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FOREWORD
Rajasthan is faced with the challenge of relatively high Infant Mortality Rates
and high Maternal
Mortality Rates, which are impeding progress and
preventing the state from achieving its human deveiopment goals.
Health
Care Systems although in place suffers from shortcomings, particularly when
it comes to responding to needs of the urban poor. Studies have shown that
distribution of health care facilities are not only uneven but are biased against
the poor, in terms of their location and access. The need for change became
evident when a "Pro-Poor City Mapping" exercise in Jaipur city revealed that
low levels
of information and
awareness on vital
health
issues,
like
immunization, use of iodized salt, use of ORS for diarrhoeal dehydration, were
the key hurdles in people seeking health care or taking simple actions at
household level.
It was at this point that “Concerned Citizens” offered its
services for informing communities through the voluntary services of young
people of Jaipur - senior students of selected schools. The exercise aimed at
not only sensitizing the young privileged citizens of the city but to also foster a
partnership between various segments of society in a bid to understand
issues, find solution and mobilize change.
“Concerned Citizens” led by Dr Raj Bhandari and the team of young members
deserve to be congratulated for their good work, which has set a trend that
needs to be built upon and explored further. This report has tried to capture
this process and
provides serious reading for all those interested in
development and the capacities of communities and children to influence
change.
/7
■
Sumita C. Gangufy
State Representative
UNICEF Rajasthan State Office
PREFACE
During Child to Child Programme for Health Awareness an innovative approach
was evolved to train and develop the senior students as ‘agents of change' to pass on
the gains of modern science to the weaker sections of the community by volunteering
their services to disseminate identified health messages.
In this report there are more answers than questions. It draws on the experiences
of many individuals in various settings with minimum resources. All along, a conscious
effort has been made to make the process participatory and relate to ground realities.
Adults can value the need for childrens' participation only if they have themselves
experienced such opportunities and have been able to appreciate the value of self
expression, of being heard and respected - by opening a small ‘window' in the mind.
It has been our experience and learning that "As you think So shall you do". This
is probably also the central theme of all awareness programmes. Further. this| is a
mindset and not a technique. Of the four rights of the children that the U N convention
focuses on. the right to participation is the most difficult to realise. This document focuses
on how the mindset of adults can be transformed so that this right of children can be
guaranteed.
I wish to acknowledge with gratitude the guidance, help and support extended
by UNICEF and Directorate Local Bodies, Rajasthan. The principals of schools, parents
and teachers co-operated with no reservations. Each one of us is overwhelmed by the
warmth and dignity with which people of Khadda Basti received us.
I have learnt many things during the proect. I hope this episode will reinforce the
commitment of all at CCCH&D to share knowledge and undertake field work so that we
can better advocate for the voiceless, like ‘Munni’.
V. Bhandari
Secretary
rxCX* V<>
>
1
Child to Child Approach for Health Awareness
A Process Documentation
Background
The quality of human resources of any state is largely determined by the quality
of its child development services.
The children of today are the generation of tomorrow.
There has been some improvement in the state of health of children in India as reflected
by modest reduction in infant and child mortality rates and decline in the incidence of
‘severe’ malnutrition in children in recent years. However, the vast bulk of Indian children
continue to be deprived of an adequate standard of health and nutrition. Though they
may ‘survive’, they will grow into stunted adults when they mature with varying degrees
of impairment of physical stamina and productivity.
Recent inputs into child development programmes have not been unimpressive.
The country wide Integrated Child Development Services ( ICDS ) and the more recent
national drive for Universal Immunization are heartening examples of the growing recognition
on the part of our planners that promotion of child development must be the central
objective of any meaningful national developmental policy.
Despite the vast infrastructure
of health facilities like Primary Health Centre (PHC), Mother & Child Welfare (MCW) and
Family Planning (FP) services, Referral Satellite Hospitals, a brigade of private practitionersmedical and indigenous / conventional,
we are still far from desirable goals in the field
of child health. This points to either some basic flaws in our strategies or to serious
shortcomings
in
programme
implementation.
While we
have
a
multiplicity
of
over
lapping uncoordinated programmes, these are not born out of any grand design or a
coherent over arching national child development policy.
2
I
I
Slum Scenario
The historical character of slums, with dirt, squalor, open sewers, stinking garbage,
congestion etc. over the last ten decades has stubbornly persisted. With this has persisted
the uneasy dichotomy between the elite and the urban poor, the reason for which belongs
to the realm of politics and ideology and can not, therefore, form part of serious
consideration hem. Any developmental intervention in slums however should include an
attempt to correct or at least bridge some of the imbalances in the situation destribed
above.
As we stand at the threshold of the 21st century, the world has become
predominantly an urban one and most of this population is now living in low income
settlements-the slums and shanty towns. By the end of this millennium, we must at least
evolve policies and programmes to effectively face the challenge.
The public until now had a historical background that slums are linked to continued
industrialisation since Victorian times. It is also important to note that this is no longer
the major force behind urbanisation. More importantly, slums in developing countries are
growing at twice the rate of the cities as a whole. This is going to make a profound
difference to the urban citizens and more particularly the slum dwellers. How we tackle the
latter in fact will decide the future of the slum-dwellers communities who constitute a
majority of the urban poor. The examples of slums of Kanpur, Calcutta, Delhi, Mumbai
etc. in India are cases in point.
