Health for the Millions, Vol. 3, Nos. 3 & 4, June & Aug. 1980
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- Title
- Health for the Millions, Vol. 3, Nos. 3 & 4, June & Aug. 1980
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j
Vol. VI
No. 3
A Bimonthly of the Voluntary Health Association of India
JUNE 1980
HEALTH FOR THE MILLIONS
Vol. VI
No. 3
June 1980
CONTENTS
1
Management without
Apologies
5
Living in OD Times
8
The Mandar Experiment
12
News from the States
14
From Delhi & Elsewhere
15
AV Folio
Editor : S. Srinivasan
Executive Editor : Augustine
Veliath
’
i
News & Events : Nalini Bhanot
Production : P.P. Khanna
Assistance : Cynthia Browne
Circulation : A V Folio
Owned and published by the
Voluntary Health Association of
India, C-14, Community Centre,
Safdarjung Development Area,
New Delhi-110 016, and printed
at Sabina Printing Press,
387/24, Faridabad.
What dpes the future ask of VHAI ?
Nearly twelve years have passed since the Consultation in
Bangalore, in January, 1969, from which VHAI originated. These
years have been thrilling and creative.
VHAI has spread the idea of community health. Even the
word was scarcely known or used twelve years ago. The medical
colleges spoke of social and preventive medicine. There were
rural dispensaries and some hospitals had a programme of visiting
nearby villages. The services were mainly curative. The patients
were passive recipients. Now people's participation is taken for
granted.
In these years the village health worker movement, called
by various names, has grown up.
There is now realization
that the maintenance of health should be the main goal of health
services, though of course remedies and healing will always be
needed. VHAI has pioneered in introducing behavioural science
into health care administration. We have introduced anaesthesia
as a course for nurses, and promoted community oriented nursing
education.
Radiating out from our central office and from ourstate VHAs,
community health is now being taken up by numerous other
organisations. We may justly say that community health has
become a national movement. There is within us a legitimate
glow of pride for the share VHAI has had in creating this
movement.
New needs and opportunities rise in front of us. Examples of
these are developing health components for adult education and
rural development movements, improving school health and
school health education, promoting social justice and human rights
and liberation movements that pertain to health, and sponsoring
appreciation of holistic health. These and many other opportuni
ties brighten our faces like streamers of a rosy fingered dawn.
In the community health education provided by our VHAI
central office, and in our local VHAs and other community health
programmes, we need people whose lives give evidence of enlighte
ned concern for the poor. Technical qualifications remain necessary
but are no longer adequate. We need people of vision, zeal and
enthusiasm who can give our community health service a new look.
Without some competence in social analysis, it will be difficult
to help people discover the causes of their own poverty, and
organize themselves towards freedom from discrimination and
exploitation.
Our performance in this area needs assistance
and
encouragement to lift it closer to our expressed ideals. Unless we
can put greater competence and drive into meeting these new
needs, there is danger that VHAI will wither. Individuals among
us see this need. Some are generating the energy to meet it. Bui
for volume and power we need a corporate thrust.
O
COMMUNITY HEALTH
326, V Main> I Black
Koramangala
■/
EDITORIAL
India
DISABLING MYTHS
Talking about the IYDP and
the disabled gives one a benum
bing feeling of having gone
through all this before. What was
it the other day ? Oh yes, the
Year of the Child ! And what
happened to children, especially
of the poor, anyway?
measure. Enter the harried pa by making them objects of not so
sserby
who chews a lot of helpful pity.
tobacco, and who probably is an
alcoholic with chronic ulcer. He Disability Awareness
sees the limping “boy, tut-tuts
The best one can do for
away with well-intentioned con , the disabled under the cir
cern, and makes a mental note cumstances is to educate our
that the next time the blind-relief selves. Then, we could systema
Such cynicism however has boys come for money, he will tically plan and do something
no place in the river of healing. definitely give away half his day’s concrete to prevent disability in
the long run. Prevention is better
They only fester the wounds. We wages.
No, says an article in this than firefighting. How much of
have to quietly accept the fact
that a great many people who issue. Disability comes in many firefighting can we do any way
do not mean what they say will forms. The boy with the missing even if we pit all our resources
make speeches and wash their limb is only one of the many. ' against the enormous need?
Rehabilitation of the disabled
sentiments in public. A few The harried passerby would do
disabled children of the poor well to direct the well-intentioned ' is more effective if the disabled
will be garlanded on social occa concern towards himsejjMAIcoho- person is enabled to live as normal
sions and even taken to the lism, chronic ulcer and compul a life as possible in society. This
national capital to shake hands sive smoking in themselves carry means the disabled person is
with the powers that be. A great the seeds of permanent disability. provided opportunities to earn his
living and participate in society
many more disabled children of If not checked in time, that is.
without special discrimination.
the rich will go abroad and
Disabling Poverty
This also means artificial gadgets
attend special camps in Paris,
are kept to a minimum and a
Argentina or Alma-Ata. Let
The single, major cause of
solution is found to the question
them.
I disability throughout the world
of his rehabilitation at a cost
The IYDP is a time of focuss ' is still poverty. Poverty leads to which he could afford. Full parti
ing the energies of those who ignorance, disability and more
cipation and equality require that
are interested and involved. It is poverty.
One such resulting the disabled of any kind are not
an opportunity for some mean disability due to poverty is malnu
victims of pity, scorn or social
ingful long-term planning for the trition. More children die due to rejection. The disabled have to
disabled at the local and national malnutrition in India than due to help themselves as much as
levels. It is a time for initiating any other reason. Any long-term possible and society helps them
a rethinking on existing activities, attempts at prevention and reha as little as needed.
achievements and priorities and bilitation of the disabled in India
Solutions and > plans for the
have to be viewed therefore in the
initiating new action too.
prevention
and rehabilitation of
light of the poverty of the Indian
Disabling Stereotypes
the
disabled
therefore cannot be
peoples. Thus it is meaningless
imposed
from
the top. They could
Closely related to
these to talk about fitting the disabled
be only effective if there is com
in
our
villages
with
artificial
limbs,
attempts is our understanding of
munity participation just like any
who is the disabled person. The however low-cost they be. For
other health effort.
popular picture of a disabled who can afford even a so-called
Disability lies in the minds of
person is the little boy who low-cost artificial aid? Many a time
men.
It is only in the minds of
it
is
neither
low-cost
nor
an
aid.
limps along with an artificial leg
men
that
the practices of healthy
They
even
increase
the
depend
or an artificial limb, with some
braces thrown in for good ency of the disabled on society enabling can start.
HEALTH FOR THE MILLIONS/DECEMBER
1980
1
WHO IS AFRAID
OF THE DISABLED ?
Disability is of many kinds.
There is the disability due to
genetic disorders. 3% of all those
born in the world have some
kind of genetic disturbance. Of
this the largest single group of
disabled — the mentally retarded
—is usually estimated at 1-4% of
all new born children in the world.
35% of the new borns in India
and Sri Lanka have a birth weight
of less than 2.5 kg, compared to
6-8% in Europe.
Disability can be also due to
non-genetic disorders. These in
clude malnutrition, disability due
to diseases during pregnancy,
complications due to lack of mid
wifery, impairment of fetal deve
lopment, nutritional disorders and
disability due to diseases like T.B.
leprosy, malaria and poliomyelitis.
Many of them imply social reject
ion (T.B. leprosy). Some of them
diminish the ability to work (mala
ria, T.B'). Some of them like polio
are short-term infections with
life-long implications.
Malaria is back. And malaria
is a major disabler in countries
like India.
There are other equally severe
forms of disability due to other
communicable diseases like men
ingitis, encephalitis, trypanosomi
asis, hepatitis, herpes, osteomye
litis, septic arthritis, chronic eye
infection, trachoma,
onchoce
rciasis, otitis, V.D., and what
have you.
Then we have disabilities due
to what one may call somatic noncommunicable diseases like arthri
tis, paralysis, diseases of the
heart, lung and brain, cancer and
epilepsy.
2
To all this you only need to you allow for double counting you
add the havoc caused by alcoho will succeed in cutting it down to
lism, drug abuse, traumas, inju 400 million which is 10% of the
ries, accidents, artificial and natu world population. At conserv
ral disasters like earthquakes, ative estimates that is.
floods and pollution. And you
As if this horror story were
have a pretty picture of man and not enough, disability of some
nature, and how nicely they get kind or the other is multiplying
along with each other.
every second due’to^man against
If you are interested in things man — hatred, lack of love and
like counting, do not try it. World lack of mutual tolerance. They
wide estimates are not worth cause wars among nations. And
writing home about. The total quarrels at home and at work. And
number of disabled in the world they stop little children from blo
is something about 516 million or ssoming. And old men from
13% of the world population. If dying peacefully.
HEALTH FOR THE MILLIONS/DECEMBER 1980
Carol Huss, Mira Shiva, Renu Khanna and Celine P.
Enabling Cancer Patients
Through Imagery
Numerous authentic research studies have shown the link between stress and disease. The
relationship between stress and peptic ulcers, hypertension and coronary problems is already
considered an established fact. Recent work done on the effect of stress on the immunological
system of the body is mind-boggling. What emerges is the concept of a carcinogenic or cancer
prone personality and the recognition that people with such personalities require something more
besides drugs, surgery or radiation in the management of cancer. The focus would have to be not
merely on the physical aspects of the disease but also on the underlying psychological factors in the
patient.
Dr O Carl Simonton, a radiation oncologist in Fort Worth, Texas, and his wife Stephanie
Mathews Simonton, programme director at the Cancer Counselling and Research Centre, Fort Worth,
first started using positive imagery techniques for stress reduction in the treatment of cancer
patients in 1969. The therapy, individual or group is geared to allow the patient to see how he can
actively participate in his return to health.
A team consisting of Carol Huss, Mira Shiva and Renu Khanna of VHAi, and Celine, initiated a
six-week course on stress reduction using techniques of positive imagery.
These techniques
included art therapy, music therapy, yoga, dream analysis, meditation and biogenics.
six weeks we would help them to sharing left the people feeling
bring about a change in their i much less apprehensive. Our
attitude towards their disease; a i friends bade us goodbye with
change in their attitude toward somewhat tentative smiles.
We sat with eleven very appre living with the dreaded carcinoma
Before ending the first sesshensive, intensely worried people and help in the building of supp
suffering from cancer of different orting and helpful relationships in j ion we had discussed their comto the programme.
parts of the body. Some had a the group. In a supportive atmo ; mitment
relative with them, some had sphere they would be able to talk ' Would they be able to come
nobody. The patients formed a about their worries and troubles every Tuesday and Friday for two
mixed group ranging from Bhan- and find ways of coping with hours ? Would a relative or friend
dare, a 68 year old man with stress. We emphasised that this accompany them so that the
cancer of the throat, whose wife programme would not necessa support and continuity would be
was in the last stage of the same rily result in the disappearance of j ensured at home during the week
i and even after the six weeks? All
disease to the 27 year old Sushila their disease.
the same, our group was reduced
who had cancer of the cervix. She
to six patients at the next meet
was a mother of three small First Fears
ring. Having read about the high
children and her husband had
deserted her. The majority of
Wq then asked them to talk ; dropout rate in the Simontons’
them belonged to an economi about themselves. They came out ; work, we were not very discally weaker strata of society. hesitatingly. Most of them spoke I couraged.
Very few understood or spoke in low, faltering tones. Their an
English and some knew only xiety and worry was evident. Some War with WBCs
Marathi.
These patients had of them broke into tears when
The doctor in our team ex
come because they hoped that they faced the question of “atti
plained, in simple Hindi, how canwhat we had to offer might help tude towards their disease.”
i cer is caused. Using a number of
them counter their disease.
“What can I hope for ? I know , attractively sketched visuals, she
We began with an introduct what cancer does”, sobbed told them about white blood cor
ion to ourselves and the progra Sushila. We listened silently and puscles, WBCs, and the body’s
mme. We explained that in these ! feelingly. Though painful, this I immunological system. She furThe scene was the Cobalt
Conference Room, Ruby Hall
Nursing Home, Poona.
health for the millions/december 1980
of just twice a week. With each
instance of their initiative and
interest, our team felt greatly en
couraged and was spurred on to
greater spurts of creativity.
Eye-opening Art
ther went on to explain how stress ’ home and asked the person
negatively affects this protective i accompanying them to lead the
mechanism of the body. The patients in the imagery.
In our subsequent meetings
group was keenly interested and
thoroughly taken up by the drawing. we introduced some simple yoga
exercises and the group enjoyed;
After this, we went on to do doing these too.
a relaxation exercise. Each one
took up the shavasana pose and Patient Initiative
relaxed deeply. With soft strains
At the third meeting a patient
of Ravi Shanker music in the back said he wanted to start the
ground, in this state of relaxation, session with a prayer. Everyone
we led the group into an exper in the group (we had a Muslim,
ience of guided imagery. We told two Hindus and three Christians)
them to picture their WBCs as the welcomed this. Henceforth, a
guardians of their body and to bhajan was an integral part of
imagine the cancer cells as weak, each meeting.
ineffective creatures. We then
At this meeting, the group also
asked them to imagine that the .decided to meet everyday instead
WBCs were at war with the
cancer cells and were winning !
The weak cancer cells were slowly
dying and decreasing in number.
The next time we met, we sup
plied crayons and papers and
asked the group to draw their
perceptions of their own WBCs
and cancer cells. The Ruby Hall
staff were a little doubtful about
these illiterate people being able
to effectively participate in these
mental imagery exercises.
We forged ahead nevertheless.
The drawing activity started.
Creativity and optimism flowed
and produced eye opening results.
Philomena, an illiterate woman,
who had probably never held a
pencil in her hand, drew a purple
vulture which signified her WBCs
and small turquoise chickens as
her cancer cells. When asked why
only one vulture, she said “Wait1.”
and proceeded to surround the
chickens with a number of other
vultures.
Urmila got really excited by
this task. She drew one huge
snake (symbolizing her WBCs)
Slowly the realization dawned
on the group that it is their mind
that gives orders and instructions
to their army of WBCs, the guar
dians of their body. The meaning
of the exercise was now under
stood and they saw the relevance
of positive imagery. They also
understood the need to steadfastly
avoid negative thoughts and feel
ings of resentment, frustration,
anger and sadness.They had just
got in touch with their own power
to heal. We asked them to do this
exercise three times a day at
4
HEALTH FOR THE MILLIONS/DECEMBER 1980
eating up a number of small eggs
(cancer cells). She added flowers,
green grass, birds in the sky and
a strong tall tree to complete her
picture. Sushila drew a numberof
strong powerful men with bulg
ing biceps attacking a fish with
vicious looking daggers.
