Alfred S Raju : Undestand Community Health, Social Determinants, Impacts of globalization of health concet likE GLOCAL

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Title: Alfred S Raju : Undestand Community Health, Social Determinants, Impacts of globalization of health concet likE GLOCAL
extracted text: Report - PART- A
CHLP Learning
1. Introduction
I am Alfred S Raju, native of Bangalore, I completed my Master’s of Social Work
(Community Development) from Christ University. My area of interest are School
health promotion, Early Child Care, Nutrition, Mental health and Occupational
Health.
2. Why did I join the fellowship?
Community Health Learning Program of SOCHARA is one of the unique courses in
the field of Public Health. As I am in the field of Social Work and I had the desire to
connect with people, be of some help them, by learning together, the grave realities of
the world that we live in. especially when I saw the plight of some urban poor localities
in Bangalore. I felt that a systematic way of engaging in the lives of people is necessary
so that, we may be of something help rather than causing damage to them. The health
of many urban poor localities is a major challenge that I have witnessed, first of all the
living condition is not so conducive, the basic facilities like water, sanitation, hygiene
is a far reality for most of them. Apart from these, they are vulnerable to all kinds of
socio- economic, political, and cultural oppressions. In this challenging reality, it was
my desire to engage in the lives of people with Health awareness session, helping
people to help themselves, in accessing the health facilities available. The help people,
I should know the basic knowledge of Health and its various approaches.
Through this community heath learning program. I would be able to get the right
approach to engage in people’s lives at the same time to learn through
practising(Experiential learning). As the CHLP courses gives an ample space to reflect
of the aspects that we learn from the field. learning by doing is what attracted me
towards CHLP.
Through this community health learning program, I would be able to serve the
marginalized communities. It also enables to get into the action research as I am also
interested in pursuing my Ph’d in Social Work. CHLP is a great avenue that can
navigate my interest in a proper way. According to my person opinion, our experience
of realities should push us to understand the community through the lens of SEPCE,
(Socio, economic, political, cultural and environmental). This analysis through the lens
of SEPCE will lead to Action, action will further lead to research and research to
dissemination of the learnings by engaging with the communities. CHLP course
outlines interested me apply. Therefore, I applied and the experience is enriching.
3. What were my learning objectives and were they met?
My learning objective are
• To learn and understand community health
• To learn the social determinants of health both by theory and practical.
• To enhance my understanding about the concepts like GLOCAL (both local and
global), the impact of globalisation of health and its access to the poor and
needy.
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•
•
•

The alternative model available to all people irrespective their backgrounds
To visit communities (urban poor) and public health facilities available
To conduct action research especially the most marginalized and vulnerable
groups, their access to health.
Yes, My learning objectives were met, it was great unlearning, learning and relearning. The
CHLP program that is designed so meticulously and wonderfully to meet the need is
appreciable. It enabled me to understand the community more better and to approaches are
impactful. I was able to learn to understand, communicate, engage more effectively with
communities.
Community health: my understanding of the community was people coming together with a
common interest. Like associations, clubs, sports groups etc. it is self-organized groups. My
understanding of Community health changed; it gave a broader perspective towards the
concept of community. The process of enabling people, to exercise collectively their
responsibility, to their own health and to demand health as their right. The enabling, rights
with responsibility, and taking ownership of the process and demanding health as their right.
Social determinants of health
There is no single definition or understanding of the factors that affect the health of human
beings. There is no single definition of social determinants of health, but we can see some
commanlities. Many Social sectors, NGO’s recognize that there are many social factors that
affects the health of the individual. They point towards the social and economic aspect of it,
where as the module focuses on the Political, cultural and environmental factors too, which is
wholisitc in nature. Which helps a community health practioners to have a broader
understanding of a given situation. I applied this analysis in my project with Paurakarmikas of
Bangalore. It gave me broader understanding about he social setup they come from, why they
work as sanitation workers, is it by choice or compulsion, is there a particular group of people
pushing them to do menial jobs or is there no alternative, is it survival etc . I was able to connect
their living and working condition to the culture. Many hidden things are there, in the lives of
PAurakarmikas, they face the challenges in the society as they are born in a particular caste,
they are expected to work or follow a particular occupation. They are not given any other jobs
in the labour market. Politically, they are in the same condition because of the political
oppression, their children and children, from generations they have been doing these menial
types of jobs.
4. Learning from modules and how I applied the learning in my work.
The modules in the CHLP program are systematically placed. It is well crafted design
which covers the whole range of subjects that is very important for community health
practioners and social workers. The topics that interested me are as follows:
➢ Understanding Health, community, community health
➢ Axioms of community health
➢ Community health approach to Public health
➢ SEPCE analysis
➢ determinants of health
➢ Community health approach to Covid-19 by Dr. Antony
➢ Right to health and access to health care
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➢ Culture and its role in promoting equitable access to health and health care
➢ Health systems in India
➢ Pluralism in health care in India
➢ Role of health traditions and Ayush by Prof. G. Harimurthi
➢ Food and Nutrition by Dr. Ravi D’ souza
➢ C- Wash by Mr. Prahlad
➢ Women’s health /gender and health
➢ Mental health by Dr. Mohan Isaac
➢ Communicable and non-communicable diseases
➢ Palliative care
➢ Communication for health
The most interesting learning which I applied in the field are the Axioms, paradigm shift and
SEPCE analysis in the small project engagement with BBMP Paurakarmikas(Sanitation
workers in Ananadapuram and Mayabazaar Urban poor localities in Bangalore.
The paradigm shift from medical model to social model is very interesting/
Paradigm shift
Medical model
➢ Individual
➢ Patient
➢ Disease
➢ Providing
➢ Drugs/ Technology
➢ Professional

