Shereen Sureksha - final report.pdf
Media
- extracted text
-
COMMUNITY HEALTH LEARNING PROGRAMME
June 2011 to October 2011
REPORT
Shereen Sureksha
Intern, Community health Cell
(June-2011 to october2011)
CONTENTS:
What made me to join CHLP
Acknowledgements
Learning objectives
Orientation programme
List of Organizations visited
List of field visits
Paradigm shift in my life
My experience at K.G.Halli
My new learnings
Summary
ANNEXURE
Care givers test (Questionnaire)
About SOCHINI
About BNI
Photographs taken in community
WHAT MADE ME TO JOIN CHC
I am a trained nurse by profession. I completed my bachelors in the year 2002.Since then I
am working in different fields like Hospitals and nursing colleges. Wherever I worked I had
some questions running around in my mind. Whether money is an important tool for the
people in the society to get whatever they want? ,starting from education to treatment. This
brought more pain in my heart. I have decided to quit the work and find a place where there
is no corruption.
I get to know about the internship programme through Joyce , CHC accidentally. I should
thank god for the door he has opened to ventilate my inner feelings and I feel happy that
there is someone to listen to us. CHC is a place where they provide us the space to grow.
Instead of the slogan “Health is wealth” it became “wealth is health”. Now a day’s even the
Hospitals has become the business centre where they can make more money compare to
the other industry. Everywhere corruption rules the country. This made me to come out of
the private sector. That is how my journey started in CHC.
ACKNOWLEDGEMENT
This Report is a brief account of my reflections, new learning’s, Insights that happened
during my short internship programme for the past 3 months community health
programme. I am very glad to say that I could see another person in me. It has made a
paradigm shift in my life, attitude &skills. I believe this shift will really have a good impact in
my life. At this juncture I wish to acknowledge my indebtedness to all those who had been
source of inspiration and support to me during the infancy of my journey
I immensely extend my gratitude to all the staff of CHC-administrative, technical and
supportive who helped me with their generously. I would not allow this report to appear
without paying special thanks to Ms.Joyce Premila my mentor who provided me the best
opportunities to gain a wider knowledge and experience in community health as well as
gave time to express my feelings freely, bearing with tantrums on all occasions.
CHC library has been of great help to me and I have borrowed books for my
references.Mr.Swamy has been a great help to me that he had smile no matter how many
times I disturbed him to take the books from the library.
I must deeply appreciate Dr. Thelma Narayan who had keen interest in my journey and gave
me wise and constructive advise to overcome my guilt my over my attitude to the past life.
I owe my heart felt respect and love my field mentors Dr.Mani,
Ms.Aparna,Mr.Janardhanan for their guidance and support
Mr.Guru,
I thank all the facilatators Dr.RaviNarayan ,Dr.Thelma
narayan,Fr.Claud,Sr.Aquanius,Ms.Valli,Dr.Sunil, Mr.premdas,
Ms.Lavanya,Dr.Shiridi,Dr.Prakash Rao,Mr.Chander for their efforts to make me grasp the
dynamics of community health .
My warm appreciation is extended to all my young friends
Mr.Santhosh,Ms.Veena,Mr.Suraj,Mr.Oblesh who accommodated me in their circle of
“ Fellow 2011”
I thank my Husband for been a support all through my internship. Without his cooperation I
could have not completed my CHLP.
Learning Objectives
During the period of my CHLP orientation programme I found my area of interest in the
field of mental illness where I didn’t have any experience in the community. I have planned
to conduct a case study on the caregivers of PWMI.I had a deep feeling & thinking about
the stress caregivers undergo in their day today life. It strike me there that they are the
vulnerable group to develop the Mental illness in future due to various factor. Based on my
interest I formed my learning objectives as follows;
Overall Objectives:
} To conduct a study at Bangalore urban slum to understand the stress level of three types
of caregivers viz
• Having a family member who shows signs of mild mental illness
•
Having a family member who shows signs of moderate mental illness
•
Having a family member who shows signs of severe mental illness
} To understand the different types of mental health care services available in Bangalore
for people with mental illness (PWMI).
STRATEGIES TO MEET THE OBJECTIVES
•
•
•
•
•
•
•
•
•
•
•
•
•
To visit organizations involved in mental health issues
To go for field visits which is covered by those organizations
Identify a particular community where they speak the language I know (i.e. Tamil)
Planned to Take 3 families needed for my case study
Regular home visits to maintain good IPR &to gain their confidence
Give Prior information to the families about the date and time of my visit to get
them prepared
Conduct & attend the caregivers meeting in the field as well as in the organization
Observe and reflect with my mentors to analyse the problem and to find solution
Maintain daily report and documentation of observations I made in the community
Interact with likeminded people who are already animating such initiatives in these
organizations which I visit
Meet with mentors to reflect on each other and to know more about myself
Refer relevant books and materials to add more value to my content and to learn
more.
Interact with federation members for PWMI to know more about the cases taken in
the area where they live.
•
Accompany the PWMI to the hospital at the time of their regular check up along
with the caregiver.
THE ORIENTATION PROGRAMME
The orientation programme was scheduled by CHC for 10 days for all 5 interns who
volunteered to undergo the community health learning programme (CHLP). 1st of June
sessions started with the introduction about SOCHARA by Mr.Premdas.later we had many
sessions for the following days. Really these sessions were more innovative and
informative.Ofcourse I had lots of confusion with questions. There I could meet a diverse
group who joined this fellowship with different background and experience. We learnt
many things from each other’s experience. We really enjoyed those sessions. We could feel
a homely atmosphere.
Each session had its own values.Truely speaking I could understand the real meaning
of health & community health which is worth remembering. I felt very bad that so far
I was a floor mopper rather than a tap turner. Unless until we close the tap we should
continue doing floor mopping as a Doctor and nurse. We get to know the about the
importance paradigm shift in our life. During orientation we were also made aware of our
own strengths, skills & dedication needed to work in a community. A book named “Health
for all” is really an eye opener to all to know about the health system in india.We had few
organization visits to APD & BNI .Briefly speaking after the orientation all of us have been
boosted up with our area of interest.
During this period CHC celebrated Fr.Claud’s 80th birthday.That was wonderful day
and opportunity for us to be a part in that celebration.We heard the testimony of many
social activist who got inspired and encouraged by Fr.Claud during 1970’s.one of our
fellow put a word saying that, “it is an ideal parliament”.We were overwhelmed by the
presentation of the real life activists.
Field visits
I had gone for field visits to different areas like Malleswaram, K.G.Halli, D.J Halli, and
Srirampura along with the federation members. I could visit some of the houses where they
have PWMI in their family. Most of the PWMI are female population according to my
observation. And the other aspect I noticed were most of the caregivers is also women.
They shared their life stories with me briefly. The common cause for the illness which I could
find is broken family pattern especially separation of husband & wives .Which affected them
mentally and lead to psychoses. When I enquired about the social welfare programmes I
could see the awareness they have about the programmes. I am glad to see that change.
But the pension scheme has been withhold temporarily due to some corruption. This was
the problem shared by them in welfare programmes. These visits gave me an insight on the
problems and awareness people have in the community.
Visit at Malleswaram
As per the plans we made i had been to malleswaram along with
Mrs.Sharadhamma ,president of the vedike. We have visited 5 families where they have
PWMI at home. I have taken to a family where they have 2 children with congenital mental
retardation. Among them the first daughter still has 100% illness. She doesn’t even talk to
any one. The other boy has some kind of improvement after the medications. Now he is
better in handling g things. For e.g. can purchase the basic items like vegetables, provision
items for home. When we talk to them about the plan to have daycare they were so happy
to hear.Because the caregiver who is their mother was in need of some kind of
ventilation.E.g.She shared that she couldn’t attend any of the family functions due to the
responsibility of taking care for their children.
The next house we visited was a man who has moderate mental illness has had the attack of
stroke. From that time he couldn’t move his right hand & leg due to paralysis. He is married
and has 2 school going children. The care giver is her mother & wife. His mother is aged
and there is no proper income for the family.Hiswife doing domestic work and meet all the
expenses of the family including rent. Here they have lots of issues like poor socioeconomic
status, poverty & health of the women & children has been affected. No time to think even
about women health in this case.