All the patients said that they
had drawn the identities of their
WBCs and cancer ceils the way
they had visualised them while
doing the guided imagery exerci
ses. These people were beginning
to think positively about their
health. From being people who
passively observed their body
being sedated or drugged, they
were growing to be people who
had owned their power to heal.
They now had hope.
Coming Together
The Figures ssiad
The A’en-Figures
If you are interested in the
arithmetic of the disabled you
soon learn that there are no
reliable figures of the disabled and
their disabilities in India. Indeed,
that appears to be the case with
much of the developing world.
This is hardly helpful for large
scale planning. Some estimates
however have been made.
The Disabled Child
Two out of five persons in
India are children (0-14 years).
Half of this population is in the
age group 0-6 years. 81% of the
total child population of 230
million are in the rural area
(figures are of the 1971 census).
the other. 56% of-the children's
diseases treated at health centres
are due to intestinal infections,
respiratory complaints and nutri
tional disorders.
Malnutrition
There are 60 million malnouri
shed children in India, says one
estimate. 80-90% of Indian child
ren do not receive enough of the
key vitamins and minerals. 75%
do not get enough calories and
50% do not receive enough
proteins.
Every month approximately
one lakh children die and every
15,000 go blind as a result of
malnutrition.
The individuals who had come
together on the first meeting were
40% of all deaths occuring in
now a family of persons. They India are in the age group 0-5 Handicapped
mutually helped and supported years. The rural infant mortality
There are no separate figures
each other. Urmilla, who had rate is 131 per thousand. 30% of as to the number of handicapped
missed two meetings because of these deaths occur in the first
children. The total number of
severe diarrhoea (a side effect of week of life itself and another physically handicapped personsis
cobalt therapy), was seen in the
20% die in the first week to one estimated at 15 million—9 million
company of Manorama
and
month period. There are more blind, 0.75 million deaf, and 5-6
Sushila one day. The two were
deaths in the perinatal period million orthopaedically handicap
sitting on either side of her and
(28 weeks of gestation to the first ped. This does not include, how
offering words of reassurance and
week of life) than in the next 30 ever, those with impaired hearing
sympathy. Manorama was heard
years of life. Perinatal deaths are or the visually handicapped. The
inviting Sushila to her home any
caused by low birth weight, peri number of mentally disabled is
time she felt worried or depress
natal hypoxia, birth trauma and estimated to be 15 million.
ed. Sushila herself was a chang
neonatal infections including teta Spastics (cerebral palsy) alone are
ed person—by the sixth meeting,
over a million today in India.
she showed herself to be a nus and unsafe obstetric practices.
8000 spastics are born every year.
If
the
child
survives
the
first
woman of courage and hope. She
Of the estimated 2 million
offered to be a resource person i week, it has to pitch its strength
in any future work with similar j against diarrhoea, pneumonia, deaf-mutes in India, 5% of them
I measles and other infant diseases. are children of school-going age.
groups of cancer patients.
To all this if we add handiWe hope that this kind of I 40% of the deaths in the 0-14
support and fellowship will conti years age group are due to diarrh { capped persons due to the many
oea.
Malnutrition,
respiratory other not so obvious causes, we
nue even after the 12 scheduled
infections
and
communicable
j could well have more than the
meetings. The follow-up plan of
the programme consists of three- diseases contribute a substantial general world estimate of 10%
disability (that is we have now in
day meetings for intensive group number of deaths too.
counselling after three months.
*
*
*
30% of all school-going child India atleast 60 million disabled
ren suffer from some ailment or I people).
HEALTH FOR THE M1LLIONS/DECEMBER 1980
5
DISABILITY TO ABILITY
Bethany village is a rare kilometers from Delhi. In a short Sixteen Years Later
story in self-help rehabilitation. ; time there was a nucleus of
Much has happened in sixteen
Its workers get a living, wage, i thirteen families, willing to give
years.
The huts have been repla
Its two major industries show | up begging to become part of a
a profit which helps in the new community that offered them ced by. pucca houses — 23 family
other expenses of the village. I a home, a new life style, and the units and six single units. There
The story as told by the i opportunity to help themselves to is an office, a storeroom, a dyeing
‘Handloom Lady.’
achieve normal, productive lives. shed, two weaving halls with
A well was sunk, a handpump fifteen looms, three poultry hou
Sometime during the fifties and installed, and huts were built. ses which produce 1,200 broilers
early sixties various people from Bethany Village was born and the per month, two tubewells, a dis
the South, mostly from Tamil- dream of Dr Dorothy Chacko. pensary and electricity. The land
nadu, drifted toward Delhi. They I came into being. For her contri has been expanded to almost
had one thing in common... all of bution and leadership, Dr Chacko twelve acres of which 7A acres
them had leprosy... all of them was awarded a Padma Shri is being farmed by the residents.
were social outcastes. Some of in 1972.
All the residents of the Village
them left by choice, rather than ’
have the stigma of leprosy hang ;
over their families and perhaps I
ruin a daughter’s chance for a ■
good marriage. Begging was the [
only means of livelihood af that |
time. They were united by their
common rejection and common
afflictions. They lived in groups
around Delhi and Panipat. Some I
of these people who came j
from the South were weavers by j
birth and brought with them the |
skills that were later to be an i
important input into the life of I
the Village that was to be Bethany, '
It was at this time, by what i
might be regarded as an act of |
providence, a group of people in
Delhi became interested in reha
bilitation of leprosy patients and
their dependents. The objective
was more broadbased rehabili
The Poultry Industry
tation than the limited goal of
institutional care. Gradually, the
Mrs M Wingard is referred to as the “Chicken Lady”. From
Leprosy Rehabilitation Society^ experience she learned that layers were uneconomic...she switched
Bethany Village, was formed.
to broilers...she found that the difference in profit on a bird sold live
on the local markets, and that of a bird sold dressed in New Delhi
The Birth of Bethany
i can be as much as five to seven rupees. On 1000 to 1200 birds per
So Bethany village began in ; month, this can make quite a difference. The demand for Bethany
1964 on 3| acres of barren land, ■ broilers has increased to a point where, under our present method of
set aside by the Panchayat of ■ one to one selling, we can no longer meet the supply and without,
a better sales outlet we cannot handle any further production.
Teha, Haryana State, some 65
6
HEALTH FOR THE MILLIONS/DECEMBER 1980
are employed in these three j
industries,
handloom, poultry ’
and agriculture. The weaving '
industry supports one dyer, four- ;
teen weavers and one tailor. Ten •
women do part-time work, fring
ing and knotting. The broiler ;
industry supports five poultrymen .
and provides part-time employ- 1
mentfor slaughtering and dress- ;
ing. One man works full time in
agriculture, while each family has i
land for cultivation. The Village 1
supports one rickshaw puller plus [
other part-time workers on various 1
jobs. Five people are completely I
handicapped and are fully suppor- *
ted by the society.
Disabled ?
Experience over the past few years showed that the first thing
we had to do was to produce a quality prodcict, The second, and
more difficult thing was to sell it. We made tabledloth^iaqd 'napkins,
and had many good customers, but our stock on hand-kept increa
sing. We discovered that we were producing a luxury item, geared
to the affli ent, consumer society—which can absorb only so much,
and which does not always select handloom when a choice is avai
lable. More recently we have switched to more practical, serviceable
items. A Delhi export company has been our oldest, regular
customer, and they purchase everything from our four big looms.
CMC Ludhiana was a big help to us when they gave us a very large
order for bedsheets. Holy Family Hospital, Delhi, has become a
regular and valuable customer...we count on supplying them with
their bedsheets every year. Finally, two relief agencies have decided
that wherever possible, they will buy from projects tike ours for
relief purposes... bedsheets for hospitals and institutions, blankets
for disaster relief. In all of these cases, our buyers have understood
that if we are to make a rehabilitation project self-supporting, our
product will not necessarily be competitive pricewise, with the
cloth made on powerlooms. However, our customers also verify
that in quality and durability, our bedsheets and blankets are
superior. We had good help in marketing some of our products
overseas, but we have found the export market difficult and deman
ding and not really geared to a small project like ours..
Often we, the not so disabled, I
keep forgetting that our leprosy
patients are disabled at all. ,
Their integration into normal life ■
seems so complete. The children
of the leprosy patients are not •
similarly handicapped. 25 child
ren presently go to school like
any other normal children of nor
mal parents. Many of these
children are in boarding schools.
All these children come home to i
spend their vacations with their
families at Bethany. Acceptance
of the residents by their own
children is perhaps the most '
satisfying index of their almost 1
complete integration. One of our •
young women has finished class j
XI and taken secretarial training ;
and is employed at Batala. One •
of the daughters of the leprosy !
patients of our village is a gradu- i
Dr P N Behl of the Skin Insti also incharge of the handloom
ate nurse and three more are
tute,
who is also the chairman of production. Both of them have
in nurses’ training. One of them
the
society,
sends his team to been leprosy patients, and are
married a partner of her own
choice. Another had the tradi check on the health of the villa capable men doing excellent jobs.
tional marriage arranged by her I gers regularly. None of the resi
family. The spouses come from dents of Bethany Village have
Measured in terms of success
families without leprosy history. active leprosy now. The society and failure, much has been acco
The parents of the spouses too employs a full time resident mplished at Bethany Village,
are known to call on the parents supervisor (who is a trained aud thanks to many well wishers at
of their daughters-in-law.
itor) and a physio-therapist who is | home and abroad.
HEALTH FOR THE MILLIONS/DECEMBER 1980
The Future
In our progress toward "com* I
munity” and “responsibility”, we 1
have not moved forward as much
as we expected. Our tradition of •
management through communi- ’
ties would need a serious dekko.
There are 598 institutions
We tend to retain too much invol
working
for the physically and
vement not only in policy making
mentally
handicapped (188 for the
but also in day-to-day decision
blind,
148
for the deaf, 146 for the
making. This is an area for future
orthopaedicaliy
handicapped, and
improvement. We are now trying ,
116
for
the
mentally
retarded)
to place more decision making ■
into the hands of the local pan- I besides some 200 Associations
chayat. The reluctance on both | working for this group. Besides,
there are the following facilities
sides needs to be overcome.
in the country:
What else does the future
hold for Bethany Village? Frankly,
Rehabilitation Centres
: 4
I hesitate to anticipate and pres
Rehabilitation Units
: 13
cribe. Bethany has been a part
P. T. Schools
: 10
of my life for the past 10 years.
O. T. Schools
: 6
But without prejudice to any
Speech Therapy Schools
: 3
future plans, I could say that
Prosthetic and Orthotic
(a) the need for the Village to be
: 2
Engineering Schools
self-supporting; (b) a retirement
Artificial Limb Centres
: 32
fund for aged Bethany residents;
and (c) accommodation for new
Three universities and two
patient residents, would be our academic bodies provide post
priorities. Our immediate plans graduate-education in Rehabilita
are to work in cooperation with tion Medicine. Also we now have
nearby
leprosy
rehabilitation under the Ministry of Social
projects in and around Delhi. We Welfare the following institutions:
need to do this more than any
thing else if we are to sell what - .National Centre for the Blind, Dthradun
we
produce and keep our - Training Centre for the Adult-Deaf, Hydera
bad
selves going without outside
monetary aid. And if we are to
- School for Partially .Deaf Children, Hyderabad
sell what we produce, we must - Model School for the Mentally Retarded
produce what the market dem
Children, New Delhi
ands. What we have in mind is - Institute of the Physically Handicapped,
something like a central marketing
.New Delhi
agency which could do the nece - .National Institute for the Deaf, Bombay
ssary advertising and handle the
- .National Institute for the Orthopaedicaliy
sales orders for our broilers,
Handicapped, Bon-Hugly, Calcutta
handloom cloth and other goods.
There is a government of India
We need a lot of ideas and
support from everybody who is corporation—the Artificial Limb
interested in the rehabilitation of Manufacturing Corporation (ALI‘the disabled. And we are willing MCO), Kanpur—manufacturing
to share our experience for we prefabricated parts at subsidised
feel we have something special costs. However they still seem
to be costlier than artificial limbs
going in Bethany Village.
manufactured by other agencies.
THE ACTUAL
AND THE YET TO BE
* * *
8
Other Facilities
Besides there are numerous
concessions and facilities availa
ble to the physically handicapped
in university education, in Indus
trial Training Institutes for scho
larships, for employment and
vocational rehabilitation. There
are six vocational rehabilitation
centres of the government in the
country and 17 special exchanges
for the physically handicapped.
There are special apprenticeship
training schemes in 103 trades for
the deaf, dumb, blind and orthopaedicaily handicapped. Special
interest loans, grants-in-aid and
travel concessions by rail, air,
road and sea and even for supply
of petrol are available for the
handicapped.
There is no postal charge on
transmission of blind literature—
both inland and foreign. Institu
tions for the blind and deaf are
permitted to import, free of duty,
required equipment for education
and training, if received as bonafide gifts. There are even incometax concessions for the perman
ently disabled. There are lots of
legal provisions in the constitu
tion which are there more in
theory than in practice.
Not Enough
All these many services are not
enough. The services for the
education, training and rehabilita
tion of the disabled are so inade
quate that they cater to the needs
of only four percent of the blind
and two percent of the deaf.
Also, the entire area of
prevention of disability of all kinds
needs a lot more resources and
management of high calibre and
committment and vision.
HEALTH FOR THE MILLIONS/DECEMBER 1980
T. VIJAYENDRA
community to COMMUNITY
The Story of a Community Vision Project
Since independence a host of •
new communities are springing
up in the backward areas of our
country. These are the public '
sector enterprises and their town- ■
ships. While the location of these
industries were chosen explicitly
for the development of these
regions, the communities that
have sprung up have been blind
to the miseries of the people
around. Nay, sometimes, they .
Like most public sector town
ships, HOCL too has a modern 50
bed hospital fully equipped with
modern facilities. But unlike other
such hospitals, its services are
available to surrounding villagers.
This was so becausethe manage
ment was aware that they had the
only well-equipped hospital in the
region and the people needed its
services.
cation of their poverty and misery.
