B.Venkatesh : Grass root level of work in the civil society and how to involve
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- B.Venkatesh : Grass root level of work in the civil society and how to involve
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COMMUNITY HEALTH
LEARNING PROGRAM
2012-13
B.VENKATESH
CHLP FELLOW
SOCHARA
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-: Acknowledgement:-
I would like to thank Community health cell for conceptualizing and setting up the unique
community health learning program. “Sir Ratan Tata Trust” for funding it, every member in
CHC team has taken time out of their busy schedules to advise Encourage and support us.
Initially my sincere thanks go to Dr. Thelma Narayan, The Director of SOCHARA for
conducting CHLP and encouraging young fellows like me to get plunged into community health.
Dr. Ravi Narayan has been an inspiration to my life.
Special thanks are to Dr. Yuvraj, Mr. As Mohammad and Mr. Kumar who have
managed the Community Health Learning Program and provided valuable mentorship to me, the
openness of the staff members, past fellows and associates along the way was an eye-opening, I
have learnt to look for the silver lining in every dark cloud, and for this I thank the CHC family.
Also my gratitude goes to Dr. Johny Oomen and Mr. Surendra Gadika and Others
being my field mentors and guiding me and supported all my field learning’s.
My fellow travelers – Bhimraj, Guru, Rouf, Shanti, Ankit, Pravesh, Rohit, Ranu and Shashi,
Shani, Sabu, Chandar, Prasanna, Prahalad . Aditya, Rahul, Karthik, those with whom I had shared
part of the journey and have provided friendship, entertainment, inspiration, and some of their
stories have brought me tears, yet others have made me laugh, reflect and journeyed together and
will always treasure the time we have spent together.
My sincere thanks to the Administrator, the staff and supportive staff without whom my learning
would not have been happening, I shall miss my lemon Tea of SOCHARA.
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-:
About me:-
Basically I belong to an ordinary Agricultural family, coming from northern part of Karnataka. I
have more responsibility at home. Due to lack of water we are struggling to survive, and this part
of the region is a draught prone. My family has spent for me their time and money to build me of
what I am today. I am a curious as well as very accommodative and sensitive. I am fascinated of
social issues and its impacts on the society that is why I took this fellowship programme.
This has been a significant turning point in my life, after this I started reflecting about health of
common people and their struggle in life to reach an available, accessible, affordable, and quality
treatment.
I have a passion to learn about many things which would help me to widen my knowledge on any
issues especially the struggle of the people who are marginalized. It is a reason why I have
selected the issues related with senior citizens.
I am on the strong belief that they should be taken care at home because at one point they were at
their best. The modernization of today’s world put this people on the periphery of the society and
they are a burden to the community. Are they responsible for this?
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CONTENT LIST
SL
NO
CONTENT
PAGE
NUMBER
1
Why I joined to the CHLP Fellowship
4
2
Learning objectives
5
3
Introduction
6
4
Learning from collective teaching sessions
7-12
5
Learning from field visits
13-17
6
Learning from Seminars / Conferences/workshops attended
18-21
7
Learning from field work
22-30
1
First field placement FEDINA in Bangalore
22-23
2
Second field placement
24-25
3
(A)
Karunashraya Hongasandra Bangalore.
24
(B)
Little sisters of the poor old aged home Bangalore.
25
Third field placement MITRA Christian Hospital Bissamcuttack 26-32
Orissa
8
Research study report.
34-44
9
Over all learning.
45
10
Conclusion.
45
11
Reading list.
46
12
Poetry.
47
13
Photographs.
48-50
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WHY I JOIN CHLP:I am basically coming from Middle of the Karnataka stae, Davanagere district, Harapanahalli
Taluk and the Village name is Punabhagatta. My family is basically poor and illiterate. I spent my
Childhood in my village and I completed my primary education in the village and after that high
school education in other village which is 3 km away. Every day I used to walk 6 to 7 kms and
did not have any means of transport. Because of some other problems I had many challenges in
life to face. I also had health issues like scabies, chicken pox, and diarrhea. We did not have any
sanitation facilities and no drinking water. I did my higher education at the block level which is
40 kms away from my village. After graduating I joined in an NGO, HEERA as a Janitor. It was
my first job and I was very happy because I got a job. Unfortunately i did not get what I wanted
because I thought of working with health issues. For me this job meant to do with dirty job but
thought to myself that instead of wasting my time it is better that I continue this job. After two
months I was promoted as a Outreach health worker, and because my abilities I was promoted as
a Counselor, and later on as Project Coordinator, from 2009 -2013. During this period I started to
reflect on many issues like Education, health, family, and how to support people who are
infected/affected with HIV/AIDS. One day I met Dr. Yuvraj and he shared about SOCHARA, and
requested if I knew some people who are interested to work with the community level in related
to health issues would be welcomed to join SOCHARAs program. Then suddenly I cheeked the
website of SOCHARA, I got some information. I was confused, should I continue my present job
or join SOCHARA knowing that I had my limitations of English. After consulting Dr. Yuvraj I
decided to join this fellowship program.
My objectives were:•
I want to learn about the grass root level of work in the civil society and how to involve
with the people.
•
I want to know the schemes available for the community.
•
I want to know about the NRHM and ASHA.
•
I want to learn various aspects of NGOs responsibility in the civil society and their
involvement in developing a community.
•
I want to learn about health and health systems in the district as well as state level.
•
I want to improve my English knowledge.
•
I want to learn how to write a project proposal.
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Learning objectives:objectives:-
To understand
The community/public health systems
Senior citizen’s health issues and their situation
The institutionalized care to senior citizens
The various aspects of NGOs
The tribal community, their life style and health status
How to do research in health field
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Introduction :Health:Before joining Community Health Learning program I was unaware of health and its issues. I
thought that Health is only connected with the common diseases. I never thought that health has
to do with social physical mental and spiritual well being. I thought when ever people visit to the
hospital they are sick if not they are well.
After joining SOCHARA in Community Health Learning Program I understood that Health is a
fundamental right and all need health. It is not only the responsibility of the medical people but
also the responsibility of people who are involved in the well being of the population. Even a
health worker can also take health in to his hands through scientific knowledge and transmit this
knowledge to others.
WHO says “Health is a state of complete physical, mental and social well-being and not merely
the absence of disease or infirmity”. we can also add one more sentence to this WHO definition
that Health is “Health is a state of complete physical, mental social and spiritual well-being.
Community:A group of people having same identity living in a locality having a common interest looking for
a goal. Sometimes they will have the same culture, language, and same religion.
Community Health:It is related with health of the community. A well developed community should have proper
drinking water, sanitation, nutrition, good environment,(no pollution) education, accessible to
primary health care and so on.
How a healthy community should be:In the healthy community people should have more information regarding health status, easily
accessible to the health care, affordable, available and appropriate. People should have drinking
water, Environmental sanitation, good nutritious food, good education and healthy habits.
Alma Ata declared the eight components of the primary health care and the principals like Equity,
Community participation, appropriate technology, intersectoral coordination, by promoting,
preventing, curative, and rehabilitative, way the health can be achieved by all.
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Learning from collective sessions:Participatory Rural Appraisal
It is to make the people to take part in the well being of the community. To find out what are the
basic needs of the community and how to prioritize the need. It is a Participatory action of the
people, by the people, and for the people.
Any NGO before going to the field should do this PRA in order to find out what are the
expectations of the people. One can’t play the fool with the people because they are very sensitive
to such problems.
Communicable and Non Communicable disease
Communicable Disease:Communicable diseases are those that are transmissible from one person, or animal, to
another. The disease may be spread directly, via another species (vector) or via the environment.
Illness will arise when the infectious agent enters the host, or sometimes as a result of toxins
produced by bacteria in food. The spread of disease through a population is determined by
environmental and social conditions which favour the infectious agent, and the relative immunity
of the population. An understanding of the disease and the measures necessary for its containment
and management is therefore important. And so many types of communicable disease I learn in
this collective session like Respiratory Infection- Tuberculosis, Diphtheria, measles, pneumonia,
Polio, Cough etc. Intestine infection- Cholera, diarrhea, Viral Hepatitis, poliomyelitis, Typhoid,
Hook Warm, Amoebiasisetc. Arthropod Disease- Malaria, Dengue, Filariasis, Chikungunya etc.
Zoonosis-kfd, rabies, yellow fever, J.E. etc. Surface Infection-trachoma, tetanus, Leprosy, STD.
this all types of problem and disease we learn in this collective session this is very useful for me.
Non Communicable Disease
A non-communicable disease is a health event or disease which is non-infectious and nontransmissible among people. NCDs may be chronic diseases of long duration and slow
progression, or they may result in more rapid death such as some types of sudden stroke. They
include autoimmune diseases, heart disease, stroke, many types of cancers, asthma, diabetes,
chronic kidney disease, osteoporosis, Alzheimer's disease, cataracts, and more. NCDs are
distinguished only by their non-infectious cause, not necessarily by their duration. Some chronic
diseases of long duration, such as HIV/AIDS, are caused by transmissible infections. Chronic
diseases require chronic care management as do all diseases that are slow to develop and of long
duration.
In the whole week I learnt about the communicable and non communicable disease and this
collective session was very useful for me because we don’t know about the communicable and
non communicable disease and how to manage and what are the features and what are the
symptoms of the disease. I learnt about the disease they have their own symptoms and value.