All this calls for empowerment of the slum community for effective and integrated
slum development. The plight of urban poor population is worse than that of rural
population. Population Crisis Committee (PCC) says that rural population in developing
countries will decrease in absolute numbers. A major concern is horizontal increase in
population due to migrants to the urban slum areas. This has led to overcrowding and
health risks, beside creating a law and order problem.
Slums continue to be a habitat of the underprivileged. The people believe that
the slums and shanty towns are an unwanted inconvenience. The Victorian saying "the
poor shall always be with us", in a telling way illustrates the rejection of the urban poor
by well-to-do. Solving the problem of slums has to be seen in emotional terms and in
a historical framework. This should help it to be a less forbidding challenge.
3
Against the above background of not so cheerful kind, a more perceptive and
positive way of looking at urbanization and slums is emerging. The slums with all their
problems are in a state of dynamic flux and continual change, like community organisation,
community planning and community implementation as part of developmental interventions
and also because of internal states of restlessness seeking new satisfaction ( the progress
is uneven but promising). These processes are creating as well as providing social and
psychological tools for planned developmental change in the slums. These are of importance
for replication and extension.
Health challenges in children of urban slum
As the world is becoming increasingly urbanised, it is expected that by the next
decade, the number of urban dwellers in the developing world will equal its rural
population. It is generally assumed that urban areas are well catered to by health services.
But, if approached conscientiously and probed deeper, one would realise that health
problems in urban areas are no lesser than those of rural areas. This also raises the
question whether available health services are properly utilised by all sections of the urban
community.
Although Rajasthan is less urbanised than other states Jn India, continuous
immigration of villagers in the cities has led to unplanned growth of cities. The Indian
Institute of Rural Management (IIRM) study reports the expansion of Jaipur city in terms
of population and reveals that its density has increased from 5352 persons to 7882
persons per sq. km. from 1981 to 1991. There are 178 slums scattered in 70 municipal
wards. Absolute merger of Sanganer and Amber towns under Jaipur Municipal Corporation
has created the apprehension of further increase in the number of slum dwellers. This
study brought out a birth rate of 42 and death rate of 11 per 10000 in slum areas of
Jaipur city.
This survey also found that only 44% of the children were fully immunised.
Less than 10% women in urban slums have correct knowledge of instituting ORS in
children suffering from diarrhoea.
In 1995, Rajasthan unit of UNICEF commissioned a multi-indicator survey with a
focus on community health. It covered immunization coverage of infants, management of
diarrhoea and other health problems. This study was conducted in 15 clusters each in
‘A’ class cities, 15 ‘B’ class and 15 ‘C class cities of this state. Jaipur city falls in A
class cities. The major findings of ‘A’ class cities of this study are shown below :
4
|
I
I
I
I
Ratio of Children (Age wise)
Age (months)
Male
%
Female
%
Total
%
12
87
10.10%
90
11.25%
177
10.67%
12-23
161
18.72%
139
17.37%
300
18.08%
24-35
62
7.22%
70
8.75%
132
7.96%
36-47
82
9.55%
103
12.87%
185
11.15%
48-59
72
8.38%
83
10.37%
155
9.34%
60 +
395
45.98%
315
39.37%
710
42.50%
Total
359
99.95%
800
100%
1659
100%
UNICEF 1995 multi indicator survey.
Communicable diseases, which are largely preventable, top the list of health
problems amongst
the urban poor. This is primarily due to low
resistance level,
inadequate immunization, and high incidence of malnutrition. This is reflected in the table
given below :
Significant findings in slums of Jaipur
Prevalence
Percentage
of diarrhoea
7.4
Practice of giving fluids in diarrhoea
55.7
Fully immunised second year of life
41.7
Only measles coverage
43.5
Prevalence of under nourishment
41.3
Ante natal coverage
31.0
UNICEF 1995 multi indicator survey
5
Percentage of Service Seekers
Slum Dwellers
IDO
OR5
Immunization
Malnutrition
Yes
21.60%
35.1%
34.7%
41.3%
No
18.60%
62.2%
55.3%
26.4%
Don’t know
59.80%
2.7%
10%
32.3%
•I
UNICEF 1995 multi indicator survey
A large number of service seekers didn’t have any information about iodine
deficiency diseases. Nearly 62% of slum dwellers are unwilling to give ORS to their
children who suffer from diarrhoea.
An equally large number of children have not
been adequately immunised.
Information about disease, health and the quality of life can be a major driving
force for change. Good basic health information should be seen as a resource for health,
and not as an unnecessary expense. A shared agenda needs to be developed between
the public and health workers, based on real information and the raising of public
awareness with the help of mass media, educational institutions, and cultural and social
centres.
A workshop on ‘Out come of Pro- poor Participatory mapping of Jaipur city’ was
held under the auspices of Jaipur Municipal Corporation and UNICEF on 23rd Jan, 98
and one of the main issues which emerged was to bridge the gaps in information,
education and communication on vital health issues like Immunization, Iodine Deficiency
Diseases (IDD), Oral Rehydration Solution etc. Only after proper awareness is created on
the above subjects, can change be effected in the health seeking behaviour of slum
dwellers.
