Samantha - final report.pdf · Community Health

Samantha - final report.pdf

Media

extracted text: A Report on the Community Health Learning

Experience

SOCHARA
School of Public Health, Equity & Action
(SOPHEA), Bangalore

Community Health Learning
Programme,
2013-2014

“The Beginning of a Healthy
Adventure”

Samantha C Lobbo
(A Fellow Traveler)

A Note of Appreciation
SOCHARA team has been a continuous body of encouragement through my learning
journey. Be it from the teaching facilitators to the administrative team, everyone has
always managed to find time and sort out any difficulties faced. Thank you one and all
for being considerate and patient.
I would like to thank Mr. Kumar, my mentor and friend who continually encouraged,
guided me through personal and professional matters be it in the field or during
collective sessions. Also, I would like to thank Dr. Sr. Aquinas, my field mentor and
confidant, who fostered a fair amount of values and teachings about community health
within me. I truly appreciate the hard efforts of the facilitators who managed the guest
sessions and field visits. They made it a fun learning and enjoyable experience.
I would also like to mention the administrative team here who were always open to any
queries. Also, a special thank you to the team in charge of providing us tea and a
variety of food items during our sessions.
I would like to thank Dr. Thelma Narayan for letting me be a part of this insightful
programme on community health that has helped me not only understand what is the
role of a community health worker but discover the path that I was since long searching
for.
Also, I would like to thank my new extended family, Job (Joe), Venkatesan (San San),
Suresh (Anna), Lekshmy (Lucky), Banri, Them, Sabeena (Sabee), Nanda, Madhavi
(Maddy), Ganesh (Gani), Rahul (Google) and Anusha (Nusha) for their constant
encouragement and fun times throughout.
Lastly, I would like to thank my family, especially Mum, for supporting me through
this journey with patience and acceptance.

2

Table of Contents
1. Inclination towards Community Health

2. The Aims on my mind

3. The Knowledge Conclave

4. The Experiential Learning

5. My Comprehensive Understanding

6. Snapshots of my Exploration into Community Health

3

Inclination towards Community Health
My first tryst with community health was during my undergraduate studies where I
screened a group of young adults with precancerous oral lesions. I was angered and
surprised that these young men in their peak age were presenting such conditions. It
made me think why were these young men ignorant to such simple health issues? I
knew lack of health education amongst those who cam from a lower socioeconomic
background was one of the main reasons to blame. With due course of time and work
pressure, these thoughts faded.
The thoughts resurfaced and hit me hard during my internship at a hospital, when I
interacted with an elderly lady, diagnosed with the last stage of oral cancer. She was a
widower staying with her married daughter, who also belonged to a lower
socioeconomic background. They could hardly afford even the bare minimum expenses
at the hospital but yet came when the pain became unbearable they had no choice. The
reason for me writing about this particular incident is because that day I experienced an
emotional turmoil when I saw that the old lady could not even afford to get a diagnostic
test done. She was weak, anemic and malnourished. She did not have clue about the
health issues she had and due to lack of being a literate it made it more difficult for her.
This experience made me ponder on further on old thoughts about why is there this gap
in knowledge amongst those who belonged to a lower socio economic status? Why
were they the one’s who struggled with access to healthcare services? Why were they
the one’s with lesser benefits to health? How could I make a difference in these
communities and how could I understand it better? Who has made it a rule that only
those who dress well, or can afford healthcare services are allowed access? Why is it
that a person’s class, caste and economic status matter when a disease doesn’t see
whom it affects why do we see who we should treat? I pursued my higher studies in
public health but I only gained the theoretical knowledge about the health systems. So
the desire to learn what are the real health issues faced by a community. I searched
quite a bit for an internship that actually focused on the real problem and that’s when it
brought me to SOCHARA.
4

The Aims on My Mind
When I joined the programme, I had many questions regarding the health system,
policies, implementation of these policies and national health programmes. More
importantly I wanted to stop thinking in a medicalized manner and more like a layman
about health issues.
∗

To think out of the “medicalized” thought process carved in during undergraduate
studies.

∗

To understand how health is affected by various other aspects like social, economic
factors.

∗

To learn and understand the national health systems and policies.

∗

To gain more perspective on the existing national health programmes.

∗

To learn how health communication can be made use as a part of promoting health
amongst the people.

