Nirupama.pdf
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- extracted text
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2022-23
Community Health Learning
Programme
a
Nirupa
ma H S
A Report on the Community Health Learning Experience
School of Public Health Equity and Action
(SOPHEA)
Society for Community Health Awareness Research and Action
PART- A
CHLP Learning
1. Introduction
Myself, Manjula Nirupama H S with a qualification of MBA Hospital management, PhD in women studies been working with Hospital
management. I have worked with corporate hospitals of Bangalore at management level. Its been one year I joined an NGO to serve the
society in healthcare needs. As an individual I always felt to do something where healthcare become affordable and accessible to
economically deprived group of society and also felt there is a need for women to voice out their health problems, both physical and
emotional to their family and seek necessary support to overcome it. I am working towards towards my dream by joining full-timer in
an non-profit sector and enhancing my knowledge being Fellow of CHLP.
2. Why did I join the fellowship?
As I am fresher at NGO sector, I wanted to know more about community health, different axioms of healthcare, approaches,
understanding healthcare needs, getting networked with other NGO’s, knowing more and more deeper on community health and to
know more on NGO and their contribution towards society towards healthcare needs and requirement. Hence, I joined this fellowship
course. I wanted to know on the present situation in health system across country. Different ways and methods of handling the system.
I also wanted to connect to more and more community partners working in different sections of healthcare. Hence, I found being
associated with SOCHARA and fellow in CHLP will fulfill my needs. Hence, I joined this program.
3. What were my learning objectives and were they met?
CHLP is a very descriptive program designed for working professional. Being a fresher to community health I learnt from the basics
understanding axioms, social determinants of healthcare sectors and community partners at different geographical locations. I
understood healthcare system in India, visualizing equity in healthcare. Good understanding on traditional medicines and AYUSH. I
learnt more on women health, SRH, Methods of contraceptives, family planning, right to sexual health for women, maternity health and
benefits to women by government schemes and their accessibility STD,MTP, SRH, NCD, Food and nutrition impact on society, Obesity,
Malnutrition, anemia and other public health concerns and way forward thoughts on overcoming it. Right to nutritious food and
government interventions and ICDS to eradicate malnutrition. Good understanding on environment and health, sanitation, WASH,
Gender inequality in sanitation, emotional and mental wellbeing of women in sanitation, impact to environment due to wrong way of
waste management. A practical understanding on bio medical waste management at CHC and PHC. BMW collection, segregation,
treatment and disposal at urbanic and rural PHC and CHC’s. sanitation workers health safety and measurements for safe working.
Drinking water safety for a healthy community.
4. Learning from modules and how I applied the learning in my work.
Reflections on use of the LMS, videos and participation in live online sessions.
How was a balance between work, life and the CHLP maintained?
I have more interest on Community health, Primary Health care, Women health, Mental Health, Adolescent Health and awareness,
Volunteering and fund raising in health care needs.Few projects have been started at my organization level. The most exciting topics I
wanted to focus apon were
● Primary Health Care
● Women Health
● Adolescent Health
● SRH
● Food and nutrition
● Mental Health
Primary Health Care:
I had a great interest in understanding the primary health care system in rural and urban areas. Visited couple of PHC with the support of Sr.
Health officer. I tried to understand the schemes and services provided by PHC to the community. The problem faced by PHC was always man
power shortages. I had interacted with few Asha workers associated with PHC. I Tried speaking to them in understanding their knowledge level.
I had taken a session to Asha workers on empowering community on understanding the healthcare needs. As per Alma ta Declaration “Health
for All” to be the motto and the sensitization is most needed. At Rural Karnataka, Hanur, Chamarajanagar, most of the tribal soliga community
resides there. There is a need for PHC. Even today, when there is an emergency the tribals are carrying patient in dholi. At this areas PHC
building exists and there is no human resources. As an organization “Doctors for seva” I have planed for a community health project for this
soliga community where PHC care is given by our mobile medical unit, there is continuous counselling and awareness of health care is given
by our doctor
deputed for this project. We work with Arogya Bharathi Asha
Mitra’s
these villages. The detailed description is explained at project
at
Community
health – Hanur.
Women
Health:
Women is the
most neglected when we talk on health, On my interviews
and discussion
with women of middle class society and women residing in
Basti.
more evident that most of the women face issues with UTI,
It
is
Diabetes,
Blood pressure, Anemia, Menstural Problems, Obesity and
other life style
diseases. I was observed that women ware given least priority
at the family.
She takes all the pain silently.
On my visit, I personally sensitized these women to voice out their medical needs to the family and raise an alarm that she needs care.
I conducted a women health camp and awareness program at Chikkabalapura rural village and an awareness program which includes Breast
cancer awareness, General Wellbeing, how to handle Covid -19 and many more. This awareness program was on virtual media in association
with expert doctors. Also conducted a health awareness program. From doctors for seva we also conducted Breast cancer awareness and
screening camp for slums in association with Rastrothana parishad. I also incorporated women health awareness program at community health
project designing where women get regular health awareness by Asha Mitra workers. This project details been elaborately explained in
upcoming paragraphs.
Adolescent Health
Poverty, malnutrition and poor sanitation are major problems for many Indians and are a major contributor to child mortality. More than 40%
children are malnourished or stunted. Healthcare provision is poor, and many families, especially in rural areas, have major difficulties in
accessing healthcare. On my visit to schools, it was found that most of the rural girl children is not having any awareness on menarcy and
menstruation hygiene. Menstural problems like heave flow, lack of nutrition. Most children specially girl child is found anemic and average
built body. Due to the poor condition of family and poor sanitization there is lot of personal health issues and emotionally distressed. Due to
lack of accessibility of resources they are deprived with quality education and sensitization on health care. I also observed at schools of rural
place of both north Karnataka and North India, Boy have started using drugs like jardha, Hans, Pan, Alcohol.etc. as it is on the initial phase
through proper awareness, we can bring these children back to normal life. Hence a project on Adolescent health awareness program is started
pan India, the detailed description is explained at project level below.
Sexual Reproductive Health (SRH)
Reproductive health of women has largely been declining over a period of time. It is quite disheartening to see that the people living in rural
areas were not utilizing the services due to lack of awareness and timely interventions. Apart from these factors like illiteracy and lack of health
consciousness resulted in the most people not being aware of the illness at a stage when prevention is possible. My visit to basti / Slums gave a
knowledge that women are not using any conterseptive measures, due to poor life style at bastis they are prone to be more sexual infections,
Regular UTI, Painful bleeding, excessive bleeding, White discharges, Illegal abortions were commonly discussed during my visit. age,
educational level, age at marriage, no of children, age gap between the children, type of delivery etc does not have any influence on the
reproductive health of the respondents. Health care awareness in reproductive health is much needed for these women which may bring positive
attitude among these women. The same problem was discussed with an NGO – Engender Health, This NGO Engender Health is a global
organization committed to advancing sexual and reproductive health and rights and gender equality. The support individuals in making free,
informed decisions about sexuality and childbearing so they can live the lives they want. The also collaborate with local communities and civil
society organizations to prioritize health and rights and partner with health systems and governments to provide sustainable, high-quality
services and a policy environment that supports access to care. They are internationally recognized for their expertise and impact in: sexual and
reproductive health and rights, maternal and obstetric care, and addressing gender-based violence. their programs are designed to address
harmful gender norms, increase meaningful youth participation, and support health systems strengthening, which is critical to achieving
universal health coverage. A detailed discussion happened with the team during my visit to Delhi. Seeking a good collaboration with them along
with Doctors for seva, we are yet to figure our how this project to be designed to get a awareness on SRH to rural women.
