be infections.
Indicators of menstruation: 1) Pain in the stomach.
2) Pain in the back, thies and legs.
3) Fullness of breast.
4) High sexual desire.
Tai’s has some doubts to be clarifies.
- The woman who had tubectomy can this process of change in discharge is seen.
- Does the white discharge reduce white blood cell.
- Does vaccine of dog bite will affect the pregnant woman?
Trainer explained the variation in the discharge all through the month with the help
of various substances like Atta, Glue and sabudana mix like and tai’s were asked to
touch and feel and see the co-relation between the actual discharge.
Trainer said conception does not take place when the woman is breast-feeding but this
-
statement was completely opposed by the Tai’s, as they know numerous examples
where women have conceived irrespective of the fact that they were breastfeeding.
Tai’s wanted to know about the conception of twins.
Why oral contraceptives should not be given to a breast-feeding mother.
Trainer explains them about the ovulation medicines and asks some of the other
withdrawal methods that are common.
Then discussion reasons as how family planning operation may fail. About threemonth window period in case of male sterilization.
Report No-8
Topic: - After delivery
Date: - 19/07/05.
Today training started with exercise in which tai/s response was that after doing
regularly Surya-namaskar their menstrual cycle has become regular. Some Tai said regular
exercise has yield good results.
Discussion was made on some of the doubts of tai’s- At what age hysterectomy could be done.
- Could prolapsed uterus lead to hysterectomy
- People have more faith in temple rather than medicines
- Reasons of infection after delivery.
- Reasons for drying of a child in the womb.
- Why emphasis on monitoring of child in the fourth months of the pregnancy.
- What happen when umbilical cord breaks in between?
- Does white discharge lead to hysterectomy.
- Does acute pain during menstruation signifies lump in the uterus.
Then trainer had given some case studies to Tai’s for identifying the problem like a
woman has missed her periods for some days and there is acute pain what could be the
reason.
Second day trainer had given many more case studies to tai’s so they will learn to
identify various ailments with symptoms. Then Tai’s wanted to know about the shock
treatment this is the local term use for chemotherapy.
Tai’s were of the opinion that once a woman had a child and tubectomy done then her
work is over therefore one doesn’t care about her health. Then some Tai’s was to know
about excess bleeding during menstruation and earlier women use to dig a pit and use to
sit on it till it becomes full. Many Tai’s narrated about case storied where excess bleeding
had taken the live of a woman. Reasons were pointed out for excess bleeding were –
- After delivery.
- If the placenta is not completely out.
- Incomplete abortion
- Lump in the uterus.
- Starting of menstruation.
- Menopausal stage.
- Sometimes the reasons are not known.
Report No –9
Topic: - Snake bite / Fever
Date: - 2/08/05.
As reproductive health was finished we had started new topic information on
snakebite and different types of fever. Trainer had told that we had bought vaccine on snake
bit you so in emergency you send people in our hospital. So after revision while sharing
experience one Tai shared that some body had bite snake yesterday but they had gone to Pune
I don’t know what is the condition of patient today. It is nice that now snakebite vaccine will
be available here it will secure peoples life. Otherwise it is available only in civil hospitals.
Then in discussion some beliefs had come out of village area.
- If snake comes towards us it is said that take the name of ‘Astickrushi’ he goes back
without disturbing us.
- If we kill one of the twin’s then the other snake takes revenge of it.
- While killing snake it should be killed till he die otherwise if he is halfly murdered he
takes revenge.
- A person should not kill snake whose wife is pregnant.
- People are worshiping ‘Nagraj’ so nobody kills to nag. If it occurs anywhere people
keeps milk for him.
- In our village if anybody bite snake that man is kept in the village temple for one day
and he becomes ok.
Then trainer had explained them about snakes and types of snake. Every snake is not
poisonous there are some Poisonous snakes which are found very rare. Some times
unpoisonous snake bite to a man and people take that man in temple and he becomes all right
and all thinks it is due to worshipping god.
