Jyothi Lakshmi - Final report.pdf
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2014-2015
2015
Community Health Learning Programme
A Report on the Community Health Learning
Experience
JYOTHILAKSHMI.C.
JYOTHILAKSHMI.C.R
COMPANY
555-543-5432
5432
www.yourwebsitehere.com
SOPHEA
COMMUNITY HEALTH LEARNING FELLLOWSHIP PROGRAMME
A DOOR TO A WONDEROUS JOURNEY……………A JOURNEY OF RESPOSIBILITY
JYOTHILAKSHMI.C.R
CHLP FELLOW 2014
To 2015
1
Dedicated to my most beloved dad
2
MY BOW
I feel proud to have had the privilege of being associated with this great organization and its
people and I pray to God Almighty that the SOCHARAwillcontinue to hold its torch aloft in
the years to come
I am using this opportunity to express my gratitude to every one who supported me
throughout the course community health learning fellowship program
First of all am thanking GOD ALMIGHTY for giving me a unique opportunity ,being with very
powerful
organization
which
built
on the
foundation of high standards of
ethics,commitment,trust and dedication.Facilitators who constantly work and teach only on
humanitarian grounds.
My deepest Gratitude To ACCORD STAFF,Director doc.Stanly,My field mentor Doc.Mahantu
yelsangi,ICTC
counselor
Mr.Satyasheelan,Mr.Kannan,Ms.Jyothi
Nursing
school
principal,Malathi checi,Ashwini supervisor,Mr.Maniknadan Sickle cellcounselor, all tribal
counselors in PHC,All health Animators in all area centres especially Gudalur area centre
team
members,
Adivasi
munetra
sangam
leaders
,Mr
bomman,Mr.Ayappan,Mr
Kumaran,Mr.Surendran,Vidyodya school supervisor and all others who have rendered their
love,Patience,tolerance and support through out my project and above all I thank my tribal
friends for their timely support and cooperation without which I would not have been possible
to do my field work .
My very special thanks and deepest prayers to Health animator Janaki chechi and ICTC
counselor Mr.Satyasheelan for their endless support throughout my fieldwork
I bow my head to Dr.Ravi Narayan, Global Advisor of health,PHM and my Facilitator, For his
compassionate teaching, ,reaching to our level while teaching , a real teacher who teaches
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from heart .am overwhelmed after listening his journey of transformation from ivory tower
to discover the community .It is both an inspiration and an encouragement .
It gives me immense pleasure to express my sense of gratitude and sincere thanks towards
our honorable directorDoc.Thelma Narayan for sharing her wisdom and experience, her
uniqueness in what ever she do .Her special soothing tone, her dedication towards work ,her
faith in this mission, her assertiveness all are great learning lessons.
Thank you so much to my Faculty mentor Mr.Sabhu, for showing me a different route which I
never explored Till 2014and also for his constant motivation to reach higher.
My heartfelt thanks to Mr.Mohammad ,Facilitator,Sochara,for his commitment towards us,
his passionate teaching, his level of understanding about our limitations ,his direct and
indirect support whenever we need it.
I thank and respect Mr.Kumar sir for his timely support, understanding,love and above all his
punctuality
I thank Mr.Chander sir for his constant encouragement and appreciation all gives us energy to
move forward with positive spirit.
My sincere thanks to Doc.Rahul for his support ,I would say 24/7 availability, his intelligence
and above all his simplicity, all are great learning’s.
I thank Mr.Prahalad for his unique teaching, passion and commitment towards this mission
health for all
I thank Ms.Shani ,EX-staff SOCHARA,my faculty mentor for her emotional support at the time
of crisis
I thank Doc.Aditya ,facilitator for his humbleness, passion towards environment ,his teaching
gave us new insights about Environment and Health.
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My very sincere gratitude to Mr.Prasanna saligraha his energy,enthususiam,constant
appreciation for small acts, uniqueteaching, creative examples and above all his innocence
and down to earth nature all inspired me.
I thank Mrs.Janella ,Facilitator for her valuable guidance and simplicity .
I am in the debt of all administration staff,Mr.Victor,Mr.Praveen,Mr.sami,Mrs.Maria who
helped in different ways and made my fellowship more easy.
My whole hearted thanks to Mr.Hari,Mr.joseph,Mr.Tulsi for their rejuvenating lemon tea.
Heart felt thanks to sr.Sagaya mary and other sisters in the Snehalaya for providing us a
comfortable stay .
My Very special word of thanks to my mother and brother for their loving efforts,care and
motivation to reach higher achievements.
Above All my deepest gratitude to my classmates for their support,care,love,understanding
which made my fellowship more enjoyable.
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Table of Contents
A DOOR TO A WONDEROUS JOURNEY………………..From known to unknown ............................................ 10
LEARNING OBJECTIVES................................................................................................................................ 11
INNER LEARNINGS....................................................................................................................................... 12
WHAT I HAVE LEARNED .............................................................................................................................. 14
ALL ABOUT HEALTH................................................................................................................................. 14
What is health?.................................................................................................................................... 14
SPECTRUM OF HEALTH ................................................................................................................ 14
Definition ............................................................................................................................................ 14
What is Mental health? ........................................................................................................................... 15
Determinants of mental health ............................................................................................................ 15
Mental health and poverty is interlinked............................................................................................. 15
Mental health and sanitation ............................................................................................................... 15
Whether we need multi-dollar strategies to promote mental health? .................................................. 15
Activities to promote mental health .................................................................................................... 16
Mental health challenges in India ........................................................................................................... 16
Mental health policy ............................................................................................................................... 17
URBAN HEALTH.................................................................................................................................. 17
DETERMINATS OF URBAN HEALTH ..................................................................................................... 18
CHALLENGES ....................................................................................................................................... 18
GENDER AND HEALTH ............................................................................................................................. 18
OCCUPATIONAL HEALTH ......................................................................................................................... 18
HEALTH STAUS IN INDIA.............................................................................................................................. 19
HEALTH FOR ALL???? .................................................................................................................................. 20
WHAT MAKES PEOPLE HEALTHY? ........................................................................................................... 20
Concept of Disease.................................................................................................................................. 20
Determinants of Health .......................................................................................................................... 20
BIOLOGICAL DETERMINATS ................................................................................................................ 21
SOCIAL FACTORS ................................................................................................................................. 21
6
Some important areas to give attention while working to achieve health for all .................................. 21
a) Social exclusion as a driver of ill health .......................................................................................... 21
b) Poverty is a symptom -–Economic inequality breeds health inequality ........................................ 21
A dark Cloud-Inequity in health .............................................................................................................. 22
Globalization-Severe threat to both peoples health and the health of the planet ................................ 22
HEALTH =DEVELOPMENT ........................................................................................................................ 22
HOW TO ACHIEVE HEALTH FOR ALL ........................................................................................................... 23
Give importance to primary health care- ............................................................................................... 23
Alma ata declaration ............................................................................................................................... 23
Four Major threats of primary health care ............................................................................................. 24
Faith in the people .................................................................................................................................. 25
Being open to peoples knowledge ...................................................................................................... 25
What is community health? Is a mission or an alternative to achieve health for all?........................ 25
Axioms of community health ...................................................................................................................... 25
A frame work for a new Indian Health model, 1981 .............................................................................. 26
COUNTER VAILING POWER (POWER FROM BELOW)-Health should be decentralized. ............................. 26
Role of community health worker ...................................................................................................... 26
Primary health care (Health care closest to the people) .................................................................... 27
Basic Requirement for sound Primary health care (4 A ‘S) ..................................................................... 28
EQUITY ORIENTED RESEARCH FOR TRANSFORMATION OF HEALTH OF THE PEOPLE ............................ 29
Importance of Health Insurance ......................................................................................................... 30
Why health is political? ....................................................................................................................... 32
CONCLUSION........................................................................................................................................... 33
NILGIRI DISTRICT PROFILE ....................................................................................................................... 38
ACCORD (Action for community organization, rehabilitation and development)...................................... 39
History of the field placement agency .................................................................................................... 39
Vision of accord....................................................................................................................................... 39
MISSION .................................................................................................................................................. 39
Different phases of Accord activities ...................................................................................................... 39
LEARNINGS FROM FIELD WORK AGENCY ............................................................................................... 40
UNDERSTANDING THE COMMUNITY PRIORITIES ................................................................................... 41
Mullukurumbas ................................................................................................................................... 41
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Bettakurumbas.................................................................................................................................... 41
Paniyas ................................................................................................................................................ 41
Kattunayakans..................................................................................................................................... 42
Bettakurumbas.................................................................................................................................... 42
Occupational activities ........................................................................................................................ 43
Settlement pattern ............................................................................................................................. 43
Economy.............................................................................................................................................. 43
Politics ................................................................................................................................................. 43
Gender ................................................................................................................................................ 43
Education ............................................................................................................................................ 43
Electricity, water and telephone ......................................................................................................... 44
Transportation .................................................................................................................................... 44
Health systems, Health seeking behavior and health expenditure. ....................................................... 44
Health Problems...................................................................................................................................... 45
WHAT DO THE PEOPLE SAY? ................................................................................................................... 45
REFLECTIONS ABOUT ACCORD................................................................................................................ 45
REFLECTIONS ABOUT GENDER LIVE LIVELIHOOD, ECONOMIC STATUS AND HEALTH REFLECTIONS
ABOUT GENDER LIVELIHOOD, ECONOMIC STATUS AND HEALTH .......................................................... 47
KEY OBSERVATIONS ................................................................................................................................ 48
MY CONCERNS ........................................................................................................................................ 48
CONCLUSION........................................................................................................................................... 50
Perception and Attitude of using sanitary napkins as part of menstrual hygiene among tribal girls and
women ........................................................................................................................................................ 51
Disposal issues ........................................................................................................................................ 52
Acceptability and Hygiene ...................................................................................................................... 52
Affordability ............................................................................................................................................ 53
Limitations .............................................................................................................................................. 53
CONCLUSION........................................................................................................................................... 54
A study on factors influencing substance abuse among tribal youth with special reference to Gudalur
block, Nilgiri district, Tamilnadu................................................................................................................ 62
INTRODUCTION .................................................................................................................................. 62
Teen and young adult drug use .............................................................................................................. 63
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Background ............................................................................................................................................. 63
Tamilnadu ............................................................................................................................................... 64
Statement of the problem ...................................................................................................................... 64
RESEARCH METHODOLOGY .................................................................................................................... 65
General objective ................................................................................................................................ 66
Specific objective ................................................................................................................................ 66
Universe and Unit Of study ................................................................................................................. 66
Ethics ................................................................................................................................................... 66
Sampling.............................................................................................................................................. 66
Study design ........................................................................................................................................ 66
Data collection .................................................................................................................................... 67
Tools of Data collection....................................................................................................................... 67
Data Analysis ....................................................................................................................................... 67
FINDINGS................................................................................................................................................. 67
Socio-demographic information of the respondents ......................................................................... 67
Social factors ....................................................................................................................................... 72
DISCUSSIONS ........................................................................................................................................... 75
Conclusion ............................................................................................................................................... 76
REFERENCES ............................................................................................................................................ 77
APPENDIX 1:Topic guide for in-depth interview ..................................................................................... 77
ANNEXURE -2 ......................................................................................................................................... 80
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PART –A
Learning’s from Collective theory sessions
A DOOR TO A WONDEROUS JOURNEY………………..From known to
unknown
Like any other social work professional I too dreamt of challenging all the evils in our society
after my MSW PG degree. When I began working at the field of social work,I have been
enlightened, sometimesdisillusioned. I worked as Medical social worker In Medical
ICUinMultispecialty hospital .Crisis intervention through the blue tinted glasses made me to
realize many crucial things in Health care and also the inequities in the health system. Most of
the time I felt helplessness as medical social worker to do justice to the patients and families I
would say it as system error. After two years of working as medical social worker I got into
teaching field since childhood onwards I do like teaching. And I thought that my dream job will
give all job satisfaction ……..but things are almost the same…………I caught in a web of
paradox only the setting changed……”SYTEM ERROR” exists everywhere whether it is health
care or education injustice do exists…….being a Social work faculty member in the department
of social work ….I do faced many corrupt practices in the teaching field………..most of the
time felt emptiness ……..it was very difficult to impart injustice to social work
students………the entire faculty member in the department of social work was intolerant
towards the unethical professional standards…….we could not able to compromise our primary
interest to secondary gains……..will call it as “conflict of interest. We did many constructive
challenges but Failed finally. Decided to quit it was a mass resignation.