However in the last few years ,
a slow change is coming. More
and more industries are getting
into rural development. The proc- '
ess quickened since 1977 when
tax relief for rural development I
was announced. Many innovative
contributions have been made.
The Community Vision Project (
of Hindustan Organic Chemi
cals Limited (HOCL), Kulaba, ,
Maharashtra, is one such project.
PIHEL
PIHELPiH
The Project
! ELPIHELPIH
The company isjjocated in a '
I; •
backward tribal region although ;
it is only 75 kilometers from '
Bombay. From its very inception |
in 1960, the management tried to
avoid the ill effects that a modern
industry can cause in a backward
region viz, land alienation, defor
estation and increasing the mise
ries of the people. So rural deve
lopment played an important role ’
in its activities.
In 1978, there was an outbreak
of conjunctivitis in the region.
Some of the employees got toge
ther and collected money. They
got two jeeps from the manage
ment and they went to the villages.
health for the millions/december 1980
There were 12 women and 8 chil
dren in the group. They carried
a quick survey of all the indi
viduals in the villages. Where
adults would have hesitated in
entering other people’s houses,
the children merrily went in and
asked questions. Conjunctivitis
patients were treated immediately.
More serious cases were recorded
and referred to the hospital.
At the hospital they have a
deeply committed doctor.
He
organised specialists from Bom
bay for operations. A majority of
the cases were either for cataract
operations or correction of vision.
; Within 8 months they covered 18
i villages and treated more than a
thousand patients, out of which
34 needed surgical treatment and
393 needed spectacles. Nominal
fees of Rs 10/- for the operations
and 5/- for the spectacles were
charged. As a preventive mea
sure, Arovit tablets were distri
buted to more than 2000 school
I children.
With the initial success of this
project it was decided to extend
it to meet the demands of the
neighbourhood on a permanent
basis.
The project has been
registered as a trust and they
are trying to raise a fund of Rs 5
lakhs. The company is also
likely to give a matching fund.
The immediate target is to ensure
total eye care for the 20 villages
I near the company and later to
: cover the two taluks of PanveJ.
and Khalapur.
s'
Community
Participation
The project also gives another
dimension to the concept of
community participation. Commu
nity participation usually means
that the beneficiaries should parti
cipate by way of funds, labour
and organization. Here also the
community did contribute by way
of paying, partially for the opera
tions and the spectacles.
However what is important here
is the participation of the HOCL
employee community. Funds for
the project were collected from
a large number of employees.
Women and children of the emp
loyees went to the villages as
volunteers and mixed with the
families in the villages. Many
activists told us that it was a
very moving and educational
experience for them. Thus lear
ning from the villagers is as imp
ortant, if not more, as teaching
to the villagers. We have, here
a model of a community to COM
MUNITY project like the CHILD
to child project.
*
*
*
Travel Concessions
For The Blind
By Air : 50% concession on dom
estic flights of Indian
Airlines Corporation.
By Sea : Scindia Steam Naviga
tion Co, Ltd and Bom
bay Steam Navigation
Co, Ltd charge 25% of
the basic net fare or
single fare if the blind
is accompanied by an
escort.
Courtesy UNICEF
The First Indian
Braille Writer
A big advance in the education
of the blind has been made by
the invention of the Braille mach
ine. Now for the first time, an
Indian company has announced its
manufacture of the NFB UTTHAN
Braille Writer.
For further details contact:
Utthan Products
'Anurag*, Near Kamal
Colony
Navrangpura
Ahmedabad, Gujarat.
10
By Rail : 50% fare for the blind
person and escort. 25%
if the blind person travels
without an escort.
By Road: Most State Road Trans
port Companies give
50% or more concessions. Karnataka State
RTC allows free travel
and Gujarat RTC gives
75% concession.
To obtain such concessions,
the blind person must carry a
certificate of blindness.
For
further details contact:
National Association for the Blind
51, Mahatma Gandhi Road
Bombay 400 023
Crime Prevention Guide
For the Deaf and Blind
The New York. City Police
Department has designed a guide
to help disabled persons.
The guide presents infor
mation about crime prevention
in the form of booklets' in both
Braille and large print (English
and Spanish), as well as cassette
tapes. It will be available for
the handicapped at public and
special libraries as part of the
programme.
For further information please
contact the Crime Prevention
Section, 120-55 Queens Boulevard-Kew Gardens, N.Y 11424
USA.
HEALTH FOR THE MILLIONS/DECEMBER 1980
Book Preview
A Cause for Ho^e
cal' factors i.e. political,
economic, social and cultur
al dimensions;
(c) Also, till now policies have
been made at the top and there
has been no attempt at get
ting the people to participate
in programmes at any level.
In order to change this state of
affairs the report recommends
that the following steps be taken:
compared
services.
—
to
the
curative
by having a,.clear-cut drug
policy that would make the
basic essential drugs avail
able at low cost.
Although the report starts on
a radical note by stating that
health has more to do with the poli
tical system than with the organi
Published by the Indian Insti
— that health be integrated sation of health services, it ends
tute of Education, Pune, 1981,
into overall development. by taking a definite conservative
pp. 250 approx. Paperback,
This is to be brought about stand. For instance, the report
that given favourable
Rs. 18.00. Hard cover Rs.65.00.
by rapid economic growth states
and political factors,
with the objective of doubling social
Copies available from VHAI.
even
a
comparatively limited
the national per capita in
HEALTH FOR ALL : AN ALTER
economic
growth can lead
come by
2000 AD and
NATIVE STRATEGY is a report of a
giving full scale employment to an outstanding improvement in
study group set up by ICSSR and
to all at reasonable wages health status. However the first
ICMR and aims to make health
through food-for-work pro recommendation made is that of
a reality to all by 2000 AD by i
grammes. The report also doubling the per capita income.
suggesting a radical change in !
talks about improving the It has been proved time and
the present health system.
status of women, adult edu again that doubling of per capita
cation programmes, welfare income does not necessarily
Today it is obvious that more
programmes for scheduled mean an improvement in the eco
than 30 years of planning has not
caste
and tribes, developing nomic status of the whole popu
brought about any significant
an
intensive
integrated FP lation. Further, even while talking
change in the health statistics.
programme,
rural
electri about improving the economic
The morbidity and mortality rates
fication and better housing, condition of the people the report
still continue to be high. There
and finally creating a demo sidetracks from the main issue.
has hardly been any change in
cratic, decentralised parti On the one hand it talks about
the massive problems of malnu
cipatory form of government. the radical transformation of the
trition and environmental sanita
tion. Communicable diseases still — improving supportive pro society while on the other hand
take a heavy toll of human lives.
grammes like nutrition, envir food-for-work programmes have
The report states that the root
onmental
sanitation and been recommended. Nowhere in
the report is the non-implementcause of all this has been
health education.
ationofthe land ceiling act or
(a) the imitation of the western — by training a new cadre of
the
need to redistribute resources
model of an over centralised
health workers, the commu- i
even
mentioned.
heavily curative, urban elite
nity health volunteers, with
oriented, costly and depen
emphasis on decentralisation
The report cites the examples
dency creating health delivery
of services at the gram of China and Cuba as two coun
system;
panchayat level.
tries that were able to bring about
(b) treating health in isolation — by giving more importance an appreciable change in the
to the preventive and pro health status of the people withwith little or no attention
motive aspects of health as
being paid to the ‘non-medi- |
HEALTH FOR ALL:
AN ALTERNATIVE STRATEGY
HEALTH FOR THE MILLIONS/DECEMBER 1980
326, V Main, I Block
Koram^ng-la
Bangalore-560034
India
jj
going
to
solve
the
health
problems
in their economic growth. How ; clearly state how this money is to
ever, the report doesnot highlight ; be utilised, even though they do of the country.
allocation
of
money
On the whole, in the context
the ideology of these governments recommend
and the historical process through , for promotive and preventive acti of the Indian political system
which they were able to accom vities. From the structure that today, this report like many other
plish these spectacular achieve I has been laid out by the authors it ‘radical’ reports has its inherent
ments. The concept of ‘bare foot seems that a major proportion of contradictions and limitations.
doctors’ succeeded in China this money is going to be budge However, the fact still remains
I
because there was an active ted for salaries (i.e. 2 VHWs/100Q. that such a high powered body
participation of the people who population, Rs. 100 each, 2 MPWs has tried to view health in all its
were politicised enough to know for 5000 population, etc). Once dimensions'.’ Herein lies hope.
their rights and responsibilities. again that will be assuming that
— C Sathyamala.
Thus by trying to duplicate only creating more health professionals is
one part of the total process i.e.
training of CHWs is not necessarily going to mean a change in BOOK NEWS
the health delivery system because
the essential political climate is
not present. This argument can
be applied to most of the recom
INTERNATIONAL CLASSIFI with organ or system function,
mendations given. Just by decen I
resulting from any cause. In prin
tralising services one is not really CATION OF IMPAIRMENTS,
ciple,
impairments represent
bringing about a radical trans DISABILITIES AND
HANDI- disturbances at the organ level.
formation of the society.
CAPS. A manual of classifica
Disabilities^ code), reflecting
tion relating to the conseque
The report states rightly that
nces of disease. Geneva, 1980, the consequences of impairment
the main reason for failure of the :
207 pages. Available with WHO, in terms of functional performance
present health system is the lack I
and activity by the individual.
New Delhi. Price Sw, fr. 15.
of people’s involvement. The I
This manual of classification Disabilities thus represent distur
report recommends that people ■
bances at the level of the person.
should be made the active decis- , aims to improve information on
ion makers. But the study is the consequences of disease.
Handicaps (H code), concern
recommendation.
making the same mistakes by Following a
ed with the disadvantages experi
made
at
the
International
Confer
laying down, of what in theiropinenced bythe individual as a result
ion are, the steps towards develo ence for the Ninth Revision of the
of
impairments and disabilities.
pment. Even the budget, with the International Classification of
Handicaps
thus reflect interact
amount of money to be contribut Diseases, in 1975, the Twenty
ion
with
and
adaptation to the
ed by the community towards the ninth World Health Assembly
individual
’
s
surroundings.
meeting
in
May
1976,
approved
new health system, has been
worked out. The decisions have ■ “the publication,for trial purposes,
The three main purposes of
already been made. Where are the of supplementary classifications
the
manual are analogous to those
people going to participate now ? of Impairments and Handicaps
for which the International Classi
and
of
Procedures
in
Medicine,
If perhaps the communities had
fication of Diseases (ICD) is most
been involved in the planning, the as supplements to, but not as
widely used, i.e.,
suggestions might have been quite < integral parts of, the International
Classification of Diseases”.
different.
the production of statistics
In addition to its opening on the consequences of disease.
A word about the financial ;
implications of this new scheme. chapter on the consequences of
— the collection of statistics
It has been recommended that the » disease, the manual contains
government should spend about •' three independent classifications: relevant to the utilization of
services.
8-9% of the budget on health as !
Impairments (I code), concer
compared to the2% it is now spe- ! ned with abnormalities of body
indexing and case-record.
nding. The report however does not
structure and appearance and retrieval.
Impaired, Disabled or Handicapped ?
12
HEALTH FOR THE MILLIONS/DECEMBER 1980
npi | |Qfc™
bership with voting rights in the
organization, but the governing
board shall coopt individuals
committed to VHAI/KVHS philo
sophy and programmes. They
should not be elected to any
official position in the organisat
ion.
The present system of voting
Resource
persons
of
the
Eastern Region
September
1980
programme based on bed strength will be
included Dr Joyce Biswas of discontinued. Irrespective of bed
Fantasy and Planning
Calcutta Urban Service and the strength every member institution
The first Eastern Region stee
is eligible for one vote only.
staff of CINI.
ring committee meeting was held
It was also decided that VHAI/
on October 1-2, 1980 at DhyanKVHS
should provide technical
Southern Region
ashram near Calcutta. There was
assistance
and guidance to mem
sharing and discussion on issues
bers
to
plan
and implement pro
and problems pertaining to the In Review
grammes and projects. VHAI
VHAs in the region. As an
The Southern Region VHAs I
outcome of a fantasy session led had their biannual steering com- i should not undertake funding of
hospitals and programmes for the
by Renu Khanna of VHAI, the mittee meeting on October 25-26 i
time being, it was felt.
members were able to identify at Bangalore. It was decided-that
ten priorities and action plans for the regional coordinator would
Of Laws and Wages
the same for the next three years. be an invitee to State VHA gover- I
Another issue which has been
Low cost care, professional and ning board meetings. He shall
personal growth, the idea of reor attend atleast one meeting of abuzzing in KVHS is how to
ganisation and regional team were each board and that of the gene- , implement the gazette notificat
among the ten priorities.
ral body every year. Another i ion on Minimum Wages for the
hospital
employees.
highlight of the meeting was that , private
West Bengal
Members
raised
several
problems
' a six monthly performance review .
of the organising secretary with J at the special general body meet
In Bengali and in Nepali
; the elected secretary and the reg- I ing on September 24. A lively
discussion ensued. It was decided
WBVHA initiated a training ional coordinator will be carried- to send a delegation to meet the
out
in
future.
programme in Bengali on commu
labour minister to clarify various
A SWOT analysis of all the ;
nity health and development
clauses in the gazette notification.
from September
8-28, near state VHAs in ten regions was '
The meeting with the labour
Calcutta. The participants found done to help plan for the future.
minister
took place on October
The
emphasis
for
the
next
one
,
the programme very useful and
an evaluation meeting of the year in the southern region would 17, 1980. A memorandum was
News of further
training programme has been be on low cost health care, and submitted.
action
is
awaited.
Copies of the
workshops
on
physical
assess
fixed for December 10-12, 1981.
minimum
wages
notification
giving
ment,
school
health
and
holistic
Meanwhile DP Podar, the orga
payscales
for
various
work
cate
health.
nizing secretary, plans intensive
gories
in
the
hospital
can
be
follow up on all the participants.
had from K M George, Organising
Kerala
He feels future programmes
Secretary, KVHS, M-10/36 Chanshould ideally be for a month
gampuzha Nagar, Cochin 686022.
atleast.
Following the warm No to Project Funding
There was a special general
response to the training progra
Madhya Pradesh
mme in Bengali, a similar one body meeting of KVHS at Ernais planned in Nepali. It will be kulam on September 24, 1980.