If the one snake bite to two people at the same time or within some interval the poison
of that snake may affect the first one and will may not affect two second one because the bag
in which snake store its poison becomes empty.
Then trainer taught the first aid on snakebite how to identify snakebite. The signs
made by the method used in hospitals to identify that a patient has bite poisonous snake.
Report No –10
Topic: Dengue fever
Date: - 09/08/05.
Training started with revision of last week topic. After that while sharing experiences
one Tai from ‘Pimpalner’ said in our village few days before one dengue patient was found.
Everywhere it has become famous. All PHC doctors and subcentre nurse and MPW are
running towards our village and near by village to take preventive steps.
Tai’s started how dengue occurs why it has become so important that everybody is
speaking about that case. Then trainer taught the Tai’s about ‘Dengue fever’. It caused by
virus and transmitted by the bite of Mosquito called ‘Adis’. Then some Tai said we could
identify that mosquito we had seen all types of mosquito in AFMC last year’s study tour. This
mosquito’s breed in artificial collections of water in and around the houses and bite mostly
during the day.
Symptoms: I start with a high fever and chills, a severe headache and pain in muscles and joints.
In a more severe the patient may also collapse in shock. Preventing mosquito bites can
prevent by eliminating mosquito-breeding sites and dengue
Then Tai’s were asked what should be done for prevention.
- Surroundings should be kept clean.
- Water should not be stored more than seven days.
-
Water should be purified and should be kept in upper from floor.
If we saw anywhere mosquito’s larva breeding in stored water or collected rainwater
suggests putting kerosene or washing powder in that.
- Use of ‘Gappi fish’ in large storage of water. E.g. Water tank.
- The water utensils should be well closed.
- Discarded tins, broken bottles, tires tree cavities where rainwater is collected or stored
should be removed.
- While working in farm use long sleeves shirt to avoid mosquito bites.
The next day trainer had started the session with Typhoid. In which Tai’s said in
our village every time we had some cases of typhoid. And when people goes to doctor they
admits the patient,
Gives lot of medicine. Then trainer explain them that typhoid spread through bacteria its
infection causes fever and sores in the intestine, which may bleed at times.
Spread: - This disease spreads though open food and water contaminated by faeces
and urine. It infection if we does not maintain proper hygiene. The flies transfer the germs
from the faeces to eatables by contaminating open food.
Report No –11
Topic: - Malaria.
Date:-16 / 08 /05.
Today another lady doctor from FRCH, Pune conducted training. Then Tai’s sang
song after that exercise has been done.
Revision: - One by one Tai’s gave information about typhoid in detail. How typhoid
occurs what is their system what is the treatment, how to tackle with such case what care
should be taken. When patient should be sent to doctor, what happens in body when typhoid
occurs. The doctor surprise because all Tai’s gave response and nicely explained about the
typhoid.
Then that doctor had taken one game in which all group members participated game
was there was three places where the women should keep stone at those should put first place
stone. Woman who washes there hands by soap. Second place stone should be kept by those
women who wash their hands buy Ash. Those women who wash their hands bu clay after
coming from toilet must keep third place stone.
The trainer explained them how disease affect to health and how it spread through
poor sanitation, lack of hygiene, Lack of community cleanliness. Then she asks what happens
when there is such an unhygienic condition. Then Tai’s respond so many intestinal infections
and diseases like diarrhea, gastro, vomiting, Polio, jaundice, cholera, typhoid, and malaria
may occur.Trainer asked what precaution should be taken to avoid from such diseases. Tai’s
said safe drinking water should be made available, it should be taken from the cleanest
possible source, and we should keep our environment clean. There should be cleanliness in
community. Use of toilet,
Then the discussion started about how Malaria occurs what are its systomps. Trainer
explains that malaria occurs due to bite of female Anopheles. It bites only in nighttime. These
mosquitoes spread in stagnant water. When there is too little water, it affects our personal
hygiene, which leads to a variety of diseases.
Symptoms:- Shivering followed by high fever.
- Headache, fever usually comes on alternative days, some times it may come everyday.