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National Rural Health Mission
Background
The National Rural Health Mission was launched by the Government of India to carry out
necessary architectural correction in the basic health delivery system. The Mission adopts a
synergistic approach by relating health to determinants of good health, such as water, sanitation,
nutrition, and safe drinking water. It also looks at mainstreaming Indian Systems of medicine to
facilitate health care. The goal of the mission is to improve availability and access to quality
health care by people, especially for those residing in rural areas, the poor, women and children.
Reflection
NRHM is a very good concept to improve access to health care for rural communities, especially
women, children, and disabled people while promoting accountability, equity, and affordability.
And some goals of NRHM include the reduction of IMR and MMR by half, universal health care
access to public health, prevention and control of communicable and non-communicable diseases,
population stabilization, revitalization of local health systems, and promotion of healthy lifestyles.
These are to be accomplished with the help of ASHAs, and ASHA recruited to local ladies only
this is very strengthening of sub-centers, PHCs & CHCs, creation of district health plans,
integration of sanitation & hygiene, public-private partnership, health financing mechanisms,
reorienting medical education, and strengthening of disease control programs. Community
monitoring is an important component and can be accomplished through a People’s Health
Watch. And they approach to lead in healthy life and base on working with primary care level
ASHA is very useful to community because they are chosen by the community and it is their duty
to identify the health issues which are in the community and bring in to the notice of the health
system. They are given charge of thousand populations and given a small remuneration. They are
supporting the ANMs, looking after DOTS, keep in touch with pregnant mothers and looking
after immunization part.
Monsoon Game
Monsoon game is a way of teaching learners the Agricultural situations of the Indian society and
the nature is very important for Agriculture like water, fertilizer, supplementary food for the
plants to grow. This game shows the importance of the nature and the role of the money lender. In
India 80% of the population lives under poverty and they depend on crops. The game shows the
role of money lenders and how they exploit the poor formers. If the weather is good then the
crops are better and vice versa. Thus the money lenders take advantage of the poor situation and
exploit to the poor. Sometimes the government helps the farmers by providing financial loans
which sometimes need to pay back. If the crops are good payment is easier but if not the money
lenders have to be approached. They ask high interest which the Agriculturists are unable to pay
thus the land is mortgaged by the poor in order to meet the debt. This game was and eye opener
for me to reflect on the issues of the farmers of India and how they struggle in their life
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Mental health
Mental Health is considered as one of the most complicated structure of Health of human in
society. It is considered “Health is not everything but everything without health is nothing and
absolutely there is no health without mental health”. According to World Health Organization,
mental health as "a state of well-being in which the individual realizes his or her own abilities,
can cope with the normal stresses of life, can work productively and fruitfully, and is able to make
a contribution to his or her community". It means a normal and healthy person can deal with
problem and situation of life and able to take decision. He can communicate effectively and
contribute the society with their custom, traditions, and other events and also can love and
harmony with every individual and society. Mental wellness is generally viewed as a positive
attribute, such that a person can reach enhanced levels of mental health, even if the person does
not have any diagnosed mental health condition. This definition of mental health highlights
emotional well-being, the capacity to live a full and creative life, and the flexibility to deal with
life's inevitable challenges.
Health problems at community level
Health problems at community level is a very big issues because now a day’s community faces
health related problems very grievously. We look at the health problems facing at the community
like communicable and non communicable diseases, short time and long term diseases, curable
and non curable diseases, preventable and non preventable diseases. Personal hygiene is very
important for the community and the community health depends on how people live healthily in a
society.
Health Economics
Health economics is part and parcel of health. For any infrastructure economy is a must for eg.
You need building for a hospital for which you need labour who need wages and one needs to
give salary for the health workers.
Two principles applied to help this decision making Efficiency and Equity. In efficiency there are
two, Productive and Allocative efficiency.
All the activities need financing and where money is involved economic principles apply.Since
there is a need to manage the money for health care; there is also the need to pool the revenues for
the distribution of health care. There are three steps in Health financing. Revenue generation,
pooling the resources, provider payment – payment for the services.
Human Rights and Health
There was International Health Conference, New York from 19 June to 22 July 1946, attended by
61states/countries and they felt that health is a human right. Thus they signed a declaration “The
enjoyment of the highest attainable standard of health is one of the fundamental rights of every
human being without distinction of race, religion, and political belief, economic or social
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condition. The health of all peoples is fundamental to the attainment of peace and security and is
dependent upon the fullest co-operation of individuals and States.”
Everyone has the right to a standard of living adequate for ... health and well-being of
himself/herself and his/her family, including food, clothing, housing, medical care and the right to
security in the event of sickness, disability, Motherhood and childhood are entitled to special care
and assistance.
What is the Human Right and Health Right?
Every woman, man, youth and child has the human right to the highest attainable standard of
physical and mental health, without discrimination of any kind. Enjoyment of the human right to
health is vital to all aspects of a person's life and well-being, and is crucial to the realization of
many other fundamental human rights and freedoms.
The Human Rights Issues
To physical and mental health, including reproductive and sexual health, to equal access to
adequate health care and health-related services, regardless of sex, race, or other status, equitable
distribution of food, to access to safe drinking water and sanitation, to an adequate standard of
living and adequate housing, to a safe and healthy environment, to a safe and healthy workplace,
and to adequate protection for pregnant women in work proven to be harmful to them.
Reflection
Health is a right for each individual and the state has the right to protect it the main issues of the
human rights are gender bias, poverty and health, malnutrition, environment, education,
employment, and medicinal drugs.
Health Policy in India
According WHO “a national health policy is an expression of goals for improving the health
situation, the priorities among those goals and the main directions for attaining them.”
In India we have two national policies:• National Health Policy (NHP) 1983 & 2002
• National Population Policy (NPP) 2000
It means that the people should have the opportunity to participate and to access health care
freely.
Challenges and Barriers:-Social inclusion/exclusion; ability to pay, Political choice, negotiation,
contestations, Peoples’ participation, perceptions, beliefs and experiences, War, violence, conflict,
natural disasters.
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Health system
According to WHO “a health system comprises all organizations, institutions and resources
devoted to producing actions whose primary intent is to improve health.
Most national health systems include public, private, traditional and informal sectors. The four
essential functions of a health system have been defined as service provision, resource generation,
financing and stewardship.”
Health system in India is in the hands of the rich and the poor has known approachability to get
any health facilities unless one needs to corrupt. The idea of health system is to enable any person
in India to get health where ever he/she is, what kind of job he/she does and so on. If people have
the possibility of health insurance then a great worry of the people well is removed.
The main components of health systems are the following:•
•
•
•
•
•
•
•
Financing- public, private, out of pocket
Organization of health care systems
Governance & accountability mechanisms
Implementation issues
Quality of care
Outcomes and impacts, including equity
CPHC approach to health system development
Health systems as a health determinant
Traditional medicines
The tradition of India believes strongly on local health, traditional healers and herbal garden
medicine. We should encourage the people to get in to this tradition and 70% of the treatment can
be dealt with locally. The following are the available health traditions in India.
Mrga Vaidya (Veterinary), Visha Vaidya (Poison Specialist), Dais (Traditional Birth
Attendants),Bone-setters, General Herbalists – Marma chikitsa and Kannu vaidyam
Some issues which the community needs to be dealt with. Community Knowledge, Family /
Household Traditions, Kitchen Herbal Garden, and so on.
Traditional medicines are codified into two such as Codified and non-codified
Codified :- Ayurveda, Sidha, Tibetan, Unani and Homeo
Non-codified:- Traditional bone setting, Poison healer, Birth attender, General medicine and
Others
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Environmental Sanitation
The sum total of all surroundings of a living organism, including natural forces and other living
things, which provide conditions for development and growth as well as of danger and damage
see environmental factors.
Environment is very important for us to have a good health for a healthy life environment plays a
great role if the environment is corrupted then whole health system gets affected. Environment
means free from any hazardous of climate, air, waste disposal, any sort of pollution.
Sanitation means cleanness of anything which is preventing well being of a person. Sanitation is
very important for human beings. It also indicates of all pollution free.
Sanitation generally refers to the provision of facilities and services for the safe disposal of human
urine and feces. Inadequate sanitation is a major cause of disease and improving sanitation is
known to have a significant beneficial impact on health both in households and across
communities. The word 'sanitation' also refers to the maintenance of hygienic conditions, through
services such as garbage collection and wastewater disposal.
How we build at the sanitation in the community level with environmental friendly
Community Involvement, is changing the mindset of the Community, it cannot Focus on one
community (Focus should be on whole village), importance of Health in Sanitation, motivating
local Leaders, involving Govt. Officials, involving NGO’s, SHG’s, Youth groups
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Learning from field visits:Basic Needs India : Mental Health
Background
It was the first time that I heard about mental health and my visit Basic Needs India has opened
my eyes. I have been a couple of times to basic needs and had interaction with the staff. They
have opened my eyes to believe that in India there is a great number of people with mental illness.
Basic Needs India is nonprofit and non government organization working with people who are
mentally sick and mentally retarded. If the community help them to start a living after they have
been treated, they can become part of the community. The organization works with communities
to overcome stigma and abuse. Their work strives to make mentally ill people self-sufficient and
independent.
Mental health appears to be better addressed in the southern part of the country, especially
Karnataka, Kerala, Andhra Pradesh, than in the northern states. This is partially attributed to the
presence of the National Institute of Mental Health and Neurosciences [NIMHANS] in Bangalore.
Basic Needs in India is based in Karnataka and therefore has a strong presence in the urban poor
communities here.
