Balentina T. Lamare : A Report on the Community Health Learning Experience
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COMMUNITY HEALTH LEARNING PROGRAMME
February 2015 – April 2016
A Report on the Community Health Learning Experience
By
Ms. Balentina T. Lamare
Mentors
Mr. Kumar.K.J
Mr. Sabu. K U
Field Mentors
Dr. Ravi D’souza
Mr. Carmo Noronha
SCHOOLOF PUBLIC HEALTH EQUITY AND ACTION
(SOPHEA)
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SOCIETY FOR COMMUNITY HEALTH AWARENESS
RESEARCH AND ACTION
DANCE OF SOUL ON MUSIC OF LIFE
Music and musician; dance and dancer; life and living :
To enjoy, to play, to be:
Who is the subject, who enjoys?
Does Music possess the musician or does the musician
live the music?
Beneath the song of life one can perceive
The basic note of hope
That of perfection
Marred by jarring notes, true,
Not always sung by the heavenly choir;
But by the large one of life in its vibrancy!
The melody, the harmony of life!
Is it merely part of our perception about the world
Or the world itself?
-K. Pandikattu
-K. Suriano
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ACKNOWLEDGEMENT
First of all, I am grateful to God for the good health and wellbeing that were necessary to
complete my one year training in SOCHARA.
I would like to convey my sincere gratitude to Dr Thelma Narayan (Director of SOCHARA)
and Dr Ravi Narayan, for giving me the opportunity to join Community Health Learning
Programme (CHLP) and all the facilities throughout the programme.
I also extend my sincere thanks to Sir Carmo Noronha (Director of Bethany Society,
Shillong, Meghalaya) for introducing me to SOCHARA and also his encouragement and
support to join CHLP.
I place on record, my sincere thank you to all the great facilitators of SOCHARA for their
support, encouragement, guidance and knowledge they put throughout the programme.
I am also grateful to Kumar, my Mentor in SOCHARA, Bangalore and Dr Ravi D’Souza,
field mentor in Bhopal. I am extremely thankful and indebted to them for the knowledge,
valuable guidance and encouragement extended to me.
I take this opportunity to express gratitude to all the facilitators and staff of SOCHARA for
their kindness and helpful support. I also thank my friends for supporting me through this
programme. I would also like to express my gratitude to the sponsors for supporting and
making the programme successful.
I also would like to thank the participants during my study because without their support and
cooperation it would not be the successful.
Last but not the least, I place a deep sense of gratitude to my parent and family members for
their continuous encouragement, which has been a constant source of inspiration during my
CHLP.
BALENTINA T.LAMARE
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TABLE OF CONTENTS
SECTION I- Turn on the music ------------------------------------------------ 06
Chapter 1- The music opens to the floor ---------------------------------------07
Chapter 2- The song and the dance begin -------------------------------------10
Chapter 3- The power of music makes you dance ---------------------------13
Chapter 4- The song --------------------------------------------------------------35
Chapter 5- Every new music beginning comes -------------------------------39
Chapter 6- The beauty of the music --------------------------------------------57
Chapter 7- Life and music -------------------------------------------------------60
SECTION II- The Instrument of the Music-------------------------------------62
Chapter 8- Searching the note of music-----------------------------------------63
Chapter 9- Flow of song make you move and dance-------------------------76
SECTION III- The Euphony from the strings----------------------------------84
Chapter 10- The sound of music bit the mind and body tremble -----------85
Chapter 11- Music of life and hard note turn the song beautifully ---------92
SECTION IV- Writing new note -------------------------------------------------94
Chapter 1- Project Work ---------------------------------------------------------95
Chapter2 - Literature Review--------------------------------------------------- 97
Chapter 3- Research Methodology --------------------------------------------- 99
Chapter 4 – Analysis and Summary ----------------------------------------------101
Chapter 5 – Finding and Recommendations ------------------------------------------------ 108
Chapter 6 – Limitations, conclusion and reference ---------------------------------------- 109
Rhythm for SOCHARA Family --------------------------------------------------------------110
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ACRONYMS
ANC-Ante Natal Care
ANM- Auxilary Nurse Midwife
AWC-Anganwadi Centre
AWW-Anganwadi Worker
ASHA- Accredited Social Health Activist
VHSNC- Village Health Sanitation And Nutrition Committees
IGMSY- Indira Gandhi Matritva Sahyog Yojana
IYCF- Infant And Youthchild Feeding
JSY- Janani Suraksha Yojana
PNC- Post Natal Care
GOBI- Growth Monitoring Oral Rehydration Breastfeeding And Immunization
BOBIFFF- Growth Monitoring Oral Rehydration Breastfeeding And Immunization Family
Planning Food Supplementation and Female Literacy
VHND- Village Health and Nutrition Day
BCG- Bacille Calmette Guerin (TB VACCINE)
CHW- Community Health Worker
M&E- Monitoring and Evaluation
SAM- Severe and Acutely Malnourished
MFC- Medico Friend Circle (mfc)
UPISE-Understanding Patient Interest Support Empathy
SOLER-Sit Straight Openness Lean Forward Empathy Relax
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SECTION- I
Turn on the Music
Chapter 1
The music opens to the floor
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Music in the soul can be heard by the Universe.-Lao Tzu
A flat note is floating around me and I try hard to move my legs, but every time I stumble.
And air brought a beautiful note from the old days music legacy of India. I start syncing
along the music, and I was able to perform something which I call dance of soul. Soul can
only dance to the music of life.
The first step- After I completed Master of Social Work I started feeling that I was lacking
some insight and learning which I wanted to do in life. As I moved around the organizations
to do my voluntary work and I finally ended up in Bethany Society (BS) Shillong. While
going to field with BS I was able to relate issues that people are facing in day to day life. I
used to discuss with the coordinator of BS and my Aunts regarding the health issues. Always
thought where to go and learn and how to begin with it!! My philosophy process kept going
on without clue. As a girl I used to pray and tell God to show me the light that will help me to
do something in life. My voluntary work kept going and I didn’t find the right path to take.
Every time there was a question mark is in my mind. Going to field every day hurt me when I
saw people suffer. My associate with Bethany Society’ working areas exposed me to the life
of Persons with Disability (PWD). I felt I didn’t have much knowledge towards health. After
two and half months of my voluntary work the Director of Bethany Society offered me a job
as staff assistance in an inclusive school. I mingled with students and teachers from different
back ground and kept thinking about acquiring the knowledge and skills on health The
Director of Bethany Society (Mr. Carmo Norranha) introduced SOCHARA to me. When I
went through the website of SOCHARA, I felt on the top of the world because I found the
right steps. At last God heard my pray and I thanked my lucky star for bringing me to
SOCHARA…..
TRAIL OF MUSIC- Why I want to join Community Health Learning Programme (CHLP)?
I consider myself privileged to be associated with School of Public Health, Equity and Action
SOPHEA, SOCHARA for the Community Health Learning Programme (CHLP). Thank you
for letting me to express why I wanted to join CHLP, I passed out my Master of Social Work
(MSW) from Assam Don Bosco University in the year 2014 and I was specialized in
Community Development (CD). Before joining CHLP I associated with Bethany Society,
Shillong, Meghalaya.
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The very objective of my specialization in Community Development (CD) relating to health
services and to enable me to participate in activities including research, campaigns,
movement and processes “To make Health For All a reality”.
I was very much willing to join community health services and serve the rural/urban people. I
wanted to join community health programme in order to enhance my knowledge on
community health, especially community monitoring being the integral part of the
community process under NRHM; in order to educate and capacitate community member to
access and enhance participation of people in the public health programmes. By acquiring
more knowledge in community health I will be able to educate the community people through
mutual understanding and respect. Further, I will be able to communicate to the rural
population or community people at various levels through social audit.
Since, I am originated in the interior part of the North East, India, Nongtalang Village under
Jaintia Hills District, Meghalaya. The people inhabited in my village are very backward, they
are lacking behind in many ways, in terms of development, schemes implemented for the
welfare of the people, particularly health facilities; even after the implementation of NRHM
due to lack of knowledge and awareness. Since childhood I dreamt of addressing the health
issues of my community people; as it is a universal fact that “Health is wealth”. I took up
social work profession with Community Development (CD) as my specialization in order to
keep my long cherished dream alive.
The training programme offered by SOCHARA will be the major platforms for me to
enhance my learning and learn the techniques and guidelines in a systematic manner in
facilitating the health problems faced by my community people. I would like to advocate the
health issues of my village/community people by educating them about the importance of
health facilities needed, regular check-up and schemes implemented by the Government
specially for the rural areas and to enable the community people to raise their voice to let the
higher authorities be aware of the problems faced regarding health issues. As an individual, I
am very flexible in nature I am ready and eager to learn and acquire new knowledge. I have a
strong determination to keep up the dreams of assisting the health issues of my community
people.
I therefore eagerly looking forward to get the opportunity to be a part of the team in the
training programme offered by the SOCHARA, the esteem organization. I am willing to
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cooperate with the trainers and offered my services to the SOCHARA whenever required
because I firmly believe that through this programme I will be able to learn tremendously and
share my experiences with my other co-workers who are not privileged to attend the training
programme and along with the community people I will share my learning and guide my
fellow community people on how to address and find out a solution to the health issues of the
people. Through the training programme I look forward to enhance and build a good network
with the expert and organization dealing or working or having the same objectives.
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Chapter- 2
The song and dance began, where words fail, music speaks.
-Hans Christian Andersen
For me SOCHARA is a big jigsaw puzzle. All the little pieces coming together, to form a
beautiful picture. Here, in the 1 year of Community Health Learning Programme I found my
understanding, thought, behaviour and attitude is totally changed and acquired a rich
experience in Community Health as a future community health worker. There was nothing
unreal; everything was indeed very real in life. In fact, the thing that remains constant is
reality which is constantly changing. I wonder myself how the 1 year with SOCHARA
translated into action on the ground level. I believe once I return to my own place it will be
the great transformation for me to put into action along with the interest and objectives. Being
with SOCHARA, it touched my live at the grass root level because there was a time I doubted
my own capability. Always think about the high salary but now I understand the meaning of
life. I believe in myself, money is not my cup of tea. Therefore, the most important is job
satisfaction that gives peace of mind and happiness in life. Hence, working in any field needs
to be kind and accept the people the way they are and without judgemental attitude. Also
nothing is impossible in this world. What is more difficult is to find the will to do something.
So, if anyone has the will power, anything can be achieved along with the challenging and
passion.
The interesting portion to be with SOCHARA is the environment itself which was to create
an atmosphere to feel at home. When I recall back from the first day of applying the
fellowship programme, it amazes me about SOCHARA because while having skype
interview I felt like knowing them already, they make me smile and feel comfortable while
talking to them. After reaching Bangalore I had personal interview again and this made me
scared again but fortunately it was a wonderful interview I ever had. The collective sessions
brought up my knowledge and understanding level to improve my thoughtful towards the
community health in both class room and field experience. My basic objectives is to improve
my learning skills, enhance my knowledge on community health especially community
monitoring and understand the community on how to deal and work with them.
The experience of class room learning was entirely different from the previous experiences I
had during my college days. It was exciting as there were no teachers–students model of
conventional learning happened at SOCHARA. All what I have witnessed and gone through
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was a journey with fellow travellers facilitated by the travellers who have walked before us. It
was learning through experiences that gave equal weightage to both theory and practice.
During theory classes I liked the most because there is no teachers and students practice
instead it was conducted in a very different atmosphere as learner and facilitator that I never
had during my entire studies. The atmosphere in the class has transformed my thought into
optimistic and I learnt from co-fellows from different experiences, knowledge and ideas. This
is the great platform for me to be part of the program that gave me lot of new concepts and
input. The recap session was wonderful that made me to reflect and think back about what I
learnt at present, past and future. It is very meaningful session what I felt that will help each
and every one of us. It is also good practice and at the same time it reminded me what I have
learn and put theory into action. It brings new concepts and makes me reflect about the reality
that we are fighting today life time. SOCHARA is one of the greatest organisations that I will
never forget and believe in myself, I will carry the message in future. I am so grateful to God
for being with SOCHARA and this will be the greater gift I got in 1 year fellowship
programme both theory and practical. I developed and admired the whole team of
SOCHARA, they are a role model for me because each and every one of them having unique
styles of teaching and effort of work through their passion and commitment towards the
needy person. Facilitators work with different interest and try to uplift people and “Let their
voice be heard”. The most important part I enjoyed along with my co-fellows is sharing and
learning from each other’s experiences, and at the same time they are very helpful and
cooperative in overall necessities. Also had fun and jokes together with fellow-travellers and
team of SOCHARA through role play, celebrations etc. This is one of the best experiences I
mingled with my fellow-travellers because we start to feel like brother and sister in one
family and feel at home. The closeness among each and every one of us become strong and
shared our experiences without any hesitation.
Gradually I started thinking and bothered about me:-
What is the meaning of myself?
-
What is the reality in life?
-
How much my heart gets heard?
-
Whom to blame and who are responsible for it?
To answer all the question at first I have no answers!!!!!!!! Firstly, my mind become blank
and my brain become numb. Whenever I started thinking there is no answer at all. Always
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question myself why and why and why? Struggle myself to find some solution but at the end
of the day somehow I manage to find the answer. To know the meaning of myself is believe
oneself, true self, dream positively, involve with others, grab the opportunity and never give
up. The reality in life is the true life of the people that I have seen in urban slum of Bhopal.
There are many people who struggle in their life to get one day meal to eat that is the reality
of life. Trying to live the life in a very simple way but unfortunately sad to see the reality of
people who are still facing a lot of difficulties and challenges to get one meal in today’s
generation. It is too difficult to convince my heart, at the first place because it gets angry and
heard when I see the people who are not having food to eat and the living condition. The life
style is pathetic between the rich and poor. The rich become richer and the poor become
poorer. I still have no clue on whom to blame and who are responsible? I keep this question
to myself. How to start and where to find solution? It is the high time to talk on the issues of
slums and come forward with the solution as early as possible!!
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Chapter 3
The power of music make you dance
“Music is a supernatural force on the earth. It has the power to transform the heart and
mind”. -Kathy McClary
With few ideas and information I start syncing my mind and thought into deeper
understanding and gain knowledge about community health. My inner feeling haunt my mind
to search solution through my little understanding on how to contribute to the community.
So, finally I find the right track of music called SOCHARA. I am like free musician to
explore the world and make use all the ideas and knowledge from my strings.
I met many young fellows who were ready to work for the betterment of community in
future. I am glad meet someone who is confused like me towards community health. Fellows
are coming from different states of the country with different background and experiences on
how to explore the issues to reach health in reality. Meeting and sharing our own culture,
beliefs, practice, religion.
CLASSROOM SESSION
Understanding community
During the theory classes the first I understand is the meaning of “Health”, Health is a social,
economic and political issues above all a fundamental human right. When we talk about ill
health or unhealthy it forms several problems like poverty, inequality, violent and injustice
are the main cause behind and make people suffer and die for it. Hence, due to this the poor
people become the most marginalized and vulnerable in the society as a whole. Therefore,
this frame in many issues like malnutrition among the children as the one of the main issues
that is very high in our country and what I try to reflect is poverty and social cause, ignorance
and lack of education and health problem create in very thing for the poor people and
marginalized. Throughout the class room session I learnt and understood with different
perspective of Community Health:Understanding community Health?
A community is “a group of people who have something in common and will act together in
their common interest” (WHO 2003). Communities may find unity through common
backgrounds, geography, ethnicity, education, experiences, language, and with other social
themes.
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Community health is to drop-in, not drop out because whatever practices in the community it
will mark or meaningful to the community. So, to think about community health, if we want
to tackle the health issues in community the first place is need to tackle community in order
to improve the betterment of the people in health.
Personally, to understand community health need to go in-depth and understand the “Chinese
Poem”
“Go to the people’s
Live with them
Love them
Learnt from them
Start with what they know
Build on what they have”.
Community health is join hands together in-term of sickness and problems. Also, community
health is a bond between the people in the community because mostly when it comes to the
problem the community tries to help each other and respect in term of sickness. Community
health creates lot of problems when it comes to environment. So, environment play major
role in the community health and challenges for the people because people itself mostly they
didn’t understand the meaning of health. Need to make the community to understand the
issues of health.
So to verify any problem of being community health practitioner need to think about the
issues before its too late. Example environment is one of the biggest challenges for our
generation because day by day the atmosphere is changing and creates health problems.
Community health needs to clear understanding about the community before working with
people so that it will help to build and work for the betterment of the community. Therefore
mental illness is also part and parcel of community health and community needs to focus on
how to build the rapport with the community people and empower them. So, talking about
community health, health influences community in many areas. Example communitisation is
new word of NRHM, which mean process to improve through participation of the
community.
To conclude, Community health need to empower ourselves and spread message to
community in a systematic manner because dealing with community it is very challenges task
until and unless we really are committed to work with people.
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What is Health: According to WHO, “Health is a state of complete physical, mental and
social wellbeing and not merely the absence of disease or infirmity”.
My understanding of health is a resource of every life, it is a positive concept highlighting
social and personal resources. Therefore, whenever we talk about health it’s all about
identity, culture, water, environment these are all related to health because without these it
will ruine the health condition. These are part of human being when it comes to health
system. At the same time, if we think about energy it also exists to health itself.
Talking about health doesn’t mean only health but at the same time it effects the biological
environment. Therefore, well-being is very important for health.
Health is absence of diseases. So, a healthy body needs healthy mind. As we all know
“Health is Wealth”, to become healthy life we need to be healthy both physically and
mentally so that we can perform our work well and develop.
To conclude, health is fundamental right and if everyone empowers then health automatically
come up.
8 Elements of primary health care
Education
Food supply and nutrition
Safe drinking water and sanitation
MCH and family planning
Immunization day
Prevention and control endemic diseases
Appropriate treatment of cause and dangerous disease
Pro essential drug
The concept of Primary Health Care (PHC) is not new to India. The Bhore committee in 1946
gave the concept of a PHC as a basic health unit to provide as close to the people as possible,
an integrated curative and preventive health care to the rural population with emphasis on
preventive and promotive aspects of health care.
The functions of Primary Health Centre are:
1. Medical care
2. MCH including family planning
3. Safe water supply and basic sanitation
4. Prevention and control of locally endemic diseases
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5. Collection and reporting of vital statistics
6. Education about health
7. National health Programmes
8. Referral services
9. Training of health guide, health workers, local dais and health assistants
10. Basic laboratory services.
Structure of Primary Health Centre is:
1. 3 staff nurses
2. 1 LHV for 4-5 SHCs.
3. Ambulance/hired vehicle.
4. Fixed day MCH/Immunization Clinics.
5. Telephone.
6. Ayush Doctor.
7. Emergencies that can be handled by nurses- 24 X 7.
8. Drugs.
9. TB/Malaria, test.
The function of sub-centre is:
1. Maternal health care
2. Child health care
3. Family planning and contraception
4. Adolescent health care
5. Community need assessment
6. Assistant to school health services
7. Promotion of sanitation
8. Co-ordinate services of AWW, ASHA, village health and sanitation committee
9. Water quality monitoring.
Structure of Sub-Centre:
1. 2 ANM
2. 1 male MPW for 5-6 villages
3. Telephone link
4. MCH/Immunization days
5. Drugs
6. MCH clinic.
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Community Health Approach: Community health approach is to enable and empower the
community, community participation, community organization, integrate health with
development, preventive, promotive and rehabilitative orientation, self-sufficiency, education
for health and appropriate technology etc.
Social Determinants of Health
Social
Economic
Political
Cultural
Ecological
Drug Therapy
Drugs are rational and irrational.
Rational drug
Essential drug
Non-essential drug
Irrational drug
Combination
Banned drug
Hazardous/dangerous drug
In India there are over 60,000 pharmaceuticals available today but only 25% produce good
quality drugs others produce substandard quality of medicine. Example of irrational drugs are
cough syrup, pain killers, anti-anaemia, O.R.S (oral rehydration solution) preparation and
anti-diarrhoeal. Irrational drug use: Inappropriate, wrong dose, wrong duration, selfmedication, poly pharmacy. Cause of irrational drug use: Increase side effects, drug
resistance, and decrease quality of treatment. Standard treatment: Most of the cough does not
require drug treatment. Basically cough clean the windpipe throwing out irritating materials,
which may reach it from outside or is produced locally. Therefore, cough is a friend not an
enemy some of the cough is due to allergy due to irritants. Some common irritants are like
smoking, germs.
People’s alliance for right to free medicines:Responsibilities of the alliance: Watch dog with regards to access to medicine situation in the
state, monitoring activities and generate community feedback to highlight gaps in the policies
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provision and system which hinder access to medicine and involve remedies and solution to
cover those gaps.
Understanding the role and responsible of ASHA, ANM, AWW
Accredited Social Health Activist (ASHA), Auxiliary Nurse Midwife (ANM) and Anganwadi
Worker (AWW)
Role and responsibilities of ASHA
1. Create awareness and provide information to the community regarding health, e.g.
nutrition, basic sanitation and hygienic practices, healthy living and working
condition.