It spreads through a chain of infected person to mosquito and from infected
mosquito to a healthy person. A healthy person may develop malaria within two three
days of infected mosquito bite. Then the time was over so it was decided that
remaining part will be continued in next week.
Report No –12
Topic: - Malaria / Rumatic Fever/ Mumps.
Date :- 23/08/05.
Training started with exercise and while sharing experiences tai’s were happy because
they said since we are learning about mosquito every one is conscious about mosquitoes
especially children’s are finding mosquito and asking us what type of mosquito is it and what
happens if it bites.
Revision:Some time if trainer explain the possibilities and symptoms to related topic and gave
any example about it the Tai’s immediately grasp but if trainer teach do’s and don’t of the
related topic they confuses. But today’s response was nice that typhoid and Malaria has
taught and grasped by Tai’s nicely and due to practical experience it was effective to
remember them.
Then the topic started and they had asked about how to prevent from Malaria. Some
said to stop the spread of malaria we should take care that mosquito should not occur, and as
mosquito breed in clean stagnant water we should cover water and clean the utensils of water
storage. Big water storage container and pits around house should be monitoring every time.
Trainer asked what they do when there is mosquito
- Some said we make fire and puts neem leave in that so due to that smell mosquito
does not occurs.
- Some said we use mosquito repellant coil.
- Some Tai’s said we grow a bush of damro or tulsi near our house it not allow
mosquito.
- Some Tai’s said we have small children’s so we use mosquito net while sleeping.
Then Tai’s were taught herbal remedies.
Next day training started with new song, then exercise then revision was taken for the
Tai’s who were absent yesterday. Then trainer taught them about ‘Rumatic Fever’. It occurs
due to throat infection and spread through air. It attacks on the joints and severe pain takes
place in joints. It occurs specially to small children’s and adolescents, as their resistance
power is low.
One tai shared that there is one patient in our neighbors she is a small girl and she
have joint pains, she goes to doctor for taking injection in every three weeks and doctor has
said the injection should be continued till the age of 20yrs. Otherwise if it becomes severe it
will affect on heart.
Then Tai asked what happens actually when it becomes severe. It is curable? Trainer
explains that joint pain is a severe one and the initial stage of it is rumatic fever. Then they
were taught some preventive measures and home remedies for rumatic fever.
Then trainer also taught about the ‘Mumps’.
Tai’s said Mumps occurs when we continuously put air in balloon with mouth but then trainer
explain the fact as- How does it occur?
- Symptoms.
- Home remedies.
Report No –13
Topic: - Chickenpox
Date: - 30/08/05.
Today both the groups’ session was at one place because due to election period many
Tai’s were absent.
Revision: of Typhoid, Malaria and rumatic fever was taken for those Tai’s who were absent in
last week.
The discussion started on chickenpox. Tai’s started asking how it occurs, to whom and
how many time it occurs it is curable or not, we had heard it is communicable disease. Then
trainer explain them
- It is viral infection
- It is communicable disease
- And spread through air.
- It occurs once in lifetime.
- It occurs mostly to children’s because their resistance power is low.
One Tai shared her experience that her son had small reddish pimple on his body. I
was confused what happen to him he was having fever some people told me to take him in
village temple. I took her but his fever was increasing so scared and said I will take him to
doctor but my neighbors said don’t take him to doctor otherwise the disease will increase but I
did not listen and went to doctor for treatment.
Then trainer said such patient should be kept separate from other children, he should
be given separate (cotton) clothes. Then one woman asked how can a poor people will able to
do so they use one towel in whole family two brother use the same clothes alternatively. The
trainer said then the clothes of patient should be washed in hot water and wet in sunlight.
Patient should not send in school other children might affect, as it is communicable. One Tai
said but it itches severely so we use neem branch.
Some Tai said that in our village there was a belief that if any one got
chickenpox that child should not take bath. His mother should not work and touch anybody
she should not comb her hair should not put bindi for seven days she should not sleep on bed
and of seventh day she should take her child in village temple without chapple. Then only it
cures and not occurs again. Then trainer explain them that once it happen it never occurs
again as it is a viral infection automatically it cures in seven days.