The other family i visited where the breadwinner and caregiver was the mother of a young
boy with severe mental illness. When we spoke to the mother i could see the tears all the
time on her face. The stress she has undergone is so much. She shared that managing
each day is like managing year. By the time she goes for her domestic work her son go
somewhere and create some problem one or the other day in the public. Daily his mother
has to go and solve the problems which happen daily. The neighbours stay near by their
home are quiet understandable. But if he goes to the next street when he simply stands
and stares at any women they beat him up very badly and send him back. So apart from the
stress she has, she has to spend rest of her timings to solve those problems. She is a widow.
She has long suffering where her mental health also has to be taken care.
Visit at Srirampura
I had gone to visit this place along with the other fellow from BNI.There we met Ms.
Panjavarnam who is a federation member residing in the same area. First we were taken to
her sister house where her mother itself is suffering from severe mental illness. The
caregiver is her daughter. When we referred to the previous history her mother was
seriously ill. They lost the hope. By the time Ms.Panjavarnam heard about the health
facilities for PWMI.Once the treatment started to her mother she could some changes in her
mother.For.eg.Her mother didn’t took medicine for 3 months. Once the treatment started
only she has started to take food & responded little. This gave the hope to Ms.Panjavarnam
and has started to work for PWMI.
The other family where we were taken was a man who has Moderate mental illness. He was
the bread winner of the family. Due to some loss in the business he acquired mental illness
for the past 6 years. His wife shared her feelings and problems she is facing. She is having
2 school going daughters. She was worried about the future of her girl children. She goes
for domestic work to feed the family. Apart from that she has to take care of her husband.
This changed her routine life itself for the past 6 years. By the time we entered itself she was
looking for a financial support from us. These were my observations in Srirampura.
Visit at K.G.Halli
Other day I had been to K.G.Halli from APD along with Ms.Selvi federation member and
field staff of APD.We had been to 4 houses where i could spend some time with them to
know the life story of each case. The cases I have taken for my case study are these families.
They have cooperated well with me.
When we come to the life story of Ms.Sugirtha, she started to get this illness after her first
delivery. She has taken treatment in Nimhans Hospital for some time and stopped later.
Since 6 years she is continuing her medicine in Victoria Hospital. When i enquired the
federation member about the commitment she has to work for the PWMI, she replied by
saying that initially when her husband was suffering from mental illness she took him to all
type of traditional healers. But the condition worsened.Finally she came to know about the
treatment available for mental illness through some awareness programme. Then she took
him to the Hospital and could see some improvement.This incident made her to commit her
whole life to bring awareness to the public regarding Mental illness and to take them to the
Hospital .I was really impressed by her testimony. I could see the fire in her eyes.
NEED FOR THE STUDY:
Caregivers are usually so involved in caring for the needs of their loved ones that they can
easily lose sight of their own needs. To get a better idea of the level of stress they undergo I
had a desire to deal with primary caregivers.
Details of my case study:
Families selected for my study are as follows;
3 families living in K.G.halli (Near B.S.A Road)
Case A: Mrs.Suganthi(PWSMI)
Case B: Mrs.Sugirtha (PWMMI)
Case C: Mrs.Rajeshwari (PWMiMI)
Brief description about the cases with Mental illness:
Following are the cases to which the care givers are giving care at home. The caregivers of
the following cases I have taken for my case study
Case No-A (PWSMI)
:Mrs.Suganthi
} Name
: 40yrs
} Age
: Female
} Sex
:Daughter-21yrs
} Children
Son-18yrs
: Mother (Mrs.logamma-60yrs)
} Caregiver
} The PWMI was identified by APD 10yrs back. The field staff is Mrs.Selvi (vicePresident) of federation. She used to accompany her all the time to Hospital when
suganthi had severe mental illness. Later her mother accompanies suganthi.Now the
condition is better from severe to Moderate illness. Present complaints by family
are she becomes angry whenever she get head ache, and episodes of aura stage of
epilepsy at least 3-4 times a month. Present complaints of body pain and stiffness of
the body. Some times difficulty in speaking, loss of appetite.
} Patient complaints of heaviness of head & headache, body pain, lack of sleep,
difficulty to speak and feeling confused all the time.
} On my observation she responded well & relevant to my questions. She couldn’t
returns back home safely wherever she goes, sharing things with others like food,
utensil, swollen lips due to mouth biting. She has other health problems like
uterine prolapsed.
Case No-B(PWMMI)
:Mrs.Sugirtha
} Name
: 32yrs
} Age
: Female
} Sex
:Daughter-13yrs
} Children
Son-10yrs
: Mother (Mrs.Arputham-50yrs)
} Caregiver
} The PWMI was identified by APD 6yrs back. The field staff is Mrs.Selvi (vicePresident) of federation. She used to accompany her all the time to Hospital when
sugirtha had severe mental illness. Later her mother accompanies sugirtha.Now the
condition is better and has Moderate illness.
} Present complaints by family are she becomes angry whenever she get head ache,
Heavy binge of eating, sleeping most of the time, uses filthy words, careless in
handling cash, but do shopping for up to Rs.100.
} Patient complaints of heaviness of head & headache, body pain, feeling sleepy all the
time.
} On my observation she responded well & relevant to my questions. She returns back
home safely wherever she goes, likes to sleep most of the time, sharing things with
others like food, utensils.
Case No-C (PWMiMI)
:Mrs.Rajeshwari
} Name
: 41yrs
} Age
: Female
} Sex
:Sons-03
} Children
:Daughter-in-law(Mrs.Kalavathy)
} Caregiver
} The PWMI was identified by APD 3yrs back. The field staff is Mrs.Selvi (vicePresident) of federation. She used to accompany her all the time to Hospital when
she had depression, type of mental illness. She had first episode of convulsion when
she was 28yrs old. Since her husband was an alcoholic she started to get affected
mentally. Her son & daughter –in-law are the caregivers. Now the condition is better
and has Mild mental illness.
} Present complaints by family are she becomes angry & get head ache, inadequate
food intake.
} Patient complaints of headache often due to which she becomes angry all the time
and shouts at children.
My literature review related to stress
STRESS:
}
Stress can be defined as may be an internal state which can be caused by physical
demands on the body such as disease,exercise,extremes of temparature,professional
hazards and so on or by environmental and social situations which are evaluated as
potentially harmful, uncontrollable,
Or exceeding our resources for coping.
} Stress can also be defined as a failure to adapt.
TYPES OF STRESSFUL SITUATIONS:
}
}
}
}
}
}
}
}
}
}
}
}
}
}
Death of spouse
Divorce
Marital separation
Death of close family members
Personal injury or illness
Marriage
Retirement
Pregnancy
Sexual difficulties
Addition of new family members
Major business readjustment
Being fired from job
Jail term
Change in the health of family members - This is the cause for the families I have
taken for my study
STRESS MANAGEMENT TECHNIQUES: (Tips)
§
§
§
Massage:
Massage reduced the level of glucocorticoids and epinephrine in depressed
mother with infants.
Deep breathing exercise:
The first step is to bring your breathing under control;
§ Exhale completely
§ Then slowly breathe in through your nose
§ Expand your diaphragm/belly to bring air into the lower portion of your
lungs.
§ As you gradually fill your lungs from bottom to top, expand your chest
§ At the end lift your shoulders for a last bit of volume
§ Briefly pass your breathing
§ Then relax and let the air flow smoothly and fully out through your mouth
§ Pull in your stomach at the end to expel the last bit of air
§ Enjoy the emptiness for a few seconds
§ Then begin another breath
§ As we do this a few times pay attention to the sound and sensation of your
breath. If you get lightheaded at first then breathe normally.
Physical exercise;
One of the most obvious ways to relieve stress is to do what the body was
meant to do under those circumstances. Exercise proves to be an excellent
mechanism for stress reduction. It helps;
} To lower the level of nor epinephrine released in response to stress
} To improve infection fighting capability
} To significantly reduce the negative effects of stress
§
§
Practice of meditation
Relieve stress through senses
- Smell, cry, sense of humour, belly laugh, crying, listening to music
Use your sense of humour. Seek belly laugh which makes you feel good as well as
more stress proof.
Crying relieve stress
Using music also reduce stress especially slowed down rhythm.
INTERVENTIONS:
There are some interventions which I carried out based on the stress management
techniques.