2. Counsel women on birth preparedness, important of safe delivery, breast feeding,
immunization.
3. Mobilize the community and facilitate them.
4. Work with village health and sanitation committee of the Panchayat.
5. Provide primary medical care for minor ailments, e.g. diarrhoea, first aids, DOTs.
6. Accompany pregnant women and children course required treatment/admission.
7. Inform the birth and death rate in her village.
8. Promote construction of toilet under sanitation campaign.
Role and Responsibilities of ANM
1. ANM will hold weekly or forth nightly meeting with ASHA and discuss activities
under taken during the week all fortnight.
2. Acting as resources person along with AWW for the training of ASHA.
3. Informing the ASHA about date and time guiding her to the prospective beneficiaries
to the outreach session.
4. Participating and guiding in organizing health days centre.
5. Taking help of ASHA in updating the eligible couple registered of the village
concern.
6. Utilized ASHA in motivating the pregnant women for coming to sub centre for initial
check up.
7. ASHA help ANM in bringing marriage couple to sub centre to adopt family planning.
Role and Responsibilities of AWWs:
1. To elicit community support and participation in running the programme.
2. To weigh each child every month, record the weight graphically on the growth card
and maintain child cards for children below 6 years.
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3. To carry out a quick survey of all the families especially mother and children in those
families in their respective areas of work once in a year.
4. To organise non-formal pre-school activities in the Anganwadi of children in the age
group 3-6 years of age and to help in designing and making of toys and play
equipment of indigenous origin for use in Anganwadi.
5. To organise supplementary nutrition feeding for children 0-6 years and expectant and
nursing mothers.
6. To provide health and nutrition education and counselling on breastfeeding/infant and
young feeding practices to mothers.
7. To make home visit for educating parents to enable mothers to plan an effective role
in the child’s growth and development with special emphasis on new born child.
8. To maintain files and records as prescribed.
9. To guide ASHA engage under NRHM in the delivery of health care services and
maintain such record under ICDS.
10. To identify the disability among children during her home visit and refer the case
immediately to the nearest PHC or District Disability Rehabilitation Care.
11. To support in organizing Pulse Polio Immunization.
12. To inform the ANM in case of emergency case like diarrhoea, cholera.
Paradigm Shift:
Bio-medical
Social- community model
1. Individual
Community focus
2. People as patient
Equal participants
3. Providing to enabling
Empowering
4. Drugs and technology
Education and social processes
5. Professional control
Demystification and social control
4 A’s
Accessibility
Affordability
Availability
Acceptability
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Turn of the tap and mopping the floor
Turn off the tap and mopping the floor is the very important concept and I think each and
every one should know this model. It create new ideas and to understand towards the doctor.
Doctor seems to be floor mopping because for them they never practice/ taught of well-being
and because of that they are floor mopping. Therefore as community health worker we should
not be only turning off the tap or mopping the floor because if we practice like that we would
not be aware about what happen in this world. The floor mopping is the one who is of the
selfish kind. Therefore, we should practice to be turn of the tap especially working in the
community in order to aware and spread the message to the public around the globe.
Axioms:
1. Right and Responsibility:- To enabling and empower the community and uplift them
to demand their own right and responsibility and health as well. It reflects me during
my field work because I find people till date did not understand their right and
responsibility towards health.
2. Autonomy over health and development activities:- It is the community approach
involvement by creating awareness and support to the community to share their ideas
and knowledge. It also reflect me it will be the great opportunity for them to
participate individually, family and community and aware the important of health as a
whole.
3. Building decentralized democracy at community and team level:- It is through the
community participation and interaction between the community and the third person
in order to build and bring empower to the community in different activities. Through
this it make me think and realized that community participation is very down in the
community according to my field experiences.
4. Building equity and empowering community beyond social conflict: - It is the
community health approach because it is the understanding and participation of the
community itself will bring change especially vulnerable and marginalized people are
getting change to develop and shared their thought and ideas in the present situation.
Community need to empower through different action and face the problem to reach
the hills of health.
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5. Promoting and enhancing the sense of the community:- It reflect me through my
experiences in the field that need to accept the community as it is because be with the
community need full involvement with lot of activities, community building to
improve the health for all. It also reflects me that it is sign of development if there is
more numbers of women in any kind of participation in the community. To promote
sense of community it is also depends on the affective community engagement and
active participation.
6. Confronting the biomedical model with new attitudes skills and approaches:- It is the
involvement of the community itself on how to understand and acknowledged with
the present scenario of the community when it come to health care because it is the
responsibility of the community to realise the important of health care at large. Hence,
to change the community is needed first to change our self. Also reflect that
participation, contribute leader is the wonderful contribution in all round of the
community.
7. Confronting the existing super structure of medical/health care to be more and
community oriented:- It bring me back to the community because it is high time to
make the people realize about the important of health care. Also oriented the
community and enabling and empower them to stand and be able to raise their voice
in the public place.
8. A new vision of health and health care and not a professional package of actions:
When it comes to community health approach the community have to think positively
and change the mind and make the different through action and attitude. Also need to
practice by approach the community through new knowledge and ideas.
9. An effort to build a system in which health for all can become a reality:- It reflect me
to build the system for health for all into reality is need to look in all the different
aspect of socio-economic political and cultural system. Further if we cannot tackle the
issues of health for all will continue to fail in the next plan.
Playing games in Community
Building
Dynamics
Participation
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Mobilization
Alma- Ata
The Declaration of Alma-Ata was adopted at the International Conference on Primary Health
Care (PHC) held on 6th -12th September 1978. It is the need and urgent action by the
Government, health worker and community as a whole in order to protect and promote the
health for all to the people. Alma-Ata is the first international declaration comes out with the
important guidelines of primary health care. The primary health care approach has accepted
by the member countries of World Health Organization to be the fundamental goal of “Health
for All”. Also, Alma-Ata accepted that Health is a Fundamental Right. It is the right and duty
of individual and joint to participate in the planning of health care.
Reflecting back to Health it strikes my mind that people use to thinking about PHC and
through this will help the people who really needed the most. But unfortunately, the service is
very poor especially for the people who come in low background they faced plenty of
problem. What I have experiences during my field in Bhopal I have seen by my own eyes; the
doctor did not respond to the poor and marginalized sections. Therefore, the poor people
prefer to go to the private clinic or hospital because they get better treatment. This mind set of
the doctor should change their psychology towards the people who are in need more than the
people who can afford to pay for their treatment in order to improve the health condition in
our daily life as a whole.
It also needs to consider self-reliance and social awareness are the most important basic
factors for the people because people have the right and duty to participate in the process for
improvement of their health condition. I used to think if PHC stresses and focuses on the
main problem of the community it will be better for the community to improve their health
condition.
Therefore, the declaration highlights the inequality between developed and developing
countries in different terms like politically, socially and economically but it is unfortunate a
and it is unacceptable. So, as a result the Primary Health Care was introduced by the AlmaAta declaration, selective PHC will present the low-cost solution to the specific and common
causes of disease and death. The target selective PHC were clear, concise, measurable and
easy to observe. This is because the selective PHC will be able to focus and concentrate in the
most important areas. Example for this is the well-known GOBI (Growth monitoring, Oral
22
dehydration treatment, Breast feeding and Immunization) and later GOBI-FFF (adding Food
supplement, Female literacy and family planning).
At the same time what I used to think and reflect PHC also depends on the attitudes and skills
of the health worker how they treat people when it come to health, also think in order to
improve the health condition the mobilization is the main important source of health.
Johari window
Johari window is the very new model that I never knew during my whole studies.
Understanding the meaning of Johari window, it gave me ideas on how to work with my
weakness and strength at present and future. When I think about this model I find myself in
all four areas. This model is based on two ideas - trust by reveal to others, and learn about
yourselves through the feedback. I used to discuss with my friends about myself because I
want to get feedback of my weakness and this is really help to cope and understand about
self. As human every individual have our own perspective to define and also behaviour and
attitude. I use to be very happy to get feedback from others so that will help me to grow in
good way. The presentation and group discussion during the class is very helpful to grow my
understanding and confidence level. Getting feedback from facilitators is big change for me
because I never know my capability and weakness.
BLINDSELF
PUBLIC
Known to all
Known to yourself
and hide from
others
SECRET
UNKNOWN
Known to others bur
not to self
Blind to both
yourself and others
Health Problems in India
Attending the class on health problems in India is one of the learning processes in order to
apply while working with the community as well for the personal learning in future.
Health indicates into two types i.e. communicable and non-communicable diseases.
23
1. Communicable diseases:- In India the top communicable disease is malaria, tuberculosis,
diarrhoea, acute respiratory infection, leprosy, filariasis etc.
Nutritional problems (not a communicable disease, but it affects basic immunity, making one
vulnerable to other diseases): In nutritional problems it contains different categories:
Protein energy malnutrition which occur from the children who are malnourished.
Malnutrition, anaemia, diarrhoea are the main causes for the children under 5 years to
death.
Nutritional Anaemia is the lack of deficiency of iron and mostly affects women and
children. Especially for the women during delivery the blood cost up to 500ml, and
because of this iron is very important for the women during the pregnancy in order to
prevent anaemia. During delivery if the women with anaemia lost 200-300ml of
blood it will cause to death.
Low birth weight, 4. Vitamin A deficiency, 5. Iodine deficiency disorder and others.
Environmental Sanitation problems:
Lack of safe water and waste disposal. Also it is lack of facilities of air borne
diseases.
Medical health care:
It is lack of proper treatment, and the advantage is free/ accessibility and disadvantage
is in private hospital the quality of health care is not up to the standard of treatment.
Population problems:
Population problems are due to employment, education, environment, housing, health
care service and sanitation. Due to that population is the main cause led to all the
social determinants e.g. slum is one of the areas facing all the problem mentioned
above. Most of the people thought urban area is better than rural but unfortunately
according to the study by 2020 the population of urban will increase up to 50%. That
will be again the major population problems.
2. Non-communicable diseases: It also well known as lifestyle. This is because of eating
style, irregular eating, stress and not enough sleep, drinking habit. This also life style
cause to obesity, diabetes, cancer, hypertension, accidents, heart disease.
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Nutrition basic principles:
Nutrition is the science of food and its relation to health. E.g. it should not be to more
or less of nutrition. It also concern with role of food in growth and development of
body.
The relationship of nutrition are infection, immunity, fertility and maternal and child
health. While non-communicable relationship is cancer, heart disease and diabetes.
Classification of foods:
The origin of classification of food is vegetarian and non-vegetarian. The amount required to
be consumed are two types:
Macronutrient is consumed in large quantities e.g. protein, fat, carbohydrate.
Micronutrient is consumed in small quantities e.g. mineral, vitamin.
Protein:
The most important food in nutrition is body building (growth), repair and
maintenance, formation of blood, hormones, enzymes and immunes system function.
The sources of protein is animal source i.e. milk, egg and plants source i.e. pulse,
bean, cereal, nuts.
3. Malnutrition in children: Malnutrition in children has important effects. Important issues
are detection, signs and symptoms, causes, management, prevention and types. It affects the
child immunity. Its causes are due to low birth weight or poor maternal nutrition, and the
infection may be because of diarrhoea, TB, malaria, worms and UTI. Malnutrition in children
is two types:
Marasmus- It is lack of protein and calories.
Kwashiorkor- It is lack of protein.
Mild and moderate malnutrition child should get proper food and feed the child frequently
and also to check the weight regularly. The three important points to treat the malnutrition
child is Diet, Vitamin, and Mineral (Iron, Potassium).
I learnt the three main functions of foods i.e. body building food means grow food, energy
giving foods means go food and protecting foods means glow food. Through these three
25
terms I learnt on how to influence and motivates while working with people in the
community in the easy manner. This is easy words to make people understand and aware
about the important of health.
I also learnt iron is required for haemoglobin and development of body in order to maintain
the immunity. Adding to that I learnt all types of dal provides the same protein and there is no
different between low/high prices. I learnt any food items cooks in the iron utensil it contain
iron.
While interaction with Dr Ravi I learnt breast feeding contain nutritious and protect infection.
Colostrum is the yellow colour of first breast milk and this milk is very important for the
baby it provide vitamin A & K and protection again infection in the body of the baby.
Besides that I learnt the new born child should increase the weight by 30 gram per day and
200 gram a week for the healthy baby. Also if the baby passes urine many times a day which
means the baby has enough milk from the mother.
The new learning that I learn is precious baby which mean the couple having baby after long
gaps of marriage and plus the couple will not generate baby any more. This kind of baby
child needs more attention and care.
I learnt hookworm is one of the causes of major anaemia in children because the hookworms
digest lot of blood and create malnutrition for the children. Hookworms digest blood 0.2ml
per day and ½ litre a month. Also in open defecation hookworms are more prevalent and
dangerous, and mostly this creates deficiency and malnutrition.
I learnt malnutrition is the one of the major problems faced by the people especially children.
In severe malnutrition the first aid is to treat the infection that affects the child. To avoid the
malnutrition is if we can educate the mother in order to treat and care for the children at home
in a proper manner so that it will reduces the malnutrition in the society. Also the long term
malnutrition it will create the worse and reduce the growth rate of the society. Due to this
improvement will decrease in the society and poverty will increase day today life.
When I try to reflect about health care in India it strikes me the health condition of the people
did not reach them up to the standard they are supposed to get the services of health care.
First day visit slum in Bhopal I just can imagine how people living in that condition with no
facilities at all. Children health is very bad and I am thinking how they will manage with such
bad condition. It is very difficult for the people like slum to reach the objective health for all
26
because they are still lacking with all human need. Community as a whole have all social
determination in each and every household.
Being said malnutrition is very highest number in Madhya Pradesh, so during field I come
across in slum area of P.C. Nagar and Indra Nagar Bhopal there is many moderate
malnutrition in that community but unfortunately the Government concentrates only for
severe child malnutrition. The moderate children are lagging behind and this problems leads
to severely malnutrition because mostly every household have moderate children. So come
from the poor back ground no one is taking care for their health since the parent needs to go
for work. Therefore that is the main cause of malnutrition in Madhya Pradesh and also whole
country. Government are not response from the grass root it starts from top to bottom not
from bottom to top. What is the next step for the Government to take in order to reduce the
malnutrition in the country in future?
Communitization
Communitization is process to involving the community services through National Health
Mission (NHM), in order to enable and empower them through leadership from the
community or ASHA workers. The mission of the project is to provide and access to
equitable, affordable and equality health care and accountable. Communitization is the
community based monitoring and at present it called community action for health.
Therefore, reflect back to the community during my field in Bhopal, while interacting with
ASHA workers I realized she is a role model for the people in the community because she
has different roles and responsibilities. Looking at her action in the community through the
services she deliver it is wonderful for them to aware and understands about the different
social determinant. ASHA workers play the major role along with AWW and ANM in the
community especially during VHNC. She support and response to the women in community
who are in trouble during their delivery time. What I observe from ASHA workers in the
community she is passionate and committed to her work. Being ASHA workers is not easy
task but what ASHA did in the community it make me realise and amazes about her
compassion towards the community on how to improve the health condition in the
community. I appreciate about what ASHA workers done in the community because when I
think and reflect about the work and pay she got it make me understand that it is truly
volunteer work. It is great to have ASHA workers who did tremendous work towards the
betterment of the community and make the community healthy. Unfortunately, what I have
27
experience in urban slum in Bhopal I use to think, sometime people did not realize their need
because ASHA workers have to follow and inform or call them to come during immunization
in the centre. Hence, what I understand here is the community need to cooperate and join
hand together in any development in the community or else nothing succeeds like success.
Communitization also process of community monitoring and planning to practice health by
empowering and engage by themselves for improving health services. Community need to
put all the effort to work on the issues faced by the community. Reflect back to the field
experiences, Related about MDGs Communitization of health and education is one of the
biggest problems and life-threatening of health services to achieve till date. What I observe in
the community during field, there is no PHC nor CHC in the community, and talking about
the education people are still lacking behind without any proper basic education. Being
community health practice it reflect me, community should be actively participate in any kind
of development be it health, education, water and sanitation etc. Hence, be with urban slum
people it make me to reason that they are being betray by the higher authority.
Thinking about communitization is also challenges task to improve public health services.
People will faced lots of problem when it come to NHM program because the quality of the
medicine and the way they treat people in the PHC and CHC is not up to the expectation of
the public in any institutional. No doubt there is improvement but there will not sustained in
the long term. Therefore, the concept of community participation is the foundation
communitization.
To conclude, community need to tackle the problem of the public services. However,
communitization is the example on how to create the service in order to improve the health
condition in the community.
Management
During the session with Mr Prasanna on “Management” I learnt there are three main source
of management i.e. Man, Money and Material. Being said by Mr Prasanna, “keep holy space
for thinking and reflect to recharge for yourself”. It reflect me that the words creates lot of
meaning on how to spent time for self and make use of it so that it will be better way in the
future. Therefore, management it is very important and also play main role for day to day life
of each and every human being.
Through the session on management by Dr. Ravi Narayan, what I understand and learn, need
to plan and work on what we want to do because many of us always want to plan for the new
28
thing but unfortunately not willing to learnt and share with the others and what exactly we
learnt for the pass. This kind of practice fail the plan, actually need the supportive supervisor.
Also what I learnt and understand from Sir Ravi regarding management is to understand the
place and community, to find out the problems and collect information, records, district plan,
manage health programme, manage relationship with Govt., PRI, manage human resource,
monitor and evaluate, develop good relationship, promote and advocate health, promote
sustain partnership and promote community participation. What I use to think when I was in
the field and look back to the people who have all the social determinant need to find out
what exactly the problems face by the community and what is the next steps or solution to
use for the betterment of the community in the future.
Globalization
Globalization is a both positive and negative element. What it consist and how it affect the
work in the community level? It consist and effect the work through networking, free trade,
world without boundaries, standardization, global village, homogeneous, technological,
climate change, changing culture, corporation, compilation, essential drug, political,
economic boundaries.
I understand in term of community profit is not benefit money but it is to spread the wing and
welfare to the community/ society. Therefore, when we talk about health for all it include all
about sanitation and water. So health and education should not be a market. In 1990’s it came
through bank mechanism of globalization. So in India the cream of Indian farmers die due
failure of cash crop which they shifted from food crop. Globalization it also leads to child
malnutrition and suicide. When it comes to child malnutrition it is all about cash crop and the
mother don’t have time to feed the child properly. So the globalization become the profit and
benefit for the individual person. Climate change is another big issue of globalization. It is
the high time to increase the people’s voice and empower them.
The framework of globalization
1. Serving as “think model” by providing a basic for the development of future scenario
on health.
2. Economic factors.
Secularism
Secularism means respect for all religions. It stands for belief that the state moral and
education should be independent of religion. In fact, Indian constitution of 1975 includes the
29
term of secularism. But what we practice is different e.g. dalits is not free to worship as they
like. Article 25 (1) said freedom and conscience and religious is secured to all citizens. There
are many laws in writing but we never practice it. So faith should be received in the name of
aid and uniform civil code should be equal law and equal treatment for everyone. Therefore
each and every religion is highly respected. It should be a deep respect for individual and
small group. So can India have uniform civil code? Thus, knowledge need to grow because
someone get from the deep inside from others.
Universal Health Coverage (UHC)
Ensuring access to health care for all Indian citizens in any part of the country regardless of
his or her income level, social status, gender, caste and religion. UHC by 2002 vision was to
reach people in every citizen, including patient and outpatient care with free of cost. People
have the right to choose the facilities e.g. Public sector facilities and private sector/ providers.
That is the dream of universal health coverage.
Health is not complete coverage by the Government of India that is the big challenges. The
National Integrated Mission said we must get to the Government services but we in India
have all good laws but unfortunately only on paper also have a tendency never to follow what
we thought. Basic challenges of UHC are equity, access, corruption, social determinants.
Corruption is not only money but also breaking the role in what person supposed to do and
social determinants it include caste and class.
Empower action group of state: BIMAROA
Bihar, Madhya Pradesh, Andhra Pradesh, Rajasthan and Orissa.
Understanding regional diversity and contradiction:
1. Diversity health system development
2. Diversity in health human resource development
Committees that addressed health care in Indian History
1. BHORE Committee in 1946
2. MUDALIAR Committee in 1961
3. Committee on multipurpose workers Kartar Singh report 1973
4. THE Srivatsav Committee in 1975
Sanitation
Sanitation is the hygienic means of promoting health through prevention of human hazard of
wastes as well as the treatment and proper disposal of sewage or wastewater. Providing
30
sanitation to people requires a systems approach, rather than only focusing on the toilet or
wastewater. The experience of the user and wastewater collection methods, transportation or
conveyance of waste, treatment and reuse or disposal all need to be thoroughly considered.
The main objective of a sanitation system is to protect and promote human health by
providing a clean environment and breaking the cycle of diseases.