Reflection
Meeting Dr. Mani Kalliath at the Basic Needs office in Banaswadi was an impacting and personal
experience. My first visit to Basic Needs it was to learn more about Mental Health in Karnataka.
However, the conversation I had with Mr,Guru and BNI team took a turn in a more interesting
direction. Our discussion gravitated towards the state of the Indian government and its impact
[detriment] on the people of India.
On a more personal note, Mr. Guru, Dr. Mani and team emphasized the importance to examine
[everything] objectively and also maintain a sense of balance and humor in my work.
Reflection on Slum Visit [Basic Needs]
I visited a slum on where Basic Needs works to raise mental health education and awareness.
Basic Needs and other partner organizations like Association of People with Disability [APD]
work together within an urban poor community to facilitate the identification of people with
mental illnesses, provide access to resources and support systems, and raise awareness with
community members about mental illness. A voluntary community health worker [CHW] from
the slum is chosen from a self –help group to work with the community to achieve the goals. The
CHW serves as a go-to person for people who have questions about symptoms they are
experiencing or for information about what to do when family members are experiencing other
mental health symptoms. The CHW is effective in dispelling fears and stigma about mental health
in a community. The individual identified with mental illness has a caretaker from within the
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family to ensure treatment adherence and attendance of general visits at NIMHANS.
Additionally, the identified mentally ill and their caretakers have a support network, which meet
periodically to discuss relevant challenges and methods.
Our visit to the Shivaji Nagar slum was coordinated by Guru of Basic Needs and fellow of
SOCHARA . From 10am to 1pm and we divide 3 group per group one house hold one patient we
stopped at 3 households, where an individual with mental illness resided. Shivaji nagar slum is
diverse in religion and socio-economic status. Christians and Hindus are segregated and some
houses are larger than others.
Case study:At the first home my team met a 41 year old woman, who has postponed her marriage to care for
her younger brother afflicted with schizophrenia. She decided to defer her marriage till her
brother becomes better established and self-sufficient through work and treatment. The sister
stated that there has been a vast improvement over the past few years in how community
members treat her brother. Prior to Basic Needs’ presence in the community, he was taunted and
mocked by children throwing stones at him. After raising awareness about mental health through
self-help groups, groups for young children, and painting projects of murals, people have started
to understand his situation as an illness. The stigma within the community is also disintegrating as
community members are realizing that is not contagious. Currently, the brother earns money
through his work at a factory. A few of his co-workers also live in the slum and he travels with
them to go to work every day. The sister recalled there are still a few worries that she faces. She
recalled one disturbing incident when her brother was found at a liquor shop with other men from
the slum. Following the incident, the other men had to be educated that it was not safe for the
brother to mix alcohol with the medication that he was taking. This intervention by the
organizations was constructive and did not place blame; rather it was conducted in a manner that
encouraged openness and questioning. In regards to the treatment, the medication is provided free
of cost by NIMHANS during periodic check-ups. The cost of transportation is provided for by the
partner organizations. Additionally, the sister actively participates in caretaker resource meetings,
which offer her support and guidance.
Foundation of Revitalization Local Healing Tradition (FRLHT)
Vision: To revitalize Indian Medical Heritage. The Vision of FRLHT is to enhance the quality of
medical relief and healthcare in rural and urban India and globally by creative application of our
rich medical practices, action oriented research, education, training and Community services
based on India's Traditional Health Sciences.
FRLHT are basically acting on few themes which are given below: Conservation of natural medicinal resources
Information technology and traditional knowledge
Bridge between traditional knowledge and science
Scientific repositories of natural resources
Revitalisation of folk healing systems
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Research hospital
A herbal public ltd company owned by rural women and small farmers
Botanical repository
Rural health security
Scientific research
Rural livelihoods
Clinical services
Literary research
Educational Innovation.
Reflection
I spent two days at FRLHT where the focus was on AYUSH. I learned how important is the local
herbal medicine and in India we have such a strong feeling towards the herbal treatment to which
even foreigners are attracted to. One can treat almost 70% of the disease with the herbs. In a
family some herbal plants can be planted and this can be a source of remedy for some disease like
could, stomach pain, vomiting, diarrhea, skin problems, diabetes and so on. We don’t have any
written evidence of how these medicines are used and these medicines are known as grandmother
medicines. It would be good if this information can be shared with local people especially
traditional healers so that this could be an alternative way of treatment. Each family could also
have a small herbal garden in their own homes.
APD -Association of People with Disability
The Association for People with Disability (APD) is a Bangalore based organization working
since 1959 for children, youth and adults with various types of disabilities — primarily those with
physical disability, cerebral palsy, spinal cord injury, development delay, and speech and multiple
disability. Our coverage extends to Tumkur, Kolar, Koppal and Haven i districts. We have
linkages with voluntary organizations across south India and work with poor communities in and
around Bangalore.
Association of People with Disability Vision and Mission is ‘Equality and Justice for People with
Disability to enable and empower all stakeholders’
With an estimated 70 million persons with disability in India, APD is among organizations that
are at the forefront of the urgent, nationwide movement to overcome the growing challenge to
support, rehabilitate and include people with disability into mainstream economy and social life
Reflection
Being able person one cannot do much but looking at Miss Hema Iyengar I was stund to see with
such a sever handicap she was able to build up such a big organization were 28000 persons with
disability were given rights in Equality and Justice by providing care to themselves. There is a
need for such persons and organizations for providing support and help to the Handicapped.
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SNEHADHAN
Background:Snehadaan was inaugurated on July 14, 1997, and has been involving in care giving for infected
affected people with HIV/AIDS, and support and training of the family members to care for their
loved ones who are sick. Snehadaan currently has the capacity to provide in-patient care for 52
people. The outstanding infrastructure and service delivery of the multi-disciplinary team have
been duly acknowledged by the, National Aids Control Organization (NACO), Karnataka State
Aids Prevention Society (KSAPS), and Karnataka Health Promotion Trust (KHPT). It also
provides training for Doctors, Nurses, Health Care Workers, Social Workers and Medical
Students on management of HIV/AIDS. The best service delivery practices Snehadaan developed
have been replicated in many care and support centers across the country.
Vision
To provide quality and comprehensive health care to the sick, with a preferential option for the
people infected and affected with HIV/AIDS
Mission
To be a positive force in addressing the comprehensive needs of PLHIV, ensuring their dignity
and overall quality of life, by motivating, caring, supporting and rehabilitating them, with a
priority for the palliative care of those who are in the end stage of the disease.
Reflection
At Snehadhan all the components of health are met like Nutrition, socio psychological support,
family support, treatment of ART, provide Medical and nursing care, outreach programme, job
placement, networking with other NGOs and care centers, and Physiotherapy & Personal Care.
This is a tertiary center was people are brought in for a human dignity and eventually ends up
their life over there.
There is also a center for the children who are infected or affected with HIV/AIDS. Due to
discrimination these children are kept there for Education and Care, and some children are
according to the need other activities are given.
Swasthya Swaraj. Kalahandi Orissa
I had a chance to visit Swasthya Swaraj at Kalahandi. It is started by Dr.Aquinas who is a General
Physician along with other two sisters. Ms.Palak Agrval is coordinating this programme. It is the
programme for the Tribal people of Kalahandi to focus on components of health. It is a registered
NGO. These four daring women have undertaken a huge challenge and are working tirelessly to
achieve health for all. We were over whelmed by the complexities of this project and the
simplicity of these women. Kalahandi has the most beautiful landscape I have ever seen. The
environment is serene, lush and filled with enormous riches of vegetation and minerals. However,
the plight of health care facilities in the area like PHCs and CHCs are almost non-functional.
People have heard of ASHAs but have seldom seen one in their own village. District Hospitals do
provide some healthcare but most of the villages are about 70-90 kms away and then they don’t
even have connecting roads! Therefore, villagers live without minimal health support, depending
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only on their traditional medicine, or ignoring their illnesses. Women deliver alone or with the
help of their mothers if available. Even “dais” is not present in tribal villages.
Kalahandi district has 16 blocks and out of these, Thaumul Rampur block is considered the most
backward. Swasthya Swaraj team is currently initiating health related activities in 4 Gram
Panchayats of Thamul Rampur block. The panchayats are Gunpur, Kerpai, Kaniguma and Thamul
Rampur. The team is based at Bhavanipatna and thanks to their vehicle they are able to reach
these places.
They run weekly clinics in the gram panchayats. The current focus is on identifying one village
health worker “Swasthya Sathi” from each village, and arranging for their training along with
weekly clinics in different gram panchayats. They have managed to select about 50 Swasthya
Sathis at present, a tremendous achievement for a project which was started just about 8 months
ago. Clinics are also gaining popularity among the locals. They see about 30-50 patients per day,
arrange for onsite necessary lab investigations and medications, all free of cost. The myriad of
diseases is extensive with tuberculosis and leprosy being very rampant, scabies is almost
everywhere in Kuniguma block.
VIMOCHANA
Vimochana, meaning liberation, was initiated in 1979 by women and men from within the Centre
for Informal Development Studies (CIEDS) collective that had come together in 1975 to seek a
just, humane and creative society rooted in transformative politics. Vimochana grew out of the
need for a public forum that would stand for organized resistance to the increasing violence on
women and would be assertive in challenging the pervading apathy to the problems of women in
the context of larger structures of violence and power.
