A Study on Health Services Utilization by Beedi Worker at Rahattgarh
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- A Study on Health Services Utilization by Beedi Worker at Rahattgarh
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IS7
2015-16
Community Health Learning Programme
A Report on the Community Health Learning
Experience
z
3
School of Public Health Equity and Action
(SOPHEA)
socharav
bin ding community health
Society for Community Health Awareness Research and Action
CMt-p- o-otsr-e/F^ls^
COMMUNITY
HEALTH
LEARINIG
PROGRAMME
(ANNUAL REPORT)
I would like to thank SISEC for ethical gave ethical permission with their valuable
suggestions for such a small study.
I would like to thank SOCHARA, Bhopal for their support in first field work.
I would like to express my special gratitude and thanks to Beedi Rolling labour who
participate in-depth interview for giving me such attention and time.
I would like to express my gratitude towards supporter of the Programme for their kind co
operation and encouragement which help me in completion of this project.
My thanks and appreciations also go to my co-learners also who supported and encouraged
me and willingly helped me out with their abilities.
Learning been a reward indeed, it’s a life time learning memorable experience. Without the
guidance and help of all the stated persons, institutions and organizations, this would have
never been completed in such a fruitful way.
- Azam Khan
Acknowledgement
First of all I am thankful to the selection board of Community Health Learning Programme
who understand that I am keen to learn community health.
I will always be grateful to Dr. Thelma Narayan who supported me to complete the course
and accept my requests during the programme.
I owe my gratitude to Dr.Ravi Narayan, without his advice and feedback I could not complete
my research work on occupational health.
I would like to thank Mr.As Mohammed, my mentor whose guidance did half the magic of
keeping me thrilled throughout this programme.
This dissertation would not have been possible without the help of Dr.Rahul ASGR who
supported me in analysis and to understand other aspects of health in social and economical
context.
I have been fortunate that my Mr. Chander SJ supported me in proposal writing and SISEC
Presentation and he is more than a Programme Manager to me.
Especially I wish to thank Dr.Aditya P. for his continuous support while he stayed out far
from us and he facilitated new things on health like occupational health, environment and so
many new things which effect human life or health.
I would like to thank Mr.Prahalad I.M. who introduced Health & Sanitation and its first time
for me to interact on that and its important aspect of human life.
Special thanks to Mr.Kumar KJ who enriched my ideas, introduced me to other organizations
and persons for his continuous and unconditional support which encourage me in my life.
I would like to thank Ms.Janella D. For being there and support to learn ethic and social
aspects of life.
I would like to thank Kamlaamma, Br.Joseph, Hari Bhai, Vijaya, Tulsi bhai for being there
without their support its hard to live far from home.
Without Accounts, Administration and Library team we cannot imagine a learning
environment so I am thankful to Mr. Victor Fernandez,-------- Ms.Maria, and Mr.Swami.
Mr.Sam Joseph, Prof. Justin Parkhurst, Mr.Krishna Chakravarty, Mr. Magmai P., Fr.John,
and other visiting faculties has challenged and enriched my ideas.
I am thankful to all the organizations and institutions who gave us experience and exposure
individually it is hard to mention the name.
I am highly indebted to Peoples Research Soiety and Lal Jhanda Beedi Union for their
guidance and constant supervision as well as for providing necessary information regarding
the project & also for their support in completing the study.
CONTENTS
1. Reason to join CHLP
2. Learning objective
3. Abbreviation
4. Learning from Collective Sessions
5. Visits and Programme Participation Learning
6. Learning from First Field Placement(Bhopal)
7. Paradigm Shift
8. Research Study
9. Memorable Learnings and Future Plans
Reason to join CHLP
After seven years in voluntary sector I worked on democratic rights of marginalized
communities (Dalit, Minority, Child; Women) as a social advocate. 1 felt that health is an
important issue for marginalized communities but I am not aware about it. Before joining the
programme I understand the market forces decides the agenda for poor people and without
understanding the issue I can not intervene in it. I decide to join the fellowship programme
with goal of knowledge, experience and learning about Community health.
Learning objectives
1) To understand the health
2) To understand the health and development
3) To start a new journey of life.
Abbreviation
1) ASHA: Accredited Social Health Activist
2) USHA: Urban Social Health Activist
3) ANM: Auxiliary Nurse Midwife
4) VHND: Village Health and Nutrition Day
5) HIV: Human immunodeficiency Virus
6) AIDS: Acquired Immunodeficiency Syndrome
7) BWWF: Beedi Worker Welfare Fund
LEARNING FROM COLLECTIVE SESSIONS
It is one year Community Health Learning Programme (CHLP) and annual
report is based on my learning experience, observation and reflection through
collective sessions (in the classrooms and field visits) and visits. Programme
equally divided in collective sessions and field work and it is a uniqueness of
the programme which provides equal opportunity to experience community
life and community health with health care system.
HEALTH
Before Community Health Learning Programme, I thought the presence of
Doctor, Hospital, Medicine facilities is health but after the programme I
knew that it all address the need of ill-being not well-being and now health
for me is -Physical, mental and overall well being not absence of illness.
Now a day we are facing many health problems due to various reasons and we
realize it also. Flealth is important aspect of human life without healthy life
one cannot imagine value of life. Presently in our society we are discussing
the illness and its preventive measures while we have to concentrate on root.
As per WHO definition, “Health is a state of complete physical, mental and
social well-being and not merely the absence of disease or infirmity.’’(From 7
April 1948.)
Every society have rich and diverse heritage of healthy life and in our society
we call it AYUSH (Ayurved, Yoga, Unani, Siddha, Flomepathy) which is in
compact form. From last so many years we are continuously shifting to Bio
medic model and Govt, also support it on every level. To address health
problems we have health system in India which is mainly based on BioMedicine and other remedies supplement it. But in our society people first
apply traditional approach to prevent any illness or health problem and it is
also economical and tested method to get healthy life.
Public health
In our country Public Health address two major aspect of health: Health care
system and health promotion and prevention. It is led under Govt, policies
and schemes and the participation of people is very less. While health is an
integrated matter and other factors are also important (Like: People, health
Practitioners, Voluntary Organizations etc.). Basically our public health
system support and promote bio-medic but now they provide space to others
like: Unani, ayurveda also but the system treat other health practitioners not
equally, our public health system face many problems and Trained human
resources is one of a major problem so they provide space to others also but
their (Others) medicines and other things are not in good condition.
Community Health
Community health is not a new thing for our society from ancient time when
we lived in small groups or community we applied it. But after bio-medicine
and imperial time it collapse and after independence our Govt, promote bio
medicine model and it spoiled others. Community health is a very simple and
democratic model which is based on community knowledge, condition,
accessibility, availability and community participation. Public health is based
on top to bottom Approach and community health system is based on bottom
to top approach and we can small reflection in our present health care system
as Rogi Kalyan Samiti. Community health care system is harmonious and has
Ayurveda, Unani, Sidha and Homeopathy. After NRHM or NHM we can say
that Govt, realise that it is necessary for the people of country.
Public Health System in India (Structure)
Tertiary Care Centre
ft
District.Hospitals
Community Tlealth Centre
Primary Health Centre
Aanganwdi
Factor Affecting Health
In this Globalize period everybody is anxious about health and understands
the value of healthy life. Health is not a self-dependent element in human
life it is inter-dependent with others: Social, Economical, Political,
Environmental, Cultural (SEPCE) and these factors decides healthy life in
society.
A4’s (Accessibility, Availability, Acceptability, Affordability,)
4 A is a most important aspect in utilisation of health care services through
Rakku’s Story we can understand it after so many years the condition is
same. Most of the voluntary sector organisations work on awareness in
society. These following factors affecting 4 A’s:
1. Individual,
2. Household,
3. Community
4. Authorities,
5. Policies, Schemes and Law
Few organisations added two aspects in it: A (Appropriate) and Quality and
now it are A5Q.
Frame Work of Access to Health Care
Framework of Access to Health Care
Health Policy
Characterastic of
Health Delivery--^.
System
Chaeacteristic of
Population art Risk
Utilisation of
Health
Sevices
Consumer
Satisfaction
Social Determents of Health (SDH) and Social Vaccine
SOCIAL Determinants of health decides health of a person or community and
we can classify it in three segments (Conceptual Framework):
1. I
: Socio-Economic-Political
2. II
:Structural Determinants(Income, Education, Class)
:Intermediary
Environment)
3. Ill
Det erm inant s( Social,
Cultural;
Psycho
Primarily we study social status, income-employment, education, gender,
culture, women & child development, food security, social environment,
psychological environment, water and sanitation and universal access to
health care under SDH. We can tackle these issues by three steps:
1. To improve daily living conditions,
2. To tackle the equitable distribution of power, money and resources.
3. To measure and understand the problem and access the impact of
action.
Drug Companies manufacture medicines and vaccines to prevent the diseases
in human body and Social Vaccines
prevent root cause of diseases in
society on the basis of SEPEC. In developed countries they rid the disease
by social programmes. It works on two levels:
1. Structural,
2. Vulnerability.
Drug companies are interested to earn more profit so they manufacture drugs
and promote their drugs in the market. But if you want to cut you health
expenditure you will invest in Social Vaccines because it provides you
sustainable solution and resistance in society like: if you invest in Life Skill
Education you can prevent domestic Violence, Alcoholism, and HIV (through
Responsible Human Being). In comparison the cost or investment of social
vaccine is not more than vaccine and it will change the scene health
Illness comes late but inequality comes early like: Discrimination and
Dr.Karan Singh said, "Development is the best contraceptive".
Alma Ata
In 1978 an International Conference on Primary Health Care was organized in
Alma-Ata at Kazakhstan and was attended by virtually all the member nations
of the World Health Organization (WHO) and UNICEF. The Alma-Ata
Declaration of 1978 emerged as a major milestone of the twentieth century in
the field of public health, and it identified primary health care (PHC) as the
key to the attainment of the goal of Health for All (HFA). Following are key
points of the declaration:
Health is a fundamental human right and health is a most important
world-wide social goal which requires the action of many other social
and economic sectors.