Urbanization
Urbanization is the key factor in health equity development. Land is the main problems in
today generation. The urban expanding the process from rural to urban. By 2030 the
population of India will be 50% urban population. So the process of urbanization is talk for
all the affected and urbanization itself is social determinants. Urbanization includes housing,
education, income, water and sanitation, health services, social status, employment/
occupation, population, transport, life style and food production.
The world became urban. Half of the population live in the urban setting. Urban setting
attributes as size, density and vertically affects health equity both positive and negative.
Poverty leads to slum and ill-health. Slums are extreme form of poverty related to health.
Good health is a determinant of individual and societal economic status. Governance is not
just about the Government; actually governance is the key to improvement in unhealthy
social and environment in urban setting. So privatization is very aggressive and India has big
domestic market and big export.
Women’s health
When a woman is healthy, she is happy. She feels active, creative and wise. Therefore every
woman has the right to complete health care throughout her life. Women health is affected
not just by the way her body is made, but by the social, cultural, economic, environmental
and political condition. According to the book where women have no doctor, 2007 said, 80%
of women found to be anaemia and 20% are stunted. So if women already malnourished and
become pregnant she might face double problem during her delivery, e.g. heavy bleeding,
baby will be under weight. Also one woman die from a problem related to pregnancy in every
minute. The poor health of the women is due to poor nutrition, gender inequality, frequent
pregnancy, over work, poverty, lack of education and lack of appropriate health care. The two
major root cause of women health are poverty and low status lead to many issues of problem
faced by the women. Mostly in Indian context women become poor before they are born
because born to be women did not get enough to eat during pregnancy. Women in large are
31
neglect in the areas of health care and education. To be truly healthy as women need to
change and make decision if necessary for good health.
Social Vaccine
Social vaccine is a new metaphor. It is study of social, cultural, economic, ecological and
political determinants of health and constitutes the key stone for use of evidence for
development of public health policy. Social vaccine it is just and ideas. In community doing
something through action, counselling, sing, dance, festival, games, SHGs, youth group,
vocational training, improving agriculture. This is what try to make in the community is
social vaccine. Health is socio-cultural and political process. The primary determinants of
disease are mainly economic and social and therefore its remedies must also be economic and
social medicine and politics.
Therefore the social vaccine needs to focus into disease and ill health. As a result to tackling
the diseases we need to look on poverty, gender bias, conflict, stigma and social inclusion.
TEAM
T-Together
E-Each one
A-Achieve
M-More
To me define or communicate the meaning of the team, is “Team is a group of people to
think and encourage each other to achieve aim and objectives and motivate to move
together”.
Stages in Team building
Forming
Storming
Norming
Performing
Disease
Disease is an abnormal condition of a part of organ or system of an organism resulting from
various causes, such as infection, inflammation, environment factors or generic defect and
characterized by an identifiable group of signs, symptoms or both.
32
There are two types of diseases:
Communicable
Non-communicable
Communicable v/s non-communicable diseases
Communicable diseases are spread from person to person or animal to person. The spread can
happen through air and direct contact with blood. Cold is an example of a communicable
disease. Non-communicable disease is medical condition which cannot be spread or passed
from one person or animal to another. E.g. cancer, heart disease and diabetes are the example
of non- communicable disease.
Socio-economic context:
Differential exposure
Differential vulnerable
Differential outcome
Differential consequential
Conflict
Conflict is disagreement or argument. Conflict can be negative but also differ from person to
person perspective. E.g. development is different for each individual. Therefore to avoid
conflict need to withdraw in the early stage or one side should be little down of the ego.
Otherwise there will be big problem will a raise.
5 ways of conflict:
Avoiding style
Smoothing over
Compromising style
Dominating style
Joint problem solving
Health as human right
Health as human right needs to be very ethical framework. Human right to health means
everyone has the right to achieve in term of physical and mental health, include access to
medical services, sanitation, food, housing and clean environment.
Therefore, related to the services of community health better than public health, in order to
realize the requirement we need the voice of the people. In the context of health and health
care there is inter-connected right lead to social, economic, political, civic and cultural rights.
33
The human right to health means the hospitals, medicines and doctors must be available,
accessible and acceptable in term of basic equity of the people.
Mental health/Mental illness
Mental health problems range from the worries we all experiences as part of everyday life to
serious long-term conditions. Mental health is a sense of wellbeing, confidence and selfesteem. It enables us to fully enjoy and appreciate other people, day to day life and our
environment. When we are mentally healthy we can be form positive relationship, abilities to
reach potential and deal with challenges life.
According to WHO (World Health Organization), mental health is "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". WHO stresses that mental health "is not just the absence of mental disorder".
Mental illness is a health problem that significantly affects person mind, behaves and interact
with other people. A mental health problem also affects person thinks, feeling and behaves.
Mental illnesses are different types: anxiety, schizophrenia, bipolar mood disorder,
personality disorders, eating disorders, depression. Mental illness results from complex
interaction between mind, body and environment.
Chapter 4
34
The song
“A great song should lift your heart, warm the soul and make you feel good.”
― Colbie Caillat
Role play and skit is another technique that warmth just like the music in each and every
mind. Music speaks to the heard of the people in many ways. The mind and thought to listen
in deep thinking and be yourself happy in any situation. Music speaks to individual, group
and family.
Monsoon game related to community health
Monsoon game related to community health, first my mind become so numb; personally I
don’t know where to begin and where to end. It’s really take time for me to express my
feeling when it comes to reality.
According to the play, from the beginning itself I could see there is high, middle and low
class and play the same when it come caste. When I describe the whole picture of the game it
strike my mind the monsoon game turn out to be hand in hand because poor become poor and
rich become rich.
Look back to the game how it relate to community health, it truly affect majority of the
village people. Since, the landlord takes all the power and play very important role and
responsibility for all the people in the village when it come to the land because he is
economically free, I could say while playing the game and perform as adivasi family it is
really hard and very difficult time to manage in everything when it come to the monsoon. The
whole community are facing problem but unfortunately the lower caste face more difficulty
because the poor family did not have sufficient land to plant the crop and they are the first
person to face simplicity.
Whenever the monsoon was bad the whole community has to face different problem because
they are lacking of food items and through this the health problem of the people become
worse especially the people who are depend economically into agriculture.
According to my experience through monsoon game I feel the landlord take advantage for all
the poor people and make use all his power through his gang and keep attack the poor people.
Mostly people when it comes to the monsoon game they faced health problem because they
don’t have anything to eat and the children in the community become malnourish and live
without food for many days.
35
The whole community are facing health problem and there is a time the poor didn’t have
anything to eat and different diseases attack them and no money to take medicine, and they
do not have sufficient food to eat. People suffer and face the health problem till the end of
their life and landlord has no heart feeling as human being.
When it come to community health through monsoon game there is many areas bias is very
strong even the Govt. and bank never think about the poor and lowest class, because the poor
cannot afford to deal or bet with anything.
Caste system in India and its effects on health and development
Caste system in India divided into four categories i.e. Brahmin, Kshatriyas, Vysas, and
Sudras. These four categories play the main role in India. Looking to the picture of caste
system in India how its effect the health and development, this is the main difficulty that
India face problem since before independent and till today still practice. Caste system is not
only relation between caste members, but also their own notions of personhood, identity and
self-worth. There is no support system from the high class in Indian society when it comes to
caste. In fact the caste system is a great sense of caste awareness.
When it come to health the caste system also create lot of difficulty because the people from
the low caste they did not get equal opportunity or no privileged for lowest caste as they are
from low caste they deprive from their rights e.g. high caste are not allow the low caste to
enjoy the facilities provided by the Govt. especially in remote areas like Haryana, Bihar,
Utter Pradesh.
Besides that when it comes to health the high caste did not face any problem because they are
economically free of mind and tension but when it come to the low caste they have to think
twice before going to any health facilities. The higher authorities of any health centre always
looking down for the low caste and due to this also automatically the low caste will suffer
and end up and dying with chronic diseases. Also no sufficient treatment for low caste
compare to the high caste because the low caste have not financial amount to pay for the
concerned doctor.
Therefore when we talk about development the people from the low caste are not improve till
today, seem someone say India it will take time to more than 50 years to develop, and I think
this is because of caste system. India has different priority and concentration towards people,
this is always the high caste will come front and lower caste every time behind. Never give
change for the low caste to develop or improve. When we talk about development the Govt.
36
try to improve the condition of the low caste but unfortunately the high caste are always try to
pull down the low caste especially when it come to education the teachers discriminate the
students from lower caste and teacher have low expectation towards the low caste children
and girls and a demeaning and complete abuse attitude to poor children especially slum
children. Also in rural areas almost people are low caste so the high caste is not interest to
pay attention to the need of the low caste.
India has the three main practices till today as evil for everyone, i.e. economic, religious and
caste system which mean most of the rich are belong to the high caste people. Economic
difference is the way caste and religious discrimination. I doubt that how we India think that
will improve or eradicate many social evil until and unless we think and understand the three
main source that we are facing in this generation.
Role play and street play
Role play and street play is beautiful reflecting areas I could see into reality. It speaks a lot
and also makes the people understand about the reality and situation facing by the victim.
Hence being participated in different role it reflects me to “Think, Rethink and Analyse”.
With these three words I understand the meaningful of life be it individual, group, community
and society. Recalled back about all the play it reflect me, I am pretty lucky to have very
comfortable life because when I think, rethink and analyse with the life we are born with
diverse contextual. Many people who are not lucky enough to get one single strip of medicine
they have to suffer a lot in their life. Rich become rich and poor become poorest. We are
living in 21st century it is high time the underprivileged should raise their voice. We live in
this society with equal rights and responsible when it come to the law. But unfortunately, all
the dirt works have to be done by the poor in this society. Need to realize the important of
voice only if we address the issues and be united that is the strength. Society without poor
will reach nowhere because they are the one to clean every corner and make the society
beautiful. But sad to say many people are not appreciating their work, instead they use to get
blame. Poor people are always the victim of the society. I reflect the play while travelling
many a time people especially educated they don’t care to through anything in everywhere. It
is massive problem need to be issue. When I try to analyse it may be right or wrong people in
this society are self-interest and never consider about the poor people. The body language of
many people in this society are let the poor suffer it is not our responsibility to think for it and
live comfortable life. The appearance is like doing revenge to the poor, let them do it is their
37
job to do who care. It is miserable to observe the behaviour of literate people are like
illiterate. I use to rethink it the illiterate are more responsible to society than literate. They
care and think about others but at last they are the one who will suffer in their life. As future
community health worker need to address the issues before too late if we want to have better
society. We expect our society to be clean and beautiful but who will be responsible, literate
or illiterate or both?
Chapter 5
38
Every New Music Beginning Comes
“A great song should lift your heart, warm the soul and make you feel good.”
― Colbie Caillat
Workshop and organization visits is another method and tool to explore my thoughts and
understand the reality of the community health. It contribute to my little knowledge in large
amount of understanding about the certainty image of the day – to-day – life. It is like putting
dendrite in the paper to make it stick in one place.
WORKSHOPS / SEMINARS / MEETINGS
Communication
It is great opportunity to attend the workshop on communication conducted by Sir Krishna
and Mr Magimai. The communication workshop it is wonderful and make me realized the
reality. It bring lots of learning inputs, ideas and knowledge on how to use in the fields and
future. By attending the communication workshop it reflect me back to fields because there is
a time that I don’t understand how to deal with people due to language problem especially
with the slum in Bhopal. I am so happy getting the chance to attend the workshop it is
marvellous learning. Always reflect, learning new think in life is like electrified who give
innovative thought and communication to make myself understanding better. Mirror game is
new knowledge on how to reflect back with our self and apprehend the real situation.
Hence, in communication sometime we need to be aggressive but not in ordinary. Whatever
we put in our mind it become behaviour. So, self-perceived need to be together for the
betterment of self and others. There are 3 types of people who mean close to you i.e.
transparent, close and love you. So intra and inter personal is very crucial. Body and mind
belong to the same system. When you get angry it mean killing yourself. It reflect that when
we programme our mind it also think and able to help people and it would be good to think
positive. Self-confident is one of the most important to work in the community as community
health worker.
People participation for health
39
People participation is management, priority, design trust and building credibility yourself. In
the community there are 4 viewpoints:
E, M, W, 3
What I learnt is we should not use the word working with community, instead we can use
working for the people. Community define set of individual who shared common
understanding. If our goal is to work with community which means we are fool to our
experiences in order to understand the community. So we need to empty our mind in order to
understand the community. Keep everything in mind and make yourself empty. In all goods
there are different areas i.e. provision, production, consumption, co-production.
To keep in mind working with the community should not select the problems that we cannot
solved. So there are three things in need i.e. feel need, projected need, analysed need. There
also three types of approaches in community i.e. relief and welfare, community development,
sustainable system development.
CATWOE: - Client- Actors- Transformation- Worldview- Owner- Environment constraint.
Therefore, input always there in output and output always specification. Whenever we talk
about system always need to separate and clear and worldview is logic scientific. And the
most important to work with the community is to accept their opinion and do not draw the
line on it.
Community health environment survey skill (CHESS)
Workshop on CHESS is to create the platform for the person who are working for the
betterment of the environment form different organisation around the globe. Attending the
workshop on CHESS I learnt coal mining is the biggest threat of energy with 40% and also
learnt biomass mostly people use for cooking. It reflect me, many people talk about the effect
of environment but what it strike me is whenever we talk be it identity, culture, water,
environment it all related to health because this all effects the life style of the people in
future. Therefore, if I think about coalmining communities are the victim in that areas and
that has the impact of diseases. It show the result towards people in community with diverse
problem.
Art practice is excellent it reflect me, the coal mining areas effected the whole environment
also effected the health condition of the people in many way. It spread kind of diseases when
it come to air pollution, water pollution and climate change. When I try to reflect about
effected areas it remind me about my own state (Meghalaya). Wherever the coal mining areas
40
it generate lot of problems for the community especially water, forest and this effect the
health condition of the people. In some part of Jaintia hills district Meghalaya there are quite
numbers of children are disabled. So this make me reflect in deep thought may be because of
coal mining that create that problem during the pregnancy. Many women are working in coal
mining areas in that areas, possibility it will cause the foetus very dearly.
The art presentation is generate the areas from the 1 st phase – 5th phase. It is from the
beginning of the work till the environment destroy. It reflect me what will happen after the
destroyer of the environment and what will be the benefit for the future generation. I use to
hear a lot about people appearance in my own state because they thought only coal mining
give them livelihood. Fortunately or unfortunately people never think for the future of their
children. Community itself involved in the coal mining because they didn’t understand the
effect of the coal mining. It is very challenging to work in the community because of that we
need to make and convince them with different methods of awareness in very simple way to
touch their heart. Therefore, to get proper information is only the community can share their
culture, practice, religion, believe etc, so need to have good understanding with the
community.
While listening to the presenter, learnt green evolution is the main factor effect the health.
Hence, as health worker we should think beyond. Whenever we talk should not concern only
health issues but should deeply because it speak in very deep meaning and it focus in many
areas example biological atmosphere. It is 30-35% life expectancy of the people who are
working in coalmining/crash stone are shrink. Therefore, we are living in the 21 st century
with huge problem especially climate change we are face day by day. It will be the great
challenging task for the public health because is very sensitive to the climate change it
include use of electricity, water, waste management and air pollution.
Hence, what concerned me, always talk about the law of right and responsibility, people
strive and died due to air pollution be it half of indoor and outdoor population. But
unfortunately, never have the discussion on it. Be it state level nor central for the effect of air
pollution. Many expert talk about health and discuss but uneasily very few are talking about
the air pollution. Actually air pollution is one among the major problem are facing by the
people that we never thought. So if possible we should bring that issues into notice before too
late. Let the people think and debate on it on how to take up that issues?
Right to Free Medicine
41
Attending the workshop on “Right to Free Medicine” I learnt it is one of great experience I
have come across but fortunately the language is affects my understanding and not up to my
expectation of learning, but hope I will work in future. There is experience Doctors and
experts person from different organization coming to share their ideology toward the
medicine and discuss to free medicine. Discussion among the participants is to understand
and sharing the ideas on how to work with right
to free medicine because when it come to
medicine it is the Government responsibility to
take the final decision.
I learnt Madhya Pradesh (MP) has 72.59 million
populations. When it come to health Madhya
Pradesh has 50 district hospital,
56 civil
hospital, 333 CHC, 1159 PHC, 8659 SHC and
48795 Gram Arogya Kendra.
I learnt the role and responsibility towards the
decentralize procurement system, the state
drugs is responsible for state contract. The
strategy of health system is drug policy 2009
ensure from District hospital to Gram Arogya Kendra, man power and capacity building.
According to the presentation by Mr. Arpit I learnt there are 50 district drug stores. During
2014 mostly prescribed only generic drug.
During the presentation by Dr. Amit Sengupta, I learnt health care system it is unregulated
private sector and public facilities did not provide free cost of medicines. Also learnt 70% of
medicine care cost is borne by people through “Out of Pocket”. 70% spent buying medicines
source of health care.
I learnt if the big company or branded coming to the public place and the people always think
it is the best medicine and more curable because the brand speak a lot to the people but
unfortunately the branded get lot of benefit from the public. Beside that I learnt India is the
3rd produced of drugs in the world to over 200 countries. The medicines price control by the
company. The three categories term to know is lifesaving, essential and non-essential.
I learnt the trend in drug industries is manufactures especially large manufactures, who can
pay heavily to “Buy Health Care”. Adding to that I learnt the production of high expensive is
42
high demand and with low cost is low demand and short of medicines to supply. The
medicine ceiling prices is fixed for all drugs under price control.
I learnt when it come to Tuberculosis (TB) in India itself there are 170 out 200 TB patients
unaware of DOTS programme. And 50-80% TB patient in India still seeks permission from
private clinics. According to the report I learnt in Mumbai itself 100 Doctors provided 80
different prescriptions for the TB patients.
During the presentation by Dr. Narendra Gupta, I learnt the components of free medicine
scheme that is hard ware which means to make drug available in Government hospital and
software which means to change the prescription behavior of doctors. I also learnt “the best
medicine in life is free”.
I learnt during the group work is one of the great experience and opportunity to discuss and
sharing ideas with the expert doctors and expert NGOs worker. I learnt attending this kind of
workshop is one of the good opportunities to have network with different expert people for
different states and organizations. Group work is very helpful to come together and share
among the group regarding the focus topic. It is easy for the group to understand by
distribution with some points and ideas; I learnt the team work is very important to complete
the task. Towards that right to free medicine in community the NGOs need to involve more
for the betterment.
Presentation by Dr. Ravi D’Souza, I learnt rational drug therapy is logical and appropriate.
This drug accepted all over the world. Further I learnt there are two types of drugs i.e.
rational and irrational drugs. There are 60,000 pharmaceutical available in India. During the
presentation I learnt the irrational drugs as cough syrup, pain killer, and anti-anaemia. Use of
irrational drugs is inappropriate drugs e.g. antibiotic, wrong dose, wrong duration and selfmedication. Also increase side effects and decrease quality of treatment. I learnt the doctors
should prescribe minimum number of appropriate medicine and provide generic name of
medicine.
To be honest I did not learnt up to my expectation because of the language problem, but
fortunately I manage to understand somehow. Hope in future I will cope this problem for
better understanding. Adding to that I learnt Rajasthan and Kerala model to medicine is the
great example for other states to state right to free medicine because till date these is only two
state had successful to right to free medicine.
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I observe the workshop is well plan and many expert workers and doctors are coming from
different organizations.I observed most of the speakers spoke with Hindi language since
many participants prefers with Hindi language. And observe few words from the poster
“People have to pay ten to hundred times more than actually price from the same
medicines when paid out of their pocket”. “Nexus between pharma companies and
health care providers has to be broken”.
Observe there are lots of discussion and questions to the presenter and understand Ayurvedic,
homeopathic and generic/ branded branded medicines. The participants actively participate
by raising questions and contribute ideas and knowledge according to their experiences. And
mostly participants are men and discussion is well-developed and makes the day successful.
The monitor of the program play important role and manage the workshop successfully.
Reflection
Attending the workshop on “Right to free medicine” it reflect me that it is the right time to
start in grass root level to “right to free medicine” because India majority are still poor
background and many doctors take advantage for the poor people who are not aware about
what is generic nor branded branded medicine. Multi Company from a broad try to brain
wash the poor people be it illiterate or literate by use the brand name. It reflect me; myself
also think the expensive and brand company is more effective and curable but unfortunately
the generic medicine also the same supremacy.
It reflect me the big company always make the people think that good medicine is only
branded but unfortunately the companies try to fool the people and my questions, it is the
high time for the organization who are interest into the topic of medicine better to start to
spread the message to the public and create awareness and make people understand the
different through media, magazines and newspaper etc. also reflect me the networking
organization should come up and work with different community and involved more in the
rural context because rural community are more back ward and need more support and
guidance from the organizations.