Rising prices, hospital and
held in Darjeeling District for the Among the decisions taken during i
hill areas, tentatively in October the meeting were that KVHS medical expenses and demand for
should not have individual mem higher salaries have led MPVHA
1981.
health for the millions/december 1980
13
also to choose the theme of their for discussion include funding
State VHAs,
examining
1981 Annual Meeting as: “The of
I
the
need
and
possibility
of new
Cost of Health Care: Can Volun
tary Institutions Afford?" The I structures and new ways of workdates are February 6-7 at Raigarh. | ing in the VHAs and in VHAI.
■ The meeting was also attended
i in part by Dr Samuel Joseph
Bihar
I as a representative of the VHAI
! board.
Directing
BVHA
*
*
*
The BVHA directory has rea
ched the stage of final proof-read
ing and
printing and it is
coming out well. It is expected to
The greatly increased incid
be completed by December, 1980. ence of malaria is causing enough
The theme of the next AGM concern, though of graver concern
of BVHA is going to be “Low- is the rise in cases of Plasmo
cost Patient Care”. The dates dium Falciparum, a killer malaria.
are Feb 21-22, 1981 at Patna.
NMEP records show that last
This AGM will also be prob year this disease took 147 lives
ably the last for Anney Kurien as i which is the highest since the
the organising secretary of BVHA. parasite entered India from the
Plans are afoot for a new orga Far East in 1975.
nizing secretary.
Official statistics further show
that the parasite has spread from
Gujarat
the North Eastern States of Naga
land, Assam, Meghalaya, Arunachal Pradesh and Mizoram to
A High Calorie Response
Bihar, West Bengal, Orissa,
The'response to the 5th annual
Andhra Pradesh, Madhya Pradesh,
convention and general body Maharashtra and now to Mirzapur
meeting of GVHA, on September
27-28, exceeded the wildestdreams
of Fr Urrutia and his friends. The
highlights of the convention
included “Vitamin Raja”, a pre
sentation by the Johapura health
workers on simple communica
1980 is the centenary year
tion, and the health exhibition.
of
one of the oldest health
The 80 participants went back
centres
of South India: the
with joy and mutual support.
Fr Muller's Charitable Institutions,
Mangalore.
Epileptic patients are not inc
luded in any category ofthehandicapped. It is estimated that there
could be 54, 00,000 epileptics in
the country who do not enjoy
either adequate treatment or
rehabilitation services.
Killer Malaria
in Uttar Pradesh. In Patna, cases
of Plasmodium Falciparum acco
unts for over 50% of the positive
cases of malaria.
This malarial parasite can
attack the brain and does not
respond to Chloroquine though it
does respond favourably to qui
nine. According to Dr Patraib,
Director of the Eradication Pro
gramme, the problem is not the
treatment of this kind of malaria
but reaching the drugs to remote
areas, orienting the doctors
towards giving proper treatment
to the disease and getting to the
patients before the malaria has
reached an advanced stage.
Fr Muller's
Completes a Century
Delhi
The annual meeting of the
state organising secretaries took
place at Cochin, September
16-19, 1980. There was sharing
of reports of activities and pro
blems over the year. Some
important issues which came up
14
While
debate
rages
in
Fr Muller’s today as to what
ought to be a fitting centenary
memorial, one cannot let the 100
years of service pass without due
reverence and celebration. Their
homeopathic poor dispensary is
still regarded as a remarkable
achievement
of
integrating
allopathy with other systems of
medicine. The South Kanara
district health survey undertaken
by Fr Muller’s in 1977-78 was surely
the first of its kind in India,
and probably in the world. A
Fr Muller’s centenary charitable
society has been formed as an
offshoot to implement some of the
survey findings.
Like the Kannada poet, we
too will say Dhanyosmi to
Fr Muller’s.
HEALTH FOR THE MILLIONS/DECEMBER 1980
Enabling News
B
of physical therapists, parents
are being trained to help their
crippled or retarded children at
home.
techniques for disability prevention and
A No-cost Aid
rehabilitation
Tanzania has now made edu
cation of handicapped children
* investigate and assist the development
In Philippines a community
of locally produced, low-cost technical
compulsory.
This
education,
based project has been started
aids
- which includes the blind and
to assist disabled children in ; * develop and distribute training matedeaf is to a large extent carried
two villages in Neuva Ecija. It ;
rials
out with the regular public school
focuses on the prevention, early * provide enquiry and liaison services i system. However, severely handi
detection and intervention mea
and produce a newsletter to help with
capped youths may attend special
this
sures for impairments in young
I schools operated by the private
children under the age of six. * examine the possibilities of incor i organizations with supplemental
Preliminary results show very
porating rehabilitation projects into
grants
from the Ministry of
primary health care programmes.
clearly that many impairments
| Education and Social Welfare.
are temporary and can be modified
AHRTAG is ideally suited to j In addition, there are manual
or eliminated if detected in time.
I training programmes for the
One mongoloid baby was trans provide these services. It already . handicapped in various parts of
formed from a listless child to a has a wide selection of training 1 the country. After 18-24 months
lively, responsive girl in just a | materials and other data and the | of training, the client is employed
few months because of the capacity of disseminating this in- in private industry or placed in a
application of no-cost simple ; formation both at community level cooperative production workshop;
intervention measures, such as and nationally within primary and a few handicapped trainees
physical intervention/stimulation, i health care programmes.
• are given tools and equipment
Further information can be
singing and talking and playing
’ for the operation of their own
with the child. But the most ; obtained from Ann Darnbrough ! business.
important factor was the change ! or Ama Blum at AHRTAG, 85
PROGRAMME
of attitude on the part of the Marylebone High Street, London CHILD-to-child
and the
mother and neighbours: from WIM 3DE, UK.
INTERNATIONAL YEAR OF
negative to positive, from shame
DISABLED PERSONS
and pity to supportive and encou
WANTED
URGENTLY !
raging. To help children with Government Efforts
.... Information
on
disabled
impairments, programmes must
In East Africa, Kenya has the children.
involve the whole community.
most facilities for the rehabilita A FREE copy of CHILD- to-child,
tion of the handicapped, includ- published by the Macmillan Press,
, ing a public hospital unit in and a set of CHILD-to-child acti
The AHRTAG Connection
i Nairobi for amputees and the vity sheets will be sent to anyone
sending a real life description of
As a contribution to the 1981 orthopaedically handicapped and how a child helps his or her dis
IYDP, the Appropriate Health a prosthetics and orthotics train abled brother or sister or the dis
Resources and Technologies Act ing center. Services are under abled child of a neighbour. These
ion Group (AHRTAG) has set up the direction of a Senior Rehabi stories are urgently needed for
a unit which will help to spread litation Officer within the Ministry the CHILD-to-child Programme in
the International Year of Disabled
information on disability prevent of Social Services. This unit is Persons (1981).
ion and rehabilitation among inte responsible for case finding and
Please send an account, long
service delivery throughout the or short, to:rested organizations.
country. It also works closely with DUNCAN GUTHRIE, CHILD-toThe main aims of the unit will be
private
organisations serving child Programme, c/o Institute of
to:
select groups of handicapped Child Health, 30 Guilford Street,
* gather information on appropriate
persons. To relieve the shortage London WCIN IEH, ENGLAND.
What’s Enabling ?
health for the millions/december 1980
15
ENABLING
Malaysia: Rattan and Bamboo
Child’s walker
and trolley
The cost of imported materials tor the
Va" dia. rattan frame
manufacture of aids for physically disabled
children led a physiotherapist, Ms J K
Hutt, working at the Spastic Children’s
rattan binder
Association in Johore, West Malaysia to
design equipment from locally available
mild steel bar
u-ocd?n rod
bamboo and rattan. Imported equipment
5" dia. wooden wheel
was unsuited to the build of local inhabit
ants, and their way of life. The custom in
Malaysia is to sit on the floor, or on much
'/«> " thick boarding
lower seats than in the West, and to use
squat toilets. Walking aids, therefore, need
to be designed so that the user could reach i
a standing position easily from sitting on
India: Lowcost Wheel Chair
the floor.
Stabilized cane
From: Rattan and Bamboo (Ref. 2179) a report prepared by the Dis
abilities Study Unit. Wildhanger, Amberley. Arundel. W. Sussex,
U.K. Cosf?t2.00
16
In India, Shailendra Yagnik of the
National Institute of Design at Ahmedabad has developed an inexpensive wheel
chair specially designed for Indian conditi
ons. It has three wheels, two of which are
standard bicycle wheels, with the third
supporting wheel in the rear being a stand
ard caster wheel. The seat and backrest
form a single detachable unit which can be
tightened and adjusted to different-sized
users, whether children or adults. The min
imum level of the seat is kept at 14 inches
to match the height of the Indian toilet seat
so that transfer is easier. It also folds for
convenient storage and transport.
This wheelchair could be produced by
smallscale industry. Standard components
and indigenous materials are used to red
uce the cost. When mass produced, the
cost is expected to be 30% less than that
of existing wheelchairs, which tend to be
heavy, uncomfortable, and difficult to
manoeuver.
HEALTH FOR THE MILLIONS/DECEMBER 1980
HEALTH FOR THE MILLIONS
Vol. VI
No.4
August 1980
EDITORIAL
The medical profession is in the news again. 1 here has been
the regrettable paralysis of government health services at various
places in the country including the capital. Following closely was
the news of the multi-national study by the WHO, reconfirming in
CONTENTS
quantitative terms, our fears about our medical manpower planning.
We are “the world’s largest donor of medical manpower” says the
1. The Becoming of a Doctor
study. An estimated 15,000 Indian MDs—or 13 percent of the
country’s total—are working abroad and there is scarcely a
3. Can your Hospital Do it?
recipient country in the world where there are no Indian physicians.
4. No Illness is Ordinary
The
15,000 MDs outside India represents “a lost investment to the
5. My Name is Toppo
Government of India of S 144 million” - that is a loss of Rs. 115
8. Boat Ambulance
crores. To this loss we could add the loss due to the emigration
10 Physiology of Lactation
of nurses, para-medical technicians and others.
11. Health for All by AD 2000
The problem, as another article in this issue points out, is
12. News
inextricably linked with our ideas of promoting health care. The
13. Looking for a Change
causes, cures and possible solutions have been discussed time
and again by all concerned. We have learnt, quite often the hard,
13. We Need You
expensive way, that it is our political will and committment that
13. Opportunities
count for the country’s development Where there is a political
15. A.V. folio
will, there is a way.
Reference to the importance of political committment in
achieving the goal of HFA (Health For All by 2C00 A.D.) seems
to have also been emphasised in the recent WHO UNICEF regional
meeting on “Strategies for Health for All by the Year 2000”.
Editor : S. Srinivasan
“Politics and economics”, feels the science fiction writer and
Executive Editor : Augustine
futurist, Arthur C. Clarke, “are concerned with power and wealth,
Veliath
neither of which should be the primary, still less the exclusive,
News & Events : Nalini Bhanot
concern of full-grown men.
This we hope truly happens at least
in the twenty-first century. At least one good spin-off of achieving
Production : P.P. Khanna
health foi all by the year 2000, would be that the politics and eco
Assistance : Cynthia Browne
nomics of health as we now know, will cease to matter.
Circulation : L.K. Murthy
But till then the operational act of tapping political committ
ment, especially in the voluntary sector, for the goal of health
for ail will have to take the shape of institutional philosophy and
goal setting sessions, institutional reorientation following socio
Owned and published by the ' political evaluation studies, conscientization, motivation and team
Voluntary Health Association of ' bu'ldmg groups at all work levels and so on. There is scope and
cha lenge here for more creative and effective techniques^ the
India, C-14, Community Centre,
implementation level. The Government
~
of India has constituted 3
Safdarjung Development Area,
Working Group on the srole of voluntary organisations in this
New Delhi-110 016, and printed
national and global effort. The Working Group, consisting of
at
Sabina
Printing Press,
lepresentatives from the voluntary sector
including VHAI, met
last on March 20, 1980. Among the mi
387/24, Faridabad.
...any suggestions that emerged
after their detailed deliberations was
w.
the need for voluntary
organisations to bear in mind the <_
cost effectiveness of their activities vis-a-vis governmental systems
— To achieve better dialogue
Cover Picture
between the government and the voluntary
........ —A organisations, it was
felt that Standing Committees at th.. r ....
nd Local
Source - Morley and Woodland,
levels need to bn set up. Duplication 'ot ser AeT wo
need to
“See How They Grow", p. 11,
be avoided b«»eo»
.
fig. 1.8, "Justice for whom?"
We
«>,
(ron. ita
•
Gmup
THE BECOMING
OF A DOCTOR
Over the years, there has been
a tremendous increase in the
number of our medical colleges
and in the number of medical
graduates. (See table
below).
This progress, however, has not
met the expectations of even
our most optimistic citizens when
it comes to the matter of provid
ing health care to the people of
India. We now have an educated
group of men and women with the
ability to do much good to the
nations’ health but a bit short in
their willingness to do so.
Why does this
happen?
Where have we gone wrong in
our planning and priorities?
Year
1947
1961
1977
No. of med.
colleges
prominent. Intellectual satisfact
ion and national
needs are
significantly
less
important.
This throws light on the increased
demand for full time employment
in teaching hospitals or large
non -teaching institutions with
well equipped facilities for diag
nosis and therapy.
Surgery has the highest pre
ference as a speciality followed by
Paediatrics and General Medicine.
The preference for Social and
Preventive Medicine and Public
Health is the lowest. The net
orientation of the students is thus
towards urban curative practice
rather than the provision of com
Annual Admission
Capacity
No. of doctors that
qualified annually
1983
6846
11,174
959
3900
12,000
22
62
106
Who Becomes a Doctor?
There are at least two wellknown studies on the profile of
medical students. They reveal
that about 60 percent of the
students are from an urban back
ground. More than 80 percent of
them are from middle and upper
income families with their father’s
educational attainment being at
least higher secondary.
The
students are thus essentially
urban-oriented and middle class
elites.
Among motivating factors for
choosing medicine as a career,
job security, prestige and finan
cial remuneration
are more
prehensive health
rural areas.
care in
the
The studies also report that
interns are not willing to work in
rural areas because of the inade
quacy of drugs, equipment, lack
of educational facilities, opportu
nities for professional advance
ment and poor communication
systems with urban areas. If
professional standards and living
conditions are improved, then they
say they would go to rural areas
for work.