I was unsure which way I can turn. Doubt can crap in and made me wonder, “Is change really
possible? How can I challenge the system errors? How can I keep doing this work? “I feel like I
have nothing left to give and I just want to quit my profession……………again an inner
call…………..I moved to Bangalore………….a painful switchover
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Here starts my journey towards Sochara.Before starting my journey I was certainly apprehensive,
however the experience turned into more than I imagined a paradigm shift in my own attitude
and thinking towards Health and health care…………and also different practical solutions to
“SYSTEM ERRORS” .I would like to write a quote which perfectly describes my CHLP
experience here it goes
“Walk with the dreamers, the believers, the courageous, the cheerful, theplanners, thedoers, the
successful people with their heads in the clouds and their feet on the ground. Let their spirit
ignite and fire within you to leave this world better than when you found it”- by Wilfred Peterson
I hope this fellowship continues and blossoms into bigger things in the future.
LEARNING OBJECTIVES
Tap turner off of diseases in the field of health
To develop a strong commitment to social change that promotes equity and justice
in the field of health
To engage proactively with community health interventions and the voice of the
community
To reinforce my skills and transplant it into community health
To penetrate deeply to the grass root level and to understand the social
determinants of health
To develop critical self-reflection and personal learning
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To know the gap between rich and poor ,rural and urban, to understand the
different cultures
To discover what I have never experienced and never imagined
To develop critical writing skills and also develop analytical skills
To create a paradigm
gm shift in my own convictions and attitude toward Health
To Identify and rectify my personal biases
biase
INNER LEARNINGS
-“Vasudaivakudumbakam.
vakudumbakam.” During my CHLP I kept on hearing this word and the most
important value have learned is seeing
s
the world as one family .Iff we have this value it
will reflectt in our work with human beings
and rest of the values will come
automatically
UNITY
January
IN
DIVERSITY’
DIVERSITY’-The
17thh
2014
was
day
extremely
different to me. Though
hough I studied in different places and also worked in various settings
but this CHLP group is a diverse group. A union of seven states.All
ll are secure in their
own self-identity “irrespective of language,culture ethnicity etcII really connected well
with all of the other people in my group”.At
group”
the same time as a group we were not afraid
to challenge each otherviews.....I
otherviews..... do believe this sense of bonding and connectivity will
reflect
12
in
my
future
journey
journey
towards
achieving
health
for
all.
Change is a gradual process so I should not be hurry .There is no quick fix solution for all
the problems. If there is 20 reasons for a particular disease there are 20 solutions also. We
will be patient enough to achieve our mission towards Health for all.
Communication is the key –any deficits in information transfer and communication is
adversely affecting the people. We need to demonstrate effective communication skills to
build trust with service users and colleagues .so we should be assertive and at the same
time effective communication is very important.
Use of self-Use of personality,belief system, relationship dynamics and how we are using
our emotions while working with people is very important .As community health worker
we need to analyze our own constructs and their application to our daily practice.If we
are not clear about our own values and beliefs and unconsciously we projects our world
view into the community.
Empathetic understanding-we need to understand another person’s condition from their
perspective. Then only we can deeply engage with that person and give suggestions and
directions accordingly.
Community health learning fellowship is a journey of responsibility and an effort
I could able to expand my professional horizon in a more focused and meaning full way
Improves my confidence to deal with the system errors more authentically and more
hopefully
Importance of thinking and feeling. Chlp once again reminded me about how can weas
community health fellow will blend our brain and heart while promoting health for all
once again I got an opportunity to strengthen my micro skills which I have already
acquired
from
my
MSW
discipline
such
Listening,reflecting,responding,usingsilence,usingempathy,assertiveness,summarizing
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as
knowledgeupdating-make sure that we keep our knowledge and skills up to date then
only we can provide highest standards of practice for the people with whom we work.
WHAT I HAVE LEARNED
ALL ABOUT HEALTH
What is health?
Health is happiness not only for you but for the people around well you as well. It is a dynamic
state or condition that is multidimensional in nature. It is a resource for living and exists in
various nature. As a community health fellow the most important learning about health is Life
chances differ greatly depending on where people are born and raised. At all levels of income
health and illness follow a social gradient the lower the socio economic position the worse the
health. So as community health workers we need to remember these. Health is a fundamental
human right and an integral part of human development.
SPECTRUM OF HEALTH
The spectral concept of health tells us that health of an individual is not static, it is dynamic and a
process of continuous change and is always subject to variations. The lowest point on the health
disease spectrum is death and the highest point is positive health. So it is obvious a person may
function at maximum levels of health today and diminished levels of health tomorrow.
Definition
The world health organization defines health this way: “Health is a state of complete physical,
mental and social well –being and not merely the absence of disease or infirmity. Fromthis
definition we can easily understand how important mental health is.
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What is Mental health?
A person who is mentally healthy has a state of wellbeing in which he or she can realizes his or
her own abilities, and is able to cope with life’s normal stress, can work regularly and
productively .so that he or she can able to give contribution to the community.so there for is the
foundation for an individuals and community’s effective functioning and wellbeing.
Determinants of mental health
Just as illness and healthin general are affected by multiple factors,so too is mental health and
mental health disorders. These factors, which often interact,include biological, psychological and
social elements.
“There can’t be anyone more vulnerable than a person who does not know he or she is
vulnerable,” said K. Srinath Reddy, president of the Public Health Foundation of India, an
organization working to improve education, research, training and policy in public health
Mental health and poverty is interlinked
Low educational levels,poor housing and low income all gives us unhappiness and it effects our
overall mental wellbeing. As socio economic disadvantages increase,the risk to mental health
also increase. Disadvantaged individuals are more vulnerable to psychiatric disorders.Mentally
unhealthy individuals feel insecure, hopelessness, poor physical health and also more prone to
violence.
Mentalhealth and sanitation
The new key learning about causes of mental health as Community health fellow I learned is
how mental health is connected with open defecation.
Whether we need multi-dollar strategies to promote mental health?
Answer is a big no. Where some of the evidence based,high impact interventions that help to
promote good mental health.
15
Activities to promote mental health
•
School mental health programs
•
Early childhood interventions
•
Community development programs
•
Support to children
•
Housing policies
•
Violence prevention programs
•
Women employment programs
•
Support to elderly
Mental health challenges in India
“Mental health conditions are difficult to understand because there is so much about the brain
that even doctors don’t know. It is treated as a whisky washy issue everywhere in the rural
world, but in a society that does not even recognize the problem and furthermore in a rural
contest “Unfortunately, society still stigmatizes those who suffer from routine psychiatric
problems and so their treatment is either delayed or denied. We need to build up a social
movement to change mindsets and focus on the human dimension of mental illnesses, “said by
Dr.Vardhan these two statements clearly tells us about the challenge of mental health
Other challenges are
.Acute shortage of mental health professionals it has only 3,500,that’s one for every
343,000 people.
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Attitude towards mentally ill. Social stigma towards mental illness still exists so mentally
ill person and family is isolated from the main stream.
The biggest misconception in India is that illiterate patients won’t be able to make their
own decisions about consenting to treatment
Faith healers –A vast majority of patients and family is approaching faith healers and
spend huge amount on that and finally ended up in disappointment and debt.
Community Health workers role is to help patients reintegrate into their communities and refer
new patients to a local hospital for treatment
Mental health policy
Mental health policy in the grounds of equity and justice .Pillars of “policy are compassion and
responsibility”
Now India has started to pay greater attention to the country’s mental health .The new bill
recognizes the rights of the mentally ill. The new policy will give a direction to the way public
funds should be invested. The new mental health policy is likely to include components of the
bill, which allows any person who considers himself to have a mental illness to request
admission to a mental health facility independently, without the orders of a magistrate.
This provision enables a mentally ill person to seek treatment, and also secures “the right of a
person not to be institutionalized,” said Dr.Reddy.
URBAN HEALTH
Urbanization is one of the leading global trends of the 21st century that has a significant impact
on health, by 2020,over 70% of the world’s population will live in cities. While cities can bring
opportunities,they can also bring challenges for better health.286 million people in India live in
urban areas. Health of a population that lives and works closely together,usually in an
17
incorporated area such as a city or town, with a common water supply and with similar
environmental conditions.
DETERMINATS OF URBAN HEALTH
The social determinants of health are the condition in which people are born,grow, live work and
age. These circumstances are shaped by the distribution of money, power and resources at
Global, National and local levels.
CHALLENGES
Administrativeissues, Policyissues, Operationalissues, Large size of Population
GENDER AND HEALTH
The concept of gender means much more than a biological sex. It means how society fabricated
roles,responsibilities depending on the sexual classification. Society constructed the ways in
which one should think and behave. These stereo typical expectations are commonly referred to
as gender roles. Gender effects many aspects of life and it determines males and females destiny.
Traditional gender roles define masculinity as having power and being in control in emotional
situations, in the work place and in sexual relationships. Women are expected to be emotionally
expressive,dependent,passive,co-operative,warm and accepting the inferior position in marriage
and employment. Access to resources, methods of coping with stress, stylesof interacting with
others, self-evaluation, spirituality and expectations of others all connected on the basis of
gender.
OCCUPATIONAL HEALTH
It is related with safety and health in the work place. Every day approximately 15 people die
from work related injuries and many more people die of work related diseases. Occupational
health issues affect the quality of life economically as well as medically in communities in which
workers live. Types of occupational illnesses can be categorized by cause and by the
organaffected. I have learned respiratory disordrers.one important respiratory disorder is
silicosis. Workers in mines, stone quarries sand and gravel operations foundries, abrasiveblasting
operations and glass factories run the risk of silicosis.it is an acute and chronic lung disease
18
caused by the inhalation of free crystalline silica There are numerous resources to aid in the
prevention of occupational injuries and diseases,including occupational health professionals and
work place injury and illness prevention programs and health promotion programs.
Most of the companies are not giving any social security measures to the employees and in the
case of silicosis even health professionals cant able to diagnose the disease and also they are
lobbying with the companies .it is an urgent need to do some actions measures to tackle this
problem.
HEALTH STAUS IN INDIA
India faces High burden of disease because of lack of environmental sanitation, safe drinking
water,undernutrition,poor living conditions and limited access to preventive and curative
services. Lack of education, gender inequality and population explosion all contribute to Double
burden of disease.
