The Teasdale-Coriti Global Health Research Parnership
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- The Teasdale-Coriti Global Health Research Parnership
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CH F P -0.00^5 /
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Community Health Learning Programme
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REPORT
Sapna
intern, Community Health Cell
INTRODUCTION
How it all began.
In 1998, like many aspiring Grade 12 science students in India, I too was keen to pursue an
M.B.B.S degree. As destiny, would have it, I finally joined for a Bachelor’s in Dental Sciences
degree in Belgaum, Karnataka. After my initial disappointment of getting into a Dental course and
not Medicine, I quickly settled down into the program and genuinely started enjoying the whole
process.
In the third academic year, we started diagnosing and treating patients. Though clinical dentistry
gave me immense satisfaction, I could acutely sense that some incompleteness ,though I was not
able to put a finger on what was amiss .Long periods of introspection helped me understand that, I
did not feel completely satisfied with a clinical approach which was more of a one -to- one. I felt
preventive health as a strategy would be much better and perhaps working with people as a
collective was a better way to go about it. But without any guidance, peers or teachers to talk to
about my anxieties and confusions, I groped in the dark.
As the next step, I chose to pursue a Masters in Public Health (M.P.H.) from Columbia University
in New York. Living , working and studying in New York City was an amazing experience. The
courses that I enrolled for were very enriching and forced me to think along very many dimensions.
The school was and continues to be an excellent centre for research and have many Nobel Prize
winners to their credit, but I was a bit disappointed that most of the research was bio-medicine
focused or clinical trials .They did not translate into any immediate or direct benefits for the study
subjects .In my mind, I questioned the purpose of the research. Did it did not have a human face
and work toward relevance in people's lives?. It certainly had to go beyond securing grants
publishing papers and awards .1 give the example of Columbia's health research presence in
Bangladesh, which is very badly affected with arsenic poisoning .Most of the work done was of the
biomolecular adnd biochem focussed .Mitigation, remediation and alternatives were not as
important. This is not to say that I found Columbia's efforts a futile exercise or they did not do any
other socially relevant research, but the preferences were clearly skewed.
Some of my non-academic activities included internships at UNAIDS and New York City
Department of Health and Mental Hygiene (NYCDOHMH).They were more hands-on experiences
and had a embedded a much bigger perspective of people being their central theme.
After my graduation in 2006,1 joined a multi-national health insurance company in Dubai.
Exposure to corporate culture and values was an interesting experience, no doubt but my heart
longed to get into some hard -core public health action. In July 2007, I relocated to Bangalore and
decided it was high time to start the process .1 remain ever-indebted to Google for revealing to me
about various NGOs and groups that worked in the field. On the SOCHARA/CHC website, I
chanced upon a fellowship scheme which intrigued me. But I wasn’t sure if an internship was what
I wanted to do .A sense of false pride of being an MPH graduate degree holder prodded me to look
around for a full time job.
A few phone calls and emails later, I came down to CHC's office to meet Dr. Sukanya. After
lengthy discussions, she felt that it would be more appropriate for me to take up the internship as
my previous experiences and perspectives were very American and I needed to be grounded to the
Indian realities before I defined a career path. I came home and thought about it long and hard-
fellowship or job, fellowship or job????? .1 asked myself if I was actually ready to work in the notfor profit sector without having any background .Having spent most of my life outside India,I was
an “outsider”, filled with a strong sense of Indianess but not an Indian sensibility. Maybe the
fellowship was what I needed then .1 asked myself: did I know which area of Public Health I
wanted to work in? For that too, I did not get a clear answer within myself and I suddenly realized
that my understanding till date was purely theortical and nothing contextual.A mind full of noble
intentions to work amongst people,but an intellect that was clearly befert of any concrete ideas on
what to do. I suddenly felt like a big zero .It dawned on me that I needed some time and space to
actually understand what I was getting myself into. I was in the midst of a personal crisis
.Dr.Sukanya had mentioned in our discussion that one of the highlights of the program was that it
was intended to be a period introspection and reflection, which goes beyond regular learning. Then
this was it ,1 decided -A fellowship was what I needed to transplant and assimilate my learnings
to the Indian scenario, help me find a focus and also serve as a litmus test to check if I had the
mettle and actual commitment to continue my long-nursed ambitions.
Thus ,1 began my journey as a Flexible fellow
OBJECTIVES:
7. To gain a deeper understanding on the various aspects of the Public Health system in India
through readings and field visits.
2. To observe methods used in grass-roots mobilization
3. To be able to understand the various linkages in integrated development
4. To develop analytical and writing abilities for the purpose of research and communication
The Teasdale-Corti Global Health Research Partnership
South Asian Regional Training Workshop on researching “Comprehensive Primary Health
Care”
Venue :St Johns Research Institute, Bangalore
Date: 13/10/2009-24/10/2009
Introduction
The Teasdale-Corti Global Health Research Partnership Program is an innovative new collaborative
health research program developed by founding partners of the Global Health Research Initiative
(GHRI) - CIHR, IDRC, Health Canada and CIDA - with input from the Canadian Health Services
Research Foundation (CHSRF) and Canadian and developing country partners. The Teasdale-Corti
program aims to contribute to improving health and strengthening health systems in low and middle
income countries, by supporting innovative international approaches to integrating health
knowledge generation and synthesis (including consideration of environmental, economic, socio
cultural, and public policy factors) through research, health research capacity development, and the
use of research evidence for health policy and practice.
Objectives:
H
•
•
•
to foster international partnerships and collaboration to promote the generation and effective
communication and use of relevant health research in, for and by low and middle income
countries (LMICs);
to train and support researchers responsive to policy and practice priorities of LMICs
relating to or influencing health; and
to support active collaboration between researchers and research users (e.g. policy makers,
practitioners, civil society organizations, and community members) to address health
priorities of LMICs.
Workshop
The Teasdale Corti Program and Community Health Cell co-hosted a two week workshop for
selected research teams from India, Pakistan, Bangladesh and Iran. The teams typically consisted
of senior, mid -level and entry level researchers. All the teams had come prepared with their
research proposals and the workshop was an avenue to firm the proposals, exchange ideas, consult
senior researchers on practical difficulties .As a CHC fellow, I was allowed to participate in the
workshop and had the opportunity to spend quality time with each of the teams to understand their
proposals and gain an insight as to why they felt their study was pertinent and relevant. .Each team
made presentations on their research proposals, existing healthcare systems, cultural settings and
power equations that existed among the people, government and healthcare system in their
respective countries. The core issue was“Revitalization of Primary HealthCare”.Many signatory
countries of the Alma Ata declaration who had pledged to work towards “Health for All by 2000”
have conveniently failed to live up to their promises. We had discussions on what had gone wrong
and how globalization had actually lead to a deterioration of health indicators.
Various issues were raised, but some common factors in all these countries, I noted were
1. Absence of sufficient personnel to cater to the public's healthcare needs (in the public healthcare
system)
2. Lack of awareness and community participation among the public on their rights and
responsibilities
3. Caste, class and gender issues that hampered optimal functioning of the systems.
4. Corruption and apathy amongst medical personnel.
5. Problems with up scaling successful models
6. Issues of accessibility-geographical, economic, cultural
7. Over-emphasis on curative as opposed to a balance of preventive, promotive and curative
services
8. Chronic poverty of the rural population where health is just one among their many constant
worries
The opportunity to take part in group discussions, brain-storming sessions and lectures helped me
recap my public health theoretical framework. The sessions covered included:. The importance of
value and context in research and designing health systems, Participatory Action Research(PAR)
and Health systems research. Since one of the basic objectives of the program was develop research
capabilities, many sessions were devoted to various research topics like formulating research aims
and objectives, research methodologies, policy analysis and research ethics. One session, that I
found particularly interesting was the “Review of grey literature on Comprehensive Primary health
Care”-another objective of the Teasdale Corti program. These reviews were being done region
wise to capture some widely scattered ,but significant research studies and reports that may have
missed in reviews and not indexed. The grey literature review for South Asia was undertaken by
Dr.Vinay Vishwanathan at CHC and revealed some important points like the “richness” and
“wholeness” of many of the studies and there were significant lessons to be learnt from them.
Many did not necessarily fall into the purview of a well defined study methodology,which may
have made the analysis more complicated.
Impressions and Learnings:
1. A clear understanding of the term Comprehensive Primary Health care and “Primary Care” that
has been erroneously used in an interchangeable manner
2 .The need to establish a strong value system that would serve as the moral anchor of the
healthcare system that we intend to develop. The system should seek to reduce to inequities in the
community and improve access and social justice .
3. The importance of developing a culturally sensitive system that is relevant to people’s needs.The
health system should be meaningful,acceptable,effective and should incorporate the local socio
cultural-political dynamics .
LAWYERS COLLECTIVE
Date: 2/11/2008
Venue: Lawyer’s Collective, Tasker Town, Shivajinagar
The Lawyers Collective HIV/AIDS Unit was set up in 1998 based on a realization that law, policy
and judicial action based on the human rights framework had a central role to play in effectively
containing the HIV epidemic. The Lawyers Collective has been dealing with HIV/AIDS law since
the late 1980's when it handled the first HIV case in India. This case saw the incarceration of the
.H1V+ activist Dominic D'Souza under the Goa Public Health (Amendment) Act, 1986. It also saw,
for the first time, arguments that espoused the need for human rights-based approach to deal with
HIV/AIDS. Consequently, Lawyers Collective felt that a planned legal intervention was necessary
to protect the rights of Persons Living with HIV/AIDS (PLHAs). It also felt the need to inform
decision-makers about law and human rights and highlight its link with the public health crisis that
HIV/AIDS was creating. The main mission has been to contribute to controlling the HIV/AIDS
epidemic by protecting and promoting the rights of people affected by HIV/AIDS, through law
reform, legal aid and allied services of advocacy, training and research. To contribute to controlling
the HIV/AIDS epidemic by protecting and promoting the rights of people affected by HIV/AIDS,
through law reform, legal aid and allied services of advocacy.
As part of their awareness and advocacy mission ,they hold monthly meeting on various topics legal ,medical, social and political aspects of HIV/AIDS. Every month,a guest speaker is invited to
talk on a chosen theme. The audience usually comprises of lawyers, PLHAs, NGOs working with
them, doctors, social activists and any interested persons.
Topic: Star Health- HIV Care Insurance Policy
This meeting was a product information session for a newly launched insurance policy by Star
Insurers for HIV affected persons-the first of its kind in India. The pilot project would cover six
high prevalence districts in Karnataka - Bellary, Mangalore, Mandya, Kolar, Mysore and Udupi.
The presentation was done by Population Foundation of India and the objective of the session was
to introduce the policy clauses and receive feedback from interested parties .After the
presentation(Attached the policy clauses),a discussion followed and the below concerns were raised
PLHAs
1. The premiums were very steep and not affordable unless some subsidy was offered.
2. Pre-existing diseases not covered in the policy
3. Status disclosure on the cards and confidentiality issues NGOs
1 .Group discounts and applicable slabs
2. Challenges of social marketing the policy because of stigma issues
Doctors:
1. Exclusion of supplementary medications like vitamins and minerals and ART in the policy was
not acceptable as PLHAs required additional nutrients to build up their compromised immunity.
2. More clarity on any infections or diseases those are likely to excluded from coverage.
Impressions and Learnings
My work experience in the health insurance policy helped me critique the policy to a certain extent.
I was personally impressed with the scheme and felt it could be very beneficial for affected persons
,who are highly susceptible to co-infections and complications. The policy not only covered in
patient expenses but also had a provision where the dependents could claim an amount if the
insured person passes away(provided he has not completely used up his sum insured value).I did
not agree with the doctors argument on inclusion of supplementary medications as these substances
are never covered in any health insurance policy, these are to be ideally obtained from the daily diet
or came under the category of lifelong medications. Additionally this is a guaranteed expense in the
case of PLHAs and insurance as a principle only covers a probable risk. The scheme may not be
sustainable in the long run if these medications are covered.
The premiums were on the higher side especially for many who came from the poorer strata. Up to
what extent would any NGO/philanthropic organisation subsidize is the question I had in my mind.
BROCHEURE
STAR HEALTH HIV CARE POLICY
There is a lot of social stigma attached to HIV, largely due to ignorance and misconceptions about
the disease. This has resulted in HIV positive patients being isolated and neglected often by their
own family members. Star HIV Care Policy has been devised to overcome these social barriers and
pay heed to those suffering. It's a policy with several unique benefits and above all ensures care,
anonymity and privacy to the policy holders.
This policy fills the gap where all other policies and insurers treat HIV as an exclusion
For the first time in India, an insurance policy that's been designed specifically for those diagnosed
as HIV positive. HIV stands for Human Immunodeficiency Virus. It is the virus that causes AIDS.
AIDS develops when the immune system of a person with HIV becomes very weak as a result of
HIV infection.
HIV Care Unique Benefits
Complete confidentiality of the covered persons is ensured.
No bills/receipts. Lump sum is paid at one go once the claim is made.
Facilitates better health care at the critical stage (AIDS) with financial support.
This policy fills the gap where all other policies and insurers treat HIV as an exclusion.
Extension of medical cover for hospitalisation as an option.
Eligibility-Who can apply?
•
•
•
•
The policy will have to be proposed by governmental agencies, NGOs, societies or other
registered bodies serving the cause of persons infected with HIV. The benefits-when
payable, will be paid to the proposer who applies for it, for the benefit of the respective
covered persons.
The HIV Care Policy can be issued to a group of persons already infected with HIV.
Covered patients must be members/beneficiaries of the proposer and availing its
treatment/services.
There is no age limit for the applicants.
Application Procedure
•
•
•
Since the policy is for those already infected with HIV, there is a pre-insurance medical test.
Cover is provided only for persons whose CD4 count is more than 350.
Tests include CD4 or any other test as required.
Cost of Pre-insurance Medical Tests will be borne by Star Health
Premium Details
•
Premium will have to be paid to Star Health by the proposer who takes the group insurance.
2,500
4,000
8,000
Note:
*Group
discounts
will
be
considered
^Service Tax will be applicable on premium.
based
on
size
and
profile.
Additional Health Cover under HIV Care Policy (optional)
•
In addition to the above, medical cover is provided covering hospitalization expenses
excluding ART, tuberculosis and gastroenteritis, as per our standard Medi Classic policy on
payment of additional premium as an extension of the basic AIDS cover.
•
This cover will continue as long as the basic HIV policy continues. This will go a long way
in providing a meaningful protection to the victims of HIV.
Exclusions
•
•
•
Expenses incurred in treating HIV.
All medical conditions that existed prior to the commencement of cover, except those
specifically covered.
AIDS confirmation within 90 days of commencement of the policy.
Claim Procedure
•
•
•
The claimant has to undergo the confirmatory test for AIDS (CD4 count test or any other
relevant tests as may be advised by medical practitioners).
If the CD4 count is less than the medically prescribed levels for the first time and continues
for the next 60 days and after a clinical examination, the person is declared to suffer from
AIDS - the person is eligible to make a claim under the policy.
Once a claim has been settled under the policy, the insured is not eligible to be covered
under such a policy again.
Benefits of availing this policy
•
•
•
•
24 hour Help-line
Company's web enabled services giving health tips to customer
Free General Physician advice
Cashless facility if the treatment is taken in any Network Hospital
How to buy this insurance?
•
Please contact us through our Toll Free Help Line / SMS / nearest office
Peoples Health Movement,Karnataka-Jana Aarogya Aandolana Karnataka
Introductory Workshop-Bidar
Venue : Rice and Grain Merchants Office
Date: 24-25/11/2008
Jana Aarogya Andolana Karnataka is a forum of various pro- people’s groups, activists,
intellectuals, progressive people’s movements, NGOs and CBOs working to strengthen the health
sector in Karnataka. JAAK is the state unit of global People’s Health Movement (PHM) and the
India Jan Swasthya Abhiyaan (JSA) which is working towards ensuring universal, comprehensive
health care by reviving the public health systems based on the principles of Primary Health Care .
Its goal is to ensure and realize the “RIGHT TO HEALTH” of oppressed, dalit, poor, rural and all
marginalized communities.
Currently ,the Andolana has units in 17 districts of the state. District Units usually include many
of the local pro- people’s movements and NGOs in the district.In order to achieve its goal, in the
period 2003- 04 in collaboration with the National Human Rights Commission (NHRC) organized
public hearings on “Denial of Right to Health Care” in different parts of the country and
documented such cases in the public health system and placed it before the Commission. The
Human Rights Commission responded positively to the problems and demands and has directed
the national government and state governments to ensure that the public health system functions
efficiently. After 2004, the Andolana initiated a movement to “REVITALIZE PRIMARY
HEALTH CARE IN KARNATAKA”. As part of this movement, the Andolana monitored the
health systems in the districts, identified problems and gaps in the system and brought it to the
notice of the department and built pressure to ensure that the health department took appropriate
actions to deal with the same.
To drengthen the movement, the JAAK members hold district level meetings with various NGOs,
CBOs, civil society groups, unions etc to disseminate information about the movement. This
programme is usually designed to provide inputs for field level workers regarding roles and
responsibilities of Primary Health Care providers and what role community and voluntary agencies
can play in ensuring the same.The objective is to motivate and plant a seed of “demanding of
rights” in the people’s mind and put additional pressure on the governments to fulfill their
promises.