Meeting wit Staff and Directors of Engender Health – NGO, Delhi
Food
and
Nutrition:
Malnutrition,
according to the World Health Organization (WHO),
refers
deficiencies, excesses, or imbalances in a person's intake
to
of energy and/or nutrients. It is well-known that maternal, infant, and child nutrition play significant roles in the proper growth and development,
including future socio-economic status of the child.A Reports of National Health & Family Survey highlights the rates of malnutrition among
adolescent girls, pregnant and lactating women, and children are very high in India. Mother's nutritional status, lactation behaviour, women's
education, and sanitation are the key factors for mal nutrition. The effect of malnutrition are stunting, childhood illness, and retarded growth.
several government programs are in place which are focusing on eradication of malnutrition in India. there is a need for effective use of
knowledge gained through studies to address undernutrition, especially because it impedes the socio-economic development of the country. My
learning on food and nutrition has helped me in my personal life. I have started realising the importance of nutrition in children, adolescents,
women,senior citizens. I have modified my lifestyle by including lot of nutrition in my diet. The same is applicable in my family diet. This has
seen a lot of improvement in my family over a period of 3 month. The same knowledge is been spread to my neighbours and other community
I meet during my official and informal visits. I have also included Food and nutrition module in AHAP program as a part of my profession.
This AHAP program also aims in giving awareness on food and nutrition to adolescent students of government schools across country. The
details of this project has been explained in detail below.
Mental Health:
Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how
we handle stress, relate to others, and make choices. Mental health is important at every stage of life, from childhood and adolescence through
adulthood. Mental Health is caused due to childhood abuse, trauma, Child been neglected, Individuals social isolation, loneliness, Individuals
experiencing discrimination and stigma Including racism, Social disadvantage, Poverty or debt, Bereavement (losing someone close to you),
Severe or long-term stress.
On my learning on Mental health topic provided by Dr. Thekur CHLP, SOCHARA. I personally implemented on myself. The realisation of
importance of mental health, ME time and how to manage or overcome stress, anxiety, depression was learnt. On self-implementation Now I
could able to handle my work and personal life very balanced. I learnt to be empathetic, Being non judgemental and accepting individual as
they are has eased out lot of stressors in my personal life. I also learnt during my visit to seva basti and government schools that mental health
of adolescent children, working women, Family women, Women facing infertility is under lot of stress due to long term negative mental health
an individual is prone to have diabetes, hyper tension, obesity and other life-threatening disease. I also realised that creating an awareness at
early stage is more important. Hence Mental health module been added at AHAP program PAN india which has been detailed below.
I have implemented the learnings at each project.
Project 1: Adolescent Health Awareness program: (AHAP)
This project started in July 2022 with a focus of giving awareness on health issues to adolescent children at government school.
Adolescents, at 1.54 billion, make up 1/5th of the world’s population. In India, adolescents contribute to 23% of the total population – coming
up to be about 243 million adolescents. As we can see, adolescents represent a huge fraction of society and they have the power to transform
the social and economic future of our country. To enable them to fulfill their potential, substantial investments must be made in their education,
health and overall development. Adolescent Health Awareness program (AHAP) is an initiative from Doctors for seva to help adolescents for
better psychological and physical growth. Doctors for seva is conducting AHAP at the government schools, Aided schools and Municipal
schools
The program comprises 4 modules:
1)Healthy Relationship,
2) Prevention of Substance abuse
3) Healthy reproductive health
4)Healthy lifestyle
Main objective of this program
is:
1. To provide awareness among
adolescents to lead a healthy life
style.
2. To organise activities for life
skill development.
3. To help students acquire
authentic knowledge about adolescent reproductive and substance abuse.
4. To inculcate in students’ essential life skills to develop healthy attitudes and responsible behaviour towards ARSH – Adolescent
reproductive and sexual health and substance abuse.
School going adolescents’ students from 8th to 10th standard in Govt./Govt.Aided/Municipal schools. The beneficiaries of this program are
children of these Govt schools who are basically from the economically weaker section of the society. Most of the children in government
schools are first generation learners and do not have a proper support system at school to learn all the required subjects & other health related
topics. plan for 2022-23 is to cover 100 govt schools across PAN India. Preferences given to Bengaluru, Mysore, Hubli/Dharwad, Belgaum,
Vijayapura, Indore, Bhopal, Delhi/Noida, Dehradun Hyderabad, Telangana. Each geographical area is considered as 1 cluster* (each cluster
consist of 10 Gov’t Schools)
Project plan includes:
Identification of schools: Each cluster consists of 10 govt schools for this academic year we are considering 10 clusters. Total number
of schools identified across PAN India is 100.
Permission from Respective departments: Education Dept. with respective states.
Training the Facilitators: AHAP lead coordinator will take the lead role in training and facilitating the volunteers and other coordinators.
Activity based sessions: At every module there will be activity based sessions which include Ice breaker games, story telling, role plays
by the students and also skit on a few topics.
Counseling sessions: A magic corner / Adolescent corner is created at the school and a helpline number is communicated to the student
for in person counseling and/or online counseling. A posture related to the program / DO’s and DON’T’S are displayed at this corner.
Impact assessments:
1. Socio Economic Political Cultural Ecological analysis is done periodically with the help of Head Teacher at School or region
level.
2. Pre and Post assessment on each module is analyzed in understanding children wise, school wise, region wise, chapter wise
impact on the program.
3. General well-being assessment is done to understand the quality of life of adolescent students through final feedback at the end
of the program.
Project 2: Basic Care Life Support
BCLS project started from Jan 2023 with a keen observation on happening health emergencies in society. Road traffic accident and sudden
cardiac arrest are one of the most leading causes of death in India. Basic care life support (BCLS) is lifesaving intervention as a premedical
facility. Adequate knowledge and awareness about BCLS and CPR are mandatory for healthcare students, General public as first responders.
Objective of BCLS project:
The objective of BCLS project is to give knowledge, awareness and attitude towards BCLS among healthcare students and general public.
Considering the rapidly evolving COVID-19 pandemic and our better understanding of the spread of the disease, there is an urgent need to give
awareness and training on BCLS for Healthcare students and create first responder across different geographical locations.
Cardiopulmonary resuscitation (CPR) in suspected or confirmed COVID-19 patients needs Basic life support care as first intervention . CPR in
COVID-19 patient carries added risk to health care workers (HCWs) as it involves aerosol-generating procedures, requires many rescuers to
work in close
proximity, and increases the chance of breach in personal
protection due to
high-stress event. Hence BCLS program provides good
training
and
awareness
students
and
first responder community.
Lack
of
knowledge about simple yet vital life-saving skills is one
of the barriers
people face while dealing with medical emergencies.
When
people
with lack of this knowledge take action, they can
sometimes even
prove to be counterproductive and cause more harm than
among
Healthcare
workers,
Healthcare
good.
The BCLS course will enable the participants to perform cardiac resuscitation and other lifesaving skills while dealing with common
emergencies. The course has a special emphasis on building leadership and communication skills. This equips providers to help fellow citizens
in dire medical emergencies.
Doctors for seva in partnering with Jeevan Raksha team in saving lives and assuring care. Jeevan Raksha has a special purpose vehicle created
by Rajiv Gandhi University of Health Sciences, Karnataka and Swami Vivekananda Youth Movement to roll out ‘Certified Skill Courses’ in
Emergency Care and Life Support equipping doctors, nurses, paramedics, and lay public with the necessary skills to transform the Emergency
Care response system and thus save lives.
Doctors for seva will create a team of Healthcare professionals and students well equipped with BCLS course and be a TOT and create first
responder club in the society which cates towards colleges, schools and general public.
Program Structure:
BCLS is a 4-day course ( 2 days training instructors and 2 days TOT – first responders) offered for Allied Health graduates and the general
public committed to learning life-saving skills.
Some of the topics covered include first-aid in common emergencies, control of bleeding as well as managing choking, and safe use of a
defibrillator.
The series of structured sessions will make participants confident in taking charge of a situation in the prehospital environment and save lives.
During emergencies, this will enhance the opportunity of receiving much-needed care from fellow human beings across the country.
A pictorial representation of BCLS Project
Expected Impact:
We are planning to train the
instructors and first responders in a huge number to create an impact in
society. More the knowledge on understanding the health emergencies and cater towards saving lives make a a big impact to the society. In this
financial year our target is to reach 1500 community partners with basic life support skills.
Project 3: Community Health project: Hanur
This project launched in Nov 2022. The learning of CHLP has been applied in this project.