STATISTICS
TOTAL POPULATION
1,240,000,000
Gross national income percapita
(ppp international $,2012)3/910
Life expectancy at birth m/f (years 2012)
64/68
Probability of dying between 15 and 60 years m/f Per 1000 population ,2012
Total expenditure on health per capita
Intl $ 2012
Total expenditure on health as % of GDP 2012
4.1
Source-WHO
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HEALTH FOR ALL????
Secret in health is our body is the best doctor:
doctor Health
lth for all means that health is to be brought
in the reach of everyone in a given country. Itt also implies the removal of obstacles to health.
The promotion and protection of health of the people is essential to sustain economic and
socialdevelopment and contribute to better quality of life.
WHAT MAKES PEOPLE HEALTHY?
“MICROBES
ARE
INSIGNIFICANT AS A CAUSE
OF DISEASE COMPARED TO
THE ILLNESS THAT IS CAUSED
CAUSE
BY
POVERTY,THE
,THE
DESPAIR,ANGUISH
SOCIAL
AND
MISFORTUNES OF PEOPLE”
This quote gives us an insight about
how important is our social conditions
and its relation to illness.
Concept of Disease
Disease
results
from
complex
interactions between men,, an agent
and the environment. Ecological point
of view disease is “maladjustment of the human organism to the environment”.
environment”. All that is
external to man is an environment.All
environment
human beings are constantly interacting with his or her
environment in which the man lives.
Determinants of Health
ABOUT DETERMINANTS
TS OF HEALTH-INFLUENCES
HEALTH
ON HEALTH
India is a multicultural, multi
lti ethnic,multi
ethnic
lingual society with pluralistic health system
20
Health is shaped by many influences,age,sex,and geneticmakeup, medical and individual
behavior.Behaviours are shaped by living and working condition, in which we live are shaped by
our economic resources, opportunities in our life and also on the basis of our resources.
Interrelationship among these factors that determine individual and population health.
BIOLOGICAL DETERMINATS
Some biological and genetic factors affect specific population more than others e.g.; older adults
are biologically more prone to get diseases than the younger generation .some diseases are
inherited through genes.
SOCIAL FACTORS
The social and the physical conditions in which people are born, live,learn,play, work and theses
conditions play a wide range on everyone’s health. Our social opportunities and resources will
improve our quality of life eg; poverty,social norms and attitudes such as discrimination etc. and
the natural environment in which we live all influence our wellbeing example climate change
Some important areas to give attention while working to achieve health for all
a) Social exclusion as a driver of ill health
The primary determinants of disease are mainly economic and social. People are excluded are
pushed to the edge of the society. So they are lacking many opportunities for
education,health,decision making.Degree of exclusion depends upon the different dimensions. It
is closely related with the multiple identies he or she carrying. Different types of exclusion are
political, economic,cultural sociological and psychological.
We literally embody the material and social world in which we live. Diverse pathways of
embodiment include a range of phenomena .social and economic deprivation, exogenous
hazardous,social trauma,discrimination and other forms of mental, physical and sexual
trauma,inadequate health care all are the drivers of ill health.
b)Poverty is a symptom -–Economic inequality breeds health inequality
Most people in the country is unemployed are unable to earn themselves a living. Many are not
able to access to products and services. As this goes on and on, the poverty rate will increase
drastically and all have impact on our well-being.
21
A dark Cloud-Inequity in health
In equity in health exists in every state .Almost
everywhere,the poor suffer poor health .The huge gap
between rich and poor remains very wide. Health is an
indicator of development. Poor health seen as an obstacle to
development. Poverty and ill health are intertwined.Poverty
breeds ill-health.Ill health keeps poor people poor. All
people have the right to an equitable share in the worlds
resources and to be the authors of their own development and that the denial of such
rights is at the heart of poverty and suffering
Globalization-Severe threat to both peoples health and the health of the planet
‘Health for All’ means that globalization has to be opposed,and that political and
economic priorities have to be drastically changed”-The Global People’s Health
Charter,2000.
Globalization is a multifaceted process that manifests itself in the various aspects of life:
economic, political, social and cultural. Is a social force created and controlled by human beings.
Our country is the victim of globalization gloom and where we see the cloud of poverty,
illiteracy, health hazard, industrial risks,unemployment,dowry death,malnutrition,family
disorganization, urban poverty, child abuse,sex assault etc. Because of these reasons we need a
moral and social reconstruction. Because of globalization we are facing disparities in the field of
health. Create socially and environmentally sustainable form of Globalizationis the only solution.
HEALTH =DEVELOPMENT
Health and development is closely linked. Health is an integral part of development, all sectors
of society have an effect on health. The purpose of development is to permit every individual to
lead an economically and socially productive life. The link between health and development has
22
been clearly established, the one being the starting point for the other and viceversa.Actually,human health and wellbeing are the ultimate goal of development.
True purpose of development is to enhance people quality of life and true development is
the development of the needs of the most needful.
HOW TO ACHIEVE HEALTH FOR ALL
Give importance to primary
health carePrimary health care became a
core policy for the world health
organization in the Alma Ata
Declaration in 1978 and “the
health for all by the year 2000
program.
The Alma Ata Declaration
Primary health care is health care based on methods and
technology made universally accessible to individuals and families
in the community through their full participation and at a cost
that the community can afford to maintain at every stage of their
development in the spirit of self reliance and self determination.it
forms an integral part ,both of the country health system, of
which it is the central function and main focus ,and of the over all
social and economic development of the community with the
national health system bringing heath care as close as possible to
where people live and work, and constitutes.
Alma ata declaration
In September 1978,the first international declaration stating the importance of primary health
care and the worlds government s role responsibility to the health of the world’s citizen was held
in the international conference on primary health care took place in Alma-Ata,USSR. The
conference stresses the need for urgent action by all governments,all health and development
workers and the world community to protect and promote the health of all the people of the
world”
Alma Ata declared “health is a fundamental human right “whose attainment requires a
multipronged attack on the social determinants of ill health and disease. Ifdisease is the
product of social and economic inequality, then ill health of our people cannot be solved by
23
merely provision of health care but by bringing about better conditioned of
work,housing,sanitation,nutrition.
Four Major threats of primary health care
selective
primary
health care
Mcdonaldis
ation of
WHO &
UNICEF
Assaults
on primary
health care
structural
adjustment
program
World bank
take over of
third world
health policy
2.FOSTER COMMUNITY HEALTH TO ACHIEVE HEALTH FOR ALL
BUILDINGHEALTHIER COMMUNITIES–START FROM THE STRENGTHS,NOT PROBLEMS
If we build communities we can enable the community people to demand for their health .For
that we need to start from the strength of the community and also have to understand the
different dynamics of the community. The strength perspective demands a different way of
looking at individuals, families and communities. All must be seen in the light of their capacities
talents,competencies, possibilities,vision, values and hopes.it is about stepping in too quickly to
do things for people but always trying to do things with people not assuming they don’t really
have their own resources. When we start from strengths it gives people the energy to address
other things. If the community is healthy it is easy to achieve. Qualities of a healthy community
is diversity is valued, people feel included respected, trusted,people work together, assets are
valued and the goal is the overall health of the community.
24
Faith in the people
Being open to peoples knowledge -First time am listening from very efficient doctors who are
inviting peoples knowledge. Usually in the health sector Doctors are the masters and patients are
always in the receiving end but here in chlp taught me the importance of people’s point of view
and also encouraging traditional methods
What is community health? Is a mission or an alternative to achieve health for all?
A means to achieve health for all. Ill health in the ultimate analysis is a direct product of an
unjust socio-political system which results in poverty and inequality of resources and
opportunities. Here it comes the importance of community health.
Axioms of community health
Axioms are true statements which is proven.
1.Rights and responsibilities-community health is a process that enable the people to take
responsibility collectively in regard to their own health and make the people to demand health as
their right.
2. Autonomy over health-people have their own independence to take decisions about their own
health
3. Integration of health and development activities-an attempt to collaborate with all other
development activities for example. To achieve adolescent health do integrate with department
of education and planprograms like school health education etc.
To make farmers healthy integrate and plan activities with farmers with the help of agriculture
Department.
4. Building decentralized democracy at community and team level-health action initiating teams
to evolve a greater democratic,decentralized participatory, people building and people
empowering activity.
5. Building equity and empowering community beyond social conflicts.
25
6. Promoting and enhancing the sense of community
7. Confronting the biomedical model with new attitude skills and approaches.
8. Confronting the existing super structure of medical/health care to be more people and
community oriented.
9. A new vision of health and health care and not a professional package of actions.
10. An effort to build a system in which health for all can become reality
A frame work for a new Indian Health model, 1981
A model that is rooted and based in the community .Shift from top down to bottom up approach
.starting from the communities view point, and use locally appropriate strategies.
Not giving much emphasis on the modern urban hospital instead of that giving importance to
community hospitals
Shifting from Curative to more promotive,preventive and curative aspects at all levels of
intervention
Redefining the role of drugs and doctors
Decentralized,democratic and participatory approach which will include community people’s
opinions in all stages starting from planning, promoting and “training of village based health
cadres”-community Health cell,1987
COUNTER VAILING POWER(POWER FROM BELOW)-Health should be
decentralized.
Health education-Purpose of health education is to positively influence the health behavior of
individuals and communities
Role of community health worker
26
Most realistic solution for providing health care to the vast population in the rural areas is to
have community health workers trained from among the people. Health care cannot be
imposed on the people it should begin from and by the people.
While practicing community health we have to consider social climate of the times in which it
is practiced. What seemed right in one period may appear wrong in another
Primary health care (Health care closest to the people)
The components of primary health care are Health education, promotion of food supply and
proper nutrition, an adequate supply of safe water and basic sanitation, maternal and child health
care, including family planning, immunization against the major infectious diseases, prevention
and control of locally endemic diseases, appropriate treatment of common diseases and provision
of essentialdrugs.
Primary health care is the key to attaining an acceptable level of health by all.it will help people
to contribute to their own social and economic development.it follows that primary health care
should be part of the overall developmentof the society.Investing in primary health care can
result in positive health outcomes .Access to primary health care is recognized as an important
form of health Example: Investing in women’s education ,a known strong determinant of health
care for population health because it is relatively inexpensive.
If everybody does primary health car,then health for all come but we need to follow the
principles below
27
Right
to
health
Govt
respon
sibility
Appropr
iate
technol
ogy
Equity
Intersect
oral
collabor
ation
Comm
unity
partici
pation
.
Basic Requirement for sound Primary health care(4 A ‘S)
Affordability-The cost should be within the means and resources of the individual and
the country.
Accessibility- Geographical, economic,cultural –it means all primary health care services
should be accessible to people on the basis of their geographical area, economy and
culture. Nothing but it should be convenient to the people.
Acceptability- of care depends on a variety of factors including satisfactorily
communication between health care providers and the patients, whether the patients
trust their care and whether the patients believe in the confidentiality and privacy of
information shared with the providers
Availability-Care can be obtained whenever peopleneed it.
To summarize primary care is an approach that focuses on the person not the disease consider
all determinants of health o
28
Investing in women’s education,a known strong determinant of health. Socialdeterminants
are same both in urban and rural but the way it is influencing differs.
