Importance of Dental Health, Tobacco Consumption and Mental Health

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Title: Importance of Dental Health, Tobacco Consumption and Mental Health
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Community Health Learning Programme

February 2010 to September 2010

REPORT

OF. Rohini
intern, Community Health Cell

TABLE OF CONTENTS

ACKNOWLEDGEMENTS......................................................................................................................... 3
REFLECTIONS OF MY PERSONAL LIFE............................................................................................ 4
BIRTH PANGS IN MY RELATIONSHIP WITH CHLP.......................................................................6
LEARNINGS................................................................................................................................................. 8
FIELD VISITS.............................................................................................................................................11
KALANADIGAE JATHA.............................................................................................................................18
TRAININGS................................................................................................................................................ 22
MY EXPOSURE TO PUBLIC DIALOGUES -JAA-K......................................................................... 27
TRAININGS GIVEN BY ME ON THE IMPORTANCE OF DENTAL HEALTH.........................30
SUMMARY................................................................................................................................................. 32

Learning Program Report - Dr Rohini

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ACKNOWLEDGEMENTS
I thank my husband Mr.Sanjay Paul for his support and encouragement.
I thank my in laws for taking the utmost care of my children Roma Sylvia and Ruby Olivia during
my absence thus giving me freedom to do the internship. I look forward to the same support in the
future for the service of the community.

My admiration and thanks to my Mentor Joyce Premila for the words of encouragement, motivation
and feedback for my learnings. I sincerely appreciate my Mentor for assisting me to bring out this
report and do my best.
Lavanya’s presence (my fellow intern) made me comfortable in all the hardships that I faced during
my internship. She has been a great blessing

My heartfelt thanks to my fellow interns: for their love, support, encouragement and motivation
Thank you Manjula, Shivamma,Shobha, Ganesh, Hanumanthappa, Mallikarjuna, Madappan, Sejal
Parikh, Anand and also the flexi interns Sister Vinaya and Lakshmi.

I also wish to acknowledge my previous co-fellows who are Mary Julie, Jaya, Shelly Dhar.Tanuja,
Tejaswini, Bhavya, Malavika, Snehalatha, Shivakumar for their support.
I want to acknowledge my gratitude to the SOCHARA and CHC Staff, Dr.Thelma Narayan,
Dr.Ravi Narayan, Dr Sukanya, Mr.Premdas, Dr.Ruth Vivek, Joyce Premila, Mahadeva swamy,
James, Maria,Pushpa, Pralahad, Mangala and Saraswathamma for their kind co-operation.

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REFLECTIONS OF MY PERSONAL LIFE
Mysore is a well known tourist destination in India because of its rich historical heritage as much as
the beautiful geographical terrain that it boasts of. Mysore is a beautiful city with a salubrious
climate. I was born and brought up in his beautiful princely city known for its hospitality.

I lived a cocooned life. My mother worked as an assistant head mistress in an aided school in
Mysore, while my father worked for nearly fourteen years, as the section in charge of a sheet metal
firm in a private company in Riyadh, Saudi Arabia. We are two siblings. I have a younger brother.
We lived in the lap of luxury as a nuclear family. My brother and I were provided all the comforts
money can give.

Since my childhood, I nursed the ambition to become a doctor. I completed my pre degree
education following which by the grace of the Almighty I obtained a private seat in Farooquia
Dental College and Hospital, Mysore. I completed my BDS from Mysore University in the year
1999-2000 and did my one year Housemanship from the same institution, in the year 2001.
I worked as an Assistant Dental Surgeon in a private clinic in Mysore for a short period of time
between 2000-2002. My practice flourished as I was a local person and familiar with the place. I
also have a special skill in dental extractions, especially Third Molars, which is considered to be
one of the toughest procedures amongst extractions.

I was married to a Mechanical Engineer from Bidar, on May 9th in the year 2002. This was an
arranged marriage. God has blest me with the gift of two daughters, Roma Sylvia aged 8 and Ruby
Olivia aged 7, studying in First and Second standards respectively in Bidar.

Following marriage my life changed drastically. My life seemed to have many thorns as I faced
difficulties in adjustments Initially, I was helpless in expressing my feelings freely and could not get
close to my husband [Sanjay Paul] as it was an arranged marriage.
I had always had all my needs and wants met by loving parents. I now had to learn to adjust without
many of the privileges I had been accustomed to.
Bidar is a backward area in North Karnataka Region. I initially experienced a tough time and faced
lot of problems in adjusting to a rural setup. The mindset of the people of Bidar was difficult for me
to understand and co- relate. Hailing from an urban nuclear family with a very modern outlook of
life, in Mysore, I was thrust into a conservative joint family in Bidar. Because I was the eldest
daughter in law, expectations were high and the responsibilities were many and fell heavy on me. I
was expected to play the role of the eldest daughter in law, and take care of all the needs of my
husband and his family members. I used to be a free bird. The freedom I had had earlier was now
just a dream. Bidar has a harsh climate. The climatic conditions, food items, life style were all new
and different in addition to my new role!!!
I felt I was a caged bird.

There were many trials I faced when I tried to practice in Bidar. This itself became a wall of
separation between my husband and I. One reason was because he comes from a different

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educational and cultural background and did not understand the demands made on me by my
profession. I too I think loved my profession more than my family life which didn’t help either!! I
felt that since my parents had struggled hard and it was their dream I get a medical degree, I wanted
to work and fulfill their hopes in me.. Being new to the community it took a lot of time and effort to
convince my husband and in laws to allow me to practice.

The patient and doctor rapport takes time to build and it took a long time for me to get established. I
had difficulty in building rapport with patients. Because I was not recognized as a Dentist in Bidar,
I felt 1 did not have an identity of my own and also lost confidence in my ability to work as a
dentist...

Yet on reflection I can see that this was a period of maturing,of becoming more outward looking
from being inwardly focused. My eyes were open to others’ trials and tribulations. I could now
empathize with the pain others went through, especially women who seemed to be stripped of their
identity after marriage. I decided I would like to support those women who face similar situations
and work for their upliftment. I wanted to be the voice of the voiceless.
Professional Reflections
During my practice in Mysore I came across many pre-cancerous lesions in the oral cavity due to
the consumption of tobacco. Sub mucous fibrosis a pre cancerous condition in which the patient
suffers from Trismus a medical condition in which the sufferer has forceful jaw closure because of
the spasmodic contraction of the masseter muscle hence difficulty in opening and free movements
of the mouth.

Tumors of the oral cavity such as cancers of the tongue, cheeks, hard palate and soft palate are
common conditions due to the chewing of tobacco and betel nut.
After working in two different areas in Karnataka state I was pretty aware of the differences in
dental hygiene and dental problems each state faced. Having seen the condition patients due to
tobacco, and their inadequate knowledge about Dental health and oral hygiene, I wanted to work in
creating awareness on this issue. I feel sad because Dental health is not given prominence and
Dental Health and Treatment is neglected because it is quite expensive. People don’t seem to realize
the close association between dental health and general health of an individual. Dental health is
considered to be a Mirror of an individual’s general health.

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BIRTH PANGS IN MY RELATIONSHIP WITH CHLP
The Community Health Learning Program Internship came like a ray of hope that glittered in the
sky of my life. I was introduced to Community Health Cell by Mr.Shiromani, a social activist from
Bidar. He was involved in Jana Arogya ,Andolana Karnataka, Bidar Forum and also conducted the
workshops on health and health rights in Bidar

On the 21st march 2009, I attended the interview accompanied along with my father and my
younger daughter. This will be etched in my mind as it was the last time I traveled with my beloved
father. My dad was happy to know that I was selected and offered a CHLP Internship.