Background:
Nearly seven decades after independence, tribal people still suffer from inequity in health and health care. As per the report of Tribal Health in
India, major health indicators of tribal communities are significantly lower compared to non-tribal communities. Tribal communities face the
“triple burden” of disease. Apart from high rates of malnutrition and communicable diseases (TB, leprosy, HIV, etc), there is a rise in noncommunicable diseases as well. Added to this is the lack of access to health care in the tribal regions.
There is a need for Access to basic healthcare facilities, Navigational support to secondary and tertiary care .The hilly terrain and forest cover
makes the access a challenging proposition. Tribal communities have inhibition to go to Secondary healthcare and Tertiary healthcare hospitals.
The existing health system is overburdened resulting in the unavailability of quality health care services within the reach of the community at
all times.
Project:
Swami Vivekananda Youth Movement (SVYM) which is a development organization, engaged in building a new civil society in India
through its grassroots to policy level action in Health, Education and Community Development sectors from past 37 years. DFS and
SVYM have identified the need for integrated health and wellness intervention with inclusion of robust IT and support system for
bridging gaps in existing health care system in the concerned area. The aim is to work in tandem and collaboration with the existing
health providers in the area and enable the structured betterment for the tribal community. There are 157 tribal hamlets in Hanur,
Ramapura, Odayarpalya, Ponnachi, MM Hills areas, housing around 8000 people from the Sholiga Tribal community. The Goal is to
achieve & sustain enhanced health status of these indigenous tribal communities through a comprehensive & integrative health &
wellness
interventions.
Map of Hanur Taluk – Community health project
Brief
summary
on
project flow:
a
Mobile Medical van equipped with requisite medical facilities;
● Setup
Doctor,
nurse and a driver to be part of the Mobile Medical Unit (MMU)
● Arogya
Mitras visit the hamlets and ascertain the health conditions in the
community
● MMU to visit each hamlet on a regular basis
● Arogya Mitras to coordinate the health screening of needy people and follow up with referrals at district hospital; conduct
specialist health camps (like Eye, Cardiac, Ortho, Gynec, etc) on need basis
● Social worker at the district hospital to help the patients in getting the required healthcare at the hospital
● Health awareness programs and meeting with community people to be done on a regular basis
● The program also focusses on capacity building of Arogya Mitras to help them manage their activities efficiently
● Baseline assessment on
● Community health and school health program (RBSK - Rastriya Bal Swasthya Karyakram)
● Ayushman Bharat cards for the community and near by hospitals supporting the scheme
Project Structure
Expected Outcome:
1. Community healthcare approach is improvised.
2. Continuous education and awareness on healthcare is provided.
3. Behavioural changes in the community to be monitored.
4. Healthcare access to secondary / tertiary care is provided.
5. Measurement of program parameters (based on the baseline assessment done during the project initiation), like
•
No. of people screened by Arogya Mitras
•
No. of people identified for secondary/tertiary care and percentage of people availing the same
•
No. of people utilising services of specialist health camps (Eye, Cardiac, Ortho, Gynec, etc)
•
Participation of people in various health awareness programs
•
School Health program statistics
Project 4: Telemedicine – For Tribal Community
Background:
Primary care doctors are at a high risk of contracting diseases (like Covid-19) as they manage patients with fever or respiratory
symptoms. As these doctors are more likely to be self-employed or work in smaller practices where COVID-19 infection could mean
loss of livelihood. Healthcare system without primary care is crippled in its ability to manage outbreaks. People are not having access
to doctors to take care of illness. Due to pandemic situation and lockdowns, many patients have been unable or unwilling to visit the
doctors.There is increase in spending by private doctors more on personal protective equipment (PPE), sanitisation of premises,
personnel, etc.
Need for project:
Deploying telehealth solutions and programs is the need of the hour for people who are suffering from other medical ailments during
this time can receive care from home, without entering medical facilities, minimizing their risk of contracting the virus. Telemedicine
technology is seeing a surge of direct-to-consumer services operating at a large scale helping to provide care to patients. Telemedicine
hasn’t traditionally been used in response to public health crises, but that is changing with COVID-19. As this public health crisis
continues to escalate, telemedicine is quickly gaining recognition as a critical tool to slow the spread. Even the large hospitals are racing
to implement and scale up these capabilities at their frontlines.
Expected impact from the project:
● Increases healthcare access for all people from all sections of the society.
● Protects medical personnel and patients
● Enables even specialists like radiologists to consult from anywhere
● Using telehealth to provide specialty services is more feasible for rural healthcare facilities than staffing those rural facilities
with specialty and subspecialty providers.
● Telehealth allows specialists and subspecialists to visit rural patients virtually, improving access as well as making a wider range
of healthcare services available to rural communities via telemedicine
● Tele-counselling is a natural extension of the services for people who are in need in these challenging times
Project Concept:
Doctors for Seva (DFS) with its expertise, network of doctors and reach of volunteers proposes setting up Telemedicine and Telecounselling facility for the larger interest of the community and medical fraternity.
It mainly comprises of –
● Telemedicine software management system
● Team of full time and part time doctors
●
Specialists for consultation
●
Set of volunteers
●
Management personnel
●
Team of counsellors
Project Methodology:
The setup is based around commercially available Telemedicine Management System. There are 3 main categories of stakeholders
1. Team of doctors, Team of Counsellors, Volunteers and Administration personnel
2. Patients who avail these services can do so a. At their homes
b. Health centres (in semi-urban and rural areas)
c. Mobile Health clinics (in remote areas)
3. Network of diagnostics labs and hospitals
4. The services would be available using either mobile phone or laptops (with internet connection)
Monitoring and expected impact:
● Monitoring of the program would be based on the extensive reports generated by the Telemedicine Management System.
● These reports provide insight into types of illness, doctors bandwidth, logical closure of health issues, etc
● Reports be generated on the timely basis (like weekly, fortnightly, monthly, etc) to monitor the progress and track the action
points
● Inferences to be drawn based on the reports and plan of action to be prepared to increase the effectiveness and ease of operations
Project 5: Arogya Nidhi
I.
Proposal Summary:
Arogya Nidhi is an initiative by doctors for seva which aims in raising funds from different approaches. The fund generated from various
resources will be accumulated at Arogya Nidhi account. Arogya Nidhi will provide financial assistance to the needy for health care
treatments, Medical Support and towards hospitalization. Arogya Nidhi steering committee will focus on younger generation health
needs as first priority.
Project Description:
Arogya Nidhi is one of those initiatives form Doctors for seva which provides an Emergency Fund to provide financial assistance to
patients living below the poverty line and suffering from major life-threatening diseases and unable to receive medical treatment at any of the
government hospitals, specialty hospitals or institutes.
There are many people who are in desperate need of financial aid and they cannot afford their medical expenses. Arogya Nidhi will support
them by funding the needy in their medical treatment and hospitalization. Priority is given to young patient. We support up to INR 25,000/- per
patient or based on their treatment requirements.
Arogya Nidhi will support the needy on their request. Arogya Nidhi will not have any internal understanding with any hospital for any sort of
financial assistance. Arogya Nidhi will consider the patient requests who have been hospitalized either as an individual request or been prompted
by the hospital.
II.
Standard Protocol followed for financial aid
On request from the patient or hospital for financial aid
● A preliminary assessment is conducted by doctors for seva team in understanding the patient demographic details, medical condition.
● Doctors for seva team will have a home/hospital visit to understand the medical treatment/procedure needed or undergoing by the patient
at the hospital.
● Doctors for seva team will also understand the financial costing for the treatment, initial payment, discounts/concession provided by the
hospital, other sources of fundings like PM fund, CM fund, Local Body funded. Team will take the estimation cost for the patient
treatment.
● A team will also visit the patient Home to understand the socio-economic condition of the patient. Team will understand and document
the observations
● The accessor will present the documents on their observations to the internal steering committee for further decision.
● Steering committee on scrutinizing the document will decide whether the patient needs medical support from doctors for seva – Arogya
Nidhi or not.
● More priority is given to the younger patient and for curable diseases.