Imbalances
The reluctance of doctors to
go to rural areas partly accounts
HEALTH FOR THE M1LLIONS/AUGUST I980
for the unemployment among
doctors which is estimated to be
about 12,000 in this country.
About 1000 doctors emigrate
from the country every year.
According to UNCTAD studies,
each Indian emigrant doctor costs
the nation Rs three lakhs. It costs
the national exchequer more than
Rs. one lakh to turn a youth into
a full-fledged doctor.
About 68 percent of the active
medical manpower in 1979 was
reported to be in urban areas,
whereas the
remaining
32
percent of the doctors were in
rural areas where 78 percent of
the population live. The doctors
in the rural areas work in primary
health centres, dispensaries, or
have their private practice. The
rural population is also served by
other systems of medicine whose
size is not known, but whose
contribution is often underesti
mated.
We have about 247 doctors
per million population in the
country which is one doctor
per 4,000 population. This ratio
looks satisfactory but in practice
it is not so if we consider the
rural - urban distribution.
The
Union Territory of Delhi is esti
mated to have the highest doctor
population ratio in the country:
1997 doctors per million population
as against the national figure of
247. In most of the states this
ratio is far below the national
average. Himachal Pradesh has
the lowest with 85 doctors per one
million population.
1
The effects of this imbalance
are intensmed because of poverty
malnutrition, ignorance end the
consequent poor health of the
population.
The modern doctor is being
s'ow.7 dem/tho'ogissd. He is no
longer viewed by many as a
humanitarian healer of the whole
man. He is seen as a technician
highly skilled. highly pa'd, imper
sonal and superspeciai'sed. Ths
oath betakes becomes a mere ritual
rather thana philosophy to be lived.
Consciously or unconsciously, the
medical graduate is becoming a
misfit—a symbol of the mismatch
between the nations needs and
the expectations of professionals.
Factors largely contributing to
this imbalanced situation include:
— the medical graduate himself
with h's middle upper class
values, attitudes and social
class preferences,
— inability of the government and
voluntary institutions to meet
the needs and expectations of
the doctor,
— an unrealistic emphasis in cur
health care plans on a system
of medical care delivery with
the doctor as the focus, and
— the process of medical educa
tion in the teaching college
hospitals in India,
Alternatives-Medical
Teaching
2
The medical colleges with their
teaching hospitals should have a
prominent role in bringing ahoythese concomitant changes. The
change could start with a thorouah
w
The draft Sixth Plan remarks:
°The behaviour of a doctor, as
of anyone else, is determined
largely by the socio-economic and
political structure of the society
and not merely by the under
graduate
medical
education.
Marked improvements can there
fore be expected only if ana
when the society is restructured
for social justice. But within
Recently health has been
accepted as a right of ail citizens.
However, since socio-economic
conditions affect the health of
people, these conditions will have
to be changed if health is to be
considered as a universal right.
Other/rise, it is likely to remain a
right in theory only.
The effects of this imbalance
are intensified because of poverty
malnutrition, ignorance and the
consequent poor health of the
population.
the limits placed, we can achieve
a considerable amount in chang
ing attitudes, skills and knowledge
if the medical colleges restructure
the educational programmes"
The modern doctor is being
slowly demythologised. He is no
longer viewed by many as a
humanitarian healer of the whole
man. He is seen as a technician
highly skilled, highly paid, imper
sonal and superspecialised. The
oath hetakes becomesa mere ritual
rather thana philosophy to be lived.
Consciously or unconsciously, the
medical graduate is becoming a
misfit—a symbol of the mismatch
between the nations needs and
the expectations of professionals.
Factors largely contributing to
this imbalanced situation include:
Much of medical teaching
concentrates on the understand
ing of human disease than on
preserving wellness and health
in the community. The patient
who comes to the teaching hos
pital comes only as a last resort,
when the necessary facilities are
not available elsewhere. The
medical students in turn are trained
in the diagnosis and management
of the not so common ailments.
With such training, the attitudes
and skills necessary for prevent
ing and managing
common
ailments like malnutrition and
diarrhoea are either forgotten or
never learnt.
— the medical graduate himself
with his middle/upper class
values, attitudes and social
class preferences,
— inability of the government and
voluntary institutions to meet
the needs and expectations of
the doctor,
— an unrealistic emphasis in our
health care plans on a system
of medical care delivery with
the doctor as the focus, and
— the process of medical educa
tion in the teaching college
hospitals in India.
Alternatives-Medicai
Teaching
The draft Sixth Plan remarks:
“The behaviour of a doctor, as
of anyone else, is determined
largely bythesocio-economic and
political structure of the society
and not merely by the under
graduate
medical
education.
Marked improvements can there
fore be expected only if and
when the society is restructured
for social justice. But within
2
The teaching hospital provides
for the management and cure of
disease in comparative isolation
from the community. The socio
economic and
environmental
factors leading to the disease are
not adequately explored. Only
recently have efforts been made
to branch out and take a total
view of health and development.
This has been more at a planning
level. There is little evidence of
successful implementation.
Recently health has been
accepted as a right of all citizens.
However, since socio-economic
conditions affect the health of
people, these conditions will have
to be changed if health is to be
considered as a universal right.
Otherwise, it is likely to remain a
right in theory only.
The medical colleges with their
teaching hospitals should have a
prominent role in bringing about
these concomitant changes. The
changecouldstart with a thorough
health
revamping and revision of the
medical curriculum to include
exposure to management techni
ques, social work, psychology,
anthropology, health administra
tion and community development.
The doctor needs insight into
the psychological and socio
economic factors
that
bring
about disease in the community.
A new curriculum as above
could
also
emphasise
that
other disciplines of knowledge
apart from medicine are also
responsible for the prevention of
illness and maintenance of health.
The politician, thesocial histo
rian, the economist and the social
psychologist perhaps have a
clearer view of the problems of
medical care than those within
the inner sanctum of the teaching
hospital. They are much more
involved in the socio-economic
problems of the villages than
doctors.
The tradition of the teaching
hospital has been to limit their
scope to the curing of disease.
Now they need to widen their
scope by extending health services
and promoting the overall develop
ment ofthe community. Thiscan
be achieved only with the consent
and participation of the com
munity.
Even within the health field
there has been fragmentation
rather than integration. Leprosy
work, T. B. Control, Family Plan
ning, etc. are considered as separate projects and none of these
integrates the health activities
with the socio-economic develop
ment of the community. The
initiative could be taken by the
teaching hospitals, both in urban
and rural areas.
The above innovations would
,rnPly a planned programme of
for the MILLIONS/AUGUST 1980
change
and
organisational
development in the teaching
hospital. Behavioural scientists
could help in this effort. Probably
the teaching hospitals would then
be more responsive to the needs
of the environment.
dentistry, pharmacy, administra
tion, etc.
The Council would
bring the learning, ethical stand
ards, registrations etc of all
systems of medicine under a
common umbrella.
Thesesteps, once implemented
may bring us closer to our dream
of the village where the qualified
vaids, hakims, homeopathic and
allopathic doctors, all weave
themselves into a single health
care system, interlinked with
referrals back and forth and with
frequent meetings to integrate
their work better. Their collabora
tion need not necessarily mean
mixing the systems, merely under
standing and recognizing the
Alternatives-Creation of
New Roles
If the training of a young
doctor has been a bit costly and
unsuccessful, could there be
other ways of training people to
promote health?
good in each. And where the
number of qualified medical men
is not sufficient, the teaching
hospital would play its role in
preparing medical assistants.
This couid be done by the three
year course for medical practit
ioners, or by upgrading public
health nurses to nurse practit
ioners, or by giving matric pass
people a two year course in diag
nostic skills to recognize and treat
the 20 most common ailments.
This is an extract of a chapter
from the book 'The Process
of Management in Health Care
Administration' which will be
published by VHAI shorty.
Definite steps appear to have
been formulated at the August
1979 National Conference on
Health and Medical Education.
This conference approved and
Can your Hospital Do it?
recommended a three year medi
cal course. Maharashtra is plann
Last night I was reading a
ing to open schools which would
book entitled “Roads to Read
conduct such courses.
These
ing”, by Ralph C. Staiger. This
graduates would be trained to
was sent to me on request from
treat basic illnesses in the rural UNESCO (7 Place de Fontenoy,
areas and would concentrate on 75700 PARIS). From reading this
the preventive and promotive ' book it does seem that the easy
aspects of health.
[ availability of books is what will
I
A second positive step formu- ' encourage people to buy and read
lated in this line is the idea of I the books. Many of your hospitals
setting up Health Science Uni- | must now have a reasonably
versifies in each State. These • good health education progra
would teach not only the above mme. Would not this programme
three year medical course, but be even more effective if a
also nursing, pharmacy, and all proportion of those attending
the paramedical branches. All who could efford it, were encou
systems of medicine and the raged to buy a little book costing
one or two rupees!
history of medicine would be
What I would like to hear from
taught. The humanities, sociolo
you
is whether you feel that
gy, anthropology and psychology I
existing voluntary agency hosp
and their relation to health educa- :
itals and other units, could
tion, would also be covered.
become wider distributors? Do
A third positivestepformulated any of the voluntary hospitals at
to make health a reality for all is the present time have bookstalls
the government’s proposal to set available in their out-patient
up a Health Education Commi waiting area? I see these stalls
ssion to plan and ensure balanced ’ selling a series of low cost books
development of all health related I to the out-patients, but at the
disciplines - medicine, nursing, ■ same time stocking or having
HEALTH FOR THE MILLIONS/AUGUST 1980
facilities available for the staff,
particularly
the nurses and
medical assistants, to purchase
the sort of books that th ey require.
If such a programme could be
developed, I see the V.H.A.I. as
being a motivator, putting the
hospitals interested in developing
a bookstall in their out-patients in
touch with the retailers of the
books and at the same time,
making some of the invaluable
material that you have in V.H.A.I.
more widely available.
Dr David Morley
3
iwwivn
NO ILLNESS IS ORDINARY
It is generally recognized that serious illnesses,
such as measles and tuberculosis, can have grave
affects on children. Not the least of these is the
fact that the child’s food intake is decreased at a
time when he or she needs it most. That is, the
child's appetite is not as good as usual. For the
child who is well nourished prior to the onset of
illness, this decrease in food intake is probably
not too serious and can be adjusted for by providing
higher calorie foodstuffs. But for the malnourished
child, whose diet does not have great flexibility,
the decrease in food intake can have devastating
consequences, pushing the child still further into
a malnourished state from which he or she may
never recover.
In a recent study conducted by the Institute of
Nutrition of Central America and Panama (INCAP),
it was found that even the so-called “ordinary
illnesses”, such as the common cold or a bout of
diarrhoea, could decrease a child’s daily food
intake by up to nearly 20%, the equivalent of 175
calories and 4.8 grams of protein. Given this infor
mation and knowing how often a child incurs these
ordinary illnesses, it can be calculated that the
average daily food energy loss is 40 calories. This
may seem like a very small amount, but it amounts
to 18% of the mean energy deficit of a malnourished
child. That is, a malnourished child, on the average,
consumes 225 calories per day less than he or she
should for optimum growth and development. Thus
at least 18% of this deficit may be explained by
the effect of these ordinary illnesses on food
intake. These estimates are likely to be on the low
side since many children reported as healthy may
in reality be sick but do not show the symptoms
typically associated with ordinary illness (runny
nose, low fever, etc.)
Another Recognition
Sr. Carol Ann Huss, Consul
tant of the Voluntary Health Asso
ciation of India was advanced to
Fellowship status in the American
4
The study concludes that ordinary illnesses
must be included as one of the major causes of
malnutrition in developing countries and must be
considered by all programmes aimed at improving
nutritional status. The recommendation is made
that existing programmes designed to alleviate
malnutrition be carefully analysed, for certain
kinds of health interventions may prove more costeffective than such traditional approaches as food
supplementation.
(Adapted from The impact of ordinary illnesses
on the dietary intakes of malnourished children,
American Journal of Clinical Nutrition, Volume 33,
Number 2, February 1980, pages 345-350. Reprints
are available
from: R. Martorell; Associate
Professor of Nutrition; Food Research Institute;
Stanford University; Stanford, California 94305
U.S.A.)
Excerpt from
League For International Food Education - April 1980
College of Hospital Administrators
at its 46th Convocation Ceremony
held on July 27, 1980 in the Theatre
Maisonneuve at the Place des
Arts.
The ACHA is a Chicago-based
national professional society of
nearly 15,000 chief executive
officers and their administrative
staffs managing hospitals, health
service facilities, and healthrelated organizations and agencies
in the United States and Canada.
HEALTH FOR THE MILLIONS/AUGUST 1980
Perception of
My Name is Toppo
Primary Health
Care by Medical
In this article Mr. Albinus Toppo, a fictitious though a
typical Village Health Promoter tells us about the health
work in his village.
Students
1.
That there are a sizeable
number of students who do
not know what Primary Health
Care is (11.82%) or its rele
vance to India (16.32%).
2.
That there are many students
who have mistaken this for a
Primary Health Centre. (15%)
3.
That there are many (20.08%)
students
who talk about
this in general terms (which
is another form of talking
nicely about things one does
not know).
4.
That only 8/533 i.e. (1.5%)
talk about easily available
minimum care.
♦From a paper prepared for the
ICMR Symposium on “Evalua
tion of Primary Health Care Pro
gramme”.
By
Dr. Prabha Ramalingaswami &
A. Shyam **
Chairman
Centre of Social Medicine and
Community Health, Jawaharlal
Nehru University
♦♦Research Investigator, “Project
on Estimation of Cost of Medical
Education".
“My name is Albinus Toppo.