Keeping this in mind and our commitment to serve the under privileged
community, a unique intervention is proposed to generate awareness on select topics
relating to the health of the community with the help of senior school students and
teachers. Similar approach was tried by the organisation in 1989 in the slums of Jhalana
Doongri in Jaipur.
6
Senior students of schools can act as ‘agents of change’ in bringing about
a palpable change and creating an enabling environment towards healthy living
by dissemination of useful information such as immunization, iodine deficiency
diseases, Vit A, prevention of malnutrition and diarrhoeal diseases.
Campaign Objectives
1. To generate awareness on selected aspects of health namely immunization, iodine
deficiency diseases, prevention of malnutrition, Vit A,
and diarrhoeal diseases by
participatory learning and action.
2. To enhance the convergence process through evolving innovative approaches
among governmental / non governmental / indigenous medical practitioners and
establishing effective community linkages.
7
3. To initiate action in the area of mother and child health by activating Students
group and Women groups for mass mobilization and peer education.
4. To co-ordinate with other NGO’s and govt, bodies in improving the health services
available in the area
Modus Operand! :
For building awareness in Jaipur slums a three pronged strategy is to be adopted :
1. A brain storming session for heads of selected schools / teachers / trainers in
schools, would be held.
2. A two day workshop of students and orientation of indigenous medical practitioners
and women groups who are willing to take the role of ‘agents of change’ in slum
area of Jaipur would be held.
3. Field visits by students in the slum areas and awareness camps with the active
participation of community.
7
Advocacy of Project with Heads of Institutions
The Secretary of the organisation Concerned Citizen for Community Health and
Development Centre (CCCH&D) had several meetings with the heads of institutions, teachers,
basti leaders etc. The heads of institutions welcomed the idea of sensitizing the young
adults to taking interest and active participation in the health and development aspects
of the community by organising service camps during the vacations when the senior school
students are relatively free. However there were apprehensions about the number of
students who would report to undertake field visits due to the following reasons :
1. Some students go out of station during vacations
2. Consent of parents is needed for permitting the children to undertake visits to
slums.
3. The students of senior classes usually take coaching and tution privately to
compete for various exams like PMT, PET etc. A few girls join hobby classes like
cooking, sewing, drawing etc.
4. The intense heat of the summer ( 42°C to 48°C ) could adversely affect the health
of children.
The above apprehensions could be overcome by doing proper advocacy. Selection
of students will be on voluntary basis and the ‘consent of the parents would be obtained.
As regard their work schedule in the summer vacations, the children should undertake
such activities which would :
•
help develop in them a good and healthy self image.
•
help develop an overall personality along with the leadership qualities.
•
help understand their peers- living condition, concepts and values, life style
and working condition besides knowing the health needs and practices.
It is also the moral responsibility of the Principals to exhort students to
develop positive values and service orientation which would help them grow into
sensitive individuals and responsible citizens. The heads of institutions got interested
and appreciated the idea and intention of the organisation in taking such initiative which
helped in developing the individual holistically. They agreed to participate and send their
representatives to attend the service camp.
8
Survey of Kachhi Dasti
The organisation CCCH&D did a lot of ground work by undertaking field visits to
kucchi basti in Adarsh Nagar, Jawahar Nagar and Ghat Gate areas. The parameters for
selecting the Basti were based on - duration of existence, density of population, literacy,
sanitation, health and educational facilities. Finally Khadda Basti - an unauthorised slum
in Adarsh Nagar, Jaipur
was identified. On interrogating with basti leader and some
residents of the ward, it was stated to be one of the oldest Kachi Basti and the inhabitants
have been residing here for the last 25 to 30 years. But inputs in terms of better living
amenities, sanitation, drainage etc. have been minimal. During the rainy season, depressions
and large areas are submerged in water- hence the name 'Khadda Basti’.
It has about 350 households and there are about 1900 voters in a population of
7600. About 50-60% of the households have regularly piped water supply inside their
house and electrification also is nearly complete. Nearly 80% have latrines but there is
no sewerage system. New ones are dug 40 ft. deep and dumped after they get filled
up. In the absence of a sewerage tank there is a great risk of seepage underground
which may eventually lead to submersion of hutments. There is overcrowding,
but some
households do have open space. The majority of residents are Muslims, followed by
Hindus and schedule castes.
The health seeking behaviour of the people reflects that allopathy is the most
commonly sought mode of treatment amongst basti dwellers and there is one practitioner
of this system employed on part-time basis. The basti people largely availed of the medical
facilities from private and indigenous medical practitioners but the access to medical and
health care facilities from health centres of public system is rather poor. One of the
factors attributed is
non availability of drugs. A large number of pregnant women deliver
at homes and only a few go to state or private health facilities depending on the socio
economic status and complication during pregnancy. There is one Aanganwadi centre
located in the basti. It is a service delivery point for maternal and child care, nutrition,
immunization, non formal education of pre-school children.
The main vocation of the people is semi skilled work like making of wooden
handles for masonry, woodwork, painters, labourer, mechanics, business like trading of
fish, stones etc. The children are engaged in household chores and also assist in the
production of finished goods which is the traditional vocation of their elders for the last
25 to 30 years. The occupational hazard exists in wood carvers because sawdust is
9
inhaled. In one locality, there were a large number of cases of tuberculosis reported. The
present status and prevalence of disease could not be ascertained.
