Jaison - Final report - 20.04.16.pdf
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CELEBRATING COMMUNITY HEALTH!!!
Community Health Learning Programme (CHLP) 2015 – ‘16
Jaison K Sebastian
Acknowledgement
I am sure that these words are not enough to acknowledge all that happened over one year of
CHLP in SOCHARA, but still; let me give it a try.
Despite my absolute inexperience in the field of community health and with no working
experience SOCHARA was so graceful in accepting me for the fellowship. I thank Dr. Thelma
Narayan, Dr. Ravi Narayan, Mr. S. J. Chandar and Mr. A. S. Mohammad for considering me
worthy of the programme, encouraging and guiding to learn and explore community health and
above all to celebrate community.
I thank Bro. Kumar K. J for being my mentor and sparing his valuable time to help me
whenever I needed it.
I thank Dr. Rahul Asgr, Mr.Prasanna, Dr.Adithya, Mr.Prahlad, Ms.Jenalle, and
Ms.AnushaPurushotham for sharing their knowledge and facilitating the learning at different
levels.
I thank the unassuming administrative staff and the support staffs for bearing with us and for
helping to make this journey a memorable one.
I thank everyone at THI (Tribal Health Initiative) especially Dr.Regi, Dr. Ravi Kumar my field
mentor for the opportunity given to spend almost Five months with them to learn from the grass
roots.
Last but not least, I thank all my fellow travellers for the wonderful time we have had together
and without whom the CHLP journey would not have been possible.
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TABLE OF CONTENTS
ACKNOWLEDGEMENT ......................................................................................................... I
TABLE OF CONTENTS .......................................................................................................... II
INTRODUCTION ...................................................................................................................IV
LEARNING OBJECTIVES...................................................................................................... V
CHAPTER – 1
THE COLLECTIVES ................................................................................................................ 1
THE NEW INNINGS BEGINS HERE… .......................................................................................... 1
UNLEARNING, LEARNING AND RELEARNING… ........................................................................ 2
COMMUNITY ........................................................................................................................... 3
HEALTH................................................................................................................................... 4
MENTAL HEALTH .................................................................................................................... 4
LEARNING ............................................................................................................................... 4
TOWARDS HEALTH FOR ALL .................................................................................................... 5
FROM KNOWN TO THE UNKNOWN… ........................................................................................ 5
BUILDING BLOCKS… ............................................................................................................... 6
FROM FLOOR MOPPER TO TAP TURNER OFF!............................................................................. 6
PARADIGM SHIFT ..................................................................................................................... 7
AXIOMS OF COMMUNITY HEALTH ............................................................................................ 8
SOCIAL VACCINE ..................................................................................................................... 8
DETERMINANTS OF HEALTH AND SEPCE ANALYSIS ............................................................... 9
GLOBALISATION .................................................................................................................... 10
UNDERSTANDING ALMA ATA DECLARATION ........................................................................ 11
COMMUNITISATION ............................................................................................................... 11
HEALTH FOR ALL NOW! ......................................................................................................... 13
ADD-ONS................................................................................................................................ 15
REFLECTIONS AND LEARNING ........................................................................................ 20
CHAPTER – 2
FIELD EXPERIENCE ............................................................................................................. 22
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MY JOURNEY THROUGH THI ............................................................................................ 22
COMMUNITY HEALTH PROGRAMME ...................................................................................... 24
UNDERSTANDING COMMUNITY ............................................................................................. 28
COMMUNITY VISITS ....................................................................................................... 32
MEETINGS .......................................................................................................................... 33
A NOTE! ................................................................................................................................ 34
THULIR ................................................................................................................................... 36
ACCORD ................................................................................................................................. 37
PERSONAL EXPERIENCES AND REFLECTIONS ............................................................ 39
CHAPTER - 3
RESEARCH REPORT ............................................................................................................ 40
INTRODUCTION ...................................................................................................................... 41
TITLE OF THE STUDY ............................................................................................................. 43
OBJECTIVES ........................................................................................................................... 43
RESEARCH METHODOLOGY ................................................................................................... 44
LIMITATIONS ......................................................................................................................... 44
FINDINGS ............................................................................................................................... 45
CAUSES OF MIGRATION .................................................................................................... 46
PSYCHOLOGICAL ASPECTS .............................................................................................. 47
SOCIAL ASPECTS ................................................................................................................. 49
COPING MECHANISM ......................................................................................................... 51
DISCUSSION .......................................................................................................................... 52
CONCLUSION ........................................................................................................................ 54
REFERENCE ........................................................................................................................... 54
ANNEXURE - 1 ...................................................................................................................... 55
ANNEXURE - 2 ...................................................................................................................... 57
ANNEXURE-3 ........................................................................................................................ 58
THE PHOTO JOURNAL ........................................................................................................ 59
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INTRODUCTION
Into the light; finding a path…
Well, “I am a postgraduate in social work now,” I kept telling to myself. I tried my best to
convince myself that “I am a professional.” Deep within I was not convinced enough to getting
into a profession, as I felt that I was not competent enough to commit myself to any profession.
Meanwhile I wished to study further but I didn’t know what exactly to study. But what is next?
I was clueless. I kept asking myself what I should do now. I was getting all the more confused
and distressed as all my batch mates one after another getting in to jobs and finding their
grounds. Thanks to my parents that they gave me full freedom to follow my convictions but
unfortunately they were not in a position to guide me either. All that they wanted and expected
was that I get a good job somewhere, earn enough and get settled.
During these confusing and most agonising days, out of the blue, I remembered the
conversation I had with Mr.Sabu; then a facilitator at SOCHARA. He had come to our college
to conduct a work shop on research methodologies. I can vividly recall how passionate and
enthusiastic he was while introducing the organisation he was then associated with. He also
enquired us if anyone was interested to join the fellowship programme on community health.
To be frank, I didn’t know anything about community health then nor took time to understand
what it was. However, I was still not convinced that I should apply for the fellowship.
Meanwhile I contacted my HOD, Dr.Thanuja Thomas asked for guidance and it seemed that
she was quite positive about joining the programme and connected me with Mr.Sabu. She also
reminded me that one of my batch mates Ms.Nisha had done her block placement at
SOCHARA. She shared her experiences of a short stay at the organisation and insisted me to
join the fellowship.
Subsequently, after the initial dilemmas in deciding on to start a new journey to the unknown,
I wrote to SOCHARA. The reply to my letter came after a while and I was asked to get ready
for a Skype interview; first of its kind. During the interview I expressed my interest to join and
it went on well, it seemed that they were interested in me. I hopefully waited for a confirmation.
Almost after a week while going through the e-mails, to my excitement I found it. I was asked
to be in Bangalore for a personal interview.
Thus, here I am, into the light, finding a path…Time for the show now…
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Learning objectives
I joined SOCHARA with little knowledge about community health. So it was to explore
community health, to try the career options in the field as I was a fresh postgraduate with no
field experience and adequate competence. But as the fellowship progressed day by day, there
were bundles of learning and new experience coming in. Hence, the objectives of the
fellowship shifted to more about understanding health in different perspectives, as a result of
it there were many other objectives evolved. Some of them are as following;
•
To understand health in different perspectives and concepts in a holistic manner.
•
To understand community health approaches and perspectives, and SOCHARA’s
involvement in community health.
•
To develop skill that is necessary for a scholar activist.
•
To experience rural life and feel the ground realities and learn from it.
•
To practice paradigm shifts with a balloonist view.
There were also other objectives that are somehow related to the above mentioned. The journey
still continues and so there is space for new objectives too.
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Chapter – 1
The collectives
The new innings begins here…
I was all set for the match. The preparation for a long test match began as I landed up in
SOCHARA on 7th February 2015. I fell in love with the stadium, i.e. the SOCHARA campus
at the first sight itself.
There were a few members of the team management and would be
fellow players who were moving around the ground talking each other and greeting one
another. To be honest I was quite tensed and was going through lots of mental containments as
I was an amateurish young player badly wanted to get into team. I somehow regained my sense
and by the time someone came to me and we introduced each other. I was offered a chair to
comfort myself until I was called for the fitness check-up. It was time for the fitness test and I
was quite tensed. I knew that my mind was going blank but somehow I regained the control of
the mind. I was at the cabin and for the first time I sat before the team management. First of
all I was welcomed cordially and they introduced themselves as Ravi, Mohammad, Chandar;
Thelma joined us after a while. The check-up began, from the initial struggles as they cheered
me to feel free and open up I felt at ease and the process went on for almost an hour. I couldn’t
fully comprehend what was going on but still towards the end of the conversations I was feeling
good and energised. It came to an end and I was asked to move to the parlor and wait for the
final decision, as I walked back, once again my mind went blank and I waited eagerly to hear
the result.
I waited and waited, after a while here comes the good news. Thank god, I am in!!!
The warm up sessions…
With lots of excitement and enthusiasm I was on the ground, i.e. the classroom, for the first
day. It took a few days to redeem myself from the initial discomforts of meeting and being with
strangers; strangers then, not any more. I got rid of it as I started mingling with the other players
(fellows) and introducing one another. It was all the more thrilling to know that my fellow
travellers were from different corners of the country and with a verity of educational back
grounds and experiences as well. They were from Meghalaya, Manipur, Madhya Pradesh,
Orissa, Karnataka, Tamil Nadu and from my own state Kerala. They are doctors, dentists,
psychologists, a lawyer, an MBA and many social workers who are of my kind; unity in
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diversity! Thought it took a few days to get along with every one, yet it was an awesome
experience.
A new world!
As the days passed I felt as If I was in a new world. Yes, I was in a new world called
SOCHARA. It was all pleasant, benevolent facilitators, energetic and enthusiastic fellow
travellers, last but not least the unassuming staffs in the campus. Everyone easily got along
with each other and was at the service of one another. Most interestingly you will find a young
lovely couple named Ravi and Thelma (though hairs have turned white, yet they are still young
at heart and the works they do) who left their stethoscope at the medical college and decided
to be co-travellers towards making “health for all” a reality.
The life stories begin…
The orientation programme brought all of us together. My learning began at this point onwards.
The initial days went through mixed emotions. I felt like I was not supposed to be in such a
place. But these sorts of negative and belittling thoughts were washed away as the days went
on. I started feeling at ease as the fellows started expressing their interests in learning
community health and as facilitators were always optimistic, inspiring and supportive in
implanting the seeds of hope and action.
During the sharing of life story sessions, fellows opened up their hearts and shared their past
experiences. Everyone had a lot to tell. The stories started from the family background to school
and college days to the variety of sweet and bitter experiences they had gone through their lives
while pursuing their dreams. All of them were unique in their own ways and had something to
teach the others. The life stories of Ravi, Thelma, Chandar and Kumar were exceptional as they
poured their hearts out while sharing their experiences in experimenting with the realities.
Ultimately, it was a good platform to start the new phase of learning. The minds and hearts
were ready to undergo something new and exceptional.
Unlearning, learning and relearning…
Yes, it was all that I went through over one complete year of fellowship at SOCHARA. It took
me a long while to start the first chapter of the journey, a reflective story of the one year of my
journey through different frames and settings. I knew that the time had come to scribble down
all that I have seen, heard, listened, argued, discussed, debated, visualised, practiced, above all
experienced. It is once again undoubtedly established that the ever green anonymous saying
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“experience is the best teacher” as I have reached a new phase of the journey. If it was not for
the personal experiences at the field work, class room sessions, sharing of the experiences by
the fellow travellers and the events happened elsewhere, I would not have gained anything
promising even after spending a whole year. I admit that the learning through experiences
continues till the last breath I take. Learning is life long and it takes different forms and realms.
My life journey continues and I am sure that it has gone through a paradigm shift as I joined
the fellow travellers traversing the paths that are less travelled.
As i write it down, I am unsure if I was prepared enough to revisit each of the raw and robust
events, experiences and stories and do justice to the learning I have undergone. But still, let me
try to bring it all together.
Let me start it from the title of the fellowship programme its self!
“Community health learning programme”
Considering the title as individual words giving a complete meaning was not new to me. I have
heard the words community, health and learning a thousand times at least. Each time it was
attached with different connotations. I have used each of these words in different contexts too.
Community
As I have mentioned, community was not a new term for me. From the sociology classes I
attended during my under graduate and post graduate studies had given me text book
knowledge on what community is all about. Though I lived in different communities all these
years, yet I hadn’t tried to understand the real essence and meaning of community until I joined
SOCHARA.
I had a slight different experience as I was in a religious congregation for a couple of years
towards the late adolescent and the early adulthood period of my life. I remember now with
great reverence that we were known as communities among the religious circles; “community
of the poor servants of divine providence”. We were asked by the formatters constantly to live
a community life as we were a gathering of people from different states; total strangers until
we all were called together and started living under a common roof. This is when and where
the word community started becoming relevant.
