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RF_DEV_9_SUDHA
COMMUNITY HEALTH CELL
47/1 St Mark's Road
Bangalore 560001
22 March 1988
THE STATE OF I DIA'S HEALTH REPORT
(an initiative facilitated by VHAI, New Delhi)
Section: Education of the Health Team
A—A Statistical overview of the quantitative response in
the 50's, 60's, 70's & 80’s. (Pictorial presentation)
Trends and inadequacies
Manpower trends—corparisons
B—Medical Education
1.
150 years of Rhetoric/relevance
ii. The PSM Departments—enablers or blocks:
Community
iii.
oriented medical colleges—tinkering with reform
iv. The 'Shrivastava* Report—-a serious indictment
v.
The Kottayam and Jamnagar experiments - lost initiatives
vi. The 'ROME* programme - white elephants let loose
Capitation
vii.
fee medical college - business in medical seats.
viii. An alternative curriculum - a non-starter
( responses of MCI, IAAME, rnfc)
C—Nursing Education
i.
Overview of 5 decades—inadequate investment and
li.
A 'status' problem and a gender bias
iii.
Community 'nursing' alternatives
confusing classifications.
D—Paramedical training
i.
The uniprpose responses of the 50's & 60's.
ii. The multipurpose metamorphosis - Kartar Singh Committee & beyond
.....2
2
iii.
The Gandhigram explorations
iv.
Evolving the three tier system - workers, supervisors and
assistants.
E
The Community Health worker
i. The i’GO Pioneers
ii. The CHW scheme and evaluation - euphoria and disillusionment
iii. Th CHW - lacley or liberator - the NGO innovation continues
iv. The anganwadi worker - ICDS alternative
v. Alternative pedagogy - helping health workers learns the
Indian experience,
F — Education in Public Health
i. DFH to MD - loss of the old guards
ii. Th.? story of three institutions! AIIPHH/AIIMS/NlHFW
iii. The community healch alternative - masters/diplomas/leaders
JNU/RUHSA/Deenabandhu
iv. Courses and more courses - the mushrooming NGG sector
G —— Training of Pais
i. Recognising the traditional ‘obstetrician’
ii. Training - from condescension to dialogue
H — Education in Mental Health
i. Reaching the unreached
. Educational innovation to promote mental health skills in the
3-tier health system.
I — Traininc in the 'Traditional* sector
i. The non~allopathic training base - recognising the step brother
ii. Where are we heading in Ayurveda, Homeopathy, Unani, Siddha,
Yoga and Naturopathy?
3.
3
iii. Separate streams or integration—a knotty problem in training
J--Continuing Education of the Health Team
i.
A non-starter programme
ii. Leaving the field for pharmaceuticals and multinationals
K—Educating the Health Teem - A final comment
a. Trends towards Health for All by 2000 ADt challenges/altcnnatives
b. Building on failures/ inadequacies and micro level experiences
c. A plea for an alternative pedagogy & plan for manpower education.
Resource persons for ection apart from Community Health Cell Team,
Bangalore
1. Dhruv Hanked and contributors to mfc medical education anthology
2* FRCH Bombay (Ravi Duggal)
3. Prof Barerjd, JNU, CSMCH
4. Rani and Abhay Bang, Search, Gadchirtbl
5. Ulhas Jajoo, I-'GIMS Sevagram
6, ARCH Team, Mangrol
7. Mohan
Isaac & Joseph Panackel, NIMHANS
8. Abrah im Joseph, CMC Vellore
9. Daleep Hukerji, CHAI (ex-RUHSA)
10. Prera and Hari John, ACHAN & ANITRA
11. Mira Shiva, Menjunath and VHM Community Health team
12. CS Pandav, Al IMS
13. Dr CM Francis, Editor, Health Action
14. Prof George Joseph CSI Healing Ministry, Madras
15. PK Katthiyaini (ex Rural Health Cell, GOI)
16. Community Health Team, CHAI, Hyderabad
All these persons will be informed about the outline of the section
and equested tosend their own papers on the subject or any other
papers/reports/comments that they feel are relevant to the different
sub-units of the section.
Some of them will be requested to contribute
some of the box items.
Four resource centres will be particularly tapped for background
information—VHAI Documentation Centre, FRCH, JT2U-CSMCH and mfc/CHC.
The section will be put together by Ravi Narayan and the ent
the Community Health Cell team in Bangalore.
rest of
* An exploration of the known indicators of health like
IMR, Life expectancy, MMR and Under-5 mortality etc.,
should feature in one of the first dhapters and a
critical view of the broad trends since independence.
In spite of their limitations and the inadequate
data bases, these do give some idea of the State of
health of our population and offer a possibility
of comparison with other countries.
With some creative
communications, these statistics and comparisons
could bring out the stark fealities and idadequacies
of
our situation—even some of the inequalities for that
matter.
Section II A. While obesity is a growing problem
it is limited to a small number 415
a particular strata and should not
get over emphasised.
Section II
A3 & A4
of particular interest to us. Send
further details of the evolving format.
Section II
A5
SCs, landless labourers and urban slum
residents are equally vulnerable groups
and their nutritional status could be
explored in item iii) other disadVintaged
groups.
Section II
A6
Lathyrism is an unusual and unique case
study but the problems of anemia, Vitamin A
deficiency and endemic goitre are of far
greater epidemiological significance.
NIN has done pioneering work on Vitamin A
resulting in the world's largest 6 monthly
distribution programme and this needs
definite comment.
Section II
A7
The relevance of nutrition rehabilitation
centres are in question.
Therefore, is it a
worthwhile case study? The focus on the other
hand could be a wise range of projects using
locally prepared nutritional supplements not
necessarily in the NRC type set up but
more community oriented.
3
3
* Section II
A8
Food toxins particularly mycotoxins are
a major problem and could be featured in
a box item
* Section III
Could the changing agricultural environment
be introduced as a separate chapter or subsection?
The range of health problems atteibuted to
agricultural maldevelopment are more than
nutritional problems and pesticides; spread
of malaria, Japanese encephalitis, problems
related to large dams, marginalisation of .gESL
pural' poor and consequent changes in their
health and nutrition, changing work patterns
of women agricultural workers and its effects
and so on. Would you want a draft outline with
furhter details?
While talking of environment and pollution
there is a tendency to concentrate on urban
and factory environment because of the
diversity of the problem but the changing
agricultural environment, in sheer magnitude
of the people at risk is a far greater problem.
* Section II
A5
Mental Health could well feature as a separate
section rather than be clubbed with social
environment. While adverse environment does
affect mental health, mental health is more
than just that..
* Section V
A2.
Medical Education is an important sea no
doubt, and we need to refer to the curriculum
changes, Kottayam expentaent etc., but it
would be better to call this section something
broader to encompass nursing/pharmacy education
as well as the wide range of para medical training
including MPWs and CHWs.
There are lots of
issues and inadequacies but also lots of NGO
alternative initiatives.
4
4
*Section V
A4
This section needs to explore and document
the role of the large variety of issue raising
groups which include groups like mfc/SHR;
Co-ordinating agencies like VHAI/CHAI/CMAI and
the increasing range of smaller and sometimes
more localised health activist and action groups
Here again SGO roles can be critically explored.
While focussing on NGO Projects it is important
not to project role of NGOs as 'innovators of
model projects' but part of a wider NGO response
where project building is only one of a three
pronged response.
The other two being 'Innovative
training' and 'issue raising'.
* Section V
A5
The sub-sections of primary Health Care are
questionable especially items ivfi) and v).
These could feature in a eparate section on
Secondary/Tertiary Health Care. It is impor
tant to record and critically comment on the
secondary/tertiary health care build up since
Independence and the pre-occupation with
curative, institution and high tech medical model
approach to health services in India and the
increasing privatisation and corporate industry
take over of recent years.
*
Some additional projects/initiatives/issues that could
feature as box items somewhere in the reports
(a) LOCOST Baroda - Low Cost rational therapeutics
(b) ARCH, Mangrol - Under 5 care to rehabilitation of tribals
evicted by Narmada Dam.
(c) Traditional birth attendants - situation and training
experience.
(d) Deenabandhu - Herbal medicine dimension
(e) Lok Vidgyan Sanghatana, Maharastra
(f) Arogya Dakshata Mandal, Pune
(g) Appropriate technology in health care.
5
I
5
* Some resource persons
i. Nutrition/Agricultures Dr SG Srikantiah, ex-NIN
Vandana Shiva - agriculture! policy
ii Endemic goitre
: CS Pandav (AIIMS New Delhi)
iii Medical Research
: FRCH team Amar Jesani e£c/Padma
Prakash
iv. Drug issues
; Anant Phadke, Mira Shiva, Dinesh
Abrol etc.
v. Traditional
2 Dhrut? Mankad
systems
vi. Anemia/malnutrition
s Kamala Jayarao
in women
There are many others but you probably have a much larger
updated list by now. We could add to it when we get it or
atleast suggest people for areas where no resource persons
have still been identified.
A good bibliography highlighting the large range of
meaningful publications, reports and project reviews
could be an additional feature of theeport so that
readers interested in further details could follow up.
We could support the ections on Health Status, Nutrition
and Agriculture, Health,
& Agricultural Deveibppment,
Medical Education, Pestidides, Role of voluntary
organisations, non-formal health education, Appropriate
technologies in health care and health research. You must
have already identified resource persons for these
?nd
sections. We could be in touch with them and or respond
to initial drafts by them.
■Q 38
THE D0EGUL1NG TIBETAN RESETTLEMENT HOSPITAL ASSOCIATION
(Registered under the Karnataka Sc
F. O.TIBETAN
COLONY
•
ties Registration Act. 1960, Regd. $ocioty/RGN/78/UK/25 )
MUNDGOD-581411IN.K.)
O
KARNATAKA
STATE
Date
Ref.
A BRIEF COMPREHENSIVE REPORT ABOUT
MUNDGOD
DOEGULING
TIBETAN RESETTLEMENT AND D.T.R. HOSPITAL AND IT’S
ACTIVITIES: PREPAID FOR THu PILSENTATION
A
UAL iIBcTAN HEALTH RiivT»-’» ■I...-. .TING HELD FROM 4^ tot It ■
OCTOBER *1903 AT
BYo
THE 1ST
□:-|i-.rtAMSHALA •
TENPA T.K. HEALTH CO' HDINAT0.r|
bankers: syndicate bank,
tattihalli
HVt; SCHETARY
branch acct. 2209
•
INDIA
i
r
I
POPULATION, AiU'jA & SOURCR OF INCQMfi
Popularly cal_©d as Mundgod Settlement is officially called "iho Mundgod
Dooguilng Tibetan Resettlement P.O. Tattihalli, Tibotr Colony,, It’s
inception ©r the process of resettlement of Tibetans began in the year
1^67 ©n a total area of 4000 acres of land for an estimated population
■ r 5000 people only which was divided i to 11 Villages out of wh’.ch two
Villages sre exclusively for the monks• The process of resettlement is
still continueing despite the nonavailability of extra land and the
present population is about 11000 peoples to be exact 10757 as par 1992-93
; report from the Representative Office,,
Initially these settlers source of income or their 1.’ /©lyhood was expacted
frees the 32 guandas of land alloted only tr the adult members of the
family* That is to say that at present the livelyhood of the nearly
11 thousand people should ccrae fro.-r this wot land, of 3055 acres of land.
Considering the present population and the scarcity of land, tho initial
objective of providing the settlers need from thslr land produce is mad©
impossible. Thus the settlers are forced to .* ;ok out for an alternative
source of income to suppliment their family needs. These outside source
include some going out into the cities far selling sweaters and others as
their hired hands. Aparts from the Cooperative Society’s Carpet Weaving
"centres and th© Tailoring and Mechanical Automobile Workshop, settled
interpruners in the settlement is limited to a
shops and small provision shops.
restaurants, petty
Thus the general source of income of the settlers ay© pore dependent on
the outside sources rather than th© originally intended land produce
because of the f rationalisation of cultivatoabl© wot land and even this
is als© dependent on the monsoon rain which is nover predictable despite
the great scientific progress we have made in wo,, ^her forecasting. Since
the outside source is mainly the selling of the sweater and this too
depends a lot on the seasons, the very source of income of tho Tibetan
settlers is always not sure, yot they all serviv© on uncertain source of
incc .a except the organisational and the institutional staffs.
On th© whole the Mundgod Doeguling settlement is one of tha poorer
settlement yet it is the biggest Tibetan cluster outside Tibet.
There is
the need to help these people to generate a more secure and regular income
to bring an overall improvement of the settl mont and its settlors.
Conid.,2...
Facilit-s avail in this settlement are as followss
'5
9
2
Creches
Nursery .Schools
Primary Schools
1
“8
Middle School
Higher Secondary School®
2
Banks
1
Post Office
1
Automobile Workshop
4
1
1
Carpet Weaving Centres
Tailoring Centre
40 bedded Hospital
i
12 bedded T.&o Isolation Ward
1 Dispensary
11 Branch Clinics for Community Health Workers.®
Flour .Mills
Restaurants
2
8
4
Provision Stores
Motorable road through the villages with Govt® buses plying thrice a
da
1 Hose for Aged and tho Infinaed
2 .Monastic Study Centres with Libraries
1
Nunnery®
POPULATION
t
1985
1986
1987
1988
1989
1990
1991
1992
1993
MALE
5147
5254
5419
5788
57:8
5854
6696
7163
7439
• J,’ALE
3403
3636
3664
3875
3875
3562
32.7
3285
3390
TOTAL !
0550
8390
4'<M-
9083
9663
■'7 < T
9623
9416
<z:
9903
10448
10829
/ u f5
S' "> o
LlMT ’
J
■^4/
696
6'S"
A NOTE ABOUT D,T,R, HOSPITAL,
Dooguling Tibetan Refugee Settlement Hospital was established In the
/ear 1969 with assistance from Myrada to catter the health needs of
5000 initial settlers and the local villagers surrounding this
settlement. Presently nearly 11 thousand people live here.
I t has a bed capacity of' about 40 beds init llv and now w® have an
additional 12 bedded T.B. Isolation ward. It has all the basic facili
ties like moderately equlpod laboratory, an X-ray unit with a 300 MA
X—ray machine, Delivery room, Sm-Cl Operation room with few surgical
equipments, a Dental unit with Dental Chairs and an Ophthalmic unit
with Opthaimlc technician.
The following are the services rendered by this Hospital :
Regular Out patient services
Regular In patient services
Regular Eye Clinic and monthly Eye Operations
• Regular T.B. Clinic
Monthly free dental clinic,
all these are at the Main Hospital.
Under MCH programme following arc the services? provided}
Anti and post natal services
Growth -"onitoring of the under 5yrs children
Immuni
tier:
,
;
programme.
'' I
Since half of the settlement population lives about
KMs away from
this DTR Hospital as an out reach f r these people we have a branch
dispensary at Village No. 6 which provides
!aily out patient services
and MCH programes are also conducted regularly here.
As inadditional out reach facV'ty to check the childrens health
problems,visits to creches, Nurseries and 1'chools are conducted t
regular Intervals. Our CH.> are involved in the improvement of the
community’s health'hygein©.
They go into the c<r;nur.' ty and check
and educate the local public about health and heal! y habits.
Super vission and maintenance o^ T.B. treatment Is record ifi one of
their most important contributions alongwlth monitoring of the
immunisation programes and its implement,- tion.
Contd.. 2.
2
This Hospital has 31 personals as its staffs and the breakup of this
number as per their job aslgnm>nts are as follows:-
CLINICAL SECTION:
Resident Medical Officer
Staff Nurs© HNS
-
1
2
Pharmacist
Auxiliary Nurse
*>
-
1
1
Laboratory Technician
X—Kay Technician
-
1
-
1
311lor cum Asst.
Nurse Aid
C.H.W.
- ---------------------Plumber/Genorator Operator
-
1
-7
- 1
Washerv/cmen
-
I
Cook
Cooks Asst.
Gardsner/Peon
~
—
-
1
1
1
Sweeper
-
3
Health Co-ordinator
-
1
Accountant
Cashier/Office Secretary
-
1
1
Driver
-
1
OFFICE .SECrXC-N:
Financial Status of .the Hospital:.
Financially speaking the Hospital and its services are mainly dependent
on the grands received from the Department of Health, CTA of II. H. The
Dalai Lama, Dhararasala. Kc ping in mind th? objectives of this
Hospital as to provide health services to poor, most of its services
ar© at concessional rate and there are many medicines dispensed free
of charge, therefore the Hospitals dally cash collections are bare
minimal. Therefor©, the Hospital cannot maintain itself or b lilt, its
future on these minimal collections but can ex'1 at only under ’t
sufficient regular yearly grand from the Department of ’’ »lth. If th©
Department has plans of stopping this gran-’ than a new plan programme
to generate regular Income noeds tobo initiated with active assistance
I
I
■ i
:
Contd. .3,..
- 3 -
from all the concerned parties that is th® local settlers,
Representative's Office, the Dept, of Health and other related
organisations who have direct bearing on this Hospital like for
example the/monasteries must contribute in a much better way as
they are the chief benlficlarios of this Hospital ser less. The
present condition of this Hospital building and its equipment and
their rer
atian end repairs cost are one of Chis Hospitals biggest
concern,considering its expected cost whlc-~ couL
he a substantial
amount taking Into account the size of the Hospi+^i and i u present
state and the cost of the labour ’-nd material In the market.
Despite all these difficulties an ui.ojt comings the
Hospital
has c ary scope to develop Itself into a competent utility centre
taking into consideration t
basic facilities and the inf.restructure
available here provided it gets all the financial and moral support
it will need for a f«w year'' time, I am optimistic that each of you
will extend the required help to improve this Hospital. I would like
to thank you in anticipation.
Submitted by?
Tonpa T.K, (Mr.)
I
1985
1986
1987
1988
1989
1990
j 1991
1992
1993
i
) P D
inpatient
25956
21684
21536
17690.
13937
607
696
625
578
505
©77;
493
6'561
8236
645
:|
574
1412
I
T.B. PROGRAMS
Under our T.B. Programs T.B. treatmen' is carried out by our Medical
staffs and the C.H.Vis as per the guide lines sot by the DCH and its
var’ous Medical Consultants.
Financially OUT T.B. progxume is sponsored by DOH with condition that
the XXlxd lines patients must pay the 50% of their medicinal cost.
The figures for the various years of our T.B. pitlents are as follows*—
1985
1986
1987
1988
1989
1990
1991
1992
1993
PT
78
75
109
100
125
127
173
162
127
XPT
4
1
6
5
11
2
13
4
9
Sputum -=vo
50
41
59
59
112
107
132
106
84
Sputua +ve
32
35
56
46
24
22
54
60
52
.JEW CASE
80
76
111
99
92
103
170
107
RELAPSE
2
‘O
4
6
34
26
17
59
108
I
28
I LINE
48
38
70
65
100
60
74
64 !'
59
II LINE
34
38
45
40
36
6C
112
91
70
o»
«M»
11
7
<O»
«s»
W LINE
DEATH
1
1
4
2
2
3
4
5
4
STOP
56
104
78
104
33
8-.
168
100
65
115
105
136
129
186
166
136
TOTAL
- !
q2
*
O
IMMUNIZATION PROGRAMS
Immunization program© of Children of D.T.R. Settlement is being
lecked after by STR Hospital with active assistance from the local
PKC who provide us with required vaccine* and in return wo provide
them daily eonveyenc© and other related expenses.
The figure of Immunisation for the time period from 1985 to W93 is
as follows 3-
I
I- :
•
1985
1986
1987
1988
1989
1990
BCG
450
87
229
103
94
100
DOSE
20
116
93
85
92
101
II
°
10
102
83
75
85
III
°
4
116
88
57
I
«
20
118
93
Ilj
•
10
102
III «
4
1992
1993
66
51
84
73
55
96
81
77
61
80
116
74
65
62
85
92
96
78
73
54
33
75
85
93
78
78
58
116
88
57
80
36
71
64
58
46
82
113
105
103
79
77
65
I
«■»
119
75
47
34
73
74
93
72
IT
«*
91
21
43
68
71
92
93
93
554
1049
966
732
813
911
79o
.747 __
i
612
1991
sr!
DPT!
POLIO
•
MEASLES
JETER DOSE
”
TOTAL
I
48
|
MOTHER AND CHILD HEALTH
Under this program® we have our anti and post natal care of the
expected mothers with featal development monitors^.
Haematanic and
T.T. vaccines are given to th?se pregnant women alongwith advice to
consume nutricious diets. Our CHW check on these expected and now
mothers to safe guard their health.
are as follows 8-
The statistic in this field
YEAR
| ANTENA
i -TAL
1985
1059
146
36
47
63
3
75
1086
895
102
39
25
39
1
87
198?
783
96
24
25
33
4
74
1908
385
30
33
14
32
2
47
1989
1270
103
17
36
50
2
76
1990
470
96
24
32
40
1
69
■991
1035
108
23
44
41
3
65
1992
775
109
17
48
43
1
75
1990
281
63
21
25
17
1
78
BIRTH HOSPITAL OUTSIDE
HOME
DELIVERY DELIVERY DELIVERY
NEONATAL
DEATH
TOTAL
DEATH
1
fllRTH AW DEATH
I
Maintaining of birth and death records is very difficult where people ar© not
zary serious about what they say or whore people have little regard for th©
importance of maintaining an accurate sl.tlstics. Anyhow th© datas as par
th© available source of records are a.: follows 2-
1985 11986
1987
1988
1989
1990
1991
1992
1993
BIRTH
146
102
96
80
103
115
104
101
78
DEATH
75
87
74
47
76
69
65
75
48
OPHTHALMIC SERVICE
Under our eye clinic, we conduct regular (dally) eye clinic by our
Ophthalmic Nurse and we conduct regular monthly ©ye operations.
Though this programs is sponsored by CBM through Bangalore Office
the funds received is not sufficient enough to car-
out and give
satisfactory services to all, as unlike other southern settlements
whare the Doctors fees and the conveyance is paid directly by the
CBM to Dr. Philip Kuruvilla where as here in .
ndgod the Hospital
has to pay from the limited funds it received fuora the CBM.
Therefore, I would like to appeal to DOH for additional funds towards
this expenses.
1987
1988
1989
1990
1991
1992
1993
117
276
245
330
598
495
403
OPERATION
<aa
22
18
19
21
6
14
MATURE CATARACT
22
25
4
8
37
21
21
PTERYGIUM
20
36
9
14
25
10
4
glaucoma
Of»
O.P.
OTHERS
3
1
tsso
3
1
4
3
5
«w»
2
H
2
4
DENTAL SERVICES .
D.T.R. Hospital conducts regular free monthly dental clinics.
se;
The
ices include free consultation, extraction, temporary filling
and assist in refering to -he college Hospital at Dharward. D.T.R.
Hospital conducts its free dental clinic with active cooperation and
support frees S.D.M. Dental College at Dharward. The figures are as
follows 8
ADV I'ED COME
TO DHARWARD
TOTAL 0 P.D
year
FILLING
1991
103
102
27
242
1992
121
193
16
230
1993
Aug.
115
103
16
234
EXTRACTION
UNDER 5 CLINIC
Under 5 Clinic are conducted alongwith xiamunlsatlon.
Regular visits
to creches and nurseries are planed.
I
|
| 1992
11991
11993
1985 11986
1987
1988
1989
1990
0 - 1
141
107
103
62
90
96
117
138
100
1 - 5
600
657
593
655
599
451
453
918
432
Under-5
741
764
696
717
689
547
570
1056
530
SCHOOL CHILDREN HEALTH
Since this settlement has 4 different ur. Its of schools ell managed by
the CST with a hostel for the Higher Secondary Students.
The' Staff Nuree
of the school takes care of their health alongwith regular, twice a week
visit from our Medical Officer. All serious cases and more coi., located
cases neaping investigations are feferred to the
ospitai.
WATuR SUPPLY
Luckily this settlement doesnot suffer from non availability of drinking
water, some villages do find that they do not get enough water to meet
all their needs.
The condition of the water is fairly good that is to say most of the
Villages main sources of drinking water ai-a from deep bore well which Is
considered potable,, but it is not always that people drink this bore well
water as this supply is solely dependent on regu. tr supply of electricity
and proper maintanence of pura sets etc. Therefore there arp many days
when people have to use hand' pump water or shallow well water as drinking
.water and these water are not usually very potable but needs to be treated
if they would like to use it as their drinking water. In such circumstan
ce the no. of hand pumps in th© villages are not sufficient to meet the
needs of entire village.
To give figural picture of the water avalllblll-
ty condition of this settlement is as follows!
,,h
^tvizt|27
,
Total No. of over head water tanks in the DTK settlement are:
4fl>.
Source of water to all these pumps ar© deep bore well water.
The average
capacity of these over head water storage tanks axe about 4000 gallons
each* fckreb&rs of handpuisips Ln tha settlamont - 27 (14+424-42)
|4'
Average No. of hand pumps per village
2*5
On thC whole the quantity of water is below expected consumption level
and hence this shortages will effect the sanitation and hynedlc of t'>©
settlers to a considerable ©attend ©spacially its surroundings and their
’oersonai hygiene.
I
finally it it good to see in the community that a sectl.n of people ar©
there who are aware, of th© naed of timely and occasions), treatment of
drinking water. A brief education about the iuportan
of maintaining
clean water tanks protection, storage of drinking wat©.: obtained from the
deep bore well and also th© need to boil all the handpump water whenever
they haw to use it >s drinking wator,
'.asic education was dlvon to
c '.l the village leaders as a primary inu^.ruction and plan
*ui*th©r
education n this line to promote the use of safe* drinking water to prev
ent the spread of water borne di jases or the spreads of ©podemics have
boon planed. In addition to this wa plan to treat th© drinking water at
^regular intervals as and when th© need arises provided our financial
circumstance permits or if wo could get regular finar lai assistance
from DoH or any other body in this field.
The word sanitation means acts helping to maintain proper health and
healthy surroundings which inturn means proper dispersal of waste,
garbage and proper ma in tain once of sex-tex and s.. Ajge water through
well planed drainage system.
Like all the Indian Villages when the resettlement of Tibetans began in
clusters called Camps ox Villages nobody thought of or felt the need
for a proper planed drainage system.
Th© few flush toilets that were
build were also pits storage or single chamber types.
The people or
the settlers themselves didnot find the need to lay a planed drainage
and sewer systems because of the following reasons^
1
2
They are not used to using flush toilets
They didnot have the habit of using a planed drainage system, they
didnot see the need.
4
Sven if some of them wanted to use flush toilets they never ha I a
require^ jioney and knot? how to build one.
Most of these people considex*od using or construction of a flush
5
toilet not as a basic health requirement but as luxury convenience.
Th® vast open space around them has never made than feel the
3
shortages of space where they can vlieve themselves without any pre
and nost extra work or excreta dispersal or disposal expenses.
Sine® a f&w years now people’s habits and attitude have changed a lot
these days we can see people using and also constructing hygenlc flush
toilets with view not only to make themself more convenient but also to
improv® their health and the cleanliness of th© su. rounding. This is
a great improvement in th© sanitory line but there are still many more
•who are not willing to build one but there are many who cannot effort
to build one either because of f’nancial problems or because of lack
of technical know how and some with both problems.
Shortage of sufficient wat<.
for this purpe
is another deterrent
factor. Anyhow to give a clear picture of the settlements sanitations
position interms of no. of toilets is as follows »-r
Presently there are .
toilets in this settlement ar. I their
break up as per village and toilets per family is as follows;
Contd,,2
- 2 ■
I
/
Total Mo. of 'toilets in th© settlement
■
—
Total No. of toilets per Village SS'i
On© toilet for w every ».. .1 '.t.. e. families
Percentage of toilet per family
■» J • • * . . • /<>
TIio over al*
sanitation situation oi this settlement is in a much
better place than ever before. Considering tne pee. ios positive
attitude and the present awareness due to their expci.aro to the
importance of having hygenic toilets which can make a lot of difference
in their health status.
Heavy monsoon rai.t5 is one of the most
deterrent factor in their malntainence of proper sanitati n in this
sor.tlem- .i, otherwise despite all these disadvantages this settlement’s
sanitation could improve, wo a..* pursuit of doing our best to help
theea^achloving our common interest goal. If the Dept, of Health or
any other organisation or even individuals who would like to
experiment or initiate project which are aimed at 5 proving the sa
sanitation and health or its tnain&ainence procedures, w© .welcome
you to our settlement and try y.iur good intention with us and vs
will put in our best wherever
vta can put in our mark.
we are required or in whatever way
□TRH/
I:
/ /'
E , Nfr I R O N M fi ll
Talking of environment I shall n~t deal with global environmental danger
or Its present scenarios tpt because I am or we are not concerned with it,
. but because our settlement people will find it hard to understand and
corelate the resultant offset. But X will rather stick to th® impure air
they breath because of their own irresponsible act, mainly due to
Improper disposal of garbages and the conversion of every gutter and
open space around their respective villages er monasteries into open
lavatories and garbage dumps.
^The secone factor^ is the denudation of the forest around th® village
for fire wood. Thereforet the -a is an urgent need to promote more cost
effective Biogasunits and promotion solar water boiler or cookers, there
will not save the poor people ft>®iygetting physical beating forwthe forest
ranged but will reduce their work load. This way we can save th©
environment and improve the peoples health also, Another important ,1
would like to suggest is if the BeH or its various donars could initiate
or promote the use of low wattage, highly lumunicent lights, like
professor Roddy’s DEFEMDUS project explain. This can save the people
and the environment (air) from the hazards of using very dim light at
I !
night, th© frequent use of heavily sooty kerosine oil lamps on the health
of an individual,
^Now if wg talk about environment al issues in to.. s of number of trees
planted in this settlement then th© picture is not too bad as there
are a total of 21,208 trees planted in their respective gardens and on t
the road sides of the settlements main roads. Then when we talk aboUjt
environment in terms of toilets and garbage dlspnseable systems an ' n^f
'a garb' oa bins, then the picture^a scaring one.There arc only about 13
V
garbatjeblns for the whole sottl ment and even these are not used properly.
The most surprising observation to me Is that the village which has maxi
mum no. garbage bins Is one of the dirtiest village.This 1 an indicator
that mer-v provossion of garbage bins alone .,' P not 'olve our health &
enuoronment prob!ems.^hat is ne.ded Is health education
re s s Irin th®
.Importance of proper disposal of garbages and much mo'. ? imnortant is
A
th© need for Hll to chanoe old babbits and an ac .ontenco of shared
responsibility must come from the respective
t‘.lerr. themself. Only
then can we bring som® chang
or safeguard
the enver imont ' round us.
© 38
THE D0EGUL1NG TIBETAN RESETTLEMENT HOSPITAL ASSOCIATION
>
( rtegiiioiad under the Karnataka Societies Registration Act. 1960, Regd. Society/RGN/78/UK/25 )
________ !_______________________ :---------------------------------------------------------------- --------------------------------- ------—|
P.O.TIBETAN
COLONY
•
M U N D G O D - 5 8 14 1 H N. K. I
•
KARNATAKA
Ref.
STATE
•
INDIA
Date
Suggestions;
T There is an urgent need t.
change the pub M e attitude from a iWra
dement dement receiver to an active rotriver r'-asf where they
themselves should come forward s-.eklng health facility and services
and extend their cooperation to all those who are trying to promote
public health.T^o respective local individuals must accept social
rosponslbiltyof saf guarding their ov« comm.ujity*s health au ! t’u
environment arround t’ em to promote their own health.
Th© representatives Offices must give mor. importance to the cause
A
of public health and pay greater importance In the maintalnance
of public hygeine and sanitation.
i
J21 The monastries must allot specific time for health education
and the ^bbots and the disiplanarlans of the various ‘^onastries
should check the
misuse of public gutters and open spaces arround
their rosretive monastries from converting Into open toilets and
garbage dumps.
L
--............
———*-------- -------------- —xxxxxx—---- ——----------------------- —
BANKERS: SYNDfCATE BANK.