The educational facilities comprised of a Govt, school where only 50 to 60 children
are taking
education regularly at primary level. The Masjid also runs a school under tiie
supervision of Maulvi for primary class. There is government college nearby but very few
take education at that level.
Basti leaders and local residents sought to know more about the purpose of visit,
the expectation from them and how it will help in solving a plethora of their problems
like water supply, disposal and handling of garbage, better health care facilities etc.
It
was explained to them that our organization cannot provide all these facilities
as it does not have sufficient funds but it will spare no effort in putting their problems
in the right focus. Secondly, health issues must be prioritized on their agenda as they
have an impact on practically all aspects of life - social, economic and developmental.
Thirdly, healthy interaction of children from educated and elite families would create a
lasting bond and understanding with the basti people. So the whole basti should co-operate
and allow them to interact.
On Interrogation with Abdul Gaffar, leader of basti and local residents
4
They are living in the basti for the last 25 years. The basti leader was devoting
whole time to the basti until
recently when he had taken a job.
He received
education only up to primary level and others have taken education up to middle level.
They are all involved in their respective work and are well aware of the common problems
existing in the basti. None of them was directly involved in the health awareness campaign
in their locality but they have a rapport with the organisations working in the area.
On interrogation with N.L. Kataria the indigenous medical practitioner
He is working on part time basis and practices allopathy in the locality. He does
not keep meticulous records of population or families served by him. Those patients who
cannot afford expensive treatment from private clinics/ nursing homes reported to him.
He had to treat free or at token cost sometimes. Patients usually come to him for minor
ailments like fever, cough, diarrhoea, vomiting, scabies etc. He refers serious cases to
the hospital.
10
On interrogation with Nazma, a Anganwadi worker
The anganwadi worker is not a resident of the basti but comes from another
area. She keeps the records of MCH and nutritional services. The Anganwadi centre is
not commonly used as an immunisation delivery point nor does it try to involve itself in
regular health education work for the basti people. But she helps the field staff of Health
Department and voluntary agencies in organising World Population day, World AIDS day
etc.
Brief report of Brain storming session
A meeting of the heads and teachers of institutions was arranged at the office
of Concerned Citizen for Community Health and Development Centre at 11 p.m. on May
1, 1998.
It was attended by 20 persons representing Principals of various schools, leader
of kachi basti and social scientists, journalists and health workers. In the beginning,
the
background and expectations of this meeting which focus on the Pro poor programme
of urban slum were broadly explained by Dr. Raj Bhandari, a paediatrician, and the idea
of imparting identified health messages to the senior students was mooted. These students
would act as ’agents of change’ by disseminating
information and knowledge on the
select topics of ORS, Immunization, IDD and sanitation to the basti people in their own
perspective and perception.
The views expressed by all participants and guests supported the action plan to
be implemented in the slums. The group discussed the tentative dates for holding the
training of senior students. It was decided to hold the training on 9th and 11th May 1998.
It was also agreed that a total of 30 students would be sent from the participating schools
for undertaking visits to the slums. For establishing proper linkages with the basti people,
children can enact role plays, dramas and group songs. Members from other schools
and a basti school also agreed to participate in the programme.
A report on training of students held on 9th May 1998
There were 32 children accompanied with four teachers who were selected for
intensive training on various themes relating to ORS, Immunization and IDD.
11
Representatives of Institutions
In the beginning there was brief introduction of all the participants and those who
had earlier taken experience of working in slums, were requested to narrate their
experiences. There were about 4 children who had taken part in some activity in the
slums while 5 children had taken part in rural projects. It was a maiden experience for
the rest.
Senior students of schools — looking ahead
12
Dr. Bhandari gave the background understanding and insight about the project
He focused mainly on the state of health of children living in the slums and the vital role
which children with motivation can play as ‘agents of change’ in dissemination of important
messages on health He hoped that a change, however small, would effect the health
seeking behaviour of the community living in the slum. Prototype of the educational
material was prepared by CCCHaD and some other material procured from the I EC Dept,
and UNICEF, Jaipur was distributed to the participants.
Dr. S.M. Dugar, a retired professor from SMS Medical College and local practitioner
gave talk on the causation of diarrhoeal diseases, signs
and symptoms and prevention
of diarrhoeal diseases. He advised that ORS and Home Available Fluids ( HAF ) are
the mainstay of treatment and comforted that irrational drug use is on the decline.
A clean environment and safe drinking water is as important a matter of concern
as is personal hygiene eg washing of hands with soap before eating meals. The
children were explained the benefits of administration of ORS to the children suffering
from diarrhoeal diseases.
In the technical session on Immunization, the vaccine preventable diseases covered
under UIP were thoroughly discussed and children were also exhorted to spread awareness
of the 2nd phase of TTI drive to be schedule from 24th to 30th May, 1998. The success
of Pulse Polio Immunisation (PPI) was also highlighted.
In the end, the children were divided into three groups and each group came up
with role play/ group songs on the identified health themes. They were guided by their
teachers
and
appreciation
was
placed
on
record
for
this
spontaneous
activity
which emerged as an aftermath of imparting information and knowledge on the health
themes.