● If we get a requirement for any aids like orthotics, prosthetics, consideration can be done based on the need assessment and livelihood
support.
● INR 25,000/- or as per the requirement for the treatment by the patient will be decided by the internal committee on case-to-case basis.
● Beneficiary will be supported either by crowd pooling or by individual donor contribution. NOT both.
● Call for donation from various mode is considered to raise fund for beneficiary.
● On financial aid, Doctors for seva will hand over the fund to the hospital directly with proper documentation.
● If the medication is on OPD basis, Steering committee will take a decision on purchasing the drugs and handing over to the beneficiary.
● Doctors for seva at NO cost hand over the cash or Cheque to the Beneficiary directly.
● Doctors for seva will also ask for consent from the patient for agreeing to share their photos, videos and audios for social media
publication through a consent form.
● Accounts department will maintain the financial aid document on fund disbursement.
Newspaper collection drive
Strategic Planning
Vision:
In India, Most of the health issues are unspoken and unaddressed due to socio, cultural and economic issues. These issues are also
responsible for their low life expectancy when compared to other developing countries.
We at Doctors for seva are trying to reach such an underprivileged class of society and provide quality healthcare access with NO cost
or low-cost treatment without compromising the quality of care.
Objective:
To support this initiative, DFS have started Newspaper collection drive. In this campaign volunteers will collect the newspaper from the
localities with awareness and the funds generated through this drive will be utilized for healthcare needs for our beneficiaries.
SWOT analysis
Strength:
Weakness:
1. volunteers driven campaign under the
1. outsourcing resource and manpower
guidance of FT coordinator.
2. costing to company
Opportunities:
Threats:
1. DFS and its activities will be
1. Storage space
highlighted
2. Feasibility and acceptance level at
2. Brand visibility to society
RWS
3. Opportunity to raise fund on donations
3. Proper routing of funds generated to
DFS nidhi
Execution of Plan:
Phase 1:
1. Identifying the RWA’s within a 5 km radius to the collection center.
2. Identify volunteers and connect them to RWA for initial discussion on the drive so that it reaches every house at apartments.
3. A volunteer will be designated with a marked geographical area to get connected with RWS president
4. Awareness on the agenda of this drive is communicated through posters and social media assistance.
5. Every 2nd Sunday of the month will be considered for newspaper collection.
6. A designated place is communicated at respective RWAs’ for newspaper accumulation. Preferably at the security counter (or as
per RWA’s decision)
7. Cluster head - volunteer will take the responsibility of collection and segregation of newspaper at the collection center/scrap
vendor directly.
8. Identify a scrap dealer and negotiate on the pricing.
9. The fund generated on selling newspapers is transferred to the DFS account through electronic payment.
10. Analyze the pattern of collection and expenditure v/s inflow
Phase 2:
1. To set this campaign on auto mode driven by volunteers.
2. Estimate the cost involved in hiring a person, vehicle for collection at different geographical areas on designated date and time.
3. SOP to be set based on the resource availability.
4. The brand width of the collection point is expanded based on the feedback of phase 1 drive.
The amount generated through this drive will be utilized for financial support for the economically deprived society healthcare needs.
We also mobilize the college students in giving awareness to healthcare to the general public and also connect them to public in
collecting.
5. Mentorship process and reflections
My Mentor is Mr. Prahlad, MSc Environmental science, Mr. Prahlad has immense knowledge on school sanitization and waste
management. He is a part of training and development team of SOCHARA and aims in providing environmental sanitization at rural
places of Karnataka with intervention of NGO’s Community partners, Community training and community sanitization intervention.
I had couple of calls with him in understanding my interventions on several projects conducted at organization level. My deeper study
was focused on providing awareness on Menstrual hygiene to adolescent girls at rural places. His guidance and suggestions has helped
me in carrying out the project diligently.
Mr. Karthik has been a great support to me throughout this fellowship. I have never hesitated to reach out to him for anything whether
related to CHLP or my work-related doubts. he has always smiled listened patiently and helped out. His guidance and suggestions have
helped me a lot both as a fellow of SOCHARA and on my official work front. I connected with him right from the beginning and I’m
sure it will go a long way. I had couple of calls and virtual meet whenever I did not understand on ant topic or on project planning and
implementation.
Ms. Janelle Fernandes sessions were interesting and very impressive.
Her knowledge on SEPCE/SDH is amazing. She has made the topic so easy to be understood to a fresher like me. Her explanation is
awesome... she made learning easy and interesting.
I had couple of conversations with Dr. Radhika and Ms. Uma Chaitanya in understanding project as a whole. Both of them had cleared
my doubts.
Mr.Prasanna is amazing in his learning classes. He makes his topic more interesting and livelier so that even a complicated topic looks
simple and easy to learn.
I had couple of interactions with Dr. Vanitha Shankar, My fellow mate at CHLP, couple of call were made and discussed and debated
on some topics which were either interesting on discussions or difficult to understand. During course of my project, I took couple of
suggestions from her.
I also had a regular touch with Ms. Roshni and Mr. Shakti Singh related to CHLP conversations.
I would like to say that the entire SOCHARA team of CHLP which was initially lead by Dr. Radhika was so good. The entire team was
extremely helpful and easily accessible to make sure we were comfortable and our requirements were taken care of during entire course
from the day one of orientation till date.
6. Project learning experience:
CHLP has given me loads of learning on community health, different axioms of healthcare, approaches, understanding healthcare needs,
getting networked with other NGO’s, knowing more and more deeper on community health and to know more on NGO and their
contribution towards society towards healthcare needs and requirement. Hence, I joined this fellowship course. I wanted to know on the
present situation in health system across country. Different ways and methods of handling the system. I also wanted to connect to more
and more community partners working in different sections of healthcare. Hence, I found being associated with SOCHARA and fellow
in CHLP has fulfilled my needs.
7. Take away from CHLP and Looking Ahead -Where do I go from here?
I Will definitely be in touch with SOCHARA team and take their constant guidelines for community healthcare projects and needs.
Dr. Ravi Narayan, Dr.Thelma, Dr. Prithvish, Dr. Denis Xavier, Dr. Guru, Mr. Prasanna, Janelle Fernndes, Dr.Radhika, Mr. Karthik,
Ms. Uma Chaitanya, Ms.Ranjeetha.have given me a great knowledge in the subject. It was a great journey of 8 month with the entire
team and a great knowledge transfer in this learning program.
I have developed some basic skills in understanding the community problems, needs and focuses through different interventions. I
have learnt different variables on community health like socio, economic, cultural, political and local influencer. Implementation
methodologies and impact strategies through the course of CHLP.
It’s been a great honor to get associated with SOCHARA team.
PART- B
Community-Based Health Action-Reflection Project
Menstrual Health & Hygiene – Awareness
1. Background (can include information about community, community SWOC analysis / situational analysis etc.)
Adolescence is the stage of life span that represents a transition period between childhood and adulthood. Chronologically, it begins at
the age 12 years and extends through age 18. The developmental event of puberty which usually occurs at the beginning of adolescence,
signals the end of childhood; as at this time individuals become sexually mature and capable of reproduction (Bigner, 1998). According
to Nightingale Nursing Time of India (2010), the adolescents represent about a fifth of India’s population, that is, 22% of its population.
1.1 million Girls attain menarche, the first menstrual period anytime between 09 to 14 years (Jamadar, 2012). Menarche is one of the
most memorable and defining moment for adolescent girls. It is a meaningful, dramatic, and concrete event which marks puberty. Unlike
pubic hair growth and breast development, which are prolonged pubertal changes, menarche is unique in that, its onset is abrupt. As the
most distinct event of female puberty, menarche is a sign of physical maturity and fertility (White, 2008). Menarche and menstruation
are an issue that every girl and woman have to deal with once she enters adolescence around the average age of 12, until she reaches the
menopause somewhere in her 40’s (UNICEF India, 2008). Menstruation is not a rare or even unusual experience; however, in many
cultures it is a private and largely hidden one. Menstruation was literally unmentionable because there are no words in the man- made
language which could be used to describe the experience politely. Similarly, Lovering (1995) has found that adolescents have nothing
to say about menstruation itself. The only discourse which they can use to describe their experience is medical one which describes pain,
distress and untidiness. Unless these girls have period pain, or difficulties obtaining sanitary towel, they have nothing to say (Walker,
1997). There is an unspoken, culture of silence with regard to their menstruation (Jamadar, 2012). It is also considered taboo to discuss
menstruation, particularly for girls to discuss it with members of the opposite sex (Kissling, 1996; Williams, 1983). Because of social
pressure, the menstruating girl is required to maintain the taboos placed upon communication about her experience (Kissling, 1997).