Later on, in SOCHARA very often I started hearing the term community. Each one of us time
over and again listened to people and reflected oneself to comprehend the true meaning of the
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word. All that I had learnt was once again reaffirmed when I was sent to the field for about 6
months. Now with full conviction I can say that community is nothing but it is when I, YOU
and THEY come together to form “WE”.
Health
My post-graduation had lead me to understand health in general as I was getting specialised in
medical and psychiatric social work. I had to be through with the WHO definition of heath to
get through the exams; the WHO definition of heath, which says “health is a state of complete
physical, mental and social wellbeing and not merely the absence of disease or infirmity”.
Like any other lay man I knew health in terms of disease, medicine, doctors, nurses, hospital
and so on, until I joined the fellowship.
The first paradigm shift in my learning process began as I was initiated to reflect on the
definition. I was prompted to understand health in a holistic manner. The process of unlearning
just began and the true meaning of health started to unfold itself through the discussions and
reflections we had over a period of time. Subsequently, my definition of health now is
“wellbeing”, that is to say the life itself.
Mental health
Mental health has been an area of my interest form the post-graduation time onwards. My
knowledge and understanding were refined and polished through the fellowship. It has helped
me to understand the concepts and underlying issues form a different perspective altogether.
“Being born as a lady who is poor and mentally ill is the scariest thing in India.” States
Dr.KeshavDesiraju, Ex-health secretary of India on a lecture during the alumina meeting was
an eye-opener. This statement alone is enough to understand the importance of mental health.
Being mentally healthy is closely associated with determinants of health. Hence, addressing
the determinants and working on it is the need of the hour; this is the challenge I wish to
undertake here after.
Learning
For me, Learning was just the acquisition of knowledge and skills through the conventional
methods that is by-hearting something from the text books, studying whatever a teachers taught
in the class rooms, or even learning something like how to operate a computer, a new mobile
phone etc.
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But now, I am convinced that learning is not the above said alone, rather there is lot more.
Learning through experiences, reflecting and internalising what I see, hear, think, doubt, doing
and responding. It is “inside Learning” through a process of blending brain and heart together.
Hence, learning is unlearning what is already learnt, learning what is new and relearning what
is necessary.
Towards Health for all
It was for the first time I heard the caption “health for all” in SOCHARA. At the beginning it
sounded a fancy caption but as the days went on and the sessions progressed I could understand
the depth and breadth of the concept. I learnt that it was not just a caption but a dream followed
by many. Later on I have learnt that SOCHARA and health for all are inseparable and this is
what flows through its veins and the people who are in the organisation. It was one of the most
discussed topics in the class and each session opened up our understanding about the hard-core
realities about health. Many other sessions were in one of the other ways were related to the
topic and it added new dimensions to the concept discussed.
The global charter for Health has noted that: “Health is a social, economic and political issue
and above all a fundamental human right. Inequality, poverty, exploitation, violence and
injustice are at the roof of ill health and the deaths of poor and a marginalized person … Health
is primarily determined by the political, economic, social, and physical environment and
should, along with equity and sustainable development, be a top priority in local, national, and
international policy making.”
It is enough to critically analyse the above quoted words to understand the disparities and gaps
we face in making health for all a reality. We are in chaos. Our systems are still not ready or
competent enough to deal with the realities as they are hallucinated by the negative forces like
globalisation, privatisation, neoliberalism and many more. Hence, here is the relevance of civil
societies like SOCHARA who raw against the currents to reach the goal. How do we do it is
the question now and I have tried to put together how SOCHARA have tried it.
From known to the unknown…
I began my new phase of life in SOCHARA, an experiment with a new concept called
“community health”. It was a journey from the things I thought I knew to the things unknown.
Even though I couldn’t fully apprehend what was going on, yet certainly the experiences turned
into more than I ever imagined; a paradigm shift in my own attitudes, thoughts and perceptions
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towards different concepts, theories, and ground realities. Placing “health” at the centre of the
paradigm shift I underwent, there were many more things that followed.
I hope to bring them all together under a series of headings.
Building blocks…
For anything to last long, it should be built extremely well. The blocks that are used to build
also must be strong enough to with stand any adverse catastrophes. “Health” as the corner stone
we need powerful blocks to build communities that prevails against all adverse events. Once it
is done the communities can be compared with the house that is built on the rock so that when
the rain fell, and the floods came, and the winds blew and beat on that house, but it did not fall,
because it had been founded on the rock. And, not like the house built on the sand. And the
rain fell, and the floods came, and the winds blew and beat against that house, and it fell, and
great was the fall of it.
To build such communities in the modern world we live in, we need knowledge and expertise
gained through learning and field experiences that is as powerful as a two edged sword that
pears in to anything that comes as hindrances. The journey through CHLP has equipped me
and each fellow traveller with such knowledge and experiences. Some of those are as
following.
From floor mopper to tap turner off!
What a change! This is what I am supposed to be. “Are you a floor mopper or a tap turner off?”
I had no clue and was a little disturbed when Ravi asked this question to us. Every one of us
sat back and thought for a while to understand the hidden essence of the question. He went on
to explain what each of these words meant to the budding community health fellows. It was
the same he went through when he was asked the same question decades back and now I have
seen and experienced the effect it had on him; a total conversion! I now know that I am in the
process of the same conversion. The relevance of CHLP becomes evident, when the people
around us are trained or even wish to be floor moppers, I am trained to be a tap tuner off.
What does it mean to be a tap turner off?
It simply means that when I am trained and taught to deal with illnesses, disabilities and any
other health conditions in an orthodox manner using all the modern facilities and interventions
available, I am counted one among the floor moppers. Whereas, when I start to understand and
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address the root causes and the cause of the conditions mentioned above and put my heart and
mind together to deal with it, with the available and most suitable resources, I become a tap
turner off!
As I reflect on being a tap turner off, the first thought that comes to my mind is that whether I
can be a tap turner off in my own humble ways. If so, what all will be the obstacles that I should
encounter on my way. I am pretty sure that the world we live in will not easily let any of us to
be a catalyst of change as the forces that stand against us much stronger and deep rooted than
we ever imagine. So being trained as a scholar activist, the challenges before me are many.
Yet, I am prepared to take up the challenge and go forward.
Paradigm shift
It was one of the terms I kept hearing throughout the fellowship. Though it was not so soothing
to hear in the beginning because it called for a change, yet as the learning progressed the term
became more clear and self-explanatory. The vigour with which Ravi talks on Paradigm shift
is enough to trigger any of us to adapt to this change. In the context of community health and
health for all, paradigm shifts meant a transition from bio-medical model of health to social
model of health. Similarly, it called for change in looking at and understanding realities from
different perspectives other than from the conventional frames. There are seven of them
proposed by SOCHARA and they are as following:•
A shift in focus from individual to community
•
A shift in dimensions from physical and pathological to broader psychosocial, cultural,
economic, political and ecological dimensions.
•
A shift in technology from drugs and vaccines to education and social processes.
•
A shift in the type of service from social marketing and providing models to enabling,
empowering and autonomy-building processes and initiatives.
•
A shift in the attitude of people from patients and/or passive beneficiaries to people and
communities as active participants.
•
A shift in research focus from molecular biology, pharmaco-therapeutics and clinical
epidemiology to socio-epidemiology, social determinants, health systems and social
policy research.
•
A shift in structure from institutional based (hospital and health centric) work to
community based and led approaches.
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At the end of the fellowship the terms have become clearer. The field experiences at THI have
helped in understanding how these shifts can yield better results. The best example of this is
the “Health Workers” who are local girls trained over a period of two years, are the back bone
of all the activities happening in the hospital. The school health programme is another example,
wherein the students insist their parents to build toilets there by a remarkable reduction of
diseases caused by open defecation. Hence, trained as community health fellow, it is my prime
responsibility to participate and propagate the paradigm shift to make health for all a reality.
Axioms of community health
This is one of the foundations of community health proposed by SOCHARA. It is not just a
philosophy or ideology alone, rather these are statements or ideas believed to be true by the
people. The axioms become prevalent and efficacious as we travel towards the dream health
for all. In my understanding as we follow these axioms the journey towards achieving health
for all become easier. It shows ways to actualise the dream and it is a combination of various
elements. It starts with community health as a process of enabling and empowering people to
exercise collectively their responsibility, to their own health and to demand health as their right.
To do so every individuals and community should have autonomy over their health and it is
possible only when everyone has the opportunities, the knowledge and supportive structures
that make health possible in an equity basis. It also calls for integration of health and
development activities. Building decentralised democracy at a community level is another
element included. It is all possible only when a system is established where in the bio-medical
model of health system shifts its priorities to a social model with the community participation
at all levels and when the understanding of health and health care changes from a professional
package of illness to addressing the determinants of health.
Social vaccine
The term vaccine was not unfamiliar but what exactly vaccine is and how does it work was
something new. The sessions gave a clear picture about the immunization programmes and the
role of various players in the process and UNICEF has a key role in it. Yes, it is a preventive
medicine and it has improved the health status of our nation certainly. But is it enough to
achieve health for all?
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Here is the relevance of social vaccine. This is an alternative way to prevent the occurrence of
diseases. It stresses the importance of working on the determinants of health and the range it
covers cannot or will never be covered by a bio medical model of disease prevention. It
advocates working on the social and economic structural conditions that render people and
communities vulnerable to disease. How does it work is simple, it is through social actions. It
becomes possible when communities are empowered and enabled to take care of their own
health needs. It is better understood through a simple example. As we consider HIV/AIDS as
a serious issue, most of our efforts will be promoting condom as preventive measure; whereas,
through social vaccine perspective we try to replace “responsible sex” as a vaccine to tackle
the issue, thus bringing the incidents under control. The amount of money and other resources
needed to establish social vaccine is much less and the long term outcome will be much greater.
Determinants of health and SEPCE analysis
As the sessions progressed my understanding of health had become fairly clear. But still, there
was space for my thoughts to get refined. It happened through a series of processes like
listening to other’s understanding, observing and experimenting at the field, and above all
listening to the facilitators. It was furthermore clarified by understanding the determinants
health applying the SEPCE (social, economic, politics, cultural, ecological) analysis to the
learning and experiences I went through. Now I prefer to use the word wellbeing to health.
One might ask why do you want to give/attach a social, economic, political, cultural and
ecological connotation to health? My humble answer to the question is that health is not health
apart from the above mentioned. There is an element of health in everything and when anything
happens to the above mentioned it affects the health of an individual somehow.The social
determinant of health is an important concept of community health that helped me to reflect on
the underlying factors to look, learn and to understand and not to jump into a conclusion. My
field experiences have strengthened the idea of applying SEPCE analysis of health to get a
deeper understanding of health challenges going beyond the orthodox bio-medical and technomanagerial framework. Hence, being trained as a community health fellow it is expected of me
to bring an element of health in everything I think and do. It also urges me to act upon it, where
ever I am and in whatever I do.
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Globalisation
The term globalisation sounded very appealing until I joined the fellowship. I could imagine a
world without boundaries, where I can video call my cousins and friends in the foreign
countries, where i have the luxury of travelling around the world in aeroplanes and in Toyota,
Mercedes and other luxury cars, where I can get anything at my finger tip using latest models
of mobiles and tablets, where I can have the comfort of wearing clothes and accessories of
NIKE, PUMA, ADIDAS and other international products, where in can eat and drink products
from the US, the UK and form anywhere further. Our life style has changed and became more
westernised. I never could connect globalisation with health. This was all I had in mind as I
admired globalisation.
But, as the fellowship progressed my understanding were demystifying. There was a bundle of
learning coming in and it helped to understand globalisation form a community health
perspective; a paradigm shift. Now I understand the politics and under currents of it and how
it had impacted health at large. The negative side/effects of it are many. Some of them are that
it tries to reduce the control of government at various levels, instead it promotes the role of
private sector and a cut-throat completion has become the order of the day at all levels of life.
It hinders the welfare activities and tried to establish health, education, etc. as
expenditure/liability rather an investment. At this point health becomes a reality only for those
who can pay. Its effects are seen in the agricultural sector; its outcome is alarming increase in
farmer’s suicide and mass shift in the cultivation of food crops to cash crops. It also adds fuel
to the perils of climate change, poverty, non-communicable diseases and so on. Organisations
like World Band (WB) and International Monetary Fund (IMF) who are supposed to be the
agents of aid have turned into agents of trade. Consequently, globalisation is nothing new but
capitalism incarnated in a new form; it is the economics of greed! Rich becomes richer at the
cost of the poor. Hence, we can rightly say that we are dealing with a new epidemic called
globalisation.
At this point, to tackle these issues what we needed is a globalisation, a “vasudeivakudumbam”
from below. So that an equitable, sustainable, peoples lead globalisation a celebration of life in
its diversity will become possible one day.
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Understanding Alma Ata Declaration
Alma Ata (1978) is a revolutionary declaration which was held in Alma Ata, USSR, for the
first time in history where 125 countries came in the place Alma Ata, came together and dream
that it would be possible by 2000 A.D. basic ‘health for all’ would be achieved which meant
water supply, sanitation, vaccination, mother and child care and primary health care.