Alumni Meeting
First of all I would like to thank you SOCHARA family for giving me the opportunity to take
part during the Alumni meeting held on 7 th- 8th December 2015. It is wonderful to see the
44
alumni of SOCHARA are sharing their work
experiences, it’s bring me lots of inputs and
ideas.
The overall reflection about the two days
programme it make me think very broad
because it is the platform to meet and interact
with
different
people
with
different
background and also listen to the lovely
stories and experiences in different health
issues cross India. The thoughts spoke by the
speakers it is like open eyes for me and try to
reflect what is going to happen in our country and over the globe. The words by Dr. Chandra
make me think any community need to empowered mother in order to change the community
especially when it come to children because she is the one who take care and responsible for
the children. I am thinking, mother is the first person in the world to care and understand
because she is the one who carry her child for 9 months and make her smile when her child
healthy.
Fr. Claude said, “Served is the one to give strength to the people”. Thinking about his
thoughts it reflect me and recalled my field experiences because if we don’t have passion and
commitment towards the people who need help it will not bring any meaning at all and at the
same time how to serve and empowered people. Being said, “There is no respect for others
without humility in one’s self”.
45
What I learnt during the programme, it is
not easy to work with the Govt. of India
nor outside India? It is big question
marks for that? Unfortunately when I
think about that, I question myself and
think when it come to health issues it is
the big problems that people are facing
with the Govt. especially when it come to
CHC, PHC even District hospital people around the country they are facing the problems
because there is no proper facilities and treatment for people who are in need. So, when I
think, question myself what will happen to the people who don’t have anything to eat nor one
day of meal? What will they do if they have health problems where will they go for health
treatment? I keep thinking about the Millennium Development Goal, it is possible to reach
the goal and bring the objectives successfully.
The speaker Dr. D K. Srinivasa said, “Poverty and Gender equity is tremendous issues”.
Being said by the speaker it recalled my field experience in Bhopal while interact with the
director of Organisation Dr. Rahul said poverty is the main issues we are facing in India.
What I try to reflect on Millennium Development Goal said, by 2015 hunger and poverty will
eradicate. No doubt improvement is there but till date did not reach the goals. Fortunately
what I come across Millennium Development Goal try to reframe new goals and objectives
by 2030 will eradicate hunger and poverty. I keep asking myself may be or may not be will
see according to the progress of the work to come. Again taking about “poverty and Gender
equity” as the great problems it reflect me by the words of Harsh Mander said “until and
unless second class change their mind set India will never change”. Here, I agree with his
thought but my question will the second class people be able to practice, it is up to them.
Today, Indian context the health issues of the people especially rural areas become worse day
by day. The mortality rate in our country is very high till date. I start thinking, we are 21 st
century but unfortunately we are still like primitive age and this make me realized on how to
address and understand the different health problem facing by many communities in our own
state.
The discussion on ASHA workers during the programme, it bring me back to the field
experiences in Bhopal. I use to think ASHA is the role model, fortunately and unfortunately
46
what I come across about ASHA in Bhopal they are role model for the community and at the
same time they are doing so well and commit to their work. They are very passionate and
encourage people to understand the important of health. I try to reflect on ASHA activities, it
seem like ASHA have double job than the supervisor and on top of that the blame and
discouragement from the community and have plenty of challenging in the field. The work
and the pay is totally different, fortunately may be there is no good model to implement about
ASHA workers.
Therefore, when it come to public health it is also public responsible and the state
Government. When we look about and beyond health today life people are prefer to go to
private sector because they get better treatment than the Government sector. At the same time
the AYUSH doctors is very limited to cover the areas and provide services for the community
people. Thinking about that why we have limited doctors in our country since there are plenty
of doctors who are capable for that services? Keep me in dark and try to understand and raise
the big question? Why and why?
Thinking about the rural areas what they have in their hand. As we all know India is
agriculture country people depend in agriculture and if we are miss use the land of the people
like rural areas they will be the victim, migrant and displace around the country ion future.
What I learn during the programme is that rural people of India have lots to eat but
unfortunately they don’t have money in hand. Recall back about my field experience in
Bhopal and Jaintia hill (Meghalaya) make me think sanitation and water is the major issues of
social determinants that people are facing in everyday life. In order hand even domestic
violent have huge impact of the health issues. Therefore, thinking about health issues of the
people, through the sharing from the speakers I learnt that domestic violent, alcohol and
mental health are coming together and what we can do, the solution should come from the
community how to work and improve the issues because community movement must come
together in order to fight for the betterment of the community, reflect above thought what I
feel health should be social movement because we need to response to our own neighbour
and bring changes in the society.
Through the panel discussion about mental health with primary health care, I learnt when it
come to primary health the doctors failed their profession because it does not work when it
come to mental health. It reflect me that mental health is another issues of health that
everyone be it Govt. nor NGOs are neglected. It reflect me non-communicable disease like
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mental health is the biggest challenges at present in our country. Thousands of people are
suffering with mental health use to ignore it by 10-20%. This will cause to have very poor
health in life. It also reflect me the counselling they struggle to work with the community
because working with the community need to understand the culture and the practice of the
people. Common mental disorder is another issues of health problem in the community, so to
start with it need to work together with community in the grass root level. Coming back to
health care it is unaccountable because today health care seem like industries, it is only the
benefit and never think how to improve the health condition. It reflect me, everyone worried
how to improve and make a change in the society.
It reflect me during the programme whatever we think about health it should come from our
self because why health become poor day by day? It twist my mind may be because the lack
of commitment is very poor from individual who are willing to work towards the people who
are in need of hand. What I use to think and reflect about that is if the leadership and
Government join hand together and understand the community without any corruption then
there will be improvement in the society.
To conclude, coming together and sharing experiences and lovely stories is always
encouragement and make me think and recall about the pass, present and future. Being
community health fellow of SOCHARA it is delightful and be the outcome of the new
generation of community health. Ethics should practice in our life that is the greatest practice
to be the future community health, also learning to live together in harmony.
Medico Friend Circle (MFC)
First of all, I would like to thank
you SOCHARA for giving me
the opportunity to attend the
Medico Friend Circle (MFC)
meeting
in
Raipur.
Travel
together with fellow-travellers is
another experiences with lots of
fun, games and song.
We fellows divide into three groups to visit Mitanin in Raipur from different areas of slum.
With guidance and support of Ms Rizu of (SHRC) and Mr Adithya we visit Mitanin in
Veerbadhra Nagar No-49. It is good experiences to interact with Mitanin for the first time. I
48
never thought in my life to get a chance to interact with them and listen and learnt from their
experience and work. Use to hear about their tremendous work and fortunately it is like
dream come true to get the casual interact during the Raipur visit.
Mitanni means “Best Friend”. Getting to interact with Mitanni and Mahila Arogya Samiti
(MAS) in Raipur is pleasant understanding because get to know and understand about their
work toward health. The Mitanin start the day with the song. The meaning of the song is “We
did everything for others but at the end of the day we did not have anything even to cover our
body and didn’t even have foot path to sleep”. Reflect about Mitanin I admired the way they
conduct themselves and concerning the work. To start the work with the music is good
exercise because it like relaxing the mind and thought of the day. It bring effort to refresh the
idea on how to cope up with it and never give up!! It remind me a lot about music, how music
change my thinking because it create meaningful to life. Music talks a lot in very profound
way. It form meaningful and give joy to many people and realise the song is like medicine to
relax and reduce our tension and worried. Music speak in very significant atmosphere and
mainly the meaning of the song give power and strength to some extent.
The Mitanin and MAS working hand in hand in order to improve the health condition of the
people in the state. My first reflection towards Mitanin is they work better than ASHA
workers. This Mitanin is the community health worker which is known in Chhattisgarh
instead of ASHA. It also reflect me that the work they do is very heavy compare to their
salary but still they put all the effort and commitment to work for the betterment of the
marginalized in community. The commitment people it is ray of hope for improvement of
health. Therefore, it will surely change the health condition in near future. I keep thinking the
different between Mitanin and ASHA? If we try to look about the work of Mitanin is better
than ASHA but keep question myself ASHA worker is literate compare to Mitanin. And then
how Mitanin doing well then ASHA. There is any method or technique that Mitanin are
followed or the State Government take huge responsibility for community towards health.
The Medico Friend Circle (MFC) is group of doctors come together and take up some issues
of social determinants and work for the people who are vulnerable/marginalized.
It is the first experience I get to involve with expert people from different back ground and
interest. The mfc meeting is on “Urban Health”, the discussion on this topic is like open up
my eyes. It is also platform or open account to my journey as future community health
worker. My mind and thought haunting on how the urban marginalized especially Urban
49
Slum and migrant are suffer in the context of health in this era. As we all know health is
wealth then if there is no improvement on health how we expect to reach the target of MDG.
Various papers are discuss on urban health on how the marginalise are access to health care
when it come to health services in the urban areas. Reflect me it is the great opportunity to be
the part of mfc meeting because it give proportion of information in many areas of health
issues when it come to urban health system. The two day meeting discuss on urban health
with different paper on urban health. It give me lot of ideas and knowledge on urban health
system. When I try to reflect about the services of health system in urban it is mainly control
by the private sector. It show, the lack of management of Government is become so poor. The
health system become the market system in today world. Therefore, the poor people who are
vulnerable become the victim of the society. Thinking of that the government of India and
state government should take action on how to make health system will be available for the
poor people and make the change. According to the MDG is supposed to reach some of the
targets but unfortunately the indicator of health remain the same in many areas. According to
the discussion the Govt. hospital collapse since 1980’s. It makes me reflect that if our health
system fails then why Govt. is not responsible for it. What is the reason behind and what
higher authorities think about the future generation of the country. In that case, it means the
Govt. are preferring the private sector and the top priority is individual benefit.
Hence, it reflect me that it is great meeting
with the professional activist of the MFC
that make me think in many way and try to
relate the larger city it become larger
monopoly. The beautiful part is the
environment around make us comfortable
and feel free to be the part of the mfc.
What I observe and learnt from the mfc
meeting is all the professional activist raise their points and critic the paper to improve and
work in some areas that not reaching. The thought and ideas of the intelligent activists like
bringing connotation to my mind towards “Health for All”.
The main issues that I like the most is all the senior MFC speakers reflect about the different
diseases that people are facing today. Therefore, in the context of the poor if the govt. health
system are not function properly where all the poor will seek services. Whenever the
presenters and discussion on slum my mind bring me back to urban slum Bhopal. It is very
50
painful and hurt whenever I remember about the people in slum. It mind become so numb
because I really don’t understand the health system in our country. Poor become poorer and
rich become richer. The life style and living condition is worse among the worse I could say.
They lacking behind in all the social determinants including the environment, waste
management etc. They face lots of challenging when it come to health facilities because they
didn’t get the proper treatment in Govt. health services properly. According to my
experiences in urban slum of Bhopal I guarantee the urban slum is one among the vulnerable
group in all issues. Therefore, if we keep talking about the issues without action we will
would not reach anywhere. It is good example for young generation of community health
worker to listen to the expert activist in mfc meeting to understand and aware about the
reality and problems of people.
Candle light vigil for the
slum dwellers who continue
to be victims of domestic
violence
Several NGO’s in Bangalore city
organised
a
protest
against
domestic violence at Town hall
Bangalore, on 19th March 2016 from 6.00 pm to 9.00 pm. This protest mostly focused on
eviction of the slum dwellers by chasing them from one area to another area. The protest was
conducted also through song and dance by a cultural group which made the programme so
lively.
Many slum dwellers, both men and women around Bangalore are coming together to protest
and fight for their rights because they feel that it is time to raise their voice in society. They
face a lot of discrimination around the city and many women face problems with the police.
One lady shared her experience in dealing with the police in Bangalore city just because she
wanted to stand up for her rights; as a result, she got beaten up by the police. Strong women
still stand for their rights.
We are the ones who build the mansions and roads. And where are we heading now? Our
fight will never end. The people who clean the city are the ones who live in the slums. The
Government wants Bangalore to be clean but they don’t want slums. The slum community
always stays united. When it comes to politics, the politicians are very smart and cunning,
51
when election time, saris and sweets are the
price of their votes. During eviction they pick
people like waste. Most slum dwellers leave
for work every morning not knowing whether
they would still have a home for themselves
on their return. There is no peace in mind
because we did not know how long will be in
that slum areas. Therefore, lady from VIMOCHANA organiszation said, the law is the same
be it in the city or in the slum. We should not be afraid to fight for our rights in front of the
police. To do so we need to be united and
fight for our rights. The culture of the
government is to push us out in the slum.
Actually politician is the one who always
become mafia and capture the land but the
Government never fight for it. Due to that
we need to unite in one strength and not to
be scared the law is always with us. Therefore if we want justice we need to always fight for
justice.
Reflection
On reflecting on the protest it made me think and
realise about how much the slum dwellers suffer
and struggle to live. Different NGOs joining hands
together is like a ray of hope for them. I try to
reason about the reality of everyday life especially
in the slum because they feel it is time their voices
are heard by the higher authorities. As human
beings they deserve a space to live in peace. Instead of using resources to construct big malls
and buildings for the benefit of rich people. Beside that I wondered to myself, if rich people
keep complaining about their daily needs then what will happen to that of the slum dweller?
The answer is up to everyone who lives in a society.
Panel discussion on anti-discrimination
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The Alternative Law Forum (ALF) organised four panel discussions on “AntiDiscrimination”on caste, disability, gender and class at Vishranti Nilayam from 10.00 am
to 6.00 pm. The panel discussions aimed to serve as a platform for experts from various
organisations including lawyers and activists to explore possibilities of a movement against
discrimination in law.
Panel-1 Disability
Disabilities manifests across castes, classes and gender. Education for disability is a vital tool
in our society, but its implementation doess not function properly. The Act, 1995 for Persons
with Disabilities (PWD) is to have equal opportunities, protection and rights to include full
participation. But issues of discrimination are still very prevalent. According to the report
only 30% PWD have certificates in all types of disability in India.. There are direct and
indirect discrimination for PWD. With direct discrimination, for example, sometimes people
who have mental health problems are treated worse than other people or are harassed and
refused enrolment in educational courses. Indirect discrimination is often faced, for example,
in theatres, malls and railway stations where these public places are inaccessible and are not
built with infrastructure that is supportive to PWD. Therefore, disability lacks of
interventions and accessibilities. India is the fifth country to sign
the convention on
disability. No one will deprive in the ability and account of disability because in term of
disability their rights is not being recognised, also there is no good services implemented for
the disabled. For example accommodation because there is no proper facilities provide for the
disability be it Government or private.
PWD often have long term impairment in the interaction with the public. So when talking
about identity for disability there are social components to consider. Although two people
may be totally blind, one from the poor class and other from high class, they have the same
disability but different social status. It is important to empower
people with inclusiveness
who fear having to face society.
How do we address issues when it come to disabilities? Regards to that disability is very
much related to caste because many people still have strong cultural belief that disability is
curse or evil spirit happen to the individual. When it come to multiple disabilities, home
based education and care is very important. Life skills e.g. brush, wash and cleanliness etc.
Essentially law itself should provide enough support in society in the process of disability.
53
The question is how do we measure discrimination towards disability? Answer is known by
each and everyone in the society. Basically person with disability have their own uniqueness
but the perspective of people show that disabled person are doing nothing in life. People
should not measure only through look, also need to put effort to adjust with them and practice
in some of the resource that will help them to stand by their own. In term of disability need to
put theory into action and understand their capability and talents.
Panel-2Caste
What is legal remedies? What is equality? What is discrimination?
To understand the questions is up to each and every one of us.
Caste is psychological attitude, it is like operating in the structure. When it come to Dalit is
one of the big issues they are facing till today. Therefore when Dalit question the attack will
start and the high class always have the attitude towards low caste that is the fact especially in
the rural areas. Many a time we talk about the Forest Right Act. Fortunately who care for the
people who come from the low caste? 10-15 years back farmers died around 15 lakhs but
who are responsible for that issues? Did Government care for the life of humble man like
farmer? Not at all? It is sad both forest and people die at last due to irresponsible. Even
though after implement forest right act, 2006 for ST and others tribes still the people from the
low caste are suffer for their land and forest.
Further, when it come to caste system need to have the form of identity. E.g. majority of the
Dalit enter police station in account as victim not as complain man. The police always fell
Dalit don’t have the right to criticize even though they complain. Further they spoke lot about
prevention of Atrocities Act and rules 1995, it is mainly known the SC/ST act. Article 17 try
to abolish untouchability practice. It is also the principle to remove the humiliation and
harassment towards Dalit and guarantee their fundamental in term of socio-economic,
political, and cultural right.
The expert from the field of caste give example of Rohit Mavila how he face problem in his
own University because he is Dalit. The university cut off all his need when it come to
education. So the word “CASTE” should brought up in very large ACT.
Panel-3 Gender
In today world India if we don’t accept according to the higher authority that is “Antinational”. If you are secularism you are discrimination in a myth. It talk about the communal
54
riot in Gujarat how much Muslim people are suffer. They recognize them through name and
colour as muslin religion that is discrimination. The speaker focus two minority in term of
discrimination i.e. Christian women and Muslim women. As speaker these two are the main
target are very much discriminate. Bring civil uniform code it is not Hindu riot. Also mention
that communal prevention bill 95% women not access to law. All the people thoughts women
born as women itself. Therefore this is the time to think in much expanded of being male and
female. 498 (A) act is treat to life and death because act implement to make women safe not
for punishment or harassment whether physical or mental.
Transgender is another area they are facing of discrimination. For the transgender people
identify them through their colour and dress. In temple and church for transgender are not
allow them to enter because the first question for them is you are male/ female. Most of the
place they have discrimination and no peace. India is free country but unfortunately they are
not free.
Panel-4 Class
What is legal frame work in term of class?
It is to have mutuality in labour work. Especially bidi workers or factories etc. Domestic
worker and labour work it seem to be the low pay and there is lot of discrimination. Example
if we look in case 19000 workers in Karnataka the discrimination is very high when it come
to slum dweller. Basically authorities always promise something to improve but never put
into action in whatever they promise. It is just end up simply. So the slum dweller never
allow to occupy any land for themselves. Many movement is very relevant but the media did
not cover at all about the movement of the slum dweller. Since they come from the poor
background they always depend on the others class for their living.
The worker themselves are marginalized be it dalit, farmer when it come to water and the
way they suffer only themselves how much they struggle. Long term problems and failure of
law if it is largest movement need something possible to change. When we look at right/
constitution especially economic right. Right to life is fundamental right. Therefore for slum
we cannot called it slum until and unless identity or declared it as slum can being said it is
slum.
How to identify the living wages?
55
In this context there are contract and permanent workers. Contract labour did not have the
right to claim as permanent workers. In some report there are 400 permanents workers and
4000 contract workers. So the contract workers have plenty of responsible and at the same
time discrimination is very high in them.
Job card and BPL need to struggle. So what was been the role of law in addressing of any
endemic in this country. How can we look when it come to class or treat people?
Indian context there high and low class. E.g. in house of high class person has two domestic
workers. One for cooking and take care for prayer space and another is for mopping and
cleaning the toilet. That is the class system in India.
Engage in everyday because we live for everyday and think for tomorrow. If I try to analyse
about the whole discussion it is all important. People are facing almost only that issues are
discuss above. Many organizations are working in that areas but what we need to do as
individual felt need to accept the challenges so that can feel the happiness of victory.
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Chapter 6
The Beauty of the Music
“Life is one grand sweet song, so start the music”-Ronald Reagan
TEN FINGERS FOR GOD
“Ten Fingers for God” by Dr Paul Brand it is the book that make me to reflect about the
life of the people who are willing to work and uplift the people who are in need especially
with the people who in need of hand. The book inspired me a lot and when I think about the
author and the mother of the Author, it make me think so proud that someone have the feeling
for people of Country. It reflect me and encourage my thought deep inside towards the
unreached people. On top of billion struggle to works for the people like India. Dr Paul is the
first to work for the people with leprosy in India. Through his passion and commitment for
the people of India is the one of great achievement for him because he believe through his ten
fingers will change one person and if one person change it is the great change for him. He
influence many people who suffer leprosy and it reflect me that being citizen of India I learnt
need to really need to have the passion and commitment towards the community who still
lacking behind.
It is the successful story of the backward people who are suffering with Leprosy disease on
how Dr. Paul struggle and work with them with different kind of thought and mind set of the
people. Reading this book it inspired and make me realized that there are many people who
really commit and passion towards the people who are in need of hand. Ten finger is
motivating me to reflect whatever work we should feel it as passion and calling so that we
can work for betterment.