Vimochana is to strengthen women’s resistance to violence both within the home and within
communities, cultures and politics. To make families, communities and the state responsible for
and responsive to the growing violence against women. To create alternative spaces and for a
public debate and dialogue to bring about attitudinal and institutional changes in our society vis-àvis discriminatory attitudes towards women. To make visible the deeper connections between
increasing violence in the personal sphere of the home and the increasing brutalization of the
larger public polity
Reflection
There is a Gender bias against woman in the society and they are the victims of physical violence,
(dowry, and sex abuse, ill treatment at home). Burnt cases are often neglected even in the hospital
wards, no proper treatment is given and normally they end their life at the hospital. Vimochana is
fighting against such atrocities against women.
They also give counseling and if necessary go to the court for these women’s issues. They teach
them to be self supportive and self caring.
18 | P a g e
Seminars / Conferences/workshops attended:National workshop on Social Justice in Health: Research, Advocacy, Training and
Action on Realizing Health Rights
On the 10th and 11th of September, 2013 at St John’s Medical College, Bangalore, I attended a
seminar on “Social Justice in Health Research, Advocacy, Training and Action on Realizing
Health Rights.” It is an initiative taken by SOCHARA in order to create awareness on social
justice in health. The deliberations included both theoretical and historical reflective discussions,
as well as a focus on certain specific themes such as urban health, mental health, environmental
health and privatization of health care which were otherwise inadequately reflected in the current
UHC debate. The multiple approaches and pathways that have been used to address the social
determinants of health in different parts of the country were discussed, and provided a framework
for initiatives and action at several levels from individuals to families, communities and at a
larger policy level. Eighty seven participants from health sciences and social sciences background
participated at this workshop. The response very positive useful experience and are keen to work
with others in the field towards Health for All
State level Consultation on Ban on Tobacco Advertising Promotion And Sponsorship
Tobacco is a “communicated” disease. Due to tobacco there are 25 major diseases. According to
global youth tobacco survey 2003- 04, the point prevalence in 13 – 15 year olds is 4.9% and
national average is 17.5 %. There is a gap between the knowledge and community action, for this
the families need to be supportive and aware. Tobacco epidemic is preventable. The livelihood of
farmers also needs to be considered by introducing them to cultivation of alternative crops. The
FCTC clearly states that sale of tobacco products among minors is illegal, of which India is a
signatory. According to a study done by NIMHANS, youth belonging to the age groups of 12- 15
years received information about tobacco via print media. Karnataka is the second largest tobacco
growers in the country. Globally 63% of all deaths are caused by NCD’s with tobacco as the
greatest risk factor. In the world 40% male and 9% female smoke, 6 million people die due to
tobacco out of which 1.5 million are women, Advertising is a very powerful media that is difficult
to curtail but with public pressure it definitely can be overcome.
2ND INTERNATIONAL CONFERENCE ON HEALTHY AGEING IN THE CHANGING
WORLD 2013”
“The conference would be an ideal opportunity for health care providers from all disciplines and
professionals interested in the field of ageing and seek clinical information about geriatric issues.
Population ageing is the most significant emerging demographic phenomenon. Asia has the
largest number of world’s elderly (53 per cent), followed by Europe (25 per cent). Population of
elderly in our country has increased exponentially from 77 million at the beginning of last century
19 | P a g e
to around 100 million now, forming 9% of total population of the country. Thus, the country has
become a ‘graying nation.’ The impetus behind this conference is the issue of ageing and its
associated medical, social, and ethical problems. As we already know ageing is inevitable and
unavoidable; however, modern science and medical technology are trying to understand the
process of ageing and its slow impact on human body through continuous research. To a large
extent, medical science has helped in understanding how to slowdown ageing, to avoid many
diseases
typical
of
old
age
and
be
able
to
enjoy
life.
Tropical Medicine Course for Danish Doctors at MITRA
The Goal of this Programme:- To provide visiting General practitioners from Denmark with an exposure and orientation
to the signs and symptoms, diagnosis and management, epidemiology and prevention of
tropical disease, so as to equip those to better serve the members of their communities
who travel to distant lands or come from tropical countries.
- The India beyond the touristic view
- To live and work in a remote mission hospital in India, the similarities and the differences
in practice.
- Issues in health and health care, the under currents that determine who falls sick, where,
when and why.
Proceeding of the course:The 6 days Tropical Medicine course was started with we welcome and self introduction. The
course sessions was conducted as per the given schedule.
Introduction to Tropix 2013
Dr.johny Oommen
Status of Health – India, Orissa, Rayagada, Bissamcuttack.
Dr.johny Oommen
The CHB history
Dr.Johny Oommen
Visit to CHC Bissamcuttack
Dr.Johny Oommen and Team
Mobile Clinic to MITRA project area
Dr.Johny Oommen and team
Lecture 1: Perspectives of Health in Developing Countries
Dr.Johny Oommen
Lecture 2: Indian health system
Dr.Sara Bhattacharji
Lecture 3: Culture and Communication Health and Health Care Dr.Johny Oommen
Lecture 4: Understanding on Malaria
Dr.Johny Oommen
Lecture 5: Other vector-Borne disease Dengue, Chikkengunya, Dr.Sara Bhattacharji
Japanese, Rickettsial infections
Lecture 6: Communicable disease
Dr. Suranjan Bhattacharji
Lecture 7: Diarrhea and dysentery
Dr. Pragya
Lecture 8: Non communicable disease
Dr. Suranjan Bhattacharji
Lecture 9: Intrudes on Anthrax
Dr. Johny Oommen
Lecture 10: MMR in India Orissa and Bissamcuttack
Mrs. Mercy John
Lecture 11: Status of Health - India & Denmark SOWC
Dr.Johny Oommen
20 | P a g e
Reflection
This training programme was completely different from others which I attended ever before. This
programme gave me an opportunity to learn about the various tropical diseases, especially the
poor and marginalized. All through the programme was completely medical model and the
sessions were highly technical. The social aspects related to the diseases were discussed. It helped
me to understand the future of different diseases specially seen in India by which many poor and
marginalized are suffering clinically and also socially. In this training programme one special
session was taken by Dr.Johny on Aboriginal peoples who helped us to understand in detail about
them of different country and their problems and the effort made by different peoples and
organization for the upliftment of them.
Mental Health dialogue Gulbarga
Dialogue on Integrating Mental Health with Primary Health Care. I was able to profit the
maximum, because it was in Kannada and I understood the Mental Health scenario in Karnataka
mainly in the northern part.
Reflection
1.
2.
3.
4.
5.
6.
7.
8.
Aware of the existing facilities on mental health at the district level.
Every person has sometimes some signs of mental depression.
Signs and symptoms of mental health and how important it is the early detention.
Sanitation has a great role in mental health.
The importance of the Family support for a mentally ill person.
It is a curable disease and they can have a normal healthy life.
Learned how to organize, to conduct and co-ordinate.
Networking with other Government and NGOs.
Medico Friend Circle New Delhi
Background
MFC is a non funded group of members from various backgrounds from across the country –
Public health professionals, medical doctors, nurses, health activists, researchers, students and
others. Annual Meets of MFC have contributed to many debates and discussions on a range of
health related issues, for example, primary health care, universal health care, nutrition,
occupational health, communicable and non communicable diseases, women’s health, medical
education, etc. MFC (Medico Friend circle) initially started with people who were of medical
background.
But later on people of different background also joined this group thus a variety of social and
health interests were added to it.
The main topics of discussions were Gender, Class, Caste and Religion. I was in the group
dealing with Class. The main the discussion were on upper class and lower class, how the lower
class is exploited, the attitude of the medical professional at the hospitals. Indian society is very
much colored by the Class system; even it is very much available at the beurocratic level.
21 | P a g e
Example -if a person is on the level of secretary then he will be considered as high class while
under secretary is of lower class (it’s all depends on the scale of salary)
When it comes in to caste, Indian society is divided. These cast system are human made errors,
what is very important is respect for each individual. There is a fight in all aspects of our life
when it comes in to caste. I think the more we believe in caste the more difficult will be in the
future of the country.
The MFC is a platform for the following
MFC is a safe space to share without amusement and act upon resources.
Then MFC is a togetherness for peoples issue,
Get together to analyze medical education for peoples issue,
Late 1980’s ie., Formation of govt. groups to deal medical conflicts, right to health and
human rights, violence initiated that time,
o MFC took birth. Non-monopoly in nature.
o Privatization, water resource activism, research, changing yearly meet and convener.
o Community inside community model.
o
o
o
o
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Learning from field Experience:-
FEDINA
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Foundation for Educational Innovations in Asia (FEDINA)
Background of FEDINA
FEDINA was established in 1983 with the objective of reaching out to the poorest of the poor and
the marginalized, in order to improve their livelihoods. Though it was established with the idea of
‘empowering’ people by enabling them to access their rights, we invariably stepped back from
building political consciousness among people and focused more on welfare. This was due to the
political situation at that time, given that it was not too long after the emergency.
During those days, the suppression of the people had strengthened the Naxalite movement, and
the government came down very heavily on Naxalites. Therefore NGOs were overcautious and
did not want to be identified with the Naxalites. There was so much fear of the state, that any
activity that came close to empowerment or rights, were withdrawn. Partly because of NGO
intervention, many groups that were militant became less militant. People’s movements were
diverted, consciously or unconsciously, due to fear of the state.
Over the years, FEDINA has evolved gradually from Welfare to Rights and now our approach is
almost fully rights-based.
IN the late 80s and early 90s, FEDINA was mainly involved in forming Self Help Groups,
promoting income generating activities and conducting informal literacy classes for adults and
drop-out children. We worked mostly with tribal’s, dalits and senior citizens.