G) VISITS
(During fellowship)
10th International Women & Health Meeting (IWHM)
Health Rights, Women’s Lives: Challenges and Strategies for Movement Building.
IWHM was held on 21st to 25th September 2005 at New Delhi. Around eight
hundred women and some men were gathered from different parts of the country. Participants
from all over the country were feminist, health activists, community organizer, development
workers, legal advisors etc. IWHM was based on anti-imperialist, anti-patriarchy. Such global
networking will eventually build into a movement that can make a difference to people’s lives
and in particular, to women’s lives.
The 10th IWHM seeks to foreground women’s health as a fundamental human
right and the woman’s world. The understanding of women’s health today has moved beyond
maternal roles and procreation, to a more holistic notion. It also seeks to highlight politics,
policies and issues that have adverse effect on women’s health and simultaneously bring out
the linkages and interconnections of these seemingly disparate phenomena. The attempt is to
reiterate the holistic concept of health, and to strengthen the claim for health care and health
as a justifiable right for all people.
• Issues Covered.
• Public Health, Health sector Reforms & Gender: - Expanding spaces for women’s health, analysis in the context
of public health, health sector reforms & gender.
Right to health care.
- Equitable health care for the disabled, where are we?
- The gender politics of GATS & Health care provision.
•
-
Reproductive & Sexual health Rights:Sexual & Reproductive rights on political agenda.
Connecting Body politics:- Feminism, Reproduction & lesbian sexuality.
Integrating reproductive & sexual rights into our campaign & struggles.
Achievements & challenges ahead from reproductive rights and sexual rights.
The Politics & Resurgence of population Policies:Pronatalist policies or Birth Control – how women’s choices in
Eastern Europe has been shaped.
- Population Control & Reprogenetics in US. Neoliberalism.
•
-
-
Population policies & politics of food.
•
-
Women’s Rights & Health Care Technologies:Ethics, Genomic & Drugs on trial – New Arena of struggle for
Women’s rights.
•
-
Violence & Women’s Health:Violence Trauma & Healing in the lives of indigenous
-
•
-
Australian women.
The comfort women system of world war long – term effects on the lives & health
of women survivors of the wartime violence of Japanese Military sexual slavery.
Employed but not a worker, literate but not educated, earning but still in poverty
the violence of gender based development.
Emerging Feminist Perspective & Strategies: Disability, Globalization & Feminist health.
Contradiction in the right & choice language.
Abortion: On going challenge.
Global Challenges to Women’s Health:Global strategies for movement building.
Where do we go from here?
There was a posture, Pictures, exhibitions side-by-side film festival was going
on the above subjects. Then there was proper mechanism for translation system of French,
Spanish, Hindi and English languages. Entertainment, Lunch and traveling facilities were
nice and convenient. The most important thing was punctuality of all programs.
I hope that such global networking will eventually build into a movement and there
will be some impact across gender, class, caste, race, disability, sexuality and ethnicity.
•
-
“Report on Maharashtra Social Forum”
Date :-24/5/05.
It was nice experience to me to attend MH Social Forum held in Ahmednagar District.
About 10,000 People from more than 300 different organization coming under one pendal and
join hands to fight globalization and stand for equity, peace, justice-This seemed very
inspiring. All this gathers was for Maharashtra Social Forum 2005.
The first of its kind, this gathering was held on 20th-22nd May 2005 in the historic city
Ahmednagar, Maharashtra.
Globalization, privatization, liberalization seemed to have become a close of ‘triple’
that the developed world is injecting into the third world to make sure that it remains clad
with poverty, injustice, of a sure market for everything they sell. This gathering was to take of
ways to fight this and the need of masses getting together in this movement. This was held on
the background of the W.S.F. held in Mumbai last year.