In the conference the prime focus was on comprehensive primary health care and to promote
health for all by 2000 A.D. In the conference, health was the main subject and according to it
health is a complete physical, mental and social wellbeing and not merely the absence of
diseases and it is a fundamental right to all the individuals regardless their race, gender, caste,
class.
In the declaration, further discussion was talked that people have the right and duty to
participate individually and collectively in the planning and implementation of health care and
the government also have the responsibility to ensure access health care to its people. There
should be an intersectoral collaboration with other departments within the government system
and there should be reduction in armaments and to concentrate more on peace. It also talked
about equity and health and not only for the people who can pay; and health also is a
fundamental right
Primary health care is an essential health care base on practical, scientifically sound, socially
acceptable method and technologically made universally accessible to individuals and family
in the community. It should be the first contact with the community and it should address the
main problems in the community, to provide, to prevent, curative and rehabilitative services.
Communitisation
The term evolution is a part and parcel of human history. We have been witnessing it in
different walk of our lives. Healthcare has also evolved over a period of time. It had taken
different forms and it is still in the process of evolving. Communitisation is a process that
evolved over a period of time to bring or to gain autonomy over health at an individual level
and in a community level as well.
India has come up with a number of significant programs in health and one of the most
promising among them is NHRM (2005). It is modified into NHM now. As far as I understand,
the Alma Ata declaration -“health for all” is the base for the notion called communitisation.
Though primary health care was adopted as a strategy to achieve this goal, yet the importance
11
of community participation was recognized as an inevitable part of working towards health for
all. It is a combination of various elements like maximum community and individual selfreliance and participation in the planning, organization, cooperation and control of primary
health care, making fullest use of local, national and other available resources. When all these
elements are actualized in its fullest, the journey towards health for all becomes more apparent
and less uncertain.
In my opinion “Communitisation” is nothing but enabling and empowering people to take
charge of one’s own health. Eventually, it will lead to the establishment of healthy communities
around the globe. As and when this is established we find transformed individuals and
communities ready for more actions. Now, to reach this stage, it requires sincere and
wholehearted commitments and efforts from both the individuals and the authorities. If the
general public feels indifferent and thinks that the state should do everything for them, then it
becomes all the more difficult just because it requires both individual and collective
participation and action.
Further to understand what communitisation means, it is necessary to know various role players
in the process. It includes the VHSCs, ASHAs, the involvement of local self-government and
community based organizations (NGOs). Placing the community at the center, each of them
has their own specific roles to play. Ideally, they are expected to enable and empower the
individuals and community as a whole to participate, involve and engage in planning, action
and evaluation of activities (projects). Another interesting characteristic of communitisation is
that the peoples involved in the processes are mostly selected from within the respective
communities (expect for a few at upper levels of authority) and this will have direct and positive
impacts on the success of the programme.
Finally, communitisation has yielded good results and has brought changes in the health care
approaches and even more in the lives of common people regarding their health. Yet my
experience in the field and the experiences shared by the other fellows form different parts of
the country give me an impression that the notion of communitisation has not reached its
optimum level. I don’t really understand whom to blame for; is it the state and the authorities
that are under the clutches of corruption and inadequate governance or disparity/gap between
the rich and the poor and their indifferences, lack of awareness or ignorance or the so-called
influences like the capitalistic globalization trends?
12
Gender and health
Though health is a common condition of human being, yet it is unevenly experienced and lived.
There are both known and unknown players who make the situation even worse. It has been
prevalent form the time immemorial. Though the humanity has progressed so much in terms
of technology, lifestyle, knowledge accumulation and much more, yet many of these evils are
still persistent in different forms and levels. Hence, its load on the lives of humanity is
immeasurable. Being raised and lived in patriarchal society, my understanding and perceptions
were biased. Even after going through postgraduate level of education, word gender always
was attached with connotations male who is dominant to female and the question of a third
gender never been a part of a casual thought even.
It was a new beginning as the sessions preceded many of my misconceptions and biased
thoughts started diminishing and the realities were unfolding itself. Now, my understanding is
that gender is relational and refers not simply to women or men but to the relationship
betweenthem. To understand the gender bias and gender based disparities in health it is enough
to visit any of our public health systems or it is even enough to talk to a so-called educated
man. Most of them wouldn’t be able to agree to the gender equality principles, even if one
agrees; somewhere deep within will have certain disagreements on the same. Otherwise, a
person should be well oriented and towards the issue so as to have a genuine outlook on the
same. At the end of the fellowship the understanding on the issue has changed and this would
help me in dealing with the gender realities in a more comprehensive manner.
Health for all now!
It is unfortunate that we have not reached health all, it still remains a dream. The Alma Atta
conference in association with WHO and UNICEF in 1978 was a milestone laid towards health
for all. It had set a dream of attaining health for all by 2000 AD and towards making it a reality
they had chosen primary health care as a tool. But what happened to it was that the negative
forces fuelled by globalisation were so strong that it couldn’t reach to the people eventually. It
is true that genuine efforts were taken by a few and the moment couldn’t continue with full
vigour.
The relevance of community health approach becomes clear in this context. This is a way
forward by enabling and empowering people to demand health as a right and to gain autonomy
13
over one’s own health. As we work towards the goal, it is good to keep in mind that the negative
forces like poverty, illiteracy, poor standard of living, inequality and injustice at various levels
and ill-health fuelled by globalisation are stronger than they appear. So as we move toward the
dream the efforts should start by making paradigm shifts at the grass root levels to the humanity
at large. Applying various community health approaches that are discussed in the above pages
we can confidently march forward and then “health for all” becomes a reality and the
communities around the globe start celebrating life each moment and our world will become
the best place to live in!
14
Add-ons
CHLP was not just class room sessions and field work alone! It was but a combination of
various activities that added flavour to the program. There were exposure visits, participating
in celebrations, attending seminars, celebrating festivals, workshops, listing to visitors,
birthday celebrations and many more. Each of them in one or the other way enriched my
learning, more over it added colour to my personal experiences. This is the sort of learning one
can expect from SOCHARA; it is unique.
Exposure visits
Each of the exposure visits was unique. It was a combination of learning, fun, togetherness,
exploration and experimenting with the realities. Every organisations and individuals we met
had something tell us; they were all exceptional.
PHC at Dommasandra
Visit to Dommasandra PHC was memorable as it was for the first time I visited a PHC. It was
a time to listen to the medical officer and to the other staffs in the hospital and hear from them
their experience in working with people. It helped a lot to understand the government
programmes at a PHC level and also to cross check the organisational structure, programme
implementations and services provided with the book knowledge and learning I had through
the class room sessions. The interactions with the hospital team helped in clearing doubts
regarding functioning of a PHC and further interactions gave clarity regarding ASHA workers
who are the integral part of community health.
National Tuberculosis Institute (NTI)
Visit to National Tuberculosis Institute (NTI) was one of the eye openers. A bundle of
information was shared with us. Almost all about tuberculosis (TB) was shared by the resource
persons. Tuberculosis has always been recognized as an important Public Health problem. The
data displayed during the session was alarming. The magnitude and mortality rate of TB is
heavy on the poor and it is self-explanatory as we say it is a poor man’s disease. They went on
to explain in detail what TB is, types of TB, symptoms, causes and consequences of the disease,
government interventions on TB, NTI’s contributions and so on. Many of these actually were
knew to me and helped to understand it in a comprehensive manner. It also was a time to reflect
further on the plight of people who suffer from TB especially who have become a victim of the
disease in the vicious circle of poverty.
15
DOTS centre
NTI visit was followed by a visit to a DOTS (Directly Observed Treatment Short Course)
centre in the city. It was a great experience meeting and interacting with people who work in
the grass root level to tackle a disease that is considered to be so deadly. It was also a time to
hear from them about their experiences in working at a government institution and how their
service has become a helping hand to those people who are otherwise dead. I remember that
they had mixed emotions as they shared about the DOTS programme; it’s functioning,
difficulties they come across and so on. Some of the discussions we had with the team were on
types and symptoms of TB, how is DOTS administered, and the success and failure of RNTCP
(Revised National Tuberculosis Programme). The interaction was so informative that every
one of us had something to ask and then get things clarified.
Snehadaan
Snehadaan is a must visit place in Bangalore. This is where one can meet a community so
committed to the cause of persons living with HIV and AIDS. The work they do is admirable
and exemplary. Anyone who visited Snehadaan will find an answer to the question of how do
an organisation provide a comprehensive and holistic health care to the sick. Snehadaan is
working to be a positive force in addressing the comprehensive needs of the HIV infected
persons, ensuring their dignity and overall quality of life, by motivating, caring, supporting and
rehabilitating them, with a priority for the palliative care of those who are in the end stage of
the disease. The visit also helped me to refresh my awareness and understanding about the
disease.
Their work with the children infected with HIV is amazing. I still can recall a few of the faces
of children I meet on my visit. Their future might be uncertain and their past a cruel reality.
But children at Snehadaan live their present with zest. It was also an opportunity to reflect on
the plight of those diseased who are unreached and no one to care for. I think that one the many
ways in which we can tackle this deadly disease is through proper sex education at different
levels of education.
Swanthana
Visit to Swanthand was painful. It is a home run by the Daughters of St. Camillus (Nuns) for
girls who are mentally challenged and have multiple disabilities. The inmates are girls who are
found abandoned in the city’s railway and bus yards, filthy drainage pipes, and garbage bins,
public market waste dumps, left to fend for themselves by their loved ones, brought by the
16
local police. The visit made me think of the plight of abandoned mentally and physically
challenged children. Why are they abandoned, who should be blamed for are certain questions
when through my mind. I returned from Swanthana admiring the work they do providing the
less privileged a holistic care.
APD (Association of People with Disability)
I was lucky to meet N S Hema, the founder of the organization a couple of days before we
actually visited APD. What a personality! She is an adorable change maker. Though being a
victim of polio at a very young age, yet she overcame her disability with sheer determination
and hard work to be a light for thousands of disabled. You don’t now find the vigour with
which she lived her youthful years but she is still convinced about her dream of APD. I can
still recall the conversation we had, it was so inspiring that she convinced me the joy in serving
the poor and the unreached especially the disabled.
Once you are in APD you will feel that disability is no more a big issue if every disabled had
an opportunity be in a place like this. They work towards to create an inclusive society, where
people with disabilities are accepted into the mainstream economy and social life. A culture
and eco system where they can earn, live and sustain with dignity and respect. It was a rare
opportunity to be with the empowered and enabled individuals and listen to their success stories
and get inspirations. The need for the early intervention in disability was one of my key learning
from the visit.
Alumni meet
It gives me immense joy and confidence as I look back on two days of SOCHARA family
gathering at St. Johns. It was not just a gathering but a celebration of community health in
SOCHARA family. The gathering was blessed with the presence of eminent pioneers from the
field of community health; Dr.Chandhra, Fr. Claude, Fr. John, etc. The meeting was all the
more enriched with the presence of personalities like Sri. KeshavDesiraju, Dr. K. Srinivasan,
and so on. There were also many others who joined us from various walks of life who are in to
community health or wish to be a part in the movement towards achieving “Health for all”.
As I reflect on the two days gathering, the first thing that comes to my mind is the faces of
“young people” like Dr.Chandhra, Fr.Claude whose presence itself mirrored their deep rooted
commitment to serve the people in need. The interactions with them made me realise how
much committed and optimistic one should be to follow once passions in life. It also helped to
17
realize how humble and simple one would become as his/her horizons of experiences and
knowledge broadens. The other personalities I met with and interacted also gave me a feeling
that I should learn a lot from the experience of people who have travelled the paths that are less
travelled. The sessions and discussions that happened during the meeting helped me to have a
better understanding on various topics like “integrating mental health with primary health
care”, “importance of mentoring”, “health equity in India”, and so on. The experience sharing
sessions by the mentors and the alumni fellows opened up my curiosity to explore the different
areas where a community health practitioner can engage or renter services. It was also an
opportunity to meet with likeminded people and share ideas and experiences.
Both Ravi and Thelma were at their best in establishing SOCHARA as we see it now. Their
works are being paid off as there are many fellow travellers who dedicate their lives towards
establishing the goal “health for all”. I should also admit the efforts and hard works of all the
staff and the current fellows that eventually transformed a gathering into a community
celebration.
Bhoomi Habba
Bhoomi Habba was a weekend spent in a serene setting of Visthar, an NGO committed to
empowering women, children and other marginalised sections of the society. The purpose of
the Habba was to celebrate ‘Just peace’. The objective of the festival was to increase peoples’
awareness on issues pertaining to justice and peace. The atmosphere was electric as people
from different walks of life and from different corners of the country came together to share
experiences, discuss, and make a difference. BhoomiHabba was listening to folk music,
enjoying local theatre, visiting a doll and poster exhibition, tasting traditional cuisines
including local North Karnataka specialities, watching documentaries like ‘Radiation Stories:
Koodankulam’ on the on-going struggle in Koodankulam, all this and more. The poster
exhibition gave glimpses of victims by the Bhopal Gas Tragedy and each picture conveyed a
story more powerful than the numbers and statistics that describe the world’s worst industrial
disaster. The exhibition of dolls made from scrap and cloth represented facets of domestic,
social and religious life of an ‘excluded’ India. It was a memorable day and rare opportunity
of fun and learning.