I was interviewed by Dr.Thelma Narayan, Mr Sam Joseph, Mr.Premdas and Dr.Sister.Aquinas.
I am personally very thankful to CHC for selecting and considering me and rendering me a chance
to prove myself.
I joined Community Health Learning Program of Community Health Cell, Bangalore in the year
2009. During the weekends I had the opportunity to go to Mysore and spend time with my widowed
father. They are now so precious to me. I never dreamt that those were my father’s last days. Those
precious days and moments are unforgettable memories in my life.
My co-fellows were Mary Julie, ShellyDhar, Snehalatha, Jaya,Tanuja, Tejaswini, Shiva kumar,
Deeksha, Bhavya, Divya Persia and Mallvika. It was great dventure to stay in SCN Niketan, a
hostel run by nuns, as I was staying away from home for the first time. I had never stayed in a hostel
before. This batch was diverse and multi lingual as interns were from different parts of India.
Tanuja was from Manipur and represented the regional level and state level positive women’s
network. After listening to her life story of challenges, trials and tribulations, I realized how
privileged I had been in my life and that my problems were so miniscule. Mary Julie was called as
mummy by all of us because of her matured nature and advices, she and her husband Jey Paul a
previous fellow of CHLP have their own organization called Buds for Christ in Namakal, Tamil
mainly working on orphan and vulnerable children. She was also a great inspiration for me to work
for downtrodden children. The solidarity among us encouraged me to explore many issues

I attended the Orientation sessions from 4th -27th of May 2009. After that I was unable to continue,
as my father was hospitalized in Mysore. Dr.Sukanya asked me to apply leave for few days and to
come back, but unfortunately I was forced to discontinue the Internship as his health was
deteriorating fast. He needed my presence and support during this period of time. My father expired
on the 22nd September 2009, This was a terrible shock. I was depressed, The sympathy given by
CHC Staff members consoled me..
I kept in touch with Mr.Premdas, Dr.Sukanya and Dr.Ruth and expressed my eagerness to join
again. So I was invited to attend the presentation session by my previous fellows in the month of
November 2009 to assess the growth of the fellows in their respective fields. I attended the
presentation session along with my husband. The presentation session revealed the challenges and
achievements in their fields I was gifted a book on behalf of CHC, Bangalore titled. ‘Where There
Is No Doctor’ by Dr .David Werner by Mr.Premdas and he encouraged and motivated me in front of
my husband. While travelling back after presentation session I cried all along the journey in the
Train. Whenever I called Dr.Sukanya and Mr.Premdas, they comforted me.

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1 still remember the day, December 17,h 2009, when Dr.Sukanya was kind enough to call me
personally to inform that she is on leave and asked me to contact Mr.Premdas and enquire about
joining the internship next batch.

I rejoined the CHLP Internship in the month of February 2010, a month before my co-fellows
joined me.

During this period I stayed with my previous co-fellows so had the opportunity to learn from them
as they shared their experiences, challenges, hardships and struggles in their journey CHLP
Internship. I was able to appreciate their contribution to the community and how their future plans
were guided by their internship

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LEARNINGS
The following are the learning objectives that I had framed for my self as targets I desired to reach
through my internship journey.

MY LEARNING OBJECTIVES
• Continue my practice as a dentist
• Take up community dentistry as learning objective.
• To create awareness about various hazards of tobacco consumption to communities and
different methods of practices of tobacco consumption.
• Try to understand the relationship between tobacco consumption and mental health of
children.
• De-addiction
• Child abuse and child labor.
• To create awareness about Water fluoridation.
Mv Learnings Through The Collective Learning Sessions
Orientation
As a dental practitioner I was concerned only with the hospitals, doctors, drugs disease and
treatment Though I had studied Community Dentistry in my third year, the concepts of Community
Health and Public Health were new for me, As a Dentist I knew only part of it, but nothing about
health and I did not even know the exact meaning of health. The CHLP enabled me to deepen my
perceptions about health, community health and public health. After joining CHLP during the
orientation I realized and came to appreciate the concept of holistic health. My opinion regarding
health took a shift from
• Disease to Health
• Individual to Community
• Patient to People
• Providing to Enabling
• Curative to Preventive

WHO, has defined Health as 1 A state of complete physical, mental and social well being, not
merely absence of any disease or infirmity’. I realized that the Social determinants of health such as
food, safe drinking water, education, housing, employment, sanitation are necessary for the total
health and well being of an individual. These are the social determinants which are essential for the
well being of an individual. Not just medicines, drugs, hospitals, treatment and doctors. All the
sessions were equally important and inspiring. To bring out a change in the community it is very
necessary to change first oneself. Looking Inside session enabled us to know one.
Psycho-social care of disaster management
The emotional reactions reported during the disaster by the people are the normal responses to an
abnormal situation they are living in, this was made aware by Dr.Shekhar’s session on Psycho
social care of disaster management. First-aid of the disaster affected was demonstrated by
Dr.Preetesh. The most vulnerable groups are women, children, aged and disabled.

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Monitoring synthesis
Dr.V.S Prakash of Karnataka state natural disaster monitoring cell delivered the sessions on
monitoring forecasting preparedness and mitigation of natural disasters. It’s an autonomous body
affiliated to department of science and technology.
Alternative methods
Session on this was conducted by Dr.Shirdi Prasad Tekur. Alternative methods of medicine are not
supported by the government because it has no causalities and surgeries.

Basic Needs India
D.M Naidu demonstarted Lalaeppa’s documentary on Mental illness-A Journey from Mental Illness
to Recovery. Mental disability needs family, community and health workers support.

Environment Occupation and Health
Dr.Aditya was successful in delivering sessions on environmental or occupational hazards. He
advised to wear environmental lens in the communities where we live. Eco-sensitivity is the matter
of concern.

MidTerm Session
Mid- Term Sessions started from June 14lh and continued till the 25th, all the sessions were equally
Informative, Educative and Creative for me in person.
Through Personality Development Sessions by Shobha Managoli, I was able to identify children as
my community. I was really inspired by the way; she was playing the mind games with each one of
us. Dr Ravi Narayan’s sessions, looking beyond, that is not assuming the things that we see on one
particular day in a particular time, where as the History of an Issue is very necessary and important
to realize and come to a conclusion. My misconceptions about Gender and Sexuality were cleared
after Sathyasree’s sessions. Through PRA sessions, I realized that community work needs our
commitment and dedication. I learned that the community should be encouraged to participate. It
was the first time I came across the word social mapping. The sentence that motivated me was Poke
and Run Away; this means that health workers go for a short period of time stir up things and
disappear this was another acronym for PRA!! I decided to take up a particular area and spend at
least 10 years to bring about a change. Hence I would like to do some follow-up work in Hanur,
which was my first field exposure area. Dr Shirdi Prasad Tekur’s sessions gave me insights on how
to conduct Trainings on Dental Health. I realized that the trainings I had given to Government
Higher Primary School Children in Hanur was random, not properly structured. It is necessary to
prepare a Training Module so that the Trainees are benefited the most. As I am particularly
interested in the topics on the control of consumption of Tobacco I found the sessions by Dr
Vasundhara very interesting and useful. Such a complicated chapter was simplified and presented in
a proper manner. The life Threatening Diseases such as Oral Cancers are mainly caused by the
Tobacco consumption.

Six Monthly Review Sessions
Two sessions were taken one on HIV/AIDS by Dr Suresh Shellikeri and one on communication for
NGOs by Ms Shobha Managoli

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Session on HIV-AIDS
This session was taken by Dr.Suresh.V.Shellikeri. It was very informative. He made it very
interesting and interactive. Dr.Suresh.V.Shellikeri is a General surgeon with a fellowship in HIV
Medicine. He gave us a great acronym for AIDS
• A-Active involvement of Government and Non Government Organizations along with the
Medical and paramedical persons to fight out this Evil.
• I-Information to all.
• D-Drugs for all the persons at a reasonable rate.
• S-Social acceptance of patients and relatives.
He gave us a brief history of HIV. The First case of AIDS in India was reported in May 1986 in
Mumbai and the first sero positive HIV case reported in India in 1986 was a female commercial
sex worker in Madras city.
By the sessions I came to know important details such as that the diameter of Human
Immunodeficiency Virus is 120 nm and the Individual effects of HIV/AIDS which are;
• Illness and suffering.
• Shortened life span
• Loss of work and income, grief, poverty and despair.
• Barriers to health care related stigma and decimation.
• Deteriorating child health and survival.
• Weakened integrity and support structure of the family unit.