Over the subsequent few years, we began to focus more on rights of the marginalised people, and
also started working on women’s issues. In 1996 FEDINA consolidated a loose network of rightsbased groups in South India, which later came to be called Network of Social Action Groups.
Work since 1996 can be divided into two phases. In the first phase, we worked broadly on human
rights of dalits, tribals, women and informal sector workers. Later, as the groups interacted and
worked with each other, we asked ourselves if we should have specific priorities under the broad
framework of human rights. We realised that what really kept the tribals and dalits marginalised
and poor is the fact that they were either unemployed or underpaid. So logically the priority had
to be labour rights and unionization.
At this point we started looking at dalits more as workers with labour rights, and not just as a
structurally marginalised and discriminated group. It took a few years for all the groups to make
this shift from general human rights to labour rights. Now, the main priority of most of the groups
in the network is labour rights.
Objective:General objective: empowerment of the marginalized/exploited communities: informal sector
workers, Tribal’s, Dalits, and women.
Specific objective: Strengthening and forming new unions. Extending and strengthening
agricultural workers unions (as against caste organizations).Creation of informal workers, retired
unorganized sector workers, domestic workers and agarbathi workers. Empower women’s groups
to fight domestic and social violence.
Reflection
Community based rehabilitation, use of modern technologies in the field of their work
(pourakarmikas). Giving awareness of the existing government schemes, senior citizen pension
scheme, domestic workers issues, organization of unskilled workers, dalit/ tribal issues and their
rights.
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KARUNALAYA
Karunalaya It is a senior citizen home with 18 beds for the women in the outskirts of Bangalore
city and it is run by a group of and the inmates take part in all the activities of the house like
Cleaning, cutting the vegetables, helping at the kitchen, keeping the surroundings and watering
the flower garden. It is started in 2006 and they can accommodate 2 more making it to 20. The
sisters are trained nurses thus they take care of the ordinary medical issues. Religious sisters it is a
home for the destitute (Taken from the Roads) it has a homely atmosphere
Services
It has a family spirit and the elderly persons receive every day Joy and love, friendship in a
relaxed and peaceful way. Each person is very important and great attention is given
individually. Meals are prepared according to regional customs and standards, also taking into
account special diets as advised by the doctor.
Reflection
Homely atmosphere, personal care is given individually, emotional and psychological support,
timely treatment, their personal needs are taken care, and respect is given to each individual who
ever it may be.
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-:*LITLE SISTERS OF THE POOR*:April 30, 1900 – the first two Little Sisters of the Poor arrived in Bangalore. On May 2, the first
poor elderly person presented himself to be cared by them. He was received with open arms
and many were soon to follow. By May 18, there were nine residents – six men and three women.
This house is meant for the poor elderly people who have no one to take care at home and they
give more priority to most needed people who deserve. The Little Sisters as they do in all
homes soon began collecting funds. As Fr Cabard didn’t want them walking in the heat, he gave
them a horse. A benefactress, Mrs Bride, donated a cart. Thus they went begging even to distant
places and markets. Many people voluntarily offered little gifts, particularly rice.
Facilities
The Little Sisters of the Poor strive to achieve a family spirit in their Homes for the Aged. In this
home Elderly persons receive every day Joy and love, friendship in a relaxed and peaceful way.
Each person is very important and great attention is given individually. Meals are prepared
according to regional customs and standards, also taking into account special diets as advised by
the doctor.
Medical treatment is also given according to each person’s need, and the staffs are qualified
medically in order to reach in time of need.
The facilities available are Occupational therapy, Entertainment, spiritual counseling, emotional
support, and homely care.
Reflection
Homely atmosphere, personal care is given individually, emotional and psychological support,
timely treatment, their personal needs are taken care, respect and dignity for each person is given,
who ever it may be.
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MITRA
CHB
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*Madsen Institute for Tribal Rural Advancement(MITRA)*
Background of CHB MITRA
Mitra means friend. Mitra also stands for Madsen's Institute for Tribal and Rural Advancement,
which exists within the Community Health Department of the Christian Hospital Bissamcuttack
(CHB) in India's state of Orissa.
Bissamcuttack is a small town of about 10,000 people in the hill district of Rayagada in Orissa.
The Bissamcuttack block has about 315 villages and 85,000 people. Of these, 62% belong to the
Adivasi (indigenous) community, and another 17% are Dalits. Therefore, the vast majority of our
people belong to historically oppressed and vulnerable communities.
CHB is a 200-bedded mission hospital founded in 1954 by Dr Lis Madsen from Denmark. At that
time, people in this remote and mountainous area had practically no access to health care. Dr
Madsen began her work by seeing patients on the veranda of the local church. Then, she
established a small dispensary, and trained locally recruited staff. CHB grew out of these small
beginnings, and today is the main contributor to people's health in our area; the other nearest
referral centers are over 200km away. From the beginning, Dr Madsen, who had a deep-rooted
commitment to marginalized people, was convinced that it was necessary to go out to people in
their communities. She began community-based health care on a small scale, and thus laid the
foundations for Mitra. Today, Mitra consists of three pillars, viz. the Mitra Project, the Mitra
Residential School Kachapaju, and the Mitra Training and Resource Unit.
The Mitra Project
The Mitra Project works with about 12,500 people in 53 predominantly Adivasi villages. Our
approach is to be with the people, and allow their agenda to emerge in the context of this
relationship. By the late 1990s, we had grown disillusioned with the traditional models of
28 | P a g e
community health and development, with their goals and objectives and log-frame-approach
grids. From these more or less vertical approaches, we moved to what we would describe as
community dreaming sessions and appreciative inquiry. We wanted to know about our people's
real desires, and for them to become agents of change instead of objects of others' activity. What
emerged from this fundamentally different approach was a four-fold Mitra dream that we still use
as a reference point. It is the dream that “one day our people will enjoy health for all,
education for all, economic security for all, and social empowerment for all”. Each of these
dreams has simple components, and indicators that we use to measure whether we are getting
closer to or further from the dream. Every element of our approach does not take place in all
villages, and nothing must happen unless the village decides and asks for it; we work to the
maxim, 'No demand, no supply'. All Mitra decisions are team decisions, with the monthly staff
meeting being the centre of discussions, learning and planning. An informal council of tribal
leaders evaluated our work in 2005 and, based on their own dreams for their people, provided
further focus and direction for the next phase of Mitra's work.
Health for all
Six community health nurses spearhead our health-for-all work, and do so with the help of 48
village-level Swasthya Sevikas,(Health Worker) who are women chosen by their villages to serve
each community's health needs. The primary health care model we employ follows the World
Health Organization's 1978 Alma Ata concept of primary health care, which is based on the
values of equity, social justice, universal access and solidarity. Our health-for-all programme
includes mobile clinics, antenatal care, community, obstetrics, nutrition, health education,
immunization, malaria control, and health information management systems. Over the last
decade, we have seen a halving of the local infant and child mortality rates but there is still a long
way to go before we can achieve our dream indicators.
Education for all
Over the last 25 years, we have pursued our dream of education for all in multiple ways. We
began with adult education in the 1980s, moved to non-formal child education in the 1990s, and
on to formal education initiatives in 1998. At present, our primary focus is an initiative that we
call AQTE (Adding Quality To Education). This helps communities improve their government
schools by appointing educated, motivated Adivasi young people as village tutors in order to help
Adivasi children catch up by teaching them in their mother tongue. This began as an experiment
in one village school; the immediate and visible impact created an upsurge of demand for more
tutors. Now, there are 19 such teachers serving about 615 children from 22 villages.
Economic security for all
Mitra teams have facilitated the setting up and nurturing of over 50 self-help groups to help
provide economic security for their members. Most of these groups consist of 15 to 20 women
from a village, who save money together and provide each other with microcredit loans in times
of need. Some women have also joined income-generating programmes, while others have chosen
29 | P a g e
to stay with those that offer credit security. In one of the groups, and assisted by Mitra, people set
up a community-based health insurance programme.
Social empowerment for all
The concept of social empowerment for all is at the heart of what Mitra does and stands for. All
our work has to enhance empowerment and discourage dependence. Mitra has chosen to stand
alongside the Adivasi people; about half of Mitra's full-time staff comes from the Adivasi
community. The preservation and promotion of the Adivasi Kuvi language and culture is at the
core of the way we work. Thankfully, the community sees Mitra not as an outside agency but as
an insider.
Nurturing value-based leadership skills is also part of our work. Over the years, a number of
Mitra's paid staff and volunteers have gone on to assume leadership roles in local societies.
New initiatives towards improving health
Mitra is like a churn in which action and reflection, and rootedness and exposure constantly
interact with one another. This process constantly throws up ideas and possibilities that are
scientific and strategic as much as they are locally rooted and participatory. Some of the new
initiatives that have taken off in 2008 and 2009 include:
• A malnutrition reduction strategy that focuses on malaria prevention as its prime thrust;
Chloroquine malaria prophylaxis seems to help people put on weight more than food itself.
• Ageing with dignity is a community-based programme for the elderly in 16 villages; it uses a
club membership approach, and is managed by village committees;
• Living with sickle cell anemia (SCA) is a small, self-help-group approach for people with SCA
in 50 Mitra villages; this initiative seeks to enable people have dignity and health through
awareness and understanding, socio-medical inputs, and health insurance.
Mitra Residential School, Kachapaju
In 1997, a community dreaming session in the hill village of Kachapaju led to the vision of an
Adivasi school of our own, where children could grow up within an ethos that reflected their own
culture in order to be equipped to lead their community as educated adults.