TATTIhA’LLT BRANCH
a
:T. 2'2 Cfo
ADD India
(ACTION ON DISABILITY AND DEVELOPMENT INDIA)
10, Norris Road,
RICHMOND TOWN,
Bangalore 560025
Postal Address
P.B, No. 2598,
Bangalore 560025
ADD INDIA
INTRODUCTION
1.
The aim of ADD (ACTION ON DISABILITY AND DEVELOPMENT)
organisations is to promote self-help among disabled people
in poor
communities.
The
first ADD organisation was
established in Frome, Somerset
in the UK in 19S5 and the
second in
India in 1989.
ADD UK
is in the process of
facilitating local
disabled people and their friends in
Uganda,
Sudan
and
Burkina
Faso
to
establish
ADD
organisations.
At present ADD UK
is registered in these
countries.
The ultimate
aim is
to
establish
an
international network of organisations promoting self-help.
ADD UK
2.
ADD UK
works
ser v ices :
in 14
countries.
It
2.1
Development Training Services;
2.2
Planning Services;
2.3
Orthopaedic and Mobility Services;
has
the
following
In addition it also offers partnership and funding.
ADD INDIA
3.
ADD India was registered under the Karnataka Societies
Registration Act in October,
1989.
ADD India has seven
Governing Body members, out of whom three are disabled
people.
ADD India is completely autonomous promoting the
basic ethos and philosophy of ADD network which is self-help
among disabled people.
PH ILOSOPHY
4.
ADD organisations believe that disabled people are in the
best position to know their needs and therefore should be
properly consulted and supported to meet these needs if they
so desire.
They should have the opportunity to manage any
programme undertaken with them, thus facilitating leadership
d ev e1 opmen t.
5.
A disabled person understands the development needs
another disabled person because of a shared disadvantage.
of
STRATEGY
6.
The strategy in
India has been to facilitate existing
voluntary agencies to work with disabled people to promote
self-help.
The estimate of voluntary agencies in
India
working with non-disabled people mostly in villages varies
from 8 to 15 thousand.
They already have infrastructure and
staff.
It is cost effective to add on development work with
disabled people to their existing work.
In addition
disabled people, after all, live in the villages where these
agencies are already working.
The aim of any programme with
disabled people is to integrate them into the community they
live in.
So it is imperative that work with disabled people
should also be an integral part of voluntary work.
ROLE OF ADD INDIA
7.
The role and function of ADD India is to develop partnership
with these agencies and to support them.
ADD India provides
the following services within an agreed framework :
7.1
Formulating policies on work with disabled people;
7.2
Designing programme;
7.3
Developing systems for implementation and monitoring;
7.4
Training partners in these areas;
7.5
Training partners’
staff at
awareness and field workers
work techniques.
7.6
Assisting
partners
to
liaise
with
Government,
educational and rehabilitation institutions.
7.7
Supporting partners to establish services for medical
rehabilitation, primary education, skills training and
communications development.
all levels in disability
i.n animation
and group
METHODOLOGY
8.
Disabled people are victims of a culture of dependence and
silence in poor communities.
Change in their situation as
envisaged by them can occur only if and when they themselves
feel the need for the change and are willing to work towards
i t.
9.
ADD organisations encourage disabled people to form their
own organisations through a process of animation.
This slow
long process of animation gives disabled people the space
and time to reflect on their situation, to build up their
confidence in their own ability and find strength in being
together as a. group.
In time disabled people find that the
group they belong to accepts them for what they are,and does
not reject them for what they are not.
It may also be for
many disabled people that it is for the first time in their
lives where they have an opportunity to speak what they feel
without fear of being reprimanded.
This process also
enables them to identify their own needs and the best ways
of fulfilling them.
10.
As a result of
this process,
parents of disabled children
are beginning to recognise the need to educate their
disabled children and adult disabled people,
the need to
acquire skills for self-employment.
Needs for housing,
transportation, basic rehabilitation services and so on are
beginning to emerge.
MANAGEMENT STRUCTURE
11.
Development work with disabled people is part and parcel of
the voluntary agency which has a partnership with ADD India.
One of
the office bearers of the partner agency or the paid
Executive is responsible and accountable for this work.
All
the relevant staff of
the agency support this work.
At
present it has partnership with six agencies.
12.
This work has a full time field worker in four agencies and
in the other two,
this work is taken on by existing staff
involved in other work.
The ful 1-time workers cover 20
villages in one agency and the whole Mandalam in the other
three. Where the staff are involved in other work,
they
support groups in five villages.
Their task is primarily to
animate groups of disabled people and support them in
whatever they want to do to change their situation.
They
are also responsible to support groups of disabled people to
liaise with local Government and non-Government agencies,
maintaining accounts
of membership fees,
admission of
disabled children into schools and allied activities.
FIRST THREE YEAR PHASE OF THE PROGRAMME
13.
The development programme with disabled people in South
India
from January 19S7 has resulted in partnership with
eight voluntary agencies.
Its aim has been to promote self
help among disabled people in the villages where these
agencies are already working with other marginalised people
: Young
India Project - Bathalapalli Action Group in
Anantapur District,
Young India Project - Kalahasti Action
Group, Young
India Project - Sathyavedu Action Group and
Integrated Rural Development Society
(IRDS)
in Chittoor
District, Rural Development Trust
in Anantapur District,
New Education
for Liberation in South Arcot District
PREPARE in Chengai MGR District and League for Education and
Development in Tiruchirapa11i District. The partnership with
New Education for Liberation ended in 1990 and with Young
India Project - Bathalapalli Action Group in 1992.
Among
these eight, IRDS has just commenced work.
14.
The current partnerships have established 98 self-help
groups of disabled people.
These groups total membership is
about 1,470, covering an age range upto 40 years.
ACH1EVEMENTS
15.
The major achievements of
the first phase of the programme
has been that it has enabled these people to realise that
they need the same opportunities in life as able bodied
people in order to become active and effective in their
communities.
They have also realised that the -change will
not take place unless they themselves work for it. Through
the formation of self-help groups a forum has been created
for disabled people to get together and debate their needs
and,
as
a result,
disability is
definitely gaining
visibility and importance as a* issue in the areas covered
by the programme.
16.
In addition this work has enabled disabled people - men,
women,
and
children to
access opportunities
in the
environment both
from Government
and non-Governmenta1
sectors. Opportunities
include education,
se1f-emp1oyment,
transportation
and
housing.
Availing
benefits
from
Government schemes enabled disabled people to meet their
initial expressed needs. The process of availing benefits
from these
schemes has encouraged disabled people to
strengthen their conviction 'TOGETHER WE CAN'
17 .
The members of self-help groups contribute between 50 paise
to Rs.5/- a month as membership fee and have opened bank or
Post Office accounts. This money is collected and is used by
them to
meet the
expenses of
their own group for
administrative, postage and travel
connected for availing
benefits from Government schemes
18.
The other indicators of the impact of this work are:
the World Day of disabled people
18.1 Observance of
contributing effort and money for such observance;
and
18.2 Non-disabled cadres and disabled people enacting street
plays on social problems of disabled people;
18.3 Developing leadership among themselves and increasing
their capacity for analysis and questioning;
18.4 Participating
in
street
agricultural labourers;
plays
18.5 Disabled people doing skilled
other disabled people;
18.6 Disabled women
marital issues;
assisting
18.7 Joining the
efforts
obtaining land pattas;
of
the
in
jobs,
mela
of
offering to train
women
with
labourers
on
other disabled
agricultural
18.8 A disabled person contesting the district Secretaryship
of the agricultural labourers union;
18.9 Parents
of
disabled
children
motivating
counterparts to educate their children.
their
THE SECOND THREE YEAR PHASE OF THE PROGRAMME
19.
The aim of this period will be to consolidate the existing
work and to facilitate new voluntary agencies to reach more
disabled people in 150 new villages resulting in the
establishment of 30 new self-help groups every year.
In
addition, the specific focus in programme areas will be on :
19.1 Developing and establishing a Rehabilitation
19.2 Developing
Service;
and
establishing
a
Skills
Service;
Development
19.3 Creating a Forum of Disabled Women and
19.4 Establishing a Communications Development Service.
REHABILITATION SERVICE
20.
Almost all
the existing facilities for education, training
and rehabilitation for disabled people are in cities and in
towns, whereas more than 60% of them live in villages.
ADD
India aims to make rehabilitation services available in
villages.
21.
For this service to be effective,
it needs support at
different levels.
ADD
India's partners need to have their
own core team of
people to establish and manage this
service.
The core team would consist of four people with
format training
in special
education of
visually impaired
children,
hearing
impaired children,
mentally disabled
children and orthopaedic/physio technician.
This core team
would need the support at the field level.
The existing
field staff doing organisational work with disabled people
would have to be trained on an on-going basis to provide
this support.
The other element of support will include
referral centres for medical
rehabilitation.
ADD India's
aim is to achieve al! these by using existing facilities in
institutions for disabled people and hospitals.
22.
As a first step ADD India had organised training of all the
eight existing field staff
in orientation and mobility,
daily living skills and braille for a period of two months.
A two-week Workshop on Working with Children with Hearing
Impairment was also organised for these workers.
ADD India
has now organised training of the core team for Young India
Project (YIP), Rural Development Trust (RDT), and PREPARE at
their own cost as detailed below :
No. of Sponsored
Cand idates
Discipline
2
Special Education of
Visually
Impaired
Ch i1d ren
1
Special Education of
Hearing
Impaired
Chi 1 d ren
YIP
2
Orthopaedic/Physio
Techoic ian
RDT
2
Special Education of
Mentally
Disabled
Chi Id r e n
RDT
1
Special Education of
Hearing
Impaired
Chi 1d ren
RDT
2
Orthopaedic/Physio
Technician
PREPARE
1
0 r thopaed1c
Techn ic ian
PREPARE
1
Physio Technician
Partners
YIP
23.
The formal
training provided does not include any input on
management of
these services,
which is crucial
to the
success of this programme.
ADD India's role is to provide
this input on a monthly basis initially for a period of one
year.
Its role is also to establish referral networks for
medical rehabilitation and to set up a resource base for its
partners with the support of sympathetic professionals in
cities.
Without such a base upgrading knowledge and
technology will not be possible.
24.
At present this role is being fulfilled with the support of
the existing staff of ADD India.
25.
Once this service is fully established, integrated education
of disabled children in regular village schools will become
a reality in the programme areas.
--
26.
Parents are seeing the need to educate their disabled
children.
They are not willing to send them to special
schools as they are hundreds of kilometres away from their
homes.
They want their disabled children to be educated in
their own
or nearby villages
like other non-disabled
children.
SKILLS DEVELOPMENT SERVICE
27.
Most disabled people do not have even agricultural skills in
villages.
Increasing the earning , capacity of disabled
people is one of the major aims of ADD India’s development
programme.
This aim can be achieved only through skills
development.
The strategy is as follows :
27.1 To raise awareness of disabled people and the community
they live
in about the potential of d isab 1ed people to
d o s k i1 led jobs ;
27.2 To identi fy marketable skills in programme areas;
27.3 To organ i se
peop1e and
skills development
training for
d i sab 1ed
27.4 To develop and establish a system for marketing their
skills, products and services.
2B.
Finding viable income generating programmes for marginalised
people has been a challenge for decades.
This is more
difficult when it comes to disabled people for the following
reasons :
28,1 In the first place disabled people are made to believe
that they cannot do anything on their own because of
their disability.
This is due to religious prejudices,
social attitude and lack of information.
28.2 Disabled people are in the same socio economic context
as their non-disabled peers.
The additional element to
be addressed
is adaptations of tools and equipment to
suit different disabilities.
Then there is also the
whole issue
of skilIs and trades being done by
particular caste.
FORUM OF DISABLED WOMEN
29.
Disabled women
form about
30% of the present total
membership of
the group.
ADD India has become aware that
disabled women's situation is more oppressive than disabled
men's.
They are
worse off than their non-disabled
counterpar ts.
30.
If disabled women are to express the anguish and pain of
their oppression,
they need a forum for themselves animated
by women.
31.
Therefore,
ADD
India has
employed one
woman
Field
Coordinator for this purpose.
Her role wil1
be to train
women field staff of ADD India partners to work with
disabled women and to support them to meet their needs.
32.
The strategy is also to develop support services such as
counselling and legal aid by using existing organisation.
COMMUNICATIONS DEVELOPMENT SERVICES
33.
Development work with disabled people follows the same
principles as the work with non-disabled people and there
fore needs similar inputs and infrastructure. Media is being
used in work with non-disabled people. In work with disabled
people media is used to a limited extent in areas such as
prevention,
early
detection,
early
intervention
and
rehabilitation; but
it is not being used to promote
disability as a development issue.
34.
Many disabled people ADD India works with, are not only
physically stunted but also psychologically stunted due to
lack of early childhood stimulation, rejection by family and
peer groups.
while physical stunting due to malnutrition
results in
a permanent impairment,
the 'psychological
stunting' in disabled children or adults can be healed.
Psychological stunting manifests Itself
In disabled people
In villages being dependant in not being able to comprehend
and articulate.
35.
The roles village communities assign to disabled people are
being a watchman, a shepherd and shepherdess or at best a
shopkeeper and at worst a beggar
in an income generating
context.
Part of
the reason for the community assigning
only these roles to disabled people is because they have not
seen any disabled people playing other roles
in similar
commun i t i es.
36.
Seeing is believing.
Therefore, if attitude has to change,
disabled people and the communities they 1ive in have to see
examples of other disabled people playing positive roles in
their communities.
Examples of such roles could include
carpenter or a mason or a tailor or a school teacher serving
as resource people to their village communities.
37.
Attitudinal change cannot occur in void.
The best input to
facilitate this process is audio visuals of living examples
of disabled
people being
resource people
to
their
communities through skills needed by that community.
The
aim of ADD India's work is also to increase the earning
capacity of disabled people,
because this contributes to
their gaining independence and human dignity.
Equalization
of opportunities becomes probable with a better economic
ba s e.
38.
ADD India has a three year plan to establish a sustainable
resource
base
for
communications,
disability
and
development.
The aims of this service are :
38.1 To develop
material,
using
folk media
and
conventional
media
for training
in animation
dissemination of information;
the
and
38.2 To develop audio visual material to raise awareness of
disabled people and their village community in the
potential of disabled people and to inspire them;
38.3 To develop a pool
of trained people in villages to
continue to use appropriate media to promote disability
as an attitudinal and social issue.
CONCLUSION
39.
ADD India's work is only a small beginning towards promoting
self-help among disabled people in
Indian villages.
The
1,470 disabled people with whom ADD India works is only a
minute fraction of the total estimated disabled population
of 24 million people.
About 60% of this population is
spread over 600,000 villages.
BV:Mk :SG
30 July, 1992
Resume of ADD India's Expsriencs: 1987
92.
Introduction:
ADD ( Action on Disability and Development) in the
U.K.
began
in
1987,
to
explore
whether
development/organizational work with disabled people
can be added on to existing rural
development
voluntary structures
in
India.
The
history,
philosophy, strategy,
methodology and the current
status of work are described in a document entitled
’ADD India".
This documents ADD India's experience in promo ting
this work which includes experiences with V o1untary
d i sab 1ed
agencies
in
rural
development,
rura I
people,Family
and
Community
in
areas,Government, and Service agencies.
3.
Voluntary agencies:
These agencies promote work
in health,
literacy,
credit, ecology,
organizing people and
in other
sectors. Those for disabled people promote medical
rehabilitation,
literacy,
and
vocational
rehabilitation.
Disability
as a socio-political
issue is still new to the sector. Disability is a
non-issue for most of these agencies.
4.
All most all voluntary agencies are unaware of the
magnitude, nature and extent of the problem of the
disabled people.
They perceive this work to be of
specialists in nature and are daunted by the task of
equipping themselves
to do this work.
This
image
ofcourse has
its roots in disability being promoted
as a medical and rehabilitation model
in the last
two centuries.
Religion has played its role in
ingraining welfare oriented values.
5.
Disabled people are marginalised
in society.
Work
for them
also follow
suit.
Most non-disabled
people's i nte rac tion with d i sab led people takes
place in
public places.
They occupy
a
few
insignificant moments of their consciousness. These
moments
produce
stereo-typed
responses
of
we 1fare/charity either
in the form of material,
thought, feelings and or behaviour.
6.
Disability issues are neither taught nor written
about except
in professional courses,
such as
medicine and paramedical courses.
This issue does
not find a place in development studies.
These reasons coupled with the fact, that disabled
people form not even 5% of the population and are
scattered,
has left the voluntary sector in a state
of indifference to disability as a. social issue.
8.
ADD India has facilitated or is facilitating 9
agencies to do development- and organizational work
with disabled
people.
The fact that they are
undertaken this work and are doing
it as well as
their
commitment
and
competence
permit
is
commendable in the light of the level of awareness
described above.
9.
No doubt,
this work
is
integrated
into these
agencies. However,
the quantum of energy, time and.
resource a 1 1 ocation are not proportionate to the
magnitude of
the problem or in keeping with their
other programmes.
One agency got involved
in this
work for money. A group of middle class disabled.
people broke up with money as a contributing factor.
10.
Two agencies who promoted rehabilitation work for
disabled people on a small scale,
had intended to
do it
differently,
resulting in a development
programme with them. While they do organizational
work of
disabled people,
the slant
is still
rehab i1i tat i ona1.
11.
Four agencies do only organizational work of non
disabled people.
Out of
these, two continue to do
this and attempt to integrate rehabilitation in to
the structure where as the third has swung to
rehabilitation. The fourth agency is a new one.
12.
One other agency does organizational work of non
disabled people
and promotes
income generating
initiatives. The experience with this agency shows
that it may have the balance between organizational
and rehabilitation appropriately. This
is still to
be validated.
13.
Reporting and documentation of this work
is being
done at a desirable level in only two agencies.
These two agencies also have effective co-ordination
of the work. Others have a set back and are pre occupied with management problems. In the past, ADD
India was partly filling the management void in
these agencies by their monthly visits.
Having
recognized this problem, ADD India now works only
with the agencies who have a person playing the co
ordinating function,
either as part of his other
work or full time.
14.
Disabled people, Family, Community and Government:
Disabled people do not feel that they have the same
human needs as non-disabled people except for the
basic needs of food,
clothes and shelter.
Their
deprivation of
love and
affection,
emotional
security, belongingness,
self-respect have all left
them with low - self worth, apathy, depression and
dependence. The origins of current social attitudes
towards disabled people can be found in religion and
in Manusmruti.
15.
Dhritashtra, Sakuni and Manthara (
more commonly
known
as
"Guni")
represent
characters
of
helplessness and villainy. The countless proverbs
about disabled people being naughty,
wicked,
and
signs of bad omen all
reflect social
attitude
towards disabled people through history. The belief
that through disability one pays for his past sins
compounds the problem. Manusmruti prescribes that
disabled people should be
isolated from rituals,
festivals, marriage and property.
The Media also
projects them,
either as heroes or as villains and
not as ordinary human beings. They are also made
into an object of fun and ridicule.
16.
Christianity promulgates values of disabled people
of being helpless and the need for society to
protect and be charitably exposed towards them. The
Roman and Greek cultures perceive disabled people as
a result of divine possession and disabled people
are classed as 'village idiots', and 'cripples’.
17.
During the
Industrial Revolution
people
with
impairments became a. class of industrial
rejects.
But the industrial society found a solution to the
‘problem* of what to do with people who did nit fit
its agenda: the Institution. Here the disabled could
be looked after - and forgotten about.
18.
Pre-natal
genetic
screening is
geared towards
eliminating disability by ensuring that disabled
babies are not born.
19.
The family,
the community and Government reflect
these ingrained attitudes towards disabled people.
Disabled people in turn have become victims of this
attitude, resulting in their apathy and aggression.
Both family and community discourage disabled people
initially from getting together to start exploring
self-help initiatives.
Recognizing this,
ADD India
is beginning to work first with community leaders
and family
about changing their own attitudes
towards disabled people.
20.
Service agencies:
Their services manifest the age-old
charitable
attitude towards disabled people.
By and
large,
their doors are open to disabled people covered by
the programme.
Since, disability work does not have
its rightful
place in the priority ladder of these
agencies, they are not supporting people,
to take
full advantage of these opportunities. Even this, is
beginning to change for the better.
Despite these constraints, the major achievements of
the first phase of
the programme has been that it
has enabled 1,992 disabled people to realize that
they need the same opportunities in
1ife as non
disabled people in order to become active and
effective in their communities.
They have also
realised that the change will not take place unless
they themselves work for
it. Through the formation
of self- help groups a forum has been created, for
disabled people to get together and debate their
needs and,
as a result, disability is definitely
gaining visibility and importance as an issue in the
areas covered by the programme.
In addition, this work has enabled disabled people men, women and children to access opportunities in
the environment
both from government and nonGo v e r nmen ta. 1
sectors.
Opportunities
include
education, se1f-employment,
transportation, housing
and land.
Availing benefits from these schemes has
encouraged disabled
people to strengthen their
conviction" TOGETHER WE CAN"
The members of self-help groups contribute between
50 paise to Rs.5/- a month as membership fee and
have opened bank or post office accounts. This money
is collected and is used by them to meet the
expenses of
their own group for administrative,
postage and travel connected for availing benefits
from Government schemes.
24.
The other indicators of the impact of this work are:
*
Observance of
the World Day of Disabled People and
contributing effort and money for such observance;
*
Non-disabled cadres and disabled people enacting
street plays on social problems of disabled people;
*
Developing
leadership
among
themselves
increasing
their
capacity
for
analysis
ques t i on i ng;
*
Participating
in
street
plays
in
the
mela
and
and
of
agricultural
labourers;
offering
*
Disabled people doing skilled
train other disabled people;
jobs,
*
Disabled women assisting other
mar i ta1 issues ;
disabled women with
»
Joining the efforts of
obtaining land pattas;
*
Ad isabled
person
contesting
the
district
secretaryship of the agricultural labourers union;
*
Parents of
disabled children
motivating
cottnter parts to educate their children;
*
Having collective meetings to debate common issues;
*
Exploring possibility
themse1ves ;
*
‘Creative workshop' for disabled children ;•
*
Puppet show
by cadres
to raise awareness of
community of the social problems of disabled people;
*
Self-help groups
establishing
revolving fund; and
*
Self-help group
members.
25.
Disabled people when they first meet, have a lot of
expectations of
receiving material benefits. Over a
period of
time (6-9 months), other values such as
human dignity,
self reliance,
self-help begin to
emerge and dominate.
BV:SG: 30 NOV 1992.
agricultural
up
of setting
finding
shelter
a
labourers
a
for
one
on
their
union
small
to
for
credit
of
its
ACTION ON DISABILITY AND DEVELOPMENT - INDIA
(ADD INDIA)
FOURTH ANNUAL REPORT FOR THE PERIOD ENDED 01 MARCH 1993
This was a year of consolidation,
service and new partnerships.
development of a new
CURRENT PARTNERSHIPS:
Y o u n g India Project:
(Y1F)
ADD India works with
three Action Groups of YIP Batha 1 a.pa 1 1 i Action Group (BAG),
Kalahasti Action
Group (KAG) and Sathyavedu Action Group (SAG)
Bathalapalli Action Group:
(BAG)
This group has extended their work to cover villages
in Thadamari
and Narpala
mandals.
They
have
recruited one woman cadre to cope with the new work.
.
BAG also
organised
an assessment
camp for
orthopaedica11y disabled
people.
1,200
people
attended the
camp from the whole district of
Anan t hapur .
BAG is managing this work on its own.
Kalahasti Action Group:
(KAG)
Training:
One week Workshop on Disability and Development for
eight cadres of YIP working with disabled people and
one cadre from Integrated Rural Development Society
(a partner of YIP) has been held. This was followed
by a refresher course for three days.
Creative Workshop for children and Song Workshop for
disabled people and cadres were conducted.
Field Work:
KAG has come to the position of managing the field
work on its own with out ADD India's support.
Monthly review and planning meeting have become a
part and parcel of
their programme with disabled
people.
Sa.ngha leaders conduct one meeting every month, and
the other is conducted with the support of the field
workers.
They support the Sanghas in networking
with Government, Bank and other service agencies.
Ref e rra1s :
Contacts have been estab I ished with four schools for
hearing
impaired
children and also with other
hospitals and rehabilitation agencies.
Forty eight
children wil1
be admitted
into special
and common
schoo1s.
Income Generation:
Seven
people
got
financial
assistance
from
Government.
The Venkateshwara Gramina Bank has come
forward to provide financial assistance to disabled
people in the form of loans.
Two people
with fifteen
years experience
in
promoting entrepreneurship in villages visited KAG.
They are likely to use their services.
Collective of Disabled People:
Two collectives of disabled people were held and
in
each
collective,
about
300
disabled
people
participated.
Probably, for the first time in India.
the collectives of rural
disabled people have been
or gani s ed.
ADD India's Current Support:
ADD India’s current support
to KAG is to train
Sangha leaders and to firm up on the net work for
medical Rehabilitation and Primary Education which
is already established.
Assessment Programmes:
An assessment camp for hearing impaired people was
conducted with the support of National Institute of
Hearing Handicapped
and two
ENT doctors from
Victoria hospital,
Bangalore,
in KAG area.
Few
people from [RDS also attended this camp. 122 people
were assessed. The follow-up is taken up by KAG.
Another assessment programme for orthopaedicai1y
disabled children was initiated in KAG area.
The
purpose of
this exercise was to orient parents and
also
teach
them
about
the
importance
of
physiotherapy and the appropriate exercises with the
support of The Association of Physically Handicapped
team from Bangalore. In the process, the cadres were
trained
in
the
simple
techniques
of
also
physiotherapy.
78 persons were assessed and they were recommended
physiotherapy exercises, surgery or orthopaedic aids
according to their degree of disability and needs.
Follow up
1993.
visits will
be held
during May and July
KAG is net working with the
local
surgery and aids and appliances.
hospitals
for
E x pans ion:
At Present KAG works with disabled people only in 83
villages of
4 mandals
- Buchinadi
Kandriga.
K.V,B.Puram, Thottempedu,
and Sri Kalahasti. During
93-94, KAG intends to cover all
the villages
in
these mandalams resulting in new Sanghas of disabled
people.
They are also beginning to work with
disabled people in the neighbouring district of
Nellore. To cope with this work, they have recruited
two more cadres, one of them, disabled.
Sathyavedu Action Group:
(SAG)
SAG has expanded its work with disabled people to
Pichattur mandal
in Chittoor District and Tada.
mandal in Nellore District, They have recruited one
more cadre to cope with the expansion.
SAG is also managing this work on its own.
Orthopaedic Workshop :
An orthopaedic
workshop has been set up
in
Penukonda. by YIP.
This will
produce appropriate
technology orthopaedic aids and appliances,
which
are
affordable by poor people. Two technicians who
have completed
their
training
in Handicap
International, Pondicherry are currently doing this
work. YIP has also sent two women for training as
orthopaedic technicians
to APH.
They would be
trained in
making other
types of orthopaedic
appliances.
TRAINING FOR YOUNG INDIA PROJECT NEU CADRES:
ADD India facilitated a meeting with YIP and Divine
Light Trust for the Blind (DLTB) to support YIP to
organise its rehabilitation service.
The outcome
was :
YIP will
begin work with disabled people in 42
mandalams in Andhra Pradesh with 42 new full
ti me cad res;
They will
be trained in rehabilitation by DLTB
and in organisational work by ADD India;
YIP will appoint a full time Coordinator at the
central level
to coordinate its entire work
with disabled people in all the mandalams;
The President of YIP,
himself has decided to co
ordinate the programme till
a suitable person is
appointed, which is a positive sign and reflects the
level of commitment.
The module envisaged is
that the cadres would be
trained in two groups of 21 each.
One group will be
trained during
1993 and the other during 1994. This
training will be followed up by quarterly review and
planning meetings for four quarters. Disabled people
will participate in these meetings.
ADD
India's
support there after will
be train sangha, leaders.
Once this method of working is tested, this will be
replicated in other states as well.
The syllabus is in the process of being developed.
Rural Development Trust:
(RDT)
RDT has a full
pledged team of rehabilitation
workers consisting of Special
teachers for people
with Hearing
Impairment,
Mental
Retardation and
Orthopaedic Technicians.
These technicians have set
up a fully equipped workshop to produce appropriate
technology
orthopaedic
appliances
which
are
affordable by poor people.
Services are also being
developed for people with Hearing
Impairment and
Mental Retardation. They have expanded their work to
48 more v i1 1 ages.
League for Education And Development (LEAD):
ADD India took a new approach in training LEAD staff
to work with disabled people. Instead of commencing
the work and the training simultaneously, LEAD staff
assigned to work with disabled people underwent
training for eight days over a period of four months
before beginning to organise disabled people.
Field Work :
14 Sanghas are established with a total membership
of 151 people from 30 villages.
The field work is being managed by LEAD field staff.
However, ADD India’s support to the field will
continue to those staff who need strengthening.
ADD
India will
also conduct Sangha Leaders Training and
develop Net Work.
Training:
Apart from development training, LEAD staff attended
a workshop on causes and prevention of disability,
A ten day workshop
during this period.
on puppetry
was also organised
Sangha leaders training will commence during 93-94,
Income generation:
A Market Research agency made an exploratory visit
to determine whether a market research would be
beneficial
to
promote viable income generating
projects. Its recommendations are being considered
by LEAD,
Referral Net work:
Network has been established with various hospitals
and rehab iI i tat ion agencies, that are situated
in
and around T r i chy.
PREPARE
The field work is being managed by PREPARE field
India's current support is to train new
staff. ADD
field staff
in Disability and Development and
in
group work techniques as some of the old staff who
were trained by ADD
India.left.
The support also
includes
developing
net
work
formedical
Rehabilitation.
PREPARE is still in the process of
appointing a person in charge for this programme.
Training:
Sixty dhais
(traditional
birth attendants)
were
trained in disability as a development issue and on
their role
in motivating
disabled people
in
v iI 1ages.
A workshop was organised for parents of children
with hearing impairment.
This motivated
a few
parents to send their hearing impaired children to
s pec i a 1 schoo1s,
Prepare also got two people trained as orthopaedic
technicians - one of
them attended a full
time
course and the other,
a part time course. Handicap
International, Pondicherry has been assessing polio
affected children and providing the follow up,
including aids and appliances.
A ten day puppetry workshop was also conducted for
PREFARE staff and volunteers.
The sangha leaders training will commence during 9394.
NEW PARTNERSHIPS
13 agencies have been
in contact with ADD
India.
during this
year.
Among
these,
the following
organisations have resulted in partnerships:
Integrated Rural
Andhra Pradesh.
Development Society
I brahimpatanam Taluka Agricultural
Union <ITALU), Andhra Pradesh.
( I RDS ) -
Labourers
Chaitanya Institute for Youth and Rural Develop
ment (CHINYARD) - Karnataka
INTEGRATED RURAL DEVELOPMENT SOCIETY:
( I RDS)
Integrated
Rural
Development
Society
( I RDS),
Naray a nava ram in Chittoor District is registered
society established in 1939. They do organisational
work among landless labourers and do CAPART and the
Department of Social Welfare programmes. They are an
Action Group
of Young
India
Project
called
Narayanavaram Action Group (NAG). The group consists
of 13 cadres and one full
timeTTa.dre to work with
disabled people.
Four Sanghas have been developed
during this period with the membership of about 80
people.
IBRAHIMPATANAM TALUKA AGRICULTURAL LABOURERS UNION:
The Agricultural
Labourers Union was registered in
1986 and has 3000 members.
This union has been
facilitated by an outstanding lawyer.
The cadres
were trained
in "disability as a.
development issue"
and one day awareness training
was conducted for more than 50 volunteers of ITALU.
The cadres
and simple
three days.
were also trained in "Causes, prevention
intervention of all
disabilities"
for
The work has commenced in establishing 12 Sanghas of
Disabled People.
CHAITANYA
INSTITUTE OF YOUTH
<CH INYARD)
AND
RURAL
DEVELOPMENT:
CHINYARD was established in 1990. Their focus of
work is on Health and on organising Women around
thrift savi ng.
ADD India has had preliminary discussions with
CHINYARD and the training of field workers and
volunteers has already commenced.