The routes of Transmission are from infected persons through Blood Transfusions, mother to
child, sexual route, I V Drugs, hospital induced like needle stick injuries etc.
Types of HIV Antibody tests are
• ELISA
• Rapid \simple Immunoassays
• Immunocomb
• Dot Blot
• Agglutination test.

He requested us as social workers to always keep our integrity and maintain the confidentiality of
results.
Signs and symptoms are Weight loss, chronic diarrhea for more than a month and prolonged fever
for more than a month
Women are more at Risk, the chances of Male to Female Transmission is 10 times higher than
female to male transmission because of the high viral load (concentration of HIV) in the semen,
longer exposure in the vagina, trauma during the act of sex women having a larger exposed surface
area, untreated STDs and RTIs.
Women have low negotiating power for safer sex and face violence if they do not agree to their
husband’s demands.

In the case of Mother to child transmission it is only 25-35%. Caesarian section reduces
transmission by half and Zidovudine [AZT] a drug given to pregnant positive women reduces

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Transmission by 65%. If nutritious and hygienic alternative to Breast milk can be given the risk of
reduces to 22%.

He also briefed us on the prevention Measures to be taken to confine the spread of this deadly
disease as this is important for community health workers.

FIELD VISITS
Field Exposure To Jagruthi Mahila Sanghatana
The field exposure to Jagruthi Mahila Sanghatana, in Potnal village belonging to Manavi taluk,
Raichur District during orientation was very useful as it was my first visit to sub-centers, primary
health centers and PDS.

CHLII-PILI, is a residential child labor school. Here children are given equal opportunities to
explore themselves and to learn from their experiences.
I was able to interact personally and know each one of them and their ambitions in their lives. I was
amazed by their thoughts and communicating skills. The children were creative and influenced by
each others and also were encouraged and supported by their teachers and elders Interaction with
the children gave us the clear picture of the causes for the child labor.
Under the National child labor Eradication project Women and children are given opportunities and
empowered to bring about change in the communities.

Terracotta Jewelry is one in which women are employed, it's a talented and skillful occupation.
Terracotta jewelry is a skillful occupation where more than 20 women are working through self help
groups for nearly 10 years. I really appreciate the commitment of the women who work in spite of
so many Health problems

JMS encourages and trains people on producing Organic manure from Neem leaves. This is very
helpful for farmers and helps restore soil fertility of soil
Herbal medicine was one more subject interesting to every one who visits Potnal. These Medicines
were prepared from local herbs and is used to cure many skin lesions and has cured paralysis in
many patients. Women who are suffering from personal problems like white discharge are healed.
Home remedies are prepared and given for white discharge in women, for leucoderma[white
patches in the skin], the treatment for paralysis stroke, and some types of skin disease. Various oils
are prepared to prevent hair fall and promote hair growth.

This has gained in popularity. Every Thursday many people in and around Potnal come to JMS for
advice and treatment of advice and treatment for various diseases
JMS also has been encouraging communities to fight for rights and against inequities.
Songs are taught which songs of activists are. These inspiring songs encourage people to fight
against injustice and develop leadership qualities.

The life of each person in JMS, is an living example and motivation to the future generation.
Vimochana is an organization which is working for violence against women and children.

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The Holy Cross Comprehensive Rural Health Project

From April 15th 2010 to June 12th 2010, I was placed in Holy Cross Comprehensive Rural Health
Project, Hannur, Kollegala taluk, Chamarajanagara District for my field placement.

I Appreciate the Dedication and Commitment of the staff of HCCRHP, in particular sister Teena
and Sister Gloria and also Sister Dr.Aquinis the founder of the HCCRHP. The Holy Cross Hospital
in Kamagere provides health services in and around Hannur.
The HCCRHP has targeted about of 50 villages in and around Hannur to be surveyed under this
school health program. The HCCRHP were involved in the Health Promoting School Program
because children are considered as change elements, targeted and used as vessels to bring about a
change in the community. The main aims and objectives of children’s parliament is to convey the
health messages from Child-Child, Child-parent, Child-teacher and Child-Community. I was
involved in the children’s parliament and also helped them bring out a written magazine under the
school health programs
The Staff of HCCRHP have been involved in the Promoting Health in Schools Program. The main
objective of this program is that the children are used as Instruments to bring about a change in the
community. Health Messages are convened from child - child, child - parents and child
community.

As the schools were closed on account of summer vacations, we went to each village and conducted
the survey of the children studying in the classes between the 4th standard and 8th standards. Many
children were out of station, or had gone to relatives places or were busy attending some local fairs.
Along with the staff of HCCRHP I visited the following places in Hanur Division, Chikamalapura,
C N Doddi, Anaganahalli, Ellemala, BM Doddi, Kothanuru, Lokkanahalli. Kodhalli and few more
villages. Daily we used to go around 9 in the morning and return in evening. Initially, I felt
difficulty in getting adjusted but after sometime I was comfortable. I was involved in the formation
of Children Parliament, Kitchen Garden and Hand written Magazine.

Health Messages were convened through Kala jatha songs, Leadership qualities were emphasized.
In Manadalli, children from children parliament themselves gave Health Awareness program to the
community. The program was scheduled at 7 in the evening but children were so enthusiastic they
were ready and assembled in the school premises by 4 pm in the afternoon.
The staff of HCCRHP faced a tough time in engaging children for such a longtime, we were waiting
for the Electricity, as there was general load shedding till 7clock.

Children took out the procession and walked along all the streets of the village shouting Health
messages, by the time we reached the whole village was waiting for us for the program to start, but
there was no power . We all waited in anticipation for the program to start, after some time as the
villagers were seen dispersing , then we decided to get generator from the neighboring village by
paying Rs 500 for just one hour
At last around 8 clocks the program started with an invocation and the children welcomed us and
some prominent persons with a lotus flower.
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The whole program was well organized by the children with the help of HCCRHP staff.
Children performed street play to create awareness on spread of water borne, air borne and vector
borne diseases by the Germs. Children sang Kalajatha songs. Children were actively involved in the
program. Participation of children encouraged their parents and community. The community co
operated and supported us by staying and listening to us for a long period of time. We returned back
late in the night.
I had a great time with the children, my co-fellows and dear friends’ lavanya and Annie Lang from
Germany during my stay in Hannur. Sister Teena and Sister Gloria were of great help and
inspiration. I had the opportunity to take up sessions on Dental Health to 5th, 6th and 7th standard
Government school children in Hannur on 8 , 9th and 10'h of June 2010.

I was given an opportunity to promote Dental Health Education in one of the Government Higher
Primary School children for standard 5, 6 and 7 on June 8lh', 9lh and 10lh . It was quite a new and
exciting experience. Children were very excited and responded well.
The Concept of the importance of the Dental Health was emphasized. Teeth and Gums are
important in chewing different kinds of foods .Healthy teeth contributes to the Health of an
individual.

Healthy Gums are also essential to hold Teeth firmly in position. Healthy Teeth and Gum are
maintained by properly cleaning and flossing them. Importance of keeping teeth clean was taught.
Proper Brushing Technique was demonstrated with the help of Dental models and posters. Food
stuffs that affect the Dental Health of individual soft, sweet and sticky foods such as chocolates,
candies, jams and junk foods affect the Dental health of an Individual. Soft drinks like coca- cola,
Fanta are also equally harmful. They were made to understand the importance of Brushing and
proper Brushing Techniques. Bad Habits that affects the Dentition of an Individual were listed. .
Misconceptions about the Dental Practices were also cleared. The Importance of uses of fluoride in
prevention of dental caries was taught. The other Hazards of the Tobacco consumption were also
made clear

The following were also covered by me in the trainings
• The Importance of Dental Health
• Healthy Teeth leads to a good smile
• Healthy Teeth contributes to proper speech
• Healthy Teeth are essential for eating different kinds of food. Healthy Teeth depends on the
Healthy Gums
• Proper brushing techniques.
• Foods that contribute to the Dental health of an Individual.
• Foods that affect the Dental health.
• Causes of Dental caries.
• Types of Dental caries
• Preventive measures such as Topical application of fluorides and usage of fluoridated tooth
pastes.
• The important uses of Neem, and clove oil in pain relief

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A dental camp was conducted by me to assess the dental health of the children.