LOOKING AWAY
“Looking Away” by Harsh Mander, helped me understand about the different issues and
lifestyles of people who suffer in their daily life. According to Anthropologist Akhil Gupta,
“Poverty is a form of “structural violence” and that there is little substantive difference
between genocide and simply allowing poor people to die”. The book reflected
how
someone can easily promise and talk about improvement without practice. It is easy to talk
and deliver the message but what we need to do is to take action at the same time if one really
wants to change and uplift the people who are in trouble. It is shameful to read and know our
57
representative Shri. P. Chidambaram the finance minister during 2007 declared an assurance
by 2040, that India would eradicate poverty. When I reflect about the dialogue, I question
myself whether it is possible that India will eradicate its poverty by 2040, because when
recollecting back about the urban slum situation and have my doubts. I wondered ifour
representatives have time to visit the poor and take action like they promise on paper. If our
leaders make promises only on paper, is it of any use? Why is theory never put into practice.
What also shocked me was that according to the Planning Commission submission to the
supreme court in 2011, if a city dweller earns more than Rs.32 a day and a villager Rs.25 they
are not considered to be poor. Reflecting on this leaves me speechless because what can one
buy with that amount in this day and age Does the Planning Commission ever give additional
thought before submitting such a statement?! How can people survive with that little amount
for all their basic needs?? While reading the book I feel there are many areas that we still
need to work hard in and raise our voice and enable the voices of the oppressed to be heard.
Harsh Mander’s sharing of his experiences with street children and homeless people, touched
me and took me back to my previous experience with BOSCO organisation and their work
with street children.. We used to call children as the Children of God’’ but unfortunately
many a time, these very children are victims, especially the girl child.
EVERYBODY LOVES A GOOD DROUGHT
“Everybody loves a good drought” by P. Sainath, is the book that sort of understands the
reality being faced by the people around the country. It speaks a lot on how to reflect about
the struggle of the people in the country; about people from different parts of the country,
especially people in the rural areas and about how much they suffer in living their lives. They
have to struggle for all their basic needs, without much concern from higher authorities. They
migrate to and fro in search of earning a living but at the end of the day they are victimised
by larger society. On reflection, I truly believe many people in our own country are unaware
about the fact that millions of people in this country do not have food to eat. We have many
government acts but nothing put into law. People in rural areas are unaware of their own
rights and this gives people in power the opportunity to take advantage of them. We have
laws that can help but these are not implemented. Farmers commit suicide but who cares
about their life! The Government has a lot of money to give compensation but they claim it is
not ‘good practice. The Government should take responsibility for the poor and have some
mercy on them. They have to address the social determinants in their lives. We live in the 21 st
century and celebrate 68 years of Independence, yet the condition of living for India’s masses
58
is miserable. How can we expect to reach the Millennium Development Goals (MDG) target
if we still have millions in distress in this country? How can we expect to eradicate poverty?
It is just our dream. Can we make it or start practice what we are supposed to do?
WHEELS OF DESTINY
“Wheels of Destiny” by N.S. Hema, is a book that took me back to Jyoti Sroat School under
Bethany Society Shillong, Meghalaya. Jyoti Sroat School is an inclusive school running
classes from nursery to 12th standard. Reading the book helped me understand the struggle of
Hema during her life journey. It is a delightful and encouraging life story of Hema which has
inspired People With Disability (PWD). She has had tough times during her journey from
different experiences around the globe. I enjoyed reading the book. Fortunately or
unfortunately when I try to reflect back on Hema’s life journey I found she is very lucky to be
with a well-educated and supportive family. She got all the love, care and guidance she
needed. I am amazed at her father for his caring and understanding nature towards Hema’s
difficulties. If I think about the others who did not get such a chance and opportunity it hurts
me but it also made me realise that if I ever got the chance to work with challenging people I
would definitely do my best to make some changes to make their lives better. Being said by
someone if you change one person it will be the biggest change in life. I totally find myself
very lucky to have the opportunity to share and listen to the people around me. Again when I
try to reflect about the book it taught me a new lesson on how to feel for those among
vulnerable groups. It is an inspiring book and also makes me think of my inner feelings in
future. It made me reason about my life, why am I here? Can I do something in life? Make
some foot print in future? I wish God has a purpose for me in this world. I always believe that
if we want to make a change we need to change ourselves first. This book made me analyse
life again and again in depth because Madam Hema motivated me a lot through her book.
Therefore, it makes me reflect that whatever work we do, we need to remember a few
important points: First to love what we do and put all head, heart and hands into it, and to
believe working is like a calling and requires passion to enjoy the work if we really want to
make a difference in life. Engaged with the book for many days it also made me think in a
very positive way on how to help others like what Hema is doing. A small contribution to
society will make a change only if we help others to rise. Greatness does not come in position
but it will change if helping to build the lives of the needy in future and take it as challenge. It
will be like the duty and responsibility to make underprivileged to rise up and have their
voices heard.
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Chapter-7
Life and music
“Turn up the volume close your eyes and let the music take over your soul”
-Kushanwizdom tumbler
Inspiring message
Many individuals are coming to class to share their ideas and experiences during the session.
I could not mention each and every one for their inspiring messages that in some way have
made me think and change my mind. I used to think if foreigners overcome their language
barriers in order to carry out different studies to explore knowledge and gain experience, then
why should I have that fear, myself. That is one of the messages that has inspired me - to not
have fear. Their stories and experiences either personal or professional motivated me a lot.
Mrs Asha (PLHIV - Person living with HIV) shared her life story and experiences. I am
inspired by her because we should not look down on anyone because we didn’t know the real
facts faced by the victim. She shared her life story openly to us. How she suffered and faced
lots of challenges throughout her life journey. Asha studied till 10 th standard, during that time
her parents arranged for her marriage. She got married to the man who was a stranger. As an
innocent child she didn’t bother about her husband. After few months her husband
hospitalised and from that she got to know that he is HIV+. At that moment Asha was very
scared about herself. Later a blood test confirmed that she also HIV+. The family members of
her husband blame her and chased her away from their family. Asha went back to her father’s
house, unfortunately she did not tell her parents in the first place. Later, she is working with
organisation who work in the area of HIV+. After many years working in the organization
she got proposal to get married with one of her colleagues who is HIV+ himself.
Asha is the first PLHIV I met. She is very strong women and positive thinker. I am so
amazed with her story because she shared her life story without fear nor hesitation. She
encouraged us to stand and be patient with whatever issues we face. I realised that patience
will help us achieve our targets in life. Listening to her story it recall me by someone said,
“Always be yourself, express yourself, have faith in yourself, do not go out and look
successfully personality and duplicate it”. Therefore by her thought it give me great effort to
stand and take life as big challenges. I realize in life, if there is no struggle there is no
success. It reflect me, need to accept the challenges and be successful one find day. She
express greatly as HIV patient that will be the example for the others in the society. Everyone
60
have the right to live, right to freedom and right to speech. So by this law she stand herself as
one of the best example to influence not to fear or hiding their suffering. It is time to share
and make others aware and understand the reality because all the HIV patient are facing
different situation being HIV+.
One speaker who spoke about his life journey how he failed massively during his school day.
But then, his insight feeling never allow him to put him down. Being school dropout people
look down and discourage him to do any job. Many a time as human being he have feeling of
depression but never allow to overtake his dream. He use to have the feeling to help people
who are in need. He is very hard working and have different life skill in teaching. Slowly he
start his own organization.
Listening to different experiences of the person I admired and amaze on it. Through their
hard time due to their patient and honesty change many people around them. Having said
perfection is not attainable, but if we chase perfection we can catch excellence. I make me
realized not only the literate can do all good job but if we have a dream it will make a way
through willpower and commitment. Sometime I do feel failure is not always failure it is also
opportunity to start and begin the new day and life. It bring effort to love and passionate to do
what you want do. As individual this kind of sharing it bring lot of meaningful to life.
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SECTION -II
The Instrument of the
music
62
Chapter-8
Searching the note of music
“One good thing about MUSIC when it hits you, you feel no pain”
-Bob Marley
FIELD EXPERIENCES
During my one year fellowship programme I got the opportunity to do my field experiences
in SOCHARA-Centre for Public Health and Equity, Bhopal, Madhya Pradesh and
Bethany Society (BS), Jaintia Hills branch of BS Shillong, Meghalaya. These two state give
me diverse picture of people, culture, believe and religion etc. It is wonderful and different
experiences among the two states of India.
Urban Slum Bhopal, Madhya Pradesh
Bhopal is Municipal Corporation and area is 285 Sq. Kms. Initially constitution of Bhopal
Municipality was a 20 member committee. The city divided into 85 wards. Each ward elects
a comparator. Therefore Bhopal alone has 23, 68,145 and area (in sq.km) 2,772. Total
inhabited village is 511. A total habitat is 651. Forest village is 1 and town and major towns
are 2. At present there are 18 dispensaries and 26 slums in Bhopal.
Opportunity to experience with urban slum in Bhopal it is one of the great achievement for
me to know and learnt about the reality of my own country, since I never have experiences
with urban slum. What I use to think before slum is only poor people, but unfortunately being
with SOCHARA it change my mind into positive way of thought. Always think working with
urban areas it will be better than rural areas, unfortunately what I came across through my
experiences in urban slum is people are very busy with their tide schedule and no time to
spend nor interact. Now I realize rural setting is easy to encounter than urban setting. Reflect
back my experience urban slum in Bhopal, what I found people are having all social
determinant in the community, also struggle in all the basic need of their life. While interact
with the people I learnt that all the people in slum are migrant from different states to search
job and live their daily life. Hence, I try to reflect people in slum they are one among the
vulnerable and marginalized so poverty is the main backbone that leads to unhealthy lifestyle.
63
Further, to urban slum Bhopal they are lacking in everything e.g. water, sanitation, waste
management, education, health facilities and poverty. After knowing about all the issues of
the people in urban slum it reflect me and think how community will be able to cope up with
their daily life style especially when it come to their health. Today is 68 years of our
independence but still many apart of our country are still lacking behind in everything in their
basic needs. Will this marginalized people can raise their voices at present and future? Will
our higher authority response to their voice and make little different in their life?
Reflect back about my field experiences in the field with urban slum it make me think about
them because only five minutes’ walk from the main city of Bhopal it is triple diverse about
the people life style. It speak a lot whenever I think about the urban slum. The people having
different perspective and also their mind set are different from their background.
Culture of Urban Slum of Bhopal: Urban Slum has a mixed culture, Tribal, Muslim and
Buddhism. Urban slum having different pockets and people hardly mingle with other
religion.
People are migrant from different part of the country by finding job and
displacement. They enjoy to mingle among their own tribe and use their own language.
People live as daily labour. Carpenter and contraction for their basic need.
People: Urban slum has a mix of tribes and majority of the population are tribal known as
Adivasis. People are living in very bad conditions and from one small hut they live around 58 members. Without water facilities, sanitation, health facilities and some time without meal.
Waste management is another problems they are facing and through this it forms different
diseases. Muslim families did not allow their children to go to school because there is no
school in the community. It effect a lot for the community with no school in the community
and also no health services.
Rural area of Jaintia Hill Meghalaya
Opportunity for me to visit my own state during my fieldwork in rural area of Jaintia Hills,
Meghalaya. Meghalaya is emerged as a full-fledged State within the Union of India on
21stJanuary 1972. ‘Meghalaya’ meaning ‘abode of clouds’ reflects the salubrity of its climate.
The State has an area of 22429 sq. km.In the 2011 Census, there are 7 Districts, 39 C & RD
Blocks, 6839 villages. The population went up to 29, 64,007, males 14, 92,668 and females
14, 71,339. The population of Meghalaya is predominantly tribal, the main tribes are the
Khasis, the Jaintias and the Garos besides other plain tribes such as Koch, Rabhas and Bodos
etc.
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Jaintia is one of the district of Meghalaya. The name "Jaintia" has been in use only when the
area came under the British rule in 1835. The name was used to differentiate it from the
plains areas of the old Jaintia Kingdom, the capital of which was Jaintiapur, the whole area of
which is now in Bangladesh.There are five Community and Rural Development Blocks in the
district.There is only one town in the district, by the name Jowai, which is also the district
headquarters. The number of villages in the district is 537.
Being place in my own areas in Meghalaya it, reflect me on how to think about the life style
of the people in that area. The beauty of people talks a lot about their culture, believe, religion
and practice in each and every one. People living with beautiful and simple life style.
If I talk about my field experiences in Sohshrieh village of Jaintia hills people are living in
very simple life. Hence, whenever the poverty is there will be the similar problem face by the
people over the globe. What I experiences with different field it come to my mind people are
living in the same condition if the poverty is there. Therefore, through this it reflect me from
different experience of urban to rural. The social determinant is equal problem with all the
people if there is unemployment. Then, until and unless poverty is reduce and improve their
economic status the issues of health will not reduce it.
Being with my own people it make me think about their life style and the condition they live
without water, school, and health facilities etc. Looking with the education in the village it
Culture of Rural Area in Jaintia Hills Meghalaya: Jaintia Hills of Meghalaya has a mixed
culture, Non-christian, and Christian. The tribal of Jaintia have their unique languages,
lifestyle dance and music. All the people use local language living in the village. The ST
people is unique and colourful with different food habit and practices of culture.
People: Jaintia Hills has the same tribe. It is Schedule tribe (ST) dominated and all the people
are ST. People are still believe the old practice since majority are Non-Christian their faith is
so traditional. The food habit also is still very traditional. People eat simple meal and rice is
their main food. Village have lot of problem be it water, sanitation, education and health
services. There is facilities in the village and if the parent want to send their children to
school need to go to the others village and when it come to health facilities people are really
struggle because there is no facilities at all.
Reflection: Experience with the two areas urban slum and rural areas it reflect my thought
between this two areas about the different among the two environmental areas. If I try to call
65
back about the two areas of my experience, the problem they are facing it almost the same
because there is proper facilities be it health service nor education. What we need to improve
in our society is through education and health facilities. Both the areas lacking behind in
many facilities provide by the Government. Hence, it reflect me and I am worried where the
generation of our people especially children. We all know children is the next generation but
unfortunately when I look back I did not see any improvement and where is the future of the
children and women health. This is 21st century and according to the constitution of India the
children who are under 14 years should get the free education. Do the free education reach
the unreached people who need for the betterment of their lifestyle!!!!
Unfortunately, when I try to analyse about the problem face by the community throughout
my experience, I found that children and women are the real victim in our society. Why I
mention this two issues because women and child are the main who need more help and also
depends everything from the third person. Their life is full of pressure and tension in many
areas. Also reflect that until and unless education and public health improve there will be no
improvement in our society!!!! That is the question always question myself and reflect for our
society because I see the different between the educated and uneducated parents. The mind
and understanding is diverse among the two person.
MADHYA PRADESH
Madhya Pradesh started 1st Nov 1958 and situated
in central India. The state is bordered by different
states - to its northeast lies Uttar Pradesh, to its
southeast lies Chhattisgarh, to its south lies
Maharashtra, to its west lies Gujarat and to its
northwest lies Rajasthan.
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It covers an area of 3, 08,245 sq. km. Population of
72.54
million. There are 51 districts, 313 blocks and 55393 villages. The State has
population density of 195 per sq. km.
BHOPAL
At present total area under Bhopal Municipal Corporation is 285 Sq. Kms. Initial constitution
of Bhopal Municipality was a 20-member committee. The city is divided into 85 wards. Each
ward elects a comparator.Bhopal alone 23, 68,145 and area (in sq.km) 2,772. Total inhabited
village is 511. A total habitation is 651. Forest village is 1 and town and major towns are 2.
SOCHARA-Centre for Public Health and Equity
SOCHARA Bhopal launch in October 2008. It cluster based I Bangalore, Bhopal and
Chennai promote a people-centered paradigm for health and development. At present there
are 3 staffs and 2 care takers.
P.C.Nagar Slum
During my field in P.C.Nagar slum of Bhopal the community has three pockets i.e buddism,
tribal and muslim. The population the community are migrant from different part of the
country like Maharashtra, Khanva and Bilaspur. The population is 3176 and 637 households.
There is one Government L.P.school and no others facilities available. The amin ocuupation
of the people both male and female are domestic worker, construction, carpenter and some
tailor.
Story of Mrs X: Poverty during pregnancy lead to health problem
Malnutrition.........…..then what else??
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Introduction
Poverty is basically an issue of the individual. It limits people to live well with their force and
deprives them of opportunities to fully develop the expected be iteconomy or welfare.
Poverty is one big issue face by many poor people. A single household all together suffers
from poverty, which in turn, shifted easily from one generation to generation (parent to
children).In this way poverty is a big task of upcoming to face economically. Therefore
poverty during pregnancy as mother are likely face double burden of stress in life including
unemployment, environment, unhygienic, food and care for children etc.
Background
The purpose of writing this story is being with Mrs X for couple of months it strike my mind
to write small story of her journey as mother who suffer a lot of poverty in her life time.
When I try to reflection and thinking about Mrs X condition as pregnant women and her
children it make me realized poverty is the main cause for many people in our society.
Mrs X is 30 years old, mother of 4 children and at present she is 8 months pregnant and will
be delivered her fifth child but unfortunately her last delivery is not survive due to health
problem.Mrs X is origin from Sagar district of Madhya Pradesh, and belong to schedule tribe.
Due to poverty and unemployment her parent migrant to Indra Nagar slum Bhopal. Mrs X
grown up in slum with no idea about education. Roaming everyday she grow up her life
without any fear of being a girl. Later she got married to neighbour and live as nuclear
family. They settle in one small room in Indra Nagar till date. Before marriage Mrs X work
as daily labour but after having children she stop going to work and be a home maker. Her
husband (Mr Y) is daily labour (boar well) and earned Rs 4000 a month. Mr Y work in
exterior of Bhopal, and usually come home once/twice in two weeks. Mr Y is the only one
who own the bread and butter for the family. Both husband and wife are non-literate and
fortunately till date due to lack of knowledge their children are not registered yet in school.
The income earn by the head of the family is very limited and that is not sufficient for the
children to enrolled in the school. Due to poverty the children most probably depend their
lunch in anganwadi centre. Therefore, poverty cause her life very dearly with full of tension
because having malnourish child including herself is one of major problems.
Life style:
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Mrs. X live in very poor family background and the living condition is very unhygienic. Why
is this happen? It is happen due to poverty. Poverty create many issues and health problems
that lead to malnourish. The family live in one small room and manage to do all thing e.g.
cook, eating, and sleeping etc. Mrs X is anaemic and more over one son is malnourish. That
is big challenges as mother in that event.
Therefore, being with Mrs. X for couple of months I understand the way she express herself
how difficult they live their life. I cannot express how the family living in that condition
because having malnourish child and anaemic is another tension to feel as mother. There is a
time when I interact with Mrs X there is nothing to cook nor single paisa to buy until her
husband is coming home. I never thought in my life that I will meet the people who are suffer
with their daily food. This is the first experiences for me to understand the life in reality and
we all who have the privilege we should not complain our living or eating habit because there
are many people who are not getting to eat one day meal.
Pregnancy and birth is the first events that shape health outcomes within the individual life.
In my mind use to think the impact of pregnancy to poverty it create problems to both mother
and child health needs. The word poverty will understand only those who have experiences
and exposures to it both direct and indirect.
Frequently, visiting Mrs. X home I am so downhearted with the living condition of the child
in the family and it is worse than I expect. They carry their days just to roam around without
doing anything. Therefore the children whenever they come home end up with fighting each
other and there is no respect for their mother nor outsider. This kind of character and attitude
we should not blame only the parent because they live in that environment that never taught
them to be the good citizen nor good human being. I keep asking myself when will be grow
up as a country.
Poverty and pregnancy
Poverty is one of the big social issues in the society. Just think about Mrs X how poverty will
affect her health since she is pregnant. The food habit to environment is unpredictable for the
health condition of Mrs X. When it come to food habit the family eat only roti and dal,
including with the food items they got from Aganwadi centre. Mrs X had a habit of eating
ghutka and keep telling keep her to stop eating ghutka since she is pregnant because it will
effect her and foetus. Unfortunately, it become habit for her to eat and it is very difficult to
stop immediately but keep counselling her that it is not good for health and it will effect the
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foetus. The main reason of eating ghutka is to fill the stomach because there is no proper food
to eat. This family lack all the social determinants and they carry big burden of poor of the
poorest in their life.
Poverty, pregnancy and health outcome of Mrs X health and child
Health condition in the family is very poor. Mrs X health is very bad and this all about
poverty. Due to poverty it form different diseases. Mrs X is anaemic but did not confirm. Mrs
X said, Mera khoon kam hai (My blood is low) and also mention she is only 37 kg. This
make me wonder how come she will be only 37kg since she is 8 months pregnant. At present
Mrs X has severely malnourish child. His age is 1year 11 months and his weight is 5.9 kg
only. Before the child hospitalized in NRC but sad present-day also he still malnourish. Mrs
X take all the responsibility to take care for the child because her husband is out of station for
work. I realized that being poor and illiterate it cause many issues when it come to health. It
make me understand through reading many women died during delivery because they are
anaemic and poor, suddenly it reveal my thought that Mrs X will be in trouble. Looking at the
condition of the families in Slum I realise we celebrate 68 Independence Day in our country
but what slum in Bhopal are facing is still like landing in ancient time in very poor condition.