NEU SERV ICE :
Communication, Disability and Development is a new
service of ADD
India,
Media has been used in
development work for the last two decades in India.
The objective of this service is to enable field
workers and disabled people through training to use
both the electronic and folk media in development
work with disabled people.
This service has a full
time co-ordinator and this service taps the talents
of a poolf/jjesourca people from outside w'id-e the
o r gan i sa t ion.
Photo Language Presentation:
A photo language presentation on the life of a
disabled person has been made and field tested. The
script to use the first photo language presentation
of a disabled person is completed,
A second photo
language presentation is also being completed during
this period.
These presentations are being used in
training
Sessions
to
demonstrate
people's
perceptions of disability.
Creative Workshop;
A Two-day Creative Workshop for 25 disabled children
was held during August, 1992, The Workshop basically
dealt with production of creative toys.
Puppetry Workshop:
Two workshops on puppetry for disabled people and
the field staff was conducted. The themes of puppet
shows were social
issues of disabled people
Education, Property and Marriage,
The response to
the Puppet Show has been encouraging from disabled
people and the community.
Visuals:
D iscuss ion triggers
and flip charts have been
deve1 oped,
to be used as tools for animating groups
of di sabled peop1e and for training.
Work on producing posters to campaign for the Rights
of Disabled Children is
in progress. Timetable for
children above 5th standard with the message to
children about disability is also being developed.
The other results of this service include developing
sketches for training
in Rehabilitation and for
Development.
Materials for training animators
developed during this period.
have
been
also
Song Workshop:
A three day workshop to compose songs focussing on
social
problems
and disabled
people was also
conducted during this period,
ADD India Promotional Film:
The promotional
comp 1e t ed,
film
on
Add
work
India's
is
Film on Disabled people doing Skilled Work:
The recy for the film on
skilled work is completed.
disabled
people
doing
Work with other organisations:
ADD India served as faculty on ;
1
A course for Orthopaedic Technicians organised
by Handicap International
Pondicherry;
A course for activists organised
Social Institute, Bangalore and
3
by
Ind i a n
One-day
orientation
on
disability
and
development organised for 40 participants from
14 NGOs in Valliyur by RUCODE, 1 ndia. ’
These are steps
in ADD
India’s attempt
d isab i1i ty as a
development issue on
curriculum of existing training programmes.
to
to
get
the
ADD India participated in the evaluation of VIKLANG
KENDRA - ALLAHABAD,
a partner of OXFAM, Lucknow,
This has paved the way for ADD India, to play such a
role in the disability sector.
RECOGNITION BY THE STATE GOVERNMENT:
This has been obtained as a special case reflecting
the relationship of ADD India with the Government of
Karnataka,
We take this opportunity to put on record our gratitude
to our funders, partners, Government, other agencies and
the general public for their support to our work.
Bangs 1 ore
24 April 19-93
Ref :C:Rep92-93.SG.
H o n y . Seerstary,
ADD India.
LORLD_AIDS p.\Y SATELLITE. MEETING
5TH NOVEi-iJEJ. J r‘P.2
VENUE
INSA/IN1. IA Or I ICE
INTRODUCTION
Since many NGO's end Government rE;pru?.cntotives could not attend
the earlier World AIDS Day Workshop hold on 1 fth October 1 992 ,
they reouestod for a satellite meeting to get involved with
World AIDS Day activities.
THE PARTICIPANTS_AND THEIR PROPOSED FLaNS FUR WORLD AIDS_DAY
A total of 10 participants attended this meeting.
The Government
representatives expressed financial constraints but offered to
join in the AIDS Walk being organised by IHSA/India.
The
Government can also contact Doordarshin and AIR for flash AIDS
prevention messages and distribute pamphlets snd posters as
required.
It was suggested that every pamphlet and poster carry information
on w'-'ere the public could tap more AIDS related information and
counselling services.
The representative from the Lion's Club
offered to collect contributions to supoloment funds for the
AITS Welk.
The participants who attended the meeting are
NAME
:
ADDRESS
TEL. NO
01 . Dr. Gundappa
Joint Director - AIDS
Directorate 0f Health I.
Family Welfare
Anand Rao Circle
Dangsloic - 56 0 009
71 950 (0)
□ 2. Dr ,l< .Chpndreshekrr
Deputy Director - AIDS
Director of Health A
Family Welfare
Anand Rao Circle
Bangalore - 560 009
75B32
03. ilr.V. Benjamin
C/o. Community ll.’elth
Cell.
Korgmangala
Bangalore
5 3159 3
, . .2
NAME
Al’ L R E5 5
TEL ,_N0,
□4 .
M r , J o s. p h George
Mennv /ikas K .ndrn
U T C
63 , Millers herd
B; no lor-: - 560 046
3 3 001 5 (MVK )
33343B(UTC)
05 .
Mr, Solomon J.P.
MAYA
203, Commerce House
9 / 1 , 0 u r n i n g h ■ m i > c •? d
Bengelore - 51’0 052
265400
□6 ,
Dr, Shashidhar
Lions’ Club
26; II Cress, II Main
V ass ntha f-J r g a r
Bangalore
2641 95(R )
266 807(0 )
07 .
Mr . A.5, Murthy
Kplanidir, 5 th Cross
Henum&nth Negor
D < > r > y n J. o r e - 5 60 01 9
624253
• i« ■
Mi’ . Lokcshyap
B r i n d a vn , 5th A M a i n
Vijaynagar
Bangalore - 560 040
300967
09 .
Ms . T ,L.Jacinth a
Cleveland Town
Bangalore - 5'0 005
■: 0.
Ms - Na1 in i
Asst, Prog, Officer
609821(0)
530132 (R)
Shramik Vid ya Peth
D ircctornt': of Mass Educ<?t ion
P Street, He 1.-s ipaleyam
Beni;rlore - 560 0C!2
•
CONCLUSION
A' D-Dey draws nearer, we hops thcjt, atlas t 90T. of the Bnngalorc
population will he reached with basic AI))’.; prevention messages
thmunh these multi pronged approaches.
INSZ- Ar?’D;A
No. 2. Benson
Benson Town,
BANGALORE-560 046.
REPORT 0? T^O '"ORF- SHOPS ON
"STRATEGIES FOR IMPROVING AIDS PREVENTION EDUCATION IN SCHOOLS &
JUNIOR COLLEGES, e.d'galore"
FOR ISADS OF SCHOOLS/COLLEGES HELD ON THE
24th of July'92 and 11th of August '92.
INTRODUCTION :
In Day 1991, when INSA/India hosted a similar Workshop for Heads of
Schools, we received an a pathetic response with only 12 peovle attend
ing.
This year, the response has been overwhelming.
Twentytwo (22) of
the twentyfive invited attend^ the first "orkshop and thirtyeight of
the forty invited attended the second one.
THE PARTICIPANTS :
Dost of the Participants were PrincipaIs/Heads of their Institutions.
Those who could not attend sent their senior biology teachers for the
Workshop. The first Workshop concentrated on private educationa1
institutions and the second on Eangalore City Corporation High Schools
The participants who attended the first '"orkshop were:
1. Ms. E.R.Shant ha,
Asst. Mistress,
Si.il. Gangamma Hombe Gowda-^-'
Girls High School.
10. ns. R.. Shantha Kumari,
Asst.Distress,
Rani "arala Devi High School.
2. Us. Sharadamba
Asst.Distress,
Sharada Stree Sama ja Girls [•''
High School.
3. Mr .K .V. Andrews,
Pri ncipa1,
St.Mary's Public School.
* »A
\
v
\
- ,
11. Hrs.Nary Mathew,
Senior Teacher,
Eangalore International School.
12. Mr.Nohd. Gussain,
Head Master,
Quwathul Islam. High School.
15. Sr.Shalini D'Souza,
'lead distress,
Hi rmala Girls High School.
4. Ms. N.Kamalanwia,
Head lit stress,
14.
P.apu Girls High School.
5. Sr.Rose Mary,
Head Distress,
15.
Mariam Nila ya High School.
6. Mrs. Aysha Eibi,
Senior Asst.Ac Eiology Teacher- 16.
515,Army Ease ^orksho High Schl
7. Sr.Josephine "cover,
Prinet pa/
St.Joseph's Convent.
8. Er. Teppo,
Asst.Faster,
St.Germa in High School.
9. Hrs.nanasa U.S.
Senior Eiology Teacher,
St.Paul's English School.
•.
Mrs.Shy laja,
Eiology Teacher,
Tagore Memoria1 High School.
Sr. Mary Noel,
St.Theresa's Girls High School
F'rs. H.B.Geetha,
Asst.Mistress,
’
M.L.A.High School.
■,
17. Ms.Sect halakshmi,
Assistant Mistress,
Easavanagudi Girls Govt.
Junior College.
18. Drs.Gajalakshmi Murugesh,
IJombe Gowda Soys High School,
!r r.K.S. Na ga ra Ju,
Head Master,
Pamatha Girls aigh School.
; 2 :
20. frs.Jyoti P.Lal
21. !'rs. V .Gee th),
St. lira's 'Ugh School.
22. Prof.Sheila Isaac,
Princi va 1,
SSI W College.
I
.
The participants who attended the second ~f>rkshop. Corporation 'Ugh
SchooE were :
1.
1'r.Krishne Gowda,
Head Master,
Corpn.Boys High School,
Jogupalya.
2-
Ms.P.P,Vim-ala
nead distress,
Corpn.Girls High School
Dispensary Road.
' rRavindranatha,
Dr inci pa 1,
Pre University College,
Tasker Town.
12. Hr.Raghuveera E
Head Raster,
Corpn.High School,
Pi Hanna Garden.
9.
As.A a 1iha Regum,
19.
11.
Head Mistress,
Corpn.High School for Roys,
Cox Town.
— 4.
I.
5.
6.
7.
8.
Q
9.
Ms.Asmath '(ha toon,
Head Mistress,
Corpn.Girls High School,
Gandhinagar.
Ms.Jayalakshni,
Head Mistress,
Cor pa,Girls High School,
Eanappd Park,
14.
Ms. Jayant hi C.R.
Head Mistress,
Corpn.Primary School,
Lakkasandra.
Hr. V. Ra ja shekara,
Head Raster,
Corpn.Boys High School
Austin Town.
hr. H. I'empanna,
Incharge Principal,
Corpn.Junior College & High
School for Girls,
Austin Town,
i-s. .4. Sa in. pan gamma,
Head Mistress,
Corpn.Girls High School,
I- odandaranpuram.
17.
Ms.Us ha E.Naik
Teacher
Corpn.Primary School,
Govindara j Va ga r.
Es
Puda la gi rat ah,
Head. ■ aster,
Corpn. higher Hlementry School
'•'c. e la sandra .
15. :'s. .1. Victoria,
16. Ms.S.Gowramma,
Corpn. rfi gher Elementry School
Austin Town.
: s.. C. Sharadamma,
Head ."i stress,
Corpn.Girls High School
A shok ’’aga r.
18. Ur.Abdul nafiZ}
Head Master,
Corpn.'Sigh School,
S ha nt hi Hagar.
19. hr. Syed Usman,
Asst.Master,
Corpn.Girls High School,
Murphy Town.
20. hr .T. !■ .Ga ja ra. ja n,
Physical Education Officer,
Bangalore City Corporation.
21. r. E. Veerakempa iah,
Head, .- aster,
Corpn.Girls High School,
10. Mr.Kodandaramaiahsetty ,
Gaya t hri Hagar.
Principa 1,
Cornn.Junior College for Girls,
■ J ogupa la ya.
22. Er. Dakshina l.urthi Pillai,
Corpn.Junior College for Girls,
C le^ye land Town,
51. l.rs.lcbeda Ba gum,
Head "istress,
Tasker Town.
25. Mr. D. L. Chandra she ha r,
Corpu.Pre.Un.College,
Cha ma ra ja pe t.
52. Hr. Michali Pragasam,
Prinzipa 1,
Corpn.Junior College,
Ma g a di Poad.
55. Mr. H. F. adegowda,
Head Master,
Corpn. Girls High School.,
F .G. Hagar.
24. Mr. A'. 7a radan,
Head Master, '
Corporation Girls High School,
Jaya mahal.
25. Mr. H. S. Ha ja n,
Asst. faster,
Corpn.Junior College for Girls,
Sriramapura.
26. Mr. P.7.Heerabhadraiah,
Asst.Paster,
Corpn.High School,
V i ja ya na ga r.
27. Mr. DShive gowda,
Corpn. High School,
Ma ra ppa npa 1 ya .
28. Ms. F.S.Kamala,
Head Mistress,
Corpn.Girls Sigh School,
Da ya na nda Ma ga r.
29. Hr. H. L. Siddaiah,
Head Faster,
Corpn. "igh School,
Eyra sandra.
50. hs. G. S. Prema latha,
Head distress,
Corpn.Bays High School,
Sr trampur a.
54. Mr.Faghdoom Shareef ,
Cor on.Primary School,
Eroadway.
55. Mr.Munirangaiah,
Corpn.Girls High School,
Eat hikere Layout.
56. Mr. Eathnakara Hebbar,
Corpn.Junior College,
Fasturba Hagar.
57. Hr. N. S.Keerthinarayan Hao
Head .Master,
Corpn.Girls High School
Cottonpet.
58. ir.Surendra Meal,
Corpn.High School,
Ga ng a na ga r.
The high degree of the participation in the latter "’orkshop was
possible because of the special interest taken by the Corporation
Education Officer Ms.Shanthimathi, who also attended part of the
Workshop.
THE ^ORKSHOPj' AIM AMD DEJECT TV EG :
The atm and objectives for the '"orkshops were drawn out by IMS A/India
as follows:
A IMS
To promote immediate plans for incorporatin'! t IDS Educational
activities as part of ongoing school pregrzmmes with the active
participation of Heads of Schools.
.....4/
: 4 :
OBJECTIVES :
By the end of the "'orkshop,
the participants will:
(a)
discuss appropriate approaches to .’IDS Awareness building
programmes in their respective schools.
(b)
outline approaches to formulate future policies for dealing
with HIV infected persons, be they students or staff in their
schools.
(c)
support the training of the rrigh School teachers for ongoing
AIDS Education Programmes in their schools.
(d)
express willingness to lend support and actively participate
in public AIDS awareness campaigns: eg. on "or Id AIDS Day.
THE ~ORKSHOD PROCEEDINGS:
Both the "orkshops were designed to elicit optimum participation
from the participants.
Having begun with t short introduction inti
pre evaluation, Dr .V. Ravi from the \‘euro Virology Department of ,
NII'HANS discussed the Cause, Spread •nd Prevention of AIDS and. th':
need for urgent intervent ions in India.
This was followed by a short video film on what interventions other
countries have started.
The group then discussed appropriate strategies for AIDS prevention education in schooIs/co lieges.
A list
of this is appended as Appendix I.
The noon session began with a discussion on the psychosocial aspects
related to HIV infected persons - with special reference to children
and staff who have HIV infection.
The groups worked out approaches
to dealing with such situations.
Finally, members of the groups gave us dates for I*'SA/India to
conduct the AIDS Education Session in thzir schools.
One principal
of a Corporation High School (which wc had covered with AIDS educa
tion in January 1991) felt confident to conduct the AIDS Prevention
education (with INSA’s help)
and has planned to do so in the near
future.
"e hope for more such positive initiatives by others in
the future.
The "orkshop ended with each participant filling up the post test
questionnaire and renewing premises to build up .'.IDS Prevention
education programmes in their areas.
THE VENUE :
Both workshops were held in Hotel Harsh'i, whose staff who took over
the catering' to enable the participants and. INS.'./India to concentrate
entirely on the 'orkshop.
It was also interesting to note the number of the hotel boys who
were interested in the programme and. fallowed, it closely'.
CONCL’.'SIC v :
INSA/India wishes to express its thanks to the Heads and. partici
pants who attended both workshops.
~e also wish to record our
deepest appreciation to Dr.V.Ravi who continues to be a constant
supporter of the AIDS Prevention Education in schools and to lead
the discussions at the Workshops and Dr.V.Eenjamin\was present
for the 2nd "orkshop and. helped us.
~'e have no words to express
our deepest gratitude to .'is. Shunt himat hi, Corporation Education
Officer, whose doors were always open for INSA/India and whose
tireless efforts resulted in
tOOfy turnout at the latter Workshop.
INSA/India does not forget its'donor the Ford Foundation, who made
this possible.
These two "orkshops were a fitting final to 1st Project year of
AIDS Prevention Education in schools/colleges of Fangalore and a
curtain raiser to our subsequent three years.
ith best wishes from INSA/India team,
Sujatha de .'agry, Edwina Pereira, Ehanu nau.1, Ehaga vandas, Ceet ha,
Char let and Tina King.
/
A p P E V £> Z Z ' Z 7
Group Discussion, on:
"Appropriate strategies for' AIDS Prevention Education in 'Ugh
Schools and. junior Colleges".
•
1st Workshop :
GROUP I’s sharing :
1.
Creating awareness to parents,students and teachers by
ta Ikingt't
/X hem about AIDS.
2.
Intervene at government levels to incorporate AIDS into
syllabus.
J.
Have AIDS Education programmes for schools in the neighbour
hood coordinated by one of the participant schools.
4.
Invite INSA to discuss AIDS Prevention Education at the Board
Meeting of Principals.
5.
Encourage Head Haster/Mistrcss Association to pass-a resolu
tion to include AIDS Education in their schools.
6.
Put up posters in schools/pub lie places.
7.
Encourage individual teachers to educate parents of the
children in their class.
GROUP Il's sharing :
1.
Select a school as a lead school to that other teachers from
different other schools closeby can come
’ for AIDS Preven
tion Education.
2.
Train all teachers of one school on AIDS
3.
Take the Reproduction subject for Xth standard students
first and then AIDS can be done easily.
4.
Put up literature on AIDS in school notice boards.
5.
Save ongoing programmes to update teachers.
6.
7.
8.
9.
I
Save workshop for different teachers not just biology teachers.
They have to be frank and open and free with children.
continuity of such
workshops should be there.
;
Organise inter-school quia competition on '‘.IDS
I
g
I'
t* ’:
keep -June-August free because it is the best time to contact''
schools for AIDS Prevention sessions.
1
Contact the Directorate of Text Books and Commissioner c\f
'•
Public Instruction and discuss the dire need for AIDS Dr*evention Education.
I
....2/
f
7 '
6
■
t
[I
I
• 2
2nd Workshop ('Corporation School s,)
GROUP I's Sharing :
7.
Talk to the staff about AIDS
2.
Invite INS'. to Project their films on AIDS
J.
Obtain literature from. INSA on AIDS and distribute.
4.
Motivate teachers to talk, to students about AIDS Prevention.
5.
Request the Health Department of the Bangalore City Corporation
to deliver talks (NOH $ )re lated to AIDS.
6.
Invite eminent doctors from National Institutes for talks
and symposia an AIDS/Drugs etc.
7.
Promote chiIdren to write on AIDS and other aspects of health
arid hygiene.
8.
The Bangalore Maha Nagara Paa lika may publish literature on
health with attention to IDS-Pre vent ion to be distributed
freely to the students.
9.
Arrange quiz programme on health in general and AIDS in
particular with some prizes.
10-r-
‘ Put up posters on AIDS Prevention on notice boards.
11.
Call parents meeting'impress upon them the topic of AIDS
along with other aspects of health and. hyginr-z.
12.
Financial and may be given by Bangalore City Corporation or
INSA for holding meetings of staff and parents on AIDS and
other aspects, atleast nominally.
19.
Involve voluntary associations like the Rotary in the AIDS
Prevention projects.
GROUP Il's sharing :
f.
Arrange staff meeting in the school to discuss about AIDS
2.
Children should be shown through films that A IDS is spreading
through a virus.
3.
Moral education periods should be utilised for AIDS discussion.
4.
Eminent doctors should be invited to the school and lectures
should be arranged on AIDS.
5.
Posters and literatures concerning to AIDS should be displayed
in the schools to enlighten the children.
6.
'"orld AIDS Day should be conducted in the schools on 1st
December every year in a benefiting manner.
•• 5 ••
7.
Films concerning
8.
During health education periods AIDS should be introduced
tn school syllabus.
9.
"Responsible individua1 behaviour" slogan in solution for
the problem should be highlighted.
AIDS should be screened in -‘the schools.
Group Ill's sharing :
1.
Head Master/Mistress can conduct staff meeting to educate
the teachers regarding AIDS and request the biology teacher
to pass on information regarding sex educat I on to their
students whenever the situation arises in the class room.
2.
Head Master/Mistress should arrange for a meeting inviting
IHSA of local doctor who knows about AIDS.
J.
Celebrate "I or Id. AIDS day on Dec. 1st every year in the schools/
colleges.
4.
Display in the school notice board, pictures and pamphlets
on AIDS.
5.
Visiting a hosvita1 along with selected students to observe
AIDS Patients.
6.
~"hile conducting teachers and parents meeting Head Master/Mistress
may explain rapid spreading of 'IDS.in India and its prevention
7.
Institutions having T.V.mzy arrange films on AIDS.
8.
Head Master/ rJe id Mistress may tike the help of INSA in order
to educate chi Idren.
9.
Responsible individual behaviour should be created among the
students through moral education.
10.
Request the department to introduce AIDS chapter in the
syllabus of biological science.
11.
Spoken language should be used to propagate message about
AIDS prevention.
GROUP TV's sharing :
1.
Ering in awareness among the stuff members regarding AIDS
2.
This year's teachers Seminor should be on Prevention of AIDS
and related matters.
Debate Essay, Compet tons and models to
be prepared by the schools.
f.
Arrange, for lectures by the teachers in their class rooms and
make the students aware of the. seriousness of the problem.
4.
Preferably have the smaller groups to be. addressed by the
r.
che rs.
. '
>
....4/
/
J
5.
Try to involve all the teachers in ■ .due: ting the students.
Encourage students to make posters, pictures and drain Ings
on AIDS Prevention.
6. T
Arrange for lectures and film shows from outside agencies.
Involve INSA with the school programme, request them to supply
posters in local languages pre ferally.
7-
INS', is requested to involve the mass media like TV, Radio,
Cinema and other agencies to publicese A IDS .prevent ion .
Introduce short films in between TV film, Cinena, Chitrahaar
programmes during prime time like the one shown today (KarateKids)
INTBM ATIOHAL NURSING SSHVICES ASSCCI A.TICN/ INDI A
Ho.?, Denson Road,
Benson Town,
BANGA LORR - $60 046
WORLD AIDS DAY R'r.DCRT
1st December, 1991
INTRODUCTION
Being one of the few Organisations tn Bangalore actively
involved tn AIDS Prevention Education, INSA/Indla was reques
ted by other agencies to coordinate efforts in Bangs, lore
for creating public awareness on Torld AIDS Day, $991.
In preparation for this, INSA/Indta organised a Workshop for
related Government officials, voluntary agencies and. the
media to plan activities for Torld AIDS Day. This ‘.'orkshop
was well attended by the Government officials - Dr.Gundappa,
Joint Director, Dr. Sarntullah and "r. Ba ladev and by voluntary
agencies like Vadhyam, ‘Aedia Centre, CRUST, Joint Aomen's
Programme , The Family Planning Association of India etc.
Though the constraints of time and funds remained, the planning
between Government, voluntary agencies and the press helped
make Forld AIDS Day tn Bangalore the first coordinated effort.
towards AIDS Prevention in Tanga lore, in particular and
Karnataka in general.
TCI ARDS 7,'OPLD AIDS DAY ACTI71TIBS
With 1st December being forld AIDS Day, INSA/India with active
collaboration with the Government, other voluntary agencies
and the press undertook the following activities:
1.
Pactories, Youth Clubs, the Government and USA/India:
I.
TSA/India
received posters and pamphlets on AIDS pre
vention from the Karnataka State AIDS Cell and distri
buted the same in 19 large scale industries in Bangalore
with discussions with the respective Human/Persons 1
Re lattons Officers to put them up tn strategic points
in factories to increase workers' awareness of HDS
prevention.
Ten youth groups also were given the same
with extensive discussions with their leaders.
The
target population covered, thus was estimated to be
10,000 - if not more.
Divya Shanti - the Government and IT'S'./Indic :
Dtvya Shanti, a voluntary agency Organised a 1'orld AIDS
reek from 90th November to 6th December. Dr.Gundappa,
Joint Director and others from the State AIDS Cell wore
present at the inaugural and '.ILS related material mare
given for the occasion.
The week consisted of various
AIDS education related programmes and ISSA/ India was
asked to speck about ''.ID'' ''reventton to three groups
organised by Dtvya Shanti :
: 2 :
5.
(a)
the slum rpprten /for cJor>3ty slum.s
(b)
their high school boys and girln
(c)
their staff, teachers and. social workers.
fta d h ya n - Govenment and r
* / Tndir. :
Hadhyam, a voluntary agency who has links with the press
conference on the ens of *orld -iTne pjay, 30 that all
newspapers (all languages) carried an AIDS related artJcl.n
on lorld AIDS Day,
About 70 newspaper/periodica 1 agen
cies were contacted and. about 1/2 that number turned up
for the press conference held at the Press Club of India.
The speakers were Dr.Gundappa, from the Ptate AID" Cell,
Dr,Navi front. KIWIN? - Neuro Virology Department and
IKS a/India.
4.
C.V.A.I's one day retreat "Sharing the Challenge" :
The Christian Medical Association of India in Bangalore
held a retreat tn St.Park's Cathedral for their member
organisations to increase AID" Prevention awareness
and INSA/India was one of their speakers on thit occasion.
Others wore representatives fmo st ..John' s Medical College,
Bangalore, and NINKA".').
5.
Karnataka Child Development Council, Xadhyan, I.'I.C.
and INSA/India :
A hundred trainees of creches (balseoikn. teachers 1 of
the Karnataka State Child development council were exposed.
to AIDS Prevention education through a discussion and
video ftlm organised by INGA/India and followed by a
puppet show organised ty the Indian Health Grganlsatton(IHC)
Bangalore branch and Nadhyam, These baIsewika teachers
have access to women in the communities where on anganwadt
(creche) is situated.
Government made posters were used
also. Madhyam and IPO also performed puppet shows tn
various slums around Pangalore to spread AIDH prevention
messages.
6.
Other activities :
The Karnataka State AID" Cell proposed to send a circular
to each of their primary and district health centres to
undertake .'IDG education activities and. distributed, the
i’HO Tor Id AIDS Day pamphlet to each of them.
I' .'/India
conducted an AIDS Education programme, tn Jyoti "tear. College
as part of its ongoing programmes.
CGND LG"ION
The motto "Sharing the Challenge" hrenro a reality in
7
City with voluntary and Governmental agencies collaborating tospread AIDS and HIV prevention awareness on forld. ‘.irg
INSA/India thanks all who pj rt Ic t p.ited and hopes the coll'' bora
tion effort will be strengthened as time goes on.
THE IHSJi/India team
REPORT OH THE t.'JA!CF UH
"TOWARDS
WORLD
LAY
Al.
1992-
1 1t h October 19 9 2
Venue
Hotel Hu she. ,
jineger
lore
Or g ~ n is eci 'Gy
i i->'h_•rn Communications E.
11 j A / 1 nr! ia ,
INTRODUCTION
s
With 1st December being World ,<I! _ u e y (WAD) end the theme
for 1 992 being "A Community Cor.imitmr nt ,
IHSA/Indie approached
Medhyam Communicrtions to help n.v 'ai-c
Workshop for interested
NGO's -nd Government Organisations in InngclorE to prepare
pirns end co-ordinete efforts to r,..-c World AID'; Dry (week) 1 992“
a moons to disseminate AI’J.3 Pr v.nti -n messages to the gcnonl
public.
The Workshop aim'd io i"i.i.d out i.lnt. Ali/.'i i;i Is I.cd
activity each organisation . r,s doing, 'what resources were ?t
their disposal, whet esch could do for LAD end from where
resources could be tapped -nd cool'd to raise public awareness
on WAD .
THE PARTICIPANTS
:
Though 95 organisations/persons w. r . contacted through letters
and telephone, a total of 15 p rsens from various non governmental organisations one! one rap; u. cent inn the; Government
attended the workshop.
They ware
NAME
Al'DJEuL
TEL HO.
01 . Er. IJanjunde Gowda
Deputy ..ir.'.ctor
74039
(Public; ti. n )
Health L family Welfare Dept.
Anand :• o
i.rcle
Dangclor'. - 560 009
02. Mr. Joseph George
i.anav Vi.Kondro
333430
United Thnnlrnical Callr.g;. 332844
17, mill as Gc’.-d
B.-ng lor- - 510 04 6
03. Ms. Us ha As ho I: Kumar
!. -t.(.'!3pt. Of I omi.n
!■ t u d i e s )
Mount --rmal College
261 759
2
04 . Dr. Sov.'hhagya
Puttcram
A r. t . I"
or
(i o u j. n I th a la- v )
H.T
"
r.3.
.0900
narr-r
■ -• 560 029
□ 5 . Dr, Ravi Mohan M.
Jl.-eF bank e-’ficor
India:; ■ >.
.s.i Society
Ban al..::. - 560.001
264205
06. Mr. R n j a r a m
Cone. ..n !' r ■ t.rking
Ch i1dru t •
26/1 ,
7 l n- er;v- Garden
Oh.jap: n• ‘ ' 1 li
I nd i.i-,- •-- gar
Bangalore - 560 000
5 721 1 1
575258
6/121 21
Extn .
Neuro Pc th':;
•
07. Or.Latha Jr(i?nnrthr'
Tru j t a :
266131
Bf nr-- J..-.re M.c'lcrl Services 569799
Trust
I m pari 1 C c u t
Cunninrii; r. :;c ■ d
Brnnrlorc - SCO 001
□ 8. Ms. Maya Sharma
Car .. L- s nr: n d u n t
buurdh rshrnJ . C . ii oad
Banc.-:.!. ,:r: - 560 006
09 . Ms.Jayshri Kothevalc
C cun? filler
3 6.5647
F . I- . I\ .J .
127, Sri la th, ,\tn . 1':-1 3 th Cross
West P :t' i>.) d
i>ll' s- < . - m
Dang;lure - 560 055
1 0. Mr. Samson John
Journ list
Janj;, J.-y v. ni.
Ou-uns I', -"d
Bcnnalrr.. -56 0 001
263941
1 1 . Mr . S .V.Srinivas
M urt h y
C c - o r d i n a t.. r
Incii-n
d Cr.. ;;s Society
26, .7'Ci. ih.-uxs... Road
Drnjrki.- - 560 001
264205 (0 )
268430 (0)
530258 (H)
1 2 . Er.Sneha Kulkrrni
T.nd;-n 'i-cisty Of
Health
i' r.i i n 5.s tr at.o r a
Ulsrjor
B - n < a 1 a. r :
574297
1 3 . Ms. Meera Chekrrhorty M a n i n i
''.5, -'■th M .J-jck
..a j.- j : nr
8; ngcl rr. - 56 0 01 0
(0)
(R )
333201 (0)
642702 (F>)
358127
1 4 . Ms . N r 1 i n i
Asst. P.c . . Officer
609821 (0)
Shr a ml. !< Vic'yr path
530132 (R)
1 ir set a r ,-:t-' Of Hess Erfuert ion
F Str a- a t , Erl c s i p a 1 a y r m
B a n <- ■. - SiO 002
1 5 . Ms . Alka
Indier H • 1th (j r g n i s a t i a n
9 J • : , Lrne
BriLprt
Be nr - I,..; .. - 560 053
7271 2
Nc
1 6 . D r . Elizabeth Par r 1 D . D ivy-- ./> • ntli i Christian
A ss : c i r t i u n
Ling-raj jurom
Bangels r i; - 560 084
ORGANISERS
01 . Ms . Suchrrita Ecshwer
Prog. Ji r , c t c r
575800
02 . Ms . Janaki
03 . Ms . Sadha
MADHYAM CUM.,
IC AT IONS
P . 3 . 4 610
59, Miller .
Dens: n Tenn
BANGALORE - SCO 046
01 . Ms.
Sujrtha de M-gry
Prog.
,j 3 r .1- c -t.) r
02 .