The 3rd day schedule was full of activities and discussion; plenty of session’s youth
and women were given special attention. The discussion included those in Globalization and
peace, The status of women in globalization, Privatization of public sector, problems of dalits
and tribal, Exploitation of natural resources and people’s right, Status of youth in the present
century, Problems of workers in the unorganized sector. There were street plays and slogan,
competition attractively volunteers along with a series of documentaries and film show on
above subjects. Cultural activities in the right made the programme more colorful.The
presence of Dr. Raj. Arole, Shri Anna Hazare, Shri Popat Pawar, and such great missionaries
poured spirit into the programme. This programme ended with burning a lamp of hatred
against imperialism and a vision and motivation to fight against it in the hearts of many.
“Report On Meeting With Manisha Gupte.”
Date: - 08/08/05.
Today I had taken appointment with Manisha Gupte. I met her in her house. We had
discussion on some issues like how domestic violence affect on women’s health.
While talking about ‘Nari’ (my case study) she said woman are bitted by their husband
not due to Alcohol, but due to her helplessness, innocence husband knows that his wife
has no one except me; she is helpless, illiterate, no family support so if something is
wrong with him he beats her when he is drunk.
Alcoholism is such a big problem all over many crises took place due to this, it affects
on health of many people directly or indirectly and many people especially women are
suffering from that. Then I asked why govt. is not taking any step against it. She said see
why govt. will take step, they are getting large income from that and this politicians
require money for election and they permits and they get large money from this than other
source. The leaders of such thing has ruling on some communities where there are
distributors and beneficiaries all over the country that satisfy their economic benefits
through their votes.
The greatest risk for poor health and quality of life is poverty.
Here as men have made up the major proportion of those engaged in productive activities,
”men’s work” is valued. Because women have made up the major proportion of those
engaged in reproductive activities,” women’s work” is less valued.
Today importance is given to curative health, which depends on heavy expenditure.
There is a need to think the basic causes and necessities of people to expend on their
health not curative but preventive system will never look after it. So for that awareness
among the people about their rights, health right is necessary and they should be made
recognize there priorities and people themselves should take essential steps and we should
come forward to aware and educate people about there rights, health needs, and motivate
them, mobilize them, organize them to demand the right things. We cannot move people
towards change before their minds set up changes.
Look society is like this it will take time to change the thought of people one should be
very flexible and adjustable while working in community. There are many problems
which cannot be fully solved by any reason but the continuation of work should not be
disturb we should consider whom and what should be important to be preferred for the
problem. The decision that you make and the action that you take upon the earth are
important. At each moment you choose the intentions that will shape your experiences and
those things upon which you will focus your attention.
H) ACTIVITIES
“Kishori” Group Melawa.
Date: - 06/07/05.
Topic:- Discussion on personal health and hygiene and Nutritious food.
Today we had arranged meeting of young girls at watershed community center of
‘Sangvi surya’. Meeting started at 10 am. Around 18 girls were presented all are of age 14 to
19. Some of them are school going and some had left the school due to family responsibility
and lack of transportation facilities. So initially we made introduction then discussed about
likes and dislikes (about food, dressing, lifestyle) Then we found that some girls are shy and
responding and mixing so we decided to play ‘Carum-board’ which was available in the
‘Watershed community center’ they had made there groups and enjoyed the playing then we
started discussing the about Nutrition from a manual ‘Building capacities of women’s’.
NUTRITION: - The body of an adolescent is critically in need of better nutrition to
keep up with rapid growth spurt. This growth spurt can compensate for the loss of growth
during the first six years of life, if the young person is provided with adequate nutrition,
health and developmental facilities like education, exposure, challenges and support. For girls,
apart from the growth spurt, factors such as onset of menstruation, early marriage and
pregnancy, childbirth and motherhood create a demand for extra nutritional requirements. On
an average, girls require 10 per cent more iron intake than boys do, it make up for
menstruation blood loss.
Preventive Action With Community Participation.
Date:- 10 /08/05.
