Functions of Various NGO's
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- Functions of Various NGO's
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Report of the Community Health
Learning Programme
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Submitted by
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Dr. Keerti
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Community Health Cell
Bangalore
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PREFACE
I am a MBBS graduate from Bangalore Medical College.
I have written the entrance exams for post graduate
course and inclined to take up any post graduate course,
with no exact preferences for a particular course.
Now being at the end point of
entrance exams I had to choose any one subject. So came
a choice of taking up psychiatry.
I had an opportunity to meet Dr .Ravi Narayan who
happens to be community health advisor of Community
Health Cell and also my mentor for Community heath
learning programme. He gave me several ideas as to
what I can do in the next one and half months of free
time. Though I found my plans of enjoying myself with
my friends at beach side resort were going to end, I did
not want miss the chance of take up the suggestions of
Dr. Ravi. Entering into the scene was one of classmate
and very close friend of mine Dr.Vinay.H.R, who also
happened to be taking up Psychiatry as a profession with
me in the same institute. Dr. Ravi addressed both of us
and gave an opportunity to take up Community Health
Learning program fellowship on a short term- flexible
basis. Completely elated, we both, I and Dr.Vinay.H.R
agreed for the same.
I would like to thank Dr. Thelma Narayan, Dr. Sukanya,
Dr. Vinay Vishwanatha and Mr. Eddie Premdas for
consolidating the plans for CHLP short term fellowship
programme and schedule the learning programme as per
our needs.
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The academic programme schedule
Dr. Ravi suggested us (this include me and Dr.
Vinay.H.R)
1) To plan and visit various NGOs which work
towards community mental health
2) To observe the functioning of these organisations
3) To interact with the mental health professionals and
the users in these NGOs
4) various materials to read as a part of our fellowship
programme
5) To utilize library for various reference materials.
6) To interact with the team of Community Health
Cell.
7) To think and reflect back our experiences during the
learning programme.
8) To discuss any queries or any issues of learning
interest with the CHC team.
9) To write a report regarding the learning in CHLP.
10) To give formal presentation regarding our
reflection to CHC team.
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Uniqueness of CHLP Programme at CHC
There are many uniqueness of this programme. Learning
experience here at CHLP is not just like the academic
programmes in university.
CHLP has helped in understanding my roots and my
responsibility as a healer. I have met so many dedicated
intellects (dedicated to community health) in this programme.
This has certainly rebooted my interest in psychiatry.
Why CHLP is different than the mediocre courses:
1. It is here where one learns what one wants to learn and do not
learn what is being thought. It is customised for ones need.
2. Here I learnt the role of basic doctor in the community and
was also oriented towards the role of the mental health
professional in the society. Here I want stress a point that these
things are unfortunately not thought in our main stream
academics, though all the educators think it is avery important
one.
3. It is here I unlearnt many things what a doctor shouldn’t do.
For example we doctors will be discussing on a certain patients
health with the family members without involving the patient
perspective of the illness.
4. For the first time I am experiencing the mentor-student
relation. The stimulus one gets from this mentor- student session
seems to be an ever lasting phenomenon.
5. The knowledge one gains here is not just from books and
materials but from personal experiences of the faculty.
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6.1 had a constant company of Dr. Vinay.H.R who had also
participated in the same learning programme as of mine and has
a similar academic background as mine and similar inclination
towards community health. This helped me keeping myself
more involved in CHLP. We used to discuss various issues in
community mental health and functioning of various NGOs. We
both provided each other the critique and answers on these
issues.
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APSA(Association for Promoting Social Action)
This is the first NGO me and Dr.Vinay had the opportunity to visit in our
CHLP fellowship.
APSA is a child-centred community development organisation.
We met Mr. Lakshmipathy co-founder of APSA who gave us a brief
introduction of the functioning of APSA.
We were introduced to various wings of APSA:
1) NAMMANE: It is a crisis intervention centre for children in acute
distress. Runaway kids, child labourers, street children, young
victims of domestic violence find residential support here.
2) National child labour project: APSA provide education to rescued
and rehabilitated children in the age group of 8-15. They provide
both formal and non-formal education to children based on the
individual interest and preferences.
3) Kaushalya: is a vocational training centre: Here students aged 1618 years receive professional training in desktop publishing,
tailoring, basic electronics, screen printing and stationery making.