I accompanied two health activists Obalesh and Akhila to Bidar in North Karnataka.Bidar is also
called as Hyderabad Karnataka courtesy its geographical proximity to the metropolis.The district
has historically performed very badly on the Human Development Index of Karnataka
JAAK was invited by a local Labour Union leader Mr.Shanbhag who felt that JAAK values and
ideals were in resonance with those of his organisation and many other local groups.The meeting
started at 11.00 am and spread over two days to prevent the attendees from feeling overwhelmed,
instead of feeling empowered after gaining new knowledge. On the first day there were around 50
participants which dwindled down to 22 on the second day. This was normal and expected, both the
health activists told me. Not all NGOs and CBOs were keen to add another egg in their basket and
take up additional responsibilties. The workshops are designed to be a mix of information sessions,
group discussions, games and songs to keep the interest alive and maintain a informal learning
environment.
The topics covered in the workshop over the 2 day period were:
1. Definition of health and how social determinants played a role
2. Health statistics in Karnataka
3 Factors affecting access to health
4. Health as a right-JAAK movement and simplified explanation of People’s Health Charter
5. National Rural Health Mission (NRHM) and broad overview of the schemes available
6. Discussion on personal experiences at local Primary Health Care Centres (PHC)
7. Garnering support and commitment for the movement.
8. Enlisting their help to conduct a basic survey of local PHCs
At the end of the workshop, only three groups volunteered to conduct the survey of their local
PHCs
Impressions and learnings:
Majority of the participants were women, but the men were more vociferous and dominated the
discussions and voiced their opinions very often. The women were docile, meek and many times
did not even participate in the discussions even after a lot of coaxing and encouragement. Most of
J
the women were also visibly distracted by late afternoon and they told us that they were keen to
return to their houses before the children came home.Very often the discussions turned into
arguments between various groups. They were tendencies to digress from health issues to other
local matters and both the activists had to diplomatically steer them back towards the agenda. The
groups looked at JAAK as another potential funding agency and were eager to now and understand
how to avail the resources from them. The concept of a people’s movement did not gain immediate
acceptance amongst all members in the audience.
This workshop made me realize that grassroots mobilization involves a great amount of work to
ignite and sustain motivation. To convert people from simple being passive recipients(not blaming
them or being insensitive to their circumstances) to active demanders is nothing short of a
Herculean task, especially when all individuals have their own priorities and convictions .Money
seems to be an attractive bait and a program/movement as a standalone may not attract the interest
of all groups unless they are genuinely interested and committed. I observed the strong gender
barriers in discussing and raising issues because of the social conditionings.
URBAN HEALTH CARE MEETING with Institute of Public Healtli(IPH),Association of
People with Disabilities(APD),APSA (working with street kids and destitute women) and
PARASPARA trust (working on child labour issues in Bangalore slums.)
Venue: CMAI office, Queens Road, Bangalore
URBAN HEALTH
There has been a progressive rise of urbanization in the country over the last decade. As per the
Census 2001, there were 285 million populations living in urban areas. The decadal growth of
population in rural and urban areas during the last decade (1991-2001) was 17.9% and 31.2%
respectively. The urban population in the country, which is 28 percent in 2001, is expected to
increase to 33 percent by 2026. This unprecedented growth in population poses challenges for the
city governments in providing basic services in urban areas. Existing health and basic services like
drinking water, housing, electricity, drainage, sewerage etc, are not accessible to most of urban
poor populations living in slum or slum-like conditions. There exist multiple issues which limit the
reach of basic provisions of health and basic services to all in urban areas. These issues range from
lack of government priorities in urban health, inadequate public health infrastructure in urban areas,
varying socio-economic, environment and infrastructural conditions among vulnerable and nonvulnerable slums, increase usage of private health services by urban poor to lack of social security
mechanisms.
Urban areas are flooded with hospitals, nursing homes and clinic of various type and size. • These
institutions would continue to flourish as the environment and living conditions deteriorates. Both
the urban poor and rich fall prey to this situation but the poor are the worst affected. The present
health care facilities available for urban poor are family welfare and family planning focused which
should move towards a comprehensive primary health care, enabling people to take care of their
own health not merely providing some services.
In 1982,The government of India appointed the Krishnan Committee to address the problems of
urban health.. Its report specifically outlines which services have to be provided by the health post.
These services have been divided into outreach, preventive, family planning, curative, support
(referral) services and reporting and record keeping. Outreach services include population
education, motivation for family planning, and health education. In the present context, very few
outreach services are being provided to urban slums.
u
Research by IPH and partners
S.J. Chander (IPH) and the members from the above mentioned NGOs are interested in urban
health issues in Bangalore .They are collectively trying to do a systematic review of various Urban
Health Care Centres in Bangalore to take stock of existing facilities,availability of personnel,
drugs,etc.The social workers from all the organizations had conducted some surveys in the wards
that they work.Each month they report of the finding of any one particular aspect of the Urban
Health care syste.The meeting I attended very briefly touched upon the facilities and personnel in
each UHC
The findings of the survey broadly were
1. Most health centers had a non-working or lacked a refrigerators for storage of vaccines and other
temperature sensitive drugs.
2.The Health care centre’s had designated days for child clinics, maternity clinics, contraceptives
and reproductive counseling which many users were not aware of. The unpleasant experience of
discovering specific days after reaching the centers, dissuaded many people from returning the next
time.
IMPRESSIONS and LEARNINGS
Urban health is a complex situation due to many reasons-like migrations, lack of basic amenities,
high population densities,malnutrition and many more.In the past,there has been a systemic neglect
of Urban Health.But in the wake of the NRHM,the National Urban Health Mission too will be
launched shortly and has in the past not been paid much attention to their health. An understanding
of the current state of affairs would be of utmost use and can be incorporated into the
implementation and recommendations framework The survey undertaken by the NGOs show the
typical lag in the forces of the supply and demand side .
1
/ Medial \
/ College & \
/ Apex
\
/ (for writ andean) >
District Hospital
1 per district
.. (for
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0
I&
28
Zonal Hospital
2,50t(»a Pcpu§at5cn
Urban Health Cwtre
50,000 Poputetuton
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Source:NRHM task force on Urban Health Model
ARGHYAM-Workshop for school teachers on India Water Portal.Org
Venue: Kendriya Vidhyala MES,Bangalore
H
Date:31/1/2009
Arghyam is a public charitable foundation set up in 2005.They focus on supporting strategic and
sustainable efforts in the water sector that address water needs for all citizens. They work with
several partners to manage the India Water Portal which is an open, web based platform for sharing
knowledge, information and data on the Indian water sector.
As part of their advocacy strategy,they have designed an unique platform(sub -section on the water
portal) for teachers and educators, students and parents, principals and school management to share
learning resources on water.
The objectives of the workshop were to
1. Sensitize teachers to environmental issues and in particular water related issues
2. Seek to establish a dialogue between teachers and the water portal in order to develop mutual
areas of cooperation
.3. Enable the teachers to incorporate new and innovative techniques to highlight the importance of
water to students
The workshop started with an introductory talk by Dr. Rajagopalan,a prominent environmentalist
who has authored several books on environmental education .He briefed the teachers on the
precarious situation of our planet and how a unified global effort could decelerate the damage rate
even if a complete reversal was not possible Arundhati Nallapat, a Bangalore based artist used a
story-telling telling technique with expressions, voice modulations and gesticulations to tell the
story of the origin of river Kaveri -this method she said would be very appealing to younger
children. This was followed by a discussion between the coordinators from Arghyam and the
teachers. The points raised were:
1. The teachers voiced their concerns, doubts and even explained that it was
incorporate such topics for board exam going students.
impractical to
2. The teachers were also concerned that taking up additional responsibilities would mean an
addition to their existing burdens.
3. Repeated use of power point presentations for various subjects had made it a less interesting
medium of instruction, but also confirmed that visual images helped the children retain better.
4. Topics such as environment, climate change should form a part of the curriculum in the younger
classes as they were usually more receptive and not burdened with board exams.
5. The school had a “water audit” in place and required some help with water harvesting
6 .All teachers agreed that a value-based education was a must ,but was wary that switching over to
such a system may take a long time and may not be feasible .
Arghyani was very happy to receive the feedback and also proposed some follow up meetings.
They intended to conduct similar meetings in various other schools in Bangalore city. The last
segment of the workshop was guiding the teachers through the water portal website and the various
sections .The teachers browsed through various topics and worked on many of the modules .This
was to give them a hands-on experience on how they could adapt the modules to the classroom
setting and for some instant feedback on how to make the site more fun yet educative.
IMPRESSIONS and LEARNINGS:
Water is a precious resource and very critical in a country like India. Though the National Water
Policy, 2002 and the various state water policies give first priority to drinking water amongst
various water uses, we have a long way to go to achieve the Millennium Development Goal (MGD)
of providing safe and adequate drinking water.Burgeoning population, unequal distribution of water
resources, rapid industrialisation, climate change have all lead to an acute shortage of potable
water. The effort to conserve and preserve water resources should be a collective one and imparting
the importance to school children is a good step.
Subsequent to the workshop, I also browsed through the portal and found it very useful ,
informative and user-friendly as well.lt covered a range of topics like water management, e-forums
for concerend citizens, many articles by eminent resourcec persons,maps,statistics and even short
films
I was impressed with the website and Argyam’s efforts to mainstream the issue with educators.But
this Pit,I don’t feel that the buck does not have to stop with schools and teachers. Parents and the
community in general also have to play a role in being role models .Neighborhood clubs, building
associations could play a more active role in this well in inculcating the importance and necessity
of protecting the environment and how it is actually part of our civic duty to do so.
State Level Advocacy Meet on Implementation on Tobacco Control Laws in
Karnataka
Venue: NIMHANS Convention Centre, Bangalore
Date: 6/2/2009
Introduction:
THE CIGARETTES AND OTHER TOBACCO PRODUCTS (PROHIBITION OF
ADVERTISEMENT AND REGULATION OF TRADE AND COMMERCE, PRODUCTION,
SUPPLY AND DISTRIBUTION) BILL, 2003 (AS PASSED BY THE HOUSES OF
PARLIAMENT) is a bill to prohibit the advertisement of, and to provide for the regulation of
trade and commerce in, and production, supply and distribution of, cigarettes and other tobacco
products and for matters connected therewith or incidental thereto. Section 4 of the Act also
prohibits smoking in Public places.
The Tobacco Control Act was passed in 2004 and the implementation is only slowly gaining
momentum in the country. Today,tobacco use is not just a health issue , it is a social issue as well.
The Statutory Act has gone one step ahead and even given powers in the hand of passive
smokers.But the information is yet to percolate onto ground level. An inter-sectoral approach
between the government, civil society, NGOs and various industries is required to make the
implementation a success. Karnataka is an advantageous position as their health secretary, Shri
Madan Gopal is a dynamic and progressive and very keen to work on anti-tobacco issues.
The main objective of the workshop was to create a platform for various groups to convene and
work towards making the legislation a movement. The workshop had very good representation
from NIMHANS. various NGOs, faculties and students of medical, dental and social work colleges,
psychiatrists ,medical officers ,Industry representation- Mysore Tobacco Company, and Officers
from the departments of Education, Transport, Commerce, Agriculture and Police.
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The workshop commenced with a talk by Dr.Gururaj, head of epidemiology who spoke about the
epidemiology, public health impact and also gave a brief talk on the history of Tobacco cultivation
in India. Dr.Bengal, Professor, NIMHANS briefed the gathering about various cessation mehods
that were available
1. Nicotine patches
2. Medication
3 .Nicotine partial antagonists
4. Counselling
5. Yoga and meditation
Dr.Panchmukhi, director CMDR(Centre for multi-disciplinary development research) enlightened
us with the rationale of alternatives to tobacco cultivation and how many farmers were in cash crop
debts and under the clutches of banks and money lenders. Ms.Bhavani Thyagarajan, Consultant,
Tobacco Control-WHO India Office, gave us a general overview of the Tobacco Control Laws and
National Tobacco Control Programme and the enforcements of various sections. The workshop also
included presentation of managers from the labour and transport departments on how they sought to
tackle the issue ,but admitted the first step was to educate and reinforce the message among their
staff members. A senior HR manager from BOSCH also spoke about how they have worked
towards implementing a tobacco-free environment and how they sustained the program. The
District Health Officer(D.H.O.) from Raichur spoke about on-going school awareness programmes
in the district. The workshop ended with a panel discussion where representatives from various
sectors were on the dais and the audience could interact with them. A very interesting point raised
by the Assistant Commissioner of Police(A.C.P.),Bangalore ,Mr.Nanjappa that the Tobacco laws
could have been integrated within the Indian Penal Code and also felt a lot of ground work had to
be done for a well-defined implementation framework. In the absence of such an integration, he
felt the Police department felt incapacitated to implement and penalise offenders under the Act.
IMPRESSIONS and LEARNINGS:
Health effects of tobacco have been proven through numerous epidemiological studies since the
past 50 years .Tobacco use is rampant in India and the legislation was much needed .From the
various discussions, I noted that that public education and awareness is the first step to tobacco
control and the next step is in the effective implementation of the various sections .Civil society and
media also have to play a very pro-active and positive in the movement.
The success of the anti-tobacco lobby could be attributed to research that provided scientific base
for progress on policy front ,activism and advocacy efforts and the Commitment by the
Government of India (Ministry of Health and Family Welfare) towards effective tobacco control
efforts .The Tobacco industry has continued its resistance to various regulations .They also have a
tendency to bring economic issues related to tobacco production and tobacco control and over
emphasizing employment issues in connection with tobacco control .
A multi-sectoral approach from civil society,health professionals and various government
departments would be required for successful implementation and eradication of this menace.The
success stories from Bosch and The Labour office were example of how the willingness to take up
an initiative,supportive management and perseverance could help in tackling the issue.
The Hindu Article date:Feb 18, 2009
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Over 50 p.c. of pre-university Bangalore students are smokers
Nagesh Pabhu
Rules to discourage tobacco use have had no impact on youth
At least 18 colleges had tobacco selling points Many students influenced by peer pressure
Bangalore: The findings of a study, conducted by the Institute of Public Health (IPH), Bangalore,
this year, shows that over 50 per cent of pre-university (PU) students pursuing courses in arts and
humanities are smokers.
The rules and advertisements to discourage the use of tobacco products by the youth have had no
impact on students in Bangalore. The study revealed that 58.9 per cent of students of arts and
humanities, followed by 30.6 per cent and 10.6 per cent students of science and commerce streams,
respectively, use tobacco products. The study was conducted in two stages in Bangalore’s 19 PU
colleges on 1,087 students of first year PU (53 per cent) and second year PU (47 per cent). At least
18 colleges had one or more tobacco selling points within 100 yards of their campus. The
Cigarettes and Other Tobacco Products Act, 2005 prohibits sale of tobacco products within 100
yards of any educational institution. As much as 55.8 per cent of students said that peer pressure
had influenced them to use tobacco products.
More than 30 per cent said their teachers were smokers, while 31.74 per cent said that at least one
parent used tobacco products.
Cinema influence
As much as 18 per cent felt the need to smoke or consume tobacco when they saw film stars
smoking or chewing gutka in films, IPH’s Upendra Bhojani, who conducted the study under the
guidance of the Institute for Social and Economic Change, told The Hindu.
Face-to-face with an “Ever-green Hero”-Visit to the Chakashila Wildlife Sanctuary
Date: 17-18/1/2009
Chakrashila Wildlife Sanctuary , covering an area of approximately 45,568 sq. kms , is located
in
the
Dhubri
District
of
Assam
and
is
68
kms
from
Dhubri.
This area was recognised as a Sanctuary by the Govt, of Assam on 14th July 1994. It is surrounded
by
hills
and
there
are
two
lakes
on
either side
of the
sanctuary.
Many different mammals, birds, twenty three species of reptiles, more than forty butterfly species
are found in this area.The famous “Golden Langur” also lives here.
The Ever-green Man
Saumyadeep Datta belongs to a Zamindari family of Assam.Even during his school days, he felt
frustrated in closed classrooms and could not relate to blackboard teaching and preferred nature
walks and bird-watching. Saumyadeep enjoyed reading books and journals on environmental issues
and created his own library of ecological studies. At the age of thirteen, he established Nature's
Beckon a small NGO interested in conservation issues.
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In 1988, he gathered a team of friends and organized the All Assam Environment Awareness
Campaign that stretched across Assam, from the Brahmaputra to the Barak valley, in collaboration
with the government of Assam. Saumyadeep and his team traveled across the state, met youth
groups, and urged them to set up nature clubs in their towns and cities. After its completion, over
100 nature clubs sprung up across Assam. In the late 1980s, Saumyadeep and his friends discovered
the Golden Langur and four other endangered primates in Chakrashila, his home-district. Gathering
his base of youth volunteers, Nature's Beckon, which he had organized earlier, Saumyadeep
launched a grassroots environmental movement that succeeded in getting the state to declare
Chakrashila a wildlife sanctuary. Today, it is managed completely by the villagers. Since 1994, no
forest ranger or beat officer has been deputed by the government to Chakrashila - a first in the
history of forest management in India
The Environmental Movement:
Saumyadeep's experience in the Chakrashila Wildlife Preserve (upgraded later in 1994 to a Wildlife
Sanctuary) spawned over many years of practical learning. He has mobilized and trained a youth
environmental movement of over 3,000 volunteers to return the rain forests to their indigenous
people, and initiate conflict resolution, crime prevention, and peace initiatives among them. Most
importantly, it has organized rural youth leaders - most vulnerable to extremist pulls - to turn
around unprotected green belts into "people's sanctuaries." By demonstrating that the youth of
tribes share a common green heritage, it has shown them positive lifestyle options in eco-activism.