•
existing gross inequality in the health status of the people, between
developed and developing countries, within countries, is politically,
socially, and economically unacceptable and therefore its common
concern to all countries.
•
People have a right and duty to participate individually and
collectively in the planning and implementation of their health care.
•
Primary health care is essential health care for human Life.
•
Through full and better use of resources we will achieve Health for All
(HFA) by the year 2000 in the world.
But after sometime both the main organisers of meeting WHO and UNICEF
took their own way and poor countries trapped into World Bank an IMF's
neo-liberal policies. But Alma Ata is a landmark declaration in the matter of
health worldwide, it gave a dream and dreams give us hope and courage.
Gender and Health
As per constitutional right every citizen have equal right and marginalized
groups have special rights but our social structure is not so democratic and
every Govt, welfare schemes utilization is affected by social structure or
mind-set. In mainstream society women and children are most vulnerable the
percentage of anemia is higher in women than men and it is a single example
while we have so many health and social indicators which clearly exhibit the
real story. Few years ago they address the women health issue under RCH-I
and RCH-H now it's called RMNCHA+ (Reproductive Maternal Child
Health). Our public system address Family Planning Issue which is mainly
concentrated on women and distribute pills of iron to eradicate anemia while
they are have many health problems due to current global economic trend,
private health care services and lack of awareness. Govt.'s health care centers
provide many family planning remedies but every year they fix targets of
sterilization and many women lose their life in the premises of hospital in
absence of proper treatment or negligence. Social status, undignified life
decides health status of a person in the society.
To address the Indian women's issue eminent groups and other voluntary
organizations formed "Indian Women's Health Charter 2007". Govt, initiated
many Health Care Programmes but its long way to address health problem of
Indian women.
Communicable disease (CD)
Communicable diseases spread from one person to another. It is spread by
bacteria or virus or through any infectious fluid. Presently marginalized
communities of third world countries suffered by it and prevalence are high,
The most common communicable diseases found in India are as follows:
Malaria, Typhoid, Hepatitis, Jaundice, Diarrhoeal Diseases, Amboise's,
Cholera,
Brucellosis,
Flookworm
Infection,
Influenza,
Filariasis,
Tuberculosis, Chicken Pox; scabies. Every year many children died by
pneumonia and Diarrhea and both are preventive but our system is interested
to talk about disease(Morbidity) and death(Mortality) while every disease
tells the story of Social Determinants and death shows the systemic
approach.
Causation Framework of Disease is:
AGENT
ENVIRONMENT
Non-communicable disease (NCD)
Non-communicable diseases (NCD) are not passed from person to person.
They are typically of long duration and progress slowly. The most common
NCD's include cardiovascular diseases (such as heart attacks and stroke),
cancers, chronic respiratory diseases (such as chronic obstructive pulmonary
disease and asthma), diabetes, Obesity, Anaemia, Headache, Depression,
Anxiety, Epilepsy; hypertension.
NCD is based on web of Causation and Association, first it requires
essential cause and after that it requires other factors.
Web of Causation and Association=>Multiple Factors=:>interacts=>disease
Diseases have the following stages:
Mild =>Acute=>Severe=>Chronic=>Death
today NCD’s are not the health problem but developmental challenge before
human life, marginalised communities are the main victim of it and the
marginalised section of society are in double risk or have Double
Burden(CD+NCD) of disease.
HIV and Public Health Approach
In this developmental era HIV is a disease of fear, myth and stigma in society
while it is simply a disease which diminishes immune system in human body.
In practical a person with HIV -AIDS live happily within society by these
ways:
•
•
•
Accept Status,
Abstinence,
Maintain healthy life style.
Some groups’ faith and bio-medic groups advocate it on the stated base: A
(Abstinence), B (Be Faithful), C (Condom).
Dr. A.P.J Abdul Kalam mentioned the achievement of a HIV lady’s life in
his book and her struggles also. As per her experience she expressed in our
collective session that a person need support system it is important to deal
with any condition may be illness or other problem. As per my interaction
with Doctors, Caretakers and others I have observed besides lack of
awareness, medicinal facilities and poverty HIV Affected person face
stigma, discrimination and High Risk.
Most of the bio-medic and faith base groups exercise slogan "Safe-Sex" but
if you analyse the problem and it intensity, Dr.Ravi Narayan’s opinion is
appropriate "Responsible-Sex" is the best way to address on the basis of
public health approach.
Waste and Waste Management
In our society we are rapidly generating waste from daily life, industrial and
other activities from last fifteen years we are anxious about it. Waste is
classified in these categories:
a) bio-degradable waste
b) non-biodegradable waste
a. bio-medic waste
i. Non-hazardous waste (79.90%)
ii. Hazardous waste (10.25%)
For segregation of bio-medic waste institutions use yellow, red, blue,
black poly bags as per waste.
b. E-waste: E-waste is based on electronic items (Like Computer,
Mobile, etc.)
In our society we are generating waste from Industries, Agriculture, and
Domestic Usage. From Domestic use we produce Gray Water by washing;
bath and Black water from toilets (26.7%).
Everywhere we are facing problem of waste from plastic and tetra packs and
waste create these problems:
a) environmental,
b) health
c) wasting resource
We can manage our waste by these steps: Recycle, Reuse, Reduce(R-3),
treatment, landfill and awareness. Landfill is least preferred way to manage
waste but authorities practice it frequently.
waste is not fully waste without knowledge its waste while people who have
knowledge to utilise it is resource or wealth for them but in our country
waste is matter of local authorities (Municipal Corporation, Panchayat;
Cantonment etc.). In some areas people use toilet waste for Bio-gas
generation and some people use poly-bags for other household articles. We
have guidelines for Bio-medic waste management in our country. We can
handle it by eco-sanitation management which is based on the principal of
recycle.
Water-Sanitation
In the agrarian era sanitation is not a problem big before us but now in the
globalise era or urban and industrial time it is a big question before us. Lack
of clean water for drinking, cooking and washing, and the lack of sanitary
waste disposal are to blame for many deaths a year, say experts. Now Safe
drinking water and sanitary waste disposal is a big question before human
life. Now poor sanitation and contaminated drinking water increase many
diseases. In poor sanitation open deification is a one problem in it and
Government of India announced "Swach Bharat" Campaign and toilet
construction is one of a key element of the campaign. But it depend on
community culture (Value, Behaviour, life style, attitude, Assumption) so the
programme is on toilet construction not to change their practices.
Open deification is not a simple thing, it affects mental health also on the
basis of gender and people face these problems:
1. animal attack,
2. teasing and harassment,
3. reduction in food intake,
4. menstruation course problem,
5. misunderstanding/suspicion,
6. domestic violence,
7. feeling of shame,
8. feeling of worthless,
9. worry,
10.low self-esteem,
11 .mental-stress(Disable),
12.impact on mental health,
13.Suicidal Thoughts.
The disease burden is high in India, for obvious reasons like poor sanitation,
lack of access to fresh water, poor hygiene, etc., which are common in the
most developing countries.
Occupational health
Occupation and livelihood is a major part of our life working condition and
environmental effect on the health of a person who involved in the
occupation is occupation health. We can classify it on the basis of nature
(Agriculture, Industry), region also. We can also study wages, gender, caste,
and age in it.
DEFINITION((ILO / WHO 1950)): Occupational Health is the promotion
and maintenance of the highest degree of physical, mental and social well
being of workers in all occupations by preventing departures from health,
controlling risks and the adaptation of work to people, and people to their
jobs.
Presently people face many problems in their occupation in rural and urban
area but these are major problems:
•
•
•
•
•
minimum wages,
land holding
reliable source of Income,(in rural area :Seasonal)
dignity
Working environment and safety.
In India MNREGA is the only law which is directly address livelihood issue
of rural people.
internationally and nationally experts agreed on that the working hours
decides quality of productivity but now in the changing era of development
Indian Govt, amending the laws against it.
Respect is important for every occupation but in our society we not
respecting equally like: Housewife, manual scavenger, cobbler, farmers and
other traditional skilled labour and stigmatise them with their caste and
stigmatisation is dangerous for civilised society. The major concern of
occupational health is to protest health of a worker (Informal and informal
labour).people study fact and Impact, Impact and repercation in occupational
health.
first of all Govt. Formed laws, policies in the interest of people and
implemented it and after a period evaluate it and make necessary arrangement
in the it but evaluation part is missing in our system or hard to do so. But
now many organisation and groups are working in the interest of working
class in the country.
Mental Health
As per definition mental health is state of well-being where every individual
realize his or her own potential with sound mind and contribute to his or her
community. The positive dimension of mental health is stressed in whose
definition of health as contained in its constitution: "Health is a state of
complete physical, mental and social well-being and not merely the absence
of disease or infirmity." Present life style is very complex and as result
without age and gender classification people suffered by mental illness and
mental disorder. Our Govt, understands the condition and as result they
formed mental health policy and incorporated in National Health Mission also
but the condition of mental institution and the number of Psychological
Experts and Service Providers is not satisfactory. Effects of mental illness
1. stigma
2. discrimination
3. denial of illness
4. harmful treatment
5. chaining and locking in the room
6. social boycott
7. denial of property rights
8. marriage and legal separation
9. family members not getting marriage alimony
10.Denial of right to treatment
It is not a new health problem in or society; some people refer traditional
faith-based healing method. But it is right time to increase awareness about
it.
Climate Change & Global Warming
The terms "global warming" and "climate change" are often used
interchangeably in newspapers and television reporting, but they are really
separate things. Globally people discuss its impact on earth and on the life of
living being. B the five points we can try to understand it:
1
2
3
4
5
What is weather?
It is a short term condition of atmosphere.
What is climate?