Mitra and a cooperative of 16 hill tribe villages jointly envisioned this school, and worked
together on a plot of land in the middle of the forest to make their dream come true. The school
opened in July 1998 with 31 children. Today, the Mitra Residential School, Kachapaju, which is
also lovingly called "Mrs K" after its acronym MRSK, is an Adivasi school providing education
from grades 1 to 5; it has 143 children and nine staff. The school aims to offer its children the best
possible education in an atmosphere that reflects the culture and wisdom of the Adivasi
community. We begin by teaching in Kivu; gradually we introduce the children to Oriya and
English, and even some spoken Hindi. The school follows the government curriculum but
education at "Mrs K" overflows far beyond the walls of the classrooms to include topics such as
nature, health, drama, crafts and much more.
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The Mitra Training and Resource Unit
In 1997, we stumbled across an innovative way of controlling malaria that evolved from our
struggle with this one disease that accounted for one-third of the deaths in our area. Before we
knew it, we were inundated with requests from action groups and non-governmental organizations
(NGOs) in Orissa and beyond for assistance and training. This led to the formation of the Mitra
Training and Resource Unit by a community health nurse in 2000. The unit takes lessons learnt
from the field, and shares them with other groups and individuals through training, consultancy
and publications. Over the years, we have shared our expertise in primary health care, malaria
control, HIV and AIDS, epidemiology, reproductive health and other subjects with governmental
and the non-governmental groups. At present, we are part of a technical think tank that the
government has set up to look at issues related to health sector reforms.
Mitra: a way of life
Mitra is an experiment in evolution, with one foot in the grassroots reality of village life, and the
other in the world of science, health, education and development. We are constantly
brainstorming, dreaming and reflecting, and out of this melting pot come ideas and programmes.
Many dreams never translate into action; most often we are disappointed with ourselves and fall
short of our own expectations. We are conscious that what we do is minuscule compared to what
needs to be done, and even what we should be doing.
However, through all the years of Mitra's existence, we have been confident that it is the people of
the villages themselves who have the solutions to their problems. We believe in these people and
their strengths. At the core of Mitra is our relationship with the 12,000 people living in 53 villages
around us; this is the foundation of all we do. Together, we are able to unearth issues and needs,
and discuss possibilities. Then, we act together. The action and reflection that takes place during
this process feeds back into our relationship, and we all grow together. Our work is our life. For
us, Mitra is much more than a programme; it is a concept, a philosophy, and a way of life.
Towards Health for All
Primary Health Care
• Mobile clinic: 50 per month
• 50 Swasthya Sevikas – village health workers
• Community Health Insurance
1. M – CHIP, Dakulguda
2. Swasthya Paanthi, MAS
3. Swasthya Paanthi, DSH
• 2 Nurses-run Sub-Centres at P Dakulguda & Kachapaju
• Health Education
• Mitra Nutrition Programme
• Mitra Malaria Control Programme
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•
•
1. Medicated mosquito nets
2. Neem – based repellants
3. “MAL MAL” camps
4. Treatment & referral
Special Initiatives
1.
Sickle Cell Anemia Group
2.
Geriatric care
3.
Hypothyroidism Support
4.
School Health Programme
Management information system
1. Village Swasthya Patta
2. Data Analysis & Feedback
Towards Economic Security for All
• SHG Programme
1. Over 50 Self – Help Groups
2. Credit & Saving Programme
3. Income Generation Programme
4. Health Insurance programme
• Agricultural Initiatives
1. Discussion forum for farmers
Towards Social Empowerment for All
Programmes for
1. Youth: on leadership, HIV – AIDS etc
2. Women: Exposure Programmes, Leadership Training
3. Mitra Volunteers: Training & Exposure Programmes
• Ageing with Dignity
1. A support programme for the Elderly
2. 500 subscribing members
3. Health & Social Support Initiatives
Towards Education for All
• The MKB Initiative(“Milla Kahini Basa” or Children’s Play Place)
1. 11 Centers
2. 11 shishu Didi’s
3. 177 Children
•
AQTE Initiative (“Adding Quality to Education”)
Catalyzing Quality education in Govt. Primary Schools
1. 17 Teachers
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•
•
•
•
•
•
•
•
2. 612 Student
High School Kids Camps
1. Coaching camps in English, Maths & Science
2. Exposure to computers
Nancy Henry Scholarships for Higher Education
MRSK(Mitra Residential School, Kachapaju )
1. an adivasi primary school, kuvi – cum – odiya medium
2. jointly managed by Mitra & the people of 16 hill – tribe villages
3. 155 children – 50% boys & 50% girls; 12 staff
Old student Follow – up Programme
Post – Matric Scholarships
Teacher Training for AQTE Volunteers
Education Consultancy
Kuvi Sanskriti Kendra – an initiative to preserve, celebrate and nurture the Kuvi
Language and Culture.
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My Research study report
An Exploratory Study to Understand the Physical and Emotional Problems
Experienced by the Elderly in Old age Homes in Bangalore
Introduction
What is ‘old age’?
According to the World Health Organization (WHO), most countries have selected an arbitrary
chronological age of 60 or 65 as a definition of ‘older person’. This age is chosen simply because
it tends to be the age when most (but not all) people retire – that is retire in developed countries. 1
In recent years, there has been a sharp increase in the number of older people worldwide2 and
more old people are active nowadays than at any time in history.3 India is the second largest
population of elderly (60+) in the world.4As per the 2001census, the number of older persons
were 70.6 million (6.91%) and projected to grow to 94.8 million (8.3%) in 2011, 118 million
(9.3%) in 2016 and in 2026 it is expected to touch 173 (12.4%) million. (5)
In today’s world the family is becoming more and more nuclear and the old system of the joint
family is disappearing. So there is isolation for the elderly from the present family set up. Though
people retire at 65 years they remain healthy and productive but due to demand and competition
they are unable to find employment. This leads to unemployment and a feeling of wastefulness
among the senior citizen.
Ageing of the population along with changes in the family structure and shifts in intergenerational
relations has brought into focus issues pertaining to the elderly in India. In the early times the
elderly people somehow managed to keep themselves busy by either taking care of the grand
children or doing odd jobs at home like shopping, taking the grand children to school and
spending time with them. With decreasing size of the family and migration to the cities senior
citizens are finding it difficult to keep them occupied.
The growing visibility of old age homes in India points to the needs of elderly, which were not
recognized earlier. Old age homes have sprung up to cater to the needs of the elderly from
different socio-economic backgrounds. The interests of the elderly to spend their old age in sacred
places, the migration of children in search of employment opportunities, their maladjustment in
family and poverty of the elderly are the major reasons for the Indian elderly to shift to old age
homes. The busy life of the city and its challenges which make the senior citizen unwanted is also
another reason for the senior citizen opting for such homes. However in recent times, as a result
of demographic transition, rapid pace of industrialization and urbanization, disintegration of joint
family structures into nuclear ones, increasing participation of families in non-agricultural labor
force, the older people have become more vulnerable. The lack of familial support made elderly
resort to old age homes run by private and or voluntary organizations for their care and support.(6)
There are two types of Old Age Homes in India. One is the "Free" type which cares for the
destitute old people who have no one else to care for them. They are given basic necessities like
34 | P a g e
shelter, food, clothing and medical care. The second type is the "Paid" home where care is
provided for a fee. Such "Retirement" homes have become very popular in India and they are well
in demand.
Today, the old age homes are indispensable as they are needed to take care of the lonely and
forsaken elderly in the evening of their lives. Whenever the family does not provide full
protection and security to the aged, the society has to share the burden of looking after them.
Nowadays, old age homes are established to take care of the old. This idea of
“institutionalization” of the aged has largely been borrowed from the western countries. In the
context of the dynamic changes taking place in Indian society, the problem of the aged has
assumed importance. There is a gap between the needs of old people and the availability of health
and social service in these institutions. There is much research on the problem of the
institutionalized old people abroad but in India, very little organized information is available
about the problem of the aged living the families and in old age homes. Thus this study is being
conducted to understand the reasons for moving into old age homes, their health problems and the
issues faced at the old age home to understand the relationship between staying in an old age
home, health status and the issues faced by senior citizens.(7)
Objectives
1. To understand the reasons for elderly people coming to the Old Age Homes
2. To understand the problems faced by the Elderly in Old Age Homes.
3. To understand major health problems of the Elderly at the Old Age Home.
Material and Methods
Study area- The study was conducted in Bangalore urban district.
Study population- The study population consisted of elderly population of an old age home
located in central Bangalore.
Study duration- during the period of Sept and Oct-2013
Study design- A qualitative study design was used since to answer the research question and to
achieve the objectives there was a need for in-depth understanding required which would not have
been possible if a quantitative study design was used.
Sample- A total of 6 residents of the old age home were selected and interviewed out of one
hundred and twenty residents in the old age home.
Data collection – Data was collected using in-depth interviews and observations. In-depth
interviews were conducted using an interview guide and recorded using a voice recorder. The
interview guide was prepared in English and then translated into Kannada. Observations were
made using a checklist.
35 | P a g e
Data analysis – Data was transcribed from the audio recordings then translated into English.
Translated data was entered into and analyzed using NVivo Version 10.
Consent- I have got consent from the respondents after having explained to them my intention of
doing a study on them. Also I explained to them in no way it will do harm to them and it is strictly
kept confidential, though I have used some of the group photos in my report but I have not
disclosed their names.