Ms . Ed wine Pen? ir a
Asst. Prr- . fircct.-r
03 .
Ms . Bhanu Paul
Faculty I Member
INSA / I?'
No. 07, 1st Fleer
3rd Cross,
Nandidurg Nord Extn.
BANGALORE - SCO 046
- c ~i 5 2 2
561261
(R)
(R )
- : 4
THE WORKSHOPrOROCEEBINGS
:
Thu workshop began with c short intr
uct i;:n which helped each
one gets to know each ether.
A discussion on the Indian AIDS
scenario end the need, for steeping up intervention was then
focussed upon, after which, a video presentation on whet other
countries were doing for AIDS prevention '..'as screened.
This
set the tone for each participant to discuss in detail specific
actions they could take up for '.'AD 1992 and follow up actions
for the rest of the year.
These -ru summarised below :
01 .
Mndh yom_ Cyjnijujiicc;t io ns is presently involved with raising
health awareness through various media.
For WAD 199?, they plan to
02 -
03.
:
i)
organise a Press Conf.■.rns.ee in the preceding
week, sc. thqt all major news papers carry
ncn-thrcat^'^/factuol AIDS related messages
during V.'AD 1992.
ii)
organise a poster comp...titi. n on AILS in
Mount Carmel College.
iii)
Puppets shows/streut pl- yo on AIDS at public
places ( Shiva j in- gar , i'.-jestic) and as
requested. Please inf. rm them before-hand.
INSA / India
i)
AIDS walk with school :
ii)
distribution of pust..rc, pamphlets, inserts in
magazines targetting industries.
iii)
concept (AIDS) letters fur religious heads to
use during their preaching.
iv)
AIDS education sessi nr: -s requested.
nd _.th,;r participating
Dr.Naniunde Gowda: being Deputy LiZu.ctcr (Publications)
he could, with permission uf hi' superior Mrs. Sushccla,
ipt. Director IEC - Phene 7104c) m.-ke available Govt.
pesters and pamphlets an A I?iS • s per request. The ether
government contacts are :
i)
Dr. Ch endr oshekh - r fj-vek, ...uputy Director
(AIDS) Phene 73151 Extn.294
ii)
Dr .Honnabh"ve, Adr'n. ..iructur fur National
AIDS Control Programme.
They could participate in th^ press Cunfurunce and may
be able tt? help getting De -rd rrsh-n slots for AILS
related messages.
'-J>
5
04 .
□ 5.
Mr. Joseph George : Hrnrv.Vik: s^.K.'nc'rj: (MVK) does offer
counselling services and is p;.-.,:prer' to do counselling
for HIV infected persons (unofficially).
They cm
train counsellors -for AIDS specifically if others need
such training (Contact : Dr. Carlos V'olsh , Director).
Ms. Us hr. Ashok Kumar from .Mount■rmel.._C_Gllu_g£
' organising :
i) the poster competition on AIDS with Madhyam
Communication.
ii) an AIDS education so si.n for 900 students on
3rd December 1992 with IIJSA/Indic.
Of'.
Mr. R.?icrrm fr-m C: ncern Far Cor.kinq Children shored
that every month they del with me theme end since
December is rlrecdy planned f. r, they would adept
AIDS cs the theme fi?r February 1 993 during which month
AIDS educational messages will be highlighted through
puppet shews, video films, discussions etc.
They will
also place AIDS inserts in their wall newspaper - Bhima.
07.
Dr. Lathe J a q a n a t h an invites m mburs to let others know
that blood cm be tested for HIV 1 + 2 at Bengal ere
Medical Services Trust for l\s.75/-.
For LAD '92 she
could get business c. ncerns to s onsor production of
AIDS prevent!', a mess-cos f_r jmrdhcrshcn and hoardings if
E.-.-rd-rshan will offer time free and publish the sponsor's
name. She also has : ceuns. Hing centre 'Vishwns' which at
present is not f-ing co u nc ■: 1 i i? ■ f. r 11IV u, AIDS’ related
hers<’ns till the st~ i‘ ar;. t.vt iriei .
Ms. Maya Sharma
from D □prdaiwjjy n.i
Insight
programme offers to caver i’AD activities done by others
(so please inform her of your specific activity, date
and place).
She has .. f fur -d to help arrange a meeting
with the required personnel at
to make Dr.Lathe
Jaganathm's offer a reality.
OB.
09.
Ms. J a y a s h r i K o t h a v a 1 e , a cjuns'-’llcr at F P A I is organising
a Seminar on AIDS on the ?nd/3rd December 1 992 for
college students.
The FFAI has - ge..d booklet "Talking
AIDS" which is available un request for Rs.10/- each
plus postage.
10.
Mr. Samson J.'hn would writ, -n article highlighting
basic AIDS prevention muss.-gus far his newspaper
Sm j a ya Voni .
1 1 .
Mr. S.V. Srinivas Murthy from Indian Red Cross Society
(IRCS) offers to. make available bleed testing facilities
far HIV 1 + 2 testing at a n.minal fee.
He is else the Notional Vice (’resident of the IRCS of
India and will spread AIDS related information through
them.
6
1 2-
Ms, Moore? Chrkrnbcrty from ii.'jiini. pirns t. stage
street pi.-ys end puppet shows cn AIDS in slums
of the c?ty with Madhyam Communication's help.
13. . Dr. Snehe Kulkerni from JISHA is presently undertaking
HIV surveillance studies in selected slums for the
Govt. Cf Indic.
She hrs tc d.iscuon plrnj for WAD with
her teem end will lei us kn w.
.
Ms. N e 1 i n i fr -m Shr.~m.ik Vid;-''? Pec th (SVp) hrs offered
tc organise the women fr.m slums tc participate in
INSA's AIDS Walk.
Also to promote AIDS education in
slums through puppet shows with M--dhyrm Cemmuniceticn ' s
help.
They could also undertake spreading AIDS messages
through struct ploys cn request.
15.
Ms, Alka from j_H_O hrs at her disp. sol pamphlets, booklets
in Kennrde, Hindi -nd English and posters on AIDS for
distribution.
Those, who. need them could make requests.
She else has video'^s on AIDS for sale.
16,
Dr. Elizabeth Pearl will under tn k;j AIDS prevention
education in surrounding -3. ;alur slums and arrange for
the Livyr Shsnthi schorl to he covered vic INSA
during that period.
1
TO SUMMARISE
For
:
i) booklets un AIDS contact - FPAI G. IHO
ii.) pamphlets &. pesters on AI.-.u - Govt.
,. INSA &. IHO
iii)
video cassettes cn f. IDS - Ii’i'JA (Rs. 3 50/- per cassette)
&. IHO
iv)
puppet shows on AIDS - ii-r’hy^m Communication
v)
street-, ploys cn AIDS - Mrr'hyum Communication 8. SVP
AIDS education in scho Is, colleges, slums,
industries - INSA
vii) C-un.lelling Services - CREST £. HVK
vi)
viii)
If y'u find hoardings -vcil-blc far AIDS - Dr,Lethe
7
• : 7
CONCLUSION
: -
:
V'e hove together , just trken
ne st.-p fcrv;rrc’.
But with
nur trt-'l C'mmitm.- nt together,
c; n r
miles tcwrrds
mrkinn n£_rna in Be no.-l. re ’-y -Ip t /.ILS bec.-uso I didn't
kn-w hi-.w t- prrtect mysal fi: .
TL 's nn;.ds ?ur commitment n community commitment.
International Nursing Services Association
RURAL HEALTH DEVELOPMENT TRAINERS' PROGRAMME
AIDS EDUCATION PROGRAMME
REPORTING ON THE AIDS PREVENTION EDUCATION IN SCHOOLS
FOR THE PERIOD SEPTEMBER 1$92 TO FEBRUARY 1W5
INTRODUCTION :
Many milestones have been covered with
the
AIDS
Prevention Education in Schools during this period.
Hence, there is much to share and we hope this will be
as interesting to read as it has been for us to write.
During this period, several Workshops have been held,
many schools reached and Tibetan settlements visited to
spread AIDS Prevention messages. With exams far away,
it was a good time to contact schools because they were
prepared to spare the time for us to talk to the
students.
We also had the added advantage of the
weather being kind which prompted us to visit those
Tibetan settlements which would be near difficult to
reach in summer.
TIBETAN SETTLEMENTS :
INSA's AIDS Prevention Education Programmes were held in
a remote, small Tibetan village of Mainpath in Ambikapur
District, Madhya Pradesh, which has a population of 1468
approximately.
Further down into Maharashtra is the
village of Bandara with a 1103 strong population where
the programme was again repeated. At both these places,
the response was good plus, the settlement officer, with
prior notice from us and the Department of Health,
Dharamsala, made sure that atleast one person from each
family
attended
the
sessions.
At
both
these
settlements, approximately 900 to 1000 persons attended
the sessions.
Also, two Tibetan schools at each
settlement with a total of 95 students were covered. An
interesting fact that seems to emerge as we cover the
Tibetan population is that
homosexuality is unknown
amongst them.
If it does exist, people are unaware of
it !
87. 1ST FLOOR. 3RD CROSS. NANDIDURG ROAD EXTENSION. BANGALORE - 560 046.
::
2
::
SCHOOLS AID COLLEGES
Back in Bangalore, we worked at high speed to try and
cover as nany schools and colleges as we could before
they began preparations for the final exams. Whether it
was because of the increased coverage about AIDS in the
Ileus or whether word had spread of our Workshops and
visits to other schools we night never know, but all of
a sudden there was greater acceptance of AIDS Prevention
Education iron us. Besides, we were even being invited
to those schools who at first had shunned us. Another
bit of luck that case our way was getting to know a
group of young enthusiastic people, all of whom are
students from various colleges and who belong to an
international student organisation called AISEG, which
originated in Brussels. Of late, these people have been
contacting
schools
and
colleges,
making
all
the
necessary arrangements and then inviting us to go over
and conduct the AIDS Prevention Education.
This has
been of great help plus, it has saved us a lot of time
waiting
around
principals’
offices
to
get
an
appointment.
The breakdown of the number of schools and colleges
covered from i.e. September 1992 to February 1993 :
SYLLASUS
SCHOOLS/COLLEGES
ENGLISH tlEb.
EAhWh TIED
FOLLOWED
Covered
Boys
Girls
Boys
Girls
S.S.L.C
38
1226
1766
1915
4230
I.S.C.
3
103
170
—•
——
C.B.S.E.
-
——
—
—
——
COLLEGE
11
45
3740
——
—
52
1374
5676
1915
4230
Total No. of High Schools & Colleges covered
Boys in High Schools & Colleges
°
3,289
Girls in High Schools & Colleges
=
9,906
Total Number of Students covered
- 13,195
Total Nunber of Staff covered
■IO TEACH A HEALER
*»
52
38
INTERNATIONAL NURSING SERVICES ASSOCIATION.
COMMITTED TO SELF HELP
OTHER GROUPS :
"
"
Apart: from schools and colleges, the School of Nursing
at St. Martha's Hospital, Bangalore, invited us to
address a group of about 100 student nurses, doctors and
pararaedicals. The C.M.A.I., also invited us to speak to
150 members of various church groups.
Since March 1993, AIDS messages are being flashed three
to four times a week on Bangalore Doordarshan after the
local Kannada news.
This message is followed by the
next frame saying,
"for more information,
contact
INSA/India", followed by our address. This has brought
in a flood of letters from the public requesting more
information from us I
WORKSHOPS :
One of our main aims in conducting workshops was to gain
entrance into the teaching institution and this approach
has certainly helped in a big way.
Principals and
senior faculty who were hesitant to have us talk to
their students were confident and comfortable to invite
us after attending the Workshop and knowing how we
handled the subject.
During the last six months, we
completed three workshops as follows :
17th September 1992
Eighteen Principals/Lecturers from colleges attended
this
Workshop.
The
discussions
were
lively
and
interesting. Some good suggestions came from this group
for e.g. :
a) NSS programmes can integrate AIDS Education which
then can be extended to the slums.
b) Have a special AIDS Workshop for 2-3 NSS sutdents
from each college so that they can spread the
message.
c) It is not enough to do a one off education - there
has to be continuous reinforcement.
4/
TO TEACH A HEALER
INTERNATIONAL NURSING SERVICES ASSOCIATION.
COMMITTED TO SELF HELP
4
18th Septeraber 1992
Sixteen Imams from selected mosques of Bangalore were invited
to a Workshop. The interest shown was very encouraging and
each left the Workshop with a decision to speak about AIDS at
their Friday prayers. As one Imam remarked, "if we speak to
them now they will be able to protect themselves".
17th October 1992
This workshop was for various NGos, government persons from
the Department of Health and the Press in preparation for
World AIDS Day.
17th to 21st November 1992
The highlight of all our Workshops was the INSA UTSAV which
was organised to celebrate INSA/India's 10th anniversary. The
main theme of the UTSAV was "AIDS Prevention Strategies,
Communication and Counselling." A total of 120 of INSA/lndia
and INSA/USA alumni registered but only 80 persons attended
the Workshop.
It involved four complete days of discussion
and looking at various aspects of AIDS. On the last day each
of the Workshop participants made a commitment to include
preventive counselling of AIDS into their ongoing programmes.
Many of these participans, since returning to their projects,
(most of them located in interior villages) have started
talking about AIDS. (A complete report on the UTSAV is being
prepared and will be sent shortly.)
An unique feature was
the message on the spread and prevention of HIV, presented in
the Yakshagana dance form (the folk dance of Karnataka) in
which the role of the HIV was performed by the only male
member of the INSA/lndia staff Mr. M. Bhagavandas.
•
PUB NITE
On December 4th, Mr. Ajlt man! of Intervention, and his
colleagues took on a fundraising campaign for INSA/India’s
AIDS Programmes at the Black Cadillac Pub in Bangalore.
There was an overwhelming response from individuals and
companies. The TTK group was one of the major contributors.
After all expenses were met, Interventions handed us a cheque
for &.34,766.10.
The money is to be used for dubbing the
films, "Karate Kid" into various regional languages.
....5/
rEACH A HEALER’
INTERNATIONAL NURSING SERVICES ASSOCIATION..
COMMITTED TO SELF HELP
INSA/India
is
in
correspondence
with
Street
Kids
International, Canada, regarding this.
with the remaining
money, if any, other educational material will be developed.
WORLD AIDS DAY
Over 1500 school children participated in a 6 kilometer walk
which was flagged off by the Hon'ble Mayor of Bangalore City.
They walked the route wearing their red ribbons signifying
AIDS
awareness
and,
distributing
pamphlets
on
AIDS
prevention. The entire expenses for this programme on World
W AIDS Day was funded by the NGO AIDS Cell.
Nevertheless, it
is being included in this report since school children were
involved.
STAFF TRAINING :
With the increasing load of work with schools and colleges on
AIDS, it became impossible for only the INSA/India faculty to
handle all the classes. As time passed, we realised that our
secretaries had become equally competent in imparting AIDS
Prevention education. To provide them with more information
and help them develop greater confidence, we sent the three
of then to the Christian Medical College, Vellore, to attend
one of Dr. Jacob K. John's programmes. With this exposure,
we find that their enthusiasm in the programme has shot up.
the three secretaries who went for the training from March
22nd to 26th, 1993, were Mrs. Charlet, Mrs. Abigail Thomas
and Mrs. Tina King who do the classes in English.
•
EVALUATION :
We requested Interventions to do an evaluation of our AIDS
Prevention Education in schools, taking a random sample of
500, a topline report was prepared, which is being enclosed.
6/
ACH A HEALER'
INTERNATIONAL NURSING SERVICES ASSOCIATION
COMMITTED TO SELF -HELP
CONCLUSION :
As always we owe our continued success to many who have
helped us.
Dr.Ravi from the Department of Virology,
MIMHANS, for his continued interest in our programmes and
for being our regular resource person for every Workshop;
Dr.Jacob K.John for his help, support and encouragement.
We are especially grateful to Dr.John for having taken time
off to come and help us conduct the Workshop for the
Muslim Imams. To our Governing Board members who allow us
to grow and above all to Ford Foundation without whose
support we would not be where we are. A tortoise sitting
on a gatepost remarked, "I got here only because someone
put me here.
"Thank you, Ford Foundation, for putting us
where we are !
"IO TEACH A HEALER'
INTERNATIONAL NURSING SERVICES ASSOCIATION..
COMMITTED TO SELF -HELP
RURAL HEALTH DEVELOPMENT TRAINERS PROGRAMME
AIDS EDUCATION PROGRAMME
2, BENSON ROAD. BENSON TOWN BANGALORE 560 046 CABLE . INSAINDIA
3BC9UD HALT YEARLY REPORT OF Tii2 (uGD-AID3
CELL FUNDED) IUSA/ZZ7OIA PROJECT FOR “DEVELOP
1.17’Jui?Jcj
—I.iG AIDS uDJCATi.91; UuilDl»D
BUSIITES3 C3HCERU3 III BAUGALDRE CITY”
DCCEllBER 1992 - I1AY 1993
TBoryjCTio:i :
Having been involved Ln AIDS Prevention Education in
Schools/Collcgcs of
Bangalore,
and
tho Tibetan
Resettlenent Colonies in India, we felt we could
roach out to a ouch Larger population through direct
intervention with t.io factory workers in Industries,
tills way we would be targetting a largo captive
populace in Bangalore who arc at risk of infection.
It clearly pinned us down Co start AID3 Prevention
Education for factory workers Ln Bangalore and now
there is no Looking back!
Ito
share
with
highlighting
this period.
the
you
our
2nd
activities
of
half
Che
yearly
project
report
during
ACTIVITIES
a) Doceaber 92 - February 93
Tills quarter began with tho AIDS Walk on Docoober
1st. Around 1700 students who had been covered with
AIDS Prevention Education participated in the 4 Kns
Walk through central areas of Bangalore city. Prior
to the Walk,several industries were contacted to
participate through conpleaontaries; which resulted
in industries partly donating banners, refroshnents
and transportation used. Too walk was flagged off by
the tlayor of Bangalore city, was given police support,
and free first aid services fron the St. John’s
Anbulancc Association. Tao Ualv. on December 1st
helped to spread AIDS
Prevention nessagos through
the
banners carried
by
tho
students
and the
distribution of 10,090 paaphlcts. Tais was later
screened on Bangalore Doordarshan several tines.
•TO TEACH A HEALER’
INTERNATIONAL NURSING SERVICES ASSOCIATION.. COMMUTED TO SELF HELP
Sono post-happonings of this Wall: are that :
" a natron of a Local government hospital approached
Il'SA for more AIDS information : Her son who halted
his veliicle a: a traffic stop cn route to work was
presented with a pasphlet by students participating
Ln the walk.
Rotary Club of Blriyur, Worth Karnataka
received one of our panphlets and reproduced 10,000
of then for distribution Ln their town during that
week.
s Bangalore Doordarshan has screened AIDS Prevention
□essages several tines at prime tine citing IIISA with
our full address/phono number to be contacted for
core information, we are still unaware of our
benefactor.
* we have subsequently received several queries by
call and continue to do so.
Besides the Walk on ’Jorld AIDS bay, pamphlets were
distributed at a subsequent International Women’s
Bazaar.
Several industries were contacted for conducting AIDS
Prevention Education sessions in the Latter part of
tnJLs cj
.
Tae first AIDS Prevention Education was held on the
27th of February *93 at the Bharat Frits Werner Ltd.
Unlike our planned coverage of Che entire worker
cadre
at
the
industry,
this
factory
selected
representatives £tom the management and workers to
cone together for an initial session which included
discussions about the Cause, Spread and Prevention of
AIDS and a video presentation of an AIDS filr^followed by a question and answer session.
’TO TEACH A HEALER’
INTERNATIONAL NURSING SERVICES ASSOCIATION... COMMITTED TO SELF HELP
Since then wo aave covered workers
in
eight
industries despite the various sot bachs wo have had
to face upto during our visits Co Industries ixiile
requesting Cnee and convincing Chon on the need for
AIDS Prevention Education. In all, a toc/.al of 23
factories ’./ore contacted. All of then had not sent
their representatives to attend an earlier/L'orhshop
on Che 10th October 92 when ue addressed Che Managers
of various factories. L’c have been rebuffed by sone
of the factory nanageaent staff with petty excuses
such as ”do don’t have the tine”, ’’out productivity
"our
factory workers
are
xrald
be
off -------- P
gnorant” and so on a as a result we were able Co
lonpietc only 9 induistrlas (of the targetted 10
Tt'-diLlLi
X.QS; for the fir sc project year ). Solow i s a
List of Cue factories where we conplote-d the AIDS
Prevention education in dannada and/or Lnglish.
1.
ixiarat Pritt, darner Ltd
2.
Southern
hailways
llacdoor
bangalore branc.i - 2 sessions
3.
dirloshar Electric Co’ Ltd
4.
Tata Tea Ltd - 4 sessions
5.
u. Dasappa u Sons Pvt Ltd
5.
Indian Oil Corporation Ltd
7.
Sharat Pecrolaun Corporation Ltd
S.
Indian Oxygen LCd
Union
(Madras),
3. Indian Tobacco Coupany Ltd ~ 2 sessions (sessions
continuing in June ’93)
■TO TEACH A HEALER
INTERNATIONAL NURSING SERVICES ASSOCIATION... COMMITTED TO SELF HELP
International Nursing Services Association
RURAL HEALTH DEVELOPMENT TRAINERS' PROGRAMME
A DS EDUCATION PROGRAMME
Below are Che deCails of Che nueber of facCorles,
sessions and workers covered fros Decenber 92 Co Hay
a-?
llano of Induscry
No. of workers
Male
1
Fesale
Morl:
force
Lang
750
Kann/
Eng
1. BharaC FrlCz
Uernar LCd
40
2. a)SouChern
Railways Hazdoor
Union (Madras),
B'lore Branch
- workers
55
4
Eng
-Doctors
4
8
n
3. Kirloskar ElecCrlc
Co’ Led
150
”
b)
2500
Kann
4. TaCa Tea Led -1 sess 65
Eng
"
-2 sess 50
Kann
"
-3 sess 75
(1
"
-4 sess 120
11
5. H. Dasappa & Sons PvC
LCd
85
15
6. Indian Oil CorporaCion LCd
47
3
Cl
7. BharaC PeCroleun
CorporaCion LCd
75
5
II
8. Indian Oxygen LCd
40
9. Indian Tobacco Co’
LCd — 1 session
15
- 2 session
40
40
200
Kann/
Eng
Kann
2000
(1
fl
SI
87. 1 ST FLOOR. 3RD CROSS, NANDIDURG ROAD EXTENSION, BANGALORE - 560 046.
'If
insk
HALF YEAS ADI1IIIISTSATI7E DETAILS
a)
Staff :
The IIISA/India teas lias been further
strengthened with a full tine staff on the industries
budgets Ms. Tina King who is exclusively in charge of
contacting and arranging for the AIDS Prevention
Education sessions in Industries. Tina King is
supported Ln her worlz by the rest of the I1ISA/India
teas who are actively involved in the promotion of
this project®
b)
Finances :
The detailed statooent of accounts
for the last financial year is sent to you with this
report.
FOAUAHD PLAITS :
Though this project ends Ln May '93, we have a few
others who have requested I’JSA/India
for AIDS
Prevention Education sessions
Lined up for July
93. We plan to reinforce AIDS Prevention ecssages to
worhors
already covered through a newsletter. Our
AIDS
Information Cell is open for any of their
individual queries too. 'Jo plan to continue as per
plan
in
the
Project Proposal
subject
to
the
availability of funds.
CD’ICLUSIOU :
■Jo are 'very grateful and owe tills project’s success
to JGO-Ccil, Jew Delhi but for whose financial
support and co-operation, this project would not nave
been possible. He also Cairo this opportunity
in
thanhing the sanagcoont in all the industries where
we have conducted the AIDS Education, for all their
support and co-operation in aaicing our combined
efforts worthwhile. Jo hope that to sone extent wo
have opened the door for discussions on framing
policies in each of these factories. Jo hope that all
chose factory workers who we have educated will pass
t.ie indoraatiun to their fanily ueubers, neighbours,
friends and others and join hands with us in helping
to contain AIDS.
THE UiSA TEAM
’O TEACH A HEALER’
INTERNATIONAL NURSING SERVICES ASSOCIATION... COMMITTED TO SELF HELP
REPORT ON THE INSA/INDIA WORKSHOPS ON
STRATEGIES FOR AIDS EDUCATION IN HIGH SCHOOLS & COLLEGES
For Heads of Schools/Colleges Held on the
17th - 19th August 1993
INTRODUCTION :
With a view to cover all Government and Govt Aided High
Schools with AIDS Education in the next phase, INSA/India
contacted the Department of Education who, once motivated
sent a joint circular to all the schools in their
juridiction through the Deputy Director of Public
Instruction. One hundred and fifty schools were contacted
to attend a one day Workshop on any of the 3 consecutive
days
the dates also jointly chosen. However on the last
day (19th August) the Department of Education had an
urgent internal meeting of all their Head masters. The
INSA/India Workshop was, at the last moment limited to
just the 17th of August. On this day 54 Heads attended.
On the 18th of August, since 11 Heads attended we had the
Wosrkshop for them also.
On the 19th 3 Heads turned up
and we talked to them on a one-to-one basis.
It is with
pleasure that we present you with this consolidated report
of the Workshops on "Strategies for AIDS Education in High
Schools and Colleges".
THE PARTICIPANTS :
A total of 65 attended the Workshop each of whom have an
average of 500-1000 High School students.
They belong to
the fully aided Govt.Schools,
partly aided and
some
were from private schools who have Government recognition.
There
were
42
men
and
23
women
927„
were
Head
Masters/Mistress and 8% were senior teachers delegated by
their Heads who were not free.
A list of Participants who
attended on all three days is appended (Appendix I)
2/
1
THE WORKSHOP DESIGN :
Beginning
with
a
welcome,
introduction
and
a
pre-evaluation, a discussion on the global perspective,
cause, spread and prevention of AIDS ensued.
This was
followed by screening Shyam Senegal's "Scourge".
The
psychosocial
aspects of AIDS in relation to schools,
parents and staff was then discussed. Following this,
participants were broken into groups of not more than 7
each to discuss appropriate strategies for AIDS Education
in their High Schools and Colleges.
A synopsis of this is
given as Appendix II.
A video film that has been screened
in the 100 odd schools that INSA has already covered with
AIDS Education was then screened (Karate Kids) to get feed
back
on
its
appropriateness
in
their
school/college
settings.
Most of the Heads felt that 'Karate Kids' (in
English
&
Kannada)
would
be
fine
in schools
while
'Scourge' would be better in Colleges. (Karate Kid has
been dubbed in Kannada and is priced at Rs. 300/ plus
postage for sale).
Each participant was then handed a RED RIBBON - a symbol
for uniting to spread AIDS Prevention education.
Though
their files contained basic AIDS information related to
schools,
participants
requested
more
information
and
bought a Kannada version of 'Talking AIDS' and some other
bought English versions availagble. Fifteen participants
requested INSA to conduct the AIDS Education Programme in
their schools giving us an exact date and time.
The rest
also welcomed such education but promised to let us know
the exact date and time within a week as they needed to
discuss it with their staff.
Even as the Workshop ended
participants were singling out INSA staff to let us know
what other education strategies to use and how all their
misconceptions and fears about AIDS were cleared.
3/
3
POST WORKSHOP QUESTIONNAIRE
At the end of the Workshop participants were requested to
share their opinion on the following through a written
questionnaire.
***
the need for HIV Prevention
All
of
them
unanimously
stressed
the
importance
of
educating students on the cause, spread, prevention of
AIDS.
They felt they could facilitate this process
through expediting red-tape to enable INSA to do this
education in their schools as just the first step.
** *
measures to be taken if one of their staff has HIV
infection
89%
of
the
participants
felt
that
they
should
be
supported,
allowed
to
continue
work,
should
not
be
isolated but counselled.
Whatever palliative treatment to
be
made
accessible
through
financial
assistance
confidentiality to be strictly maintained.
Of the 117, who did not agree, 47> felt they should be asked
to go on voluntary retirement and that they needed to be
isolated.
They also felt that students be kept away from
such a staff.
47» did not respond to the question.
***
measures to be taken if one of their children has HIV
infection
917» of the participants felt the child need not be
isolated under normal circumstances while 97» said 'Yes' to
isolation. 937» of the participants strongly reiterated
that
the
child
can
continue
school.
847o
of
the
participants felt there was no need for informing others
about the child's HIV status even to the parents, while
167<> responded that parents ought to know.
4/
Many of the participants discussed in small
informal
groups and with the INSA team conflicting situations like
a HIV positive pregnant women 'should she abort or no ?'.
Participants were beginning to think of AIDS - not just
from the disease perspective - but about the many grey
areas behind the human mind and soul of an HIV infected
person.
CONCLUSION :
We take this opportunity to thank each Head Master, Head
Mistress who took time out to attend the Workshop and
tender valuable suggestions to strengthen AIDS Education
in school/college settings.
We thank the decision makers
in
the
Department
of
Education
who
consented
to
participate in AIDS prevention education through first
delegating their Heads.
All this would not have been
possible withoutn the timely, silent support of our donor.
Thank you, Ford Foundation.
LIST OF PARTICIPANTS
NAME
1. Mr.U.S.Pan! Rao
2. Mr.B.Shankar Rao Gujjar
3. Mr.Shantha Kumar
4. Ms.N.Sharada
5. Ms.Y.V.Rajalakshmi
6. Ms Rose Mary
7. Ms.K.Emerencia
8. Mr.M.V.Satyanarayan Rao
9. Ms.K.Anusuya
10.Ms.M.R .Vijayalakshmi
11.Ms.Neerajakshi
12.Ms.Hameede
13.Mr.Abdul Rawoof
14.Mr.K.Swamy
15.Mr.N .P.Raghavendra Rao
16.Mr.V.G.Hegde
Mr.G.V.Nagaraj
17.
18.Mr.Sunder Raj
Mr.Dhruva
19.
Rao K
20.Mr .Pandurangaiah Setty
21.Ms .C.Arulambikai
Ms.Vijaya
22.
Kumari
Ms.Harsha
23.
Shanthilal
24.Ms .V.C.Aleyamma
25.Ms.Shakira Begum
26.Ms.Shakuntala Bai
27.Mr.H.S .Swamy
28.Mr.Anwar Shariff
Mr.Vishwanathachary
29.
30.Mr .P.Raghavendra
31.Mr .V.Lakshmana Rao
32.Mr.Abdul Aleem
33.Mr.B.Ramakrishna
34.Mr. T.S.Rajagopal
35.Mr .Somasundaram
36.Mr .Narayana Rao
37.Ms.Fahmida Rahim
38.Ms.Rajeswari Murthy
39.Mr.Srinivasa Murthy
40.Mr .N.Hanumantharaya
SCHOOL/COLLEGE
Govt.Girls High School
Govt.P.O.Coliege
Govt.High School
Mahila Vidyalaya High School
PVP High School
Carmel High School
St.Alphonsus High School
Govt.High School
Ananda Composite Jr.College
Govt.High School
Vidhya Mandhir High School
Fatima Girls High School
Govt.High School
Govt.High School
B & L P.(J.College
N.K.S.English High School
B & L High School
A.E.S.High School
HMT Secondary School
Govt.High School
Gandhi Vidya Shala High Schl.
K.R.W.A.Vidyaniketan
Adarsha Girls High School
Vyalikaval High School
The Beacon High School
Govt.High Schl.Rajajinagar
Govt.High Schl.-Palace G.Halli
Govt.High Schl.-Hebbal
Govt.High Schl.-Makali
AMS Composite P.O.College
Bapuji Residential High Schl.
Govt.High School, Cox Town
Siddartha Gauthama High Schl.
Govt.High Schl.- Yeshwanthpur
Raghavendra High School
Siddartha Junior College
Govt.High Schl.- S.Nagar
Sri Raghavendra Ashrama H.S.
Sri Raghavendra Ashrama H.S.
B.S.A.P.Girls High School
41 Mr .S.Narasimhaiah
42.Mr.M.S.Kempayya Math
43 .Ms.Manjula Devi
44.Mr.Govindappa
45.Ms.Ananthalakshmi S.T.