On 10th August in the training session Tai’s were given Practical so from next day we
had decided to arrange ‘shramdan’ of all Self help groups. So at first we went to ‘Pimpalner’
Two three Tai’s were come. Then we made announcement in speaker about the precautions to
be taken for Mosquito bite and written Messages on Village Panchayat’s blackboard, also
paste the message on common places where possible in which we had written all the
necessary steps of preventing from mosquitoes. Then we gave round to whole village. We put
kerosene or washing powder where there was collected rainwater, discarded tins, tires, broken
bottles, and stored water. Side by side we gave all information about what we were doing and
why?
Then next we went to ‘Sangvisurya’ we had kept their ‘shramadan’ all self-help group
and school children’s and Tai’s were came. We put clay (Murum) on the big area where there
was colleted rainwater. Then we made announcement in speaker about the precautions to be
taken for Mosquito bite and written Messages on Village Panchayat’s blackboard, also paste
the message on common places where possible in which we had written all the necessary
steps of preventing from mosquitoes.
Again next day we went to ‘Panolli’ where some Tai’s and we together gave round in
village and put kerosene or washing powder where we found larva of mosquito in collected
and stored water. Then we made announcement in speaker giving ten rupees to a ‘Davandi
man’ about the precautions to be taken for Mosquito bite and written Messages on Village
Panchayat’s blackboard, also paste the message on common places where possible in which
we had written all the necessary steps of preventing from mosquitoes. Then Panolli Tai’s said
we will suggest our Grampanchayt to Put ‘Murum’ on the open water pits on the road side
and school play ground and open space.
Report On Violence Against Women.
Any discussion of health in the context of the social, cultural and economic factors
cannot be complete without addressing the gender perspective in access to healthcare and
services. Gender differentials in health have consequences not only for the women themselves
but also for the well-being of their children (particularly females), the functioning of
households, and the distribution of resources.
Health as a human right promised to codify the needs of people, reformulate them into ethical
and legal norms and direct the efforts in a way that optimizes the satisfaction of the vulnerable
population’s basic needs in a sustainable manner.
Case Study: - (Note writer don’t want to disclose the actual name of the victim so she had
given a nick name as ‘Nari”.)
‘Nari’ – Age 30 – Village – Pimpalner. She is a member of “Parvati self help group. I met
her very first time when I newly formed that group in Jan 2003. She is a fair looking with
brown eyes and curly hair. Her is small and sweet with one son and husband. Her mother in
law stays at Mumbai. Her son is studying in first standard that is always ill; her husband does
nothing except taking milk at dairy. They have one small own house, little farm and 3-4 cows
whose milk is 40 liters in a day. But still she is not happy because her husband is a drunkard
wanders with village leaders and waste money in drinking and useless things. When she came
to know that self-help group is made to solve problems of each other, she then started
complaining me in SHG meeting about how her husband abuses her, since he is a drunkard he
always beat her and does not allows her to participate her in any activities. She is a good
singer and she sings Bhajans in spiritual occasions but she has to struggle for that with her
husband She complaints that he does not allow me to go anywhere. He is always suspicious
about me. He does not keep any money with me. I have no right to interfere in his personal or
any matter of him, family matter, and money matter. I had two cesarean but my no child is
alive then many years I had no pregnancy then I went to Gujarat there was woman she gave
me medicine and then I had one son Praveen. Still he will beat me for any reasons in front of
my son. Many days we dint talk with each other we had no sexual relation. My son is affected
so much he always becomes ill and frightened always in the evening when my husband is
home.
Once when ‘Nari’ was beaten she was admitted for two days in hospital I and his
village woman Sarpanch (she was one of her group member) and some group member’s went
her home to see her that time we talked to her husband for two three hours we explain him
that your family is small and sweet why you behave like this if your wife died who will look
after you and your son what will you get disturbing your own things village people will come
to see Tamasha nobody except your wife will care you in your bad days and your child seeing
this will never accept you. But we found he is very sharp he told us I understand how to run
family and behave but I don’t know what happens to me. I don’t like some of her behavior she
talks in front of me, she insults me and always suspicious about my behavior, she does not
listen to me gives backwards to me. After long discussion we removed their
misunderstandings they also apologies each other and us. He said thanks for advising us I will
not do like this again.