Thus, as new youth leadership emerges around forest belts of Assam, wildlife protection is fortified
and the economies of local communities are uplifted. Saumyadeep aims to replicate the model
across the seven strife-tom states in the country's Northeast and is establishing linkages with citizen
organizations and bureaucrats in the region. Saumyadeep defines a "people's sanctuary" as one
created through grassroots pressure on the government to provide high conservation status and
stringent legal protection for bio-diverse hot-spots around which communities live. In return,
communities provide the management and vigilance systems for the sanctuary.
The Chakrashila Story
Saumyadeep's intervention in Chakrashila began when the law evicted villagers from a protected
green belt in Chakrashila. In response, Nature's Beckon facilitated the forest communities'
resettlement in the fringe areas, and trained sixteen villages around the sanctuary to regenerate their
own forests around Chakrashila and establish sustainable food security and income-generation. A
combination of ingenious irrigation methods and traditional forest-based food and cash-crop
cultivation has led to substantial improvement in the quality of their lives. Annual income has gone
up by Rs. 10,000 .The model conflict resolution center within Chakrashila is called Tapovan, which
has broken the antagonism between villagers and bureaucrats, achieved state respect for Nature's
Beckon's efforts, and spurred successful grassroots campaigns for governmental accountability on
social-sector spending. Health and education programs are offered to children of differing ethnic
groups in Tapovan.
Training takes place in villages. Saumyadeep and his team start by disseminating information on
wildlife conservation. Next they walk the villagers through discussions on the tenuous links
between environment, economy, and militancy, and encourage debates. They identify potential
youth leaders and involve them in exhaustive nature camps, educational trails, constructive peer
interaction, etc. The aim is to help them look anew at forests, which they have for so long viewed
with apathy. Interactive games like "feel a tree" and family motivation programs work especially
well with families of poachers and timber smugglers. Through low-cost training aids, journals, and
workshops, Nature's Beckon trains these eco-emissaries in fifteen steps of biodiversity management
and protection.
As the number of training programs in villages increase, so do the numbers of youth volunteers,
who provide a new, young, alternative leadership to villages. Populations that were once hired by
extremists, timber smugglers, poachers, etc., for nominal wages to plunder green belts, are now
reducing human demand on central forest systems, relocating their economic bases away from
endangered wildlife and plant species, and designing new forest-based development programs
along the fringes of the forests. Saumyadeep interacts with them at regular intervals for fresh
insights and to share experiences.
Our experience:
The CHC team had very long conversations with Soumyadeep .In a simple story telling fashion, he
told us about Chakrashila’s history and the environmental movement in Assam.He also answered
our queries on various technical aspects of environmental management.We were on a two hour trek
to the top of the Chakrashila mountain. Later in the evening,he also introduced us to the youth
group of a neighbouring village,whom he had helped organize and set-up.The group of 30 young
boys who were very deeply committed to environmental s. The boys had formed a night squad and
kept all night vigils to catch hold of any illegal smuggling of timbers from the forest..The youth
group was also a forum to address many social issues.They told us that the villages had both the
hindu and muslim communities ,but had always co-existed in harmony. They were a bit concerned
that in the current backdrop of communalism factions may appear and disturb the peace.We also
discussed general issues like the provisions of the NRHM(National Rural Health
Mission),RTI(Right to Information, Act) and the problems with irregular supplies at the
PDS(Public Distribution Systems).This informal chat was a very informative and healthy dialogue
between the CHC team and the youth group.
The next day we also went to a local wetland and saw many rare birds. It was indeed a treat for all
the city breds bumpkins.
IMPRESSIONS and LEARNINGS:
I could see parallels between health and environmental movements. A dynamic leadership is pre
requisite, a clear and well defined vision,p eople’s ownership of the problem and the determination
to be part of the solution. It was obvious that the people needed to develop a lot of trust in their
leaders. The community needs to be convinced that they were the ultimate beneficiaries of what
they were seeking for and there were no vested interest from outside parties. Sustainability is an
issue that any leader and the community and movement needs to grapple with. There is an inherent
tendency for the public to depend on their leaders directions and not wanting to take risks
themselves.
Saumyadeep’s was a case where he showed that Action was possible and results could be
produced.In the landscape of terrorism and various other issues that plague the North-East ,he has
managed to bring in solidarity to the movement.
Our chance to see the golden langur and the wetland were rare opportunities and I hope that
Saumyadeep and the villagers are successful in the eco-tourism endevours and hope their message
speards and the movement gets more strength and support from all.
MILANA - A Family Support Network of people living with HIV
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Venue: MILANA office. Old Race Course Road, Bangalore
Date: 26/2/2009
MILANA’s activities centre around providing care and support services for people living with HIV
to help them lead a meaningful and positive life. Their main focus areas of work are:
1. Womens and Children Rights
2. Home based care and counselling
3. Care, support and treatment
4. Economic empowerment
5. Capacity Building and advocacy
I spent half a day with Jyothi Kiran, the founder and coordinator of MILANA. She narrated the
story of the humble beginnings of MILANA and how she was inspired to start a drop -in centre for
positive children.Her experience , working with them made her realise that unless the families too
were involved in the process, no progress could be achieved. Hence the program vision expanded to
the families as well. With time, various support groups were formed and now MILANA has 300
families that attached to them. These families and PHLHs(People living with HIV) seek support,
compainionship and guidance on various issues.
The programmes that MILANA administer are
l.Nutritional support in the form of monthly rations for 60 children and their families.
2.Educational support-additional coaching classes for Orphans and Vulnerable Children who are
usually at a higher risk distress,economic hardships and exploitation.
3. Drop-in centres for PLHA and their families who are looking for support ^guidance and sense of
bonding. The members receive counseling and training which works toward a holistic
development.
4.Support groups for members to share their feelings and concerns openly. These meeting are very
encouraging and resourceful.
5.Confidential telephonic counseling
6.Home Visits: Peer counselors visit affected individuals and their families to check on them,
impart awareness and education, provide referral services and regular follow-up on their health
status.
■7. Alliance building with other NGOs and CBOs working on HIV/AIDS in Bangalore and
Karnataka.
8. Income generation activities that are self sustaining e.g. embroidery and crafts unit and a catering
unit managed by positive women.
Some of the Challenges that MILANA faces as an organisation are
1. Limited trained and professional staff
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2. Practical challenges in documenting their best practices.
3. Long term funding for sustainability
I interacted with two peer counsellors who told me their tragic stories. They were inspired to join
MILANA as they could empathize with the trauma of being HIV positive understand the bitterness
and were victims of stigma. They are keen to ensure that affected people should not suffer on
account of their ignorance and not to hide is shame They aim to encourage people to face life and
live it to the fullest by serving as ambassadors of hope and providing support and kinship.
I also attended a support group meeting for the mother of HIV positive children. These meetings
are held on third Wednesdays of the month. The topic for the month was how to help the children
cope up with exam stress(March is the month of final exams in many schools ).The discussions
centered around delicious and nutritious recipes and morale boosting techniques.
The women knew that the children required special attention because their HIV status. The mothers
explained to me how painful it was to see their children being isolated and discriminated. These
kind of experiences made many resolve that they would not reveal the childrens status in school.
Many of the women were single parents and had to juggle between being bread-winners and
caretakers as well.
IMPRESSIONS and LEARNINGS:
As a medical professional and a public health worker ,1 cant even begin to count how many times I
have read and heard about the stigma surrounding HIV.During my internship at UNAIDS ,New
York , I started to look at the disease through a more serious lens. Though, I was familiar with
technical know-how of the disease ,its statistics and various other aspects, the MILANA visit was
my first experience of directly interacting with a group of Postive People. It was very inspiring for
me to meet these positive women who had decided to face life with such optimism .My previous
knowledge and understanding of stigma was taken to a new level when I heard of the personal
experiences of many of the women. In India, where our traditional and cultural beliefs have strong
gender banders inequality, women are often forced to live their lives feeling disempowered and
inferior to their male counterparts. Many women discover their HIV status during pregnancy, and a
positive diagnosis can seem like the end of the world, especially for an individual already burdened
with the challenges of poverty, inequality and sometimes even domestic violence The situation can
be made worse by the lack of sources of psychological support.
In such a scenario, support groups like MILANA plays the multifacted role of a friend,guide,
mentor and confidante. Empowering these women through knowledge, awareness, mobilization and
capacity building is very commendable.
MEDICO FRIENDS CIRCLE-ANNUAL MEETING
Venue: Bongaingaon,Assam
Date: 14-16 January 2009
The Medico Friends Circle(MFC) is a nation-wide platform of pro-poor and pro-people health
practitioners,scientists and social activists who are interested in the health problems of India.The
group has been actively involved in analyzing the existing system and tried to evolve a more
humane and just arrroach to healthcare.
Their main activities are:
iI
1 .The MFC bulletin which acts as a medium for members to exchange views and ideas,critisize and
analyze policies,reports and initiatives
2. Special Cells are units that are formed in response to certain situations that warrant detailed
discussions.e.g. Primary Health Care Cells ,Women and Health cells
3. Collective Actions and campaigns to study and act on certain problems .e,g.Binayak Sen
campaign,Study of health effects of Bhopal Gas Leak
4. Annual MFC Meet: A national level meet is held ever year, where the MFC members discuss
and debate on a selected theme.
The 35lh Annual Meeting of the MFC was held in Bongaingaon Assam on 16lh and 17th
January,2009.The theme for this years meet was “Displacement and its effects on health”
REPORT
Medico Friends Circle Annual Meeting 2009
January 16 and 17, 2009
Action North-East Trust, Bongaigaon, Assam
The 35th Annual Meet of the Medico Friends Circle was held at the ANT campus in Bongaingaon,
Assam.
Dr. Sunil Kaul and Jennifer Liang (Jenny), the hosts for the meet welcomed all the delegates
.Jenny remarked that the meet was being held during the auspicious time of the “Magh Bihu”
festival in Assam and it was a great occasion for all to celebrate. This was followed by a general
round of introductions by all the attendees
The MFC group has officially turned 35 this years and the group felt it would be worthwhile if
senior members could recap the major events and milestones of the group.
Dhruv, Meera Sadagopal, Sarojini and Probhir contributed to this discussion.
The MFC was an off-shoot of the J.P. movement and consists of both medical and social workers,
the core values being pro-people and pro-poor. The group has been built up on two pillars: One in
the form of annual meetings and second as bulletins. Every few years the bulletins are compiled in
the form of anthologies. With the advent of internet, the group has also formed an e-forum for
debates and discussions. The group being totally voluntary based has faced problems with sustained
an continuing motivation and over the years the debated have generally mellowed down. The group
now consists of 50-60 members and the monthly bulletin is dispatched to around 300 members.
Meera recalled how the famine and scarcity period of 1972-1973 was a landmark period and was
also the time that Jaiprakash Narayan started the Tanin Shakthi movement. Ashok Bhargawa was at
this time working with some famine hit crisis in Nagpur and was very hurt and upset to see how
marginalized communities were further debilitated with the famine ,He penned down his thoughts
and feelings in an inland letter, cyclostated 40 copies and sent it out to various people who he felt
could empathize and relate to the situation .A group of agonized doctors met in Ujjain and
discussed amongst themselves how politicized health had become. Meera remembers how they all
felt very useless and convinced that becoming revolutionaries was the only way forward. Over the
years the MFC group has met and discussed various matters of reat concern like population issues
,etc and some of the debated points, she felt were even valid today.
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Sarojini added how MFC has always maintained a secular identity.Post the Godhra carnage,MFC
had filed a Public Interest Litigation(PIL) against Praveen Togodia in the Indian Medical Council
asking them to revoke his license.
Sunil spoke how how MFC defined itself as a “thought current” .He pointed out that all the
members were all working various issues under the social and health development umbrella , hence
it was a bit difficult to gamer momentum and evince equal interest from all members on some
issues. Renu stressed on the fact the meet was and should always remain of an informal nature and
that new members should not hesitate in raising points or asking questions. Probhir spoke about
how Wardha had always been the preferred location for the annual meet by virtue of its location in
Central India. Over the years, MFC felt it would be a better if a new venue was chosen every year.
INTRODUCTION:
Day 1 January 16th 2008
The topic for this years discussion was Displacement and its’s ill-effects on health. The background
papers were circulated on email. The discussion was to be based on the contents of the papers ,
general understanding of the issue and personal experiences. This was MFC’s first meet in the NE,
all felt it would be pertinent to have a orientation to the NE and the issues that had made it a distant
entity for the rest of India. All were also enthusiastic to understand the causes for mass
displacement in the NE states.
Introduction to North-East: Raju Nazary, Sunil Kaul and Digambar Nazary
The North-eastern states are called the 7 sisters (8 including Sikkim): Assam, Arunachal Pradesh,
Mizoram, Tripura, Nagland, Manipur and Meghalaya. Assam borders Bhutan, Arunachal borders
Tibetian part of China. Meghalaya borders Bangladesh, Mizoram borders Myanmar and
Bangladesh and Sikkim borders China and Bhutan.So it is not very difficult to understand why the
area is of such huge security to India.
The “Chicken Neck” is the geographic area connecting India’s mainland to the north-east, the
dimension being 14 km north to south. It contains the Siliguri area of West Bengal and contains the
NH 31. There is more than one definition of the chicken neck.One being the BJP government’s
definition in Jharkand, where the entry point to the neck has been identified as Kishanganj, the
other being the north-eastern definition where Srirampur..
Assam is the largest of the NE states with 27 districts and a population of 2.26 crore. Manipur has 9
districts with a population of 26 lakh. Arunachal has 9 lakh population and Sikkim has 6 lakh. At
the time of independence ,Meghalaya,Mizoram,Manipur and Arunacahal Pradesh were all part of
Assam but were eventually carved out into separate states. Tripura and Manipur were princely
states and were later merged and Indian states.
The Bodo movement organized by the Bodo tribal community was to demand a separate statehood.
After years of resistance they were granted a special status of Tribal Council as per the Sixth
Schedule of the Indian Constitution. The Bodo territorial Council was formed in 2003 and
Bodoland has been carved out of Sonitpur, Darrang, Nalbari and Chirang districts. The district is
giverened by Council ministers who administer the set-up,but the line department maintains links
with the Asam government.One of the main demands of the Bodos were the use of Roman script
for their language,they were eventually granted devanagiri script that has now been developed uptil
the M.Phil level.
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The health statistics are
Infant mortality rate: 68
Maternal mortality rate: 96
Sex ratio: 930 per 1000 males
A public health problem that has been found recently in Assam is the presence of high fluoride
content in the water in 25 of the 27 districts. Considering the Arsenic issue in Bangladesh, there is a
good chance that the same may be found here. Malaria is found everywhere here, but more in the
forest fringes. Of the cases detected, 95 to 96% are falciparum positive. Chloroquine and Quinine
resistance are common. There is also a high prevalence of Japanese Encephalitis. In the KarbiAnlong region, approximately 1000 people die annually due to complications of Malaria. The west
and south of Garo hills are also high prevalence areas for Malaria. The usual regime of treatment
consists of a cocktail of chloroquine, quinine and artemesine.
Bhramaputra and the dams:
The NE has been touted as India’s future powerhouse. The Bhramaputra enters India after
traversing China.There is a project proposal to build 236 dams across the river including four super
big dams. The Macmohan line is the border that separates India and China.Post the 1962 war, it is
the river in between the two mountain ranges which is accepted as the boundary. If the first 50
dams get built, the river bed of the Bhramaputra will rise by 2 metres. Approximately ten lakh
people will get displaced.
Social Issues:
“Caste” is not a big issue in the NE, people are more divided along tribal lines. Untouchability is
very rarely seen but does exist in subtle forms. Most of the barbers,sweepers and sanitary workers
are from U.P and Bihar. There are scheduled castes in Manipur but the inequities are much lesser
here as compared to mainland India. The British brought in tribals from other areas of India to the
NE to the tea plantations, but these people have now been given ‘OBC’ category in some places
and are under the general category in some places. Though 23% of Assam’s population is adivasi,
they have only 7% reservation. It is difficult to say who is SC or ST or OBC, all are adivasi at the
end of it. There are 230 ethno-linguistic lines in the NE. “Nagamese” a mix of of Assamese, Naga
and Hindi and widely spoken in Nagaland. . The Shankar Dev movement, a Bhakthi movement has
been instrumental in clearing out untouchability and caste system from the NE. Most of the tribal
communities also feel that people in the mainland or plains look and treat them in an inferior
manner.
Contrary to the common perception, less than 13% of the people in the NE are Christians. Official
statistics reveal that 30% of the people in Assam are Muslims. One cannot clearly say if they’re
from India or Bangladesh. People have been internally displaced in the NE since centuries. The
Nepali community took the milch route to enter India and they have been involved in cattle rearing.
In Meghalaya, most tribes are matrilinear. Male child neglect is also seen. Manipur has a
matriarchal system, and hence the lower rate of infant mortality due to womens empowerment
In upper Assam enrollment rates are very high-9O-95%, but beyond higher secondary, there is a
higher drop out rate. There is also a concept of venture schools and colleges since 25 years in which
youth initiate the functioning of a school or college and then the government takes over it.
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The private sector is very poorly developed and government jobs continue to remain the main
source of employment. The infrastructure and developmental indicators are also very poor.
Mizoram is the least corrupt state in India whereas Assam, Meghalaya and Nagaland are very
corrupt states.