4.Health system as a health determinantValue based health care system
Values are far more important in today’s age of science and technology. We need to reexamine the system of values under which our socio political systems operate nationally and
internationally. Development of a value based health care system is the challenge of the
current decade.Any activity that is directing towards health is health system. Proper public
health management it is a multidimensional phenomenon and it includes the following factors
Protecting promoting and improving peoples health through collective action
Health programs for needs of population as a whole
Promoting healthy life style and prevention programs
Creating supportive environments
Documenting ,monitoring,evaluation,research and action
I have learned that health system means not only Public health system local health traditions
also included in the health system
We should have the courage to challenge our self then only we can challenge the system
EQUITY ORIENTED RESEARCH FOR TRANSFORMATION OF HEALTH OF THE
PEOPLE
Tool for liberation and social transformation-Evidence Based Research not opinion based. The
country needs a lot of research,study,collection and analysis of authentic data and effective
dissemination of observation and findings. Participatory research can transform society. Involve
people’s health by participatory manner .To incorporate research into social mobilization and
to use the findings to effect changes in public health policies
29
Evidence based public health is the need of the hour.Translating research into policy
6.HEALTH FINANCING
India is one of the main countries in the world where people pay out of their pockets for health
services resulting in financial burden to the poor.Hospitalisation or chronic illness often leads to
liquidation of assets or indebtedness. Vast majority of people borrow money or sell assets to
cover expenses and consequently they fall below the poverty line in one year.
Importance of Health Insurance
This cartoon depicts how terrible
the expenses of hospitalization
Today it is extremely risky to fall
sick we either die or go bankrupt
.How to provide accessible health
care to 1.2 billion people .Ask
people about their priorities
.Health care for the people must
move beyond a few vertical programs and incorporate provider priorities. It should be people
centered.
7.HEALTH POLICY
Policy is a plan or course of action
Health policy –Public health is an art of preventing disease ,prolonging life and promoting life
through organized efforts by the public and private organizations that are dealing with health
and also the efforts of the communities and individuals .To achieve this a plan is very important
to enhance the communication between health policy and system. Health policy includes three
things ,decisions ,plan and action that are undertaken to achieve specific health care goals
within a society. Before making a policy for health we need to consider the health needs of the
30
people in that particular country.so background of that country is essential ,a situational
analysis is essential. Peoples health status and health situation differs. To analyze the health
situation we need to do the health assessment and also focus the focus the social determinants
of health. Health is state subject so assessment of different dynamics of that particular state is
very important ,The social ,economic, political ,ecological and cultural dynamics of the
population.
Three things in health policy
action
Background of the country
decisions
plan
Action
Advantages of health policy
It is a lens for the future
primary objective is to achieve health for all
Giving directions to different groups who are involved in the health care and health
system
31
Helpful to set priorities
The plans, programs and policies are required to be reviewed from different viewpoints to
evolve a dynamic process. Policy makers should address the significant health problem and also
careful about which segment of society mostly needed it.Health policy which gives importance
to prevention, promotion and health maintenance is a much better model.
Today it is extremely risky to fall sick we either die or go bankrupt .How to provide accessible
health care to 1.2 billion people .Ask people about their priorities .Health care for the people
must move beyond a few vertical programs and incorporate provider priorities. It should be
people centered.
8.WHAT IS HEALTH CARE ETHICS?
“Science can tell you how things relate to eachother science will never tell you what you
ought to do”
Health care ethics is how to make morally good choices and to do well,based on beliefs and
values about life,health,suffering and death. Ethics is about the values that should be respected
by all health care workers while interacting with individuals, families and communities.
Human resource is the core building blocks of health system
How to deal with the power dynamics in the health system.
Humanize the doctor treatment relationship
9.HEALTH IS POLITICAL
Politics,power and ideology which influence peoples in many ways.Public policy as a
determinant of health .Health and its promotion, are profoundly political.
Why health is political?
Health inequalities-Like any other resources or commodity under a neo liberal
economic system some social groups have more privilege than the others
32
Health determinants-The social determinants of health are dependent on political
actions
Citizenship-The right to a standard of living adequate for health and living is an aspect of
citizen ship and a human rights. Power is exercised over it as part o f wider economic,
social and political system .changing this system requires political awareness and
political struggle.
In this above context awareness of political nature of health will lead to a more affective health
promotion strategy and more evidence based health promotion practice.
10.Promotion of AYUSH (world’s largest democracy) 70
percentage of people are AYUSH.focused attention to
development of educatin and research in alternative
medicines.But the question here is which one is alternative.if
we get sick first we are using our traditional medicines,then we
will appraoch other treatment faculties according to our
individual choice.Allopathic treatmnet overpowered our
country .but the departmnet of Ayush is progressing at the
sametime we should think about how much countrys budget
is allocated for AYUSH.I firmly believe that as community health professional it is our duty to
facilitate importance of the introduction of AYUSH in our community.
CONCLUSION
It is obvious that we have all the necessary tools of reaching the goal “Health for All” but we
need to fully utilize the existing favorableclimate, secure clear dissection and put all our
energies to make it happen. 80 % of the health problems are been solved within the community
and family only 20% we need to go for doctors. We need to develop a health system where
people are not passive recipients but active participants’. Finally,all the reforms can become a
reality only when the people implement them have integrity. It is not just the causes of disease
and death that need to be addressed.It is also major questions about what constitutes health
33
and enhances life so a new pattern of health care and approach that are flexible,
responsive,people centered and based on,collaborative, networking and leadershipwith focus
on Social, political,cultural,ecological context since social phenomenon is changing each and
everday.
FIELD VISITS
Sln
Organization name
Actions
SNEHADHAN,Camillian community care
Addressing the comprehensive needs
Centre for Persons living with HIV,Bangalore
of HIV infected persons and providing
No
1
holistic and comprehensive health care
to the sick
2
APD,Associations for people with
disability ,Bangalore
3
SEVA IN ACTION, Bangalore
Transforming the lives of people with
disability to create a inclusive society
Bridging the gap that exists between
the needs and provisions required for
people with disabilities
KAIROS,Kannur Association For Integrated
Working with marginalized people for
Rural organization and support
their development
5
Shanti pain and palliative
Holistic care for the terminally ill
6
FRLHT,Foundation for revitalization of
Conservation of Indian heritage
4
local health traditions
34
Each and every field visits was unique and insightful on the basis of the service the concerned
institutions are providing.
Visit to Snehadhan helped me to refresh my awareness and understanding about Persons living
with HIV and the changes happened so far. I could able to understand the attitudinal shift of
society in respect to stigma and discrimination in the subsequent years. Introduction of ART
made a huge impact on the PLWHIVS .death rate has been reduced
Visit to APD, Association of Persons with disability not Association for persons with
disability.Organization name itself shows their ability .Thelma madam said “when we reach in
the last 10 years of life before death all of us have some kind of disability”. The organization is
helping
the
disabled
able
persons
to
reduce
the
impact
of
disabilitythrough
medical,vocational,social and psychological rehabilitation .ultimately disabled people can
actively participate in the main stream of community life. Their community based rehabilitation
program me is helping them to achieve social integration..
Visit to Seva in action made me realize disability is a social issue and also human rights issue.
Seva in action is a movement to deal with all these and they have made a difference in the lives
of disabled people. Dealing with the problems of the most marginalized in the disability and
demystification of rehabilitation technology is rewarding. Different kinds of programs helped
the disabled persons to become more economically secure and build their self-esteem that in
turn increase their quality of life. Preventing disability is also important for the community
health professional.so these type of visits helped us to get more awareness about the current
status of disability in our country.
Field trip to Kerala was both informative and enjoyable. We exploredtwo organizations in
Kerala. We first visited KAIROS,Kannur,they are trying to create a society of justice and peace.
Understand the different rural development programs implemented by KAIROS,their projects
are both sustainable and participatory. The activities of Self groups are amazing. They are giving
importance to the most ecological dimension of health, important threating issue i.e.: water
literacy and water conservation. The program Inclusive children parliament is real innovative
35
idea .it will help the children to take decisions about their own problems in their tender age ,all
will indirectly leads them to be good citizens in the future.
Visit to Shanti pain and palliative was both informative and painful.it focuses caring not curing.
They are promoting a culture of healing to the terminally ill persons irrespective of
caste,religion,age or illness. Interactions with the pain and palliative society members was
thought provoking.one member said “Each file is a life and volunteer ship is a responsibility.it
counts a lot to me about the responsibility of each citizen towards terminally ill persons. The
service offered by the society is amazing. I could able to get an understanding about how the
care of community people will make an important remark in this very sensitive issue. A talented
sensitive doctor, nurse or volunteer can make an impact on the patient and family members
here. They are using different approaches with different patients according to the need of that
particular patient and family. After my visit I did remembered a sentence which I have already
read in one book. Here it goes. In the ultimate analysis,we are all mere temporary custodians of
the wealth we generate, whether it is financial,intellectual or emotional. The best use of all
your wealth is to share it with those less fortunate. The cycle of life……..to be born, one must
die-so why not die with dignity.
Visit to FRLHT was a unique experience. I learned many aspects of conservation of natural
resources and how they are using these resources into Indian systems of medicine. Though
allopathic treatment established a standard in the Indian psyche if we get any illness definitely
all Indians use to try initially our grandma remedies that includes herbs from our garden. Here
comes the relevance of revitalization of our medical heritage.it is high quality medical practices.
Foundation reaching success in the creative application of traditional health sciences for
enhancing the quality of health care in rural and urban India.
36
PART- B FIELD PLACEMENT
NAME OF THE FIELD WORK AGENCY: ACTION FOR COMMUNITY
ORGANISATION DEVELOPMENT AND REHABILITATION,GUDALUR(ACCORD)
REHABILITA
,GUDALUR(ACCORD)
CONNECTING THE DISCONNECTED
37
NILGIRI DISTRICT PROFILE
District Headquarters
Udhagamandalam
Population(Census 2011)
7,35,394
Total Male
3,60,170
Total Female
Children Under age six
66,799
Scheduled Caste
32.08%
Scheduled Tribe
4.46%
Literacy Rate
5,69,647(85.2%)
Area
2,452.50
Total Household
Total workers
Taluk
-
197,653
349,974
Ooty,conoor,Gudalur,Kotagiri,manjoor,Pa
ndalur
Municipality-
38
Ooty,Conoor,Gudalur,Nelliyalayam
Town Panchayat
11
village Panchayat
35
Revenue villages
54
River-
By Kara
DamAdivasi population In
Bykara,sandinella,mukruthi,avalenchi
20,000
Gudalur blockAdivasi groups in Gudalur
(PANIYA,MULLUKURUMBA,BETTAKURUMB
A,KATTUNAIKEN
ACCORD(Action for community organization,rehabilitation and
development)
History of the field placement agency
Various tribal communities of the Gudalur region lived in villages peacefully in relative isolation
until 1985.They heavily depend on land and forest over which they had the traditional rights.
The Gudalur initiative started with the realization that outsiders intrusion in the tribal area and
they were forced to move from their own land and also denied their human rights .The action for
community organization,rehabilitation and development (ACCORD) was born in November
1985.
Vision of accord-To help the tribal community of the Gudalur valley in the Nilgiri district of
Tamilnadu to take control of their own lives.
MISSION-To redesign the system for human rights,health,education,housing and culture. To
help the adivasi community to cope with the onslaught of modernity on their way of life and to
prepare them to emerge from their forest retreats with their heads high,proud of their culture and
their people.
Different phases of Accord activities
Beginning Phase-Human rights interventions
Phase two-Development interventions
Phase three-community institutions
39
Future plan-Strengthening adivasi leadership and area centres
Expanding community institutions
Establishing collective enterprises
Housing
Aim of accord was the holistic development of adivasis and their initiatives made a huge impact
on adivasi community. Displacement affected their wellbeing and the central problem faced by
tribal people was the lack of identity earlier they need some outside support but now they
become self-reliant.Accord will help the communities to empower to address their problems by
themselves.