My Objectives were:
To assess the Dental Health status of the children in the community.
To create awareness about the importance of Dental Health.
To promote Dental Health education.
To elicit the Knowledge, Attitude and Practices of the children in the community.
Diagnostic Survey
1.Periodontal Disorders-Gum problems.
2. Dental Caries.
3. Causes of Malocclusion.
4. Flourosis.
I was able to conduct the health camp and create awareness among the children with regard to
dental practices.

A Questionnaire was prepared to access the Knowledge, Attitude and Practices of the children
[KAP Study],

Questionnaire For The KAP Survey Purpose .
• Name of the pupil 2 age of the pupil 3 gender or sex of the pupil. 4 complaints
• Dental caries
• Bleeding gums\ spongy\swollen gums
• mobile teeth\missing
• Discoloration of the teeth
• Bad breath
• Malocclusion.
• Importance of Dental Health
• Food stuffs affecting Dental Health
• Causes of protrusion of teeth
• Impact of missing teeth
• Practices
• Frequency of brushing
• Brushing medium used
• Toothbrush, neemstick or finger
• Cleaning medium used toothpaste or powder - rangoli powder or charcoal
• Chewing of tobacco pr beetle nut
• Nail biting, thumb sucking, flossing
• Nutrition and dental health

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KAP Study
1. Knowledge: Importance of Dental Health; Foods stuffs that affect the Dental Health; causes
of protrusion of Teeth, Impact of Missing teeth , Dental Health is essential for good general
health to be emphasized.
2. Attitude
3. Practices.
a. Frequency of Brushing,
b. Brushing Medium used, Tooth Brush or Finger, Neem stick.
c. Cleaning medium used- Tooth Paste, Tooth Powder, charcoal, Rangoli powder,
Brick powder.
d. Consumption of Tobacco and betel nut chewing. Thumb sucking.
Children were advised to convey the information back to their families and communities.

Cluster Resource Persons Meeting was held on the 31st of May 2010 In Holy Cross Comprehensive
Rural Health Project, Hanur, Kollegal District, Chamarajanagar District
Cluster Resource Persons are Government school teachers selected and appointed by the state
government. There one cluster resource person for every two panchayats. In Hanur, there is 22
Gram Panchayats, with 13 cluster resource persons. There is one Block Resource Person High
school and 3 for Primary school. Every year the government spends nearly 5000 rupees per child for
Education Purpose.
On the 26th May, I went to Anagallidoddi a small village in Hannur with Chandrika one of the staff
of Holy cross comprehensive Rural Health Programme. There I happened to meet one of the
ASHAs of that area. 4 villages were given to her to work. The ASHA is also a DOTS provider. She
was able to diagnose a 21 years old patient with Tuberculosis and send her to Bangalore for DOTS
PLUS treatment. The patient was given 6months treatment.

There was one more old aged male patient in his late sixties TB with HIV co-infection she spoke
about who was given CAT- Land DOTS.

The ASHA has been able to convince pregnant women to choose Institutional Deliveries. Families
were sensitized to Immunization and family planning. Her incentive as a DOTS Provider is Rs 250
for a patient. She is unhappy with the incentives she is getting. In this village Maternal and Infant
Mortality has reduced. There is no sub center, PHC in this village. In case of casualties they need to
go Hannur which is almost 9-10 kms far away.
This village has no toilets, though they got loans. Discarded Commodes were.
Education was
only up to the fifth standards, following this many children dropped out of school. Others had to go
to other villagers to continue the education

My Reflections:

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Dr Sister Aquinas, Founder and the other sisters of Holy Cross Comprehensive Rural Health
Project in Hannur, are involved in remarkable service for humanity.
Due to the work of the sisters there has been a significant reduction in the Maternal Mortality and
Infant Mortality Rates
Chamarajanagara District is considered as one of the backward areas where the Health Indicators
are poor and as bad as North Karnataka Region.

The children don’t have access to education as facilities are poor. Many children are forced to work
due to poverty. Girl children especially are not allowed to continue their education once their reach
puberty. I visited The Sadvidya Residential School in Prakashpalya, which caters to rescued
children who are child labourers and school dropouts.
The main reasons for school Dropouts are Migration of the families in search of Livelihood. Girls
are not allowed to continue their studies after they reach puberty.
Toilets are largely not promoted by the school development and Management committees due to
water scarcity. Most Schools don't have compounds. Many schools are used as toilets for the
community. Government school Buildings are very pathethic. Rs5000 is given by the Government
Education Department to the schools for Water Tanks constructions. Rs 3000 is given for
cultivation of kitchen Garden, so that green leaves and vegetables grown by the children will be
used, Nutritional values of the vegetables are provided in a list.

Child marriages are common in these regions. Girls are not allowed to continue their studies after
they reach puberty. Girls are considered as a burden to their families. Girls are married off at a very
young age and they become mothers in their teenage.

Maternal Mortality and Infant Mortality Rates are very high due early marriages, early pregnancies
and poor health services.
Women are tortured by their husbands and even killed for no reason at all. I came across many
families and children with a history of husbands killing his own wife. Children are taken care by
their grandparents and the culprits are married to another woman and living happily. The plight of
such children is quite pitiable. Such children become school dropouts and child laborers.

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Poor and needy are denied of the Health Services.
Child Marriages are common in this region
There are cases of women killed by their husbands
Women are also tortured and physically abused by their husbands.
Single parent children are more prevalent and these are taken care by their grandparents or
other family members. These children are prone to child labor and school dropouts because
they have to earn.
Communities are very superstitious.
Transport facilities are very bad

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MY INVOLVEMENT WTH CHC RELATED EVENTS
On 17th February 2010, I participated in CMCA”s [Childrens Movement For Civic Awareness]
Annual day celebrations which was titled "JOSH". This was held at the police grounds, Bangalore.
I was accompanied along with Mr.Mahadevaswamy and Mr.James to the event in which more than
two thousand Government High School children in and around Bangalore came together.
Mr.Mahadevaswamy introduced me to Sathyawathi and Swetha both previous CHLP fellows of
CHC, who now work in CMCA.

Community Health Cell was offered a stall to participate and to create awareness on the following:
The other stalls apart from our stall were from Forest Department, Traffic Police Department of
Bengaluru and other NGOs. The disposable of garbage by various means was taught. By the end of
the event children were served lunch.
CHC stall helped convey health messages on different topics. The Health Messages were conveyed
through songs, charts roleplays etc. We distributed pamphlets to the children, concerned officials
and other participants as well as we collected pamphlets and play cards from other Departments.
• Nutrition and balanced diet. The CHC stall displayed nutritious food items such as green
leafy vegetables, fresh fruits, dry fruits, milk and milk products such as butter, cheese, curds
and ghee, meat, egg, chicken and fish. The Stall was a big success and it attracted the mob
because, it displaced all the Nutritious and Balanced Food such as green leafy vegetable,
fruits, milk and other products which go to maintain a balanced diet.. Colorful charts on
balanced diet and nutrition were added attraction to it. The charts on health, especially the
importance of dental health and different stages of dental caries as tooth decay is more
prevalent among children. Balanced Diet and Nutritious Food has all the minerals and
vitamins that are needed to the healthy growth of children. The spread of infectious diseases
and communicable diseases
• The Hazards related to the consumption of tobacco such as smoking and smokeless tobacco
which is also known as chewing tobacco or spit tobacco.
• The spread of other infectious and communicable diseases such as malaria and tuberculosis.
• Genetically modified food such as BT Brinjal and BT Cotton was highlighted as it was the
talk of the town during that time.
• Importance of Medicinal plants such as Aloe Vera, Hibiscus and Tulsi and their uses were
discussed. The uses of Aloe Vera are: the pulp of the leaves are used in skin infections,
white discharge in women, diabetic patients are advised to eat it on an empty stomach to
keep Blood sugar under control as it tastes bitter, when applied on the face it acts as a
natural moisturizer, the pulp along with lime juice applied on the scalp helps in hair growth.
Hibiscus leaves applied on the scalp acts as a conditioner. It is used in the manufacture of
shampoos.
• Gender sensitization. Importance of breast feeding and importance of the girl child in the
family and many more issues were conveyed through charts displayed and explained to
children in detail.
• HIV- AID. The role plays and charts helped to convey the message.