4) Child Line 1098: It is a 24*7 toll free telephone line for children in
distress. Interventions range from medical help, shelter and
repariation to protection from abuse and rescue.
Observations and reflections:
1) APS A is located amidst shelter homes of construction workers and
coolies which supports the theme of the organisation which intends
to cater to the urban slum community.
2) The child crisis intervention centre ‘Nammane’ meaning our home
- the name itself attracts the children in distress to the organisation.
There is protocol followed after the rescue of the child is done and
is brought to the centre. A child undergoes a thorough medical
check-up followed by a counselling session with the child. In these
sessions the lay counsellor gets to know the child, understand the
problems faced by the child. The issue is discussed with the
committee which decide upon the next course to rehabilitate the
child - either short term or long term. The rehabilitation processes
also involve retracing the psychosocial support of the child.
3) The community formed in this centre is really an inspiring one.
Here there is a bala panchayat is organised among the inmates
which takes decision regarding the maintenance of the routine
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activities of hostel. This develops responsibilities and sense of
belonging among the children. Here one can observe how a child is
mature and bold enough to make its own decision.
4) The 24 hour child-line is not all that we understand from outside
world. It takes lot more than courage and commitment in rescuing
and rehabilitating a child. The child-line personnel need to be
shrewd enough to nail the child abusers and also gentle enough to
care the rescued child. Some of the personnel also reported how
they are under stress when they rescue an abused child (usually
child labour) from an influential family.
5) The vocational training is innovative in a way that it also runs a
parallel placement services also. This centre encourages the
trainees to save money for their future endeavours. The centre
maintains a track of each of its student and run a programme once
every 3 months where in the placed students will share their
experiences, difficulties and solutions with each other.
6) The innovative approach of educating the children of construction
workers through Tent schools. Classes will be taken to children
near the construction sites and are tracked so as to ensure they
complete basic education of 10th standard.
7) The whole experience at the organisation gave me chance to peek
into the psyche of rehabilitated children and the strength of micro
community among the children of the organisation.
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Bosco Mane
It is like a first referral unit for child under distress. It is located in
Chamarajpet Bangalore.
1) It caters as a short term rehabilitation centre for children under distress.
The user group include runaway kids, child labourers, street children,
young victims of domestic violence.
2) It also runs a 24 hour child help-line. The child-line is co-ordinated
with APS A and Makkala Sahayavani.
3) This organisation runs a juvenile justice unit. This unit caters to
children booked under juvenile justice act. It is a known fact that juvenile
offenders are treated as adult criminals in not only the community but
also under police custody. Here is where the juvenile justice wing of
Bosco Mane starts to act. The unit members visit the police station make
a detailed note of the circumstances form which the child committed the
crime, the present physical and mental health status and psychosocial
support of the child. The Juvenile justice unit intervene and provide
support in the above mentioned regards.
Observations and Learning:
1) In this organisation I participated a meditation session for children.
The meditations really mellowed down the hyperactive kids. Initially
before entering into the session room one could easily make out that
certain children were pulling other children’s shirt, poking, pinching each
other.
But when they were coming out of the meditation most of the kids were
well behaved and were comparable to angels. Meditation would have
certainly helped them to calm down.
2) Run away kids, street children are intelligent and brave enough to face
the challenges of the mean world. Community has to identify their
capacity and has to redirect them towards productive endeavour.
3) The problem of run away kids or street kids is not a unilateral one but
has multiple roots like: family discord, educational/ academic pressure,
peer pressure, and very rarely so called personality or temperamental
disorders. Very less emphasis has been provided to the prevention aspects
of this run-away problem. What one follows is crisis intervention rather
than a crisis prevention programme.
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HOSPET Visit
Objectives:
1. Meet Dr. Ajay Kumar, consultant psychiatrist and know about his
community approach in his practice.
2. Meet Dr. Bhagyalakshmi, director of ‘Sakhi’- a NGO working on
various issues in Hospet.
Meet with Dr. Ajay Kumar:
Dr. Ajay is a consultant psychiatrist practising in Hospet. He completed
his undergraduate in JNMC Belgaum and postgraduate in MAHE
Manipal. Though he had pressures to go abroad for his career, he decided
to work in his native-Hospet. Hospet is a taluk in Bellary district. As
there is dearth of psychiatrists in neighbouring taluks and districts, he has
extended his service in neighbouring places like Gangavathi, Koppal,
Kanakagiri, Hadagali, etc...He has adopted several community based
therapies for his clients, some straight from the texts and some
innovatively developed by him.