Post lunch session:
The Armed Forces Special Power Act is a Draconian Act -that has been imposed at various times
in the NE. The act has never been amended after it was passed in 1961. The AFSPA is applicable to
any “disturbed area”. Under the Act, the police or the military can shoot anyone or arrest anyone
under suspicion; the military can destroy a place without explanation if they suspect terrorist
activity there. There is a strong anti AFSPA movement building up in the NE ,but the centre has
not chosen to take any action. The Act, according to many has no relevance and is just fueling the
alienation gap between mainland India and the NE. The number of armed groups have, in fact
increased from 7 to 34 now over the years.
Irom Sharmila Chanu, a volunteer at a human rights NGO has been on a “fast on till death” since
2000 to protest against the atrocities through the AFSPA and to repeal it. She is currently being
force fed and has been in and out of the hospital repeatedly. Her demonstration has rekindled the
spirit against the act. Many recommendations have been submitted to the central government, but
Manmohan Singh has not considered them till date.
Historical evolution of the resistance movement in the NE:
The year 1828 was a landmark year for the British Army. The treaty of Yandavoo was signed
between the Burmese and the British. After this, the NE land area came under British regime.When
India was waging her freedom struggle against the British,the Naga tribesmen joint the fight as
well. They sided with the Indian National Congress with the understanding that the struggle was
against a common enemy and that post independence, they would be a sovereign and independent
state. But in 1947, the Nagas were surprised that India’s boundary spread over their territories. In
1949,The Naga people submitted a referendum to the Indian government where it is said that 99%
of the Naga people voted for sovereignty. Upto 2007, there were 3 groups of Nagas fighting for
sovereignty.
Mizoram became the only state in India to be bombed by the home government. In 1959, the cyclic
bamboo flowering was followed by a huge rodent problem and famine. A movement for autonomy
started under these circumstances .The Indian government was very angry with the stance adopted
by the people subsequently many areas were bombed and all the people were relocated and
displaced. After many years of strife, peace accords were signed and presently, Mizoram is one of
the most peaceful states.
Assam has had a long history of identity conflicts. During the 1960’s, there was a movement for the
employment of only Assamese speaking people for government jobs. The issue was initially taken
up by the student’s union and later by the ULFA. The ULFA was formed in retaliation to two
issues: the imperialistic role that the Indian central government was playing and the issue of
immigrants into the NE. The Bodo movement was to assert the demand of a separate land for the
indigenous Bodo Community. The Bodoland Monitory Force is an armed group fighting for the
sovereignty of Assam. The NDFB and Ceasefire are 2 active armed groups in Assam fighting for its
sovereignty.
Tripura borders Bangladesh. During the 1970s, following the creation of Bangaldesh, there was a
mass influx of Bengali Hindu immigrants. Official statistics cite that, in 1947, 70% of Tripura’s
h
population was tribal, but in 1970 only 29% was tribal. Additionally, due to the formation of
national parks and reserves, the tribals in Tripura have felt alienation and groups like the National
Liberation Front who are voicing the opinion.
Ethnic conflict and displacement:
Following the Mizo movement, around 40-50000 Rihang refugees were displaced and Following
the 1996 riots in Assam, almost 2 lakh people became homeless. Around 14-15 refugee camps still
exist post these ethnic conflict riots and the people there live under very bad conditions. Many
young girls disappear mysteriously from the camp-trafficking . The children who are growing in the
camps have very aggressive mindsets as a result of all the psychological trauma.
In general, there has been a mass exodus of young people from the North-East to other cities in
mainland India. In the NE, there are just 3 engineering colleges and many prefer to come down
south to places like Bangalore where many private institutions offer courses . The NE youth have
experienced this situation of tension from a very young age and hence they’ve become numb to an
extent. The question is how the freedom of ethnic groups can be guaranteed and why more and
more armed forces are being used to oppress the people. Most of the problems are due to the
development model ,the Indian government has adopted. The new development models will only
create further unrest. In the Indian mainland, for the 4400 dams built, still over 90% displaced
people have officially not received any rehabilitation measures. The government’s mindset should
move away from a population based model for health services because of the low density and long
distances between health centres.
Post tea:
Introduction to theme: Displacement and its effects on health.
Flooding and erosion are two major reasons for displacement in the North-East. Floods are
welcome to a certain extent because the banks are enriched after the water recedes. But erosion is
more precarious since pieces of land simply get cut out and are washed away. Hydel projects and
tea plantations whose creation needs bunds, embankments etc are a major cause of erosions.. These
cause the water to come down with great force and erode large parts of land. This phenomenon
leads to pauperizations of victims very fast. Erosion also leads to ethnic conflicts because of fights
over relief land and measures. Many of these people and camps are termed as illegal .
Chattisgarh Issue: The mining work in the south of Chattisgarh, Orissa and Jharkhand is the major
displacement causing factor. The burden of displacement inevitably falls on the poor, the tribals
and the rural people.Lack of employment and other livelihood opportunities because of the agrarian
crisis in the rural economy has also caused widescale migration to urban areas. Integration into the
global economy is yet another cause leading to displacement.
If we look into some of the health effects of displacement,one would notice very high morbidity
and mortality among the displaced populations as compared to the control groups. Health impact
assessment should also be done along with environmental impact assessment.lt has generally been
noticed that post dam constructions, there has been a 32 fold increase in smear positivity for
Malaria. Migration also mitigates the effect of the work of community health projects and works all
over the country, as the target population is always in an unstable state. The primary victims of
climate change are the rural masses and the poor.
Reading of Binayak Sen’s letter:
Dr. Binayak Sen been imprisoned since over one and half years under the Chattishgarh Special
Security Act. He has done a lot of work in community health and determinants of health. He also
participated in the civil rights movement in Chattisgarh and has spoken against the fake encounters.
He wrote a letter that was read out in the meeting, the contents of which are briefly discussed below
Diplacement has been a continous feature in human history,wether in the case of native Indian
Americans,the African slaves who were transported to planatations,the Indian partition or even the
situation in Palestine today.The presence of Salwa-Judum in Bastar has caused a lot of
displacement. “It is important to choose your politics before politics choose you.”
Continuing with the discussion:
“Displacement” is not clearly defined. Sometimes it is by choice and sometimes forced. It is
important to define who is being displaced. There is a lot of influx of people into Maharashtra
causing the locals to complain how they are losing out on job opportunities.
One must keep in mind the details of where the migrants are coming from and where they’re
going,if adequate health facilities can be made available at the site of migration.. For displaced
people, two types of rehabilitation are necessary-short term and long term.
There is no clear guidelines as to what kind of health facility should be made available during times
of conflicts like blasts and floods. The 3 points one needs to consider while studying displacement:
Displacement is not just an isolated phenomenon. The context of power is important. There is
disposition, disparity and discrimination seen alongside displacement.
Important concerns with issues of power: many times,displaced people often go to areas with
already marginalized people.This lead to both groups fighting over existing resources. The
standards of relief services sometimes is such that the relief camps have better facility than the
surrounding village and this too creates conflict. References were made to how in the Narmada
settlement case, the policies are getting clever. The policy on paper is to run a parallel health
system for the displaced population. The situation has become such that the mainstream and the
alternate systems are both washing their hands off the case.
Raju pointed out that many rehabilitation packages are incomplete and insensitive to the people’s
needs.The government currently offers the refugees a paltry sum of Rs 10,000 which does not
amount to anything to start a new life.
Rakhal contributed to the discussion with his experiences from the Tsunami rehabilitation.lt was
important he said ,to keep in mind when natural disaster strikes and we try to lean up the mess
,there are already a number of problems affecting the communities. There are disasters from the
past that have not yet been tackled.He gave the example of the Pulikat lake near Sriharikota .The
community there was fraught with caste issues and had evolved a caste based system for fishing i.e.
inland or deep sea and fishing days and timings-called the PADI system. As a part of the
rehabilitation program the government gave all the fishermen motor boats for deep sea fihing.In a
community that was already in a fragile state,these measures only serves to complicate the exiting
relationship.A well-established fishing rights and system therefore came into question.
A common phenomenon observed in many refugee camps is how communal groups and Right
wing groups also use the situation to their advantage.
Sathyashree cited her experiences from upper Assam mainly known for floods, but also suffering
from a major erosion problem erosion. Since 1952 ,the height of the bed of the Bhramaputra has
increased by 5 m. Also, there was an earthquake in 1950 which increased the height of the bed in
some places by 10 m. Assam has lost 7% of its fertile land to erosion since 1952. In many tribal
areas there is no system of land papers, there is just acknowledgement. When they get displaced
,the people find it very difficult to prove their legal hold over the property. The government has
built a lot of embankments along and this has led to increase in malaria, kala-azar, caused
increased siltation and increased river height. They worsen the flood situations and also lead to
conflicts between communities
Post displacement arises a situation where both the people and medical personal don’t know which
PHC they come. Sanitation is another major issue, especially for women.
Manisha spoke about womens role, rights and situation in disasters and conflict situation: during
the tsunami many more women were killed than men due to a variety of reasons. The remaining
women survivors also had additional burden of tending to those left behind, finding firewood and
cooking for all the refuges. So in effect they had become even more marginalized in the difficult
situation.
Post dinner:
Dr.Binayak Sen -Action plan
Binayak is one of the most active MFC members and has always shown open willingness to go
against the state.
MFC’s Action Plan:
1. Keep Binayak’s case alive in the media
2. Friends to go in a rotation system to attend the court hearings.-Chinnu to collect names of
interested members and Anant Phadke to coordinate the schedule
3. Approach contacts who could help with an appointment with Sonia Gandhi,Catholic
church,Rahul Gandhi,PM.
4. Fax-Jam of important politicians and decision makers on the 14th of every month.
5. Organise a vigil on 14th1 Many and conduct a peaceful demonstration to reinforce our demand for
Binayak’s release.
17th January:The discussion revolved around various papers and articles that had been circulated
prior to the Meet.The papers focussed on various injustices meted out on adivasi communities in
the name of development, how access to healthcare was very complicated in a displacement or
disaster scenario.The groups also discussed various topics like safegaurds, solutions-both political
and administrative. The National policy on rehabilitation was also discussed.
The Community Health Cell ,Bangalore has took up the MFC convenership for the next two years.
They will be coordinating all the MFC activities over the defined time period and will remain the
link connecting all the members. The proposed venue for the next annual meet is Bhopal and the
theme will be on Environmental health.
COMMUNITY HEALTH CELL-SILVER JUBILEE PREPERATIONS
The Community Health Cell celebrated their Silver Jubilee Anniversary in December 2008.
An Alumni workshop was hosted on 4th and 5th of December .December 6th was celebrated in the
form of cultural programs. As a Bangalore based intern with CHC,I lent a helping hand with all the
preparations. The CHC core team and staff members held regular meetings from mid 2008 to plan
out the events, but the pace of worked increased from November as the clock started ticking
towards D Day. All team members were given specific responsibilities, but were all part of the
larger group and were prepared to help out in whatever way they could. We all put in extra hours of
work every day and started working on Saturdays as well to meet set deadlines. The whole
experience was an eye-opener to the work culture of an NGO, which was very different from the
Corporate world I was used to. The non-hierarchical and informal atmosphere made the entire
experience so much more pleasant.
I was give the responsibility if designing, arranging and managing the poster exhibition on 6th
December at the Bangalore Medical College Auditorium, where the Jubilee function was to be
held. In addition, I also helped to edit some of the Jubilee publications.
ALUMNI WORKSHOP
The programme schedule for the alumni workshop was
1. Sharing of experiences, memories and events of their CHC association by SOCHARA
members,alumni and interns
2. Health in a globalised world-macro realities, drug policy, closure of vaccine institutes.
3. Health in the context of gender, caste and identity politics
4.Film Screenings by Pervez Imam
Alumni Workshop report
Please note that I have not included notes from the sessions that I could not attend,as the Jubliee
team had to be present at the BMC auditorium for preparations.
REPORT:
CHC SILVER JUBILEE-ALUMNI WORKSHOP 2008
Contents
1) Introduction
2) Reflections and Insights by Co-initiators and SOCHARA members
3) Community Health is Today’s Globalized World-Discussions moderated by Sukanya
a) Globalization and health
b) Drug Policy-Campaign against Novartis
c) Closure of Vaccine Units in India
4) Community Health in today’s identity politics
a) Impact of Identity Politics on health
b) Impact of Caste and Gender Politics on health
c) Sexual Minorities and health rights
5) Community Health and Engaging with the state
a) NRHM and role of society
b) Community Health Work in Sithlingi,Tamil Nadu
c) Community Monitorining process from different states
Objective:
The objective of this workshop was to bring together alumni from various batches of the
Fellowship Scheme to share their ‘Community Health Journeys’, on the occasion of CHC’s Silver
Jubilee. It was a chance to enhance our learning through collective reflections of various
SOCHARA members and associates. The workshop was also an occasion for nurturing our
collectivity and broadening our perspectives on how the ‘social paradigm’ has shaped community
health action from our experiences. Community health work has taken various dimensions in the
current context of macro policies of globalisation, liberalisation and privatisation; the seemingly
endless identity conflicts - caste, class, religion and gender; and the potential of engaging with the
State. In this workshop, we have discussed and shared practical examples of community health
work in the context of such challenges and understood the communities’ struggles of resistance and
resilience that enable their right to health
Introduction:
The workshop began with a brief round of introduction of all the attendees which included
SOCHARA members, CHFS fellows and the CHLP fellows of the current batch.
The first round was from the four co-initiators of CHC
Dr. Thelma was the first speaker of the “Sharing and Reflection” Session. She initiated her sharing
by explaining how the late 70’s and early 80’s, was a period when a lot of projects in the field of
public health were initiated. The formation of groups like Medico Friend’s Circle (MFC) and
studies like the Delphi Study with CHAI opened her eyes to the vast differences between
community work and research and also how power was a player is “Health Politics”. Dr. Thelma
explained how her PhD on the T.B. policy in India from the London School of Medicine and
Tropical Hygiene helped her gain exposure in policy engagement and community empowerment.
And she was appreciative of the fact that the opportunities to study in a renowned institute helped
her gain exposure and understand many facets that may not have been easily possible in India. She
explained that the concept of evolving the fellowship program was an innovative method to create a
critical mass of activists and practitioners. She expressed her gratefulness to the CHC staff who
helped both Ravi and herself in finding the time and space to evolve CPHE.
Mr. Gopinath one of the co-initiators of CHC along with Ravi, Thelma and Krishna started his
sharing on how he did not have any interest in Community Health to begin with, though was
working at St. Johns Medical College. But, his discussions with Dr. Ravi helped him think in an
alternative style and he too took the risk of leaving St. Johns along with Ravi and Thelma. Over the
years, he said CHC helped him focus and he went on to specialize in Personnel Management. In
CHC, he played the role of shaping up its administration department .He ended his sharing by
expressing how indebted he was to his teacher General Mahadevan .He concluded by stating that
his journey with the organization still continues, though he is no longer a staff member at CHC
Mr. Krishna started his reflection with how he had known Dr. Ravi from his childhood. He initially
joined CHC as an office assistant and later on developed an interest in art for the purpose of health
communication. He explained how he attended several art courses and has now become a media
specialist. Krishna was grateful that he was able to pursue the vocation through his experience in
CHC, he has also attributed his time there is helping in his own self-transformation process.
At the completion of his sharing, Dr. Ravi was quick to add that none of the co-initiators had any
form of specialization prior to coming into CHC. He cited Krishna’s as an example of an individual
who taught the co-initiators that it was necessary to focus on an individual’s strengths rather than
his weaknesses. This alone would encourage him or her to bloom. The CHC co-initiators are very
happy that Krishna was able to find his niche and successful in his profession today.
Fr. Claude
Fr. Claude was one of the earliest supporters of CHC. He saw both Ravi and Thelma had a very
unique approach and had their ideas set in a very different path as compared to their peers.Fr
explained how he was thrust into the field of community work in the 1970’s.This was a period
when India was entering a revolution period and young people were all arising to do something for
their country. He mentioned that two life altering experiences in his life were
1) The disaster situation of the Andhra cyclone where he witnessed a Dalit colony in Georgepet
swept away.
2) Attending a pedagogical seminar Paulo Ferios in Mumbai where many revolutionary and
inspirational ideas were discussed.
He mentioned that many times people questioned him as to why he had so much faith in Ravi and
Thelma. His standard reply to this question was that both they were serious, persistent, determined
and consistent in their beliefs and values. Fr. Claude appreciated that they had an ideology, a vision
to bring about transformation and change. They targeted the weakest people. They had not changed
but have grown into the change .He concluded his sharing stating that he believed that all beings
were divine and the spirit of CHC continues to spread.
Dr.Mohan Issac
Dr. Mohan Issac, the SOCHARA president was pleased to note that the attendees of the alumni
workshop were a mixed crowd. He remarked that all of them were co-travelers on similar yet
different paths. He reflected on how his family was apprehensive with his decisions to take up
Psychiatry as his post graduation specialization and how his mother was very upset with his
decision to work with mentally ill patients in a rural area of Bellary. But his commitment and faith
never let him down and the lessons he learnt from the community experience have been invaluable
for him.
His observations of CHC as an organization at this point in time were:
1. CHC has been able to bring changes in people’s personalities.
2. They have been a group of innovators, motivational agents and a mentoring point.
3. They have all been risk takers.
4. It is a group that believed that well -taken paths are not challenging.
5. The importance in vision and faith in the work that they did.
He also pointed out that typically any organization, especially the non-profit sector would define
their growth in the following ways
1. Creating an endowment
2. Building a huge infrastructure
3. Associations with bigger entities as an institutional back-up
4. Translating success as a big number on the pay-roll
Dr. Mohan expressed his happiness at that way CHC has grown and expanded over the years, he
believes that an all round growth has been achieved with our foray into local, national and
international movements. He is personally satisfied that we have been able to achieve great heights
without dilution of our values and vision. He mentioned that his current assignment with the
University of Western Australia allows him to remain associated with CHC ,thus he is still able to
be an active member in the organization’s activities.