Nevertheless, girls have questions and concerns regarding their own menstruation, and find the need to discuss this topic with friends.
The social prohibition upon discussion of menstruation with others often causes parents to avoid discussing menstruation with their
daughters, leaving the girls feeling unprepared for menarche (Kissling, 1996). Girls who are aware of how to deal with menstruation
tend to cope with it much better than those who are caught unaware. Preparedness gives girls the power to handle it in a mature way and
also feel confident that there would be no embarrassment resulting from these intensely private moments. The setting of menarche is
often celebrated in many cultures and during this period there is a tradition of preparing and giving food rich in iron and protein content.
Modernization has seen the cessation of this practice of celebration to a certain extent but many households still follow the practice of
providing the nutritional supplementation during menarche (Jamadar, 2012).
Indian Practices Related to Menarche and Menstruation
There is a wide range of significance attached to menarche. The attitudes of societies toward menarche vary from delight and pride to
fear and shame (Jamadar, 2012). Many anthropological accounts describe societies in which women withdraw during menstruation to
special menstrual huts and lodges, which may also be used during bleeding after child birth (Walker, 2008). The starting of menstruation
is often met with a variety of reactions. In the Indian cultural context, attainment of menarche by girls is considered a biological indicator
that the girl is ready for the commencement of sexual relations. This is evident from the traditional practice of “Gauna” that was
commonly followed in the olden days. In this system the girls used to be married off at an early age but continued staying in the parental
home without consummation of marriage. However, when a girl attained menarche the ceremony of Gauna would be performed and
then the girl went to live at her husband's house where she would begin her married life (Jamadar, 2012). Among the Vaishnava Bauls
of Bengal, menstrual blood is thought to have potent energizing properties. Traditional songs lyrically refer to it as a river that rises once
a month (Robb, 2011). In some places of lower Assam, in Pathsala, when the girl attains her menarche, she is not given any thing to eat
nor she is allowed to see male members of the family till fourth day and on the fourth day she is given the ritual bath, like a bride. She
is then married to a banana tree as custom goes, with great feasting and enjoyment (Devika, 2014). Different cultures have varied beliefs
and myths related to menstruation. Some reach a level of especially labelling it as the curse, on the rag, weeping womb, bloody scourge,
the red plague, under the weather, and being unwell (Costos et al, 2002). Menstruation also has a long history of strict cultural taboos
across India, which causes real harm. In some study areas women are forced to live in a cowshed throughout their periods. There are
health issues, like infections caused by using dirty rags, and horror stories related to it (George, 2012). Our cultural taboos also include
avoiding sour foods for fear of a smelly period, not touching certain food items to prevent contamination and the general belief that
menstruation dispels contaminated/toxic blood. There is also the belief that the body is ridding itself of hot negative energy and warm
baths can be harmful to the body and/or the environment (UNICEF India, 2008).
2. Objective of the intervention/ community health action initiative.
● To study socio-cultural beliefs/myths; taboos/restrictions related to menarche and adolescent menstruation of adolescent girls
of different geographical area.
● To study the adolescent girl’s perception about the socio-cultural constructs of menarche and menstruation and their
adaptability to it.
● To assess the intergenerational continuity and transition in the menstrual knowledge, attitude and practices.
● To provide awareness among adolescents to lead a healthy life style.
● To help students acquire authentic knowledge about adolescent reproductive and menstrual hygiene awareness
● To inculcate in students’ essential life skills to develop healthy attitudes and responsible behaviors towards ARSH & MHAP –
Adolescent reproductive and sexual health & menstrual hygiene awareness program.
3. Description of the intervention and implementation, community engagement process
Study Target groups were School going adolescents’ students from 8th and 9th standard in Govt. schools. The beneficiaries of this
program are children of these Govt schools who are basically from the economically weaker section of the society. Most of the
children in government schools are first generation learners and do not have a proper support system at school to learn all the required
subjects & other health related topics. In this project of 3-month tenure 6 school are considered with an average of 30 girl child in
each school. The target girl child in this program will be 180 appox is considered.
Location of schools selected were.
1. Government High school, Hattihalli, Chikkodi Dist, Karnataka
2. Gov’t high school, Ranipur, Haridwar, Uttarkhand.
3. Gov;t primary school, Pashulok, Rhikesh, uttarkhand.
4. Sarvodaya kanya Vidyalaya, mandi ghao, New Delhi.
5. Belgavi
6. Hubbali
MHAP program was conducted to spread awareness and inculcate in students’ essential life skills to develop healthy attitudes and
responsible behavior towards Adolescent Menstrual hygiene and reproductive and sexual health among the adolescent children at
gov’t schools.
Approximate duration
of this program is 3 months for 6
school. Module (Ice
breakers,PPT, Videos and one on
one discussion on their
challenges)
hours.
volunteers visited the school 2
Myself and
times in a month.
Module
was covered in 4
was
covered
in
2
Sessions.
Module
wise
description is given as follows:
MODULE: Menstrual
Hygiene and Awareness Program,
the awareness session
begin with Ice breakers , PPT ,
Videos, discussions
AT SESSION:
We
explain about menstrual hygiene
for girls. At the end of the session, we provided a book which was done by WOW-NGO (world of Women) and reusable cotton
sanitary pad were also distributed which was contributed
from NAARI - NGO
SWOT Analysis:
Myths/ Taboos/ Restrictions followed by students at different geographical locations:
Cultural Taboo on Menstruation
i) Taboo/Restrictions Related to Open Discussion on Menstruation
Not surprisingly, there is a strong taboo against menstruation being talked about openly in the public. Adolescent girls in all geographical
locations reported that “menstruation is a topic that is not be discussed openly as it is seen as a matter of shame and embarrassment”. No public
discussion on the matter is allowed ever by the family. Further, talking about such issues in front of males is all the more forbidden. The
adolescent girls also added by saying that “basically no women speak about menstruation in front of male members ever”. It was also found
that all the girls treated menstruation as a private matter and tried to keep it as a secret, especially from the male member of the family. In other
words, the state of menstruation was never acknowledged publically; it is personal matter for a woman. “Menstruation is one of those things
you know, everyone knows about it but no one is allowed to talk about it. Even boys know about this and that’s why most of the boys giggle
and laugh during biology class when the topic of menstruation comes up. During the awareness program girls found it shameful to discuss
menstrual hygiene along with boys in the class. Silence on menstruation and related issues have been maintained at class rooms and at families.