Techniques used among the caregivers are;
} Physical activity
} Deep breathing exercise
} Massage
} Relieve stress through senses
(Smell, cry, sense of humour,belly laugh,crying,listening to
music)
FEEDBACK GIVEN BY THE SAMPLES I HAVE TAKEN (CAREGIVERS):
} ‘I feel better now after I do this relaxation technique which you taught’
-Mrs. Arputham
} ‘I am getting better sleep now a days and & stopped thinking too much’
-Mrs. Logamma
} ‘I started to accept my mother-in-law’s anger and whenever I get anger and head
ache, the deep breathing exercise taught by you reduce my heaviness of the head. I
am happy that I could manage everything now’
-Mrs.kalavathy
MY REFLECTION:
I have learnt a lot through implementation of what I read.I read a book called stress-Burnt
out to balance.Which gave me an insight on the different techniques to manage stress level
at home.I applied my learnings into practise.I could see a better response from the
community. I could really analyze the importance of putting text into context .The feedbacks
given by them were such an encouraging tool for me to involve more in community health
care. I could feel the real joy in my heart.
As an Intern at BNI
Since my objectives were based on the mental illness I was posted at BNI, Banaswadi.My
field mentor was Dr.Mani.I was guided by my mentor during my field placements. I had
been to Different organizations like APSA, Paraspara, and APD for an orientation. They are
the partner organizations of BNI.These organizations work for PWMI too. They conduct
awareness programmes, Advocacy for PWMI.And I planned my daily activities along with
Ms.Aparna programme co-ordinator at BNI as per Dr.Mani’s Instruction. Every Tuesday’s I
have planned to go to BNI .I have reflect with my mentor on the observations I made and
analysed some issues like bribes in Government hospitals, Denial of the general healthcare
for the PWMI, Alternatives for the caregivers who are old age. Some reflections analysed
are to give awareness to the federation members regarding right to avail free health
services. So that they can create awareness among public. I spent some of my times in the
library at BNI office to gain information regarding social welfare programmes, mental health
services at Bangalore. I could participate in the federation meetings conducted at BNI. The
issues discussed on the meeting were;
• Registration of Federation for PWMI as an independent body
• Tentative planning’s for the intervention to be carried out for the next two
years
• Conducting Review quarterly community meetings with office bearers
• Field staffs requirements
• Budget plan for two years including salaries
During the time I spent at BNI I did documentation of my works. After my field visits I have
chosen K.G.Halli & D.J.Halli to conduct my study. These places comes under the coverage of
APD.I approached Mr.Janardhan, programme coordinator from APD to chose the families
from their field area . The reason why I have chosen is I was comfortable with the language
Tamil. Later I have chosen my cases for the study at K.G Halli itself. One of the cases I have
taken from D.J Halli was not co-operative because they expected some financial support
during my visits. During my each visits they started to avoid me by telling they have fasting,
need rest & so on. So after the failure of all my efforts I have decided to take one more
family from K.G.Halli itself. I have taken 3 families of different categories. I have started to
go for regular visits on every Wednesday, Thursday & Friday’s. During my first visit I have
taken Ms.Selvi federation member cum field staff to the houses taken for my case study.
My second visit onwards I carried out myself.Initally I could gain confidence of the family
members by maintaining good IPR (Inter personal Relationship).The good thing is they
accepted me as one in their family which gave me a foundation to conduct my study.
Mid-term & Final collective session
I have planned to spend all the Mondays at CHC to refer the resources available in
Library and from my mentor. I got the opportunity to share my thoughts & views with
Ms.Joyce, my mentor. I made use of the computer they provided for documentation &
reference point.
We had midterm collective sessions & final collective sessions at CHC & CPHE. This was
again the source of knowledge and courage. We had sessions by different expertise. I got to
know the new term called communitization, how communitization works.The experiences
shared by Dr.Rakhal do was inspiring. We discussed that interventional gaps can be filled by
inputs of people & how we can bring voice or idea of people.
Health as human rights session done by Mr.Premdas gave us an insight on the rights we
have and constitutions on right to healthcare. I got some information on IPHS standards
from central to peripheral level, Importance of strategic thinking when we start to approach
vulnerable group.Eg.Madagaskar technique used by ANT trust in paddy forming to approach
the people. I personally learnt a lot during these sessions. We discussed about dysfunctional
family and addiction cycle, brought some new ideas and thinking about how these issues
directly or indirectly affect the member in the family.
During our final collective session we had sessions by Dr.Ravinarayan, Dr.Thelma narayan,
Dr.Mohammad, sr.Aquainus, Fr.Claud & Ms.Valli. These informations we never get in any
book source which was really enriching our knowledge. The session done on Johari window
was informative and useful practically. Session on inward learning itself taught me how to
look inward myself and brought some positive changes. Bio ethics is something which we all
should practice in the medical field. The important principles of ethics like beneficiencymaleficence, Autonomy, Informed consent & social justice should be kept in mind .I learnt
newly about groups to avoid in research.
We had the session by Dr.Adithya made me to think about the negligence of occupational
health in our country. It was a subject taught to me during my nursing as a least important
syllabus & not much in detail. I felt guilt about myself for not done anything for occupational
health hazards. The life story shared by Mr.Oblesh was really a challenge to the society to
evolve changes in Paurokarmika community. He himself is an example to come out from
their traditional employment. It was fun & thought provoking listening to him about his
experience as an activist. I learnt about 102 different caste systems in Karnataka.
The session we had about life skill & critical thinking was amazing. This session taught me
to talk less and work more, Importance of critical thinking & no one can come to a
conclusion about anything. All I liked about his session is exercises given related to the topic
he covers. This method of learning kept us physically & mentally present. I had a session
about inner healing by Dr.Shirdi Prasad .This was the first time I listen to inner healing in my
lifetime. He gave us an insight about the connection between Body mind & soul. Here &
now mechanism which he taught me was really brought some inner healing. Tools he gave
for inner healing started to work in me & my family. Alternative system of medicine like
AYUSH should be utilized by the people. We need to create awareness more to public
regarding the importance of alternative systems of medicine.
Methodology
The method which I have used in my case study is Questionnaire, through which I can
understand the stress level of the care givers of PWMI.The subjects I have taken to my study are
care givers of patients with mild, moderate & severe mental illness. I have taken measures to
conduct the study by gaining their confidence through regular home visits. Through regular visits I
got the approval by the caregivers to conduct my study. The questionnaire which I used for my study
as follows;
Caregiver Stress Test
Physical health
Have you noticed that your own health is suffering or you are getting ill more
frequently?
Have you noticed a disturbance in your sleep patterns because of the care you
provide for your loved ones?
Do you feel physically exhausted by the amount of care your loved one needs?
Have you had difficulty keeping your mind focused on what you are doing?
Social Relationships
Do your family members or friends say you seem stressed out?
Is your caregiving taking a toll on your job?
Is your caregiving taking a toll on your family life?
Do you feel that your social life has suffered because you are caring for a loved
one?
Do you feel you need more support from your family members with your
caring?
Do you feel that your care giving efforts are not appreciated enough by your
loved one or family members?
Personal demands
Do you feel that the amount of care your loved one requires is too
overwhelming?
Do you feel like you are “missing out on life” or that “life is passing you by”?
Do you feel that your loved one is completely dependent upon you?
Do you worry that you should be doing a better job in caring for your loved one?
Do you think about leaving the care of your loved one to someone else?
Emotional well-Being
Have you felt that you don’t have enough time for yourself because of the time
Never
Rarely
Sometimes frequently
you spend with your loved one?
Do you feel that you don’t have much privacy as you’d like because of your
loved one?
Do you feel emotionally drained by the care you provide?
Do you ever feel embarrassed by the behaviour of your loved one?
Do you resent or feel angry having to care for this loved one?
Point values: Never(0),Rarely(1),Sometimes(2),Frequently(3)
} 0-15=Minimal stress
Stress levels are easily managed. Keep evaluating your stress
level periodically to see if your stress level increases.
} 16-30=Mild stress your stress level is tolerable, but you should also consider asking for
some help or taking more time for yourself. Setting some time aside for yourself each week
or joining a caregiver support group can help a great deal in reducing your stress level.