It concerned me where will be the future of Mrs X children. What is our responsibility
towards the people who are in essential stage? I wish if the organizations working in different
issues in slum areas come together and join hand towards them there will be possibility to
improve the living standard in slum otherwise we will get stuck in the middle of the rock and
reach nowhere.
Knowing Mrs X for months I am familiar with her health and child situation through
interaction, discussion and observation. Over to Mrs X health as a pregnant women, some
time I fell it is heart burden for me because I cannot do or help to improve her health
situation. Poverty and health has inter-connected be it pregnant or not it truly effected the
health of any human life. Poverty is the main culprit for all the issues in the life of people
because change it to different direction. The principal of poverty is very vast because the
roots of poverty cause to migrant, health etc. Person like Mrs X husband need to travel a lot
due to unemployment and this will cover many intention to happen for his life. It will not
effect only himself but for the whole family as well. Of course, the family will suffer all the
needs in their life because they have to move around and find out the place to work and settle
down. Due migrant there is no happiness or enjoyment of living in one place to another place.
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The pressure for the person like Mr Y who have to migrant for his work place to place is
having tough time and tension will be the another delinquent for him. Migrant is major issues
face by the slum dweller. For that reason, there is no proper identity for them e.g.
Government provide different scheme for BPL but unfortunately people like slum they didn’t
have appropriate proof to show and this cause them dearly not to get what they are supposed
to get as BPL family. So migrant create to insignificant thing to the people like Mrs X to face
in daily life. Therefore, migrant lid to health issues because there is no proper housing nor
facilities from the part of Government. When it come to health issues Mrs X have lot of
problems started from the family because at home the condition of the house is very
unhygienic. The environment is another problem when it come to health issues because the
surrounding itself is worse. As human being living in that condition it will surely to have
many health issues. Due to environment too Mrs X can’t avoid the unhygienic or maintain
cleanliness. She have all social determinants around her not even single services available.
Mother and children did not get proper food, clean drinking water, nor toilet available.
Everything behind that is the main function of poverty. Being human lacking everything
especially food the health condition of the children form to malnutrition and mother become
anaemic. Consequently the whole family face different kind of sickness e.g. children are
malnourish or having diarrhoea.
Therefore the outcome of health when it come to Mrs X and children is very poor.
Nevertheless the main source of that is income disparities make to compare the health
condition of the child. Hence when it come to Mrs X health is limited because the income
status is not sufficient for her and children. Comparing with highest and lowest income
mostly the lowest income like Mrs X had all health problem because cannot afford to pay for
health services. Fortunately or unfortunately Mrs X will be at risk because pregnancy stage is
one big issues for women health living with low income. The behaviour and practice is
another problem for Mrs X because lack of education, health risk etc., such as eating ghutka
occur many years of practice will reflecting to health problems. Therefore the combination of
poverty and practice is the real aspect facing by Mrs X throughout her life and might be
transfer from one generation to generation. According to my observation Mrs X and children
health is the social outcomes that affected her and children very severely.
Experiences during Mrs X delivery
71
One day myself and my co-fellow went to field early morning and when we reach Mrs X
home we find her lying down in the floor and complain about her leg paining. At that
moment I realise it is due date for the lady to delivered. During that situation no one in her
home except her small children. At moment I contact Madam Nidhi and convince her to
come to the field since we have language problem. Fortunately, Madam Nidhi could not
come because of her tide schedule. I contact Dr. Ravi our field mentor to give his suggestion
and he refer me to take the patient to J.P. Hospital. At that minute we are so nervous and
confuse what to do with Mrs X. I went and talk to neighbour and seek help and one old lady
are willing to help us and stay with patient in hospital. My co-fellow contact 108 van and we
got message it is still far to reach us. We take the responsibility and took Mrs X by auto to
hospital. While travelling by auto it is very amusing and great experience too because in the
middle of the road we saw 108 van and both of us we are shouting to the ambulance to stop.
At that minute the ambulance stop and proceeds to J.P. Hospital. Since we are tide with our
schedule we let the patient and neighbour to go to hospital. In evening we visit Mrs X in
hospital and come to know she deliver normal baby girl. Mrs X is so joyful to see us and
express her gratitude for being with her and she also mention if we are not there she will
delivered at home with no one. That time the condition of Mrs X is good without any severe
bleeding but unfortunately so sad to see her because she did not have single paisa with her.
So, we decide to give some amount of money. Giving her money is not big deal instead we
are happy to see her doing good but sad to see her weight and haemoglobin is very low but
still she delivered 2.5 kg baby girl. But what it make me think about her is how she will be
when she go home. The condition of the house and environment it will effects the baby badly
I guarantee. Conceive every year is another problem for the mother to gain weight. There is
no time to maintain and her body detained day by day.
After three days Mrs X discharge from hospital and back home. Visit the Mrs X baby, all the
neighbour are very happy with us for taking the responsibility to take her in the hospital
because it is co-incidence on that day there is Aganwadi worker nor ASHA worker.
Intervention
The intervention process is through counselling with the help of field guide Madam Nidhi
that Mrs X need to take Iron folic acid every day, colostrum is very important for the child to
give and feeding the child till 6 months. At first Mrs X not willing to deliver in hospital but
keep counselling her for betterment since already anaemic. If there is anything happen during
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delivery at home it will be in danger. Hence, if she delivery in hospital it will protect and
prevent both the child and mother. During her last delivery at home later having lots of
problem and baby did not survive. This time it is wonderful at least we can convince Mrs X
to delivery in hospital that is our successful during field.
Service of Aganwadi worker and ASHA worker
When it come to Aganwadi and ASHA worker services in slum of Indra Nagar it show she is
doing quite well and trying her best to work for the benefit of the people around her area. She
take responsibility to give the medicine and supplementary food provide by the Govt. for the
pregnant women and children and currently there is no ASHA worker. So the Aganwadi
worker working alone in her area doing all the job. What I observe from Mrs X AWW given
her three types of medicine to eat. But the interesting part is that Mrs X is not taken the
medicine regularly, so whom to blame Mrs X or AWW. My understanding level if the
pregnant women is not getting proper explanation and counselling from AWW or ASHA
worker it would not work because the lady is illiterate. During immunization day in
Anganwadi Centre the ANM use to counselling the pregnant and lactating women in different
matters for the benefit of the family. Family planning in slum is still big problems because
both husband and wife did not understand the important of family planning. The Anganwadi
worker provide pill and condom in the centre in order to protect the pregnancy. Fortunately it
is not work at all because pregnancy is not reduce. Therefore, it is the big challenges for the
health worker if the community did not response adequately.
Reflection
My reflection towards Mrs X is one of the great experience I had during field. Working in
slum is not the easy task kind of job because there are all different of problems, when I try to
reflect about the slum I use to think from where that people are coming from. Migrant it is the
heavy load for them to carry their daily life. Where they will go and have the identity as local
person in the society. I use to think person like Mrs X when she will improve their standard
of living. It will take time for her generation to come up with that condition in the slum.
Seeing her condition it reflect me where is there future? Is there any change for them to
improve her family situation? I doubt because all the problems they carried in their shoulder.
I strongly believe the living condition of Mrs X and slum as whole it will take many a year to
come up to improve the standard of living. People are lacking behind in all facilities and how
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we think India is shining. The higher authority should have responsible to visit slum, and
think what action or solution take place then may be will be having India shining. It should
not only in papers or city to have India shining because slum is part of society as well. There
should be practical not only in paper when we talk about India shining.
MEGHALAYA
Meghalaya emerged as a full-fledged State
within the Union of India on 21st January
1972. ‘Meghalaya’ meaning ‘abode of
clouds’ reflects the salubrity of its climate.
The State has an area of 22429 sq. km
In the 2011 Census, there are 7 Districts,
39 C & RD Blocks, 6839 villages, both inhabited and uninhabited. The population went up to
29, 64,007, males 14, 92,668 and females 14, 71,339. The population of Meghalaya is
predominantly tribal, the main tribes are the Khasis, the Jaintias and the Garos besides other
plain tribes such as Koch, Rabhas and Bodos etc.
JAINTIA HILLS
The name "Jaintia" has been in use only when the area came under
the British rule in 1835. The name was used to differentiate it from
the plains areas of the old Jaintia Kingdom, the capital of which was
Jaintiapur, the whole area of which is now in Bangladesh.
There are five Community and Rural Development Blocks in the
district. Only one town in the district, by the name Jowai, which is
also the district headquarters. The number of villages in the district
is 537.
Bethany Society
Bethany Society (BS) is a not-for-profit, secular, registered, charitable Society established in
Mendal, East Garo Hills, Meghalaya in 1981, under the inspiring leadership and vision of
Sister Rosario Lopez, “dream of an earth fully alive, wherein everyone enjoys fullness of
being”.
74
Bethany Society work towards “forming partnerships with people, communities and
resources so as to create opportunities which empower, enhance dignity and lead to security
of health, food, livelihoods, and shelter in a sustainable manner”. Also work forPeople in
vulnerable situations such as persons with disabilities, children, youth and women living in
extreme poverty, particularly in remote rural areas. Bethany Society work across the
Northeast India, but the major focus of interventions is in Meghalaya.
BETHANY SOCIETY- MAWBYNNA PHRAMER, JAINTIA HILLS.
Bethany Society Jaintia lunch in February 2010. At present there are 4 staffs and focus 30
villages. Few year back they start with inclusive early intervention unit. There are few
children around the nearby villages.
Sohshrieh Village
During field Sohshrieh Village is my concentrate areas. It has 2500 approx. population and
205 households. The village has both Pacca and Kachha house. The whole village has only
one lower primary school and one upper primary school. There is no health facilities at all.
The main occupation of the people are daily labour, cultivator and driver. People are facing
lot of problem with sanitation and water. 90% of the population is non-christian and people
are still having strong traditional believe system.
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Chapter-9
Flow of song make you move and dance
“Good music doesn’t have an expiration date”-Unknown
Field Visits
Snehadhan
Snehadhan is the centre for the infection person with HIV/AIDS. This centre the beautiful
environment and infrastructure provide to the patients is very systematic plan. The service
provide to the patients is appreciated because it is very rare organization who can provide this
kind of services for the HIV/AIDS patients. Especially country like India think to be
HIV/AIDS patients is the taboo for the culture and religion. What I learnt from this visit is
incredible because it brought the human dignity to each of the patients. If I compare with the
previous year’s HIV/AIDS patients is the one who face lots of discrimination in the society
and till today in some of the rural areas still have that believe system. The patients feel very
comfortable to be in the centre because they get love and care who are not discriminated them
as affected and infected disease. In the centre they treat them as patients who have disease in
their body like others diseases. There also centre for the children who are infected with
HIV/AIDS. The children from the centre are all infected children and they face lots of
discrimination too in the society. Many people who are illiterate have no heart feeling for the
children who are infected and due to this discrimination as centre who looking in that areas
put the children into school and care centre. The children are doing different activities in
school and hostel as well. Even there are some students who are good in sport are represent
the state in sport. The centre also provide training for the doctors, nurses, social workers and
health workers in management of HIV/AIDS. Snehadhan get full support from state
government of Karnataka and NGOs for the tremendous work they are doing to the people
with HIV/AIDS.
Sundana Centre is the special centre for the differently children under 14 years. Been in the
centre it touching me so much when I see different kind of children who are totally change
their look. At the moment it is very hard for me to accept this kind of condition face by the
human being. It is the first experience I got to see why some people have such inhuman heart
to make their own blood suffer. It is very painful heart for me to see that situation faced by
the children who did not know anything for their life. When I realise about the condition of
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the children in the centre, it is not the children problems but it is the parent who are
responsible for all the good and bad condition of their children. But God is wonderful and
love the children, he send the beautiful heart that is sisters (nuns) in this world to look, love
and care for such special children. I can express my feeling through writing towards the
children in the centre but I believe God will blessed sisters to have healthy life, support and
guidance because I use to think may not be able to have such beautiful heart like sisters to
care for such children who are fully need help. I admired the way sisters maintain the centre
how clean and beautiful it is, with all their love and care message for each children that will
bring happiness to the life to them.
National TB Institute and Bhoomi Habba
Visiting National TB Institute (NTI) and DOTS Centre it reflect me that Government and
Society need to take care for TB issues because sometime I felt that Doctors did not treat the
patients in the very proper manner especially the people in the lower caste and rural areas.
Therefore, I felt if the DOTS centre are available in the village it will help the patients
especially with those who are not effort to go to private clinic or hospital in the far centre. It
also reflect me that, many a time it is lack of information regarding with TB because
awareness did not reach to the people who are in need.
It reflect me, need to understand and follow the guidelines of the TB disease in order to
improve the condition of TB disease. At the same time it also strike me that the drugs also
lead to kind off suicide due to misuse or side effects of the drugs.
Getting the opportunity to visit NTI, I learnt the body that could not effected by TB is hair
and nail. Beside that I learnt pre-counselling is important for the TB patients. Also the TB
patients did not het the treatment or relapse for 6 months it will spread 10-15 person a year. I
learnt that India is highest no of TB patient and there are 43,000 TB patients every day in
India. It is new learning for me that the TB tablets strip are countable till the end of the
patient’s course. Without treatment 2/3 die of TB patients, and those who are infection
gradually are more prone to diseases and because of that TB is highly need treatment.
Further; I learnt that 1/3 population infected by TB and 1.5 to 2 million people died due to
TB at the age of 15-54 years. Also TB is top three cause of death in women at the age 15-44
years.
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TB is more prevalence to women than men. This point I keep question myself why women
are more affected than men? I did not get the clear picture of my question……..
So, if we want to reduce in the burden of the disease for TB need to change and break the
transmission.
Visiting Bhoomi Habba is one of the great and wonderful experiences. Bhoomi Habba means
Earth festival. The environment is so lively and surrounded with mango tress and some tress.
This make the environment to be so green and clean. The most touching and inspired me is
the doll’s exhibition because the doll’s speak and represent phases of human conditions in
different meaning in life be it domestic, social, religious and beautiful life. And through these
doll show and guide me towards a deeper meaning and awareness of the excluded in my own
country. Also I enjoy eating different food items.
Since it is earth festival; it reflect me that environment is the most beautiful for all of us to
live in this globe because environment give us everything to enjoy our life. And without
environment it will be very difficult and at present we struggle a lot in order to fulfil our need
because we misuse and destroy our environment in very bad system. So, it reflect me we
should not blame or give all the responsibility only to the Government because I felt that it is
we all are responsible for our environment. Until and unless we all are responsible it will be
very hard to come out with many issues that we are facing today. Environment is very
precious for all of us need to protect and save our environment.
Foundation of revitalization local healing tradition (FRLHT)
Foundation of revitalization local healing traditional (FRLHT) established 2003. The concept
is to bring hidden in reality and can take up into policy makers. There are 3 main school:1. School of health science
2. School of life science
3. School of conversation of
natural resource.
Trans-Disciplinary University (TDU) is defined in the Act as: Indian traditional health
sciences, Biomedicine, Life sciences, Social sciences, Environmental studies, Design &
Architecture, Performing and Fine arts, Engineering and Management.
A- Ayurveda
Y- Yuga and Naturopathy
U- Unani
S- Siddha
H- Homeopathy
Sva-rig-p is Tibetan medicine
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Folk Traditional Healers: 1. General practitioners 2. Traditional bone sitting 3. Traditional
birth attendants
4. Poison healers
5. Ethno-veterinary practitioners
6. Traditional
ophthalmologists.
During the visit in FRLHT I come to know this institute working on how to make the
traditional herbs practice alive. It is wonderful visit because I never thought that there will be
such big institute who are working for the local herbs. Looking at the surrounding I felt it
bring life to the traditional herbs and bring back the practice of the old medicine in this
generation. The way of collecting seeds from different states is like bringing together all the
sources of plants and make new ecological. In FRLHT the surrounding of the environment is
very different because the trees and plants offer us wonderful fresh air and pleasant weather. I
realized being in FRLHT for two day I really felt the uniqueness of the climate. Planting trees
and flowers it make massive changes around. It recall me back to class during session with
Sir Adithya and CHESS workshop on environment. Environment is very is precious over the
globe. It strike me back field in slum Bhopal, the weather there is extremely hot and the
whole slum could find any trees and people try to search trees and relax themselves.
Environment without trees it will be dehydrated exactly what we human being need air and
water for our body. Therefore bring back the practice of herbs it will be great changes
because each and every plant is medicine and also there is no side effect. Herbs is good
medicine if we know how to make use of it.
Action in Disability and Development (ADD) India
Action in Disability and Development (ADD) India is the organization working with Person
with Disability. The founder of ADD is Mr. B. Venkatesh, a visually Impaired (VI). ADD
work for 25 years in the area disabled people directly to empowering and access to their right.
Mr. Ranganath said the new definition of disability is “Person with disable is not disable but
it is the system and people who need to understand the person with disable in our society”.
E.g. if the teacher did not know how to teach braille doesn’t mean the child is disability
instead it is the teacher who is disability. Besides that the good person to deal in the
community are AWW, teachers, ASHA, ANM and home base intervention.
I learnt to work in the community it is very important to promote direct intervention because
it help the PWD and community as well. To form SHGs is another tools to improve the
livelihood of the community mainly in rural areas because they are one among the group who
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can address the issues in the community. Also learnt education is most important areas to
concentrate for the PWD because PWD have their own talent if they get the opportunity to
show it. There is a time the work did by PWD it is very difficult for the normal to do the
same job. So PWD is special and have different uniqueness in themselves. We should respect
and understand their need if we want to make a change. Also learnt community base
rehabilitation is another areas to improve the livelihood of person with disability. I learnt
there are different types of disability i.e. Blindness, Low Vision, Low locomotor, Mental
retardation, Mental illness, Speech and hearing impaired, Autism, Cerebral palsy, Multidisability, Plegaria and Cross disability (More than one of the disabilities)
I learnt to work in the areas of disability need to have good network with village headman,
president and some main person of the village. Most probably disability is the new areas
especially in the rural and to work in the village the higher authority is very helpful because
till date there are very few organization who are concentrate to work with disability. While
interact with the senior programme manager I learnt there are different laws for person with
disability i.e. 1987 Mental Health Act-This law is only for the mental health. Legally
protective with respect to health, family life, property and social inclusion. 1992
Rehabilitation Council of India Act- The purpose of this act is to produce human resources
especially education and vocational training for person with disability. This law mostly focus
on teachers, doctors and lawyers. 1995 Person with Disabilities- This law has 3 mechanisms.
1. Equal opportunities.
2. Protection of rights and
3. Full participation. The main
purpose of this law is to bring people to the main stream and inclusion. And according to this
act the states should have their own role and regulation for the PWD. 1999 National Trust
Act- Focuses 4 types of disabilities. 1. Autism
2. Cerebral palsy 3. Mental retardation
4.
Multi-disability.
Beside that I learnt monitoring is one of the most important, be it with staffs, individual,
group and community because monitoring play important in such good manner especially
with the team. Monitor is another back bone of the work because guidance, motivate and
supportive can change the mind and behaviour of the person. Also to work for the PWD
family play another role and for family need to sensitize them to understand the problem of
the PWD and also make them to understand how to improve and empower the person with
disability.
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Listening to the conversation with the programme coordinator it reflect me, when we talk
about person with disability constantly neglect about their needs particularly toilet. It is high
time to debate about toilet in any meeting especially for the person with severe disability.
Hence all this need to address in the public place or community base rehabilitation centre. I
appreciate the work done by the ADD because for the person with disability will feel, they
also a part of the society too. Work humbly in any work it will surely show the foot print
behind.
The Association of person with Disability (APD)
ADP is 57 years organization and main aim
is to reach out and rehabilitate person with
disability from the under privilege segment.
APD has 4 vertical i.e. early intervention,
spinal cord, livelihood and education. The
organization as a whole focus on Cerebral
Palsy, autism, speech and hearing, locomotors and global delay development.
During the visit in APD I learnt person with disability are very unique because many of them
are working with different department in ADP. They have their own role and responsibility
for their work. Looking at PWD in APD I admired the way they work because I observe they
are very hard working and I appreciate so much the organization for giving chance for them
to live their livelihood.
My observation and learning during my visit to APD is different because from the day one it
is under women’s day all the male staffs organised women’s day for the female staffs. They
offer roses to all the female staffs and provide with lunch. Being women I am so proud to see
how male staffs respectful for women. It is symbol of respect and dignity for women in the
society.
Taking around the APD what I learnt is all the departments are very busy with their own
schedules. It is systematic and well organised organization with full of enthusiasm to the
person with disability.It is good environment for the person with disability to be able to stand
by their own feet and also earn their own bread and butter. It is good platform for the person
with disability to support their family and for themselves too. What I observe in the early
intervention unit and home visit many person with disability come from muslim community.
But then the support and guidance given by the family to their children is appreciated. The
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parent are very compassionate to take their
children to APD for better treatment.