I was born and brought up in this
village. I am married now and have
children. As my father is quite
old, I am responsible for culti
vating the family fields.
thought a patient had a ruptured
appendix and she wanted him to
go to the hospital. The patient
just refused to go because he
knew he would not be able to pay
the bill and he did not want “to
beg”.He went home and died. So
In 1976 when Sr Mary first
I started a medical insurance
suggested having a camp to learn
scheme. The families in my
about Hygiene, Sanitation, Nu
village pay Re. 1/- per month
trition, First Aid, Mother Child
for
this scheme so that in future
Care, Natural Family Planning, ‘
improved
Agriculture,
Home . no one will refuse to go to the
Nursing and treatment of disease, , hospital when Sr Mary recom
I did not know what she was mends it.
talking about. Still, we had so
There was a similar problem
much sickness in our village,
about
payment for the medicine
especially malaria, and Sr Mary
I
gave
to
the patients. Two pansaid we could do something
about that. So the people of my ; chayat members helped us to
village chose me to attend the ! discuss this problem at a village
camp. Then I went to another | meeting. After that the people
camp in 1977. I had learnt a lot
by then and was able to encour- !
age everyone in our village to ;
contribute so that we could pre- !
vent malaria. As a result, no one
got malaria in 1978.
I was very pleased with my
success. I started visiting the
people in my village regularly and
found out their health problems.
The people started trusting me
and now call me whenever there
is an emergency. Usually, I can
deal with the problem but some
times I need to take the patient
to Sr Mary at the health centre.
Sr Mary makes it a point to teach
me while she does the treatment.
Sometimes she has to send a
patient to the hospital.
Once I
HEALTH FOR THE
M1LL1ONS/AUGUST 1980
remember, Sr Mary i
4 CHANCE TO TEACH.
Mr. Toppo
demonstrating the treatment of an injured,
hence promoting community participation
in health care.
5
started paying me for the cheap
medicines and once a year they
even give me some rice.
Strengthening
Programme
the
VHP
“1 went to a special camp for
supervisors and now I support
and encourage ten VHP’s in their
work. I am really grateful to our
teachers (Sr Bridhi Chandra,
DSA, Sr Julie, JMJ, Sr Desm
ond, Carm., and Sr Basil, SCSC)
who see to it that we keep on
learning year after year.
I use a cycle from the health
centre when I am travelling to the
ten other villages. This makes it
easy for me to do my field work.
We VHP’s get together often.
Sometimes we.have meetings in
the jungle where we collect
herbs and share what we know
about “Desi-Dawa”. We also put
up health dramas a few times a
year at the bazaar. On Sunday’s
after prayers in our village cha
pel, I give a health talk or demon
stration.
Every month Sr Mary holds a
follow-up meeting and makes it
so interesting that almost all of us
VHP’s attend regularly. She has
started serving us a delicious
meal too so that we don’t have to
bring our food from home. We
make a lot of decisions about
the health work in our parish at
the follow-up meetings. For inst
ance we have decided that we want
to take up a leprosy/tuberculosis
survey in our villages and we are
going to build latrines in our
own homes and hope that others
in our village will then want one.
I am looking forward to meeting
other VHP's from other places at
the coming VHP rally in 1980.
year with how much better our
health centre is and how the
services now reach everyone.
Sr Mary now has a trained ANM,
Emilia helping her. So everyday
one of them is out in the villages
assisting us VHPs with ourwork.
The doctor from the hospital
comes every month to see patients and has left behind what
Sr Mary calls “standing orders",
something like what we VHPs
have in our First Aid Box. Sister
now does laboratory tests that
help her in diagnosing illness.
Sr Mary has always been sending
in statistics about her work to the
Health Coordinator, but now we
Service
Health Centres
Hospitals
Village Health
Promoters Camps
conducted 1st
and 2nd
Cheap Medicine
Fund Utilized
Monthly visit by
doctor
Data collection from
Health Centres
Continuing Educa
tion ; attends
RAHA meetings
Health Education
ongoing in Health
Centre
Mother-Child programme/under
three’s prog.
Simple lab in
health centre
Antenatal care,
dai training, postnatal visits
Medical insurance
Scheme
Malaria Prophylaxis
Over All Development of School Health
Programme
Existing Services
Sanitation
“Somehow I am struck this Programme
6
are sending in figures on our
VHP work too. The medicines
we use are much less expensive
than what is available intheshops
because Sr Mary gets most of
them from the Cheap Medicine
Fund (centralized purchasing of
common medicines at the cheapest price available in India.)
This really helps our poor people.
Sr Mary attended a seminar
on “Physical Assessments’ ’ in
Kunkuri in November and when
she returned to the Health Centre
she was full of new ideas. She
now has a tape recorder that she
listens to on various health subjects and lately she has recorded
Total
No in
Raigarh
78
79
20
22
2
2
78
14
1
79
14
1
78
34
3
79
36
3
9
14
3
5
12
19
20
23
13
14
33
37
13
17
9
12
22
29
16
18
7
9
23
27
22
23
13
14
35
37
23
24
15
15
38
39
18
23
6
10
24
33
6
14
0
1
6
15
3
6
1
7
4
13
3
6
8
6
0
3
3
4
3
9
11
10
0
2
0
0
0
2
0
3
0
0
0
3
No in
Surguja
HEALTH FOR THE MILLIONS/AUGUST 1980
health talks in Hindi and Oraon
for use in our under three's
clinics. What I like best is that
instead of waiting for sick people
to come to them, Sr Mary and
Emilia are often out on their
cycle or luna reaching us in the
village.”
Health and Development
“About twice in a yearSr Mary
goes off to the RAHA meeting
and she always comes back with
some new ideas which she
shares at our VHP follow-up
meeting. This year in April she
learnt the importance of “Health
by the Pupil”.
She discussed
this with the school teachers and
with their help, all the school
children will be taught to use
healthy practices in the home and
village. In this way, they will get
to know as much about health as
we VHP's know. Sr Mary now
has all sorts of health posters,
flashcards, flannelgraphs in the
Health Centre (some of which
she received and some she made).
We VHP’s take these and use
them in the villages. Nowadays
we are also making our own. Sr
Mary participated in an Achieve
ment Motivation/Awareness edu
cation workshop some time back
so this year she was able to
conduct this workshop with us.
Through simple games we VHPs
experienced and then discussed
the importance of cooperation,
standing together for what is
right, taking initiative and believ
ing in ourselves and our Adivasi
people. Now seeing what we are
and what we are doing together I
am so proud to be an Oraon.
Relations with Government
“You know, I think the fact
that we VHPs are serving our
people and that our Health Centre
is doing a good job is stimulating
the government workers to do a
better job too. We make sure that
the malaria workers spray our
villages. Sr Mary takes blood
smears of all the malaria cases
and the Government Malaria
Officer gives some tablets of
Chloroquine free. Sr Mary has
approached the Primary Health
Centre this year and received
vaccines (DPT, DT, Smallpox,
cholera), Vitamin A, Iron and
folic acid free for our under
three’s and mother-child pro
gramme. Sometimes Sr Mary
goes far away for meetings like
the CHA, MPVHA and AFPRO
workshops.
She comes back
looking fresh, more enthusiastic
and full of good practical ideas
like how we can manure our
fields with compost rather than
expensive chemical fertilizer (for
which we just don’t have cash).
During the year we occasionally
see visitors from strange-sound
ing places like Sevagram, VHAI,
MPVHA,
OXFAM,
CEBEMO,
MISEREOR, CARITAS,
CRS,
ISI and XISS. We like to learn
something from these people
when they come and it makes us
feel important to think that these
people come from so far to see
what we are doing.
Areas of Development
“I don't know how it is in other
places, but in our areas so many
programmes are going on. What
ever ideas we come up with at
our village meetings, or at the
VHP follow-up
meetings for
improving our situation-well, it is
easy to implement it. We have
adult literacy centres in each of
our villages. Farmer education
programmes touch just about
every village. More and more
young women are going for
balwadi teachers training and
then returning to start balwadis
in the village. When I go to the
home of a grihini graduate I know
that she, the mother of the home,
will know how to take care of her
HEALTH FOR THE MILLIONS/AUGUST 1980
family in a healthy way so my
work is easier there. The “shadi”
schools really prepare us for
married life... Our school system
is constantly progressing and
with it our people improve. This
year we are really trying to have
family prayer and to pray occassionally in small groups together.
We feel so united and strength
ened in the Lord. The Mahila
Sangh is getting more and more
active in the villages starting
kitchen
gardens,
silk-worm
scheme, rabbit-raising and sewing
crafts. The only problem with all
this activity is that sometimes we
VHP’s are involved in one way or
another with all these program
mes and there just isn’t enough
time.”
Services for Children
“This year Sr Mary had dai
training for twenty-five dais from
our villages. Now these experi
enced women are doing even more
than they used to. They see the
pregnant women during the
antenatal period and treat anae
mia with gur and iron tablets and
deal with other problems or refer
complications to Sr Mary. There
were no complicated deliveries
this year and the dais continued
to visit the mother and the new
born baby for several weeks. In
the under three’s clinic in my
village we have worked so hard
that now you never find a thin,
malnourished baby. All of them
are immunized and treated as
soon as the first sign of illness
occurs.
Mothers
are now
practicing Natural Family Plan
ning. They know what to feed their
babies at the proper time and
they are now growing the food
themselves.
In the
balwadi,
the preschool children are really
flowering.
It makes me very happy to see
how much better everybody is in
my village and in the other villa
ges where I help."
7
AIR CDR. P. DHARMARAJU
BOAT
AMBULANCE
A new Transport Design in Disaster Medicine
in labour from the marooned i
villages to the nearest primary I
Floods are a disaster in India health centres or hospitals. It is
affecting a population of 75 million difficult for Mobile Medical Teams ■
and covering 34 million hectares to reach inaccessible, far flung :
of land. They cause loss of life and remote places. Country boats |
and property and disrupt commu are not easily available for emer
nications and public utility gency medical and health relief ‘
services. The villages and ham measures, nor do they lend them- j
lets are marooned and become selves readily and effectively for |
inaccessible due to subversion of improvisation, specially for the i
road communications; thus the installation of out-board motors. 1
population of these marooned This hampers speedy evacuation i
villages and hamlets get isolated which is an essential requirement ■
from the main land, at times for of emergency medical care. Keep- '
The Union Minister of health and
extended periods of timeas during ing this unsatisfactory situation :
Family Welfare officially launching the
the floods in 1978 in West Bengal. in view, a boat ambulance has been
Boat Ambulance on the Yamuna River
In short, floods cause greater loss conceived for the exclusive pur
front at the Sailing Club, Delhi on
of life and property throughout pose of delivering emergency
November 7, 1979
the country than many other medical and health care. This 1
natural disasters.
concept was shared with the , A. The boat ambulance is of
fibre glass construction and
From the medical and health various flood prone States. Their 1
its principal dimensions are
point of view, accidents such encouraging response prompted ;
the author to design and develop j
a. over-all length
as drowning, injuries due to
the boat ambulance to meet j
4.40m. (14*. 6”)
house collapses, electrocution,
emergencies during floods. It was '
insect and snake bites, diseases
b. breadth extreme
gratifying that the State Govern
like
diarrhoea,
dysentery,
1.95m. (5*. 6”)
gastro-enteritis and respiratory ments of Bihar and Orissa indi
cated
their
requirements
of
five
c, height of the cabin
infections occur as a result
1.77m. (5*. 10”)
of floods. Malaria and cholera and eight boat ambulances res
pectively. The development and
get accentuated due to extensive production of the boat ambulance
B. The following installations and
water logging and drinking water was undertaken in collaboration
fitments have been provided
contamination, respectively.
with a private firm in New Delhi
in the cabin of the boat ambu
under the author’s guidance and
lance
The Genesis of the Boat
supervision as per the qualitative
requirements laid down.
a. Two buoyancy blocks, one
Ambulance
Characteristics
of
the
Boat
on either side, act as plat
During floods, the health authori
forms on which the stretch
ties have considerable difficulty in Ambulance
ers rest firmly and securely.
The boat ambulance has the
evacuating the seriously injured,
the ill and the expectant mothers following characteristics :
b. Two specially - designed,
Introduction
HEALTH FOR THE MILLIONS/AUGUST 1980
light-weight folding stretch
ers have been provided for
installation, one on each
side, witha34cm (14”) wide
gangway in between them.
The working height of the
stretchers is 53 cm (21”).
c.
d.
e.
f.
g.
Provision for stowing an
oxygen cylinder with suction
attachment has been made
between the left buoyancy
block and the medical assi
stant’s seat.
h.
Two suspension hooks have
been provided in the cabin
ceiling for suspending bottles/
plastic disposable bags con
taining intravenous fluids with
giving sets.
i.
Two sets of cupboards, one
on either side, have been
provided for storing essen j.
tial medicines, disinfectants,
etc.
The following drinking water
and hand-washing facilities
have been provided.
A storage box with snug
fitting lid for storing splints
including Thomas splints,
dressings, nursing appli
ances etc. has been provided
in the right buoyancy block.
Two seats, one on either
side, have been provided
for the Medical Team com
prising one doctor and one
paramedical person.
The cabin is provided with
two sliding windows on either
side for ensuring adequate
ventilation and the windows
have been provided with
screens.
A water tank with facility
for refilling safe and pot
able drinking water from
n. A 12 volt battery is towed in
outside. The same water
the fore-end and under the
may be used for washing
sliding table.
also.
ii. A wash basin with a drain o. Three on and off switches for
operating the boat lights are
pipe with outlet for drain- |
provided in the cabian.
ing the waste water.
i.
Provision is made for keep
ing registers and other stat
ionery items under the seats.
Hi. Soap dish.
iv. Towel ring.
I
I k.
The cabin is provided with a i
sliding entrance door at its
fore-end. A fixed glass win
dow has been provided in the
middle one-third of the slid
ing door.
p.
The interior of the cabin is
lined by plywood with an air
gap of 2 cm between the
fibre-glass canopy and the
lining for providing adequate
insulation against heat and a
smooth internal finish.
q.
A detachable wooden step
ladder has been provided for
stepping in and out of the
cabin.
The cabin is provided with a
fixed glass window throughout its breadth at the rear. ■
This window coupled with the ;
The boat ambulance has been
fixed glass window in the sli- i
i fitted with three lights (battery
ding door in the front will pro
loperated), a cabin light, a flood
vide forward view for the boat
i light, outside the cabin and a red
crew.
• navigation light over the centre of
m. A sliding table has been pro j the roof. Provision is made for
vided near the doctor’s seat. I fitting an out-board motor (OBM).
I.
Side view of the interior of the Boat
Ambulance showing light-weight stret
cher firmly resting on the buoyancy
block, oxygen cylinder with suction atta
chment, built-in cupboard for storing
essential medicines etc., plastic disposable
transfusion bag with giving set suspended
from the cabin ceiling, medical attend
ant's seat and gang-way in the middle
for facilitating medical and
nursing
care during transit.