Social Model
Community
People
Health
Enabling
Knowledge social processor
Demystification

Reflections on use of the LMS, videos and participation in live online sessions.
LMS is a great tool in times of Covid and online world. The material for reading was uploaded,
the videos, lecture were available to me. Any point of the time we can access and read. It helped
to watch the lecture later. I sincerely attended all the lectures, unless there was some emergency
and was caught up with work. It is great learning tool, as we can upload our assignments, attend
quiz, assignments. Online sessions have positive as well as negative benefits. The positive side
of it was that, we can attend the classes from our home and from our comfort zones, online
classes was the norm of Covid times, as we are coming out of the covid, it gave us an
opportunity to learn in a safe environment. Personally, I like the offline classes as there is faceto -face meeting , discussion and learnings. I am also slowly adopting to the new norm of the
times, that is attending online classes. It would have been more interesting and active
participation if it was offline(my personal opinion). But I feel that it was great effort from
CHLP team in preparing the modules and uploading the appropriate material every week is
appreciable. LMS is a great platform, in the longer run we all will get used to it as we live in
the tech-savvy world.

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How was a balance between work, life and the CHLP maintained?
It was quite a challenging task to work and also study. The CHLP online was designed in
such a way that it did not interfere with my work schedule. We had weekly twice online
sessions which also was during evenings when all of us were done with our work. It was
quite flexible with regards to online class. I was able to attend almost all the classes. The
readings and timely submission of assignments were a challenging for me. As I couldn’t
give my best of 100% for which there is regret. There is always a feeling that I could have
done much more better. I should have done my assignments on time. It was a great learning
opportunity for me as I can confidently say that I have learnt something that I will put into
practice. Certainly, there is some improvement and betterment in my knowledge, attitude
and practice. I am indebted to the CHLP team for their patience and understanding us. I
believe it is just the beginning, many things to learn as I embark on this journey of
community health. I trust that everyday we can learn something new. CHLP has ignited the
fire in me, it will continue to inspire me to read more and engage in the lives of people and
to learn from them.
5. Mentorship process and reflections
The Mentor was assigned to me by the CHLP team is an excellent person. Initially
when I saw the mentors list. I was not that much happy about he unfamiliar name that
was assigned to me. It was Ms. Florence Jasmine David from INSA India. I had been
to Indian Social Institute and INSA, India office, but I have not met Ms. Florence J,
David before. My Initial visit to her, I had inhibitions. As I met her, it looked like she
is very strict by her appearance and her interactions with her office staff. The staff
members in INSA office welcomed me with smile and made me to sit in their office.
They introduced themselves and enquired about me and my background, my areas of
interest. The interaction with staff members was good. They made me to relax and be
comfortable.
Ms. Florence David, my mentor came and introduced herself to me and asked about
my background. She sat with me for an hour and half we both worked on the topic
that I was interested in, we spoke about the locality where I am going to engage with
for my project. She gave me necessary support and feedback as we worked on
schedule of visits to the community, the Need base assessment, planning of the
awareness session with Paurakarmikas.
She along with the team visited the Anandapuram slum community on December 1,
2022. She had transit walk and also tried to understand the community, its
composition, need and how we can effectively work in the community. Since, I awas
not planning to give awareness to the community. We moved our focus on sanitation
workers who are working in the community, from the community. We felt the need
and planned accordingly.
In fact, in collaboration with SOCHARA, Ms. Florence and team had conducted a
program on World AIDS day at Anandapuram to the community volunteers, around
30 women attended the awareness session. Aspects like what is HIV, how it spread,
how to prevent, when contracted what help should be sought, the stigma of HIV was
discussed.