Punyakoti foundation:
This is an individual’s committed effort to give it back to the society.
10% of his income goes to Punyakoti foundation. This foundation runs
several activities like Manochetana and Mukthi(refer below).
Manochetana:
Dr. Ajay starts his work every day by visiting a school for mentally
retarded and mentally challenged kids. He has named this school
Monochetana that means energy of the mind. He strongly believes that
every kid is special and has an alternative means of understanding the
world around them.
The school is situated in one of the residential areas of Hospet. It
occupies 5000 sq feet and caters to 12 children. But has the capacity to
include more children. He has designed every inch of this school with
utmost attention. He explained us the importance of using basic colours
for the walls. The walls have projections of individual bricks with gutters
in between them. This helps the children to develop sensory perception.
The same is with the doors, which has small square projections. There are
chairs and tables specially designed for kids with mental retardation
associated with hyperactive disorder. This is just to mention a few
examples of the environment created for child to improve its skills.
Perhaps one has to visit personally to understand the design of the school.
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There is a team of MSW professionals trained schoolteachers and
volunteers working along with Dr.Ajay. He devotes his time in the school
by training the team and the parents. He gives appointments to parents on
opd basis for his school. Here he trains them regarding the practices that
are to be adopted at home. Dr. Ajay has adopted methods like meditation
and music therapy apart from the usual rehabilitation for the kids in the
school.
Mukthi:
Dr. Ajay treats the acute episode of alcohol withdrawal and other
substance abuse in a hospital setup. He has an in-patient setup for this
purpose. However, the rehabilitation part is taken up in a different
manner. The trained counsellors help the clients to recover and maintain
the abstinence. There are motivation classes and sessions with thepatient
and family where in the counsellors look into all the aspects which
would lead a substance abuser to relapse into abuse. Finally they discuss
the plan to tackle or to prevent the relapse.
Observations and reflections:
1. A consultant’s responsibility increases if he decides to work in
semi-urban set up. Dr. Ajay dons the role of a primary mental
health worker when he runs an out reach clinic and also of a
consultant in tertiary centre.
2. Community Psychiatry is not a separate field of practice.
Community approach can be adopted in day today practiced.
3. Psychiatrist need not be least religious person in the community.
Maintaining neutrality in religious context but promoting the
spiritual part of all the religion is very much essential especially in
the field of mental health.
4. Cultural Psychiatry is the need of the hour. Understanding the
culture of a particular community will smoothen the client
approach and yield better treatment out come.
Meet with Dr. Bhagyalakshmi:
Four main issues were discussed With the director of ‘Sakhi’:
1. The problems faced by adolescent girls in the social and domestic
context
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2. The devadasi cult.
3. The upper caste dal its.
4. The regional problem of illegal and unethical mining of ores in and
around Hospet.
Learning and reflection:
1. The problems faced by adolescent girls are among the least
addressed. (it is to be noted that problems faced by adolescent
boys much more worse as males in a family discuss much less
regarding the sexual health when compared to females in the
family discussing such an issue much more openly with each
other.) The main problems ‘Sakhi’ has addressed are: 1) Less
financial support for the girls for education. 2) These age group
females tend to fall in the hot cauldron named “LOVE”. It is one of
the most difficult problems to handle. Dr. Bhagya feels that these
age group girls are mature enough to understand the relation but
not mature enough to understand the reality. She reports of these
TRIANGLE love stories where an adolescent is in love/ or is
attracted towards 2 male peers and is undecided to which way to
move. And moreover a girl is pre-occupied with ideas of love that
she would concentrate less on her studies or career. 3) Pre
occupied with many myths related to health. 4) exam stress. 5) The
help from mental health worker is a remote possibility in the
peripheral parts of the state.
2. The DEVADASIS are a sect of traditional prostitutes more
common in northern parts of Karnataka. Though such practices
were more open and religious places allowed such activities seem
to be stopped. But this just on a superficial look. Dr. Bhagya
reports that now also traditional prostitution is very much common
and has switched places from religious sanctum to residential
areas. ‘Sakhi’ works with these groups encouraging the present
generation of adolescent children of devadsis to take of education
or alternative jobs to make a living.