Visited davangere I observe cerebral palsy
and mental illness is another problems face
by many people. Parent and family members
are very cooperative and supportive for the
patient. They encourage and appreciate the
patients even though he/she doing small
work to be done. Therefore, everyone need
appreciation especially patients truly value
the support and appreciate. Besides that I observe in the temple many family of psychiatric
patients still have strong traditional believe in mental illness. But I consider awareness is still
lacking behind. But it reflect me it is high time to reach people and make them understand
that mental illness is diseases and need to accept mental illness as disease otherwise there will
be no improvement. No doubt with religion but it should be side by side along with the prayer
and health care service. In many part of the country mental illness is still believe as spirit,
ghost or something wrong in the family.
The inspiring and encouragement learning in horticulture department is remarkable. As
organization they conduct the programme in very good manner and well plan. It is the
incredible when I saw the picture of 15 years back how beautiful to see APD from hiils and
stones into garden and lawn. Many PWD live their livelihood by doing the training in APD, it
is beautiful and emotional to see some of the PWD that I never saw work and put so much
effort to complete their task. I am thinking for myself what I am going to do for me in future.
I got inspired so very with two of the trainer in horticulture department with their
determination. The campus is lively with beautiful environment with different plants and
flowers who make the person with disability to feel alive when they are with the garden.
Learning is delightful because I get to learn new skills especially in early intervention unit. It
is great opportunity for me to learn and observe new technique to deal with the person with
disability. Fortunately it give me the clear picture and environment to understand that even
disable can do many thing if they get support and guidance from professional and expert. It
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takes time to be like the normal person but what I learnt the patient and commitment speak
loud to the person who can really accept it as challenges to reach a target.
Being with APD it reflect me from morning during my travel till the end of a day. All the
people busy with their own work and no one bother about others. People in the same bus
speak with different languages. It reflect me this is the beauty of India and also people are
very helpful and kind to help even though for stranger. Hence, when I think about the
disability and mental illness I always have the thought that it is very inter connected to health.
Therefore it reflect me we should reach the people who are unreached or not aware about the
important of person with disability. Everyone has their own believe system but at the level of
mental illness and disability need proper health care.
I use to reason person with disability is
the one among the vulnerable group at
present in the society. People use to
think person with disability cannot do
anything but the fact is that they need
someone to listen and have patient
according
to
their
capability.
Whatsoever, the person with disability
are unique and special, they have their own gift and values.
Similarly, if I reflect about many areas around found that there is no proper friendly
environment for the person with disability (PWD) and person with mental illness (PMI). I
always ask question to myself can this generation change the mindset of people in term of
looking down for the PWD and PMI. Many a time I use to reflect awareness is the priority
followed by acceptance. If we don’t accept what we learn and aware about the reality then
how we expect to see the change in the society? Therefore, it is high time to wake up and do
some changes as new generation of the society?
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SECTION-III
The Euphony from String
Chapter-10
The sound of music bit the mind and hit body tremble
“We all can dance when we find music that we love”-Giles Andreae
The first learning coming to my mind about health is a need to think both positive and
negative because people always think negatively but unfortunately need to appreciate and
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reason it positively. It is not always negative because people think about health only when
they are sick. What I learnt is each person has different perspective from individual to
individual.
Thinking about “Health for All”. I am always asking the question especially when I walked in
slums because I recall back all the issues in the slum my mind become numb. Therefore, what
is the main reason behind the context of slum community? People like slum living with all
the social determinants it make me to reason on how to identify the problem or find solution.
It reflects me, need to question ourselves what is the main problem behind and find solution
both positive and negative.
There was a time when I use to reflect “Who am I”? Through this quotation I practiced to
think and related myself like animals character because it is an important role to understand
self on how I play the role in my life be it at home or outside.
Thinking again about “Health” it reflects me in today’s world the “Health Care” become the
top priority for the people to do with different business with heavy amount and benefit.
Health care at present, the main outcome is playing game with the precious life of human
being. It is due to globalization which leads to all the issues and problem faced by the poor
people. This creates the records that poor become poorer and rich become richer.
When I reflect back during the class room session, I realized whatever we did in community
we should drop-in in the community not just drop out. This reflect me if we educate one
person, it is a big change for the community. Malala Yousafzai said, “One book, one pen, one
child and one teacher can change the world”, that is what I felt that the benefit come from the
facilitators.
Learning
To begin with the classroom learning my hand and mind kept flowing to write but I cannot
express everything in writing. To put in writing whatever I learnt throughout 1year CHLP is
very vast because I never expect to have such great learning that will truly help me to stand
by myself. What I learnt is the environment created by SOCHARA, it amazes start from the
beginning. This is the best example as future community health worker I need to have in any
point or place I work with. Further I learnt many new concepts during the classroom with
diverse ideas and knowledge in different perspective.
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In the process of learning I realized the fact that the classroom session was the back bone of
my learning and enduring objective to be achieved.
Sharing and discussion within the facilitators and fellow travellers was the biggest learning
that I could make use in my future because everyone has uniqueness of thought and
knowledge. It is the immeasurable learning especially when it comes to the topics taught
during classes it is just like put and pasting in my mind. Understanding oneself give me brief
ideas about myself to understand my strength and weakness both inside and outside learning.
The beauty of learning in the classroom bounces me to understand the clear picture of
community health. Compare my understanding level from the beginning till the end it
contribute up to the extent that I never thought to have such excellent learning.
Understanding the four tier of health system is like open eye for me to understand the
services. It is very a important topic that I learnt during the classroom session because it
contribute to my knowledge, when it comes to health system. In term of health system I had
no ideas at all. In this period I am very happy to know the key concept of our own health
services. As an individual before joining SOCHARA every time I prefered Private Health
Care but at present I understand the important of the Government Health care.
Health has constantly events of illness and on how to find the solution in term of preventive,
curative, rehabilitative. Health system has different act in term of health services but still we
failed to learn the lesson from the other countries. India has higher no of IMR, malnutrition
etc. but still our Government treis to reduce the health budget despite lowest health care.
Even though India knows as privatization country. Health is inter-connected with social,
economic, political, cultural and ecological. Despite the definition of WHO “It is a state of
complete, physical, mental, and social wellbeing, and not merely the absence of disease or
infirmity”.
Paradigm shift gives me the amusing image of the reality on how to practice if we want to be
the change. I would like to quote George Bernard Shaw “Progress is impossible without
change, and those who cannot change their mind cannot change anything”.
Axiom brings back to my attention into community. We live in the country of agriculture, so
the community is the main source to reach the health for all through their cooperative and
participation not by using them simply without any benefit.
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Public health plays a very important role in terms of sanitation and safe drinking water. This
two view deals with day to day life of the person. Public health is always to treat and prevent
not to be cure.
During the session with Madam Thelma about the Health Policy what I learnt, it should be
norms and value on it. The goals of the health policy should include equity, accessibility,
affordability, regulation, law, human resources, financial, vaccine, drugs and infrastructure.
When human resource transforms into system it will be very crucial. Therefore, if we want to
have the better resource needs to adjust with time, because Time is a very important resource
in our hand. When the session kept going it was like an open mind for me to understand more
about the health policy. Health policy is the reason to strengthen the health system and
accountability. Definition by WHO, “A National Heath Policy is an expression of goals for
improving the health situation, the priorities among those goals and the main directions for
attaining them.”
A Health System comprises of all organizations, institution and resource devoted to
producing action whose primary intent is to improve health is called health system. It reflect
me when it comes to health issues in today’s generation, health is the biggest business for the
people to make money. I used to think why health system failed? May be the Govt.
concentrated only with the few areas of health and does not change the health status of the
people to improve well. I also learnt that India is one of the most privatized countries in the
world. Talking about health why in India the post-natal and adolescence is still neglected.
There is no proper plan or solution on how to uplift the lifestyle of the people in the society.
Learning in the class is like everyday news channel who give information to the audience to
aware about the present situation. Glocalization is the very new concept for me to aware and
understand between globalization and glocalization. Globalization is worldwide movement
towards economic, trade and finance. It is also a way that local or national doing things
become global. It is all about the economic, technology, politics and culture. E.g. market is
one example benefit the globalization. People are preferred to go and shop in the mall instead
of buying anything in local market. Because of the mind-set, the people always think about
their status that will affect them. Actually the public didn’t understand that globalization will
put them into threat. People have different perspective about globalization, because some
thinks it helps everyone while others think it hurt people. Glocalization is the product to
benefit the local market and distribute it to the universal level. Glocalization is the mixture
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understanding that brings together the words globalization and localization. E.g. to improve
the local market which will increase profit for the local people. Besides that I learnt that there
are four types of persons we never dare to ask question i.e. Pandit/priest, teacher, doctor and
lawyer.
Documentary movie is another outlook because it conveys lot of message to understand and
reflect back about the reality. Watching the documentary on “Caste System” I learnt and
observed everywhere public play major role to response be it positive or negative. Since we
in North East do not practice caste system I find the life of women is terrible. We are living in
the 21st century, unfortunately the caste system especially in rural is still very strong. The
practice of high caste and low caste is still very prevalent. If we talk about caste system, God
does not believe in caste system but why we people practice and believe in it? Remedies are
not prescriptive science and remedies are not only to understand but it is also a practice by
people.
The point of view of “Mallur Story” is another level that inspired me about the hardworking
of the community and free mind to think. Whatever we want to do without the cooperation
and participation will reach nowhere. Each and every individual play a vital role in the
community and they are the best example for the other communities to get involve
themselves into the team work. It is wonderful to see the community without any
discrimination and they sacrifice and forget about the caste system for the benefit of
development. In the story I learnt there are many women who participated in it show that if
there are many women there will be development. I also learnt that youth are the agent of
change in the country. To work in the community, knowledge cannot change the people but it
is the attitude and skill that can change. Although we can change but the good example is to
change oneself and be the role model for others.
During the session also learnt empowerment is very important because need to empower the
community through different skills and methods in ways of understanding their own need. To
have a dream one needs to have resources including economic, health, education, basic need,
security, social satisfaction and well-being. When we talk about health for all it will be a
success only if empowerment is done on day to day basis and to achieve we need to have
strong group and that will be the best tools to change the world and work as a team and build
good rapport and cooperation among the group.
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Besides that the great learning I had was SOCHARA is one of the greatest gifts of God for
me because I love singing but never meet people like SOCHARA who encouraged and
motivated that singing is also another tool to work in the community. I am so inspired by
their words and appreciation and I strongly believe I will make use of music as one of the
tools to work in the community in future. Celebration with music brings people together and
enjoy as one community.
Field learning
The field experience is another learning for me as a future community health worker because
I always wanted to see the reality of India, and getting the opportunity to be with the one of
the marginalized and vulnerable people like urban slum dwellers. I could see the true India
and the life style of people is diverse among the people. Urban slum is the people who lack
all the social determinants in their daily life, this makes me recognise about the circumstances
and illness they are facing. For the first time I visited urban slum in Bhopal it makes me
angry and sad at the same time because whenever I think about them it affects me and I don’t
get sleep particularly when I rainy season. People are welcoming but they are busy with their
tight schedule of working with very low amount from hand to mouth. Whenever I went to
field always thought, how people living are living in that condition but when I try to frame
the situation I find the answer that it is all about poverty. People suffer in each and every
single day especially women. Having experiences with the urban slum it is memorable and
the sad and angry experiences will never wipe my eyes and the life style of urban slum. I will
carry the message and reality of the people and spread the message about the reality of the
urban slum of Bhopal on how we can work out in better way and improve the living
condition of the marginalized in all around us wherever I work.
I learnt working with slum will be the great challenging task because the different people
have different attitude and this is due to the lack of honesty, loyalty and lack of operating in
changed work. I learnt to be future community health worker money is not major ingredient
for me because major ingredient is the true and profound for the poor people those who needs
and deprive for the dignity of life, voice less, marginalized in the society.
Another experiences with the rural people in Jaintia Hills in Meghalaya I came to know and
aware about my own areas, since I never had experience before. When I visited Sohshrieh
Village of Jaintia Hills it shocked me when I see the condition of my own community
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because I always thought people are better but unfortunately people are still lagging behind in
many ways. There is no proper drinking water, sanitation, health centre and education etc. So
strange for me to know about my own state and see the condition because children are still
living and carry the very simple life style. Therefore, it reflects me that poverty is the major
issues faced by people. According to the Millennium Development Goal aim and objective by
2015 the target is to eradicate poverty, but unfortunately did not reach the target. Therefore,
the new aim is by 2030 will eradicate the poverty. So my reflection towards the poverty is
that I doubt will be able to eradicate the poverty? Why I mention because according to my
experience in the field I thought it will take many years to come out with the fact of poverty.
Until and unless we accept the fact will never eradicate the poverty. In India a third of the
population is below poverty line then how we expect poverty to be eradicated. It is not a easy
task instead it is big challenge work if we want to see the different.
Therefore, I think about the experiences in the field it make me worry about the lifestyle of
the children in the community both Bhopal and Meghalaya. We all think children are future
of tomorrow but unfortunately I could see it is very difficult for the children to come out due
to poverty and also there is no school in the village and slum. Then how we expect the
children will be the future of tomorrow.
To be with the community we need to be active listener and be patient. Community have lot
of thing to share about the past, present and future. Once we build the rapport with them the
relationship is strong. So, working with the group in the community, the coordinating and
monitoring need to be a discipline. Because for the community when they trust they can
really work as a team for the betterment of the community. At the same time, it is challenging
job but if the passion and commitment is there the person will enjoy his/her work. At that
time the work will be smooth and satisfied. Of course some people used to say language is
barrier but I think, up to extent can manage with it because once person involves with the
work he/she do it in real to sacrifice for the work. The task is another difficulty because if the
community are not cooperate and involve together. The compassion it speaks to the one who
put his/her task in front of all the work to do. Therefore to be with the community need to be
analytical thinker. And this will help the community to grow in many areas. Leader plays a
vital role in the community and if leader is smart and willing to work in the group for the
betterment of the community then there will be a change very soon.
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Beside that I learnt some administration work during my field that will help me to maintain
the work in the future. But the most important to be with individual, group and community
team work is very important because without team work the work or plan will not be
successful. Even though the task is difficult if the active participants from the community are
strong the work will be comprehensive.
Chapter-11
Music of life and hard note turn the song beautifully
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“If you think positively, sound becomes music, movement becomes dance, smiles
becomes laughter, mind becomes meditation and life become a celebration”.
-Unknown
Challenges
The hard note is the high note of the music. I need to work very hard and keep practice the
song and learnt the hard note and touch the right track of song and make it complete.
1. Finding common time to meet was one such challenges
2. Trusting and respectful
3. Language
4. Support to develop relationship with community
5. Lack of awareness
6. SEPCE
7. SWOT
Outcomes
1. Working with community is the main challenges, but I should learnt to accept the
challenges and move forwards
2. Develop listen skill
3. Turning off the tap and mopping the floor
4. Be active
5. Keep learning
6. Role model
7. Knowledge is power
Reflection
1. Know the meaning of myself: When I think about know the meaning of myself. At
first I really don’t understand what the meaning of myself is. It makes me think and
confuse, and at the end of the day I realized it is not easy to get answer in one or two
days. At last I realize meaning of myself is believe oneself, dream positively, true self,
involved with others, grasp the opportunity and never give up!
2. When I imagine about the whole picture of two months in urban slum, it reveal me
that it is all about poverty. We need to take action firmly and money is not major
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ingredient but the major ingredient is the true and profound for the poor people those
who needs and deprive for the dignity of life, voice less, marginalized in the society.
And working in the urban slum area need to dedicate and be passionate and uplift the
people who are in need of help.
3. It reflects me, if you hurt, worry and indeed be with the poor people who really need
help because they are the one to help the ones. Being with the rural people it is
privilege of spending a great time with villagers most accepted person.
4. Urban slum remain hidden under the umbrella of silence.
5. Only few accept and listen to the voice of the slum and certainly no lawmakers did for
their improvement.
6. When “I” is replaced by “WE” even illness becomes wellness.
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SECTION -IV
WRITING NEW NOTES
TITLE: A STUDY ON NUTRITIONAL STATUS OF PREGNANT WOMEN AND
ROLE OF ANGANWADI WORKERS OF PHRA MER IN JAINTIA HILLS,
MEGHALAYA.
Introduction
Chapter-1
The study on “A study on Nutritional status of pregnant women and role of Anganwadi
Workers” has been the subject of my research during the period of fellowship programme.
Researcher (I) have found the nutritional status of pregnant women is one of the biggest
problem because women remain unaware of their own health problem such as hygienic, diet
and family planning, and because of the low knowledge it involved and repeated pregnancies.
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Women is regarded as the nerve centre of the family and society maternal nutrition and health
is consider as the most important regulator of human foetal growth (Ventura 2008).
From ancient time it has been recognized that pregnant women form one of the most
vulnerable parts of the population from nutritional point of view. Maternal nutrition and
health is considered as the most important regulator of human foetal growth. A healthy
mother can produce a healthy child. Pregnancy is the era of dynamic transformation for a
mother needing a lot of care. Through this period the fetus is nourished directly by the mother
through placenta. A woman’s normal nutritional requirement increases during pregnancy in
order to meet the needs of the growing foetus and of maternal tissues associated with
pregnancy (Lisa, 2009).
In pregnancy anaemia has a major effect on the health of the foetus and the mother.
According to Agarwal (1991) maternal anaemia resulted in 12 to 28% of foetal loss, 30% of
prenatal and 7 to 10% of neonatal death. Anaemia in pregnancy is also linked with increased
of maternal morbidity and mortality. A women’s normal nutritional requirement increase
during pregnancy in order to meet the needs of the growing fetus and maternal tissues
associated with pregnancy.
The Integrated Child Development Service Scheme (ICDS) is the world’s largest community
based outreach programme which offers a package of health, nutrition and education services
to the children below six years and pregnant and nursing mothers. The Integrated Child
Development Services scheme (ICDS) was started in Karnataka on 2nd October 1975.The
welfare of pregnant women, nursing mothers, adolescent girls and children below 6 years has
acquired a prime place in the programme. The programme is a package of six services
namely, supplementary nutrition, immunization, health check-up, referral services, and
nutrition and health education for mothers / pregnant mothers, nursing mothers and to
adolescent girls. Anganwadi workers is a woman of same locality, chosen by the people,
having educational qualification of middle school or Matric or higher. She is assisted by a
helper who is also a local woman and is paid honorarium. The Anganwadi worker is the most
important functionary of the ICDS scheme. The Anganwadi worker is a community based
front line worker of the ICDS programme. She plays a very important role in promoting child
growth and development. She is also an agent of social change, mobilizing community
support for better care of young children (Kant et al. 1984).The Anganwadi Worker monitors
the growth of children, organizes supplementary feeding, helps in organizing immunization
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sessions, distributes vitamin A, iron and folic acid supplements, treats minor ailments and
refers cases to medical facilities (ICDS report, 1995).
1.1 Background
From the point of view, pregnant women are recognized as one among the vulnerable group
when it comes to health. They need better care and more food than the normal person because
she needs to have proper diet and care for the foetus to grow. 20 pregnant women were
selected for the study in Sohshrieh Village. Among the 20 pregnant women many are
uneducated and they don’t care about the health or diet. A life course perspective observes
peoples’ behavior – what choices do they make about food and eating and what are the most
important factors, affecting those choices (Rozin P., 1990).
The researcher conducts a research topic on “on “A study on Nutritional status of pregnant
women and role of Anganwadi Workers” in Sohshrieh Village (Jaintia Hills, Meghalaya).
The researcher felt that nutritional status of the pregnant women especially in the rural areas
is another major problems face by the women during their pregnancy. Generally during
pregnancy the women in rural areas did not have much time to think about their diet because
they have to think about the others children and family. Researcher felt it was particular
interest to know and explore food that women are consume during their pregnancy. Also felt
it is opportunity to study the present topic because it is significant to bring awareness on how
the socio-economic affect one individual to another.
Chapter-2
Review of Literature
Initially when women become pregnant they often think they need to consume more food in
order to make them healthy and assure to grow the foetus. “An adequate diet during
pregnancy maintains the nutritional status of the mother at a level that conserves her own
body tissues and contributes to the normal development and birth of a healthy, full-term
baby” (Nti C. et al. 2002). As many researches show, during the pregnancy women often
become aware of nutrition, seek health advice and change their diets (Anderson A.S., 2001).
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During the pregnancy maintaining the weight is very important at that time because women
need healthy food and may they can seek advices from the health worker or doctors. “They
have a collective impact and may interact with individual characteristics to influence healthy
eating by pregnant women” (Fowles E., 2008).
Nutritional need during pregnant
Nutrition during pregnancy is a significant public health concern (Wen et al., 2010) because
pregnancy is a critical period during which good maternal nutrition is a key factor influencing
the health of both mother and child. During the prenatal period, the developing foetus obtains
all of its nutrients through the placenta, so dietary intake has to meet the needs of the mother
as well as the products of conception, and enable the mother to lay down stores of nutrients
required for the development of the foetus (Williamson, 2006). According to WHO (2014),
nutrition is the intake of food considered in relation to the body’s dietary needs. Good
nutrition, well balanced diet combined with regular physical activity is a cornerstone of good
health, whereas poor nutrition can lead to reduced immunity, increased susceptibility to
disease, impaired physical and mental development, and reduced productivity (WHO, 2014).