Dr. Mani Kalliath
Described himself as a co-traveller in CHC. He shared how he was a confused and rebellious
individual in his youth and had difficulty forming a sense of direction. It was during this phase that
he met Dr. Ravi who helped him look into communities and alternative health paradigms. Over a
period of time, his interest in Community Mental health grew and he chose to remain in the field as
it gave him a well defined focus as opposed to a CHC’s generalist philosophy. He stressed on the
importance of having an organization like CHC. There may be many committed NGO’s, there was
•clearly a lack of all of them heading in the same direction and an organization like CHC ,he felt
would help define and set a common goal.
Sr. Aquinas:
Started her journey into community health around 12 years back as a disillusioned doctor at St.
Johns medical hospital. She was surprised to see that conventional medical care only catered to the
ailments and diseases of the affluent, whilst the diseases like T.B-those of the common man were
very often neglected. She recalls crossing paths with Dr. Thelma because of their common interest
in T.B and was then introduced to CHC.
Admist a lot of chaos and confusion in her mind, Sr Aquinas took a bold step to move beyond the
boundaries of clinical medicine and work with marginalized communities. Her first project was
with a Tibetan colony in Kodehalli. She eventually got involved with the National Tuberculosis
Programme and the success rate in this mission encouraged her to get more involved with
communities. Sr notes that it was during her work with rural communities she realized that health
was not an isolated issue, there was the issue of basic needs like food, livelihood and non-formal
education that needed to be tackled before even addressing health matters. As Sr.Aquinas reflected
on her journey, she said she has faced a lot of opposition from the religious hierarchy who felt
threatened by her non-conventional mode of functioning. Looking back, she does mention the
frustration in not seeing any visible efforts of her work with communities, but she still feels that the
journey has been enriching and fullfiling, she is happy that she now has the credibility to encourage
people onto field work. She expressed her gratefulness to CHC for their invaluable guidance, and
was very appreciative that CHC has been instrumental in guiding many young professionals into
the field of community health.
Fr. John started with his “Community Journey” as a social work graduate. He was offered the
CHAI leadership , and one of the conditions he laid down in front of the board at that point was
that Rural Health had to be incorporated as a component in their work. He recollected how he came
down to Bangalore to meet Dr. C.M. Frames ,who he hoped would give him clarity on how
community health functioned .It was at this juncture that he met Ravi and Thelma and was
introduced to CHC. They all got together to define Community Health as a concept for CHAI
.After close to six months of discussions, Fr.John says they were able to emerge with a clearer idea
and understood that community health was about people’s empowerment and political action .The
task was now to explain this complex idea to the CHAI board and member organizations. This he
said ,was implemented by holding many dissemination workshops ,where CHC took an active part.
Fr. John explained that one of his memorable achievements prior to leaving CHAI was that ,he
was able to convince the association to change the name from Catholic Hospital Associations of
India to Catholic Health Association of India .despite stiff opposition and resistance. Fr. ended on
the note that the CHAI is strongly advocating herbal and home remedies and was very happy to
share that three member institutions were totally managing on ayurveda and alternative medicine
therapies.
J
Ravi’s Sociological Comment: In the CHAI circles, previously big hospitals like St.Martha’s, Holy
Cross etc were known as son-in laws and the smaller community based centers were the daughter
in- laws. With the change in name from Hospital to Health, the bigger establishments felt the roles
were reversed.
S.J. Chander calls himself a product of CHC and is very privileged to be part of an organization
like this .His journey started when Ravi took him into CHC after completion of a diploma in
Community Health. He fondly remembered the good old days when CHC was a smaller intimate
group. It was Ravi , who felt that he should build up his cadre as a resource person and encouraged
him to work and study with rural, urban poor and tribal communities. He praised the organization
for allowing research, training and working togo hand in hand. His experience of working with an
eminent personality like Dr. Shiradi who was a great motivational speaker is also worth
mentioning. He has since then worked with various organization, namely APD-(Association of
People with Disabilities),was and continues to be a part of the PHM movement and mentioned that
he was currently involved with the Anti-Tobacco Campaign. Chander explained that he chose to
join Institute of Public Health,Bangalore in June 2007 to work and experience a different ideologythat of engaging with the state to bring about change.
He concluded his reflection by stating that he has never felt he was not a part of CHC and it was
:the alternate health paradigm that inspired him to work in community health with a different
approach.
Dr. Ravi Narayan saga with CHC was an intertwined personal and personal journey and it would be
difficult to separate the two. He belong to a refugee family who settled down in Delhi after the
partition and came down to St.Johns to do his medicine. .The East-Pakistan partition was a life
altering experience, recalled Dr.Ravi.lt was here that he realized that he knew very little about
medicine and also that people when left to their own devices knew about survival and how to
survive ,it was in fact the educated classes who had to learn from them. This experience changed
his outlook and disillusioned him about hospital medicine.
After his return to Bangalore, he worked with a Corporation hospital in an urban slum area and
developed an interest in Public Health. After his post-graduation in Community Medicine from
AIIMS, Delhi, Dr. Ravi joined St. Johns and was associated in various projects like setting up the
Malur Cooperative and designing the Community Health Worker’s Training mainly for non-doctors
in rural areas .He described how Anant Phadke was instrumental in introducing Social Analysis
into mainstream and how he paved the way for the formation of a “though current” called Medico
Fiiends Circle. Towards the late 70’s ,early 80’s ,he said that there were many community health
professionals who all felt that they lacked a place in India where they could all get-together and
discuss common issues and problems. It was suggested that a centre of Community Health Practice
be set-up. It could be a community of Community health initiatives within a larger political and
social context. The whole thing started out as a meeting place. The idea of CHC as a society of
professionals thus evolved. CHC thus started as a coffee club culture, listening to the stories of
piofessionals
realities, praxis of experiences.
Dr. Ravi stated that his two big milestones for 2008 has been
1. The launching and functioning of the WHO commission on social determinants
2. The fact that WHO has recognized the importance of Primary Health Care .
Dr. Ravi expressed his keenness in noting that civil society movements were collective voices.
Dr. Aziz briefed the workshop attendees about the impact of globalization on health. He started the
discussion with the definitions of liberalization, privatization and globalization. He explained how
the economic crisis in the 90’s lead to inflation and budget deficits and why India was forced to
borrow petro- dollars from institutions like World Bank and IMF who laid down stringent
conditions- called SAP(Structural Adjustment Policies) for the purpose of debt recovery .One of the
clauses that were enforced were reduced spending on social sectors like health. India had until this
point adopted the NEHRUVIAN GROWTH MODEL which consisted of reforms like
1. Public sector participation
2. Protection of domestic industry against foreign players
3. Tarrif imposition on imported goods.
The borrowing from these international bodies induced us to switch from the Nehruvian model to
LPG (liberalization , privatization and globalization ) model. This in turn led to an market scenario
which lead to an exploitation of people. Many domestic industries became vulnerable when the
markets were flooded with foreign goods which were cheaper and the cut on social budgets affected
the common masses. All these newly introduced measures only benefited the rich who became even
wealthier. Though it cannot be denied that we have been achieving growth ,the benefits do not
seem to be reaching the poorer sections and our poverty levels is currently 29% and in 1989,prior to
the liberalization reforms ,poverty stood at 28%.So we need to ask ourselves if opening up our
economy has changed the scenario
Health in the context of identity politics
Jenifer Liang works with the ANT(Action North Eastern Trust), Bongaingaon, Assam. Her
presentation centered around health in an insurgency affected area in North -Eastern India. She
started her discussion giving a brief description of the seven states in the north-eastern parts of the
country. The chronic insurgency has been that of the Nagas.
In lower Assam where Jenifer works was an area affected by the Bodo ( a small tribal community)
struggle , fraught with tension and this has led to a complete breakdown of the healthcare system.
The persistent health problems in this area include loss of life- both civilians and security
personnel. Additionally, because of the high level of militarization, widespread psychosis is also
seen. Local medical institutes are often shut due to threats of extortion and kidnapping. Many staff
members often use insurgency as an excuse not to report to work, hence absenteeism is also very
common.
High levels of corruption, HIV and drug trafficking are rampant in this area. Unemployment has
caused a mass exodus of young people. Under such extreme conditions, they also indulge in risk
taking behaviors very quickly. Women are often targets of violence.The militant groups are often
against health programs like pulse polio, family planning. There are also around one lakh IDPsInternally Displaced persons as a result of the Bodo-Sandli conflict.these persons are still waiting to
be rehabilitated and have very minimal access to healthcare.
To sum up the matter, the whole situation is politically very sensitive, the social system has become
very lopsided. It has been observed that the majority groups manage to retain a stronghold and the
minorities get isolated. Hence, an overall reluctance to share ideas and thoughts is seen. No new
community models have evolved over the past few years and fighting for health as a right is very
complicated and multi-dimensional issue.
Manjusha, an ex-fellow is an MSW graduate from Maharashtra. She described her experiences of
working in integrated rural and health development programs in drought prone areas of
Maharashtra. She discussed the context of gender and caste politics in the context of health. It was
initially very difficult to make inroads into many of the rural communities who were caught up in
poverty, illiteracy , gender imbalance and many other social issues. When the team first started
working on watershed development, they had to work by the government rules which insisted that
all developmental work would have to incorporate community participation. This idea was not
initially well accepted by the people.
Manjusha’s role was basically to work on community participation, organization and women
empowerment. She recalled how she used to spend hours in various households discussing various
issues and trying to secure their cooperation in the projects, but tangible outcomes were never seen.
But the overall experience opened Manjusha’s eyes to the extent of caste divide in the villages and
how it remained a barrier to development and progress. Over a period of time, she was able to
organize the women in self -help groups and the men into farmers groups. The villagers were
attracted to the groups once they understood its money-making potential for e. g. in the first few
years, men from the upper castes would not allow their women to get involved in the SHG’s which
they thought purely belonged to the lower castes, but the financial gains eventually prompted them
to push their women into form groups as well. These groups eventually became information
dissemination sessions where issues like governance, panchayati raj, women’s rights, health and
social matters were discussed. Many men and elders in the community started feeling threatened
when the women started questioning them.
Manjusha quipped how she had received many death threats, but decided she would stick on to her
job since she believed strongly in her principles. Though she does not remain associated with that
project any longer, she is still in touch with the villagers and was very happy to know that the
community participation rates have increased and ended her presentation with how the villagers had
united to make their local PHC more accountable and how they have managed to transform the
same centre into a rural hospital.
I
Maheshwari is associated with RUSAC , Tamil Nadu narrated her experiences of being a “insider”
of the “Dalit Women’s Movement”. RUSAC works on the principle that self-reliance is the first
step to self-empowerment, that equality needs to be established and caste system should be
abolished. Maheshwari pointed out that some of the major issues that dalit women like her faced
were-male domination, sexual violence, domestic abuse and Sexually Transmitted Infections
(STI’s).Many times ,women like her were afraid to come out in the open about their problems
fearing that there would be backlashes and that they would be branded as immoral women. She
gave a few examples of how doctors and other personnel in medical centers took advantage of the
fact that women were uneducated and ignorant. There have been cases where the doctors have not
even bothered to inform the patients that they have inserted a Copper T for contraception purposes
and the women have found out about it only when complications and infections arose. The doctors
do not communicate and explain the consequences of tests and treatments. Since the women have
no knowledge on these subjects,they have to completely rely on the doctors and have blind faith in
them.She is a strong advocate of counseling centres in PHC where family planning counseling
services would be offered and stressed on the importance of informed consent.
Society in her opinion has very strong discrimination rules about men and women.Men could
choose to be unfaithful and even remarry but women had to remain calm and accept things as they
were. Women are never party to the decisions on how many children they should bear .It is the
men who make such decisions. All the women know is that they need to cooperate with their
decisions. Being a dalit itself has many implications according to her, they were subject to more
injustice and unfairness. Even with the advent of education, the situation has not changed too much.
The Dalit women are not aware of their rights and entitlements and hence are more vulnerable to
exploitation
The struggle against inequality and assertion to rights of human dignity is a long drawn and
difficult struggle. She ended her presentation by giving an outline how RUSEC functioned as an
organization to empower Dalit women both on the health and social front.
Sathyashree is associated with SANGAMA, a Bangalore based organization which works for the
rights of sexual minorities. She began her presentation by defining who sexual minorities were. She
also gave us a bit of the historical basis on the IPC 377 which states that homosexuality is unnatural
and punishable under the law. The British and Dutch colonists had passed this law to oust the hijra
communities who were controlling the land-holdings in the Mughal empire. Criminalising them
would eliminate them and enable the colonists to gain access to the empire. Incidentally, today
these very countries have repealed the law, whereas India is still on preliminary discussions.
It was during her fellowship with CHC, Sathyashree got an opportunity to delve into some a lot of
issues and problems surrounding this group of people .In India, there is a lot of stigma associated
with Homosexuality. Lesbian suicides are very common in India, Men who feel out of place with
their bodies join the hijra communities. When men become effeminate, they are denied healthcare.
With lesbians, the doctors typically get into a preachy mode. Because of the stigma attached, the
incidence of HIV/AIDS and STI’s are very high amongst these groups .
Sathyashree stated a few statistics about the situation in Bangalore. The prevelance of HIV/AIDS
status among the Hijras in the city is around 25-28%.There are around 27 Hamams (bath-houses) in
Bangalore city . There are high rates of anal sex in these places , no condoms are used and when
anal rupture happens, they do not avail any medical help as well. Very often even though it is very
easy to track transsexual men, getting across to their clients is really not very easy, hence it is very
difficult to contain the spread of infections.
Sathyashree concluded her presentation by saying that many times homosexuals are asked why
they are unable to change and the majority(heterosexuals) who think they are normal point their
fingers at them, but the situation is indeed sad.
Question and Answer session:
QI.In Tamil Nadu,the prevelance of dowry was very high in the 60’s.What is the current
situation?Question directed to Maheshwari
Ans.The situation has worsened. Even with an increase in the literacy levels, we have not’been able
to wipe out this evil .A standard of 20-30 sovereigns of gold are typically given to the boys family.
Cases of dowry harassment and deaths have only gone up.
Q2.How does one work to build on cultural identity in a positive manner?(Directed to Jenifer and
Sathyashree
Ans. 1. Trying to create spaces to discuss neutral issue or national celebrations. A common
platform to discuss matter would be a start.
2. Working with young people
3. Ensuring minority groups like transgenders are all united while demanding for their rights.
Q3. How to discuss the issue of dominant ideology in relation to cultural diversity in the situation
of inequality?
Ans.We need to try and again find common platform to discuss matters .We need to respect the
choice both individuals and groups. And, we need to find a way of celebrating diversity without
resorting to violence.
Q4.What is the Dalit situation in the North-East?
Ans. Caste is not so much an issue as much the ethnicity. It is mostly inter-tribal issues there.
Q5.How does one work on intergrating the Hijra community and the general community?
Ans. Community programs are needed to educate everyone. It is heartening to note how they were
now involved in some govt processes as well. But it is very difficult and will take a very long time
to overcome the social paradigm.
DECEMBER 6"1
The Silver Jubilee Cultural Celebrations were held in the Bangalore Medical College Auditorium.
The cultural celebrations were a melting pot of dances,songs and skits by various cultural groups
from Karnataka and Tamil Nadu.The CHC team also felicitated all their associates and partners
who had stood by them over the years.The Centre for Public Health and Equity(CPHE) a new
functional unit of CHC was also formally launched.The last segment of the cultural programs was a
series of short films by renowned documentary film makers followed by a panel discussion.
REPORT ON POSTER EXHIBITION
As a part of the Silver Jubilee celebrations ,the Community Health Cell held a day long celebratory
event on the 6th December 2008 at the Sri Rajendra Prasad Auditorium,Bangalore Medical
College. The organizing committee was keen to celebrate the keen with the participation of
associates,dignitaries and the communities .As a part of the day long event,CHC also hosted a
poster exhibition at the venue.
The objectives were :
1. To showcase the prolific collections of poster materials collected by CHC over the years.
2. To display posters on social,economic and political factors and its relevance to health
3. To utilize the poster resources as a means to demystify health as a concept
4. To convey how the various linkages could be used in civil society movements to assert that
Health is a Right for all
The CHC team chose 20 themes and selected around 6 posters per theme. The posters were chosen
such that they were simple,self-explanatory , contained more visual images than written content and
yet conveyed the message they was meant to . The selections were displayed all around the
auditorium and hence made it easy for the attendees to walk around and browse through the
posters.
The themes were:
1. Violence Against Women
2. Disability
3. Human Rights
4. Consumer Rights
5. Genetically Modified (GM) Foods
6. Mental health
7. Drug Policy in India
8.Smoking and Tobacco Use
9. Globalization
10. Environmental Health
11. National Rural Health Mission
12. Matemal and Child Health
13. Corruption and Brain Drain in the Indian Healthcare System
14. Nuclear Race in India
15. Nature's Fury-Disastrous effects of natural calamities
16. Community Health
17.Occupational Health
18. Bhopal Gas Tragedy
19. People's Health Movement(PHM)
20. Jan Swasthya Abhiyan (ISA) and Jana Aarogya Aandolana, Karnataka(JAAK)
The feedbacks received indicated the exhibition was well received and appreciated. Many attendees
remarked that they were not even aware posters on some very important topics existed. The
positive feedback has been very encouraging for the CHC team and we hope we can avail more
opportunities to hold similar exhibitions whenever possible.