3. Dr. Bhagya spoke elaborately on the issue of upper caste Dalits.
These people are basically dalits who were fortunate enough to
benefit from the policies of the government and raise to
comparable status in the society. But problem with most of such
beneficiaries is that they demonstrate less responsibilities towards
their own caste or community from which they arose.
4. Dr. Bhagya’s heart swells up when she speaks of the problem of
illegal mining in the surrounding area. She explains how she has to
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face the problems with the mining tycoons when she and her team
tried to capture the illegalities of mining operation and the ground
realities of the people’s problems.
5. It is unfortunate to say that most of the health professionals are
busy curing the illness rather to prevent them. This discussion made me
wonder are whether a doctor really addresses the problem at its root
cause. The answer was a clear NO.
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STATE LEVEL ANNUAL CONVENTION OF SEXUAL
MINORITIES and LAWYER’S COLLECTIVE
State level annual convention of sexual minorities was organised in
Indian Social Institute, Bangalore. It was organised in co-ordination with
3 NGOs-Sangama, Suraksha, and Samara, all working for the cause of
Sexual minorities.
My activity in this convention: I had an opportunity to participate in this
convention for a day. I was involved in 2 group discussions among the
sexual minorities, social workers, social scientist and journalists. The
topic of the discussion was mainly of the problems faced by the sexual
minorities and probable solutions for it.
Lawyers Collective is a non profitable organisation working towards
various social causes. Ensuring human rights of Sexual minorities is one
among them.
My activity: Participated in a group discussion involving sexual
minorities, lawyers, and social workers.
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These two circumstances opened a new world to me. In my experience as
a doctor I found Sexual minorities (Hijdas /Transvestites) only in railway
stations, bus stand or sometimes in traffic signals. Usually these people
are found clapping their hands loudly in awkward manner making sure of
their presence. I had never tried before to understand them in the
community context.
What I understood: 1) Sexual minorities have a normal psyche as every
other individual in the society (may be that they are bit more pre occupied
with sexual thoughts or fantasies).
2) The problem of sexual minorities being differentiated from the
community starts from home itself. First the parents identify that their
child is sexually different from others. They try to bring their kid to main
stream society but fail badly. This causes a gap in the relationship
between the parents and their sexually different child.
3) This difference in the relations gradually increases in intensity. The
child would be more comfortable with people similar to itself. This makes
the child to search for Hijdas as popularly called in India. Child gradually
drift from family boundries and enter into a new community of sexual
minorities.
4) These sexual minorities in India are well organised traditionally. These
people represent a sub-community or a micro-community of their own.
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But the problem with such organised group is though they are organised,
it is filled with lot of ignorant and illogical and sometimes dangerous
traditional practices. Social discrimination is a minor problem for them. It
is the harassment from the police and the public which bothers them the
most.
5) There are many NGOs which are trying to strengthen the this
community in terms of providing them awareness regarding health, their
rights as humans and encouraging them to be collectivised rather than just
being organised. The advantage of being collectivised is people here can
raise a voice their own and demand for their rights.
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MEDICO-PASTORAL-ASSOCIATION
It is one of the first voluntary organisations caring for the mental health
rehabilitation needs of the Indian society.
The efforts of this association are targeted towards empowering
caregivers and beneficiaries through training programmes.
It is a halfway home running at three levels
1. Crisis intervention
2. Behavioural modification
3. Occupational therapy
Navajeevan: It’s a short term staying facility (usually in months) for
rehabilitation. This hostel provide the the recently mentally stabilised
people to experience more independent living.
Extended care services: This provides a rehabilitative process for a
longer duration sometimes running years together.
Day care services: Here all the boarders in the hostel and also some
clients of mental health rehabilitation from outside the hostel join the
daily activities. The activities is scheduled in such a way it keeps the
users busy from morning till evening.
Sahai helpline: It’s a suicide prevention helpline. It is run by trained
volunteers. It provides telephone based suicide prevention counselling
services.
Our (me and Dr. Vinay ) activities:
1. We participated in few of the activities designed for the clients. These
activities were like drawing or paper cutting or similar sorts which
involved colours and a bit of art in it.
2. Interacted with few of the boarders. Experienced their stay in the hostel
by befriending some of them.