Climate is an average of weather (30 days) and it depends on multiple
factors like: rivers, sea, hills; geographical position.
What is climate change?
Change in average and variability of climate I called climate change. It
depends on frequency, magnitude, geographical distribution and intensity.
What is Global Warming?
The rise in Global Temperature is called Global Warming due to this
global average temperature increase and change the natural cycles like:
water, sea level etc. The rise in global average temperature doesn’t mean
the temperature will increase by the same amount everywhere. It does not
mean that everywhere in the world the average temperature increase on
same level, just increase average temperature and it change the climate.
Globally we are agreed upon the reasons of climate change are man-made
increase greenhouse gases due to uncontrolled fossil fuel consumption.
Why everybody worry about climate change?
A) . Sea Level increasing,
B) . crops are affecting,
C) .Bio-Diversity affected,
D) .Diarrhoeal disease increased,
E) .food production decrease.
Direct impacts of climate change are:
• water scarcity,
•
•
•
•
conflict & Violence,
disasters,
displacement,
Mental health affected.
Indirect impacts of climate change are:
• Water bone disease Increased,
• Malnutrition,
• Allergic
• Respiratory problems,
• Dangerous for small islands.
Causes of climate change are:
1 Deforestation
2 Industrialisation,
3 Warfare,
4 Excess fossil fuel consumption,
We can mitigate climate change by the New model which is based on
Drivers(D),Pressures(P),State(S), Exposure(E), Effects(E) and Action at all
level(A). Source: Drivers: Industrialisation, Energy consumption, Pressure:
CO2, CPU; Green House Gases, State: Government, Exposures: flood,
draught, temperature variation, extreme weather, effects: Direct and Indirect
effects.
We can mitigate it by adoption (Accept results) and these preventive
methods: Forestation, Appropriate Fossil fuel Consumption, Waste
Management. Social Justice and Equity are the two major basic content of
mitigation. On the name of development all the state Drivers and State actors
working on it but without Conversion, Equitable Distribution, and
appropriate Consumption it will not happen (Equitable and sustainable
Development only possible through stated ways.
Policy Analysis
Policy analysis sessions conducted by Dr.Justin Parkhurst( London School
of Flygiene & tropical Medicine) he described the policy making with
various definition and examples like : "the authoritative
allocation of
values"-Easton 1953. "Albert Einstein said," there is only one constant in this
universe and that constant is change". Policy process: change involves
political struggle and struggle require power. Policy Analysis is focus on
how, who, why and not what while Politics address: who, what, when, how
and Science address only the good and bad impact of it. We can analyse
Policy by following approaches:
1.
2.
3.
4.
Interest Focused Approach,
Institutional Approach,
Group-Network Approach(Stakeholder)
Idea Based Approach
Policy change process is based on Rational, incremental and dynamic. We
can understand it by the diagram:
Policy Cycle
Agenda Setting
Problem
Identification
Programme
Evaluation
Policy
Implementation
Policy Formulation
We can analyse policy by two ways: a).Content b), Process analysis.
Content address objective, aim, assumption, value, distribution. We use
policy analysis retrospectively and prospectively. Policy analysis is not an
easy task it has many challenges like: analysis inherently subjective, all
policy is unique in time and place (How to generalise) and data is
sensitive & restricted difficult to capture due to complexity and dynamics.
Policy analysis is necessary for improvement," Policy analysis matters
because it helps us to act and move effectively".
In policy analysis agenda and stakeholder are two important content who
influence the policy, stakeholder’s role, organisation & network and power
to influence it and agenda clarify distribution. Key actors of policy are
state, market, consumer, community and civil society. Institutions set
agenda and under agenda setting Kingdon Theory is based on the
following streams:
1. problem stream,
2. policy stream,
3. political stream
To analyse policy under stated theory is easy and practical but we found
many differences between National and Global policy making like:
1. decision making arena,
2. Different actors & stakeholders,
3. global agenda rapidly change,
4. weak governance and accountability lines for global level,
5. Others.
Stakeholders Power and influence decide agenda of policy and it is based
on:
1. Who has power?
2. Who has influence?
3. What source of power - where does it come from?
4. What source of influence?
5. How is power exercised?
6. What is power?
As per Luke power is based on three dimensions:
1. power of decision making,
2. power of non-decision making,
3. Power as thought control-influence of desires.
Source of power are capital (Social, cultural, economic; symbolic power),
right and entitlements. Before analysis defining issues and problems is
necessary. Stakeholder’s analysis is necessary in the process because they
have interest. Under Prospective Policy Analysis these steps are necessary
to plan policy change:
1.
2.
3.
4.
Position Strategy,
Power Strategy
Player Strategy,
Perception Strategy
In India policy decides who is BPL and APL and entitle to get benefits from
welfare schemes, nowadays influential stakeholders got benefits (Like:
Business Houses) on the cost of public money and policy makers present
Placebo-Policies before public to keep public happy and hopeful, create space
for elite to serve their interest. Sometime police analysis is political analysis.
Transactional Analysis
Dr.Eric Berne (1971) Transactional Analysis: interpersonal relations tool
which explain the behavior of people and why they behave like this. You can
observe a persons behavior by the vocabulary (Words), gesture (Actions) and
attitude (Behavior).
Every human being behaves on three levels (Ego states):
1. Parent Ego State
2. Adult Ego State : always reasoning (Never combined by one emotional
feeling)
3. Child Ego State: behave like child.
Suggestions:
❖ Do not stuck, use option in life
You can measure your own energy (Ego) by ego gram.
Script: a blue print of your life plan.
Ego-gram: By ego gram you can measure the stage of a person and these are
major bar contents in it Child-Parental (CP), no-parental (NP), Adult
(A), FC, RC, AC, LP
You can change you ego-gram by these: awareness, acceptance, decision to
change (Decide); take steps to change.
Ideal Ego-gram need:
1. decrease CP,RC
2. increase A, LP, FC,NP
Four Life Positions:
Life position is based on Strokes (Appreciation,
acceptance),
1. I am not OK you are OK
(0-25)
(Inferiority complex)
"get rid off me" position, "Withdrawal".
2. I am OK you are not OK (25-40)
(Fundamentalism, Flomicide),
"Get rid off you" position.
3. I am not OK you are not OK
criticize , Suicide , Homicide
4. I am OK you are OK
(This is only a single healthy position)
Time sharing
24 hrs: 7 hrs sleep, 17 working hrs.
1 7 working hrs.
2.5 hrs. rituals
2 hrs, withdrawals (physic, psych)
3.5 hrs pastime (time spend without any profit motive)
4 hrs games (psychological)
3.5 hrs. activity
1.5 hrs intimacy
Games: psychological game is a series of an interaction relationship or
transaction between one person to another person or may be group
leading to a pay off.
❖
❖
❖
❖
❖
❖
❖
Activity: any work without profit motive.
Intimacy: physical, psychological; spiritual
Psychopathology:
Contamination(Most problematic) of ego-state
a) Single
b) Double
2 Exclusion
3 Symbioses
Single contamination: by Parents or By Child
1
A).
Parental: fundamentalism,
invading, prejudice.
fanatic,
suspicion,
oppression,
dictatorship,
Fundamentalism: strong believes on false theories. Our society is a
suppressive society who serves interest of imperious people. Main problem of
all our problems in our world is contamination.
WHY PEOPLE PLAY GAMES?
To get psycho strokes (Appreciation, Recognition) and Psych-Script is a blue
print of your life plan.
What to do in the Game?
A) Give Adult Transaction
B) No game will play from your adult transaction.
C) Change the subject.
D) Reject any role in a game.(Persecutor, Rescuer, Victim)
Degree of Games:
A) First Degree: It is a Temporary Stage.
B) Second Degree: It is a Revengeful Stage.
C) Third Degree: Killing
Dynamics of Stroke (Psycho): A Psychological stroke may be word, gesture
or act of recognition, one person gives to another. Strokes
can be Positive or Negative, Conditional or Unconditional,
Genuine or Counterfeit from Parent, Adult and Child.
Psychological Hunger: Depends on Stroke to get recognition.
1)
2)
3)
4)
5)
Conclusion:
1)
2)
3)
4)
Getting positive stroke or at least negative stroke.
Favorite ego-state (Life Position)
To remain your favorite ego-state(V)
Favorite structure-gram.
Favorite game.
Keep high your adult ego-state,
Reject any role in game that will keep me happy every time.
Be generous to give positive strokes on time.
These points give me success in my life.
Eric Bern's Games formula "G":
C+G=R:=>S=>X=>P
Gimmick, Response, Switch, Cross up, Payoff)
(Construct,
Stepan Karpman’s easiest Formula called Drama Triangle is based on
Persecutor, Rescuer; Victim likes this:
Stephan Karpman' Drama
Triangle
P
R
P=Persecutor
R=Rescurer
V=Victim
V
Systemic Thinking
In the Systemic Thinking first of all we should know the objectives of
organisation nature of organisation and why people participate in the
activities of a voluntary organisation?
Voluntary organisations objectives are good and based on pious hopes and
based on need of community like: relief & welfare (Immediate), Community
Development (5-10 Years); Sustainable System Development (10-20Years).
Activities of NGO's are based on Felt Need, Projected Need and Analyse
Need (Time & Effort).
Before starting a programme we should design trust building within
community by your skill and knowledge, Create Dendrite because every
human being's memory is combination of Emotion and information and
construct trust. Soft system methodology model (Google +SSM) and a
purposeful Activity Model (PAM) construct trust in the community and it
will be right time to start wok with community.