HEALTH AWARENESS CAMP at FIREWORKS COLONY
Venue: Mythri Sadan,Firworks Colony
Date: 19/2/2009
The Christ University ,Bangalore has a social work department .Two undergraduate students from
the department approached CHC for some guidance and help in conducting a health awareness
camp in one of the slums where they were doing a field posting under the guidance of a NGO
called Mythri Sarva Seva Sadan. They wanted some help from us with a poster exhibition and also
wanted someone to come and give a talk to the slum dewellers on heath. Aditya ,a co-intern and
myself volunteered to help out the students for the event.
MYTHRI - Mythri Sarva Seva Samithi, Bangalore (1987) is a registered, nonprofit organization
involved with urban poor and waste related environmental issues. It works with waste picking
groups and has specialized in urban poverty alleviation and integrated sustainable waste
management. Mythri has nearly two decades of experience in pioneering number of innovative
initiatives locally and nationally and is a well-known leader in the subcontinent on the subject.
Health and hygiene education, ecological sanitation, neighborhood cleanliness through community
participation, decentralized approach to waste management with the integration of waste pickers,
small enterprise development and development of low income communities are some of the
milestones Mythri has achieved as a part of its intervention. Other areas of Mythri’s activities are
schooling for vagrant children, medical care and skill training for street children, housing,
sanitation; self help group promotion, micro credit programme for the poor, networking and child
rights activism.
Mythri has been involved with WASTE for the past 9 years in promoting Integrated Sustainable
Waste Management (ISWM) and currently functioning as partner in Integrated Sustainable Support
of Urban Environment (ISSUE).
The students showed us around the slum area .There were around 300 residents in the area and mot
of then were rag-pickers. One major self-sustaining projects in the slum is a Community toilet and
bath facility maintained and run by the residents themselves. The residents pay Rs 1 ever time they
use the facility and have employed 7 workers from within the slum itself to ensure that hygiene is
maintained. The monthly collection is upto Rs 12,000 which goes towards the salaries of the
employees and other expenses.
The exhibition and talk were attended by young women and children from the slum. Aditya gave a
small talk in Kannada on health as a responsibility and how mental and physical health co-existed.
This was followed by a small medical camp where the mother discussed some common ailments
affecting them and children.
BASIC NEEDS seminar on sharing of Change Experiences of Persons with Mental Illness
and their caregivers
Date:8/11/2008
Venue: Vidyadeep College, Bangalore
Mental illness is a problem that is often ignored and this is especially the case in the poorest
countries in the world. With complete lack of locally available, free mental health care, many of the
poor, mentally ill people stand little hope of recovery.
World Mental Health day falls on 10th of October every year. In this connection, Basic Needs India
(BNI) organized a half-day session on change experiences of persons with mental illness (PWMI)
and their caregivers on 8th November 2008, at the Vidya Deep College, Ulsoor Road,
Bangalore.Since 2004, the organization has been addressing the mental health issues among the
urban poor in Bangalore city, in partnership with three partner NGOs, namely Association of
People with disability (APD), Association for Promoting Social Action (APSA) and Paraspara
Trust.
Based on several consultations with persons with mental illness and their care givers and feedback
from field staff,Basic Needs was convinced that a more holistic approach was require to deal with
mental health in the urban scenario.In 2007,they initiated a pilot project to offer nonpharmacological treatment (Psychotherapy) to selected PWMI and their caregivers. The approach
involved the coordination with the three NGO partners were in touch with the community and their
needs, their field workers received training from the specialists in Psychotherapy from Athma
Shakthi Vidyalaya. The funding came from well-wishers in Philips Medical Systems, a corporate
firm based in Bangalore.
REPORT:
The programme started with a self-introduction by each of the persons assembled, which included
the PWMIs from the urban project and their families, students and staff of a various of educational
institutions in Bangalore,staff from the partner organizations and representatives of the Philips
Medical Systems.
Mr. Naidu, the General Secretary of the Trust spoke about the vision of the programme, stressing
that the approach had to be inclusive and address the causative factors for mental illness and not
just the symptoms. Training in coping skills was necessary both the PWMI, as well as their primary
caregivers. This was followed by a brief talk by Dr. Mani, Director of BNI, in which he spoke on:
What are the needs of the PWMI,; how does the Public Health system respond to their needs, and f
what is the role of non-drug therapies in treatment of mental illness. He also pointed out that the
drug-based medical therapy worked also tends to cause dependency. The medical system also
does little for the caregivers and the family. This was followed by a talk by Fr. Hank Nunn, who
heads the Athma Shakthi Vidyalaya. Who pinted out that core to anyone’s recovery is that they
develop self -confidence and power of their spirit,Hence Atma Shakti.This he felt could be
supplemented by medicines to aid recovery.
All the attendees were then divided into three groups, one for each partner, in which experiences
were shared by one person with mental illness , caregiver and social worker. In some cases the field
workers also shared their experiences. As one of the outcomes of this community outreach it was
being discussed whether the caregivers could be used as community-level barefoot mental health
counselors. The social workers explained how working in mental health had been a huge step for
them as well.The difficulties in even approaching and building a rapport with mentally ill persons
and families is not an easy task,especially when most of them already lived in difficult
circumstances in slums .Persistent efforts and sustained motivation in the form of regular home
visits is almost a daily feature in their schedules.But,it was certainly an achievement worth
celebrating when patients slowly start recovering and started coming back to a normal life.They
also listed issues within the health system-shortage of essential psychiatric drugs and mental health
personnel.
The seminar ended with an open session, questions were invited from the participants.
IMPRESSIONS and LEARNINGS:
Personally for me,the whole session was extremely moving. The Mentally ill-community has been
neglected by us-society, policy makers and even the medical fraternity. The incorrect images and
incomplete understanding of the spectrum of diseases has made the community even more
vulnerable .Our medical education system has also failed to understand and incorporate the
Psychiatric needs of our country. In such a scenario, the importance of sensitizing general
practitioners on appropriate and timely diagnosis cannot be over-emphasized.
The seminar also opened by eyes to the “unmet needs” of the care-givers who were themselves in
need of support and help. Care-givers and family members are valuable resource persons from
whom we can learn lessons to create community awareness and help to fight stigma.Aftr listening
to various care-givers,I noted the following:
1. Mental strain and exhaustion :Faced with looking after a mentally ill person who needs to be
monitored throughout adds extra pressure on the care-giver to remain vigilant to the patients needs
and demands.In the long term,they too face depression and feel an overwhelming sense of
hopelessness’ ^specially if the recovery is not hopeful. Spouse care givers often face the double
burden of managing the household and looking after the patient. Parent care-givers live in a
perpetual state of worry about who will look after their mentally ill child after their demise
2.Financial liabilities and livelihood issues: The long drawn treatment of mentally ill persons take a
toll on family finances and many times they also have to quit their jobs to remain at home and take
care of their mentally ill family member.This adds to the financial distress.
3.Stigma: Society generally tends to discriminate against both the affected person and their family
members and do not prefer to associate with them.Affected families are generally looked down
upon and this too adds to a form of social stress and isolation.
4. Lack of awareness :Mental health has been under a shroud for a very long time doe to the
negative branding by our society.Like many other issues in our country, people to do not come out
openly to discuss the problems they face. Due to ignorance and lack o avenues to gain the right
information ,family members do not even know that many mental conditions are treatable, leading
to a delay in treatment administration. They are also not aware of the various government schemes
that the disabled persons could avail of.
5.Absence of a community support system:The stigma widens the gap between the families and the
outside world.In a highly prejudiced society,t he lack of community support and empathy hinders
the rehabilitation process.
2.Field Visit with BASIC NEED and APD(Association of People with Disability)
Location,: Chamraj pet,B angalore
Basic Needs and APD partner to provide mental health facilities in parts of Urban Bangalore. I
visited the APD field office with a Basic Needs staffer Muniraju and a Mental Health researcher
from Canada named Farah. The objective of this field visit was to gain a snapshot of how an Urban
mental health programme functioned.
The APD field office primarily served as a reporting station for 5-6 field staff who were mainly
involved in identification of persons with mental illness, awareness building and follow-up.
Additionally the office also has a physiotherapy and rehabilitation section, a counseling centre and
houses a small special needs educational unit as well. This unit designs both vocational and
cognitive development based education for both adults and children with disabilities. Counselling
sessions are held twice a week for both disabled persons and care-givers. The staff are also trained
to refer the clients to appropriate centres for further treatment and care. After a brief round of
introductions to the centre’s staff members and a small tour of the facilities,we were taken for two
home visits.
The clients in both the homes with persons with mental illness and were not financially well off.
HOME VISIT 1:A 19 year old girl who was diagnosed with hyperactivity, attention defecit
disorder, epilepsy and behavioral problems from the age of 5.The family of 5 lived in a tiny
cramped room.For many years ,the family fearing stigma and discrimination never revealed it or
discussed it with anyone. But as the client grew older, her tantrums , outburst and convulsions
become worse and increased in frequency.She repeatedly ran away from her house and hid in some
relatives or neighbours house till the family came searching for her, she refused to return home
many times .They took her to a local doctor who prescribed some medication,but she was not very
compliant with the regime.APD identified the case last year and have been working with her and
the family since then.Many follow up visits were required to convince the family to take the girl to
see a psychiatrist again. With consistent follow up and counseling ,she has become much more
cooperative ,takes her medicines regularly and there is a substantial improvement in her
disposition.The convulsions have almost disappeared but does become hyperactive on occasions.
The mother is the main care-giver .She appeared to be highly stressed and expressed to us that she
was feeling hopeless about the girls case. She told us that she was previously working as a domestic
helper, but was forced to quit the job because of her daughter’s condition. Her husband is a chronic
alcoholic and did not contribute much to the family income. In this scenario,they were in perpetual
debt. Two of the elder children were girls who were married and could not help the family
financially.And the boy was much younger to the client. To us it appeared that the household had
actually 3 persons with mental health problems-The girl herself, the father with his alcohol
addiction problem and the mother in a state of depression but who was not even aware that she was
suffering with a condition with the crumbling state of affairs around her. Though the girl’s
condition had improved,the mother was still not confident to leave her alone.As she got better,
APD found an employment with a neighbourhood screen printing press.She had grasped the job
and was gaining confidence,but unfortunately, the employer had to downsize his unit because of a
drop in business.APD was now trying to place her elsewhere or train her in some home based
livelihood activity.
HOME VISIT 2:A 25 year old man was diagnosed with psychosis, hyperactivity and loss of
memory since the age of 2O.He is the youngest of 5 children and had a very normal childhood and
adolescence. After junior college, he was working along with his brother as a graphic designer in a
family owned set-up. The family recollected how active and helpful he was prior to his illness. Five
years ago, he came home one night and said that a bird him on his head,he went to sleep and after
he got up, he was never the old person they knew. He could not recognize any family member and
also started behaving in a strange manner.He refused to eat food or take a bath and kept pacing up
and down the house the whole day.Gradually,he started confining himself only to the house and
refused to even step out.The family feels that the illness could be a combination of
1 .Dejection in a love -affair,where the family did not approve the girl of his choice
'2.Financial liabilities in business
3.Black magic by some enemies
They have since the onset of illness been very regular in taking him to NIMHANS ,Bangalore.The
pharmacological therapy did help in calming doen his restlessness to a certain extent,but the other
symptoms still persisted. On a couple of occasions, he even left home and was found by the Police
in the outskirts of Bangalore. They family has now started taking him to a “Dargah”-(a Muslim
religious place where prayers are offered at a saints tomb) once a month and feel that he has
certainly improved a bit, he has started bathing and dressing himself and also has an appetite, but
his psychosis and non-recognition of family members still exists.
VOCATIONAL TRAINING CENTRE, Magadi Road: APD also runs a vocational training centre
where 10-12 persons with different mental illnesses and a case of mental retardation are.The centre
is a two room structure located in a public park on the Magadi Road ..APD secured Bangalore
Municipal Corporations(BBMP) permission for the purpose of converting it into a centre which
would cater to the needs of disabled persons .
The group is involved in assembling of some small electronic devices for a ship repair
company.The goal of such a vocational centre is to provide a therapeutic employment and
also as a means of earning their livelihoods.”Ail therapy” is also offered in the centre twice a week.
A social worker was in-charge of the centre and maintained the quality control of the devices and
ensured that they take their food and medication on time.
IMPRESSIONS and LEARNINGS:
Both the home visits were eye openers on how an entire families could be devastated both
emotionally and financially when they have a mentally ill person in their house.The stigma and fear
of society’s reactions did force them to not think of treatment as a possibility.The care-givers in
both houses were also drained to a big extent,but kept their morale going.Both these cases were
examples of how non-institutional rehabilitation approach could be used more often.I refrain from
saying Community based rehabilitation as I was not convinced or did not see any support from the
external community to the special needs of these members,both these were vases of family
supported rehabilitation. None of the families thought access to doctors or medicines were an
issue. I felt this could have partly been because they were based in an urban location and had a
well known establishment like NIMHANS.Also ,once they came under Basic Needs and APDs
scanner ,they were regularly visited and monitered
Persistent follow up sessions are required to track any changes in these individuals,which APD has
been successfully doing under the guidance of Basic Needs.I also appreciated the fact that the
rehabilitation model focused on the sustainable livelihood module as a form of rehabilitation .
UNDERSTANDING INTEGRATED DEVELOPMENT
1. Tribal health Initiative, Sittlingi Tamil Nadu
The Tribal health Initiative is a non for profit organisation in Sittilingi valley, Dharmapuri District
of Tamil Nadu. It was founded by a doctor couple Drs Lalita and Regi in the late 90’s.
Gi and Tha ,as they are fondly known here in Sittlingi finished their post graduation medical
education and were working in Gandhigram Hospital in Tamil Nadu.Within a few years ,they felt
that the hospital was slowly digressing from the original values on which it was founded . On their
personal agenda, community health was a priority as opposed to merely treating diseases.They felt
the urgent need to move out of an institutional set-up and work amongst the people.After visiting
many projects and scouting locations and studying their conditions,they finalized on Sitttlingi in
Tamil Nadu for two reasons
1. This tribal belt was an interior location with very less access to medical facilties.The closest
hospital was at Harur around 50 kms away
2. The location in South India was preferable, as the couple were more comfortable and familiar
with the culture and language.
3. The area had abysmal maternal and infant mortality rates which they felt could be considerably
reduced
The Sittilingi valley and the surrounding Kalvarayan and Sitteri Hills, are inhabited primarily by
tribals known "Malayalis" or "Hill People" ,Their main sorce of sustenance was and remains
agriculture.
Their first set-up was in a thatched hut which served as both an Out -patient clinic and a basic
operation theatre.From such humble beginnings in 1993 , the initiative has become a 30 bedded
hospital.lt has an emergency room, diagnostic laborotary,a neonatal unit.lt is also a govt recognise
ICTC and DOTS ccentre a(Govt sponsored).Along the way ,Gi and Tha got into an integrated
development mode of working.This they say was not intentional or planned at their end.They got
into various other projects and initiatives as and when the needs of the people arose and priorities
had to be attended to.
The Trust has been supported by various funding agencies at different point in time.But the major
benefactor is a group called “Friends of Sittlingi” who not just help the initiative monetarily,but
also contribute and assist in developing and planning strategies ahead.
HEALTH INITIATIVE:
a)Hospital:The hospital is now a thirty bedded unit with two wards and has surgical, medical and
obstetric patients. There are two operating theatre with appropriate sterilisation and anaesthetic
facilities., The hospital also has an electrocardiogram ,defibrillator ,ultrasound scan machine and an
incubator. Separate buildings house the out-patient pharmacy,X-ray units and laborotary and
hospital office.The hospital is also a govet recognized ICTC and DOTS centre.The campus tries
and meets more of its energy needs from solar power.They also have a unique biogas machine
where placenta is the raw material.The Pannacy is equipped with almost all essential allopathic
medicines and also have a few ayurvedic preparations as well.Most of the medicines are procured
from LOCOST-a Vadodara based NGO ,that manufactures quality drugs at reasonable costs.
b) Health Workers:Gi and Tha felt it was essential to develop a cadre of workers equivalent to
nurses.They trained the first batch of tribal girls in 1996 .These women They are able to diagnose
and treat common problems, assist in the operating theatre, care for inpatients , go out to the
villages for antenatal and child health checks and even give spinal anaesthesis!!.It is now evolved
into a non -formal two year program ,where young girls who have passed SSLC are inducted into
not just health care,but general community issues as well .After their training the women are
employed in the hospital
c) Health Auxiliaries are a second group of slightly more older women are chosen by their
communities. They basically live in the villages from all parts of the valley and the hills as well.