AMS was established with the support of tribal groups.it stressed the need for the preservation of
tribal identity .Adivasis have had felt a strong urge to work for their own upliftment.Accords
interventions demonstrated how a social movement can make a difference when everyone in the
community is involved .
LEARNINGS FROM FIELD WORK AGENCY
Gudalur is a Panchayat Town and taluk in nilgiridistrict,Tamilnadu.Nilgiris known to be the
Blue mountains of eastern and western Ghats. It is the highest mountains ranges of south India.
The word Gudalur means The meeting place.ie,Koodal(joining)l+Uru(village).It is a joining
place where the three states boundaries meet Kerala, Karnataka and Tamilnadu. History Says
that it is a land of hard workers. This is the place where we can see people from Kerala and
Tamilnadu live together cordially. Gudalur is blessed with natural and human resources with a
varied landscape.Though some parts had become very dry,other areas remained green. People
here are multilinguistic,multireligious and culturally diverse. Both nontribal and tribal residing
here.
Tribal have different languages but still they know tamil and they can manage Malayalamtoo.
They have heterogeneous socio economic, cultural milieu with a varied landscape. Different
40
adivasi groups of the region lived in villages. Most of them live only in one hamlet constituting
around 10 to 20 households. They are fragmented and scattered and have a simple life and
heavily depend ended on land and forest.There is little individual difference at the level of socio
economic and culturalbackground. Here all are equal, rich or poor. No power dynamics.
Tribal communities live in various ecological conditions ranging from plain, hills and
inaccessible areas. They are at different stages of social economic and educational development
.A few tribal groups have adopted a main stream of life but some others are still primitive. In the
earlier days tribal lives were filled with music.Stories of the forest and fields, their joys and
sorrows have all found voice in their songs. Based upon the individual choices some started new
life styles but at the same time they are concerned about the continuity of their culture
UNDERSTANDING THE COMMUNITY PRIORITIES
Sources of livelihood of different tribal groups
Mullukurumbas
They are well disciplined and their economy has passed the primitive stage.
Occupational activities of mullakurumbas
Most of them have cultivable lands, others are Agricultural laborers, ,plantation workers,
working in private and public sectors some are engaged in business and petty shops running.
Bettakurumbas
They are the fearless people in the forest(friends of wild animals)
Occupational activities
Majority working in forest department as watchers and elephant care takers .others are engaged
in collection of forest produce and selling to traders,self cultivation and basket weavers
Paniyas
Paniyas are the most socially backward group. Majority of them are working under local
landowners scattered throughout the Gudalur Taluk
Occupational activities
41
Most of them are agricultural labourers,plantation workers,self-cultivators,working in tea
factory,watchmen,suppliers of fuelwood,working in Ngos.
Kattunayakans
UNDERSTANDING THE COMMUNITY PRIORITIES
Sources of livelihood of different tribal groups
Mullukurumbas
They are well disciplined and their economy has passed the primitive stage.
Occupational activities of mullakurumbas
Most of them have cultivable lands, others are Agricultural laborer’s, plantation workers,
working in private and public sectors some are engaged in business and petty shops running.
Bettakurumbas
They are the fearless people in the forest(friends of wild animals)
Occupational activities
Majority working in forest department as watchers and elephant care takers .others are engaged
in collection of forest produce and selling to traders,self cultivation and basket weavers
Paniyas
Paniyas are the most socially backward group .majority of them are working under local
landowners scattered throughout the Gudalur Taluk
Occupational activities
Most of them are agricultural labourers,plantation workers,selfcultivators,working in tea
factory,watchmen,suppliers of fuel wood,working in Ngos.
Kattunayakans They are the chiefs of the kadu
42
Occupational activities
They are involved in mixed economic activities like forest produce collection,honey
collection,agriculture,labour work and also engaged in work given by the forest department and
some working in Ngos.
Settlement pattern
Pattern of settlement is dispersed, isolated and clustered. Most of them live only in one hamlet
constituting around 10 to 20 household. Villages are circular,quadrangular,round depending
upon their geographical orientation.
Economy
People are free from the clutches of the Zamindars.The backbone of the economy is tea
plantations. Government is taking effort to protect the tea sector.
Politics
Most of the land is largely held by high ranking property owners of the dominant castes. Caste
based vote banksystem. Now ST population has representation in the village panchayat.But still
regulated by Nontribals unequal distribution of resources.Govt had undertaken suitable measures
to eradicate
Gender
No gender discrimination. Socially tribal women have the autonomy to select their partner and
have equal status with men.
Education
A large number of adolescents are out of school get married early, many are exposed to tobacco,
or alcohol abuse. Especially there is high dropout rate between middle school and high school.
I could able to collect information from different sources(school headmasters, accord education
coordinators, community leaders) and in their perspective reasons are as follows.
One govt primary school teacher narrated about their attitude towards education in his own
words actually this teacher is taking effort to motivate their parents and finally frustrated and
concluded in her words -“enne thalada ammava njan nannavilla”.
43
Domestic-lack of shared parental responsibility (father who have left home, Alcoholic father) so
lack of role model. No future orientation, children are often kept at home to care for the younger
children, early marriage,child-labor is wide spread.
Accessibility-many tribal villages do not have education facility within in a walking distance.
Culture-like other wild animals and plants they too enjoy freedom. So they will not like to be in
the rigid class room structure.
Infrastructure-overcrowded class rooms so lack of attention by teachers.
Basic amenitiesHousing
Many villages have government housing facility but quality is very poor. Most of the homes in
the villages in which I visited have only minimum of shelter and safe drinking water. Thatched
huts with one or two rooms and a place for cattle and poultry. The rooms are ill ventilated,dark
and dusty. The roofs are leaky and floors are soaked. All are struggling for the basic
requirements.
Electricity, water and telephone
Some villages had been electrified but many remote villages are still struggling to get electricity
many steps were taken by the government and ACCORD to bring drinking water and succeeded.
At the same time safe drinking water is an issue for many. They use to take bath in the nearby
stream. Almost everyone around has a mobile of his /her own.
Transportation
The rough and hilly terrain of Gudalur can only transverse via jeep or motorcycle. The
accessibility is different and difficult further towards the villages. Construction of link roads
connecting many villages but the remote tribal villages have no roads.
Health systems, Health seeking behavior and health expenditure.
Primary health care centers,sub-centers, private hospitals,NGO hospital all are providing health
care services. At the time of emergency they are depending allopathic treatment. Health seeking
behavior is associated with socioeconomic, demographic factors and also faith and satisfaction
about thetreatment. Here the choice of health seeking behavior is influenced by their culture and
44
socio economic background and accessibility of health services. Distance also begins to play an
important role.Tribal are giving first preference to Ashwini hospital,their second choice at the
time of illness is govt.services. Minority group are using other alternative medicines.Mixed
picture of continued belief in the old system and a steadily rising faith in the new. They believed
that diseases caused by hostile spirits, the ghosts of the dead or the breach of some taboo. What
is spiritually caused therefore,must be spiritually cured and this is the main reason why the
people in the interior prefer to go to their own tribal native healersfirst then only they will go to
treatment
Health Problems
Major
health
problems
found
among
the
tribal
are
respiratory
tract
infections,hypertension,anemia,frequentcough,feverandcold,worminfection,Ulcers,tuberculosis,
urinary tract infections, Sickle cell anemia, and substance abuse disorders.
WHAT DO THE PEOPLE SAY?
Expressed needs from the community I interacted with many people in the community and
they expressed their immediate needs to address is land rights-patta,many tribal don’t have
land,burialgroundpreservation,issuingofCommunitycertificate,Scholarship,Unemployment.Schoo
lDropout issues,Alcoholism,Oldage problems. Problem of alcoholism is rampant here and
require a different approach. Majority of the tribal people viewed alcoholism as their problem.
Repeatedly raised the issue of alcoholism. It was realized that alcohol was no longer a moral or
health issue alone. It had become a development issues. This large scale trade of liquor was
sponsored by the state government itself.
REFLECTIONS ABOUT ACCORD
PATHS ARE MADE BY WALKING – I have read this Sentence in ACCORD website and
I found out it is true. “Yes they walked ,still walking and made many paths and still making
new paths……………….”
45
Aim of Accord was the holistic development of Adivasis
and their initiatives made a huge impact on Adivasi
community. Displacement affected their well-being and
the central problem faced by tribal people was the lack of
identity. Earlier they need some outside support but now
they
become
self-reliant.Accord
will
help
the
communities to empower to address their problems by
themselves. MS was established with the support of tribal
groups. It stressed the need for the preservation of tribal
identity.Adivasis have had felt a strong urge to work for
their own upliftment.Accords Interventions demonstrated
how a social movement can make a difference when
everyone in the community is involved. I could get the realization of meaningful partnership
bottom up approach and countervailing power.
I could able to connect with the Axioms of community health in their work. Accord Facilitated
the tribal community people to take care of their own health and also made them to realize their
autonomy.Accord leadership enabled them to raise voices to get their rights and partially they
succeededstill they need to fill some gaps. Though tribal old traditional herbs were very powerful
in the olden times they never ever visited any hospitals but now they have their own allopathic
hospital so more inclined to that vast majority of them forgot the traditional herbal medicines so
initiators have to rebuild that system again.
The staff (all are tribal except a few) was extremely supportive and was willing to help me in any
way that they could
46
REFLECTIONS
It is entirely a new way of perceiving and understanding,indeed a new way of living and
being. Great confusion –a confusion of understanding, a confusion of cultures and
values
REFLECTIONS ABOUT GENDER LIVE LIVELIHOOD, ECONOMIC STATUS AND
HEALTH
Both men and woman are getting equal pay depending upon the work. Seasonal variations affect
their livelihood. They have simple life and no power relations between men and women. Women
enjoy equal status with men.No gender discrimination. Socially tribal women have the autonomy
to select their partner and have equal status with men.
Mullakurumbas are integrated into the main stream. Except mullakurumbas others have
little difference at the level of socio economic and cultural background. Other groups have
almost similar socio-economic structure and not worried much about the income. All have their
own unique home management traditions. Most of the family’s income is managed by the female
members. Male members are spending most part of their money to consume alcohol. Every
village have Special place for GOD(Daivapura or Kavu ). Infrastructure facilities are lacking in
many villages No electricity, using crude lamp, depending on surface water for drinking and
cooking purpose(open well,river water, spring water etc respectively)
Tribal communities may take a long time to reach the level of other castes in social and
economic advancement because of their ambivalent attitude to move forward and the internalized
and externalized stigma plays a major role in that.Tribal were not in any-way inferior to the rest
only different in terms of values, beliefs and practices. One of the greatest sufferings encountered
by the tribal in the region has been the alienation of their ancestral land. Most tribal people live
in
remote
rural
hamlets
in
hilly,
forestedareas,
whereilliteracy,
poor
physical
environments,malnutrition,inadequate access to safe drinking water,lack of personal hygiene and
sanitation make them more vulnerable to disease. So government implemented different
programs.
47
Health service providers are committed to give appropriate care though they are target oriented.
The outcomes are maternal mortality rate and infant mortality rate reduced. Tribal are receiving
antenatal care and immunization programs and hospital deliveries are increased
Implementation Challenges faced by service providers are the Accessibility and
acceptability-to
cover distance of many kilometers to get access to it and sometimes
disappointed with the ambivalent attitude to receive treatment and also the physical strain
KEY OBSERVATIONS
How they are treating their women. Both men and women have equal dignity, no dowry
death, no female infanticide.
Tribal elders have complained of the loss of their old traditions.