Apply public goods theory it contains Easy-Difficult, Low-High joint use
relation and all goods have following four Function and Four Questions:
1. Provision Function
Provisional Questions (in Beginning)
2. Production Function
Production Question(Day to day Activity)
3. Consumption Function
Consumption Question(How many )
4. Co-production Function Co-production Question (Participation)
System thinking is based on Input and output, output change form of input
or you can say input is unfinished and output is finished thing. System is
based on specification without it can not exist and specification is based on
Client, Actors, Transformation (Information of Input), Worldwide View,
owner; Environmental Constraints (CATWOE). Before intervention we plan
activities and event (time) and the structure is:
1. List Problem(Need Assessment)
2. Priority Ownership(Money)
3. Public Goods Categorisation
4. Function
5. Flow Chart(System Design)
Every time System thinking is in circle and in loop our system control birth
by Immunisation, Nutrition, Health System and Death by Health Care, Food,
War, Disaster and you can say it in different words its combination of Cause
and effect. We can understand
it by the following diagram:
Cause
(Link)
LoopfF eedbackX-)
(+)
Effect
Birth(+)
Death
Population
Cause and effects have adverse
relation if cause if heavy than
effect of intervention is light
and
if
cause
is
light
intervention of effect is heavy.
Prioritisation,
control
and
owner ship decide the success
sustainability
of
and
programme.
Technical adviser is an expert
of CATWOE he will analyze
Transformation (T) on the basis
of Objective Current (Tl), Objective Desired (T2); Specification (T3). In
first phase we will prioritise the problem, choose Skill and knowledge,
CATWOE; Reality Check:
Reality Test (Relevancy)
Idea
k
Actor-Tech
f
Relevancy
Test with
Client
PAM-1
MC4
MC3
MC2
Mental Construct
(MCI)
nlcal Expert
Actor-Govt.
Actor-NGO
We perform reality check with various actors (Govt, Community, and NGO)
by flowcharting. Effectiveness, Efficiency; efficacy (E3) decides success of
your plan and it will also show you approach towards problem.
Personality and Communication
Mr. Krishna Chakwarty conducted the class without notebook and pen and all
the sessions are completely practical which was based on various exercise
(Mirror, Use of Prop, self-sound creations etc.) and plays to perform. After
two days training fellows developed a play and played it on Cleanliness and
health with other issues. He explored the qualities and barriers in smooth
communication in participatory mode with fellows.
Qualities of speaker are:
1. Eye Contact,
2. Confidence,
3. Gesture,
4. Addressing Everyone,
5. Facial Expression,
6. Voice Modulation,
7. Knowledge about Subject,
8. Careful Listener.
Barrier in Communication: Fear of Others Reactions
My learning’s are: Observe Listen, Humble and Patience.
Communication is an important part of our life, our life is based on
relationship and relationship is based on communication and without
communication we are in great risk or in deep rouble. Most of the time in
our life we communicate from non-verbal mode of communication. We have
three types of communication: Crucial, Important and Interesting.
Barriers in communication are:
1. Language,
2. Acceptance,
3. Superstitions,
4. how to start communication with community / woman,
5. How to approach?
6. How to tackle emotions?
Answer: You should be a good listener.
Qualities in group communication are:
1.
2.
3.
4.
patience
listener,
time needed
Leadership (Democratic, Autocratic Dictator Etc.)
5. Empathy (Not Sympathy because most of the time sympathy is lip
service)
6. partnership,
7. Inter-Personal-Communication(Trust or Close Communication)
8. Responsibility,
9. people's Participation,
1 0.Media
In Nero- Linguistic- Programme we follow these
Study=>identify=>Interact=>Repo
>Aware=>mobilise
If programming is perfect outcome will be fantastic and responsibilities have
risk. If you want to achieve something change the meaning and after that it
will be mission.
Our analyse anything on the basis of VAK (Visual, Auditory; Kinaesthetic)
and it is called Representational System.
: Colour, Light, Size,
Visual
(Seeing)
Auditory
(Hearing)
: Tone, Volume
: Temperature, Pressure
Kinaesthetic
(Feeling)
Primary Representational System (PRS) Example:
I hear what you mean.
I see what you mean
I feel what you mean.
A community health worker influence community leaders by stated PRS
Example.
1. Intra-personal communication is good like: Self Analysis, Prayers and
Self Assessment.
2. Self-Disclosure is important but boring like: Preaching, Teaching and
Boring.
3. Inter-personal communication like: I, Family, friends, relatives, coworkers, people.
<♦ If you use three words great, marvellous and excellent everyday to
encourage five people you can get amazing results.
Every Communication has five levels:
1. kliche
: Good Morning, Bye
2. Information
: Facts.
3. Opinion
: Point of view, trust building and leaders share
opinion
and risk.
4. Experience
:SWOT(Strength, Weakness, Opportunity, Threat)
S WOC(Strength, Weakness, Opportunity, Threat)
SOFI(Strength, Opportunity, Fear, Impediment)
5. Peak :
conversation reach any of the time.(Forget
About it )
Generally communication is nothing it is knowledge sharing information and
idea opinion between two people or among group of people. It is based on
Knowledge, Attitude and Behaviour.
KNOWLDEGE , ATTITUDE AND BEHAVIOUR CONTROL GRAPH
K
Communication is a complex process and it has important elements of cycle:
COMMUNICATION -CYCLE
ENDEI
FEED
RECEIVER
•
MESSAGE
CHANNEL
Diluted and Halt Communication is Very Dangerous.
Problems in communication is based on
• WIGO (What is going on?)
• WIS (What is selected?)
• WIMTU (What its Mean to us?)
Three Dangerous things in communication are:
1. Deletion
2. Distortion
D+D+G=DDG
3. Generation
Outsource
5 senses
====^DDG=-*Mind
■^Constructed reality
Problem in Listening
Physical Tired
1
2
WIGO
3
Language
4
Distraction
5
Psychological
6
Speed (200 words wpm)
Unfamiliar with topic (Lack of interest)
7
Preconceive notion (Filters)
8
Sitting Arrangement
9
Two Principals of Listening are:
1 UPISE(Understand, Patience, interest, support, empathy)
2 SOLER(sit-straight, openness, Lean-forward, empathy, relax)
(Anthropological research observation is important to cater society.)
Left side of brain is logical and right side is creativity, under Nero linguistic
Programming we have five rapport positions:
1. Content Rapport
identifying Key Words,
:Short Form without lose of feeling,
2. Emotional Rapport
3. Tone & Tempo Rapport :Positive conversation,
:Mirror,
4. Posture Rapport
5. Breathing Rapport
: intense (Lover, Mother and Child)
Under Communication we can access eye ball movements also. Psychological
empowerment is the prerequisite for development. Interpersonal analysis is
based on: goal, aim, mannerism, attitude, Reading, training programme; role
model.
Creating Group is important, without group we are unproductive and we can
create it by following steps:
1. creating group idea is better than individual
2. group idea or decision is better,
3. effect of group is great,
4. group decision is not a argument nor debate,
5. Group seeks conviction.
Ten Commandments for communication:
1. best possible solution,
2. avoid pre-conceived notion,
3. participate (Contribute your idea),
4. say what you really think(Honestly, no need to please)
5. be flexible(Consideration)
6. learn to listen,
7. do not start on a different track (Brief and to the point)
8. ask for clarification
9. have a grip over the discussion
10.Agree to disagree.
Your communication should be short, sharp and penetrating (SSP).
Listening is not acceptance, rejection is not sin but without reason it is.
We found these task Functions in group communication as:
1. Information Giver,
2. Opinion Giver,
3. Direction giver,
4. Summarisers,
5. Reality Tester,
6. Evaluator.
They all play important role in group with these role players
communication spoiled. In a meeting these functions for maintenance:
1. Flarmonizer
2. gate keeper
3. praise giver,
4. tension reliever,
5. empathetic listener,
6. Inter-personal problem solver.
In community effective communication is important and tool to address and
engage with real issues.
Use of Rational Drugs
Medical Practitioners prescribed Drugs to patient to recover from illness but
under the influence of pharmacy companies many Health Practitioners
prescribed medicines irrationally (Combination) to patient which is not
ethical. They prescribed medicine more than required, inappropriate
medicines and combinations of medicines and its called doctor shopping. We
understand the necessity of prescription to avoid Risk, Drug Resistance and
poverty if they prescribe rationally.
Rational Drugs means which is based on effective, sufficient, adequateduration, clinical condition and lowest cost. Due to irrational medicine
prescription many people lost their life or trapped into poverty. If we use
rational medicine we can avoid Minimise Health Expenditure, Drug Toxicity,
Antibiotic Resistance, Side Effects.
In 2002 our Govt, initiated National Pharmaceutical Policy - 2002(NPP); it
is based on following objectives:
•
Ensure affordability of medicine,
•
Encourage indigenous remedies(R&D)
•
Encourage
It is a compact form of policy and addresses these:
1. Drug Price Control Order(DPCO)
2. Drug and Cosmetic Act,
3. NIPER(National institute of pharmacy education and research)Act
Under DPCO, National Pharmacy Pricing Authority regulates the pricing.
Drug and cosmetic Act prohibit spurious medicines production and clinical
trials and NIPER address educational part.
Public Health Movements and Community Action for Health (CAH)
In context of health Policies influence Drivers (Elite-Class, Companies,
Govt., Consumers) and in India we have a very good History of Public health
Committees (Sokhey, Bhore, Mudallar) and
policies (National Health
Policy2002, National Health Mission 2013) but the recommendation and
implementation is very hard and our Govt, signed Alma-Ata Declaration with
125 countries but before that many Medical Practitioners and Others have
similar intension like "health for all". And they after alma-ata they thought
that the implementation part is weak so we need movement to create people's
pressure on system and they initiated People’s Health Movement (PHM),
and India people called it "Jan-Swasthy-Abhiyan"(JSA), before PHM many
groups (MFC, VHAI, CMAI, ACHAN) were exist but most the groups are
Doctor Dominant and its major hurdle to address public health because
people thought health is doctors issue.
They realise and analyse the problem and formed Public Health Movement
nationally after that they aware, mobilise and gather the public and organised
World Health Assembly where 75 countries 1500 representatives
participated and they launched People’s Health Charter in 50 Languages. It
changed the scene of public health in India. After it Governments and other
interest group (Drivers) realise the power of people besides election in a
democratic country. JSA established the truth that we will win if we are
united with people.