} 31-45=Moderate stress
Taking some time off should be considered to help reduce
stress. Asking family members for support or looking into respite care or day care might be a
good option. You can also find other caregiving services in your area.
}
46-60=Severe stress
you should seriously consider working with a home care agency
to support your caregiving at home. Please find out day care services in your area or avail
the interventions provided by centres like APD.
RESULTS
CARE GIVERS
Mrs.Logamma
SCORE
LEVEL OF STRESS
38
Moderate
46
Severe
(Mother of case-A)
Mrs.Arputham
(Mother of case-B)
Mrs.Kalavathy
(early stage)
15
Minimal
(Daughter in law of case-C)
NEED FOR THE STUDY:
Caregivers are usually so involved in caring for the needs of their loved ones that they can easily lose
sight of their own needs. To get a better idea of the level of stress they undergo I had a desire to
deal with primary caregivers.
Details of my case study:
ORGANIZATIONAL VISITS:
Visit to paraspara trust:
I got the opportunity to visit the organization through BNI .I have interacted with
Mrs.Bhagya, Managing Trustee .She gave me the outline of what Paraspara is doing for
the society. I have interacted with the field staffs Ms.Yashodhamma & Mr.Murthy who
are mental health workers and federation members. They shared their field experience.
The organization initially started during 1995-96.Initially they worked for child rights and
advocacy, Later they included women health & women empowerment.
Since 2004 they started to work for mental health issue. They do identify PWMI & refer
them to psychiatrist in government Hospitals like Nimhans, Victoria&K.C.G.Later they do the
follow up care. These field staffs are the PWMI (vedike) Federation members who belong
to the same community. One of the reasons why paraspara had the urge to work for PWMI
is that the children couldn't go to school because they were suppose to take care of person
with mentalillnes in their families. This motivated Paraspara to involve care for PWMI.So
that children burden could be reduced.
Since from 2004 to 2006 paraspara was supplying the drugs for PWMI which was prescribed
by Psychiatrist. Later Federation members with public protested and availed the Medicine
supply from the government hospitals itself. The area covered by paraspara are 8 wards,34
slums. They do have IGP(Income Generation Programme) to help those with disability .They
give capital amount of Rs.2000-5000 to start their own business. They arrange subsidiary
loans too. They got the State award 2006 for child & women Rights. These were my
Observations & new learning’s of my Organization visit to paraspara.
Participation in caregivers meeting:
I had a visit to malleswaram, Bangalore urban slum. There I met Mrs.Sharadamma
(president) Federation for PWMI.We had care givers meeting. The issues discussed were
about,
•
Corruption in K.C.G Hospital to avail all the health care facilities.
•
Newly married migrants couldn't avail free health care services due to the delay in
the enrolment of their names in the Ration card.
•
Their expectation towards federation members to accompany them and to be with
them all the time in the hospital.
•
About day care facility for the PWMI
Plans of action:
1. To stand united and fight against corruption at Hospital.
2. To inform health commissioner and if no actions were taken place then to protest.
3. To discuss with medical commissioner for newly married migrants.
4. Explained them about the concept of communitization and made them clear to be
independent.
And gave awareness about health as human rights & their responsibility.
5. Mobilizing government resources to form day-care centre for PWMI.
Participated in federation members meeting:
I had visit to APD and attended Federation members meeting .The members participated
were Mr.Guru, Ms.Aparna, Ms.Veena & myself represented BNI, Mr.Devaraj from
APSA, Mr.Basaiah Ms.Champa from APD, Mrs.Selvi, Ms.Panjavarnam, Ms.Sharadamma,
Ms,Rathnamma, Ms.sugirtha, Ms.Logamma from federation, Mr.Murthy from Paraspara.
There we discussed on the Agenda as follows:
a) About registration of federation as an own body:
Federation members were given instruction about after registration done what are their
responsibilities.Mr.Guru explained the up's & down's which comes in future. Members
got an insight about how dedicatedly they should work to grow the federation. Finally
they concluded by saying that they want some time do discuss and get the confirmation to
register. But planning to register within this month with the acknowledgement of vedike
members. The organizations promised to support for maximum3 years financially.
b) Conducting quarterly meeting:
They have decided to meet every 3 months to have review meeting. Last meeting held on
17/08/2011.Next review meeting planned in the month of November. Feb-April quarterly
report presented by Mr.Devaraj from APSA, May-August report has to be prepared by
Mr.Murthy from Paraspara trust.Sep-Nov report will be prepared by Mr.Basavaiah from
APD. These are the senior field staffs from various organization volunteered themselves to
support federation members in the process of Report preparation and presentation.
c) Celebration of World mental health Day:
Planned to celebrate World Mental Health Day along with the review of quarterly
meeting. Budget of Rs.25000 is needed to spend on those days. Fund raising programme
they planned to conduct. One of the idea is DMHP is telecasting a T.V show on Mental
health programme in DD channel every Monday at 8.30pm. Dr.Chandrasekar from
K.C.Genearl Hospital sent a proposal to BNI to conduct the survey on the awareness of
public regarding Metal illness based on the T.V show. They have 8000 application forms
with the questionare.Each filled forms will get the remuneration of Rs.90.Mr.Guru from BNI
explained about this proposal .He suggested the Federation members that they can raise
fund by accepting this proposal & 50% of remuneration they can have and 50% they can
keep for federation. They have planned to prepare palm plate on mental illness.
d) Supports for federation members:
As per the plan Total 6 member’s organizations planned to support. Among them BNI
accepted to support 3 member, and other 3 members will get support from organizations
like APSA, PARASPARA & APD one each. Each member will be getting the remuneration of
Rs.2000 per month. The names of the executive body members are as follows;
1. Mrs.Sharadamma (President)
2. Mrs.Selvi (vice-President)
3. Mr.Prakash (secretary)
4. Ms.Panjavarnam (member)
2 members yet to be decided by the president. Mr.Prakash as a secretary yet to be
confirmed due to the reason that he couldn’t spend fulltime in the federation. These 6
members name list will be confirmed within 2 weeks.60 members are in the process of
volunteering themselves in this federation. An interesting part is PWMI also joined this
membership. All these federation members belong to the same comunity.Executive body
members got training from BNI.
Issues discussed:
There are some issues discussed on the meeting.
1) Regarding Bribes in Hospitals:
•
Planned to meet Mr.Rajanna (commissioner for disability) and discuss this existing
problem.
• To meet Medical commissioner also and to explain the problem and find
the solution.
•
To submit the written complaints from the affected individuals & vedike members to
the commissioner.
2) Regarding the reason for temporary with hold of pension schemes:
The actual reason was the pensions distributed are more compare to the statistical
information of no of widows, death rate, PWMI and so on. To stop this consumer corruption
government withholds the schemes for a short while.
Visit to the Joint commissioner office:
On 17th of September I went to Joint commissioner office to meet the welfare officer
along with sharadamma to ask about the schemes for SC&ST, along with mental health
coordinator Mrs.Sunandha & Ms.Veena, Intern from BNI we went to meet the welfare
officer. We spoke about the welfare schemes .Later They guided the President of federation
Mrs.Sharadamma to go & approach the slum Board office for this scheme.
Then we discussed about the issues regarding day care in malleswaram. Because federation
members planned to keep a daycare centre based on the expectation of public. So far they
have sent this issue to the commissioner office and awaiting for the reply. It was a follow-up
visit.
Visit to Basic needs India
Introduction
Mental Health in India
The Indian Government estimates that 1-2% (10 to 20 million) of the Indian population
suffers from major mental disorders, with around 5% (50 million) suffering from minor,
depressive disorders. According to WHO Project Atlas 2002, based on data collected
between October 2000 and March 2001, the India Profile shows availability of 2.51
psychiatric beds for a population of 100,000. India has 3,500 psychiatrists, 1000 psychiatric
social workers and 1,000 clinical psychologists – all serving a population of one billion.1 This
clearly explains the magnitude of the problem and the very scanty resources. Poverty is an
important context for mental health. Over one third of the Indian population lives below
the poverty line. This means 70-90% of their incomes goes to food and related consumption
(Duggal 2002:2). About 70% of the population lives in rural India. National health policy
1983, Mental Health Act 1987, National health policy 2002, and District Mental Health
Programmes have been there on paper. Policies and legislation relating to mental illness
have been strongly criticised in India, on the charge that they are of little relevance to the
lives of persons with mental illness.