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Reflections Of The Event
All the stalls were attractive, informative and educative. Children were enthusiastic and were
involved in the event completely. This event provided them an opportunity to know so many other
issues apart from their regular studies.

Some shared that they were not able to consume the proper diet due to their financial status.

I personally encouraged the children. I would like to support and also conduct this type of events or
exhibitions in future in other rural areas for the benefit of the children.
Protest Rally Against The Death Of Beggers
A Protest rally was organized on the 3r of September 2010 in Bangalore to protest against the death
of beggars. A candle light vigil was held which concluded in front of Mahatma Gandhi statue on
MG Road in Bangalore. I participated in this rally along with my co-fellows. Students from
different colleges,various Non Government Organizations and many volunteers came to show their
support. At the Protest Rally we shouted slogans against the government.
There were Placards and Pamphlets demanding that Beggars Deserved to live in Dignity.
Demanding for better living conditions for them and pressing the government to take the initiative
to probe into the death of beggars in the beggars colony in Magadi Road, Bangalore.

Protestors lit candles, wept and prayed for the departed souls.

KALANADIGAE JATHA
On 2nd October 2009, heavy rains created havoc in the North Karnataka region including Raichur,
Badami, Bagalkot,Gulbarga, Haveri, Belgaum. Raichur district was the worst affected. Many
villages were inundated and homes were lost due to the overflooding fo river banks. There was a lot
of loss of property. The state and central governments assured compensation for the victims affected
and the construction of the houses for their loss of property.
But sadly the governments have failed to keep their promises and till now even after 10 months
nothing noticeable has been done in this regard. So many NGOs and other organizations in Raichur
district, took up this issue and organized the Kalanadigae Jatha,to draw the attention of the state as
well as central governments to the plight of the villagers .

As a part of the Jana Arogya Andolana and Community Health Cell, Bangalore, I participated in the
jatha from the tenth of August till the 14lh August 2010 with my co-fellows. It was a unique
experience and it was quite exciting, because it was the first jatha in which I had participated.

The jatha was flagged off from Katakanuru, Raichur District. It was inaugurated by H. D.Revanna.
Through the jatha those who participated in it. noticed and brought out the loopholes of the
Governments. It was organized by Flood Relief and Rehabilitation Committee Raichur District.
The other organizations which participated in this Jatha are,
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Zilla Congress Party, Raichur
Zilla JDS Party, Raichur
Hyderabad Karnataka Vimochana Vedike.
Madigah Dhangura samiti
Jana Arogya Andolana Raichur
Nava Jeevana Mahila Hookuta
Gram Vikas samiti, Raichur
Jagruthi Mahila Sanghatana, Potnal
Inn Green Society,Gillesuguru.
Prerana samasthae, Raichur.
Vemukthi society,Raichur
Shruthi samsruthi society
Spade society, Raichur

Journey log ofpadayatra
• Flagged off at Katakanuru.
• Katakanuru to N. Hanumapuru,which is almost 2-3 kms far away.
• N.Hanumapura to Yelia Bejjali which is about 5 kms in distance.
• Yelia Bejjali to Bejjali camp another 3 kms .Night Halt in Bejjali camp.
• On 11th August 2010, the second day of the Jatha which started from Bejjali camp and reached
Tungabadra village around 10 in the morning
• From Tungabadra to Chikkamanchalli it was almost 5 kms far.
• Chikkamanchalli was the most badly affected area during the floods and I was able to talk to
few persons how were affected by and the persons how received compensation for the damage
of their property.
• Night halt was in N.Malkapura.
• On the third day of the Jatha, which was on 12,h august 2010, we went to Talamaari.

Reflection and experiences during the jatha
In every village, the community was mobilized to speak about their Grievances We walked from
one affected area to other, mobilizing the communities to take imitative to fight for their own
benefits.In Katakanur, for the construction of permanent houses,for which labourers were hired
form the neighboring state of Andhra Pradesh. When lavanya and Hanumanthappa tried to engage
in conversation with them we were chased away by the contractors, who kept a close watch on us.
At Talamaari we spoke to few displaced people belonging to the dalit colony. We were told that one
person died just 10 days ago of a scorpion bite. Scorpions and snakes were spotted in temporary
shelters seeking refuge due to heavy rains.
Walking in the hot sun without proper food, water and shelter made me realize and experience the
hardships faced by the victims.

The common problems faced by all the victims are
• No Houses, they continue to stay in Temporary shelters till now.
• Scarcity of water supply
• No supply of electricity in both temporary shelters as well as in allotted houses.

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•
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No food to eat because of lack of job opportunities^ also due to lack of identity proof)
No education for children as they have no school buildings and as to travel far to attend
school.
No Transportation facilities.
Non Accessibility, Availability and Affordability to Health services.
Child Rights are Violated as Children are deprived of Education
Electricity and water supply are major problems faced.
The quality of the houses constructed is poor due to scarcity of water supply-no curing done.
They can easily fall down
The constructed houses are very congested and small.
Denial of Health services.
Starvation was faced by many due to poverty and lack of employment and lack of access to
PDS
Failure of the Government in providing the permanent shelter to the affected even after
nearly for a year is still difficult for me to understand.

In some parts these Temporary shelters are used as cow sheds, and denied to the victims.

Due to soil erosion villagers have not been able to cultivate the land and hence jobless.
There is no value for the lives living in these areas. Infants lived in pitiable dangerous conditions.
There were many snakes and scorpions infesting the surroundings. We were shown a scorpion
which had been lying under the mat upon which is infant was sleeping. Snakes were seen more
often due to heavy and continuous rainfall. Here there was a death of an elderly person due to
snakebite a few 10 days ago. His wife shared her feelings and pleaded with us to recommend her
name for compensation. No compensation has been given for their damage.

I was interested in knowing on what basis compensation was given. They expect some kind of help,
may be financial help or any other from those how visit them. Even after 10 months few have
received any compensation from Government for their loss of property and lives. They continue to
stay in Temporary shelters with no basic facilities.
The houses being built are of poor quality, no curing has been done because of water scarcity. The
dimension of the built houses is 17/13 square feet. Till date there is no authentic report of the
damage caused, layout required, layout sanctioned and houses built. Allotment of the houses is
incomplete till today. The victims are unsure of getting the permanent houses. These are also liable
to fall due to poor quality of construction and heavy rains. The victims were unsatisfied and
expressed their helplessness over the issue.

In Chikkamanchalli, a victim complains of insufficient compensation because he has spent more for
his treatment and health aspect to rectify his partial paralysis of his right side of the body while
shifting from his native to temporary shelters.
Another 12 years old girl had fractured her hand and not been able to.continue her education was
given minimal compensation. Her parents told us that she was denied of health services in District
Hospital in Raichur. She was given alternative methods of treatment.A widow complained of
nonpayment of compensation for her husband’s death during the floods in that area.