Community Action for Health (CAH) is based on Community Health
Problem and its Community Based Solutions. Through CAH we can change
anything and in these processes: Library, Resource Centre, Lecture, Study
Circle and Cultural Activities are important tools t empower community
towards health. It counter the idea of serving people, it establish idea of
working with people - as per Mr. Alan Leather (Action Village of India).
• Globalization and Health :
Globalization is not a new thing for India from ancient times people from all over world
come to India for business, education and spiritual learning. Due to After gulf war, split of
Russia and Economic Recession world became uni-polar behind G7 Countries (Now G8).
IMF, World Bank and Asian Development Bank dictated the terms of loan to the developing
and underdeveloped countries before loan. And their terms are based on Liberalization,
Privatization, Globalization (LPG) and the main source of these elements are World Trade
Organization and GATT (General Agreement on Trade and Tariff) and most of the third
world countries sign it.
From 1989 our country follows the world economic order under the leadership of IMF and
World Bank and decrease expenditure on welfare and public services. Privatize the Public
Sector companies into private sector company listed it into Stock Market and encourage
privatization of services like: Education, Health, Public Services (transport, Water,
etc.)Banking, Natural Resources on the name of Neo-Liberalization Policies or Economic
Reform. After 2000 Govt, of India boosts the speed of reforms and auctioned the natural
resources like: Coal, Mineral Mines, land and water also and formed Special Economic
Zones (SEZ) in many parts of country.
All these new economic policies effect democratic nature of our country and our Govt.'s try
to forget 'welfare state’ concept and as a result our health system badly affected, in 1978 our
country signed Alma-Ata declaration with 120 countries and primary objective of the
declaration was "Health for All" by 2000 but now World Bank and IMF change it "Health for
who pays" and as result every year number of Private Health Care Institutions increased,
worth of pharmacy companies increased but on the health index the scene is completely
different. Our country is a heaven for multinational pharmacy & health insurance companies
they are making a huge profit.
In conclusion globalization is not a new phenomena but present globalization is fueled by
multinational corporate.
• Social Stratification and Health:
Before my learning sessions 1 understand caste and gender play a major role in a person's life
or community life but at SOCHARA, I understand that it also effect health. Upper caste, class
or high income group people easily utilize the public health services while another side of
people unable to access the public health services. Gender based cultural practices also affect
the health of a person like: higher number of anemic Women. Condition of public health
services in low income group areas are in shocking condition. Every year we read the story of
negligence like: institutional death of women in sterilization camp; lose of vision in eve
camps etc. and all these happened with Low Caste, class or low income group communities.
Most of the marginalized communities under high risk of health problem.
• Research:
Before Community Health Learning Programme Fellowship, I only know the data collection
in community not more than that and little bit familiar with statical terms (Mean, mode,
median; Standard Deviation) which was in my master's subject.
In SOCHARA I understand need of research for development and research is evidence(Facts
and figures),
sources of data(SRS, NFHS,DLHS,AHS, NSSO), Types of Research :
quantitative and qualitative research : Quantitative Research quantify the things and
incidents(How many, How Much, How Often)
while Qualitative Research developing
explanation of social phenomena and finding answers of questions (Why, What, How), data
handling and analysis(interpretation of Data).
I understand more about qualitative research
an in-depth interview or study of person /community to get in-depth understanding about the
issue capture real situation and feeling of community. After collection of in-depth interview
we analyze it manually or by the help of software.
VISITS AND PROGRAMME PARTICIPATION LEARNING S
Transit Walk (Rajendra Nagar-Bangalore)
It was my first field visit in non-Hindi speaking area where most of the population migrant
from various place like: Tamilnadu, Rural area of Karnataka and other areas also. As per my
observation I think on the basis of problem we are united. People face many health problem
but the authorities are ignorant towards it.
Snehdaan (Bangalore)
Snehdaaan is place where you can feel smile of HIV / AIDS infected children and their
participation in games without fear. They try seriously while they also face discrimination in
the society.
National Institute of Tuberculosis & Yashwantpur DOTS & AIDS Centre (Bangalore)
Visit of national institute of tuberculosis is a life time learning experience where I have
learnt about key aspect of TB, Burden of disease, TB control programme (RNTCP), types of
TB(Pulmonary(Communicable) and Extra Pulmonary(Non-Communicable), MDR and XDR
). TB is a most dangerous disease but easily preventable in a specific time. TB patients have
high risk of HIV also.
Association of People with Disability (Bangalore)
After the whole day visit at their workshops(Vocational), schools, screening of documentary
and sharing of Person with Disability, I have learnt that Life is full of challenges but if we are
competent to change it in opportunity than a person will be useful for himself or herself.
a
Anganwadi(Mailasandra-Bangalore)
All the Anganwadi
are same but it was a model on the basis of cleanliness and child
participation the centre worker was working there from last co many years and her interest
keep the centre live. The centre worker’s interest keeps it active and clean.
Primary Health Centre (Dom Sandra- Bangalore)
It was a first PHC visit for me and it is also a model PHC for me where doctors and staff are
serving patients. I have learnt that in urban area health centers require multi-lingual
information on public domain because many patients were not fluent in regional language.
Ekta Parishad (Bhopal)
During My first field work I have visited Ekta Prishad and am working on effective
implementation of Forest Right Act, PESA and land right. They believe in dialogue, non
violence and de-centralization. Their sustainability is based on the following:
1. Re.l/-froma Family,
2. 1 hand of grain,
3. 1 person from a family,
4. 1 month for action
5. Ekta Europe and other Supporters(South Asian Peace Alliance SAPA)
Power of Poor: Most of the citizens of rural India are poor but they have instinct to struggle
and survival (They survive on one meal, less sleep with out bed, minimum utilization of
water) and it is energy or you can say power of poverty.
And after visit of Ekta Parishad I have learnt the essential elements and energy of people’s
movement.
Sambhavana Trust (Bhopal)
I have visited Sambhavana Trust and they are working for gas tragedy victims and fight for
them inside and outside court with an alternative health centre under various settings
(Research, Documentation alternative therapies etc.) and they have expertise on industrial
disasters or chemical disaster. After so many of years of struggle people have faith on them
and their work establish credibility among the people.
Kolar PHC and District Hospital (Bhopal)
During visit of PHC Kolar and District Hospital I observed that most of the Programmes
supported by various agencies like: Unicef, UKAID, USAID etc., Hospital staff is co
operative but they have lot of pressure without any excuse while they have shortage of skilled
human resource and I also observed that mental health is not in priority list in system while
they have counselors on various subjects (like: Family planning).
M.P. Vigyan Sabha (Bhopal)
They are working with tribal community by 'Science for people' and 'Sustainable Livelihood
by non-timber products' Programmes and the manufacture many herbal products (Soap,
Honey etc.). But as per my understanding the success of any livelihood or another
developmental programme require multicultural approach.
Centre for Integrated Development (Kolaras- Gwalior)
I have spent two days with Sahariya tribe community, visited four villages with Mr. Sabu
there.
I observed that the life of Sahariya community is difficult and most of the
developmental Programmes are on paper they are struggling for minor entitlements like: PDS
Card, Voter Id, and Land. I have learnt so many things there but the important learning is
"Without struggle or fight they can not survive".
PARTICIPATION
CHESS (Fire Flies-Bangalore)
Representatives many countries discussed health, environment, mining, land acquisition,
energy policies and its impact on health and environment. After sessions and open discussion
and play I have understand that in India we have very limited access to clean energy, recently
Govt.'s establish a new trend to pass ordinance (Executive power) without which is easy in
the interest of corporate or multinationals which is against the democratic values, coal mining
create many health and environmental problems like green house gases-black lung disease
food scarcity and global warming.
Bhoomi Festival (Vasteras - Bangalore)
I saw first time that the festival is based on social issues with creative workshops and
documentary screening. After participation in the festival I understand the importance of
f
culture and its relation with people. Documentary screening division was outstanding they
screened 5 minutes to 10 minutes documentary on climate, people's struggle and commercial
food production and it was full information and efforts. It was a really "learn with fun"
experience.
Women’s Day (SCMI-Bangalore)
The programme was organised at SCMI where Dr.Revthi Kutty addressed problem of Dalit
women and societal attitude towards marginalised community. And as I understand that the
women from Dalit community face double problem (Inside and outside community).
Free drug distribution-medication policies (Bangalore)
The programme was organised by SPAD and others at SCMI where the discussed the free
drug distribution-medication policies and regulations regulating health services. After
discussion I understand that the health services also need a regulator in the interest of patient.
Conversation on Anti-Discrimination (ALF-Bangalore)
Alternative law forum (ALF), was organized a conversation on anti-discrimination on the
basis of disability, caste, class; gender. From last few years they are exploring the
possibilities of a movement against discrimination of all forms
which could lead to the
drafting of comprehensive anti-discrimination law. They interviewed 85 persons in south
Indian states who belongs the stated identity. I have attended many Programmes on caste,
gender and disability but it was first programme for me on class based discrimination. While
day programme teach me many aspects of discrimination and I have learnt the following:
Disability and discrimination:
1
1.1
After RTE and SSA we have a good programme for CWSN and we can
protect and develop their level through.
1.2
Most of our structures (Cinema, Malls etc.) are not disabling friendly but not
anybody raise the voice.
2
1.3
Systematically our approach I right but the major barrier is attitude.
1.4
Disability has strong relationship with class and caste.
1.5
Social participation floor or level differs on the basis of disability.
1.6
We need reasonable accommodation also (Mental).
Caste and Discrimination: Indian judicial system is not fully equipped to address
the caste based discrimination and Prevention of Atrocity Act (POA) is the single
remedy among the Dalit community. Caste is not a physical unit it a Psychological
unit in our mind when Dalit raise the questions attack happens it not a matter that
it will be institutional or structural attack. Implementing agencies (Police,
Judiciary; Beurocracy) are busy to maintain the colonial system. When we raise
the question of discrimination they raise the question of reservation while the
duration of duration of reservation is sixty years but the discrimination has long
history.