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Apart, from her timely messages, mentoring through whataspp. Email, calls and
physical meetings. Ms. Florence was very gracious, she helped me in my session by
donating material for the sessions worth one lakh(mouth wash, paste, Junior
Horlicks). Which I distributed during my sessions with Paurakarmikas at
Anandapuram and Mayabazzar. She encouraged me to go out of box and think. Apart
from giving health awareness to 107 Sanitation workers, around 60 women and 110
children were given health and nutrition awareness. I am grateful to my mentor, who
is kind hearted person, who has passion to serve the marginalized communities. The
speed at which she works is incredible, she is always available for any kind of help or
suggestions. She gave me the best possible help from her side. I am happy to get to
know her, she is a good human being , philosopher, kind hearted person and she has
rich experience in developmental sector. I was very fortunate to have her as my
mentor for CHLP project.
6. Project learning experience
Orientation
The week orientation at St. John’s medical college campus was an eye opening and
introduction of me to the journey of Community health. It enabled me to get a wholisitic
picture about the vast topic health. Different people’s sharing about their experience in
the meeting was interesting, it gave me the desire to know more and to involve the
community in addressing the issue. Community at the centre of all the we do in enabling
the community members to solve their problems. Community identifies, community
plans, community executes and community takes credit for all that is done.
Sessions on understanding health was one of the topics that interested me. The multidimensional aspect of health as a human right enabled me to focus on the areas of my
interest. For many accesses to healthcare is a far reality. The issues related to health and
how we can be the catalyst gave me an impetus to work that i am engaged with
esepcailly Parikramas. The TB medicines or the ART accessibility by patients is
difficulty, due to poverty many patients they do not take medicines this includes
Sanitation workers.
SEPCE analysis
I was familiar with SWOT/ SWOC analysis. Introduction to SEPCE gave me little more
broader understanding of the community that I was engaging with. As I was interested
in working with Paurakrarmikas and their health. As in was exploring as in how to
engage with Paurakarmikas, many challenges arised. As Paurakarmikas, there is set
standard for contractors to follow in safety and welfare of the workers. As I was
discussing with the Paurakarmikas, I understood that Paurakarmikas as divided into 2
types in BBMP, 1. Directly appointed by BBMP and 2. On Contract basis. As I was
thinking of taking awareness sessions on occupational health and safety, my few
interactions with the workers and sanitation workers challenged me to drop
occupational health and safety topic, since there are contract workers, I was suggested
by the community well wishers that if we touch this topic of the social security needs
and the safety measurements, the contractors will not be happy, since the
Paurakarmikas will protest and demand the boots, gloves, helmets, jackets etc for which
contractors are responsible. Since it was sensitive issue I chose not to touch the topic
instead I thought I can touch upon the health of Paurakarmikas.
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It was great learning experience to me personally. I always use to wonder and their lives
intrigued me to work with them. Whether it was Covid times or non- Covid times, we
have seen this group of people relentlessly working to keep our city clean. The whole
world was shut down due to Covid -19 but the Paurakarmikas were on their duty.
Working and ensuring that the city is clean. Whether it’s rainy day or sunny, they are
in the streets cleaning, collecting garbage from households and streets. As we learnt
about social determinants, clean environment, water, sanitation also is one of the major
components that determines the health of an individual. The Paurakarmikas ensured
that the city and its residents are safe, whereas why are they ignorant about their health
and their lives was my question. Therefore, I tried to explore the lives of Paurakarmikas,
their background, their economic gain by putting their lives in risk etc.
As I had few interactions with the sweepers and waste collectors on the road and my
apartment, I understood the reality of their lives. most of them are in this profession not
by their choice. It is due to the caste that they were born, it was their survival rather
than their livelihood. They had to work as Paurakarrmikas since they are not employed
anywhere due to their caste or the religion of their birth. It was eye opening to me as,
even when they feel like working in some other shops or factories, they are not
considered due to societal unwritten laws. Therefore, they have no choice but to work
as sanitation workers. As my interaction continued, to my understanding, most of them
are Dalit, that too dalit women, out caste, Panchamas, they don’t fall in the caste
hierarchy of the social system of India. They twice or thrice discriminated based on
caste and gender. At this point I understood, the intensity of the issues faced by the
Paurkarmikas.
They are treated with derogatory terms such as kuppa, thoti, chappar, BBMP, Mali,
waste pickers, some of them even expressed that they were physically and sexually
abused by the upper caste people in the society. One of the worker aid , there is not
safety for their lives, no dignity of labour.
The sessions enabled me to see the Paurakramikas and their lives from close proximity.
Most of them are migrants, they have migrated to cities like Bangalore, Mumbai,
Chennai, Hyderabad because they can work as sanitation workers, work is found every
day, whereas when they live in their villages, they get work only when some animal is
dead or someone in the village dies. Therefore, most of them find cities to be the places
where they have continuous work and they can survive.
The facilities that they are suppose to get as sanitation workers is also far from reality.
Their salaries are not paid on time, sometimes 6 months sometimes it’s a year. We have
heard stories of Paurakarmikas taking their lives because they were not able to feed
their families. The work conditions are also some situation questionable, still manual
scavenging, human entering the drains and cleaning in spite of clear guidelines of
engaging machines is mentioned in BBMP solid waste management TOT training
manual. The condition of contract BBMP Paurarakrmikas is even worse comparatively.
Some of them had to go through abuses, some contracted respiratory diseases even then
they have to work, some even died while working, no compensation or work was given
to family members. If we dig deeper into the lives of the Paurakarmikas, we will come
to know their real pain and pathos. Most of them suffer inside because they do not have
any one who listens to plight and ensures their safety. As residents of this each one
should be conscientized about the issues of the Paurakarmikas, they are treated like
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animals, some times worse than animals. Programmes involving citizens and
Paurakarmikas should be organized where dignity and human worth of Paurakarmikas
is conscientized. Researches related to their lives, occupation, challenges, stigmas
should be taken. Awareness related to Rights and responsibilities should be taken.