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In Hellabechalli camp, we came across a family in which all the four children were Mentally
Retarded, the eldest was a 25 years old female.. All the four had hydrocephalic heads and abnormal
behavior. Consanguineous marriage seems to be the reason.
The unfortunate parents of these shared their grievances about her health and other aspects. It was
difficult to take care all of them, in particular the girl as she has attained puberty and she is unaware
of her own body and the hormonal changes that takes place within her. Her mother expressed her
helplessness in this regard. As she wanders from one place to another she could be easily sexually
exploited.
Lavanya and I tried convincing her mother to get a hysterectomy [surgical removal of the
uterus]done for her to avoid the further complications. But she showed disinterest in this regard.
In N Malakapura, the community was very responsive was mobilized very fast, but there was a
sudden death in the community and the mob scattered. It was told that he took initiative in
mobilizing the community and he died of heart attack. In N.Hanumapura, we were told that a lady
had lost her speech due to the shock of the floods and needs psychosomatic care. In Talamari, the
victims shared that only few victims have allotted permanent houses and few have obtained more
than one house by corruption. Around 1000 people gathered at the venue on the 14th August 2010 in
the Dr.Ambedkhar circle in Raichur for the final day

A Live Documentary was shot when the victims shared their grievances with tears in their eyes.
They shared of the misuse of the funds collected on the account of Flood relief. The unequal
distribution of the compensation amount reveals the corruption and apathy of the government.
A copy was to state and central government concerned officials to take initiatives in this issue and
the put an end to the corruption. Telecast of the shot documentary was shown to the audiences on
the 14lh August 2010 night in front of Dr.Ambedkhar statue in Raichur. On 15th August 2010, the
memorandum was submitted to the Deputy Commissioner of Raichur. He assured the gathering that
he would take appropriate steps and do his best.

This field exposure was an eye opener to many field realities and sharpened my insights. The
Kalanadigae Jatha was an eye opener for me personally and as well as to my co-fellows.
Exposure to the life of Durgi-Murgi Tribals

Along with Mr.Karibasappa, Mr.Hanumanthappa ,Lavanya and Shivamma I went to ByadagI
Taluk, Haveri district. The objective we had was to understand the life of the Durgi-Murgi Tribals.
They live in very pathetic conditions-in small pitched tents made up of some clothes and plastic
covers on a sloppy hill top-directly exposed to sunlight and cold. After the conversation with some
of them we realized that they are neglected and unnoticed community.
An eight year old was cooking and looking after her two year old sibling as her mother was no
more. Infants were seen with no proper clothes [warm clothes]. We were told that a few days ago an
old woman had died due to exposure to extreme cold. There were around 12-15 tents in that small
particular area. After further conversation with few of them it was revealed that their main source of
living was to carry the deity -the goddess Maramma from one place to another and to punish\ beat
themselves and beg arms. They were given money, some grains and rice.
But now they are not allowed to do as begging is banned. So they now go wandering from village
to village selling Hair Pins for their lively hood. Usually women earn by selling other commodities

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such as artificial Ear rings, Finger rings, chains etc and men are seen relaxing without any
responsibility. Most of them are drunkards and addicted to many harmful substances such as Betel
Nut chewing with Tobacco, Smoking and snuff. I was astonished; when I saw them Chewing Betel
Nut with tobacco very often and even the quantity of consumption was more. It’s the common
practice among them.
They assume that it quenches their appetite and is alsousual time pass. Human Rights and Health
Rights are violated.
Reflections
• They are deprived of all the benefits given by the state government.
• Housing, Education, Job, Health services and many more.
• They are chased from place to place with no land given for them to settle down in one
particular area.
• Left unnoticed.
• They are an invisible community for those the government and others don't give any value
for their lives.
Mr Premdas, Mr.Karibasappa along with few others of their community have been struggling hard
for their up-Iiftment of the community in future. I hope that things will favour them in few.

TRAININGS
Revised National Tuberculosis Control Program (Rntcp) Training

This was conducted for the staff of CHCRHP was conducted on 25th May2010 in the office from 10
am.

Session was conducted by a lab technician and senior Directly Observed Short Source Treatment
(DOTS) provider. In India, RNTCP was started in 1993
Cowdaily, a small village in Kollegal Taluk is considered as the most affected one in whole of
Karnataka. HIV with co-infection Tuberculosis is very prevalent.

HCCRHP is involved in the detection, sputum collection and transportation of samples to the
nearest Designated Microscopic Center (DMC) of the suspected individuals for the diagnosis
purpose. There are 4 DMC in Kollegal district. There must be 1 DMC for every 5000 population.
Indians are affected by TB due to low nutrition levels. A patient dies every minute in India due to
tuberculosis. In a day almost 5000 patients die in India due to this infectious disease. Tuberculosis
is an air borne disease, which spreads when one coughs without holding a cloth and shares things
openly. Symptoms of this contagious disease are cough for more than 2 weeks, evening rise in the
body temperature, weight loss, loss of appetite and Haemoptysis. There are 2 types of Tuberculosis,
Pulmonary and Extra pulmonary Tuberculosis. Sputum is collected twice, Spot Sample and Early
morning sputum sample in empty stomach to diagnose TB

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DOTS treatment is classified into cat-1 [ red box],cat-2[blue box] cat-3[green box] and non- dots
[loose drugs], cat-1 Treatment is given to patients with bilateral involvement of lungs - smear
positive, those who have coinfection with HIVXTB, and those with Extra- pulmonary tuberculosis,
treatment is given for 6 months treatment. The first two months is called the Intensive phase and the
next 4 months the continuous phase, it has 23 -strips, 8 tablets in a week. CAT- 2 , This is 8 months
treatment given to Relapse cases , Defaulters, Failure cases. It is a three months Intensive phase and
5 months continuous phase. Cat- 3 is given Cases of Pleural Effusion Non Dots Is 1 Year Treatment
Given For Patients On Traveling. Aims Of RNTCP Are 85 Percentage Cure And 70 Percent
Health And Human Rights

A Training to activists of FEDINA (Foundation For Educational Innovations In Asia), on health and
human rights was organized at Community Health Cell on 14,h and 15th of July.
The unorganized sector has been classified into many divisions as
1. Garment workers
2. Construction workers.
3. Agarbathi workers.
4. Domestic workers.
5. Elderly unorganized workers.
There are many Trade unions, but not working on health related issues of them.
Health is not considered as a fundamental Human Right.
Following the previous training a base line survey was done in all these divisions and the fact
findings are were presented to us as a group. Activists reported that women preferred the private
sector over the public sector to go for health related problems.
The most common complaints were;
• Back pain
• Headache
• Body pain
• Burning of the Eyes
• Thyroid problems.
• Respiratory Tract Infections.
• Skin Allergy.
• Particularly in women, white discharge is the most commonest complaint.
• Cases of Miscarriage among pregnant.
• Swallowing of Needles.
• No Drinking water facilities and toilets are poor.
The objectives for the training were
Objective 1; To facilitate the understanding the framework of human rights and fundamental rights
especially regarding health .
Objective 2. To facilitate participants in understanding the gender perspective of health in general
and in occupational settings and identity common occupational health issues.

The concept of Rights, Human Rights, Right to Health and Fundamental Rights was explained by
Prem Das in a very well structured and descriptive manner To strengthen the unionization, it is
necessary to solve the health related issues to mobilize the community. Health is an important issue

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linked with the occupation of an Individual. So we are concerned about the occupational Health
Hazards.
Unorganized sector of women’s health, who are earning very minimal wages of 1400 to 4000 a
month are focused

The sessions were conducted by Joyce Premila on women’s health. She guided us to help reflect
upon strategies to collectively address to women’s health in their work places and Dr Adithya spoke
about the Occupational Health Hazards. Everyone has problems in life, so it is necessary to find a
way out to solve our problems and come out of our problems . The change should take place within
us to see a change in the community. Hence it is very essential to see that everybody gets involved
in community Health. .He listed the following steps which needed to be taken
Steps to be taken
• Health promotion.
• Specific protection.
• Early diagnosis
• Treatment and rehabilitation.
• Psycho-social aspects are important.
• Withdrawal of the Levels of Intervention or solution and Immediate cause are important.
The 2 days workshop was very useful for me personally because I was able to analyze the various
occupational health hazards, especially among women.

Faces Of Capital Development
I attended a workshop conducted by FEDINA for their activists at Indian Social Institute on 27th,
28'h, 29th and 30th of July 2010.
I learnt through a session taken by Mr. Duarte Barrette (Executive Trustee, FEDINA) that Worlds
Women Day is also know as International Working Women’s Day.

This came into being when working women in Chicago took the initiative and demanded that
certain rules must be implemented to improve the working conditions of the women. These were
1. Equal wages for Equal work.
2. Creches, in the working places.
3. Better working conditions for women.
4. Regularization of the working hours.