On second day of training,
in the morning session Ms. Vanya who is a paramedic
and possesses experience of working in the slums of Bombay and Jaipur
spoke with
sensitivity on interpersonal communication, rapport building and how to familiarise with
the basti people.
Dr. A L Sharda explained about various indicators of health like IMR, MMR etc.
and problem of overcrowding in urban slums. She also gave a talk on iodised salt and
iodine deficiency diseases which are responsible for mental and physical retardation in
children. The government policy that iodised salt is mandatory for public sale was also
13
stressed In the end, a simple test for iodine content of common salt was demonstrated
with
on.
Intensive training of the future trainers
Dr. Bhandari also showed the immunization card (mother and child vaccination)
which was available at all MOW centres and advised that people should be guided towards
availing the services already existing in these centres. Those people who have knowledge
about ORS and Iodised Salt but are not ready to accept using it must be specially
targetted. The advantages of such practices must be highlighted. The children were very
receptive and assured they would use creative skills for developing posters, role plays
etc. They were exhorted to interact and sensitize the peer proup for accompanying them
in the basti and working hand in hand, breaking any barriers which impeded the fulfillment
of their mission.
Facts of visits to the Khadda Basti
Students and teachers zeroed at the basti for planned action at 7 AM. Each
interaction lasted about two hours. At the end of the visit, the office of CCCH&D was
meeting place where informal discussions were held and refreshment served. It also
served as storehouse of information where handouts, books and journals were kept
and group meetings held.
14
Visit 1 : (16th May 1998) The basic aim was rapport building and interacting
with the slum dwellers. Two Basti leaders accompanied us to the slums and introduced
us to the people living there, convincing them that we were really going to help them
unlike their previous experience.
/In
■■I.
Field experience In slum - accepting the challenge
The teachers divided the students into groups of two, to facilitate house to
house contact and exhorted the students on how to keep the right step forward in
winning over their confidence so that by interacting with them they could actually make
a difference. The students mixed easily with the other children of the basti which enthused
the parents
and then it became easy to pass the information. For familiarising and
understanding, the students tried to learn about education, health and recreational facilities.
The teachers took into confidence some of the adult members of the family and explained
to them the purpose of the programme.
Visit 2 : (23rd May 1998) The motto was to establish a lasting relationship
so that they would welcome our further visits and became interested in listening
to us. So we made sure that our future visits will definitely make a deep impression on
15
•4
Rapport building — A novel experience
them. By encouraging them to share experiences, we tried to strengthen the relationship
of the last visit. There was still resistance at some places but gradually the behaviour
became quite positive and receptive. The message of the TTI programme from the 24th
to the 30th May was propagated as per government guidelines so that maximum number
of women turned up for immunisation.
Visit 3 : (30th May 1998) The participating students had composed a song to
pass on the information and they sang it with such dedication that there was a lot of
appreciation. Music is one of the best ways to reach any one’s heart. This was proved
when others also joined in. The older children of the basti were really motivated and they
agreed to join hands for such programmes. Students who were specially trained also
demonstrated the technique of constituting ORS and answered all questions related to
the topic.
The day also happened to be the last day of the TTI
programme (2nd
phase) organised by the government. The task force of the students helped in
motivating and escorting those who sought TTI vaccination (married women in the age
16
Entering
group
to
40
the government and
Into a relationship- Deepali Paul supervises
years).
The
students
helped
non-government sectors
in
the
service
conducting
providers
the
from
immunisation
programme.
Visit 4 : (6th June ’98) Health messages which were delivered to the
people on ORS, IDD and Immunisation were well received looking at the active
participation of the local people. The students also played cricket with the children
and invited them to work together for disseminating health messages. The children
rejoiced at the idea
The group undertook a ‘Pad Yatra’,
displayed the banners and placards,
chanted theme songs as the procession marched ahead. It culminated in assembling at
the temple of Kali Mata where ‘Prasad’ was distributed to al! and the meeting concluded.
A firm resolve was made to take the programme from door to door for the welfare of
the people.
17
Motivating for Immunization - TTI campaign
Visit 5 :
(13 June’ 98) The students strengthened the old linkages and
tried to enthuse their peers and the community people with the knowledge of health
related topics. There was an attempt to meet the peer group mainly boys who had
assured support earlier. But the difficulty faced was they had left for work already. Most
of the children did not go for higher studies.
We converged finally at the house of ‘Badi Bi’ a middle aged lady, who was very
co-operative and helpful. She allowed us to use her house which had a large ‘angan
(open space) where the children could assemble and discuss strategies. It was also
suggested by her to hold medical camps, melas and nukkar sabha for promoting the
health theme. She also offered her place for any function we propose to hold as her
place was quite popular for hosting such events in the past. A song competition and
quiz with basti children was organised and prizes distributed.
The teacher discussed with the students the course of the next meeting and
advised them to make a social and resource map of the Basti. It facilitated the process
of increasing the outreach and also helped to draw design for establishing
permanent resources for health activities in the basti.
18
Pad yatra for using iodized salt - Mr. V.P.Singh leads
Visit 6 : (20, June’ 98), The field visit to the slum area in Khadda and Harijan
basti was undertaken. The identified health messages were given in the basti.