The society attaches stigma to mentally ill people and their family members. They suffer
shame and are objects of fun and mockery. It is this ostracism that makes it so difficult for
mentally ill people with mental health problems to be a part of standard poverty reduction
programmes and constantly remain marginalized2. Human rights abuse is yet another
common feature. In the year 2000, 23 persons with mental illness who were chained in a
faith healing place charred to death in Ramnad district of Tamil Nadu3. Any facility that
exists, it is in the urban areas that catering to those who could afford. State of a poor
mentally ill person from a village is any one’s imagination.
Basic Needs India is a registered non-governmental organization established in the year
2001; the registered office is located in Bangalore. Having recognized the growing needs
of mentally ill people and their families in rural areas and lack of opportunities / facilities,
Basic Needs India programme has a strong focus on poor people with mental illness in
rural areas. It strongly believes that every human being has the potential, if tapped well,
to manage his/her own life. It equally emphasizes on sustainable development leading
to poverty reduction / eradication. In the whole process, Basic Needs India visualizes a
community where persons with mental illness and family members are accepted and fully
participate in all aspects of life including social and cultural meaning they get included in
the development process. Vision
Basic Needs India seeks to satisfy the essential needs of all people with mental illness in
India and to ensure that their basic rights are respected and fulfilled
Mission
Initiate programmes in India, which actively involve mentally ill people and their carers
and enable them to satisfy their basic needs and their basic rights respected. In so doing,
stimulate supporting activities by other organizations and influence public opinion
Objectives
§ To restore mental health and human dignity through appropriate interventions thus
resulting in acceptance, de-stigmatization and relief to care givers.
§ To support people with mental illness to exercise their rights through new initiatives
in mental health and development.
§ To bring financial stability to these families through economically viable income
generation activities designed for mentally ill people and family members.
§ To develop and promote social horticulture / land related activities appropriate to
the community.
§ To promote and carry out action research (involving people with mental illness)
and disseminate the information / results so as to contribute to the overall body of
knowledge in the area of community mental health and development.
§ To work with established government organizations / NGOs to enable them to have
the capacity to adapt their programmes to take into account the needs of people
with mental health problems.
§ To focus on ‘advocacy‘, ‘proper legislation’ and ‘gender and equality issues’.
Coverage
Basic Needs India works in parts of 48 districts of Southern India, Bihar, Jharkhand, Orissa
and Maharashtra. The total no. of families addressed is around 16000.
Approach
Basic Needs along with its partners has developed a model called “Community Mental
Health and Development” which strongly believes in consultations with all stakeholders.
This model was developed in consultation with people with mental illness, their carers and
field staff of organizations. Basic Needs India works in partnership with other organizations
involved in disability and development and advocates inclusion of mental health in existing
development programs. This innovative intervention ensures involvement of people with
mental illness in their own development and is rights based in its approach.
The Programme has, at present, five modules which have been developed after extensive
consultation with mentally ill people, their carers and the CBO’s. The five modules are:
1.
2.
3.
4.
5.
Community Mental Health
Capacity Building and Animation
Sustainable Livelihood
Research
Administration.
Values
The organisation should be informal, transparent and accountable and should be a strong
advocate of equal opportunities with particular emphasis being placed on mental illness,
gender equity and poverty.
BasicNeeds should be open to positive and supportive criticism. In this context we need
to be responsive to our monitoring structures and to evaluations of our work both at an
informal and formal level. The Trust will institute a social approach to audit from early on
thus encouraging a culture of disclosure, openness and accountability.
This approach should permeate all of the work of the Trust including its fund-raising;
Internet based information, annual reports and other documents. The belief and value
system of the organisation should be related to the quality of our work and the quality of
our relationships.
The Community Mental Health and Development Programme emerged, as the needs of the
mentally ill have been overlooked and the visibility of human rights violation. Although the
central and state government health plans include mental health in the national programme
and have provided support for mental health program in the five year plans since 1982,
India faces the twin challenges of very limited professional resources and large numbers
who require services. Therefore, in addition to the existing institutions and professional
services available, the focus is very much required on community care and community
resources. Thus, this paradigm gives opportunities for innovation and barefoot workers
addressing the issues in the community. Non-governmental organizations have a vital role
to play in the area of Community Mental Health. In addition to the mental health act of
1987, another significant development is the enactment of ‘The Persons with Disabilities
Act’ (PDA), 1995, as it has included mental illness under the definition of disability. The act
provides for education, employment, social security, non-discrimination, affirmative action,
prevention, research and human resource development.
Visit to APSA( Association for Promoting social Action)
I could visit APSA during field placements. This visit was really an eye opener for me to
understand what an NGO can achieve. It’s a 32 yrs old organization. Organization provides
training & education for children rescued from domestic violence & child labour. They
provide shelter for the children in the name of “Namma mane”. After the bridge course
sheltering provided only for girls for a year till they are employed. For male children group
living system has been encouraged.
It’s a right- based child- centred community development organization. They work towards
the development of community through a systemic process of empowerment. Their
partners in its process are communities of street children child labourers and other children
in distress including abandoned and run away children, child victims of abuse & prostitution,
children of sex workers as well as the larger communities of the urban slums.
APSA believes in the strength of the people and their ability to fight for their own rights.
They provide bridge course facility. They have approximately 60 -70 staffs in APSA,
Bangalore.80% they run outreach programme. They get funds from multi organization.40%
fund raised by the organization itself. They conduct training & education programmes.
They give training on tailoring, Printing, Multimedia, Electronicworkshop.Theyget orders
from different companies on production they make in their own institution. These are the
achievements of APSA .
They have classes like life skills education. Where they teach them about time management,
money management, Sex education through some materials .Those materials are really
worthy to make the children understand about sexdifferences and make them understand
the changes which happen in their body. The class rooms they constructed also by students
plan, especially the infrastructure which reminded me the days of gurukulam study method.
They have 7th & 10th classes where they will be placed in the n\mainstream education once
they complete their 10th & 7th classes in APSA.The children they fond in street & orphans
their life time expenses including food, shelter & education was born by the organization.
Really after the visit there was a kind of satisfaction which i felt because of the work done
by the organizations like this. I was very glad to hear the amount of children they rescued so
far. Again this give hope for the children who are suffering.
Visit to Streisand Foundation
It’s a Non Governmental organization works for the dropped out children. This organization
was started on 20/10/2010.It has been a year completed. Now they have their 5th Batch.
Each batch they select about 30-50 students. First month regular classes.2nd & 3rd month
onwards field placement to supermarkets like More, total & beauty parlours .Later
people from different sector interview them and place them in the job according to their
potentiality. They train them by sessions by different experts from different fields for 3
months. Then they place them in their area of interest like beautician, salesboy, B.P.O’s
and so on. I got an opportunity to volunteer myself to take sessions on Health & Hygiene.
Where my mentor Ms.Joyce also volunteered herself to take some session on health &
sexuality. I was encouraged by her. This was my Experience in Streisand foundation.
Criteria they have to select dropped out children are;
§
The Monthly income of the family should be Rs.5000 and below.
§
The age should be between 18-26yrs
§
The candidate should have an urge to come up in life.
These are the criteria for selection.
SOCHINI (Society of Community Health Nurses of India)
INTRODUCTION:
Change and advancement is inevitable in any sphere of a profession. Community Health
Nursing is no exception. Any individual requires the satisfaction of their survival needs,
security needs and a sense of belonging to be met before they function at their optimum
level. An association therefore, primarily caters to the individual rights of its members so
that each one can effectively and efficiently function to fulfil the common goal.
Therefore, the Society of Community Health Nurses of India [SOCHNI] supported by its
members hopes to serve its individual members in enabling and empowering to serve the
community at large and to promote and protect professional interest of Community Health
Nurses.
Society of Community Health Nurses of India was formally registered on 24th March 2009 at
Bangalore. Registered office will be at Bangalore, however the Head Office will be Vellore.
VISION OF SOCHNI:
The vision of our Founder MEMBERS IS THAT COLLABORATION FOR CONTINUED EDUCATION
AND PROFESSIONAL DEVELOPMENT OF COMMUNITY HEALTH NURSES TO EXPAND THE
SCOPE OF COMMUNITY HEALTH NURSING PRACTICE IN INDIA.