∗

To gain a better understanding in the usage of research methods.

∗

To experience first hand the health issues faced by communities with regards to the
health schemes.

5

The Knowledge Conclave
The collective sessions have been a great help to understand many aspects of health,
topics such as the axioms of community health, health movements, health policies,
social determinants, health finance, management of health programmes, existing health
systems, research methodologies and many other aspects.

Few reflections from these collective sessions:
!

What is a community?
Community health for me always had a meaning that we find the solution to the
problem the community faces and we help the community solve it. But this session
made me realize that it is not about what we feel but hearing out what the
community feels. It is not us going in as experts but to go as facilitators, become
one with the community, understand the community, it’s values, culture. It is about
becoming one with the community, once this is done that is when you understand
the real issues.

!

Health Systems
Previously only had the basic knowledge of what the Indian health system
comprised of, but during this session I received a broader understanding about how
the public health care services and private health care services differ. The public
sector hardly being used in comparison the private that is dominant. In India, nearly
70% of the private health care services are used while only 1.1% of our GDP is used
for our public health. Public sector ownership is divided between central and state
governments, municipals and panchayats. The public health system consists of the
central body known as the ministry of health and family welfare. The healthcare
facilities include teaching hospitals, secondary level hospitals, first level referral
hospitals (Community health centers), primary health center and sub centers. The
importance of each level of healthcare services, the need for a consistent presence
of healthcare personnel especially in a rural setting was brought to light during this
session.

6

!

Health Policies
Understanding the health policies present in the country and how they are not being
utilized is something to ponder upon. With the government providing so many
schemes for the marginalized communities but yet the health status of these very
communities is not improving. It makes one wonder as to why these schemes are
failing? Is it due to lack of awareness amongst the marginalized communities or
lack of follow up by the government? Though just finding the cause behind this will
only help half of the process, the main thing to be considered is how do we make it
accessible for these communities?

!

Social Determinants of Health
This for me would be the biggest learning from this fellowship. It gives a fuller
meaning to the definition of health by WHO, “Health is a state of complete
physical, mental and social well being and not merely the absence of disease or
infirmity.” Learning how health is not just about disease but includes economical,
social, religious, environmental, nutritional, etc., determinants that affect one’s
overall being. To learn and understand it at a theoretical level is completely
different from experiencing it at the field level. It is surprising to see how our
medical schools completely make us methodical in depriving a “patient” the health
services only because he/ she cannot pay for the treatment they deserve. As doctor’s
we take the oath not to consider all these determinants but yet when we work in
hospitals we do the very same, we deny certain people their right to good health
only based on these very social determinants. I find the concept of “Health is a
Right” to be one that needs to be focused more upon by all systems of education.
No one should be denied or be deprived of their right to good health just because of
their social, economic, religious backgrounds.

! Equity vs. Equality
This is another concept that brought to light the difference between equity and
equality. One always assumes both the words mean the same but once explained it
all makes sense. The picture representation of the difference between equity and
equality sums up the difference where the need for access to healthcare or any other
7

service is to be provided for those in need and not for all. The strong need to follow
the principle of equity rather than equality is very much needed in our country, not
only in the field of health but all other aspects as well. Personally, I feel if we apply
the principle of equity in the public sector, it will help bridge the growing gap
between the poor and rich.

!

Health Economics
An introduction to what is health economics and financing. The interesting
connection about how economics is mainly finance that helps manage resources to
provide for health services. It gives us the tools to prioritize and manage resources
for health programmes. It is the management of material resources and human
resources. There are two types of scarcity in economics, the desire to remain healthy
and limited resources. We need to keep in mind two points when it comes to
economics- efficiency and equity. Without either one then it the balance does not
occur. Various types of health financing such as OOPE (Out of Pocket
Expenditure), tax, income based funding, loans, user fees and insurance were dealt
with. Concepts of risk pooling cross subsidy and principle of solidarity play a key
role when it comes to deciding what best suits a health system. There are different
types of health insurance such as public insurance, social health insurance, private
insurance and community based insurance. The concept of global budget and its
role in health was also brought into consideration.