Through out History we find that most of the struggles of women were ignored and suppressed
though the women took leading part. Main issues faced included
• Issues like Women Empowerment
• Freedom of Expression for women
• Eradication of Sati system
• Education for women
• Abolition of Child Marriage.

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During the German Revolutionary period around 1910, a petition was cleared for the Freedom to
vote for women.
Taylorism and Fordism .These were two new terms I was introduced to named after the founders.
Taylor 1856-1915 and Ford 1863-1912.were two American Revolutionists, who introduced
methods to measure the work pressure and production time, ie The Time that is required to produce
the prescribed product Time and action are standardized together. To increase the production, the
standardization of Time and Breaking of the operations in to fragments is very essential

Most IT Companies are well equipped with Air-Conditioned rooms, toilets facilities are good.
Employees are encouraged to take adequate rest as well to improve the production.

Unfortunately the unorganized sector pushes employees to work constantly, because the Time is
considered as precious as Money by the owners of the company. The workers become disposable
commodities who can be replaced as apposed to the view by the IT sector where employees are
valued. Here in the unorganized sector and crude methods are used to intensify the Work Pressure.
Workers here have poor working conditions, poor toilets, and no drinking water facilities. Use of
toilets is discouraged with toilets often being locked.
On 27lh and 28lh July 2010 along with FEDINA Staff I attended a workshop in Indian social
Institute, which was a follow up session for the previous training as detailed above my me which
took place on the 14lh and 15th July 2010.
Health And Human Rights Training In Haveri (CHC)
On 26th, 27th and 28th August 2010, I attended 3 days workshop on Health and Human Rights in
Haveri District. It was organized by JAA-K,Jana Arogya Andolala-Karnataka. JAA-K activities
and Representatives from 8 different districts of North Karnataka were present

CHC coordinated these meetings. More than 50 activists from various other organizations from all
these districts were registered. The present batch CHLP fellows were given a chance to participate
and get to know about the Jana Arogya Andolana [ JAA-K] activists and also its activities. Some of
the Karnatake interns were involved as facilitators as well.
The meeting started with a brief introduction by each participant about oneself and the organization
he/she represented. Lunch was arranged in the premises itself.
In the afternoon the session on Globalization was facilitated out by Dr.Akila Vasan in a very
interesting manner. She kept us engaged and simplified such a complex subject in teaching us.

The session on Patents taken by Naveen Thomas also quite interesting and kept the participants
alert

The session hat got me fully engaged because it was on my field was the session on essential drugs
taken by Dr.Gopal Dabade from Dharwad I had heard so much about him. I was glad to have the
opportunity to spend time with him and learn more on the subject. I appreciate the simplicity as he
explained the subject. Though I come from a medical background I had never come across the list
of essential drugs. He gave us both the generic and trade names of the drugs. I was astounded at the
depth of his knowledge. I also got to learn home remedies for various ailments.

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We had a lot of activities; Participants took part with a lot of enthusiasm. A lot of creativity was
demonstrated in the performance of cultural activities such as street plays, role plays, singing songs
and conveying the health messages through dances and skits

We had a Feedback session where we all contributed to discussing how we could strengthen the
activities of JAA-K Mr.Karibasappa shared his experiences and the challenges he faced in Haveri
district. He also shared how he used RTI (Right to Information) in order to obtain information on
various health issues.
Based on the information by RTI, a few government officials were fined and made to pay the
penalty. We were able to appreciate that group solidarity can lead to a better life, when we
collectively demand for rights to essential health services.
Right to information session at Headstreams
I attended a right to information half day session at Headstreams. I learnt the following which is
needed to put it an application.
Application should be Under Right To Information Act 2005.
The public information officer is the concerned person to be addressed and the PIO[public
information officer] who may be either the District Health Officer, or the Block Education Officer.

The application contains the following -subject of the information
• -Name
• Address
• Particulars of information\documents\inspection sought:
• Period for which information is requested:
• Initial Fee Paid.
The sending address to address queries regarding Right To Information in Karnataka is
The Karnataka Information Commission M.S.Building Dr.Ambedkar Veedhi, Bengaluru-560 002.
There are 30 sections out of which only 20 are needed .It is written as complaint under section 18 of
Right to Information Act -2005.

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MY EXPOSURE TO PUBLIC DIALOGUES -JAA-K
Public Dialogues were held in the following eight districts of North Karnataka
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Bagalkot
Tumkur
Haveri
Chitradurga
Bellary
Raichur
Hospet
Davangere.

Public Hearing: Bagalkote
On 19lh February 2010, I attended a Public hearing in Bagalkote. It was organized by Jana Arogya
Andolana Karnataka. Mr.Premdas, Mr.Obalesh, Mr.Karibasappa, Smt.Swarna Bhat and many more
were involved in organizing this event.

A Few miscreants did not allow the program to proceed because of the absence of few concerned
government officials on the dais. This led to misunderstandings between the audience and other
officials, resulting in the discontinuation of the process.
In spite of requests made by Mr.Premdas, the State convener and Swarna Bhat the local social JAAK activist and the organizer to continue, as the public had come from far off places foregoing their
day’s earnings so that hey share their grievances in front of the concerned government officials.
This was with the aim put an end to the corruption in the public health services and to create
awareness about the irresponsibility of the health professionals and the denial cases were seeking
some compensation.

The District Magistrate spoke about the spread of infectious diseases and their prevention and
requested the public to take initiative regarding Health. Regarding corruption the concerned
Government officials were questioned cautioned and requested to offer their services promptly in
future

Denial of the health services during delivery which resulted in the death of a mother and a child due
mere absence and negligence of the concerned government doctor in the PHC. Shreemathi, 21 years
old wife of Mallikarjuna gowda junaali visited Nandakeshwara PHC in Badami Taluk, Bagalkote
District on 3rd December 2009 for the purpose of delivery.The couples hailed from B.NJallihalli.
The doctor examined Shreemathi, the pregnant women and asked her to come after two days.
she developed labor pain and was taken to Nandakeshwara PHC On 6,h December 2009 at around 8
O’clock in the night. The doctor told the family members that she expected a normal delivery and
went to her resting room. The pain increased and became uncontrollable and as the condition of the
patient was deteriorating the family members informed the doctor and requested the doctor to come
and examine the patient. But the doctor did not bother to come; instead she scolded and chased
them away. At around 3 O’clock in the early hours of 7lh December 2009, the mother and the
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unborn child died in the Nandakeshwara PHC itself. Mallikarjuna was in great grief as he lost both
his wife and child.
The family members were upset and angry because in spite of transporting the pregnant women
from their residence to the nearby PHC and requesting the doctor to examine the patient condition
and doing her best to save lives of both the mother and the child there was negligence on the part of
the doctor. The deaths could have been avoided. The irresponsibility of the doctor for not rendering
her services in case of emergency was a gross violation of health rights.
The negligence of the doctor resulted in the unnecessary death of two lives, so they protested in
front of the PHC demanding the doctor’s suspension and also the compensation for the deceased.
The doctor was absconding after the issue.
• Nandakeshwara PHC is under Karuna Trust[public private participation]
• No Antenatal checkup done as there are no ANM”S.
• Previously she was treated in Badami Hospital.

Demands were:
• The immediate suspension of and action to be taken against the concerned lady Doctor.
• Immediate appointment of Gynecologists in the PHCs.
• Withdrawal of the PHC from PPP [Private Public Participation]
• Health services to be rendered to the needy in case of emergencies.
Denial of health services in PHC for HIV patients, particularly Caesarean operation was referred to
hospitals in Belgaum or other places

Tumkur
The Public Hearing was Organized by JAA-K[Jana Arogya Andolana Karnataka.] Tumkur District
Forum on 21sl July 2010 in Woodlands Conference Hall, opposite the KSRTC Bus stand. The
scheduled timing to start was 11am in the morning. When we went there many physically
challenged and Mentally Retarded individuals were seen thronging the venue with the help of
attendees. Anxiety was seen on many faces.
The Dias was occupied by the concerned Government officials such as Municipality President,
District health officer, as we as professors of different colleges.
Issues discussed were:
• Women with Disability.
• Malnutrition
• Fluoride concentration in Drinking water.
• Some denial cases.
State convener Mr.Premdas addressed the issue of Malnutrition and the lack of employment. He
focused on
• Employment
• PDS[Public Distribution Services]
• Anganwadi.