3. Participated in of the group activity- picture dramatisation.
4. Interacted with the personnel of Sahai Helpline.
My observations and Interpretations:
1. What attracted me most in this institution is the quote written next
the association’s name: Step into my shoes, wear my skin. See
what I see, Feel what I feel.... This quote says little but conveys a
demystifying message to whoever reads and tries to understand. It
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is to note that the so called mentally ill are at a different level of
perceiving the surrounding and self. The so called normal people very
rarely succeed in understanding them.
2. The daily activities practised might get real boring that too if done
routinely. Keeping up the interest of the user in such activities
seeks a higher level of creativity in the caregiver.
3. The job of the counsellor at the Sahai- suicidal prevention helpline
is a tough one. Her job was similar to that of a business
entrepreneur. She needs to help people over phone which means
she has to solve some of the problems of the client over the phone.
She had a vast reach of contacts of many professionals ranging
from teacher to lawyers. She has to be smart enough to
communicate in such a way that she would reach to the cause of
the problem of the client. Then she should ensure that she gains the
rapport with the client and then a possible solution can be charted
out.
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Richmond Fellowship
Richmond fellowship society provides rehabilitation therapy in
short- and long-term care homes, vocational training plus outreach
care and mental health programmes in rural areas. It also believes
passionately in training the next generation to deliver the
professional services this disadvantaged group need. It has its
uniqueness of both adopting and popularising therapeutic
community approach to the client.
The best part of RTS is that it trains various mental health professionals
and offer degrees like MSc in psychosocial rehabilitation and counselling.
Here we (me and Dr. Vinay) were oriented towards the functioning of
various wings of RTS.
ASHA is a half way home wherein the home-like environment is
provided for the user. This residential care is provided to 6 months to a
year.
Jyothi is a halfway home all similar to ASHA but here the care is
extended to more than a year, sometimes for life-time.
Chetana is a day-care centre catering to clients with various disabilities
like schizophrenia, Mental retardation with behavioural problems.
My observations and interpretations:
1. Here they have adopted a model of mental health spectrum. Mental
health is seen as a dynamic spectrum rather than as a state of being
healthy or diseased.
2. Understanding the need of halfway homes: these models of therapeutic
community approach give relief not only to the users but also the family
members of the users.
3. The best part of the organisation is that they avoid the term patient and
use the terms as clients or users or residents. Though they may use the
technical terms only when it is utmost necessary and inevitable. This
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model of micro community proves the fact that it can do wonders when
taboo of labelling the person as a patient/mentally ill is removed.
4. These models of half way homes are suited for urban areas and would
cater to only to the financially affordable families/ clients. These are not
socially replicable models in the rural areas of our nation. But still one
gets to know how the approach can be given to the clients through
halfway homes and we need to come up the ideas of models that has more
wider application in the society.
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FEDINA
It is organisation working towards the empowerment of the marginalised
especially the aged in urban slums.
My involvement in FEDINA: Group discussion with the volunteers and
the personnel involved in the field activities. I got a briefing about their
activities and experiences in the field of mental health.
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What I understood:
1. Though there are many self help groups and NGOs working
on the target of social empowerment they lack the concept of
holistic approach in which health is considered as a
component of the empowerment.
2. There exists a wide difference in the mental health status in
different genders in the older age group. The whole group
unanimously expressed that women are more worried about
the future than the males. Women were more committed to
family than the males.
OTHER ACTIVITIES DURING CHLP:
I met a few interesting and enthusiastic personalities during my CHLP.
1. Professor Dr. Mohan K Isaac — consultant Psychiatrist
2. Professor Dr. Sarah Bhattacharjee
3. Mr. Naidu of Basic needs.
4. Mr. P. Sainath Editor of THE HINDU daily.
Their inputs though were very brief, but without them my CHLP would
be filled with a lacuna.
Presentation: At end of my CHLP programme there was a presentation
given by me and Dr. Vinay.H.R. This presentation was regarding our
learning and interpretation of the experience during 2 months of CHLP.
This presentation was chaired by Dr. Thelma Narayan. There were inputs
by Dr. Vinay Viswanatha and Dr. Sukanya. Dr. Anirudha.T.J, Dr.
Harishkumar and Ms. Lakshmi shared their experiences during our
presentation
- Media
Dr. Keerti CHLP 2002.pdf
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