! National Rural Health Mission & Communitization (Community
Action for Health)
To learn that this was the largest public health initiative in the world that ad a
community-based approach was interesting to learn. To see that at the policy level,
the government had a well-written plan that did bring about a change in the health
sector. Understanding that this health mission was prioritizing communitization
through which the people are involved in the decision making process is a welcome
change. Learning that though the government has tried to push forward the thought
of community monitoring, it’s acceptance by the medical sector has not been

8

positive. There is a strong need to close this gap or thought process by the medical
community as to why should the community monitor their actions.

! Health Pluralism
From this session, the learning’s that came out were that once the medical
community starts accepting that doctor’s are not just medical school graduates but
also those who come from other backgrounds such as Ayurved, Unani, Siddha, and
Homeopathy we could help address the health issues faced. All fields combined will
show better results than the divide and rule policy that we see presently in our
health system. The allopath doctors are given higher regard and thus along with this
our traditional healing methods are fading away slowly. The dependency on drugs
and combination drugs is growing increasingly; if only the promotion of traditional
healing methods to treat common health problems is done will it survive and help
all communities irrespective of their socioeconomic backgrounds.

! Urban Health
Urban health is another growing area of worry as the migrant population is
continuously increasing. From this session, the understanding about the issues such
as land rights, health issues, public distribution systems, more importantly
recognition as a citizen was seen. The migrant population that come from various
rural backgrounds in search of a better pay scale or quality of life struggle to make
ends meet, living in poor conditions without any of the basic amenities. This
constantly growing community suffers even with access to health care facilities and
absence of healthcare knowledge also adds to their woes. A lot of thoughts that arise
in the mind one majorly being why are the urban slum dwelling communities
considered to be illegally living on government property when used by the
government to do all the nitty gritty work illegally?

! Ethics
A big gap in all the systems of our country! From this session, an understanding
about what ethics truly means and what are the ethical considerations with respect
to health. The strong need to keep in mind the ethical values when one conducts a

9

research, treating patients or even just plain assignment work during our early years
of education. I strongly feel, there is a need to change our educational system, that
teaches us always to “Copy and Paste” when we do assignments or even for that
matter general assignments. We are not taught to acknowledge where we get our
information and this too for me is unethical. The other though that comes to mind is
the need to treat a human being with an ethical and moral mind, though most
healthcare providers take the Hippocratic oath, hardly we follow it.

! Mental Health
It is a growing health issue regardless of age, gender or religious background. To
learn and understand the difference between mental retardation and mental illness is
a key learning for me. Usually it is always assumed that one who suffers from a
mental illness cannot be “normal” again and this is where we need to change these
assumptions in the communities. To do so, the education component is very
essential.

! Occupational Health
This for me has constantly been a nagging concern as the working conditions for
those who belong to the lower socioeconomic groups are extremely poor. Most of
them are exploited and paid a meager salary for their hard work. This community is
also a growing one, which further builds the need to try and bring about health
policies or at least certain regulations that can be followed for their safety that is
indirectly relevant to their health status.

! Social Exclusion
Social exclusion for me was limited knowledge as I always assumed it was related
to a defined group of people such as transgenders, sex workers etc. Only during this
session I learnt that it is those marginalized communities that are socially excluded
due to various social determinants and not just occupation specific. To watch a heart
wrenching video on the “Devdasi” system or the Dalit communities forced to clean
toilets in villages or even the tribal communities completely kept away from the
ever-changing cities development was an eye opening experience. It brought to light
10

the need to introspect on why and how these communities are being socially
excluded? How can we bring a change in this thinking? The suppression these
communities face through social norms, how can we change that?

! Universal Health Coverage
It was interesting to understand how UHC works and that how the neo-liberal
thinking has somehow tried to bury this concept. The need for this type of a concept
is very much needed with the principle of equity in mind. The access to health care
services would improve for those who previously did not have so and the
improvement in health status not only for those who previously had access but for
those who did not.

! Qualitative and Quantitative Research Methodologies
These sessions were like a refreshers course but with much better grasp over the
topics. Though, I had studied quite a bit about the quantitative methods, qualitative
research has been a new learning with the various ways of conducting research and
also the major importance of ethical clearance for the very same. Also, the
curiousity to know which method is better for research led me to the answer that a
mixed approach always gets us closer to the answers we seek.