NREGA offers job opportunities for 100 days for the poor. Yet people are not given jobs. It is this
which causes them to remain poor. He also called for the standardization of the food supplied to
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Government school children to pregnant women through Anganwadi. The present food distributed
was a powder, which none of the children seemed to want to eat. The powder was most often of
poor quality and smelled and tasted of staleness. He called for the regularization of health services.
There was a need to see that essential medicines were made available in sub-centers, primary health
centers and district hospitals.
People from the physically challenged association spoke passionately about their needs.lt was
estimated that there are around 14,000 Mentally ill patients in Tumkur District, but not a single
psychiatrist doctor has been appointed in the district hospital. Hence cases are referred to
NEMHANS [National Institute of Mental health and Neuro Sciences] in Begaluru and the lacks of
Medicines to treat these patients were also highlighted.
Pavagada, a Taluk in Tumkur District is affected by Water Fluorosis.The fluoride content of water
is more than Immp.Cases of skeletal and Dental fluorosis have been reported from this area.

Municipality president M P Mahesh, requested the community to co-operate with them by joining
hands to bring about the change. He assured the gathering that he would take the initiative to ensure
the cleaning of garbage to prevent the spread of contagious diseases. The Zilla panchayat president
who had come late was seen having an argument with state convener Mr.Premdas regarding the
quality of the supplied food in one of the Anganwadis to school children and to pregnant women in
that particular area.

The supplied food was of poor quality and it was used as fodder to cattle. She was not ready to get
convinced when she was told that the grass root level workers have been doing the baseline survey
to find out the facts for the past 3 months and the findings were true. When audience raised their
voices regarding the issue, then she calmed down and
apologized and concluded the event by
rendering assurances to take immediate steps to rectify the fault. Many people shared their
grievances about health services.
I came across Severely Malnourished children in the venue. One physically challenged woman
shared her grievances and requested all of us to give preference to them and render help to them. It
ended up without as many arguments, when compared to the Bagalkot Public Hearing, which I
attended in the past for the first time. I felt that there the audience were wild and arrogant.

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TRAININGS GIVEN BY ME ON THE IMPORTANCE OF DENTAL
HEALTH
Having attended a session on Training, I began to read a lot of books and worked on a module to
give trainings.

I started working from 5th July 2010 on the preparation of the Training Module on the Dental
Health. In order to do this I spent lot of time in reading books and collecting materials. The books I
read are:
1 Where There Is No Dentist By Murray Dickson.
2 Identifying The Training Needs- Tom Dell And Malcolm Leary
3 Heritage Amruth-Dental Care, A Magazine For Healthy Living -The Natural Way.
4 Community Dental Health- George M. Gluck.
5 The Magic Power Of Self Image Psychology - Dr Maxwell Maltz.
6 The Scientific Basis And
7 Oral Health Surveys.

Training to CHC Staff
On The 19,h July, I gave a Training on Dental Health to CHC Staff. This was greatly appreciated by
everyone. There were many questions asked which I was able to clarify. The session was very
interactive and gave me confidence to speak to adults and give sessions on dental training

On the 24lh August 2010, A training on the importance of Dental Health was given to the students
of the Goodwill Girls polytechnic college, Coles park, Bangalore. The total strength of the students
was 50 and the time allotted was 40 minutes.The age group was around 17 to 18 years.
The main objective of the session was to facilitate the participants to
of Dental Health.

understand the Importance

Outcome: students were able to understand the Importance of Good Oral Hygiene.

Methodology applied was Large Group Discussions and lecture method
Students were asked to list out the parts of the mouth and the functions of the various parts.

The association between the oral health and general health was taught.

Oral cavity is readily accessible and reflects the General Health of an Individual. It also helps in
the early detection, diagnosis and prompt treatment of various diseases and conditions and
nutritional deficiencies.
Since my main focus was on the Teeth and Gums I asked students to pronounce alphabets such as F.
V, S, C Etc. This helped them appreciate the importance of teeth for pronunciation
• Teeth helps in pronunciation,
• Adds Beauty to your Face and

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• Aids in chewing.
Composition of the tooth
• Crown and Root.
Crown is that portion of the tooth which is seen when we smile and talk.
The root is embedded in the jaw bone and it constitutes about 2\3rds of the tooth.
• Different layers covering the tooth.
o Enamel is the outer covering and it is the most mineralized Tissue hence it is the
Hardest Tissue in the Human Body.It is whitish in color.
o Dentin is slightly yellow in color and it has cushion like function.
o Pulp is the vital and soft tissue which contains Blood Vessels and Nerves.lt sends
Impulses to the Brain.
o Cementum covers the root portion of the tooth and it connects the tooth to the jaw
bone.
The purpose of the different types of teeth is to chew different types of food.
The anatomy of teeth was taught to them. Students were helped to name and identify the different
kind of teeth. In the mid line of the face are Central Incisors one each on either side of the mid
line next to them are Lateral Incisors which are 2 in number. They are chisel shaped and sharp. The
main function of these teeth is to cut the food particles into smaller pieces to aid the chewing.
Canines are located in the corners of our mouth One on either side. They help in tearing of the food.
They have the largest root.
There are two Premolars seen in between the canines and molars. They help in crushing of the
food.
We have three Molars. They have flat surfaces and they help to grind the food.
Types of Dentition was discussed
o Primary Dentition
o Permanent Dentition.
Questions asked were
1 What is Root Canal Treatment [RCT] Why it is done and when it is done?
2 Why calcium in take is good to health?
3 Proper Brushing Techniques.
Reflections :
Students participated well and the session was interactive.
Students need to be educated and motivated to maintain good oral hygiene.
Students should been given awareness on Hazards of chewing Tobacco and Smoking.
Preparation of the Training Module was finalized.

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SUMMARY
I gained a lot of knowledge on many subjects. This internship has been an eye opener tome
regarding Community health. I have had a paradigm shift from seeming health through the limited
lens of a dental practitioner to that of a holistic approach which looks at all the social determinants
of health.

Through CHLP Internship I was able to appreciate the ground realities faced by the marginalized
and oppressed. I also could appreciate the work of the JAAK to empower communities in how to
achieve health, to render health services to the poor and needy, especially children, women and
elderly.

I learnt about Health, Health Rights and Human Rights. As a medical professional I always
supported and was in favor of doctors and health professionals, but after these nine months of
CHLP Internship I now have a different perceptive of doctors, health and health related issues, I
came to appreciate the importance of basic Infrastructure in the health services. I have already given
my learnings in the collective teachings and field experiences.
CHLP has broadened my perceptions in many fields.
The following were eye openers to me
• The amount of corruption prevalent in health services
• The irresponsibility of many of the Medical and paramedical staff towards giving health to
the poor
• Existing barriers in the availability of the health services
• Poor Infrastructure of the SC, PHC and district hospitals including poor staff facilities
• First Aid and psychosomatic care for the disaster victims.- Disaster Monitoring cell.
• The impact of globalization on health and medicines
• Essential Drug list.
• Adult learning, inside learning, outside learning and Group learning
• NRHM-National rural health mission which focuses mainly on maternal and infant health
and mortality rate.
• NREGA-National Rural Employment Guarantee Act provides job opportunities.
• PDS-Public Distribution Services.
• Exposure to evil practices such as Devadasi system, child marriages
• Dalits [Invisible community] and the trials and hardships they face
• VHSC
• ASHA workers, their problems, responsibilities, challenges
• ICDS- Integrated child development scheme.
In future, I would like to serve humanity not just as a dentist, but also as a community health activist
for the betterment of the community.

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Media: Rohini Devakrupanidi CHLP 2010-9-FR58.pdf

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