Anubhav series and Journal club
During the first collective a number of anubhav series presentations were held. Each of them
introduced unique successful organizations working at grass root levels. It was a time to learn
18
from the experience of pioneers. It also introduced various models of community based
development programmes along with various other activities. Journal club was a time to
critically analyse and reflect on different journal articles, books, write ups and more. This
process has helped to develop critical analysis skills and also to learn about various streams of
thoughts.
FRLHT
The visit to Foundation for Revitalisation of Local Health Traditions (FRLHT) was another
unique experience. The campus was so green, full of medicinal plants from around the country
and well maintained; I felt like I was in the lap of nature. The vision of FRLHT is to revitalise
Indian Medical Heritage and thereby enhance the quality of medical relief and healthcare in
rural and urban India and globally by creating institutions for knowledge generation,
dissemination and community outreach. It has a university named Trans Disciplinary
University (TDU) and Institute of Ayurveda and Integrated Medicine (I-AIM) as the healthcare
services arm of TDU. Though I had heard about AYUSH, it was through this visit I understood
about in detail. The works they do in the campus on documentation of local health traditions
and the research conducted are remarkable. The need and importance of Introducing local
health practices (home remedies) as the 4th tyre in the Indian Health System was a food for
thought.
Community celebrations
SOCHARA is not a place of learning alone, but a place of fun and celebrations too. We never
missed to celebrate any cultural, religious celebrations, birthdays and special events.
Celebrations started with HOLI, the celebration of love; first time in my entire life. I remember
Ravi’s statement, “we are here to celebrate community.” Each of these celebrations was a time
to reflect and learn something new. The most important learning of all these celebrations was
that every one of us knew what is “we-feeling” all about. There were also lessons of sharing,
caring, feeling, mutual understanding, and more. At the end of the fellowship I sum up all my
experiences as a calumniation of community celebration.
19
Reflections and Learning
CHLP was an awesome experience. It was a holy space to learn, reflect, practice, experience
and to celebrate a whole lot of things. Some of my reflections are as following;
•
Community health approaches are context relevant, optimistic and pragmatic practices
as we move “health for all.”
•
There are many hindrances and negative forces that block our path towards the goal.
Some of them has to be fought and defeated, alternative ways to be taken to get away
with other obstacles.
•
The need of the hour is empowered and enabled individuals and communities along
with just and equitable policies and governance, by the governments, active health
movements supported by civil societies to tackle the challenges existing and emerging.
•
“Scholar Activist” is the new role I have chosen at the end of the fellowship and I should
establish myself through my deeds and life, placing community at the centre of focus.
To fulfil this role I should go to the people live with them, love them, learn from them,
start with what they know, build on what they have. To do so I should further develop
my intrapersonal and interpersonal skills.
•
A shift from microscopic view to balloonist view and from floor mopper to tap turner
off is the paradigm shift happening in me.
•
I have learned that there is an element of Health in everything and without health
everything is nothing.
•
Understanding health in a holistic manner and working on the determinants of health
would yield better results.
•
I believe that change is a slow and gradual process hence, we should work patiently and
committed so that our dream will come true one day.
One year of CHLP journey has come to an end. There were many things happened; paradigm
shift in my own convictions and attitude towards health is the best that happened. I am sure
that this report is not enough to describe the things I have learned, unlearned, relearned and
experienced over a year. Though the fellowship has completed, yet the journey towards our
common goal continues. I can confidently say that I am prepared to journey through the paths
less travelled as a scholar activist. The real journey starts now and I hope that I will be able to
make small steps with in my capacity towards the goal!
20
References
•
Jan SwasthyaSabha. Health for All Now: The People’s Health Sourcebook. AIDIndia, Chennai; 2004
•
The SOCHARA Team. Social Justice in Health: Multiple Pathways towards Health
for All. SOCHARA-SOPHEA, Bangalore; 2014
•
People’s Health Movement. Health for All Now! Revive Alma Ata. PHM Secretariat,
Bangalore.
•
www.sochara.org
•
www.phmovement.org
•
www.communityhealth.in
21
Chapter – 2
Field Experience
My journey with THI
It was an experience of a lifetime to be at THI (Tribal Health Initiative). It was a time to
experience the ground realities and to be a part in the daily life of Sittilingi. I learnt a lot about
Maleivasi community life, their culture, traditions, festivals, economics and politics of the
villages, health issues among both men and women including children and elderly, reflected
on the existing government health systems of the land, listened to the voices of youth regarding
issues they face their lives and above all THI’s interventions and its outcomes. It was also a
time to apply and practice almost all the learning I had during the collectives in the field. I
learnt a lot from them too. After the initial dilemmas and struggles to adjust to the new place,
I picked up the rhythm.
THI other than providing health care has various other initiatives. Community health
approaches are used extensively in their works and Health Auxiliaries (HA) are the best
example of it. They view health as a state of mental, social and economic well-being and not
the mere absence of disease. Their health interventions go beyond merely providing curative
and preventive medical services. The farming and craft initiatives are directly connected to
maintaining health and well-being in the communities they serve. This is supported by the
Educational Initiative, Thulir and the Technology Initiative.
Tribal Health Initiative (THI)
Amid quacks and blindfolded ignorant endeavours of the common people, which hardly cured
any diseases or ailments, Dr.Regi George and Dr.Lalitha in 1993, seeing the need of a proper
health care centre in Sittilingi, formed the Tribal Health Initiative (THI). Sittilingi is a remote
village in Dharmapuri district, 90 km away from Salem town in Tamil Nadu, which used to be
a horrible place where tribal people used to do black magic and apply fake injections to cure
people. This is when the young doctor couple took the initiative. They went ahead to provide
medical services to the people of Sittilingi, leaving their promising careers in the cities. Dr.Regi
George is an anaesthesiologist and Dr.Lalitha is a gynaecologist. They are now fondly called
22
“Ji and Tha” by the people. They were inspired by Mahatma Gandhi and the vision of “Health
for All”. Along with them now THI has Dr. Ravi and his wife Prema, the Head nurse who
extend their selfless service to the people of Sittilingi. All of them are so humble and exemplary
in their own ways. The commit with which they work is admirable and they are great
visionaries too. I consider it as a golden opportunity to be part of their initiative for a couple of
months.
THI, as of 2016, has grown to be now a 24-bed hospital with a labor room, neonatal unit,
operation theatre, diagnostic laboratory and imaging facilities, a community health outreach
program, an organic farming initiative, school health programme and a craft initiative which
aims to revive traditional Lambadi embroidery.
THI’s approach to medical care went one step ahead in educating the people and ‘helping the
tribals help themselves’. They wanted to create a general understanding about health and health
issues and make the natives acquainted with basic first aid. Today, over 36 neighbouring
villages are benefiting from the Tribal Health Initiative that sprung at Sittilingi. And, the NGO
doesn’t pertain only to the domain of medical facilities. They organize educational program,
cultural activities and community development initiatives.
VISION
The vision is that “the people of Sittilingi valley and Kalrayan Hills lead a better quality of
life”.
They hope to attain the highest possible level of physical, mental and social health. To enhance
their socio-economic status while retaining their pride, self-respect and self-reliance and
ensuring their active participation in programmes meant for their welfare and to create an
atmosphere highly conducive for the growth and development of local cultures and customs.
MISSION
The mission for the people of Sittilingi and the Kalrayan Hills is
•
To be an educator to protect and promote health and improve basic knowledge levels.
•
To provide affordable and acceptable basic health care services to the area.
•
To be a facilitator to help people undertake collective action for their welfare
23
•
To provide a support system to help people come back to sustainable methods of
farming
•
To facilitate peoples knowledge about their rights and responsibilities and help them
exercise
•
To help them acquire additional skills and assist them in achieving self-reliance through
small scale entrepreneurship
•
To provide support for the social upliftment while retaining and building on their local
cultural strengths
VALUES
The basic values for their work is Faith in the people and their wisdom Sincerity, honesty and
total commitment in work, Secular and non-political to respect the dignity of every individual.
Community Health Programme
One of THI’s signature programmes is the health outreach programme. It provides simple
curative, preventive, educative and rehabilitative services to around 33 villages in the Sittilingi
valley and the Kalrayan Hills. This programme caters to a tribal population of over 16000
tribals.
Health Workers
They are the back bone of the tribal hospital. During the early periods of the organization, they
started training local girls as health workers who are now able to diagnose and treat common
problems, assist in surgeries, conduct deliveries, and go into villages to provide ante-natal and
child care. The dedication with which they work amazed me. It was interesting to know that
they knew almost everyone in the valley and also are aware of all that is happening around
them.
The alsoconduct monthly mobile clinics for all pregnant women and under 5 children. This has
been the most essential factor in significantly bringing down infant and maternal mortality and
morbidity in the area. They are part of each and every activities happening in THI.
Health Auxiliaries
They are the true heroes of the land and an integral part of THI’s health activities. The health
auxiliaries are older women chosen by the community from each village. Some illiterate, some
barely educated, these women are trained for a year in basic medical care, hygiene and first aid
24
among others. She offers advice on good nutrition, hygiene, birthing practices and simple
ailments, maintain records on important health events in the village and act as facilitators for
all community development work. She also has basic tablets for dispensing at the village level.
Every month, Health Auxiliaries gather at the THI campus for a day, to meet with each
other. At these meetings, they discuss the health of their villages, reporting births and deaths
of village members, and other relevant information. These meetings also allow for their
continuing education opportunities.
Senior citizen clinics
With the intention of reaching the unreached and witnessing the plight of old aged people THI
initiated this programme. They are able to reach over 500 senior citizen of the valley. All they
have to do is to pay a nominal annual fee of 100 rupees and can avail any facilities of the
hospital for the whole year. Aged people otherwise left uncared and unnoticed can now relay
on the hospital team when they visit the village one a month.
It was one of my memorable experiences in Sittilingi as I had the opportunity to visit the aged
along with the hospital team almost every week to different villages. It was also an opportunity
for the elderly of the respective villages to come together, meet each other and talk each other.
School health programme
This is a recent initiative by the organisation. I never missed a chance to accompany the team
to visit the schools. The school, where they have introduced the school health programme were
90 kilometre away from the base hospital. It was also an opportunity to explore and to know
the interior tribal villages of Kallrayan hill ranges. There were no buses to reach the villages.
Villagers had to come down 20 kilometres to board in the bus. This alone is enough to
understand the life in those villages. Through this programme they have tried to introduce basic
health education, sowing the seeds of personal hygiene and sanitation into children’s minds.
These children being first generation learner meant a lot to their loving parents. In a sense, they
have now become ambassadors in what could become a major change in these remote tribal
villages.
The following are the testimonies form the children I interacted with during the field visits:-
25
•
A girl studying in class nine after learning about Tuberculosis from the programme
managed to convince her father, who was suffering from chronic cough to go and get it
checked at the hospital.
•
Two students have convinced their parents to build toilets in their houses, after learning
about health problems from open defecation.
The farming initiative
People from the local Malavasi communities have lived by rain fed subsistence farming and
the produce of their forests for a very long time. Traditionally they grew about fifteen different
varieties of crops suited to the environment and had ample food the whole year around. This
tradition has been displaced by the pressures of a modern consumer economy to grow cash
crops. These crops are water intensive and people are forced to use chemical fertilisers and
pesticides in an attempt to maximise returns. Eventually the tribal farmer finds himself in a
situation where he is easily exploited.
Nutrition and livelihood are two factors that contribute significantly to an individual’s health.
Thus, when the people of the surrounding villages started bringing their farming troubles to
THI’s attention, an opportunity for growth became apparent and THI expanded its programs to
include a farming initiative. Ji and Tha knew that “unless we start dealing with the determinants
of health, we would not be able to bring the tribal community to achieve a better health status.”
Working with the credibility they had already gained in the community, THI began teaching
the farmers various organic techniques, aimed at saving the cost of chemical pesticides,
increasing the farmers’ yields, and improving the health of the consumers. Since its inception
in 2005, the Tribal Farming Initiative has grown to include the following components/
programs:
•
Formation of SOFA (Sittilingi Organic Farmers Association), an association of farmers
currently practicing organic methods, and is in the process of receiving organic
certification from the government. Currently there about 200 farmers who are registered
of which half have got ‘organic certification’ from the Govt. of Tamil Nadu. Now they
are a registered company.