OBJECTIVES:
To establish & sustain a bond of abiding friendship & fellowship among the
COMMUNITY HEALTH NURSES IN INDIA
2. To keep the COMMUNITY HEALTH NURSES informed of the current events and the
developments.
3. TO SUPPORT COMMUNITY HEALTH NURSING EDUCATION IN INDIA
4. To instil in the minds of members an interest in professional development by
conducting conferences, seminars, workshops etc.
5. To encourage students and teachers OF COMMUNITY HEALTH NURSING to
UNDERTAKE QUALITY PUBLICATIONS.
6. To raise funds for the activities of the Association.
7. To PROVIDE A COMMON PLATFORM TO COMMUNITY HEALTH NURSES TO EXCHANGE
IDEAS, carry out RESEARCH ACTIVITIES, provide consultation and undertake projects.
8. TO CONTRIBUTE TO IMPROVING THE STANDARDS OF COMMUNITY HEALTH NURSING
PRACTICES.
1.
ACTIVITIES:
SOCHNI conducted a National workshop on “Defining Community Health Nursing Practice”,
on 12th February 2010 at Dhanavantri Hall, Rajiv Gandhi University of Health Sciences,
Bangalore. Resource faculty were drawn from various strata of the academicians and
administrators who included Director of CHAI, WHO consultant, lawyers, women activists,
nursing faculty & community nurses. The delegates and resource faculty who participated
were of the opinion that India needs to wakeup to the need of the hour of having an
Independent Nurse Practioner in the community in order to meet the Millennium needs.
PARADIGM SHIFT IN MY LIFE
MOVING FROM
TOWARDS
Medical model
Community model
Individual approach
Collective Approach
Public Health
New Public Health
Instead of Supporting community
community to participation
Active speaking
Active listening
Equality of healthcare
Equity of health care
Rule follower
Rule breaker if ethical
More Academic &little Activity
Medical Ethics
Academic,Active,Laboratory,Action to be more &
equal
Humanistic Ethics
Deep Thinking
Critical Thinking
Looking outward
Looking inward
Medical model Vs community model
So far my thinking about community model is 20% is only the need & medical model
is 80% and most needed for the public. But now my eyes are opened enough to knoe the
importance of community model.
Individual approach Vs collective approach
Due to the reason i worked in Hospital set up my concentration was only on the
individual. But now i learnt about the collective approach which plays an important role to
make a huge change in the health of an individual.
Community participation
Without community participation it is very difficult to make a change in the
community. Health education & training programmes at the community level create the
awareness among pubic. Instead we do everything for them we should teach them to
demand their own needs.
Holistic Development
So far I read lot and practiced little. But now could limit myself equally in academic
performance ,laboratory ,Reflective & Active. This is the major change happened in my life.
Active listener
Before I joined the CHC I was more speaker than a listener. But now i became a
Active listener.
Humanistic Ethics
I was very much keen to practise medical ethics. But now I start to think the ethics in
Humanistic way.
MY NEW LEARNINGS
Learning’s from my objectives
}
}
}
}
}
}
Caregivers are the most vulnerable (mental illness).
Management of stress at early stage gives positive results.
Importance of regular home visits
Majority of PWMI are female
Majority of care givers are also female
Importance of daily report and documentation
New learning’s:
}
}
}
}
}
}
}
}
}
}
}
The meaning of community & community health
What & how do NGO’s contribute to health?
Regarding child help line at APSA
About JAA-BU network
About social welfare programmes for people with mental disability
Federation for PWMI
How Streisand foundation for dropped out works
Capacity building from peripheral level
About an budding organization called SOCHINI
Community participation
Unity is strength
Learning’s from my objectives
}
}
}
}
}
}
Caregivers are the most vulnerable (mental illness).
Management of stress at early stage gives positive results.
Importance of regular home visits
Majority of PWMI are female
Majority of care givers are also female
Importance of daily report and documentation
Looking Inward
•
I could identify the potentialities in me
•
Felt like being a part in the community
•
•
•
•
•
•
•
•
•
•
•
•
•
My views and perspectives about N.G.O’s changed
My perspective about community health changed.
Learnt that Involvement of community is most important factor to change the
society.
Change happened like I could break the cell around me and started to be like
balloonist to see the problems from above
Different scopes a nurse has to choose
Inner healing took place
Stress management techniques I taught to the care givers helped me personally.
I learnt how to be humanistic in ethics
Change in my approach to the community members
A kind of satisfaction in my home visits
I could wake up the another shereen in me
Gained more information & knowledge regarding health systems in India
The real meaning of equity
SUMMARY
On the whole I gained many experience during this learning programme .As we know
learning never ends. I am in the process of learning in my life. During my CHLP I had gone
for visits to many NGO’s to know its functions and role in the society.
After my orientation programme I formed learning objective to understand the stress
level of the caregivers of PWMI.Based on the results I could apply some of the stress
management techniques to those caregivers. This gave a positive feedback from the
caregivers.
Instead of expecting people to come to us, we should go and find solution to the
problems. I could see the reflection and give my reflections in the meetings which I have
attended. I could say really a paradigm shift is happening from my institutional life to
community oriented life. Books like “Health for All Now” will really bring sense and worth
to our life to be an activist rather than a pessimist.
ANNEXURES
Methodology
The method which I have used in my case study is Questionnaire, through which I can
understand the stress level of the care givers of PWMI.The subjects I have taken to my study are
care givers of patients with mild, moderate & severe mental illness. I have taken measures to
conduct the study by gaining their confidence through regular home visits. Through regular visits I
got the approval by the caregivers to conduct my study. The questionnaire which I used for my study
as follows;
Caregiver Stress Test
Physical health
Have you noticed that your own health is suffering or you are getting ill more
frequently?
Have you noticed a disturbance in your sleep patterns because of the care you
provide for your loved ones?
Do you feel physically exhausted by the amount of care your loved one needs?
Have you had difficulty keeping your mind focused on what you are doing?
Social Relationships
Do your family members or friends say you seem stressed out?
Is your caregiving taking a toll on your job?
Is your caregiving taking a toll on your family life?
Do you feel that your social life has suffered because you are caring for a loved
one?
Do you feel you need more support from your family members with your
caring?
Do you feel that your care giving efforts are not appreciated enough by your
loved one or family members?
Personal demands
Do you feel that the amount of care your loved one requires is too
overwhelming?
Do you feel like you are “missing out on life” or that “life is passing you by”?
Do you feel that your loved one is completely dependent upon you?
Do you worry that you should be doing a better job in caring for your loved one?
Do you think about leaving the care of your loved one to someone else?
Never
Rarely
Sometimes frequently
Emotional well-Being
Have you felt that you don’t have enough time for yourself because of the time
you spend with your loved one?
Do you feel that you don’t have much privacy as you’d like because of your
loved one?
Do you feel emotionally drained by the care you provide?
Do you ever feel embarrassed by the behaviour of your loved one?
Do you resent or feel angry having to care for this loved one?
Point values: Never(0),Rarely(1),Sometimes(2),Frequently(3)
} 0-15=Minimal stress
Stress levels are easily managed. Keep evaluating your stress
level periodically to see if your stress level increases.
} 16-30=Mild stress your stress level is tolerable, but you should also consider asking for
some help or taking more time for yourself. Setting some time aside for yourself each week
or joining a caregiver support group can help a great deal in reducing your stress level.
} 31-45=Moderate stress
Taking some time off should be considered to help reduce
stress. Asking family members for support or looking into respite care or day care might be a
good option. You can also find other caregiving services in your area.
}
46-60=Severe stress
you should seriously consider working with a home care agency
to support your caregiving at home. Please find out day care services in your area or avail
the interventions provided by centres like APD.
RESULTS
CARE GIVERS
Mrs.Logamma
SCORE
LEVEL OF STRESS
38
Moderate
46
Severe
(Mother of case-A)
Mrs.Arputham
(Mother of case-B)
Mrs.Kalavathy
(Daughter in law of case-C)
(early stage)
15
Minimal
About BNI
The work
I nitiation
During January 1999 Chris, along with Trustees of World in Need, visited Bangalore
to understand the situation of people with mental illness in India. They visited some
facilities and met important people involved in the work. In addition, on 25th Jan 1999, The
Association of People with Disability (APD) hosted a workshop. 25 people from South India
participated and the need to work with poor mentally ill people, the most marginalized lot,
for their overall development clearly emerged.