3
Gender and Discrimination: First question comes in mind how we can measure
discrimination?
Before talk about gender based discrimination we should talk
about religion based discrimination (Muslim and other minorities) because it's
common in pubic domain but nobody want to address it. From last twenty five
years a group of people demonizing the words: Secularism, Tolerance; Equality,
Social Welfare and if you talk about people's right they divert it by responsibility.
They establish a parallel code of conduct which is beyond law, they say we
respect law and legal system but they did not exercise it.
After independence to till date communal riots are the permanent feature of our
democratic country and in the communal riots women are the main victim we have
seen in Gujarat, Kandhmal and other places. Few laws are also barricade to
exercise the democratic rights like: law on Beef and Religious Conversation (In
M.P. Religious Freedom Act). On the basis of religion Muslim community
suffered by many social problems like: Triple talaq, Halala, Shariya Laws,
democratization process of community, absence of ideal role model (Like:
Ambedkar, Phule etc.)And actual representation in the society and other places.
Across the country every Government is in busy systemic ghettoisation of Muslim
community. Women of Muslim community have double burden of discrimination
and Governments are decisive by the nature and every time they follow populist
approach on the name of majority or faith. Muslim women are faceless creature
from independence to till date Govt, only consider Muslim Men’s (Fundamentalist,
Conservative and Orthodox)Voice on the basis of participation they never realize
the women of community face problems in the community.
Many people advocate the uniform Civil code in the matter of gender but they
simply present CUT PASTE version of Hindu family law on Muslim women while
within Islamic domain community have many remedies. And triple talaq is also a
constitutional challenge in India.
Member of Trans Gender Community also raise the issue of discrimination
within the community also on the basis of their caste, they face discrimination in
religious places (Like: children of Satan) and Honor Killing.
4
Class Discrimination: class based discrimination is not a new thing for India
before colonial era oppressed class community face discrimination. After
independence our constitution gave us right to equality or neutrality of law but in
practice oppressor class (Imperious class), implementing agencies neutralizing the
law in the interest of corporate. Slum dwellers, domestic workers ; labour unions
face many problems like eviction, living wages, labour rights but nobody is
interested to solve it. On the name of development without rehabilitation they
evict the slum dwellers from their shelters, they limits the rights of labour on the
name of labour reform. Karnataka have rich history of labour movements and it is
demand of time to coordinate all the labour movements. Workers of Honda
(Rajasthan) also shared their experience in the factor and the nature of labour
court there.
National Meeting on ‘Maternal and Neo-Natal Health1 (Bhopal)
The National Meeting on ‘Maternal and Neo-Natal Health" organized at Bhopal by the
Common Health (CH) in collaboration with the Society for Community Health Awareness
Research and Action (SOCHARA) for two days. I have learnt without addressing these:
•
Denial of services(in health care services).
•
VHND Monitoring,
•
Blood Availability,
•
Availability Essential Medicines.
We can not handle maternal and neonatal health properly.
Free Drug (Bhopal)
It’s a two days workshop on free drug distribution policy by Prayas at Bhopal they discussed
the policy and its logistical system contents with Govt. Officials and others. After attending
the programme I understand the complexity of the issue like: essential drug list and practical
problems of supply, implementing problems and if you start a scheme without preparation
(Logistical) you can get adverse result. So we need proper planning before initiating any
scheme and network of other beneficiaries who monitor it.
Beedi Labour Meeting (Bhopal)
I have participated one day state level meeting on Beedi Labour Condition and Future
Strategy, activists, representatives of Beedi Rolling Union, Journalist and researchers
participated. In the meeting they discussed the problems of Beedi rolling labour, the role of
labour welfare board and successful cooperative model of Kerala Dinesh Beedi also. After
participation I learnt that one side union or collective is important but another side they need
support for their future because the consumption of Beedi is decreasing so they require
alternative employment also.
Workshop on “Religion, Culture and Constitution” (Harda)
It was two day meeting with local leaders, lawyers and students of Harda District who work
for peace, communal harmony and development. In the meeting people discussed religious
values, politics of religious identity, multi-cultural heritage and constitutional values. After
participation I learnt that Religion, Culture and constitution is co-related and have an
important role in society but from last few years people use it for their political interest, they
propagate religious identity not values while values of religion and constitution is the core
element. All these practices are the tool of exploitation against marginalised communities. I
also addressed session on Health and Constitution.
MFC (Raipur)
In Raipur all he fellows of SOCHARA visited three slum areas of Raipur in three groups to
know the Mitanin Programme and I have observed and compared these from Madhya
Pradesh (One day Field Visit):
• The Mitanins of the area getting support from system (SHRC), they fight for
community in the hospitals and they are not assistant of ANM. Sometime they
complained about ANM and Hospital staff also.
• A person's orientation is important regarding programme and services.
• Community supports a person who works for them.
• If we compare condition of MP and CG ASHA (Mitanin) is totally different, in MP
they feel like they are Govt, servant not activist.
• In MP they are busy with Hospital and ANM but in CG they support other activities
also like: Utilization of untied fund.
• In MP it's hard to found but in CG they wrote the Mobile Numbers on Wall with toll
free Complain registration Numbers.
Theme of MFC meeting is Urban Health and the following points are my learning:
• We are following global trends in business and other area of life than why we are not
advocating universal training for medical practitioner.
• JNNURM & RAY is focused on urban poor but it is not addressing the problem of
migrant labour and their health is in under threat. Construction sites are major
breeding point of disease and most of the construction labors are migrant.
• On paper s it is easy to find health services in rural area from Govt, but in urban area
it's hard.
• In context of waste-management our local authorities follow colonial system.
Burning of waste is dangerous we can replace poly-bags with our jute or other bags
and packaged food to other traditional food (Ground Nut, Jaggry) because packaged
food increase waste.
• Urban area ghettoisation (Dalit, Muslim, and LGBT) is also violence prone area.
• Health care Facilities and Health Seeking Behavior have huge gap.
• Cost recovery idea is not appropriate in health.
• Health is more than illness.
Learning from First Field Placement
My first field placement was in SOCHARA Bhopal in urban slum of PC Nagar in this
field work I have to understand about he community and find out the problem in
community.
Understanding of Organization
SOCHARA Bhopal is extension of Bangalore SOCHARA and focus on public health
issues like: Malnutrition, Maternal Health, Mental and Occupational Health and other
community initiatives also. Through capacity building, research-study and advocacy
SOCHARA intervene on public interest matters with alliance of Fellows-Collective (30
districts) and other originations, campaigns. In Bhopal, SOCHARA intervene in six
(PC Nagar, Ishwar Nagar, Gulab Nagar, Indra Nagar, Meera Nagar, Sai Baba
Nagar)slums directly and the primary interventional area are Anganwadi, support
USHA, ANM, Mahila Arogay Samiti and slum community. Main focus of the
organization is community participation in health services. The focus area at present is
malnutrition, Mother and Child health in slums.
The main objective of the organization is democratization of health services through
Community Action, Research and supports most of the grass root organizations. To
address the malnutrition they are educating empowering Asha, Anganwadi worker with
mothers of children and they also promote local food in place of packaged food item.
Understanding about Community
Bhopal is the Capital of Madhya Pradesh and basically administrative city, it is famous
for lakes and historical buildings (Places, Mosques etc.). But last thirty years Bhopal
Gas Tragedy is the recognition of the city and victims still waiting for the justice. After
this man-made disaster Government of Madhya Pradesh Recognized large number of
slums and residents of slums got Patta. Bhopal Municipal Corporation is the principal
provider of civic services to the residents of Bhopal. Key activities under BMC
comprises (Bhopal Municipal Corporation)
Street Lighting
Citizen services
Health & Sanitation
Heritage cell
Garden
Water supply
Fire services
Housing Status of Bhopal Urban Poor: Land is an important economic resource and
the ownership of such economic resource is important for every family and household.
In Bhopal, only 62% of the slum households have Patta, which is an important
document given by Tehsildar for land ownerships. Households with Patta usually live in
Pucca houses the households have Possession Certificate document and might be living
by Semi Pucca structured homes of slum households. The main reason of rising
population in slum areas is Migration and it is becoming a serious issue for cities.
Growing urbanization and employment opportunities have attracted majority of the
people away from their home to earn basic livelihood.
In Bhopal municipal
corporation recognized 366 slums it means that the municipal corporation is responsible
for civic amenities. Most of the people n slum areas migrated from one place to another
within the city.
Earlier I have stated that SOCHARA intervene in six slums actively at No. 12 Bus Stop
and after transit walk I decided to experience or understand Ishwar Nagar community.
Ishwar Nagar is a largest slum area in No. 12 Bus Stop Slum most of the residents
migrated from one place to another (Like: Habibganj Naka, Abbas Nagar, 12No. Stop
etc.) From last 30 years. Most of the resident's native place is from Maharashtra, Sagar
and Rewa and they live in their ghetto or pockets from last 20 years. Election after
election they got entitlements like Patta, Ration Card, and Electricity connection, Road,
Water, School and Anganwadi also.
Culture: People follow their own culture and marry in similar community. Muslim
celebrates Eid and Hindu celebrates Diwali and
Marathi speaking people celebrate
Dr.B.R. Ambedkar's Birthday on April 14.
Livelihood: The major source of livelihood is construction work for men and domestic
work for women recently they have other sources also like Sand Loading and
Unloading.
Main Concerns of Community: Livelihood is the primary concern of the community
because nature of their job is uncertain and second is health because they live in very
unhealthy environment and most of their money goes on it and their last priority is
education they enrolled their children in schools Government, private and madarsa also.
They understand the importance of education so the children of the area enrolled in
schools.