7. Take away from CHLP and Looking Ahead -Where do I go from here?
CHLP is a unique program in which all the components of health are discussed.
Especially community health approach to public health. Putting community at the
centre and discussing, planning, executing the solutions. Collective engagement in the
finding solution for the issues faced by the communities. Building solidarity among the
communities. Rights and responsibilities, autonomy over health, health of people in
people’s hand. To integrate health and developmental activities, building equity and
empowering communities beyond their social conflicts, promoting and enhancing the
sense of community. Looking ahead, I would to see myself involving in sensitizing
Paurakarmikas about their health, their rights and responsibilities.

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CHLP Report – 2023 Community-Based Health Action-Reflection Project
Submitted by: Alfred S. Raju
Occupational health and safety of Paurakarmikas in Bangalore
“You must be the change you wish to see in the World” – Mahatma Gandhi
The engagement with Pourakarmikas was aimed to understand the working condition of in
Anandapuram ward and give health education.
Historical Background of Pourakarmikas
Cultural values have been attached to waste for a long time now (Blincow 1986) and waste
collection in India dates back to 17th century: bones, rags and paper were the first commodities
that were collected. Historically, any occupation related to waste, garbage, handling of
carcasses and human excreta has been traditionally bound to the lowest caste (Chandran et al.
2013). In the hierarchical structure of the caste system in India, scheduled caste is at the bottom
most rung of the ladder (Darokar 2010). Occupations assigned to scheduled castes like
sweeping streets, removing garbage, removal of dead animals, leather work, funeral work and
manual scavenging are considered to be polluting occupations and the communities engaged
in it are considered as ‘untouchables’ or ‘asprushas’ in the Indian society (Beck and Darokar
2005). Therefore, members of this occupation face discrimination, stigma, social exclusion and
isolation due to the concepts of purity and pollution (Sicular 1992).1
The castes involved in waste collection in Karnataka are: Adi Andhra, Adi Dravidas (Holeyas),
Adi Karnataka (Madigas) and Bovis (Oddas) (Karanth 1995). A 2010 study on informal waste
pickers by Mythri Sarva Seva Samithi (MSSS) concluded that scheduled caste (SC), other
backward caste category (OBC) and Scheduled Tribes (ST) including nomadic tribes, sheik,
kounder, Hakki Pikki Tribes are also involved in waste-picking (as stated in Chandran et al.
2013). The survey conducted by the Committee on Improvement of Living and Working
Conditions of Sweepers and Scavengers headed by I.P.D Salappa (1976) showed that
Scheduled Castes, Scheduled Tribes, Muslims, Christians and non-Scheduled Castes like
Lingayats, Kurubas and Mudaliars are engaged in waste-mrelated occupations. Chandran et al.
2013 states that people from non-scheduled castes and religions join the vocation due to
economic pressures.2
Socioeconomic Status of Pourakarmikas
Caste based social exclusion and discrimination in the pourakarmika community is common.
Social exclusion is defined as the “limited capability of an individual to participate in the
society” (Darokar 2010). Due to social exclusion that is either subtle or evident, members of
the social group are prevented from enjoying full participation in the larger society in terms of