•
Creation of the SVAD (Sittilingi Valley Agricultural Development) brand, under which
25 organic products are sold in various cities in south India
26
•
Formation of Women’s Self-Help Groups (SHGs), which perform value-addition
processing, increasing the profit margin for specific products
•
Creation of Seed Banks, ensuring the survival of various minor millets and other
traditional seeds, which were at risk of extinction due to the increased demand for rice
and decreased demand for other similar sources
Craft Initiative
The Craft Initiative enables local Lambadi women to become economically self-reliant while
preserving their traditional embroidery. Their products are sold under the brand name Porgai,
which means ‘pride’ in their dialect. The local Lambadi tribals migrated from the north of India
several hundred years ago. They have their own distinctive dialect, costume and traditions.
Their tradition of embroidery was very nearly lost. Only a few of the older women remembered
how to make the distinctive designs. This tradition has now been revived by the Tribal Craft
Initiative, with the older women teaching the younger women. They collectively work under
the organisation and about 60 artisans work now under the umbrella ‘Porgai Artisans
Association’.
This initiative is based on the principles of
•
Preserving the magic of their age old Lambadi embroidery
•
Respect for the artisan and fair wages for their time and skill
•
Empowering rural women by adding to their income
•
Reviving a dying traditional craft
•
Encouraging future generations to take pride in their culture
A visit to Neyyamalai
It was a soothing experience to visit the new project area named Neyyamalai. We had a great
off road jeep ride to the top of the hills. They had no roads till 6 months back except for the
rocky, uneven path paved into the mountainside, which motorbikes could traverse with
difficulty. Electricity too arrived just 6 months back, before which the Government had put up
solar panels in each house, which provided one night light per hut. For many years the tribals
from this remote hill range brought down their sick in hammocks made of bamboo and old
sheets and then either caught the infrequent buses or pay through their nose and hire a jeep to
27
come to Tribal Hospital. THI wanted to reach out to them, as no health personnel were ready
to go there.
Once you are on the top of the hills, it is lovely. We spoke to a group of people who had
gathered near the local temple and asked them about the conditions there, their health, food and
agriculture. Water is often scarce and by common agreement all hand pumps are chained and
locked except for a few hours in the morning. Neyymalai's stepped hill sides. Cooking hut is
part of every house. There is no access to medical facilities and it is either the medical shops
in Thumbal for minor illness or Tribal Hospital for major illness. By default, most agriculture
is organic, but there is huge exploitation by the middle men as the tribals are not able to bring
the produce down to the plains, whereas the middle men employ tractors or jeeps. The food is
still mainly traditional as they still grow and eat a lot of millets, so they are all relatively healthy.
They keep cattle, poultry, and goats and go for the occasional undercover hunt to supplement
their nutrition.
Neyyamali is a new frontier for THI, where they try to extend their services to the people who
are unreached, and underprivileged. It is a perfect example of traversing the paths less travelled
and it has proven true of THI.
Understanding community
PHYSICAL ASPECTS:
Situated between the Kalrayan hills and Sitteri hills, Sittlingi is a scenic village in the valley.
Sittlingi is surrounded by hills all around and is close to Dharmapuri, Salem and Villupuram
district. Sittlingipanchayat comprises of 21 villages and are bordered by streams all around.
Has close to 50,000 population and most of them have at least 2-3 acres of land. Most people
live in their fields than as a community in the village. Each village has its own temple and deity
they worship. The entire village usually meet up in the temple for the thiruvizha (temple
festival). For the 21 villages there are 2 PHC about 14 kilometers apart. There are about 5
primary schools and two secondary schools. No colleges or vocational study centre are
available.
HEALTH STATUS:
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Before THI came to this area, lack of medical facilities was one of the major problems. There
were no functional PHCs [Primary Health Centre] in the area. The IMR (infant mortality rate)
was 146/1000. Most sick people in the villages had to walk 3-5 km. to the road to catch the
bus. Any emergency needing surgery or specialist treatment is 100 km away in Salem. After
THI started its activities, now there is a vast improvement in Health facilities.
OCCUPATION:
The predominant occupation is agriculture. Agriculture is mainly rain-fed. They grow
traditional millets like bajra, corn, ragi& pulses without irrigation. Pesticides and fertilizers are
used only for newer crops like hybrid rice and cash crops and not for the traditional crops. A
few families (mostly non-tribal) have started growing cash crops like sugarcane and industrial
tapioca now. Sheep and cattle rearing is the second major occupation. Many men have migrated
to Kerala and Tirupur (garment industries) in search of work. Many people work as casual
labourers - Daily wages for men are Rs.300 and for women Rs.200. Almost all families own
land and a house to live. Family size mostly ranges from 5 to 8.
FOOD:
Bhajra or ragi porridge or rice with rasam and sambar is the normal meal. With the introduction
of free rice through PDS families now mostly go for rice and rice related foods. Vegetables are
not included much in their food. Vegetables are available but they don’t make use of them as
they sell it of in the market. Generally vegetables are grown in their own land during the rainy
season; otherwise Vegetables are bought on weekly market days and the vegetables available
in the weekly market are tomato, potato, brinjal, cabbage & beetroot. They keep cattle, poultry,
and goats and go for the occasional undercover hunt to supplement their nutrition. Through the
organic farming initiative THI is trying to bring back the earlier food practices among the new
generation.
HOUSING:
Most people have their own houses. There are different types of houses mainly three types of
them. They are kooraveedu (kacha), medhaveedu(semi kacha) and periyaveedu (packka) the
Koora houses have low mud walls with hipped roofs thatched with hay or sugarcane leaves.
Houses have lofts for storage. They have a "panthal" or a covered space in front of the house
which is basically a framework of bamboo or country wood poles covered with bamboo and
shoots & leaves of a plant called "Velarithalai" (the peculiarity of this plant is that the leaves
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do not drop away from the shoot after drying for a considerable length of time). This space is
the most important space in the house- besides keeping the house cool it also functions as the
living room. Cooking is mostly indoors and is done on the traditional wood stoves. The smoke
is considered beneficial to drive away insects and to keep the house warm in winter. In the
recent years, many of the houses are getting renovated and furnished into concrete houses.
SANITATION:
The tribal hamlets are generally kept clean and are in fact cleaner than other rural villages of
Tamilnadu. Water supply is mostly from govt. built bore wells (hand pumps) or from open
wells. Open-air defecation is a popular practice. The govt. has recently provided a water closet
for each house. These have been fitted near the houses, with no walls around, no proper septic
tank and no water supply. None of them are being used. A few of the newly built houses have
well maintained toilets. The younger generation especially school and college going girls are
in the opinion that they should have toilets while the elder generation is not so much convinced
about having toilets attached to home.
EDUCATION STATUS:
Most of the elder generation - men and women are illiterate. Till the last decade, the school
dropout rate was high among children, but now education seems to be a priority for most
parents. Most children now go to the government schools in spite of the difficulties in reaching
the school and poor quality of the facility. Most government schools have one or two rooms
staffed with one or two teachers. Teachers mostly live in Harur (40 km. away) and their work
schedule is guided by bus timings- they come around 10.30/11 am. And leave by 3 pm. Quality
of education imparted is generally is comparatively poor. In the recent years youngsters go to
colleges. 2-3 college buses form Selam come and goe every day carrying the students. A
bachelor degree in arts or science is the highest level of education they get but it doesn’t
necessarily help them to get a job.
SOCIAL PROBLEMS:
Till a decade ago, dowry was not known there. The bridegroom had to pay a bride price to the
bride. Now with the migration of non-tribal into the area and the migration among the tribal
youth and adults, the dowry system has started. Girls are married off immediately after
attaining puberty. Female infanticide and alcoholism are the other problems prevalent there.
Borrowing money from moneylenders at high interest rates is common. Youth out of school
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and unemployed or working as migratory labour also are matter of concern. All of it is fuelled
by incidents like failure of rain and increased need for money to meet the demands of modern
life.
OTHER INTERVENTIONS IN THE VILLAGE:
The Govt initiated women’s self-help groups have been formed in all the villages. Every village
has one or two such groups with around 20 members in each group. The Forest Department too
has started some Women’s saving groups in some villages. The main activities of these groups
are related to savings and loans. Other Village issues are not usually dealt with or discussed in
these groups. The Christian missionaries have been working here for many decades now and
there are many converts to Christianity.
THI’s presence over 20 years has made significant shifts in the lives of people and the
community as a whole. They have an affordable, available, accessible, and accepted medical
care at their disposal. The organic farmers association along with the Porgai association has
led to the creation of SHGs. Almost all the employees of the organization is form the
communities and most of the development works are also done by them.
FACILITIES AVAILABLE:
Most villages are electrified. There is telephone connectivity and mobile networks but they are
unreliable. The change was visible with almost every one having a mobile. The younger
generation has tried to get a latest touch phone with android version at their disposal. Some of
them spent their savings of a full year to buy the latest phone available in the market. Post
office, Panchayat office, Tea shops, ration shop and a small grocery shop with minimal
provisions, an anganvadi, a primary, middle and high school, and crèche are available in
Sittilingi. Most tribal hamlets do not have all of these facilities and people walk to Sittilingi.
For Photocopying, workshops, bigger grocery shops, Bank, Electricity office, Cinema theatre
and Police Station- one has to travel to Kottapatti 12 km. away. Vegetable and Fruit Markets,
Bakery, Dental clinics, Government offices, fuel gas refills, etc. one has to travel out of their
villages. For all bigger hospitals, stationery items, clothes shops, construction materials and
everything else, one has to go to Salem (90km)
INFRASTRUCTURE:
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Most villages are well connected by roads, built by the pradhanmantri gram sadakyojana. The
roads are well maintained. Public transport is still a problem as hardly 4-6 buses are available
the whole day. There are government schools, PDS stores, anganvdies and other government
buildings along with few private shops exist. The tribal hospital and Thulir School add beauty
to the valley.
PATTERNS OF SETTLEMENT:
Most people live in their fields than as a community in the village. They prefer doing so as it
is easier to work in their fields. There is a clear distinction between the tribal villages and nontribal villages. There are two villages that are populated exclusively by the SC community
(Lambadi group). And there is a village comprising entirely of BC population.
DEMOGRAPHICS:
Sittilingi is located in Harur Dharmapuri Tamil Nadu. It is a valley surrounded by the Kalrayan
hills and Sitteri hills. People from all age groups are seen here, most of them are scheduled
tribals, expector two Lambadi villages and one OBC village. The language spoken is Tamil
and Lambady community has their own language. The Sex ratio is almost equal. Education has
picked up momentum now, especially college education.
COMMUNITY LEADERS;
The formal leader is the Panchayat leader Smt.Thenmozhi elected by general election. In the
case of informal leaders, each village has an ooruthalaivar, a kangani and gounder. Ji and Tha
are also considered leaders now by many.
COMMUNITY VISITS
Government has provided the village with good infrastructure. To understand more about them
I visited 2 PHCS, a few schools and anganwadis.
Kottapati PHC- A well maintained building with all facilities was seen. It caters to population
of 20,000 people in a 15 km radius. Two allopathic doctors and a siddha doctor have been
appointed there. Other staff also included a nurse, a health inspector, pharmacist, lab technician
and cleaning staff. They are also doing some national programs on Yaws eradication and on
Non communicable diseases. They also have a fully equipped ambulance with two EMT. They
have an OPD of almost 100-150 patients per day.
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Belanoor PHC- This is in a rented building with not much facility. Only one doctor, a nurse
and a cleaner have been appointed till now. It caters to a population of 15,000 populations for
a radius of 8 kms. They have an OPD of about 40-50 patients per day.
Primary school Belanoor- They had a good building with clean toilets. It caters to about 70
school kids for classes between 1-5. Two teachers have been appointed. They have very well
maintained records about the students. Mid-day meal is prepared in the campus and provided
to the students every day.
Middle school Sittilingi- Good school building with separate classrooms for all classrooms and
science lab and computer lab. About 5 teachers have been appointed for 150 students for classes
6-8. Here also mid-day meal is prepared and served every day.
AnganwadiBelanoor- A small room and a kitchen have been constructed for the purpose of
anganwadi. Around 12-15 kids under 5 years of age are enrolled. They also are provided with
lunch under the Mid-day meal scheme. Regular ANC check-ups also take place and the women
are provided with Sattumaavu. One anganwadi worker and cleaning cum cooking staff were
present.
Medical pluralism- I also got to visit traditional healers, snake bite healer and a traditional bone
setter. People in the village still utilise the traditional practices of healing although it looks like
dying. Dais is also present and at home birth is still practised by some.
MEETINGS
I got to meet a lot of groups and people who visited THI. It was very interesting, informative
and inspirational to meet them.
MRSK- A team from Odisha Bissamcuttack visited THI to especially help out with the new
educational institute Thulir to be started in Sittlingi. There was a good exchange of ideas about
education and community development. It was inspirational to see young boys and girls from
tribal villages in Odisha who were trying to make changes in their villages.