! Environmental Sanitation
This session will be a memorable one for me; reason being it was a reality check to
hear Prahlad speak about how ignorant we are to this topic. To learn about how
challenging it is to try and change the behaviour of communities, but first to become
a part of the communities and then try to help them. His “walk of shame” with the
village folk and simple ways of letting the community come up with answers was a
very nice learning as to how you interact with the community and feel one. While,
seeing how caste plays a massive role in discrimination even when it comes to
environmental sanitation. Coming to the urban side, understanding how garbage
disposal and segregation is important in maintaining an environmental friendly
surrounding. To understand, manual scavenging something that persists even today,
and is illegal but yet continues.

11

! Environmental Health
Aditya’s discussions on this topic have been insightful and vast. Understanding the
seriousness of how the environmental issues affect the health status of communities.
The discussions on various real life incidents like the Bhopal gas tragedy where it
was the poor who suffered and continue to do so from a range of health issues. The
need for implementation of stricter laws by which foreign and local companies
abide is strong. Introduction of stricter laws too may help, but it is not just an issue
at a higher level. Even the awareness at the grass root level is very much needed.

!

Health for All & Paradigm Shift
Health for all is not for those who can’t pay, who can’t reach us, is it reaching
everybody or not? It is very important that there is no barrier brought especially
money, caste – the service, which we are doing, needs to follow the six principles as
below:
1. Intersectoral collaboration
2. Community participation
3. Appropriate technology – all of health has technology in it, make a choice and
then introduce it. (For the people)
4. Equity- reaching the unreached
5. Right (Health as a Right)
6. Primary Health Care
To see that though we have everything thought of, I truly wonder why is it we have
deviated from these principles to a much-undesired one.
The paradigm shift is very much needed now at this moment where the gap between
the rich and poor is increasing at an alarming rate! For it happen the “change” in the
thought process of those not only on the top but also of those at grassroot level is
required. The thinking from that of a “medical model” to a social one, with the
individual focus shifting to a group or community; patient’s are seen more as
people; it is seen as overall health of these people and not just merely the disease;
instead of being the expert and providing, to enable these very people to take over.

12

Fig.1: The Paradigm Shift

!

Medical Model

Social Model

-Individual
-Patient
-Disease
-Providing
-Drug Technology
-Professional Control

-Group/Community
-Person/People
-Health
-Enabling
-Social Process
-Community Control

Inner Learning Sessions with Kumar
These sessions have been extremely helpful, especially for one’s personal growth.
The open discussions about one’s feelings and reflections about various personal
and professional lives helped me understand my fellow traveler’s better. Expression
of one’s inner feelings and trust are something that I learnt from these sessions.

13

Guest Lectures:
The guest lectures have been inspiring and at the same time so vast in teachings. I
have truly learnt a lot from these lectures, with community health workers from
various backgrounds coming to discuss with us the work they do with communities.
!

P articipatory Rural Appraisal & Systems Thinking with Mr. Sam
Joseph
This for me has one of the major learning’s about what is a community. Mr. Sam
Joseph’s words still ring in my head, “Do not go to a community, if you do not
intend to let them help themselves.” Understanding from the very basic what is a
community to how we can help figure out what are the issues they feel they are
facing through simple activities like social map, ADICO, CATWOE, PAM
(Purposeful Activity Mode), etc. To also practically apply it has been helpful in my
understanding.

!

The A.N.T with Dr. Sunil Kaul
To hear Dr. Sunil’s community health journey and the work he is doing at
Bodoland, Assam was interesting. To be faced by so many challenges and yet try to
work with the community is what I learnt from his journey. Not giving up.

!

Low Cost Communication with Mr. Krishnachakravarty
A hilarious session about how one needs to keep in mind their body language,
presence and actions when in the community. A fun filled two - day session with
various confidence-boosting activities that ended with the team of fellows
presenting skits on various health issues. The overall learning from this session has
been to go down to the level of a community and try to communicate in a way the
community understands.

!

Healthcare Management with Dr, Kishoremurthy and Dr. Vasundara
The discussions about a manager’s role in healthcare and how to be a good
manager, one needs to make the most of the limited resources available. The main
role for a manager is to always think out of the box and it is not about just practical
14

resources but also human resources that come into play. Being confident and a team
player are the utmost major points for a successful manager and both the guest
lecturers emphasized this.
!