Anusha Purushotham, “Swept-under: A study in the Health status of Municipal Pourakarmikas (Solid Waste
management workers) in Bengaluru(MPH thesis: School of Health Systems Studies, TISS:Mumbai, 2019).
1

2

Ibid..Pg.3.

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economic resources, educational opportunities, political participation or participation in other
organisations (Kadam 2017).3
A study conducted on the sanitation workers in the Municipal Corporation of Ahmedabad
found that most of the sanitation workers belonged to the Valmiki community (Mishra, Dodiya
and Mathur 2012). Houses of members of this community were built with mud, bamboo, plastic
sheets. Many of them did not have toilets at home. Children had high dropout rates and those
who dropped out had to take up traditional caste based occupations. Widows of workers who
did their husbands’ duties received half the wages or lesser. Many workers did not receive
provident fund, medical insurance or other benefits (Mishra, Dodiya and Mathur 2012). Such
discriminations and neglect are evidence of how the interlinking of occupation and caste affects
their lives.4
Similarly, a study in Gulbarga district, Karnataka, by Bhimasha and Sedamkar (2015) described
how sanitation workers experienced a low socio-economic status due to the nature of their
work. Society’s attitude along with low salary and limited job opportunities further isolated
them. The health status of pourakarmikas is also dismal, considering their role as the backbone
of the waste management system in the city. Their absence for a day will bring the city to a
standstill. Despite their crucial role in the smooth functioning of the city, pourakarmikas are
largely neglected both by the government and the society. With majority employed under
contracts which have only been recently converted to direct payment under the BBMP,
pourakarmikas have low job security and inadequate employment benefits, especially with
respect to healthcare and occupational safety. Faced with the harsh elements of nature, they are
left to fend for themselves with little assistance from the state or their employers.5
Health Risks of Pourakarmikas
A study in Lobatse, Botswana, showed that lack of protective equipment and clothing results
in respiratory illnesses and other health issues among landfill employees and scavengers
(Gwisai, Areola and Segosebe 2014). Similarly, there are studies in the Indian context that point
towards a higher morbidity rate among sanitation workers when compared to the general
population. The job of pourakarmikas involves collecting waste – organic and inorganic,
collecting recyclable material and transporting it to the waste pick-up lorries. There is an
inherent occupational risk since the wastes that they handle can be hazardous since most of the
solid waste in developing countries like India is not segregated at the household. Therefore, the
waste maybe mixed with infectious medical waste, toxic waste materials and sharp objects to
name a few. Pourakarmikas have higher exposures to injuries and health hazards and
consequently suffer from a variety of illnesses and injuries (Jayakrishnan, Jeeja and Bhaskar
2013).6
Health awareness for Paurakarmikas
Background of the locality
Ananda Puram is a urban poor locality which is near K. R. Market in Bangalore. It has 940
households, most of the people living here work as vegetable vendors, coolies in K.R. market
or work in shops in and around the busy market. The locality area is 2. 5 acres, the land belongs
to one individual. Now government is negotiation with the owner of the land. The community
illegally settled in this land 8o years back and now it has close to 4000 members. the ward
Ibid…pg3.
Ibid…4
5
Ibid…4
6
Ibid…4
3
4