GUDALUR- A group of people especially farmers came to THI to spread awareness about
Forest Act and rights of the people living in the forest. It was a new information and extremely
useful to the farmers in Sittlingi. The farmers in Sittlingi also talked about organic farming and
gave them tips about starting it.
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MADURAI COMMUNITY DEVELOPMENT COLLEGE- 15 students from the college
visited THI to understand the working and the impact made by the organisation on the village.
The students were from different places in India and from different educational background.
They were also given a motivating talk by Dr.Regi George and Dr.Lalitha.
FOREIGN MEDICAL INTERNS – there were as many as 15 medical students from Germany
and UK, one each from South Africa and Australia. It was also a time to interact with them and
to know about their culture, practices, health care system, life style, interest in exploring the
rural India and so on.
A note!
He was a healthy, hardworking and only earning member of the family till two days back. But
now he is just crawled up in a hospital bed with burns all over his shoulders and neck and arms.
The mistake he did was he was lying down below a shelf with a lightened kerosene lamp. It
fell on him when he was fast asleep probably dreaming about a sophisticated fantasy world and
just caught fire. Of course the fire doesn't know it is a real person. So was he unlucky to lie
down at the wrong place? Was he unlucky to be asleep which made him not aware of his painful
agony he is facing now?
I believe he was just unlucky to be in one of the villages in INDIA which doesn't have electricity
in 2015 when we are talking about net neutrality, he was unlucky to still rely on kerosene lamps
when we are trying to settle down in the next planet and he was unlucky enough to reach his
emergency care after half a day when we are learning to use robotic surgeries. (Written along
with Dr.Sangeetha on Face Book)
The youth meeting
Inception of the idea
During my second field visit to THI, I went there with a blank mind. After the initial dilemma
I was quite convinced that I should do something solid. I had a series of discussions with both
my mentors, Dr.Ravi and Kumar; we decided to focus on the youth in the valley. We knew that
they are going through a tough time and something had to be done! THI had a great interest in
the development of youth program and they were waiting for a right opportunity. So it was
time that they knew that I could easily get along with the youth, I was given the responsibility
34
to gather the youth together for a day. The days that followed were tough as I had to go around
the villages interacting with the youth and informing them about the event. It was a great
experience and learnt a lot about the village and the plight of the youth in the valley. Everyone
had something to tell and each of them was excited as they felt that THI has a special interest
in them.
The meeting
Well, the Youth meeting happened on a fine Sunday (9/8/2015) and 55 youths from the nearby
villages participated. The meeting was a much awaited one and also the first of its kind in the
entire valley. We had a guest Mr.Guru from CMC Vellore who guided the gathering along with
the hospital team. Krishna and Anu of Thulir shared their experiences in working with the
children and the youth in the valley. They were at their best as they dealt with many of them
and are concerned for them. They went on to ignite the young minds talking extensively on
different aspects of “job/work”. They tried to bring out the misconceptions and myths regarding
village life and how the adivasi communities conceived jobs. We did it through interactive
sessions so that the participants could express their thoughts and concerns. As the meeting
progressed the youth were split into different groups and were asked to discuss among
themselves and to note down the strengths and weakness they thought they had as individuals
and as a group. Later on as they presented it by turn, they were guided to transform the strength
they possessed into action and the weakness to strengths.
The meeting was basically to bring together the youth in the valley to identify various problems
they face in their day to day life and to introduce the idea of developing youth groups for their
own good. It was amazing to see the young people participating in the activities and sessions
with much eagerness and enthusiasm. We split them in two four different groups and guided
them to note down the strengths and weakness they think that they have, from a personal
perspective and as a communities point of view. Each team came up with various points and
we had an open discussion thereafter. The meeting ended with a fellowship meal (Sittilingi’s
special organic millet meals) prepared and served by the women group which is so delicious
and healthy.
All went good; Ji and Tha have conveyed that they always had a special concern for the youths
of Sittilingi and will be always at their disposal. They also promised that THI will spend and
35
share it’s time and energy to uplift the younger generation of the valley. As I sit back and write
it, I cannot believe that I had become an instrument in bring the youth together for initiating a
youth development programme.
THULIR
A centre for learning in Sittilingi village
I met another couple in Sittilingi, forgoing the luxuries of the city to be with and serve the
people in need. When, Anuradha and Krishna moved to Sittilingi in 2003, their idea was to
create a space for learning that would be tailored to the local needs. With the help of Tribal
Health Initiative they did a survey of the villages, and visited local schools to understand what
was needed. To their surprise they found that almost all children below 14 were enrolled in
schools! The parents were quite keen on schooling and so children were religiously sent to
schools even when there were no teachers to speak of or any learning happening. They also
found that most children dropped out of formal schooling at class 8 to 10 levels, often after
failing exams. These teenagers consequently had very low self-esteem, lacked basic academic
skills, were frustrated and mostly migrated to nearby towns to work in the textile industry.
Schooling had, however, convinced them that farming or any kind of work with the hands is
inferior and something to be ashamed of. In this context they decided:
1. try to improve academic skills of school going children
2. Try to see what can be done for teenagers who had stopped schooling.
Thus Thulir started off as a post- school Learning Centre. They tried to design activities that
reflect Meaningful Education, they believe, must comprise of a balanced mix of skills that
involve
•
The “hands”: the ability to shape materials and make useful objects.
•
The “head”: reading, writing, reasoning and critical thinking.
•
The “heart”: aesthetic sensibility, and a sensitivity to the environment that should
Their efforts have earned results in the lives of many young people in the valley.
Comments
When Thulir started, Anu and Krishna were hesitant to start a school. They chose to start a
resource center that could have various activities and reach out to more number of children,
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school going, out of school etc. and also involve the youth in various ways – helping with the
activities of the center, training sessions for the youth on various livelihood skills etc.
In my view, Thulir has been able to create such a space where children and youths can come
and participate in different activities. Not any space, but a vibrant learning space for the
children who come in the evenings, after school. The beauty of this environment is that there
is no force or pressure on the children who come here. The adults offer whatever they have and
can and children are free to make what they want of it. And it is okay to be doing nothing as
well. Not everyone has to participate in the song, balloon making, painting, or origami sessions.
Everyday unfolds in a different way and there is no “schedule.” Consequently, children who
do come on any given day are engrossed in whatever it is that they are doing individually or in
a group.
The post school programme that Thulir ran for many years is a unique opportunity to explore
the role of work in education. The idea of hands on work as part of the learning process at
Thulir brings in useful vocational skills. Young adivasi people have been benefited by being
able to acquire skills that come in handy to make a living in the village or elsewhere. Over the
years, they have tailored learning to suit individuals and specific groups, experimented with
different mix of skills. So some years the emphasis was on construction skills [masonry,
plumbing, electrical wiring etc.], while on other years it was on electronics, and bamboo crafts;
and on still other year teaching preschool children, crafts, soap making etc. the hands on work
based programme have given confidence to the students to tackle academic exams which they
could not earlier. Many decided to continue higher studies enrolling in class 11 in schools
outside of the valley, some even at the age of 19 and 20! Some have gone on to Colleges for
degree courses. Thanks to Thulir that Sittilingi now also have some of the best masons,
electricians, plumbers, and farmers who were trained by Thulir.
ACCORD
I was lucky to visit ACCORD (Action for Community Organisation, Rehabilitation and
Development) in Gudalur. I spent almost a week and tried to explore the activities of the
organisation. The people I met were accommodative and willing to share their experiences. In
accord one can find adivasis both men and women who are empowered and enabled. It all
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started way back in November 1985, when Stan and Mari started ACCORD as an activist group
in response to the rampant land alienation of the adivasis in the Gudalur Valley and to help the
adivasis organise themselves in order to assert our human rights - especial land rights and out
of the realisation that the adivasis of the valley were being cheated and exploited.
The vision: - To help the adivasi community of the Gudalur Valley in the Nilgiris district of
Tamil Nadu to take control of their own lives.
They knew for sure that adivasis had to retrieve the ancestral lands taken away from them by
force and deceit and believed firmly that adivasis had a genius of their own and that if people
could regain their dignity, pride and self-esteem, they could once more take charge of their own
lives. Thus they stated working for human rights, health, education, housing and culture. And
their mission is to redesign the systems necessary for that, to help the adivasi community cope
with the onslaught of modernity on their way of life and to prepare them to emerge from their
forest retreats with their heads held high, Proud of their culture and their people. Now, Accord
is basically a resource centre and a catalyst for various activities happening in and around the
campus and they are AdivasiMunnetraSangam (AMS), Ashwini hospital, Vidyodaya School,
Maduvana estate and so on.
Comments
I find the organisation very interesting and unique. The starting of all these was through an
adivasi movement, a collective effort and participation of people who no longer want to be
slave of anybody and it has grown to such heights. It was also a get together of five different
adivasi groups named Mullukurumbas, Bettakurumbas, Paniyas and kattunayakas for a
common cause. The fight they began still continues in different ways.
They grew and developed with ACCORD and the areas of growth and development are: Health
aspects of the adivasis are taken care by the base hospital where all the nurses are adivasi
women and the health animators at community level are chosen from the adivasi community
by the village sangams. They are well trained to cater the health needs of their people.
Education; Taking the children to the schools and teaching them in their own languages were
the tasks of the adivasi education volunteers. They set up a school named Vidyodaya were the
adivasi children were given a holy space to learn and it has initiated drastic changes in the lives
of many. Economics; to meet the economic needs the poor adivasis they came together and
decided to have a tea plantation where they own the land and share the profits of their hard
38
works and this has initiated other developmental activities too. Most importantly the ownership
of each activity is in the hands of the adivasis.
I could easily connect to the learning from the collective with the things happening in Gudalur.
It was like the perfect example of a community health approach and they actually practice it.
Everything from the Axioms of community health to addressing the determinants of health to
maintaining sustainability in the commitment undertaken was evident. These efforts are paying
off now as the communities started regaining their identity and initiating a holistic development
in their lives.
Personal Experiences and Reflections
Almost 5 months of stay at THI and a week stay at ACCORD was more than my imaginations
and expectations. The interactions with the local communities’, outsiders, the persons who have
become an instrument of change, my personal experiences and explorations have helped me to
get a relatively clear picture of what is happening around me. I have tried to put some of them
here…
Both the organisations are trying to do the best towards the dream health for all and others can
learn lot from their experiences.
Considering THI; in the past 10 years, the Valley has been undergoing rapid changes. Whereas
earlier farming activity was mainly for family’s food consumption and therefore was mostly
rain-fed food crops comprising of a lot of millets, of late there is a lot of cash crop cultivation
like sugar cane, turmeric, tapioca, paddy etc.
There are other changes to, increasing mechanisation in the farms, more shops servicing local
needs, improved running of schools, so more children pursuing high school, proliferation of
cable TV, cell phones, increasing consumerism etc.
There are opportunities now locally for increasing income levels as a result of migration, cash
crops, new service sector, organic farming, etc. But there is also increasing pressures to
continue academic learning to join high school outside the Valley and to continue “college”
education; with the hope of getting jobs.
39
Since Health care and Education opportunities has increased with the availability of
Ambulances, easy connection to the city etc., and life style changes happening there is now
increased need for cash.
While Basic health and hygiene has improved (though open defecation prevalent still), there
have been changes in diet from millets to polished rice and less physical effort in Farming due
to mechanisation. Consequently there is an increase in life style diseases such as hyper tension
and diabetes.
Alcohol abuse is on the increase and so is domestic violence. There are an alarming number of
suicide attempts, especially among the youth.
As in any other communities, migration has become a part of their lives; it is fuelled by various
events such as continuous monsoon failure, low price for the agriculture products, life style
changes accelerated by the modern technologies, increased need for cash and so on.
References:
•
www.adivasi.net
•
www.tribalhealth.org
•
www.thulir.org
Chapter - 3
RESEARCH REPORT
40
A study on the psychosocial impacts of seasonal migration on Maleivasi
youths in Sittilingi.
Introduction
Migrations have occurred throughout human history. Migration occurs at a variety of scales.
People move for a variety of reasons. Human migration is the movement by people from one
place to another with the intention of settling temporarily or permanently in the new location.
The movement is typically over long distances and from one country to another, but
internal migration is also possible.
Seasonal migration
Seasonal migration is very common in agricultural cycles. They are likely to move from place
to place in search of employment, or to continue returning to the same place year after year.
Such circular flows encompass migrants who may stay at their destination for six months or
more at a time. Scholars have long characterized this migration as a type in which the
permanent residence of a person remains the same, but the location of his or her economic
activity changes (www.migrationpolicy.org).
Migration in India
According to the 2011 Census of India, more than two-thirds (69 percent) of India’s 1.21 billion
people live in rural areas and this population account the most to migration. The Census does
differentiate internal migration within districts, between districts in the same state, and across
states. In 2001, inter-district migrants accounted for 76.8 million migrants, and there were 42.3
million interstate migrants. Therefore, about 191 million people—or 19 percent of the total
Indian population—were migrants from other districts or other states. The NSS counted 15
million short-term migrants, but other estimates have placed the number at about 100 million
(www.indianstatistics.org).