They come to Sittilingi once a month for reporting and training. They offer advice on good
nutrition, hygiene, birthing practices and simple ailments. They host the field clinics for pregnant
mothers and children. Tha explained to the CHC interns how she struggled with training of the first
batch.Many of these women were simple and illiterate as well.It was not easy for them to easily
accept and understand the seriousness of the work they were doing.But persistent efforts and
constant encouragement helped these women bloom into confident workers who now act as a link
between the communities and the hospital. They have mapped every village, filed every family's
profile, and recorded every individual's health status. Mothers are being made aware of feeding and
basic health and hygiene advice imparted has also improved the survival prospects for pre-term and
low birth weight babies and also anaemic and malnourished mothers
AGRICULTURE INITIATIVE:
In 2004,Gi and Tha undertook a padayatra and visted a lot of villages in the valleys and
suiTounding hills.They spent many days among the villagers ,talking to them and getting a pulse of
the main problems that they were facing.Once recurrent issue was that of livelihoods. The tribals
have always been dependent on farming and forest products. They were used to growing various
varieties suited to their local environment. But, this tradition has been displaced by the pressures o
to grow cash crops. Most of these water and chemical intensive as well eventually leading to
vicious debt cycle.Realising the seriousness of the matter, they organized workshops on organic
farming techniques and also took the farmers to various other organization and initiatives to
demonstrate that these eco-friendly methods were practical .A sizeable number of convinced
farmers have now growing cotton, turmeric, pulses and rice organically. They are also being
encouraged to try intercropping and cultivate ragi which is far more nutritious than other cereals
.We interacted with a few farmers who told us that they were initially apprehensive and thought
that shifting to organic methods was a huge risk .They had observed a decrease in productivity in
the first year, but by the second year,it was comparable to previous time.Some of the farmers also
confessed that organic farming was not actually a new practice and was extensively practiced by
their ancestors, but some where along the way,the knowledge and traditions had been lost. The
organic cotton growers have found a buyer in the state Co-optex ,who have using them to
manufacture Organic shirts .
Various women self-help groups have been formed to process and powder the pulses, spices
market them. The products made under the name of Svad are available in select stores across India.
Tha mentioned that storing and preserving the harvested crops was very difficult as they did not
want to depend on the usual chemical preservative methods .This meant that all the produce had
very limited shelf lives.lt was also difficult to control the pest infestations.
She was also of the opinion that these products could be locally marketed instead of making it an
exclusively to meet urban needs.She is also concurrently working with an SHG to understand the
feasibility of manufacturing Ragi biscuits -(all the raw materials like milk,ragi and honey from
Sittlingi itself and for the people of Sittilingi .This she was a local alternative to MNC biscuits and
other confectionary products which were not nutritionally very rich and expensive as well.
Education Initiative:
Anu and Krishna are both architects and have worked for a long time in constructing houses in rural
areas. They have been working with different NGOs, in Gandhigram near Madurai and Gudalur on
sustainable and eco-friendly housing construction using local materials. They were keen to see that
the tribal communities they worked with would eventually become self-reliant and confident in
handling their own construction. In course of time ,they started working with children who had
dropped out of school and later, also spent time teaching younger children. The couple have also
been friends with Gi and Tha for a long time. After a year of travel to various alternative education
efforts in India, they moved to Sittilingi in 2003 and Thulir was started.
This initiative caters to two categories of students
1 .School going students from Sittilingi and nearby villages:Thulir plays the role of an after school
program for these childen.They get additional tutoring for difficult subjects at school and also get
involved with art & craft workshops over the weekend.
2.High school drop-outs :Teenage boys and girls who may have discontinued their education for
various reasons are impartment both academic and livelihood skills training like bee keeping,
bamboo crafts, masonry, electrical wiring, plumbing, basic electronics, organic farming.
Anu and Krishna also take up and discuss various global and social issues to expose the children to
what is happening out in the bigger world, thus forcing them to think out of their routine lives.
They also use the environment as a focal point in learning various subjects and skills
The campus is quite unique in that it has a lot of open space for children to run and play.The little
huts where they children huddle around to study are all made of mud walls and thatch roof. The
school has an office,library,multipurpose room and shed for arts and crafts and livelihood
trainings.lt is powered by solar energy and only has dry composting toilets
CRAFT INITIATIVE:
One village in the valley has people of Lambadi origin(India’s gypsy community).The local
Lambadi tribe migrated from Noth India many hundred years ago and have their own distinctive
dialect, costume and traditions. Their tradition of embroidery is very unique and almost been
forgotten after their integration into the community where they settled.The Initiative is an attempt
to revive this tradition and make it a source of livelihood for the women as well.Very few elderly
women still remember the techniques and are in the process of teaching the younger ones. This
tradition has now been revived by the Craft Initiative, with the older women teaching the younger
women. The craft line is called "Porgai" which in their dialect means "pride",.They are currently
working with a Bangalore based designer Smitha who is guiding them to make more consumer
oriented products and keep in mind their preferences.
THE ANT-Action North-Eastern Trust,Bongaingaon,Assam.
The ANT is a not for profit organisation based in Bongaingaon ,Assam.It was founded by Dr.Sunil
Kaul,an ex-army doctor and Jenifer Liang a social work graduate .The mission is to work towards
sustainable and holistic development of the rural poor mainly in the North -East. Their inspirationThe ant,which is a small,unassuming creature besides being ubiquitous, well- known for its hard
work, ceaseless activity, resourcefulness and its ability to work together in its community..They
have primarily been working with marginalised groups of the Bodo Community -A tribal group in
Assam. Admist the background of ethnic conflicts,ULFA terrorism and historical neglect of the
North-East by the Indian government,this project has been working with great determination and
grit to focus on development.
Both Sunil and Jenny came from the development sector and when they chose to work in the
Chirang district.They were clear that they had an integrated development approach in minds. Their
previous experiences had seasoned them to understand that a means of sustenance was what most
communities wanted. Money ,they realised played the role of a very strong determinant of health
and development.
The ant was started in October 2000. By March 2001, villages of Rowmary were chosen as the
stepping stone for future developmental activities. Currently their activities extend to other gram
pachayats Malepara, Birhangaon, Amguri , Koila Moila and Amteka on the Bhutan border .
Bongaigaon town was chosen as the base due to its proximity to the work area and to remain in
touch other agencies who could facilitate their work.Sunil recollects that it took them almost 6
months to gain an entry to the Communities.They initially just went cycling for kilometers at a
stretch to various village to gain an indepth understanding of the issues and problems that plagued
the villagers. They were finally introduced to the community by the Student’s Union who did not
feel that the couple or their work would be a threat to them.They initially helped the community to
organize Banana and mushroom cultivation as a viable means of livelihood. The project did not
become a huge success due to lack of a demand for the products,inability to harness processing and
storage facilities for such small units of products ,but nevertheless they had gained an entry to work
with the Bodos communities in the villages.
The ANT how works in around 90 villages on issues ranging from health,livelihood,gender
empowerment,agriculture and in the field of rights and entitlements.They also support and act as a
technical resource for other development focused NGO’s in the North-East. Additionally , they are
also involved in state and national level advocacy on various issues.The campus is located in
Udanshree Giri and houses a training centre for IDEA, accommodation for staff, weaving sheds and
a community kitchen and dining facilities. They have their own patches of organic farming and also
vermi-composting units.
HEALTH WORK:
a)Village Pharmacists- From conversations with Nandi- Village Pharmacist a.k.a. Milonee
The Village pharmacist programme was started in 2003 as a health outreach program for the far
flung areas. Women volunteers selected by the village are trained to handle about 30 medicines for
common ailments. Working as barefoot doctors and some as village pharmacists, they sell high
quality, low-cost generic medicines that benefit the poor, especially women and children who get to
access and afford essential and rational medical care at their doorsteps.These volunteers were
selected by a village managing committee and were trained by Sunil and Jenny through both theory
and field based practical work. The initial training was for seven days and followed up by monthly
trainings and meetings. Every year, around 15 new volunteers were inducted and there were four
groups in 4 years.
The training touched upon some aspects like
1 .Parts of the body,recognizing common diseases and treating them
2. In-depth training on malaria, typhoid, pneumonia, diarrhea and dysentery.
3. Health education topics for pregnant women,importance of pre-natal check up and how to use the
stethoscope to detect foetal movements.
4. Preperation of ORS
Over a period of time, when the Milonees felt confident about their knowledge, they were given
medicine boxes from the ANT office. These boxes typically contained antibiotics,
albendazole,asprinis,neomycin,malarial drugs,cough syrups,oral contraceptive pills and condoms.lt
also contained a stethoscope ,thermometer, delivery forceps and speculum. Along with the
medicines ,the Milonees were also given price-lists for the drugs within their kits.Some of them
went around in cycles to distribute the medicines, but Nandi typically stayed at home and dispensed
medicines whenever someone came to her. When the patients approached the, they knew how to
use a set of questions to arrive at the diagnosis. She typically saw aound 30-40 persons a month.
Most of them were for Malaria and commom cold and fever.Many women also came to her for
OCP .She has observed that condom acceptance was not very high in her village. She used to also
counsel them on natural family planning methods like the Calender Method and about tubectomy.
In addition to the medicine distribution, the milonees were also expected to keep records of all the
patient they saw in the month. The also had to collate the number of diarrhea cases, children and
lady patients they saw in a month. Initially, the concept of Milonees was very well received ,but
when a few cases were successfully treated, they gained more acceptance and demand for them
grew. Personally, for Nandi ,the program helped her understand more about diseases and also gain
a new degree of respect in her community. Her husband has also got high regard for her work and
helps her whenever he can. With a huge smile ,she also told me that now she has no apprehensions
or inhibitions in discussing or asking Sunil question related to reproductive health.
b) Community Laboratories:Conversations with Surjeet,Malaria is an endemic problem in this
belt.Very often ,late diagnosis proved to be fatal.Most villages so not have any diagnostic facilities
and by the time they reach one,it would be very lateTo address this problem,Suni designed the
concept of a Community Lab technician ,who would be trained and placed within the villages for
easy reach and quick diagnosis and confirmation of Malaria..
Surjit was selected by the All Bodo Students Union to undergo training under Sunil.
The mimimum criteria was 10th standard pass and an interest in this type of work.He
received some basic training in both theory and practical at Rowmari for one and a half months and
also went to the National Malaria Institute in Delhi for further training .In addition to this, every
month,the four laboratory technicians had to come back to the base office for follow training and
reporting statistics. The technicians were trained in the lab techniques of diagnosing malaria,
typhoid jaundice, diabetes and pregnancy.
ABSU helped him select and set up a shop within the Market place. ANT supplied him with the
microscope and the reagents and continues to do so .To supplement his income, He also set up a
stationary shop within the shop premises.Once the diagnosis is established ,the slides were also sent
back to Udanshree Dera for confirmation. .Till date, Surjit has had 1695 persons visit his lab.He
was kind enough to also show me one of his confirmed slides and explained to me how to identify
malaria under the microscope. Some of the challenges ,he faces are
1. The venture is not a profit making one and can be very seasonal sometimes
2. Though he is trained and has provisions for testing malaria, pregenancy, hemoglobin and
bilirubin, there are hardly any requests other than malaria
3. Many clients only came when the doctor asked for a lab report. People generally lacked the
confidence to self-diagnose even when they knew they had symptoms.
4. NRHM has ensured that the sub-centre close by is equipped with reasonable quality of
laboratory facilities
3.National Rural Health MissiomRole in Community Monitoring:Conversations with Jenny
ANT’s observations and experiences with Community Monitoring in Rowmari district
1 .The ASHAs who form a huge component of this program are not yet appointed in many places
2. The formation of Village health and Sanitation Committee has been delayed in many villages
3. The ASHAs who were already working need a lot of support from their peers and other CBOs
4. NGO may be successful in mobilizing people to demand for their health rights. But the system
has not responded as quickly as one would have desired
5 .Not all the District Program Managers are efficient and committed, hence the government system
in itself is fraught in bureaucracy and red-tapism, thus delaying the delivery of services.
6 .Lack of apathy from the officials’ side to respond to the publics demands and problems.
Some of the positive changes are
1. Availability of a doctor 24/7 at Subigar PHC,where previously none was available
2. Availability and reach of ambulance to remote area has improved
D) MENTAL HEALTH CAMPS: Conversation with Jenny
Like the rest of India, Assam too faces is a wide gap in the availability of mental health services
and what is actually required. The ANT team also had a personal experience when one of the staff
members had a manic attack and became violent. After medication was administered ,he clamed
down in some time and returned to normal.This first hand experience opened their minds to the
possibility of medicines to treat mental illnesses.
Recognizing the dire need to bridge the gap in Rowmari district, where not a single psychiatrist or
mental health personnel is available ,the ANT has partnered with an Ashadeep,a Guwahati based
NGO.
Monthly mental health camps have started from June 2007 .Till date the camp has received around
180 patients.Simultaneously, Ashadeep is also working with the ANT staff to train them in the
basics of mental health interventions.
Jenny, who is trained in psychiatry social work, is aware that the services need to expand into the
community and counseling services are an important component. But they are still in the process of
mobilizing resources to expand the program.
LIVELIHOOD ACTIVITIES:
1. Aagor Dafra Afad is a womens weavers collective formed in 2002 as a liveilihood initiative for
some of the poorest women from the Bodo community. The Bodos have a traditional design and
weaving style . Through Aagor, they have found a medium to showcase their skills as well. The
strength has around 300 full time weavers spread over 15 villages and enlists additional weavers
when there are big orders.This project was initiated within Ant ,but has now become a separate
trust since 2005 and it completely managed by a group of trustees chosen from among the weavers.
Though ,the group did face many hiccups when they started working on their own, they are
learning along the way and have managed to sustain the group so far.
Smitha, a Bangalore based designer worked with the Bodo women for a few years to understand
their systems and and to help them adapt their products in tune with current demand. She now
manages The ANT store in Bangalore and designs most of their items.
Aagor items are also sold at Fab India and various exhibitions throughout India
PRODUCTION:
The team design in Aagor is as below:
Managing Trustees
MaOager
Production coordinator
Hrdinator-3
Cluster Ci
Weavers(villa[je or organisation based)
Production process
The program when initiated in 2003 ,was intended for the poorest women in the village and the
same principle is even followed now. The Managing trustees identify needy persons as and when
required. Most of the weaving is for cotton fabrics-80% ,the rest of the 20% is in Eri silk.The yarn
is procured from Salem and Eri is a local product.All the women have the loom and weaving units
in their houses itself.The cluster coordinators hand over the designs and requirements to the
weavers and also coordinate with them for the delivery dates and perform quality checks as well.
Quality control is taken very seriously at Aagor and the weavers are penalized if their products
don’t meet the set standards. The average earning per member is usually around Rs. 2000 and they
are paid on basis of how many yards they have woven. The pricing for the final product is done by
the trustees based on the costs incurred. Average monthly production is around 500-600 metres.
Manish Verma, Aagor’s manager told me that they usually price it with a profit margin of 1520%.In addition to paying out the salaries, the weavers also get an end of the year bonus depending
on business performance. The collective is also in the process of setting up a corpus for emergency
use .They also intend to set up some scholarship schemes for the weavers children, health insurance
and disability benefits. The group’s learning curve has been very steep over the past few years.They
are slowly understanding how professional values are of paramount importance for the groups
success. Manish mentioned that he was a bit disappointed that the group had still not reached the
original target of proving employment to 500 weaver ,but agreed there has been improvements
albeit slow.
LAIMUN - Binding Unit:
The unit is basically a womens self-help group set up in 2002 .There was a consensus that the cut
pieces from woven materials could be put to use to generate some type of employment instead of
being wasted.two members of the group went to Delhi to get some initial training in design and
production. Now they have a full fleciged catalogue that includes diaries ,photo frames, file folders,
shoulder bags ,wall clocks and many more.
Their products are mostly sold at the ANT store and other craft e xhibitions.
In the early years ,the group used to rent out a room to work in.With their group savings, they have
now bought a piece of land and constructed a small unit.
Other Livelihoods:
The Livelihood group was started in 2003 .The team identify women and youth from financial
backward backgrounds and organize them into self-help groups. In addition,they try and place them
in some skills training program and alsofarovide small interest loans for small start up businesses
within the SHG. for e.g vegetable vending, shoe store, mobile repair storea, animal husbandarypigs,goats and poultry, sericulture.The loans are usually in the range of Rs. 5,000 to 20,000 and the
interest is 1% per month.
The livelihood group is also provides loans to purchase a Solar LED Units .Eletricfication in
Rowari and surrounding villages is still very less and hence the group though this environmentally
friendly device would be very welcome in the villages.The set consists of two lights and a mobile
charger ,but has not been a very successful program.
Some of the major achievements :
1. Increasing awareness of income generation in the villages
2. The accountability has improved
3. Various SHGs and individuals who have succeeded in their ventures stand testimony to the
success of the program.
The groups also faces many challenges like
1. Identification of suitable persons for the program:The program is meant for the poorest of the
pool but the group feels dissatisfied that they have not been able to reach out to much more.
2. Loan defaults are increasing because of the lack of an entrepreneurial attitude amongst the
defaultors, lack of motivation and personal circumstances .
WOMENS EMPOWERMENT:
Jagiuthi is an initiative that works on women’s empowerment by training and awareness
progiams.They also organize the women into Self help Groups
to promote economic
strengthening. A unique initiative of the program is the establishment of a Cycle Bank. This project
was proposed as another means to provide independence and empowerment to women by
providing them a means of easy transport .It aims reaching out to rural women who need to travel
very far to access medical facilities, sell their farm produce etc. The cycle bank provides cycles to
women on a loan till they are able to pay off their loan and own the cycle. The cycles will be rented
after a small down payment followed by easy monthly installments to cover the rest. They provide
cycle liding lessons to women who do not know to cycle .The groups is a very active and
enthusiastic bunch of women who have held many cycling training camps and cycle races to
encourage the members .
AGRICULTURE RESOURCE GROUP:
The ANT set up resource centres in Rowmari ,Mongolian and Koila Moila to provide technical
assistance to farmers on Organic Farming and also act as a platform for farmers groups to discuss
important issues like watei scarcity, electrification, finances etc .The main crops in this area are rice
and mustard as cash crop.
Each resource centre serves around 13-14 villages. They have around 25 members. In additions to
awareness building, the group also plans exposure visits to various University experimental projects
and demonstration farms to orient them to of practical issues in organic farming. The group has
also been popularizing SRI-Systemic rice intensification .