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number according to the BBMP ward division and numbering is 139 with 15 streets. Mostly,
SC community, few Gounder(30houses), Muslims. (20 houses)
To understand the community, survey has been conducted by the field Coordinators. Door to
door survey has been conducted. Engagement with the community has been smooth since
SOCHARA’s presence was already there. This ward has 58 Paurakarmikas, 35 female and 15
male which includes with drivers.
As the process of engaging with the community, the following steps were followed.
Rapport building: To build rapport initial visits were made, introduced self and the objective
of visit was explained to Paurakarmikas after three visits. Along with Paurakarmikas, Team
comprised of Health inspector Venkatesh and supervisor Surya Naryan.
Goal Setting: In discussion with the Health Inspector and Paurakarmikas: detailed discussion
took place related to need assessment and awareness session. It was decided not to touch upon
the social security schemes and eligibility as most of the Paurakarmikas are appointed on
contract basis. Session on health aspect was thus decided keeping in mind the challenges in the
context.
Objective: To Conscientize Pourakarmikas on importance of health.
1. Need assessment
➢ Focus Group Discussion was conducted to understand common health issues of
Paurakarmikas. During the Focused group discussion. Paurakarmikas reported the
following issues:
Health issues
➢ Respiratory - Breathing problem: The dust and smoke during sweeping the streets
and collection of waste.
➢ Wounds/ injury to hands and legs: Since they find broken glass pieces, sharp objects
like nail, iron pieces, safety pins etc. many Pourakarmikas reported that they had
serious injury to their hands.
➢ Head ache and vomiting: few Pourakarmikas reported that they had vomiting when
they worked in conditions like where the chicken and animal waste was dumped on
the road along with garbage. Pourakarmikas had to clear it with their hand, there was
foul smell which cause vomiting and head ache.
➢ Allergies and skin problems: as they come in contact with chemicals in the garbage,
some of them use DDT and bleaching powder to clean the open drain. That creates
skin rashes.
➢ Vector Borne disease: Due to poor drainage diseases Chikungunya, Dengue,
Malaria. Some of the Paurakrmikas had Dengue and have recovered.
➢ Alcohol and Tobacco usage- All the male Pourakarmikas consume Alcohol and few
women chew Bettle nut and some use Pan.
➢ Body pain and Back pain: The movement of Push cart in many women complained
about having severe back pain as they push the carts carrying garbage, the movement
of the Push cart in the Slum areas is difficult as the roads are not level.
Social Security needs
➢ Health risks awareness/ education to Pourakarmikas
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➢
➢
➢
➢

Health screening with the help of Local Primary Health Centre
Social Security
Health Insurance
Supply of gloves, masks, Gumboots, and headgears

After FGD, session on occupational health issue was planned to all the Sanitation Workers
at Ananda Puram on 11th January 2023 at 10:30 am.

2. Awareness Sessions Conducted at Ananda Puram on 11th January 2023.
Rapport building games: All the Participants actively participated.
Photos of Paurakarmikas
Work conditions

Pic : Without hand gloves and boots collecting waste

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Pic : Without hand gloves and boots cleaning the open drain

12

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Consent to click the pictures was taken before the session with all the participants.
What is health Question was asked to the participants. Participant expressed health is
keeping ourselves well without diseases, not falling sick, physically strong, maintain personal
hygiene, meditation.
Definition of health was explained in vernacular language based on WHO definition,
“Health is a state of complete physical, mental, social, well-being and not merely the absence
of disease or infirmity.”

4 levels of health services were explained –
➢
➢
➢
➢

Preventive,
Promotive
Curative and
Rehabilitative

Prevention is better then cure was explained, to prevent the illness, what all measures should
be taken was explained to them through using the BBMP Training of Trainers of Solid Waste