About two out of ten Indians are internal migrants who have moved across district or state
lines—a rate notable for the sheer numbers who move within a country with a population that
tops 1.2 billion. A significant share of internal movements is driven by long-distance and maledominated labor migration. These flows can be permanent, semi-permanent, or seasonal.
Internal migrants have widely varying degrees of education, income levels, and skills, and
41
varying profiles in terms of caste, religion, family composition, age, and other characteristics.
Micro-surveys suggest that most migrants are between ages 16 and 40, particularly among
semi-permanent and temporary migrants, whose duration of stay may vary between 60 days
and one year (national-sample-survey).
Tribal migration
Scheduled Tribes (STs) are indigenous, have their own distinctive culture, geographically
isolated and are low in socio-economic conditions. For centuries, the tribal groups have
remained outside the realm of the general development process due to their habitation in forests
and hilly tracts.
Scheduled tribes and castes—the tribal and caste groups that are explicitly protected in India’s
constitution because of their historic social and economic inequality—are over-represented in
short-term migration flows (www.migrationpolicy.org). And most labor migrants are
employed in a few key subsectors, including construction, domestic work, textile and brick
manufacturing, transportation, mining and quarrying, and agriculture.
Migration and youth
For young people, the decision to migrate is often related to important life transitions, such as
obtaining higher education, starting work or getting married. Migration can have a positive
impact on young people by opening up new opportunities. However, for some young people,
the migration process confronts them with particular challenges and confers to them certain
vulnerabilities. These vulnerabilities include discrimination based on gender, migration status,
ethnicity or religion; poor working; lack of access to basic social services such as health; risks
associated with sexual and reproductive health; and lack of social protection (www.un.org).
Many migrants—especially those who relocate to a place where the local language and culture
is different from that of their region of origin—also face harassment and political exclusion
Therefore, the migration experience can end up representing either an opportunity or a risk for
young people and can either lead to their development or the very opposite, depending on
policies and measures supporting them.
Migration in the context of Sittilingi
Sittilingi is a medium size village located in Harur of Dharmapuri district, Tamil Nadu with
total 367 families residing. The Sittilingi village has population of 1474 of which 752 are males
42
while 722 are females as per Population Census 2011. Most of the people natives to Sittilingi
belong to the theMalayali tribes, the name derived since the valley is surrounded on all sides
by hills, ie, “malai” in Tamil.In Sittilingi the predominant occupation is agriculture. Agriculture
is mainly rain-fed. They grow traditional millets like bajra, corn, ragi (millets) & pulses without
irrigation. A few families (mostly non-tribal) have started growing cash crops like sugarcane
and industrial tapioca now. Sheep and cattle rearing is the second major occupation. Many men
have migrated to Kerala and Tirupur (garment industries) in search of work. Many people work
as casual labourers - Daily wages for men are Rs.300 and for women Rs.150. Almost all
families own land and a house to live (from the meetings I had with the labors during the earlier
field visits).
According to THI, in the recent past the youths in the valley have gone through different
challenging situations and one of them is migration. Though the educational and the economic
status have improved considering the past, yet the youths fail to meet the expectations and the
demands of modern society. In this they either stay back home doing nothing or are forced to
go out of the village to earn and meet the needs. The testimonies given by the youths in the
youth meetings tell about the seriousness of difficulties they face in their daily lives and the
inability to tackle them effectively. The hospital records give us an alarming increase in the
number of suicidal cases which adds fuel to the present scenario. This is the context in which i
wished to do the study.
Title of the study
A study on the psychosocial impacts of seasonal migration on the Maleivasi youths in Sittilingi,
Dharmapuri, Tamilnadu.
Aim of the study
To identify the psychosocial issued face by the Maleivasi youths in Sittilingi who are seasonal
migrants.
Objectives
1. To identify psychological impacts experienced by the young seasonal migrants at the
place of migration.
2. To identify the social impacts experienced by the young seasonal migrants at the place
of migration.
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3. To identify various coping mechanisms evolved due to seasonal migration among the
migrants.
Research Methodology
The study was a qualitative study as the study looks into the psychological and behavioural
aspects of the youth in Sittilingi resulting from seasonal migration.
Data collection technique and tool
The data was collected from primary sources and the respondents were selected through
purposive sampling. The study was conducted using in-depth interview as a data collection
technique and interview guide as a tool.
Study area and population
The area of the study was three villages named Sittilingi, Moolasittilingi and Nambangadu.
The sample size was 10 in number and was selected based on the purposive sample. Any
Maleivasi youth who are aged between 20 to 30 both married and unmarried who were willing
to be a respondent was included in the study.
Data analysis
The data collected through in-depth interviews was analysed manually using the principles of
thematic analysis.
Limitations
Time limit for conducting the study is considered as a major limitation of the study. The study
was conducted within one month. In order to extract the information regarding psychosocial
impacts requires spending much more time in field. Another major constrain was a lack of
proper communication facilities and a lack of fluency in Tamil. It was Diwali and the people
were in a festive mood. The finds would have been better and more detailed if I could interview
the family members and key informants to understand the impacts better and also conduct
FGDs to understand communities perception regarding the topic. The study is small and
pertaining to Sittilingi alone so the finding of the study cannot be generalised.
Scope of the Study
A further study can be conducted to understand the problem better and there by THI can think
of necessary steps to be taken, as they wish to intervene with the youth of the valley.
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Findings
Number Age Education
Occupation
Marital Status
Land
Income per
Years of Place of migration
Holding
month Migration
1
26 5th
wood cutter
Married
3 acres
15000
3 Eranakulam, Kerala
2
22 12th
wood cutter
unmarried
1 Acre
15000
2 Malapuram, Kerala
3
24 12th
construction worker
unmarried
2 Acres
14000
4 Aluva, Kerala
4
22 BA(ENGLISH)
supervisor at a garment
unmarried
Nil
12000
1 Tiripur, Tamilnadu
factory
5
22 12th
works at power loom
unmarried
1 acre
12000
3 Tiripur, Tamilnadu
6
26 8th
works at power loom
Married
2 acres
15000
6 Tiripur, Tamilnadu
7
27 10th
construction worker
Married
Nil
15000
2 Bangalore, Karnataka
8
26 8th
wood cutter
Married
2 Acres
18000
7 Malapuram, Kerala
9
26 9th
wood cutter
Married
2 Acres
20000
7 Vadakara, Kerala
10
21 12th
construction worker
unmarried
3 Acres
10000
2 Vengara, Kerala
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Causes of migration
The causes of migration are complex. There are more people depending on agriculture than
land can support, along with this there is climate change due to tremendous decrease of
monsoon and untimely rain falls, uneconomic land holdings, poverty, unemployment and
indebtedness in the villages. Besides, a fairly large class of landless agricultural labourers has
long been in existence; how do they live?
In the case of Sittilingi, a seasonal migrant community all the above said are somewhat true.
The testimonies of respondents affirms how once a self-reliant agrarian community people had
to migrate to earn livelihood and to run their families. Here, the main cause of migration is due
to the failure of monsoon on consecutive years and the untimely rain falls that spoils the crop
massively. “We do not have enough rain for years now. The monsoon has failed. The rain god
has failed us, how do we live?” says a respondent. Another respondent says “even if it rains, I
cannot predict when it rains. The rain comes as it wishes and spoils the crops”. In the words of
another respondent “there is no proper rain for last 6-7 years, streams, wells and ponds have
dried up, how can we saw the seeds?”
The loss of land owing to the accumulation of debt, the concentration of the land into a few
rich land lords who are either locals (maleivasitribals) or the newcomers (non-tribals) also have
been a cause. A respondent says “we have only a little land, we sold off the land to pay the
debts”.
In the words of a respondent “I don’t have any land. Even if I work at someone else’s field, I
get only Rs 300 a day and I don’t get work every day. How can I take care of my family? How
can we live? “These landless rural labourers are the first to feel the pain of agricultural distress,
and improved means of transport enable them to leave the villages in search of work and higher
wages in the urban areas,
Some have also migrated to industrial areas in quest of work further as in the case of youths
who have gone through some sort of higher level of education; a basic degree is the highest. In
the words of a respondent “I have completed the college, with my degree I cannot do anything
here, I have go to the town to get a job” Besides sometimes the villagers may seek employment
in the towns to evade the village money-lenders or to earn enough for building a new house
and to own personal vehicles, cattle or more land.
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Psychological aspects
When we consider migration, it is definitely not easy to moving to a new place. Many people
do it, and many cities have been built at the cause of migrants, but that doesn’t mean that
changing from own locality to a totally strange environment is a smooth task. The stress of the
move and adjustment to the new place, as well as the loss of so much from the old life and
place, can lead to anxiety and depression along with other psychological problems amongst
migrants. Psychological aspects are those that affect thoughts, emotions, behaviour, and
memory, learning ability, perceptions, understanding and coping mechanisms.
In its simplest terms the migration of a person places him in a situation involving psychological
adjustments greater in degree than he is accustomed to making, and often they are new in kind.
If the environment he has left is quite similar to that which he enters, his adjustments are few
and relatively easy; hence he is not likely to suffer any very serious disintegration of character,
nor is he likely to cause much disturbance in the life of the group and the community into which
he enters. If, on the other hand, the adjustments are many and difficult, because of wide
differences in various cultural and social patterns between migrant and native.
Missing family and friends
Often the hardest thing for a new migrant to cope with is the loss of family and friends. This
can cause an empty longing that is hard to relieve and that can lead to depression. It also can
lead to absenteeism at the work place. This was evident from the respondents’ statements.
“When I go for work I cannot be with my family, I cannot be with my children. I miss my
friend and the village”. Thus says a respondent.
Stress
The presence of stress at work is almost unavoidable in many works, especially when one is a
migrant labour. It is a kind of experience that entails a threat to something of value to the
individual. It was evident among the respondents. A respondent explains, “If I stay back I can
be with my wife and children. I will be happy. But when I am at the work place I think of my
family. I get tensed often. Even if I have any tensions I have to keep it in mind and work.
Sometimes it hurts a lot. If not I cannot work... I lose my concentration, I feel sick.” This
statement clearly states the stress condition of the respondent. Stressful experiences can of
course be of varying magnitude and duration, which may make some of them more difficult to
deal with. Moreover, individuals are not equally equipped to deal with stress.
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Guilt feeling
It is seen form the interviews that the seasonal migrants especially those who are married and
having children go through feelings of guilt. A respondent says, “Normally to leave the family
and go to work is difficult. When the child falls sick, i cannot be with her. I feel pity myself. If
I was with her, she would feel better.” Thus, this sort of feeling can affect their work.
Change in behaviour
Behavioural change happens over a period of time, especially to thoseindividuals who have
developed in one cultural context when they attempt to re-establish their lives in another one.
It can be both positive and negative.
The respondents have expressed that they have gone through some sorts of behavioural
changes. These changes have been related to the way of communication, alcohol and tobacco
consumption and they became “decent and polite”. The respondents expressed that they started
behaving better when compared to their stay in the village. Similarly alcohol and tobacco
consumption the respondents have experienced a reduction in alcohol and tobacco
consumption. Other than that they have stated that they have become “decent” – in dealing
with people. They also mentioned that they have started mingling with the strangers.
Respondent states, “I have also learnt to talk politely and also to behave well.” Another
respondent’s response is “If we go out we can earn more. We can develop our general
knowledge. We can learn some new things...” yet another respondent says, “now I know what
is happening around us. I have learnt to talk politely and to mingle with people.” These were
some of the responses from the interview.
Abuse
The respondent as they shared their experiences in the place they migrated have mentioned that
they have faced certain hard moments. In the words of a respondent who works in the power
loom factory, “I work in a power loom. It’s a difficult job. So much heat inside and I cannot
manage some times. People are tough there. The manger tortures often.” A respondent who is
a wood cutter says, “Sometimes trees fall on the houses and we get scolded. And we have to
hear slangs from the house owners and the people around.” Another man who is in a
construction site reports, “My employer is good generally but at times when something goes
wrong he fires us. If we do anything wrong we get scolded. Sometimes we are slapped even...”
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The respondent expressed their helplessness they have gone through when they have to migrate
and work in unknown places.
Social aspects
Man cannot live in isolation with the society. Everyone is shaped by the society in which he is
born, live and die. Social aspects refer to the effects on relationships, traditions, culture and
values, family and community, also extending to the economic realm and its effects on status
and social networks. This study has taken into consideration some of the social aspects and we
examine how it has impacted the lives of seasonal migrants of Sittilingi. They had gone through
mixed experiences and each of those experiences had its own impacts in their life. Especially
when they have to leave their own village to go and work in a faraway place under totally
strange employers in an unknown society, it is for sure that they go through a number of strange
experiences. Some of them are listed below.