The team returned to the office of CCCH&D to discuss the events that would be
held in the Bal Mela proposed to be organised in the bast:. It was decided to hold a
Healthy Baby Show and also perform a skit. There was a small lecture by Mr. Abdul
Aleem, social worker, highlighting that the priorities of the slum-dwellers are water,
electricity, sewerage, organised settlement and health facilities. There is also a committee
in the municipal corporation which looks after these needs The message on health
awareness, however small, is a major step in alleviating the rising cost of treatment of
common ailments
Also, the students need to understand their problems and
empathise with the basti people from time to time. Mr. Aleem also read out some
Urdu couplets to boost the morale of the students for taking up the challenge of generating
awareness in the field of health and assured them of his support.
Brief informal discussions were also held with teachers of different schools and
an outline of the function to be organized for Bal Mela was drawn. It was decided that
three points for creating a resource in the Basti be identified to enable the people to
19
seek information and services on the three identified health messages. It was
suggested
that the Anganwadi centre where ORS demonstration was held be designated as Resource
Post 1. The clinic doctor where immunization for tetanus toxoid was provided as Resource
Post 2. The place of
Resource Post 3
shopkeeper trained for testing of iodated salt be designated as
It was proposed that these three Resource posts will work in
"Tt*
A song competition and quiz- Mr. Peter judges
I
Students at work - drawing strategies
20
tandem with governmental and other agencies for expanding the above activities in
the future and pave way for sustainability of this programme.
It was felt that the young trainers had some difficulties in testing for looized sail
in the basti. At a few places, they found that the salt was semisolid and appeared
Trainer demonstrating ORS technique
substandard but tested positive for iodine. On tracing backwards, it was learnt that one
shopkeeper was providing substandard salt.
A meeting was held where in it was suggested that officials of the salt department,
Govt, of India, should be invited, for obtaining guidance and necessary direction in the
matter. This would also further strengthen the previous training on IDO.
Mid Course Training :
All the students assembled at the office of CCCH&D. A session on iodated salt
was taken up by Mr. Jaipal Singh, Asst. Commissioner of Salt Department, Govt, of India
in which he exhorted the students to take the message of iodated salt till as far as the
village level and also to other schools which are located in slums and rural areas. He
also demonstrated how to test for iodized salt and clarified that anything above 15 ppm
21
--
is suitable for human consumption. Officials of the salt department accompanied the
children to the basti and took samples of the salt from the shopkeepers
The whole team returned to the office of CCCH&D and held a discussion. It was
told by Mr. Y. Singh that the repackaged salt was substandard but contained Iodine
which was sufficient in one sample
and was sub optima! in the other sample. This was
followed by a question-answer session in the afternoon.
Visit 7 : (27 June ’1998) The students in this visit tested samples of salt in
households. At one place it was found that the salt was hard and repackaged because
it did not bear the name and address of the manufacturer. The lady of the house was
informed that she should return the salt and get it replaced by an authorised brand
having the symbol of ‘smiling sun’ which denotes iodized salt.
During the entire period, a fairly large number of community people gathered and
listened attentively. The teachers discussed issues with the Basti people and also planned
the activities to be undertaken for the Mela on 4th July.
An official testing for Iodised salt
22
1
There was overwhelming response from the local people who also agreed to
clean up the basti Throughout the process, the peers of the students were also
helpful in creating an enabling environment and taking initiatives for organizing the
Mela. Their faces lit up when they heard that prizes would also be distributed.
At the end, the students came to the office and with the help of their
teachers got engaged in group activities. Four teams comprising of school students
and their peers in Basti were entrusted with the responsibility of three Resource
Posts and Healthy Baby Competition. The planning was done and strategies for
Mela were drawn.
Visit 8 : The students converged in the basti as usual and undertook visits
along with the local voluntary groups to make the people aware of the role of iodine
in
our body, its importance as a micro nutrient and the physical and mental handicaps
which its deficiency can lead to.
They also visited the shops where the salt is sold in the Basti. They trained two
shop keepers for testing of iodine content of salt. They told them with the support of
teachers and doctor that one of the brands of salt which they possessed was not approved
F3
Students testing for iodine content of common salt
23
by the government and did not bear any address of the manufacturer. The shop keeper
should be cautious in buying such brands which are not registered 01 approved by the
government.
The visit
proved very successful
in
evoking
public acceptance
that
only
iodized salt should be consumed. However, no case of goitre or cretinism was detected
and the people here said that they had no knowledge of any such case existing in the
basti.
The Bal Mela :
On completion of the 8th visit, a mela was organized. The basti was buzzing
with activity. Some were going to work, some were enquiring about the items which
will be offered but mostly people were witnessing the arrangements being made for the
Mela.
The students also displayed posters and charts prepared by them incorporating
simple messages in Hindi. One of the slogans was "ORS Ka Ghol Pilao, Daston Ki
A shopkeeper - Testing salt
24
•V
1
Z’
Concerned citizens visit to a
Basti in jubilant mood
Bimari Bhagao" There was enthusiasm in the young people and it in creating a conducive
and enabling environment for health awareness.