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Manangement Master Trainers Manual produced in collaboration with SWMRT, EMPRI,
Padmashree School of Public Health and SOCHARA (2016)7.
To prevent contraction of illness at work place the team continued to share the information
1. Occupational Health Issues the below points with examples were discussed with the
Paurakarmikas. The points are as below:
➢ Restrict access to disposal sites- to enter the sites only with safety or protective gears
like helmets, gum boots, gloves, masks.
➢ All the workers to wear hand gloves, shoes always while on duty.
➢ Avoid manual handling of waste
➢ Manual Scavenging is Prohibited
➢ To use Auto tippers to collect Garbage than using the Push – cart which is heavy and
cause back pain
➢ If hurt – for punctured wounds to do the first aid and to consult the doctor. If necessary
to take Tetanus injection.
2. Nutrition
➢ To eat good healthy, nutritious food – food should include Carbohydrates, protein, Fats,
vitamin, minerals, Water was also explained using charts and by the help of Building
Capacities of Women’s Group on Women’s health.8
➢ Food and its functions were explained like: Provides energy, growth and developments,
protection from illness, keeps blood healthy and keeps eyes health.
3. Oral Hygiene Practices
The ill effects of chewing Pan, using tobacco , cigarettes were explained. It was
recommended to
➢ Brush teeth twice a day, before and after meals
➢ To avoid using teeth to open sharp or hard objects. (opening the bottle lids using teeth).
➢ Use massage the Gums after brushing
➢ To brush upward downward than horizontal
➢ To clean the tongue to avoid bad breath.
The Session concluded with a challenge and oath taking that everybody make it a point that
they will be responsible for their won health. “Namma Arogya Namma Kaiyalli.”
Reflection and Personal Learning from engaging with the Parikramas for 2 months.
I was fortunate to connect with the Paurakarmikas as we see them every day on the streets of
Bangalore, sincerely doing their work, be a rainy day or sunny day, or on holidays or
lockdown, we see the only people early in the morning working for the cleanliness of Bangalore
city are Paurakarmikas. Their commitment to keep the city and its citizens clean and safe is
what triggered me to dig little deep into their lives. As I was interacting and closely observing
their lives. one thing that triggered me to engage with Paurakarmikas is the news articles that I
came across during my CHLP course.

BBMP Training of Trainers of Solid Waste Manangement Master Trainers Manual produced in collaboration
with SWMRT, EMPRI, Padmashree School of Public Health and SOCHARA (2016)
8
Building Capacities of Women’s Groups on Women’s health, District Level Training Modules, developed by
CHETNA, Ahmedabad for Ministry of Health and Family Welfare, New Delhi, 1999, Pg.3-10.
7

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•

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70% of Pourakarmikas has health issues (The Hindu, Nov 16, 2022). Most of them
have high blood pressures, diabetes, skin diseases. They were aged between 28-60, the
PK’s alleged that the Civic Bodies are doing nothing to prevent their health from being
affected by doing hazardous job of cleaning the city. The Civic body has stopped
issuing hand gloves, safety masks, gumboots, jackets for more than a year.
Pourakarmikas are working hard to remove the garbage and hazardous waste across the
city. But, majority of them are suffering from illness because of lack of awareness. (Dr.
ShivaKumar).
The civic body that seeks their service seem to be ignorant about their health. Deprived
of any safety gears like gumboots, helmets and even a glove, as many as 98
pourakarmikas work in all the 35 wards with the age-old practice equipment.
Be it cleaning the drain or septic tank, the pourakarmikas do not have any modern
cleaning equipment instead do a manual job. Due to frequent sprinkling of bleaching
powder, their hands bear burn marks. They do not wear any mask while using the
fogging machine to check mosquito menace.

As a result, most of them are suffering from various health issues. Though they have brought
the same to the notice of the authorities concerned, nothing has come yet to their help.
•

Situation continues to remain apathetic to the welfare of Pourakarmikas, and most
particularly evident in the lack of providing appropriate protection. Guidelines listed in
the ministry of Social Justice and Empowerment’s advisory were regarded. (Report of
Working Condition of Pourakarmikas during Covid 19 Pandemic, ESG- India Report,
May 20&21, 2020). In reality there is minimum or not protection.