Description of old age home
The Little Sisters of Poor, home for the aged is situated near Johnson Market, Hosur Road,
Bangalore Karnataka. It is run by Little Sisters of Poor and provides care for senior citizens and
destitute.
It currently provides stay for one hundred and twenty residents with separate sections for males
and females. Majority of residents were brought by family members and a small percentage by
voluntary organizations. The people brought by these organizations are the ones who are
abandoned by family members or found on streets. The cost of maintenance of these people is
borne by the old age home itself along with financial contributions from many organizations and
local community mobilization.
Medical services are provided by a medical college and hospitals in Bangalore with a physician
visiting the home once a week and a psychiatrist once a month. There is a separate room for
medical checkups and visiting doctors. Separate medical records and medication kits are
maintained for each resident. A permanent trained nurse regularly checks vitals and dispenses
medications. In case of any emergencies residents are shifted to the St. Johns Medical College
Hospital where a separate geriatric OPD is available and provides treatment at concessional rates.
Routine activities of the residents include prayer, reading newspapers, watching TV, chatting,
helping in making beds, serving and cleaning. Residents are taken for religious activities on a
regular basis. They are allowed to visit their relatives for a day or two with permission and
similarly visits from family are also encouraged.
Results and discussion
Table 1. Demographic characteristics of respondents at old age home
Sl.No
1
2
36 | P a g e
Demographic Variable
Age(in years)
71-75
76-80
81-85
86-90
91-95
Sex
Frequency
1 (16.66%)
1 (16.66%)
0%
2 (33.33%)
2 (33.33%)
3
4
5
6
7
8
9
10
11
Male
Female
Religion
Hindu
Christian
Caste
General
Scheduled Tribe
Education
Illiterate
Primary
High school
College
Number of Children
0
2
4
7
Current Occupation
Not working
Previous occupation
Not working
Daily labor
Regular work
Business
Current Income
Nil
Previous Income per month (in rupees)
0 - 1000
1001 - 2000
2001 - 3000
3001 - 4000
4001 – 5000
Duration of living in the old age home (in years)
00-04
04-08
08-12
12-16
3 (50%)
3 (50%)
3 (50%)
3 (50%)
1-M
2-F
3(50%)
0%
1(16.66%)
2(33.33%)
2(33.3%)
1(16.6%)
2(33.3%)
1(16.6%)
6
1(16.66%)
3(50%)
1(16.66%)
1(16.66%)
6
2 (33.33%)
1 (16.66%)
1 (16.66%)
0
1 (16.66)
3 (50%)
1 (16.66)
1 (16.66)
1 (16.66)
The study was conducted in the one old age homes of Bangalore. Out of total 6 respondents, the
distribution of respondents on age, gender, religion, caste and educational qualification, men and
women living in institutions settings is presented in table above below. Fifty percent of the
37 | P a g e
respondents were men and the other fifty percent were women. Religion of the respondents is that
fifty percent are Hindu and fifty percent are Christian. Fifty percent of respondents are illiterate
and the rest fifty percent are educated high school and above. Two thirds of the respondents were
above 86 years of age and the rest above 70 years but less than 80 years.
Reason for coming to the old age home
The main reason for elderly people coming to the old age home is poverty. Residents come from a
rural setup and half of them did not have any basic education because of which they were not able
to secure jobs and they migrated to urban are a sin search of jobs which they found the in
unorganized sector and as a result did not have any job security. Work was available on a daily
wage basis and women worked as domestic help in various households. Their income was low
and they had large families to support. As they became older they had difficulty finding work and
also were not able to undertake manual work. They did not have and currently also do not have
any social security and coming from poor background they do not own land. This meant that they
did not receive pension nor had other alternative sources of income as a result of which they did
not have any income and were forced to come to old age homes. Poverty however did not act in
isolation and interacted with other factors including ill-health which further worsened the
financial status, and maltreatment and negligence of family members partly due to lack of
earnings by those interviewed.
“Yavude vidyabyasa agilla yakendare akaladalli namage sariyagi vyavaste iralilla kshta andre
kasta namage 5 mandi iddaru kelasa illa karya illa vyvasaya madidaru adaralli Adaaya illa
eallarannu kastadinda saktaa idde kuli madiye jeevanana desabekittu illaandare hotte tumbuvadu
tumba kasta agutitu yavude sarakar ikelsailla enu illa yava muladinda namage Adaaya brutiralilla
ella kuli madiye jivana nadesabekittu” (Male 92 years old)
The second reason for coming to the old age home is ill-health. According to the respondents as
one grow old health problems increase and also the body moves slowly. Due to lack of Education
they are unaware of health issues and how to adjust such issues at their age. This was further
compounded by lack of care at home and also negligence of family members. And since they did
not any source of income they were unable to seek health care and this along with poverty and
lack of care led the respondents to the old age home.
“nanage aareetia samashyegallu enu illa bayi vanaguvudu aste matte ivag nanage kivi sariyagi
kellisalla sumaru ondu varshadinda kadime agide nanage sugar ide mai mele gayavagide kai mtte
kalian berallugllu setiyuttave jothege selleta ond ekade kullitukollalu Aguvudilla nanage kalian
himmadiyalla nadiyuvaga novu barutte idannella torisidaga sugar tablet swalpa kadime madu jasti
madu anta heli hogtare adaralle kala kalitaidini.” (Male 75 years old)
The third reason is negligence of the family. The respondents felt that due to their inability to earn
money they were not taken care of the family and that if they were taken care by their family they
would not have come to the old age home. They feel that they are a burden to their families and
38 | P a g e
that they are ignored in their homes. They think that if they were earning or were receiving
pension then they would have been taken care of at their home. Due to lack of care they are not
able to meet their needs including receiving medical care. This has forced them come to the old
age home and also the mental stress resulting from lack of care has contributed to them deciding
to come to the old age home. .
The last reason is lack of care givers at home. The needs of a senior citizen are multiple. At old
age people have many health issues, they need affection and concern, but often this is ignored by
the family.
Problem faced in Old age home
The respondents feel that at the old age home they face many problems including torture,,
discrimination taste of food, verbal and non verbal abuse, work load for old people.
The main problem according to the respondents is discrimination. Those who are the running old
age home have appointed staff but some staff is not caring all the residents. The discrimination is
in form of preferential treatment in form of provision of good service, quality food, hot water,
good medication to those who are cooperating with the staff and those who are not cooperating
with the staff do not receive good services
“Avaru maduva kelasakke nanu jagalla maduttene nyayavagi ellarigu nodikoda hage nmmannu
nodikolluvudilla ellarigu kottahage koduvudilla adkke nanu jagalla maduttene yarigadaru novu
adare aspatrege kallisuttare nange enadru novu adre aspatrege hogu anta helodilla. E
Ashramadalli paravagilla channagi nodkotare aadre ello ondu kade nammannu sariyagi
nodikolluttilla taratmya madutiddare anta namge anisuttide.” (Female 86 year old)
The second problem is the respondents face is with the food at the old age home. At the old age
home two types of food is prepared one is for the staff and the other for residents of the old age
home. Respondents say that the food prepared for staff is tasty but the one prepared for them not
tasty and also food quality was poor. Though a facility for hot water is available the respondents
tell that they are not provided with the same. The respondents are of the view that food supplied
to them from outside is tasty compared to what is cooked at the old age home. Respondents tell
that when they take food provided they are facing more health problems.
“Enu nodkotare hagene illi innen sigutte illi uta kodtare tindi kodtare adu uppu khara enu iralla
kelavomme ruche irode illa illi bisi neerina tondare ide adannu bittare channagide adre kelvondu
bari namage uta ruche anislla” (Female 86 years old)
In the old age home the residents face abuse which they consider to be a major problem. The
residents face two types of abuse namely, verbal abuse and physical abuse. Verbal abuse is more
than physical abuse at the old age home. Respondents tell that staff shout at them and use bad
words. One of the reasons for which respondents face verbal abuse is regarding them not being
provided free food and the threat that they have to work otherwise they will not be provided food.
39 | P a g e
This leads to mental stress and respondents think at such instances that it is better to go back to
their homes because of all these issues that they face at the old age home.
Another problem faced by the respondents is that they are unable to carry out heavy work but
staffs give them heavy work and when they undertake such work they face health problems such
as joint pain, body ache, headache, and fever. The staffs do not understand about their problem
and give them target of work which they are not able to finish. This results in the respondents
comparing their homes and the old age home since that such kind of work they have to do or were
doing at their homes. They also think it is better to go back to their homes because due to such
work at home they have shifted to the old age home and them facing the same problem at the old
age home too.
“Namage summane kullitukollalu aguvadilla hogi snna putta kelasa gallannu maduttene adaru
saha idan madu adan madu anta kriyuttare nanna kaiyali astondu kelasa madalu aguvudilla
namma kasta arta madikolluvude illa namage adannu madu anta tumba vattaya maduttare
kelavaru hage tondare kodutta iruttare innu ullidavaru channagi nodkottare.” (Female 80 year old
and 86 year old)
According to the respondents though they and the staff stay in the old age home, the staff do not
speak to them properly and do not behave well with them because of which the senior citizens are
sad. They also tell that not having access to newspaper and television makes them sad. Since they
do not have any care givers they are ready to face the problems at the old age home but even in
the old age home no one takes care of them or cares for the problems faced by them.