The students had made 3 Resource Posts on ORS, Immunisation and IDD
respectively each manned by a group of trained volunteers. This innovation was to be a
major milestone in the developmental phase of the project. Apart from strengthening
their existing role and providing a window for service to the community, it is also a time
saving and cost effective means of promoting and sustaining health services.
Dr. Rameshwar Sharma also tested the knowledge of these volunteers by posing
some very pertinent questions and appreciated that the ‘young adults’ had transformed
into agents of change as ‘young trainers’. After visiting the Resource Posts, the healthy
baby competition which was organised by the FPAI
became the focal point. The children
in the age group of 0-1 year, 1 to 3 year, and 3 to 5 year were examined by a panel
of doctors and on the basis of certain criteria like height, weight,
head circumference,
mid arm circumference, immunisation status, and general examination were adjudged on
the basis of these criteria.
25
There was also a video cassette on the identified health themes. Besides other
attractions
like merry-go-round,
house hold
games, group songs and
role plays,
sweets (Ladoos) were also distributed to people and children to energise their mood of
festivity.
With the whole hearted participation of the community, a function was organised
for the guests. The
(Ophthalmologist, USA),
speakers included
Dr.
Shri A. L Roongta
Suresh Joshi
(UNICEF),
Dr.
R.
Modi
(Retd. IAS), Shri N L Verma (Director, Dr
Ambedkar Vidhyalaya), Mr Kataria and Rashid Bhai all of whom gave their perception of
the ‘child to child programme' and appreciated the role of the organisation in organising
this function in such a lively and remarkable manner with whole hearted participation of
the children Dr. Sharma also spoke at length regarding the unique style and coherent
design of such a community education programme undertaken by the organisation and
wished it all success.
The children, (including the basti children and peer educators) expressed
their understanding of the health message. There was a group song and instrumental
music item prepared by students of St Xaviers and a skit by Maheshwari Public School
I- ''
Students singing theme song - people Basti listen
26
One of the most successful events was when a young girl from the basti school recited
a poem on diarrhoel diseases and its relation to sanitation. Some other theme songs and
skits were composed and presented by the students and teachers group. A student, Mohit
Poddar, also flashed this project on the web as Project AWARE on the Internet, He
received several queries and messages.
The programme also helped them to cope with the psychological stress that they
fee! at this age by sharing of experiences and accepting new challenges. The spirit of
working as a team built up cohesiveness and leadership quality. It also helped in
channeling their energy by undertaking such constructive activity in the field where
both
physical
and
mental endurance are
put to test.
In
terms
of
developing
responsible behaviour, they worked together with the opposite sex in group activities
which helped them develop positive self image and confidence. The other less visible
impact was by way of learning about the hardships and difficulties faced by the people
of basti and the field visits left indelible impressions of their living conditions, environment
and sanitation, attitudes and beliefs towards various issues like gender bias, health and
family welfare.
The other visible change noticed in the outlook of the students was feeling of
achievement and satisfaction. There was a new dimension added to their personality
which enhanced their self confidence and image, improved communication skills,
promoted peer adjustment and positive development. This was amply reflected in their
behaviour and concern for the people living in the Basti.
On the whole, it was a programme of the children, by the children and for all
the children with participation of the elders in the community.
’Appreciation Galore’ and Distribution of Certificates
The exemplary work done by the students was very much appreciated. On the
occasion, Ms. M Golechha, Mrs Singhvi, Mr. Venkatesh Sriniwasan, Project Officer, UNFPA
along with other eminent members of the society presented certificates of meritorious
work to the students and teachers.
27
Valedictory function to honour children-in-charge for change
Some reactions of the people in Basti
The people in the basti appreciated the health awareness programme as an
innovation where in children of two diverse social groups and economic strata
interacted on health issues. Earlier, they had not witnessed similar activity in the last
many years. It helped the community in becoming informed on health issues and
brought about a qualitative change in their perception of ORS, IDD, Immunisation
& Sanitation.
Some children said they wanted to read and play. There are many other children
like them but elders push them into work. Some study for a while but loose interest
afterwards. Piecemeal help for children is not enough. ‘Food Card’ can be introduced to
encourage parents to send children to school and also prevent malnutrition.
28
What we learnt
il reiterates our belief and understanding on communication strategy that
1. Simple messages on health themes need to be stressed and developed as effective
communication strategy.
2. Practical demonstrations are going to have much larger impact for acceptance.
Testing of iodized salt and reconstitution of ORS were well understood and found
to be effective for the community level action
3. The feeling of caring for one’s own health was demonstrated by collective action
at ‘Bal Mela’.
4. Given the opportunity, people were willing to learn and act as co-facilatators for
their own group, paving way for sustaining the efforts for continuing good health
care facility, education, skill training and counselling.
There was also need for
1. Frequent service camps under guidance of expert doctors from time to time.
2. A good referral service for new born care, early childhood diseases, pregnant
women and old people.
3. Greater understanding of a variety of needs
education
housing, employment
generation activities.
4. More sharing of information on the priorities and projects related to children,
despite so much of accumulated experiences.
To conclude : Advocacy with the Principals, training of teachers and
a band of dedicated students along with sensitive youth are the
mainstay of replicating such a programme at community level.