46.Ms.Vasantha Malliya
47.Ms.Shantha Devi R.N.
48.Mr.M.S.Kempaiah Math
49. Mr.B.M.Bhat
5O.Mr.M.A.Alfred Joseph
51.Mr.Dennis Monteiro
52.Ms.Tahera Gulam Mohmed
53.Mr.Abdul Aleem
54.Mr. M.C.Naik
55.Mr.Chebbi
56.Mr.Chikkaveeraiah
57.Mr.Venkatesh M.K.
58 .Mr.D.B.Nanjundaiah
59.Mr.H.B.Krishna Murthy
60.Mr.B.Nagaraju
61.Mr.K.Siddalingaiah
62.Mr.D.P.Telagi
63.Ms.B.M.Premaleela
64.Ms.Gayathri G Rao
65.Mr.Sannaya Manja
Sri Veena Sarada High School
Govt.P.U.College,Ye1 ahanka
Govt.P.U.College for Girls
P.V.P.High School
Rajajinagar Girls High Schl.
R.P.A.High School
Sri Vani Girls High School
Govt.P. U.College,Yelahanka
Vikasa High School
B'lore Tamilsanga Kamaraj H.S.
Shree Shambavi Girls H.S.
Viswakalaniketan Model Eng.H.S.
Govt.High School, Cox Town
Govt.P.U.College, Peenya
Universal Edn.Society H.S.
Sri Chennakeshavaswamy H.S
Kempegowda High School
Gandhi Vidyalaya High Schl.
B.P.Indian High School
Mithra High School
Mt.Hermon High School
Jagadguru Shri Jayadeva H.S.
Tagore Memorial High School
Anupama English High School
Seva Ashrama High School
'Appendix II'
STRATEGIES FOR AIDS PREVENTION EDUCATION IN SCHOOLS
1.
To impart Moral values of life through stories, plays.
2.
To stress on developing healthy habits.
3.
To arrange exhibitions, film shows, display of charts,
posters - depicting the alarming state of AIDS.
4.
To create awareness of the AIDS to utilise
the occassion arises while teaching.
5.
To include AIDS topic in curriculum.
6.
To arrange for lectures by Doctors and experts in the
field.
7.
To organise quiz programmes, painting
Essay competitions, Debate etc....
competition,
8.
Children must
have the knowledge
education so they were aware of AIDS.
proper
9.
It can also be celeberated AIDS Day in a grand manner
on 1st December.
10.
Displaying banners and plashcards on AIDS in schools
vp
vp vp
CD vP U> Cp
O U)
U) >2)
of
whenever
sex
INSA/INDIA AIDS EDUCATION PROGRAMYE
In 1989, an idea began to take shape.
The more we talked of
it the more we felt that INSA/India needed to get itself
involved with Preventive AIDS Education tn Schools and Colleges
tn and around Bangalore City and the Tibetan settlements in
India.
A four year plan was drawn up and a modest budget
prepared.
Yet every door we knocked on was politely but firmly
shut, but the persistant search by three women-two nurses and
a teacher continued till a person in Pord Foundation listened,
beleived tn us and in our project.
There was no money immediately
available, but with a small amount of Rs.15,000/- INSA/India
launched the programme tn October 1990.
Schools and Junior
Colleges were notified through 400 letters, which brought in
a positive response from. 36 Schools and one rejection.
The
rest kept silent.
After a brief course on AIDS at C.M.C., Vellore, the INSA/India
team, offered the first education programme in a Corporation
Sigh School cum Junior College.
Here, we talked with about
six hundred girls.
Ye were given a one hour session which
stretched well over two hours and it was with reluctance the
girls allowed us to go. Since then we have talked in another
School in Bangalore and 14 Tibetan Schools in South India
Covering almost 2000 Tibetan students, 600 Tibetan men and
women. This was due to the fact, we had encouraged Dr.Kelsang,
a Tibetan doctor to train with us at C.M.C., Vellore.
A direct outcome of our training at C.M.C.,
Vellore, was an
offer from Dr.Jacob K John, Head of the Department of Psychiatry
and AIDS, who offered to do a Workshop for us for 20 Heads of
Schools in Bangalore. Although 20 were invited we had only
15 persons who turned up. The Workshop was a success with
reguests for continued updates on the AIDS status tn the
country plus invitations to their Schools.
A further Workshop
on Counselling for AIDS cases was organised- with assistance
from C.N.C., Vellore, for Religious Heads. Five from each
religious groups were invited. The Roman Catholic and theProtestant Churches, the Yulias from the Muslim Mosques end
three Hindus.
Eventually we had only nine persons come, of
these none were Muslims.
Four Protestants, four Ronan Catholic
....2/
: 2 :
and one from the Universa1 Consi ousness Group.
Nevertheless,
we were happy that we have been able to have nine more Join
the fight against AIDS.
In July we have conducted another forkshop for 28 of our
INSA/India graduates from. South India.
This has been in
collaboration with the Indian Health Organisation.
All
have returned to their Institutions with plans on preven
tive education for the Communities they work and live with.
The pebble has created its ripples.
The messages will travel
fast to various corners of this country.
The school AIDS Education Programme started in August 1991
and during that year we conducted sessions at 17 schools
and one college.
Due to various reasons such as the closure.
of schools and colleges. This year (1992), INSA/India with
its 7 member team to cover as many schools as possible so
that more boys/girls will know how AIDS is caused and how
they can prevent HIV infection.
It is towards, accomplishing this endeavour that we seek
your invaluable cooperation.
SECOND HALF YEARLY REPORT C NAP.CH 92 - AUGUST 92 )
**
*
*
OF
'
■
INSA/INDIA1 S AIDS PREVENTION EDUCATION
I N
High Schools and Colleges of Pangalore
A Tibetan Resettlement Colonies in Indic
INTRODUCTION :
This report contains the outline of the work completed by
INSA/India for the second half of the first year of funding
for the above project.
During the first four months not much could be done in schools
and colleges because of this was the time when all educationa1
institutiens were preparing their students for their final
exams. Hence, no institution was prepared to sacrifice 2 hours
for us to meet and talk with student s. However, all gave us
appointments for the next academic year. This being a lull
period for us with schools and colleges, we decided to cover
the Tibetan settlements.
TIBETAN SETTLEMENTS :
During the early half of the year we had covered six Tibetan
settlements in the south.
Hence, we decided to complete
covering the balance J settlements before we moved into the,
remaining areas in India, Having contacted the sett laments'
secretaries through Dr.Kalsang Phuntsok, a young Tibetan
doctor, from the Kollegal settlement who had been part of
our team from the onset of the programme, we began our visits.
~e had exce lie nt cooperation from all the sett lement authori
ties as a result our coverage was good. Usually, two from
INSA/India and Dr.Phuntsok would visit a settlement together
and speak to groups.
While Dr.Kalsang Phuntsok spoke to the
men and young boys, the INSA/India staff, with the assistance
of translators usually from the settlement
health depart
ment spoke to other groups. However, when we spoke to the
High School students we found that there was no need for a
translator. Before the end of February 1992 we were able
to cover the southern settlements at Hunsur, Bylaguppe and
Nungod in Karnataka.
In April, we went to Dharamsala, the seat of the Tibetan
Government in Exile, to cover as many settlements in Himachal
Pradesh. During this visit, with the assistance of the Health
Secretariat , we had a session with the Secretariat staff,
which.for some reason was not to well attended, inspite of
?
rftc .Minister
Health cue
ip th-:. a/f-e ;/.’;ps
"‘'■we ve r, those
-resent showed a lot of interest ar. a. mar.y sues', ions were asked and
doubts cle."c.i.
In Dhuramsala e i.si c’ z ~ ve-y large school
zovulatirn..
The Upper TC' (lib t..n Cii l'."en's "illa-ge) schools
fo'" hoys and girls, where a ppr-cxi ma t e ly
school students
attended. pius the Lower T'JV school where the princ i pa 1 -wanted us
to speak 'to children from 7th standard uttaris, saying that "Children
are never tor young to know the truth of g-ctectino themselves".
-t was refreshing tv meet such a progressive Principal.
Prom
Pharamsa la, the Health Secretariate arranged °or us to visit their
settlement in Ehir and Chaunthra.
Enroute, we stopped at Toshijog
where the Tibetan dance festival was in progress.
Here, Dr.Phuntsok
cad the INSA/India staff spoke to sixty adults, men and women.
The
sett lement officer made it mandat ory for at least one person from
each family to attend the AIDS education session.
^rom here, the
next stop was Ehir, where a group of 55 Tibetans were addressed
that evening. The next day at the Bhir schools approximately 600
boys and 200 girls were covered with AIDS education in two separate
sessions.
These students were newcomers from Tibet and were being
prepared, to join the mainstream of education/employment.
A group
of fortyfive persons were also addressed at the Chaunthra settle
ment.
~ith this, our total coverage of Tibetans with direct AIDS
Prevent ion Education is as follows:
Hen ................................ 240
'"omen ........... 191
Girls ......................... 1064
Boys . .......... 975
Toe al
, -
2470
IN BANGA LORE
During the second half of this yc xr wot. August i992 we held a
total of 2 ~orkshcps for Heads if sch.-cls and senior faculty.
It was interesting to note that for these "orkshops, we had
less problems with eliciting their participation..
The reasons
could be that more people see the neea to have more information
on AIDS, more of the school authentic s see the need for this
information reaching their students, the ~orkshops fell in the
1st term of the academic calendar and finally the venue for all
the '"orkshops were not in an institution but at one of the hotels.
-hen Miss Shanthimathi, the Bangalore City Corporation Chief
Education Officer heard about our programme, she requested us to
do a special virkshop for the 45 Heads of Corporation Schools in
Bangalore City, which we did and thanks to her interest, we had
56 people attending the Workshop.
'"hat is more is that she also
made sure that all the 45 Corporation High Schools invited the
INSA/India team to do its AIDS Prevention Education ' ogramme for
their students.
3/
A major session at these Workshops have been to get these
Administrators and ^acuity to consider policy decisions
concerning staff/student s with an HIV positive status.
""e
have had them look at medical reimbursements, sick leave
rules etc and have helped them realise the need to form/
clear-cut policies before they are confronted with the
actual problem.
In all a total of 2 "’orkshops were heli in the
Year (upto August 1991-1992) given below :
Corporation Schools
Christian Schools
Hindu Trust Schools
Other Schools
TOTAL
1st Project
le n
’ome n
Tata 1
26
1
1
2
12
4
7
4
—
27
98
5
3
6
—
57
—
90
AUS PREVENTION H DUCAT 10'1 III SCHOOLS AND COLLEGES
From August 19th,1991 to August 12thj 1992 the INSA/India
team have carried out AIDS Prevention Education in a total
of 94 schools. A break down of the types of schools covered
the number of boys and girls reached are shown in the table
given below.
Boys
Girls
Total
500
1400
Corporation Schools
900
-
-
-
Christian Schools
1666
2498
4164
Others Schools
1945
1593
9598
Tibetan Schools
956
399
1189
5424
10291
Government Schools
4867
+
The following table giv^n-fthe medium, of education and the
type of examination the students were being prepared for.
It also shows the language used for AIDS Prevention Education
in the Schools.
Boys
Girls
English
Kannada Tibetan
s S.L.C.
4480
5666
6100
2056
I .C.S.E.
c .B.S.E.
578
573
756
259
950
College
90
110
715
150
To ta 1 : :
5187
t
-
-
-
476
50
+
5104=10291., 7729
+
-
-
2086 -+
476 - 10291_^
The following tables below summarise ths work of I MS A/India
over the 1st year of this Project.
Tabl e - I
Ty^ of
AUGUST 91 - EEBRUARY 92
School/
. Total
'.Girls
Boys
College
S.S.L.C.
\RCH 92 — AUGUST 92
I
I
Grand.
Total
Boys
Girls
Total
5666
578
8146
8876
756
1755
661
750
4480
549
500
977
578
1214
950
1189
200
2405
110
5104
10291
.15425
I.C.S.E.
69
628
C.E.S.E.
714
College
-
215
215
259
90
Tota1 ::
1411
1725
5 54
5187
415
Tab le ■ - II
'J^pe of
School/
College
'AUGUST 91 - EE BRU ARV 92
i
Tib. i
No. of
Schools
Eng.
Kan.
S.S.L.C.
7
6
1
I.C. S.E.
4
4
-
-
C.E.S.E.
3
College
1
5
1
-
-
TOT.'. L : :
15
14
1
MARCH 92 - AUGUST 92
Grand.
No. of
„
Kan.
Tib total
Schools
-jnG'of Schl
j.
28
2
5
1
il
54
19
2
_
55
6
1
2
6
1
—
i
2
I
n;
25
—
9
2
: 5 :
\7
_
777
Distribution of men and :i>onen covered by AIDS education
by the languages used for teaching :
AUG.91
- MARCH 92 - AUGUST 92
- FEB.92
Grouid No. Eng. Kan. Tib.
Me n
5
7 omen
5
' 120
590
Total 10 1010
1
Group .No.
Eng. Kan. Tib.
1
—
1
45
96
-
1
2
141
1
1
1
2
5
4
5
7
—
COMPETITIONS
POSTER COMPETITION :
In schools where we had covered with AIDS Prevention Education,
we decided to conduct a poster competition on AIDS for the
High School students.
The poster competition was held at
three centres on 8-8—1992.
The school authorities were very
cooperative in allowing us to use the school premises for this
competition were St.John's High School, Cleveland Town,
Eangalore-560 005, Stella Maris Girls Nigh School, Gayathridevi
Park Extn. Pangalore-560 005 and Internet ionj-Year of Child
Community Centre, next to R.T. Hagar Post Office, Bangalore-52.
In all we had about 150 participants from 10 schools.
Through the posters, however we evaluated that the partici
pants knew now to prevent AIDS, Although at the outset we
had announced three prizes^ the twe judges - Nr.Jyothi Sahi,
the famous artist and Mr.Prakash Michael, a graduate from
the J.J.Schoo 1 of Art felt that none of the posters qua lified
Henc•e, ten consolation prizes
for a 1st, 2nd and 5rd prizes.
of Rs.50/- each were awarded to the following students :
7.
2.
5.
4.
5.
6.
7.
8.
9.
10.
Rekha vat hi
Sonal R.
Sheeba Mathew
Swapna Y.
Madhavi Rao
Kanicka Mary
S.Ugesh Kumar
Naveen P.
R. Shivakumar
Cassius Yates
Stella Naris Girls High School
Stella Maris Girls High School
Stella Maris Girls High School
Stella Maris Girls High School
Nt rmala Rani High School
Nirmala Girls High School
MGES English High School
Adarsha Vidya Kendra
Adarsha Vidya Kendara
Colonel Hill High School
....6/
debate
:::.pet:~icn -.
On 10-E-'992, an inter-house dec
held az '.'irmala Girls High Soho
ust'c
— - -pvcpa. vsa. a nd saca, pvc
final selection a difficult
were Sr. Sha lint, Dfr.frusad and
awarded a prize of Rs.900/-.
T
plat form for reinforcing AIDS
studenzs from their peers.
. :
on AIDS was
•. azo.
The students
■ was g z>cd, ma /< i ng the
\
for this event
ad:s. The winning house was
,;t .it
provided a
on messages to all the
QUIZ C01PETITION :
At St.Germain's Boys High School, we discussei the possibility
of having an inter-house quiz competition with the Principal,
Fr. Menezes and the senior teachers.
Permission was granted
and on 9-8-1992 the competition was conducted by the INS A-/ India
Faculty with Dr .V. Ben jamin as the subject expert.
The prises
were distributed as follows :
1st prise Rs.900/- to Aran jo Bouse
2nd prize Rs.200/- to Kroger House
9rd prize Rs. 100/- to Thomas House
All those competitions were held as a follow-up to the AIDS
Prevention Education we had given and it was a good way to
evaluate our ability to disseminate information.
AIDS !:E~S LETTER :
By 12th August 1992, a total of 9T schools and colleges were
covered and though reinforcement of AIDS Prevention were
attempted through the Quiz, Debate and Poster Competitions
’o targe- all the schools
not all schools participated.
with reinforced AIDS Prevention Education, I'JSA/India brought
out a Newsletter, which after a brainstorming Session was
~e planned to keep it short
named "TEEN-AIDS News letter".
and splice it with cartoons and pictures.
The TEEN-AIDS News letter was also distributed to each Tibetan
settlements in Karnataka and Dharamsa la, covered during this
Project period.
Feed back from the Principals and s. '.dents about the first
edition of the TEEN-AIDS News letter has been encouraging
and INS A/India plans to bring this out twice ivery year.
7/
Since I US.'./India does n~z ha v-. a TV and VC?, we have to hire
these from a. shop.
Scon me had the shopman introducing us
to High Schools we did not know existed and. we had the shop
man motivating the heads of schools he knew to invite us to
address the student s.
Mr.Pcul, who has been doing all our printing had taken cur
AIDS Prevention Education Pamphlet to the vress fcr printing.
Soon he had all the employees of the printing press wanting
to know all about AIDS and he was able to give a JO minutes
talk to them.
Nr.Paul is the husband of Ehanu Paul's who is
a faculty member of I"SA/India .
The newspaper agent who saw some of the photographs at the
office was eager to know more about AIDS.
After hearing about
it from the INSA/India staff, he requested us for 200 pamphlets
fjhich he promised to insert into each newspaper that he would
be delivering the next day saying "this is very serious and
it is important for people to know how to protect themseIves.
The least I can do is to help spread the message and I shall
do this free of cost. Usually we charge Wps.to place a
pamphlet in each newspaper".
^ith severe water shortage in Bangalore we have had to buy
tankers of water, so all these boys have received AIDS Preven
tion Education; so also the ~ig team who came to drill a well.
Besides these, the ITS.'/India team has been invited to speak
with four youth groups in 2 churches, members of the Community
Health Cell (an NGO ) and dC seminereans.
Youth groups
Other groups
Hen and women
50
STAFF INVOLVEMENT :
During the first half of our AIDS Prevention Education Program
we realised that it would not be possible for only the faculty
to take on the teaching in schools.
~e soon realised that
in most schools we would be addressing almost 300 to COO or
more high school ’students each time.
Yet, we were anxious
that each person did not have to deal with more than 100
students each time to allow for some sort of rapport to
build up. Hence, we decided to educate all the staff at
the office on AIDS Prevention.
As a result, the five faculty
members plus the two secretaries arc all involved with the
AIDS Prevention Education in schools. Hidden talents of
teaching which lay dormant with our secretaries have now been
realised by us and with confidence we can leave them to conduct
these sessions.
........... £/
m Pay this .'..'"
~ hagwanda s o" Aiss Teeth.: '--.cnuttw to C’i.”;ot io ■.• '.•.o.icoJ College to attend o cou^ on AIDS
conduce: £:. £".-.'ocot II. John.
They found it re ry useful in
boosting tho:~ confidence to tike the classes in '.IDS Preven
tion Education in schools, Colleges and for the public.
'"e
hope to- send oo" secretaries fcr the next course that C.I-..C.
plans tc have. The present cere USA/India .'.IDS Education
team are MrsiSr.jatha Do'-'/qgry, .'■"s .Edwina Per ira, Hrs.Phanu
Paul,
Eha gave n.das, 'Is. Sect ha '.erases, ’-'rs. Char let and
l
CO VC I7'SIC': :
'"hen USA/India started this project last yea", th: response
from schools were not so encoura ling.
Perhaps, they were not
aware of ths seriousness of the problem, or perhaps we. were
new to them. However, since January 1992, th.: response has
been very encouraging.
Perhaps, the one. single factor that
opened the doers of many institutions to us were the "'orkshops
we have held for the Heads of Schools and Colleges.
One of
the major fears of t-ie institutions is "how much sex-education
will be given".
Some of these fears voiced have been "why
pollute the innocent minds with information cn AIDS" - this
because we will be speaking tc them on both hetero and homo
sexual transmission and its prevention.
Other questions have
been "Is there a need to do sex education ?" or "can you omit
showing them pictures or talking to them about condoms".
At
one school we were reque sted to fast forward a cartoon film
which showed what a Condom is ! Fortunately, fewer schools
have these inhibitions and most are grateful to us for cover
ing sex education as well.
Although human reproductive system
is a part of the high school syllabus, many teachers arc too
embaressed to teach it.
As on: person informed us "when I come
to that chapter I give a set of notes to the students and ask.
them to read it at home".
It is a pity that our- schools arc still unable to handle sex
education to the students in a Senslhlx w.iu, especially as
most parents are unable to deal with it.
"hat
i 7,so evident
to us is that the students have gained knowledge to sex from.
friends, cheap ponographic literature and movies all leading
towards an unheaIthy and perverted attitude towards sex.
ne
hope that through
Prevention Education the students have
come access to correct information on net only .'IDS but also
proper sex education.
It would be wrong on our part to give the impression that our
path has been paved with success all th: way.
Our one big
set-back is our inability to have the ’ elilist' mission schools
involved in this project.
77e have tried to draw them into
Workshops and tried to meet them for discussions but have not
been very .-.uccessful.
Hay be, we need to change our approach.
Nevertheless, we will continue to try.
There is
doubt that through .'ITS Prevention Education in
Schools 1"S ■'./India has walked into ar. area of work which has
brought us in contact with several people, wizened our area
of knowledge and given us a great deal of confidence to
undertake similar projects.
"c could net havz come so far
without the unsti uted support wo have received from our
friends. Dr. V, Ravi, from the Department of "euro. Virology,
I'lMtff'jS who has been our constant Resource Person at every
"orkshop, Dr.Jacob John, who came Sanaa lore on several
accessions as our Resource Person for the earlier Workshops,
and still is always ready io help us, to our Governing Board
Members for their interest and support and finally to Ford
Foundation and to Dr.Saroj Pachauri, their consultant,
without whom this project would never have taken off.
’’’e
are thankful to them for having seen the potential in us
and for having the faith in us and lock forward to our
continued collaboration.
REPORT OF INSA/INDIA'S AIDS PREVENTION
EDUCATION IN
High Schools ano Colleges of Bangalore
g. Tib.etan. Reset.tl.ejn.ent. Colonies in I nc! ia .
.INTRODUCTION :
Early in Januaty 1991, INCA/Indie did a preliminary survey
of schools to determine how many would be willing to have
the INSA/India team visit their schools and talk to thdir
students on AIDS. The survey was conducted by 1NBA by
sending out letters with a stempad and self addressed post
card where the concerned authority only had to tick the
appropriate box, stamp it with the school seal and return
it to us
h total of 400 letters were sent after we bed procured
the list of schools with their addresses from the Inspectorate
of Schools. Of the letters sent, we received 36 positive
replies. We decided to start with this small group of schools*
However, before we launched the programme, wo realised our
need to have ourselves trained, since whatever knowledge we had'
of AIDS was from books. Hones, a request was made to C,h.CrVellore, who readily agreed to do a special 3 days1 training
programme to meet our specific needs. The course, structured
by the Department of Virology and Psychiatry, was interesting-,
informative and thought provoking. It had us discussing for
hours long after class trying to find answers to some of the
psycho-social problems this minuteinvisible virus caused in
the trail of havoc it leaves behind. This course also gave
us the opportunity to interact with those C.M.C staff who were
in charge of the AID5 programme there*
Further collaboration with Dr. John was discussed which
resulted in two workshops being conducted by Dr. John and
expenses for which were met by C.M.C. This was a big help
since INSA/India had only a mee-gre budget of Rs.10,000/placed aside for AIDS education till the grant was received.
WORKSHOPS
:
Two Workshops were conducted with the help of Dr. Jacob K. John
one was for 14 Heads of Schools and the other was for 11 Reli
gious
Heads. For both Workshops we had invited 20 persons
but for various reasons, known and unknown, all did not attend.
The main reason for only 14 Heads of Schools attending was
because the Workshop was held on a day when most schools
reopened. We have learnt our lesson and in future will consult
the school calendars. For the Religious Heads Workshop, we
had invited 5 Muslim Mullas, 5 Hindu Priests, 5 Roman Catholic
and 5 Protestant Priests. Although all agreed to come even on
the morning of the Workshop, Wb had only 8 persons who event
ually turned up plus 2 ladies (psychologists) who were inter
ested in attending. In all, we had 5 Roman Catholic priests,
3 Protestant priests, one person from the Universal Brother
hood, no Hindu or Muslims. At both Workshops Dr. John en
couraged group discussions on dealing with real life situations
I'
Swifid , , ?/Pei't 5 r ipan bs were acked to look at theix existing staff
policies in case someone become JIV positive. Much time
was spent in discussing how to counsel HIV positive persons
and how to develop support groups. Some. excellent films were
shown.
These two Workshops were followed with another for 25 of
our INSA./India graduates who are working in the field and have
not had the opportunity of knowing about AIDS. This because
INSA/India started integrating the subject on AIDS only
from the 13th Training Programme onwards in 1989. The 25
persons who were invited came from various parts of South
India. The Workshop was for 3 days and the entire expenses
were met by I.H.O, Indian Health Organisation. Dr. Vijay
lhakur of I,H.D was our main resource person.
All the participants found thu Workshop very useful and inform
ative. A great deal of time was spent by Dr. Thakur on how to
counsel a person with HIV infection and also his/her relatives.
Each session was suppoited with group discussions and an appro
priate movie. Two of the 25 participants who attended this
Workshop have returned to thnir projects and developed AIDS
prevention education in a big way. Sr. Sudha who is in Bhilai
has begun a project covering nil her schools
while Sr. Mary
Jacob at Katnbampadu village of Vijayawada District has been
doing an intensive education programme in her village in
Andhra Pradesh as can be soon from her letters.
••The first school covered on January 1991 was a Corporation
High School where, in two sessions, wc addressed approximately
350 girls. The next was a convent with 1 2D well-informed student
Then, from January to July, wc covered the schools and the
adult population in three of the major Tibetan resettlement
colonies in South India.
INSA/India and Ford Foundation
:
Having done the above spade work and gained some experience, we
had a sound base to launch the AIDS Prevention Education in
Schools on a wider scale. Hence, when we received the grant
from Ford Foundation in August 1991, we stepped up the pace of
coverage. The following tables show the extent of schools,
colleges and adult population
covered before and after receiv
ing the grant, the languages used for teaching and the type
of schools
covered :
C ontd
3/(JANUARY -. AUGUST. 1991 )
U A S. ilECcIVED
SCHDOLS COVERED BEFORE GRAJ.'T
TABLE. I
Distribution of student s covered by AILS educe tion by the
type of school/colleqe ,th,ey_ sttend. :
Type of School
Boys
Girls
Total
5.S.L.C
-
350
350
C.B.S.E
-
1 20
1 20
I.0 .S.E
222
333
555
College students
-
—
-
222
803
1 025
Tots31
TABLE II
Distribution □ f_ I njstit_uti.on.s_ c c.vp.r c d_ fo r_ AIDS education by the
language used for teaching :
Type of School
Languages u s e.d
JLOS’
KllnjO.*
Tib.
i'o. c.f Schools
S.S.L.C
1
1-
I .C .5 .E
1
1
C.S.S.E
3
3
College
-
-
c
c
Total
-
-
TABLE. .1.11
Distribution, of men and women, covered. b.y AIDS education by
the languages used for teaching :
Adults covered
No. of groups
Men
2
W omen
3
Total
5
Languages used
Kann.
Tib.
E.ng •
-
-
No s
2
400
3
250
5
650
, ,4/»
SCHOOLS /INSTITUTIONS 0.0 VS :T ED. Ar TEA R Ef- E IV IN G .GAAA'X
AUGUST 1991 TO FEBRUARY 1.992 :
TABLE IV
Distribution of Bovs and Girls covered for AIDS education
b'v the different systems of or’iuc.7 tion :
Bp vs
Type of Schoo1/cpllege
Total
Girls.
S.S.L.C
69
661
730
I ,C .S.E
62S
349
977
0.B.S.E
71 4
500
1 214
College
-
21 3
21 3
1411
1 723
31 34
Total
T ABLE V
'Distribution of types of sc.ho.o.ls' cove.zc.d. for AIDS educat.ion
by languages used, for tcrch.i.na :
N g . of schools
Type of school/colleqe
Lanquoqes
used
Tib
Eno.
Kann.
1
-
S.5.L.C
7
6
I .C.S.E
4
4
C.B.S.E
3
3
-
-
1
1
-
-
1 5
14
1
• -
’
College
T otal
-
TABLE VI
Distribution of men and women covered by AIDS education by the
languages used for teaching :
Language used
Tib
NO , of group
Total No.
Enq,
Kann .
Men
5
420
1
3
Women
5
590
2
4
1 01 0
3
7
Total
«,h/»
TA.BLE VII
Distribution of adults coyjrc.j fur /-.IDS education by their
setting :
Church Club
Adults covered
Tibetgn
Community
Slum
Total
Men
-
420
-•
420
Women
40
535
15
590
40
955
15
1 01 0
T ctal
)
I NS,A/1 nd ic - AIL'S QUESTIONNAIRE
•
Name cf School
:
Class/Std
Your Age
Institution
:
(SSLC,
Religion
Medium of Instruction
Tibetan, Hindi, Others
ICSE,ISC...
,.......................................
(English, Kannada, Tamil
)
TRUE
1 . Human Immunod of i,ency Virus
causes AIDS,
2. An HIV infected person can
look and feel healthy, but
can pass the infection to
others.
3, An HIV infected person may
not suffer with AIDS for many
years.
4. The HIV infection is passed.
on from person to person
mainly through
Sexual Intercourse
Bleed Transfusion
5. You can gat AIDS by mosquito
end bug bites.
6, Sharing infected needles
and syringes can pass on the
,)
FALSE
DON'T KNOW
i
Centd ,,6/
7. Greeting friends with hugs
and kisses can pass on the
HIV infection.
□
8. Use cf good quality condoms/
Nircdh during sexual intercourse
reduces the changes of getting
infected with HIV.
9. Oral contraceptives like MaloD can protect you from becoming
infected with HIV during sexual
intercourse.
10.AIDS con be cured with expensive
treatment.
The above table has since bec'n changed, the revised table will
be printed cut in our next report.
From the above table, the answers received during the pre and
pest tests show that the areas requiring more knowledge were
with questions 2a &. b, 5,7,8 and 9. The table shown has been
recorded from the answers received from 291 High school, students
where areas lacking in information c~n be seen.
CONCLUSION
:
This report covers only 6 rticnths that is from mid-august to the
end cf febtusry 1992. However, since this report has been
delayed it would not be out of place to state that from February
to July 1992, we have covered 34 schools. A detailed report
concerning this will be submitted by the end cf August 1992.
We, at INSA/India, thank Ford F.undeticn for helping us to
launch this project which, like the proverbial ripple, has
spread correct information on AIDS to many.
»***
International Nursing Services Association
RURAL HEALTH DEVELOPMENT TRAINERS' PROGRAMME
AIDS EDUCATION PROGRAMME
REPORTING ON THE AIDS PREVENTION EDUCATION IN SCHOOLS
FOR THE PERIOD MARCH 1993 TO AUGUST 1993
INTRODUCTION :
This report covers our work done from March 1993 to August
1993.
With exams just round the corner no school or
college was keen to have us visit the schools and take up
the class time.
Hence this period was spent by covering
Youth Clubs, updating our knowledge and acting as Resource
Persons for various seminars in and outside the city.
MARCH 1993
Mrs.Charlet, Mrs.Abigail Thomas and Mrs.Tina King attended
the four day Course on AIDS, organised by Dr.Jacob K_ John
and the Psychiatric Department of C.M.C.Vellore.
We felt
it necessary to send these three ladies for the course,
because, with the increase in the number of requests for
AIDS Prevention Education the INSA/lndia Faculty found it
difficult to meet the demand.
Secondly in most High
Schools, classes were found to have more than 600 to 800
students making it impossible for only the faculty to
teach.
Hence, it was decided that we would send our three
secretaries for the course.
They returned feeling very
confident to be able to impart information.
What we
discovered was that they are excellent teachers and are
now actively involved with the AIDS Prevention Programme.