Outside world is polluting them
The more interior the villages are,the more sufferings .They are completely detached
from all resources.
Alcoholism,in every corner of the globe has been the biggest factor in the down fall of
tribaleverywhere. I could able to see same scenario here too.
Non-tribals go away from their home town but here they are stick in their own village.
Women are valued,bride grooms pay a token to the brides family.
Community health workers trained from among the Tribalpeople. This approach is a
model to implement everywhere is based on faith in the people.
Almost all the health animators are Women. Women can contribute more on the basis of
their culture and traditions.
Community based health insurance is supporting the tribal people in the time of crisis.
MY CONCERNS
Personal encounters with tribal family context made me confused with this thought
whether the tribal children’s developmental needs are met or not?A few tribal groups have
adopted a main stream of life,while at the other end there are others who are still primitive.
All intervention strategies should focus the extremely isolated ones(Those who are
exposed to the outside world have little motivation to develop)
48
If you want to learn about the health of a population look at the air they breathe
breathe,the water
they drink and the places
ces where they live –Hippocrates. A good environment contributes
to wellbeing and wellbeing is the definition of health.
Need to address the social determinants,both
,both structural and intermediary
determinants
Approach should be area specific and need based.Emotional
based.Emotional coaching to parents for
safeguarding and promoting welfare of the child is also needed.The
needed.The holistic focus of
adivasi is universal but the priorities of tribal’s will vary from state to state and from time to
time depending on cultural and socioeconomic
socioeco
conditions.
Paradigm Shift from Emotional dependency to self reliancereliance out come of Accord leadership
Transformed into
49
CONCLUSION
Before starting my placement I was certainly apprehensive about many things, however the
experience turned into more than I envisioned.
en
Really a paradigm shift in my own attitude and
thinking.. I could able to understand how all axioms of community health beingimplemented
there at the
he same time some gaps is there.
there So the initiators have to redefine again the strategies’
culture specific approach at the same time give attention to individual differences because most
cultures are
overlapping and so
heterogenousity of culture is the problem now.
now.True
development is the development of the needs of the most needful.so everyone
everyone who is involved
with tribal welfare have to think whether equity is there if not build a system which is reaching to
all.In this regard alcoholism and mental health promotion is the need of the hour. Need to start
initiatives to strengthen the emotional, financial
financial and health literacy of the tribals.
50
BRIEF RESEARCH ARTICLE
Perception and Attitude of using sanitary napkins as part of menstrual
hygiene among tribalgirls and women
Menstruation is a phenomenon unique to the females.The onset of menstruation is one of the
most important changes occurring among the girls during the adolescent years. The interplay of
culture socioeconomic status and menstrual hygiene practices are noticeable.The profile of the
women’s reproductive health is greatly influenced by the women’s perception and attitude
towards menstruation and more importantly her menstrual practices during it. Women having
better knowledge regarding menstrual hygiene and safe practices are less vulnerable to
reproductive tract infections and its consequences.Tribal life is entirely different from other
communities and their cultural restrictions and taboos are unique during menarche and
menstruation. Their menstrual practices are also interwoven with their culture.Therefore the
present study aimed to understand about adolescent girls and women’s perception and
attitude of using sanitary napkins as part of menstrual hygiene. This brief study was conducted
51
among nursing students of Ashwini hospital, school teachers of vidyodayassa teachers, health
animators of Accord and other key informants at the primary health centre and very few village
girls in Gudalur Taluk, Nilgiri district,Tamilnadu in the month of April 2014.
Participants were non-randomly selected from the respective centres.Interviews and focus
group discussions were employed. This article explores the acceptability, affordability,hygiene
and disposal issues related with menstruation period and addressing their preferences during
menstruation. The study was located in Accord and Ashwini and few villages because all the
respondents from this sources are representing the tribal community in Gudalur.
Disposal issues
Health animators and nursing students pointed out that in most of the villages no proper place
to dispose sanitary napkins, nursing students also supported this statement. Burial of the pads
was an issue. Lack of adequate water supply also associated with disposal.
Acceptability and Hygiene
School teachers reported a strong preference for the pads over traditional methods, primarily
due to their greater effectivenessand easier to change.Govt school teachers who are working
with tribal students also opined that sanitary napkins are easy to use and hygienic the napkins
are distributed by primary health Centre staff every month in the rural schools where they also
make the adolescent girls aware about the hygienic conditions as part of the school health
program me.
When asked whether the pads worked better than cloth majority agreed that pads worked
better. Most of them had only two or three pieces of cloth and so ended by wearing damp cloth
much of the time. Later on it will lead to infections. Surprisingly all the nursing students are
preferring cloth and they considered cloth is hygienic and one student said that pads itched and
unclean and had the experience of bleeding through. Not only that they were not aware about
the difference between cloth and napkins and the hygiene related with that. Only one health
animator said that traditional methods were adequate.
52
Some responses
“pads are better as no need to wash”
“I prefer cloth it is more hygienic”. “sanitary pads need to be cha
more frequently.”
“sanitary pads need to be changed more frequently”
Affordability
The economic status of the family has a direct influence on use of hygienic methods during
menstruation
Health animators insisted that their daughters are using cloth because pads are unaffordable
though the government is supplying through primary health care centers but the quality is very
poor
“We would like to use napkins,if pads are available at an affordable cost”
Some may have heavy flow during their menstrual cycle so they tend to use both sanitary
napkins and cloths on sanitary pad along with cloth.
The reported negative points about the pads were very low. Howeverthroughout the study
most of the respondents seemed to be fine with pads. All listed the fact that pads did not have
to be washed. Some said they used clot Lack of proper place to disposal is an important
problem. Many tribal villages do not have access to basic facilities such as water,toilet and lack
of space. Disposal issues have to be addressed. So there is an urgent need to improve the
housing conditions. Some participants preferred sanitary napkins ratherthan cloth. The
interestingly all the respondents seemed to be fine with both, pads and cloth.
Limitations
The study was limited by the size of the sample and short length of time. Therefore, it is
essential that further study over a longer period of time be done.
53
CONCLUSION
Gone are the days when the tribal
bal society treated menstruating women as untouchable. Things
have changed and modernity have helped tribal women break the taboos and misconceptions
of olden times.Today, tribal women living in the extreme remote villages are using and willing
to use sanitary
tary napkins at home but will use pads while travelling. During menstruation
menstruation, at the
same time menstruating and menstrual practices are still connected with socio cultural
restrictions
ctions among tribal community. So flexible in their choices and not much aware about the
risk and health consequences of
unhygienic during menstruation.
OVERALL SUMMARY (TRANSITION
FROM
FLOOR
MOPPER
OF
DISEASES TO TAPTURNER OFF
DISEASES)
54
Let me conclude with this Gestalt poem…famous psychologist Fritz pearl regarding how
to respect a person’s autonomy…….before working with people it will be helpful if we
keep this in our mind.This is the “Gestalt Prayer” stated by Fritz Perls and it is often
argued as statement of independence in aperson’s social life.We humans are all actively,
changing organized phenomenon’s… or “gestalts“.We, individually are in a fluid state of
both
independence
and
interdependence
with
our physical
surroundings
andpeopleinour lives. Thus theGestalt prayer is philosophical statement of selfautonomy in one’s personal relationships.
“I do my thing, and you do your thing
I am not in the world to live up to your expectation
And you are not in the world to live up to mine
You are you and I am I,
And if by chance we find each other,it’s beautiful
If not,it can’t be helped”
I would like to summarize this report with this question floor mappers of disease in the field of
health or tap turner off of diseases which one is the sustainable solution… of course Tap turner
off of diseases. Isn’t it? That is what I have learned in CHLP from SOCHARA
While reflecting on what I have gained from the program,I came to one main conclusion. But I
believe the most important lesson I have actually learned is more about the process of learning
than the actual material and knowledge gained.CHLP is really a synergistic result of combining
education and real life experiences. After my field work I began to understand that cultural
competence was a foundation upon which to enrich my career. The vision of compassion plus
competent action can indeed change the world. Community is our art form the canvas of our
transformation.Most realistic solution for providing health care to the vast population in the
rural areas is to have community health workers trained from among the people. Health care
55
cannot be imposed on the people. It should begin from and by the people. This approach is
based on faith in the people. If we give appropriate training
aining they become more resource full
and capable.
Of course social work and community health are
are perfect partners in many ways, Both are
change agents, function as system maintainsworkers, holistic understanding of social
phenomena is the core value of both profession.So
profession o social work degree along with community
health fellowship will help me to support vulnerable group and being about positive change in
their lives
“Remain a beginner till the end, like a child endowed with tremendous faith and patience. So
move forward. Go to your respected areas, feel the suffering of the people and work hard.
There is lot to learn. Let us do what we can do. May God’s grace bless us all”-AMMA
AMMA
Perfect Partners
My journey of responsibility continues…………………………..
56
Some snap shots of tribal village visits in Gudalur
with tribal old age women
57
With tribal counselor in PHC
58
MFC discussions in
Hyderabad
59
60
PART–C
FIELD INVESTIGATION REPORT
61
A study on factors influencing substance abuse among tribal youth with special reference
to Gudalur block,Nilgiri district,Tamilnadu
“What we are doing is like a drop in the ocean but we want to make that drop, without
which the ocean is not complete”-Mother Theresa
INTRODUCTION
Drug addiction and alcoholism is a problem affecting all sections of the society irrespective of
the economic, social or education levels of the victim. As the drug epidemic continues to
painstakingly seep into the country’s social and cultural aspects, drug abuse naturally trickles
into our younger generation-a generation refusing to be left out. In the area of substance use
disorders a drug or a substance is any chemical that, upon consumption, leads to changes in the
functioning of human mind and more specifically leads to a state of intoxication. A wide variety
of drugs is available and is abused. The world health organization lists substance use disorders
for the following classes of substances.
Substances listed by
WHO
ALCOHOL
OPIOIDS
CANNABIS
SEDATIVE HYPNTOICS
COCAINE
OTHER
STIMULANTS,INCLUDINGCAFFE
INE
HALLUCINOGENS
TOBACCO
VOLATILE
Making up one fifth of the population 15-24 years old, carry with them India’s future. The youth
of our nation will eventually determine the country’s moral, political and social persuasions.
Bearing the burden of a densely populated country like India is no small task and drug abuse
does nothing to lighten the load. The youth of our nation has massive responsibility.And as
India’s potential rests delicately in their hands the drug epidemics continues to rage on the side62
lines.Just as a single footballer’s attitude and actions can hurt his whole team and cause them to
lose the match, illicit drugs have the potential to thwart the success of India’s future.
Teen and young adult drug use
“Educational attainment not only affects the economic potential of youth, but also their
effectiveness as informed citizens, parents and family members” says the national family health
survey of India(2009). They bring up a good point: education is a vital part of any nation’s
philosophy for success.Ofcourse, education is important, but education-like so many other ideas
in life, is a two way street. If the students don’t end up doing their partin the educational process,
the system can quickly backfire. Public schooling can ironically turn into breeding grounds for
addicts. In and out of the classroom, teens and young adults are influenced by the social
acceptance of drugs. This lack of personal responsibility, and the general apathy surrounding the
issue has filtered down to the youth – creating a normality in drug abuse. Illicit use among the
youth, specifically teenagers, presents an impending threat to our nation.