After reading these articles, I felt why should anyone depend on others for their health and
safety. Why cannot the Paurakarmikas think little different and take few precautions/
prevention steps to keep themselves healthy and safe. As Paurakarmikas work is unrewarding
or appreciated work. In Spite of not appreciated by the people, still they strive to keep the city
clean, some of the communities even call them with derogatory names, Thotti, Kuppa,
Mali,BBMP,Chappar. Inspite of having names, they are called with these Titles, which is not
good. They are ill-treated, some stories of physical abuse and verbal abuse also prevalent in
the community.
Even to think that the Paurakarmikas lives and health are dependent of people of the city. I felt
that the Paurakarmikas should realize that their health is in their hands “Namma Arogya
Namma Kaiyalli.” As they do so much for us sacrificially, let us do our part by ensuring their
safety and health, that’s where I made up my mind to be of some help by giving health awarenss
to Paurakarmikas.
Onward Plan
In this pursuit as I was preparing for sessions, Dr. Ravi Narayan, left a message on my whatsapp
to call him when I was free. The call with Dr. Ravi enabled broaden my horizon. As most of
the Paurakarmikas are women. Instead of focusing of Maternal and Child Health,(which limits
them to Uterus, child birth, caring and nurturing) why can’t we focus on Women’s health is the
challenge that he posed and he recommended the Work that CHETNA an NGO has done for
the Ministry of Health and Family Welfare, New Delhi titled as “Building Capactities of
Women’s Group’s on Women’s health. District Level Training Manual, in which Dr. Thelma
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has also contributed in preparing the modules and training the Women’s group. The book is
interesting and the modules deal with Nutrition and women’s health. Women’s work and
health, violence and women’s health, women’s mental health. Access to government service,
panchayath Raj, malaria, TB. Water and sanitation, reproductive health with activities and
notes for trainers. On this note
The experience of engaging with Paurakarmikas is interesting, in the future there is an
opportunity to discuss and bring awareness to the Paurakarmikas about the real issues that they
face on day-to-day basis not only at work place but also in their families and society at large.
Acknowledgment
I am indebted to SOCHARA and CHLP team for the constant support and broadening the
horizons in understanding the real issues of different marginalized groups face in our society.
And encouraging to use the SEPCE lens to see the issues in our society. I am also very very
grateful to my mentor, philosopher, guide and a good human being Ms. Florence Jasmine David
and INSA team who discussed, supported and hand held in every step of my journey with
Paurakarmikas. She also supported awareness sessions with products from Uni liver for which
I am ever grateful.
Annexures (Idea Draft, Participant information sheet, participant consent form)
An oral Consent was taken from all the participants of the session that the pictures taken will
be used strictly for academic purpose not for any fundraising activity. All the participants
consented.
The below statements were read to the group
Photo/Video - Consent Form

During the course of Health Awareness program, workshops or work in the community, I may
click photographs to strengthen the visibility and partnership for the programmes, advocating
for Paurakarmikas health rights and reporting. As per the SOCHARA guidelines, we shall not
use photographs, nor divulge the confidentiality of information shared privately for
counseling/mentoring. we guarantee you that photos will not be used in public newsletters and
open to public reports without obtaining a written informed consent. Even with permission, we
commit not to disclose the identity of the community or person being described.
If you give consent to our use of photographs for educational and reporting purposes as
described above, please sign your name and include today’s date



Yes, I give my consent to the photographs/video recording for purpose of capacity
building and advocacy and not for commercial use. I understand that these records may
be used in a document on the internet, and/or in different forums for the said purpose.

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Place:……………………………………………….

Date:……………………………………………….

Seal & Signature

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References
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M.T. Shivakumar, “70% Pourakarmikas in Mandaya have health Issues,” (The Hindu:
November 16,2021).

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Rise in Self-test Covid-19 kits poses health hazard to pourakarmikas in Bengaluru(The
Hindu, Januray 25,2022).

•

Pourakarmikas risk their health to ensure hygiene, (Deccan Herald: December 3, 2010).

•

ESG, Report of Working Conditions of Pourakarmikas During Covid 19 Pandemic,
(ESG – report, 20&21, 2020). esgindia.org/new

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Citizen Matters, Pourakarmikas are our Defence against Corona; here’s how to keep
them safe.” (March 19,2020). bengaluru.citizenmatters.in

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Pourakarmikas Plod on amid inhuman working conditions, (The Times of India, August
01, 2016).

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Anupama RamaKrishnana, “Poor health of civic workers swept under the carpet, (
Deccan Hearld, December 19,2019).

•

Anusha Purushotham, “Swept-under: A study in the Health status of Municipal
Pourakarmikas (Solid Waste management workers) in Bengaluru (MPH thesis: School
of Health Systems Studies, TISS: Mumbai, 2019).

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•

BBMP Training of Trainers of Solid Waste Management Master Trainers Manual
produced in collaboration with SWMRT, EMPRI, Padmashree School of Public Health
and SOCHARA (2016)

•

Building Capacities of Women’s Groups on Women’s health, District Level Training
Modules, developed by CHETNA, Ahmedabad for Ministry of Health and Family
Welfare, New Delhi, 1999, Pg.3-10.

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