Adolescent Girls never had the platform to talk about such issues and they were brought up in an environment where asking questions was not
welcomed, even today it is not acceptable to question the cultural beliefs and practices.
ii) Taboo/Restrictions on Open Display and Buying of Menstrual Sanitary/ Material
All menstruation related articles are to be hidden away. Storing of such things without being seen by others is a top most priority. The girls at
schools reported that, “our mothers and sister used to say that if our father or brother sees our menstrual products specially the menstrual stained
cloth, it’s a big sin. They therefore secretly kept all the used blood-stained clothes at the corner of the roof top. On the last day all the materials
were taken together for washing. In some geographical locations, especially in south India, girls use cloths and keep for drying by hiding under
a cloth. This was always to be done in some hidden places, away from everyone’s sight. It was also found that the older generation Adolescent
Girls / Mother of Adolescent girl studying in government school did not use readymade sanitary pads as menstrual protective material so these
women had no experience of buying sanitary pads from market. However, when the mothers and girls Adolescent girls who use readymade
sanitary pads were asked, if there is any taboo/restriction on buying sanitary pads without being seen by men other than the shopkeeper, majority
of them reported they mostly preferred not to buy this material from male shop owners because they felt shy and uneasy. Since, there is shame
associated with menstruation and it is to be hidden from males so they could never ask a male member of the family to buy sanitary towels or
pads for them. They mostly managed to arrange it as their own; or in case of young girls their elder sisters, mother or elder female of the family
arranged it for her. Nevertheless, in metropolitan city or urban areas, there are some girls who reported that they don’t feel shy and uneasy to
buy sanitary pads from a male shopkeeper and frankly asked the male shopkeeper for a sanitary pad. This again indicates the changing practices
among the growing adolescent girls of some communities. Similarly all the Adolescent girls across the project location felt that it is very
embarrassing for a female when a man finds out that a woman is having her period. Since Adolescent girls are socialized in such a way that
menstruation is a hidden issue, so all the Adolescent girls thought that it is embarrassing when a man finds out that a woman is having her
period whether by some accidental situation, like spoiling of dress, not praying, not going to religious places etc. In this entire situation the
other Adolescent Girls of the family helped a menstruating female to hide the matter. The cultural visualization of menstruation is one of a
shameful act that is to be dealt with only in private. The news of menstruation is never to be made public whatever the reason or situation. When
Adolescent Girls are not allowed to discuss about issues related to menstruation among themselves it is nearly unimaginable to consider the
knowledge of males about it. A menstruating woman has to hide it from the eyes and knowledge of all males around her. For this if required
she can lie or use disguise. Cultural taboos of the selected study areas put a control on all Adolescent Girls never to acknowledge or talk about
it. Especially males come to know about it, then it would bring them embarrassment and shame. Even buying sanitary material from male
shopkeeper is not acceptable. Hence, in short, the results revealed that menstruation is one process surrounded by strict cultural taboo of nondisclosure and non-sharing.
iii) Taboos/Restrictions on Disposal of Used Material in Open Field
Taboos were also noted on the disposal of used material in open field specially without washing them properly or without burning of used
material. There was a commonly held belief that if one throws the used material in the open field without washing it properly then it is equivalent
to throwing of newly born illegitimate child, which is further considered a great sin. There is also a belief that if the throw soiled pads without
washing, it attracts negative energy. There is a fear of GHOST Possession. Similarly, burning of any menstrual stained cloth or pad is also
regard as great sin in Study areas. Therefore, if the Adolescent Girls wanted to dispose of the menstrual material; they usually placed the cloth
or pad and burn together. Similar restrictions are practiced in other countries like in Bolivia, where girls do not discard their sanitary products
by burning. Since, blood is an extension of themselves, so they throw them or bury them. In Nigeria, women also do not burn their sanitary
materials because they believe burning causes cancers and infertility. Doing so would symbolize that one is destroying something from the
womb (Mahon and Fernandes, 2010). But contrary to these practices cross-sectional study of Sokoto, 2014. Nigeria reported the belief that
menstrual blood can attract witches who use it in black magic rituals, if not disposed of properly. Hence it is believed that used pads must be
burnt Oche et al., (2012). However, among some Study areas burning off used material wasn’t practiced. It was mandatory for the Adolescent
Girls to wash the sanitary material before disposal. Probably because of this, young girl even washed the readymade sanitary pads before
disposing them off. Where ever the source of running water say a river or a canal were available used material was disposed there, or in other
cases Adolescent Girls would bury them in soil or place them under heavy rocks on the hills or mountains. All this as culturally taught had to
be done in complete private, away from the eyes of others.
iv) Taboo/Restrictions on Bathing or Swimming
It was also found that there was no religious taboo related to bathing during menstruation however majority of Adolescent Girls did not prefer
to take bath due to the climatic condition. The women reported that bathing during menstruation due to a harsh and cold climate of Study areas
becomes quite difficult as there were always chances of back pain and abdominal pain because of use of cold water. So, the mothers and other
elder Adolescent Girls of the family advised the menstruating female not to take bath during their period. However, some Adolescent Girls also
held the belief that bathing causes stoppage of menstrual blood. This finding is in unison with a cross sectional study carried in Mansoura, Egypt
by El.Gilanya et al (2005), reporting the belief that bathing during menstruation is to be avoided. It was also believed by the Adolescent girls
that taking a cold shower retains blood in the uterus and also causes cramps, while a hot shower would increase its flow even in summer season
also. From Saudi Arabia the same study reported the widespread superstition that bathing during menstruation is painful, or it stops blood from
flowing out. For similar reasons, older generation Adolescent Girls of Study areas did not favor bathing during menstruation. They found it
unusual and amusing to take bath during menstruation as there were no traditions of bathing during menstruation in olden times. Some older
women and teachers further reported that, “now the younger generation does not like to follow this belief as this practice is not religiously
connected so it becomes easy to debunk this belief. Some girls like to take bath during periods in summer especially when they feel hot or
unhygienic and that’s too okay, it their own wish”. This highlighted that with changing times bathing practices during menstruation have
undergone some change at least. At some schools regular visits of ASHA workers is observed, due to continuous awareness girls look more
confident and has been following menstrual hygiene practices.
v) Taboo/Restrictions on Applying Henna (Mehandi)
It was also found that majority of the Adolescent Girls of Study areas were also advised against applying henna (a reddish-brown dye made
from the leaves of tropical shrub, used to color the hair and decorate the skin) during menstruation. Culturally, applying of henna during
menstruation is “Makrooh” meaning, if the advice or recommendation is followed then it is beneficial (Swaf) from religion point of view, but
if one doesn‟t follow this practice then also there is no sin or loss attached. There is no religious specific reference point for these taboos but it
was commonly believed practice of the some region where muslim community is dominating. The only exception to this rule was if the
menstrual cycle and marriage date clash, then the bride can apply henna or otherwise she has to wait for 7 days to get over with her menstrual
flow and after the customary purifying bath she can apply henna to her hands, feet and hair, if she desires. However, some Adolescent Girls of
these study areas of north India reported that there is a strict restriction on applying henna during menstruation because if one applies henna
during menstruation her body is will remain impure till the colour of henna fades away. That’s why they didn’t prefer to apply henna during
periods.
vi. Dietary Taboo/Restrictions Related to Menstruation Dietary prohibitions and restrictions were also commonly seen among the
tribals of Study areas.
At one hand, there were some food items to be avoided while, on the other hand, other food items were prescribed for intake. Adolescent Girls
were advised or recommended by their elders to avoid intake of sour and cold food like curd, butter milk, pickle, cold water and apricot in order
to minimize the chances of dysmenorrhea. These food items were considered as cold by nature and were seen as obstructing the menstrual flow
and could cause cramps and other discomfort to a menstruating female. However, at the same time they were advised to increase the intake of
hot food like local butter tea with barley flour, mutton, and leafy vegetables (spinach). Hot foods were considered to cause early and complete
cleaning of uterus; and also relieve cramps and pains. One of the distinguishing practices unique to this region was consumption of melted
butter to cope with abdominal pain. Elder women of the family recommended, Drink half cup of melted butter if the pain is severe as butter is
considered as hot food and it helps to flush out the menstrual blood from the uterus. One of the Adolescent girls reported that “In olden days,
there was no concept of taking medicines for menstrual pain, but now a days the younger generation are lucky to have the facility of medicines
in case of severe pain”. At one school which is attached to PHC on the same building, girls were addicted in consuming tablets for a minor pain.
They get medicines handy at PHC.
4. Impact of the community health action
Unfortunately, the adolescent girl is left on their own to gather information about these important physiological and reproductive processes.