29
Working with, not for, children - Listen to Learn
Some Comments
Today it was a great day of my life, not because of my visiting a slum. Today
I can feel the initial success of our programme, it didn't give me anything solid or
concrete but it gave me a lot of satisfaction, which is an abstract thing. It is colourless
and odourless but I won't say that it is tasteless, it has a taste and I believe that the
persons who have tasted it, they are the happiest in this world.
We say that we are a social creature, so we have certainduties towards our
society too. Society has given us a lot of things so we have to pay back for
all we
have got and I am just trying to do so. I feel, what we teach them is much less than
the things we can learn from them. In spite of having many bitter experiences in life
they are more flexible than us. They are not as much stubborn as I
heard. They all live
in very harsh conditions. Some of the children work to help the family and make both
ends meet. But they are not disappointed, depressed and demoralised. They are still
struggling and struggling to survive, struggling to change their destiny.
—Vikas Lakhani, XI
When I first learnt about the program I felt that it is not a fit place to go. They
are untouchable and belong to different social group. I had no feelings During the
interaction every week, I realised they too are humans and equal.
—Shobit, XI
These people in Khadda Basti are under privileged so we can do something for
them.
—Anurag Khatri, IX
Education should not be limited and must be shared with the people through
various activities both health and intellectual.
-Mohit Kacholia, XI
30
1
The people in Basti are good ana Kind. I could not do as much as I wanted
to do because I had joined hobby classes during vacations. There is too much of filth
and junk on the roadside.
-Garima, IX
I would like to go again if I get a chance. I felt like a responsible citizen of my
country in lifting up the people living below poverty line. I can now understand life better.
— Abhishek Punia
Today when I visited Adarsh Nagar slum first of all I was very excited and happy
because all of us i.e. Saint Xaviers, M.P.S., S.M.S., S.J. and Vidyashram were together
and was ready for doing such a good job, giving them health messages.
-Rahul Arora and Charu Chopra, IX
Some of the people also said we don’t want to talk to you.
You are
government people.
-Hirdesh Pliwal, XI
A difficult challenge I faced was on one of the visits to Basti where I met Munni,
14 year old who was pale, malnourished and spent long hours at work. She also took
care of a small child 3 years old. On the visits, I could see hungry eyes and sagging
spirits with little support from adult world. The experience left me emotionally drained
but it reminded me why I undertook this challenge to work selflessly on behalf of the
vulnerable.
-Purva Bhandari, IX
31
and
>o
'7
i
'■
-
How Teacher felt
Learn to Listen
Initially, I was hesitant whether students would be willing to work in the slums.
Nov/, I feel more confident and understand the various health issues of chidren much
better. The whole operation was very methodical. The strategies were carefully planned
and implemented. The participation of children, UNICEF and other organisations who
helped deserve all praise.
-V. P. Singh
Having worked in similar programme earlier also, this Child to Child Programme
for Health Awareness made me more empathetic listener. Under the guidance of Dr.
Bhandari, we could serve the marginalised and underfed, in a way that empowers them
to meet their own needs.
-Deepali Paul
It was a novel experience to work with so many children of diverse background.
A lot of work needs to be done.
-N. L Verma
The facilitators were well trained and organised. I was sceptical about their active
involvement till the end of the programme but I was wrong. They not only endured but
also enjoyed.
— Peter Thakur
Children are capable, resourceful people whose individual feelings and
opinion must be respected.
32
3oo
IS3I3>
A Message to Children
Preeti, a student of School near basti, delivers theme message on ORS
....... If disadvantaged and under-served persons in every part of the globe are to
enjoy the benefits of good health, it is essential for every man, woman and child to "think
health"-to recognise health implications in almost every facet of daily life and take the
right kinds of action, both for combating health problems and for helping themselves and
their neighbours towards healthier ways of living.
-Hiroshi Nakajima
Director General
World Health Organization.
33
WE REMEMBER
Resource Post - 1
Anganwadi centre "ORS"
|r^*‘
Lite
■ v
Resource Post - 2
Immunization Clinic
Resource Post-3
"IDD"
^5 r -t
ml
34
_____ L_.
GLIMPSES
.a
Basti students in the
role of peer educators
This is ORS packet
"Save a child with
diarrhoea11
Trainer gives health
messagesThe caravan goes
on and on...
35
W
Children welcomed in holy
Masjid Education has no
barriers
.r
• jlw
ORS- Anyone like to taste
Is the salt fit for
human consumption ?
36
*
GLOSSARY
ICDS
Integrated Child Development Scheme
PHC
Primary Health Centre
MCW
Mother and Child Welfare Centre
FP
Family Planning
ORS
Oral Re-hydration Solution
IDD
Iodised Deficiency Disease
Basti
Khadda Basti (A slum in Adarsh Nagar)
LTS
Leadership and Training in Service
HAF
Home Available Fluids
TTI
Tetanus Toxoid Immunisation
PPI
Pulse Polio Immunisation
IMR
Infant Mortality Rate
MMR
Maternal Mortality rate
Resource Post 1
Demonstration of ORS at Anganwadi Cehtre
Resource Post 2
Immunisation Centre at Medical Practitioner
Resource Post 3
Testing Iodine content of salt by Shopkeeper
FPAI
Family Planning Association of India.
CCCH&D
Concerned Citizens fo Community Health
& Development.
37
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