Chris and Nicholas had a formal chat with Naidu about initiating a programme in India
and Naidu agreed to work from February 2000. Both Chris and Naidu have been involved
in the development work of people with disability for more than two decades. Naidu
visited various places working with/for mentally ill people in the North & South India. An
advisory group comprising Valli, Hema and Sanghamitra were reviewing the work carried
out by Naidu and guiding him in the plans. After contacting some organisation, Naidu
found SACRED in Andhra Pradesh and Narendra Foundation, Mitra Jyothi, GASS and APD in
Karnataka worth having further consultations.
During September 2000 Chris, Naidu and Sony George held series of consultations with
mentally ill people, their caregivers and staff of CBOs. The ‘voices’ of the participants
were the potential seeds initiating the programme. It dispelled the myths and laid a solid
foundation for inclusion of people with mental illness into the development process.4 All the
stakeholders sitting in a circle expressed their determination to take the cause further. This
new initiative was followed by another consultation, defining the relationships’ with two
partners where the model emerged.5 Access to treatment, economic independence, social
integration, and advocacy surfaced very clearly as basic needs and the vehicle to meet these
needs is exercising rights. Dr. Sekar and Dr. Kishore Kumar of NIMHANS, Bangalore agreed
to extend their support in training and treatment.
The advisory group, along with Naidu, decided to register the organisation. Accordingly
BasicNeeds India was registered as a Trust on 22nd March 2001. The registration number is
642.
Field consultations
Partnership development
In the beginning of 2000 Thippanna of SACRED, Ananthapur, and Rajanna of Narendra
Foundation, Y N Hoskote were consulted separately about exploring the possibilities of
including people with mental illness into their existing CBR work. They were reminded of the
People with Disability Act, 1995 including people with mental illness as one of the categories
of disability. Both gave their consent. A daylong consultative workshop was held with staff.
The prevalence of mental illness and their status in the communities were reviewed and
the revealing aspect was that of realising mentally ill are the most marginalized, neglected
and subject to human rights abuse. The staffs expressed their own apprehensions to include
people with mental illness. Some volunteered to meet such people and to record people
met, conversations with them and information gathered. When they presented their
experiences in the next sitting, there was enough confidence to work with them and other
colleagues got inspired. The consultations lead to a firm agreement to initiate a programme.
Later similar consultation was held with GASS, Doddaballapur. Interestingly, these three
organisations work with disabled people and they are called CBOs as they come from the
same communities and located in the same area. Currently these three are the primary
partners.
Similar consultations had been held with Mitra Jyothi that did not take off. Consultations
with bigger NGOs like Nav Bharath Jagrithi Kendra (NBJK) in Jharkhand, SAMUHA & Action
on Disability and Development India (ADDI) and Vidya Sagar have been fruitful. Here the
consultations were held with key staff and in turn they take it others. They cover huge
areas, 29 districts in three states.
Programme development
Fascinating consultations took place in the field with mentally ill people, their carers and the
staff. Chris, Sony and Naidu developed the topic guide (Annexure ‘B’) after long discussion.
Animation is the key word in consultation and it is drawing from people and echoing their
voices. The participants were divided into three groups i.e. people with mental illness,
carers and staff of CBO and were asked to discuss and depict the world of people with
mental illness. Carers expressed their apprehensions about mentally ill people discussing
about themselves. When it came for presentations, the presentation of mentally ill people
was nothing but truth and other presentations were coloured by their own misconceptions
and intentions. This was a revelation. This exercise was followed by ‘needs’ and ‘what
next’. In all the consultations the need for both mentally ill and carers to meet often on a
common flat form was conspicuous and they all wanted access to treatment, enhanced
family incomes, social integration, training and other capacity building. This exercise has
been followed with all the partners. At the end of the day debriefing sessions contributed
to the depths of understandings. The processes have been documented and analysed.6
The other field consultations include family visits, workshops for staff, workshops for
caregivers, monthly meetings, self-help group meetings, community meetings, etc. All these
field consultations are aimed at awareness building, knowledge about mental illness and
management, life skills, livelihoods, social integration and importantly relieving from human
rights abuse and restoring their rights.7 Significant area of field consultations is introducing
research component. Staffs are capacitated to gather relevant information, update the
personal files and analysis of the information to track changes over a period of time and to
disseminate.
6 Process documents and Process analysis documents
7 Workshop reports & visit reports
Consultations at various levels
Emergence of the model
After the initial field consultations with Mitra Jyothi, SACRED and Narendra Foundation it
was felt necessary to consult the project heads and the staff to give meaning to bottomup approach and more importantly to arrive at the approach to meet the expressed needs.
SACRED & Narendra Foundation participated in the consultations. Chris, Dr. Kishore and
Naidu facilitated the process and Sony George documented the process.8 The whole
exercise was guided by the first consultation’s ‘needs’ and ‘what next’. The needs list
was classified broadly into appropriate treatment at local level and follow-up, economic
independence and social integration. Training and skill development was from the staff.
To make these happen heads of the organisation expressed strong administration and
management support. BasicNeeds said that when such an important work for the most
needy people, the whole process and the learning need to be recorded in the required
fashion. The nomenclature of these elements is as follows:
•
•
•
•
•
Community Mental Health
Income Generation
Capacity Building
Research
Administration and Management
Thus the model emerged and each of the above became the modules. Later Income
generation was renamed as Sustainable Livelihoods. The work under each module was
discussed and agreed upon. Further discussions defined the roles and responsibilities of the
participants to implement the model. This model has been considered good and has been
implemented by all other partners who joined later.
Content (our work with the partners)
The above model may be regarded as an attempt to provide a methodology for
implementing the WHO 10 recommendations for working with mental illness in the
community.9 To implement effectively this model a MoU has been signed with each partner
incorporating the expected outcomes under each module.
Community mental health
“The condition of health is not a static state of perfect wellness; it is, among others, a
condition of ongoing healing process”
About 150 field staff members from three primary partners and four secondary partners
have been trained in identifying, screening, referring to treatment and very importantly
following up regular treatment & addressing side effects with the help of five resource
8 Defining the relationship document
9 Chris – A model in mental health & development
organisations and five resource persons.10 These barefoot workers have been the turning
point in giving meaning to the community mental health.
The diagnosis and treatment varies from place to place. The approaches include camps
organised by NIMHANS, camps organised by partners, people going district hospitals,
mental health institutes, and private psychiatrists.11 Some access alternative treatments like
homeopathy & ayurveda.
2,250 people have been identified and over 1000 people have been regular for treatment.
Each partner has a mental health co-ordinator who takes the responsibility for the
implementation of the work. Majority of those who are regular get stabilised. Very few
relapses were noticed. So far people with major mental illness have been identified. Such
people are highly symptomatic and obviously their behaviour is seen as major problem and
family members give up hopes; when they see changes for the better in fairly short time,
they find it dramatic and magic. Concerns about dropouts, drug regime and other physical
ailments associated with mental illness.
Sustainable livelihoods
‘One of the main reasons that people find it hard to accept mentally ill people as equal
members of their communities is that they do not see them as capable of contributing
to the household or the community. In poor rural communities the ‘value’ attached to
an ability to earn income is great and often is the defining factor for a person’s standing
within the family’.12 In every consultation, people with mental illness and their caregivers
expressed ‘increased family income’ as their next important need to ‘cure’ or ‘treatment’.
This conforms with the theory of illness leading to poverty and poverty leading to illness.
After stabilisation, consultations take place both with the affected group and the family
members regarding some gainful occupation. After taking all illness related issues into
consideration the first preference would be given to ‘going back to the previous work’.
Necessary preparation and training is given to all concerned i.e. mentally ill person,
caregiver and field worker. In some case where previous work does not suit in further
stabilisation a new enterprise is developed. Assessing the skills, market, financial viability
and coping abilities are necessary components of this venture.
About 150 people out of 417 people have gone back to their previous work and 45 persons
have undertaken new jobs and the rest do participate in domestic and field work from the
primary partners.13 In the case of chronic illnesses, family members have been supported.