Changing socio-cultural environment does however makes the teenage girls desire information from various sources such as media, schools,
teachers and friends. Costos et al, 2002; Charlesworth, 2001; Houppert, 2000; Cronje & Kritzinger, 1991 also reported that “even today
menstruation is a secret of mother and daughter in many families. It is not discussed in the open” On tribal girls‟ adaptability towards the
menstrual beliefs and myth, the results reveal that majority of girls from both study areas did not follow the belief that one should avoid daily
bathing and hair washing during menstruation, not cutting off nails or hair during menstruation and also did not believe in adhering to dietary
restriction during periods. The girls were more flexible and had altered these beliefs according to their convenience and situation. However, the
girls were found to be following many other practices such as those related to storage and disposal of used material/sanitary material. Since, the
menstrual blood is considered contaminated and something not to be visible to others, probably the disposal of such material was done in
complete secrecy and seclusion. It was found that majority of girls avoided disposing used materials by burning, but instead they disposed the
used material by throwing in open areas and that too after proper washing. Beliefs like public hiding of menstrual cloths and protection products
was practically followed by majority of the girls because these Adolescent girls were of the notion that those who see such clothes, especially
if blood-stained, will be cursed. However, the girls had completely abandoned some of the other’s beliefs such as avoid sharing same blanket
with menstruating women, avoid eating together or sharing food on same plate with menstruating women, and avoid crossing or walking over
any baby clothes. Certain beliefs and myths associated with menstruation are such that they are not practically implementable but are rather
ideological in nature. These are beliefs which would indirectly affect the practices but were at the same time directly impacting the attitudes
and perception that Adolescent Girls hold towards menstruation. The beliefs which majority of sample adolescent girls still agreed and reported
as true included, The period affects the performance of women at work. It is embarrassing when a man finds out that a woman is having her
period, Menstrual Blood smells bad, Menstruating women and girls are unclean, Menstrual blood is dirty blood, It is important to keep the
period a secret. The results highlight that the adolescent girls of both the study areas have modified some of the prevalent socio-cultural
constructs, while others are still practiced and believed to be true. This implies that slowly but steadily the adolescent girls also try to unfollow
some of the constructs that they feel are outdated and not of much utility. The hygienic practices during menstruation were unsatisfactory among
majority of Adolescent Girls from both the study areas. Large numbers of older generation Adolescent Girls of Study areas were ignorant,
holding negative perception and following unsafe practices related to menstruation, probably because of illiteracy, poverty and other related
factors. The
results also highlight that most sample Adolescent Girls
go
through
their periods very secretively without really bothering to
figure out if
their practices are hygienic in nature or not and the trend
is still being
followed in majority of the cases. The Adolescent Girls
of
Study
areas continue to be susceptible to urinary tract infection
and
other
gynecological problems owing to poor menstrual
hygiene. The
mothers and grandmothers themselves did not know the
adverse
consequences
menstruation
as a result they failed to guide their offspring about the
safe
and
hygiene menstrual. Bhatia and Cleland 1995 also
reported that
poor personal hygiene and unsafe sanitary conditions
of
unhygienic
practices
during
result in the girls facing gynecological problems. El-Gilanya and Badawi, (2005) also found that menstrual disturbances are the commonest
presenting complaint in the adolescent age group and unhygienic practices during menstruation can lead to untoward consequences like pelvic
inflammatory diseases and even infertility.
During My session a pre assessment and post assessment forms were given to girls. This assessment had 5 basic questions, Basically trying to
understand their knowledge level on menarchy and menstruation cycles.
The 5 questions were as follows.
1. What is considered as a normal menstrual cycle (number of days)
2. How many days of bleeding during periods is normal?
3. What kind of fabric/clothing should be used during periods
4. At what age do periods normally stop (menopause)?
5. When which of the following symptoms/problems occur during periods, we should consult a doctor?
These questions have multiple choices which is given in ANNEXTURE 1
On analyzing Pre and post assessment following graph is derived.
For the question 1: What is considered as a normal menstrual cycle (number of days) on pre assessment Adolescent girls response was 19%, Post session
on awareness the understanding level was raised to 36%. However, I was expecting atleast 60% from the respondent. Probably the length od menstrual cycle
varies with each individual and that has created little confusion among the girls. A booklet has been distributed which talks about this question too. On
reading this girl will get more awareness on their Menstural cycle days.
For the question 2: How many days of bleeding during periods is normal - on pre assessment Adolescent girls response was 46%, Post session on
awareness the understanding level was raised to 72%. Most of the respondents were clear in their cycle days. The delta is because of some girls between the
age group of 12 to 16 years were yet to attain menarche and it was difficult for them to understand in detail as they are yet to experience the menarche.
For the question 3: What kind of fabric/clothing should be used during periods - on pre assessment Adolescent girls response was 47%, Post session on
awareness the understanding level was raised to 66%.. On explanation my expectation was 90% but that could not achieve because at some study areas, girls
are using clotha and at some study areas girly are using sanitary pads. Hence confused created among girls who have never used cloths or sanitary pads.
For the question 4: At what age do periods normally stop (menopause)- on pre assessment Adolescent girls response was 41%, Post session on awareness
the understanding level was raised to 73%. Probably on session, they would have co related to the elderly lady at their family.
For the question 5: When which of the following symptoms/problems occur during periods, we should consult a doctor - on pre assessment Adolescent
girls response was 42%, Post session on awareness the understanding level was raised to 60%. Their understanding level on normal menstrual cycle and
assessing abnormalities has increased.
It was advised that on regular awareness sessions adolescent girls get proper awareness on their menstrual health.
5. Learning and Reflection
Some of the prominent and commonly held beliefs/myths include: Menstrual blood is “dirty blood” that does not come out of the body when
one misses her period; Eating hot food during menstruation helps in early cleansing or expelling of the menstrual blood; Menstruation
symbolizes psychological and physical maturity among Adolescent Girls; Bathing during menstruation causes cessation/stoppage of menstrual
blood. Bathing during menstruation leads to impurity or contamination of body. Women must hide menstrual protection product/material
because ones whose blood-stained clothes are seen by others is a great sinner, Sex during menstruation is a great sin, Disposal of used sanitary
materials by burning leads to infertility, Women whose protective materials are sniffed by dogs become infertile, Menstruation that does not
appear on the exact day of the month is irregular, It is very disgraceful for Adolescent Girls when a man finds out that a woman is having her
period. All these beliefs and myths highlight the notion of menstrual blood as being dirty or contaminating. Menstruation is also associated with
maturity and fertility but again the concept of sin or curse is also associated with those who do not hide menstruation and menstrual material
from others. These signify that in a way the menstrual beliefs and myths are a means of controlling not only the minds and bodies of Adolescent
Girls but also their behaviors and everyday life. Everything that a female does or thinks is controlled by these customary beliefs and myths. The
older generation of women especially the grandmothers and mothers have diligently followed and believed in these myths. However, many
young sample adolescent girls either thought of these beliefs as erroneous or were not sure about the authenticity or practical viability of these
beliefs. Young girls probably owing to their education or media influences find many of these beliefs and myths outdated and objectionable.
Between the two study areas of North India and South India and its culture, it was found that grandmothers and mothers confirm to various
beliefs and myths associated with menstruation. Among the girls however, no major differences were noted according to their customs.
My Awareness sessions at these schools have given a highlights on Menstural hygiene, understanding myths and facts so that the younger
generation is empowered in handling and accepting menstruation positively. A hand book on their regional language been handed over to the
girls so that they can refer the content as and when they need. At some schools washable cotton sanitary pads were distributed and awareness
on how to use and wash, dry those pads were also been given to adolescent girls.
Extensive misunderstanding and lack of knowledge about vital concepts of reproductive physiology and menstruation among the Adolescent
Girls was also noted. It was found that half of the sample adolescent girls felt that menstruation means release of impure blood, is a sign of
fertility and symbol of maturity for marriage. Mundey et al, 2010; Chaudhari, 1998; Khanna et al 2005 also found that there was a low level of
awareness about menstruation among the girls when they first experienced it. Adolescent girls did not have adequate knowledge about the
causative factors leading to occurrence of menstruation and majority of them didn’t know exactly why it is occurs. The girls were not able to
differentiate between urethral and vaginal opening. This shows the low level of knowledge among girls about female anatomy. Arumugam et
al, (2014) and Nemade et al (2009) also found that majority of girls are not aware about the cause and the exact anatomical organ involved.