The farming in most of these areas are primarily rain-fed and hence the productivity is greatly
affected by the monsoons.The people are totally unaware of the water-harvestingThe resource
group provides information and expertise on this as well.They are also encouraging the farmers to
take up vermicomposting and are providing low interest loans of Rs 5,000 to set up the unit.The
group also sells organic fertilizers, seeds, tools and other implements to farmers.
I visted a demo farm with a group of farmers from another village.The 80x 40 plot was managed by
the resource group and had cauliflowers, potatoes, cucumbers and cabbage. The resource group
explained to us that prolonged use of pesticides and fertilizers had contributed to increase in soil
salinity thus decreasing its fertility. The productivity transition years from chemical intensive to
organic were likely to be much lesser compared to preceding years.But once the soil is “healed”,
the yields would improve .
IDP Camp, Deoshri
In 1996 and 1998,over 200,000 people were displaced following the two waves of Bodo-Santhali
ethnic violence. The Santhalis formed 80% of displaced groups while the rest were Bodos and a
few Nepalis and Rabhas. The government put the refugees in make-shift relief camps in Kokrajhar
and Dhubri districts. A small fraction of the displaced went back to their homes and villages ,but
most of the displaced have been living in sub-human conditions in these camps for over ten years.
The conditions in the camps are abysmal. Deosri and most areas where the camps are located in
Chirang District are reserved forest areas. The Assam government started the second phase of the
so called “rehabilitation” in 2004. Families have been given Rs. 10,000 as housing grant and
“released” which basically meant that theey were stopping relief rations and now the refugees had
fend for themselves. The actual scenario was that many were unable to even go back home and had
to restart life with money handed over.
The ANT established a cluster office in Deoshri in 2006 and have been working with these
displaced populations since then.The ANT team estimates that there are around 200-300 families
in the camps still waiting to be rehabilitated .The team based in the IDP conduct village profiling
exercises to gather information of the demographic characteristics. They have been attempting to
also coordinate activities similar to the Rowmari and other clusters in Chirang districts where they
work. Hence the cycle bank initiative, formation of self help groups and similar programs are being
attempted here as well .The ANT is also trying to incorporate a rights based approach in their
activities at Deoshri, sensitization activities on NREGSJCDS ,NRHM are also organized
Some of the major social and health issues in the camps include high levels of alcoholism, domestic
and sexual violence and unemployment. Many of the camp dewellers worked in Bhutan for daily
wages and were subject to exploitation.
I walked around the villages in the camp at Deoshri and met a few families. All of them had more
or less accepted that they would never return to their villages .They were in fact scared to do
so,fearing riots again. Unemployment was one of their biggest problems. The families also did not
spend the rehabilitation money in an effective and efficient manner Many had ended up in wasting
it rather than any using it constructively.
I
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As I walked to the camp, I could sense despair and hopelessness and what struck me was people
had actually accepted that their lives would never change and lived with the situation as if it were
dust on their bodies .A very different approach to development in such a scenario would have to be
worked out as opposed to the conventional model we usually understood.
IDeA-Institute of Development Action
The institute is an effort by the ANT , to help in capacity building of NGOs and other development
focused groups in North East .They conduct short term courses on various development related
topics throughout the year. Resource persons are brought in from all of India to give the
participants a broad based understanding of issues like NGO management, accounting mechanisms
etc.The Institite also designs tailor made courses depending on the needs of various groups.
INTEGRATED HEALTH and DEVELOPMENTAL PROJECTS
OBSERVATIONS AND LEARNINGS
One of the main reasons that I visited both these projects is to understand how various activities
were interlinked to try and understand what Community Development actually meant. It seemed to
me that no matter what the entry point into the community,e.g health in Sittilingi or Livelihoods in
Chirang, eventually the project gains a life of its own and will chart out a direction. One by one
either by default or design, various other activities and initiatives get added on. This felt like the
communities almost knew what they wanted .But were many times not confident or knowledgeable
enough to take the big steps in a new direction.
Some of the common points I noted between founders of both projects
1 .The founders were strongly inspired by Gandhian values
2.Both sets of founders were couples ,who had made a joint decision to work in a rural area with a
marginalized community that they did not belong to
3.They created and developed a cadre of women health care workers-equivalent to barefoot
doctors.And it is these women who formed the backbone for the success in the healthcare programs
and its outreach.
4. The cornerstone to womens empowerment activities in both projects was organizing Self Help
Groups and group savings.
5. The initiators were convinced about the use of Organic farming techniques not just as a
development activity, but also practiced it themselves in their own kitchen gardens.
6. The founders of in such projects would be looked upon to as leaders and initiators of almost any
new ventures .There was surely a great deal of dependency on the founders both for a sense of
concrete direction and in decision making.
7. Livelihood issues and addressing the socio-economic situation is key in community development
My over all impression and understanding of Community Development boils to Community and
Individual Empowerment. Any process ,event and activity that helps the community and
individuals realize their potential, look beyond their circumstances and works in manner to restore
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human dignity and confidence such that they have a greater degree of control of their lives is
empowerment. And when individuals and the community are empowered by knowledge, self-worth
and money, they know they have moved steps ahead and development has taken place.
In Sittilingi ,the first project I visited was more of a listener and was eager to grasp whatever Gi
,Tha and other staff members told us about THI.I did not take the pro-active step of interacting with
the community because of the short duration of the visit and also because it was my first exposure
visit and I was not very sure how to approach the community or how and what to ask them .By the
time I visited ANT,I had read up about few more Integrated Developmental projects in India and
also had a small though not a perfect framework on what to look out for. I was in Bongaingaon for
a week and spent a lot of time speaking to various community members and got a first hand
account on how they were part of the process.
CIVIDEP-GATWU-CHC Meeting
Date:7/11/2008
Attendees:
CIVIDEP: Suhasini
Munnade: Pratibha
Sukanya,Aditya,Sapna
CHC:
CIVIDEP as an NGO was registered in 2000, but formalised operations in 2OO2.They focus on
issues concerning garment industries workers in Bangalore. They have helped form a womens’
group called ‘Munnade’ in 2002 and the GATWU (Garment workers’ union) in 2006,both which
work in unison to address issues that plague these workers.
Munnade’ is an organisation of women workers in the garment industry in Bangalore. Any woman
garment worker in any garment factory in Bangalore can be a member paying the membership fee
The issues of concern have been:
Wage related issues, worker’s bonus, provident fund, termination of work, ESI related issues,
workers harassment, organizing workers, many individual cases of work related illness and workers
rights.
The GATWU is now approximately 2500 members strong. The objective of CIVIDEP is to make
the union strong and self reliant. So far, the workers have been bringing the issues to the notice of
CIVIDEP who have been helping them through legal means, organizing the workers and drawing
up strategies. They say that the higher management is usually unaware of the work situation and the
ones responsible are the middle management.
l.Macro picture of the safety standards in the garment industry
The garment industry like any other industry comes under the Factory Act and hence has to provide
for the workers health and safety. The structure of the factory has to be designed for adequate
ventilation, lighting, toilet facility and water availability. The safety regulations are to be displayed
in every workspace. Unfortunately, there are no specifications for workers in the garment factories
The working conditions in these factories do not abide by any laws are often quite pathetic
.Common complaints include over-crowding of workers, inadequate toilet facilities Jack of
drinking water facilities, poor ventilation etc.
iI
Cividep and Munnade believe that the workers have very little knowledge and perception of
Occupational hazards and health.Very often health issues like backache,headaches, piles (in tailors)
are assumed as individual health problems and they do not connect it as an outcome of their jobs
and work schedule.
Some examples of existing regulations for the safety of the workers and prevention of occupational
diseases are:
1 .The workers who are involved with fabrics should be provided with appropriate masks to prevent
inhalation of fibres.
2.Those working with cutting of cloth sheets should be provided with metal(steel) gloves to prevent
injury.
3.Those working with power looms rubber sheets are to be provided as a foot mat to prevent
electric shocks.
But the workers have complained that the use of protection equipment is only enforced when
foreigners/buyers come to inspect the factory premises. These protection mechanisms are not
mandatory during working hours. Also they have expressed the discomfort when using them. The
workers have also pointed out that there are only signboards and instructions for the
Fire/Emergency Exit and a few posters of the Labour laws. Additionally all these are in English
and not local languages, thus reducing the workers understanding of the content.
Some issues concerns that were discussed in the meeting included:
1. Workers in the tailoring departments are very susceptible to needle injuries. Loss of
concentration even for a second is dangerous and the needle would punch through the skin.Often
the workers are taken to the ESI hospital, treated , bandaged and sanctioned leave for 7-15 days.
There was one serious case where a worker lost the use of his thumb in such an accident scenario
2.Women in the ironing department are exposed to very high temperatures and very often the steam
from machines blow directly onto their lower stomach. But as such no health complaints have been
reported.
3 A huge number of them suffer from tuberculosis. According to an ESI doctor, 85% of the TB
patients he sees are garment workers. But he was unable to confirm the statistics due to lack of
identification details in the records and inadequate follow-up
The activists highlighted and pointed out that the Gokuldas industry fared much better with regards
to safety compliance and Bombay Rayon fared very poorly.
2,Examples of cases dealt by CIVIDEP in the past:
In 2005 ,GATWU identified a problem in one of the factories and directly approached the brandBabyGAP .Though the outcome was positive in the sense that the workers conditions became an
International campaign, the union also had to face legal charges on account of not approaching or
lodging the complaint with the local bodies/authorities and bypassing them to reach the mother
company.
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GATWU learnt a very important lesson from this episode and in the below case alerted the rightful
authorities on the complaint . A lady worker ,eights months into her pregnancy miscarried right in
front of the factory The matter was raised as to why she was working when she was so late into the
pregnancy and why maternity leave was not sanctioned. The issue taken up by the groups and an
appeal was submitted to the court and also the international buyers. Since then, a register has been
maintained for pregnant women and also ambulance facility has been made available.
There was a case of electric shock around two years back, for which they sent a letter across to the
Inspector of Factories. An inspection was commissioned to investigate the case who found that the
existing mechanisms were faulty. The factory management was instructed to make the corrective
measures. Subsequently , the victim was also granted medical aid and treatment costs .
In a case of harassment, a woman was kept locked in a room for reporting late to work She was
detained in the room during the work shift and was denied food or water.The worker fainted due to
stress . An appeal was to the Labour Court, Police station and Inspector of factories submitted with
the help of Munnade The case went on for 2 years and eventually the worker won and received a
compensation of Rs. 46000.
A factory helper was killed in the factory premises by a factory bus.After enquiry and investigation
,a compensation of Rs. One lakh was awarded to her family.
3.CONCLUDING REMARKS:
GATWU has gained a lot of popularity over the past few years, though it a relatively young
organization. They are known to take up serious issues ,analyze the and take the appropriate steps
to resolve the issue . The workers have slowly started realising the power of collective bargaining
and are now directing their problems and grievances through the Union /Munnade and not
approaching the management directly.The Union workers are also more aware these days on how to
approach GATWU to complain about leave issues, bonuses and harassment
CIVIDEP has also been instrumental in advocating that a strike/protest cannot be initiated without
understanding the background of the issue. For e.g. The workers would like to take up the matter
of raising the minimum wage with the management. But Cividep and Munnade looked into the
matter and concluded that it is not the management but the government who has set the minimum
wage limits, hence protesting against the factory would not yield any results.
REFLECTIONS
If anyone asked me to sum up my fellowship experiences , I would put it down as
R.O.M.E.(Reorientation of My Education)- a slight modification from acronym-R.O.M.E.Reorientation.
This I say because, the fellowship has changed the way I understand health and re-oriented my
muddled professional thoughts in a more organized manner. I am now convinced and subscribe to
the “iceberg theory”, there is much more to learn from the communities than what meets the eye. I
have learned to “learn and unlearn” and realign my thoughts along various planes and also been
able to identify that lacunae's that exist within myself because of various self-introduced biases.
The various reports I have submitted here have been my learning and reflection points and helped
me discover where I want to go from here.
Looking Inward:
u
Introspection ,during the course of the fellowship has been a major step in my personal and
professional journey. When I joined the CHLPJ was assailed with doubts and beset with
confusions. There were times that the whole exercise of looking in seemed so overwhelming that I
would want to find some sort of escapism. More often ,1 could only see my murkier side and would
feel guilty and ashamed that in my state of ignorance and lack of empathy, I had possibly
developed many prejudices about various communities. I knew my passion was to work with
communities, but maybe the energy was misplaced, I felt I had only a superficial idea of what
existed out there .My false pride in being an of having an Ivy League degree and my ability to
speak good English were not the actual tools that a community would need to develop. If anything
,my additional qualifications could even be a hindrance if it blinded me from seeing the ‘whole
picture’ .1 have been brought with very middle class values and as I grew up, I simply believed
that truth.love and peace were just values we all needed to have and all the worlds problems would
be sorted out, but the fact is the values in itself have many ramifications and I needed to
accommodate social justice and equity into my own system before I sought to change it the ‘system
‘ that served people.
Finding the right balance is necessary for me. I could romantisize my concepts but if pragmatism
did not figure into plans, then I perhaps I was fooling myself .1 have begun to understand that
finding that fine intersection of personal and professional life is a struggle, I would have to grapple
with. I say this because the social group I move with don’t share similar views.I could choose to
ignore them and be in my own bubble or continue mingling with them. At what cost,I have asked
myself many times?I knew that there would be a level of hypocrisy within me. If my values
belonged to one set and if I would have to pretend to have another set when I move with other
groups .This inner turmoil ,1 am still facing.
My various readings, discussions and meeting with people have made me realize that I have been
ignorant and oblivious to many things in life until now. The fellowship and my reflections has
helped connect the dots and this has lead to a better understanding of the linkages that exist in our
lives and the world as well.
The need for a regular internal reflection is necessary to ground myself and also take stock of all
my actions and thoughts .Self evaluation and appraisal is needed to ensure my emotional and
spiritual growth.
Looking Outward and my understanding of community:
The world community has now become a bigger term for me than before.In my mind,I had always
defined it as a group of underprivileged people in a defined geographical are.I now understand that
it is not so.Today I understand that and group of people bound by a similar set of problems and
somewhat same level of resources and understandings to cope up with problems form a community.
The Socio-political-economic and cultural synergy in the mesh in which the health of the
community lies. Unless these dimensions are addressed simultaneously, we cannot make inroads in
health promotion.
All communities have an inbuilt potential to rise above their difficulties and circumstances. But
they are struggling to even meet their basic needs, where is the question of fighting for rights here.
The role that health activists play are in organizing,motivating,guiding and helping them to
mobilize themselves. The initial phases are totally hand-holding, but at some point they need to be
let go and allowed to evolve ,it is only then that they take ownership of their lives and work
towards improving it.
H
The world is moving in a more materialistic direction and choosing to ignore the need for a holistic
development.Money has become the passport to power .It is in this harsh reality that we work and
the same reality in which all the communities co-exist.In such a scenario,the communities are being
further marginalized and development seems almost like a non -existent dream that will never
become a reality.
Indivial and community empowerment -physically, mentally, emotionally, spiritually, financially,
socially are all required if a change it to be seen. But threading all facets is not an easy task and
everyone may not exhibit similar growth rates.And without addressing people livelihood issues,we
could not seek to improve their healthThis is one of the major challenges I see in working with
communities.
What next?
During the course of the fellowship,! was keen to take up a job which allowed me to focus on
Urban health issues.This I felt would be a practical,doable yet community oriented and where
much intervention is required. Bangalore-the city I live in is facing massive problems as a result of
its rapid urbanization and unplanned growth.In the wake of the NUHM also coming,! felt I could
surely take up a role that would fulfill my expectations. As I write this report, I have been offered a
full time Research and Advocacy position with an NGO called Basic Needs India. BN! works on
community mental health and implement a developmental model that was conceived 8 years ago
after consultations with persons with mental illness and their caregivers. Their programs are mainly
in rural areas of various states and Bangalore Urban. Though the focus is not exclusively Urban,!
was convinced that here was one marginalized community that faced a huge level of discrimination
across the social hierarchy .Till date mainstreaming them remains a challenge. This was also a
community that would need to depend on some type of medical intervention for prolonged periods
of time, hence the need to engage with the state for better facilities and medicine supply would
mean indirectly working towards the strengthening of the health systems. The work would be a
field of multi-sectoral collaboration and would offer me the opportunity to learn a lot hands -more.
I intend to pursue my reading of all community and development based literature at the same pace
like I did at CHC.I would also at some point want to work on strengthening my writing skills for
the purpose of effective Public Health Communication. In some sense ,1 intend to keep the spirit of
the fellowship alive in me for the rest of my life, by this I mean I want to always remain as
enthusiastic student of the community and be ready to receive what it wants to teach me. My
interaction with may activists have revealed to me that a burn out and disillusion are part of the
journey in the Non-profit sector,It was natural to feel disappointed when nothing changes despite
years of efforts. Should I ever reach such a point ,1 hope to return to CHC to help me reflect and
reinvigorate myself.
If anyone were to ask me where I saw myself 10 years from now.My reply would be simple:! want
to remain a community health practitioner,an eager student for life and also a teacher who will be
able to complement a theory lesson with an experience or a story from the field.
CONCLUDING NOTE
My personal observations and conclusions on various projects, readings and seminars remain my
own and may not necessarily be shared by the organizations or people I have interacted with. I am
aware that my “myopic vision” may have led to my partial grasp of the truth;this may have in turn
impaired my explanations and understanding on many matters.
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