Tribal Health in Kalahandi with Dr. Sr. Aquinas
To get a brief summary about the tribal communities and the poor functioning of the
health systems in Kalahandi, Orissa was interesting. To hear about how these
communities do not have access to basic amenities and suffer especially when it
comes to health was heart breaking. It was interesting to hear about how a health
programme was going to be initiated by Dr. Sr. Aquinas and her team to help
educate the tribal’s and make them take care of their own health. To see the
dedication and passion to continue empowering communities through their
knowledge was the perspective I gained from this interaction.

!

Comprehensive Rural Health Project, Karnataka with Sr. Tina
Sr. Tina’s community health journey was interesting to hear and also her study on
the health indicators with regards to maternal health that she conducted by creating
a HMIS to get a better understanding. Her bold nature and activism is something I
truly learnt to appreciate from her sharing.

!

Transactional Analysis, Seva Sadan, Bangalore
A three-day workshop on how to manage various forms of relationships and the
various forms of introspecting into it. It is very important to keep this in mind when
we work in the community, along with the team members we work with.

!

Life Journey Narrations
By Rakhal, Prasanna, Chander, Ravi, Prahlad, Kumar, Victor, Pushpa, Sangeetha
(Kiran Trust), Helen have helped me understand the various challenges one faces
when they decide to go down a different direction than the usual. They also brought
to light the fact that it is OK to be confused about the path you choose and that you
will somehow always find your inner calling sooner or later.

15

The Experiential Learning
Field visits:
!

FRLHT, Bangalore

!

Rajendra Nagar slum, Bangalore

!

Hakki pikki colony, Bannerghetta

!

Green foundation, Kanakapura

!

Ramnagara Health camp by Bangalore University, Ramnagara District

!

Headstreams, Bangalore

!

Community Action for Health, Perambalur District, Trichy

!

Medico Friends Circle Meet, Delhi

!

KARGERICON 2013, Geriartric Conference, Bangalore

!

NIMHANS Sakkalwara Wellness Center, Bangalore

!

APD (Association for Physically Disabled), Bangalore

!

The National Workshop on “Social justice in Health”, Bangalore

!

State Level Consultation on ban on Tobacco Advertising, Promotion and
Sponsorship

!

Jan Swasthya Sahyog, Bilaspur

!

Protest against Monsanto, Bangalore

16

!

The Urban Escapade with Bangalore Baptist Hospital
Overall, my visits have given me an understanding of the work being done by the
team in both the urban and rural settings. I have realised that language plays a key
role in grasping the community’s attention and also helps in “fitting” in.
Working in a highly populous urban slum like D.J Halli in Bangalore with the
health team has taught me a lot. Getting to interact with the communities dwelling
there, showed a lot of issues faced by them that indirectly or directly affects their
health. The main issues, notice by me was that since it was a migrant population,
language plays a very big role to interact with the communities. During the
government school visits, I learnt that a two-way approach helps children best
understand. An interactive one with discussions helps a lot, visual aids being a
bonus. I also learnt that the urban communities even though in a city, face various
issues like space, environmental hygiene, inaccessibility to health services, land
rights, no proper water and electricity facilities. Each family struggles to live within
the four walls along with which most are daily wage labourers that adds to their
woes. Anemic mothers, malnourished children are a common sight to one’s eyes.
Visit to the Anganwadi’s where the teacher alone has to manage nearly seventy
children below the age of 5 is surprising to see. The Primary health center too due to
absence of doctors and staff seems to not work upto the standards. The main focus
of the PHC is family planning that makes the health workers not focus on the
overall health of the community members.
From this field placement, I have overall learnt that communication plays a key role
when it comes to interacting with a community and learning from them. Health
education lacks a lot and the need for it amongst the community. The
implementation of programmes by the public health system needs to improve
immensely for it to be available for communities who cannot afford high end health
care services.

17

!