According to Adolescent Girls of Study areas menstruation occurrences is indeed essential for every female as one gets rid of spoiled or dirty
blood from the body and it helps to detoxify our body. Urban and semi urban girls showed slightly better knowledge than their village or rural
counterparts. Even though menstrual knowledge and practices during menstruation were unsatisfactory among majority of the girls from both
the study areas but the present generation girls had better sanitary facilities available. Improved living condition and medical facilities could be
the attributing factor for this. The current existing practices of the adolescent girls related to menstruation especially those associated with their
health and hygiene, diet, and daily activities are far better than older generation Adolescent Girls. However, there is still a need to educate the
girls about the facts of menstruation, physiological implications, significance of menstruation, and adequate hygienic practices. Some
Adolescent girls reported that during menstruation their daily activities were affected but they don’t let their work suffer, so they carry on with
their daily job except prayers while enduring the pain. The results over all highlight that even today Adolescent Girls of Study areas tend to
have insufficient and incomplete information related to menarche and menstruation. Over all analysis of the female Adolescent girls attitude
towards menarche and menstruation reveals that majority of them had low acceptance of menarche and held moderate attitude towards menstrual
symptoms. Many of them felt ugly and gross during their periods. Majority adolescent girls had moderate to low level of openness towards
menstruation, while most Female Teachers were moderately open towards it. The results highlight that there still exists a culture of silence
among Adolescent Girls themselves about this crucial physiological process. Further, not surprisingly majority of the Adolescent girls held very
low positive feelings indicating that all the Adolescent Girls were not happy and excited during menstruation nor they were pleased, proud or
felt special while having their periods. Those having highly negative feelings towards menstruation found menstruation, “scary and
uncomfortable”. They were also bothered about buying pads from male shopkeepers, embarrassed to ask questions about periods and disliked
its unexpected nature. On living with menstruation dimension, it was found that majority of Adolescent girls held low attitude towards it.
Overall, the findings reveal that majority of Adolescent Girls held low level of acceptance, openness, positive feelings and living with
menstruation but moderate to high negative feelings towards menstruation indicating that though this is a regular and important feature of a
grown up female yet the sample Adolescent Girls across the study area found it difficult to accept it completely and hence had more negative
feelings than positive feelings. Probably, the entire menstruation process is constructed as dirty, unwelcome and an open secret that the
Adolescent Girls themselves have the tendency of developing more negative and unacceptable attitude towards it. Katheryn (2004); and
Mathews, (1995) reported that girls prior information related to menarche is important to develop positive attitude towards menstruation. The
more educated they are prior to menarche, the more positive attitude will likely to develop at initial experience towards this physiological
process (Marvan & Trujillo, 2009; Ruble & Brooks-Gunn, 1982). On the basis of the current research, it can be concluded that menstruation is
associated with impurity in one or the other form according to both religious and cultural perspective among the selected study areas More
essentially, menstrual practices always included various form of restrictions being imposed on Adolescent Girls. Multiple beliefs/myths,
taboos/restrictions exist which all signify menstruation as unwelcomed, dirty and complex. Even today Adolescent Girls tend to follow these
constructs with only a few modifications. Young adolescent girls of current generation follow many of these beliefs and restrictions and have
been able to abandon only a few of them. Their knowledge and practices reflect a picture of widespread misinformation and unawareness.
Menstrual hygiene is poor and along with this the attitude of Adolescent Girls towards menarche and menstruation, also continues to be negative.
There is a need to cultivate a feeling of unconditional acceptance of menstruation by the Adolescent Girls themselves. They need to understand
that menstruation is a normal physiological process which makes them unique and not inferior or dirty.
Generating Awareness about Reproductive Physiology and Pubertal changes: For ages women themselves tend to have limited and
incorrect information about their own bodies and especially their reproductive system. Adolescent Girls continue to look at their bodies and its
processes through the images created by the dominant males around them. Talking and communication about reproductive system and pubertal
changes is strict taboo in most cultures including that of Study areas. As a result a number of myths and restrictions continue to flourish around
menarche and menstruation. The only way these beliefs, myths and restrictions are challenged and overcome is by creating awareness about the
reproductive system and one’s own bodies. Scientific and medical knowledge about puberty and pubertal changes is essential for all adolescent
girls so that there is unconditional accepting it.
For this the following can play a significant role.
Role of Mother: It is strongly recommended that mothers should pay attention to their adolescent daughters concerns and keep the lines of
communication open. The adolescent girls should be taught about pubertal changes and menstrual practices at an early age, in fact before
attaining menarche, in order to be prepared emotionally and psychologically for it. Mothers being more experienced can create a home
environment that doesn’t stigmatize menstruation and can help in the girls’ smooth transition to adolescence and youth hood.
Role of Teachers and Schools: Schools can become harbingers of change and teachers can play an important role in bringing awareness about
issues such as knowledge about menstruation, its physiological implications, and hygienic practices. Both male and female teachers should be
capacitated on feminine hygiene issues and puberty education so as to empower them in supporting pubescent girls when needed. Materials or
books on menstruation should be provided in the schools for girls to read and understand the changes that occur in their bodies. Books can also
teach the various menstrual management and hygiene practices. Schools can focus on making reproductive education or in fact family life
education a compulsory part of their curriculum.
Role of Media: Usage of electronic media i.e. television and radio for generating awareness can have far reaching effect. Youth and adolescents
are especially attracted and influenced by such media sources and hence can learn about sexual and reproductive health SRH matters more
easily. Print media channel i.e. newspapers articles, magazines, nonacademic books, pamphlets, posters especially those, printed in local
language can be used to make the growing adolescents aware of their bodies and pubertal changes. Social medias like Instagram, Facebook and
reels, stories on these social media can reach this generation very fast.
Advocacy through Community Heads/Preachers, Professional and NGOs: Advocacy through the existing social structure like the
community heads, religious preachers, professional workers and Non-govt organization would be very effecting in curbing the effect of the
myths and cultural beliefs that surround menstruation. It was too evident from the study that majority of women residing in villages of Study
areas were illiterate and mostly depended upon their community leaders and religious preachers for information related to dos and don’ts
regarding menarche and menstruation. Therefore, the help of these heads and religious leaders can be sought to accept menstruation as part of
normal growing up. There is a need to destigmatize the process, in order to help Adolescent Girls enjoy better reproductive and sexual health
SRH. Health professional such as doctors, health workers and paramedical staff can also be roped in to help develop awareness about
reproductive physiology and menstrual hygiene. Non-govt organizations already working in health and education sector can also assist in this
matter. Awareness camps or trainings programmes, workshops, demonstrations and discussions should be carried out within the schools as well
as in the community settings. Since menstruation is a socio- cultural concept here, therefore active participation of all section of society is
needed.
Addressing Secondary Social Issues: Secondary factors such as poverty, illiteracy, lack of infrastructure development, regional disparities are
also found to be indirectly linked with adolescent menstrual and subsequent reproductive health. Many Adolescent Girls even today cannot
afford to buy readymade sanitary pads due to economic compulsions. Therefore, it is mandatory that the overall standard of living be improved
of all study areas. Economic upliftment coupled with higher literacy rate and better and accessible medical facilities can definitely bring about
sustainable change in the health and wellbeing of adolescent girls as well. Availability of sanitary pads on affordable cost and incinerators
accessibility is mandatory for Eco Friendly environment.
Annexture 1
Pre and post assessment form given to all girls at selected schools for study.
Menstrual Health and Awareness Program (MHAP)
Name:
School Name:
Class:
Age:
Date :
1. What is considered as a normal menstrual cycle (number of days)
15 - 22
22 - 45
28 - 30
Don’t know
0.
How many days of bleeding during periods is normal?
3-7
5-8
2-7
Don’t know
0.
What kind of fabric/clothing should be used during periods?
Polyester
Cotton
Any cloth can be used
Don’t know
0.
At what age do periods normally stop (menopause)?
25 - 35 years
45 - 55 years
35 - 45 years
Don’t know
0.
When which of the following symptoms/problems occur during periods, we should consult a doctor?
If more than one pad is changed in 2-3 hours due to extreme heavy flow
Bleeding for more than 7 days
Changes in smell or colour of white discharge
All of the above situations
6. Photographs
7. References
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