Health Problems in Old age people
As human beings get older they start facing a lot of problems of which health problems are a
major issue. The health problems faced by the elderly at old age homes are similar to those
experienced by those staying at home however certain differences do exist. The health problems
faced by the respondents include Communicable disease, Non communicable disease, mental
health problems and Physical health problems.
1. Communicable diseases which are seen among the respondents include skin problems, cold,
cough, fever, eye problems, headache and diarrhea. (Figure1).
“Nange kannugalu sariyagi kanuvudilla operation agide matte nanna kivi sariyagi kellisuvidilla
kaikalunovu mutte selleta nidde sariyagi barilla enu saha sariyagi nenapuiralla ellamaratbidtini
nanna kainail bhara yattuvudakke agalla nange tumba dura nadkondu hogalu aagalla
idellasamasye ide ivag naragalu sakastu tondare koduttade adakke sister matrekoduttare adallade
nange maikadita jasti adakke matrekodtare adre idella novige nange nidde sariyagi barodeilla.”
(Female 86 years old)
40 | P a g e
Figure 1: Communicable diseases faced by respondents
Non Communicable disease:The chronic illnesses faced by respondents include diabetes, asthma and those related to the
prostate gland.(Figure 2) These illnesses required old term care and usually do not have a cure.
Figure 2: Chronic illnesses faced by respondents
41 | P a g e
Mental Health:Mental health issues at the old age are a common problem which usually manifest in the form of
memory loss, loneliness, sleeping disturbance, sad movement, depression, anxiety. These
problems are faced the by respondents also and figure 3 below shows the pattern of the mental
health problems faced by the respondents.
Figure 3: Mental problem faced by respondents
Physical Health:The physical health problems faced by the respondents include joint pain, hearing loss, tiredness,
sweating, dry mouth and loss of hair.(Figure 4)Some of these problems are linked to the poor
nutritional status of the respondents. ]
Figure4: Physical health problem faced by respondents
42 | P a g e
“Nange mai kai ella jibi jibi annuttade ega nanage buja kai kalian kandagallella tumba novu
baruttade matte nanna kai kalian beralugallu setiyuttave jotege selleta onde kade kulitukollalu
aaguvudilla nange kalin himmadigllella nadeyuvaga tumba novubaruttde idella vayassadmele
sahaja ankondu kalakalita idiniaste.” (Male 75 years old)
Links the problems at old people
Unemployment
Contract based work
No Job security
Less income
Poverty
Migration
No assets
No Children
Old age
home
Negligence
of family
members
Mental
health
Health
problems
Verbal
abuse
Bad habits
Less
Nutrition
No
Earning
Physical
abuse
No care
givers
Residential
home
Old age
Depression
Psychological
problem
Physical
health
Chronic
disease
No pension
Lack of
Education
No Gvt Job
Loneliness
Lack of
personal care
Conclusion
An attempt was made to study the relevance and usefulness of old age homes in Karnataka, with
the objective to find out the reason for coming to the old age home, their level of satisfaction
about the conditions and life in the home and health problems in old age of the inmates. Six
inmates of an old age home in Bangalore urban, Karnataka were selected for the study.
Information regarding the reason for the coming to the old age home, health problems in old age
home and problem faced in old age home, was collected from the respondents using an interview
guide.
43 | P a g e
Major findings revealed that the majority of the inmates joined the Old Age Homes due to family
problems like poverty, ill health and absence of caregivers. Poverty however did not act in
isolation and interacted with other factors including ill-health which further worsened the
financial status, and maltreatment and negligence of family members. Elderly people has some
problems in old age home as they face many problems like torture, discrimination, lack of tasty
food, verbal and non verbal abuse from inmates as well as staff and work load. And the health
problems are like communicable and non communicable disease, mental and physical health
problems. Communicable diseases include skin problems, cold, cough, fever, eye problems,
headache, joint pain, and diarrhea; chronic illnesses like diabetes, asthma and those related to the
prostate; mental health problems like dementia, loneliness, sleeping disturbance, depression, and
anxiety; and physical health problems like joint pain, hearing loss, tiredness, sweating, dry mouth
and loss of hair.
Based on the research findings the following recommendations are being given:
Recommendation
1.
2.
3.
4.
Educate personal and community on aging and problems of elderly and remedies.
Provide group therapy like counseling and family intervention.
Since the families are nuclear in size there is a need for institutionalized old aged home
The existing government facilities like old aged pension, senior citizens card, free
treatment facilities at government hospitals, supplement of nutritious food and club for
senior citizen.
5. At institution provide quality care and psychosocial support.
References
1. World Health Organization (WHO2007),
2. Hafez G, Bagchi K, Mahaini R. Caring for the elderly: a report on the status of care for the
elderly in the Eastern Mediterranean Region. EMHJ July 2000; 6 (4):636-643.
3. McMurdo ME. A healthy old age: realistic or futile goal? BMJ 2000; 321(7269): 1149–1151.
4. Government of India. Eleventh Five year Plan Document 2007- 2012, New Delhi: Ministry of
Planning. (2008)
5. Registrar General, Census of India -2001, New Delhi: Government of India. (2001)
6. Mishra A.J., A study of the Family linkage of the Old Age Home Residents of Orissa, Indian
Journal of Gernotology., 22(2), 196-221 (2008)
7. Gunashekaran S and Muthukrishanaveni., Living Condition and Health Status of Elderly in Old
Age Homes,
Help Age India – Research and Development Journal.14(3), 8-18 (2008)
44 | P a g e
Over all learning
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Faith in myself and others
Self Confidence
Love and respect for each other
Communication skills
Dedicated to work in the community
Time management
Patience
Respond to communicator
Learnt about communicable/ non communicable disease
Learnt about the exiting health systems of the Govt and the Different way of Pvt/Public
hospital functioning.
Learnt little of Odiya (Language of Orissa State)
How to get involved in the community.
Learn the culture / habits of the Tribal belt
Apprehension about working in Tribal areas has disappeared.
Love for nature.
Value of relationship
Trust
Empathy
Documentation skills
Reporting skills
Conclusion
Health for all is a subject very dear to me since I was unaware of it from elsewhere except
SOCHARA. Me coming from a normal family I was introduced to universal health and its
components which has become a challenge to me personally. The experience which I have after in
contact with senior citizens has personally questioned me “what is wrong with the
society.
society.” My involvement with Adivasi tribal people in Orissa has been an eye opener to the
values which they cling to their daily life. They taught me self respect, self confidence and how to
be in friendly with the nature. Yes, I have become “a lover of the nature”.
nature”.
I am convinced that “Health
Health is a challenge for us today”
45 | P a g e
Reading list
Health status of the urban elderly- Siva Raju, S
Qualitative Methods in Mental Health Research-Kapur, R L Ed.
Caring for Elderly People in the Community 2nd -Williams, Edrs
Bharata samajakarya viswakosha. Vol. 1-Marulasiddhaiah, H M
Janarogya- Arogya Hakku
Health Status of the Urban Elderly - A medico social study-Siva Raju, S
Psychology Part - 1: Textbook for 1 year PUC-Nataraj, P
Mental Retardation - A manual for village rehabilitation workers-NIMHANS
Health action – Oct-2013
Karnataka towards Equity, Quality and Integrity in health – Task force on health and
family welfare government of Karnataka-2011.
Research method knowledge base-Trochim, William M K
Population Ageing and Health in India – S Irudaya rajan.
Active Ageing a policy framework
Che Guevara Reader. 2nd edn - Deutschmann, David
Anand for newsly married couples-Invally, Prasanna
When a lawyer falls in love- Amrita Suresh
An Agenda for Caring – Interventions for Marginalized groups – Harsha Mander and Dr.
Vidya Rao
46 | P a g e
POETRY:-
Saaviraru Janagalle Bandu
Seriri Ondagi Indu
Samudayavannu Kattuvirindu
Seveya Padeyalu Endu
|| 2||
Ondondu Kaiyannu Hididu Indu
S
Swabimanadi Baduki Endu
Samatheyannu Saralu Neevu
Ondagi Banni Ellaru Endu ||2||
Chadurida Janagalle Neevu
O
Hedaradiri Endendu
Kuggadiri Nanna Sodhar Sodhari
Sahakara Sigalilla Endu
||2||
C
Hakkugallannu Padeyuvadu
Namma Aajanma Sidda Hakku
Maretu Hogadiri Bandugalle
Idu Nimmaya Kartavya Endu ||2||
Arogya Namma Ellara Hakku
H
Uchitavagi Adu Sigutirabeku
Sarvarigu Sama Ballu
Sarvarigu Sama Palu
||2||
A
Rajiyagdiri Kutantra Janarige
Lancha Kodadiri LanchaBakarige
Ramanagiri Nambida Janarige
Ravanna Patra Dharisadiri ||2||
R
Andada Nadu Nammadagalu
Namma Hakkanu Kellalu Mareyadiri
Nambugeya Samudaya Kattalu
A
SOCHARA Samstheyu Mareyadiri
Bandugalella Ondagi
Nava Samaja kattalu mareyadiri ||2||
Saviraru Janagalle Bandu Seriri Ondagi Indu!!!
Seriri Ondagi Indu!!!!! Seriri Ondagi Indu!!!!!!
47 | P a g e
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A Celebration at Home for the Aged
Lunch at mid day
Senior Citizen Group discussion
Sharing with Senior Citizens
48 | P a g e
Team at Bissamcuttack Orissa
My tribal family at Dharasing Orissa
My learning’s
49 | P a g e
Thank You AEI for Dignity
50 | P a g e
Position: 2233 (3 views)