In this module family is considered as one unit and there fore the entire family’s needs
and their current income patterns help planning the income generation project. Even
recently started programme in Bihar & Jharkhad 7 people are gainfully employed.14 Another
important feature of this module is people joining the self-help groups, micro credit
groups and accessing loans as members. Currently an effort is made to link such groups
in Karnataka to The Bridge Foundation, professionals in micro-finance. People also access
10 Training reports
11 Partners reports (CMH module)
12 Anil K Patil & Nicholas Colloff – sustainable livelihoods paper
13 Output to purpose report
14 Quarterly report from NBJK (third quarter)
money from government schemes and financial institutions.
Lakshmana, from SACRED project area, said that he was denied opportunities to learn his
family trade of weaving and openly confronted his mother in the very first consultation
meeting. He emotionally told no body eats gold; all eat salted food when an issue of loss
surfaced.15 The same Lakshmana today is weaving, earning around Rs.2,000 a month
and is married. This story tells the process of interventions and completing the circle i.e.
treatment, income, social integration and the same status like that of his brothers in the
family. This one story is self-explanatory.
Capacity building
Capacity building has clear focus on the levels, i.e. person with mental illness, family
members, community, organisation involved and others.
The techniques used are animation and facilitation either in a meeting or in workshop as
detailed in the field consultations. It has always been drawing from people and not preachy.
Therefore, the building capabilities at all levels takes place in a planned way meaning home
visits, group meetings, staff meetings, workshops for caregivers, staff, local communities,
review meetings, plans & budgets, etc., are the occasions. Awareness building on existing
laws, government schemes & concessions and preparing them to lobby for their rights
and networking among partners is an important aspect of capacity building. Partners are
involved in annual reviews and preparation of plans and budgets.
Nick Hewson, well-wisher participating in a world mental health day organised by SACRED
attracted media attention demonstrating solidarity.16
During the year 2002, it became very clear working with big NGOs is essential to scale-up
the operations and the concept of secondary partnership emerged. NBJK, in Jharkhand,
SAMUHA in Karnataka and ADD India & Vidya Sagar were identified. All of them have been
capacitated to include people with mental illness. Together, they operate in 29 districts. It is
a substantial breakthrough to make the organisations presence felt.
Consultations have been held for staff development, organisation development and in any
required training e.g. Chris conducted training in animation to all the primary and secondary
partners; one in Hazaribagh and another in Chennai.17
Research
Initially the value of action research was recognised and from the beginning field staff have
been trained to collect data from the field and to file properly. At partner level, individual
files with relevant data are maintained and updating files is mandatory. In the month of
15 Process document
16 Nick’s visit report
17 Vandana – Animation training
May 2001 Chris had a small session with the team and the following themes were felt very
necessary:18
•
•
•
Empirical research
Life stories
User-led research
Life stories have been followed regularly and on other two issues it could be called more
data collection and documentation. Life story writing is an intense process by which
mentally ill people begin to narrate their experiences, situation in their own ‘Voice’.19
Training was imparted to field staff to gather data and to record the same in a manner
that helps the worker, organisation and to disseminate such information for the good of
the users of service. The outcome of the training was the format for individual files.20 Life
stories have been edited and used. Two more associates have joined the team. Jointly
with partners a format has been devised recently for sending quarterly reports. It is a very
comprehensive format that gives qualitative and quantitative information regularly.
The partners feel the advantage of this module to track changes in each individual case.
Management & Administration
In this area Firdaus takes care of the financial needs of our partners as per the
Memorandum of Understanding. Janardhana is the project manager for three primary
partners, Anil for SAMUHA and ADD India & Vidya Sagar and Naidu for NBJK. The project
managers closely work with the partners right from the preparation of plans & budgets and
other responsibilities include arranging required training for all the modules, monitoring the
progress, getting quarterly reports and financial statements and analysing them. Conducting
annual reviews and evaluations and taking mid course corrections, supervising and ensuring
proper implementation of research module, disseminating all the necessary information,
arranging visits with prior intimation, getting audited financial statement of annual accounts
form the important elements of management. Project managers work in close relationship
with the mental health co-ordinators.
Four organisations namely APD, Mobility India, APSA, and Paraspara working in Bangalore
slums have been consulted in two workshops and a programme has been conceived to work
with urban poor mentally ill people in Bangalore.
Series of consultations have been held with APD involving Thrive, UK to introduce social
horticulture for mentally ill people along with other disadvantaged groups.
18 Report on Chris’s training
19 Shoba – Wide canvas
SOCHINI (Society of Community Health Nurses of India)
INTRODUCTION:
Change and advancement is inevitable in any sphere of a profession. Community Health
Nursing is no exception. Any individual requires the satisfaction of their survival needs,
security needs and a sense of belonging to be met before they function at their optimum
level. An association therefore, primarily caters to the individual rights of its members so
that each one can effectively and efficiently function to fulfil the common goal.
Therefore, the Society of Community Health Nurses of India [SOCHNI] supported by its
members hopes to serve its individual members in enabling and empowering to serve the
community at large and to promote and protect professional interest of Community Health
Nurses.
Society of Community Health Nurses of India was formally registered on 24th March 2009 at
Bangalore. Registered office will be at Bangalore, however the Head Office will be Vellore.
VISION OF SOCHNI:
The vision of our Founder MEMBERS IS THAT COLLABORATION FOR CONTINUED EDUCATION
AND PROFESSIONAL DEVELOPMENT OF COMMUNITY HEALTH NURSES TO EXPAND THE
SCOPE OF COMMUNITY HEALTH NURSING PRACTICE IN INDIA.
OBJECTIVES:
To establish & sustain a bond of abiding friendship & fellowship among the
COMMUNITY HEALTH NURSES IN INDIA
10. To keep the COMMUNITY HEALTH NURSES informed of the current events and the
developments.
11. TO SUPPORT COMMUNITY HEALTH NURSING EDUCATION IN INDIA
12. To instil in the minds of members an interest in professional development by
conducting conferences, seminars, workshops etc.
13. To encourage students and teachers OF COMMUNITY HEALTH NURSING to
UNDERTAKE QUALITY PUBLICATIONS.
14. To raise funds for the activities of the Association.
15. To PROVIDE A COMMON PLATFORM TO COMMUNITY HEALTH NURSES TO EXCHANGE
IDEAS, carry out RESEARCH ACTIVITIES, provide consultation and undertake projects.
16. TO CONTRIBUTE TO IMPROVING THE STANDARDS OF COMMUNITY HEALTH NURSING
PRACTICES.
9.
MEMBERSHIP RULES AND REGULATIONS:
a)
Member: ALL COMMUNITY HEALTH NURSING STUDENTS AND COMMUNITY HEALTH
NURSING FACULTY are entitled to become members of the association.
Ø The members pay the membership fee, as determined by the Executive committee.
Ø The membership fee is subject to revision at the discretion of the Executive Committee
from time to time.
Ø The life membership fees is Rs. 2500/- only.
Ø Membership to the Association in non-transferable for any reason including death of
the member.
Ø If an existing member wishes to resign from the Association, the Membership fee will
not be refunded.
Ø All members are bound by the constitution of the SOCIETY OF COMMUNITY HEALTH
NURSES OF INDIA-SOCHNI and the memorandum of the Association.
ACTIVITIES:
SOCHNI conducted a National workshop on “Defining Community Health Nursing Practice”,
on 12th February 2010 at Dhanavantri Hall, Rajiv Gandhi University of Health Sciences,
Bangalore. Resource faculty were drawn from various strata of the academicians and
administrators who included Director of CHAI, WHO consultant, lawyers, women activists,
nursing faculty & community nurses. The delegates and resource faculty who participated
were of the opinion that India needs to wakeup to the need of the hour of having an
Independent Nurse Practioner in the community in order to meet the Millennium needs.
Objectives of the workshop:
1. To examine in the Indian context the concept of Independent Community Health
Nursing Practice
2. To explore the scope of independent practice across settings in achieving the MDG’s
[Millennium Development Goals].
3. To discuss the legal and ethical issues in the independent Community Health Nursing
Practice in India.
4. To analyze the strategies to overcome the social, professional and policy issues of
Independent Community Health Nursing Practice.
Photographs taken in the field
Not viewed