Difficulty at the work place
When a migrant has to leave his own village and find a place to live in the place he migrated
to, finds it difficult to adjust with the situations. They are now in a new place working under
people who are stranger to them. The respondents are reported to have gone through mixed
experiences at the work place. The respondents were employed mainly in power loom industry,
construction sites, wood cutting and manual works. People who work in the power looms are
reported to have tough time as one of the respondents says, “I have to work from morning 8
tonight 8, and there is lot of sound and heat, the work load is too high and there is no support
from others.” Some of them also complained about facing difficulty with the supervisor; in the
words of a respondent, “The work load is high and the supervisor torchers often.” Some of
them also shared that it is difficult to get the wages on time and sometimes they have to keep
asking the employer and they keep changing the dates.
Whereas, it was quite different in the case of respondents who were employed in to wood
cutting in Kerala said that though they had language problems in the beginning, yet the
employers were generally good and the places they worked were also adjustable. They also
said that they had enough freedom to move around and mingle with people. In the words of a
respondent, “my employer takes me in his car and we have food together.” They have also
expressed that they like the places and the surrounding and the local people in the place they
migrated to.
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Difficulties at the place of stay
A migrant who leaves their own homes and move to strange places to work finds it difficult to
find a place to stay. The place they are migrated is strange and different in all aspects when
compared to their native. Until they migrate they lived in a comfortable zone along with the
family members and relatives. But now they are in a totally different place and have to live
with the strangers. The respondents are reported to have gone through mixed feelings as they
talked about their place of stay. Some of them complained of high rent, others said the room is
too congested and other complained about not getting enough water and so on. They added that
they often regret for leaving their villages whenever they face any difficulties. One of the
respondents who work in a power loom industry at Tiruppur reports that, “I live with other 6
people. Our room is too small and we don’t have proper water connection too. Another
respondent a wood cutter in Kerala said that, “the room rent is too high so we have to live in
many number.” Some of the respondents who are wood cutters in Kerala reported to have faced
difficulty with the neighbours at their place of stay.
Economic improvement
Better wages is one of the reasons behind migration and it is true in the case of Sittilingi
migrants too. Many of the respondents reported that as they have migrated they started earning
more and as a result they have something for themselves now. The wages are most often the
two to three times higher than what one would otherwise earn in the village. Many of them
send a portion of the earnings regularly to home. Many of them also reported to start savings.
Some of them were able to pay back the debts they had. A few of them have bought a new
motor bike, in the words of a respondent, “I have bought a new bike after going for work to
Thiripur.” There are also people who have started building new home; a respondent said that
he has been working in Kerala for around 7 years and I have built a home now.” Many of the
people who were employed in the wood cutting field and they are reported to earn rupees 1000
to 1500 a day according to the work experience. One of them states, “I get 1500 rupees a day,
after all the spending I can save around 15000 a month.”
Meanwhile there are respondents who say that they don’t have any savings or economic
improvement but still they manage to live on. They expressed that if they were not to find a job
they and their family would be in debt and in poverty.
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Family being happy
Family is an integral part of every individual. It is true in the case of migrants too. When a
family feels happy because of one who earns for them, it is a great feeling for that individual.
In the case of a migrant, though he has to go through tough time, when he/she knows that the
family is happy it becomes a great comfort to the migrant. The interviews reveals that there are
different situations where the family being happy. Some of them are the economic
improvements, better productivity of the individual, change in the behaviour and attitudes. One
of the respondents states. ‘My family is happy now, I sent them money and we are living better
now.” migrants who are not married say that their parents are happy now because if they were
to stay back in the village they would have become local rowdies and since they have gone to
earn they are no more a part of any such activities. Though most reasons of happiness are
economic improvement yet there are also other impacts like behavioural changes that bring
happiness in the family.
Coping mechanism
Among the migrant labours the phenomena of coping mechanism is clearly visible. Migrants
use different coping strategies at the same time.
In the case of the seasonal migrants from Sittilingi migrating to other places itself is a coping
mechanism used. “If I stay in the village, I don’t earn anything and don’t want see my family
starving. So I go to work in Kerala;” Thus says a respondent. Another respondent says “who
will give us employment in the village. I don’t have anything to cultivate either. So I have to
keep aside the pleasure and fun of being with the family and go to work.”
When they feel Extreme physical exhaustion they resort to have drinks and smoke as a coping
strategy. This is evident from the words of a respondent as he states, “I climb the trees, cut it
down and load it to the vehicle, when it is night I get unbearable body pain, I don’t get sleep at
night. I drink at night so that I can sleep for sometimes at least.”
Some of the other coping strategies used by them are going for films, going for sightseeing on
free days, sleeping the whole day and so on.
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Discussion
The purpose of the study was to understand the psychosocial impacts of migration due to
seasonal migration among the youth in Sittilingi. This was a qualitative study using in-depth
interview as technique. I felt it was appropriate to do in-depth interviews so that I could capture
more personal experiences of the respondents. I had the plan to do FGDs to understand different
aspects of the study better but unfortunately time and situation didn’t allow me to do so. The
challenges were regarding the lack of fluency in Tamil language, not getting respondents on
time and when i got the chance to meet the respondents, most of them were in the hangover of
Diwali celebrations. The study would have been better if I could get adequate time and if the
in-depth interviews were to be done with family members of the migrants and a few key
informants of the village.
Migration is a common phenomenon found throughout the communities around the world.
There are different type’s migrations and seasonal migration is one of them. It is commonly
found prevalent among the tribal agricultural communities in the interior rural parts of the
world. It is usually understood as associated to economic aspects of the individuals. But it is
undoubtedly known that it is not only associated to economic aspects alone but there are more
aspects to it. Each those aspects also has some sorts of impacts in the personal and social life
of every migrant. Each of them will also differ from one to other migrants according to the
sorts of migration he or she enters into. Some of the impacts may have positive effects and
outcomes to the individuals whereas; some of them may be with negative effects and outcomes.
This study tries to understand psychosocial impacts on the lives of individuals who are young
and who are seasonal migrants specifically from Sittilingi. Psychosocial aspects and impacts
are very vast understand and it needs time and efforts so I have touched upon only very specific
impacts. The reasons behind migration and the coping mechanisms evolved as the result of
migration is also mentioned here.
There were many reasons mentioned by the respondents such as unemployment, monsoon
failure, huge debts and all of them are fuelled by the demands of the modern day. The increased
need for money to meets the needs of the day is also seen in the tribal villages of Sittilingi. The
reasons behind the migrations are mostly interconnected, as there is a shortage of rain leading
to poor agriculture outcome and to overcome it people approaches money lenders and end up
in debts as the same happens in the successive years and as the cycle continue they have on
other better option than migration. At the same time the youngsters who had the opportunity
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of higher education wish to get a job suiting their education and they do not want to follow
agriculture as their elders did leading to migration. Most of them end up in some other works
like employee at power looms in Tiruppur, construction workers or wood cutters in Kerala as
they find it difficult to face the cutthroat competition of the modern world. Along with the
above mentioned factors increased demand, better wages, better surroundings and living
conditions, proximity are some push and pull factors that make the migration possible.
Psychological aspects and its impacts is a vast area to understand and so, I have tried to look
into only certain specific areas that the respondents felt most comfortable to talk about. They
have expressed to have experienced positive and negative effects of migration. Every migrant
long to stay with their family but they cannot, missing family and friends were the most
common complaints and it causes them stress and loses concentration in the work and guilt
feeling, thereby accidents have happened and could happen. Verbal and physical abuse also
adds fuel to the stress and in a long run it can lead to depression. Meanwhile it was evident that
as the result of migration, they have undergone behavioural and attitudinal changes (learnt to
be more polite and decent) and also there was a decreasing trend in the alcohol and tobacco
consumption due to work related and economic reasons.
Social aspects of migration are relating to relationships, traditions, culture and values, family
and community. It is a vast area to understand so I have tried to understand a few of them
comfortably expressed by the respondents. Problems at work place and at the place of stay are
the most expressed and they are interconnected as they are strangers to the place and have gone
through feelings of discrimination, helplessness, anger, resistance, heavy work load and so on.
They also undergo problems regarding food and accommodation as it is expendable they have
to adjust themselves. In spite of all these people find joy because of the slight economic
improvements personally and in the family.
As a response to all the above mentioned they have adapted to various coping mechanisms.
Finding a place of migration itself was a coping mechanism evolved along with others like
absenteeism form work, going for films and roaming around on free days and even tobacco
and alcohol consumption occasionally. Like in any other case, the seasonal migrants from
Sittilingi undergo similar psychosocial impacts and adapt different coping mechanisms that
help them to get away with the disturbing thought about family, work related stress, and so on.
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Conclusion
The study has helped to understand and identify various reasons behind the decision to migrate,
psychosocial impacts and its effects and the coping mechanisms adapted by the young seasonal
migrants of Sittilingi. The study reveals that migration itself was a coping mechanism evolved
as a result of various difficulties like unemployment, increased need for money and failure of
agriculture due to different reasons, faced by them in their native. Though most of them go
through tough situations in the place of migration, yet they had to adjust with it so that they
and their family will have a better life. Monetary benefits are the prime factor that promotes
migration among them. Contrary to the common belief that migration results in higher intake
of alcohol and tobacco products, the study reveals that the level of alcohol and tobacco
consumption has come down among the migrant youth in Sittilingi. The study finds that the
migrants are happy that they have experienced certain behavioural attitudinal changes. Almost
all the migrants wish to come back to the village once they have enough to live on.
Reference
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Annexure - 1
In-depth interview guide
Personal background
1. What is your name?
2. What is your age?
3. What is your educational background?
4. Since when are you migrating to other places for work?
5. What were you doing before migrating?
Reasons for migration
6. What are the reasons for being migrated?
Place, season and duration of migration
7. When do you normally migrate?
8. Where do you migrate to?
9. For how long you migrate?
10. How much do you earn?
11. How do you spend it?
12. Do you have savings?
13. Where do you save your money?
14. Do you support your family?
Life at place of migration
Can you explain about what is life like in the place of migration?
1. Explain about the place where you stay(size of the room, members)?
2. How do you manage food?
3. How far it is from your place of work?
4. What is your work time?
5. How do you spend your free time?
6. Do you go for a film? If so, what sort of film?
7. Who is your favourite film star?
8. What recreational activities you participate?
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Problems faced in place of migration
1. Can you explain about the difficulties you face at place of stay?
2. Do you miss your family and village?
3. Can you explain about difficulties faced at place of work?
4. What do you do about those problems?
5. What do you do when you fall sick?
•
What are your personal needs?
•
How do you manage your personal needs?
•
What are your future plans?
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Annexure - 2
Certificate of Consent
Title of the study: -A study on the psychosocial impacts of seasonal migration on the
Maleivasi youths in Sittilingi, Dharmapuri, Tamilnadu.
Name of the researcher: Jaison K Sebastian.
Name of the Institution: SOCHARA, Bangalore.
I have been invited to take part in the A study on the psychosocial impacts of seasonal migration
on the Maleivasi youths in Sittilingi, Dharmapuri, Tamilnadu. I understand that it involves me
taking part in an in-depth interview and focus group discussion. I have been explained the
purpose and procedure of the study. I have been informed that no risk is involved in taking part
in the study and that there will not be any direct benefits for me. I understand that the
information I will provide is confidential and will not be disclosed to any other party or in any
reports that could lead to my identification. I also have been informed that the data from study
can be used for preparing reports and that reports will not contain my name or identification
characteristics. I am aware of the fact that I can opt out of the study at any time without having
to give any reason. I have been provided with the name and contact details of the researcher
whom I can contact.
I have read the foregoing information, or it has been read to me. I have had the opportunity to
ask questions about it and any questions I have been asked and have been answered to my
satisfaction. I consent voluntarily to be a participant in this study.
Name of Participant__________________
Signature of Participant ___________________
Date ___________________________
Thumb print of participant
If illiterate
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Annexure-3
PARTICIPANT INFORMATION SHEET
Dear Participant,
I, Jaison K Sebastian a fellow (CHLP) at SOCHARA, Bangalore, thank you for your time and
willingness to hear and read about the field study titled “A study on the psychosocial impacts
of seasonal migration on the Maleivasi youths in Sittilingi, Dharmapuri, Tamilnadu.” I intend
to do. This study will be done as part of my fulfilment of the Fellowship program requirement.
For any adverse effect as result of the study, you may inform,
S J Chander
Programme Officer
SCHOOL OF PUBLIC HEALTH EQUITY AND ACTION (SOPHEA)
No. 359, 1st Main, 1st Block, Koramangala,
Bengaluru – 560 034 Karnataka, India
Email: chc@sochara.org
Phone: +91-80-25531518, 25525372/09448034152
Web: www.sochara.org
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The photo journal
These are some of the pictures randomly clicked during the CHLP journey. Each of these
pictures speaks for themselves.
Rays of Hope…
Warriors of Sittilingi
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Thank you!!!
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Position: 1797 (2 views)