The other side view of the interior of
the Boat Ambulance showing the light
weight stretcher on the buoyancy block,
water tank, wash basin with tap and drain
pipe, towel ring, soap dish, built-in cup
board, plastic disposable bag with giving
set suspended from the cabin ceiling,
side window with screens, fixed glass
window at the rear of the cabin throughits breadth.
HEALTH FOR THE MILLIONS/AUGUST 1980
9
Red cross markings have been
displayed, one on either side of
the cabin and on the roof of the
cabin. In addition to the two
stretchers and the 12 volt battery,
the following accessories have
also been provided :
An extra pair of oars in case
the other oars become unser
viceable in transit.
b. Four life jackets for use in
emergency.
c. One boat hook.
The boat ambulance has been
subjected to rigorous testing in
the Yamuna River for safety,
stability and reliability by marine
engineers and found satisfactory
in all respects.
a.
Role of the Boat Ambulance
By virtue of its speed, the fully
equipped boat ambulance serves
to convey Mobile Medical Teams
to a larger number of marooned
villages and hamlets. Speedy
and casualties to the comfor
table evacuation of the nearest
health
centre is
facilitated.
The provision for administering
intravenous fluids and oxygen
enablethe medical team to under
take cardiopulmonary resuscitattion and provide critical medical
and nursing care.
lake in Orissa, the extensive net
work of rivulets and canal systems
in Kerala, Sunderbans of West
Bengal and in the Union Territory
of Goa.
utilising indigenous materials.
Seven such boatambulanceshave
been manufactured so far and
supplied to the State Govern
ments of Bihar and Orissa. Being
reinforced fibre-glass construct
ion, it is resistant to weather, fire
vermin and other destructive
forces.
Limitations
A minimum depth of one
metre of water is an essential pre
requisite for the safe operation of
the boat ambulance with theOBM. Official Recognition
It is not advisable to ply the ambu
The boat ambulance was
lance boat when the flood waters officially launched by the Union
are surging in. However, it is safe Minister of Health and Family
to utilise it immediately after the Welfare on the Yamuna River
waters become placid.
front at the Sailing Club, Delhi on
Manufacture of the Boat
November 7, 1979. The Director
Ambulance
General of Health Services expr
The entire boat ambulance essed full satisfacton regarding
(except the on-board motor) has the functional performance of the
been developed and manufactured boat ambulance.
Physiology of Lactation
All women arenotalike as regards | calcium and iron are little influ
their capacity for lactation. Some' enced by the nature and the
possess a much higher potential amount of maternal diet within a
than others. In common with all wide range of intake. The conce
physiologic functions the actual ntration of the constituents of
performance is not as great as ’ breast milk is also not influenced
the genetic potential, leaving | by the period of lactation. It is
some for physiologic reserve. In ! known that if the mother’s diet is
the same woman second and later j inadequate the output of milk will
one lactations tend to be more |
be reduced. Even then many
successful than thefirstindicating i
that, as in all reproductive func studies have shown that mothers
tions, trial runs are necessary of low socio-economic class are
able to secrete 400-800 ml of milk
The size and stream-lined con before optimal performance is
per day in the first year of lacta
achieved.
figuration of the boat ambulance
tion.
makes it highly manoeuvreable.
The high conversion rate of
When the diet during pregn
It is easy to steer the boat in food energy into breast milk, the i ancy is poor the mother will gain
narrow streets in urban areas low requirement of proteins, | little weight. Such a mother will
during floods. Thus it augments added to the biological ability to commence lactation with inade
modernisation of disaster mana store energy during pregnancy, quate body stores of calories to
enables mothers who are sub
gement techniques.
fall back upon. In spite of this the
sisting on marginal nutrition to
The boat ambulance may also breast feed their infants for pro milk output can be considerable.
be used for delivering routine longed periods. Mothers in pri For example, in onestudy of South
medical and health care, to areas soner-of-war camps have been Indian women of low socio-econo
easily accessible by water during reported to breast feed their mic group it was found that the
average daily output of milk was
the non-flood season. For inst infants successfully.
The concentration of the , 400 ml at the end of 18 months of
ance, it can be effectively utilised
to approach rural areas in the j various constituents of breast milk i lactation. It is likely that in such
northern rivers in Bihar, Chilka like protein, fat, carbohydrate,
Continued on Page 16
10
HEALTH FOR THE MILLIONS,/AUGUST 1980
health
for
all
BY
AD
2000
A conference was held by presenting the latest position
In the matter of research it
WHO South East Asia Regional paper, special papers were read was felt that for the next few
Organisation (SEARO) from 24th on inter sectoral collaboration, years research should be concen
to 30th June to discuss the strat systems approach, decentralisa trated on “health services” in
egies for Health for All by AD tion as akey process; assessment, preference to bio medical. Priori
2000. It was jointly organised by mobilisation and utilisation of the ties should also be given to the
WHO and UNICEF. High power financial resources needed for extension activities.
delegations were
sent from HFAby2000 and research support
In the final stage of the
Bangladesh, Burma, India, Indo to HFA 2000.
conference
papers presented by
nesia, Maldives, Mangolia, Nepal,
It was emphasised that there
each country on the national
Sri Lanka and Thailand. The is no contradiction between the
Minister for Health for Maldives development of self-reliance as strategies were discussed. WHO
also
attended.
Distinguished part of the national strategy for produced a draft on the regional
scientist members of the South HFA and using the resources of strategy and in the final plenary
East Asia advisory Committee on WHO and UNICEF in that session. The draft was presented
on the 30th June and was accep
Medical Research were also direction.
ted
with a few comments.
present. Amongst other agencies
The detailed country reports
In the paper on regional strategy
present were the Programme showed a wide divergence and ;
Officer of Swedish International patterns in primary health care, j emphasis was laid on the follow
Development Agency (SIDA), The Indian pattern is well known. ing subjects:
UNICEF expert on Health and I Nepal had great reliance on a) development of appropriate
Social
Development,
two Panchayats and it was establish
low cost technology;
representatives of the American ing medical posts at the lower
Public Health
Association, a level. Thailand had village health b) community participation;
representative of the
A.I.D worker as well as communicator. c) manpower development in
(Agency forlnternational Develop Mongolia had a system of feldsh
cluding development of auxil
ment) of American Embassy and ers, one for 6 or 7 households.
iaries and para medicals;
J.S. Bali, who was specially
An
interesting
experience
invited to represent the Voluntary which came to notice was the d) managerial process;
e) political commitment;
Health Association of India.
setting up of “village development
The objectives of the confer committees” in Thailand involving f) basic services approach.
ence were:
multi-sectoral
activities.
The Note: Community participation
also meant holding of
a) to review national strategies committee consisted of leaders of
seminars and workshops
society.
Sri
Lanka
included
the
and analyse progress
in
by voluntary organisations.
planning and management of cooperation of the NGO organisa
It was agreed ultimately that
tions in the planning of PHC
national programmes;
the role of regional strategy is to
programmes.
b) To analyse major problems of
It was felt that although foster the national strategies and
national strategies, if any;
population control would be give them maximum help and
c) To formulate regional strat essential for the achievement of collaboration.
This regional conference will
egies in support of country HFA by 2000, the subject was
strategies.
not included for discussion in this lead to a full WHO meeting of
about 140 countries in May 1981.
In addition to each country conference.
HEALTH FOR THE MILLIONS/AUGUST
1980
11
News
Preventive immunizations,
□ In a bid to control the high I 2.
oral
vitamin A supplement,
prices of branded drugs, the '
iron
and folic acid tablets.
government’s opening move has :
3.
Imparting
health education.
been to abolish the brand names ,
About improved child care
of five drugs in their single ingre- |
The new central budget has dient dosage form. These drugs ; techniques, CINI - Child In Need
special provisions for meeting the are analgin, aspirin, chlorpro Institute has offered to train
needs of women and children. mazine, ferrous sulphate and "Shishu Kalyanis” for thegovernFunctional literacy centres for piperazine. The Registrar of trade ment.
women to provide education in marks has also been notified
Bihar
health, child care and nutrition are not to register new brand names
to be increased at a total cost of for any of these drugs. This
Rs 237 lakh. Rs 225 lakh has been decision of the government is in
alotted for production units in
keeping with the recommendations
the voluntary sector to provide
of the Hathi Committee on the
women with training and work.
Inspired by the 6-H programme
pharmaceutical industry.
Rs 175 lakh has been put aside
on "Hospital Administration”
for nutrition programmes for chil
J & K
that has been
going on in
dren. The budget also caters for
Jamshedpur,
two
more 6+1
J &. K plans to extend the
a scheme to provide day care
groups were to be initiated;
services to the needy children and Rehbar-i-Sehat (health guide) pro one by Sr Amala of Carmel
to provide protective centres for gramme for primary health care Hospital, Mahandaur and the
children in the age group of to the entire state over a period other by Sr Jane, Holy Family
of five years.
five to eighteen.
Conceived in 1976 as a pilot Hospital, Kodarma. These were
project, a batch of 76 school for dispensaries, the theme being
A total of Rs 294 crores will teachers were selected and trai "Community Health”.
ned as Rehbar-i-Sehat. The con
Carmel Hospital stole the lead
be available for the period 1980-81
trol
of
the
project
and
the
health
and
hosted their first 6+1 meet
to provide clean drinking water in
I
institutions
in
the
block
was
ing
on
the subject, for dispen
rural areas. By the end of this
year, it is expected that 35,000 I transferred to the Jammu Medical saries in Palamau District, on
May 30-31, 1980.
villages will have arrangement for ; College.
The Rehbar-i-Sehat spend an
Resource persons were Ms
protected water supply. A part
of this sum of money willbeused : extra two hours in school after Anney Kurian, Executive Secretary,
for improving water supply in closing time and meet the basic BVHA;MrTony Kokoth; SrBonosa
j health requirements of the people. and Sr Dr Melanie from Carmel
drought affected areas.
They also educate the people on
Hospital. It was coordinated by
| different aspects of health care.
Sr Amala of Carmel Hospital.
The Health and family welfare ! School health has improved rem- An interesting part of the meeting
is to be revitalized and for 1980-81, » arkably as a result of this pro- was conducting exercises among
; gramme.
participants to make them analyse
Rs 250 crores has been set aside
concepts
such as "community,”
West Bengal
for this project. In family welfare
"health
”
,
"cooperation”, "moti
the emphasis is to be placed on
The Government of West vation” and "communication”.
educating the people on the desi
The meeting ended with an
rability of having small families ! Bengal is proposing to use a new
exercise on goal setting and after
;
category
of
"grass
root
’
’
workers
and providing the necessary
technical services at a cost of I called "Shishu Kalyanis” to imple- j the inputs, each participant pre
Rs 140 crores. The rest of the | ment its integrated programme ' pared their short term and long
outlay has been earmarked for i in mother and child care. The | term goals.
They plan to have their next
providing health education, health package of services includes
Nutrition supplementation meeting at Chianki on August
services in rural areas and for the I 1.
eradication of communicable dis
using a semi processed I 8-9-1980. The theme will be
eases.
food.
"Village Health Workers".
Health related
outlays in the new
Budget
Spreading their
Wings
Drinking water
Family Planning
12
HEALTH FOR THE MILLIONS/AUGUST 1980
Looking
Those interested may write to:
Miss
M E Connellan, C M
Vonapope, Box 75, Kokopo, ENBP,
Paupa New Guinea.
for a
Change
Applications are invited from
Pharmacists having two years
diploma, preferably with one-two
years experience. Apply with bio
data, within ten days to : The
Personnel Manager, Kurji Holy
Family Hospital, Patna 800010.
We
A married couple wish to join
a medical team of missionaries.
The husband is a registered
medical practitioner as well as a
leprologist, running his
own
clinic. He has been practising
medicine for twelve years. His
wife is a qualified and experienced
pathologist.
Please write to : Dr James
Puthenpura, Mercy Clinic, Victoria
Mission, P O Gahari Kothi, Dist
W. Champaran, Bihar.
Need
You
Wanted immediately —
a physiotherapist and a pharma
cist. Apply to The Administrator,
St Joseph’s Hospital, Dindigul,
Tamil Nadu-624007
Wanted
1. Head Nurses
A workshop for nurses, nursing
2. Registered Staff Nurses
administrators and educators is
3. Trained Theatre Nurses
Please send copies of Nursing being organized at Padhar Hospi
tal from September 15 to October
A young
couple with a Certificates, Registration Certifi 3, 1980.
master's Degree in social work cates and bio-data, within fifteen
The course is divided into two
from Delhi University is interested days, to the Dean, G. Kuppu- groups. The first group deals
swamy
Naidu
Memorial
Hospital,
in working in a Community Deve
Coimba with Administrative Planning and
lopment
Programme.
North Pappanaickenpalayam,
Evaluation (Sept 15-23,1980). The
Indian, Hindi speaking areas tore 641 037
second group deals with Patient
preferred.
Care Planning and Evaluation with
Wanted for a mission hospital emphasis on
Communication
Please write to : Mr Kalyan
Paul, D-91, Defence Colony, New in a rural area in Pune district, Techniques (Sept. 23-Oct 3,1980).
Maharashtra.
Delhi-110 024
Two instructors from interna
1. A lady doctor, MBBS, with
tional School of Nursing, Emory
about five years experience in
University, USA, will participate
obstetrics and gynaecology in
A medical technician, pres
throughout the workshop.
a big hospital.
ently working in a mission hospital
A maximum of 20 delegates
In Paupa, New Guinea wishes to 2. A doctor, MBBS, for general will be taken for each group and
medical and surgical work. priority will be given to delegates
work with a hospital in India. In
This would involve care of from Madhya Pradesh and nearby
her present post, she is incharge
outpatients and inpatients in States. For further details please
of a small but busy laboratory and
a general hospital and in write to : Dr AV Choudhrie,
is responsible for training three
outreach clinics in the villages. ' Padhar Hospital, P O Padhar,
local people.
She has wide
A married couple will be I Betul Dist., M.P.-460005
experience in all forms of labora
preferred. Previous experience
tory work as well as experience in
will be considered.
Salary
theatre x-ray and general nursing
CMAI will be holding its bien
scale: 600-50-900-75-1350-100procedures. She would be pre
nial conference at Jaisinghpura,
1950
’
DA.