Therefore, women of child-bearing ages should maintain good nutritional status through a
lifestyle that improves maternal health and reduces the risk of birth defects and chronic health
problems in their children. The key components of a health-promoting lifestyle during
pregnancy include appropriate weight gain, appropriate physical activity, consumption of a
variety of foods in accordance with the dietary guidelines for pregnancy, appropriate and
timely vitamin and mineral supplementation, avoidance of alcohol, tobacco, and other
harmful substances, and safe food handling (Kaiser & Allen, 2008).
Income Level
Housing, sanitation, diet end life-style are all affected by a person's income level
(Worthington-Robartset al., 1985). As a person moves down the socio-economic ladder, she
will have more difficulty purchasing items that ore essential for survival, such as proper
foods. Lechtig et al. (1975) found that protein end calorie malnutrition are frequently
associated with a low income level. This malnutrition leads to e smaller placenta which limits
the transfer of nutrients to the foetus. A result of this limited transfer is poor fetal growth.
Organ studies show that there is a decrease in the amount of adipose tissue and a decrease in
the size of fat cells in infants from poor families. Also, organs, in these infants are smaller
than those of better nourished infants. These organs include the liver, adrenal glands, thymus,
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spleen, heart, kidney, and skeleton (Noeye, Diener & Dillinger, 1965). Information from
these organ studies suggests that a poor income position and its consequent malnutrition con
ultimately affect the development and health of the foetus. A study conducted on 17,196
British births compared the foetal death rate in each of five social classes and found that the
death rate for babies from 20 weeks of gestation to one week of life increases as the family
moves down the socioeconomic ladder [The Lancet,1976]. Thus, not only is the foetus at a
greater risk for retarded development, but it is also at a greater risk for death.
Nutritional status during pregnancy
Nutritional status during pregnancy is an important variable to measure because the foetus is
directly affected by the mother's nutritional state. When pregnant, the woman needs to change
her food intake in order to compensate for the increase in her metabolic rate. An increased
basal metabolic rate requires an increase in calories in order to maintain optimal physical
function (Rambo, 1843). Actually, during the pregnant state, a woman's calorie consumption
should exceed her expenditure. This imbalance of the food intake will affect the growth and
development of the foetus and also at the same time the women should own her physical
functioning.
Nutritional status is very difficult to measure. Several methods are used, but no one way is
known to be better than the others. Nutritional status may be accessed through
anthropometric measurements, such as upper arm circumference, height and weight.
Laboratory studies, including haemoglobin measurement, may be indicators of nutritional
status.
Chapter-3
Research Methodology
The basic purpose of this study is to explore the source of economic status and food
consumption of the pregnant women and role of anganwadi worker in Sohshrieh village from
the perspective and the thought of the participants. This study design is a qualitative method.
Common theme will be identified and analysed in an attempt to clarify the source of
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nutritional status of pregnant women and how the anganwadi play role to the pregnant
women in the community and perhaps to suggest further areas of study.
This chapter focuses on the research design, method of the study, population and nature of
data, sampling and size of the sample, tools of the data collection, data analyses, and
limitation.
The researcher conduct this study because nutritional status of pregnant women is one of the
vast and vulnerable group are lacking behind. Women during pregnancy suffer a lot be it
work, food, tension and health. The researcher fell nutritional status is one of the major
problem areas need to improve with women health during pregnancy.
Objectives
1. To study socio-economic status of selected sample of pregnant women at Phra Mer?
2. To know the food consumption patter of selected sample of pregnant women?
3. To find out the role of Anganwadi workers in the nutritional of pregnant women.
Purpose of the study
The purpose of the study is to investigate the source of nutritional status and food
consumption of the pregnant women. The researcher felt that it is one of the major issues
faced by the pregnant women in their life due many social problem be it individual, group
and community. The researcher felt it is interesting topic to study because it will give proper
information how the pregnant women have the eating habit during their pregnancy.
Study design
Qualitative research: Qualitative approach focuses on objectives to enquiry and application
of analysis for attainment of objectivity and generalizations. The qualitative research use face
to face interview, questionnaire and in-depth interview as method of collected data.
Study Area- Sohshrieh Village, East Jaintia Hills, Meghalaya.
Population: The population of the study is the pregnant women and anganwadi workers.
This study is confidential for the purpose of the participants to participate actively.
Sampling: In this study the researcher will be using Random sampling technique.According
to Parten, “Random sampling is the form applied when the method of selection assures each
individual or element in universe an equal chance of being chosen.”
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Sample size: Size of the sample conducted 20 pregnant women and 3 Anganwadi workers,
age between 18-45 years are the representative of the entire population.
Nature of data: The researcher herself collected the data from the selected participants
through questionnaires and in-depth interview. Official formalities will be maintained.
Primary and secondary data will be utilized.
Tools Applied- A face to face interview schedule according to the convenient time of
respondents was used as a tool for data collection with various framed on the nutritional of
pregnant women and role of Anganwadi workers.
Data analysis
After data collection the analysed and interpreted using appropriate statistical techniques to
establish the nutritional status of the pregnant women. The collected data would be tabulated
and analyse by using excel. It is essential for the scientific study and the data is attempts to
fully and accurately summarize and represent the data that has been collected.
Chapter-4
Analysis and summarising
The purpose of this study was to determine how the nutritional status and role of anganwadi
worker when it come to pregnant women in the community. This chapter will begin with
statistic interpretation and follow by the summarisation of in-depth interview. The population
of this study consisted only pregnant women and anganwadi worker. The total numbers of
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participants is 20 pregnant women and 3 anganwadi worker. The maximum majority of the
pregnant women got married at the age of 20 years.
Figure 4.1.1: Age, Qualification, Year of Joining and Work Experience of Anganwadi
Workers
2008
1998
1996
Sum of Work
Experience (Years)
Sum of Year of Joining
9
19
17
From the figure above show the participants have different age group, qualification, year of
joining and work experiences. The finding from different scores under others categories.
Figure 4.2.2: Education of pregnant women
10th standard
Primary
Secondary
Uneducated
From the figure above it show the education of the pregnant women is very low and majority
of their qualification are primary and secondary is very low.
Count of Income
Row Labels
Agriculture
Agriculture, Govt.
servant
Daily Labour
Self-employed
Shop keeper
Grand Total
Column
Labels
10th standard
Grand
Primary Secondary Uneducated
Total
1
1
4
6
1
1
5
1
1
8
101
1
1
3
3
1
8
1
9
3
1
20
Table 4.1.1: Occupation and education
From the figure above the higher numbers of occupation are daily labour and lowest is
shopkeeper. 8 numbers are primary standard and uneducated participates in the study and 3
are secondary and 1 is standard 10th.
Count of Occupation
Column Labels
Row Labels
10th standard
Primary
Secondary
Uneducated
Grand Total
> 6000
Table 4.2.2: Income and occupation
2000>6000 4000
1
1
3
1
1
3
2
8
41006000
3
1
4
1
1
4
6
Grand Total
1
8
3
8
20
From the figure above the income is almost equal to all according to the occupation. 8
pregnant women income is above 6000 and 6 participants earn 4100-6000, 4 participants earn
2000-4000.
Figure 4.3.3:Marital status and age of marriage
6
5
4
2
2
1
From the figure above it shown majority of respondent’s marriage at the age of 20 years and
lowest is 18 years.
Figure 4.4.4: Family profile of the respondents
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15
5
From the figure above it shown the family profile of the respondents and majority are join
family than the nuclear family. 15 respondents are joint family and 5 respondents are nuclear
family.
4.5.5: Meat and Poultry
10
7
3
From the figure above it show majority of participants who eat non-veg are 10 respondents
and eat 2-3 times in a month and 7 respondents eat once a month and 3 respondents eat once
a week.
Figure 4.6.6: Cereal
16
Total
4
2-3 per day
4-6 per day
From the figure above it show among the 20 respondents eat rice than the others cereal. 16
respondents eat rice 2-3 times per day while 4 respondents eat 4-6 times per day.
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Summarized of Nutritional status
Nutrition status: (food habit, availability)
According to the respondents their nutritional status is not much important to them because
there is very limited food available in the village. Therefore their food habit is been practice
generation in very simple way. There is no practice or modification during their pregnancy
time because it very difficult for them to get the food or their diet in the village. The pregnant
women are eating whatever they use to get in the village and also availability at home. They
cannot compared themselves with urban people or television. They have habit of eat in very
simple manner.
Socio-psychological Aspect: (Society, education, food practice)
When it come to the socio-economic aspect of the pregnant women the main issues that they
mention it is the society practices when it come to food habit example battle nut and battle
leaf is the main practice in the community. The pregnant women don’t have any ideas about
the important of their health, because they are illiterate and education is meaningless for
them. It shows that due to the lack of knowledge the pregnant women are not bothering about
their health and did not understand the meaning of their health.
Diet: (Traditional practice, time, responsibility)
Diet is very important for every one because diet is the main factors give strength and effort
to build the immune system of the human body. Therefore, the response of the respondents
show very less and they lack of knowledge about their diet and it is not the priority for them
to care about the diet. Their expression shows that they did not understand about the foetus
health. Suppose if the mother is not healthy the child also will not be healthy. But still they
don’t know much about their diet. When it come to the diet of mother and child if the mother
is not eat properly there will be at risk both the mother and child.
Community mechanism (ASHA, AWW, DIAS, Family, accessibility, affordability)
The community mechanism during the pregnancy is one of the ASHA workers who give
them some support during their pregnancy and Anganwadi worker as well who try to support
through ICDS scheme. The pregnant women in the village also prefer traditional birth
attendants for their delivery and till now the home delivery is still practicing because it is
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accessible (TDA) any time they need and at the same time affordable to pay. And most of the
time TDA is free service.
Time table: (food intake, quantity, quality, culture practice)
When it come to food intake of the pregnant women usually they eat more than before
pregnancy. They fell like eating more and the quantity also it increase. But the quality of the
food is different with the urban women. In rural areas pregnant women are usually eating the
same food habit as they eat during their normal life. They did not have the habit of eating
special during their pregnancy. Therefore when it come to culture as tribal their custom is
normal to eat battle nut and leave. Actually the tobacco is not good during the pregnant time
but what people in rural as tribal they don’t care because it is the culture they are practice
from generation to generation and also there is no restriction to eat. Their food habit is totally
different from the urban areas.
Life style (Food habit, affordable, food interest)
When it come to the life style of the pregnant women is very simple because in the village
they eat in such a way that they will fill their stomach not to have proper diet. One of the
pregnant women said, there is local snack called “Pukhlein” in the areas that is her special
food and most of the pregnant women fell eating fruit is compulsory during pregnancy.
Pregnancy is crucial stage but what women in the rural areas interest in food is not changed at
all. One of the pregnant women said, there is a time if she did not get to eat what she want
automatically upset and disappointed with everyone. Most probably the pregnant women
mention they don’t have favourite food.
Psychological aspect (like and dislike)
It is the psychology of the people in every community during the pregnancy because some of
the unwanted items are using example kerosene. It is very bad and it will effect for the foetus
but still using it. And almost the pregnant women mention they eat lots of the sour fruits it is
normal for every pregnant women. Also mention there are many like and dislike food during
their pregnancy. As they (pregnant women) mention there is some food never eat much
before but unfortunately it become daily food e.g. local snack and some local vegetable.
Food intake (variety of foods, timing, quantity, family size)
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The food intake it depends the varieties of food available in the areas. The food items mainly
pregnant depend on rice, vegetable and meat. One of the pregnant women mention “Eating
papaya and any bitter items is strictly prohibited during pregnancy that is the practice from
many generation” because cultural believe will cause abortion. Corn is very common in the
areas and most of the women said they eat extra rice than before and believe it will give
strength and energy. It seems it is the foetus want to eat. And rice is compulsory for the
people be it pregnant or not pregnant. There is no timing for eating any time it is easily
hungry. But after delivery the parent never allows to eat meat that is the culture and belief in
the village. One pregnant woman said, “During pregnancy is not supposed to eat ladies
finger, pumpkin, raw papaya and all bitter items because it will affect the foetus and it is
belief and practice as well in the village”. For the pregnant women in the rural areas the
family size also very important because if the family come from the poor background they
can effort to eat if she want to eat too. That will affect the foetus and the mother as well she
cannot eat properly during her pregnancy or it may lead to the anaemia and underweight of
the child when she delivered.
Economic and biological status (consuming capacity and affordability)
Economic is the main financial problem for the poor family background to adjust with their
eating style especially with the big family it is difficult to manage. One of the participants
said, “Due to poverty I never think to eat properly what I want because have to look for my
children too”. It is according to the capacity of the women to eat and affordable to buy food
items. Meat, fruits and milk is very expensive cannot effort to buy and end up with dhal and
potatoes every day. Education for children also is important so instead of buying eatable
items need to pay for school fees of the children. This is another problem the pregnant
women cannot afford to buy whatever she wants to eat as pregnant mother. It also said they
are not use to egg and milk so they never take or drink milk it is only sometimes.
Food processing (living condition, availability of food grain)
For the pregnant women in the rural areas it is tuff time when it comes to eating food because
the life condition also play major role in everyone. It is affordable or not and it is available in
the areas or need to buy in the market. The life in rural is very humble, people eating very
simple way and there is no special be it pregnant or not pregnant. Mostly they cook same
thing as always. The pregnant women are so blank when it comes to food available for the
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pregnant women. Since there are many local green leave the women are eating lots of boil
instead of fry food.
Privilege (Respectful, no recognition)
The respondents had no answers because they never know or think in their life to have special
food item for themselves during the pregnancy. Since it is matrilineal culture women had
privilege to eat whatever they want but the only thing is that people in rural are not practice
for anything special during pregnancy. Pregnant women when it comes to religious practice
they have believe system to do special pray for them before and after delivery for both
mother and child. The life style is not stable if they come from the poor family background
because when it come to health facilities is not available in the village. Each and every house
hold is different, so the kind of appreciation of being pregnant also is different especially
from the poor family back ground pregnant women did not get any appreciation of being
pregnant.
Chapter-5
Finding and Recommendation
The main finding
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1. The researcher found anganwadi worker has different experiences in the field
according to the years they are joining. And the education does not matter much
because only one anganwadi have completed matriculation and the rest primary.
2. When it comes to education among all the respondents who participates they have
very low education and primary standard are the higher numbers follow with lowest
numbers of 10th standard.
3. When it comes to occupation of the respondent’s daily labour is the higher number
follow by agriculture and shopkeeper is lowest numbers. 8 respondents are primary
standard and 8 are uneducated respondents in the study and 3 are secondary and 1 is
standard 10th.
4. The income is almost equal to all according to the occupation. 8 respondents income
is above Rs 6000 and 6 respondents earn Rs 4100-Rs 6000, 4 respondents earn Rs
2000-Rs 4000.
5. Compare marital status and age of marriage the higher numbers of respondents
married at the 20 years and lowest is 18 years
6. When it come to family profile of the respondents, majority are joint family than the
nuclear family. 15 respondents are joint family and 5 respondents are nuclear family.
7. Majority of the participants who eat non-veg are 10 respondents who eat 2-3 times in
a month and 7 respondents eat once a month and 3 respondents eat once a week.
8. The researcher found among the 20 respondents eat rice than the others cereal. 16
respondents eat rice 2-3 times per day while 4 respondents eat 4-6 times per day.
Recommendation
1. To consider of socio-economic status need to look with others criteria of the problems
like education level and marital status of the living condition.
2. To conduct large sample in order to know the relationship and shown the good study.
3. To assess the questionnaires to improve and fulfilled the study.
Limitation of the study
During the data collection the researcher experienced lots of difficult because most of the
respondents are busy with their current schedule due to harvesting time.
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Time constrain is one of the difficulties, since the respondents were not available at the same
time. So need to go many a time to request them to spend few minutes.
It was great experiences that help researcher to understand the limitation of the nutritional of
the pregnant women. Regarding to the respondents they do not response much to their health
because they lack of aware and knowledge towards their own health.
Conclusion
In the present study the nutritional status of pregnant women has been investigated. The study
basically conducted in order to gain a broader understanding of the source of nutritional
status affected by pregnant women.
References
International Journal of Current Research Vol. 3, Issue, 11, pp.122-125, October, 2011.
International Journal of Scientific and Research Publications, Volume 3, Issue 9, September
2013.
International Journal of Science, Environment ISSN 2278-3687 (O) and Technology, Vol. 2,
No 6, 2013, 1277 – 1296
Health line ISSN 2229-337X Volume 3 Issue 1 January-June 2012.
http://www.who.int/topics/en/
http://nrhm.gov.in/communitisation/village-health-nutrition-day.html
http://nrhmmeghalaya.nic.in/
Nutritional status of rural pregnant women of Haryana State, Northern India…… Jood et al.
http://en.hesperian.org/hhg/Where_Women_Have_No_Doctor
http://www.apa.org/pi/ses/resources/publications/factsheet-women.aspx
Guidelines for Community Processes-2013 National Rural Health Mission
Chinese poem by Lao Tsu
RHYTHMING FOR SOCHARA FAMILY 2015-2016
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Dr Ravi well known as story teller and cutie chap, but don’t worry Dr
Thelma we know you as sweet, adorable and knows you both as cutest
couple.
Mahammad and Chander, we know what you all discuss about us in your
room but we are happy because we know that it’s for our good and your
efforts have proven it.
Kumar is motivating and encouragement facilitator during recap sessions
sand Rahul as helpful, intelligent and silent killer.
Jannelle known for her charming smile but don’t be jealous Anusha we
love your smile as well. You are friend and facilitator at the same time,
may you get all the happiness and successful.
Prahlad you are a stallion of sanitation and Adithya in love with nature. We
are proud of you both. Prassanna an all-rounder, a global man!
Swami you hold the key to knowledge, count on how many books are
borrowed and how many are returned a day but don’t worry you have a
colleague like Maria who keeps checking how many absentees are there a
day.
Victor you are the righteous banker, but don’t be panic too much about
the Stipend and hostel fees because Mathew always besides you to help
with that tension.
Tulsi, Hari and Joseph, how unassuming are you! You kept us awake
during the tiring sessions. The smelling of Milk-Lemon-Sugarless tea
flavour is the secret of your signature style and the taste give us full
energy back in the class.
Amma and Akka…. If it was not for your efforts we would not have had the
luxury of a clean and tidy surrounding. Your lovely smile in the morning
brings joy to our heart.
Keep going Fair Asha as we all know you as good imitating and good
leader, lovable and hardworking like Uma.
Continue to share your thoughts and ideas to the groups keen Rajeev,
Carry on to be a poet Samar and get the world’s attention.
Keep smiling Aruna and Balentina your smile will win the heart of people.
Adorable and charming like Dala, Fatima you have soft corner to be true
community health worker, wish you all very best in future.
Anji you are person with full of vision and mission and Chandu you willing
to share with what you have to others we appreciate it. Azam you are the
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Bhaijan for all of us! Remember us sometimes. Suresh you are smart and
intelligent, blow-out your knowledge to the community.
Anumaria Jacob we call you affectionately Anu, Swetha.Y we call you
sincere Swet.
Shenaz you are wise and sweet friend, and Sweta.G you are friendly and
ready to learn new knowledge.
Jaison known as gentle and helpful guy. Hiding talent but we know you
have the good quality of leadership, and Khirod you are very kind and soft
spoken person, always willing to give your hand to others who need.
Kulesh you are very silent person but your contagious smile speak to all
the group, and Kamlesh continue to spread your hindi speaking to the
people who did not understand much like me.
All said and done
And now that parting time has come
But do not think that we are once and for all gone
Whenever we reach Bangalore
We should remember to stop and peep by
When we feel like give up with our tide schedule
Remember that out of hard labour comes the honey.
HOME
It’s been one year down the line
Let us all turn back to time
When “You” and “I” was never mine
And how our love begin to twine
It started feeling I am home.
Every morning, straight out my bed
Waking up listening and singing my favourite songs
Getting ready to take each step
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Taking every chance, cause I’m all set
Because I felt I am home.
Then the good times comes, left no regrets
Some calm and some noisy dreams are on my bed
Thousand nights, thousand dreams, thousand shining eyes
On every beautiful dream I laid my eyes, we walked in people’s shoe
Lived their joy and rue because they said I am home
We’ve had ups and downs, sometime dust sometime crown
Struggles in pain, do you think it’s vain?
In burning desert it will bring rain
Well this is life my friends, it’s true,
Sometimes we lose sometimes we gain
There will be sun there will be rain
Do not get down we will be home
Me….mo….ries that we’ll carry, home.
BALENTINA T. LAMARE
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