Background
WHO defined youth as ‘the individual belonging to the age group of 15-24 years? Youth
population
is
the
most
susceptible
population
to
initiate
substance
use
in
India.(http://www.whoindia.org/SCN/Tobacco/Report/TCI -Report.htm) This is because youths
are easily influenced by
Peer pressure, sibling pressure, substance use by parents, easy
availability, colourful and attractive packaging of such substances, lucrative advertisements
through mass media by celebrities and lack of awareness regarding consequences of substance
use on health.
Globally 4 out of 10 US AIDS death are related to substance abuse and addiction. Estimated
economic cost to society due to substance abuse and addiction are illegal drugs 181 billion
dollars /years, Alcohol is 185 billion dollar/years and tobacco is 158 billion dollar /years. India is
experiencing a rapid health transition with large and rising burden of chronic non communicable
diseases including substance abuse. Drug and alcohol abuse is a matter of great concern in India
both due to its established linkage with HIV/AIDS.Since India opened up its economy to the
world in the 90’s,the country has gone through rapid socio-economic upheavals. This
63
globalisation was accompanied by rapid urbanisation and industrialisation which brought along
prosperity and changing values and life styles. Common substances used in India is
tobacco,alcohol,cannabis,opium,heroin are the major drugs of abuse in the country.
About one fifth of the world’s population or more than a billion youths who are living in a world
that is rapidly changing exposing them to new value system, modern communication and often
unfamiliar or hostile cultures. WHO rightly said-“if current trends continue, 250 million children
alive today will be killed by tobacco”
The incidence of drug abuse among children and adolescents is higher than the general
population. This is notably because youth is a time for experimentation and identity forming.
In India an NGO survey revealed that 63.6% of patients coming in for treatment were introduced
to drugs at a young age below 15 years. According to another report 13.1% of the people
involved
in
drug
and
substance
abuse
in
India
are
below
20
years.
(www.childlineindia.org.in/children-affected-by-substance-abuse.htm)
Tamilnadu
Alcoholism is becoming widespread problem in the Indian society and Tamilnadu is no
exception. The age of first exposure to alcohol is dropped to 15 years. This trend is causing socio
economic Problems but little is being done to arrest this social trend. On the contrary the state
govt is encouraging alcoholism to gain revenue. Tamil Nadu state Marketing Corporation is a
company owned by the Tamil Nadu Government which has a monopoly over wholesale and
retail vending of alcoholic beverages in the state.(Tamilnadu every day,11th July2013 –problem
of alcoholism in Tamilnadu)
Statement of the problem
Adolescence is a period of transition from childhood to adulthood. These are the formative years
when the maximum amount of physical, psychological and behavioural changes take
place.Tribals are also in the way of transition and are reaching the mainstream and also
influenced by many factors in which they are not exposedbefore. The problem of tobacco and
alcohol consumption among the residential tribal school students of tribal area is an important
one.A cross sectional study was conducted in selected residential tribal schools of Nagpur district
in central India. Study result showed that 2.86% of school students were indulging in smoking
64
while 41.74% were using tobacco in smokeless form. There have been many suicide among
paniyas in recent times.The reason vary from poverty and indebtedness, conflict within the
family or its breakup due to migration by some members,alcoholism,chronic stress due to
insecure and impoverished livelihood conditions,feelings of alienation or loneliness, lack of
psychosocial solidarity or community feelings-all by products of the present day living
conditions. Alcoholism and other psychic and sociocultural ramifications constitute the major
problem among the tribal people. Researcher had discussion with Adivasi munnetra sangam
leaders, health animators of Accord and had brief visits to different villages. From the
discussions and observation researcher got a message that substance abuse is a significant
problem in the Gudalur region.Boys are more likely than girlsto use all substance and use them
inrisky ways.Substance use has widespread consequences on the user, his family and the society
at largePhysical consequences of drug use are enormous a Physical consequences of drug use
are enormous and differ from substance to substance economic loss due to money spent on
substances,loss in productivity, conflict with family members,crime,stigma and discrimination
are some of the major social,familial,financial,legal consequences. Today’s tribal people social
structure shows an alarming increase in family dysfunction,personal distress,substance
abuse,depression,suicide.It is widely accepted that substance abuse in boys is closely linked to
their overall social situation,status and a variety of local, economic and cultural factors.
Adolescent and youth population is considered as very decisive population for the prosperity of
any nation. These are the special reasons why we need to concentrate more on youth so that it
can be corrected at an early age. Under these circumstances,it was considered useful to examine
the reasons for the existing situation .So that actions will be taken to overcome this. Many
studies were conducted on substance abuse among the youth in urban areas. However no detailed
studies have been undertaken on these aspects in the tribal population in Gudalur Block.Hence
more such studies are required to know the factors influencing this behaviour so that preventive
actions can be taken as early as possible.
RESEARCH METHODOLOGY
Research question
What are the various factors influencing substance abuse among adolescent tribal boys?
65
General objective
1. To Understand the factors influencing tribal youth to substanceabuse
Specific objective
1.To identify the socio-economic and cultural factors leading to substance abuse among tribal
youth
2.To assess the personal factors influencing youth to substance abuse
3.To understand the regulatory mechanisms response to substance abuse
Universe and Unit Of study
Five different groups of tribal are living in different ecological conditions in Gudalur block.
Population of the study was tribal youth and the key stakeholders belong to tribal community in
the programme area of the partner organisation,ACCORD,Gudalur.The participants chosen on
the basis of their lived experiences, unique status, experience and knowledge
Ethics
The study was approved by Adivasi munetra sangam members(AMS)
Sampling
Purposive and snowball sampling.
Snow ball sampling chosen for youth. The key respondent was selected with the support of Ngo
staff and that participant suggested someone else who might be willing for the study. Researcher
choose participants who gives a richness of information as per their unique experience
Study design
It was a qualitative study using FGDS and in-depth interview. Interview guides were semi
structured, open ended and probing questions. Questions for the FGDS focused on participant’s
experiences and perceptions about factors leading to substance use among youth. Questions for
the key informant interviewers
focused on the interviewers experiences about factors
influencing substance use.
Interview guides and consent forms were piloted to check for their validity and language
appropriateness.FGDS and interviews were digitally recorded, transcribed the verbatim, and if it
was performed in Tamil and Malayalam, translated into English.
66
Data collection
In-depth Interviews were held with youth aged between 14 to 24 years.
Focus group discussions-Two focus group discussions were held. One with NGO staffs and other
with Adivasi munetra sangam leaders.Participants were selected purposively
with assistance
from health animators. Six members from different tribal groups were selected. FGDS were
selected on the basis of tribal group and also on the basis of positions in the Adivasi munetra
sangam.All focus groups were conducted in Malayalam and tamil and lasted 90 minutes to one
hour.
Tools of Data collection
Semi-structured interview checklist
Data Analysis
Interviews and other information were all recorded in the local language,Tamil and audio taped
and transcribed verbatim for analysis into English.The transcripts were read carefully several
times to allow the researchers to become familiar with the participants experiences and
meanings. So researcher could able to get a clear picture about the study conducted. Field work
and reflections supported this. Themes emerging from the transcripts were assigned codes. The
data for each code were compiled in Microsoft word. These were then summarised to arrive at
the results.
FINDINGS
Socio-demographic information of the respondents
Age of the key participants interviewed individually ranged between 18 to 25 years,all of them
studied up to 8th to 12thstandard and discontinued education for various reasons. Now all of them
working in unorganised sectors as painters,construction workers and Ngo staffs.Except one all
other participants initiated using drugs in their school days. Only one started this habit after
entered his work. Two focus group discussions were held.one with NGO staffs and other with
Adivasi munetra sangam leaders. NGO staffs selected for FGDS are from mullukurumba,
Betakurumba kattunaicken,Irulas and Paniya tribal groups and they are handling different
positions in the ACCORD as school supervisor,teacher,health animator, pharmacy assistant and
project assistants and have experiences with ACCORD between 2 to more than 10 years.FGD
67
members from Adivasi munetra sangam leaders are from different tribal groups and they are also
handling different positions as Area centre coordinators, secretary,president and also started
working in AMS since 5 to 15 years.
1) PERSONALFACTORS
1.1 Money spend
All participants said the Money spend on drinking is 1500 to 2000 per month and hans daily 10
rupees. All of them are going for work and getting more wages and they don’t know how to save
money so spending their earning in negative channels.
1.2 Motivation
All participant started using drugs by the influence of their peers. Some started at the time of
schooling some after started working with other elders. Some using to get physical and
psychological relief after work. Motivation behind drug use was for fun with friends, to get relief
from pain and during festivals and so on.Initially they started using only for fun gradually they
are addicted to it. Few participants shared it is because of parents drinking habit they also started
like that seeing their parents drinking when they are small children.
Some of the responses of the key participants
“We feel like we are possessed we forget everything when we play we will be too much into it”
“They feel more energetic after drinking so it is a booster”
“No,I didn’t do it in school.After I dropped out studies, I used to work, I saw people along with
me using it and I too started and gradually it became an habit” ”
“I feel relaxed.and will get sleep after tiresome
68
According to NGO staff
“children seeing their parents drinking so later they also started drinking”
“There is always a tendency among the youth to imitate others”
1.3 Source of drugs and various drugs used
Various drugs used by youth are alcohol Hans, tobacco, beetlenut chewing. They do buy alcohol
from beverage shops and other items from small petty shops.
1.4 Attitude and knowledge
Every participant have negative attitude towards drug usage. They are aware that it is bad. One
participant told that it is going to spoil tribal community only one participant said he is not using
alcohol because it will affect others in the family so he is using only Hans. All of the participants
are very well know about the harmful effects of alcohol and other substances
1.5 Influence of media
No one has hero worship and imitating heroes from the movies. All are influenced by friends or
family members not through media.
69
2)SOCIAL AND CULTURAL FACTORS
Traditions
parents
attitude
CULTURE
community
attitude
community
leaders
attitude
2.1 Traditions
Most of the participants expressed that their culture is changing rapidly and that is not a positive
change too. Earlier days their life is filled with music dance, hunting and other entertainment
programmes. Joint family system shifted to nuclear family but now because of the interactions
with different cultures and boys are migrating to other states for work and their daily wages also
increased. Ultimately leads to changes in their basic life style include dress code,food fads and
leisure time activities etc. Olden days they used to offer Alcohol to God at the time of special
celebrations but only elders drink after the rituals and was limited to that particular occasion
but now each and every occasion whether it is death or marriage every one use all type of drugs.
70
According to NGO staff
“Influence of many cutures and interatcions with Non-tribal and media influencing them in
negative ways”
2.2 Parents attitude
Most of the families fathers and elder ones drink. But their attitude towards children’s usage is
negative and they use to scold them for that. Only one respondent said that his parents are not
aware about his drinking habit.
2.3 Attitude of community people and community leaders
Majority of the interviewers expressed attitude of community people and leaders towards
substance use is negative but no one will ready to stop that. They did many discussions and
meetings but not effective.
In olden days elders used to drink illicit liquor which was made in their own villages but only
elders drink. Youth was really scared to do any negative things in front of the elders and did it
secretly but now all changed.As part of their culture they had many rules and regulations all are
ready to listen the headman in their particular village. He was the person who is having the
authority to punish whenever anything goes wrong in their village. Many social changes
happened most of them got education and knowledge he only dealt all the issues related with the
community people. So some sort of discipline was there community head man was there to look
after all issues related with their community people. They also said service providing
organization organized many meetings to implementing strategies to remove this evil but only
females attended.
Some responses:
“Now a days community feelings also disintegrated, all became self-centered. No one is there to
give them proper guidance”
71
A younger NGO staff who participated in the focus group discussion shared that “our
community is like a bus without a conductor”.