Apply
to
Miss
DN
pared to work for a period of two
Geyer, Post Box No 4, Dhond, i Mathura (U.P.).
years starting from the end of
Dist Pune, Maharashtra-413801 ; Theme : “Together in Christ —
January next year.
•
HEALTH FOR THE MILLIONS/AUGUST
1980
CCWMU :TY HEAL"H
328. V Main, i Block
Ke.T?
Bangalore- JCCL4
CELL
13
Please write for application to: International Seminar on Societies
Caring for the whole person”.
VHAI, C-14, Community Centre, in Transition:
Dates : November 21-23, 1980.
Alternatives for the Future.
Interested institutions please j Safdarjung Development Area.
Dates : December 12-15, 1981
contact Dr D Isaac, General New Delhi-110016.
At: Cuttack, Orissa
Secretary, CMAI, P B 24, NagpurPersons interested in presen
International Congress on
440 001
ting papers at this seminar or in
•
Primary Health Care
attending it may write at their
Community Health Development
“Primary Health Care : World earliest to : Institute of Oriental
Training Programme.
Strategy” is the theme of the and Orissan Studies, ‘The Uni
For : VHWs, CHVs, leaders and Third International Congress of verse', Maitree Sarani, Cuttacksupervisors.
the World Federation of Public 753001, Orissa, INDIA.
Health Associations (WFPHA),
Duration : 20 days
to be hosted by the Indian Public
Dates : September 8-28, 1980
The Christian Rural Health
Venue : Child In Need Institute Health Association next February
Programme,
Doliambo, has recen
23-26
in
Calcutta.
Village Danlaspur
The meeting has five sub-themes: tly acquired a new building to
West Bengal
* developing national plans of serve as base centre. This new
and at Anand Bhawan
action;
building
has
been
named
Village-Jagdalpur
*
special
demonstration
and
“
Christian
Rural
Health
Centre
”
West Bengal
research
projects
in
primary
and
was
inaugurated
on
May
27
Language : Bengali
health care;
by the Bishop, J E L Church.
Fees : Rs. 100/- per candidate
* implementation of field pro
This new centre will be able to
Participants must be sponsored
grammes;
accomodate
16 inpatients and has
by an Institution which must state
* manpower
planning
and
a laboratory, labour room, a room
how it anticipates to benefit by
training;
for MCH Clinic, a simple opera
sponsoring their candidates to
* community participation
this course. Seats are limietd
The Indian
Public Health tion theatre, a hall for conducting
to 20.
Association has dedicated the a health education programme
Congress to the memory of Dr and a room for the possible Instal
For further details please write
John B, Grant, who during his lation of a simple x-ray plant.
to : Mr D P Poddar, Organizing
years with the Rural Health Unit
The construction of the centre
Secretary, WB VHA, PI/4/1 C.l.T.
and Training Centre at Singur, j was funded by the Nordelbisches
Scheme Vll-M, V.I.P. Road,
India, pioneered many of the pra ' Mission Zentrum, Hamburg, West
Kankurgachi, Calcutta-700054.
through
Jeypore
ctices being promoted under Germany,
WB VHA also coordinatestrai primary health care today. Dr Evangelical Lutheran Church.
ning programme in leparosy for Grant's son, James Grant, Exe
PMW’s (six months), ANM cutive Director of UNICEF, has
A group of young men are
Nursing (eighteen months), Lab concented to give the keynote
being
trained for hospital main
oratory Techinician (two years). address. A field trip to the Singur
tenance.
Hospitals wishing to spon
They would also be pleased to Health Centre is part of the
sor
this
training
may write to us.
meeting
programme.
help members in meeting training
The training can then be oriented
needs otherthan those mentioned
specifically to the need of the
above.
Human Relations Workshop
sponsoring hospital.
•
Eastern Region VHA.
Write to: MIT, Health
for the
Applications now being taken Dates : October 6—10
Millions,
Voluntary
Health
for January 1981 Nurse Anaes Venue :
Gopalpur-on-the-Sea,
Association
of
India,
C-14
thesia Course (Batch XI). Seven
Orissa.
Com
mu
nity
Centre,
For further details contact
students can be accomodated.
S.D.A, New Delhi 110016
Course for September 1980 S. Srinivasan, VHAI, C-14
Produced
for India by the
!
will begin September 1 1980 and Community Centre, S.D.A.
World Neighbours in collaboration
one more student can be accom
New Delhi-110016.
with Helen Kellers and the Indian
modated in this class.
Social Institute.
•
•
•
14
HEALTH FOR THE MJLLIONS/AUGUST 1980
PERSONNEL IN CHURCH
RELATED INSTITUTIONS
Published by C.B.C.I. Rs 12/pages 196 Available from Voluntary
Health Assobiation of India.
Good Food, Good Health,
Good Eyes
This is amotivational filmstrip.
It is designed to teach mothers
about vitamin A and blindness that
comes as a result of vitamin A
deficiency. Every year approxima
tely 100,000 of the world's children
become blind from vitamin A
deficiency. The filmstrip explains
the warning signs of vitamin A
deficiency blindness, the relation
ship of good nutrition and health
to good eyes, what foods contain
vitamin A and ways to prevent
vitamin A deficiency blindness.
Fullframe, 35 frames, colour,
script in English and Hindi.
Caring For Baby
This filmstrip gives an overview
of what it takes to care for a baby.
It was photographed in India and
is produced in cooperation with
the Indian Social Institute. The
story emphasizes the importanceof
prenatal and postnatal nutrition
and care for the mother, immuni
zation for the baby, and the impor
tance of breast-feeding and of
nutritious soild food for the baby.
Full-frame, 54 frames, colour,
script in English and Hindi.
Both these filmstrips are now
available from Voluntary Health
Association of India,
C-14
Community
Centre,
S. D. A,
New Delhi 110 016-
nger than the traditional walls of
the same thickness.
This is a ‘How to Do’ manual.
Every step is illustrated with line
drawings and action photographs.
The houses built in this manner
cost little more than Rs. 1,000/-
In this revised and enlarged
new edition, are some of the basic
norms towards developing our
institutions to build up a structure PRIMARY CHILDCARE
conducive to the harmonius em A guide for the community
ployer employee relationship.
leader, manager, and teacher
The book contains many basic
BOOK TWO
guide lines, common practices
by: Maurice King, Felicity King.
and also legal obligations.
Soebagio Martodipoero, pp. 194
There are sections on selec
Published by Oxford Medical
tion and recruiting, hours of work
Publications. Rs. 60
and leave, wages, disciplinary
A sequel to Primary Child Care
action andtermination of services.
Book
I, this book offers a slightly
But beyond the world of legali
ties, proceduresand cautions, this different package. This is a guide
community
leader,
humourously illustrated and easily for “the
manager
and
teacher"
mainly
readable text leads you to the
the trainer of health workers, it
heart of the matter: Human Rela
tions and Beyond.
A handy offers a series of tests containing
volume for those responsible for multiple choice questions that can
be used in many ways. The
work and employment conditions
questionnaires can be used to
in the voluntary sector institutions.
evaluate the learning of the
health worker,
assess further
training needs, find weak spots
RURAL INDIA: VILLAGES IN
I in the
programme's training
I method etc. Interestingly, for
RAMMED EARTH
by Poppo Swami published by one who can read this level of
Dienste in Ubersee, Rs 18/-, pages English, it can form a self instruc75, in English, Hindi and Tamil. . ctional book for learning and testAvailable from Voluntary Health i ing oneself.
Association of India.
The first few chapters, which
This nation needs millions of i cover only a quarter of the book,
low cost houses. The production i give a little about planning Primary
of cement and bricks seem never Child Care, but give a fairly
to cope with the need. The teach- ' elaborate description of how to
nical and industrial innovations use the questionnaire for different
don’t seem to reach the village i ways of evaluation.
houses.
The rest of the book gives the
Here is a refreshing manual 1 actual questionnaires.
These
that shows one way out by taking I range from tests for simple read
the same local materials and indi ing ability to tests knowledge
cating possible improvements that ! about care of the sick child. The
may be done at the village level.
questions are crossreferenced
The author claims that rammed j with the chapters that they relate
walls prove to be four times stron- ' to in the 1st book of the series.
HEALTH FOR THE MILLIONS/AUGUST 1980
15
The amount of energy spent
in designing and compiling this
book must be appreciated. It
will save a trainer many man
hours designing tests for evalua
tion. And like all preset instru
ments it also has some amount
of rigidity. Its best use can be
made by those using Book I. For
others, the principles are of value
and modifications can be made.
HEALING WITH WATER
Special applications and uses
of water in Home Remedies
for everyday ailments Jeanne
Keller
forms of water applications as a
means of healing.
The book gives specific instru
ctions for those who wish to
retain their health and the proper
functioning of their body, or
even to improve the functioning
of a specific organ. Some typical
titles in the book include “Getting
rid of lumbiago,” “Getting rid of
sciatica”, “The great benefits of a
short wrapping” etc.
A look is worth a “dekko” by
those who are in search of alter
nate technologies of healing.
aSHHBBSBMKBBaRKSni
Coconut Water
“We have been teaching and
(D B Taraporevala Sons & Co.
using
coconut water as a source
Pvt. Ltd., Bombay, India reprint,
of rehydration fluid. Getting
1979, pp 220). Price not stated.
The gradual disillusionment sterile water here is a problem.
of people with the organised We also get the mothers to give
systems of health care has led to their children the boiled ricecook
the emergence of a number of ing water which they usually skim
different schools of health care off and throw away. It is water
and cure. Some of these schools they boil three times a day in the
are a revival of time-tested reme course of their normal food
dies and traditions. Some others preparation They can skim it off
are a product of modern man’s and cool it in a clean container
amazing ingenuity. There is a and give it to the children who
third school of practitioners have diarrhoea. Compliance is
whose function and behaviour easier to get than if you ask them
has been not unlike the ephe | to boil a pot of water especially
meral manufacturer of a still more I to give to the child. It also has a
i little nutritive value and they can
ephemeral brand of soap.
There are men and women who ■ add honey (or sugar) and salt to
believe yoga is not scientific. j it to increase its value asarehyThere are others who feel science | dration fluid.”
baby. The average daily intake of
food provided 1400 calorics and
less than 40 gm protein.
The
average weight gain in pregnancy
was 6-5 kg, most of it (6.0 kg)
comprising of the weight of the
conceptus, so that immediately
after delivery the net increase in
weight was found to be 0.68kg.
As lactation proceeded
the
women tended to lose weight for
the first six months, after which
the weight became stationary.
The average weight loss in one
year as compared to the initial
weight of the mother was 1.5kg,
most of which occurred in the
first six months after delivery. In
spite of the loss of weight thesecretion of milk was adequate to
support the growth of the infants,
who grew from an average weight
of 2.90kg at birth to 7.39kg at the
age of one year.
From Breast Feeding
by
Dr Ebrahim.
Wanted Urgently . . .
Information on
disabled children
A FREE copy of child-tochild, published by the Macmillan
Press, and a set of child-to-child
activity sheets will be sent toanyone sending areal life descrip
tion of how a child helps his or
is not scientific. There are yet
her disabled brother or sister or
■ Victoria Rennie Senegal
others who believe that if a thing
the disabled child of a neighbour.
! L.I.F.E. March 1980 Newsletter.
works, it is good enough. QED.
These stories are urgently needed
Water healing-the subject of
for
the
child-to-child
Pro
(Contd. from page 10)
the book under review - is not
gramme
in
the
International
Year
•: conditions the nutritional and I
scientific. It is a low-cost tech
Persons (1981).
j energy cost of lactation is subsi- ' of Disabled
nique. It is partly a product of : dised by maternal tissues.
Please send an account, long or
time-honoured wisdom. And the
In one study 82 women of the short, to: Duncan Guthrie, chiidauthor claims it works. The book ■ lower socio-economic group in :
to- child Programme, c/o Institute
is a product of her 63 years of ‘ South India were followed from
of Child Health, 30, Guilford
experience and her desire to share > the 16th week of pregnancy upto •
Street, London,
WCIN IEH,
her knowledge of the various one year after the birth of the , England.
16
HEALTH FOR THE M1LL1ONS/AUGUST 1980
WOBW Nedghfoews Hhs.s5' Ips.
Caring for Baby
This filmstrip gives an overview of what it takes to care for a baby. It was photographed
in India and is produced in cooperation with the Indian Social Institute The story emphasises the
importance of prenatal and postnatal nutrition and care for the mother, immunization for the baby
and the importance of breast-feeding and of nutritious solid food for the baby. Full-frame, 54
frames, colour, script in English and Hindi, Rs 60. Available from Voluntary Health Association
of India at a subsidized price of Rs. 25/- for rural health workers programmes.
Good Food, Good Health, Good Eyes (Indian Version)
This version of the earlier filmstrip on vitamin A dificiency blindness is produced in
cooperation with Helen Keller International and the Indian Social Institute. Xerophthalmia (vitamin
A deficiency blindness) is an eye disease of the very young - infants and children, usually under
five years of age. Every year approximately 100,000 of the world’s children become blind from a
deficiency of vitamin A. This filmstrip explains the warning signs of vitamin A deficiency blind
ness, the relationship of good nutrition and health to good eyes, what foods contain vitamin A
and ways to prevent xerophthalmia. Full frame, 35 frames, colour, script in English and Hindi,
Rs. 45/-. Available from Voluntary Health Association of India at a subsidized rate of Rs. 21/- for
rural health workers programmes.
Skits ©e& Bepxosy Edseafa
The Well Wisher (English)
Hitaishi (Hindi)
— Dr M Owen
COMMUNITY HEALTH CELL
326. V Main, 1 Block
Koramangala
Bangalore-560034 '
India
Do It Now Do It Quickly
-
S. R. Mukherjee
Not Alone
-
Leprosy Mission Health Education Centre
Team Work
-
J. R. Tipping
Restored.
-
J. R. Tipping
Available from Voluntary Health Association of India.
Rs. 1.00 each.
IVe have died, ive have slain and been slain,
We are not our oldselves anymore.
I feel new and eager -
To start again.
It is gorgeous to live and forget,
And to fee! quite new.
See the bird in the flowers ? - he's making
A rare to do !
See how gorgeous the world is
Outside the door I
D. H. Lawrence
(Quoted in 'Sons and Lovers’)
For Private Circulation Only
Position: 1293 (5 views)