The Tribal Experience in Kalahandi, Orissa with Swasthya
Swaraj
My two-month field placement in Thuamalrampur block, Kalahandi district, Odisha
with the Swasthya Swaraj Comprehensive Community Health Programme was a
one of a kind experience. Like most urban settled individuals, I was apprehensive
about shifting out of my comfort zone to a complete unknown rural setting that too
in a different state. More importantly, I was entering a health field that I had never
considered before, tribal health. For me, tribal communities meant those who lived
high up in the mountains amidst forests and hunted for a living.
On arriving in Bhawanipatna, I was pleasantly surprised by the silent and peaceful
environment that contrasted the bustling city life that I was used to. I expected or
rather was mentally prepared for beautiful scenic views; many mountains and
streams; health issues similar to those previously seen in a semi rural setting and of
course, no communication networks or electricity. However, I saw and experienced
was something different altogether.
Yes, I did see beautiful sceneries, a lot of mountains, but the health issues were far
worse than what I had imagined: Anaemic women with pale skin and children
hanging from their waists, constantly suckling away from their bosoms;
malnourished babies and children with big bellies, brown coloured hair and scaly
skin; tired men looking older than their actual age and troubled by constant body
aches. This was a common sight in every village I visited.
The highest educated individual in any village would be either a fifth pass or a tenth
pass. No one would have studied further due to lack of knowledge about what they
could do next and also, financial issues. Naive children who eagerly wait to attend
schools are faced with disappointment due to absent schoolteachers. Young boys
and girls who managed to complete their twelfth grade, keen to study science or
commerce subjects, were left with no choice but to continue studies in an arts
college due to lack of other educational facilities.

18

Men work as daily wage labourers or are involved in any other sort of menial
labour. They are underpaid for their hardwork, usually as low as ten rupees per
day!
For years together mothers have continued to give birth alone in a dark room by
themselves and are prepared to give birth to a live or dead child. What is more
haunting to see is the common emotionless narration by these very mothers about
being pregnant five times and only three of their babies surviving. Death is
considered and accepted as a norm of their everyday life.
Health facilities are almost non-functional. Even though there is a community
health centre, absence of either doctors or other staff makes its presence pointless.
The district hospital is almost 75kms or more from the villages. Those who make it
to the hospital have to be there within a certain time limit or else have to bear extra
expense as all the doctors from the district hospital shift to their private practices by
afternoon. Transport is another major issue for the tribal communities with only two
to three buses plying from the main town (Bhawanipatna) to the villages. They have
to walk, passing through two to three mountains to reach the bus stop from where
they can catch it. The buses too leave only at a certain time and if one misses the
bus, the only option is to walk all the way back to their village from the town. Due
to lack of health personnel at health facilities and loss of daily wages, the people
tend to ignore any health issue they face and are obligated to visit the local healers
or quacks in their villages.
Anytime we visited a village, we were always requested to visit one house or the
other to check on someone who the village folk felt were seriously ill. During clinic
sessions every Saturday, most of the tribal folk would come with complaints of
itchiness and wounds on their hands and in the private areas of the body that would
be diagnosed as scabies. This scabies "effect" was not restricted to any age group,
being present even in new borns. With these wounds they continued to do their
laborious work and walk long distances.
In the Swasthya Swaraj Comprehensive Community Health Programme, the team is
trying to focus on the various aspects of health issues faced by the tribal folk and try

19

to help the respective communities have their own primary healthcare providers. It
primarily addresses most of the social determinants of health like education, health
awareness, nutrition and employment for the youth etc that are affecting the tribal
communities. I was a part of the recently started training programme of the
community nominated Swasthya Saathi’s (our tribal women primary healthcare
providers). It was delightful to see the women transform from shy, silent tight
lipped ladies on day one to open, outspoken and creative ladies by the end of the
programme. This programme was recently kick-started with one doctor managing
everything with a few team members to support. The challenges faced by the team
are many, one mainly being the need for more human resources especially, doctors
and nurses. Travel too is a very big challenge as most villages are placed in remote
interior regions of forests and hills.
I was also lucky to learn a little about the culture of the tribal community with
respect to the marriage customs, body art, piercings, communication and other
traditions. Marriage customs are similar to those seen in romantic stories, where the
boy woos the girl and then ends up kidnapping her from her native village to prove
himself worthy and brave. Body tattoo art and piercings are a big favourite among
the women who enjoy decorating themselves. The love and trust among the tribal
communities is something I think we all can learn in this day and age where it is
seen to be diminishing.
My learning from this journey have been rich both in number and value. I closely
witnessed equality, community support and the simplicity of tribal communities.
There are huge gaps in the delivery of primary healthcare services that immediately
need to be addressed along with health promotion and education. I now have a
better understanding about how social determinants play a critical role in health.
Health is not restricted just to treatment of diseases or conducting programmes with
a top down approach but it has many components that need to be understood and
addressed. The social exclusion of tribal communities is something that needs prime
consideration before these communities disappear due to development /
urbanization.