Social Problems: As per my interaction with community members, children and other
Voluntary organizations members the place is full of problems by the system and by the
people. People face many problems: Seasonal Employment, Alcoholism, Gambling,
Addiction (many: Whitener, Tobacco), Domestic Violence, Child Abuse, Eve-Teasing,
disease (Typhoid, Jaundice, Malaria, etc.Malnutrition, Stress-Anxiety etc. By the
system they face many problems like the whole slum area have water supple pipe lines
but MCP Supply water from water tankers, roads without cleanliness, drainage is
choked, everyplace is full garbage, all the Govt, health services is 5 K.M. far from the
area and uncertain Housing status due to JNNURM and Ray.
Social Determinants of Health: the Social determinants in community are (SEPEC):
A)
Poverty,
B)
Clean Dr inking Water (Sanitation),
C)
Housing,
D)
Health,
E)
Hygiene,
F)
Child Labour,
G)
Education,
H)
Health services,
I)
Common Place.
Medical Pluralism: People from these slum areas try their traditional remedies if they
have any idea of illness after that they go to Private clinic. Govt. Hospitals and
traditional healer. In jaundice, typhoid and metal Problem they prefer traditional healers
and shrines. In minor illness they prefer Private clinics (Bengali Doctor) or nearby
nursing homes in case of urgency. In delivery, TB and other cases they prefer Govt.
Hospital (Dist. Flospital and 1100 quarter Clinic). Some of community members avail
services of Traditional Birth Attendant at the time of delivery but after the Ladli Laxmi
Scheme and Maternal Health support Scheme the number of institutional delivery
increased.
Day by day the number of immunization and visits at Anganwadi increased due to
Active visits of ASHA's and also in VHND. They are also facing problem of storage
space, water, electricity and rent also.
The first information point about health is ASHA and Anganwadi in the community.
Institutions in the Field Area : Ishwar Nagar is the largest in the area and it has
Anganwadi, Govt. Primary School, a Private Middle School, Fair Price Shop (PDS) and
Child Learning Centers (NGO's). All these institutions are easily accessible to the
community and they utilize the services as per their necessity. In district hospital they
have Breast Milk Bank, NRC, One Stop Crisis Centre (Violence against Women);
Blood Bank also.
Learnings: During field work I have learnt the following with community members and
others (Govt. Officials-WCD, Health, and Education):
1. Observation: Before CHLP I observed many things but after joining the
Programme I utilized it in my life as an experiential learning. In initial stage
language and circumstances is the major barrier for a learner but observation gives
us a new dimension to think about the life.
2. Systemic and Critical Thinking: Before CHLP Programme I have experienced
Flow-charting in computers in my college days but it is also essential in life without
systemic thinking we can not plan activities and assume the result. Critical Thinking
is necessary for a person and it requires logic and address issues collectively in the
interest of society.
3. Research & Documentation: In simple way we need facts and figures to establish
any issue or thought and it require Research (Re+ Search) and it's not a new thing. It
depends on aim and objectives. Research and other activities need documentation
for record and other purpose also. Both were new for me before CHLP but not now.
4. Social Determinants of Health (SDH): Social Determinants of health is collection
of Social, Economical, Political, Cultural and Environmental condition which
determine the health of society. After joining CHLP, I understood that many health
problems like: Malnutrition, TB etc are not only health problem and we can prevent
many diseases by real development.
5.
Organization and Alliance: The CHLP taught me many collective actions in
community and organization and alliance is essential for it without organization and
alliance we can not achieve goals in the interest of community.
6. Analysis and Assessment: Before any Programme we need real assessment and
analysis to understand the nature of problem and its root cause, after that we can
plan or strategies the activities.
7.
Relation bebveen Development (Globalization) and Health: Before CHLP I
thought that health is an independent issue but after joining the programme I
understood that it is inter-dependent issue. We can prevent many diseases by
development, behavioral-attitudinal change and social dynamics. Irrational
Urbanization and industrialization also affect our health.
8.
Communitization and Public Action : Communitization and Public Action is
very important aspect of life, in my opinion communitization is similar to
democratization where community decides many things what is best in the interest
of community(Like : Local or Regional needs and solutions). Real Democracy is
based on people's participation (Planning and Decision) and action.
9.
Prioritization and Resource Mobilization: To address any social issue
prioritization of problem is essential because our society faces many problems in
day to day life but we can select it as per our Skill and Knowledge with community
consent. After prioritization we need resource to run it so local resource
mobilization is necessary.
10. Equity and Empathy: We need Empathy to empower the community and our
community health journey starts from equality to equity.
Conclusion
After completion of one year learning fellowship programme, I understand clearly that health
is not an independent content in human life its depends on social, economical, political,
cultural and environmental conditions. Active listening, learning, observation and
intervention create bonding with community and it is an asset for any kind of intervention.
Without community recognition and support we can not address public interest matters. I
always remember tap turner off rather than floor mopping and balloonist approach to see a
problem in collective manner.
Reading
2. Where there is no Doctor,
3. Everybody Need a Good Drought -P.Sainath,
4. Article on Health Right
5. Article on HIV -Yogesh Diwan
6. Maternal Health Dialogue(News Letter)-Matemal Health Right Campaign
Paradigm Shift
Me
We
Bio Medic Remedies
Social & Other Remedy
(Not Alternative)
Observer
Analytical
Specific Approach
Wholistic Approach
Global
Local
Independent Problem
Analysis
Inter-Dependent-Problem
Analysis
Critical Thinking
Collective Efforts
(Combination)
Economical
Valuable, Sustainable
Class
Community
Equality
Equity
Sympathy
Empathy
Floor Mop- Per
Tap Turner Off
Research Study Report
A Study on Health Services Utilization by Beedi Worker at
Rahattgarh
Aim:
•
This study aims to identify the health problems and explore barriers in accessing the
health services of BWWF and CHC by Beedi Workers at Rahatgarh, Dist.
Sagar(M.P.)
Specific Objectives:
•
To identify the health problems faced by Beedi Workers with reference to their socio
economic condition.
•
To document barriers in accessing the services of BWWF clinic & CHC).
Background of Community
In this neoliberal world nature of many industry has been changed, some industry travelled
from small scale to factories and some has been travelled from factories to house hold nature
and beedi manufacturing industry is one of them which comes in the second stage, from
factories to house(in unorganised manner). Basically Beedi manufacturing industry is situated
in rural areas where there is no alternative employment and cast factor is also involved in it.
Most of the labours in manufacturing of beedi belong to scheduled tribe, in Tendu Leaves
collection, SC and Muslim community in beedi rolling (manufacturing). The beedi industry is
the one of the many among the unorganized sectors all over India. Due to unorganised nature
of industry and large number workforce of women and girls create huge profit to
Sattedar(middle-man) and owner at low cost, risk and liabilities. It is a unorganised, labour
intensive, back breaking and vigorous occupation.
In M.P. 10.21 lakh labours have identity card in the beedi manufacturing industry and as per
the Govt, data 60% women involved in it. And beedi rolling labour faced two types of
identity first one who have labour departments Id(for minor health and other problems) and
another one is identity card with salary slip(For Major benefits Pension, social security etc.)
and the second one category is very low in numbers(hundreds). The main centres of beedi
rolling in MP are Sagar, Jabalpur, Tikamgarh; Damoh where most of economic activities are
based on agro-forestry and industrial economic intervention is very low.
Many studies exposed that these workers suffer from various diseases due to their occupation
and socio-economic condition. They suffered with many diseases but initially tobacco dust
affect their eyes, respiratory system and long duration sitting posture gave them neck ache,
backache, spondilitis, lower limb swelling, digestive problems and also they suffered with
TB, Asthma, skin disease and Cancer. To address the health problems of Beedi worker Govt.
Set few clinics(Under Beedi Worker Welfare Fund) at block level and district where the
number of Beedi worker labour is high. In the context of health services Rahatgarh also have
BWWF Clinic and Community Health Center(CHC). But the condition of BWWF Clinic is
similar like Beedi Rolling labour and CHC with 22 beds serve the Population 31537, where
most of the 5945(Census 2011) belongs beedi rolling process. A male doctor and a
compounder look after the BWWF clinic with limited Three Day Medicine. Most of the
beedi worker suffered with various health problems and these health services are busy to refer
them to district hospitals at Sagar. Due to their socio-economic condition it is a very big
problem to them.
Three acts directly address the beedi industry and labour and nine other acts also address it
but the Acts does not apply to the occupier or owner of a private dwelling house involved in
the manufacturing process with the help of his family or anybody who is dependent on him.
Many studies exhibited the health problems, welfare schemes and its impact on beedi worker
but the gap between health services and health condition of beedi workers health still exist
which needs to be address.
Methodology
Study design
Qualitative study
Type of study
•
Descriptive study
Sampling unit:
•
Sample Size type: 20 families involved in beedi rolling.
•
10 women (SMuslim and 5 Dalit Women) 10 men (SMuslim and 5 Dalit men).The
respondents will be selected from in 5 wards out of 15 wards of Rahatgarh, District
Sagar(M.P.)where the Muslim and Dalit are more who are involved in beedi rolling.
Inclusion Criteria : Respondents from 5 wards where Muslim and Dalit dense
population live, who involved in beedi rolling and utilized health services within a
year.
Techniques and tools
•
In-depth interview
Tools
•
In-depth interview guideline
•
•
•
Observation
Consent form
Recording
Results:
Background of community and work
In my study I had 20 respondents in that 5 women from Muslim, 5 from Dalit, 5 Men from
Muslim and 5 Men from Dalit Community and they are involved in Beedi rolling from last 10
- 20 years. These two (Dalit and Muslim Community) communities are largely involved in
Beedi manufacturing process and in the Rahatgarh they do not have any other livelihood
options there.
Health problems faced with reference to their socio-economic condition.