March also saw the end of the XXth Training Programme,
through which 14 Participants of the Rural Health and
Development Training Programme received AIDS Prevention
Education Programme.
Several of them have returned to
their organization with plans to begin AIDS Prevention
Education.
2/
87. 1 ST FLOOR. 3RD CROSS. NANDIDURG ROAD EXTENSION. BANGALORE - 560 046.
-
2
-
APRIL 1993
A lot of time was spent contacting the Commissioner of
Public Instruction (CPI) and the three Deputy Directors of
Public Instruction (DDPI) to have them collaborate with
INSA/India and have the Principals of the schools under
their
jurisdiction
to
attend
the
Workshop
on
AIDS
Prevention Education in schools and Junior Colleges.
We
also contacted the Commissioner and Joint Director of
Youth Clubs for Bangalore.
We felt that an important
section, namely the young adults, were not being reached
by us.
With this in mind, we decided to contact the youth
clubs in the city.
The three DDPIs, the Commissioner and Joint Director of
Youth Clubs were very supportive of our programme and
extended all cooperations.
However it must be mentioned
that to meet each we had to make more than ten trips
a
lot of time and energy spent, but worth it in the end.
A
lot of time was also spent by the staff collating the Pre
and Post test questionnaires completed by High School
and College students.
MAY 1993
The INSA/India team was invited to talk on AIDS at one
Youth Club and at two slums in the city.
The slum
programme was organised by one of the NGOs working in the
area.
Some of the interesting questions we had were
1.
2.
3.
4.
5.
Earlier it said AIDS came from forestpeople and they
started destroying it is it true ?
Can the virus be killed by boiling it for 20 minutes ?
Even if the blood is removed from that person then
does it cure the person ?
Why can't doctors
and blood banks be made more
responsible ?
If a faithful housewife gets HIV/AIDS, whose to blame?
3/
•IO TEACH A HEALER'
INTERNATIONAL NURSING SERVICES ASSOCIATION..
COMMITTED TO SELF HELP
6.
What care is given in other Countries for an AIDS
case?
How applicable is that care here ?
7.
So far, what is the families' reaction to having one
of their members infected (in India) ?
8.
What else can we do to help prevent AIDS ?
9.
If we change the infected blood then can we get rid of
the disease ?
10. If we have oral sex only with our partner regularly do
you think I can get AIDS ?
JUNE 1993
Since most of the schools were just reopening, it was
difficult for the INSA/lndia team to be given a slot by
the managements.
A paper was
presented by Sujatha de Magry on AIDS
Prevention Education in schools at the Respect for Life
Conference at Bangalore.
Bhanu Paul who had left for a
Course with INSA/USA presented a paper on AIDS Prevention
Education in schools at the NCIH at Washington, plus she
was also asked to chair a panel discussion.
Both of which
she did well and was appreciated.
JULY 1993
The momentum of reaching the Youth began to increase, with
several invitations coming in.
Seven Youth Clubs were
covered.
A total of 400 youth attended the sessions.
With further request to speak at slums, INSA/lndia carried
it programme to 387 people in slums.
July also saw us busy with preparation to translate the
much used film 'Karate Kid' into Kannada.
Having received
permission from Street Kid International, Canada, we have
successfully dubbed
the
film.
This
will
be
a
big
advantage with the teaching as this is one film that has
been frequently used by us for all groups; one that is
enjoyable and at the same time gives accurate information
and the desired message.
We now have the Kannada version
for sale..
The money for this was raised by Interventions
at the Pubnite.
4/
"TO TEACH A HEALER"
INTERNATIONAL NURSING SERVICES ASSOCIATION
COMMinED TO SELF HELP
/Of
AUGUST 1993
Three workshops are being organised for Heads of Schools
from each of the Zones.
Each Zone has approximately 300
schools, some of which we have already covered.
Three
Workshops are planned for 17th, 18th and 19th.
At each
Workshop there will be 50 Principals.
A consolidated
report is enclosed herewith.
The AIDS Education Programme was conducted in 8 schools
covering 831 boys and 993 girls in their teens during this
month.
The
INSA Teen AIDS
Newsletter
(a copy of which is
enclosed) was sent to the 116 schools and colleges that we
have so far covered with AIDS Prevention Education.
Plans
are also underway to conduct an indepth AIDS
Education Programme for deputed teachers from the High
Schools and Colleges we have so far covered to be able to
carry on the AIDS Prevention Education Programmes for the
subsequent batches of students.
CONCLUSION :
There have been no staff changes nor any on the Governing
Board.
All
of
us
thank Ford Foundation for
their
continued support.
#################
IO TEACH A hEAlER
INTERNATIONAL NURSING SERVICES ASSOCIATION
COMMIHED TO SELT HELP
REPORT ON HEALTH ACTIVITIES UNDERTAKEN IN H.D.KOTE PROJECT
INTRODUCTION:
Health Sector has been one of the most important and key program area in
MYRADA/PLAN H.D.Kote Project. The primary aim of the Project is to establish
a micro level primary health care development system, which could be managed
and sustained by the community at the village level. It has been observed
that there has been good support, cooperation and involvement of the people
and Govt, in all our health activities.
It would be quite difficult to consolidate the health activities which the
Project has implemented during the last decade. However, we will try to
mention the activities undertaken by the Project. The entire health
activities can be broadly classified into :
I.
Preventive Health Care.
II.
Curative Health Care.
III. Development of Individual and Community Health Infrastructure.
I.
PREVENTIVE HEALTH CARE PROGRAMME :
The following are some of the programs:
1.
In order to bring down the infant mortality rate from 120/1000 in 1981
to 70/1000 by 1995 the following programmes were undertaken.
A.
Training of Village Birth Attendance (Dais): Every village has a
traditional birth attendant and she is basically called as
’Sollagathi’ (Village Traditional Dais). She attends to all the
child births in the village. Though she did not undergo any
systematic training in maternity practice somehow, she manages her
job. She is backed by vast experience. She comes from the lower
strata of the society, but is acceptable to the community. Her
services are inexpensive. She is available in the village all the
time. However, she carries her profession in the traditional way
and uses orthodox methods and about 80-85% child delivery is done
by her at the village level. Lack of appropriate modern scientific
outlook, absence of aseptic technic and antiseptic precaution
often leads to untold misery like foetal maternal death at times.
Dais and villagers both accept this as fate. Added to this, most
of the Dais are illiterate and their services are restricted to
home delivery practice only.
MYRADA/PLAN H.D.Kote Project with the help of Self-Help Credit
Groups (SHCGs) were able to identify such dais and organised a
training course of short duration, to make them better suited for
conducting aseptic home maternity
practice. Through proper
exposure, the linkages between proper antenatal/postnatal care,
breast feeding, child care, preparation of nutritious food using
locally available materials,
oral
rehydration therapy(ORT),
immunisation to children and pregnant women, hygiene and home
sanitation, etc., were made clear to them. Once the training
programme was completed, a small kit/bag containing scissors,
dettol, cotton, neem oil, soap, blade, thread, 1 1/2 mtrs rexin
cloth, one note book, pen, saree and such essential items required
to conduct
home deliveries especially under better hygiene
condition were given to them. This was regularly replenished by
the Project. The dais previously used old knife, sickle, etc., to
cut the umbilical cord of the new born babies. Consequently,
neonatal, tetanus/maternal deaths were in alarming number. These
Dais now wash their hands with soap and water thoroughly, before
touching the case and use a sterilized sharp scissors or safety
blade to cut the umbilical cord. They also motivate the pregnant
woman to go to the nearest PHC to get tetanus toxoid (TT)
atleast 2 times during the last trimester of pregnancy. These dais
also inform all pregnant women that she would attend to the child
birth only if the pregnant lady is vaccinated. This motivates them
to oblige and follow the vaccination schedule.The saree was to be
worn by the Dai only when she would go to conduct the deliveries.
The note book and the pen were given to record the date and name
of the woman who delivered. As most of the Dais were illiterate,
this would be written by one of the SHCG members, or by an
Anganawadi teacher, if she was available.
Dais meeting would be arranged at the cluster level once in 2-3
months and the information of the work done would be documented by
MYRADA/PLAN
staff (Sector Officer/Extension Officer). For every
aseptic delivery she conducts, she gets Rs.5/- , which comprised
of Rs.3/- for aseptic delivery, Rs.1/~ if the pregnant women is
motivated to get 2 TT injection and Rs.1/~ if the dai visits at
least twice the mother and child within one month. From the past 4
years, the Project has trained 252 Dais and these Dais have
conducted 10947 aseptic home deliveries.
VILLAGE HEALTH PROMOTERS(VHPs): These persons are also identified
by the SHCGs and MYRADA/PLAN staff. The VHP usually would have an
education qualification between V to X std. and may be a boy or a
girl. Even Anganavadi teachers are selected. These VHPs undergo a
residential training varying from 10-20 days and are trained in
community health activities in order to support the traditional
dais work,
like organising immunisation camp, promotion of
nutrition Program, personnel hygiene, development
of homestead
plots, maintenance of sanitary surroundings, first aid, etc. So
far, the Project has trained 65 VHPs. These VHPs create awareness
on various health aspects which are essential among rural women
and men. These trained VHPs organise health education classes on
the importance of immunisation, safe drinking water, demonstration
of ORT, promote astra ole and kitchen garden, etc. This has
enabled many people to pay attention to health related issues.
They are also reoriented once in 3-6 months.
The above activities has been able to bring down IMR to 74/1000.
The Dais and-VHP supplement and complement each others work at the
village level. The focus has been to train more Dais and VHPs, so
that each village will have the above, thus leaving behind grass
root level workers, who will take care of community health
activities when the Project phases out.
Health Fund:
The SHCGs were encouraged to start a health fund on their own. The
SHCGs members contribute between Rs.10-25/- each and a matching grant @
1:1 to 1:4 is given by the Project. The fund is part of the Common
Fund, but this fund is kept separately and is used only for health
needs of the members. The purpose of the fund is to ensure, speedy,
T
timely and necessary cash to meet medical needs of the family, so that
the family do not fall into clutches of money lenders during such
emergencies. Normally, the SHCGs charge very little or no interest.
Money is returnable in easy installments and is managed by them. So far
almost 70% of the SHCGs have health fund in their groups and the fund
is managed solely by them.
3.
Immunisation to children and pregnant woman:
The Project also assists the Government Health Department in organising
immunisation to children 0-5 years (DTP, BCG, measles) and pregnant
woman. The pregnant women and children are identified by our Dais. The
VHPs and Dais arrange a meeting of all pregnant woman and mothers whose
children need to be immunised. The Govt, health educator educates the
community and a date is fixed for the immunisation camp. Usually, the
Govt. personnel with vaccines are sent by the Project jeep and
immunisation is conducted at one time covering 3-5 villages in one day.
In emergencies when there is shortage of vaccines, the Project helps to
get the vaccines, so that immunisation is conducted on time.
4.
Nutrition Program:
The following are some of thenutrition programmes undertaken
:
a)
The programme was initiated after the Child Baseline Survey. Themalnourished children survey identified areas of malnutrition.
Selected villages were taken up for the implementation in 1991.
The coverage was for 12-60 months old children. In 1992 it
extended to pregnant and lactating mothers. Now the identification
of children is done by Anganwadi Teachers who are trained by the
Project and is verified by the Govt, medical doctors in camps,
organised by MYRADA/PLAN. Children are weighed before, during
(every month) and at the close of the programme. Records of
weights are maintained by the Anganwadi teachers. Each SHCG has
put up a time table and entrusted few members in the group to be
responsible for
timely supply
of supplementary food which
comprises of ground nut with jaggery, eggs, milk, mango or papaya,
banana,
boiled
bengalgram,
etc. The SHCGs also undertake
preparation and distribution of food to the children and mothers.
About 961 women and 962 children were covered from the past one
year. Before the programme is taken up all the children to be
covered under this programme are dewormed. A total of 1713
children were dewormed in the last Fiscal Year (July ’92-June ’93)
and were also given Iron and B complex tablets, thereby combating
worm infestation.
b)
Poultry Birds (4+1) were distributed to 869 chronic patients
suffering from TB, anemia, malnutrition, etc.,-for rearing and
using eggs for consumption, so as to improve the patients
nutritional status of food intake.
c)
Vegetable' Seeds: Six to eight different hybrid varieties of
vegetable seeds, including greens of high nutritive value were
distributed to 10964 families from the past 4 years to develop
kitchen garden through the SHCG, so as to consume the same and
enrich their nutritional food intake.
d)
Family Planning: In order to propagate Family Planning and
encourage small family happy norms 16 Family Planning Camps were
conducted and 1379 women underwent laproscopy and tubectomy
operations. These women who underwent the above operations were
assisted with nutritious food like 50-75 kgs of ragi, 5 kg of
different pulses (Bengalgram, Greengram, Dal), 10 kgs of wheat and
2 kgs of oil, with a view to ensure at least 15 days rest for
them, otherwise they would go in search of casual labour, as they
need to earn their livelihood and this would affect their health.
The Govt, would contribute Rs.135/- per women, who underwent the
above operation'. This program was done in collaboration with
Family Planning Association of India, Govt. Health Department and
Dais, who were trained by MYRADA/PLAN.
Health Education:.
Community health education was imparted in 95 villages in last Fiscal
Year for a duration of half a day to 2 days. The trainings were
organised by the Project and was conducted by Govt, health training
team. Subjects dealt were immunisation, mother and child care, breast
feeding, personal hygiene, supplementary nutrition food preparation,
ORT, first aid, epilepsy, use of astra ole & biogas, etc.
CURATIVE HEALTH
CURE:
Hospitalisation:
This program is restricted normally to Foster Families. Whenever the
families have to undergo major hospitalisation and the families do not
have the capacity to meet the requirements, the Project meets the
entire expenditure of the patient and is treated as a grant. The SHCGs
monitors and keeps control over the actual expenditure and disbursement
of money. Usually, it is reimbursement of the SHCGs, after they have
spent the money on the patient, after proper approval from the Project.
The travel and food expenses are borne by beneficiaries except in few
cases, where MYRADA/PLAN meets all the expenses on genuine cases. So
far MYRADA/PLAN has assisted 356 patients from the past 5 years.
Training for the Blind:
An Officer was deputed from the "Centre for the Rehabilitation of the
Blind", Bangalore. A total of 33 young blind men were trained to be
independent of others for their day to day activities. 12 of them were
enrolled in the school for the blind in Mysore.
Rehabilitation of the Handicapped:
The District Rehabilitation Centre for the handicapped, Mysore, came
forward and
requested MYRADA/PLAN’s
assistance to identify the
physically handicapped/ retarded children and they offered to treat
them. Several camps were arranged in collaboration with the Project.
The centre has supplied hearing, walking aids, crutches, etc.
Where surgery was required, the Centre arranged for it in the Govt, and
JSS hospitals, they charged for medicine and surgery, which was borne
by the Project. About 57 members benefitted from this Programme, during
the last Fiscal Year (July '91 - June ’92).
Health Camps:
20 health camps were organised. This includes eye, leprosy, skin, TB,
blood, general checkup, etc. A total of 3524 patients attended these
camps. The Programme was chalked out by the Project and a team of
Doctors from Mysore, visited these camps. Eye camp was organised in 2
villages in collaboration with Lions Club and Swamy Vivekanands Youth
Movement (Voluntary Agency). About 265 persons were treated in both the
camps. Operations were conducted and spectacles were provided. Food was
supplied by the Project and cost of specialist fees, accommodation,
travel and drugs were borne by the above agencies.
Ill- INFRASTRUCTURE DEVELOPMENT:
The following are some of the Health infrastructure
programmes, taken for. both individual and community.
A.
development
Individual Health Infrastructure Development Programmes:
1. Housing: So far the Project has assisted the community to build
2008 houses for houseless Foster and Target Group Families. The
houses are 20’ X 12’ sq.ft with 2 windows, 2 ventilators and one
door. The families have contributed site and unskilled labour,
apart from daily supervision. From the past 2 years, the Project
has not been using wood for all its construction programmes. The
target is to provide houses to all houseless Foster Families by
Fiscal Year ’96.
The Project has also assisted 525 families for repair of their
houses. Materials like tiles, bricks, doors, windows, cement for
flooring and plastering of walls and roofing materials have been
provided to improve their housing condition, thus providing basic
shelter.
2.Electrification of houses: So far 2544 families have been
assisted for electrification with 2 bulbs and a socket to their
home. The cost of electrification comes to Rs.900/- to 1200/-, of
which 15-20% is contributed by the families. This programme will
not only lessen the expenditure on the cost of scare kerosene, but
will also provide better environment and encourage school going
children to study.
3. Low Cost Latrine: Low cost latrine has been taken up in the
Project area from the past 5-6 years. Though, we have installed
more than 1200 latrines, most of them are not being used and this
programme is unsuccessful. On analysis, we find that it was wrong
selection of villages, as well as beneficiaries and in most of the
places, adequate water was not available. Only the low cost
latrine slabs were distributed and we expected the families to
build walls around them. Therefore, the programme failed. Now a
new low cost latrine UNICEF model is introduced in collaboration
with Govt. The Govt, supplies one bag of cement and low cost
latrine unit, which comprises of cumoed, vent pipe, and fly trap.
The Project supplied bricks and skilled labour. This program was
taken only where Potable Water systems were commissioned and 281
latrines have been completed in FY 92 and the programme is found
to be successful. 2 community latrines and 20 school toilets were
also constructed with the purpose of maintaining hygiene in and
around schools and community surroundings.
4. Astra ole & Biogas Program: In order to encourage families to
use smokeless efficient stove, astraole was introduced. This
helped the families to have smokeless kitchen, reduced the time
for cooking and also reduced
fuel cost. This program greatly
benefitted the women who would have inhaled the smoke, which would
have had an affect on the eye and lungs. The Project has built so
far 4219 astraoles from the past four years.
Apart from this 300 biogas plants of 1 cubic metre and 122 plants
of 2 cubic metre has been constructed and commissioned from the
past 5 years in the Project area.
B.COMMUNITY HEALTH INFRASTRUCTURE DEVELOPMENT:
1.
Potable Water System: In order to ensure community have access to
safe drinking water supply and so contribute to a reduction of
infant mortality, adult mortality and reduce water borne disease,
93 villages were covered under this scheme. The community and
Govt, contributed almost 30-50% of cost. But only in 50 villages,
the scheme has been commissioned. This is basically because though
30 systems are completed in all respects, these systems are
pending because they have not been energised by the Karnataka
Electricity Board. To preserve the quality of water, platform
construction around taps, cleaning of the potable water tanks
twice a year, is done by the community and local Govt. Apart from
this, 23 villages have also been assisted for extension of
pipeline as the villages have grown. Platform construction arid
animal water trough are made necessary components of the system.
Management of
the system
once commissioned
is the joint
responsibility of the SHCG and local govt (Mandal).
The Project has also arranged 5 batches of training to men and
women for a duration of 2-3 days each on borewell handpump
maintenance. Main subjects dealt were maintenance of handpumps,
methods of preventing water from pollution, role of rural women
and children in the maintenance of handpumps, need for environment
education to community and control of water borne diseases. The
Govt, has contributed roughly around Rs.10 lakhs during the past
3-4 years towards implementing potable water scheme..
2.
Support to Govt. Primary Health Centres and Primary Health Units:
Supporting the Govt. PHC and PHUs with basic construction (1
maternity ward, 2 family planning sub centres, 1 dormitory for
general hospital) and equipments (X-ray machine, refrigerator,
beds, sterlisers, dental unit, etc.,) has strengthened the much
needed infrastructure development of the existing govt, medicare
system, which would help to provide assistance towards curative
heal th.
3.
Drainage: U shaped stone slab drainage with cement patch work was
taken up in 21 villages of the Project area involving SHCGs,
Mandal Panchayat and the residents of the respective villages. In
5 villages the drainage work is completed. The villagers dug
trenches and contributed unskilled labour.
. PROSPECTS:
Construction of houses
to
houseless
families,
Potable water,
electrification of houses, drainage & promotion of nutrition programs
to malnourished children and pregnant women, immunisation to children
and pregnant women will be taken on a massive scale in the next 4
years, so that all the target group families will have basic shelter,
safe drinking water, better hygienic condition and will improve the
status of malnourished children, thus bringing down IMR, with Govt, and
community participation and contribution.
The health fund which has
been established will
be
further
strengthened
with community
contribution, participation and management. The focus will be on
training more Dais and VHPs, so that each village will have the above,
thus leaving behind grass root level workers, who will take care of the
community health activities, when the Project phases out.
COMMUNITY HEALTH PROGRAMMES
Department of Community Health
St. John’s Medical College Bangalore 560 034
CONTENTS
1. FOCUS
Page
3
2 . STAFF
3
3. HEALTH CENTRES
4
4. PROFESSIONAL TRAINING PROGRAMMES
4
I. Under-graduate Medical Education
a) Rural Orientation Camp
b) Community Health Action Programme Camp
c) Clinico-social case work
d) Institutional visit
e) Seminars, Symposia and Lectures
f) National Service Scheme
g) Rural Internship Training
h) Elective training for Foreign Medical Graduates
rt in io in in io co co
II. Post-graduate Medical Education
a) M.D. Community Health
b) Academic Exchange Programme
cococo
r— r— r— t—
III. Continuing Medical Education
a) For Government Medical Officers
b) Colloquim for Practitioners of ISM
c) Plantation medical Officers Courses
t~-
IV. Nursing Education
cococo
5. TRAINING OF AUXILIARY HEALTH WORKERS
I. Community Health Workers Course
II. Anganwadi Workers Training Programme
III. Traditional Birth Attendants
a) Contact Training Program
b) Regular Training Program
coco®
IV. Health Animators Training Programme
9
6. HEALTH RELATED TRAINING PROGRAMS
9
I. Health Management Training
9
II. Food Hygiene Course for Hotel Managers
& Supervisors
9
III. Food Hygiene Course for Cooks & Servers
.. .
9
IV. Teachers’ Training Programme.....................
9
V. Training Program for Deacons & Seminarians.......
9
VI. Training Programmes in First Aid.................
10
VII. Training in Occupational Health..................
10
VIII. Training Programs in AIDS........................
10
IX. Natural Family Planning..........................
10
X. Child to Child Health Education..................
10
XI. Group Motivation Program for Parents of
Spastic Children.....................
11
XII. Women’s Literacy Program.........................
11
7. EVALUATION ..........................................
12
8. SERVICE PROGRAMS....................................
13
9. RESEARCH............................................
15
10. MUGULUR HEALTH TRAINING CENTRE......................
16
11. MAHILA VIKAS PROJECT................................
17
12. CENTRAL DOCUMENTATION AND MONITORING................
17
As a Nongovernmental body of many years standing, the Community Health
department of the St. John's Medical College has developed for itself
significant social commitmments. The main focus of the activities of the
Department of Community Health is on the following areas:
1. Development of Health Training Programs for auxiliary and lay personnel.
2. Coordination of training efforts with the Health Needs of other Voluntary
organizat ions.
3. Enhanced collaborative research with private Voluntary organizations and
Governmental health sector.
4. Developmment of Extension education capabilities by the Department.
5. Evolution of problem based learning methodologies for medical, paramedical
and lay training.
6. Staff development by way of exposure to varied training and research
oppurtunities at all levels of trainee capabilities, thus emphasizing
the place of "Health Team" approach in training.
7. Development of Urban training and research oppurtunities in anticipation
of future health needs.
8. Opening up of exciting frontiers in medical science research such as PRA
techniques, qualitative research methodologies, plantation medicine
spec i f ies etc.
STAFF POSITION OF THE DEPARTMENT
Doctors
Para-med ica1s
Others
11
7
5
4
HEALTH CENTRES UTILISED FOR TRAINING/ SERVICE/RESEARCH ACTIVITIES
1. Urban:
2 . Rural:
Place
a) Shanthinagar Urban Hlth.Centre
b) Rajendranagar Slums
c) Lakshmanrao Nagar Slums
a)
b)
c)
d)
e)
f)
g)
h)
i)
Dommasandra Pri.Health Centre
Anekal Pri.Health Centre
Bidadi Primary Health Centre
Mugulur Sub-centre
Solur Health Centre
Sriramanaha11i Health Centre
Hoskote Health Centre
Ka1akunteagrahara Health Centre
United Planters Association of
Southern India Estates
Catchment Population
51,000
5,700 ,/
7,000
48,000
56,000 '
43,000
10,000
5,000
10,000
20,000
7,000
PROFESSIONAL TRAINING PROGRAMMES
I. Under-graduate Medical Education
a) Rural Orientation Program Camp
Conducted during the months of January-February, the main objective
of the camp is to expose the medical students to the various facets
of rural life through a residential program at the Mugulur Health
Centre. The students visit all the rural sub-centres and are guided in
determining the various factors which govern rural life such as
Agriculture, Animal Husbandry, Small Scale Industries, Fairs,
Festivals, Customs and traditions, Commerce and Trade,
Transport, Traditional systems of health, Housing and Environment,
Role of women in Society, Maternal Care practices, Child Care
practices and Food practices. These are presented in the form of
field projects by groups of the students. An additional feature is
their exposure to many innovative teaching methodologies such as
simulation games etc. In addition,the students also organize many
"Child to Child" health education programmes, Mothers motivation
programs, Health Teaching etc. Faculty of the Department of Community
Health are resident at the camp throughout.
b) Community Health Action Program Camp (Rural/Urban)
This is a program for the VII term senior Clinical students and has
an Urban and Rural component. It is conducted for four weeks
durat ion.
i) Urban Component:
It enables the student to understand delivery of
health care in urban areas, assess the effects of the workplace on
health and to plan a health intervention strategy for a specified
group. It also allows him a bird’s eye view of the Nongovernmental
sector in health care.
5
ii) Rural Component:
The student studies clinical problems in the
context of family and social parameters and can assess the
status of the communi ty by collating and analysing data collected by
qualitative and quantitative epidemiological techniques. He also
arrives at an understanding of the rural health care delivery system
and the functions thereof and can plan and carry out an appropriate
health education program for the community.
c) Clinico-Social Case Work
This is conducted every month, by posting them in batches to the
rural and urban health centres. Their training involves case work in
the field, working up the social aspects of a number of communicable
diseases as well as antenatal cases. The objective is to train the
students to consider a case as a holistic health care problem rather
than a mere clinical entity. The socio-economic causes,contributing
factors and consequences of major diseases are highlighted in this
training program in addition to the usual clinical features of the
diseases. An important feature is the study of health care utilization
by patients and the implications of such patterns.
d) Institutional Visits
This is an effort to expose our students to real life situations, they
are taken to various health institutes, field projects and institutions
of public health importance. Here they get a chance to interact with
other health agencies and their staff and get an idea of actual field
problems in health care.
e) Seminars, Symposia and Lectures
Over 400 hours are spent in the theoretical and practical training of
medical students during the course of their undergraduate period. All
subjects ranging from Maternal and Child Health, Epidemiology and
Nutrition to Behavioural Sciences, Health management and National
Programmes are taught using conventional and innovative teaching
techn i ques.
f) National Service Scheme (NSS)
Under this scheme, the medical students carry out community health
and development projects at various villages in batches once a
week. In contrast to the generally known NSS activities, the NSS
program of this institution aims at highlighting community health
and community development as the main features of this service.
Education for school children, adult education, school health
education, improving environmental health, afforestation etc. , are some
of the main components of this program.
6
g) Rural Internship Training Program
All interns, in batches are posted to the Rural Health Centre for a
period of three months each. They are posted to all the rural centres
enumerated earlier which includes Plantation Estate hospitals, Non
government organization hospitals and Government hospitals.Apart from
managing the rural clinic, these interns are also involved in
epidemiological surveys, domiciliary visits, domiciliary deliveries,
immunization and school health. Besides, they participate in all the
other rural services programmes conducted by the department. They
have successfully participated in field evaluation surveys for
immunization coverage (UNICEF) in remote villages in a number of
Districts in Karnataka.
h) Elective Training for Foreign Medical Graduates
Students from Universities in U.K., New Zealand, Holland, USA,
Germany, Sweden, Australia, Ireland undergo 4 weeks posting in our
department. They are trained through participative learning in our
Rural & Urban Slums Field Health Programmes.
II.Post-graduate Medical Education:
a) M.D. (Community Health)
This course commenced from February 1991 with a course capacity of 2
students each year. The stress is on field based and experiential
learning. Thesis topics are directly related to evaluation of ongoing
departmental field programmes, so that outcomes are utilised for
betterment of programmes. Se1f-1 earning, Seminars, Group discussions
and Field visits to other health projects, are the methodologies
followed. The thesis topics chosen are as follows:
i) Evaluation of Community Health Workers Course conducted
by St. John’s since 1981 - 90
ii) Health System Analysis and Evaluation of Plantation Health
Services at United Planters’ Association of Southern India
Estates.
iii) Health Needs Assessment in Rural Field Area of Mugulur
Health Centre.
iv) Health Seeking Behaviour of a Rural Population
v) Deployment of School children in promoting CSSM in a rural
community
b)
Academic Exchange Program
A formal Academic Exchange program has been established with LUND
University, Malmo, Sweden. The objective was to promote exchange of
Post-graduate students for shared field experiences in Community
Health. One of our post-graduates conducted a study on "Evaluation
of Community Participation in Alcohol Prevention Program in
Kirseberg, Sweden" . Likewise two of their students undertook a field
study in our health centres on " Follow-up of Pulmonary Tuberculosis
treatment in India"among other programs.
7
III.Continuing Medical Education:
a) For Government Medical Officers
Under the Child Survival and Safe Motherhood Program of the Government
of India and UNICEF, 60 medical officers of the Karnataka Health
Services have already been trained by faculty drawn from our staff. We
have also conducted various courses under the Universal Immunization
and Oral Rehydration Therapy Program of UNICEF and Government of India
at our institution.
b) Colloquium for Practitioners of Indigenous systems of Medicine:
Forty practitioners of the disciplines of Homeopathy, Ayurveda, Siddha,
Unani, Herbal, Herbo-minera1, Acupressure and Acupuncture, Yoga
participated in a One-day Colloquium held during May 1991. Invited
A11opathic Specia1ists from our hospital had an opportunity to interact
creatively with these Indigenous practitioners. The main objective of
this colloquium was to bring about a mutual appreciation of the basic
principles of the various systems.
c) Plantation Medical Officers Course: As part of our collaboration with
UPASI, a refresher course is conducted for Medical Officers of various
plantation hospitals. We have also conducted specific training
workshops at the plantations and our department. The topics covered
range through Rational Drug Therapy, Pesticide Toxicity Management,
Health Care Financing, Health Information Systems and Health Records
Maintenance and Health Welfare Audits.
IV.
Nursing
Education
The categories of Nursing students trained in Community Health
” include:
i) Diploma Certificate Course in Nursing and Midwifery
ii) Post-Diploma B.Sc. in Nursing
i i i) B.Sc. Nurs i ng
Apart from the regular didactic lectures in Community Health topics,
the main involvement of the department is in the Rural Training Camps.
The objectives are similar to the Rural Camps of medical students.
Each camp is of ten days duration at the Rural Health Centres and
conducted in collaboration with the staff the College of Nursing.
8
TRAINING OF AUXILIARY WORKERS
Community Health Workers Course
This programme is designed to train lay persons working in difficult
areas in the basics of health care and health referral. It is a 3 month
course conducted at the Mugulur hea1 th Training Centre of the College.The
course content is arranged in an easily understood life cycle format and
a problem based style is adopted for the training. Topics covered include
First Aid, Home Nursing, Natural Family Planning, Herbal Medicine,
Counselling, Community development and Human Biology are also conducted.
The posting comprises mainly of various field projects on the Dynamics of
rural life, rural Mobile clinic work, Domiciliary deliveries, Maternal
and Child health, School health etc. Rural Project Planning and
Management of health centres is also taught to the community health
workers. Inclusive of the current 28th Basic course for Community Health
Workers, a total of 536 Community Health Workers from every state in
India and also from Nepal have been trained.
I.