Then ‘Nari’ was selected for community health worker’s training from her village and
basti. After some months she again started complaining about her husband in SHG meetings.
That his husband does not give money in her hand and demands loan from SHG without my
consent and does not allow me to come for our monthly Shg meeting and group member’s
scolds me saying that why you sends your husband for meeting you are not repaying your
loans installment regularly and demanding loan, I feel this so much I have no right to ask my
husband if I ask he says this is none of your business do what I says to you I will give money
when I will feel then I say the shg member will not take money from you but I know he gives
and takes money from one of our shg member who lives near by her, he has relations with
her, he always goes to her house eat there, he helps her in farm and he always insult me in
front of her and always talk and give example of her how to behave that woman’s husband did
not say anything. But this I can’t say to my group members they don’t understand my problem
that nothing is in my hand. She was asking me for help she likes health training where she
was feeling free and happy at least for two days in week but now her husband was troubling
her not to go for training. So I talked with her group members in her absence but many of
them were saying ‘Nari’ is acting she has no trouble she stays with her husband very nicely
we see her laughing and happy with him she only attracts us for excuses for not following
group rules if there is any money problem then she starts complaining. And why should we be
bad with her husband. So let’s not interfere in her matter better to cutoff her name from shg so
her husband will not trouble to our group.
I remember one day, she had telephone me unexpectedly and started crying and asking
me for shelter if she leave her house. Because my husband is troubling me and now I am
unable to tolerate. We had a quarrel yesterday he had beaten me badly if you dint help me I
will suicide. I said her don’t worry we will think on it nicely and then you take decision
because leaving home is not an easy task you will have to think every thing. But I got
frightened and I asked to one of my senior how to deal with such matter but he said we should
not involved in anybody’s personal matter, let them solve their problem with their own. But I
was worried so I went to the village woman sarpanch and ask to help her. Both of us went and
saw her condition she was injured her husband was went somewhere then sarpanch said don’t
worry I will talked with my husband and he will look after him. But I suggest you don’t take
it seriously every woman has to face this problems but why to leave home otherwise they will
get free atmosphere. She said but now I am unable to tolerate. So I said if you leave home
you, there are rehabilitation center for woman but once you gone you should not see back to
your family if your husband come and apologies you she said what will this society think
about me, how I will feed my son what will happen to my house, cows my husband will sell
all things and what we will do in future so I said all these things you will have to think first
and then take any step. She said I don’t want to live with my husband but these community
will not allow me to live alone my husband will find me from anywhere and will kill me. I
want to live for my son I cannot go beyond my culture and traditional boundaries I have no
strength and daring to face any challenge. So we could possible to give only emotional
support nothing else.
On 21st June, 2005 Wednesday health workers training got over in evening ‘Nari’
came from back side avoiding all village people without knowing her husband and mother in
law (she had came yesterday) leaving her child in school. She had came by walking and
looking frightened her husband had called her mother in law from Mumbai and had complaint
about ‘Nari’ and she had a quarrel with her and she had threatened her that I will show you
what we can do after coming my son they had a planed to kill me Then we had listen ‘Nari’s
story silently she was telling that today my mother in law came to our house unexpectedly I
was feeling ill so I said her husband had not came home from yesterday he is not looking after
home .So she got angry and started using bad words she was saying that I trouble her son he
has some prestige in village and you are not behaving properly you doubts about him and
does not work. She started threatening me that we will kill you and I got very afraid. Because
my husband is of criminal nature and I know that for money he can do any thing. So want
your help for my child sake I want live with my family but I am unable to tolerate this
violence. I think if Anna Hazare speaks to my husband he will behave properly. So Sarika and
I told this to Rakhal & Subhashri took her and went to Anna next day. Anna said you make
police complaint and go to your sister in Mumbai till then I will call some of your village
leader and then we will see what to do. But she said they all are drunkard and if I made police
complaint he will never accept me again and will disturb my whole life. I want you once talk
and warn him.