Only one participant said even “our community majority of us are drinking and involved in these
activities so they are not bothered about this”
Only one respondent said that his parents are not aware about his drinking habit.
“All are using this so they don’t have the right to advice others. No one have the capacity to give
guidance to others.AMS leaders also drinking so how can they change”.
According to AMS member
“People have more money and knowledge. And also was influenced by non-tribal agents are
there to sell this. Beetle-nut using they started by seeing their parents and other substances from
their parents. So imitating behavior”
Social factors
family
environment
school
environment
social
position
family influence
teachers
attitude towards
drug use
occupation
family support
living conditions
72
2.4 Family environment
Most of the participants shared that their family environment is not conducive for the smooth
development of them.Their fathers and elder brothers are using these kind of substances
especially alcohol and also expressed that they do have fights at home.
Response from FGD-They did not get any proper guidance from their parents in their childhood.
2.5 Family influence
Majority of the respondents expressed that in their family most of the elders are drinking
alcoholism and using Hans, smoking tobacco etc though the parents are close to each other
sometimes domestic violence occurs also because of alcoholism. They indicated that they do
learn this unhealthy habit from their parents.So indirectly parents and elders are influencing them
and promoting substance use.
A key informant acknowledged: “observing elders I too developed this habit of drug use”
“Yes I too started this habit after seeing my elders using substances at home”
2.6 Family support
All most all the participants indicated that they do get support from the family and also family
members do encourage and appreciate them if they do something good. Only one participant told
that his father was not supportive only his mother is taking care of the family. All of them said
they do share their inner feelings to friends more than parents.
2.7 Geographical conditions-climate
Most of them opined that climate is influencing them. If they drink their body will be warm
“if the climate is cold, we will drink to get warm”
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2.8 School environment
School environment was good and they had many fun times there at school. School environment
was very good and all teachers were friendly and used to advise them when they are doing any
wrong thing. All had very good memories about school. In their school days teachers used took
awareness classes about the harmful effects of drug usage when they were studying.
2.9 Social position
Regarding stigma and discrimination most of the respondents said they never faced any
discrimination in school. In the school also every one treated them equally both teachers and
classmates. They do attend non-tribal wedding and other social functions. Fathers drink with his
friends. So children also imitating
2.10 Living conditions
Interviewers expressed In olden times nothing was there to eat so our ancestors were chewing
beetlenut to suppress hunger.Gudalur valley is a hilly terrain and the climate is always cold so
one reason for using drugs is to make their body warm. Most of them are working and getting
wages at the same time Govt is providing free services also. They don’t know how to spend
money so they are spending it in unhealthy ways. Some participants said youngsters know the
sufferings of their parents so they do give a small share of their wages to parents and rest of the
money they spend on these. The settlement pattern also influencing them most of them are living
in clustered settlement so they are exposed to both positive and negative things. If one person
start any bad habit that person will pass it on to the entire village.
Two key participants From NGOacknowledged :
“my village was an educational center learned many things from the village. We do respect
elders and scared to do anything wrong. But now no community and all become self-centered
and all are thinking globally. May be this will be problem for this habit. Settlement pattern is the
strong positive factor in our culture. Friendship link also changed. Now all are alone.”
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“Many positives. We are seeing and observing many generations,young,old middle age but now
everything changedwages increased no one have commitment towards family and no
responsibility”
REGULATORY MECHANISMS
Majority of the respondents shared accessibility and unrestricted easy availability paved way to
increase in alcohol consumption. Construction of link roads to almost all villages is a means to
increase the accessibility. In Gudalur block itself 4 bars and 25 Tasmac shops,so availability
plays an important role here.Regulations by the govt is also very poor. Bar near to mosque and
school all shows that there is a gap in the implementation of laws.At the same time Treatment
facility for addicts are not available. Both from government side and private.
Alcoholic Anonymous member responded
“Actually distributors are more dangerous than victims”
DISCUSSIONS
Adolescence has been defined by the WHO as the period of life spanning the ages between 10
and 19 years and youth as between 15 and 24 years. Since the dynamic transition which takes
place during this period of life has as much to do with social cultural conditions in which young
people live. Adolescence drug abuse is one of the major areas of concern in adolescent and
young peoples behaviour.It is estimated that, in India,by the time most boys reach the in ninth
grade, about 50 per cent of them have tried at least one of the substance of abuse nature(Dealing
with substance abuse –Munmum Mukherjee,Health Action July 2014).
Substance abuse has been an on-going issue for the world’s indigenous people. It is a social and
health issue for indigenous communities worldwide,and has been the focus of many studies. The
effects of this have led to family and community breakdown and continuous to be prominent
struggle in many indigenous people.
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Tribal youths also living in a world that is rapidly changing exposing them to new value system,
modern communication and often unfamiliar or hostile cultures. Tribal land and forests have
come under the control of outsides who dehumanize their men through alcohol. Some will not
give wages instead of that they will offer alcohol and poor people they will satisfied with
that.The consequences of alcohol impact their physicaland emotional well-being. Drug use was
not only their individual choice social and family circumstances playing an important
role.Accessibilty and availability is the most important factor there in Tamilnadu.They should be
treated as peoples and not as objects of schemes planned by the dominant decisions makers. In
2003 Tamilnadu .govt took control of the sale of Indian made foreign liquor.TamilNadu Prohibit
private parties from owning liquor stores making the state govt the sole retailer of alcohol.This
increased the availability and accessibility.Unrestricted easy availability of alcohol and tobacco
is the major trigger factor from the Govt side. Construction of roads to each and every tribal
village make the transportation easy. Aalcohol and tobacco are the most commonly used
substances.
Alcoholism is known distinctly associated with suicides,especially when drinking starts at an
early age.
Conclusion
The study helped the researcher to explore and understand the extent to which personal, social
and cultural factors contribute to youths drug abuse. Drug use is an ongoing and escalating
global health problem. Drug use and abuse is a problem of the youth and has increased in the age
group of 15-25 in the last years. Numerous reasons were found out from the study transition
from old culture, Easy availability,experimentation,free food from Government,disintegration of
family values ,financial and health illiteracy .The Gudalur valley is at the tri-jucnction of the
states of Tamil Nadu,kerala and Karnataka.so there is a strong influence of all three dominant
cultures.The recent years have witnessed momentum changes that have influenced their lives
and thinking in many ways. The world is fast moving from fragmented countries and cultures
towards becoming a global village.it is also urbanizing rapidly. The value system are changing.
No one has been left untouched by the economic liberalization, media explosion and
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technological relevance. The tribal are children of nature and their life style is conditioned by the
ecosystem. The deprivation of land and forests are the worst forms of oppression that these
people experience. The constitution of India makes special provisions for socio economic and
educational development of these groups. Despite the govt initiative, the existing socio economic
profile of the tribal communities is low compared to the main stream population.A culture
specific approach at the same time give attention to individual differences because most cultures
are overlapping and so heterogenousity of culture is the problem now. At the present juncture
when we face a competing and challenging world situation ,what the tribal people need is
GOODGUIDANCE to change their ambivalent attitude towards positive change on the other
side will check whether they are happy with their present situations if so let them move forward
with their own soul.
REFERENCES
1.WHO:Lexicon of alcohol and drug terms.WHO,Geneva 1994
2.WHO:Health of young people-a challenge and promise.WHO,Geneva 1993
3.Substance use disorders –manual for paramedical personnel
4.WHO-Adolescence the critical phase-The challenges and the potential
5.Culture and drug abuse in Asian settings-research for action-Tanya Machado St.Johns medical
college,Bangalore
6.,The Nilgiris-Frontier,Autumn Number ,Vol.43 No 12-15,October 2010. Glimpses of adivasi
situation in Gudalur
7.International journal of collaborative research on internal medicine and public health
8.Drug Abuse in the Indian youth- October 8th 2011,article,hope trust
APPENDIX 1:Topic guide for in-depth interview
Self Introduction
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Introduce myself and briefly explain the study .Inform them about their rights as voluntary
participants of the study and make sure they arecomfortable to start the interview.
1. Which language you comfortable with tamil or Malayalam
2.Your name?
3.How old are you?
4. What are you doing?
5.Can you tell something about your family?
6.Can you please tell me about your childhood?
7.What about your schooling?
8.Do you have wide ranging social circle?How often do you interact with your friends and other
members of your social circle?
9. Do you like this climate?
10.How do you enjoy it?
11.Do you think that this climate also influence you to start any new habits?
12.What sort of habits?
13.How did you first start it?
14.Does your friends influence you ?How did they start?
15.Can you tell me some adventurous activities usually do with your friends for fun?
16.Does any of your friends or family members use alcohol ,tobacco or any other drugs?
17.Have you ever tried or experimented tobacco, alcohol or any other drugs?
18.How old were you when you first tried tobacco, alcohol or any other drugs?
19.Can you tell me the reasons for initial drug use?
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20. Where do usually smoke and with whom?
21.How frequently you use all these? How much money spend to buy these substances?
22.Can you tell me the experiences after consuming these substances?
23.Are you feel more relaxed or confident and also feel a sense of growing ?
24.Can you tell me about the harmful effects of these substances
25.which is the latest movie you watch? Are you get inspired by the hero who uses these
substances?
26. Do you like this climate?
27.Do your family or friends ever tell you that you could cut down on your drinking or drug
use?
28..Are you agree with this statement? “It is normal that young people will try drugs atleast
once”
29.When ever you feel sad with whom you will share your personal feelings? With mother,
father or friends?
30.When you are upset ,what you will do ?Are you try to talk freely with others or any other
ways to solve your problems?
31.Does your father /mother appreciate your effort?
32 .Your parents are aware about your drug habits? If so their reactions?
33.Do you have any idea about community peoples response towards alcoholism, tobacco usage
and other drugs?
34.Do you think that alcoholism, tobacco usage is widespread in your community now days?
Can you tell me your views about that?Is it part of socialization ?
35. What are the main festivals and celebrations in your community?
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36. Can you tell me the different rituals and customs associated with those celebrations?
37.Does every body from your community gather together for social functions?
38 :Have you ever attend any social gatherings other than your community? If so what is those
occasion?
39:Can you please explain the experiences of those occasions? Is there anything else of relevance
that you would like to add?
ANNEXURE -2
FOCUS FROUP DISCUSSION CHECKLIST –KEY STAKE HOLDERS(COMMUNITY
LEADERS AND NGO STAFF)
I am aware that alcoholism and other substance abuse are very common in this region. Can
you tell me more about it.
Probes: What are the social changes taken place so far?
: Can you tell me the major livelihood of your community?
: What are the settlement patterns? Is it influence the behavior ?if so is it influence
positively or negatively?
: Can you please explain the strength and weakness of your community?
:Tell me your views about substance abuse ?
:Are you aware that here adolescent boys are using tobacco, alcohol and other
drugs?
:Can you tell your view about such habits and how they developed such habits?
:Is it part of the belief system ?
: Is Gudalur a tourist area? Do you think that tourism also play an important role in
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developing such habits?if so How?
: Who will take decisions when ever anyone of your community encounter any
problem
: Is it the community leader or the concerned family itself?
:Have you ever discussed the problem of substance abuse of boys in the community
meetings?
:Do you think teenagers need role models from home and community?
:What are the changes from the government side to tackle this issue?
:Have you ever noticed that availability and accessibility of drugs make the teenagers
to start such habits
:Is there anything else of relevance that you would like to add?
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Community Health Learning Programme is the third phase of
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