II. Anganwadi Workers Training Program (Karnataka State Council for
Chi Id Welfare)
This is conducted twice a month at our Rural Centres throughout the
year. The trainees are both pre-p1acement and in-service. The topics
covered First Aid, Applied Nutrition, Peop1es’organisation &
participation, Antenata1/Intranata1/ and Postnatal care, Psycho
social problems in children, Safe Drinking Water, Blood and Anaemia.
III.
Traditional Birth Attendants (TBAs)
a) Contact Training Program:
A one day program to create awareness of scientific antenatal,
natal, postnatal care among the Traditional Village Midwives in
our field practice areas of our rural centers in order to reduce
Maternal Mortality. Training programmes for 40 trainees have been
conducted. The emphasis is on attaining Safe Motherhood status in our
field areas.
b) Regular Training Program:
These are Extension Training Programs conducted for other Non
governmental Organisations at their respective centres. The NGOs
involved were MYRADA, Samooha Project (ACTION AID), Sabala
Project (ACTION AID). The training objectives are similar to the
above mentioned Contact program and many such programs were
conducted. Apart fromm these a significant contribution has been in the
training of health workers from these NGOs in appropriate water
purification techniques and other felt needs areas.
9
c) Health Animators Training Program:
These are a cadre of voluntary workers selected from the
community. Their main task is to initiate health actions through
motivational programmes for which the scientific input is given
by our department including methods of motivation, communication,
evaluation and strategies for implementation of Basic Health Care. The
Animators from the following organisations, namely MYRADA, Association
for Physically Handicapped, Womens’ Voice, Viveknagar Slums, have been
trained by our staff.
^[EAI.TH RELATED TRAINING PROGRAMMES
I.
Health Management Training Workshop for Plantation Managers
Major workshops at UPASI Head quarters on the plantations, are conducted
by our staff. The areas of training include Health Economics, Health
Welfare Auditing, Costing, Social Welfare Programs, Health Information
Systems and Water Systems Management.
II.
Food Hygiene Course for Hotel Managers and Supervisors
A five-Day training program is conducted to provide knowledge and
skills in the areas of Food storage, Food preparations, Food
serving, Waste food disposal, Management of Food poisoning,
Prevention of Food Adulteration and Elements of Microbiology.
Ill .Food Hygiene Course for Cooks and Servers
This course is similar to the above mentioned course but is
conducted at the Hotel premises itself in the local language, for
Cooks and Servers. The topics are especially selected to reflect
Indian foods and Indigenous techniques of food preparations. The
course is of 5 days duration.
IV.
Teachers’ Training Program
The main objective of this program is to train Rural School
Teachers in the organization of School Health Services, early
diagnosis of childhood ailments, identification of Psycho-social
problems in children, Monitoring growth and development, detecting
Malnutrition status, Applying First Aid Measures and also detecting
early cases of Leprosy in children. This is a monthly program
conducted in Anekal Taluk for 40 teachers per session. Similar
programmes have also been conducted in Bangarapet.
V.
Training program for Deacons, Seminarians and others
A One-week training program for Deacons and Seminarians from various
seminaries are conducted. Skill oriented teaching in the fields of First
Aid, Personal Hygiene, Home Nursing, Management of Common Ailments are
the main thrust of these needbased training sessions.
10
VI.
Training Programmes in First Aid
One-week skill oriented training programs in First Aid have been
conducted for the workers of the following organisations:
a)
b)
c)
d)
Karnataka Association for the Blind
OXFAM
MYRADA
ESCORTS Industries
VII. Training in Occupational Health
With the objective of imparting specific training in the early
detection of Occupational Hazards and evolving preventive and
control methods, One-day training programmed in Occupational health
were conducted for the following industries:
a) Indian Telephone Industries
b) ESCORTS
c) Thermax Company
VIII.Training Programmes in AIDS
These are single contact programs designed to arouse curiosity and
awareness about AIDS among as varied a selection of the community as
possible. The sessions are arranged in a question and answer format in
order to clarify issues raised by the audience more than to expound on
the clinical characteristics of the disease. AIDS awareness programmes
have been conducted for the following organizations :
a)
b)
c)
d)
e)
f)
Stumpp, Scheule and Somappa
College of Nursing, SJMCH
Krupanidhi College of Pharmacy
Catholic Sabha of BangaloreBishop Cotton’s Girls Schoo 1
Mount Carmmel College
IX.
Natural Family Planning
Training programmes in the field of Billings Ovulation Method, have
been conducted for medical students, nursing students, community
health workers and health animators at Mugulur and Hosur (MYRADA)
and GOA University.
X.
Child to Child Health Education
Using behavioral methods, unique methods of teaching children to
teach other chi1dren,specific health education program have been
conducted in all the Rural and Urban Health Centre areas. Novel methods
of utilizing other communication channels such as Chi 1d-to-Mother,
Mother-to-Mother , Chi1d-to-Community strategies have been evolved.
A highly creative exper ience, CtC has yielded a rich harvest of
innovative dramas, songs and dances that are used for community
11
education. CtC education has been used as an entry point for more
conventional intervention in many communities.
XI.
A
Group Motivation Program for Parents of Spastic Children
This program was conducted for the parents of spastic children
identified in Mugulur area and serves as an example of a departmental
response to a locally identified need. The program included skill
development in the Home Management of Spastic children by the parents of
these children. Field visits and house motivation techniques were also
employed as was the use of locally available appropriate technology for
aiding the disabled children. This program was conducted in
collaboration with Spastic Society (Bangalore).
XII. Women’s Literacy Program
This program being conducted in Adugodi slums, Shantinagar is an
important experiment in combining literacy with health education.
A significant feature is the health discussion that evolves from the
very words that help develop the reading and writing skills of these
impoverished, illiterate women. An interesting spin off has been the
attention to personal hygiene that these women have shown on coming to
the literacy classes.
XII. Development Training
Training has been given to members of the Mahila Mandals of the 16
target villages in Mugulur area in respect of Tailoring, Poultry
farming, Sheep rearing, Rabbit rearing and Agarbatti rolling. This has
been done after assessment of both the local needs and of local
resources. The women were taken to the resource centres for each of
these income generating possibilities and were given an intensive
”
briefing on their pros and cons. Some of the intensely exciting features
that have been incoporated into these programs are
* homebased income generating scheme
* use of hybrid varieties which are resistant to local diesease
* use of high profit, low cost varieties
* development of poultry banks
12
EVALUATION
The Department has considerable experience with evaluation. These range from
large scale evaluation of City Health Needs Assessment and District
Immunization Coverage Evaluation to Investigation of Food poisoning outbreak
and Water Systems Analysis of an industry. Many of these are related to our
training and service involvement with industry, Core group on Immunization of
the Government of karnataka, and the Catholic health system. Some of our
Evaluatory projects include:
Urban needs assessment of Bangalore City
Health welfare audit of UPASI plantations
UIP Coverage Evaluation of
Water System Analysis of Escorts factory, Hosur
Evaluation of the Community Health Workers Course at SJMC
Evaluation of Community Health capability of the St Martha’s
Hospital, Bangalore
Food Hygiene Quality of SJMC Canteen
13
SERVICE PROGRAMMES
PROGRAM
1) Fixed Rural Health Centres
* Primary Health Care Activities
* Residential Doctors available
* Venue for Rural Training Camps
PLACE
a)
b)
c)
d)
e)
f)
g)
h)
i)
FREQUENCY
Mugulur HTC
Throughout the
Bidadi PHC
year
Dommasandra PHC
Mailur HC
Solur HC
Sriramanaha11i HC
Hoskote HC
Kalakunte HC
Estate Hosp.
Rural Mobile Clinic
* Curative and Preventive
Services (Immunization
MCH Services)
* Internship Training
* Field Visits
18 vi1lages in
the Primary
Health Centres
of Dommasandra,
Anekal & Bidadi
Daily
3) Urban Health Program
* Child to Community progam
* Women’s Literacy program
Shantinagar slums
5 days/week
4) Maternal & Child Health
Clinics
* Checkup of
1) Pregnant Women
2) Newly Delivered Mothers
3) Infants & Under-fives
* Immunization
Mugulur HTC
Kalakunte HC
Once a fortnight
Ma]lur HC
Once a month
Anekal PHC
Dommasandra PHC
Once a week
^5) School Health Services
* Medical Check-up
* Child to Child Hl th.Educat ion
* Screening for Learning
disabi1 it ies
* Leprosy Detection
6) Specialist Camps
* Providing secondary care
* Screening & Diagnostic
Servi ces
* Specialities involved
i) OBG
i i) Dermatology
iii) ENT
iv) Dental
v) Ophthalmology
vi) Orthopedi cs
vi i) Pediatr ics
Mugu1ur
Chikkat irupathi
Hebbagodi
Mad iwa1 a
Adugod i
Bidad i
All Rural Centres
Urban Centre
On-go i ng
Once a month
Thrice a year
14
7) Natural Family Planning
Services
Al 1 Rural Centres
On-going
8) Mahila Mandal Group Motivation
Program
* Motivation for health
act ivi ties
Bidad i
Chikkatirupathi
Mugu1ur
Urban Slums
On-going
9) Referral Services
for Tertiary Care to hospitals
From a 11 Rura1
Centres & Urban
S1 urns
0) Exhibitions on Health
A11 Rura1 & Urban
Health Centres
St.John’s Medical
Co 11ege
1 1 ) Industrial Health Services
* Pre-placement examination
* Periodic Medical Examination
* Factory Safety Survey
Stumpp, Schuele &
Somappa
* Industrial Canteen Food
Hygiene Education
* Preparation of Health
Education Material for
Sericulture Hazards
12) Canteen Inspection Services
to ensure Food hygiene practices
On-going
Once a month
Twice a year/
need based
Central Silk Board
Indian Telephone
Industries
St. John’s Medical
Col lege Hospital
Canteen & Dietary
Section
Once in six
months
15
RESEARCH
Project:
Place
Sponsoring Agency
1) Women in Health &
Deve1opment
Improving Womens’ Health
and Socio-economic status
through training, self
financing & cooperatives
using net-work of village
level change agents.
Mugulur & 15 neighbor
ing villages
FORD Foundation
Tobacco Related Diseases
in Plantations
A ten year prospective
cohort study on
1,00,000 workers.
3)
Delivery of Primary
Health Services in Slums
Based on the Need Assessment of Slum Dwellers
Strengthening Delivery
of Pri.H1 th.Services
U.P.A.S.I. Estates
Nat. Inst i tute
of Health,USA
Bangalore City
401 Slums
World Bank
Ensuring full community
part ic ipat ion
Dommasandra
4) Education Strategy in
early detection of Cervical Bidadi
Cancer
Training of Local
Anekal
Midwives in the Detection Solur
of early Cervical Cancer
Indian Council
of Medical
Research
&
Kidwai Cancer
Inst i tute
Health Education Strategy
for Cervical Cancer
Awareness among Rural
women.
5) Health System Analysis of
Plantation Health Services
Evaluation for
recommending cost
effective methods of
delivery of plantation
hea1 th servi ces
U.P.A.S.I.
Estates
U.P.A.S.I.
16
6) Evaluation of Community
Health Workers Training
Program
Actual health needs
of community served
Al 1 India
Diocese
Mugulur Health Training
Centre & surrounding 15
villages
St. John’s
Mugulur Health Training
Centre & surrounding 15
villages
St. John’s
Ka1akunteagrahara Health
Centre and surrounding
viIlages
St. John’s
Current health work
being done by CHWs
Relevance of content
and methodology of
CHW courses conducted
in St. John’s.
Evaluating Health Needs of
Rural Communities around
Mugulur Health Centre
Community level and
family level surveys to
determine felt needs
of the rural community
in the field of health
Using the above information
to plan community health
services at Mugulur Health
Centre
8) Health Seeking Behaviour of
a Rural Population
9) Deployment of School Children
in Promoting CSSM in a rural
Communi ty
MUGULUR HEALTH TRAINING CENTRE
St. John’s has constructed its own Rural Health Training Centre at Mugulur
village. The purpose is to conduct all training programmes in a fully
residential manner at Mugulur village. Residential facilities for staff and
trainees and provision of learning situations have been provided. All
programmes are coordinated with a Central Village Health Committee at Mugulur
consisting of members chosen from surrounding 15 villages. The emphasis is on
residential training facilities and provision of Primary Health Care
facilities only.
17
MAHILA VIKAS PROJECT
The Mahila Vikas project is a health cum development scheme funded by the
Ford Foundation. Its basic and most enduring tenet is the empowerment of
rural women by lifting the yoke of economic submission through income
generation oppur tunities and women’s groups organization. Started in 1991,
the project is in its third year. Mahila Mandals have been organized in all
16 villages covered by the project by locally recruited Health cum
Development Trainers. The women are able to take the decision making with
respect to health into their own hands. Poultry farming with the special
'Giriraja’ variety of chickens, tailoring classes, rabbit rearing, agarbatti
rolling and the special ' Bandur’ sheep rearing are in place. On the health
^bont, Traditional Birth Attendants have been trained in the 5 cleans of
delivery and the necessity of early registration of pregnancy. The Mugulur
Health Training Centre provides local medical support in case of need.
CENTRAL DOCUMENTATION AND MONITORING
Staff members of the department and Rural Health Centre doctors collate and
analyze Health Data. The objective is to create extensive documentation of
all activities in order to facilitate evaluation of the work of the
department.
At Mugulur Health Training Centre, a Family Folder system has been adopted
which permits easy transcription to the cumulative records while yielding
good individual data. The Mugulur HTC has organised its morbidity records to
fall in line with the ICD classification of disease and all daily and monthly
records are in this format.
fcie.re is extensive descriptive documentation of the processes of the various
e^tivities undertaken at all health centres. An important example is the
Urban Child to Child program and the Mahila Vikas project.
Yet another important feature is the use of Graphical displays at the Mugulur
HTC and at the Department to depict results of studies as well as trainee
profiles etc.
There is also a Central museum of photos showing the different activities and
programs of the Department. These provide an opportunity for Guests to review
the strides that the Department has been making in Community oriented Health
Care.
HEALTH STATUS OF THE PEOPLE OF KARNATAKA IN THE CONTEXT
OF THE HEALTH SITUATION IN INDIA.
Background paper prepared for the
Annual General Body Meeting of
FEUORD-K
17-18 May 1990
at Belgaum
by
Thelma Narayan
Community Health Call
47/1 St Mark's Road
Banqalo ’e 560001
CONTENTS
ft.
B.
INTRODUCTION
1.
What is Health
2.
Hou do ue measure he- 1th
3.
Some background factors
4.
Major Health Problems in India
FOCUSSING ON KARNATAKA
1.
The Population and its Distribution
Sex ratio; situation of women; age
distribution; chi.l.d health; urban/rural
differences
2.
Birth a nd Death Rates
3.
Chances in Health Indicators over time
4.
Growth Rate
C.
NUTRITION LEVELS
D.
DISEASE PROFILES IM KARNATAKA
E.
CONCLUSION
REFERENCES
ft. INTRODUCTION
1.
What is health?
Health 'is defined by the World Health Organization (1940)
as a state of complete ohysical, mental and social well being
and.not merely the absence of disease or infirmity. This implies
a goal of positive health for each individual in society.
India had suggested that spiritual health be also included
in this definition.
We need to try to understand the general status of health
I
of the., people of India and of Karnataka in the context of
this definition. Here we would be locking at the levels
of health of the peculation as a whole and not merely that
of individuals. However,
keeping in mind the many stratifi
cations of class,, caste and gender that are present in Indian
society today, it. would be equally important to try and
understand the health status of these different sub-groups
of the populations. There would also be differences according
to age and occupation. Tribal and urban slum populations
aisohav-0 levels of health resulting from their own particular
socio-economic-political-cultural situation.
2.
How do we measure health0
..
Given the above definition it is rather difficult to
measure the exact status of health of peoole. However-, over
the years certain indicators have been developed which give
some estimate of the levels of health and disease which can
be used to compare different populations and to monitor
changes in'the- same population over time. Some of these
are life expectancy, infant mortality rate, maternal mortality
rate etc. These terms will be explained as we go along. For
specific diseases we can get a picture of the disease load
in a population by their incidence and prevalence.
There needs to be a good health information collection
system to work out these indicators. And to do this there
needs to be a well spread out health service system- which
most people use, which works relatively efficiently and
where records regarding various health and disease-, events
are well maintained.
In India, though the development of the health infrastructure,
throughout the country, by the government, in terms of
number of sub-centres and primary health centres established
and number of health personnel trained has shown a large
quantum increase, the level of functional efficacy of these
facilities leaves much to be desired. It is also an accepted
fact that the data colie ted at these centres is of
questionable quality. However, the census, the National Sample
Surveys, studies by research institutions and data from
some voluntary health projects do pro'/ide us with useful
information regarding the health indicators mentioned above.
2
?
3. Some background factors to consider
When ue try and understand the health status of the people
of India it is important to keen in mind the magnitude of
our country—the geographic size and aven more its population.
Ue are second only to China- in population size, there being
850 million of us. This is egual to the population of USSR,
USA and Japan put together. It is said ue add an Australia
to our population every year.
Our vast copulation i-■ also very diverse:for instance
people in very different geographic ar‘as from the snowy
Himalayas, the deserts of Rajasthan, the great river valleys,
the hilly regions and coastal belts; there are different
ethnic background, a variety of language groups, religions
and cultures; levels of socio-economic development, education
and political consciousness also vary a great deal. All these
factors affect health in numerous uays; hence, talking about
the health status of the people pf India as a uhole is a
very broad generalization.
The average figures given in the
tables hide diff recces that occur from olace to place and
group to group.’ Uithin Karnataka itself, there are differences
in the health indicators betueen urban and rural areas and
from district to district. It uould be revealing to knou
the breakup by income level, caste/tribe, age and sex.
.
Another factor to consider is that the health of individuals,
communities and populations is a dynamic state, changing
over time, responding to a number of factors uhich have
a relationship uith it. It has been observed in populations
that as certain diseases decl ine, others rnay become apparent
or develop aneu. This has been termed the onion-peel effect.
Major health problems in Indi_a
Keeping in mind all the above factors it can be said
broadly that in India people suffer from the diseases of poverty
alongside the diseases of modernization. The 30-40% of the
population under the poverty line (about 230-300 million)
and also the lower middle cla.s continue to bear the burden
of malnutrition uhich bakes its greatest toll from children
g
and mothers. They also suffer from the lack of clean uater.
"
and sanitation, adequate housing and clothing all of uhich
result in various communicable or infectious diseases:eg.,
tuberculosis, leprosy, gastroenteritis, typhoid, cholera,
jaundice, diarrhoeas, malaria filaria etc.,
This ill health
affects the uorking and earning capacity of people.and often
results in disability and even unnecessary and early death.
The tragedy is that most of these diseases are preventable.
by an overall equitable development process and also by public
health measures.
3
3
TA3LE -1.
Percentage of pooulstion below the poverty line
1983-84 (Provisional)
.— -
R'ural
Urban
Combined
Karnataka
37.5
29.2
35.0
Kerala
26.1
30.1
26.8
28.1
40.4
37.4
_ —_
— — . — _ -_— - . —_ — . ------ - - - —_ —— — —
Source: Status Report 1988-89, Govt of Karnataka, Dept.
of Health & Family Welfare.
All India
Modernization, industrialization and urbanization have
brought along their own ills. Th'^rn arg many soacific
occupational' health problems arvd ■invirnram~r>tai pollution
problems associated with th? various industries. In
agriculture also there is extensive use of chemicals as
fertilizers and pesticides which enter the"'fopd chain
affecting the total population, though more specially the
sprayers and agricultural workers. Rural urban migration has
resulted in the growth of the 'septic fringes of cities'
•where people have to live in dehumanized conditions resulting
in many social health oroblems in addition to those of
poverty: eg., broken families., alcoholism, prostitution"
gambling etc. Rapidly growing cities face a major strain
on their basic ser-vic=s, air pollution, traffic accidents,
housing problems and alienation of the individual with its
accompanying host of psychological and psychiatric problems.
Ca»vtf>ars,
cardiovascular diseases and stress related disorders
are on the increase.
8.
FOCUSSING ON KARNATAKA
Karnataka is better than the national -.verage in all
the health indicators, coming second only to Kerala in some.
However much more remains to be done. A brief overview
of the health situation will now be given highlighting
only the more important aspects.
1 •
The population and its distribution
With a population of 37.1 million (1981 census),
Karnataka accounts for 5.42% of India's population, ranking
8th among the States in terms of population size. With
an area of 191,791 so kms the population density is
194/sq km (all India 216/sq km). Estimates of the population
in 1990 are 44.48 million.
The following table gives some of the features of the •
distribution of th? pooulation in Karnataka.
Table 2
Population distribution in Karnataka (1981)
(T = Total; R = Rural; U = Urban)
Females
Males
Sex
Ratio
Area in Km
Popula-.
t io n
T
191,791
37135714 18922627 18213087
963
R
188108.2
26406108 13352400
13053708
978
U
= — =■—
3682.8
5159379
926
10729 606 •5570227
=
— — .w —
= — = " — — — rr. — — — “ — —
%Urban
Populat ion
28.89
1987, CRHI, DGHS,
Sou rce: Health Inf ormat ion of India ,
NewDelhi.
(a) The sex-ratio is the number of females per 1000 males.
In most countries of the world this is in favour of females.
However in India (and Pakistan, Bangladesh, Afqanistan etc)
g
it is the reverse and more importantly has been, steadily
”
decreasin'? since the turn of the century,even post-independence
The decline has come to a halt only in the last census (19R1).
The only two States in India to have a positive sex ratio
are Kerala and Roa. Within Karnataka, Dai<shin Kannada Dist
also has.a positive ratio. Otherwise.it varies in the
different States and Districts. The adverse sex ratio has
been ascribed as being due to various casues—high maternal
mortality following early marriage and repeated pregnancies,
poor educational status of women, low utilisation of health
services by women—the underlying reason being the inferior
status of women in society.
Table 3
Conditions of children and women in India
Indicator
IIndia
Develpping
countries
Developed
countries
1 25
96
20
2. % of new borns
weing less than
2.5 kg
27.5
18
9
3. % of anaemia among
pregnant women
70
60
20
4. Maternal mortality
per 100,000 live
births/per year
418
400
20
1. Infant Mortality
(deaths)
(per 1000 live
births per year)
Source:
Health Care in India,
CSA, Bangalore
19"83,
Joseph” G
5
5
(b) The age distribution of the population in
Karnataka is as follows’ (1981 census)
0-14 years
:
15 — 59 years
: 53.8%
60 + years
:
39.6%
6.6%
This is very similar to the all India pattern. With almost
40% of the population being children, ours is predominantly a
young population.
(c) Though the indicators of child healt_h have shown
some improvement over the years, it still remains a matter
of sarious concern. As shown in Table 3, the infant mortality
which is the number of children who dis before they roach
the age of one year still remains unacceptably high. About
30% of newborn babies have a low birthweight (less than
2.5 kg). These babies are three times more likely to die in
infancy than babies of normal weioht at birth. The under 5
or toddler death rate is also very high.
Table 4
Estimated Infant Mortality Rates,
1985
Urban
Comb ined ____
105
57
95
Uttar Pradesh 152
77
'40
Karnataka
80
41
71
Ker al a
32
30
31
Rural,
India
Source: Registrar General, India
As can be seen, Karnat ka is on the lower side of the range
of IMR's■among the States.Having reached thus far it would bo
useful’to have a more detailed district wise and population
grown wise break up of IMR. Perhaps Volags in Karnataka
could study.this measure in their respective areas as it is
an acceptable and good indicator of the standard of life
of a given population.
Table 5
Other childhood death rates - All India, 1983
Rural Male
Rural Female
Urban Male
Urban Female
0-4 year
40.5
43.1
21.1
21 .7
5-8 years
3.4
4.0
2.0
1 .8
10-14 years
1.7
2.0
0.9
1 .2
Age Specific
death rate
Source: Health Information of India,
1987, CBHI, DGH5, New Delhi
6
6
In India, deaths of children still account for about 40%Xof
the total deaths that occur—28.8% in Karnataka, fl very
large number of these are preventable- and we need to make
specific efforts to allow these numerous children, the full
bloom of their lives.
(d) The urban population of Karnataka has been growing
and is high (*28.9%) compared to the all India figure of
23.31%. It is necessary to find out what percentage of ■
the urban population are slum dwollers. fl largo chunk —
30% of the urban population —are in Bannalore, the remaining
being spread over 281 towns.
Urban areas monopolise much of the health care and other
social service facilities. These include finances available
from both the government and private sector, hiqhly trained
health-personnel, sophisticated capital intensive equipment
and medical facilities.
In the village and hamlets, medical facilities are scarce
and oof poor quality. There is a shortage of basic essential
drugs and vaccines. Ther
are poorly trained staff in charge
of large areas and basic public health measures of safe
water supply and facilities for sanitation very inadequate.
The disparities of income and living conditions along with
the abo e factors is revealed in the striking difference in
health indicators betworn urban and rural areas.
Table 6
Urban/Rural inequalities (%)
in India
Urban
Rural
1. Population (1981)
23.7
76. 3
2. Doctors (1961-71)
70-80
20-30
3. Nurses/pNMs (1971)
60
40
4. Hospitals (1981)
73.9
26.1
5. Dispensaries (1981)
20.2
69.8
6. Hospitels/dispansary
beds (1981)
83
17
Source: Health Care in India, Ooseph G et al,
CSfl, Bangalore
A
1983,
7
7
Table 7
Urban/Rural Health indicator
India
Karnataka
~R u raT”
Urban
Rural
Urban
1 . Birth rate
(1986)
26.8
29.9
27.1
34.2
2. Death Rate
(1986)
6.8
9 .4
7.6
12.2
3. Inf ant
mortality
rate (1986)
47
82
62
105
4. Expectation
of life a-t
birth (19761980)
64
53.9
60.1
50.6
Source:
2•
Status Report 1988-39, Govt of Karnataka, Dept of
Health & Family Welfare, Bangalore
Birth and Death Rates
The crude birth rate is the number of births per 1000
population per year. Amongst the States, Goa and Kerala
have the lowest birth rates. The goal of the family welfare
programme is to reduce the crude birth rate to 27/1000
population by 2000 AD (it is already 19.1/1000 population
in Goa). These targets and the programme are not applicable
to tribal populations.
In Karnataka it is 29/1000 (1985)
The crude death rate is the number of deaths per 1000
population per year. Karnataka has already reached the national
goal of a crude death rate of 9/1000 population to be achieved
by 2000AD.
3.
Changes in health indicators over time
A brief oicture of the change in health indicators that
have occurred in India since Independence is as follows:
Table 8
Y e a.!f
Infant
Mortality''
Rate
Life expectancy
at birth
Birth rate
Death rate
1941-51
39.9
27.4
134
32.1
1951-61
41.7
22.8
146
41.3
1961-71
41.2
19.0
138
45.6
1980
33.3
12.4
127
52.1
Source: Health Care in India, 3os eph G at al, CSA, Bangalore
...................... 8
8
4•
Growth Rate
Since Independence the death rate in India has declined
more steeply compared to the birth rate which dedr -ased only
gradually. Hence we have a high growth rate with an enormous
increase in total population from 361 million in 1951 to
685 million in 1981. Ue are estimated to be 840 million now.
In Karnataka, the increase in population has been from
million in 1951 to 37 million in 1981.
Here
one must mention the experience of some Volags
working with defined popul'abion groups who state that there
is an under-enumeration of the total population in their
area: eg., in tribol regions. It would be important to have
an estimate of the extent to which this occurs as it would
have serious implications.
Only some health indicators have been highlighted in
the Section above to present a general idea of the health
situation prevailing in India and particularly in Karnataka.
C.
NUTRITION LEVELS
The nutritional status of individuals is closely linked
to their health status, determining to a large extent their
resistance to disease. Tho optimal growth and development
of children is also dependent on nood nutrition. There are
also specific nutrition' deficiency diseases like protein
calorie malnutrition, iron deficiency, an-emia, Vit. A
deficiency, Vit 3 <1 D deficiency etc.
Some statistics regarding child malnutrition at an all
India level are:
1.
% of infants with low birth weight
: 30%
2.
% of malnourished children
(moderate/severe)
:around 40%
Children affected by iron
deficiency anaemia
:around 50%
3.
4. Number of children turning
blind each year mainly due to
Vit. A deficiency (estimate)
:40,000
(Source: Future—-Develooment Perspective^ on Children,
UNICEF (Based mainly on government statistics
relating mostly to 1986).
The National Nutrition Monitoring Bureau systematically
collects information on a representative stratified sample
of ho useholds in rural and urban areas in 10 States of the
country, of which Karnataka is one. Every fifth rural household
does not eat adequately and among children below 4 years of
age, one in 3 consumes less food than recommended.
9
9
Family income 'nd land ownership are critical
determinants of food intake. Those who own more than 10
acres of land have a mean intake of 3100 calories per day,
those who own less than 5 acres ate 2600 calories par day
while landless labourers consumed 2300 calories on an average.
Protein intake showed a similar trend. Overall the calorie
intake in Karnataka is higher than in neighbourinn States
like Andhra and Maharashtra.
Fluorosis caused by excess fluorine in the water, has
been reported to be a public ha 1th problem in some areas,
affectinn the bony skeleton, teeth, sometimes causing
knock knees. High levels of fluoride (5-11 ppm'l in open well
water has been reported in villages of Chitradurga, Tumkur
and Bellary districts. Dental fluorisis affected 75.76% of
individuals surveyed in Mundarqi Taluk of Dharward Dist
where the fluoride content of water was 3-7.6ppm. Fluorosis
has also been reported in some areas close to dams with the
possible causal factor being ecological changes caused by
construction of dams.
0.
DISEASE PROFILES IN KARNATAKA
An understanding of the quantum load of different
diseases in a population also gives an idea of the level of
health of the pooulation. However, this is mor' easily said
than done particularly in India. Some of the difficulties
in measuring disease have been mentioned in the earlier part
of the note. The situation is even more complex because
several systems of medicine/hcalinq practices are actively
present here, each with their own approaches to disease/
symptom complexes. Hence government heal'-h services cannot
be the base used to measure disease in the community as only
part of a population may use that service. The only alternative
is to conduct community based surveys which are very expensive
and cumbersome undertakings. Given the scant resources in
the health sector it has not been possible to conduct nation
wide sample surveys to measure different diseases. More
complete information is available about soma diseases: eg.,
leprosy and tuberculosis for which there are Motional Health
programmes with active case detection.
Available information on some of the diseases in Karnataka
as given in the Status Report 1980-99, Government of Karnataka,
Dept of Health and Family Welfare, will now be given.
Table 9
Deaths
_1988 (Provisional)
Cases
Deaths
1140
125303
1987
Cases
A . Respiratory
diseases
1. Tuberculosis 103006
2 . i . A c ut e
Respi ratory
infect ion
.Pneumonia
1172
75
192127
84
6599
contd.............. . .............. . 10
10
Table 9 (c o n t d , .)
1988 (Provisional)
1987
Casas
Deaths
543944
’ 91
Cases
Deaths
205161
237
E. Gastro
intestinal
diseases
3. Dysentry
(all forms')
4. Acute
diarrhoeal
diseases
85393
524
14091
639
6. Cholera
1918
87
2167
70
7. Infectious
hepatitis
7774
122
5413
60
8. Typhoid
17941
28
15406
36
5. Gastroenteritis
4
C.
9. Malar ia: total
pos it i ve cases
88505
127008
Plasmodium
falciparum
cases
29582
37667
2457
11 870
10.Filaria
11.Lepro sy
D. Vaccine
preventable
childhood
diseases
12 .Diphtheria
2223
16
550
12
13 .Measles
8522
25
4481
25
14.Whooping cough
4928
14
7113
12
15.Poliomyelitis
2456
30
o 759
22
16.Tetanus
1517
314
4841
299
17.1nfluenza
339827
8
18 .Chickenpox
2387
4
19 .Japanese
encephali t i s
132
43
81
27
20.Kyasanur
Forest Disease
51
10
56
■
E. Others
6
... 11
11
Table 9 (contd . . .)