‘Nari’ was facing all these since she was married according to her she was deceived by
her in laws by telling that her husband is well educated and working in Mumbai on a nice
post. They had showed duplicate certificates to her father. ‘ Nari’ is having two sisters and
parents had died. They had equally distributed their property within these three sisters. Her
elder sister is living in Mumbai with her family. Second one is widow living in fathers house
in Nighoj. My husband had use all money which he got from my father and when he was
arrested in case of kidnapping two girls for that case he had kept his land on mortgage to my
elder sister and taken 1.5 lakh rupees. He troubles me for that so my sister will give him his
land and not ask for any money. But he can’t say this directly.
We had decided last month to take all training tai’s for a study tour to show them Parinche
project and Mahabaleshwar on Saturday 24th June but the now we were thinking what to do
with Ranjana meanwhile we had taken suggestion from Manisha gupte (Masum), Prof. Garole
(HST) etc. So it was decided late at Friday night not to keep ‘Nari’ alone we will take her for
tour and Rakhal will stay here in Ralegan to attain the discussion with her husband, village
people and Anna. But Anna was busy with some Ministers so two three day the program
postponed. We then send her to her sister at Nighoj and ask her to call her elder sister from
Mumbai. Her husband was finding her everywhere like a hungry lion. Then he got
information from other Tai’s of his village because Tai’s had seen her in study tour. I had
some suggestion from my colleagues you should had informed to her village people, Why you
keep her for so many days without knowing anybody, you should take community
participation they will take responsibility of her and they will decide what to do after all it is
their village matter. So according them we call some of the village people and explained them
the matter so they become ready to meet Anna. Next day Nari’s husband came and started
shouting and asking about her wife we send her to Anna he went and talked with him they
scold and explain him and ask to call village leader to solve the matter. Next day Anna called
everybody and in front of all both of them we explained and made compromise in written
village people said we will take responsibility her husband said I will behave properly and
then every thing was over they went their home.
Few days after when I went to Pimpalner I got news that ‘Nari’ ran away from house.
This time she was at her sister’s home she had phoned us and she said she had made police
complaint and now she has decided to take divorce. And several things disturb me.
I don’t know what will happen in future about her son.
What will her son might be thinking about his mother and father.
Why men do not understand women’s problem and needs.
I don’t know whether the decisions regarding her, community involvement was right or
wrong.
What was the reason of community was not ready to accept his fault and teasing her.
Why a woman’s decision have no value.
Why she was held responsible for all this matter.
Why she was confused to take decision.
I don’t know why she decided to take divorce now.
What will she do now? Many people now telling that she was character less. All are blaming
her for his behavior.
Question arises:
1) Why Men’s beat their wives after drinking Alcohol.
2) Why people suggest not interfering in women’s violence case.
3) It is said that in all good and bad things women are responsible
4) Why no community is supporting ‘Nari’.
5) Why ‘Nari’ wanted Anna should make compromise and talk wit her husband.
6) Why ‘Nari’ was double-minded position.
7) Now ‘Nari’ wants divorce at any cost why?
8) Community knows all facts of ‘Nari’ and her husband but still they are teasing and
taking side of her husband.
9) Why community are scolding all Tais of training because of her.
10) Why ‘Nari’ was bounded by social system was it really necessary to include
community in her personal matters.
11) Why ‘Nari’ was feeling helpless.
12) What does the Laws says regarding Domestic violence?
13) What are the resources (counseling/ legal / shelter) available in Ahmednagar District?
Response from community:They all believed that it was a woman’s responsibility to keep the marriage together, come
what may. Violence against women especially spouse abuse, is a private family matter is a
common attitude with in the community. You should not give her shelter, she was not nice
woman she had relations with other men she wants to be separated. Her husband had
threatened to Subhashri I will see you etc Women of her Shg were saying that we could had
forgive her if she had not ran from house. She should have think about her son.
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