Among 20 women(Age 30-55) and men(Age 30-55) participants they are involved in beedi
rolling most of them are literate, their family size is between six to seven, a large number of
Beedi labor own house but not on their own name and all the houses are Kuchcha, only men
have other livelihood source which is only Hammali in Mandi; they all have Beedi Labour
Card which have limited entitlements (Ration, Hosital,Death Claim (without ESIC, PF) and
other type of Beedi Labour card issued by labour department but endorsed by beedi company
and number is too small(this contains all social security entitlements.). Govt, fixed the rate of
1000 Beedi is Rs.92/- but they get only Rs.55-60/- per 1000 Beedi. If three or four person
involved in beedi rolling in a day they role only 1000 beedi.
Abida B Said ” Yahan beedi Nahi Banayege to kya karenge or koi Dhanda bhi to nahi hoi. ”
Beer Singh Said”Beedi Card se Ration to Mil jata hai per uske liye paisa bhi to chahiye or
ration bhi time per nahi ata hai. Kabhi kabhi mandi mai majduri bhi karlete hai. ”
Prem Bai said '’bhaiya Baap dada ka ghar hai to rehlete hai nahi to mushkil hoti bahar
jayenge to kiraya bhi chahiye jaise bhi ho gujar karlete hai. Beedi cards to banjata hai per
uska fayda lena asan thode hai. ”
Anjum B(Divorcee)Said "Hum Padhe Likhe(8th) bhi a hai per yahan to Beedi Banane ka
kaam hi mila sakta hai. "
Mohammad Yusuf Said, "Bahut Kuch Badla hai per yahan kuch nahi badla Bachpan yahi
dekha rahe hai. Sattedar hi yahan sabkuch hai. Ekbar dharna diya tha to majduri Rs. 92/- ka
rate fix kiya tha per kaun deta hai. "
Shakila B. Said, ” Bachche ko anganwadi mai kuch mil fata hai per bade kahan jayeimke liye
to yahan beedi banana hi ek rast hai. Vaisse to bacchchon ko koi beedi banana koi nahi
sikhata per dekhte dekhte sikh jate hai or apne maa-baap ki madad kame lagte hai per
school sab jate hai. ”
Rahatgarh administered by Nagar Panchayat and all the wards have anganwadi and the
children of Beedi labor go there regularly. All the children of Beedi labour enrolled in Govt.
School after Right to education the enrolment of children increased and they get free
education, uniform, mid day meal and scholarship also there.
Due to poor socio-economic condition most of the Beedi rolling labour face similar health
problems like : Malnutrition, Anemia(food Scarcity),joint pain, stomach pain, problem in
delivery, (sitting position), cough, respiratory ,eye problems, TB(Tobacco Dust), Cancer and
skin disease(Tobacco Contact).
Regarding health problems one of a lady Kama B who recovered from TB and now her
daughter-in-law getting treatment said a very strong statement, ” Lagta hcii Bimari se hamara
rishta ho gaya hai, ek to iti pareshani uprse himari ab kya kare. ”
Sufiya Said,’’mere Abbu Beedi Seka Karte the ab Saans lene me mushkil hoti hai kamzor bhi
ho gaye hai, ghar mai koi or admi bhi nahi hai meh ek behan or Maa hai. ”
Shabnam who volunteerly work for a CBO and Beedi labour Said, ’’Choti Moti Bimari taklif
to chalti rahti hai per agar delivery ke time Sagar bheja to Rs. 2000-3000/- ka kharcha
matlab kisi se paisa lena padehga jis ko chukana beedi banakar hi hai. Ab agar ggharwale
kamate hi Rs. 4000-4500/- hai or 6 khane wale to karja kaise niptaye. ”
Jagdish (Recently recovered from Piles (Operation) Said, ” Beedi Card Choti moti bimari ke
Hye to thik hai baki ke Hye khud hi kuch karna padta hai nahi to marne se zyda jina
mushkil. ”
All the respondents whom I have interviewd are associated with Beedi Labour Union and
women are involved in CBO named “Hausla” where they learn tailoring and embroidery also.
Barrier Accessing Beedi Worker welfare Fund Clinic(BWWF) and Community Health
Centre(CHC)
All the Beedi labour utilize both(BWWF and CHC) the health care services as per
requirement, knowledge and referral. On the basis of accessibility, availability,
acceptability, affordability; quality we studied these health care services and respondents
also shared their like and dislikes onn it. BWWF clinic Treats minor disease and refers
the patient to district BWWF Hospital. The patients face the following problems:
On the paper hospital open every day but Doctor Visit once in a Week for
three to four hour.
Shortage of medicine always there,
Lady Doctor is not there.
Kamla Bai Said/Tteedz Aspatal paas mai hai per Doctor nahi hota hafte mai ek
baa rata hai to bhid bahut hoti hai. Bachchon ko or hame choti moti bmari mai
yahan ka ilaj kaam kar jata hai. ”
Sheela Rani said, ” Hamari do delivery hui per humko janch karana hoto CHC
mai jan padega jo door hai or Hamara Beedi aspatal mai Lady doctor hoti to
kaun jata. "
Kear Bai said, "Beedi aspatal mai kabhi bhii jao dawa ki hamesha dikkat hogi. ”
Shyam Bai said, (iek din doctor ata hai to ek din aspatal chalo hota hai, mera beta
le jata hai to uski majdoori jati hai.
Azizuddin Said,” Kuchdino pahle mere aant ka operation hua per hame hoi
madad nahi mill sab kuch bahar se karna pada. Bahut mushkil hai. "
BWWF clinic is in the centre of the city, clean, provide spectacles ; behavior of
doctor and support staff is nice but most important thing is proper treatment
which is not there.
Community Health Centre (CHC) have 22 beds, TB, Delivery, Vaccination and other
facilities are there. Most of the Beedi rolling labour visit there for delivery, vaccination
and TB treatment. They face the following problems there:
Permanent Residential Doctor is not there nurse and other staff
manages the CHC.
They prescribed medicine from outside.
They terrorize them on the name of referral, referral means
Rs. 3000/- + for delivery and it's a heavy burden for low
income group community.
Accessibility is the main problem there because there is no
proper road.
Staff treat them rudely.
Building is good.
Shabnam Said, "aspatal achcha hai per Doctor samay per nahi hone se mushkil
hoti hai or kabhi kabhi sister log Sagar bhejne ka naam lekar darati hai. ”
Anjum Said, ” Delivery ke Hye jate hai vaise to beedi aspatal jate hai, yahan per
sidhe sidhe kuch nahi hota chila chili hoti hai per aspatal hamara hai to kyon kahi
or jaye. ”
Ganga Bai Sai, ,fis aspatal tak pahuchna sabe badi mushkil hai koi thik rasta nahi
hone se badi pareshani hoti hai, barish ke din mai to or mushkil hoti hai. ”
Mohammad Sharif said, ' log yahan nahi aayenge to jayenge kahan per yahan
zydatar dawa bahar se likh dete hai. Staff ka vyhar bhid per nirbhar karta hai agar
zyda rush hai to phir mushkil hoti hai. ”
Kama B Said, ^TB ke ilaj ke liye ye behtar jagah hai meri bahu ka bhi ilaj yahi se
chai raha hai. Agar yaha nahi hota to maloom nahi kya hota. Bas aana mushkil
hota hai per kya kare. n
In conclusion we can say that the CHC need Proper Road, skilled full-time human
resources ; sufficient medicines to serve the people of Rahatgarh.
As per the labour department the beedi labour have these entitlements :
PDS(For a member 1 KG wheat, 1 kg rice- sugar, 4 liter kerosene 1 pk salt),
Death claim (<60yrs get Rs.l 1500/-),
Health Schemes benefit (like free drug and treatment at authorized hospital),
TB Treatment Rs. 10000/heart & cancer Rs.2.5 Lacs, free vision aids,
Housing support Rs.40000/- for 600 sq feet
Girl marriage Rs.5000/-
Scholarship to student (class 1 to 5) Rs.250/For Shed construction Rs.2.5/- lacs
But I practical it is hard to get these stated entitlements most of the beedi rolling labour
get PDS,Free drug and treatment at BWWF clinic and spectacles but other entitlements is
far.
Strengths and weaknesses of the study
Strengths:
•
•
The main strength of the study was the whole hearted corporation of the responders
even in their limited time.
I conducted the whole interviews alone for all respondents and I collected the
maximum details I can in limited period.
Weakness:
•
Sundays are not holidays for them so it is very tough to take their time within the busy
schedule.
•
Since I conducted the interviews alone I feel like data that I collected incomplete and
would have been better if I had a companion.
Conclusion
From the study positive and negative result is seen: health problems faced by beedi labour
and health care services there. Most of the health problems are related o their socio-economic
condition and the response of health care services is not adequate towards the marginalized
community, utilisation of health scare services is not a easy task for community while the
system is not friendly. Active participation of the community is a hope for change and they
need a information and support system to utilize the existing entitlements.
Reference :
www.censusindia.gov.in/201 Icensus/populationenumeration.aspx
Memorable learning
•
Language is not a barrier observation and reflection is important.
(T.N.)
•
Skill and knowledge is the key of success. (Sam)
Political analysis is necessary to analyze the policy. (PSS)
Qualitative and quantitative method compliments each other. (ASM)
Story telling (Dastangoi) is ancient tradition of our culture and culture
is important, it decides manything. (RN)
Discipline maters but humanity first. (KKJ)
Work with smile. (SJC)
Your adult so behave like adult. (ASGR)
Before doing anything think about nature. (AP)
Caste and class maters in our society (Sabu)
Work with people not for people (ALAN)
Future Plan
•
Collect print media reports on health issue of last six month (Jan
Jun416) and
•
Start Health Right campaign (After July’16) with collective support.
•
Start youth recreational activity in Mhow or Bhopal.
I
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SOCHARA
# 359, 1st Main,
1st Block, Koramangala,
Bengaluru - 560034
Tel: 080-25531518; www .sochara.org
■ AA 0
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Position: 5855 (1 views)