_ _
1987
Cases "
Deaths
__(_Provi s_ioral)_
Cases ’
Deaths’”
21.Rabies
3486
46
3297
36
22.f*laningicoccal
infection
523
73
118
12
23 .Syphilis
5375
2
5749
1
24. Gonococcal
infect ion
5036
25 .Encephalitis
1347
26.Haemorrhagic
fever
53
27.Guinea worm
990
28.All other
diseases
7927329
7620
190
13991
7683977
10045
These figures are of those patients/cases who reported
to the government helth services. They do not represent the
actual incidence of the disease in the community, ft survey
in Chiraigaon Slock, Varanasi showed that 77% of the
population never used the primary health centre servicesad
only 10.4% of illnesses in that community were attended to
at the primary health centre. The number of deaths due to the
different diseases given in the Table also do not represent
the disease mortality rate but probably are the number who
died out of those who reported. Hence, it would be unwise
to draw too many., inferences from this data.
Based on other reports and interactions with several
peonle all that one can say is that tuberculosis is still a
major public health problem more than 40 years after Independence
causing much suffering, disability and death in the prime of
life. It is a disease that affects children and young adults
especially males. All development workers should be aware
of the National Tuberculosis programme and create an awareness
about the facilities provided under this.
When trying to work out the percentage prevalence rate of
tuberculosis from figures given in the above report all the
districts, except Kolar, had a surprising uniformity upto the
third decimal point!
The prevalence rate was 2.12 per 100
population. This is rather surprising and raises questions
about the basic validity of the data.
12
12
Leprosy: The av rape prevalence rate for the entire
State is given as 3/1000 population in 1989. However,
there are large regional differences. The districts with
high prevalence rates (per 1000 population) are:
Raichur
8.8
Gulbarga
8.6
Rellary
6.9
B idar
5.7
B i j anur
5.3
Mysore
3.9
Mandya
3.6
Kolar
3.6
The vaccine preventable diseases in childhood are
diphtheria, whooping cough, tatanus, poliomyelitis, measles
and tuberculosis. Great emphasis is be inn niven to immunization
programmes by the government, sponsored by UNICEF, through
the Universal Immunization Programme (UIP) and the Technology
Mission. Unfortunately it is being converted into a verticalised,
top-down, target-oriented programme during the past few years.
The history of our own health services and programmes has
shown that an integrated health service at the level of the
community works best, is most cost-effective and acceptable
to the peoole. But this lesson seems to have been lost under
various pressures and compulsions working at an international
and national level.
Malaria which had declined consi 'erably in the 601s
has shown a resurgence in the 70's due to various reasons.
Greater recognition is now being nven to environmental and
biological measures for the control of mosquitoes, instead
of relying only on insecticides as there hasbeon growing
resistance in the mosquitoes to the latter.
Elater end food borne diseases or the gastro-intestinal
diseases (cholera, gastroenteritis, dysentry, ETTarFhoeas,
viral hepatitis, tyohoid) are a major cause of ill health
in India and Karnataka. Facilities for safe water suoplv and
proper sanitation are still inadeouate especially in rural
areas. There is a continuin'? need for t.1’ is to be a major
area of focus as a preventive he-lth measure even though a
water and sanitation decade has already gone by.
Kyasanur Forest Disease (KFD) is a viral disease transmitted
by ticks to man. It w?s first reported in 1956-57 in Kyasanur
Forest in Shimoga district. It also affects adjoining nr’as
of Uttar Kannada, Chickmagalur and Dakshin Kannada districts.
KFD is associated with the foiling of forests and clearing
of land for agricultural use. Those at greatest risk of
infection ar° cultivators visiting the forest accompanied by
their animals or for cutting wood.
1
Japanese Encephalitis (JE) is also a viral disease
transmitted by mosquitoes. Mand ya and Kolsr districts are the
most affected.
This is a brief overview of some of the communicable
diseases. Non-communicable diseases including cancers,
cardiovascular diseases, dia'botes, mental ill health have
not been discussed.
13
■ -13
CONCLUSION
E.
Causation of disease and th?_determinants of ^health
Concepts regarding the causation of disease or
ill-health have evolved From miasmic theories (factors
relating mainly to the environment) to germ theories (discovery
of bacteria, parasites, viruses etc) to multifactorial theories
(a number of factors including both the above) in the West.
In India, our own ancient systems understood the health of
individuals to be the result of a composite of physical,
mental and spiritual factors and the importance of food,
cleanliness, good housino and a disciplined wav of life were
ac.epted as necessary for good health. Whether social, economic
and political factors were recognised is a debatable issue.
Presently, however, it is accepted that some of tha
basic determinants of the health status of a population are:
i.
adequate and equitable distribution of
income, food, shelter and clothing;
ii.
accessibility to safe water supoly, sanitation
facilities, education and employment;
iii.
a healthy environmont; and
iv.
h’althy social relationships and life styles.
The role played by the health care services is
secondary to those.
It has been shown by the histories of the developed
countries that communicable diseases like tuberculosis,
leprosy and gastrointestinal dis°a~es declined before the
era of antibiotics and vaccines followinn the improvement
of the socio-economic condition of the peculation and by
imclementat ion of basic measures of sanitation.
Thus groups involved with rural development work, education,
awareness building, conscientization all contribute
significantly to improving the health status of people.
REFERENCES
1 ■. Central Bureau of Health Intelligence, Health Information
of India, 1987, DGHS., Govt of India, New Delhi
2.
Bureau of Health Intelligence, Status Report^ 1988-89,
Dept of Health & Family Welfare, Govt" of Karnataka, Bangalore
3.
Joseph G et al, Health Care in India,
Social Action (C SA T,"""Bangalore
4.
Narayan R, Health, Nutrition and Agricultural Development
(an exploration “focussing on Karnataka State), 1987,
Community Health Call, CNFCE., Bangalore
5.
Park 3E and Park K, T_exjt book of Preventive and Social
I’ladicine, 197 6, Banarsidas Bhanot, Jabalpur.
1983,
Centre for
HEALTH STATUS OF THE PEOPLE OF KARNATAKA IN THE CONTEXT
OF THE HE'LTH SITUATION IN INDIA.
Background paper prepared for the
Annual General Body Meeting of
FEVORD-K
17-18 May 1990
at Belgaum
by
Thelma Narayan
Community Health Call
47/1 St Mark's Road
Bangalo 'e 560001
CONTENTS
A.
B.
INTRODUCTION
1.
Uhat is Health
2.
Hou do ue measure health
3.
Some background factors
4.
Major Health Problems in.India
FOCUSSING ON KARNATAKA
1.
The Population and its Distribution
Sex ratio; situation of women; age
distribution; chi1d health; urban/rural
differences
C.
2.
Birth and Death Rates
3.
Changes in Health Indicators over time
4.
Grouth Rate
NUTRITION LEVELS
□. DISEASE PROFILES IM KARNATAKA
E. CONCLUSION
REFERENCES
A. INTRODUCTION
1.
What is health?
Health is defined by the World Health Organization (1948)
as a state of complete physical, mental and social well being
and.not merely the absence of disease or infirmity. This implies
a goal of positive health for each individual in society.
India had suggested that spiritual health be also included
in this definition.
We need to try to understand the general status of health
!
of the, people of India and of Karnataka. in the context of
this definition. Here we would be locking at the levels
of health of the population as a whole and not merely that
of individuals. However,
keeping in mind the many stratifi
cations of class,., casts and gender that are present in Indian
society today, it would be equally important to try and
understand the health status of these different sub-groups
of the populations. There would also be differences according
to age a.nd occupation. Tribal ano urban slum populations
also-hav- levels of health resulting from their own particular
socio-economic-political-cultural situation.
2.
How do we measure health0
Given the above definition it is rather difficult to
measure the exact status of health of peoole. However-, over
the years certain indicators have been developed which give
some estimate of the levels of health and disease which can
be used to compare different populations and to monitor
changes in the same population over time. Some of these
are life ex'pectancy, infant mortality rate, maternal mortality
rate etc. These terms will be explained as we go alonn. For
specific diseases we can get a picture of the disease load
in a population by their incidence and prevalence.
There needs to be a good health information collection
system to work out these indicators. And to do this there
needs to be a well spread out health service system, which
most people use, which works relatively efficiently and
where records regarding various health and disease- events
are well maintained.
In India, though the development of the health infrastructure
throughout the country, by the government, in terms of
number of- sub-centres and primary health centres established
and number of health personnel trained has shown a large
quantum increase, the level of functional efficacy of these
facilities leaves much to be desired. It is also an accepted
fact that the data colle ted at these centres is of
guestionable guality. However, the census, the National Sample
Surveys, studies by research institutions and data from
some voluntary health projects do provide us with useful
information regarding the health indicators mentioned above.
2
2
3. Some background factor? to_ consider
When we try and understand the health status of the people
of India it is important to keep in mind the magnitude of
our country—the geographic size and even more its population.
Ue are second only to China in population size, there being
850 million of us. This is equal to the population of USSR,
USA and Japan put together. It is said we add an Australia
to our population every year.
□ ur vast population i -■ also very diver se: for instance
people in very different geographic ar’as from the snowy
Himalayas, the deserts of Rajasthan, the great river valleys,
the hilly regions and coastal belts; there are different
ethnic background, a variety of language groups, religions
and cultures; levels of socio-economic development, education
and political consciousness also vary a great deal. All these
factors affect health in numerous ways; hence, talking about
the health status of the people of India as a whole is a
very broad generalization.
The average figures given in the
tables hide diff fences that occur from place to place and
group to group. Within Karnataka itself, there are differences
in the health indicators between urban and rural areas and
from district to district. It would be revs-aling. to know
the breakuo by income level, caste/tribe, age and sex.
.
Another factor to consider is that the health of individuals,
communities and populations is a dynamic state, changing
over time, responding to a number of factors which have
a relationship with it. It has been observed in populations
that as certain diseases decline, others may become apparent
or develop anew. This has been termed the onion-peel effect.
4•
a j o r he al th pro blems in India
Keeping in mind all the above factors it can be said
broadly that in India people suffer from the diseases of poverty
alongside the diseases of modernization. The 30-40% of the
population under the poverty line (about 230-300 million)
and also the lower middle cla s continue to bear the burden
of malnutrition which takes its greatest toll from children
g
and mothers. They also suffer from the lack of clean water.
"
and sanitation, adequate housing and clothing all of which
result in various communicable or infectious diseases:eg . ,
tuberculosis, leprosy, gastroenteritis, typhoid, cholera,
jaundice, diarrhoeas, malaria filaria etc.,
This ill health
affects the working and earning capacity of people.and often
results in disability and oven unnecessary and early death.
The tragedy is that most of these- diseases are preventable.
by an overall equitable development process and also by public
health measures.
. . .3
3
TA3LE -1....
Percentage of peculation below the poverty line
1983-84 (Provisional)
Rural
Urban
Combined
Karnataka
37.5
29.2
35.0
Kerala
26.1
30.1
26.8
-
— ■
-
All India
40.4
28.1
37.4
— — — _ — — -- —•_—
—_ —
Source: Status Report 1988-89, Govt of Karnataka, Dept.
of Health & Family Welfare.
Modernization, industrialization and urbanization have
brought along their own ills. Thorn 'arg many soacific
oceuputional' health problems af>d envirnrarn~n±ai pollution
problems associated with th? various industries. In
agriculture also there is extensive use of chemicals as
fertilizers and pesticides which enter thfood chain
affecting the total population, though more specially the
sprayers and agricultural workers. Rural urban migration has
resulted in the growth of the 'septic fringes of cities'
where people have to live in dehumanized conditions resulting
in many social health problems in addition to those of
poverty: eg., broken families., elcoho'ism, prostitution"
gambling etc. Rapidly growing cities face a major strain
on their basic ser-vic=s, air pollution, traffic accidents,
housing problems and alienation of the individual with its
accompanying host of psychological and psychiatric problems.
Caittfsra,
cardiovascular diseases and stress related disorders
are on the increase.
B.
FOCUSSING ON KARNATAKA
Karnataka is better than the national -.verage in all
the health indicators, coming second only to Kerala in some.
However much more remains to be done. A brief overview
of the health situation will now be given highlighting
only the more important aspects.
1.
The population and its distribution
With a population of 37.1 million (1981 census),
Karnataka accounts for 5.42% of India's population, ranking
Sth among the States in terms of peculation size. With
an area of 191,791 so kms the population density is
194/sq km (all India 216/sq km). Estimates of the population
in 1990 are 44.48 million.
. . . .4
The following t able gives some of the features of the •
dist ribution of th? population in Karnataka.
Table 2
Population distribution in Karnataka (1981)
(T = Total; R = Rural; U = Urban)
Sex
Ratio
Area in Km
Popula-.
t io n
T
191,791
37135714 18922627 18213087
963
R
188108.2
26406108 13352400 13053708
978
U
_ M.
3682.8
Females
Males
%Urban
Population
28.89
5159379
926
mr ~~~ *~** • •■ = — = —= ■ ■• = - d ' Zr “ * —■"
10729606 5570227
m *• — mm m rm ■ ~~r •*» ~~~ —— ~~~ • - mr
Source: Health Information of India,
1987, CBHI, DGHS,
NewDelhi
(a) The sex-ratio is the number of females per 1000 males.
In most countries of the world this is in favour of females.
However in India (and Pakistan, Bangladesh, Afqanistan etc)
it is the reverse and more importantly has been, steadily
"
decreasin'? since the turn of the century,even post-independence.
The decline has come tn a halt only in the last census (1981).
The only two States in India to have a positive sex ratio
are Kerala and Roa. Within Karnataka, Oakshin Kannada Dist
also has a positive ratio. Otherwise ..it varies in the
different States and Districts. The adverse sex ratio has
been ascribed as being due to various casues--high maternal
mortality following early marriage end repeated pregnancies,
poor educational status of women, low utilisation of health
services by women—the underlying reason being the inferior
status of women in society.
Table 3
- Conditions of children and women in India
Developed
countries
India
Developing
countries
125
96
20
2. % of new borns
weing less than
2.5 kg
27.5
18
9
3. % of anaemia among
pregnant women
70
60
20
4. Maternal mortality
per 100,000 live
births/per year
418
400
20
Indicatpr
1. Infant Mortality
(deaths)
(per 1000 live
births per year)
Source: Health Care in India,
OSA, Bangalore
19~83,
Jose pin G et al,
5
5
(b) The age distribution oF the population in
Karnataka is as Follows’ (1981 census)
0-14 years
: 39.6%
15 — 59 years
:
53.8%
60 + years
:
6.6%
This is very similar to the all India pattern. With almost
40% oF the population being children, ours is predominantly a
young population.
(c) Though the indicators o_F child _heaLth have shown
some improvement over the years, it still ramains a matter
oF sarious concern. As shown in Table 3, the inFant mortality
which is the number oF children who die beForo they roach
the age oF one year still remains unacceptably high. About
30% oF newborn babies have a low birthweight (less than
2.5 kg). These babies are three times more likely to die in
inFancy than babies o F normal weight at birth. The under 5
or toddler death rate is also verv high.
Table 4
Estimated InFant Mortality Rates,
Rural
Urban
105
57
95
Uttar Pradesh 152
77
:40
Karnataka
80
41
71
Kerala
32
30
31
India
Source: Registrar General,
1985
£o.mb i_Q.511
India
As can be seen, Karnat ka is on the lower side oF the range
of IMR's among the States.Having reached thus Far it would be
useFul“to have a more detailed district wise and population
grouo wise break up oF IMR. Perhaps Volags in Karnataka
could study.this measure in their respective areas as it is
an acceptable and good indicator oF the standard oF liFe
oF a given population.
Table 5
Other childhood death rates - All India, 1983
Rural Male
Rural Female
Urban Male
Urban Female
0-4 year
40.5
43.1
21.1
21 .7
5-8 years
3.4
4.0
2.0
1.8
10-14 years
1.7
2.0
0.9
1.2
Age SpeciFic
death rate
Source: Health InFormation oF India,
1987, CBHI, DGHS, Mew Delhi
6
6
In India, deaths of children still account for about 40%4 of
the total deaths .that occur—28.8% in Karnataka. A very
large number of these are preventable- and we need to make
specific efforts to allow these numerous children, the full
bloom of their lives.
(d) The urban population of Karnataka has been growing
and is high (28.9%) compared to the all India figure of
23.31%. It is necessary to find out what percentage of •
the urban population are slum dwellers. A largo chunk —
30% of the urban population—are in Bangalore, the remaining
being spread over 281 towns.
Urban areas monopolise much of the health care and other
social service facilities. These include finances available
from both the government and private sector, highly trained
health-personnel, sophisticated capital intensive equipment
and madical facilities.
In the village and hamlets, medical facilities are scarce
and oof poor quality. There is a shortage of basic essential
drugs and vaccines. Ther
are poorly trained staff in charge
of large areas and basic public health measures of safe
water supply and facilities for sanitation very inadequate.
The disparities of income and living conditions along with
the abo e factors is revealed in the striking difference in
health indicators between urban and rural areas.
Table 5
Urban/fiural inequalities (%) in India
Urban
Rural
1. Population (1981)
23.7
76.3
2. Doctors (1961-71)
70-80
20-30
3. Nurses/ANns (1971)
60
40
4. Hospitals (1981)
73.9
5. Dispensaries (1981)
20.2
69.8
6. Hospitals/dispensary
beds (1981)
83
17
Source: Health Care in India, Joseph G et al,
CSA, Bangalore
.
26.1
1983,
7
7
Table 7
Urban/Rural Health indicate; .
w
—
~~ «.* —
™
ro.’ •— — ;
XP • - • -— .r» “
‘ rP " —- •— —— —— -—- •'— — —•» ■- ■*“ “X — —1
Karnataka
India
Urban
Rural
Urban
Rural
1. B irth rate
(1986)
26.8
29.9
27.1
34.2
2. Death Rate
(1986)
6.8
9.4
7.6
12.2
3. Infant
mortality
rate (1986)
47
82
62
105
4. Expectation
of life at
birth (19761980)
64
53.9
60.1
50.6
Source:
2•
Status Report 1988-89, Govt of Karnataka,
Health & Family Welfare, Bangalore
Dept of
Birth and Death Rates
The crude birth rate is the number of births per 1000
population per year. Amonost the States, Goa and Kerala
have the lowest birth rates. The goal of the family welfare
programme is to reduce the crude birth rate to 27/1000
population by 2000 AD. (it is already 19.1/1000 population
in Goa). These targets and the programme are not applicable
to tribal populations.
In Karnataka it is 29/1000 (1985)
The crude death rate is the number of deaths per 1000
population per year. Karnataka has already reached the national
goal of a crude death rate of 9/1000 population to be achieved
by 2000AD.
3.
Changes in health indicators over time
A brief oicture of the change in health indicators that
have occurred in India since Independence is as follows:
Table 8
Yea1;
Infant
Mortality^
Rate
Life expectancy
at birth
Birth rate
Death rate
1941-51
39.9
27.4
134
32.1
1951-61
41.7
22.8
146
41.3
1961-71
41.2
19.0
138
45.6
1980
33.3
12.4
1 27
52.1
Source: Heal th Care in India, Dos??ph G at al, CSA, Bangalore.
...................... 8
8
4•
Growth Rate
•
Since Independence the death rate in India has declined
more steeply compared to the birth rate which dec'r-ased onl.y
gradually. Hence we have a high growth rate with an enormous
increase in total population from 361 million in 1951 to
685 million in 1981. Ue are astimated to be 840 million now.
In Karnataka, the increase in population has been from
million in 1951 to 37 million in 1981.
Here
one must mention the experience of some Volags
working with depine; population groups who state that there
is an under-enumeration of the total population in their
area: eg., in tribol regions. It would be important to have
an estimate of the extent to which this occurs as it would
have serious implications.
Only soma health indicators have been highlighted in
the Section above to present a general idea of the health
situation prevailing in India and particularly in .Karnataka.
C.
NUTRITION .LEVELS
The nutritional status of individuals is closely linked
to their health status, determining to a large extent their
resistance to disease. The optimal growth and development
of children is also dependent on no.od nutrition. There are
also specific nutrition' deficiency diseases like protein
calorie malnutrition, iron deficiency, an-emia, Vit. A
deficiency, Vit 3 d D deficiency etc.
Some statistics regarding child malnutrition at an all
India level are:
1.
% of infants with low birth weight
:30%
2.
% of malnourished children
(moderate/sevare)
:around 40%
Children affected by iron
deficiency anaemia
:around 50%
3.
4. Number of children turning
blind each year mainly due to
Vit. A deficiency (estimate)
:40,000
(Source: Future--Develooment Perspective* on Children,
UNICEF (Based mainly on government statistics
relating mostly to 1986).
Tha National Nutrition Monitoring Bureau systematically
collects information on a representative stratified sample
of ho useholds in rural and urban areas in 10 States of the
country, of which Karnataka is one. Every fifth rural household
does not eat adequately and among children below 4 years of
age, one in 3 consumes less food than recommended.
. . . .9
9
Family income ?nd land ownership ?re critical
determinants of food intake. Those who own more than 10
acres of land have a mean intake of 3100 calories per day,
those who own less than 5 acres ate 2600 calories per day
while landless labourers consumed 2300 calories on an aver-ge.
Protein intake showed a similar trend. Overall the calorie
intake in Karnataka is higher than in neighbourinn States
like Andhra and Maharashtra.
Fluorosis caused by excess fluorine in the water, has
been reported to be a public he 1th problem in some areas,
affecting the bony skeleton, teeth, sometimes causing
knock knees. High levels, of fluoride (5-11 ppm'l in open well
water has been reported in villages of Chitradurga, Tumkur
and Bellary districts. Dental fluorisis affected 75.76% of
individuals surveyed in Mundargi Taluk of Dharward Dist
where the fluoride content of water was 3-7.6ppm. Fluorosis
has also been reported in some areas close to dams with the
possible causal factor being ecological changes caused by
construction of dams.
D.
DISEASE PROFILES IN KARNATAKA
An understanding of the quantum load of Different
diseases in a population also gives an idea of the level of
health of the pooulation. However, this is mor-' easily said
than done particularly in India. Some of the difficulties
in measuring disease have been mentioned in the earlier part
of the note. The situation is even more complex because
several systems of medicine/healinn practices are actively
present here, each with their own approaches to disease/
symptom complexes. Hence government health services cannot
be the base used to measure disease in the community as only
part of a population may use that service. The only alternative
is to conduct community based surveys which are very expensive
and cumbersome undertakings. Given the scant resources in
the health sector it has not been possible to conduct nation
wide sample surveys to measure different diseases. More
complete information is available about some diseases: eg.,
leprosy and tuberculosis for which there are National Health
programmes with active case detection.
Available information on some of the diseases in Karnataka
as given in the Status Report 1980-89, Government of Karnataka,
Dept of Health and Family Welfare, will now be given.
Table 9
_________ 19 87
Cases
Deaths
1988 (Provisional)
Deaths
Cases
A . Respiratory
diseases
1. Tuberculosis 103006
2. i .Acute
Respi ratory
infect ion
.Pneumonia
1140
125303
1172
192127
75
84
6599
contd.... ................
10
10
T able 9 (contd..)
1988 (Provi sional)
1987
—' • . •. ».
.. -
•
Casas
Deaths _
543944
' 91
Cases
Deaths
205161
237
E. Gastro
intestinal
diseases
3. Dysentry
(all forms)
4 . Acute
diarrhoeal
diseases
85393
524
14091
639
6. Cholera
1918
87
2167
70
7. Infectious
hepatitis
7774
122
5413
60
8 . Typhoid
17941
28
15406
36
5. Gastroenteritis
/
C.
9. Malaria: total
positive cases
88505
127008
Plasmod i urn
falciparum
cases
29582
37667
2457
11870
10 .Filaria
11.Leprosy
D. Vaccine
preventable
childhood
diseases
-
12.Diphtheria
2223
16
550
12
13 .Measles
8522
25
4481
25
14.Whooping cough
4928
14
7113
12
15.Poliomyelitis
2456
30
o 759
22
16.Tetanus
1517
314
4841
299
17.Influenza
339827
8
18 .Chickenpox
2387
4
19 . Japanese
encephalitis
132
43
81
27
20 .Kyasanur
Forest Disease
51
10
56
6
■ ’
E. Others
........... 11
Table 9 (contd . . .)
1987
Cases "
Deaths
1988 (Provisioial)
Cases
Deaths
21 .Rabies
3486
46
3297
36
22.fleningicoccal
inf ect ion
523
73
118
12
23. Syphilis
5375
2
5749
1
24. Gonococcal
infect ion
5036
25 .Encephalitis
134 7
26.Haemorrhagic
f ever
53
27.Guinea worm
999
28 .All other
diseases
7927329
7620
190
13991
7683977
10045
These figures are of those patients/cases who reported
to the government he'lth services. They do not represent the
actual incidence of the disease in tho community. A survey
in Chiraigaon Rieck, Varanasi showed that 77% of the
population never used the primary health centre servicesad
only 10.4% of illnesses in that community were attended to
at the primary health centre. The number of deaths due to the
different diseases given in the Table also do not represent
the disease mortality rate but probably are the number who
died out of those who reported. Hence, it would be unwise
to draw too many., inferences from this data.
Based on other reports and interartions with several
people all that one c'n say is that tuberculosis is still a
major public health problem more than 40 years after Independence
causing much suffering, disability and death in the prime of
life. It is a diseasethat affects children and young adults
especially males. All development workers should be aware
of the National Tuberculosis programme an'1 create an awareness
about the facilities provided under this.
When trving to work out the percentage prevalence rate of
tuberculosis from figures given in the above report all the
districts, except Kolar, had a surprising uniformity upto the
third decimal point!
The prevalence rate was 2.12 per 100
population. This is rather surprising and raises questions
about the basic validity of the data.
12
12
Leprosy: The av-raoe prevalence rate' for the entire
State is given as 3/1000 population in 19R9. However,
there are large regional differences. The districts with
high prevalence rates (per 1000 population) are:
Raichur
8.8
Gulbarga
8.6
Rellary
6.9
Bidar
5.7
B i j aour
5.3
Mysore
3.9
Mandya
3.6
Kolar
3.6
The vacci_ne preventable diseases in childhood are.
diphtheria, whooping cough, tetanus, poliomyelitis, measles
and tuberculosis. Great emnhasis is beino niven to immunization
programmes by the government, soonsored by UNICEF, through
the Universal Immunization Programme (UIP) and the Technology
Mission. Unfortunately it is being converted into a verticalised
top-down, target-oriented programme during the oast few years.
The history of our own health services and programmes has
shown that an integrated health service at the level of the
community works best, is most cost-effective and acceptable
to the people. But this lesson seems to have been lost under
various pressures and compulsions working at an international
and national level.
Malaria which hod declined consi 'erably in the 60's
has shown a resurgence in the 70's due to various reasons.
Greater recognition is now being ^iven to environmental and
biological measures for the control of mosquitoes, instead
of relying only on insecticides as there hasbeen growing
resistance in the mosquitoes to the latter.
Uater and food borne diseases or the ga st r o - inte_s t inal
diseases (cholera, gastroenteritis, dysentry, diarrho’eas,
viral hepatitis, typhoid) are a major cause of ill health
in India and Karnataka. Facilities for safe water sunplv and
proper sanitation are still inadeouate especially in rural
areas. There is a continuing need for f'is to be a major
area of focus as a preventive he-1th me-sure even though a
water and sanitation decade has already gone by.
Kyasajaur_ Forost Disease (KFD) is a viral disease transmitted
by ticks to man. It was. first reported in 1956-57 in Kyasanur
Forest in Shimoga district. It also affects adjoining ar^as
of Uttar Kannada, Dhickmaqalur and Dakshin Kannada districts.
KFD is associated with the foiling of forests and clearing
of land for agricultural use. Those at greatest risk of
infection ar° cultivators visiting the forest accompanied by
their animals or for cutting wood.
Japanese Encephalitis (JE) is also a viral disease
transmitted by mosquitoes. Mandya and Kolar districts are the
most affacted.
This is a bri-^f overvieu of some of the communicable
diseases. Non-communicable diseases including cancers,
cardiovascular diseases, dia'betes, mental ill health have
not been discussed.
13
■ *13
E.
CONCLUSION
Causation of di_sease and th_a__dti term wants of Jnealth
Concepts regarding the causation of disease or
ill-health have evolved From miasmic theories (factors
relating mainly to the environment) to germ theories (discovery
of bacteria, oerasites, viruses etc) to multifactorial theories
(a number of factors including both the above) in the West.
In India, our own ancient systems understood the health of
individuals to be the result of a composite of physical,
mental and spiritual factors and the importance of food,
cleanliness, good housing and a disciplined way of life were
ac.epted as nrcessary for good health. Whether social, economic
and political factors were recognised is a debatable issue.
Presently, however, it is accepted that some of the
basic determinants of the health status of a population are:
i.
adaguate and eguitable distribution of
income, food, shelter and clothing;
ii.
accessibility to safe water supoly, sanitation
facilities, education and employment;
iii.
iv.
a healthy environment;
and
healthy social rnlationshios and life styles.
The role played by the health care services is
secondary to these.
It has been shown by the histories of the developed
countries that communicable diseases like tuberculosis,
leprosy and gastrointestinal dis^a-es declined before the
era of antibiotics and vaccines following the improvement
of the socio-economic condition of the pooelation and by
imolementation of basic measures of sanitation.
Thus groups involved with rural development work, education,
awareness building, conscientization all contribute.
significantly to improving the health status of people.
REFERENCES
1. Central Bureau of Health Intelligence, Health Information
of India, 1987, OCHS., Govt of India, New Delhi
2.
Bureau of Health Intelligence, Status*Report^ 1988-89,
Dept of Health & Family Welfare, Govt of Karnataka, Bangalore
3.
Joseph G et al, Health Care in India, 19JB3, Centre for
Social Action (CSAf, Bangalore
4.
Narayan R, Health, Nutrition and Agricultural Development
(an exploration focussing on Karnataka State), 1987,
Community Health Cell, CNFCE., Bangalore
5.
Park 3E and Park K, Text book of Preventive and Social
fladicine, 1976, Banarsidas Bhanot, Jabalpur.
SOLVING PROBLEMS AND MAKING DECISIONS
When a group (or an individual) is faced with solving a
problem or making a. decision, there are five steps which can
be followed.
These steps will make for greater clarity and
effectiveness while considering the problem or the decision,
and they w±ll also lead to a better final decision.
1 .
Define the probl m
Ksk yourselves "What is the real problem before us?1'
If
you cannot agree on what the problem is, you certainly will
not agree on the solution!
A clearly-defined problem is
already a great help towards a solution.
What appears to be the problem may be only a superficial
sympton.
Underneath there may be larger and deeper issues.
Express the problem in "How to..." terms.
Do not say,
’the problem ife moderating discussion ,,
ut,
The problem is
how to learn to moderate discussions effectively1.
2•
COLLECT POSSIBLE SOLUTIONS
fisk yourselves, :what are the possible solutions to
this problem?1’ Make a list of all the ideas, possible
solutions and suggestions without evaluating any of them.
;The process is similar to 'brain-storming').
It is important to separate the collecting of ideas in
this step from evaluations The evaluation should come only
in the third step.
If you evaluate ideas in this second
step, itwill inhibit the contribution of further ideas.
Make the list of possible solutions as long and complete
as possible.
Some people believe that the quality of the
final decision depends on the number of possible solutions
collected during this second step.
• Evaluate the possible solutions and choose the best
Ask yourselves, "Of all the alternatives we have listed,
which is the best solution?"
Weigh the pros and cons of each possible solution.
Encourage dissent and disagreement among the members
of the group.
This will help in the completed examination
of every possibility.
Beware of easy agreements-they
probably have not been thought through completely.
At the
same time, avoid being defensive or making others feel
defensive.
Try to separate the ideas and solutions from the
individuals who contributed them.
There are two important aspects to an effective decision
One is the quality of the decision.
Ask yourselves,"loes
this decision accomplish our purpose? Will it effectively
solve the problem?" The second aspect is the acceptability
of the decision to those who have to carry it out.
If you find that you now need further information or
an expert opinion, get it before the decision is made, not
afterwards!
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