20

My Comprehensive Understanding
For me the overall learning’s through this journey have been plenty. I had a
completely different perspective about community health before coming to
SOCHARA, more of a medicalized one. Initially it was difficult to grasp few
concepts or let go of the fact that “I” am an expert about a certain field and “I”
know what is best for a community. Through the collective sessions and field
placements the shift within me has been a strong one. It is not about being the one
who teaches the community but more of learning from the community, because one
can learn so much from not just one individual but the whole group, if given the
chance. Understanding the community and becoming one with them is the first step
to this learning journey for me. You realize that it is easy only if you let go of your
inhibitions, fears, and more importantly ego. For someone from the younger
generation where peer pressure of finding a good job with a good salary affects you,
it is completely fine to be different from the herd. I learnt this during the course of
time seeing that being different is good, because that helps you seek what you want
to truly do. In this day and age where people are more focused on gaining more for
themselves, we are forgetting to see that others around us exist. It is a worry, but
with like-minded people the change can be brought even if a slow one. It is
motivating when you hear Dr. Thelma and Dr. Ravi speak about how they have
waited forty years and are seeing the shift happen slow and steady.
Community health needs to be strengthened and this will only happen if more
people, mostly the top level folks start thinking with an equity principle. The need
for attention towards implementation of all the health programmes and schemes at a
field level is high. The public healthcare system needs to shift it’s focus from
vertical programmes that are disease specific to one that has overall good health.
Personally I feel the health of the marginalized communities needs to be considered
immediately as, if ignored they will diminish out the picture which will be
unfortunate.
Lastly, for me health has taken a new turn where I know now that it is not just aout
treating the disease but about facilitating a positive change with the community. I
may not be able to bring a change that is big but I surely can initiate that change is

21

what I believe. Hope my journey in community health continues and I can motivate
all those I meet to see the “Health for All” view.

“I alone cannot change the world, but I can
cast a stone across the water to make many
ripples”
- Mother Teresa

22

Snapshots of My Exploration into
Community Health
! Collective Sessions at SOPHEA:
o Defining Community Health

o Systems Thinking Session with Mr. Sam Joseph

23

o State Level Consultation on Ban on Tobacco Advertising, Promotion
& Sponsorship, Bangalore

24

! Field Visits:
o Foundation for Revitalisation of Local Health Traditions,
Bangalore:

o NIMHANS Sakkalwara Wellness Center

25

o Social Map, practical experience at Maganappanapalya:

26

o Medico Friend’s Circle Annual Meet 2014, Delhi

27

o National Launch of National Urban Health Mission, Freedom Park,
Bangalore

The Honourable Chief Minister of Karnataka, Shri. Siddharamaiah & The
Honourable Minister of Family Health & Welfare, Shri Ghulab Nabi Azad

28

!

Protest against Monsanto

29

!

Visit to Jan Swasthya Sahyog, Bilaspur

30

Field Placement at Bangalore Baptist Hospital:

The Urban Health Center

The surrounding area in DJ Halli

The Primary Health Center, DJ Halli

A Anganwadi School, DJ Halli

*Health Awareness at Devanahalli Govt School

31

*The Baptist Community Health Team

Field Placement with Swasthya Swaraj, Kalahandi,
Orissa
A few glimpses of the tribal community I became one with

32

Reconnecting with nature, traveling back in Time

33

Travel is a challenge

Common health issues seen: Scabies, Malaria &Malnutrition

34

The Community Health Centre and District Hospital, Bhawanipatna

Peripheral Clinics at Kaniguma Panchayat by Swasthya Swaraj Health Team

The Opd Registration

The Examination Room

The Lab Facilities

The Pharmacy Outle

35

The Swashtya Saathi’s of Kaniguma Panchayat

With the three Didi’s who are the pillars behind the community health
programme

36

My extended family

37

Community Health Learning Programme is the third phase of
the Community Health Fellowship Scheme (2012-2015) and is
supported by the Sir Ratan Tata Trust, Mumbai and
International Development Research Center, Canada.

School of Public Health, Equity and Action (SOPHEA)
SOCHARA
st
# 359, 1 Main,
1st Block, Koramangala,
Bangaluru, Karnataka, India – 560034
Tel: 080-25531518; www.sochara.org

Position: 3925 (1 views)